The divide between mine and my mother’s generation of women is glaring when it comes to a number of areas. We prefer The Notebook, while they prefer An Officer and a Gentleman. We crush on Ryan Reynolds while they mooned over John F. Kennedy Jr. We down Red Bull while they imbibed Tab.
But nowhere is this generational divide more apparent than when it comes to the diaphragm.
While the contraceptive device was a well-established option for women 30 years ago, it has all but disappeared from the latest generation of sexually active women.
Earlier this year, TVLand’s Younger crystallized this contraception generation gap when Kelsey (Hilary Duff) asks Liza (Sutton Foster), her 40-year-old coworker posing as a 26-year-old, to help her when her menstrual cup is stuck.
Liza is completely perplexed about the menstrual cup—for the record, it’s a device inserted in the vagina to catch menstrual flow that is reusable and, thus, does not generate as much waste.
“You know, it’s like a tampon, but eco-friendly,” Kelsey tells Liza.
“It sits up in your stuff like…like a diaphragm?,” Liza asks, to which Kelsey responds, “What’s a diaphragm?”
Darren Star, creator of Younger, actually stole that female device-stuck-in-vagina gag from his own Sex and the City.
The only difference is that when he included it in 1999’s “The Cheating Curve” (season two, episode six), it was a diaphragm stuck inside Carrie that Samantha needed to retrieve.
Today, 16 years after that episode aired, a generation of sexually active women wouldn’t laugh at that joke. Instead, their faces would glaze over as they tried to imagine how a diaphragm worked.
While menstrual cups have become almost trendy, brag-worthy devices for women, diaphragms have plummeted in popularity and usage.
According to the U.S. Centers for Disease Control and Prevention (PDF), the percentage of sexually active women who have ever used a diaphragm has fallen from 17.1 percent in 1982 to 3.1 percent by 2010.
Personally I cannot think of a single female within 10 years of my age (25) who has even tried using a diaphragm.
I have encountered my share of the intrauterine device (IUD) evangelists.
They swear by the T-shaped contraception, which are inserted in a woman’s uterus for years of “worry-free” sex, some offering as much as 12 years of protection from pregnancy. Almost every sexually active person I know has used a condom at one point, if not regularly.
Even the rhythm method—based on a woman tracking her own menstrual cycle to prevent her pregnancy but without actually using forms of contraception, like pills, condoms, or diaphragms—appears to be making a comeback.
Over the same 1982-2010 timeframe that the diaphragm completely tanked in usage, the percent of sexually active women who said they’ve practiced the withdrawal method jumped from 24.5 percent to 59.6 percent.
The concept of inserting a device into the vagina to prevent pregnancy goes back to ancient times, Dr. Kirtly Parker-Jones, vice-chair of education in the department of obstetrics/gynecology at the University of Utah, told The Daily Beast.
Personally, her own mother and grandmother relied on the diaphragm, which was available to American women well before the pill. In fact, women were being fitted for diaphragms before contraception was even legal in all 50 states.
“My father’s mother took my mother, her future daughter-in-law, to the Margaret Sanger clinic in New York to get a diaphragm because contraception was illegal in their state of Massachusetts,” Parker-Jones recalled.
For women, the diaphragm provided a level of reproductive autonomy at a time when they had relatively little power, inside or outside the bedroom. “It [a diaphragm] was something they could control,” said Parker-Jones.
In contrast, “with condoms, a woman might carry one, but there’s a negotiation process,” she said—a negotiation that nearly every straight, sexually active woman encounters at some point in her life.
We’ve all heard the not-invalid claims that condoms hinder sexual sensation, but the beauty of the diaphragm is that “men can’t feel it,” said Parker-Jones. In fact, a man doesn’t even have to know his partner is using one, which many women may find advantageous.
Dr. Eve Espey, the chair of the University of New Mexico’s department of Obstetrics and Gynecology, said that she relied on the diaphragm as her form of contraception for 15 years after her IUD, which is often mistakenly idolized as foolproof, failed.
“I had an IUD back in 1979, the Copper 7, and a year later, I got pregnant. Thank god I had a miscarriage, but after that, I didn’t trust the IUD,” she told The Daily Beast. “I tell women all the time that IUDs are super effective, but I do have women who get pregnant on them.”
For Espey, the diaphragm proved the most effective form of contraception, though she understands why it has fallen out of favor.
She cites the HIV-AIDS crisis as a driving force behind women’s decision to ditch the diaphragm.
“There was a big focus on condoms to prevent HIV. If a woman was going to use a barrier method, it switched to being a condom,” she says.
While some studies have investigated whether the diaphragm reduces STI transmission, the diaphragm is not considered a safe and reliable form of protection.
During the same time that the diaphragm has declined in popularity, other forms of contraception that also don’t offer STI protection have entered the market—and have become increasingly popular.
Hormonal methods of contraception other than the pill, such as contraceptive rings and patches, were not even on the market when the CDC began tracking birth control.
By 2010, 33.8 percent (PDF) of sexually active women had at least tried some form of them.
While the array of new birth control options over the past couple of decades have contributed to the diaphragm’s decline, Espey believes another, less quantifiable factor could be at play.
“We live in a convenient culture,” Espey says. “This is total conjecture on my part, but I do think because it’s [using a diaphragm] a project, women became less interested in using that kind of method.”
“Project” may be an understatement. Not only does a woman have to be specially fitted for a diaphragm, but she needs to do a fair bit of prep work before she’s ready to do the deed.
“One of the problems of sex with a diaphragm is it interferes with the spontaneity of the act of intercourse,” Espey explains. “You have to stop. You have to load up your diaphragm with spermicide. A diaphragm requires a lot of user intervention.”
While Espey says a diaphragm can be inserted up to six hours in advance, there’s another potential downside.
In case you had any doubts, spermicide is not pleasant to the palate. “ So, if you have oral sex, it does not taste good,” Espey says. Duly noted.
Espey believes the reason women may be more willing to put up with the menstrual cup maintenance, which involves its own potential insertion challenges and regularly cleaning, is because periods always necessitate some level of work. “Menstruation is a project to start with,” she points out.
There are certainly legitimate reasons why the diaphragm has become less popular, but it appears to have set off a vicious cycle. Many pharmacies have stopped stocking diaphragms, making them harder to access.
Thus, even women who seek out this form of contraception may not actually get ahold of them.
Perhaps even problematic is that some young doctors are not well-practiced in fitting women.
“It’s unfortunate because I don’t think my residents have ever fit a diaphragm. They don’t have a clue,” said Parker-Jones. “Maybe five years ago, a resident came to me and said, ‘Someone wants a diaphragm. Do you know how to do that?’”
“The fact that doctors don’t recommend them and don’t know how best to use them is what is keeping a new generation of women from using an improved version of their mother’s method,” Jeanette, a 31-year-old in Seattle, told me as she recounted her challenges getting a diaphragm.
Jeanette’s doctor pointblank discouraged her from using a diaphragm.
Jeanette ended up ordering a non-prescription diaphragm online that was made in the UK, which she says came with a fitting set for her to figure out the right size for herself. “It was cheaper than a 90-day supply of pills or NuvaRings,” Jeanette says.
It also didn’t involve spermicide. Rather, she has used the “continuous use” method, which involves keeping a diaphragm inserted, except taking it out once a day for showering and cleaning, but not using spermicide.
Some studies have shown this is effective, though it is not conclusive. Jeanette’s doctor said she “couldn’t recommend it as a method because it wasn’t one of the ‘approved’ methods at her clinic.”
It’s important to note that a doctor would likely be hard-pressed to endorse Jeanette’s style of diaphragm use. The National Institute of Health still states that “spermicidal cream or jelly should be used with diaphragms.”
However, Jeanette says her diaphragm and the continuous-use method hasn’t failed her.
“It’s weird to me that the diaphragm isn’t talked about more. It’s eco-friendly, reusable, hypoallergenic, no hormones,” she says.
While the array of contraception on the market may seem almost gratuitous, it is important to remember how much of a woman’s sexual life is spent trying to prevent a pregnancy.
A diaphragm may not work for a single woman with a more spontaneous sex life, but it could be ideal for a woman in a long-term relationship who wants to do away with hormonal contraception.
“Most women don’t want more than two kids. That means there is a very long period of time you’re trying to avoid pregnancies, [and] that’s why it’s good to have a range of methods,” says Espey.
“What may have been a great method for you when you were 17 may not be a great method for you when you’re 37.”
