As the name implies, a spermicide is a chemical compound that kills sperm. Spermicides are available in a number of forms that are safe and easy to use—aerosol foams, gels or jellies that require an applicator, dissolvable suppositories, and dissolvable squares of film. The active ingredient in these products is nonoxynol-9, which works by damaging the surface membrane of the sperm cell. Like other barrier contraceptives, spermicides do not affect hormone levels in the body or change the environment of the uterus.
Spermicide products require no physical examination or prescription. They can be found in the feminine hygiene or family planning sections of drugstores, discount department stores, and some large supermarkets. They also are available from women's health centers, HMOs, and family planning clinics.
A spermicide can be inserted ahead of time without the need for a partner's involvement, and its presence seldom can be distinguished from the natural lubrication of the vagina. Furthermore, some types of spermicides—such as the vaginal contraceptive film or the vaginal inserts—come in packages small enough to carry easily in a purse or pocket for those times when you unexpectedly need pregnancy or disease protection and your partner does not use a condom.
IN A NUTSHELL
Spermicides kill sperm and are good methods of birth control. The woman puts a spermicide in her vagina just before having sex. If used alone, spermicides are fairly effective in preventing pregnancy. A male condom and a spermicide together offer excellent protection against pregnancy and STDs, including AIDS. Spermicide gels also are added to a diaphragm or cervical cap to make them more effective.
Spermicides can be bought in drugstores without a prescription. They are available in several forms: foams, gels or jellies, suppositories (tablets), or dissolving film.
Spermicides can prevent gonorrhea and chlamydia, but it is not clear how much they protect against STDs that are caused by viruses, including AIDS.
Spermicides also can provide fairly good protection against pregnancy if you forget your birth control pills for several days in a row or do not refill the prescription in time. A condom plus spermicide is even better. An application of spermi-cide is a good addition to birth control methods like the cervical cap or condom. It is also a necessary part of using a diaphragm.
At any time, if your method develops a problem, like a condom tearing or your cervical cap being dislodged, an immediate application of spermicide may prevent conception. If such an accident should happen, in addition to adding sper-micide, it is important to call your family planning practitioner about emergency medical contraception (see Chapter 16). Obviously, keeping a spermicide on hand is a good practice.
For typical users, spermicides in any form, when used alone, have a first-year failure rate in protecting against pregnancy that ranges from 6 to 21 percent. Typical users are couples who do not use the spermicide every time they have sex or do not always use it correctly. Couples who use a spermicide every single time they have sex, and use it according to its directions, have the lowest failure rates. The rates are similar to those for condoms, diaphragms, and cervical caps.
SPERMICIDES AVAILABLE (1996)
Jellies and Gels
Conceptrol Gel Disposables (pre-filled applicators)
Koromex Crystal Clear Gel*
Gynol II Original Formula* (no applicator included) Gynol II Extra Strength Foams
Koromex Foam Delfen Contraceptive Foam Vaginal Suppositories Koromex Vaginal Inserts** Conceptrol Inserts** Semicid** Encare** Contraceptive Film
Vaginal Contraceptive Film (VCF)** Bioadhesive Gel
Advantage 24 (pre-filled applicators)
*To be used only with a diaphragm or condom; not to be used alone. **Requires 10 to 15 minutes to melt before effective.
Highly important to the success of this method is placing the spermicide right at the cervix, which can be felt as a bump at the end of your vagina. Furthermore, some products require at least a 15-minute wait so they can melt and spread around before you have sex. However, spermicides are not all similar in how they should be used. For the greatest effectiveness, it is necessary to read the directions that come with each product.
Most spermicide failures are experienced by young women who are in their very fertile, peak reproductive years and by women who have intercourse frequently. The fewest failures occur with women whose risk of pregnancy is reduced because they have intercourse less often or are over age 35 and are not so fertile. But at all ages, the
conscientious use of a spermicide improves its effectiveness as a birth control method.
In vaginal sex, spermicide users are clearly protected against the chlamydia and gonorrhea bacteria, which usually enter the body via the cervix. There is some evidence that they may also receive protection against cervical cancer and hepatitis B. Nonoxynol-9 kills the AIDS and herpes viruses in test tubes, but how effective it is against these diseases in actual use has not been determined. How well each product covers and protects every part of the vagina also is not known, although spermicidal foam appears to provide the most thorough coverage.
Family planning professionals advise that a male condom plus an application of spermicide, or a female condom used alone, seem to be the best protection against disease. Next in order of effectiveness are a condom used alone, a diaphragm or cervical cap used with spermicide, and a spermicide product used alone.
Spermicidal products cause very few side effects while providing good protection against pregnancy and a number of sexually transmitted diseases.
As we noted above, spermicides are an effective destroyer of the viruses and bacteria that cause certain common STDs. Thus, they also seem to reduce the danger of acquiring pelvic inflammatory disease.
The most common health problem associated with spermicides is irritation involving the penis or the vagina. The symptoms generally
WHO SHOULD NOT DEPEND ON A SPERMICIDE?
Spermicides should not be used as the sole method of birth control by a woman who absolutely does not want to become pregnant. If you must avoid pregnancy for medical or other reasons, discuss with your family planning practitioner which contraceptive method or combination of methods could provide better protection.
are feelings of itching and burning. Sometimes these side effects disappear after a short period of use. If not, try another brand or type of spermicide, because the reaction may be to the amount of nonoxynol-9 or the perfume in the one you are using. To rule out either of these as a cause, try a product that is unscented or contains less nonoxynol-9.
When used very frequently—several times a day for many days— spermicides can irritate and crack the lining of the vagina, making it susceptible to disease organisms.
Nonoxynol-9 also can encourage the presence of candida albicans, the organism that causes yeast infections, because it kills bacteria that usually keep candidiasis under control in the vagina. If you have frequent yeast infections while using a contraceptive method that requires a spermicide, you may need to switch to one that does not involve its use. This is something to discuss with your health care provider.
A thorough review of all available data has led medical experts to conclude that the use of spermicides does not affect any pregnancy that may follow. Early reports of an association between the use of spermicides and spontaneous abortions or children born with birth defects did not hold up in recent studies.
As we noted earlier, you can obtain a spermicide in a number of forms: aerosol foams, gels or jellies, vaginal inserts, and small squares of film that dissolve. Although all are easy to use, some are easier than others to carry with you in a pocket or purse.
Jellies, Gels, and Foams
Spermicides are available in a variety of foams, gels, and jellies. Starter packages of most brands contain the spermicide plus reusable applicators; refill packages and Ortho's Gynol II do not include applicators, which are necessary for using these spermicides. Products like Conceptrol Gel Disposables and Advantage 24 offer individual applicators prefilled with spermicide for one-time use.
Some products are made to be used primarily with the additional protection of a diaphragm or cervical cap. Others are formulated to be used alone, and an applicator of these generally will contain more nonoxynol-9 than an applicator of a product designed to accompany a diaphragm or condom. Read the label carefully to be sure you are getting the degree of protection you want.
Normal body temperature melts most spermicides, allowing them to spread around the vagina and over the opening of the cervix. Melting takes place within minutes, so these spermicides are effective almost immediately after application. For full protection, you must apply the spermicide high in the vagina, close to the cervix.
Most spermicides are effective for only 1 hour, so they should be applied not long before you have sex. If an hour passes before you have intercourse, add more spermicide. If you are going to have sex again and more than an hour has passed since you inserted spermi-cide, use another application.
The amount of active ingredient differs from product to product. It is important to use the applicator that comes with a particular spermicide, because the applicator is sized to provide the correct dose for its product only. To insert the applicator easily, choose a position that is comfortable for you. You can stand with a foot on a chair or bathtub, squat on your heels, or insert it while you are lying down.
Do not throw out the applicator when you have finished with that container of spermicide. Save it to use with refills. You will get more spermicide for your money if you buy refill containers that are sold without applicators.
After sex, do not douche or wash out the spermicide for at least 6 hours. A tampon or minipad used after lovemaking will protect you against any leakage.
For gels and jellies in tubes, remove the screw-on top of the tube and put on the applicator in its place. Squeeze the tube to fill the applicator until the plunger is pushed out completely. Unscrew the applicator, gently insert it deep into the vagina, and push in the plunger as far as it will go. Remove the applicator from the vagina by its barrel, not by the plunger. Pulling on the plunger may cause it to suction out some spermicide.
Contraceptive foams are available in pressurized aerosol cans and are used with applicators. Before using, it is important to shake the can thoroughly to mix the spermicide into the foam—the spermi-cide tends to settle in the bottom of the can. The foam should have the consistency of shaving cream—the more bubbles it has, the better it will spread around your vagina.
To fill the plunger-type plastic applicator, place it on the can of foam and either push or tilt it so foam flows into it. As the applicator fills, the foam pushes up the plunger. (The filling technique varies from brand to brand, and each package has directions explaining how to use it.) When full, insert the applicator deep into the vagina and push in the plunger until it stops. Remove the applicator with the plunger still pushed in to avoid withdrawing any foam. You can insert foam up to 30 minutes before you have sex. If you do not have sex within that time, add another applicator of foam just before you do have intercourse.
Care and Storage. Wash the applicator thoroughly inside and out with hot water and detergent or soap. Do not boil it, because the plastic is likely to melt. To keep it clean, store the applicator in the original box or in a closed plastic bag. Store all spermicides at room temperature, away from extreme heat or cold. They should not be used more than 2 years after purchase or beyond the expiration date marked on the package.
With foam, it is impossible to know how much remains in the can after you have been using it a while. To make sure you do not run out, buy two containers at first and, from then on, buy another every time one becomes empty. That way you will always have a supply of foam on hand whenever you need it.
Cost. Gels and jellies cost about $10, depending on size and whether the package includes an applicator. Foams cost about $16 or more per can. After you have an applicator, it is more economical to buy the refill containers that are sold without applicators, because they offer more spermicide for the money.
Newly available is a spermicide gel that combines nonoxynol-9 with a patented "bioadhesive" that clings to the cervix and the walls of the vagina for 24 hours. This product, Advantage 24, contains less nonoxynol-9 than many others—enough to protect against pregnancy but usually not enough to irritate the vagina or penis. It is not washed away by the man's ejaculate, the woman's menstruation, or any secretions. Advantage 24 is not perfumed or flavored and does not leak from the vagina. After it is applied, sex can take place anytime in the next 24 hours. One application, however, cannot be used for multiple acts of intercourse—additional applications are needed.
Advantage 24 is sold in prefilled applicators for one-time use. Before inserting it, you hold the thick end of the applicator and shake it vigorously—like a thermometer—to force the gel to the thin end. You then twist off the tab at the thin end, insert that end into your vagina as far as possible, and squeeze the thick end of the applicator to deposit the gel close to your cervix.
You can use Advantage 24 alone or with a condom. As with other spermicides, douching is not recommended. If you feel douching is necessary, wait at least 6 hours after your last intercourse.
Care and Storage. Store at room temperature, away from extreme heat and cold. For example, do not leave the package in a coat pocket or in a purse on a radiator.
Cost. Advantage 24 is sold in packages of three for $7.99 or six for $11.99.
Vaginal Suppositories (Inserts)
Vaginal suppositories (often called inserts) are pushed with a finger well up into the vagina, where they melt or foam, allowing the nonoxynol-9 to spread around the upper vagina and over the opening of the cervix. Depending on the brand, they must be inserted 10 or 15 minutes before sex and are effective for 1 hour. A new tablet is needed for every additional intercourse or if sex is delayed beyond the 1-hour time limit. As usual, it is best not to douche, but if you feel you must, do not douche until 6 hours have passed since your partner's last ejaculation.
The Encare suppository does not melt but instead foams as it dissolves. You may find that this foaming action creates a warm feeling in the vagina that feels strange at first.
Care and Storage. Keep suppositories away from extreme cold or heat and store at room temperature. If a tablet melts, leave it in its plastic casing in a cool place, such as the refrigerator, for about an hour, and it will regain its shape and firmness.
Cost. Suppositories range in price from about $8.99 for a dozen to $12 for 18. They are the least expensive of all spermicides, and the packages are small and easy to carry in a pocket or small purse.
Vaginal contraceptive film (VCF) is a somewhat novel approach to using a spermicide. It can be used alone, but it is most effective when used with a condom or to back up a diaphragm or cervical cap, particularly during a woman's most fertile days. Each piece of film is 2 inches square, very thin and flexible. Like a vaginal suppository, it is pushed up as close to the cervix as possible. Body warmth melts the film, transforming it into a sperm-killing gel within 15 minutes. After it has melted, it is effective for 2 hours. If you want to have sex after that time, add a second piece of film. The gel washes away naturally after a few more hours have passed and leakage seldom is a problem.
To use vaginal contraceptive film, wash your hands and dry them well before you remove the film from its package. If your hands are damp, the film will stick to your fingers. Fold the square of VCF in half and then in half again. Find a comfortable position and use your longest finger to locate your cervix at the end of your vagina. Bend the folded VCF over your longest (middle) finger and hold it there with your thumb and forefinger as you push it into your vagina. Push the VCF up your vagina with your middle finger until the film reaches your cervix. You will know that it is in the right place when you can feel the bump of your cervix through the film. Insert the VCF quickly so it does not start to melt and stick to your finger. Practice a few times without having sex so you are able to put the film in quickly and correctly—all the way up to your cervix.
You can place VCF into your vagina up to 1 hour before you have sex. If you do not have intercourse within that time, however, you must use another VCF. Just remember to wait 15 minutes each time for it to melt and coat your cervix. Use a VCF for each intercourse. Afterwards, do not douche or wash out the VCF jelly for at least 6 hours. Because it dissolves so thoroughly, you probably will not feel the need to douche.
Care and Storage. VCF should be stored at room temperature. If kept in its sealed packet, VCF can be usable up to 4 years.
Cost. Vaginal contraceptive film is sold at prices that start at six for $7 or a dozen for $9.50.
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