#2 How Do You Use a Diaphragm? When to Put It In, Out & Shake It All About

How Do You Use a Diaphragm?

When to Put It In, Out & Shake It All About

Retro Diaphragm Flying Saucer cartoon
Warning: Contains explicit content ♦ & is not to be used as medical advice ♥ Disclaimer here

So last post we talked about what a diaphragm actually is (if you’re not sure or you don’t know how to find your own cervix; go back to it) and why it’s so f*cking fantastic and empowering to have your own little contraceptive vagina accessory that nobody else has any say over!

Now, they’re not right for every single situation so you’ve got to understand how to properly use a diaphragm before you start assessing whether it might suit your current sexual habits.

HOW DO YOU GET A DIAPHRAGM?

  • To get a diaphragm you need to book an appointment with your healthcare provider; so that you can find out which size you need and be shown how to put it in correctly.

NOTE ON THE SIDE: You may have heard of a new type of one size only diaphragm called Caya which you can just buy and use without any appointments. Cayas fit most women but not all and there aren't many studies on using them. I personally would opt for types of contraception that have been around for ages (because there’s more proof in their pudding) and secondly I think anyone who is new to diaphragms would benefit from seeing a professional to make sure they’re using it correctly.

Actually finding someone who is qualified to deal with diaphragms can be a pain; my local clinic only had a handful of appointments once a month and these were frequently cancelled. 

Councils are making cuts to sexual health services - if you have experienced difficulty accessing services you could email your local MP to voice your concern. If that sounds long why don't you make the exercise more enjoyable; for example starting your email with:

MY VAGINA NEEDS MORE! ...

APPOINTMENTS!’.

So anyway, if you want a diaphragm, you may have to persevere. You will also probably have to stand your ground about your decision. Be prepared for this. My Nurse tried to dissuade me from getting one, telling me they’re not very effective and that if I didn’t want to use hormonal methods I should get the coil instead. My response to this was F*CK NO.

When you do go for your diaphragm appointment; do not do what I did...

Girl Dancing
Oh how the mighty will fall once morning breaks

The Tale of ‘One Nurse, Two Fingers’

I was up most of the night getting in.toxic.ated but had managed to drag my sorry munted self out of bed to get to the clinic because I’d been waiting literally months for the appointment.

I sat in the waiting room doing my best to ignore a banging headache and the sickly approach of a comedown (and the accompanying mental misery... did everyone secretly think I was annoying and preachy... how crushingly depressing is the short sighted nature of humanity and perhaps we are all marching towards an apocalypse... why didn't I have any juice...) Eventually I was called in and distracted from my queasy thoughts; the Nurse handed me a diaphragm and instructed me to take my pants off and pop it in. I had no idea what to do with it or where my cervix was so she kindly drew me a diagram of my insides. It was just like being back at school in a science class; except the next part involved me spreading my legs, putting 2 fingers up my vajay and attempting to locate my mystical cervix.

I found it in the end (my fingers are pretty short), but the hangover was reaching high intensity at this stage and I hadn’t even attempted to squeeze the diaphragm up there.

Inserted Diaphragm diagram

Nevertheless, I soldiered on, pinching and curving the diaphragm as instructed. But I just COULD.NOT.GET.IT.RIGHT

The Nurse would put it in me, I would feel it and take it out, attempt to put it back in, fail, and repeat. By this time I was feeling pretty sick and rather disillusioned with the whole situation I.E. the Nurse and I taking it in turns to put our fingers in my pussy.

Perhaps that sounds kind of erotic and fun... It wasn’t.

We gave up in the end. I was dismissed from the failed science experiment and sent home (to practise). The next day, sober, I put the diaphragm in perfectly on the first attempt.

SO HOW DO YOU ACTUALLY PUT A DIAPHRAGM IN?

How to Insert a Diaphragm Instructions

It sounds a bit complicated - but once you’ve done it a few times it’s easy. You put a bit of spermicide inside and round the rim, put it in, feel the diaphragm to make sure it’s covering your cervix, and you’re done.

 Once things get going I just pop to the bathroom to put it in ... it only takes me a few seconds.

Emma McGowan, sex educator and long term diaphragm user

WHEN DO YOU PUT A DIAPHRAGM IN?

You can put it in just before sex, or you can put it in while you’re choosing your underwear hours before your date.

"You should insert your barrier before you become aroused or during the early stages of foreplay. That’s because when aroused your pelvis becomes engorged with blood and your vagina lengthens considerably (which is called tenting) as your uterus and cervix are pulled up out of the way of a thrusting penis. Once the vagina tents it is difficult and sometimes may be impossible to place a cervical barrier correctly."

It’s like a whole festival going on up there that you didn’t even know about!

Festival Scene
Perhaps they're engaging in a hearty conversation about vaginal tenting

For some reason, when my bf and I were road-tripping in our van I decided this would be a good time to whip out a diaphragm to try with him for the 1st time. Obviously, when you’re sharing a VW with someone there’s not much privacy and, in my mind, inserting a diaphragm is kind of a boner kill - so I made him stand outside in the dark. However, it may have had this effect anyway as before I kicked him out he saw the large blue flying saucer and his reaction was basically: JESUS CHRIST!! What sorcery is it that allows you to hide that thing inside of you and I certainly do not trust it to impede my almighty sperm..!!??

We gave it a go but his d*ck was not appreciating it so we tossed it away.

NOTE ON THE SIDE: I have successfully used a diaphragm on one night stands with other guys, with varying levels of endowment, so I hypothesise that each male + female’s individual anatomies combined with style of sex and accustomed sensations will affect whether or not they like it.

I guess my bf and I go deep or go home. (but we should try it again at some point - perhaps without the element of surprise)

Can you put it in whenever you like before sex?

  • Basically yes, but it depends what spermicide you’re using (and as we mentioned earlier you have to put your diaphragm in before your vagina sets up camp)

Can you leave a diaphragm in for as long as you like?

WHAT ABOUT THE SPERMICIDE?

Whenever you use your diaphragm you also need to use roughly a teaspoon of spermicide; it looks and feels like lube but is used to kill or immobilise sperm.

There is conflicting advice on using spermicide but it should help in 3 ways:

  1. by putting it round the rim of the diaphragm it creates more of a seal between it and the walls of your vagina
  2. wherever the spermicide is it also acts as a further barrier because sperm cannot easily swim through it
  3. it kills/immobilises the sperm

Many studies on spermicide use end their findings by concluding that more research needs to be done, with one even stating that the spermicide could actually cause the diaphragm to become dislodged more easily because of its slipperiness. However, spermicide used by itself is about 70% effective in preventing pregnancy (obviously DON'T use it by itself because that figure is low!) so it seems intuitive that spermicide would certainly be beneficial. All manufacturers state you absolutely must use spermicide.

There are basically 3 types (excluding any homemade natural recipes):

1. IRRITATING: the standard ones containing Nonoxyl-9, such as Gygel

This is what the NHS provides. It may cause UTIs, skin irritation and sensitivities. The World Health Organisation state that using N-9 damages tissue in the vagina and puts women at higher risk for catching STDs, and they state frequent use of N-9 is not recommended.

If you are using one like this you need to reapply more between each act of sex or if your diaphragms been in place for more than 3 hours. 

I would worry about getting head if you’re using this kind because it doesn’t sound very tasty, but I brought this up when I interviewed sex educator Emma McGowan and she assured me her partner isn’t fazed by it.

2. HARMLESS: Natural alternative versions containing lactic acid such as Contragel

  • This contains no harmful chemicals but is just as effective 
  • It has a mildly acidic taste which is pretty innocuous. I gave a bit to one of my mates to try and she seemed to think it was pretty damn tasty
  • I contacted Contragel and their lab advised that: "Contragel can be applied a few minutes before or up to two hours before having intercourse, when used with a diaphragm."

3. TASTY: Manuka honey with a UMF of 16+

One day I am absolutely going to try using a diaphragm with honey. Because - DELICIOUS! (but potentially problematically sticky...)

Manuka honey also sounds exciting because you can leave your diaphragm in for 5 days without risk of irritation or odour and you also do not have to reapply it in between acts of sex!

WIN WIN WIN

However as clinician, researcher and lecturer in female health Dr Trevor Wing notes; Manuka UMF16+ or higher honey is used as the spermicide as we know this immobilises sperm in the lab comparable to other spermicides.. There is good anecdotal evidence… but in the absence of good RCT (randomised and controlled trials) women wishing to use this (diaphragm/or caps with the honey) must make up their own mind.

Time taken to immobilise sperm in super fertile semen

Nonoxyl-9 spermicide 45 mins
Spermicide containing lactic acid (such as FemProtect or Contragel) 31 mins
Manuka honey 16+ 138 mins
All sperm were immobilised within the 6 hour time period and the honey also seemed to have an additional barrier effect as the sperm were less able to penetrate it

If you need to re-apply spermicide you can use your fingers or get a little applicator that screws to the end of the tube so you can just squirt it up.

I spoke with David from Ethical Family Planning (their website is also very informative) and he said:

"We work with many midwives and Gyno´s who are barrier specialists and they say in that scenario its best to use a finger to apply more gel, not an applicator. The idea is that after intercourse you should check, with a finger, that the barrier is still correctly in place before having intercourse a second time. That could be done whilst applying more gel."

How To Reapply in a Sexy Scenario?

If you have sex more than once in a row you don’t want to have to get dressed and run down the hallway to the loo and whack some more in and then return; you want to just carry on f*cking.

No fear. You could put a bit more up there by fingering yourself in a semi-sexy way and if you're horny enough to be having more sex straight away; pausing for one sec to feel your diaphragm and get some more goo involved isn't going to ruin the marathon. Besides, if you feel really self conscious about it you could give him head as a distraction while you're doing it (I just got on all fours on my bed to make sure that this is logistically possible).

Or you just put on a silky dressing gown, go to the bathroom and sort your spermicide, and simultaneously check how smudged your mascara is, before coming back for more.

Great Wall of Vagina Panel 1 by Jamie McCartney
Your unique interior anatomy may affect whether or not the diaphragm is your new Must-Have vagina Accessory (Great Wall of Vagina Panel 1)

Before using a diaphragm it's important to see an experienced professional as well as doing your own research. There is an incredible group on yahoo that I suggest you join as it has advice such as:

Cervical Barrier Tips for Newbies

The learning curve: It’s important to understand that there is a learning curve when starting to use cervical barriers and that the most failures occur within the first few months of use. We urge members new to using a diaphragm or cap to use another effective method of contraception (usually condoms) while testing the fit and function of your barrier with several energetic acts of  intercourse in each of as many positions as you typically use to gain confidence that your barrier will not displace before you use it for contraception.

Initial barrier wearing: It is a good idea to wear a new diaphragm or cap for at least 6 to 8 hours (the minimum safe wearing interval after intercourse) during days before you use it for protection to make sure it’s comfortable. That will also give you time to wear it ‘dry’ (w/o spermicide in the dome) so you can see what your normal cervical fluids that collect in the dome look like when it is removed.

Check that your cervix is protected: Just because your diaphragm is comfortable after insertion does not mean it is covering your cervix. Your fingers need to be long enough to check the position of your diaphragm or cap – to feel the tip of your cervix beneath the dome - to make certain that it is correctly positioned so the dome is covering your cervix.  You should check the position of your diaphragm immediately before and again immediately after each act of intercourse to make sure everything is where it should be.

Diaphragm sizing: It is important that you wear the largest size diaphragm you can comfortably wear when not aroused because when aroused your vagina lengthens (tents) considerably. The largest size comfortable is particularly important when using a position where you can be deeply penetrated, like when being taken from behind, doggie style.  

A wearing regimen: It is a very good idea to develop a wearing routine with your diaphragm or cap inserting before DH comes home or every night before bed – or what ever works best for your lifestyle - so you don’t get caught unprotected and find yourself having a ‘just-this-once’ encounter. That sort of thing is called ‘user failure’ and is responsible for a very large percentage of the unintended pregnancies that occur while using cervical barriers. Women who are in very spontaneous relationships often like to use a continuous wearing regimen. (Leaving it in for 24 hours for example, then washing and re-inserting)

*** if that seems like a lot of hassle, I will say that I simply got my diaphragm and started using it with folks. So really it's your call about how fastidious you're going to be. Better safe than sorry though

WHEN DO YOU TAKE A DIAPHRAGM OUT?

The standard advice is to wait six hours.

You might have heard that sperm can live for about 5 days inside you; but this is only if they get up into your womb.

They cannot live in the vagina for this long as vaginas are acidic and inhospitable - sperm can’t handle their acid and most are defeated within minutes if they do not make it to the cervix.

Although there are reports of sperm swimming around in the vagina for up to 12 hours after ejaculation, most are immobile within half an hour. And remember, this is even without spermicide; which should immobilise all sperm within 6 hours.

I simply took my diaphragm out in the shower the next morning.

Key Points for Success:

  • You need to get the right size diaphragm from an experienced professional
  • Pick which spermicide you want to use and follow its guidelines for timing
  • Always leave it in for at least 6 hours after your last act of sex

When you use your diaphragm properly; they have been found to be just as effective as condoms, although most studies conclude condoms are slightly better at preventing pregnancy even if you use both perfectly. Seeing as not getting pregnant is pretty goddam important to you if you’re bothering with all this; the next post will go into the hard and fast evidence of how reliable they really are.

♦ Over to You ♦

Have you used a diaphragm? Do you have any other tips if so? Would you consider using honey?! Leave any thoughts and comments below!

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