Diaphragm

Effectiveness: 84% - 94%

The diaphragm may offer some protection against sexually transmitted infections (STIs).  For the best protection, use with a male condom to help prevent STIs. 

The Disappearing Diaphragm
by Minna Dubin

In the 1930s, the diaphragm was the most frequently prescribed form of birth control in the United States.  But by 2002, less than one-third of one percent of U.S. women using contraception used a diaphragm.  The diaphragm's effectiveness hadn’t changed, nor, significantly, had the diaphragm itself — aside from a new “wide-seal” model that came out in 1983.  Why has diaphragm use been steadily decreasing with each decade? 

More options, says Teresa Scott, CEO of Planned Parenthood of the Bluegrass in Lexington, KY, and professor of human sexuality at Eastern Kentucky University.  Indeed, the sheer number of birth control options available today — not just the diaphragm and condom, but the pill, patch, ring, shot, and, most recently, a new type of implant — is startling.  And today's generation, says Scott, has always had birth control available to them and doesn't necessarily understand what women went through to get it.  "Women were grateful to have a diaphragm," she says, of previous generations who had limited options for safe and effective birth control methods.  "Women now want the best and latest." 

Barrier Method Breakdown

Prescription barrier methods include not just the diaphragm but also the cap and shield.  
They work by covering the cervix — keeping sperm physically apart from an egg.  They must be used with spermicide cream or jelly to be effective.  The diaphragm is a shallow, dome-shaped cup with a flexible rim — typically made of latex.

A diaphragm is a good birth control choice for a woman who wants a safe, easily reversible, non-hormonal method that is used only during sex.  Diaphragms are easily portable.  In general, they cannot be felt by either partner during sex, and can be inserted hours ahead of time, so as not to interrupt intercourse.  And diaphragms are relatively affordable.  After the initial fitting and cost of the diaphragm, it can be reused for up to two years.  The only ongoing expense is spermicide.

There are downsides, too — just as there are with all birth control methods.  Diaphragms are not suitable for women with allergies to latex or spermicide.  They are not recommended for women who have recently given birth, had an abortion after the first trimester, or had cervical surgery.  Other conditions may also rule out use.  And women who are not comfortable touching their genitals or who have difficulty inserting a diaphragm may not feel that it’s the best option for them.

Testimonials

Even with the advent of the birth control pill, the diaphragm remained a popular choice with some women.  Ella Samuels, an artist from Philadelphia who is now in her 60s, used a diaphragm in her 30s.  "I had read about it and my doctor was familiar with it," says Samuels.  She saw both the pros and the cons.  “[The diaphragm is] not as convenient as an IUD, because you have to put it in [before sex]," says Samuels.  "On the other hand, it’s more convenient than a condom because you can put it in before you start.” 

Fran Gallun, another former diaphragm user, also in her 60s, began using a diaphragm in her mid-20s.  She had taken the pill but grew concerned about possible side effects, and she and her husband did not like condoms.  "I felt the diaphragm was the best choice — noninvasive."  She used it for 15 years, though she found it "a little annoying" at times. 

Both Samuels and Gallun knew other women who used diaphragms.  But diaphragm use has declined among younger women.  Indeed, when asked if she knew anyone who uses a diaphragm, 21-year old Ashley Kelley, a college senior, said she hadn't.  “I’ve heard rumors of [my boyfriend’s] parents …" she says.  "It’s just not my generation.” 

The Bigger Picture

With so many new birth control choices, the diaphragm may be suffering from a poor reputation among providers and women alike.  Experts suggested as much in a 2003 article on the diaphragm published in Perspectives on Sexual and Reproductive Health, “In the current environment, where easy-to-use, highly effective, coitus-independent hormonal methods dominate the market, many women are likely to see the diaphragm as outdated, messy, unreliable, and generally inconvenient," they wrote.  "Some health care providers who have ignored [the diaphragm] for decades may hold the same negative perceptions of the diaphragm that some women do.”

Some providers do not suggest diaphragms because other methods, such as the IUD, the patch, or the ring, have less potential for "user error" — which can be especially important for younger clients.  And health care providers want to help clients choose the method that will be the best, most effective, and most "user-friendly" for their individual needs.

There may be larger forces at play as well.  Scott says providers are often influenced by the samples, literature, and products they receive — and diaphragms are not heavily marketed and promoted by manufacturers.  Indeed, barrier methods in general lack the kind of marketing dollars that have made household names out of birth control pills such as Seasonale, which has ads in print and on television that promote its primary selling point — just four periods a year.

One of Many

Today, it's a buyer's market when it comes to birth control.  And while diaphragms may no longer corner the market, as they did 75 years ago, they remain a good birth control choice for some women.  Women who are interested in the diaphragm should talk to their health care providers and educate themselves about the pros and cons of the method.  As always, the best birth control method is not necessarily the newest, the cheapest, the most convenient, or the most high-tech but the one that best meets each woman’s needs.

Minna Dubin is a freelance writer in Lexington, KY. Published: 08.07.06 | Updated: 09.28.06