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a) Yes, diaphragm use increases the risk of urinary tract infections (UTI).
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a) Most studies have found that diaphragm users develop UTI at a rate two to three times higher than non-diaphragm users. However, it is not understood why this is the case. Foreplay and intercourse seem to introduce E. coli bacteria into the vagina. The spermicide, and probably the diaphragm itself, encourages vaginal and urethral colonization of the E. coli.
Several approaches may solve the UTI problem. Urination just before and just after intercourse may offer some protection. Wearing the diaphragm for less time may help. A smaller device, or a different rim style, may relieve pressure on the urethra. Switching to a cervical cap may be an option that retains many of the same advantages as the diaphragm.
- Foxman B, Chi J-W. Health behavior and urinary tract infection in college-aged women. Journal of Clinical Epidemiology 1990;43(4):329-37.
- Hooton TM, Hillier S, Johnson C, Roberts PL, Stamm WE. Escherichia coli bacteriuria and contraceptive method. Journal of the American Medical Association 1991;265(1):64-9.
- 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.
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b) There is no evidence that the cervical cap increases the risk of UTI, although it may do so.
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b) Since there are relatively few cervical cap users, it is difficult to study side effects of cap use. Since the cervical cap shares with the diaphragm the feature of extended spermicide exposure, it is possible that cap use will increase the risk of UTI to a similar extent.
- Hooton TM, Hillier S, Johnson C, Roberts PL, Stamm WE. Escherichia coli bacteriuria and contraceptive method. Journal of the American Medical Association 1991;265:64-9.
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