Now that I’ve caught your attention–
The title of this NY Magazine article: “No Pill? No Prob. Meet the Pullout Generation” certainly caught mine. Reading it was one of the most bizarre experiences I’ve had in a long time. The gist of it is that many modern women are so dissatisfied with all the many contraceptive choices available to them that they are opting for what used to quaintly be called coitus interruptus.
That is, they’re opting that their male partners opt for it, because unless things have changed an awful lot since I was young, it’s more a man thing.
Hormonal contraception is much simpler, and more effective, as well as esthetically and emotionally pleasing, but not when it makes you feel sick or makes you fear you’re risking your life. The IUD comes with its own health problems, and condoms are a drag.
But they’ve all got to be a darn sight better than the somewhat exquisite timing, control, and renunciation involved in “pulling out,” don’t they? I understand using the latter technique once in a while as a stopgap measure in a pinch. But regularly, as part of a committed relationship, as these women say they (or rather, their partners) do? Not to mention the fact that it’s a notoriously unreliable and ineffective method, more likely to result in a pregnancy than condoms regularly used?
But the most puzzling thing of all about the article was the complete absence of any discussion of the diaphragm. The diaphragm is a far-from-great method of birth control (I say that as a person who used one for many many years). But surely it’s better than the method they’re choosing instead?
Which made me wonder—has the diaphragm, that rite of passage of my mother’s generation (and which featured heavily in fiction such as Mary McCarthy’s The Group and Philip Roth’s Goodbye Columbus)—gone the way of the dodo?
That in turn led me to Google “Whatever happened to the diaphragm?” Sure enough, there it was, an article in a 2010 issue of Ms. Magazine that said that the diaphragm had become nearly non-existent as a birth control method:
Nevertheless, diaphragm use declined after the Pill was introduced, from 25 percent of married women in 1955 to 10 percent in 1965, and kept dropping thereafter, to just 4.5 percent of all women in 1982 and 0.2 percent today, according to the CDC…
Although diaphragms must be accurately fitted by a health care professional and re-assessed every few years, they remain cheaper than hormonal methods and require less frequent physician visits. A diaphragm can be inserted hours or moments before intercourse, and it is a fully reversible, female-controlled method of birth control.
From the comments to the article I gathered that many gynecologists today don’t even seem to know how to fit a diaphragm, and women are often actively discouraged from getting them. I wondered whether most young women and men today even know what a diaphragm is, or how it works.
What’s going on here? Shouldn’t contraception be about choice? Why are choices shrinking rather than expanding? It can’t be because the diaphragm is a barrier method; after all, so is the condom. Clearly, there’s a demand for non-hormonal methods of birth control; the diaphragm fills that need. Yes, it has the drawback of needing to be used with each act of sex, but so do condoms and certainly so does withdrawal. And although its track record isn’t perfect in terms of preventing pregnancy, it compares favorably with most other non-hormonal methods (if “used properly”). It’s somewhat messy, but not all that messy, and many women would gladly trade a bit of messiness for freedom from the health fears inherent in pill and IUD use.
It seems, rather, that the ignoring of the diaphragm has been a choice of the medical profession and/or the manufacturer. And it seems to be in the nature of a self-fulfilling prophecy. The less it’s mentioned to women, the fewer know about it, the less demand there is for it. The less demand there is for it, the less it’s mentioned, the fewer use it—in an ever-decreasing spiral.
And then, and then, I saw this:
…[T]he Caya, a new, one-size-fits-most diaphragm, looks like something Polly Pocket might be into: It’s lilac, squishy, and comes in its own little case. The look is part of its appeal. It’s an attempt to break down the stigma that diaphragms are your grandma’s birth control and to make them relevant again.
It’s made of a material and is a shape that’s easier to insert and remove. It’s smaller and more flexible, and sports a lavender color that apparently appeals to modern women although it wouldn’t do a thing for me. I applaud the makers, who may have built the diaphragmatic equivalent of a better mousetrap.
[NOTE: More about the diaphragm’s near-disappearance here and here. The comments to the latter article indicate that at the time the comments were written, doctors couldn’t even find a set of rings (used to properly fit diaphragms on patients) any more. One women said her family practice physician’s assistant asked her if she was still “taking” her diaphragm. Another commenter said she couldn’t find a drugstore that carried one.]
