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Diaphragms - as a method of contraception

The barrier methods of contraception (BM) include diaphragms, cervical caps, sponges, condoms. The mechanism of the contraceptive action of BM is based on preventing the penetration of spermatozoa through the cervical canal into the upper part of the reproductive system by creating a mechanical obstacle (barrier). According to world statistics, in 1990, about 72 million married couples used traditional methods of contraception. BM can be used in isolation, however, it is more advisable to use them in combination with spermicides to enhance contraceptive action. The table shows the contraceptive effectiveness of various methods of barrier contraception. The diaphragm. For the first time a diaphragm made of rubber was proposed in 1883 by the German scientist S. Hasse. Later diaphragms gained popularity not only in Germany, but also abroad. So, in Holland they got the name "Dutch cap" - "Dutch cap" or "Dutch candle". After 100 years, an improved diaphragm model with a soft latex border and a rim appeared, providing tight contact with the walls of the vagina.

CONTRACEPTIVE EFFICIENCY OF BARRIER METHODS OF CONTRACEPTION MEANS OF BARRIER CONTRACEPTATION INDEX OF PEARL (count of pregnancies per 100 women / years of treatment flexible, springy rim. There are several types of diaphragms that differ in the structure of the rim. Each type is available in sizes from 50-55 mm to 95 mm:

1. flat spring diaphragm - most suitable for non-deliverable women with good vaginal muscle tone, as well as for patients with a shallow recess behind the pubic bone arch; it folds easily and can be inserted into the vagina with a special tool;

2. diaphragm with a spiral spring - recommended for patients with moderate muscle tone of the vagina and moderately pronounced groove of the pubic arch; for convenience, the introduction of a special tool can be used;

3. diaphragm with arched spring - has a large spring force and in the folded state takes the form of an arc:

There are several models of this type:

o diaphragms folding at any point along the rim,

o diaphragms that fold only at two points (hinged design) - acceptable for most women, including patients with weak vaginal muscle tone, with cyst and rectocele;

4. a diaphragm with a wide jumper in the form of a flexible border (1.5 cm wide, connected to the inner edge of the rim), which provides tight contact with the walls of the vagina, and is convenient for applying spermicide;

Available in two versions:

o arcuate, folding in two points,

o with a spring of the folded type, folding at any point.

It should be noted the relatively low effectiveness of this method of contraception during periods of high fertility (25 - 35 years) and / or sexual activity (more than 4 sexual intercourses per week). Selection of the diaphragm The doctor selects the aperture of the appropriate type and size, and also teaches the patient the technique of its introduction and extraction. When choosing a diaphragm take into account the width, depth of the vagina and muscle tone of the perineum. The optimal is the diaphragm, the introduction of which does not cause discomfort (larger diaphragm will cause lower abdominal pain, discomfort and other complications; at the same time, a smaller diaphragm will not protect against pregnancy).
There is a fairly simple technique that allows you to make sure that the size of the diaphragm is correct: the largest diameter of the diaphragm should be equal to the depth of the vagina, i.e. the distance from the lower edge of the pubic bone to the posterior fornix of the vagina. Properly chosen diaphragm should not be displaced, as it is in close contact with the side walls and the rear vaginal fornix. For women who give birth usually fit a diaphragm from 70 to 80 mm. After childbirth, abortion, gynecological operations. for weight loss, as well as weight gain of more than 4 kg, it is necessary to select a different size aperture. The technique of introducing the diaphragm. Check the integrity of the diaphragm. The inner surface and the edges of the diaphragm should be smeared with spermicidal paste in the amount of 1 tbsp. spoons (for example, nonoxynol-9). Squatting or lying on his back, dissolve the labia with his left hand. The index and thumb of the right hand to enter the diaphragm (compressed) on the back of the vagina to the back of the arch. After that, push the front part of the diaphragm rim up along the front wall of the vagina to the lower edge of the pubic bone. Palpation check the correct location of the diaphragm, which should cover the cervix. The diaphragm is injected immediately before sexual intercourse and left in the vagina for 8 hours after intercourse. Removing The diaphragm is removed, sipping it downwards with the index finger down the leading edge (sometimes a woman has to pull herself). In case of repeated sexual intercourse, it is recommended to additionally introduce spermicidal cream or jelly into the vagina using an applicator. Diaphragm care After each use, the diaphragm is washed with soap, wiped and lowered for 20 minutes in 70-80% ethanol solution for disinfection. Store the diaphragm in a dry place.

Indications for use:

• local contraception in women with a reduced risk of pregnancy (with rare sexual intercourse or in the late reproductive period),

• in combination with a rhythmic method of contraception,

• a temporary method of contraception during a break in the use of oral contraceptives (OC) or intrauterine devices (IUD). Contraindications:

• high risk in case of unwanted pregnancy,

• allergy to rubber, spermicides, latex,

• endocervicitis,

• cervical erosion,

• suspicion or the presence of a malignant transformation of the cervix,

• colpit

• recurrent urinary tract infections,

• toxic shock syndrome in history,

• anomalies of vaginal development,

• omissions of walls of a vagina (an exception - a diaphragm of a hinged design). Complications and side effects:

• allergy,

• urinary retention,

• a feeling of discomfort in a woman and / or sexual partner due to the pressure of the diaphragm rim,

• recurrence of vaginal candidiasis,

• exacerbations of inflammatory diseases of internal limitations of the method:

• relatively low contraceptive efficacy,

• the need for simultaneous use of spermicides, as well as the manipulation of the vagina immediately before sexual intercourse,

• does not remove the "fear" of an unwanted pregnancy (due to low efficiency). Advantages of the method:

• simplicity and availability,

• reusability;

• prevention of cervical cancer (when used for 5 years or more), as well as sexually transmitted diseases.
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Diaphragms - as a method of contraception

  1. Cervical caps as a method of contraception
    Cervical caps were created at the same time as the diaphragms. Have the form of a wide thimble or cup. The caps were originally made of silver or copper, later - from rubber, aluminum, dense rubber, plastic, and now from soft rubber. There are several types of cervical caps: 1. Kafka cap made of rubber, aluminum or thick rubber, dimensions 25, 28.31 mm
  2. Subcutaneous implants as a method of contraception
    Norplant ("Norplant") - produced by "Leiras Pharma-ceuticals", Finland. It is represented by flexible silastic capsules 3.4 cm long and 2.5 mm in diameter, each of which contains 35 mg of levonorgestrel. Norplant-2 - consists of 2 capsules with a length of 44 mm and a diameter of 2.4 mm, containing 35 mg of levonorgestrel. The mechanism of contraceptive action is based on the release of levonorgestrel capsules of norplant
    Inside uterine contraception (IUD) is one of the most common effective methods for preventing unwanted pregnancy. According to the WHO, currently more than 60 million women use various types of uterine products (IUDs), which are second only to oral hormonal contraceptives. In Russia, according to statistics, this method
    Barrier contraception (BMC) refers to all methods of preventing pregnancy that mechanically prevent sperm from entering the cervical canal and / or contribute to the chemical inactivation of sperm in the vagina. There are: • male barrier method - a condom (Innotex, Durex, Contex, Vizit, Life Styles, Sico, Trojan, etc.); • female barrier methods -
    Currently, the most common methods are contraception: hormonal, intrauterine contraception, mechanical contraception, surgical sterilization, rhythmic method, barrier methods of contraception and spermicides. The effectiveness of the contraceptive method is determined by the Pearl index, that is, the number of pregnancies occurring in 100 women using this method.
    The choice of contraceptive method depends on its effectiveness, which, in turn, depends on how constantly and correctly it is used. Table 2.1 (Hatcher R. et al., 2004) compares the frequency (in%) of the occurrence of unwanted pregnancy during the first year of using various methods of contraception with their correct use (consistently and correctly) and with typical
  7. Abstract. Ways to contraception How to avoid pregnancy, 2006
    Introduction Methods of contraception. Mechanical methods. Chemical methods. Biological methods. Emergency contraception. Intramacus drugs. Physiological methods. Sterilization. Use of contraception by adolescents. Conclusion.List used
  8. History and modern methods of contraception
    ... To have children, Who does not have enough mind? A.S. Griboedov Contraception. Mechanical, chemical, hormonal, physiological methods of contraception. Condom. Contraception (from the Latin. Contraceptio - against conception) -preservation from conception. In the modern market of medical and pharmaceutical services there are a huge number of methods and means to prevent
  9. Modern methods of contraception.
    Recommended reading: 1. Bagdan Shandor et al. Modern pregnancy prevention and family planning. - Budapest, 1998. 2. Baychurina A.Z. Contraception. - M., 1999 3. Viner E.N., Volynskaya E.V. Valeology: Training Workshop. - M .: Flint: Science, 2002.- p. 38-43. 4. Egides A. Planned child // Family and school. - 1989-№9., Pp.41-44. 3. Markov V.V. Basics of a healthy way
  10. Rhythmic contraceptive method
    The rhythmic (biological) method of contraception is based on abstaining from sexual intercourse in the periovulatory (fertile) period or using other means of contraception during these periods. The contraceptive effect of the method is explained taking into account the concepts outlined below: • ovulation occurs 14-15 days before the onset of the next menstruation (provided that the woman does not suffer from gynecological
  11. Immunological methods of contraception
    Immunology of reproduction, immunology of pregnancy - these major problems of obstetrics and gynecology have not been studied enough so far. Nevertheless, there is a lot of research on the problem of the immunology of contraception. Interruption or prevention of pregnancy is possible with the passive transfer of antibodies or active immunization. Therefore, immunology is directly related to the treatment
  12. Physiological methods of contraception
    Physiological, or ovulation, methods of preventing pregnancy are based on accurate knowledge of the day of ovulation, individual calendar records of the time of ovulation, the life expectancy of the egg cell and sperm. Mandatory use of physiological methods is the regularity of the menstrual cycle in women. To do this, use the following indicators: basal body temperature,
    Family planning programs include the use of contraceptive methods that are based on the physiological features of the fertile (when pregnancy may occur) and non-fertility (when pregnancy is extremely unlikely) phases of the menstrual cycle, as well as the method of interrupted sexual intercourse. Adequate awareness and awareness of women about the most likely time of ovulation
  14. Barrier contraceptive methods
    Barrier contraceptive methods are based on the creation of obstacles to the penetration of sperm into the cervical canal and the uterus of a woman. Usually, the sperm from the vagina through the cervical canal into the uterus after 2-10 minutes, although in some cases this can occur after a few hours. Men and women use various mechanical (cervical caps,
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