mission impossible Sept. 22, 2016
It's Way Harder Than It Should Be to Get a Diaphragm
By Elise Pillion
"Do you know where the spermicide is?" my husband asked the middle-aged pharmacy employee, a woman with thick, frizzy dark hair who looked as if it was the first time she'd ever been asked that question. She took a few steps forward and stared at the store shelves, making small, frantic movements, looking puzzled. "It's supposed to be right here," she muttered as she sorted through the boxes of condoms and lube, while her co-worker, a scrawny kid of about 18, giggled uncontrollably. "What's spermicide?" he had asked her just a moment ago, to my utter disbelief (I thought the name was pretty self-explanatory). I stood like a statue, hoping they would figure it out while I pretended I wasn't having one of the most uncomfortable shopping experiences of my life.
My husband and I left the pharmacy empty-handed, though an online search would later reveal that we had been staring directly at the spermicide the whole time. I remembered seeing the purple box on the top shelf, though it didn't say "spermicide" anywhere — the brand name was front and center, along with a line stating that it's for the prevention of pregnancy — oh, and the words "contraceptive gel" were there, too, in teeny, tiny writing.
Thus began my months-long (and at times mortifying) journey toward finding, fitting, and using a diaphragm, one of the most archaic methods of birth control still in use.
My chosen method of birth control for the past eight years had been the pill. But in an attempt to curb the intense nausea I had begun feeling every morning of the first week of the pack, and to allow my body to return to producing hormones without interference, I decided to ditch hormonal contraceptive methods for the only noninvasive option outside of condoms: a diaphragm.
When I was in college, the diaphragm was the last thing I wanted to use. My mother suggested it when she learned I was on the pill. My reaction? Hell no. I did not want to be bothered with that mess. I said I'd consider it, thought I knew I wouldn't.
But now I'm at a different point in my life, I thought to myself one bright morning a few months ago while hugging the toilet bowl, maybe the diaphragm won't be so bad after all.
Now that I had my own apartment with my own bathroom, a supportive husband, and the time and space to learn how to use the damn thing, I reasoned I should try. Plus, Carrie Bradshaw used a diaphragm on Sex and the City, so that's kind of a plus (even if she's the only television or movie character I've heard of who did).
I told my husband that I needed to get off the pill ASAP. After seeing what I'd been going through, he agreed.
Diaphragms have become nearly obsolete over the last few decades; few general practitioners fit or prescribe them, and a study from 2006–2010 found that only 3.1 percent of women in the U.S. have ever used a diaphragm, according to a National Health Statistics report from the Centers for Disease Control. That's down from 1982, when 17 percent of women had used one.
The first birth-control pill in the U.S. was approved for contraceptive use in 1960, and the diaphragm's steady decline ever since has been largely attributed to increased use of the pill. It's not hard to see why — the latter is both more effective and, I'll admit it, much more convenient. Pop a pill, and voilà! Who'd want to put up with the work of a diaphragm when the alternative is so easy?
When I sat in the exam chair at my local family-planning clinic and told the doctor I wanted a diaphragm, her face was still, her eyebrows raised slightly. She seemed hesitant. "One in five women who use it will get pregnant each year," she told me. I later learned this is slightly misleading: Diaphragms are 94 percent effective when used correctly every time, and 88 percent effective with normal use, according to Planned Parenthood. But I insisted, and she proceeded.
She did seem to rush me through the appointment, deciding awfully quickly that the first and only size she tried was the best fit and giving me only a minute or two to awkwardly walk around the exam room before she impatiently popped her head back in to see what I thought. I had no idea what I thought. But since I couldn't feel it as I performed an array of poses around the exam room, we determined it must be the right size.
When it finally arrived in the mail four weeks later, I remembered that we'd need to revisit the unfortunate spermicide issue. Oy. So, I called up my local pharmacy to see whether they carried a certain brand.
"Bartell's Pharmacy, this is Fester speaking, how may I help you?" I heard a man ask as a wave of panic rushed over me. The man on the other end of the line was my new next-door neighbor (I'm fairly certain he's the only 20-something in my neighborhood named Fester). I prayed the phone he was using didn't have caller ID. They didn't have it, but I'm fairly certain I went undetected — or at least that's what our brief encounters in the apartment lobby since then would imply.
After that, I smartened up and bought the stuff online. Now I was in business: no condoms, no hormones, and no more awkward trips to the store! Success.
If you don't plan for it, it can be pretty annoying to have to run to the bathroom and spend a good few minutes messing with a diaphragm. When you combine the physics of trying to keep the springy silicone dome folded in half, with one hand, after you've made it nice and slippery by putting spermicide in the center and around the rim, things can get a bit dicey. It's a miracle I haven't yet sent mine flying into the toilet. But once you get the hang of it, it usually doesn't take more than a minute or two. And it's actually better than condoms, since you can insert it ahead of time (if it's been more than hour since insertion you'll need to re-up on spermicide, but you can pre-fill applicators ahead of time for a quick fix).
When it comes to the experience of using the diaphragm, my doctor told me that most women and their partners can't feel it during sex. But I am very petite and my husband is not so petite, so we can both feel it, a little bit. (I was initially convinced that it must not be the right size and might get displaced, though a second trip to the doctor confirmed the fit was in fact correct.) But it's not uncomfortable or distracting, and it's much better than condoms.
I think it's unfortunate that more women don't use diaphragms, now that I'm one of the few who do. But luckily for us fans of this old-school method, there's been at least one recent development. In 2014, the U.S. Food and Drug Administration approved Caya, a one-size-fits-most diaphragm that eliminates the need for a fitting at the doctor's office and is just as effective as a traditional diaphragm. I plan to try one in the future. The company also sells Caya Gel, a natural spermicide made without nonoxynol-9, the active ingredient found in most spermicides, which can irritate the skin.
While it took a few months to get adjusted to using a diaphragm, it's been worth it. I'm now free from unbearable nausea, from monthly trips to the pharmacy (and from occasionally forgetting to take pills) — and free of the need to go through this headache again anytime soon.