Pros and cons of Using Diaphragms as a Birth Control Option

Dear Dr. G,

I have recently come across your column and found it interesting.

I noticed that you predominantly answer questions for men, but after all, sex is for both men and women (most of the time, anyway). So, I hope you don’t mind answering my query about female condoms.

I have been going out with my boyfriend for nearly a year and we recently started having sex.

Initially, he used a condom but then started complaining that he was lacking sensitivity. For the last few occasions, he decided not to use the condom, claiming that the “withdrawal technique” is safe for both avoiding diseases and pregnancy.

I am not convinced. I don’t want to take the pill because I am worried about the possible side effects.

I hear there is such a thing called female condoms. Can you tell me more about it?

Are they as safe as the condoms for men?

Regards,

June

The concept of stopping the sperm from getting into the uterus and finally reaching the eggs has been attempted for thousands of years. Records have shown that various objects such as oiled paper and lemon halves (Yes! Lemon halves!!) mixed with honey and cedar resin were applied to the cervix to preclude the progression of the ejaculated sperms. It was not until the late 19th century that the Germans introduced the use of rubber devices with spring molded rim to fit the edges of the cervix for the purpose of contraception in women.

The barrier technique for contraception in women gained popularity after advocacy by birth control activists. In the 1940s, one third of all married couples in the US were using the diaphragm as the main modality for contraception. After the introduction of oral contraceptive pills (OCP) in the 1960s, the number of women using the diaphragm dropped dramatically. In 1965, only 10% of American couples were using the device and the number was recorded to be less than 1% in 2002. In fact, some pharmaceutical companies have even discontinued the production of the diaphragm, making it a rare option for women to use as a form of contraception.

The idea of using diaphragm is straightforward. This barrier method of birth control relies on the placement of the device over the cervix, with the application of the spermicide, before sex. The device is required in place for at least six hours after sex. The efficacy of the female barrier technique is reported to be around 12%, however the initial fitting by a healthcare provider is generally required to ensure the correct size is used.

The obvious advantage of using diaphragm is the empowerment of women. As the device does not interfere with the natural menstrual cycle and is only used during sexual intercourse, it is making a comeback in recent years. Despite the introduction of diaphragm made by different materials such as latex, rubber and silicone, the low efficacy and higher risk of certain sexually transmitted infections are still the big concerns amongst women using this method of family planning.

Medical literature has consistently reported the failure rate of diaphragms used with spermicide to be 6% per year. However, the actual pregnancy rates amongst the diaphragm users is reported to be as high as 39%.

With such a high incidence of pregnancies, it is therefore widely unacceptable amongst couples.

The other more alarming concerns about the use of the diaphragm is the risk of infection. Some users of the diaphragm reported irritation and recurrent urinary tract infections. In fact, the risk of encountering toxic shock syndrome is also a concern if the device is left for more than 24 hours. In recent years, some evidence also revealed the use of spermicide together with the diaphragm causes the cells in the cervix to be particularly susceptible to certain sexually transmitted infection, such as HIV. Therefore, the diaphragm may give a false sense of security in the prevention of sexually-transmitted infections.

When it comes to contraception, it is an age-old argument of who should be in charge. It is still in the best interest of women to be in control for avoiding unintended pregnancies and infections. If I am put on the spot for my views on female condoms, I would say that the best method of contraception is non-sexual contact, if the threat of abstinence is persistent. Most men will give in to the use of condoms, eventually!