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New types of diaphragms and cervical caps versus older types of diaphragms and different gels for contraception: a systematic review
  1. Ingela Lindh1,
  2. Jwan Othman1,
  3. Mariann Hansson2,
  4. Ann-Catrin Ekelund3,
  5. Therese Svanberg4,
  6. Annika Strandell1
  1. 1 Department of Obstetrics and Gynecology, Sahlgrenska Academy at Gothenburg University, Sahlgrenska University Hospital, Gothenburg, Sweden
  2. 2 Department of Gynecology, Kungshöjd, Gothenburg, Sweden
  3. 3 Medical Library, Skaraborg Hospital, Lidköping, Sweden
  4. 4 Medical Library, Sahlgrenska University Hospital, Gothenburg, Sweden
  1. Correspondence to Dr Ingela Lindh, Department of Obstetrics and Gynecology, Sahlgrenska Academy at Gothenburg University, Sahlgrenska University Hospital, Gothenburg 413 45, Sweden; ingela.lindh{at}


Introduction Our primary objective was to evaluate whether new types of single-size diaphragms or cervical caps differ in prevention of pregnancy compared with older types of diaphragms, and whether different types of gels differ in their ability to prevent pregnancy. A secondary aim was to evaluate method discontinuation and complications.

Methods A comprehensive search was conducted in PubMed, Embase and the Cochrane Library. The certainty of evidence was assessed according to the GRADE system.

Results Four randomised controlled studies were included in the assessment. When comparing the new and old types of female barrier contraceptives the 6-month pregnancy rate varied between 11%–15% and 8%–12%, respectively. More women reported inability to insert or remove the FemCap device (1.1%) compared with the Ortho All-Flex diaphragm (0%) (p<0.0306). Urinary tract infections were lower when using the single-size Caya, a difference of −6.4% (95% CI −8.9 to −4.09) compared with the Ortho All-Flex diaphragm. The 6-month pregnancy rate for acid-buffering gel and spermicidal nonoxynol-9 gel varied between 10% and 12%. The discontinuation rate was lower in women who used acid-buffering gel compared with nonoxynol-9 gel (risk ratio (RR) 0.77, 95% CI 0.68 to 0.97).

Conclusions Pregnancy rates were generally high in women using female barrier contraceptives. There was no difference in the efficacy for pregnancy prevention between the new types of diaphragms and cervical caps and the older diaphragms. The new types of diaphragms and cervical caps resulted in fewer urinary tract infections. Acid-buffering gels did not differ from spermicidal nonoxynol-9 gels regarding pregnancies but seemed to be better tolerated.

  • barrier methods

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  • Contributors TS and ACE conducted the searches and made the first selection of articles. All authors contributed to the selection process and quality assessment of the articles. AS, IL, JO and MH took part in a critical discussion regarding the findings. The first draft of the manuscript was prepared by IL and AS. AS performed the meta-analyses. All authors have read and approved the final version for publication.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests AS has nothing to disclose, IL has received compensation from Exeltis and Campus Pharma for lectures during the previous 3 years, and JO has received compensation from Astellas for lectures;

  • Patient and public involvement Patients and/or the public were not involved in the design, or conduct, or reporting, or dissemination plans of this research.

  • Provenance and peer review Not commissioned; externally peer reviewed.