Diaphragm

The diaphragm is a barrier method of birth control that works by blocking access to and holding spermicide near the cervix.

Quotes

 * As only one underpowered study was identified, we cannot distinguish between the contraceptive effectiveness of the diaphragm with and without spermicide. We cannot draw any conclusion at this point, further research is needed. However, the study provides no evidence to change the commonly recommended practice of using the diaphragm with spermicide.
 * Cook, L.; Nanda, K.; Grimes, D. (2002). "Diaphragm versus diaphragm with spermicides for contraception". The Cochrane Database of Systematic Reviews (3)


 * Marie Stopes had championed her ‘Pro-Race’ version of the rubber cervical cap because the diaphragm ‘must be worn so as to cover the whole of the end of the vagina and depends on stretching the vaginal walls to stay in position…[so] certain movements of physiological value (particularly to the man) which ideally the woman should make are then impossible’. Van de Velde agreed with Stopes that the diaphragm limited vaginal movements but he commented dismissively that most ‘women to-day are not able to operate their pelvic muscles voluntarily to the best advantage in coitus, so the inability to do so would not represent any appreciable loss to them’. It is possible that the sexual upbringings of women over generations ensured they were unaware of the range of movement the muscles associated with vagina were capable of.
 * Cook, Hera, “The long sexual revolution: English women, sex and contraception 1800-1975”, ‘Oxford University Press’’, 2004, p.242; quoting Stopes, Contraception, 162, Th. H. van de Velde, Fertility and Sterility in Marriage (1931), 334.


 * In 1977, Ruth Hall felt there was ‘little evidence to support Stones’ belief that the vaginal pessary [diaphragm] would stretch vaginal walls’. Yet diaphragms came in sizes ranging from 5 to 9 centimetres in diameter and there was no consensus as to whether the use of larger sizes was more or less uncomfortable for users. As vaginas vary in size, the larger sizes must have stretched the vaginal walls and, in some women, pressed on the bladder or otherwise caused discomfort. This is another example of the willingness to see the vagina as inactive.
 * Cook, Hera, “The long sexual revolution: English women, sex and contraception 1800-1975”, Oxford University Press, 2004, “Vaginal Orgasms, Clitoral Masturbation”, p.247; quoting R. Hall, Marie Stopes: A Biography (1977), 198.

“A History of Birth Control Methods “, “Planned Parenthood”

 * Giovanni Giacomo Casanova takes credit in his autobiography for inventing a primitive version of the diaphragm/cervical cap (Suitters, 1967). He placed the partly squeezed halves of lemons over his lovers’ cervices. Casanova was exaggerating his own inventiveness. Similar devices had been used for centuries around the world. Asian sex workers applied oiled paper discs to their cervices. The women of Easter Island used algae and seaweed (Himes, 1963). Sponge, tissue paper, beeswax, rubber, wool, pepper, seeds, silver, tree roots, rock salt, fruits, vegetables, and even balls of opium have all been used to cover the cervix in an attempt to prevent unintended pregnancy (Himes, 1963; London, 1998; Skuy, 1995). In 1838, German gynecologist Friedrich Wilde created rubber “pessaries” for individual patients with custom-made molds. Wilde’s pessaries resembled today's cervical caps. He used modern materials to imitate the traditional German custom of applying disks of melted and molded beeswax to the cervix to prevent conception. Primitive rubber pessaries were made by Connecticut inventor Charles Goodyear in the 1850s (Himes, 1963). Pharmacies sold them to married women, supposedly to support the uterus or hold medication in place (Chesler, 1992). By 1864, the British medical association was able to list 123 kinds of pessaries being used throughout the empire (Asbell, 1995). In America, sponges enclosed in silk nets with drawstrings attached were commonly used and advertised in newspapers and magazines (London, 1998). But the Comstock laws that were enacted in the 1870s suppressed the dissemination of contraceptive devices and information in the U.S. (Chesler, 1992).
 * p.7.


 * The diaphragm played a special role in Margaret Sanger’s effort to rescue America from the Comstock laws. During a trip to Holland in 1915, she learned about the use of snugly fitting spring-loaded diaphragms that were developed in Germany during the 1880s. In 1916, she was arrested and sent to jail for telling women about them. Her month in jail only strengthened her resolve to teach women how to use diaphragms —she even taught diaphragm use to the women she was with in jail (Chesler, 1992). Sanger had to find a way around the Comstock laws, which prohibited the transport of birth control devices or information through the mail. Her solution, clever ⎯as well as illegal ⎯also involved the diaphragm (Chesler, 1992). Sanger's second husband, Noah Slee, owned the company that manufactured 3-IN-ONE Oil, a lubricant for metal parts. Slee imported diaphragms from manufacturers in Germany and Holland to his factory in Montreal. He had the diaphragms packed in 3-IN-ONE cartons and shipped to New York (Chesler, 1992). Slee also solved Sanger’s difficulty obtaining contraceptive jelly to use with the diaphragm. He got the German formula and manufactured the jelly ⎯illegally⎯ at his plant in Rahway, New Jersey. In 1925, he put up the money for founding the Holland-Rantos Company, which manufactured the first American diaphragms, and ended the need for contraband versions (Chesler, 1992). Sanger met a Japanese physician at an international conference on birth control and got him to mail her a package of diaphragms in 1932, but the package was confiscated by U.S. Customs officers. Undeterred, Sanger decided to test the Comstock laws that forbade distribution of contraceptives and contraceptive information through the mail (Chesler, 1992). She arranged to have another package of diaphragms mailed from Japan to Dr. Hannah Meyer Stone, a New York City physician who supported Sanger's crusade for reproductive rights. This package was also seized by Customs (Chesler, 1992). In 1936, Manhattan Judge Augustus Hand, writing for the U.S. Court of Appeals of the Second Circuit, ruled that the package could be delivered. The case, United States v. One Package—said package “containing 120 rubber pessaries, more or less, being articles to prevent conception” ⎯was a watershed in U.S. birth control history. It severely weakened the federal Comstock law that had prevented dissemination of contraceptive information and supplies since 1873 (Chesler, 1992).
 * pp.7-8


 * By 1941, most doctors recommended the diaphragm as the most effective method of contraception (Tone, 2001). But with the invention of the pill and the increased popularity of the IUD, the diaphragm and cervical cap fell out of favor during the 1960s. Diaphragms continued to be available but U.S. companies stopped producing cervical caps. When the early high-estrogen birth control pills and certain IUDs were found to cause medical problems, American women increasingly returned to using simple barrier methods that didn’t affect their hormones or menstrual cycles (Bullough & Bullough, 1990). Diaphragms became quite popular again, but the cervical cap had disappeared from the American scene (Chalker, 1987). The Food and Drug Administration approved the Prentif Cavity-Rim Cervical Cap for use in this country in May 23, 1988 ⎯nearly 60 years after it was introduced in the United Kingdom. Strenuous efforts by clinicians affiliated with feminist health centers had brought the cap back to America (Bullough & Bullough, 1990). But by 2002, the Prentif cervical cap was displaced in the marketplace by FemCap® (Cates & Stewart, 2004).Today, fewer than 0.01 percent of U.S women rely on diaphragms and caps for contraception (CDC, 2010).
 * p.8