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  • Title: Vaginal mechanical contraceptive devices.
    Author: Smith M, Barwin BN.
    Journal: Can Med Assoc J; 1983 Oct 01; 129(7):699-701, 710. PubMed ID: 6616379.
    Abstract:
    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. Consumers and physicians are considering mechanical contraceptives as alternatives now, for in recent years there has been an increasing number of reports of adverse reactions and risks associated with IUD and oral contraceptive (OC) use. Yet, the contraceptive devices designed to mechanically cover the cervix have been the least studied and evaluated method of birth control. The currently available vaginal mechanical contraceptive devices are described and their efficacy and advantages and disadvantages are compared. Vaginal sponges are made from various types of synthetic and natural polymers. There is a wide variation in the reported rates of efficacy of vaginal sponges, and it is difficult to obtain accurate figures on rates of efficacy. The International Fertility Research Program (IFRP) has reported a failure rate with the sponge of approximately 7 or 8 pregnancies/100 woman years, or a 6 month pregnancy rate (according to life table analysis) of 3.8 +or- 1.3/100 women. The sponge does not interrupt sexual spontaneity. The spermicide is immediately available after each coital act, and 1 sponge lasts for many coital acts. The sponge is easy to use, and no medical supervision is required for fitting, as the sponges come in only 1 size. Women have cited discomfort to themselves or their partners as the main reason for discontinuing the use of vaginal sponges. The cervical cap is a thimble shaped rubber or plastic device that is placed over the cervix to provide a barrier against sperm. The cap is often used in combination with a spermicidal agent, and it must be left in place at least 12 hours after intercourse to prevent remaining viable spermatozoa from entering the uterus. Failure rates for cervical caps compare favorably with those for diaphragms (3-16%, and 1.9-19.6% respectively). Cervical caps can be left in place longer than other barrier methods, and there is no absolute need to use chemical spermicides. Disadvantages of the cervical cap are the limited number of sizes available and the fact that 40-60% of women cannot be fitted, including those with a long cervix, a flat cervix and vault, or vaginal prolapse. The diaphragm is a shallow rubber cup strengthened by a rim containing a spring. The use of a spermicidal agent increases the efficacy of a diaphragm. The device should be inserted a maximum of 6 hours before intercourse, and a new application of spermicide is required for each repeated coital act. The diaphragm should not be removed until 6-8 hours after the last coitus. Failure rates are in the range of 1.9-2.0 pregnancies/100 woman years. The diaphragm is safe, effective, temporary, natural, easy to use, and inexpensive. Disadvantages are that the diaphragm interferes with sexual spontaneity, is messy and inconvenient, and some women cannot be fitted because of anatomic abnormalities.
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