title: Acceptability of the diaphragm in Mombasa Kenya: a 6-month prospective study.
abstract: OBJECTIVE
  If proven acceptable, safe and effective, the diaphragm could be used as a female-controlled method of preventing both sexually-transmitted infections (STIs) and pregnancy. This study's aim was to assess the acceptability and safety of the diaphragm among sexually-active women in Mombasa, Kenya.
  
  
  METHODS
  We conducted a 6-month prospective study among female sex workers (FSWs), and women attending sexual and reproductive health services. Diaphragm acceptability was assessed using continuation rates and factors associated with acceptability. Safety evaluations included colposcopy findings and incidence of urinary tract infections (UTIs) and STIs.
  
  
  RESULTS
  Half the 185 participants were FSWs who had less schooling and were less likely to be married than other women. After 6 months, 55% (56/102) of sexually-active women reported having used the diaphragm each sex act during the preceding month. Women liked using the diaphragm (95%, 104/109), and 96% (125/130) reported willingness to continue using it. Colposcopy did not reveal significantly more vaginal or cervical lesions. Use of the diaphragm was not associated with an increase in bacterial vaginosis or UTIs. A pregnancy rate of 12 per 100 women/years was observed.
  
  
  CONCLUSIONS
  After 6 months of diaphragm use in this setting, continuation rates were sustained, user satisfaction was high and adverse effects were few.
authors.affiliation: International Centre for Reproductive Health (ICRH), Tudor Four Estate, Tom Mboya Avenue, PO Box 91109, Mombasa, Kenya. stanley.luchters@icrhk.org
authors.forename: Stanley
authors.initials: S
authors.lastname: Luchters
authors.forename: Matthew F
authors.initials: MF
authors.lastname: Chersich
authors.forename: Irene
authors.initials: I
authors.lastname: Jao
authors.forename: Anouk
authors.initials: A
authors.lastname: Schroth
authors.forename: Swaleh
authors.initials: S
authors.lastname: Chidagaya
authors.forename: Kishor
authors.initials: K
authors.lastname: Mandaliya
authors.forename: Marleen
authors.initials: M
authors.lastname: Temmerman
mesh_terms: D000328:Adult; D003274:Contraceptive Devices, Female / Q000706:statistics & numerical data*; D005193:Family Planning Services; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D007630:Kenya / Q000453:epidemiology; D016015:Logistic Models; D008875:Middle Aged; D010342:Patient Acceptance of Health Care / Q000208:ethnology*; D011320:Primary Health Care; D011446:Prospective Studies; D011477:Sex Work; D012749:Sexually Transmitted Diseases / Q000453:epidemiology / Q000517:prevention & control; D014552:Urinary Tract Infections / Q000453:epidemiology / Q000517:prevention & control