Recommendations for Contraceptive Use
		Barrier Methods

Recommendations	Rationale
a) Diaphragms? No, diaphragms have to be fitted, and a variety of sizes need to be available where this method is offered.	a) Two studies of a Nonspermicidal Fit-Free Diaphragm (60 mm) have been done. The first report, an analysis of past diaphragm use, found the Pearl pregnancy rate to be 1 per 100 woman-years. In the second, a prospective non-randomized trial, the 12-month life table pregnancy rate was 24.1 per 100 women, and the high failure rate led to early termination of the study. The effectiveness of this modified approach to diaphragm use has not been confirmed. Stim EM. The nonspermicide fit-free diaphragm: a new contraceptive method. Advances in Planned Parenthood 1980;15(3):88-98. Smith C, Farr MG, Feldblum PJ, Spence A. Effectiveness of the non-spermicidal fit-free diaphragm. Contraception 1995;51:289-91.
b) Cervical caps? No, currently available cervical caps must be fitted, and a variety of sizes need to be available where this method is offered.	b) Until one-size-fits-all caps are available, fitting caps to each client is recommended. New cervical barrier devices have been devised, at least one of which is one-size-fits-all, and human use studies are under way. Hunt WL, Gabbay L, Potts M. Lea's Shield, a new barrier contraceptive preliminary clinical evaluations three-day tolerance study. Contraception 1994;50:551-61. Mauck C, Glover L, Miller E, Allen S, Archer D, Blumenthal P, et al. Lea's Shield: a study of the safety and efficacy of a new vaginal barrier contraceptive used with and without spermicide. Contraception 1996;53:329-35.

Any part of Recommendations for Updating Selected Practices in Contraceptive Use may be reproduced or adapted to meet local needs without prior permission from the TG/CWG Secretariat, provided the TG/CWG is acknowledged and the material is made available free of charge or at cost.