The Diaphragm and Other Intravaginal Barriers: A review

 Literature on the vaginal diaphragm and other intravaginal barrier devices is reviewed.   Although use of the diaphragm in the U.S.  has declined considerably since the early 1960's, there is some evidence that this trend is being reversed due to disillusionment with oral contraceptives (OC) and the IUD, though this apparent reversal has yet to be established.  Generally, the vaginal diaphragm is ignored as a contraceptive method in developing countries.  The diaphragm is a good alternative method for women who cannot use OCs or the IUD.  It is also advantageous during lactation as it does not interfere with the production of milk.  The 4 most widely used diaphragms are the coil-spring, flat-spring (Mensinga), arcing (Findlay), and Matrisalus.  Once fitted into the vagina, the device blocks sperm transport to the cervix.  It is held in place by spring tension exerted from the rim, the woman's muscle tone, and the pubic bone.  Since the diaphragm does not fit tightly enough to prevent sperm passing around the rim, a spermicide should be used with the device.  Procedures for the fitting of the diaphragm, its insertion and removal, and guidelines for its use are described.  Failure rates with the device range from 6-25 per 100 woman-years of use.  Failure can be due to improper insertion, improper fit, displacement during coitus, and defects in the diaphragm.  The diaphragm has recently been used for administering abortion-inducing prostaglandin E2.  Manufacturing standards and procedures are reviewed.  Cervical caps, which are similar to diaphragms in many aspects of use and effectiveness, except that they cover only the cervix and are held in place by suction, are discussed.

Johns Hopkins Bloomberg School of Public Health,Center for Communication Programs,Population Information Program