Diaphragm more effective contraceptive than sponge

January 01, 0001

Diaphragm more effective contraceptive than sponge

Clinical Question: How effective are the vaginal sponge and the diaphragm (used with a spermicidal cream) as contraceptives?

Bottom line: In a large US trial, for every 100 women who used the sponge for a year, about 17 became pregnant. Of those who used the diaphragm, 13 became pregnant. In a UK trial, for every 100 women who used the sponge for a year, about 25 became pregnant. Of the diaphragm users, 11 became pregnant. About 30% more women stopped using the sponge than the diaphragm. Allergy to the sponge was a problem for some women. However, discomfort caused about the same numbers of women to stop using either birth control method.

Caveat: The potential adverse effect of the spermicide nonoxynol-9, in high concentration in the vagina from sponge or diaphragm use remains a concern.1 Other randomised controlled trials will be needed to resolve the potential role of spermicides in preventing sexually transmitted infections or in causing adverse effects. The company manufacturing the sponge has filed for bankruptcy, so the continued availability of the sponge is uncertain at this time.

Context: The contraceptive vaginal sponge was developed as an alternative to the contraceptive diaphragm. The sponge, made of polyurethane impregnated with nonoxynol-9 (1g), releases 125mg of the spermicide over 24 hours of use. Unlike the diaphragm, the sponge can be used for more than 1 coital act within 24 hours without the insertion of additional spermicide, and the sponge does not require fitting or a prescription from a physician.

Cochrane Systematic Review: Kuyoh MA et al. Sponge versus diaphragm for contraception. Cochrane Reviews, 2011, Issue 3. Article No. CD003172. DOI:10.1002/14651858. CD003172. This review contains 2 studies involving 1689 participants.

Cochrane PEARLS Practical Evidence About Real Life Situations. No. 317, October 2008.
Written by Brian R McAvoy. Published by the Cochrane Primary Care Group

Category: W. Pregnancy, Family Planning. Keywords: contraception, diaphragm, sponge
Synopsis edited by Dr Linda French, Toledo, Ohio. Posted on Global Family Doctor 20 September 2011

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Pearls are an independent product of the Cochrane primary care group and are meant for educational use and not to guide clinical care.