Contraceptive vaginal rings: a review.

Development efforts on contraceptive vaginal rings were initiated over 40 years ago based on two principles: the capacity of the vaginal epithelium to absorb steroids and the capacity of elastomers to release these hormones at a nearly constant rate. Numerous models of contraceptive vaginal rings (CVRs) have been studied, but only two have reached the market: NuvaRing, a combined ring that releases etonogestrel (ENG) and ethinylestradiol (EE), and Progering, a progesterone-releasing ring for use in lactating women. The main advantages of CVRs are their effectiveness (similar to or slightly better than the pill), ease of use without the need of remembering a daily routine, user's ability to control initiation and discontinuation, nearly constant release rate allowing for lower doses, greater bioavailability and good cycle control with the combined ring. The main disadvantages are related to the mode of delivery; CVRs may cause vaginal discharge and complaints, ring expulsion is not uncommon, the ring may be felt during coitus and vaginal insertion may be unpleasant for some women. The studies reviewed in this article provide evidence that CVRs are safe, effective and highly acceptable to women. There is no doubt that CVRs offer a new, effective contraceptive option to women, expanding their available choices of hormonal contraception.

State-of-the-art of non-hormonal methods of contraception: I. Mechanical barrier contraception.

Mechanical barriers, specifically male condoms, command renewed interest and are used today by more people. The worldwide prevalence rate of male condoms was about 6% in 2007 corresponding to 65 million cohabiting couples. The prevalence of female barrier methods, including diaphragms, cervical caps and female condoms has declined to less than 1% of women in North America and in north-west Europe. Even smaller percentages use female barriers elsewhere. First-year life table pregnancy probabilities of mechanical barrier methods range from 4 to 19 per hundred in clinical trials. The male condom is the only proved preventive tool against several sexually transmitted infections (STIs), especially HIV. The effectiveness of the diaphragm and cervical caps in this regard appears limited. Further research is needed to measure the efficacy of female condoms in disease prevention. Sponges are not known to protect against STIs. Because of their ease of use and availability, low short-term costs, relative freedom from side effects, and usefulness in combating STIs, mechanical barrier methods, especially condoms, will continue to be used on a large scale. For our literature search we used personal files, search engines such as Popline, Medline, PubMed and Google, and data bases of WHO, FHI and Cochrane Library.

"Simple methods" and "determined contraceptors": the statistical evaluation of fertility control, 1957-1968.

PIP: This paper discusses the use of two US research projects in legitimizing fertility control through the authority of scientific research. The projects included field trials of "simple methods of contraception" and IUDs that were sponsored by the US Population Council and the Planned Parenthood Federation of America (PPFA). Research was used to test whether simple methods and the IUD were safe and effective. In 1957, contraception research did not have the support of the academic medical leadership, and most state health departments did not distribute birth control literature. The clinical field trials were conducted through 95 PPFA-affiliated centers under the direction of PPFA's Medical Director Mary Calderone during 1957-64. The institutional affiliation served to give legitimacy to PPFA and to validate use-effectiveness of creams, jellies, or spermicides with a diaphragm. The Population Council reactivated the National Committee on Maternal Health (NCMH) with Christopher Tietze as head and as a member of the Advisory Committee of the new PPFA Clinical Investigation Program. Clarence Gamble, who believed in the "anything that works approach," severed his relationship with NCMH. Calderone thought that "any method was better than no method, but the most critical factor in effectiveness was availability." What was innovative about these trials was the study of the practice of contraception and the use of a statistical measure. The trials found that the diaphragm was the most effective and acceptable method. The EMKO brand was the most popular foam. Tietze's evaluation of five different IUDs during 1963-68 did not meet the rigorous criteria of Louis Lasagna, but did determine the regularity and continuity of contraceptive practice. Life table methods were used to demonstrate a statistically valid result. By 1964 contraception became recognized in the medical field. By 1968 a statistically valid result among "determined contraceptors" established the medical legitimacy of the IUD, and global distribution ensued.^ieng

Condón femenino: nuevo dispositivo de barrera

Es posible que próximamente las mujeres tengan su propio condón: un nuevo dispositivo anticonceptivo que también podría ofrecer protección contra las enfermedades de transmisión sexual (ETS). El "condón femenino" es una funda desechable de látex o plástico blando, que se coloca dentro de la vagina. Muchos de los métodos eficaces para el control de la natalidad son controlados por los mujeres, pero el principal método para la protección contra las ETS (el condón masculino) no lo está. En la estela de la pandemia del SIDA, el brindar a las mujeres el potencial de proteger su salud sexual tiene mayor urgencia que nunca

An historical look at a contemporary question: the cervical cap.

PIP: The cervical cap was most likely invented during the 19th century and was rediscovered in 1908 by a Viennese physician. The cap was always more popular in Europe than in the US, and the introduction of oral contraceptives and the IUD in the 1960s led to a declining interest in barrier methods. In 1977, the US Food and Drug Administration banned distribution of the cervical cap, presumably in reaction to outbreaks of toxic shock syndrome and despite rising interest in the device on the part of the woman's health movement. It is important for health educators to be informed about empirical research about the cervical cap so that they can counsel consumers in the event that the device is reclassified for general use. Acceptor studies have identified convenience, safety, spontaneity, and comfort as reasons for selecting the cervical cap, while difficult insertion and removal, odor, partner discomfort, and uncertainty about contraceptive effectiveness are cited as reasons for disliking this device. Dislodgement has been a major problem, experienced by almost half of cap acceptors at some point. Discontinuation rates after 6 months of use have been in the 25-40% range. No cases of pelvic inflammatory disease or significant cervical pathology have been recorded. The unplanned pregnancy rate associated with the cervical cap has been estimated to be about 8%. Omission of spermicide, dislodgement, faulty technique, and irregular usage account for most of these failures. There is a need for additional research addressing the issues and documenting the limits of safe cervical cap use.^ieng

The cervical cap as a contraceptive alternative.

A recent resurgence in the United States of popular interest in the cervical cap has prompted reexamination of its safety and effectiveness as a contraceptive device. Despite widespread use in Europe, few studies are available for evaluation of this non-hormonal, non-invasive barrier method of contraception. The U.S. Food and Drug Administration classified the cap as a "significant risk device" and has limited dispensing of the cap to providers with Investigational Device Exemptions. Use and fitting of the cervical cap are described.

PIP: This paper describes the clinical use of the cervical cap as a contraceptive alternative. The US Food and Drug Administration has classified the cap as a "significant risk device" and has limited dispensing of the cap to practitioners with Investigational Device Exemptions. The most recent study of the cervical cap's safety and effectiveness, based on the experience of 371 women, found a method failure rate of 3.7/100 women/year. Accidental dislodgement of the device during intercourse appeared to be the major factor in the failure rate. Use of the Vimule cap has been associated with vaginal lesions; thus, approval of exemptions for this device has been withdrawn. Only 50-70% of women who request caps can be fitted due to either contraindications to use or problems with fit. Included among the device's contraindications are medical illnesses that make pregnancy a significant health risk, an abnormal Pap smear, gonorrhea, and less than 6 weeks postpartum or postabortion. Some researchers maintain that the cap's contraceptive protection is attributable to its barrier effect and that a spermicidal supplement is not necessary. Efforts are currently underway to improve the basic design of the device, eg disposable cervical caps, caps impregnated with spermicide, caps with outflow valves, and caps molded to fit the cervix. US drug manufacturers have expressed little interest in the cervical cap, leaving it to women's health activists and foreign manufacturers to promote the device as a contraceptive option.

Barrier contraception: a comprehensive overview.

The barrier class of contraceptives used either alone or with supplementary spermicidal agents includes the most ancient of methods for the control of human fertility. Modern innovations have effected marked improvement in their efficacy and acceptability, so that they have become key means of controlling fertility in the world today. The traditional diaphragms and condoms decreased in popularity to some extent when methods such as the OCs and IUDs became available for general use. However, the plain or medicated barriers are regaining their rightful position in our contraceptive armamentarium as more and more questions are being raised about the real or potential adverse side effects of systemic and intrauterine contraceptives. There is evidence throughout the world of the growing popularity and use of locally acting mechanical and/or spermicidal contraceptive methods. Their impact upon the increasing world population can be expected to become even greater when the true need for the control of fertility becomes more generally recognized and appreciated.

The cervical cap: past and current experience.

In the past several years, a new trend has emerged where women in increasingly growing numbers are becoming hesitant to accept the risks associated with hormonal and invasive methods of birth control. It is as part of this trend that a revival of sorts is occurring with the cervical cap, a form of birth control with roots which precede recorded history and which, in its modern form, was widely advocated in late 19th and early 20th century Europe. Based on the principle of occlusion, the cervical cap appears effective and risk-free, both vital concerns to women of all centuries. Women's health activists and organizations have been in the forefront of this revival. Two of the first organizations to take an active interest in making the cap available were the New Hampshire Feminist Health Center in Concord, New Hampshire, and the Emma Goldman Women's Health Clinic in Iowa City, Iowa. The National Women's Health Network, a national organization based in Washington, D.C., has also been an active advocate on the cervical cap's behalf.

PIP: The historical background of the development and use of cervical caps and recent efforts to revive its popularity were described, and current issues concerning its use were discussed. The cervical cap is generally made of rubber, shaped like a thimble, fitted over the cervix, and held in place by suction. It functions as a mechanical device to prevent sperm from entering the cervix. It is sometimes used in combination with chemical barrier methods. During the 1800s various types of rubber cervical caps were invented and during the 1900s many types of caps, made from either metal, celluloid, or rubber, experienced fluctuating levels of popularity. Cervical caps declined in popularity as acceptance of oral contraceptives and IUDs increased. As this trend continued, fewer caps were manufactured, caps became increasingly difficult to obtain, and fewer medical personnel were trained to provide the method. In response to growing concern over the side effects associated with IUDs and oral contraceptives, many women are expressing a renewed interest in cervical caps. Recently the New Hampshire Feminist Health Center and the Emma Goldman Women's Health Clinic in Iowa City began to fit women with cervical caps. Currently only a few cap sizes are available and as a result a large proportion of women cannot be properly fitted with the device. Current issues center on 1) the length of time the cap can safely be left in place; 2) the type of material from which they should be manufactured; and 3) whether a spermicide should be used with the device. Failure rates and contraindications were also discussed. The device is not currently approved by the Food and Drug Administration and since caps are a low profit item the drug industry will not expend money for the clinical testing of the device. Recently the National Institute of Health made funds available for clinic testing. The cultural acceptability of the device and physician attitudes toward the device were also discussed. Several researchers are attempting to develop improved cervical caps.

IUDs--update on safety, effectiveness, and research.

After nearly two decades of use, the IUD remains "a generally safe, effective and useful form of birth control" (337). With fewer than six pregnancies per 100 women-years of use and fewer than ten deaths per one million women-years of use, according to a comprehensive new review by the United States Food and Drug Administration, the IUD has an important place in modern family planning programs.