• A comprehensive diaphragm fitting with proper education and practice on how to use it cannot be done properly in a short visit. This is personalized care without the ob/gyn office rush to see (and bill insurance for) as many women as possible per hour all day long.

• Consults are 2-2.5 hours each, but you will need to budget 3-3.5 hours as while each individual situation is unique and you may require more time, any of the women before you may have required more time as well.

• I personally bring my nurslings everywhere so I very much understand this question. This is not a passive gyn consult where you can nurse through anything, nothing is “being done to you,” here you are THE Active Participant here and that requires attention and focus.

• If you have the ability to leave your baby for a few hours, that is best to be able to learn this new skill. This is a very involved and active consult and requires you to be as relaxed as possible. Having a nursling automatically adds time to the consult. If you are like me and bring the nurslings everywhere, then it is absolutely necessary to bring a second pair of hands for the baby so that you are only involved in nursing and can hand off the baby for naps/ playtime etc. Please indicate in your intake form if you will be bringing a baby and a baby helper.

• A diaphragm is primarily a vessel for the gel, NOT a barrier. A diaphragm without gel has an efficacy of 70-80% at most, meaning that without gel, sperm obviously gets around the diaphragm and gets to your cervix; the diaphragm is not fully blocking your cervix. A properly fitted diaphragm with comprehensive education and practice on how to use it is essentially a little tub for your cervix keeping the cervix bathed in the gel, so that when sperm gets around the diaphragm it must go through the gel.

• While a diaphragm can be placed immediately before intimacy and used without any wait time, it can be inserted up to 2 hours before intimacy without having to add more gel with an applicator. Unlike spermicide-only methods there is no wait time necessary. After intimacy, you can remove your diaphragm at least 6 hours later (or in the morning after at least 6 hours). After removal, you give it a quick rinse with water and a shpritz of hand soap and let it air dry.

You and your husband should not feel or be bothered by the diaphragm during intimacy. For many, the hardest part is remembering to take it out in the morning, so most do not feel it at all. Everyone has a unique pelvic floor situation and certain pelvic floor challenges may lead to more awareness of your diaphragm. That said there are effective core and pelvic floor coordination strategies to improve the situation at home.

• 80% of men do not feel and are not aware of when the diaphragm is inside or not.

• 20% may feel a difference when you’re in your fertile window or not, based on how your cervix position changes with fertility in combination with the amount of excess pelvic floor tension you’re holding on to. In those situations it should NOT cause any pain or discomfort. Experience of ease and comfort however is individual and based on the optimization of your pelvic floor strategies.

• A properly fitted diaphragm is a completely independent non-systemic method of child spacing on its own without FAM. It is completely possible and common to use your properly fitted diaphragm each and every time you’re intimate throughout the cycle. It great to be able to implement and deepen your FAM practice and understanding without the pressure to get it perfect to get pregnant. Then once proficient you can totally choose to only use your diaphragm from Mikva until your fertile window is confirmed close for that cycle, but it’s totally up to you and fine to use all cycle.

• One of the big factors that has led to incredibly high efficacy among women I have fit is my particularness in doing comprehensive diaphragm fittings when we are potentially fertile (while they are NOT potentially non-fertile).

• When fertile your cervix is higher, softer, and more open, while when non-fertile it is lower, more firm, and more closed. Even a good fitting done when you are non-fertile can lead to getting a size that seems right but may not fully cover your cervix when you are actually fertile.

• A comprehensive diaphragm fitting should optimally happen when you are potentially fertile and up to 2-3 high temps (at the latest), and from about 12 weeks after birth for postpartum women who are not yet cycling. If cycling or coming off a systemic method, it should be at least 5 days after your Hefsek.

• Once consult registration closes, I will go through all the Intake Questionnaires, you will receive information and instructions regarding the optimal timing for your individual situation.

• This is essentially about your body NOT being under the influence of high levels of Progesterone (past 3 high temps), synthetic Progestins, or Inflammation from a Copper IUD.

• For cycling women this is from about CD 11 until your 3rd high temp at the latest, and at least 5 days after your Hefsek, though we endeavor to meet before Mikva when possible to not need to delay intimacy.

• Long cycles have a longer potential diaphragm fitting window from about CD 11 until your 3rd high temp at the latest, and at least 5 days after your Hefsek, though we endeavor to meet before Mikva when possible to not need to delay intimacy.

• The optimal window for diaphragm fitting is from about CD 11 until your 3rd high temp at the latest, and at least 5 days after your Hefsek, though we endeavor to meet before Mikva when possible to not need to delay intimacy. If you came off synthetic hormones and have not had a period, you are most likely still potentially fertile and have not yet ovulated. Please start charting with temp as soon as possible, and I will contact you to clarify before scheduling. 

• While on the pill there is NO cycle and thus NO potential fertility, so when you go off and get a withdrawal bleed, the optimal time for diaphragm fitting is from about CD 11 until your 3rd high temp at the latest, though we endeavor to meet before mikva when possible to not need to delay intimacy.

• Having done hundreds or more-after birth check ups and diaphragm fittings for postpartum women, I have determined that when a comprehensive fitting with proper education and practice on how to use it is done from about 12 weeks after birth, we see the lowest chance of size change with ROF, Return Of Fertility.
• In an ideal world, I would like to see all postpartum women refit when their fertility returns, this is why in the consult we spend a lot of time and energy on how to self-assess proper placement and full cervical coverage to know what it will feel like if size changes over time.

• One of the big factors that has led to incredibly high efficacy among women I have fit is my particularness in doing comprehensive diaphragm fittings when we are potentially fertile (while they are NOT potentially non-fertile).
• When fertile your cervix is higher, softer, and more open, while when non-fertile it is lower, more firm, and more closed. Even a good fitting done when you are non-fertile can lead to getting a size that seems right but may not fully cover your cervix when you are actually fertile.
• The synthetic Progestin in hormonal methods, both combination Pill/Nuva and Progestin only Mini-Pill/ Mirena, leads to cervical positioning that is different than what it may be while you are fertile. Depending on your personal situation and current birth control method you will receive instructions of when to stop the hormones or when your IUD removed.
• Please wait for individual instructions based on your personal situation. For your own understanding, you will essentially stop the Pill/ Nuva about 14 days (2 Weeks) before your scheduled consult, so that when you stop you will get the withdrawal bleed about 2-4 days later, and then about 11 days later will be your consult.

• What’s the question? Obviously you should start tracking, even if only for this 1 purpose. If you’re not tracking yet, and you start tomorrow, then you’re tracking.

• Postpartum diaphragm fittings should optimally be from about 12 weeks after birth if you are not yet cycling. Before then we are all a bit prolapsed, even minorly, and your cervix has not yet returned to its regular position. If you do suddenly get your period before your scheduled consult, please let me know ASAP. For women who get fertility back very early, ie before 12 weeks, consults before 12 weeks may be considered on a case-by-case basis.

• Please wait for individual instructions based on your personal situation. For your own understanding, you will essentially stop the Pill/ Nuva about 14 days (2 Weeks) before your scheduled consult, so that when you stop you will get the withdrawal bleed about 2-4 days later, and then about 11 days later will be your consult.

If you are off systemic methods, the optimal time for diaphragm fitting is from about CD 11 until your 3rd high temp at the latest, and at least 5 days after your Hefsek, though we endeavor to meet before Mikva when possible to not need to delay intimacy.

• IUD removal pulls down the cervix and uterus and can change the diaphragm size. In addition, the inflammation in the uterus may also change uterine position.
• To reduce cervical trauma, IUD’s are generally removed during your period, and the should be at least 7 days from removal until the consult (and at least 5 after Hefsek). So you should aim to have your IUD removed as early as possible during your period so that the consult will be in the optimal window for diaphragm fitting from about CD 11 until your 3rd high temp at the latest, and at least 7 days after IUD removal and at least 5 days after your Hefsek, though we endeavor to meet before Mikva when possible to not need to delay intimacy.

• Aside from being messy and less comfortable for you, this is not a time that your anatomy is potentially fertile. The optimal window for diaphragm fitting is from about CD 11 until your 3rd high temp at the latest, and at least 5 days after your Hefsek, though we endeavor to meet before Mikva when possible to not need to delay intimacy.

• We aim to scheduled consults when you are potentially fertile BEFORE mikvah night to minimize the need to delay intimacy. Diaphragm fitting and learning to use it very rarely result in seeing any blood. If we were to see any, I am also a Bodekes and can determine if it is non-uterine/Nida Blood for discussion with your Rov if necessary. If you have a history of difficulty during Sheva Nikiim, it may be best to Toivel and then come for consult, please indicate this history in your Intake Questionnaire.
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• Diaphragms have a 2 year use life and should be replaced that often even without any size change. While the materials do degrade over time, they have been lab tested to work for at least 2 years. Additionally it’s still a foreign object in the vagina, and for the sake of the vaginal flora it’s best to swap it out with a new one every two years. Your size should be refitted at least that often.
• In an ideal world I’d like to refit yearly, but experience has shown, especially when women are given comprehensive education, guidance, and practice on how to use it, that a refit about every 2 years is totally fine. Well Women’s Check-ups, where we check the diaphragm size, core and pelvic floor engagement and coordination, assess vaginal flora, as well as cycle concerns and challenges is the ideal. May one day the next generation be Zoche to a situation where such care is normal and “standard.” The reality is that most women local to me usually get refits only every 2 years before buying a new diaphragm.
• My goal in the consult is to educate each woman on how to Self Assess when the diaphragm is getting too small or too large so that I can support provide support if there seems to be a size change. In the consult, we also assess for how likely size changes are for your individual anatomy and how stable your current diaphragm size is.

• Yes it is best to get a refit after every birth, but most women use their old diaphragm until at least 12 weeks postpartum or even later postpartum before Return Of Fertility and are able to self-assess as well.

• Technically the recommendation is that a weight fluctuation of 15 pounds requires a diaphragm refit (and that can be up 7 pounds and down 8 pounds totaling 15 pounds of change), but it is less about the actual weight change and more about how your pelvic floor anatomy responds to the weight change.
• For the above reasons I find it most sucessful to give a personalized recommendation based on your unique pelvic floor and anatomy while educating women on how to self-assess for diaphragm size changes.

• As discussed in the workshop, I do not recommend the use of Nonoxynol-9-based spermicides (or any surfactant-based spermicides). (Gynol, VCF etc). Their mechanism of action is essentially similar to putting harsh laundry detergent into the vagina that kills the sperm but also kills off all the good bacteria, putting the environment at risk of irritation, yeast overgrowth, urinary tract infections, bad bacteria, and pH imbalances, all while burning off the upper layer of vagina epithelium/ skin.
• For use with a properly fitted diaphragm, I only recommend using CayaGel/ ContraGel (they are exactly the same made by the same company with different packaging for different markets.) It does not kill the sperm, rather it is a lactic acid gel made to keep vaginal flora in balance which makes it harder for sperm to function longer than 5 hours as happens during non-fertile days.
• For most of our cycle the vagina environment is acidic due to the presence of a good bacterial population lactobacillus, responsible for making lactic acid. This acidic environment protects us against yeast overgrowth and bad bacteria, it is also inhospitable to sperm which cannot function longer than 5 hours without the fertile fluid to protect and nourish it. The gel is lactic acid based and thus vaginal flora friendly. The diaphragm keeps your cervix bathed in the gel and your diaphragm stays inside for at least 6 hours after intimacy, after which point it is safe to remove your diaphragm.

• The gel is food grade and safe for ingestion.

• This occurs when the vaginal pH has become imbalanced and not acidic enough (Basic) or if there is an internal rash or irritation. Women are at higher risk for these after using systemic methods (hormonal/IUD etc) and especially after using and Nonoxynol-9 Spermicides. In the consult we assess vaginal flora and vaginal tissue resilience. If there is an underlying vaginal flora imbalance, you will be guided on how to optimize your vaginal environment for ease of diaphragm use.

• Prolapses come in different levels, from mild to severe. The closer you are to mild prolapses, the easier it is to use a diaphragm. But as the prolapses become more severe, using a diaphragm can become more challenging. However, I want to make sure that every woman has the knowledge, understanding, and ability to use her comprehensively fitted diaphragm, even with more challenging prolapses.

No, these sessions are not medical appointments and are not billed through insurance. They are in-person coaching sessions focused on diaphragm use and pelvic health, provided as woman-to-woman care in a safe and consensual environment.

Please indicate this information on your application form. In these scenarios, I make exceptions to the 12-week recommendation, but it will likely be necessary to invest in a follow-up appointment when you are further along postpartum.

Please use the same email address for your consult as you used for the main workshop. The pre-consult session will appear in your library at notjustmd.com/library.