Learning to use the one-sized SILCS Diaphragm in South Africa: Improvements after 5 uses
ESC Congress Library. Beksinska M. May 4, 2016; 126881; A-055
Dr. Mags Beksinska
Dr. Mags Beksinska
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Abstract
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Objective: To assess the ability of women in a public-sector setting in South Africa to successfully fit and learn to use the SILCS diaphragm, and to evaluate changes in ease-of-use and reported problems over the first 5 uses.
Methods. The study from which these data are derived was a randomized, crossover study among 115 women in Durban, South Africa, designed to assess the acceptability and preferences for the SILCS diaphragm used for gel delivery compared to gel delivery from prefilled applicator. The data analysed here is limited to the SILCS gel delivery arm. Data were collected via coital logs, questionnaires, and focus group discussions with women and male partners. Literate, sexually active, non-pregnant women, 18‒45 years, in a monogamous relationship for at least 6 months, using a non-barrier method of contraception were eligible. Women used the SILCS with gel applied directly to the device during five separate sex acts. Confidence about inserting/using the SILCS, and perception about ease of use and acceptability were evaluated after one and five uses.
Results. A total of 115 black women, aged 18‒44, were enrolled and 106 (92%) completed the study. Only four women were unable to fit SILCS after training. Ease of insertion improved over time, with 72% reporting that the SILCS was easy to insert at first use, compared to 87% reporting ease of insertion at use 5. Most (83%) also felt comfortable after 2‒3 insertions. Experience of gel leakage before sex reduced from 14.2% to 5.7% and leakage after sex declined from 2.8% at first use to 1.9% at fifth use. Women's confidence of correct placement increased from 76.4% to 80.2% after five uses.
Conclusion. These results show that with short-term training and counseling women can learn to fit and use the SILCS Diaphragm-even when women have never used a diaphragm before. Within the first five uses, confidence and ease of use increased, and the number of reported of problems decreased.

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