If you, like me, have arrived at this website in a state of mild outrage after weeks of digging around local pharmacies looking for diaphragm gel, and have experienced the saga that is accessing a diaphragm within the U.S. in the first place , you've come to the right place! I was able to track down a mail-order pharmacy that would fill my prescription for a Caya diaphragm after MONTHS of looking, and even then, they only stocked a contraceptive gel that comes in 10 individual pre-filled applicators (i.e., not a great quantity, not specifically designed for use with a diaphragm, and an atrocious waste of plastic). I am in disbelief that this product, designed for use with the Caya, which is available (though hard to access) in the U.S., is not stocked by ANY U.S. pharmacies as far as I can tell, and dang near impossible to get here. Anyway, rant concluded. I was skeptical of ordering from an online shop and getting it shipped internationally, but this was one of two sites I found carrying this gel, and the other one was based in Germany, so I figured I'd give it a go. The product is legit, shipped quick, and arrived in good condition. It is easy to use and this is the optimal packaging for use with the Caya. I am a huge fan of the diaphragm as a safe, easy, non-hormonal alternative to other forms of birth control. I recommend using it in combination with careful cycle tracking and avoiding it on high-fertility days, as it is less effective overall than condoms or other methods. But if you, like me, do not want to be on hormonal birth control and don't want to be constrained to using condoms exclusively, combining this with an understanding of your cycles and fertility is an amazing option, and should be accessible to all. Thank you so much for making this option available to us in the states.