Diaphragm, contraceptive

Various physical barrier devices are available for contraceptive use by men and women. Modem barrier methods such as diaphragms, condoms, and cervical caps were made possible by the discovery of the vulcanisation of mbber. 

The cervical cap birth control device has been available in Europe for many years and in the U.S. since late 1988. It is a small, mbber, dome-shaped device that fits snugly over the cervix. The cervical cap has some advantages over the diaphragm, but has not Hved up to widespread expectations that it would become an overwhelmingly popular method of contraception (100). 

The Contraceptive diaphragm, Emory University, School of Medicine, Healthcare Communications Network, New York, 1989. 

Personal preference plays a large role when determining the best contraceptive option. For instance, if a woman is not interested in using a method that will interrupt sexual activity, then a diaphragm would not be appropriate. Preference of the sexual partner may be important as well. Certain agents such as male condoms require the male partner to play an active role in contraception. 

Condom, diaphragm, or cervical cap with contraceptive or antimicrobial agent (including virucidal) agent. 

Barriers condoms are the commonest form of mechanical contraception in use. Their use is important not only in contraception but in protection against infection by HIV and other sexually transmitted diseases (see below). It should be noted that diaphragms do not protect against such diseases. 

Rule 14 deals with devices used for contraception or the prevention of transmission of sexually transmitted diseases - Class 11b, for example, condoms, contraceptive diaphragms and if they are implantable or long-term invasive Class 111, for example, intrauterine devices. 

On the day after week 4 ends, a new 4-week cycle is started by applying a new patch. Under no circumstances should there be more than a 7 day patch-free interval between dosing cycles. If there are more than 7 patch-free days, the woman may not be protected from pregnancy and back-up contraception (eg, condoms, spermicide, diaphragm) must be used for 7 days. 

First day start - For first day start, apply the first patch during the first 24 hours of the menstrual period. If therapy starts after day 1 of the menstrual cycle, a nonhormonal back-up contraceptive (eg, condoms, spermicide, diaphragm) should be used concurrently for the first 7 consecutive days of the first treatment cycle. 

There is now a new day 1 and a new patch change day. Back-up contraception (eg, condoms, spermicide, diaphragm) must be used for the first week of the new cycle. 

Use after childbirth - Women who elect not to breast-feed should start contraceptive therapy with the norelgestromin/ethinyl estradiol transdermal patch no sooner than 4 weeks after childbirth. If a woman begins using the patch postpartum and has not yet had a period, consider the possibility of ovulation and conception occurring prior to use of the patch, and instruct her to use an additional method of contraception (eg, condoms, spermicide, diaphragm) for the first 7 days. 

The contraceptive vaginal ring may interfere with the correct placement and position of a diaphragm. A diaphragm is not recommended as a backup method with contraceptive vaginal ring use. 

Data from the classic Nurses Health Study, followed up in 1994, reflected no difference in all-cause mortality between women who had ever used oral contraceptives and those who had never used them (7). There was also no increase in mortality associated with duration of use and no relation with time since first use or time since last use. Similarly, in the OFPA (Oxford) study, the overall 20-year mortality risk for oral contraceptive users compared with women using diaphragms or IUCDs was 0.9, suggesting no effect (8). Although the number of deaths from each cause was small, the pattern is consistent with the risks found in other studies. Oral contraceptive users had somewhat higher death rates from ischemic heart disease and cervical cancer, but lower rates of ovarian cancer mortality. Breast cancer mortality was similar for oral contraceptive users and non-users. 

Nonoxynol-9 is an approved spermicide with strong antiviral activity. A vaginal device which facilitates the controlled release of nonoxynol-9 has been developed for contraceptive and anti-STD purposes. The device, available as a diaphragm or a disk pessary, is fabricated from silicone elastomer matrix system. The drag release profile demonstrates square root time kinetics (M co tV2) (see Section 4.4.2). 

Sterilization Oral contraceptive Condom Spermicide Withdrawal Diaphragm Periodic abstinence Intrauterine device (IUD) Douche... 

Bernstein, G. S. (1974), Conventional methods of contraception Condom, diaphragm, and vaginal foam, Clin. Obstet. Gynecol., 17,21-33. 

Oil-based lubricants cause failure of rubber condoms and contraceptive diaphragms many lubricants, e.g. hand or baby creams, wash off readily, but are nevertheless oil-based. Barrier contraceptive devices made of polyurethane, e.g. the female condom (femidom), are not so affected. 

Modem spermicides are produced in a variety of formulations, including gels, foams, creams, suppositories, pessaries, capsules, foaming tablets, and melting films. Spermicides are also used in conjunction with other methods, such as diaphragms, condoms, and sponges, but also with intrauterine contraceptive devices and methods based on fertility awareness (1). 

A number of surviving patients had several recurrences during subsequent menstrual periods (up to five), these events each being progressively less severe in their clinical course (8,9). Insertion of a contraceptive diaphragm can trigger the toxic shock syndrome, even at times other than during menstruation. 

Spermicidal condoms emd intrauterine devices (lUDs) contmning copper or a hormone are medicines, whereas non-spermicidal condoms and other barrier-type contraceptives (e.g., diaphragms) cire medical devices. 

If using a barrier method of contraception (e.g. latex diaphragm, cap or condoms), it may be damaged and become ineffective with... 

Clinically important, potentially hazardous interactions with acenocoumarol, condoms, contraceptive diaphragms,... 

Commonly used methods of reversible contraception include oral and transdermal contraceptives, long-acting injectable estrogens and progestins, implantable progestins, condoms, spermicides, withdrawal, the diaphragm, periodic abstinence, and the intrauterine device. These methods differ in their relative effectiveness, safety, and patient acceptability." ... 

Gallo ME, Grimes DA, Schulz KE. Cervical cap versus diaphragm for contraception. Cochrane Review 2003 3. 

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