The Diaphragm Comeback — Is This Hormone-Free Birth Control Method Right for You?

The diaphragm has been around for more than 100 years and has a fascinating history. It was outlawed in the U.S. for decades. Advocates smuggled it into the country from Europe (legend has it that Margaret Sanger taught her cellmates about them while awaiting bail). It eventually became the most popular birth control option in the U.S. But once hormonal contraception came on the market, the diaphragm fell out of favor. 

Fast-forward 50 years and the diaphragm is making a comeback. With new models that are easier to fit, people are looking at this tried-and-true method with fresh eyes. Here’s how you can decide if the diaphragm is the right birth control for you. 

What is a diaphragm?

The diaphragm is a device people use to prevent pregnancy. It’s a shallow, dome-shaped cup made of either silicone or latex. It’s only available by prescription. But you can get a prescription via a telehealth appointment. 

There are two brands available — Caya and Milex. 

Caya was released in 2015, making it the first new diaphragm to be designed in nearly 50 years. Caya comes in one size, so you don’t need to be “fitted” for it. Getting fitted means that a healthcare provider makes sure the diaphragm fits over your cervix. 

Milex is an older design that still comes in different sizes. You need to be fitted for a Milex to make sure you get the right size. If your weight changes by more than 10 pounds, you’ll need to be refitted to make sure your size still fits. 

How does a diaphragm work? 

The diaphragm works by blocking sperm from entering the uterus. This keeps the sperm from meeting an egg and forming an embryo. 

When you use a diaphragm, you insert it into your vagina and position it so that it covers your cervix, which connects the vagina and uterus. Even with a perfect fit, diaphragms can’t block every sperm cell. So you need to use spermicide with your diaphragm so it works better to prevent pregnancy. 

The diaphragm stays in place while you’re having sex. You take it out 6 hours later, once all the sperm is gone.

How do you insert a diaphragm?

It takes a bit of practice to get used to inserting a diaphragm. But learning to insert one is easier than you think. Here are the basic steps:

• Wash your hands with soap and water.

• Put spermicide in the diaphragm. Your diaphragm comes with an instruction manual that tells you how much spermicide to use.

• Get in a comfortable position, like you’re putting in a tampon or menstrual cup. You can kneel, squat, lie down, or stand with one foot up (tub ledges and toilet lids are good options, depending on your height).

• Squeeze the outer rim of your diaphragm so it folds in half.

• Insert your diaphragm into your vagina and and push it gently along the back wall of your vagina until it reaches your cervix.

• Let go of the diaphragm so it unfolds in place. 

How do you remove a diaphragm?

Taking out a diaphragm is easy. First, wash your hands. Then, insert one finger into your vagina and find the rim of the diaphragm. Pull down gently on the rim and your diaphragm will come right out. 

Wash your diaphragm with soap and water and let it air dry. Once it’s dry, you can store it in its container.

What are the advantages of a diaphragm?

There are several great reasons to use a diaphragm:

• It’s a hormone-free option. If you can’t (or don’t want) to use hormonal birth control, the diaphragm is a completely hormone-free birth control option.

• It’s convenient. Diaphragms are small and easy to take with you. You can put a diaphragm in up to 2 hours before you have sex. And you can leave it in for up to 24 hours afterward. But you need to refill it with spermicide if you’re going to have sex again later.

• You’re in control. You only need to use a diaphragm if you know you’re going to have sex. So you’re in control over your contraception use. That’s not the base for birth control pills, which you need to take every day. And an IUD stays in place all the time.  

• It might be more eco-friendly. You can reuse a diaphragm for up to 2 years if you clean and store it correctly. And they’re hormone free. So they might be better for the environment than other options. 

What are the disadvantages of a diaphragm?

Diaphragms aren’t perfect. Here are some disadvantages to consider:

• They’re not as effective at preventing pregnancy. Diaphragms prevent pregnancy about 94% of the time. But that’s only with perfect use. In reality, studies show they’re about 88% effective. Birth control pills are slightly better, at 91% with “typical” use. IUDs are 99% effective with typical use. 

• They don’t prevent sexually transmitted infections (STIs). Like many other contraceptive options, diaphragms don’t provide any protection against STIs. So you’ll still need to use condoms. 

• You have to remember to use it. You have to remember to put your diaphragm in every time you have sex. You also have to remember to reapply spermicide. Spermicide only lasts for about 2 hours. So if you put in your diaphragm too soon, you need to take it back out, refill it, and place it back in with new spermicide. 

• It can lead to urinary tract infections (UTIs). Studies show that diaphragm use is linked to higher rates of UTIs. So if you’re prone to UTIs, you’ll need to consider if it’s worth the risk of more frequent UTIs.

How to know if a diaphragm is right for you

If you’re still on the fence about whether a diaphragm is right for you, ask yourself these questions:

• Do you feel comfortable inserting a diaphragm in your vagina?

• Do you want birth control without hormones?

• Will you remember to insert a diaphragm before every time you have sex?

• Can you use spermicide?

• Are you willing to be fitted (and possibly refitted) for a diaphragm?

If you answered “yes” to all of these questions, a diaphragm could be the right option for you.  

Why trust our experts?

Written by:

Adriena Beatty D.O., MBA, CPE

Adriena Beatty, DO, MBA, CPE, is an Army veteran and board-certified obstetrician and gynecologist with over 20 years of experience. She is a graduate from Tuskegee University with a degree in chemical engineering and chemistry.

Edited by:

Patricia Pinto-Garcia, MD, MPH

Patricia Pinto-Garcia, MD, MPH, is a medical editor at GoodRx. She is a licensed, board-certified pediatrician with more than a decade of experience in academic medicine.

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