Diaphragm

How it works

The diaphragm physically covers the cervix. Spermicide immobilizes or kills sperm. Using both together increases effectiveness. The diaphragm alone is not enough. Its effect ends as soon as it is removed. Fertility is not affected. The diaphragm does not protect against STIs; a condom should be added.

Types

• Classic diaphragm: Chosen after a fitting. A new fitting is needed after childbirth, weight change or surgery.
• One-size diaphragm (Caya type): Fits most women. Even so, a check is recommended at first use.

At SoftCare, the right type and size are determined by examination. If your size changes, you are reassessed.

Who it is suitable for

• Those who do not want to use hormones
• Those who prefer protection only when having sex
• Those who do not want an IUD or implant
• Breastfeeding women

Situations that need care:

• Latex or spermicide allergy
• Frequent urinary tract infections
• Uterine prolapse or an anatomical obstacle
• The first 6 weeks after giving birth
• During your period (not recommended for some types because of the risk of toxic shock)

In the CDC US MEC 2024, the diaphragm is category 1 in most situations. Spermicide is used with caution where sex carries a high HIV risk.

Insertion

• Wash your hands.
• Apply spermicide inside the dome and around the rim (about one teaspoon).
• Squeeze the diaphragm between two fingers.
• Push it into the vagina. The front rim sits behind the pubic bone.
• Check with a finger that the cervix is completely covered.

It can be inserted up to 2 hours before sex. If inserted earlier, the spermicide may be less effective. Additional spermicide may be needed.

Timing rules

• It stays in place for at least 6 hours after sex.
• The total time should not exceed 24 hours. Some types allow up to 30 hours.
• If you have sex more than once, apply more spermicide each time. Do not remove the diaphragm.
• If removed before 6 hours, protection is reduced.
• If left in longer than 24 hours, the risk of toxic shock syndrome rises.

At SoftCare, the timing rules are given in writing.

Removal and care

• Hook the front rim with your index finger and pull it down.
• Wash it with lukewarm water and soap.
• Dry it and store it in its case.
• Check for holes or tears.
• Replace it every 1–2 years. If your size changes, a new one is chosen.

Oil-based lubricants can damage latex. Use water-based products.

Side effects and risks

Common:

• Vaginal irritation or burning (from the spermicide)
• Increased risk of urinary tract infection
• Latex allergy

Rare risks:

• Toxic shock syndrome (if left in too long)
• The diaphragm slipping out of place
• Increased risk of HIV transmission linked to spermicide (with frequent use)

If urinary tract infections keep coming back, the size is checked or another method is discussed. If you have fever, a rash, vomiting or dizziness, remove the diaphragm and seek urgent care.

Effectiveness

• Perfect use: about 94% (6% first-year pregnancy rate)
• Typical use: about 83–88% (12–17% first-year pregnancy rate)

Things that reduce effectiveness:

• Not using spermicide
• Incorrect insertion
• Removing it before 6 hours
• A hole or tear
• Poor fit

Adding a condom lowers the risk of both pregnancy and STIs.

How it differs from the gold IUD and other methods

At SoftCare, the gold IUD is our first choice. The diaphragm may be preferred in these situations:

• A patient who does not want to use hormones
• A patient who wants protection only when having sex
• A patient who does not want an IUD

The gold IUD carries no risk of forgetting and is more effective. Condoms protect against STIs. The diaphragm is only a barrier against pregnancy. It does not protect against STIs. The decision is based on hormone preference, frequency of sex and ability to use it consistently.

Follow-up

• Fitting and insertion training at the first visit
• A new fitting after childbirth, weight change or surgery
• Annual check-up
• Assessment for recurrent urinary tract infections
• STI testing if there is a risk

At SoftCare, patients starting the diaphragm get insertion practice and written timing rules.

Our approach at SoftCare

At SoftCare Clinic, assessment for the diaphragm starts with a gynecological examination and fitting. The gold IUD is our first recommendation; the diaphragm is discussed with patients who do not want hormones or prefer protection only when having sex. The right size is chosen. You are taught how to insert it. Timing rules are given in writing. If there are recurrent infections or difficulty using it, another method is recommended. If there is an STI risk, condoms and testing are recommended.

Appointments: +90 212 241 30 10 · softcareclinic.com

References

• 1. Centers for Disease Control and Prevention (CDC). U.S. Medical Eligibility Criteria for Contraceptive Use, 2024.
• 2. American College of Obstetricians and Gynecologists (ACOG). Barrier Methods of Birth Control.
• 3. Cleveland Clinic. Vaginal Diaphragm.
• 4. NHS. Contraceptive diaphragm or cap.
• 5. Trussell J. Contraceptive failure in the United States. Contraception. 2011;83(5):397–404.
• 6. Fihn SD, et al. Association between diaphragm use and urinary tract infection. JAMA.
• 7. T.C. Sağlık Bakanlığı. Gebeliği Önleyici Yöntemler.
• Note: Timing rules and spermicide use may vary by type of diaphragm. At SoftCare, the gold IUD is our first choice; the diaphragm is discussed with selected patients. This reference list is for information purposes.

A citation does not mean that SoftCare wrote that text.

Medically reviewed by Op. Dr. Şükrü Sanus, Obstetrician & Gynecologist · Last medical review: 2 October 2026