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Subject: Fitting Contraceptive Diaphragms
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Items for a gynecologic examination (Appendix H: Instruments and Materials in a Standard Gynecological Tray)
Diaphragm fitting rings or diaphragms for fitting
Nonhormonal, reversible contraception
Intolerance to hormonal contraception
Desire for sexually transmitted disease (STD) protection
History of toxic shock syndrome
Congenital vaginal abnormalities (septum)
Patient <6 weeks postpartum
Use of petroleum-based products that may damage latex diaphragms
Drug allergies to the spermicides
PEARL: Check size by trying a larger or smaller diaphragm and compare the fit.
PITFALL: Discomfort or excessive pressure on the urethra indicates the device is too large, and a device that is easily displaced or expelled is probably too small.
PITFALL: Have the patient perform a Valsalva maneuver (i.e., cough). If the diaphragm is displaced or comes out, select the next larger size, and try again.
PEARL: When properly fitted, the patient should not feel any discomfort and should be comfortable during intercourse.
PITFALL: Caution the patient not to puncture the diaphragm with a long or ragged fingernail.
Increased risk of urinary tract infection
Toxic shock syndrome: 2.4 cases per 100,000 women (occurs almost exclusively when the diaphragm has been left in place >24 hours)
Ortho-McNeil Pharmaceutical Company, 1000 Route 202 South, Raritan, NJ 08869-0602. Phone: 1-800-682-6532. Web site: http://www.ortho-mcneil.com.
Milex Products, Inc., 4311 N. Normandy, Chicago, IL 60634. Phone: 1-800-621-1278; fax: 1-800-972-0696. Web site: http://www.milexproducts.com.