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?

Signed,
Newlywed

Dear Newlywed,

Since you're a new diaphragm user, the difficulties and discomfort you've experienced so far may be related to your inexperience with this contraceptive option. Despite the fact that you’ve already had some practice at your health care provider's office, the real-world insertion in the moment may feel different. Good news though, insertion gets easier with more practice! Diaphragms come in an array of shapes (coil, flat, arc-like) and sizes, ranging from 50 to 105 millimeters (about two to four inches) in diameter. Some folks 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 then popped open again, covering the cervix completely. A properly placed diaphragm typically won't be felt once it's been placed inside of a person's vagina. If you’re still not satisfied after double-checking the fit, style, and placement of the device, you might consider an alternative method of birth control.

To help, Planned Parenthood details the steps for proper diaphragm insertion:

  1. Wash hands with soap and water.
  2. Put a tablespoon of spermicide in the diaphragm.
  3. Get into a comfortable position, like when putting in a tampon. 
  4. Separate lips of the vulva with one hand and use the other to pinch the rim of the diaphragm together to fold it in half.
  5. Push the diaphragm as far up and back into the vagina as it'll go, dome pointing down. Tuck the edge of the diaphragm behind the pubic bone. Make sure the cervix is covered.

If you continue to sense the diaphragm shifting around or placing pressure on your bladder (causing the need to pee), then you might consider a refitting. You may remember when you were first sized for a diaphragm, your health care provider likely inserted a variety of fitting rings into your vagina. During this fitting, you and your provider will be able to determine which of the rings is the largest one that will fit comfortably inside of you. Practicing inserting and using this ring at your provider's office until you get the hang of it may help to make a difference. However, keep in mind that diaphragms do move a bit inside of a vagina as the body goes through changes (such as lubrication) during arousal.

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

  • Weight change of more than ten pounds
  • Pregnancy
  • 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 person's cervix. Having sex, whether for the first time or after a long abstinence, is one of the most common reasons for this change, though hormonal modifications may also trigger some cervical shape shifting.

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

Finally, if after refitting and practice you still don't feel secure using a diaphragm, then you may consider switching to another method of birth control. You might want to ask your health care provider to discuss other contraceptive options with you and your partner. For more information about the pill and other forms of contraception, check out the Contraception section of the Go Ask Alice! Sexual and Reproductive Health archives.

Here’s to happy, healthy, less-sticky sex!

Alice!

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