Intervention Review

Sponge versus diaphragm for contraception

  1. Maureen A Kuyoh2,
  2. Cathy Toroitich-Ruto2,
  3. David A Grimes1,
  4. Kenneth F Schulz3,
  5. Maria F Gallo4,
  6. Laureen M Lopez1,*

Editorial Group: Cochrane Fertility Regulation Group

Published Online: 8 OCT 2008

Assessed as up-to-date: 23 JAN 2011

DOI: 10.1002/14651858.CD003172

Database Title

Additional Information

How to Cite

Kuyoh MA, Toroitich-Ruto C, Grimes DA, Schulz KF, Gallo MF, Lopez LM. Sponge versus diaphragm for contraception. Cochrane Database of Systematic Reviews 2002, Issue 3. Art. No.: CD003172. DOI: 10.1002/14651858.CD003172.

Author Information

  1. 1

    FHI, Clinical Sciences, Research Triangle Park, North Carolina, USA

  2. 2

    FHI, Population and Reproductive Health, Nairobi, Kenya

  3. 3

    FHI, Quantitative Sciences, Research Triangle Park, North Carolina, USA

  4. 4

    Centers for Disease Control and Prevention, Division of Reproductive Health, Atlanta, Georgia, USA

*Laureen M Lopez, Clinical Sciences, FHI, P.O. Box 13950, Research Triangle Park, North Carolina, 27709, USA. llopez@fhi.org.

Publication History

  1. Publication Status: New search for studies and content updated (no change to conclusions)
  2. Published Online: 8 OCT 2008

SEARCH

ARTICLE TOOLS

View Full Article (HTML) Summary (58K)Standard (170K)Full (183K)
 

Abstract

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要

Background

The contraceptive vaginal sponge was developed as an alternative to the contraceptive diaphragm. The sponge, made of polyurethane impregnated with nonoxynol-9 (1g), releases 125 mg of the spermicide over 24 hours of use. Unlike the diaphragm, the sponge can be used for more than one coital act within 24 hours without the insertion of additional spermicide, and the sponge does not require fitting or a prescription from a physician. How the sponge compares with the diaphragm in terms of efficacy and continuation is not clear.

Objectives

To compare the efficacy and continuation rates of the sponge with the diaphragm (used with nonoxynol-9). Our a priori hypothesis was that the sponge would have higher rates for failure and discontinuation than the diaphragm.

Search methods

We searched the computerized databases MEDLINE, EMBASE, POPLINE, LILACS, and CENTRAL. In addition, we searched the reference lists of relevant articles and book chapters. We also contacted investigators involved with the identified trials for other published or unpublished trials.

Selection criteria

We included randomized controlled trials comparing the vaginal contraceptive sponge (Today; Collatex) with any diaphragm used with nonoxynol-9 to prevent pregnancy.

Data collection and analysis

We examined the studies identified through the literature searches for possible inclusion and evaluated their methodological quality using the Cochrane guidelines. We entered data into RevMan and calculated Peto odds ratios for overall pregnancy and 12-month discontinuation using numbers of women as the denominator. We also abstracted 12-month cumulative life-table ratios for these same outcomes but were unable to aggregate these data.

Main results

The sponge was significantly less effective in both trials in preventing overall pregnancy than was the diaphragm. In the larger US trial, the 12-month cumulative life-table termination rates per 100 women for overall pregnancy were 17.4 for the sponge and 12.8 for the diaphragm. The rates were 24.5 for the sponge and 10.9 for the diaphragm in the UK trial. Similarly, discontinuation rates at 12 months were higher with the sponge than with the diaphragm (Odds ratio 1.31; 95% CI 1.07 to 1.59). Allergic-type reactions were more common with the sponge, although discontinuation for discomfort differed in the two trials.

Authors' conclusions

The sponge was less effective than the diaphragm in preventing pregnancy. Discontinuation rates were higher at 12 months as well. Other randomized controlled trials will be needed to resolve the potential role of spermicides in preventing sexually transmitted infections or in causing adverse effects.

 

Plain language summary

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要

Effect of the vaginal sponge and the diaphragm in preventing pregnancy

The vaginal sponge is a birth control method used in the birth canal. The sponge is soft and round, and has a loop on it for removal. The sponge contains a chemical to kill sperm. The diaphragm is a rubber circle that goes in the birth canal. It helps to keep sperm from getting into the womb. The diaphragm also holds a chemical to kill sperm. This review compared how well these two methods work in preventing pregnancy.

We did computer searches for randomized trials that compared the sponge with the diaphragm. In addition, we looked at reference lists and book chapters to find trials. We also wrote to researchers to look for more trials.

In a large U.S. trial, the sponge did not work as well as the diaphragm in preventing pregnancy. For every 100 women who used the sponge for a year, about 17 got pregnant. Of those who used the diaphragm, 13 became pregnant. A U.K. trial found similar results. For each 100 women who used the sponge for a year, about 25 got pregnant. Of the diaphragm users, 11 became pregnant.

About 30% more women stopped using the sponge than the diaphragm. Allergy to the sponge was a problem for some women. However, discomfort caused about the same numbers of women to stop using their birth control method.

 

摘要

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要

背景

比較避孕海綿與子宮帽之於避孕的效果

避孕海綿是除了子宮帽之外,節育的另一項選擇.避孕海綿是以聚氨酯(polyurethane)製成,並以nonoxynol−9(1g)加強作用,可釋出超過24小時,125mg的殺精劑.不像子宮帽,避孕海綿置入後,在24小時內,就算性行為超過一次,也都能發揮作用,不須再另外置入殺精劑,也不需處方籤或由醫師置入

目標

為比較避孕海綿與子宮帽(有添加nonoxynol−9)對於節育的效率及使用持續性,我們假設避孕海綿之於子宮帽有較高的失敗率及較低的使用持續性

搜尋策略

我們搜尋了電腦化資料庫包括MEDLINE, EMBASE, POPLINE, LILACS,以及 CENTRAL.此外,我們還尋找了參考文獻中的論文及書目.對於其他相關的已發表或未發表的試驗,我們也諮詢了相關學者.

選擇標準

我們蒐羅了有關使用避孕海綿(Today;Collatex)或任何含有nonoxynol−9成分的子宮帽來避孕的隨機試驗

資料收集與分析

我們自文獻搜尋引擎蒐集相關文獻,並以考克藍指導方針來審視其研究方法的品質.我們將使用此兩種避孕方法下的懷孕數,以及12個月後停用此兩種避孕法的人次當作母數,輸入RevMan軟體及Peto odds ratios衡量效應尺度.我們並且擷取了這些數據的12個月累計生命表,但無法總計這些數據

主要結論

兩個試驗同時顯示避孕海綿對於避孕的效果明顯低於子宮帽.在一篇美國較大型的研究中,使用避孕海綿及子宮帽之下懷孕後中止妊娠的累計率分別為17.4%及12.8%.此比率在一篇英國的研究中則為24.5%及10.9%.同樣的,對於12個月區間內的停用率,避孕海綿亦高於子宮帽(Odds ratio 1.3; 95% CI 1.1 – 1.6).過敏反應在避孕海綿組較為常見,儘管在這兩篇研究中,因不舒適而停用的比率有所差別.

作者結論

避孕海綿的避孕效果較不如子宮帽,而在12個月內因不舒適而停用的比率,前者也較後者高.至於殺精劑對於防治性傳染病的角色以及其副作用,則有待其他的隨機試驗來驗證

翻譯人

本摘要由臺灣大學附設醫院陳怡伶翻譯。

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

總結

避孕海綿與子宮帽的避孕效果 避孕海綿是一種用於陰道的節育方式.其外型為圓而柔軟,附有一圓環供取出之用.避孕海綿內含化學物以殺死精子.子宮帽是一種置入陰道的橡皮環,可避免精子進入子宮.子宮帽內亦含化學物以殺死精子.此篇回顧比較了這兩種避孕方法的效果.我們利用電腦搜尋有關於此兩種方式的比較性隨機研究,此外我們參閱了這些研究的參考文獻.我們也與研究者通信以得到更多相關研究的文獻.在美國一篇大型的研究指出,避孕海綿的避孕效果並不如子宮帽.每100名使用避孕海綿的婦女中有17名懷孕.而每100名使用子宮帽的婦女中有13名懷孕.另一篇英國的研究也顯示了類似的結果:一年中,每100名使用避孕海綿的婦女中有25名懷孕.而每100名使用子宮帽的婦女中有11名懷孕.至於停止使用率,避孕海綿組約高於子宮帽組有30%.有些婦女對避孕海綿有過敏的狀況.使用後不舒服的人數與停用的人數是相同的.

View Full Article (HTML) Summary (58K)Standard (170K)Full (183K)