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Diaphragm use and urinary tract infections: analysis of urodynamic and microbiological factors
To investigate how diaphragm use predisposes to urinary tract infection we studied 22 women who experienced 1 or more urinary tract infections while using a diaphragm and 21 who used a diaphragm and did not have a urinary tract infection. For women with and without a prior urinary tract infection the mean peak urine flow rate was significantly less with than without a diaphragm. However, the mean decrease in peak urine flow rate with a diaphragm was not significantly greater for women with a prior urinary tract infection. There also was no significant increase in time to peak flow with the diaphragm in place. Women who reported a sensation of obstruction to voiding with a diaphragm demonstrated a significant decrease in peak urine flow rate and this finding was particularly apparent in those with a history of urinary tract infection in whom the peak urine flow rate decreased by an average of 10.0 ml. per second. Current users of a diaphragm with a history of urinary tract infection had heavier growth of coliform organisms from cultures of the vagina and urethra, and significantly more episodes of infection than women without such a history (p equals 0.03 and 0.05, respectively). We conclude that use of a diaphragm can cause urinary obstruction in some women but that the obstruction is of relatively small magnitude and does not correlate with the acquisition of a urinary tract infection. Changes in vaginal flora associated with diaphragm use may be of greater importance.
To investigate how diaphragm use predisposes to urinary tract infection we studied 22 women who experienced 1 or more urinary tract infections while using a diaphragm and 21 who used a diaphragm and did not have a urinary tract infection. For women with and without a prior urinary tract infection the mean peak urine flow rate was significantly less with than without a diaphragm. However, the mean decrease in peak urine flow rate with a diaphragm was not significantly greater for women with a prior urinary tract infection. There also was no significant increase in time to peak flow with the diaphragm in place. Women who reported a sensation of obstruction to voiding with a diaphragm demonstrated a significant decrease in peak urine flow rate and this finding was particularly apparent in those with a history of urinary tract infection in whom the peak urine flow rate decreased by an average of 10.0 ml. per second. Current users of a diaphragm with a history of urinary tract infection had heavier growth of coliform organisms from cultures of the vagina and urethra, and significantly more episodes of infection than women without such a history (p equals 0.03 and 0.05, respectively). We conclude that use of a diaphragm can cause urinary obstruction in some women but that the obstruction is of relatively small magnitude and does not correlate with the acquisition of a urinary tract infection. Changes in vaginal flora associated with diaphragm use may be of greater importance.