Diaphragms probably don't even cross your mind when it comes to your birth control options, and you’re not alone. Most women now opt for the Pill, condoms, or an IUD. But diaphragms still exist—and a small but growing number of women are helping them make a comeback as their preferred method of birth control. “Diaphragms are becoming more popular again,” says Jessica Shepherd, M.D., an assistant professor of clinical obstetrics and gynecology and director of minimally invasive gynecology at the University of Illinois College of Medicine at Chicago. Sure, the vast majority of her patients still explore other forms of birth control, but Dr. Shepherd says she’s seen a recent uptick in women asking about the diaphragm.
Why the sudden interest? I have to confess, before I had my son, I was a diaphragm user, so I kind of get it. I knew I wanted to try to get pregnant in six months or so, and wanted to explore a hormone-free birth control method that wasn’t condoms. So I tried out the little silicone cup. I have mixed thoughts about my experience—I loved not having to take a daily pill but wasn’t totally sure that I was putting in the diaphragm the right way. You also have to leave the diaphragm up there for hours after having sex, so, when my husband and I engaged in a little prework fun, I had remove the device at the office and wash it out in the bathroom sink while praying none of my coworkers caught me in the act.
But Caroline, 30, has had a different experience. “My friends make fun of me for using such an old form of birth control, but I like the idea of using something that doesn’t have hormones,” she says. “I thought about the copper IUD, but got too freaked out by the ‘This could puncture your uterus’ thing.” Caroline has used her diaphragm for a year now and says she has it down: “I just pop it in before sex with some spermicide, take it out hours later, and otherwise forget about birth control.”
Her reasons for digging the diaphragm aren't rare: Dr. Shepherd says women who opt for the barrier tend to like them because they’re environmentally safe and nonhormonal, and they don’t require the whole IUD-insertion process.
The process of getting a diaphragm is pretty simple, says Christine Greves, M.D., a board-certified ob-gyn at the Winnie Palmer Hospital for Women and Babies: You get fitted for one by your ob-gyn, learn how to place it in a follow-up visit, and then it’s good for the next two years. It’s also inexpensive, she points out—diaphragms cost anywhere from $0 to $75, per Planned Parenthood.
To use a diaphragm, you either sit down or elevate one leg to change the angle of your pelvis, squirt some spermicidal jelly or lube into the inside part, fold it up, and then slide it up there before sex. The back rim should fit into the posterior part of your vagina behind your cervix, and the front should fit nicely behind your pubic bone, Dr. Shepherd says. Six hours after you have sex, you can remove the diaphragm (it’s a good idea to wait because sperm can swim around the barrier if you remove it sooner). Then, Dr. Shepherd says, you wash it with soap and water, and you’re good to go.
It sounds simple once you get the hang of it, and it is. But there’s a reason diaphragms have been usurped by more popular birth control methods like the Pill and IUD—it’s not as effective at preventing an unintended pregnancy. According to Planned Parenthood, if women always use the diaphragm as directed, six out of 100 will become pregnant each year. If they don’t always use it as directed, 12 out of 100 will become pregnant each year. (Women who use IUDs, on the other hand, have a less than one percent chance of getting pregnant with them, and nine out of 100 women who don’t use the Pill perfectly will have an unintended pregnancy.)
Women also will need to get fitted for a new diaphragm if they gain or lose a significant amount of weight, have a baby, or undergo certain surgeries, Greves says. And then there’s the fact that you have to walk around with a diaphragm in your vagina for hours after you have sex. It was annoying to me to have to remember to fish it out, but it’s no biggie to others.
Greves says she doesn’t think diaphragms are the best option for everyone due to their higher rates of failure, but says it’s a good choice for women who can’t use hormonal birth control and don’t want to get a copper IUD. “If combined with perfect condom usage, that can help reduce the failure,” she says.
If you’re interested in trying out a diaphragm, talk to your doctor. He or she should be able to help you decide whether it’s the right method for you.
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