[Physical contraceptive methods].
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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.
Forty-two percent of collagen sponges tested as an intravaginal barrier contraceptive method developed malodor when retained for 5 days. Only 4% developed odor when the sponge was removed within 24 hours after intercourse, rinsed, and reinserted. While sexually active volunteers found odor in 37% of the sponges, odor formed only in 4% of the sponges worn by sexually inactive users. No difference in the rate of odor formation was found when neutral pH (7.0) and acid pH (3.4) collagen sponges were tested, although we believe that a pH 3.4 is too acid and promotes odor formation. The optimal pH of the sponge should be 4.5 to 5.5. Malodor was efficiently extracted from sponges by washing in acid milieu of tap water and vinegar or 0.1 M acetate buffer, pH 4.0. Alkali extraction procedures were ineffective, and lukewarm water was slightly less effective than acid extraction of odor. At the time of malodor development, the high content of polyamines (putrescine, spermine, spermidine) in the ejaculate decreased to undetectable values. We conclude that the ejaculate is the major source of malodor formation in intravaginally worn collagen sponges. Removal, rinsing optimally in vinegar solution, and reinsertion within 24 hours after intercourse reduces the chance of malodor formation.
With the growing interest in barrier contraceptive methods, the cervical cap has come back into use in North America. We examined the cap's effectiveness, safety, continuity of use, and user satisfaction among 617 women who were fitted at a family planning clinic in Toronto, Canada, between May 1981 and November 1983. Follow-up information was available for 516 of these women. Using a life table analysis with Bayesian adjustment, the probability of becoming pregnant after 12 months of use was 0.166 with a standard error of 0.022. There is evidence that after 1 year of use the caps deteriorate and that this deterioration may increase the risk of pregnancy. Many of the women in this study were very satisfied with the cervical cap; however, such problems as dislodgement, discomfort to user and partner, difficulty with insertion and removal, and unpleasant odour affected acceptability and continuity of use. It is likely that these problems could be alleviated by improving the quality of or changing the materials, modifying the design to improve the fit, and providing a greater range of sizes.
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A case-control study using data on deliveries in the mid-1970s at five Connecticut hospitals (cases, n = 1427; controls, n = 3001) found little relationship between delivery of a malformed infant and use by the mother of nonhormonal contraceptive methods at conception. Of particular interest was the lack of an association with use of the rhythm method (odds ratio (OR) = 1.02, 95% confidence limits (CL) = 0.73, 1.42), spermicides (OR = 1.26, 95% CL = 0.85, 1.85) at conception and a modest association for the intrauterine device (IUD) one week before conception (OR = 1.99, 95% CL = 0.98, 4.04). Continued use of the IUD after conception may further increase the risk for malformations but this observation was statistically unreliable in the present study. Mothers of newborns with cleft lip and palate (OR = 2.91) and congenital hydrocele (OR = 4.64) were more frequent rhythm users at conception, and mothers of newborns with multiple anomalies had more recent IUD exposure (OR = 9.87), but these and all other specific congenital malformation groups were not significantly related to any non-hormonal contraceptive after adjustment for multiple observations. Potentially confounding maternal risk factors were controlled.
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