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Contraception for the insulin-dependent diabetic woman: the view from one clinic.

Experience in a large diabetic clinic has confirmed the suspicion that insulin-dependent diabetic women are at considerably increased risk of thromboembolic disease if they take combined estrogen/progestogen oral contraceptive preparations. The most obvious alternative, an intrauterine device, is associated with an unexpectedly high failure rate, probably because of an unusual metabolic interaction with the diabetic endometrium. In a small group of diabetic women the progestogen-only pill was found to be a successful form of contraception not associated with any side effects except for menstrual irregularities. For most diabetic women the choice of contraceptive should therefore be between a progestogen-only pill and a mechanical method. Female sterilization and injectable progesterone each have their place in particular circumstances. Careful counseling of each patient is essential to ensure the best choice of contraceptive and correct application of the chosen method.

Adult↗

Urinary tract infections among diaphragm users.

An association between diaphragm use and the subsequent development of lower urinary tract infections (urethritis, cystitis, etc) has been suggested by two recent studies in the literature. The present study uses a case-control approach to determine the relative risk of developing urinary tract infections among diaphragm users aged 15 to 45 years during a 15-month period. Patient charts at a family practice clinic were reviewed for evidence of documented urinary tract infections and method of contraception (n = 98). As a control, all women aged 15 to 45 years seen for upper respiratory tract infection during the same period were reviewed (n = 126). Depending upon how a urinary tract infection was defined (urinalysis positive, culture positive, both positive), the relative odds for the development of subsequent urinary tract infections range from 0.88 to 1.10. When all barrier methods were considered together, this odds ratio ranged from 0.88 to 1.21. Documentation of symptoms and laboratory confirmation of urinary tract infection were lacking in many charts reviewed. Despite these limitations, the study findings call into question the assumption that diaphragm use may lead to the subsequent development of urinary tract infection.

Adolescent↗

Vaginal mechanical contraceptive devices.

The alleged adverse effects of oral contraceptives and intrauterine devices have led to increased consumer and physician demand for vaginal contraceptive devices. The efficacy and the advantages and disadvantages of vaginal sponges, cervical caps and diaphragms are discussed and compared in this article.

Contraceptive Agents, Female↗

Relationship of weight change to required size of vaginal diaphragm.

Health care providers are instructed to counsel diaphragm users to return for a re-fitting of the device if there is a change in the patient's weight. Texts on contraception do not give a rationale for this rule. In an effort to explore the effect of weight change on the required size of diaphragm, the charts of 80 diaphragm users were reviewed. All women had at least two visits for diaphragm fitting. A table was constructed with weight and diaphragm size for each subject at each visit. The subjects ranged in age from mid-tens to early forties and all were patients at the same clinic. Chi-square analysis of the data revealed no correlation between weight change and change in diaphragm size.

Adolescent↗