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Diaphragm vs Withdrawal

A side-by-side comparison of two birth control methods — efficacy, cost, how they work, and who shouldn't use them.

Last verified October 11, 2026Updated October 11, 2026

Side-by-side comparison

Diaphragm A reusable silicone dome that covers the cervix to block sperm, used with spermicide each time you have sex.
Withdrawal The man withdraws his penis from the vagina before ejaculation to reduce the chance of sperm reaching the egg.

Method	Diaphragm A reusable silicone dome that covers the cervix to block sperm, used with spermicide each time you have sex.	Withdrawal The man withdraws his penis from the vagina before ejaculation to reduce the chance of sperm reaching the egg.
Efficacy	Diaphragm 83% typical use Least effective: under 90 out of 100 people successfully prevent pregnancy per year.	Withdrawal 80% typical use Least effective: under 90 out of 100 people successfully prevent pregnancy per year.
Cost	Diaphragm $0–$250 Insurance: Usually	Withdrawal $0
Duration	Diaphragm Reusable for up to 2 years (replace sooner if damaged)	Withdrawal Per act
Reversibility	Diaphragm Reversible	Withdrawal Reversible
STI protection	Diaphragm No	Withdrawal No
How it works	Diaphragm A reusable silicone dome covers the cervix to block sperm from reaching an egg. Used with spermicide for added effectiveness.	Withdrawal The man withdraws his penis from the vagina before ejaculation to keep semen out of the vagina. Pre-ejaculate may contain some sperm. A 2024 pilot study found sperm in about 13% of pre-ejaculate samples, though roughly 75% of participants had no sperm in any sample.
Prescription	Diaphragm Required Hybrid (Fitting or Ship)	Withdrawal Not required Self-Directed
Side effects	Diaphragm Increased risk of urinary tract infection Vaginal irritation from spermicide Toxic shock syndrome risk (rare)	Withdrawal None reported
Who shouldn't use this	Diaphragm Uterine or cervical anomaly preventing fit Sensitivity to silicone or spermicide Inability to insert or remove reliably History of toxic shock syndrome High risk of HIV exposure (because of the spermicide)	Withdrawal Partner unable to withdraw consistently before ejaculation Need for highly effective contraception

Key differences

With typical use, 17 in 100 people using Diaphragm get pregnant in a year, vs 20 in 100 with Withdrawal (both least effective). How long it lasts: Diaphragm, reusable for up to 2 years (replace sooner if damaged); Withdrawal, per act. A prescription is needed for Diaphragm, not for Withdrawal. Diaphragm: costs $0–$250. Withdrawal: costs $0.