Recommendations for Contraceptive Use
		Barrier Methods

Recommendations	Rationale
a) Diaphragms? No. Women with any number of births can use the diaphragm. The fit of the device should be checked after delivery or second trimester abortion, however.	a) Since the diaphragm comes in sizes from 50 mm to 105 mm in different models, almost all vaginas can be accommodated. The size and muscle tone of the upper vagina can change after pregnancy, though, so a new device may be needed. It is unclear whether the effectiveness of the diaphragm varies according to parity. In one large study of diaphragm users, parous women had a lower pregnancy rate than nulliparous women; in another, the rate among parous women was higher than that in nulliparous women. Parous women do not need to be advised that they are at higher risk of pregnancy. Hatcher RA, Trussell J, Stewart F, Stewart GK, Kowal D, Guest F, et al. The diaphragm, contraceptive sponge, cervical cap and female condom. In: Contraceptive Technology. New York: Irvington Publishers, 1994:191-222. Trussell J, Strickler J, Vaughan B. Contraceptive efficacy of the diaphragm, the sponge and the cervical cap. Family Planning Perspectives 1993;25:100-5, 135.
b) Cervical caps? No. Women of any parity can use the cervical cap, but the fit of the device should be checked after delivery or second trimester abortion. Parous women who use cervical caps tend to have a much higher pregnancy rate than nulliparous women users.	b) The cervical cap comes in four sizes: 22, 25, 28 and 31 mm. Most women can be fitted properly, but perhaps 10% of prospective users cannot be fit and must use a different method. In a large clinical trial, the pregnancy rate was substantially higher among parous women than nulliparous women for both typical and perfect use. Secor RMC. The cervical cap. NAACOG's Clinical Issues 1992;3(2):236-45. Hatcher RA, Trussell J, Stewart F, Stewart GK, Kowal D, Guest F, et al. The diaphragm, contraceptive sponge, cervical cap and female condom. In: Contraceptive Technology. New York: Irvington Publishers, 1994:191-222. Trussell J, Strickler J, Vaughan B. Contraceptive efficacy of the diaphragm, the sponge and the cervical cap. Family Planning Perspectives 1993;25:100-5, 135.

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.