Diaphragm (contraception)

Diaphragm

Principle of contraception with a diaphragm

A diaphragm (plural diaphragms or diaphragms ; ancient Greek διάφραγμα diaphragm "partition") or vaginal pessary is a mechanical means of contraception in the female, the front of the cervix is located, these bathes in a sperm-retardant gel and so the penetration of sperm into the uterus prevented.

application

Contraceptive diaphragms are soft, bowl-shaped caps made of silicone with an integrated metal or plastic spring. Before sexual intercourse, they are placed in the woman's vagina so that they sit between the cervical end of the vagina and the pubic bone , thereby completely covering the cervix. The appropriate size of the diaphragm must be determined by a gynecologist , midwife or nurse and is between 60 and 90 mm in diameter. In addition to multi-size diaphragms, which are offered in 5 mm increments, there has also been a unit-size diaphragm since 2013 that fits around 85% of women and should also be adjusted by a medical specialist.

An adequate contraceptive effect can only be achieved if spermicides or the predominantly lactic acid-based spermiostatics are used at the same time and the diaphragm is not removed earlier than eight hours after sexual intercourse. However, residence times longer than 24 hours should be avoided. If a diaphragm is left in the vagina for too long, toxic shock syndrome can be triggered in rare cases . Likewise, when worn for days during menstruation, menstrual blood can build up. Pessaries do not protect against sexually transmitted diseases .

Contraceptive safety

The Pearl Index of the diaphragm, when used together with a sperm-inhibiting / spermicidal gel, is between 1 and 8 without gel to 20, depending on the study. A male condom has an index between 2 and 12; a female condom has an index between 5 and 30. The lower the index, the safer the method of contraception. Using a diaphragm for effective contraception requires some practice and discipline.

Contraceptive gels and creams

The diaphragm should always be used with a contraceptive gel or a contraceptive cream, otherwise it will not provide adequate protection against pregnancy. There are products with spermicides that kill the sperm. In the meantime, these have been largely superseded in Germany by sperm statics, gels that use a combination of acid and gel structure to immobilize the sperm. The safety of spermicides and spermostatic drugs is now considered to be equivalent. Research is currently being carried out on new substances which, in addition to inhibiting sperm, have microbicidal potency, e.g. B. to prevent the transmission of HIV, human papillomaviruses, etc. Together with the diaphragm, the gels should not be inserted more than two hours before sexual intercourse. If you have had multiple sexual intercourse within 6 hours of inserting the diaphragm, it will not be removed. Instead, another spermiostatic or spermicidal gel is introduced into the vagina by means of an applicator so that no sperm that may still be living in the acidic vaginal environment can reach the cervix. Alternatively, a condom can be used for multiple intercourse.

costs

Depending on the product, the costs are between 35 and 50 euros, corresponding gels around 10 euros with approx. 15 applications per tube. There may also be costs for shipping, customization and, if necessary, a check-up.

Web links

Wiktionary: Diaphragm - explanations of meanings, word origins, synonyms, translations

Familienplanung.de - Diaphragma : The information portal of the Federal Center for Health Education (BZgA) - independent and scientifically based
Pro Familia German Society for Family Planning, Sex Education and Sexual Counseling e. V.

Individual evidence

↑ István Batár, Irving Sivin: State-of-the-art of non-hormonal methods of contraception: I. Mechanical barrier contraception . In: The European Journal of Contraception & Reproductive Health Care . tape 15 , no. 2 , March 16, 2010, ISSN 1362-5187 , p. 67-88 , doi : 10.3109 / 13625181003708683 ( tandfonline.com [accessed November 10, 2018]).
↑ Olga Loeber: A cheer for the diaphragm . In: The European Journal of Contraception & Reproductive Health Care . tape 17 , no. 2 , January 31, 2012, ISSN 1362-5187 , p. 89-92 , doi : 10.3109 / 13625187.2011.636461 ( tandfonline.com [accessed November 10, 2018]).
^ Pro Familia: Pearl Index
↑ Marta Baptista, Joao Ramalho-Santos: Spermicides, Microbicides and Antiviral Agents: Recent Advances in the Development of Novel Multi-Functional Compounds . In: Mini-Reviews in Medicinal Chemistry . tape 9 , no. 13 , November 1, 2009, ISSN 1389-5575 , p. 1556–1567 , doi : 10.2174 / 138955709790361548 ( eurekaselect.com [accessed November 10, 2018]).
↑ Pro Familia: The Diaphragm.

[1] István Batár, Irving Sivin: State-of-the-art of non-hormonal methods of contraception: I. Mechanical barrier contraception . In: The European Journal of Contraception & Reproductive Health Care . tape 15 , no. 2 , March 16, 2010, ISSN 1362-5187 , p. 67-88 , doi : 10.3109 / 13625181003708683 ( tandfonline.com [accessed November 10, 2018]).

[2] Olga Loeber: A cheer for the diaphragm . In: The European Journal of Contraception & Reproductive Health Care . tape 17 , no. 2 , January 31, 2012, ISSN 1362-5187 , p. 89-92 , doi : 10.3109 / 13625187.2011.636461 ( tandfonline.com [accessed November 10, 2018]).

[profamilia-pearl-index-3] Pro Familia: Pearl Index

[4] Marta Baptista, Joao Ramalho-Santos: Spermicides, Microbicides and Antiviral Agents: Recent Advances in the Development of Novel Multi-Functional Compounds . In: Mini-Reviews in Medicinal Chemistry . tape 9 , no. 13 , November 1, 2009, ISSN 1389-5575 , p. 1556–1567 , doi : 10.2174 / 138955709790361548 ( eurekaselect.com [accessed November 10, 2018]).

[5] Pro Familia: The Diaphragm.