After an initial phase of instruction and practice, most women are able to insert and remove their diaphragm with ease. Proper use involves applying spermicide to the device and placing it deep inside the vagina so that it securely covers the cervix.

A woman may insert a diaphragm up to six hours before intercourse. Before insertion the woman should:

1. Wash the diaphragm (initial use only). It should be cleansed with mild, non-perfumed soap and warm water, rinsed and dried carefully.
   
   
2. Empty her bladder and wash her hands.
   
   
3. Inspect the diaphragm for cracks or small holes. It may be held up to light or filled with water to detect these flaws. The device should not be used if cracks or holes are discovered.
   
   
4. Place spermicide in the cup of the diaphragm. The amount of spermicide necessary is determined by the manufacturer of the spermicide.
   
   
5. Use her fingertip to spread some of the spermicide around the rim of the diaphragm (the side that will be in contact with the cervix). Avoid applying too much spermicide to the rim. Doing so may result in difficulty controlling the diaphragm during insertion.

To insert the diaphragm into the vagina, a woman should:

1. Assume the most effective position. A diaphragm can be inserted while standing with one leg up on a stool, squatting or lying down. Women who are used to one position and then change to a different position need to be particularly careful that the cervix is covered when positioning the diaphragm. The position of the cervix and the walls of the vagina will differ depending on the woman’s position.
   
   
2. Hold the diaphragm with the dome down (spermicide side up) and press the opposite sides of the rim together between the thumb and third finger. The device may be held from above or below.
   
   
3. Use the free hand to separate the lips of the vagina.
   
   
4. Hold the folded diaphragm with the dome down (spermicide side up) and push it gently into the vagina.
   
   
5. Guide the diaphragm along the rear wall of the vaginal canal, guiding it backwards as far as it will go behind the mouth of the cervix. The index finger should remain on the outer rim of the diaphragm to help guide the device into place.
   
   
6. Push the rim of the diaphragm up until it “locks” into place behind the pubic bone.
   
   
7. Run the index or middle finger over the diaphragm’s dome to verify that it is covering the cervix and held in place by the upper edge of the pubic bone and the rear wall of the vagina. If the device is in correct position, the cervix should be easily felt through the rubber. It will feel like the end of a nose. It is normal to detect folds in the diaphragm when it is in place.

The coil and flat spring styles of diaphragm may be inserted with a plastic tool known as an introducer. The tool may be used to hold one side of the diaphragm’s rim. To prepare a diaphragm for insertion with an introducer, a woman will follow the same instructions for washing and inspecting the diaphragm and then:

1. Hold the introducer in one hand, with its notched side facing down.
   
   
2. Hold the diaphragm in the free hand with the dome down (spermicide side up).
   
   
3. Squeeze the opposite sides of the diaphragm together and place one end of the rim into the notched end of the introducer. 
   
   
4. Fit the other end of the diaphragm over the notch corresponding to the diaphragm’s size. Sizes are shown next to each notch on the introducer.
   
   
5. Turn the introducer over and insert the necessary amount of spermicide into the fold formed on the dome side of the diaphragm. The necessary amount spermicide is determined by the manufacturer of the spermicide.
   
   
6. Use a fingertip to spread some of the spermicide around the rim of the diaphragm (the side that will be in contact with the cervix). This will make insertion easier and help fasten the diaphragm in place.

To insert the diaphragm into the vagina with an introducer, a woman will:

1. Insert the introducer into the vagina, with the spermicide side facing up.
   
   
2. Guide the inserter along the rear wall of the vaginal canal, guiding it backwards until the diaphragm has been inserted as far as it will go behind the mouth of the cervix.
   
   
3. Once the diaphragm is in place, twist the introducer slightly to the left or right to release the diaphragm.
   
   
4. Slowly withdraw the introducer from the vagina.
   
   
5. Insert an index or middle finger into the vagina and use it to determine if the near rim of the device is pushed up behind the pubic bone.
   
   
6. Run an index or middle finger over the diaphragm’s dome to verify that it is covering the cervix. If the device is in the correct position, the cervix should be easily felt through the rubber. It will feel like the end of a nose. It is normal to detect folds in the diaphragm when it is in place.
   
   
7. Wash the introducer with soap and warm water, rinse and dry.

Once in the body, the diaphragm should fit comfortably. Any discomfort or pain while the device is in place may indicate that it has been placed incorrectly or that it is the wrong size.

In order to prevent pregnancy, the diaphragm must be left in place for at least six hours following intercourse. Women may have intercourse more than once while using the diaphragm. However, more spermicide must be used each time. The spermicide should be inserted into the vagina, without removing the diaphragm, using a spermicide applicator. Movement and changes in position should not move a properly inserted diaphragm. However, if a diaphragm becomes uncomfortable, a woman should check to be sure it has not moved out of position. A woman can shower or bathe while the device is in place, as well as urinate and have a bowel movement.

To prevent infection and other side effects, the device must be removed within 24 hours.

To remove the diaphragm, a woman will:

1. Insert the index finger inside the vagina and place it behind the front rim of the diaphragm.
   
   
2. Pull the diaphragm downward and out of the vagina.
   
   
3. Wash the diaphragm with non-perfumed soap and warm water. Rinse and dry it carefully.
   
   
4. Return it to its original container and store it in a dry, cool place.

In some cases, a woman may have difficulty reaching the rim of the diaphragm. Straining down, as with a bowel movement, may force the rim down, making it easier to reach. Suction may also make removal difficult. However, the suction may be broken by placing a finger between the vaginal wall and the rim of the diaphragm. Women should take care not to tear the rim or pierce the rubber with a fingernail during arousal. 

Although a properly placed diaphragm usually stays in place, some women may discover that their diaphragm is not in the correct position when they go to remove it after intercourse. An incorrectly positioned diaphragm may result in conception, and emergency contraception may be needed to prevent pregnancy.