Spermicides

Spermicides are non-prescription and easily available in many different preparations (creams, foams, jellies, suppositories).  Ideally, spermicides should be used with another method, such as condoms or diaphragms. Vaginal spermicides, when used alone, are much less effective in preventing pregnancy than birth control pills, the IUD, or spermicides used with another form of birth control, such as cervical caps, condoms, or diaphragms. Studies have shown that when spermicides are used alone, pregnancy usually occurs in 21--26 of each 100 women during the first year of spermicide use. The number of pregnancies is significantly reduced when spermicides are used with another barrier method, particularly the condom. They work by blocking entry of sperm into the uterus with foam or thick cream and creating an environment in which sperm cannot survive. All types contain a sperm-killing chemical such as nonoxydol-9.

• Read product instructions carefully. Some spermicides require the couple to wait 10 minutes or more after inserting the spermicide before having sex. One dose of spermicide is usually effective for one hour. For repeated intercourse, additional spermicide must be applied. After intercourse, the spermicide has to remain in place for at least six to eight hours (different depending upon the product) to ensure that all sperm are killed. Women should not douche, rinse the vagina, or bathe during this time.  If using a spermicide with another barrier contraceptive, make sure the directions for the spermicide you choose state that it is safe for use with latex cervical caps, condoms, or diaphragms. If the directions do not specify that the spermicide is safe with latex products, it may cause cervical caps, condoms, or diaphragms to weaken and leak or cause condoms to break during intercourse.
  
  
• Laboratory studies have shown that the most common spermicidal agent, nonoxynol-9 kills or stops the growth of the AIDS virus (HIV) and herpes simplex I and II viruses. It was also shown to be effective against other types of organisms that cause gonorrhea, chlamydia, syphilis, trichomoniasis, and other sexually transmitted diseases (venereal disease, VD, STDs).  Although this has not been proven in human studies (clinical trials), some scientists believe that if spermicides are put into the vagina or on the inside and outside of a latex (rubber) condom, they may kill these germs before they are able to come in contact with the vagina.
  
  
• It is not known whether spermicides can cause breaks in the skin that could actually increase the chances of getting a sexually transmitted disease, especially AIDS.  A recent large study in South Africa found that the most widely used spermicide, nonoxynol-9 is associated with an increased risk of HIV infection in South African women prostitutes who used it frequently (up to 20 times per day).  Nonoxynol-9 is widely used in the US for contraception alone and with condoms.  About one-third of lubricated condoms sold in the United States are covered with it.  This study may change the recommendation to use condoms with nonoxynol-9.  Not only might it not afford the protection it had been assumed to provide, it may cause an increased risk for HIV infection.  This study's results must be interpreted with great reserve however. It is unclear how applicable the differences are from a population of prostitutes having intercourse with up to 20 different partners per day and using this spermicide 20 times per day in a country where HIV infection is becoming epidemic to the American sexually active adult population.
  
  
• As a result of this research, however, at least two other studies of nonoxynol-9 gel in African women have been halted as have 2 studies of nonoxynol-9 in the US.  Based on this information, American women who are using condoms solely to prevent disease or who are at increased risk of  HIV should choose condoms that are not coated with nonoxynol-9 and choose another spermicide.
  
  
• For those who are not in a confidently monogamous relationship, the use of a spermicide is still recommended even when you are using non-barrier methods of birth control, such as birth control pills (the Pill) or intrauterine devices (IUDs) to confer additional protection from STDs.
  
  
• As with any medicine, when considering whether to use vaginal spermicides, their risks must be weighed against their potential benefits.  This is a decision you and possibly your doctor will make.

Allergies-If you have ever had any unusual or allergic reaction to benzalkonium chloride, nonoxynol-9, or octoxynol-9, it is best to check with your doctor and read the ingredients carefully before using any vaginal spermicides.  How do you know if you have an allergy (or sensitivity) to one of these products?  During use of spermicides, either partner may feel burning, stinging, warmth, itching, or other irritation.  Using a weaker strength of vaginal spermicide or one with different ingredients may be necessary. If you are using benzalkonium chloride suppositories, it may help to wet them before they are inserted into the vagina. If any of these effects continue after you have changed products, you may have an allergy to these products or an infection, and should contact a doctor as soon as possible.

Pregnancy-Studies have shown that the use of vaginal spermicides does not increase the risk of birth defects or miscarriage.  The only reason to use a spermicide during pregnancy is for STD protection although many women have used spermicides for contraceptive purposes when they were already pregnant.

Breast-feeding-It is not known if vaginal spermicides pass into breast milk in humans. However, their use has not been reported to cause problems in nursing babies.

Adolescents-These products have been used by teenagers and have not been shown to cause different side effects or problems than they do in adults. However, some younger users may need extra counseling and information on the importance of using spermicides properly to maximize their effectiveness.

Medical problems-Having certain medical problems may affect the use of vaginal spermicides. In some cases spermicides should not be used.  If you have any of the following medical conditions, check with your doctor before using spermicides:

• Allergies, irritations, or infections of the genitals.
• Conditions or medical problems where it is important that pregnancy does not occur.
• Recent childbirth, miscarriage, or abortion.
• Toxic shock syndrome (history of)-Cervical caps or diaphragms should not be used in these cases because there is an increased chance of developing toxic shock syndrome.
• Sores on the genitals (sex organs).

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Created: 10/31/2001  -  Donnica Moore, M.D.