To get it in, I squash it flat then fold it in half, pinch it close as I insert and then twirl to create a seal.

To get it out has took me a few cycles to get the hang of, but I pinch the bottom and push the sides together to break the seal, and then attempt to semi-fold without tipping or spilling while pulling it out. I don't use the stem, that just hurts and without pinching to break the seal I feel like I'm trying to pull my insides out! I often wonder if it bruises, and what would the Dr think if I went in for a pap smear and she saw a massive bruise in my vagina and on my cervix