PocketGuide: Barriers and Spermicides - Diaphragms: Conditions Requiring Precautions

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PocketGuide for Family Planning Service Providers

Barriers and Spermicides

Diaphragms: Conditions Requiring Precautions

CONDITION	History of Toxic Shock Syndrome (TSS)
PRECAUTION	Women with a history of TSS should avoid using the diaphragm unless other more appropriate methods are not available or acceptable. (WHO class 3)
RATIONALE	Toxic shock syndrome has been associated with diaphragm use and women with a history of TSS are at increased risk.

CONDITION	Repeated urinary tract infections (UTIs)
PRECAUTION	Advise client to empty her bladder (void) immediately after intercourse. Consider single dose prophylactic antibiotic with intercourse. If condition does not improve, help client choose another method.
RATIONALE	Occasionally, the diaphragm causes urinary tract infections (UTIs) in some clients. This may be due to pressure on the urethra produced by the device. Often the symptoms (urinary frequency and burning) are not due to a UTI but to urethral irritation.

CONDITION	Uterine prolapse (uterus protruding into the vagina)
PRECAUTION	Help client choose another method.
RATIONALE	Uterine prolapse can cause difficulties in insertion and correct positioning of the diaphragm, increase the possibility of expulsion and decrease its effectiveness.

CONDITION	Severe cystocele or rectocele (bulging of the walls of the bladder or rectum into the vagina)
PRECAUTION	Determine the extent of defect. Examine carefully after fitting to ensure that the diaphragm can be retained. Ask client to strain (push down) with the diaphragm in place to see if it is displaced.
RATIONALE	Pelvic relaxation may prevent proper placement of the diaphragm, increase the possibility of expulsion and decrease its effectiveness.

CONDITION	Vaginal stenosis (narrowing of the vaginal canal)
PRECAUTION	Examine carefully after fitting to see that client can insert the diaphragm properly. Client may need to choose another method.
RATIONALE	Vaginal stenosis (acquired or congenital) may make proper fitting and placement of the diaphragm difficult, increase the possibility of expulsion and decrease its effectiveness.

CONDITION	Genital anomalies
PRECAUTION	Ensure that condition does not interfere with use. If it does, help client choose another method.
RATIONALE	If abnormalities present, they may make fitting/insertion of diaphragm difficult. If diaphragm is not placed correctly, the method will fail.

Last Updated: 09 Jul 2003

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