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Yes, but not as effectively as with spermicide.
Until better data on contraceptive effectiveness refute the traditional recommendations, users should be advised to add spermicide to fitted diaphragms.
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Two studies of non-fitted diaphragms without spermicide had conflicting results. Research on fitted diaphragm use without spermicide are also conflicting. In a retrospective review of patient records, women using fitted diaphragms continuously (removing them only to wash) without spermicide had a lower pregnancy rate than did women following the traditional instructions. In a randomized trial comparing fitted diaphragm use with versus without spermicide, the typical use and perfect use pregnancy rates were lower in the diaphragm with spermicide group, but the study was small and the difference was not statistically significant.
Some providers believe that spermicide cost, messiness and potential for irritation have resulted in poor compliance, and recommend diaphragm use without spermicide in an effort to enhance acceptability. But another important attribute of the diaphragm is that diaphragms used with spermicide protect against cervical infections and that spermicide use may reduce the risk of human immunodeficiency virus infection. If spermicide use is partly responsible for reducing the risk of sexually transmitted disease infection in women using diaphragms, it would be a disservice to instruct women to omit spermicide.
- Ferreira AE, Araujo MJ, Regina CH, Diniz SG, Faundes A. Effectiveness of the diaphragm, used continuously, without spermicide. Contraception 1993;48:29-35.
- Stim EM. The nonspermicide fit-free diaphragm: a new contraceptive method. Advances in Planned Parenthood 1980;15(3):88-98.
- Smith C, Farr G, Feldblum PJ, Spence A. Effectiveness of the non-spermicidal fit-free diaphragm. Contraception 1995;51:289-91.
- Bounds W, Guillebaud J, Dominik R, Dalberth BT. The diaphragm with and without spermicide: a randomized, comparative efficacy trial. Journal of Reproductive Medicine 1995;40:764-74.
- Roddy RE, Cordero M, Cordero C, Fortney JA. A dosing study of nonoxynol-9 and genital irritation. International Journal of STD & AIDS 1993;4:165-70.
- Cates W Jr, Stone KM. Family planning, sexually transmitted diseases and contraceptive choice: a literature update-part 1. Family Planning Perspectives 1992;24:75-84.
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