Will the Contraceptive Diaphragm Make a Comeback?

Robert L. Barbieri, MD reviewing Schwartz JL et al. Obstet Gynecol 2015 Mar 5.

A new, reengineered single-size diaphragm will soon be available, but its contraceptive efficacy is modest.

During the 1960s and 1970s many women selected the barrier diaphragm as their contraceptive of choice, but its use has plummeted in recent decades. A new, reengineered single-size contraceptive diaphragm marketed as Caya is available in Europe and is FDA approved. This diaphragm has a contoured nylon spring to fit women of different body sizes and an indentation in the rim for easy grasping to assist with removal. Investigators enrolled 450 women needing contraception to use this diaphragm for ≥190 days; 300 women were randomized to an acid-buffering contraceptive gel and 150 women to nonoxynol-9.

A total of 35 pregnancies occurred for an overall 6-month pregnancy rate of 10.4 per 100 women. Six-month pregnancy rates were 9.6 and 12.5 for the acid-buffering gel and nonoxynol-9 groups, respectively. More than half (62%) of participants reported at least one problem including urogenital pain, irritation, pruritus, abnormal vaginal bleeding, vaginal infection, and urinary tract infection.

CITATION(S):

Schwartz JL et al. Contraceptive efficacy, safety, fit, and acceptability of a single-size diaphragm developed with end-user input. Obstet Gynecol 2015 Mar 5; [e-pub].