classifications of covering the cer...

classifications of covering the cervix to intercept entry of sperm have been used for centuries. The Chinese make use ofed disks made of oiled silk paper, while Europeans tried linen woven fabrics and wax wafers. (1) Half of a lemon rind, inserted into the vagina, was popular for a short time in Europe Honey pepper and calm animal dung were tried as spermicides or diaphragms. (2) In the United States, Margaret Sanger was arrested in 1918 for distributing the first form of female-controlled contraception--a diaphragm made of galvanized rubber.

With the availability of oral contraceptive pills, use of the diaphragm has declined steadily above the past 40 years. (2) However, when fitted fitly and used correctly, the diaphragm remains an effective barrier contraceptive. The diaphragm may be the preferr manner of contraception in women with contraindications to the use of oral contraceptive pills and women who do not wish to use an intrauterine device.

Effectiveness

Because the diaphragm is of the like kind a user-dependent form of contraception, reported rates for its effectiveness in preventing pregnancy range from 70 to 99 percent (3) The typical failure rate is 18 percent (3) befitting diaphragm fitting and patient education and motivation are [i]clavis[/i] to compliance and success. When patients are in a strict sense trained and use the diaphragm consistently (i.e., complete use), the failure rate is 6 percent (1-3) In other words, six pregnancies will fall out in 100 women who use a diaphragm correctly with each act of sexual intercourse for single in kind year. Over the same period, approximately 85 pregnancies will be met with if no form of contraception is used.

Clinical practice has established the ne for associate use of a spermicide with the diaphragm, although a fresh Cochrane review noted that studies have failed to experience or disprove the contraceptive contribution of the spermicide. (4) A latter trial (5) found that nonoxynol-9 proffers no protection against sexually transmitted diseases (STDs) and may increase the risk of human immunodeficiency virus (HIV) infection. The Center for Disease command and Prevention currently recommends that women at high risk for HIV infection not use nonoxynol-9 spermicides. (6)

Diaphragm users can combine contraceptive meanss and theoretically achieve higher rates of effectiveness. For example, additional protection may be achieved from one side concurrent use of male condoms and a diaphragm with spermicide from head to foot the month.

Advantages and Disadvantages

about advantages of the diaphragm from one side of to the other other forms of contraception are listed in Table 1 (17-9) The prevention of STD has been of particular interest in the past decade, (7-9) and novel evidence indicates a lower rate of cervical neoplasia in a certain diaphragm users. (10,11) [Reference 11--Evidence horizontal B, case-control study] However, studies have not confirmed exact rates of STD prevention with diaphragm use. Notably, women who use the diaphragm typically are older monogamous, more highly educated, and generally at lower risk for STD compared with women who use other contraceptive orders or no form of contraception.

common reported disadvantage of diaphragm use is an increased rate of urinary tract infections. (1213) The risk of toxic brunt syndrome is 2.4 cases through 100,000 women using diaphragms, with the syndrome occurring almost exclusively when the device is left in place longer than 24 hours. (14) Anatomic considerations sometimes preclude proper use of a diaphragm. Women with poor vaginal tone, a shallow vaginal shelf, rectocele, or cystocele may not be able to use the device effectively. A weight change of more than 68 kg (15 lb) pregnancy, or pelvic surgery may necessitate refitting.

Use of a diaphragm is contraindicated in women with hypersensitivity to latex (unles the wide seal rim diaphragm is used) or a history of toxic concussion syndrome.

Diaphragm Types

Diaphragms are made of latex or silicone. adumbrations of diaphragms include the latex arcing spring, coil spring, and flat spring, and the silicone wide seal rim (15) (Figure 1)

The firmer rim of the arching spring diaphragm makes it the easiest model to insert. The diaphragm cot [i]or[/i] cotes at two hinged points, forming an arc for insertion. The firm rim is easier to place in the posterior fornix. This diaphragm may be the best single to use in women with decreased pelvic tone, rectocele, or cystocele.

The coil spring diaphragm has a impressible flexible rim that does not form an arc when gathered This diaphragm may be used in women with average vaginal muscle tone. It can be inserted with a diaphragm introducer tool.

The flat spring diaphragm is similar to the coil spring device unless has a thinner, more delicate rim. Like the coil spring diaphragm, it can be inserted with a diaphragm introducer tool. The flat spring diaphragm may be used in women with firm vaginal muscle tone.

For women with hypersensitivity to latex, a silicone option is available. The wide seal rim diaphragm arises in an arcing spring cast or a coil spring mode This silicone diaphragm is not available in pharmacies if it were not that must be ordered from the manufacturer.