Dear Alice,

I have recently married and started using a diaphragm. I practiced a few times inserting it in the Dr.'s office and before using it "for real," but I am never quite sure I'm doing it right (we've been using it about a week). I follow the instructions and it is definitely lying flat over my cervix and behind the pubic bone, but it seems to wrinkle and slide around. It also makes me feel like I need to urinate all the time. In addition, it unrolls before I get it all the way in, and I wind up COVERED in spermicide (it's also a very weird feeling). I'm worried that it won't be effective. Should I be re-fitted? I have read that starting sexual activity can change the cervix (I was celibate about 7 years before marrying). Sometimes, we just give up and use a condom instead, but I don't like that. Any help?


Dear Newlywed,

Since you are a new diaphragm user, the difficulties and discomfort you've experienced so far could be related to your inexperience with this contraceptive option. Insertion gets easier with practice. Diaphragms come in an array of shapes (coil, flat, arc-like) and sizes, ranging from 50 to 105 mm (about two to four inches) in diameter. Some women find that using the kind of diaphragm that has two hinges and bending it into the shape of an arc is easier to place into the vagina. This prevents it from springing open before it's firmly in place in your vagina and popped open again, covering the cervix completely. Once inside, a woman should not be able to feel a diaphragm.

If you continue to sense the diaphragm shifting around and/or placing pressure on your bladder (so you feel as if you will pee), then a refitting might be in order. When you are first sized for a diaphragm, your gynecologist or women's health care provider will insert a variety of fitting rings into your vagina. Then, together you can decide the largest ring that can fit comfortably for you. Practicing inserting and using this ring at your provider's office until you get the hang of it can make a difference. Diaphragms do move a bit inside of a woman because her body goes through changes during arousal.

It's also common for diaphragms to seem less comfy, even after years of tried and true use. Instances when you definitely need to go in for a refitting include:

  • Weight change of more than ten pounds
  • Previous pregnancy
  • Past miscarriage or pregnancy termination
  • Having had vaginal or pelvic surgery
  • Any pain or discomfort, either on insertion or during use

Another common cause of discomfort is a change in the shape of a woman's cervix. Beginning intercourse, whether for the first time or after a long abstinence, is one of the most common reasons for this change, though hormonal modifications can also trigger some cervical shape shifting.

Whatever the reason for your discomfort might be, forcing its users to resort to Houdini-like dexterity was never the diaphragm's intent. A trip to a gynecologist or other health care provider will, at the very least, provide a second training session on insertion and might lead to a newly-sized, correctly and comfortably fitted diaphragm for you.

Finally, if after re-fitting and practice you still don't feel secure using a diaphragm, then you may switch to another method of birth control. Your gynecologist or health care provider can discuss other contraceptive options with you and your husband.


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