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AIDS Education and Prevention :... Dec 2009Women need more choices for protection from HIV and other sexually transmitted infections (STIs). We conducted a randomized 4-week study in Madagascar in preparation for... (Randomized Controlled Trial)
Randomized Controlled Trial
Women need more choices for protection from HIV and other sexually transmitted infections (STIs). We conducted a randomized 4-week study in Madagascar in preparation for a Phase III randomized controlled trial (RCT) of the diaphragm with a candidate microbicide for STI prevention. All participants completed quantitative surveys; half participated in a qualitative interview. We advised women to wear the diaphragm at all times except for daily cleaning (rather than inserting it before intercourse). The objective of this analysis was to determine whether women who followed this "continuous use" approach more often used the diaphragm for 100% of sex acts as compared with other women. If so, this would support advising continuous diaphragm use in the upcoming RCT. To meet our objective, we analyzed qualitative data thematically, developed a measure of continuous diaphragm use based on qualitative data, and used multiple regression to evaluate the measure's association with adherence to diaphragm use during 100% of sex acts. Women who wore the diaphragm continuously had 4 times higher odds of reporting diaphragm use during 100% of sex acts (OR: 4.6, 95% CI: 1.2, 24.0). If the diaphragm proves effective against STI, continuous use may help women achieve high levels of protection.
Topics: Administration, Intravaginal; Adolescent; Adult; Anti-Infective Agents, Local; Contraception Behavior; Contraceptive Devices, Female; Female; Follow-Up Studies; Humans; Madagascar; Middle Aged; Patient Compliance; Regression Analysis; Sexually Transmitted Diseases; Surveys and Questionnaires; Treatment Outcome; Vaginal Creams, Foams, and Jellies; Young Adult
PubMed: 20030496
DOI: 10.1521/aeap.2009.21.6.512 -
JAMA Apr 1986
Topics: Contraceptive Devices, Female; Female; Humans; Urinary Tract Infections
PubMed: 3951099
DOI: No ID Found -
The Australian & New Zealand Journal of... Feb 1986A prospective study of diaphragm users at the Family Planning Association of Victoria was undertaken. Despite the women being well motivated and instructed the pregnancy...
A prospective study of diaphragm users at the Family Planning Association of Victoria was undertaken. Despite the women being well motivated and instructed the pregnancy rate was high (24 per 100 woman years) and the continuation rate was only 35% at 12 months. Three-quarters of the women who became pregnant admitted that they did not use a diaphragm on every occasion. Therefore emphasis must be placed on the committed use of the diaphragm every time coitus occurs. Even so, the diaphragm does not appear to be a very safe method of contraception, and may be better suited to family spacing rather than as a method when high efficacy is required.
Topics: Contraception Behavior; Contraceptive Devices, Female; Female; Follow-Up Studies; Humans; Prospective Studies
PubMed: 3460577
DOI: 10.1111/j.1479-828x.1986.tb01533.x -
Duodecim; Laaketieteellinen... 1987
Review
Topics: Contraceptive Agents, Female; Contraceptive Agents, Male; Contraceptive Devices, Female; Contraceptive Devices, Male; Female; Humans; Male; Risk Factors
PubMed: 3331144
DOI: No ID Found -
Human Fertility Dec 1946
Topics: Contraception; Contraceptive Devices, Female; Diaphragm; Female; Humans; Suppositories
PubMed: 20245995
DOI: No ID Found -
Fertility and Sterility Mar 1983
Topics: Contraceptive Devices, Female; Female; Humans; Intrauterine Devices; Shock, Septic; Syndrome; Tampons, Surgical
PubMed: 6825875
DOI: 10.1016/s0015-0282(16)46912-8 -
JAMA Aug 1987
Topics: Contraceptive Devices, Female; Female; Humans; Shock, Septic
PubMed: 3613015
DOI: 10.1001/jama.1987.03400070046018 -
Contraception Oct 1986A literature review yielded no scientific basis for the currently accepted recommendations on the length of time spermicides used with diaphragms continue to kill sperm.... (Clinical Trial)
Clinical Trial
A literature review yielded no scientific basis for the currently accepted recommendations on the length of time spermicides used with diaphragms continue to kill sperm. Twelve volunteers provided 68 spermicide samples representing 6, 12, 18, and 24 hours of in vivo insertion in a contraceptive diaphragm using Ortho Creme, Gynol II, and vehicle controls. Testing for continued spermicidal effect was performed in the laboratory using quality semen from 2 donors and employing the Multiple Exposure Photography system of semen analysis. Results showed effective spermicidal action after 12 hours of insertion, mixed effectiveness after 18 hours, and poor effectiveness after 24 hours with both products, with Ortho Creme being more effective in the longer insertions. Placebo jelly enhanced sperm activity while placebo creme had a moderate inhibitory effect. Recommendations for further study are made.
Topics: Adult; Contraceptive Devices, Female; Female; Humans; Spermatocidal Agents; Time Factors; Vaginal Creams, Foams, and Jellies
PubMed: 3780236
DOI: 10.1016/0010-7824(86)90090-9 -
Sexually Transmitted Infections Dec 2005The diaphragm, a woman controlled, reusable contraceptive device, might prevent some sexually transmitted infections (STIs). We assessed the acceptability and...
OBJECTIVES
The diaphragm, a woman controlled, reusable contraceptive device, might prevent some sexually transmitted infections (STIs). We assessed the acceptability and feasibility of use of silicone Wide-Seal Arcing Diaphragms (Milex Products, Chicago, IL, USA) by sex workers in Madagascar.
METHODS
Over 8 weeks, we evaluated method acceptability by examining patterns of and problems with women's diaphragm use. We also evaluated several measures of study feasibility, including recruitment and follow up methods.
RESULTS
91 women from three cities (Antananarivo, Tamatave, and Mahajanga) participated, and 87 (96%) completed follow up. At enrolment, participants reported a median of six sex acts with five clients in the previous week. During the follow up period, participants reported a median of three sex acts with three clients during the previous 2 days, and self reported continuous diaphragm use during the previous day increased from 87% to 93%. Seven women became pregnant (incidence 53 pregnancies per 100 woman years). Self reported use of male condoms and diaphragms was fairly constant over the study period: women reported condom use in 61% to 70% of acts and diaphragms in 95% to 97% of acts. The number of participants reporting diaphragm problems decreased from 15 (16%) at the first visit to six (7%) at the final visit. 20 women (22%) needed replacement devices during follow up because their original diaphragms were lost, were the wrong size, or became seriously damaged.
CONCLUSIONS
Given the high use and steady decrease in reported problems during the study, we believe diaphragms are acceptable and feasible in this resource poor, low education sex worker population.
Topics: Adolescent; Adult; Condoms; Consumer Behavior; Contraceptive Devices, Female; Feasibility Studies; Female; Humans; Madagascar; Sex Work; Sexual Partners; Unsafe Sex; Urban Health
PubMed: 16326849
DOI: 10.1136/sti.2005.015107 -
Contraceptive Technology Update Dec 1980
Topics: Americas; Community Health Workers; Contraception; Contraceptive Devices, Female; Data Collection; Developed Countries; Family Planning Services; North America; Physicians; Research; Sampling Studies; Therapeutics; United States
PubMed: 12310050
DOI: No ID Found