The Contraceptive Sponge

The contraceptive sponge is a soft, foam device that contains spermicide and covers the cervix. It prevents pregnancy by killing sperm in the vagina and blocking the cervix to hinder the progress of sperm into the uterus.

If you prefer a form of contraception that isn't permanent, doesn't contain hormones and requires no prescription, the contraceptive sponge may be an ideal choice. On the other hand, the sponge lacks the effectiveness of other forms of birth control, so it's not the best choice if pregnancy would pose a major problem for you.

Get the facts about the contraceptive sponge before you decide whether it's the best birth control method for you.

What is it?

The sponge is a soft, disk-shaped device made from polyurethane foam that fits over the opening of a woman's uterus (cervix) to block and absorb semen. It's available without a prescription and requires no special fitting. The single-use, disposable sponge contains the spermicide nonoxynol 9, which it releases slowly over 24 hours.

The Food and Drug Administration (FDA) approved the contraceptive sponge (Today Sponge) for the U.S. market in 1983. It quickly gained popularity as more than 90 million sponges were sold during the first four years after its release.

The Today Sponge was taken off the market in 1995, however, after the FDA reported finding that water at the company's factory was contaminated. Rather than invest in improvements to meet manufacturing standards, the company stopped making the sponge.

Now produced by a different company, the Today Sponge is sold in Canada. It received FDA approval April 22, 2005, but is not yet available in U.S. retail stores. Other sponges, such as the Protectaid Sponge and the Pharmatex Sponge, are available outside the United States.

How do you use it?

Before inserting the sponge, wash your hands so that you don't introduce germs into your vagina. Then wet the sponge thoroughly with tap water to activate the spermicide. Squeeze the sponge gently until sudsy. Place the sponge in your vagina — with the dimple-side facing up and the string loop facing down — so that it tightly covers the cervix. The walls of your upper vagina hold the sponge in place, and the cup-like indentation helps keep the sponge centered on your cervix.

Insert the sponge before sexual intercourse and leave in place for at least six hours afterward. Protection begins once you insert the sponge and lasts up to 24 hours — the amount of time the spermicide is effective. During this time, you're protected even if you have intercourse more than once. After you remove the sponge, you're no longer protected against pregnancy.

To remove, pull the sponge out of your vagina using the string loop. Occasionally, the sponge may turn upside down, making the loop hard to reach. If this happens, slide your finger around the edge of the sponge to find the loop or grasp the edge of the sponge with two fingers and gently pull. Sometimes the sponge may adhere to the cervix because of suction. If this happens, use your finger to lift the sponge away from the cervix on one side, breaking the seal. Then, you can remove the sponge normally. Check the sponge after removal to make sure that you've removed the whole sponge, not just part of it.

If you can't remove the sponge or you remove only a portion of it, contact your doctor.

Are its effects reversible?

Yes, the contraceptive sponge is a reversible form of birth control. The sponge's protection diminishes after 24 hours, making pregnancy possible almost immediately thereafter.

How effective is it at preventing pregnancy?

Like other forms of birth control, the effectiveness rate of the sponge varies depending on how carefully you use it. Effectiveness also depends on whether you've given birth.

To better understand these percentages, consider a group of 100 women who have never given birth. With typical use, 16 of these women will become pregnant within one year of use, but only nine will become pregnant if they use the sponge perfectly each and every time they have intercourse. The effectiveness drops even further for women who have previously given birth. Of 100 of these women, 32 will become pregnant after one year of typical use and 20 will become pregnant after one year of perfect use. By comparison, the birth control pill, with perfect use, can reach 99 percent effectiveness — meaning only one pregnancy out of 100 in women who use the pill perfectly.

These factors may decrease the effectiveness of the sponge:

• Certain vaginal or uterine conditions, such as when abnormal connective tissue divides the vaginal canal (vaginal septum) or when the uterus drops into the vaginal canal (uterine prolapse). These conditions may affect how the sponge fits on the cervix. Check with your doctor if you have concerns.
• Medications for vaginal yeast infections, such as topical creams and suppositories. These medications dilute the spermicide, lowering its effectiveness.
• Whether you have given birth. The birth process stretches the vagina and cervix, which may affect how the sponge fits on the cervix. Check with your doctor if you have concerns.

Are there any associated health risks?

Some women using the contraceptive sponge have developed toxic shock syndrome (TSS) — a rare, life-threatening bacterial infection.

Signs and symptoms of TSS include:

• Fever
• Nausea
• Vomiting
• Diarrhea
• Muscle pain
• Dizziness
• Faintness
• Sunburn-like rash on your face or body

Because of the risk of TSS, don't leave the sponge in place for more than 30 hours, and don't use the sponge while you're menstruating or if you have a history of TSS.

In addition, don't use the contraceptive sponge if you're allergic or sensitive to the spermicide nonoxynol 9. Also, if you elect to use the sponge, wait at least six weeks after childbirth to allow the uterus and vagina to return to normal size. If you've had a miscarriage or other termination of pregnancy, your doctor can help you determine the best time to begin using the sponge.

Does it help prevent sexually transmitted diseases?

Despite being designed to block sperm from entering the uterus, bodily fluids that carry sexually transmitted diseases, such as HIV/AIDS and gonorrhea, can still come in contact with your vagina and vulva and may bypass the sponge and enter the uterus after removal. Therefore, contraceptive sponges aren't an effective means of protection against these diseases.

How much does it cost?

When last sold in the United States, a single contraceptive sponge cost about $1.25 to $1.50.

Advantages and disadvantages

As with any form of birth control, it's important to consider the advantages and disadvantages of the contraceptive sponge:

The above article was adapted from the following web site:
http://www.cnn.com/HEALTH/library/WO/00045.html

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