CONTRACEPTION...CONTINUED

DIAPHRAGM

A diaphragm is another barrier method of contraception used by women. When using a diaphragm a woman is in charge of contraception and protecting herself. Failure rate of the diaphragm in perfect conditions are 6% however in day to day use (typical) use it is 12%. It was first used in 1880. By 1940 it was very popular, 40% of all married American women used a diaphragm.

A diaphragm is made of latex or silicone. It is a dome like cap with the rim moulded with a spring. The springs are of three types coil springs, arching springs and flat springs. Arching springs are the strongest, they arch when we compress it .It is useful for women who have poor vaginal tone such as a cystocele or rectocele as opposed to the flat spring which is useful for woman with good vaginal tone.

A Diaphragm is useful for woman who has occasional intercourse. They come in different sizes (50 -95millimetres) and need to be fitted by a clinician. Vaginal shape changes at different times of menstrual cycle, the best fitting of the diaphragm is the largest one you can comfortably use at any time of the menstrual cycle. It needs to be refitted after child birth and weight change of 4.5kilograms or more. A correctly fitted diaphragm will snugly cover the cervix and the other end lies under the symphysis pubis.

A Diaphragm should be inserted before intercourse, and should be left in for 6-8 hrs. It should never be left in for more than 24 hours as it can cause a serious problem, called toxic shock syndrome.

Toxic shock syndrome (TSS) is a life threatening infection caused by 2 toxic bacteria , it often happens if a tampon or a diaphragm is left in the vagina for more than 30 hours. It is the toxins liberated by the bacteria that cause the illness. It is estimated that 2.4 cases of TSS happen if 100,000 women are using the diaphragm.

The other problem it can cause is urinary tract infections and ulcers on the vagina especially if it is loosely fitting. In

a tight fitting diaphragm your  partner will be uncomfortable as he can feel the rim.

For fitting the diaphragm, make sure that your hands are clean, the diaphragm is clean and has no holes. Then squeeze the rim , put  a water based lubricant on the rim and about a teaspoonful of spermicide in the dome of the Diaphragm. You can insert it with your finger like a condom making sure it is covering the cervix. The cervix is the end of the uterus in the vagina from where the sperms enter the uterus. Some companies provide an inserter to insert the diaphragm particularly the flat spring type. If you wish to have sex soon after the first act, please reinsert the spermicide cream again. To remove the diaphragm put your finger behind the front end of the diaphragm and pull it down.

Some women are not suitable for a diaphragm such as

1) Those who cannot insert or remove

 it easily.

2) Those who have a large prolapse of the pelvic organs.

3) Those who are allergic to latex and cannot get a Silicone condom.

4) Do not have access to care givers to have it fitted in.

5) Had a baby less than 6 weeks prior.

6) If they have had repeated bladder infections, urinary tract infections is one of the side  effects of the diaphragm.

7) If they have had Toxic shock syndrome previously.

8) Those women who require the diaphragm in sizes smaller than 60 millimetres or bigger than 85 millimetres in ortho diaphragm cannot use the newer diaphragms. These newer diaphragms all come in one size they are called Caya and Duet. Caya is the  only diaphragm  available in the market at present. There is a clear silicone diaphragm called Semina which is available in Brazil only. Older types of diaphragms are slowly being phased out.

CAYA DIAPHRAGM

Just when the use of the diaphragm was going down to less than 10% the FDA has approved this new diaphragm CAYA (SILCS) for use in the USA, however they are waiting for distribution. It was researched by the women themselves from all-round the world.

This brings the barrier contraception into the 21st Century. It is available in Europe, Asia and Africa. It will soon be available in Australia. The new design has a bigger contour made of soft silicone. There is a rim around it. This can be easily compressed for insertion. One end of the rim has a dimple, this helps to know that this is the front end to go under the symphysis pubis. This dimple is very useful to remove the diaphragm by putting a finger in this dimple. Raised dots are located on the side of the Caya, this helps to locate the correct side. As already mentioned one size fits most women. If you used the older type of diaphragm and your size was less than 65 ,millimetres or more than 85 millimetres , you are not suitable for the Caya. A spermicide is also required. Previously a spermicide called Nonoxynol (N-9) was used. This kills the sperm, but it was also causing vaginal irritation. Its use has been stopped. This is replaced by a Gel supplied with CAYA, called Contra Gel. This is made from lactic acid and is water soluble. The viscosity of the Gel and low pH immobilize the sperm. A Caya costs about $60(aus) and the Gel costs $30 (aus) for(60 mls). These costs are approximate, depending on the country .You need to use only3-4 mls of the gel each time. 

You need to follow the same technique for insertion as previously described for the normal diaphragm. In can be inserted 2 -6 hours before use, it must be left in for 6 hours after use. Never leave it for more than 24 hours for the risk of TSS. If you need to have sex again please insert Gel again using an applicator. After use clean the diaphragm with warm soapy water, no harsh detergents and air dry it, and keep it safely in the container provided. It can be used for up to two years.

Lots of research is being done to see if we can use a Gel which can be both a Microbicide and Spermicide. So far no great success has been achieved. A new diaphragm is being made called Duet, which will incorporate this dual purpose Gel.  The BufferGel Duet is a clear diaphragm having one size that fits all women. The BufferGel Duet is made of dipped polyurethane and the BufferGel is still being developed for dual activity.It will be great if this can be achieved.

At present 2 million women round the world are infected with HIV, if only they can be protected.

This UFO shaped gentle and soft diaphragm CAYA has created quiet a sensation among the barrier contraceptives in the 21st Century. Only if we can quickly make a microbial and spermicidal Gel. It will serve the duel purpose of contraception and protection from STD’s.

Caya can be used on an intermittent basis, if you can learn how to assess the fertility time in your cycle. I will talk about this when I talk about natural family planning.

1) At present both men and women love

It. Women in particular as they are totally in control even without there partner’s knowledge. Men because it does not inhibit the spontaneity with sexual activity.

2) It can be used on an intermittent basis

 whenever required.

3) Totally hormone free.

4) Does not interfere with menstrual cycle.

5) Instantly reversible.

6) No toxic side effects, as it does not need to use N-9 (Spermicide). It can be toxic only if you forget it for more than 24 hours, it can cause TSS.

7) It can be used by breast feeding mothers.

8) Useful for women who cannot tolerate hormones.

9) Some menopausal women find it useful as it acts as a cushion and prevents pain during sexual intercourse.

10) It is latex free and one size fits all.

In conclusion it seems that this new diaphragm will be the future of  barrier contraception especially if we are successful with a dual purpose Gel.