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RHO archives : Topics : Contraceptive Methods

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). (See Condoms and nonoxynol-9 on the Male Condoms page.) A recent Cochrane Review of 10 high-quality randomized controlled trials show that N-9 provides no protection against STIs. 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 prelubricated 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).

For information about microbicides, see the Contraceptive Research and Development page.

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Characteristics of spermicides

Effectiveness

20 to 25% failure rate (typical use) in the first year of use. Efficacy is improved if spermicides are used in conjunction with mechanical barrier methods, most commonly condom, diaphragm, and cervical cap.

Age limitations

No restrictions on age.

Parity limitations

No restrictions on use.

Mode of action

Spermicides destroy or immobilize sperm.

Effect on STI risk

Somewhat protective; using spermicides alone is not recommended for HIV protection.

Drug interaction

None.

Duration of use

Used at or near the time of intercourse; appropriate for both short-term and long-term use; women can use spermicides throughout their reproductive years.

Return to fertility

Immediately upon discontinuation.

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 STIs (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.

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