Prolonged use of a diaphragm and toxic shock syndrome.
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A comparative trial was conducted in the United States to compare the Today contraceptive sponge and the diaphragm used with spermicide. Subjects were randomly assigned to contraceptive methods and were followed up for 1 year. None of the subjects were previous sponge users, but about 30% were previous diaphragm users. The overall cumulative 1-year life-table pregnancy rate was higher for sponge users compared to diaphragm users. No serious side effects occurred with either product. The discontinuation rates for allergic-type reactions and discomfort were higher for sponge users. Similar rates of method-related complaints and discontinuation rates for personal and product-related reasons suggest there were no differences in the acceptability of the two products. In this trial, the allowable use time for the sponge was 2 days. The sponge is now recommended for 1-day use. The overall results of the study indicate the sponge to be a safe and acceptable method of contraception with an effectiveness rate in the range of that for other vaginal contraceptives.
A new method was developed to assess the quality of the barrier property of several types of commonly used contraceptive devices (diaphragm, cervical cap, and condom). Our data showed that butoconazole nitrate cream and wax inserts did not affect the barrier property of the contraceptive devices when the products were placed in contact with the devices for up to 72 hours at 37 degrees C.
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The vaginal diaphragm is currently less popular than other contraceptive methods, such as the pill, IUDs or surgical sterilization. It is however, regarded as one of the safest methods of contraception available and complications of diaphragm use are rare. This report describes a case in which a vesicovaginal fistula and genitourinary tract infections complicated the use of this contraceptive method.
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Severe urinary tract complications secondary to a chronic indwelling contraceptive diaphragm are described in a patient who presented with urinary incontinence.
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A striking increase observed in the demand for the diaphragm method at a contraception clinic for university women was documented by means of a record review and questionnaire. Record reviews completed at the conclusion of each semester from December 1973 to December 1976 showed a statistically significant increase in diaphragm acceptors. In the fall semester of 1976, diaphragm acceptors (49% of 151 patients) surpassed pill acceptors (46%). Data from 123 questionnaires revealed that concern for pill and IUD side effects was the primary reason for diaphragm choice. The study numbers are small, but a definite trend is evident. These educated young women may be forerunners, and an increase in diagphragm use in the general population may be seen in the near future.
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