Contraceptive Efficacy, Safety, Fit, and Acceptability of a Single-Size Diaphragm Developed With End-User Input

• Published in: Obstetrics and gynecology (New York. 1953) Vol. 125; no. 4; pp. 895 - 903
• Main Authors: Schwartz, Jill L., Weiner, Debra H., Lai, Jaim Jou, Frezieres, Ron G., Creinin, Mitchell D., Archer, David F., Bradley, Lynn, Barnhart, Kurt T., Poindexter, Alfred, Kilbourne-Brook, Maggie, Callahan, Marianne M., Mauck, Christine K.
• Format: Journal Article
• Language: English
• Published: United States by The American College of Obstetricians and Gynecologists. Published by Wolters Kluwer Health, Inc. All rights reserved 01-04-2015
• Subjects: Acrylic Resins - adverse effects; Adult; Contraceptive Devices, Female - adverse effects; Equipment Design; Female; Humans; Male; Nonoxynol - adverse effects; Patient Satisfaction; Pregnancy - statistics & numerical data; Propensity Score; Spermatocidal Agents - adverse effects; Vaginal Creams, Foams, and Jellies - adverse effects; Young Adult
• ISSN: 0029-7844; 1873-233X
• DOI: 10.1097/AOG.0000000000000721

OBJECTIVE:To estimate contraceptive efficacy, safety, acceptability, and fit of a single-size diaphragm used with contraceptive gel.
METHODS:We conducted a multicenter trial in which 450 couples used the single-size diaphragm, 300 randomized to acid-buffering gel and 150 to nonoxynol-9, for at least 190 days and six menstrual cycles. Visits were at enrollment and after menstrual cycles 1, 3, and 6. Study outcomes included pregnancy probability, safety, acceptability, and fit. Pregnancy and safety were compared with an historical control group who used a standard diaphragm with these gels.
RESULTS:Most (439/450 [98%]) women could be fitted with the single-size diaphragm. A total of 421 of 450 (94%) provided follow-up. The 35 study pregnancies yielded 6-month Kaplan–Meier cumulative typical use pregnancy probabilities per 100 women with 95% confidence intervals (CIs) of 10.4 (6.9–14.0) for all users and 9.6 (5.5–13.6) and 12.5 (5.4–19.5) with acid-buffering gel and nonoxynol-9, respectively. Historical control analysis yielded a propensity score–adjusted estimate of this pregnancy probability for the single-size diaphragm of 11.3 compared with 10.7 per 100 women for the standard diaphragm ([rounded] difference 0.7, 95% CI −3.6 to 4.9). Approximately half (51%) reported at least one urogenital event but compared favorably to the standard diaphragm in historical control analysis. Most (282/342 [82%]) liked the diaphragm. Results suggest that if provided by a clinician, 94% (95% CI 92–96%) could insert, correctly position, and remove the diaphragm.
CONCLUSION:The single-size diaphragm was safe, as effective as a standard diaphragm, and acceptable when used with contraceptive gel.
CLINICAL TRIAL REGISTRATION:ClinicalTrials.gov, www.clinicaltrials.gov, NCT00578877.
LEVEL OF EVIDENCE:II