Where did all the diaphragms go? Not in the vaginas of modern American women, that’s for sure. Until I started researching this article, I’d never heard of anyone in my age group using one. No one ever suggested one to me as a viable form of birth control: not my mom or my doctor or anyone I’ve ever spoken to about reproductive health. But diaphragms were a hugely popular form of birth control from the time Margaret Sanger introduced them to the U.S. in 1916 until just a few decades ago. Why aren’t we using them today?
Diaphragms, it seems, are dinosaurs. I first learned what a diaphragm was when I read Erica Jong’s Fear of Flying when I was in my early teens. They seemed weird and super 70s to me, like shag carpet and macrame. But I was curious: Are women still using them, and if so why? And how is it?
In case you don’t know what a diaphragm is or how it works (and if my research is any indication, if you’re under the age of 40 you may very well not) it’s a small dome-shaped device that fits into the vagina and covers the cervix, serving as a barrier to sperm. Diaphragms are usually made of silicone or latex and they’re fitted for each specific woman by a medical professional. They must be used with a spermicidal lubricant. They also must be inserted no less than 30 minutes before sex, and taken out at least six hours and up to 24 hours after having sex.
Sounds kind of labor intensive, right? That’s a big reason as to why it’s not a popular birth control option anymore. Once the stigma against taking the pill started to subside in the latter half of 20th century, women felt more comfortable using hormonal birth control and as a result, the not-so-user friendly diaphragm fell by the wayside.
Another reason why diaphragms aren’t a popular birth control option? You have to be comfortable with touching your vulva and vagina to use one correctly, and many women today are decidedly not. Camilla Bicknell, a nurse practitioner who is also an author of The Pregnancy Power Workbook, told me:
Younger women traditionally avoid methods of contraception that involve “touching down there.” I’ve heard words like, “yuck,” “sick,”“I’ll mess it up,” and “it sounds too scary,” when discussing diaphragm use.
But perhaps the biggest reason why hardly anyone uses diaphragms anymore is because of their debatable success rate of preventing pregnancy. I’ve found varying numbers, everything from 84%-94% from the CDC to 95% from the American Pregnancy Association. The American College of Obstetricians and Gynecologists estimates that out of every 100 woman using a diaphragm correctly, 12 will get pregnant. Planned Parenthood estimates that 6 in 100 will become pregnant with proper use every time.
The higher end of the estimates is pretty comparable to condom use, which has an effectiveness rate of anywhere from 82-98% (depending on proper usage). But unlike condoms, diaphragms don’t protect against STDs. To be effective, they have to be inserted and used correctly every single time. It’s a lot easier to take a pill.
It’s also a lot easier for a doctor to write a prescription for a pill than to to fit a diaphragm and spend time carefully explaining its use. Bob Smithing, a nurse practitioner with FamilyCare of Kent in Kent, Washington, told me:
I think many clinicians don’t routinely mention barrier methods other than condoms in their discussion of options. It takes more time to explain and fit and it’s just not as easy as handing out a prescription. When I do presentations on birth control options (both to individual patients and health professionals) there is a very limited interest in barrier methods. I think that it is a combination of less convenience and less effectiveness.
It’s true that many just aren’t aware of barrier methods other than condoms. Think about the last time you saw a commercial, a magazine ad or even a health pamphlet that contained information about cervical caps, contraceptive sponges or diaphragms. Never, right? According to Dr. Alyssa Dweck, co-author of the book V is For Vagina, “there is absolutely no media marketing to the public regarding the diaphragm.”