Yellow fever in Côte d'Ivoire

25 January 2011 - On 3 January 2011, the Minister of Health in Côte d'Ivoire notified WHO of a yellow fever outbreak in the north of the country. As of January 17, 2011 a total of 12 cases tested IgM positive by ELISA at the Institut Pasteur of Abidjan and were subsequently confirmed positive for yellow fever by the regional reference laboratory, the Institut Pasteur of Dakar (by ELISA and PRNT). These cases originate from Béoumi and Katiola districts, in the Bandama Valley Region in the centre of the country, and Séguéla and Mankono in the Worodougou Region in the north of the country.

In response to this outbreak, a field investigation was conducted in Béoumi and Katiola districts from 10 to 15 January 2011 by the Ministry of Health with support from the WHO country office. During this investigation a total of 64 suspected cases, including 25 deaths, were identified. Further laboratory testing is on-going.

On 22 January, the Ministry of Health of Cote d'Ivoire started an emergency vaccination campaign targeting over 840,000 people aged nine months and older in Béoumi, Katiola, Mankono and Séguéla districts, with support from WHO and UNICEF. GAVI-funded vaccines released by the International Coordinating Group on Yellow Fever Vaccine Provision (YF-ICG) for the 2010 country mass preventive campaign will be used. The four districts were part of the 61 districts chosen for the preventive campaign, which could not be conducted last year due to the political situation.

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Cancers

Cancer Type

AIDS and HIV

What is HIV?

The Human Immunodeficiency Virus (HIV) is the virus that leads to AIDS. HIV belongs to a subset of retroviruses called lentiviruses (or slow viruses), which means that there is an interval -- sometimes years -- between the initial infection and the onset of symptoms. Upon entering the bloodstream -- through mucous membranes or blood-to-blood contact -- HIV infects the CD4+T cells and begins to replicate rapidly.
Scientists believe that when the virus enters the body, HIV begins to disable the body's immune system by using the body's aggressive immune responses to the virus to infect, replicate and kill immune system cells. Gradual deterioration of immune function and eventual destruction of lymphoid and immunologic organs is central to triggering the immunosuppression that leads to AIDS.

What is AIDS?

Acquired Immunodeficiency Syndrome (AIDS) is the final stage of HIV infection. The Centers for Disease Control establish the definition of AIDS, which occurs in HIV-infected persons with fewer than 200 CD4+T cells and/or persons with HIV who develop certain opportunistic infections. In 1992, the CDC redefined AIDS to include 26 CDC-defined AIDS indicator illnesses and clinical conditions that affect persons with advanced HIV.

What is a retrovirus?

A retrovirus is any of a group of viruses that contain two single-strand linear RNA molecules per virion, which means it carries its genetic blueprint in the form of ribonucleic acid (RNA) instead of deoxyribonucleic acid (DNA). Additionally, the enzyme reverse transcriptase is employed to copy its genome into the DNA of the host cell's chromosomes. Usually the cellular process involves transcription of DNA into RNA. Reverse transcriptase makes it possible for genetic material to become permanently incorporated into the DNA genome of an infected cell.

What is the distinction between HIV and AIDS?

AIDS is a disease developed by a person living with HIV, which is a viral organism. The term AIDS applies to the most advanced stages of HIV infection. Although an HIV-positive test result does not mean that a person has AIDS, most people will develop AIDS as a result of their HIV infection.
There are four main stages in the progression of an HIV infected person developing AIDS. The period following the initial HIV infection is called the window period. It is called this because this period reflects the window of time between infection with the virus and when HIV antibodies develop in the bloodstream. An HIV test that looks for antibodies taken during this time can result in a false negative, though antibodies usually appear within six months of the initial infection.
Seroconversion refers to the period of time during which your body is busy producing HIV antibodies, trying to protect itself against the virus. This is the period after the initial infection when many people experience flu-like symptoms and swollen lymph nodes � this is a highly infectious stage.
After most people seroconvert, they usually experience a symptom-free period or asymptomatic period. This stage can last anywhere from 6 months to over 10 years, varying from person to person. Although the person with HIV is experiencing no symptoms, the virus is still replicating inside the body and weakening the immune system.
After this period, severe CD4+T cell loss leads to the symptomatic period, in which the body experiences the symptoms associated with HIV. This is the final stage before developing AIDS.

What are CD4+T cells?

CD4+T cells are the immune system's key infection fighters and the entity that allows HIV to enter, attach and infect the body's immune system. The CD4+T cells (also called T4 cells) are disabled and destroyed by the virus, often with no symptoms, causing a significant decrease in the blood levels of T4 cells. In the advanced stages of HIV, the body may have fewer than 200 T4 cells, while a healthy adult's count is 1,000 or more. In this way, the body's immune system is continuously weakened from the moment of infection and the inability of the immune system to fight infection opens the door to opportunistic infections.

What are opportunistic infections?

According to the CDC, AIDS-defining opportunistic illnesses are the major cause of morbidity and mortality among human immunodeficiency virus (HIV)-infected persons. Opportunistic infections are a result of the weakened immune system present in persons with HIV/AIDS. An infection takes the "opportunity" provided by the weakened immune system to cause an illness that is usually controlled by a healthy immune system. These infections are sometimes life-threatening and require medical intervention to prevent or treat serious illnesses. Persons living with advanced HIV infection suffer opportunistic infections of the lungs, brain, eyes and other organs. The 26 CDC-defined AIDS indicator illnesses are opportunistic infections. There are medical treatments that can slow the rate at which the immune system is weakened and early detection offers more options for treatment and preventative care.

How is HIV transmitted?

HIV infection most commonly occurs through sexual contact. However, the virus can also be spread through blood-to-blood contact -- such as sharing needles or blood transfusions involving unscreened blood. Studies have shown that HIV is not transmitted through casual contact such as touching or sharing towels, bedding, utensils, telephones, swimming pools, or toilet seats. Scientists have also found no evidence of transmission through kissing, sweat, tears, urine or feces. It is important to acknowledge that it is not sex that transmits HIV, but certain bodily fluids: blood, semen (including "pre-cum"), vaginal secretions and breast milk. High-risk behaviors that can result in HIV transmission are sharing needles for drugs, tattoos, body piercing, vitamins or steroids with an HIV-infected person and/or engaging in unprotected anal, vaginal or oral sex with a person who is HIV infected. The virus also can be transmitted from an HIV-infected mother to her child through pregnancy, birth or breastfeeding.
It does appear that persons already infected with a sexually transmitted disease are more susceptible to acquiring HIV during sex with an infected partner. Mucous membranes, a weak point in the skin, include the lips, mouth, vagina, vulva, penis or rectum. Because mucous membranes are porous and viruses and other pathogens are able to pass through, these areas are rich in immune cells. When a person already has a sexually transmitted disease, sex organs may be flooded with CD4+T cells, making it much easier for HIV to infect.
The only way to determine HIV infection is to be tested for the virus. It is not unusual for HIV-infected persons to experience symptoms years after the initial infection; some may be symptom free for over 10 years. However, during the asymptomatic period, the virus is actively multiplying and destroying cells in the immune system, weakening the body's ability to fight infection. The effect is most keenly observed in the decline of the immune system's key infection fighters in the blood, the CD4+T cells. There are medical treatments that can reduce the rate at which HIV disables the immune system; early detection offers more options for treatment and preventative care. As a matter of safety, people who engage in high-risk behaviors -- such as intravenous drug use or having unprotected sex with multiple partners -- should be tested regularly.

Breast cancer

Breast cancer is a cancer that starts in the tissues of the breast.
There are two main types of breast cancer:
    * Ductal carcinoma starts in the tubes (ducts) that move milk from the breast to the nipple. Most breast cancers are of this type.
    * Lobular carcinoma starts in parts of the breast, called lobules, that produce milk.
In rare cases, breast cancer can start in other areas of the breast.
Breast cancer may be invasive or noninvasive. Invasive means it has spread to other tissues. Noninvasive means it has not yet spread. Noninvasive breast cancer is referred to as "in situ."
    * Ductal carcinoma in situ (DCIS), or intraductal carcinoma, is breast cancer in the lining of the milk ducts that has not yet invaded nearby tissues. It may progress to invasive cancer if untreated.
    * Lobular carcinoma in situ (LCIS) is a marker for an increased risk of invasive cancer in the same or both breasts.
Many breast cancers are sensitive to the hormone estrogen. This means that estrogen causes the breast cancer tumor to grow. Such cancers have estrogen receptors on the surface of their cells. They are called estrogen receptor-positive cancer or ER-positive cancer.
Some women have what's called HER2-positive breast cancer. HER2 refers to a gene that helps cells grow, divide, and repair themselves. When cells have too many copies of this gene, cells -- including cancer cells -- grow faster. Experts think that women with HER2-positive breast cancer have a more aggressive disease and a higher risk of recurrence than those who do not have this type.

Schizophrenia

What is schizophrenia?
Schizophrenia is a serious and challenging medical illness, an illness that affects well over 2 million American adults, which is about 1 percent of the population age 18 and older.  Although it is often feared and misunderstood, schizophrenia is a treatable medical condition.
Schizophrenia often interferes with a person's ability to think clearly, to distinguish reality from fantasy, to manage emotions, make decisions, and relate to others. The first signs of schizophrenia typically emerge in the teenage years or early twenties, often later for females. Most people with schizophrenia contend with the illness chronically or episodically throughout their lives, and are often stigmatized by lack of public understanding about the disease. Schizophrenia is not caused by bad parenting or personal weakness. A person with schizophrenia does not have a "split personality," and almost all people with schizophrenia are not dangerous or violent towards others while they are receiving treatment. The World Health Organization has identified schizophrenia as one of the ten most debilitating diseases affecting human beings.
What are the symptoms of schizophrenia?
No one symptom positively identifies schizophrenia. All of the symptoms of this illness can also be found in other mental illnesses. For example, psychotic symptoms may be caused by the use of illicit drugs, may be present in individuals with Alzheimer’s disease, or may be characteristics of a manic episode in bipolar disorder. However, when a doctor observes the symptoms of schizophrenia and carefully assesses the history and the course of the illness over six months, he or she can almost always make a correct diagnosis.
As with any other psychiatric diagnosis, it is important to have a good medical work-up to be sure the diagnosis is correct. Drug use can mimic the symptoms of schizophrenia and may also trigger vulnerability in individuals at risk. Other medical concerns also need to be ruled out before a correct diagnosis can be made.
The symptoms of schizophrenia are generally divided into three categories -- Positive, Negative, and Cognitive:

• Positive Symptoms, or "psychotic" symptoms, include delusions and hallucinations because the patient has lost touch with reality in certain important ways. "Positive" refers to having overt symptoms that should not be there. Delusions cause individuals to believe that people are reading their thoughts or plotting against them, that others are secretly monitoring and threatening them, or that they can control other people's minds. Hallucinations cause people to hear or see things that are not present.
• Negative Symptomsinclude emotional flatness or lack of expression, an inability to start and follow through with activities, speech that is brief and devoid of content, and a lack of pleasure or interest in life. "Negative" does not refer to a person's attitude but to a lack of certain characteristics that should be there.
• Cognitive Symptoms pertain to thinking processes. For example, people may have difficulty with prioritizing tasks, certain kinds of memory functions, and organizing their thoughts. A common problem associated with schizophrenia is the lack of insight into the condition itself. This is not a willful denial but rather a part of the mental illness itself. Such a lack of understanding, of course, poses many challenges for loved ones seeking better care for the person with schizophrenia.

Schizophrenia also affects mood. While many individuals affected with schizophrenia become depressed, some also have apparent mood swings and even bipolar-like states.   When mood instability is a major feature of the illness, it is called schizoaffective disorder, meaning that elements of schizophrenia and mood disorders are prominently displayed by the same individual.   It is not clear whether schizoaffective disorder is a distinct condition or simply a subtype of schizophrenia.
What are the causes of schizophrenia?
Scientists still do not know the specific causes of schizophrenia, but research has shown that the brains of people with schizophrenia are different from the brains of people without the illness. Like many other medical illnesses such as cancer or diabetes, schizophrenia seems to be caused by a combination of problems including genetic vulnerability and environmental factors that occur during a person's development. Recent research has identified certain genes that appear to increase risk for schizophrenia. Like cancer and diabetes, the genes only increase the chances of becoming ill; they alone do not cause the illness.
How is schizophrenia treated?
While there is no cure for schizophrenia, it is a treatable and manageable illness. However, people sometimes stop treatment because of medication side effects, the lack of insight noted above, disorganized thinking, or because they feel the medication is no longer working. People with schizophrenia who stop taking prescribed medication are at risk of relapse into an acute psychotic episode. It’s important to realize that the needs of the person with schizophrenia may change over time. Here are a few examples of supports and interventions:

• Recovery Supports/Relapse Prevention: There is increasing recognition of the benefits of learning from "someone who has been there." NAMI’s Peer to Peer program is designed to help individuals with mental illness learn from those who have become skilled at managing their illness. Peer support groups are also recognized as invaluable as individuals living with mental illness report better recovery outcomes as the shared experience is recognized as extremely beneficial. NAMI C.A.R.E. support groups are available in many communities and are expanding to better meet this need.
• Family Support: Caregivers benefit greatly from NAMI’s Family-to-Family education program, taught by family members who have the knowledge and the skills needed to cope effectively with a loved one with a mental disorder. This program is available in all 50 states through many NAMI affiliates, and is offered in multiple languages in many communities.
• Hospitalization: Individuals who experience acute symptoms of schizophrenia may require intensive treatment, including hospitalization. Hospitalization is necessary to treat severe delusions or hallucinations, serious suicidal thoughts, an inability to care for oneself, or severe problems with drugs or alcohol. Hospitalization may be essential to protect people from hurting themselves or others.
• Medication: The primary medications for schizophrenia are called antipsychotics. Antipsychotics help relieve the positive symptoms of schizophrenia by helping to correct an imbalance in the chemicals that enable brain cells to communicate with each other. As with drug treatments for other physical illnesses, many patients with severe mental illnesses may need to try several different antipsychotic medications before they find the one, or the combination of medications, that works best for them.
  
  • Conventional Antipsychotics were introduced in the 1950s and all had similar ability to relieve the positive symptoms of schizophrenia. However, most of these older "conventional" antipsychotics differed in the side effects they produced. These conventional antipsychotics include chlorpromazine (Thorazine), fluphenazine (Prolixin), haloperidol (Haldol), thiothixene (Navane), trifluoperazine (Stelazine), perphenazine (Trilafon), and thioridazine (Mellaril). Some of the risks that may be incurred from taking these medicines include dry mouth, blurred vision, drowsiness, constipation, and movement disorders such as stiffness, a sense of restless motion, and tardive dyskinesia.
  • "Atypical" Antipsychotics were introduced in the 1990s. When compared to the older "conventional" antipsychotics, these medications appear to be equally effective for helping reduce the positive symptoms such as hallucinations and delusions, but may be better than the older medications at relieving the negative symptoms of the illness, e.g., withdrawal, thinking problems, and lack of energy. The atypical antipsychotics include risperidone (Risperdal), clozapine (Clozaril), olanzapine (Zyprexa), quetiapine (Seroquel), and ziprasidone (Geodon).Clozapine (Clozaril) is an atypical antipsychotic medicine with special benefits and risks that are too numerous to cover in this brief fact sheet.All these antipsychotics have serious side effects such as weight gain and the risk of diabetes, but they all do not carry the same relative risk for these conditions.

All medications have side effects.  Different medications produce different side effects, and people differ in the amount and severity of side effects they experience.  Side effects can often be treated by changing the dose of the medication, switching to a different medication, or treating the side effect directly with an additional medication.  NAMI’s fact sheets on medications, developed by independent pharmacists, are a starting point to understand the risks and benefits of any individual medication.   Individuals thinking of starting or changing their medication should always gather good information, consider the risks and benefits, consult with their doctor and loved ones and work together to develop the most safe and effective treatment plan possible.

• Psychosocial Rehabilitation: Research shows that people with schizophrenia who attend structured psychosocial rehabilitation programs and continue with their medical treatment manage their illness best. One example of an effective psychosocial approach for the most severely ill, or those with both mental illness and substance abuse, is the Program for Assertive Community Treatment (PACT), an intensive team effort in local communities to help people stay out of the hospital and live independently. Available 24-hours a day, seven-days a week, PACT professionals meet their clients where they live, providing at-home support at whatever level is needed.Professionals work with clients to address problems effectively, to make sure medications are being properly taken, and to meet the routine daily challenges of life, such as grocery shopping and managing money.

meaning of psychological health

This is a question that psychologists have grappled with for decades. The articles I reviewed for my own research with The Psychological Health Index date back to the early 1970's.
There is no question at all about the fact that psychological health is important with respect to how we function and adapt, and with respect to whether our lives are satisfying and productive.
What the researchers argue about is whether psychological health is a single factor, or whether distress and well-being are actually two seperate issues.
While the argument continues, the verdict is clear: general well-being does not simply mean that you are free from anxiety and depression.  It involves something more.   But for general purposes, it can usually be said that it's two sides of the same coin. Usually, people are either happy or they're not, and if their mood isn't good, they are often distressed to some extent.
Psychological health and well-being should also not be confused with the question of whether or not you suffer from mental or emotional disorder. The research on well-being concerns itself with the feelings of normal individuals, or subjects from the general population.  When we talk about psychological health, we are referring to how ordinary people are doing in life. In other words, if you are feeling distressed, that doesn't necessarily mean that you are mentally ill.
Ordinary life often presents the individual with extraordinary challenges, complexities, setbacks and hardships.  Psychological health concerns itself with how you cope, how your are doing in response and whether you find life to be interesting and enjoyable.  Although life is better when we are feeling good, there is no avoiding the fact that there will be ups and downs.
In the end, psychological healh and well-being is basically about: "how are you doing?"
If you consider well-being as two separate issues, the upside involves two factors:   is your mood generally positive, and do you enjoy a number of "positive emotional ties."   In other words, are you happy and do you have friends?   In addition to feelings of emotional satisfaction, a positive mood also depends on whether or not you generally feel calm and peaceful.
On the downside, emotonal well-being involves three factors: do you suffer anxiety, are you depressed, and do you feel like like you have lost control and can't do anything about your feelings. This is the other side of the coin, the experience of psychological distress.
These are the questions that The Psychological Health Index addresses. This questionnaire is a modified version of an instrument developed by the Rand Corporation for use in a variety of health and medical outcome studies. It is a short version of a longer "test,"  and even though it is just a few items long,  it has proven to be a remarkably useful way to ask people: "how are you doing?" ... "how is your mood today?"
My own reseach in this area has demonstrated that how you respond to the brief Psychological Health Index is significantly correlated with your perceived personal health status.   If your score on this instrument is negative, you are more likely to have more physical health complaints.
I ususally advise people to take this test every now and then, and not just once.  Things change and feelings change.  In the same way that it is a good idea for healthy individuals to monitor their blood pressure on at least an occasional basis,  it's a good idea to keep an eye on your mood.  Mood is a vital sign.

diaphragms and cervical caps

There are two main types of contraceptive caps:

• the diaphragm.
• the cervical cap.

Diaphragms are a good deal bigger than cervical caps – they’re about as wide as the palm of your hand. You put the diaphragm into your vagina before sex, positioning it so that it keeps sperms from getting anywhere near your cervix.
Cervical caps are much smaller – about the size of a small egg-cup. You have to put the cervical cap directly onto your cervix, so as to stop sperm getting in. Cervical caps are much less commonly used than diaphragms - they’re mainly for women who, because of the shape of their vaginas, find it difficult to keep a diaphragm in place.

Diaphragms

What exactly are diaphragms?

Diaphragms are ‘domes,’ made of thin, soft rubber, or silicone. They form an excellent physical ‘barrier’ to sperms – though you have to use a spermicide (chemical) with them as well.
You can’t just buy a diaphragm ‘off the peg’ at a chemist – for the simple reason that women’s vaginas come in various sizes (particularly after they’ve had children). So you need to have your vaginal size assessed by a doctor or family planning nurse. She or he will then prescribe the size you need.
Most importantly, she or he must teach you exactly how to put the diaphragm inside – and how to get it into exactly the right place. If you haven’t been taught how to do this, you’ll probably position it so that it doesn't cover your cervix; this would leave you wide open to conception.
The diaphragm is far less popular than it was before the introduction of the Pill, but even in 2008 , it is still used by a sizeable minority of women in the UK – particularly those in their 30s and 40s. The most recent survey carried out by the Office for National Statistics showed that 3 per cent of women aged 16 to 49 were using it.
Used properly, the diaphragm is an efficient and safe type of contraception. It has a success rate of roughly 95 per cent per year among women who’ve been trained to use it correctly. But if you just ‘stick it in’ at the last moment, without being too sure where it’s going, then your success rate will be much lower.
In general, if you are a sexually-active woman, there’s a lot to be said for inserting your diaphragm every night before you go to bed (and leaving it in all night) – in case you make love.
Each diaphragm will last several years if it is carefully looked after, so this is an inexpensive contraceptive method, apart from the expense of the spermicidal cream or gel that must always be used with it. (However, you can obtain the cream or gel free of charge on an NHS prescription.)

Who can use the diaphragm?

Diaphragms can be used by most women without any kind of inconvenience or discomfort. So this is a good option for a woman who dislike condoms, or who cannot take the Pill for some reason or another, or for women who can’t use IUDs. It’s also popular with women who are older, and whose fertility is therefore a little lower.

How do you use a diaphragm?

The diaphragm looks like a little hat without a brim. It is ‘bendy,’ and can be folded so that it goes into the vagina easily. Before you insert it, you need to smear spermicidal cream or gel onto it, to give you adequate protection – in other words, to prevent sperms from creeping round the edge. A diaphragm without spermicidal cream will not be very effective in preventing pregnancy.
You put your diaphragm high up in your vagina, so that it covers the cervix. The top end of the dome goes behind your cervix, and the bottom end of the dome is tucked up behind your pubic bone.
When the diaphragm is placed correctly like this, it cannot be felt by either the woman or the man during intercourse.
It is quite easy to take the diaphragm out after use – simply by hooking your fingertip round it. The nurse or doctor will show you how to do this. Generally speaking, you’re safer not to take it out until the morning.
After taking it out, you wash it, dry it and put it away in its box, which is rather like a make-up compact.

What are the advantages to this method?

One of the key advantages to the diaphragm is that it can allow sex to be spontaneous. A woman can easily insert the diaphragm whenever she expects she may be having sex that day. But if you insert it more than three hours before you make love, you should put in some extra spermicide – before your man enters you.
Diaphragms should always be left in place for at least six hours after sex
However, if sex does not occur, it is quite safe for a woman to leave her diaphragm in, and even to go to sleep wearing it. But a diaphragm should not be left inside you for more than 30 hours, as this might possibly cause an infection and/or a discharge.
There is another advantage for the many women who feel particularly sexy during their periods, but whose men might be squeamish at the sight of blood during intercourse. With a diaphragm in place, there is usually no sign at all that the woman has a period, so the couple can make love as normal.

What are the disadvantages?

Some women do have difficulty in coming to terms with the idea of putting a rubber dome inside their vaginas. But with a bit of practice, they usually become quite happy about it.
Also, if you suddenly find yourself in a sexual situation and have to insert your diaphragm in a hurry before intercourse, that can interfere with spontaneity. Furthermore, there’s a risk that if you’re in a rush, you may not put it in correctly!
Some couples have difficulty in remembering to ‘top up’ the spermicide if love-making goes on for several hours, or if they have sex more than once in any one session.

Is the diaphragm an effective type of contraception?

Yes, a diaphragm is indeed an effective form of contraception - if spermicidal cream is always applied before sexual intercourse, and if the device is left in the vagina for six to eight hours after the intercourse has finished.
If used correctly, the diaphragm is generally reckoned to be 92 to 96 per cent effective against pregnancy. Obviously, the pregnancy rate is higher if it is not used properly. But it is lower if you’re in your late 30s or your 40s - which is when many women use it.

Are there any side effects?

• A very few women have an allergy to the material that the diaphragm is made from.
• Cystitis is a problem for a few users – possibly because the front of the diaphragm presses against the urinary passage.
• Some people are sensitive to spermicides.

What types of diaphragms are there?

In the UK, there are five brands:

• Refexions flat spring.
• Arcing silicone.
• Omniflex coil spring silicone.
• Ortho coil spring.
• Ortho All-Flex.

It’s mainly up to the doctor or family planning nurse to decide which type suits your vagina – and what size you need. (Sizes range from 55mm diameter to 100mm diameter.)

How long will your diaphragm last?

Given luck, several years. You should keep an eye on your diaphragm to make sure it is OK. Get a replacement immediately if it has perished or if it gets damaged in any way. Do not attempt DIY repairs!
You will need to see your doctor for re-measurement if your weight changes by more than seven pounds (about 3kg) either way (since that may alter your vaginal ‘fit’) - or if you resume wearing a diaphragm after a pregnancy.
Please note that if for any reason the diaphragm doesn't suit your particular vaginal shape, there is the alternative of a cervical cap (see below).

Cervical cap

What is a cervical cap?

The closely related 'cervical cap' is also a good method, but is used by fewer women. It is much smaller than the diaphragm, and looks rather like a very large thimble.
It fits over your cervix - like an egg-cosy over a boiled egg - so you have to be very sure that you can find your own cervix with your fingers, and put the cap snugly over it.
Nearly all cervical caps are prescribed and fitted in Family Planning Clinics though a few GPs now fit them. The doctor or family planning nurse will help you find a cap which is right for the shape of your vagina and cervix, and will advise you what size you need.
In Britain, there are four brands which are widely available.

• The Dumas Vault cap (sizes 1 to 5).
• The Prentif Cavity Rim (sizes 22mm, 25mm, 28mm and 31mm).
• The Vimule (sizes 1 to 3).
• The Femcap (soft silicone, sizes 22mm. 26mm and 30mm).

How do I put a cervical cap in?

The family planning nurse or doctor will teach you how to do this.
Before insertion, you need to fill the little cap one third full of spermicide. Then you squeeze it between finger and thumb in order to get it into your vagina. Finally, you put it over your cervix – where it is held in place by suction. Finally, put some more spermicide into your vagina.
The clinic staff will also show you how to ‘hook’ the cervical cap out with your finger, which is usually not too difficult. (As is the case with a diaphragm, it should stay in all night after love-making.)

Warning!

There is a rare infection called 'Toxic shock syndrome' (TSS), which is often associated with tampon use. If you have ever had TSS, it is doubtful whether you should use a diaphragm or cap.