BY CAROL WARD, MD

You probably wouldn’t believe me if I announced that there’s a contraceptive that doesn’t fill you full of hormones, doesn’t change your cycle, libido or menstrual flow, doesn’t involve an insertion procedure in a doctor’s office, doesn’t need to interfere with the heat of the moment, is as reliable as most other methods of birth control, and is magnificently inexpensive. I know, it sounds pretty perfect!

What could it be?

That method is the contraceptive diaphragm. The diaphragm is a neglected — but elegantly simple and cheap — birth control device that’s inserted by the woman herself.

The actual diaphragm is a flexible round “hula hoop,” with an intervening dome of soft rubber attached all around. It comes in sizes corresponding to the depth of woman’s vagina, from 65 mm to 95 mm. An initial fitting by a doctor or nurse practitioner is required, and insertion practice is usually done in the office to reassure everyone that the diaphragm springs open properly in the vagina and is in place, covering the cervix with spermicide. One simply takes the diaphragm, squeezes about a teaspoon of contraceptive jelly or cream into the cavity of the diaphragm (plus a little around the rim for lubrication). With one hand holding the diaphragm (folded like a taco), the other hand is free to push it in. Once beyond the vulva, the diaphragm pops open and slides into place. A quick check to make sure the cervix is covered, and ta-da! It’s practically effortless!

Home, Sweet Home

Now, the magic may commence! Simply insert the diaphragm prior to lovemaking, and remove it four or more hours afterward (when all the little swimmers are reliably dead).

A word of caution: It’s best used by someone who engages in sex in the same location most of the time. Personal responsibility and compliance is a requirement for success! Many women find it helpful as contraception in-between babies.

Why isn’t the diaphragm more popular?

A minimal amount of manual dexterity and practice is required for insertion. A woman needs to be comfortable touching herself, and feeling for her cervix to make sure that the diaphragm is covering it. She also needs to be able to extract the diaphragm after sex. Then there’s washing it off and letting it air dry — women using the diaphragm should have a supportive partner who isn’t turned off by the drying gizmo beside the sink.

What does the medical industry have to do with it?

Simply put, drug companies make more on birth control pills than they do on contraceptive jelly. Modern doctors may not even have a lot of practice fitting diaphragms, making it potentially challenging to find someone who does.

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