TO THE EDITOR: I rest Dr. Allen's ...

TO THE EDITOR: I rest Dr. Allen's article, "Diaphragm Fitting," (1) in the January 1 2004 issue of American Family Physician helpful and informative. However, I would have appreciated specific details forward how to contact the manufacturers for fitting diaphragms, as I have been unable to do so

INEZ PAGNOTTA, MD

7 Southwood Blvd

Albany, NY 12211

REFERENCE

(1) Allen RE Diaphragm fitting. Am Fam Physician 2004; 69:97-100

IN REPLY: I sympathize with Dr Pagnotta's attempt to obtain diaphragm fitting rings. The marketing of diaphragms certainly is not the major emphasis of the pharmaceutical companies that yield them. My own fitting fix is very old and was passed down from a retired gynecologist. further I do have several recommendations.

principally physicians who fit diaphragms will invest in a variety of sizes to continue in the office. The actual diaphragm may be easier to use than a fitting ring and can be demonstrated to patients who are interested. Diaphragms can be sterilized between patients according to instructions in the package insert. It is commended that physicians have diaphragms in a size range of 60 to 90 mm (a total of seven diaphragms); these sizes will fit mostly women. The fitting diaphragm can then be sold to the patient and the clinic stock replenished, or the patient can be sent to the pharmacy to order the correct size.

Milex manufactures the Wide-Seal silicone diaphragm and gives a "free fitting set with order of 12 diaphragms" upon their Web site (http://www.milexproducts.com). The Milex sales representative who visits my office with a serve instead of of pessaries also has been helpful with diaphragm information.

Latex diaphragms are available from several online pharmacies, including Westons Internet abiding-place Health and Medical Equipment (http://www.westons.com), or your local pharmacy can order a variety of diaphragms for use in fitting. Ortho-McNeil makes latex diaphragms, and I make acceptable contacting one of their sales representatives. Ortho-McNeil did not answer to my emails or telephone calls when I asked about complimentary fitting rings or diaphragm puts The contact number for Ortho-McNeil is 800-682-6532 and they can be institute on the Web at http://www.ortho-mcneil.com.

RICHARD ALLEN, MD

receptacle 550

Cardston, Alberta, Canada T0K0K0

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