CONTRACEPTION, PLANNING A FAMILY AND INFERTILITY: THE DIAPHRAGM AND THE SPONGE
This can look awesomely large to some women and is shaped something like a section of a tennis ball. The correct size for the woman has to be selected by her GP or clinic and the woman has to be trained how to use it. A spermicidal substance is applied to both sides prior to insertion. After sex it must be left in place for six hours. The failure rate is similar to that of the condom.
A woman with a prolapse may find it hard to fit but the new arcing diaphragm helps overcome this problem. The diaphragm is non-hormonal but requires high motivation for consistent use. It can cause some complaints of loss of sensation especially for the woman whose most sensitive part is her front vaginal wall. This is almost entirely covered by the rubber of the device. To some extent it protects against sexually transmitted diseases and cancer of the cervix but it cannot be relied upon to protect against AIDS. Urinary tract infections are more common in diaphragm users and the method is unsuitable for women who are habitual cystitis sufferers.
The sponge-This modification of an ancient method is enjoying something of a revival since it is easy to insert and does not need to be fitted by a doctor. One such product consists of a 50 mm X 25 mm dimpled polyurethane sponge impregnated with 1 gram of nonoxynol-9 spermicide. There is a ribbon on one side to facilitate removal. The sponge must be moistened before insertion. Its failure rate is about 10 pregnancies per hundred woman years so, whilst better than nothing, it is probably best suited to the older woman with declining fertility or the couple who wouldn’t mind much if pregnancy occurred. Attempts to perfect it could be rewarding.
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