I grew up in the late eighties, so I could never have sex without fear of disease or death, but now I can't have it without playing pregnancy roulette as well. For some the idea that disease or death is a lesser sentence than pregnancy for enjoying her sexuality seems ludicrous. For me, it’s not. The birth control pill was always my method of choice.

What could be easier than taking a pill in the morning that has the wonderful side effect of light periods with no cramping and a set schedule? If I could solve any problem in my life through taking a pill I would. It's my favorite way to get anything. Who needs to eat right when there are vitamins? And diet pills?

I started taking birth control pills when I was sixteen. My mother took me to the doctor because I told her someone needed to see my knee. I remember staring at that knee and asking this jovial, stubby fingered old man if I could go on the Pill so I could...umm...regulate my periods as he was testing my reflexes in the knee. My mother didn’t appear to be shocked—neither did the doctor. It was at an Army teaching hospital. I got the doctor, an intern, and because the first two were male, I got a female nurse to balance things out in the ratio and—my mother. All of them making unnecessary eye contact with both my eyes and my vagina.

The Pill was always serious boyfriend kind of stuff, though the definition of serious boyfriend has changed over the years. Like most women I know, I have condom sex with a new boyfriend for about the first six months. Four months into this cycle and I get back on the Pill.

The condom months are never good for me. For even when I could feel good about the safety part, condoms, no matter what brand, always make me itch. Add some foam to that and I might as well have scraped my labia with poison ivy. The Pill brought some moodiness, slight weight gain, mild periods. But now, as of last year, I’ve been told I can’t take the Pill anymore; makes my blood pressure shoot up forty points or so on the top and twenty something on the bottom. That’s it. They won’t let me take it anymore. My sister suggests Depro Vera shots but anything hormonal I’m told will send the blood pressure sky high.

If not the Pill, and not the condoms, what else is out there? Well, there's the diaphragm or the IUD. I thought the diaphragm was the part of my lungs I'm suppose to sing from if I don't want to go hoarse. Diaphragm breathing is supposed to help give me an edge in a yoga class. And I didn’t even know that IUD’s were still on the market. "They’re making a comeback," a friend of mine said. "And they're good for ten years. I’ll be in menopause by the time mine needs replacing." It sounded a little like a timing belt to me and somehow that didn’t seem comforting; I don’t even use tampons. Besides, I was about to leave the country in two weeks when my gynecologist informed me of my climbing blood pressure. If there were any side effects from the IUD, they would show up sometime in the first two months, he warned. I could see my future: inflammation, expulsion, doubling over with painful cramps while living in a small conservative village in Japan. I can barely say konnichiwa and I’m suppose to learn to say, "Sorry for bothering you, most honorable doctor, but can you get this string out of me?" So, no the IUD wasn’t going to happen, and comeback or no, the graphics on the pamphlets in the gynecologist’s office scared me too.

Pamphlets with house-in-the-country mom and dad, their pullover cotton sweaters cuffed like nooses around their necks. A Golden Retriever licks a blonde kid in a soccer uniform. "Perfect for the woman in a monogamous relationship who has already started her family." Does this imply the powers that be in the contraception world aren't sure whether it makes you sterile so, hey proceed at your own risk?

It didn't say anything in the pamphlet about a woman who might want another kid some day from one of her "we're-just-good-friends-oh-my-god-I-can't-believe-we-just-did-it" serial "we're-not-in-a-relationship" relationships.

I call the nurse at my gynecologist’s office. An IUD is fitted when a woman's on her period; a diaphragm is fitted when she isn't. I've been calling this office scheduling and canceling my two options—and half the time I forget which is supposed to go in when. She schedules me for the diaphragm reluctantly.

Nothing on the sexual history form that the nurse has me fill out the morning of the big day seems to fit me. There’s nothing on the form that explains real frumpy, chunky early thirties single American woman sexuality: I have sex with more than one partner in some years—hell, more than one partner in one day if I can manage it. In some whole years I don't have sex at all. I’m starting to daydream when the nurse wakes me.

"Well, Honey," she shrugs, "You're just gonna have to get yourself a diaphragm and lots of jelly to kill of all of them sperm. Now, of course, my last child was conceived with one though. Heh, heh. Should have used more jelly.”

First of all, I don’t like hearing about women getting pregnant on birth control. The idea of jelly reminds me of peanut butter, too much of peanut butter. It makes me think of elementary school lunches. And now, thanks to the nurse and my 70s up bringing, I’m visualizing my vagina as a giant slab of dry organic toast.

I used to think you lost all dignity when having a Pap smear exam, but I would take that speculum carjack any day over a diaphragm fitting. Sure, you have your legs up in stirrups, but they often warm the equipment and it isn't a procedure directly related to sex. Even nuns and virgins have to have pelvic exams. The pap smear is a unifying examination that all women, regardless of their sexual prowess, must go through, and like a breast exam, women engaging in this sort of exam are looked upon as doing their part in preventative medicine. It can be a little uncomfortable but a little swab on glass and it’s all over with a pap smear and usually my gynecologist is talking about a great new Thai food restaurant or how to mix the perfect margarita.

No, the diaphragm fitting is all about sex. This time when I'm spread out before the doctor we both know that the only reason I've come to see him is so I can have sex without making another baby in the process. There's no way to hide this. I am being fitted for something invented by a man to stop another man from becoming a father—and I’m just the conduit between them.

There is a whole arrangement of different sizes of diaphragms on a big cold stainless steel tray like a flight attendant’s food cart next to the examining table. Are cervixes like snowflakes or fingerprints, I wonder?

Diaphragms are the color of glazed donuts and maple bars. Little rubber cups arranged from smallest to largest. You get to find out how big you are. My gynecologist and I realize two minutes into the fitting that I’m not big boned down there, I’m just fluffy. He settles on fitting me with a medium, a dead center medium diaphragm and all at once I’m not so sure I like the idea of being average.

He has me lay back and inserts it and tells me how I’ve got to insert it at least an hour before sex and I can keep it in all night to make sure everything’s dead before I remove it. Do men know when you excuse yourself to the bathroom what the two of you may be doing in an hour? How disturbing. That’s got to mess up dinner plans, I’m sure.

"Okay, we've got a nice fit going," my gynecologist smiles. "Now I’ll give you a couple of minutes to take it out and put it back in a few times. You know, just to get used to it." And he leaves me to go stick his hands up someone’s rectum and scrape something unpleasant onto a slide.

Il Postino, I suddenly notice, is playing close caption style on the TV in the corner. This doctor has the nicest examination rooms—a little TV showing an art flick in every room. And to take my mind off the gruesome task at hand, I glance up at it now and then. I’m not one of those queasy types. Not too girlie to deal with my own body. I’ve got two editions of Our Bodies, Ourselves and I’m not afraid to use them. I’ve been known to pick gravel out of knees, pull splinters out of fingers, and squeeze puss out of a cuticle. I say gruesome more as in gruesome discovery. Like going on a hike and finding a bloated body floating in the river.

I discover something about myself that I must have known since I tried to play piano and couldn’t reach the whole octave. The reason I still can buy mittens in the girls department: my hands are too small. I can’t get my hands around the diaphragm. It’s like standing on tiptoes to reach a cookie jar a foot out of range.

I’m lying down, so I get up and squat. Nope. Stand. Nope. Fetal position? Nope. Leg lifts style? From behind? Every position I've tried and never tried during sex I try in that room all the while I’m glancing upwards at a beautiful Italian countryside thinking of Neruda.

I’m on the floor fully clothed from the waist up, fully naked from the waist down. Trying to get at the foreign object with the nice fit.

The old Aunt in Il Postino is complaining to Pablo Neruda that metaphors will be the undoing of her niece. My gynecologist knocks and comes in. I scramble back to the table and waddle backwards like a sick crab with my legs and knees spread apart. For a brief moment, I think about needing to maintain some dignity. Who am I kidding? Dignity seems like the only thing that can easily be removed from my body. "How did we do?" he asks with one of those smiles that says he just made a hundred dollars off of me for pure sport. And what were we doing anyway? He wasn’t here. We were up to our armpits inside my vagina I want to say, but chicken out.

"We couldn’t get it out," I say. "Not even once?" He looks shocked. He expected more from me. I’ve failed him. I’m not even making eye contact now. I’m watching the postman eat a bad fish dinner and black coffee contemplating his next move.

"Couldn’t get it out, huh?" "What? Oh, um, no." I tell him that yoga and martial arts experts have nothing on me. I’ve tried every position known to womankind. I’ve studied the moves of all sorts of animals in the jungle and bush. Copied them, aped them. Nothing. This diaphragm might as well have been put on with crazy glue. I’m thinking about stopping at the video store on the way home to rent and watch the rest of Il Postino. Or maybe I can go another round in his office here until the film is over.

"Well, I can't very well let you have a diaphragm if you need me to get it out for you." He bends down for a peak inside and sticks in his hand. I imagine that he’s up to his shoulder reaching for it in there. I can’t look. Think Italian countryside.

"Wow. You’ve got some suction in there. Great suction. I’ve never seen anything like it." Ever notice how doctors add things like "great" or "awesome" or "incredible" to things you’ve never considered a point of pride? It’s like when your mother looks in the toilet bowl when you are two and says great job! I knew you could do it!

"Wow, it really is a good fit. Don’t feel too bad, even I’m having trouble getting it out…wait there it is."

The postman is looking forlorn and bitter he looks out to the sea, the roar of the ocean takes over all other sounds. And all of a sudden comes a breaking of the sound barrier from the end of the table. The postman is looking down. I imagine our eyes meeting but I have a feeling he’s looking down at where the doctor has just pulled a giant glazed donut from my body. Tears are welling up in the postman's eyes. Mine too.

"I can’t give it to you," the doctor says in a voice so humane I’m surprised. "You’ll have to go back to condoms or the IUD."

Why can’t we get pregnant from taking out the garbage or taking lint out of each others’ belly buttons? I’m crying as I go to buy condoms on the way to the video store. A Costco size box so I won’t have to do it again for a long-long time. I dream of my husband’s vasectomy.