Diaphragm versus diaphragm with spermicides for contraception

Area of Science:

• Reproductive Health
• Contraception Research
• Clinical Effectiveness Studies

Background:

• The diaphragm is a common contraceptive device usually paired with spermicide.
• Some experts question the necessity of spermicides with diaphragms, suggesting alternative usage guidelines.

Purpose of the Study:

• To compare the contraceptive effectiveness, safety, and acceptability of diaphragms used with versus without spermicide.

Main Methods:

• A comprehensive literature search was conducted across multiple databases (MEDLINE, EMBASE, POPLINE, CINAHL, Cochrane Controlled Trials Register) and expert consultations.
• Included randomized controlled trials focused on women of reproductive age using diaphragms as the sole contraceptive method, with or without spermicide.
• Data extraction was performed independently by two reviewers, with discrepancies resolved by consensus or a third reviewer.

Main Results:

• Only one relevant study was identified, which was underpowered due to insufficient participant recruitment.
• No statistically significant differences were observed in pregnancy rates (typical or consistent use) or discontinuation rates between the two diaphragm usage groups.
• A trend suggested higher pregnancy rates in the diaphragm-without-spermicide group, but this was not statistically significant.

Conclusions:

• The current evidence, based on a single underpowered study, is insufficient to differentiate the contraceptive effectiveness of diaphragms with or without spermicide.
• Further research is required to definitively assess the comparative effectiveness and safety of diaphragm use with and without spermicide.