••• Chapter 61^ Family Planning and Sterilization^617
❍ Can oil-based products be used with female condoms?
Yes. The synthetic material it is made with (nitrile or polyurethane) is stronger than latex and is less susceptible to
deterioration.
❍ When should a diaphragm be inserted?
Ideally, <2 hours before intercourse. If placed 3 to 6 hours before intercourse, an additional dose of spermicide
should be inserted. For every act of intercourse after the diaphragm has been inserted, another dose of spermicide
should be placed.
❍ After insertion, how long does the diaphragm provide effective contraception?
A diaphragm should be left in place for 6 hours following intercourse. For longer intervals, additional spermicide is
recommended.
❍ What is the failure rate with diaphragm?
6% with perfect use, 16% with typical use.
❍ How much spermicide should be used with the cervical cap?
The dome should be one-third full. Additional spermicide is not necessary for up to 48 hours.
❍ Are female condoms, diaphragms, and caps equally effective for nulliparous and parous women?
For nulliparous women, yes. For parous women, the cap is less effective.
❍ How frequently should women using cervical caps have Pap smears?
The FDA recommends a pap after 3 months of use. Otherwise women using vaginal barriers need no special
follow-up.
INTRAUTERINE DEVICE (IUD)
❍ What percentage of women use an IUD?
In the United States, about 7% of contraceptive users chose an IUD. Worldwide, up to 50% of contraceptive users
use them.
❍ Who are the candidates of an IUD?
Candidates of IUD:
- Multiparous and nulliparous women at low risk of STDs
- Women who desire long-term reversible contraception
- Women with the following medical conditions:
- Diabetes
- HIV-positive women
- Immediately postabortal or spontaneous abortion
- Thromboembolism
- Menorrhagia/dysmenorrhea—levonorgestrel only preferred
- Breastfeeding
- Breast cancer—copper only within first 5 years of diagnosis