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Contraception for midlife women.

Women wish to continue to be sexually active long after their desire to bear children. The risks associated with unintended pregnancy easily can be avoided by providing women with information about, and access to, contraceptives that are safe and effective. Because fertility naturally declines with age, different contraceptives may be more suitable for women toward the end of their reproductive years than were appropriate at periods of peak fertility. This article discusses the risks and benefits of various contraceptives for midlife women and the implications of this information on nursing practice.

Adult↗

Effectiveness of the non-spermicidal fit-free diaphragm.

Standard instructions for diaphragm use call for an individually sized latex diaphragm, used in conjunction with spermicide jelly. However, some investigators have reported that the diaphragm can be effective without a spermicide. A non-randomized trial designed to measure the contraceptive effectiveness of the diaphragm used without spermicide was conducted. A total of 110 self-selected women were enrolled to use a non-spermicide fit-free (60mm) diaphragm for a period of one year. They were advised to wear the diaphragm continuously, removing it once each day for washing but not within six hours after intercourse. Product-related problems related to insertion, retention and removal were few at both the 6- and 12-month follow-up visits, most commonly odor. The 12-month life table accidental pregnancy rate during typical use was 24.1 per 100 women (29.5 per 100 women without female barrier experience and 17.9 per 100 women with barrier experience). Over 85% of the women who returned for follow-up visits reported using the diaphragm during every act of intercourse. Until better data refute the traditional recommendations, users should be advised to add spermicide to fitted latex diaphragms.

Adult↗

Preliminary findings on used cervical caps.

Rubber cervical caps (Lambert-Dalston), used for periods of time ranging from 1 month to 3 years, were collected and assessed for deterioration and contamination as part of a product safety and efficacy study. Examination at magnification of 10 to 30 times as well as evaluation of surface damage and bulk mechanical properties revealed significant deterioration on all caps used consistently for more than one year. Changes were also evident on caps worn for shorter periods. Potential for adverse reaction from rubber degradation products and contamination adsorbed from disinfecting agents does not appear negligible. This problem, in combination with the inability to satisfactorily clean the caps after use, further limits their clinical value. A rethinking of cap design and the choice of better cap materials appears necessary to minimize long-term user problems and to mitigate product-related aesthetic deficiencies of this fertility control method.

Consumer Product Safety↗

Fitting of diaphragms.

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Contraceptive Devices, Female↗

Notice, 11 July 1988.

On 11 July 1988, the US Food and Drug Administration approved the use of the cervical cap as a contraceptive. The cap is to be used in conjunction with a spermicidal cream or jelly to prevent pregnancy. It must be left in place for a minimum of eight hours after intercourse and may be left in place for a maximum of 48 hours.

Americas↗

Contraception.

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Contraception↗