671:
679:
253:, and remain in the vagina for 6 to 8 hours after a man's last ejaculation. For multiple acts of intercourse, it is recommended that an additional 5 mL of spermicide be inserted into the vagina (not into the dome—the seal of the diaphragm should not be broken) before each act. Upon removal, a diaphragm should be cleansed with mild soap and warm water before storage. The diaphragm must be removed for cleaning at least once every 24 hours and can be re-inserted immediately.
29:
281:. The method effectiveness is the proportion of couples correctly and consistently using the method who do not become pregnant. Actual effectiveness is the proportion of couples who intended that method as their sole form of birth control and do not become pregnant; it includes couples who sometimes use the method incorrectly, or sometimes not at all. Rates are generally presented for the first year of use. Most commonly the
3296:
603:, an increase in the length of the vagina, occurs during arousal. This means that during intercourse, the diaphragm will not fit snugly against the pubic bone because it is carried higher up the vaginal canal by the movement of the cervix. If the diaphragm is inserted after arousal has begun, extra care must be taken to ensure the device is covering the cervix.
574:. A diaphragm that is too small might fit inside the vagina without covering the cervix, or might become dislodged from the cervix during intercourse or bowel movements. It is also more likely that a woman's partner will feel the anterior rim of a diaphragm that is too small during intercourse. A diaphragm that is too large will place pressure on the
435:
argued in the later 1920s-1930s that while the muscle movement by women is restricted it does not make all that much difference since most "women (in the 1920s) are not able to operate their pelvic muscles voluntarily to the best advantage" (during sex). However, Stopes anticipated this rebuttal, and in so many words classified it as a lame excuse.
444:
study were given a 60 mm diaphragm rather than being fitted by a clinician. Other studies have been small and given conflicting results. Insufficient studies have been conducted to conclusively determine effectiveness without spermicide. The current recommendation is still for all diaphragm users to use spermicide with the device.
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748:
Diaphragms played a role in overturning the federal
Comstock Act. In 1932, Sanger arranged for a Japanese manufacturer to mail a package of diaphragms to a New York physician who supported Sanger's activism. U.S. customs confiscated the package, and Sanger helped file a lawsuit. In 1936, in the court
785:
during the late 2000s. It was licensed to Kessel
Marketing & Vertriebs GmbH of Frankfurt, Germany, which began to market it as the Caya Diaphragm. The diaphragm was approved for contraception in Europe in 2013 and in the United States the following year. Since then, Kessel has also developed a
762:
was more popular than the diaphragm, the diaphragm became one of the most widely used contraceptives in the United States. In 1940, one-third of all U.S. married couples used a diaphragm for contraception. The number of women using diaphragms dropped dramatically after the 1960s introduction of the
648:
It is widely taught that additional spermicide must be placed in the vagina if intercourse occurs more than six hours after insertion. However, there has been very little research on how long spermicide remains active within the diaphragm. One study found that spermicidal jelly and creme used in a
720:
gynecologist, Wilhelm P. J. Mensinga, published the first description of a rubber contraceptive device with a spring molded into the rim. Mensinga wrote first under the pseudonym C. Hasse, and the
Mensinga diaphragm was the only brand available for many decades. In the United States, the physician
495:
is much like a coil spring, but thinner. This type of rim may only be used by women with firm vaginal tone. Flat spring diaphragms may also be inserted with an introducer for women uncomfortable using their hands. Ortho used to manufacture a flat-spring diaphragm called the Ortho White. Reflexions
744:
when she returned in 1916. Sanger and her second husband, Noah Slee, illegally imported large quantities of the devices from
Germany and the Netherlands. In 1925, Slee provided funding to Sanger's friend Herbert Simonds, who used the funds to found the first diaphragm manufacturing company in the
443:
It has been suggested that, for women who experience side effects from the spermicide nonoxynol-9, it may be acceptable to use the diaphragm without any spermicide. One study found an actual pregnancy rate of 24% per year in women using the diaphragm without spermicide; however, all women in this
644:
Traditionally, the diaphragm has been used with spermicide, and it is widely believed that the spermicide is a significant factor in the effectiveness of the diaphragm. However, some have asserted that the diaphragm's mechanism of action is primarily as a physical barrier and that a diaphragm is
487:
flattens into an oval shape when the sides are compressed. This rim is not as strong as the arcing spring, and may only be used by women with average or firm vaginal tone. If an arcing spring diaphragm is uncomfortable for a woman or, during intercourse, her partner, a coil spring may prove more
434:
claimed that when wearing a diaphragm, the vagina is stretched such that certain movements made by the woman for the benefit of the man were restricted by the diaphragm spring. In later years there was some discussion of this, with two authors supporting this concept and one opposed. One of them
661:
It has been suggested that diaphragms be dispensed as a one-size-fits-all device, providing all women with the most common size (70 mm). However, only 33% of women fitted for a diaphragm are prescribed a 70 mm size, and correct sizing of the diaphragm is widely considered necessary.
652:
It has long been recommended that the diaphragm be left in place for at least six or eight hours after intercourse. No studies have been done to determine the validity of this recommendation, however, and some medical professionals have suggested intervals of four hours or even two hours are
585:
Diaphragms should be re-fitted after a weight change of 4.5 kg (10 lb) or more. The traditional clinical guideline is that a decrease in weight may cause a woman to need a larger size, although the strength of this relationship has been questioned.
1369:
Bulut A; Ortayli; Ringheim; Cottingham; Farley; Peregoudov; Joanis; Palmore; Brady; Diaz; Ojeda; Ramos (2001). "Assessing the acceptability, service delivery requirements, and use-effectiveness of the diaphragm in
Colombia, Philippines, and Turkey".
467:
folds into an arc shape when the sides are compressed. This is the strongest type of rim available in a diaphragm, and may be used by women with any level of vaginal tone. Unlike other spring types, arcing springs may be used by women with mild
306:
For instance, someone using a diaphragm might be fitted incorrectly by a health care provider, or by mistake remove the diaphragm too soon after intercourse, or simply choose to have intercourse without placing the diaphragm.
353:(STIs). Cervical barriers such as diaphragms may offer some protection against these infections. However, research conducted to test whether the diaphragm offers protection from HIV found that women provided with both male
256:
Oil-based products should not be used with latex diaphragms. Lubricants or vaginal medications that contain oil will cause the latex to rapidly degrade and greatly increases the chances of the diaphragm breaking or tearing.
771:. In 1965, only 10% of U.S. married couples used a diaphragm for contraception. That number has continued to fall, and in 2002 only 0.2% of American women were using a diaphragm as their primary method of contraception.
562:
Diaphragms usually come in different sizes and require a fitting appointment with a health care professional to determine which size a woman should wear. Single size diaphragms that do not require fitting also exist.
657:
recommends leaving the sponge in place for only two hours after intercourse. However, such use of the diaphragm (removal before 6 hours post-intercourse) has never been formally studied, and cannot be recommended.
337:
Like all cervical barriers, diaphragms may be inserted several hours before use, allowing uninterrupted foreplay and intercourse. Most couples find that neither partner can feel the diaphragm during intercourse.
260:
Natural latex rubber will degrade over time. Depending on usage and storage conditions, a latex diaphragm should be replaced every one to three years. Silicone diaphragms may last much longer—up to ten years.
589:
Diaphragms should also be re-fitted after any pregnancy of 14 weeks or longer. Full-term vaginal delivery especially will tend to increase the size diaphragm a woman needs, although the changes to the
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The rim of a diaphragm is squeezed into an oval or arc shape for insertion. A water-based lubricant (usually spermicide) may be applied to the rim of the diaphragm to aid insertion. One
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less than ÂŁ10 each. In the United States, they cost about US$ 15 to $ 75 and are the birth control method of 0.3% of women. These costs do not include that of spermicide.
610:. It is common for a woman to wear a larger diaphragm during menstruation. It has been speculated that a woman may be fitted with a larger size diaphragm when she is near
327:
The diaphragm does not interfere with a woman's menstrual cycle, therefore, no reversal or waiting time is necessary if contraception is no longer wanted or needed.
895:
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There are a number of variations. The SILCS diaphragm is made of silicone, has an arcing spring, and a finger cup is molded on one end for easy removal. The Duet
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1659:
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The idea of blocking the cervix to prevent pregnancy is thousands of years old. Various cultures have used cervix-shaped devices such as oiled paper cones or
705:. However, the diaphragm—which stays in place because of the spring in its rim, rather than hooking over the cervix or being sticky—is of more recent origin.
2541:
2161:
1561:
Hildesheim A; Brinton; Mallin; Lehman; Stolley; Savitz; Levine (1990). "Barrier and spermicidal contraceptive methods and risk of invasive cervical cancer".
778:
announced the discontinuation of the Ortho-All Flex
Diaphragm, making it very difficult for women in the US to have that option as a birth-control method.
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751:
408:(TSS) occurs at a rate of 2.4 cases per 100,000 women using diaphragms, almost exclusively when the device is left in place longer than 24 hours.
2774:
1992:
1885:
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736:, which prohibited sending contraceptive devices, or information about contraception, through the mail. Sanger learned about the diaphragm in the
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316:
The actual pregnancy rates among diaphragm users vary depending on the population being studied, with yearly rates of 10% to 39% being reported.
2455:
3020:
2478:Über die facultative Sterilität vom prophylaktischen und hygienischen Standpunkt (Pseudonym C. Hasse), Verlag Louis Heuser, Neuwied/Berlin 1882
508:
204:, it is not very effective at doing so. There are a number of types of diaphragms with different rim and spring designs. They may be made from
319:
Unlike some other cervical barriers, the effectiveness of the diaphragm is the same for women who have given birth as for those who have not.
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2043:
1274:
415:, especially if the diaphragm is too large, and causing irritation and preventing the bladder from emptying fully. However, the spermicide
3181:
1034:
934:
1154:
965:
2801:
2019:
1505:
1833:
Bounds W; Guillebaud; Dominik; Dalberth (1995). "The diaphragm with and without spermicide. A randomized, comparative efficacy trial".
1303:
S. Marie Harvey; Sheryl
Thorburn Bird; Meredith Roberts Branch (November–December 2004). "A New Look at an Old Method: The Diaphragm".
824:
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traditionally circular, multi-sized diaphragm made from the same materials that they released in
Germany in 2020 under the name Singa.
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2635:
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Diaphragms are available in diameters of 50 mm to 105mm (about 2–4 inches). They are available in two different materials:
231:
Before inserting or removing a diaphragm, one's hands should be washed to avoid introducing harmful bacteria into the vaginal canal.
2606:
990:
1735:
cook, Hera: The long sexual revolution: English women, sex and contraception 1800-1975. Oxford
University Press, 2004, pp. 247-8
1054:
1526:
J, Kelaghan; G.L. Rubin, H.W. Ory and P.M. Layde (July 1982). "Barrier-method contraceptives and pelvic inflammatory disease".
1355:
1798:
Ferreira A A; AraĂşjo; Regina; Diniz; FaĂşndes (1993). "Effectiveness of the diaphragm, used continuously, without spermicide".
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2262:
1414:
1349:
873:
220:
1237:
864:. In Hatcher, Robert A.; Trussell, James; Nelson, Anita L.; Cates, Willard Jr.; Kowal, Deborah; Policar, Michael S. (eds.).
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2926:
427:. For this reason, some advocate use of lactic acid or lemon juice based spermicides, which might have fewer side effects.
2836:
1706:
2896:
2865:
2592:"Fertility, Family Planning, and Reproductive Health of U.S. Women: Data From the 2002 National Survey of Family Growth"
1667:
330:
The diaphragm only has to be used during intercourse. Many women, especially those who have sex less frequently, prefer
1455:
Trussell J; Strickler J; Vaughan B (1993). "Contraceptive efficacy of the diaphragm, the sponge and the cervical cap".
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before sex and left in place for at least six hours after sex. Fitting by a healthcare provider is generally required.
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satisfactory. Unlike the arcing spring diaphragms, coil springs may be inserted with a device called an introducer.
3015:
768:
2153:
368:(PID) is caused by certain STIs, diaphragms may lower the risk of PID. Cervical barriers may also protect against
3273:
2916:
2099:
1604:
Fihn S; Latham; Roberts; Running; Stamm (1985). "Association between diaphragm use and urinary tract infection".
292:
For all forms of contraception, actual effectiveness is lower than method effectiveness, due to several factors:
201:
173:. It is moderately effective, with a one-year failure rate of around 12% with typical use. It is placed over the
2487:
Aus dem ärztlichen Leben. Ratgeber für angehende und junge Ärzte (Pseudonym C.Hasse), Verlag Otto
Borghold, 1886
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3045:
2858:
702:
638:
376:, although the protection appears to be due to the spermicide used with diaphragms and not the barrier itself.
125:
2655:
3035:
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2699:
350:
34:
670:
2404:
Mauck C; Lai; Schwartz; Weiner (2004). "Diaphragms in clinical trials: is clinician fitting necessary?".
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The spring in the rim of the diaphragm forms a seal against the vaginal walls. The diaphragm covers the
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3240:
3205:
3153:
614:. The correct size for a woman is the largest size that she can wear comfortably throughout her cycle.
3063:
2500:
2444:
1112:
1084:
2340:
Bernstein G (1977). "Is effectiveness of diaphragm compromised by postcoital swimming or bathing?".
649:
diaphragm retained its full spermicidal activity for twelve hours after placement of the diaphragm.
246:
may be placed in the dome of the diaphragm before insertion, or with an applicator after insertion.
2971:
189:
2182:
Kugel C, Verson H; Verson (1986). "Relationship between weight change and diaphragm size change".
402:(UTI) Urinating before inserting the diaphragm, and also after intercourse, may reduce this risk.
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2011:
1986:
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383:(preparations that, used vaginally, protect against STIs) that are currently in development.
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166:
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during pregnancy mean even women who experience second-trimester miscarriage, or deliver by
349:
There is some evidence that the cells in the cervix are particularly susceptible to certain
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effective without spermicides, but insufficient studies have been conducted to prove this.
618:
405:
369:
197:
2631:
2591:
2383:
2210:
Fiscella K (1982). "Relationship of weight change to required size of vaginal diaphragm".
1302:
8:
3248:
3223:
3025:
2937:
2278:
Leitch W (1986). "Longevity of Ortho Creme and Gynol II in the contraceptive diaphragm".
764:
606:
A woman might be fitted with a different size diaphragm depending on where she is in her
424:
185:
2417:
982:
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Edward Bliss Foote designed and sold an early form of occlusive pessary under the name "
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1938:
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477:
250:
2911:
1383:
582:. A diaphragm that is too large may also cause a sore to develop on the vaginal wall.
480:. Arcing spring diaphragms may be easier to insert correctly than other spring types.
313:
reports that the method failure rate of the diaphragm with spermicide is 6% per year.
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1409:(4th addition ed.). Cincinnati, Ohio: The Couple to Couple League. p. 146.
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The increase in risk of UTIs may be due to the diaphragm applying pressure to the
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2548:
1241:
729:
607:
524:
373:
286:
2536:(Polity Press, 2008, originally published in German 2003), p. 154; Andrea Tone,
1963:"The diaphragm with and without spermicide for contraception: a Cochrane review"
1862:"Use and Effectiveness of Barrier and Spermicidal Contraceptive Methods | GLOWM"
2979:
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1714:
544:
213:
1978:
1921:
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1117:
World Health Organization model list of essential medicines: 22nd list (2021)
891:
883:
741:
733:
709:
695:
578:, preventing the bladder from emptying completely and increasing the risk of
296:
mistakes on the part of those providing instructions on how to use the method
270:
170:
460:. Diaphragms are also available with different types of springs in the rim.
3113:
3081:
2941:
2841:
2425:
2361:
2158:
PocketGuide for Family Planning Service Providers: Barriers and Spermicides
2085:
1947:
1746:
1617:
1539:
1391:
1324:
1268:"After your doctor or health care provider prescribes your Ortho diaphragm"
1207:
1191:
1089:
World Health Organization model list of essential medicines: 21st list 2019
759:
590:
571:
528:
431:
2501:"Evolution and Revolution: The Past, Present, and Future of Contraception"
2326:
2299:
2231:
2203:
1962:
1846:
1819:
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1660:"Drug Information: Nonoxynol-9 cream, film, foam, gel, jelly, suppository"
1645:
1625:
1582:
1547:
1484:
1439:
341:
The diaphragm is less expensive than many other methods of contraception.
216:. They work by blocking access to and holding spermicide near the cervix.
28:
3186:
3173:
2678:
2132:
2072:"Women find arcing-spring diaphragm easier to insert, studies indicate".
737:
420:
416:
380:
379:
Diaphragms are also considered a good candidate as a delivery method for
282:
2850:
1125:
1097:
708:
An important precursor to the invention of the diaphragm was the rubber
2946:
1476:
755:, a federal appellate court ruled that the package could be delivered.
500:
334:
such as the diaphragm over methods that require some action every day.
243:
178:
65:
2107:
2985:
2956:
722:
611:
504:
473:
469:
1525:
1468:
1316:
2906:
2568:. Northampton, Mass: Sophia Smith Collection, Smith College. 1995.
868:(20th revised ed.). New York: Ardent Media. pp. 779–863.
457:
235:
209:
2589:
1273:(Press release). Ortho-McNeil Pharmaceutical. 2004. Archived from
1832:
717:
575:
532:
412:
354:
1368:
184:
Side effects are usually very few. Use may increase the risk of
3103:
2752:(69 ed.). British Medical Association. 2015. p. 559.
1960:
1906:"Diaphragm versus diaphragm with spermicides for contraception"
1560:
634:
630:
567:
556:
548:
540:
536:
507:(BufferGel is currently in clinical trials as a spermicide and
285:
is used to calculate effectiveness rates, but some studies use
193:
174:
2590:
Chandra, A; Martinez GM; Mosher WD; Abma JC; Jones J. (2005).
1454:
1240:. Feminist Women's Health Center. January 2006. Archived from
1797:
698:
691:
687:
511:). Both the SILCS and Duet diaphragms come in only one size.
453:
392:
239:
205:
951:
Women's Health, An Issue of Medical Clinics of North America
519:
2538:
Devices and Desires: A History of Contraceptives in America
1499:"QUESTIONS & ANSWERS: The MIRA Diaphragm Trial Results"
2656:
Ortho Diaphragm Discontinued | The Blog That Ate Manhattan
1603:
503:
diaphragm is made of dipped polyurethane, pre-filled with
2512:
2184:
Journal of Obstetric, Gynecologic, & Neonatal Nursing
1747:"Effectiveness of the non-spermicidal fit-free diaphragm"
1426:
Guttmacher Institute (1992). "Choice of Contraceptives".
1337:
1111:
1083:
621:
only. Many other countries do not require prescriptions.
496:
also manufactured a flat-spring diaphragm up until 2014.
358:
2403:
1101:. WHO/MVP/EMP/IAU/2019.06. License: CC BY-NC-SA 3.0 IGO.
2181:
1745:
Smith, C.; Farr, G.; Feldblum, PJ.; Spence, A. (1995).
1338:
Hatcher, RA; Trussel J; Stewart F; et al. (2000).
732:
fled to Europe in 1914 to escape prosecution under the
221:
World Health Organization's List of Essential Medicines
2253:(Revised ed.). New York: HarperCollins. pp.
1631:
917:
Hillard, Paula J. Adams; Hillard, Paula Adams (2008).
781:
The single-sized, silicone diaphragm was developed by
219:
The diaphragm came into use around 1882. It is on the
3284:
1859:
1404:
1020:
Textbook of Therapeutics: Drug and Disease Management
361:
infection as women provided with male condoms alone.
269:
The effectiveness of diaphragms, as of most forms of
1425:
398:
Diaphragms are associated with an increased risk of
155:
Urinary tract infection, toxic shock syndrome (rare)
2050:. Ortho-McNeil Pharmaceutical. 2001. Archived from
1504:. Cervical Barrier Advancement Society. July 2007.
653:sufficient to ensure efficacy. One manufacturer of
2246:
1632:Heaton C, Smith M; Smith (1989). "The diaphragm".
1023:. Lippincott Williams & Wilkins. p. 419.
923:. Lippincott Williams & Wilkins. p. 240.
752:United States v. One Package of Japanese Pessaries
690:halves, or have made sticky mixtures that include
633:, and physically prevents sperm from entering the
617:In the United States, diaphragms are available by
344:
115:For size fitting and prescribing in some countries
2505:Contraception Online (Baylor College of Medicine)
2006:
2004:
2002:
419:is itself associated with increased risk of UTI,
3308:
2799:
1903:
249:The diaphragm must be inserted sometime before
33:An arcing spring diaphragm in its case, with a
1999:
1961:Cook, L.; Nanda, K.; Grimes, D. (2002-04-01).
1305:Perspectives on Sexual and Reproductive Health
920:The 5-minute Obstetrics and Gynecology Consult
916:
391:Women (or their partners) who are allergic to
200:may occur. While use may decrease the risk of
3327:World Health Organization essential medicines
2866:
2806:. Jones & Bartlett Learning. p. 94.
1298:
1296:
1294:
566:A correctly fitting diaphragm will cover the
357:and a diaphragm experienced the same rate of
2495:
2493:
1991:: CS1 maint: multiple names: authors list (
1884:: CS1 maint: multiple names: authors list (
1783:: CS1 maint: multiple names: authors list (
1707:"Femprotect - Lactic Acid Contraceptive Gel"
1428:The Medical Letter on Drugs and Therapeutics
1052:
2700:"Singa®: distribution of the new diaphragm"
2339:
1910:The Cochrane Database of Systematic Reviews
1528:Journal of the American Medical Association
983:"Contraception | Reproductive Health | CDC"
826:Handbook of Contraception and Sexual Health
2907:Preventing sexually-transmitted infections
2873:
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2209:
1291:
1262:
1260:
1258:
1017:Helms, Richard A.; Quan, David J. (2006).
1012:
1010:
1008:
852:
850:
299:mistakes on the part of the method's users
2880:
2800:Alexander, Linda; LaRosa, Judith (2009).
2490:
1937:
1344:(18th ed.). New York: Ardent Media.
1124:
1096:
1048:
1046:
1044:
1016:
977:
975:
954:. Elsevier Health Sciences. p. 508.
912:
910:
908:
438:
302:conscious user non-compliance with method
2750:British national formulary : BNF 69
2313:Kovacs G (1990). "Fitting a diaphragm".
2312:
2277:
2244:
2154:"Diaphragms: Management of Side Effects"
1904:Cook, L.; Nanda, K.; Grimes, D. (2002).
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2036:
1866:The Global Library of Women's Medicine
1860:Linton, A.; Kiley, J. (January 2017).
1405:Kippley, John; Sheila Kippley (1996).
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905:
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107:Left in place for 6–8 hours afterwards
16:Cervical barrier type of birth control
2854:
2837:"Is the diaphragm making a comeback?"
2834:
2779:. John Wiley & Sons. p. 15.
2742:
2238:
1899:
1897:
1895:
1189:
1144:
1142:
1140:
1138:
1136:
1119:. Geneva: World Health Organization.
1091:. Geneva: World Health Organization.
1053:Corson, S. L.; Derman, R. J. (1995).
813:
799:In the United Kingdom, they cost the
2912:Over-the-counter oral contraceptives
2554:
2445:"A History of Birth Control Methods"
2380:Cervical Barrier Advancement Society
2368:
2160:. Reproductive Health Online. 2003.
2016:Cervical Barrier Advancement Society
1689:"Natural Spermicides and Femprotect"
1664:Medical University of South Carolina
1225:
1153:. Planned Parenthood. Archived from
947:
105:Inserted before sex with spermicide.
2897:Comparison of birth control methods
2432:
2418:10.1016/j.contraception.2003.11.006
2092:
2033:
1168:
1149:Johnson, Jennifer (December 2005).
993:from the original on 2 January 2017
674:Mensinga “occlusive pessary” (1911)
13:
3274:Male contraceptives in development
2828:
2511:(6). February 2000. Archived from
2196:10.1111/j.1552-6909.1986.tb01377.x
1892:
1407:The Art of Natural Family Planning
1133:
745:U.S., the Holland-Rantos Company.
740:and introduced the product to the
395:should not use a latex diaphragm.
14:
3338:
3294:
2820:from the original on 2017-09-24.
2803:New Dimensions In Women's Health
2224:10.1097/00006205-198207000-00004
1575:10.1097/00001648-199007000-00003
1358:from the original on 2008-05-31.
1073:from the original on 2017-09-24.
1037:from the original on 2017-09-24.
968:from the original on 2017-09-24.
937:from the original on 2017-09-24.
901:from the original on 2013-11-12.
843:from the original on 2017-09-24.
769:combined oral contraceptive pill
728:American birth control activist
264:
27:
2917:Oral contraceptive formulations
2793:
2717:
2692:
2667:
2649:
2638:from the original on 2016-03-09
2624:
2612:from the original on 2007-06-30
2583:
2572:from the original on 2006-09-12
2526:
2481:
2472:
2461:from the original on 2010-12-14
2397:
2333:
2306:
2271:
2249:Taking Charge of Your Fertility
2175:
2164:from the original on 2007-04-16
2146:
2121:
2065:
2022:from the original on 2006-10-05
1954:
1853:
1826:
1791:
1738:
1729:
1711:Woman's Natural Health Practice
1681:
1652:
1597:
1554:
1519:
1508:from the original on 2007-08-02
1448:
1398:
1362:
1214:from the original on 2007-09-29
1190:Allen, Richard (January 2004).
1151:"Diaphragms, Caps, and Shields"
1059:. CRC Press. pp. 211–212.
386:
351:sexually transmitted infections
345:Sexually transmitted infections
202:sexually transmitted infections
64:Failure rates (first year with
2835:Marks, Olivia (10 July 2015).
941:
226:
1:
1384:10.1016/S0010-7824(01)00204-9
806:
372:(HPV), the virus that causes
322:
2292:10.1016/0010-7824(86)90090-9
1812:10.1016/0010-7824(93)90063-D
1763:10.1016/0010-7824(95)00075-l
1666:. March 2006. Archived from
794:
570:and rest snugly against the
273:, can be assessed two ways:
120:Advantages and disadvantages
7:
3224:Fertility awareness methods
2599:Vital and Health Statistics
366:pelvic inflammatory disease
10:
3343:
2725:"NEU! das Singa diaphragm"
2566:The Margaret Sanger Papers
1693:Ovusoft.com Message Boards
1129:. WHO/MHP/HPS/EML/2021.02.
665:
514:
147:May be reused 1 to 3 years
3266:
3237:
3219:Calendar (rhythm) methods
3202:
3195:
3172:
3132:
3094:
3072:
3044:
3004:
2995:
2970:
2925:
2889:
2675:"A new kind of diaphragm"
2540:(MacMillan, 2001), p. 57
2129:"A new kind of diaphragm"
2100:"Contraceptive Diaphragm"
2074:Contracept Technol Update
1922:10.1002/14651858.CD002031
1196:American Family Physician
1113:World Health Organization
1085:World Health Organization
829:. Routledge. p. 62.
823:Everett, Suzanne (2014).
725:" starting in the 1860s.
716:in 1844. In the 1880s, a
151:
143:
135:
124:
119:
111:
101:
93:
88:
80:
72:
63:
55:
47:
42:
26:
21:
2534:Contraception: A History
2354:10.1001/jama.237.24.2643
2104:Family Practice Notebook
1341:Contraceptive Technology
866:Contraceptive technology
859:"Contraceptive efficacy"
857:Trussell, James (2011).
758:Although in Europe, the
447:
311:Contraceptive Technology
190:urinary tract infections
3134:Emergency Contraception
2245:Weschler, Toni (2002).
1979:10.1093/humrep/17.4.867
801:National Health Service
776:Janssen Pharmaceuticals
682:Photo of Caya diaphragm
580:urinary tract infection
400:urinary tract infection
196:for more than 24 hours
3054:Multi-month injections
2997:Hormonal contraception
2961:Levonorgestrel implant
2927:Long-acting reversible
2773:Shoupe, Donna (2011).
2382:. 2004. Archived from
2212:The Nurse Practitioner
2131:. 2015. Archived from
2106:. 2000. Archived from
1618:10.1001/jama.254.2.240
1540:10.1001/jama.248.2.184
683:
675:
597:, should be refitted.
559:
439:Use without spermicide
139:Catches menstrual flow
3317:Barrier contraception
3182:Vaginal pH modulation
3159:Low-dose mifepristone
3059:Progestogen-only pill
2953:Contraceptive implant
712:process, patented by
701:to be applied to the
681:
673:
655:contraceptive sponges
522:
332:barrier contraception
3214:Breastfeeding method
3124:Contraceptive sponge
3008:estrogen–progestogen
2957:Etonogestrel implant
2048:Ortho Women's Health
948:Wipf, Joyce (2015).
430:In the early 1920s,
406:Toxic shock syndrome
370:human papillomavirus
279:actual effectiveness
275:method effectiveness
198:toxic shock syndrome
3249:Non-penetrative sex
3241:vaginal intercourse
3206:vaginal intercourse
3026:Contraceptive patch
3021:Extended cycle Pill
2938:Intrauterine device
2902:Male contraceptives
2562:"Biographical Note"
1192:"Diaphragm Fitting"
790:Society and culture
765:intrauterine device
625:Mechanism of action
425:bacterial vaginosis
186:bacterial vaginosis
3149:Ulipristal acetate
3137:(Post-intercourse)
3031:Monthly injections
2661:2014-08-10 at the
2547:2016-06-13 at the
2452:Planned Parenthood
2315:Aust Fam Physician
1967:Human Reproduction
1457:Fam Plann Perspect
684:
676:
560:
251:sexual intercourse
3282:
3281:
3262:
3261:
3090:
3089:
2264:978-0-06-093764-5
2080:(4): 41–2. 1986.
1463:(3): 100–5, 135.
1416:978-0-926412-13-2
1351:978-0-9664902-6-8
1056:Fertility Control
875:978-1-59708-004-0
192:. If left in the
159:
158:
3334:
3299:
3298:
3297:
3290:
3200:
3199:
3046:Progestogen-only
3002:
3001:
2875:
2868:
2861:
2852:
2851:
2846:
2822:
2821:
2797:
2791:
2790:
2770:
2764:
2763:
2746:
2740:
2739:
2737:
2735:
2721:
2715:
2714:
2712:
2711:
2696:
2690:
2689:
2687:
2686:
2677:. Archived from
2671:
2665:
2653:
2647:
2646:
2644:
2643:
2628:
2622:
2620:
2618:
2617:
2611:
2596:
2587:
2581:
2580:
2578:
2577:
2558:
2552:
2530:
2524:
2523:
2521:
2520:
2497:
2488:
2485:
2479:
2476:
2470:
2469:
2467:
2466:
2460:
2449:
2441:
2430:
2429:
2401:
2395:
2394:
2392:
2391:
2372:
2366:
2365:
2348:(3): 2643–2644.
2337:
2331:
2330:
2310:
2304:
2303:
2275:
2269:
2268:
2252:
2242:
2236:
2235:
2207:
2179:
2173:
2172:
2170:
2169:
2150:
2144:
2143:
2141:
2140:
2125:
2119:
2118:
2116:
2115:
2096:
2090:
2089:
2069:
2063:
2062:
2060:
2059:
2040:
2031:
2030:
2028:
2027:
2008:
1997:
1996:
1990:
1982:
1958:
1952:
1951:
1941:
1901:
1890:
1889:
1883:
1875:
1873:
1872:
1857:
1851:
1850:
1830:
1824:
1823:
1795:
1789:
1788:
1782:
1774:
1742:
1736:
1733:
1727:
1725:
1723:
1722:
1713:. Archived from
1703:
1701:
1700:
1685:
1679:
1678:
1676:
1675:
1656:
1650:
1649:
1634:Am Fam Physician
1629:
1601:
1595:
1594:
1558:
1552:
1551:
1523:
1517:
1516:
1514:
1513:
1503:
1495:
1489:
1488:
1452:
1446:
1443:
1434:(885): 111–114.
1420:
1402:
1396:
1395:
1366:
1360:
1359:
1335:
1329:
1328:
1300:
1289:
1288:
1286:
1285:
1279:
1272:
1264:
1253:
1252:
1250:
1249:
1234:
1223:
1222:
1220:
1219:
1187:
1166:
1165:
1163:
1162:
1146:
1131:
1130:
1128:
1109:
1103:
1102:
1100:
1081:
1075:
1074:
1050:
1039:
1038:
1014:
1003:
1002:
1000:
998:
989:. 21 June 2016.
979:
970:
969:
945:
939:
938:
914:
903:
902:
900:
863:
854:
845:
844:
820:
714:Charles Goodyear
703:cervical opening
287:decrement tables
37:added for scale.
31:
19:
18:
3342:
3341:
3337:
3336:
3335:
3333:
3332:
3331:
3307:
3306:
3305:
3295:
3293:
3285:
3283:
3278:
3258:
3239:
3233:
3204:
3191:
3168:
3136:
3128:
3109:Internal condom
3104:External condom
3096:Barrier Methods
3086:
3068:
3040:
3007:
2991:
2966:
2928:
2921:
2885:
2879:
2831:
2829:Further reading
2826:
2825:
2814:
2798:
2794:
2787:
2771:
2767:
2760:
2748:
2747:
2743:
2733:
2731:
2723:
2722:
2718:
2709:
2707:
2698:
2697:
2693:
2684:
2682:
2673:
2672:
2668:
2663:Wayback Machine
2654:
2650:
2641:
2639:
2630:
2629:
2625:
2615:
2613:
2609:
2594:
2588:
2584:
2575:
2573:
2560:
2559:
2555:
2549:Wayback Machine
2531:
2527:
2518:
2516:
2499:
2498:
2491:
2486:
2482:
2477:
2473:
2464:
2462:
2458:
2447:
2443:
2442:
2433:
2402:
2398:
2389:
2387:
2374:
2373:
2369:
2338:
2334:
2321:(5): 713, 716.
2311:
2307:
2276:
2272:
2265:
2243:
2239:
2208:
2180:
2176:
2167:
2165:
2152:
2151:
2147:
2138:
2136:
2127:
2126:
2122:
2113:
2111:
2098:
2097:
2093:
2071:
2070:
2066:
2057:
2055:
2042:
2041:
2034:
2025:
2023:
2010:
2009:
2000:
1984:
1983:
1959:
1955:
1916:(3): CD002031.
1902:
1893:
1877:
1876:
1870:
1868:
1858:
1854:
1831:
1827:
1796:
1792:
1776:
1775:
1743:
1739:
1734:
1730:
1726:
1720:
1718:
1705:
1704:
1698:
1696:
1687:
1686:
1682:
1673:
1671:
1658:
1657:
1653:
1630:
1602:
1598:
1559:
1555:
1524:
1520:
1511:
1509:
1501:
1497:
1496:
1492:
1469:10.2307/2136156
1453:
1449:
1422:
1417:
1403:
1399:
1367:
1363:
1352:
1336:
1332:
1317:10.1363/3527003
1301:
1292:
1283:
1281:
1277:
1270:
1266:
1265:
1256:
1247:
1245:
1236:
1235:
1226:
1217:
1215:
1188:
1169:
1160:
1158:
1147:
1134:
1110:
1106:
1082:
1078:
1067:
1051:
1042:
1031:
1015:
1006:
996:
994:
981:
980:
973:
962:
946:
942:
931:
915:
906:
898:
876:
861:
855:
848:
837:
821:
814:
809:
797:
792:
730:Margaret Sanger
668:
627:
608:menstrual cycle
601:Vaginal tenting
517:
450:
441:
421:yeast infection
389:
374:cervical cancer
347:
325:
267:
229:
106:
38:
17:
12:
11:
5:
3340:
3330:
3329:
3324:
3319:
3304:
3303:
3280:
3279:
3277:
3276:
3270:
3268:
3264:
3263:
3260:
3259:
3257:
3256:
3251:
3245:
3243:
3235:
3234:
3232:
3231:
3226:
3221:
3216:
3210:
3208:
3197:
3193:
3192:
3190:
3189:
3184:
3178:
3176:
3170:
3169:
3167:
3166:
3161:
3156:
3154:Levonorgestrel
3151:
3146:
3140:
3138:
3130:
3129:
3127:
3126:
3121:
3116:
3111:
3106:
3100:
3098:
3092:
3091:
3088:
3087:
3085:
3084:
3078:
3076:
3070:
3069:
3067:
3066:
3061:
3056:
3050:
3048:
3042:
3041:
3039:
3038:
3033:
3028:
3023:
3018:
3012:
3010:
2999:
2993:
2992:
2990:
2989:
2983:
2980:Tubal ligation
2976:
2974:
2968:
2967:
2965:
2964:
2950:
2944:
2934:
2932:
2923:
2922:
2920:
2919:
2914:
2909:
2904:
2899:
2893:
2891:
2890:Related topics
2887:
2886:
2878:
2877:
2870:
2863:
2855:
2849:
2848:
2830:
2827:
2824:
2823:
2812:
2792:
2785:
2765:
2758:
2741:
2716:
2691:
2666:
2648:
2623:
2582:
2553:
2532:Robert JĂĽtte,
2525:
2489:
2480:
2471:
2431:
2396:
2367:
2332:
2305:
2270:
2263:
2237:
2174:
2145:
2120:
2091:
2064:
2032:
1998:
1973:(4): 867–869.
1953:
1891:
1852:
1841:(11): 764–74.
1825:
1790:
1757:(5): 289–291.
1737:
1728:
1680:
1651:
1596:
1553:
1534:(2): 184–187.
1518:
1490:
1447:
1445:
1444:
1421:, which cites:
1415:
1397:
1361:
1350:
1330:
1290:
1254:
1224:
1167:
1132:
1104:
1076:
1065:
1040:
1029:
1004:
971:
960:
940:
929:
904:
874:
846:
835:
811:
810:
808:
805:
796:
793:
791:
788:
667:
664:
626:
623:
516:
513:
449:
446:
440:
437:
388:
385:
346:
343:
324:
321:
304:
303:
300:
297:
266:
263:
228:
225:
214:natural rubber
167:barrier method
157:
156:
153:
149:
148:
145:
141:
140:
137:
133:
132:
129:
122:
121:
117:
116:
113:
109:
108:
103:
102:User reminders
99:
98:
95:
91:
90:
86:
85:
82:
78:
77:
74:
70:
69:
61:
60:
57:
53:
52:
49:
45:
44:
40:
39:
32:
24:
23:
15:
9:
6:
4:
3:
2:
3339:
3328:
3325:
3323:
3320:
3318:
3315:
3314:
3312:
3302:
3292:
3291:
3288:
3275:
3272:
3271:
3269:
3265:
3255:
3252:
3250:
3247:
3246:
3244:
3242:
3236:
3230:
3227:
3225:
3222:
3220:
3217:
3215:
3212:
3211:
3209:
3207:
3201:
3198:
3194:
3188:
3185:
3183:
3180:
3179:
3177:
3175:
3171:
3165:
3164:Yuzpe regimen
3162:
3160:
3157:
3155:
3152:
3150:
3147:
3145:
3142:
3141:
3139:
3135:
3131:
3125:
3122:
3120:
3117:
3115:
3112:
3110:
3107:
3105:
3102:
3101:
3099:
3097:
3093:
3083:
3080:
3079:
3077:
3075:
3071:
3065:
3062:
3060:
3057:
3055:
3052:
3051:
3049:
3047:
3043:
3037:
3034:
3032:
3029:
3027:
3024:
3022:
3019:
3017:
3014:
3013:
3011:
3009:
3003:
3000:
2998:
2994:
2987:
2984:
2981:
2978:
2977:
2975:
2973:
2972:Sterilization
2969:
2962:
2958:
2954:
2951:
2948:
2945:
2943:
2939:
2936:
2935:
2933:
2930:
2929:contraception
2924:
2918:
2915:
2913:
2910:
2908:
2905:
2903:
2900:
2898:
2895:
2894:
2892:
2888:
2883:
2882:Birth control
2876:
2871:
2869:
2864:
2862:
2857:
2856:
2853:
2844:
2843:
2838:
2833:
2832:
2819:
2815:
2813:9780763765927
2809:
2805:
2804:
2796:
2788:
2786:9781444342635
2782:
2778:
2777:
2776:Contraception
2769:
2761:
2759:9780857111562
2755:
2751:
2745:
2730:
2726:
2720:
2705:
2701:
2695:
2681:on 2015-10-26
2680:
2676:
2670:
2664:
2660:
2657:
2652:
2637:
2633:
2627:
2621:See Table 56.
2608:
2604:
2600:
2593:
2586:
2571:
2567:
2563:
2557:
2550:
2546:
2543:
2539:
2535:
2529:
2515:on 2014-02-22
2514:
2510:
2506:
2502:
2496:
2494:
2484:
2475:
2457:
2454:. June 2002.
2453:
2446:
2440:
2438:
2436:
2427:
2423:
2419:
2415:
2411:
2407:
2406:Contraception
2400:
2386:on 2009-01-14
2385:
2381:
2377:
2371:
2363:
2359:
2355:
2351:
2347:
2343:
2336:
2328:
2324:
2320:
2316:
2309:
2301:
2297:
2293:
2289:
2286:(4): 381–93.
2285:
2281:
2280:Contraception
2274:
2266:
2260:
2256:
2251:
2250:
2241:
2233:
2229:
2225:
2221:
2218:(7): 21, 25.
2217:
2213:
2205:
2201:
2197:
2193:
2189:
2185:
2178:
2163:
2159:
2155:
2149:
2135:on 2015-10-26
2134:
2130:
2124:
2110:on 2006-09-02
2109:
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2087:
2083:
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2075:
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2054:on 2006-10-16
2053:
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2037:
2021:
2017:
2013:
2007:
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1800:Contraception
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1764:
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1751:Contraception
1748:
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1716:
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1670:on 2007-10-12
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1378:(5): 267–75.
1377:
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1372:Contraception
1365:
1357:
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1343:
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1326:
1322:
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1244:on 2006-10-20
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734:Comstock laws
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710:vulcanization
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265:Effectiveness
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171:birth control
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112:Clinic review
110:
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94:Reversibility
92:
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83:
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71:
67:
62:
58:
54:
50:
46:
41:
36:
30:
25:
20:
3267:Experimental
3118:
3114:Cervical cap
3082:Ormeloxifene
3064:Vaginal ring
3036:Vaginal ring
2942:Hormonal IUD
2842:The Guardian
2840:
2802:
2795:
2775:
2768:
2749:
2744:
2732:. Retrieved
2728:
2719:
2708:. Retrieved
2706:. 2019-12-03
2703:
2694:
2683:. Retrieved
2679:the original
2669:
2651:
2640:. Retrieved
2632:"Diaphragms"
2626:
2614:. Retrieved
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2598:
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2474:
2463:. Retrieved
2451:
2412:(4): 263–6.
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2384:the original
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2240:
2215:
2211:
2190:(2): 123–9.
2187:
2183:
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2157:
2148:
2137:. Retrieved
2133:the original
2123:
2112:. Retrieved
2108:the original
2103:
2094:
2077:
2073:
2067:
2056:. Retrieved
2052:the original
2047:
2044:"Diaphragms"
2024:. Retrieved
2015:
2012:"Diaphragms"
1987:cite journal
1970:
1966:
1956:
1913:
1909:
1869:. Retrieved
1865:
1855:
1838:
1835:J Reprod Med
1834:
1828:
1806:(1): 29–35.
1803:
1799:
1793:
1779:cite journal
1754:
1750:
1740:
1731:
1719:. Retrieved
1715:the original
1710:
1697:. Retrieved
1692:
1683:
1672:. Retrieved
1668:the original
1663:
1654:
1640:(5): 231–6.
1637:
1633:
1612:(2): 240–5.
1609:
1605:
1599:
1566:
1563:Epidemiology
1562:
1556:
1531:
1527:
1521:
1510:. Retrieved
1493:
1460:
1456:
1450:
1431:
1427:
1406:
1400:
1375:
1371:
1364:
1340:
1333:
1311:(6): 270–3.
1308:
1304:
1282:. Retrieved
1275:the original
1246:. Retrieved
1242:the original
1216:. Retrieved
1199:
1195:
1159:. Retrieved
1155:the original
1126:10665/345533
1116:
1107:
1098:10665/325771
1088:
1079:
1055:
1019:
995:. Retrieved
986:
950:
943:
919:
865:
825:
798:
780:
773:
760:cervical cap
757:
750:
747:
727:
707:
685:
660:
651:
647:
643:
637:through the
628:
619:prescription
616:
605:
600:
599:
591:pelvic floor
588:
584:
565:
561:
552:
498:
492:
490:
484:
482:
478:retroversion
464:
462:
451:
442:
432:Marie Stopes
429:
410:
404:
397:
390:
387:Side effects
381:microbicides
378:
363:
348:
340:
336:
329:
326:
318:
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310:
309:
305:
291:
278:
274:
268:
259:
255:
248:
233:
230:
218:
183:
162:
160:
3187:Nonoxynol-9
3174:Spermicides
1695:. June 2003
1238:"Diaphragm"
987:www.cdc.gov
738:Netherlands
509:microbicide
493:flat spring
485:coil spring
417:nonoxynol-9
283:Pearl Index
227:Medical use
81:Typical use
73:Perfect use
3311:Categories
3254:Abstinence
3229:Withdrawal
3196:Behavioral
3144:Copper IUD
2947:Copper IUD
2734:August 13,
2710:2020-08-14
2685:2015-11-08
2642:2016-05-26
2616:2007-05-20
2576:2006-10-21
2519:2017-09-24
2465:2010-12-16
2390:2006-09-17
2168:2007-09-15
2139:2015-11-08
2114:2006-10-18
2058:2006-10-18
2026:2006-10-18
1871:2024-08-12
1721:2006-09-17
1699:2006-10-17
1674:2006-08-06
1512:2007-07-22
1284:2007-07-22
1248:2006-10-15
1218:2006-10-15
1161:2006-10-15
807:References
572:pubic bone
529:pubic bone
501:disposable
323:Advantages
244:spermicide
179:spermicide
128:protection
66:spermicide
43:Background
3203:Including
3119:Diaphragm
3016:Oral pill
2986:Vasectomy
2376:"Sponges"
1930:1469-493X
997:1 January
892:781956734
884:0091-9721
795:Economics
723:womb veil
612:ovulation
595:C-section
553:diaphragm
505:BufferGel
474:rectocele
470:cystocele
163:diaphragm
97:Immediate
56:First use
22:Diaphragm
3301:Medicine
3238:Avoiding
3006:Combined
2982:(female)
2818:Archived
2729:Medintim
2704:Medintim
2659:Archived
2636:Archived
2607:Archived
2570:Archived
2545:Archived
2456:Archived
2426:15033398
2362:12259737
2162:Archived
2086:12340681
2020:Archived
2018:. 2000.
1948:12137639
1880:cite web
1591:30392531
1506:Archived
1392:11448468
1356:Archived
1325:14744659
1212:Archived
1208:14727824
1115:(2021).
1087:(2019).
1071:Archived
1035:Archived
991:Archived
966:Archived
935:Archived
896:Archived
841:Archived
774:In 2014
767:and the
458:silicone
364:Because
236:teaspoon
210:silicone
144:Benefits
131:Possible
2884:methods
2327:2346425
2300:3780236
2232:7121900
2204:3517255
1939:8411872
1847:8592310
1820:8403903
1771:7628202
1646:2718900
1626:3999367
1583:2083303
1548:7087109
1485:8354373
1477:2136156
1440:1448019
666:History
576:urethra
533:urethra
525:bladder
515:Fitting
413:urethra
355:condoms
136:Periods
51:Barrier
35:quarter
3322:Vagina
3287:Portal
2988:(male)
2931:(LARC)
2810:
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2756:
2605:(25).
2542:online
2424:
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882:
872:
833:
718:German
635:uterus
631:cervix
568:cervix
557:rectum
549:cervix
545:fornix
541:uterus
537:vagina
423:, and
194:vagina
175:cervix
3074:SERMs
2610:(PDF)
2595:(PDF)
2459:(PDF)
2448:(PDF)
1587:S2CID
1502:(DOC)
1473:JSTOR
1278:(PDF)
1271:(PDF)
899:(PDF)
862:(PDF)
749:case
699:resin
696:cedar
692:honey
688:lemon
555:, 9:
551:, 8:
547:, 7:
543:, 6:
539:, 5:
535:, 4:
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527:, 2:
476:, or
454:latex
448:Types
393:latex
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212:, or
206:latex
177:with
165:is a
152:Risks
89:Usage
59:1880s
2808:ISBN
2781:ISBN
2754:ISBN
2736:2020
2422:PMID
2358:PMID
2342:JAMA
2323:PMID
2296:PMID
2259:ISBN
2228:PMID
2200:PMID
2082:PMID
1993:link
1944:PMID
1926:ISSN
1914:2011
1886:link
1843:PMID
1816:PMID
1785:link
1767:PMID
1642:PMID
1622:PMID
1606:JAMA
1579:PMID
1544:PMID
1481:PMID
1436:PMID
1411:ISBN
1388:PMID
1346:ISBN
1321:PMID
1204:PMID
1061:ISBN
1025:ISBN
999:2017
956:ISBN
925:ISBN
888:OCLC
880:ISSN
870:ISBN
831:ISBN
783:PATH
456:and
277:and
188:and
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1975:doi
1934:PMC
1918:doi
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1532:248
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1380:doi
1313:doi
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359:HIV
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