diaphragm contraceptive

Molded natural rubber dome with a flexible rim that fits into the vagina & covers the opening of the cervix. It functions as a mechanical barrier to sperm & as a support for spermicide. Effective use of a diaphragm requires use in conjunction with a spermicidal agent & leaving in place for at least 6 hours. If intercourse occurs more than once in 6 hours, spermicidal agent should be reapplied leaving the diaphragm in place. Effectiveness of a properly fitted & used diaphragm is 95%. Sizes: 1) range from 5.5-10.5 cm in 0.5 cm increments 2) 7.0-7.5 cm most common 3) check size every 2 years & after pregnancy, pelvic surgery or weight gain of > 25% of body weight They differ in the type of spring mechanism used in the construction of the rim. Types of springs 1) arching spring diaphragm a) most commonly used b) easiest to use 2) coil spring diaphragm 3) flat spring diaphragm The proper fit is the largest size diaphragm that covers the cervix & fits snuggly between the posterior vaginal fornix & the pubic symphysis without causing discomfort. It should be easy to remove by inserting the forefinger under the anterior rim. Indications: - contraception Contraindications: - immediate post-partum period - fit may change during postpartum period rendering contraception less effective Adverse effects: 1) minimal 2) allergy to rubber or spermicidal agent 3) increased incidence of urinary tract infections 4) pelvic discomfort 5) inconvenience

References

Medical Knowledge Self Assessment Program (MKSAP) 11, American College of Physicians, Philadelphia 1998