Problems Reported as Side Effects or Problems With Use

May or may not be due to the method.

• Side effects or problems with spermicides or diaphragms affect women’s satisfaction and use of the method. They deserve the provider’s attention. If the client reports side effects or problems, listen to her concerns, give her advice and support, and, if appropriate, treat. Make sure she understands the advice and agrees.
• Offer to help the client choose another method—now, if she wishes, or if problems cannot be overcome.

Difficulty inserting or removing diaphragm

• Give advice on insertion and removal. Ask her to insert and remove the diaphragm in the clinic. Check its placement after she inserts it. Correct any errors.

Discomfort or pain with diaphragm use

• A diaphragm that is too large can cause discomfort. Check if it fits well.
  
  • Fit her with a smaller diaphragm if it is too large.
  • If fit appears proper and different kinds of diaphragms are available, try a different diaphragm.
• Ask her to insert and remove the diaphragm in the clinic. Check the diaphragm’s placement after she inserts it. Give further advice as needed.
• Check for vaginal lesions:
  
  • If vaginal lesions or sores exist, suggest she use another method temporarily (condoms or oral contraceptives) and give her supplies. Lesions will go away on their own if she switches to another method.
  • Assess for vaginal infection or sexually transmitted infection (STI). Treat or refer for treatment as appropriate.

Irritation in or around the vagina or penis (she or her partner has itching, rash, or irritation that lasts for a day or more)

• Check for vaginal infection or STI and treat or refer for treatment as appropriate.
• If no infection, suggest trying a different type or brand of spermicides.

Urinary tract infection (burning or pain with urination, frequent urination in small amounts, blood in the urine, back pain)

• Treat with cotrimoxazole 240 mg orally once a day for 3 days, or trimethoprim 100 mg orally once a day for 3 days, or nitrofurantoin 50 mg orally twice a day for 3 days.
• If infection recurs, consider refitting the client with a smaller diaphragm.

Bacterial vaginosis (abnormal white or gray vaginal discharge with unpleasant odor; may also have burning during urination and/or itching around the vagina)

• Treat with metronidazole 2 g orally in a single dose or metronidazole 400–500 mg orally twice a day for 7 days.

Candidiasis (abnormal white vaginal discharge that can be watery or thick and chunky; may also have burning during urination and/or redness and itching around the vagina)

• Treat with fluconazole 150 mg orally in a single dose, miconazole 200 mg vaginal suppository once a day for 3 days, or clotrimazole 100 mg vaginal tablets twice a day for 3 days.
• Miconazole suppositories are oil-based and can weaken a latex diaphragm. Women using miconazole vaginally should not use latex diaphragms or condoms during treatment. They can use a plastic female or male condom or another method until all medication is taken. (Oral treatment will not harm latex.)

Suspected pregnancy

• Assess for pregnancy.

• There are no known risks to a fetus conceived while a woman is using spermicides.

New Problems That May Require Switching Methods

May or may not be due to the method.

Recurring urinary tract infections or vaginal infections (such as bacterial vaginosis or candidiasis)

• Consider refitting the client with a smaller diaphragm.

Latex allergy (redness, itching, rash, and/or swelling of genitals, groin, or thighs [mild reaction]; or hives or rash over much of the body, dizziness, difficulty breathing, loss of consciousness [severe reaction])

• Tell the client to stop using a latex diaphragm. Give her a plastic diaphragm, if available, or help her choose another method, but not latex condoms.

Toxic shock syndrome (sudden high fever, body rash, vomiting, diarrhea, dizziness, sore throat, and muscle aches). See Appendix B – Signs and Symptoms of Serious Health Conditions.

• Treat or refer for immediate diagnosis and care. Toxic shock syndrome can be life-threatening.
• Tell the client to stop using the diaphragm. Help her choose another method but not the cervical cap.