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American Family Physician Jan 2004When used with a spermicide, the diaphragm can be a more effective barrier contraceptive than the male condom. The diaphragm allows female-controlled contraception. It... (Review)
Review
When used with a spermicide, the diaphragm can be a more effective barrier contraceptive than the male condom. The diaphragm allows female-controlled contraception. It also provides moderate protection against sexually transmitted diseases and is less expensive than some contraceptive methods (e.g., oral contraceptive pills). However, diaphragm use is associated with more frequent urinary tract infections. Contraindications to use of a diaphragm include known hypersensitivity to latex (unless the wide seal rim diaphragm is used) or a history of toxic shock syndrome. A diaphragm is fitted properly if the posterior rim rests comfortably in the posterior fornix, the anterior rim rests snugly behind the pubic bone, and the cervix can be felt through the dome of the device. The diaphragm should not be left in the vagina for longer than 24 hours. When the diaphragm is the chosen method of contraception, patient education is key to compliance and effectiveness. An extended visit with the physician or a nurse may be required for a woman to learn proper insertion, removal, and care of the diaphragm.
Topics: Anthropometry; Cervix Uteri; Contraception; Contraceptive Devices, Female; Contraindications; Equipment Design; Female; Humans; Latex Hypersensitivity; Palpation; Patient Compliance; Patient Education as Topic; Shock, Septic; Spermatocidal Agents; Time Factors; Urinary Tract Infections; Vagina
PubMed: 14727824
DOI: No ID Found -
The Cochrane Database of Systematic... 2001The diaphragm is usually used with a spermicide. However, some practitioners have suggested that spermicides offer no additional contraceptive protection and have... (Review)
Review
BACKGROUND
The diaphragm is usually used with a spermicide. However, some practitioners have suggested that spermicides offer no additional contraceptive protection and have advocated alternative guidelines for the use of diaphragms.
OBJECTIVES
The objective of this review was to compare the effectiveness, safety and acceptability of the diaphragm with and without spermicide.
SEARCH STRATEGY
We searched MEDLINE, EMBASE, POPLINE, CINAHL, the Cochrane Controlled Trials Register, and reference lists of relevant articles. In addition, we contacted experts in the field to identify unpublished studies.
SELECTION CRITERIA
Randomized controlled trials comparing women of reproductive age using the diaphragm with and without spermicide as the sole contraceptive method that reported clinical outcomes.
DATA COLLECTION AND ANALYSIS
Two reviewers independently extracted data on outcomes and trial characteristics and any discrepancies were resolved by consensus or by consultation with the third reviewer. The results of the one identified study are presented descriptively.
MAIN RESULTS
We identified only one study. No significant difference was found in the pregnancy rates (with typical use or consistent use) or discontinuation rates between the diaphragm-with-spermicide and diaphragm-without-spermicide groups. There was a trend towards higher pregnancy rates in the diaphragm-without-spermicide group. However, this study failed to recruit the planned number of participants and was consequently underpowered.
REVIEWER'S CONCLUSIONS
As only one underpowered study was identified, we cannot distinguish between the contraceptive effectiveness of the diaphragm with and without spermicide. We cannot draw any conclusion at this point, further research is needed.
Topics: Contraception; Contraceptive Devices, Female; Female; Humans; Pregnancy; Randomized Controlled Trials as Topic; Spermatocidal Agents
PubMed: 11406025
DOI: 10.1002/14651858.CD002031 -
The Cochrane Database of Systematic... 2002The diaphragm is usually used with a spermicide. However, some practitioners have suggested that spermicides offer no additional contraceptive protection and have... (Review)
Review
BACKGROUND
The diaphragm is usually used with a spermicide. However, some practitioners have suggested that spermicides offer no additional contraceptive protection and have advocated alternative guidelines for the use of diaphragms.
OBJECTIVES
The objective of this review was to compare the effectiveness, safety and acceptability of the diaphragm with and without spermicide.
SEARCH STRATEGY
We searched MEDLINE, EMBASE, POPLINE, CINAHL, the Cochrane Controlled Trials Register, and reference lists of relevant articles. In addition, we contacted experts in the field to identify unpublished studies.
SELECTION CRITERIA
Randomized controlled trials comparing women of reproductive age using the diaphragm with and without spermicide as the sole contraceptive method that reported clinical outcomes.
DATA COLLECTION AND ANALYSIS
Two reviewers independently extracted data on outcomes and trial characteristics and any discrepancies were resolved by consensus or by consultation with the third reviewer. The results of the one identified study are presented descriptively.
MAIN RESULTS
We identified only one study. No significant difference was found in the pregnancy rates (with typical use or consistent use) or discontinuation rates between the diaphragm-with-spermicide and diaphragm-without-spermicide groups. However, this study failed to recruit the planned number of participants and was consequently underpowered.
REVIEWER'S CONCLUSIONS
We cannot distinguish between the contraceptive effectiveness of the diaphragm with and without spermicide.
Topics: Contraception; Contraceptive Devices, Female; Female; Humans; Randomized Controlled Trials as Topic; Spermatocidal Agents
PubMed: 12137639
DOI: 10.1002/14651858.CD002031 -
The Cochrane Database of Systematic... 2003The diaphragm is usually used with a spermicide. However, some practitioners have suggested that spermicides offer no additional contraceptive protection and have... (Review)
Review
BACKGROUND
The diaphragm is usually used with a spermicide. However, some practitioners have suggested that spermicides offer no additional contraceptive protection and have advocated alternative guidelines for the use of diaphragms.
OBJECTIVES
The objective of this review was to compare the effectiveness, safety and acceptability of the diaphragm with and without spermicide.
SEARCH STRATEGY
We searched MEDLINE, EMBASE, POPLINE, CINAHL, the Cochrane Controlled Trials Register, and reference lists of relevant articles. In addition, we contacted experts in the field to identify unpublished studies.
SELECTION CRITERIA
Randomized controlled trials comparing women of reproductive age using the diaphragm with and without spermicide as the sole contraceptive method that reported clinical outcomes.
DATA COLLECTION AND ANALYSIS
Two reviewers independently extracted data on outcomes and trial characteristics and any discrepancies were resolved by consensus or by consultation with the third reviewer. The results of the one identified study are presented descriptively.
MAIN RESULTS
We identified only one study. No significant difference was found in the pregnancy rates (with typical use or consistent use) or discontinuation rates between the diaphragm-with-spermicide and diaphragm-without-spermicide groups. There was a trend towards higher pregnancy rates in the diaphragm-without-spermicide group. However, this study failed to recruit the planned number of participants and was consequently underpowered.
REVIEWER'S CONCLUSIONS
As only one underpowered study was identified, we cannot distinguish between the contraceptive effectiveness of the diaphragm with and without spermicide. We cannot draw any conclusion at this point, further research is needed. However, the study provides no evidence to change the commonly recommended practice of using the diaphragm with spermicide.
Topics: Contraception; Contraceptive Devices, Female; Female; Humans; Intrauterine Devices, Medicated; Randomized Controlled Trials as Topic; Spermatocidal Agents
PubMed: 12535422
DOI: 10.1002/14651858.CD002031 -
PloS One 2022The diaphragm changes position and respiratory excursions during postural loading. However, it is unclear how it reacts to lifting a load while breath-holding or...
OBJECTIVES
The diaphragm changes position and respiratory excursions during postural loading. However, it is unclear how it reacts to lifting a load while breath-holding or breathing with simultaneous voluntary contraction of the abdominal muscles (VCAM). This study analyzed diaphragm motion in healthy individuals during various postural-respiratory situations.
METHODS
31 healthy participants underwent examination of the diaphragm using M-mode ultrasonography, spirometry, and abdominal wall tension (AWT) measurements. All recordings were performed simultaneously during three consecutive scenarios, i.e., 1. Lifting a load without breathing; 2. Lifting a load and breathing naturally; 3. Lifting a load and breathing with simultaneous VCAM.
RESULTS
Using paired-samples t-tests, lifting a load without breathing displaced the diaphragm's expiratory position more caudally (P < .001), with no change noted in the inspiratory position (P = .373). During lifting a load breathing naturally, caudal displacement of the diaphragm's inspiratory position was presented (P < .001), with no change noted in the expiratory position (P = 0.20) compared to tidal breathing. Total diaphragm excursion was greater when loaded (P = .002). Lifting a load and breathing with VCAM demonstrated no significant changes in diaphragm position for inspiration, expiration, or total excursion compared to natural loaded breathing. For all scenarios, AWT measures were greater when lifting a load (P < .001).
CONCLUSION
In healthy individuals, caudal displacement and greater excursions of the diaphragm occurred when lifting a load. The postural function of the diaphragm is independent of its respiratory activity and is not reduced by the increase in AWT.
Topics: Diaphragm; Exhalation; Humans; Muscle Contraction; Respiration; Ultrasonography
PubMed: 36215306
DOI: 10.1371/journal.pone.0275389 -
American Family Physician May 1989Use of a diaphragm plus spermicide provides effective protection against pregnancy in motivated women and decreases the risk for some sexually transmitted diseases....
Use of a diaphragm plus spermicide provides effective protection against pregnancy in motivated women and decreases the risk for some sexually transmitted diseases. Potential risks of this contraceptive method include the development of urinary tract infections and the possible teratogenic effects of nonoxynol-9, the active agent in most spermicides. Contraindications include a large cystocele or rectocele, uterine prolapse and recurrent urinary tract infections.
Topics: Contraceptive Devices, Female; Female; Humans; Patient Education as Topic; Spermatocidal Agents; Urinary Tract Infections; Vaginal Creams, Foams, and Jellies
PubMed: 2718900
DOI: No ID Found -
The Nurse Practitioner Dec 1995Using a diaphragm as a barrier contraceptive has received little attention in recent literature. A discussion of the role of the diaphragm to prevent pregnancy, as well... (Review)
Review
Using a diaphragm as a barrier contraceptive has received little attention in recent literature. A discussion of the role of the diaphragm to prevent pregnancy, as well as sexually transmitted diseases, is presented. A procedure for properly fitting the diaphragm is described. To ensure compliance, a review of a plan for education and practice by users is outlined.
Topics: Contraception; Contraceptive Devices, Female; Female; Humans; Nurse Practitioners; Patient Education as Topic; Physical Examination; Pregnancy; Prescriptions; Sexually Transmitted Diseases; Vagina
PubMed: 8610032
DOI: No ID Found -
Perspectives on Sexual and Reproductive... 2003
Review
Topics: Contraception; Contraception Behavior; Contraceptive Devices, Female; HIV Infections; Health Promotion; Humans; Patient Acceptance of Health Care; Risk Factors; Sexually Transmitted Diseases; United States; Women's Health
PubMed: 14744659
DOI: 10.1363/3527003 -
The European Journal of Contraception &... Apr 2012
Topics: Contraceptive Devices, Female; Female; Humans; Pamphlets; Spermatocidal Agents
PubMed: 22292510
DOI: 10.3109/13625187.2011.636461 -
Journal of Obstetric, Gynecologic, and... 1986To evaluate the necessity of refitting the vaginal contraceptive diaphragm after weight loss or gain, an ex post facto/correlational study examined the relationship... (Review)
Review
To evaluate the necessity of refitting the vaginal contraceptive diaphragm after weight loss or gain, an ex post facto/correlational study examined the relationship between body weight change and diaphragm size change. The hypothesis that no relationship exists between weight change and diaphragm size change was tested by selecting 125 clients from two family planning agencies. Weight change and diaphragm size change were compared statistically via chi-square tests, two-tailed t-tests, and regression analysis, revealing overwhelming support of the hypothesis. No significant relationship between weight change and diaphragm size change was found, which suggests that refitting the vaginal diaphragm after weight loss or gain is unnecessary.
Topics: Adolescent; Adult; Body Weight; Contraceptive Devices, Female; Female; Humans; Middle Aged; Nursing Assessment
PubMed: 3517255
DOI: 10.1111/j.1552-6909.1986.tb01377.x