Spermicides

Overview

Spermicides are chemical products inserted in a woman's vagina before sex that inactivate or kill sperm. They have been available for more than 40 years, and the rigorous contraceptive testing required by the U.S. Food and Drug Administration was not required at the time of their approval (FHI 2000). The main chemicals used in spermicides are nonoxynol-9, octoxynol-9, menfegol, and benzalkonium chloride. Of these, nonoxynol-9 is the most common. Spermicides often are used as a temporary method while waiting for a long-term method or by couples who have intercourse infrequently. Many breastfeeding women who need contraception use spermicides since they increase vaginal lubrication, can be used immediately after childbirth, and have no hormonal side effects. Spermicides come in several different forms—cream, jelly (gels), melting suppository, foaming tablet, aerosol foam, and C-film. Some condoms also come lubricated with spermicide.

When used alone, spermicides provide some contraceptive protection, but are best when used with a barrier method to prevent pregnancy. Spermicide products can vary in the concentration of active ingredient. A study looking at the effect on contraceptive effectiveness of five nonoxynol-9 spermicides of varying dosages (ranging from 52.5 mg to 150 mg N-9) and forms (gel, film, suppository) found that the higher-dose products (100 mg and 150 mg) were more effective than the low-dose product, but the form of the product did not appear to have significant influence (Raymond 2004).

Recent research on the effects of N-9 have led to a rethinking of policy and recommendations around use of spermicidally coated condoms for HIV prevention (AGI 2002). A recent Cochrane Review of 10 high-quality randomized controlled trials show that N-9 provides no protection against STI's. Additionally, these trials suggest that use of N-9 is associated with an increased risk of genital ulceration when compared with a placebo. However, because most of these trials were conducted with high-risk female sex worker populations working in high STI prevalence areas and with high rates of partner change, these results are not generalizable to lower-risk women using N-9 occasionally as a spermicide (Wilkinson et al. 2002).

A recent statement from the Medical Advisory Panel of the IPPF recommends that N-9 should be used only in combination with a female mechanical barrier method and that condoms pre lubricated with N-9 have no advantage in contraceptive efficacy and should no longer be recommended. Family planning associations that have current stock condoms with N-9 should finish existing supplies; however, N-9 lubricated condoms should not be distributed to women at high risk of HIV/AIDS (IMAP 2003).

Characteristics of spermicides

Effectiveness

Research on the effectiveness of spermicides, particularly nonoxynol-9 (N-9), to reduce STI transmission has provided conflicting results. Laboratory tests of N-9 consistently show that N-9 kills HIV and other STI pathogens. Early small-scale studies of N-9 use suggest that it may protect against STI's. (Kreiss 1992; Niruthisard 1992). Results of a two-year study in Cameroon, however, found that where a high percentage of sexual acts were protected by condoms, use of N-9 (lower-dose film) did not confer additional protection against gonorrhea, chlamydia, or HIV (FHI 1997). Data presented at the XIII International AIDS Conference indicated that frequent use and higher doses of N-9 can lead to tissue trauma, thus possibly increasing the risk of infection. These latest data show that N-9 is ineffective against HIV transmission among women who use large amounts of spermicide on a frequent basis. Based on data presented at the conference, the U.S. Centers for Disease Control (CDC) recommends that HIV-prevention guidelines be revised to indicate that N-9 should not be recommended as an effective means of HIV prevention. UNAIDS and the CDC are considering official revisions to public health guidelines for the use of N-9 for HIV prevention and for pregnancy prevention in populations at high risk for HIV.

How do I use Spermicides?

There are several different types of spermicides. Most are similar in terms of cost and how well they work. Put the spermicide in before every act of sex. Always read the directions that come with every spermicide. If you have sex again, insert more spermicide. Do not douche for at least 6 hours after intercourse, or you could wash away the protection. They come as jellies, creams, suppositories and foam.

We are presenting this information but believe that as a teenager you should use spermicides with condoms for extra protection.

Spermicidal Jelly
Jellies come in tubes. Squeeze the product into the applicator. Put the applicator into your vagina as far as it will go. Push the end of the applicator to empty the product into the vagina. The product must reach the cervix to be effective. Jellies provide immediate protection. If you are using jelly alone, then the protection lasts for 1 hour. If sexual intercourse lasts longer than that, or if you have sex again, apply another dose. If you are using it with a diaphragm, the protection lasts for up to 6 hours. See the diaphragm section for more information. If you find that this product is irritating to you or your partner, you should try a different product or a different type of spermicide, or you may want to try a different method of birth control.

Creams
Spermicidal creams come in a tube and are used the same way as the jelly spermicides (see above).

Suppositories
Unwrap the suppository. Then put it as far as you can into your vagina. It should be placed as close to the cervix as possible. Suppositories take 10 to 30 minutes to be effective. The protection lasts from 10 to 30 minutes after insertion up to 1 hour after insertion. Read the product label carefully. If it has been longer than 1 hour since you put it in and you are still having sex, you should put in another suppository.

Foams
Foam comes in a small container. Shake the foam can hard, for about 20 shakes. Then, put the product in an applicator, and empty it into the vagina. The product must reach the cervix to be effective. Foams provide immediate protection, and continue to provide protection for an hour after the foam was inserted. If it has been longer than 1 hour since you put it in and you are still having sex, you should put in another dose. If you have sex again, apply another dose.

The above articles were adapted from the following web sites:
http://www.rho.org/html/cont-spermicides.html
http://www.coolnurse.com/spermicide.htm

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