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Diaphragm Linked to Infection

July 12, 1985|ALLAN PARACHINI | Times Staff Writer

New evidence has emerged to validate the link--tenuous until now--between the diaphragm and urinary tract infections in women.

It isn't clear whether a different diaphragm design would help or even how the diaphragm happens to make it easier for urinary tract infections to occur. But a team of researchers at the University of Washington in Seattle has added new confirmation to conclusions by a Los Angeles urologist first published about three years ago that initially made the link.

The new research indicates that relative to other forms of birth control, a diaphragm user stands more than four times the chance of contracting a urinary tract infection.

Exacerbating Factor

The leader of the new study, however, said he worried that publicity about the research could prompt diaphragm users to become less vigilant in terms of birth control--a development he said would create far more problems for women than it could possibly solve. And while, despite the increase in risk, the diaphragm can scarcely be called the principal cause of urinary tract infections, a new study identifying this form of birth control as an exacerbating factor bears unwitting testimony to what many women have perceived as an uncomfortable reality.

That reality is that though urinary tract infections are seldom serious and almost never kill or maim, they are--occasionally or frequently--a nagging, tiresome and disquieting problem for most American women, yet physicians know surprisingly little about the extent of the problem or its toll in agonizing discomfort and are generally disinclined to find out more.

This is apparently true even though urinary tract infections are such a common part of being female that many women refer to them as the equivalent in women's reproductive health of either the common cold or sore throat.

It isn't even known, for instance, what proportion of women have experienced urinary tract infections and what fraction of those who have contract them chronically. Neither is it known how often women who come down with such infections simply tough it out, relying on home remedies and determination, as opposed to the number who seek the aid of their doctors.

How to Tough It Out?

There is even disagreement among doctors over how to tough it out. Some physicians find validity in the traditional folk treatment--drinking cranberry juice--and some don't. And doctors also disagree over how a woman can avoid getting an infection in the first place, though many doctors agree that drinking large quantities of water or fruit juice and emptying the bladder as soon as possible after intercourse are wise precautions.

Neither the federal government's National Center for Health Statistics nor any other organization questioned by The Times keeps records for the incidence or treatment of urinary tract infections. The federal agency does say that in 1980-81, the last 12-month period for which figures were assembled, there was an estimated total of more than 8.9 million physician office visits for symptoms common to urinary tract infections.

But those figures take no account of the number of times women seek treatment by telephone--an apparently commonplace response--or treat the infections themselves. A small and informal survey by The Times indicated that many women who contract urinary tract infections often--three or four times a year is enough to be called "frequent," doctors say--routinely keep stocks of antibiotics hoarded from previous prescriptions and treat themselves through self-medication.

Estimates of the incidence of urinary tract infections range from speculation like that in an article in a nursing magazine last year that 25% of women have a urinary tract infection at one time or another to the observation of a Planned Parenthood researcher that every woman will come down with one at one time or another in her life after sexual maturity.

Little is known about the dimension and severity of the problem apparently because, like the common cold and the sore throat, urinary tract infections seldom pose a threat to life or long-term health and lack the challenge and prestige of research in such glamour fields as cancer and heart disease.

Contrary to what women may believe, moreover, men aren't immune, either. Though urinary tract infections in males are comparatively rare--because of differences in urinary tract physiology between the sexes--they do occur, by some estimates at about 10% the rate of such infections in females.

Urinary tract infections apparently occur because bacteria that grow naturally in the intestinal tract somehow find their way into the vagina and, from there, into the urethra and bladder. It may be, according to literature in the field, that the bacteria originate near the woman's rectum or it could be that they come from somewhere on the man's body. On the other hand, it could be neither of these sources and the bacteria actually originate by some means that remains to be discovered.

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