Diaphragm versus diaphragm with spermicides for contraception

 

Abstract

Background

The diaphragm is usually used with a spermicide. However, some practitioners have suggested that spermicides offer no additional contraceptive protection and have advocated alternative guidelines for the use of diaphragms.

Objectives

The objective of this review was to compare the effectiveness, safety and acceptability of the diaphragm with and without spermicide.

Search methods

We searched MEDLINE, POPLINE, CENTRAL, LILACS and reference lists of relevant articles. We also searched for clinical trials in ClinicalTrials.gov and the International Clinical Trials Registry Platform (ICTRP). In addition, we contacted experts in the field to identify unpublished studies.

Selection criteria

We included randomized controlled trials comparing women of reproductive age using the diaphragm with and without spermicide. The diaphragm had to be the sole contraceptive method, and the report had to include clinical outcomes.

Data collection and analysis

Two authors independently extracted data on outcomes and trial characteristics. Any discrepancies were resolved by consensus or by consultation with a third author. The results of the one identified study are presented descriptively.

Main results

We identified only one study. No significant difference was found in the pregnancy rates (with typical use or consistent use) or discontinuation rates between the diaphragm-with-spermicide and diaphragm-without-spermicide groups. A trend toward higher pregnancy rates was noted in the diaphragm-without-spermicide group. However, this study failed to recruit the planned number of participants and was consequently underpowered.

Authors' conclusions

As only one underpowered study was identified, we cannot distinguish between the contraceptive effectiveness of the diaphragm with and without spermicide. We cannot draw any conclusion at this point. Randomized controlled trials with adequate numbers of participants would be required to adequately examine this issue. However, the study provides no evidence to change the commonly recommended practice of using the diaphragm with spermicide.

 

Plain language summary

Diaphragm compared to diaphragm with spermicide for birth control

The diaphragm is an important type of birth control. The woman controls the method and it does not involve taking a drug. Also, the birth control can be reversed right away. The diaphragm is often used with a spermicide - a chemical to kill sperm. Many women feel that the spermicide is awkward and messy to use. Spermicides may increase the risk of infections in the urinary tract. Some health care workers think that spermicide does not help with birth control.

This review looked at trials of diaphragms used with and without spermicide. We looked at how well each method worked, how safe it was, and whether women liked using it.

We did computer searches for randomized trials that compared the diaphragm only to the diaphragm with spermicide. We also looked at reference lists to find trials. In addition, we wrote to researchers to find more studies.

We found one trial that looked at using the diaphragm with and without the spermicide. Of the women who used the diaphragm only, slightly more got pregnant than did those who used the diaphragm with spermicide. The study was too small to know how well the spermicide worked with the diaphragm for birth control. Large trials would help to address this issue. Current evidence gives no reason to change the practice of using spermicide with the diaphragm.

 

摘要

背景

比較單用子宮帽與子宮帽合併殺精劑的避孕效果

子宮帽常併用殺精劑。但有些臨床醫護人員認為殺精劑不見得能提供額外的避孕效果，因此對子宮帽的使用開始主張不同的指導方針。

目標

本篇回顧的主旨在於比較“單用子宮帽”與“子宮帽合併殺精劑”兩種避孕法，其有效性、安全性、和可接受性。

搜尋策略

我們搜尋了MEDLINE, EMBASE, POPLINE, CINAHL, CENTRAL, LILACS和相關文章的參考文獻。此外，我們也與相關領域的專家聯繫，以取得未發表的研究。

選擇標準

比較育齡婦女僅以“單用子宮帽“或”子宮帽合併殺精劑“作為避孕法之隨機對照研究，且有報告臨床結果者。

資料收集與分析

兩位作者各自擷取研究結果及實驗特徵。有歧異則取得共識或會商第三方。相同研究的結果以敘述方式呈現

主要結論

我們僅找到一篇研究。“單用子宮帽“或”子宮帽合併殺精劑“這兩組之間，懷孕率(不論典型用法或一致持續用法)或終止使用率並沒有顯著差異。在“單用子宮帽”這組，懷孕率有偏高的趨向。但是因為此研究的參與者沒能達到計畫的人數，因此統計檢力不足。

作者結論

既然僅有一檢力不足的研究，我們無法分別子宮帽有無合併殺精劑時的避孕有效性。目前我們仍無法下結論，有待進一步的研究。不過這項研究未能提供證據來改變目前臨床對此避孕法的普遍建議—使用子宮帽時併用殺精劑。

翻譯人

本摘要由成功大學附設醫院尹子真翻譯。

此翻譯計畫由臺灣國家衛生研究院(National Health Research Institutes, Taiwan)統籌。

總結

比較單用子宮帽與子宮帽合併殺精劑 子宮帽避孕是重要的節育方式。女性可以自主控制使用，不需涉及藥物。同時，其對生育的控制可以隨時回復。子宮帽常與殺精劑(用以殺死精子的化學物質)併用。 許多女性覺得殺精劑在使用上尷尬不便且凌亂。殺精劑可能增加泌尿道感染的風險。有些醫護人員認為殺精劑對於節育沒有幫助。本篇回顧著眼於比較子宮帽合併殺精劑的研究。我們探討這兩種方法的效用、安全性、以及女性是否偏好使用。 我們以電腦搜尋比較”單用子宮帽“和”子宮帽合併殺精劑“作為避孕法之隨機對照研究。我們也查閱參考文獻清單來搜尋相關試驗。此外，我們聯繫研究者以查詢更多研究。 我們發現一個研究，以子宮帽合併殺精劑與否作為避孕法之比較。單用子宮帽組，比起子宮帽合併殺精劑組，懷孕者些微較多。但這研究樣本數太小，難以清楚了解子宮帽合併殺精劑作為避孕法效果如何。目前的證據不構成理由來改變現行子宮帽合併殺精劑以避孕的做法。