Gender violence and reproductive health.

The available literature reflects the growing interest in gender violence and reproductive health. Violence is generally studied by identifying pathologies, measuring their demands on services and evaluating their repercussions on fetal outcome. Institutional violence, however, has received little attention and is mainly concerned with the consequences of inappropriate use of technologies. Data from the Sexuality and Health Feminist Collective shows that among patients, 20.5% stated that they have never talked about their sexual life with their partners; 38.3% stated that they have had sexual intercourse against their will, including situations ranging from sexual harassment to rape which was referred by 12.3% of them. One of the most relevant issues arising from the anamnesis and interviews of these women was the violence to which they were submitted by health services. The high prevalence of violent situations indicates the urgency of incorporating an approach which deals with gender violence and promotes the empowerment of women into the routine of reproductive health services.

Effectiveness of the diaphragm, used continuously, without spermicide.

The experience of 670 diaphragm users from three Brazilian clinics was retrospectively reviewed. Most of the subjects (441) followed the traditional method (TM) of using the diaphragm, only at the time of sexual intercourse and with spermicide. One third (215) used the diaphragm continuously (CU), without spermicide, removing it only at the time of their daily shower to wash it, with immediate re-insertion. The total pregnancy rate was 7.0 per 100 women-years for the whole group. Patient and total failure rate were significantly lower in the CU (0.6 and 2.8), in comparison with the TM sub-group (6.5 and 9.8). The discontinuation rate for urinary infection or other medical reasons was not greater in the CU group. Logistic regression analysis, including age, parity, number of abortions and of living children, years of schooling, whether living with a partner, presence of mild cystocele or retroverted uterus, and form of use of diaphragm (TM or CU), showed that only the TM of diaphragm use was positively associated to patients' and total failure rate.

PIP: In Brazil, a retrospective review of clinical records of diaphragm users from the Sexuality and Health Women's Collective in central Sao Paulo, the family planning clinic at the State University of Campinas, and a private practice in Belo Horizonte was performed to compare data on 215 women continuously using it without spermicide, except to clean it during a shower, with data on 441 women using it with spermicide only during sexual intercourse to determine diaphragm effectiveness. The patients' failure rate stood considerably higher among women using the diaphragm with spermicide (6.5 vs. 0.61; p .05). The method failure rate was just slightly higher in the diaphragm with spermicide users' group (3.53 vs. 2.2). 71.47% of all women continued use for 12 months, especially women continuously using the diaphragm without spermicide (84.84 vs. 63.28%; p .05). Women who used the diaphragm with spermicide were more likely to discontinue for vaginal discharge and for other medical and personal reasons than were those who continuously used it without spermicide (p .05). They were also more likely to be lost to follow up (16.4% vs. 6.43%; p .05). The logistic regression analysis indicated that diaphragm with spermicide use was positively linked to patients' and total failure (p = .042). These findings suggested that the messiness of diaphragm use with spermicide, its interference with sexual intercourse, and perhaps spermicide cost contributed to its high discontinuation and failure rates. The findings should raise interest in identifying means to improve acceptance of and use effectiveness of the diaphragm.