• L Cook, K Nanda, and D Grimes.
• Clinical Trials, Family Health International, 2224 E NC HWY 54, Durham, NC 27707, USA. lcook@fhi.org
• Cochrane Db Syst Rev. 2001 Jan 1; 2003 (2): CD002031CD002031.

BackgroundThe diaphragm is usually used with a spermicide. However, some practitioners have suggested that spermicides offer no additional contraceptive protection and have advocated alternative guidelines for the use of diaphragms.ObjectivesThe objective of this review was to compare the effectiveness, safety and acceptability of the diaphragm with and without spermicide.Search StrategyWe searched MEDLINE, EMBASE, POPLINE, CINAHL, the Cochrane Controlled Trials Register, and reference lists of relevant articles. In addition, we contacted experts in the field to identify unpublished studies.Selection CriteriaRandomized controlled trials comparing women of reproductive age using the diaphragm with and without spermicide as the sole contraceptive method that reported clinical outcomes.Data Collection And AnalysisTwo reviewers independently extracted data on outcomes and trial characteristics and any discrepancies were resolved by consensus or by consultation with the third reviewer. The results of the one identified study are presented descriptively.Main ResultsWe identified only one study. No significant difference was found in the pregnancy rates (with typical use or consistent use) or discontinuation rates between the diaphragm-with-spermicide and diaphragm-without-spermicide groups. There was a trend towards higher pregnancy rates in the diaphragm-without-spermicide group. However, this study failed to recruit the planned number of participants and was consequently underpowered.Reviewer's ConclusionsAs only one underpowered study was identified, we cannot distinguish between the contraceptive effectiveness of the diaphragm with and without spermicide. We cannot draw any conclusion at this point, further research is needed.

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