[Contraception in the future].
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Using a diaphragm as a barrier contraceptive has received little attention in recent literature. A discussion of the role of the diaphragm to prevent pregnancy, as well as sexually transmitted diseases, is presented. A procedure for properly fitting the diaphragm is described. To ensure compliance, a review of a plan for education and practice by users is outlined.
This study measured short-term female condom acceptability among 51 female sex workers in San José, Costa Rica. Each woman was trained in use of the female condom and was asked to use the device if clients refused to use male condoms during a 2-week study period (male condoms were also distributed). Two follow-up visits with short interviews were scheduled, including questions on general reaction to the female condom by the participants and their clients, ease and comfort of use, and preferences for male or female devices. At the first follow-up visit, 51% of the women reported they "liked the female condom very much" and 45% reported they "liked it somewhat." Similar results were reported after the second follow-up phase. Sixty-seven percent of the participants preferred the female condom over the male condom, and, according to the the women, over half of their clients liked the female condom "very much" or "somewhat." The most common problems during the first phase were difficulty to insert (61%) and discomfort (43%). However, during the second study phase a reduction in these problems (22% and 25%, respectively) and other use-related problems were noted. Although this new method is not yet available throughout Costa Rica, these results should encourage sexually transmitted diseases and HIV service organizations to make this method accessible to women.
The incidence of serious psychiatric illness, as measured by first referral to hospital for specialist advice and treatment, has been investigated among 16,746 women taking part in the Oxford Family Planning Association contraceptive study. Of these women, 9,504 were recruited while using oral contraceptives, 4,144 while using a diaphragm and 3,098 while using an intrauterine device. The results are reassuring with respect to oral contraceptive use. First referral rates per 1000 woman-years of observation in the oral contraceptive, diaphragm, and intrauterine device entry groups were 3.0, 2.6, and 2.8 respectively for non-psychotic psychiatric disorders and 0.46, 0.43 and 0.53 respectively for psychotic disorders. Attempted suicide occurred only 40% as often amongst diaphragm users as amongst users of oral contraceptives or intrauterine devices; this finding presumably reflects the characteristics of women who choose the diaphragm as their birth control method.
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The authors describe their experience with a group of 49 sexually active, already protected women in order to evaluate the acceptability, side effects and post-coital spermicidal activity of a new vaginal contraceptive. The intravaginal insert (IVI) consists of a polyester resin plug (sponge) containing a 5% solution of nonoxynol-9 bound in a cold formation process, and having a cotton loop attached to the lower end. The results of this study indicate that this new vaginal contraceptive is free of major side effects, is well accepted by users, and has strong spermicidal and mechanical activity. Future clinical testing in order to try its anti-conceptive effectiveness is warranted.
The results of a study of sexually transmitted disease (STD) incidence and related risk factors for STDs among uninfected women at high risk of contracting STD infection in Bangkok are reported. Comprising the control arm of a randomized controlled trial of a vaginal contraceptive sponge and STD incidence, 163 women aged 18 or older were recruited from 4 massage parlours and followed for evidence of new infections over a 6-week period or until cervical infection occurred. Gynaecological examinations were performed and endocervical specimens were obtained at weekly intervals, at which time women returned coital logs recording their number of sexual partners. There were 76.5 new STD infections per 100 woman-months, including 31.7 with gonorrhoea, 43.1 with chlamydia, 1.8 of trichomoniasis and 3.5 of candidiasis. None of the risk factors examined were good predictors of STD infection in this population, which may be related to the restricted admission criteria in the study.
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