providers and available only by prescription.
For use, the diaphragm and spermicide can be inserted hours before intercourse. If more than 6 hours elapse, the diaphragm can remain but additional spermicide is placed in the upper vagina for maximum protection. Spermicide is reapplied before each subsequent coital episode. The diaphragm is not removed for at least 6 hours after intercourse. Because toxic shock syn drome has been described following its use, it may be worth while to remove the diaphragm at 6 hours, or at least the next morning, to minimize this rare event. Diaphragm use is associ ated with a slightly greater rate of urinary infections, presumably from urethral irritation by the ring under the symphysis.
FemCap is currently the only available cervical cap in the United States. Made of silicone rubber, it has a sailor-cap shape with a dome that covers the cervix and a lared brim, which allows the cap to be held in place by the muscular walls of the upper vagina. Available in 22-, 26-, and 30-mm sizes, it is used with a spermicide applied once at insertion to both sides of the dome cup. For contraception, it should remain in place for 6 hours following coitus and may remain for up to 48 hours. Even with proper itting and correct use, pregnancy rates with this method are higher that with the diaphragm (Gallo, 2012b; Mauck, 1999).
These family planning methods attempt to identiY the fertile days each cycle and advise sexual abstinence during these days. Their major drawback is their limited eicacy, which is shown in Table 38-1r. Common forms of these fertility awarenessbased (FAB) methods include Standard Days, Temperature Rhythm, Cervical Mucus, and Symptothermal Methods. Some smartphone applications aim to assist these practices (Fehring, 2013).
he Standard Days Method counsels women to avoid unprotected intercourse during cycle days 8 through 19. For successful use, women must have regular monthly cycles of 26 to 32 days. hose who use this method can mark a calendar or can use Cycle-Beads, which is a ring of counting beads, to keep track of their days.
he Temperature Rhythm Method relies on a sustained O.4°F rise in the basal body temperature, which usually precedes ovulation. For maximum eicacy, the woman must abstain from intercourse from'the irst day of menses through the third day after the temperature increase.
he Cervical Mucus Method, also called the Two-Day Method or Billings Method, relies on awareness of vaginal "dryness" and "wetness." hese reflect changes in the amount and quality of cervical mucus at diferent times in the menstrual cycle. With the Billings Method, abstinence is required from the beginning of menses until 4 days after slippery mucus is identified. With the T wo-Day Method, intercourse is considered safe if a woman did not note mucus on the day of planned intercourse or the day prior.
he Symptothermal Method combines changes in cervical mucus-onset of fertile period; changes in basal body temperature-end of fertile period; and calculations to estimate the time of ovulation. This method is more complex to learn and apply, but it does not appreciably improve eicacy.
These contraceptives are marketed variously as creams, jellies, suppositories, films, and aerosol foam. \10st can be purchased without a prescription. They are considered a less efective method (see Table 38-1). If pregnancy does occur, they are not teratogenic (Briggs, 2015).