Is This Old-Fashioned Birth Control Actually Making a Comeback?

A Virginia-based women's health company hopes to reinvigorate interest in an old form of birth control with Caya, the first one-size-fits-most diaphragm. 

Caya is the first contraceptive diaphragm to hit the market in more than 50 years. When its United States release was announced last week, it briefly captured the Internet's attention and was hailed as a contraceptive of the future — despite the fact that very few women today use diaphragms, or even know what they are.

The makers of Caya are hoping to appeal to a savvy consumer base increasingly concerned with the substances that go into their bodies, who may be looking for a non-hormonal alternative to their current birth control. But the diaphragm may be facing an uphill battle.

What, exactly, is a diaphragm? Diaphragms are reusable latex cups that fit over the cervix and prevent sperm from entering the uterus, protecting the wearer from pregnancy. Unlike male condoms or female condoms, which put a barrier between the vagina and entire length of the penis, diaphragms do not protect against sexually transmitted infections. 

The device is inserted into the vagina before sex along with spermicidal (sperm-killing) cream. The diaphragm must be left in for at least six hours after sex to ensure that the sperm cells are no longer functional.

Developed by pharmaceutical company HPSRx, Caya can be used for up to two years. Unlike older diaphragms, Caya doesn't need to be fitted by a gynecologist for insertion, a past hurdle that was "not only unpleasant, but you then have to rely on the pharmacy to provide your size," Annette Larkin, press officer for CONRAD, the nonprofit marketing Caya, told Mic. 

Instead, Caya's makers claim the device fits around 80% of women, and Larkin added, "The Caya is far more easily available and can be ordered through the website as long as you have a prescription."

Larkin also said Caya has a small dome at the front that makes removal much easier. Previously, women had to hook their finger around the rim of the diaphragm to remove it from the vagina, whereas Caya's dome gives the device something of a "pull tab."

Bringing old-fashioned birth control back: Despite all its improved features, Caya faces a tough road. Diaphragms were quite popular in the first half of the 20th century. Since the mid-20th century, however, their use has fallen off dramatically, especially among young women. According to the Centers of Disease Control and Prevention, roughly 8% of women using contraception ages 15-44 opted for the diaphragm in 1982. By 1995, that percentage had plummeted to 1%. 

The diaphragm received a slight bump in pop culture visibility in the early 2000s, thanks to a Sex and the City episode in which Carrie Bradshaw enlists the help of her friends to retrieve it from inside her. But today, many women have no idea what a diaphragm is, let alone whether or not it's effective. In a sample collected between 2006 and 2008, virtually no women were using the diaphragm.

"Diaphragms haven't really been marketed to women in recent years, so women are generally not very aware of [them] as an option," Vanessa Cullins, vice president of external medical affairs at Planned Parenthood Federation of America, told Mic. They're also not very profitable for pharmaceutical companies to make or market, she added, because women only need one for several years. 

But Caya is hoping to change that by marketing to lower-income women who may not have unlimited access to medical resources. 

"CONRAD's mission is to develop reproductive health products for women all over the world, including women in low resource settings who may have more limited access to physicians," Larkin said. "Instead of taking a pill every day, or a shot every few months, a diaphragm that can be used when you need it is an excellent birth control option — especially for women who can't negotiate condom use with their partners."

Preferable to the pill? Aside from its low cost, Caya has another advantage over traditional birth control: It's non-hormonal. The pill is still the most popular method of contraception, with 28% of women ages 15-44 who use contraception choosing it, according to the CDC. But many women complain of side effects from the pill and other hormonal birth controls, such as mood swings and weight gain.

That's ignited interest in non-hormonal options. Reddit contains no shortage of threads about "non-hormonal birth control" by women looking for alternatives, and fertility awareness mobile apps abound, with blogs and forums to go along with them. The concept of an injectable male contraceptive has also been met with great fanfare, unsurprisingly. 

"It seems to me that a hormone-free option is very timely," Larkin said. "There is a new generation of women who are more conscious of what they are eating and what they are putting in their bodies. We're living in an age where food manufacturers are feeling the pressure to eliminate high fructose corn syrup and use hormone and antibiotic-free meat and dairy. Why not put the same attention on birth control?"

Ariella, 26, decided to start using a diaphragm four years ago for a similar reason. "I love it mostly because I do not want to have to take hormones and would like to know that in case situations arise where condoms don't work or aren't available, I have a good backup method," she told Mic. She's currently on her second diaphragm. 

An uphill battle: But in trying to recapture the marketplace, Caya may be up against its old foe: the intrauterine device. When used properly, Caya is about 88% effective, which is about on par with the male condom (82%) and the pill (91%), according to the CDC.

But more and more women are opting for long-acting reversible contraception such as the implant and IUDs. A 2014 CDC report said long-acting reversible contraception (LARC) use was highest among women ages 25-34, with 11.1% reporting that they used methods like the implant and the IUD. The IUD also comes in a non-hormonal copper version that can be left in place for up to 10 years. 

"IUDs and implants have extremely low failure rates — less than 1% — which rival the rates seen with permanent birth control," Cullins said. "Once an IUD or implant is inserted, you can pretty much just forget about it."

Even longtime diaphragm users like Ariella are considering making the switch to the IUD. "It is a bit annoying to always have to use condoms since diaphragms aren't that effective," she told Mic. "I am actually in the process of switching to an IUD because I think they are super cool and because they are the most effective."

That said, the diaphragm does have one distinct advantage over the IUD: cost. IUDs are expensive, and if not covered by insurance the cost of obtaining one can run up to $1,000. Caya, on the other hand, only costs about $36.

A woman's choice: Though the diaphragm is a viable, effective non-hormonal alternative, it's not without side effects. According to Caya's website, some women may experience irritation from the spermicidal cream that goes in it, while others may find the device increases urinary tract infections. It also takes practice to insert it properly, and unlike the male condom, you can't tell visually whether it's in the right place. It may also be pushed out of place by large penis sizes or heavy thrusting. 

Plus, it takes effort to put in. As one 35-year-old woman told Mic, "I've done it, but it's a pain. Like, it takes two seconds to get a condom. It took like 3 minutes to [insert a diaphragm] properly. I wasn't very good at it."

So will women really take to a new kind of birth control, one that doesn't spike their hormones and that can be removed at will? Or is it a long-term device that young women want, one they don't have to worry about for years on end or fiddle with? It's hard to know whether Caya will make a real dent in the market, but having more options is always a good thing for women looking to take control of their reproductive destinies.

"The diaphragm may be a great option for some women as it is safe, simple, convenient and contains no hormones," Cullins said. "Yet birth control methods are not one-size-fits-all. A method that's perfect for one woman may not be right for another."