Contraception

Vaginal Spermicide

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Vaginal Spermicide, Spermicide, Nonoxynol

  • Indications
  1. Use with contraceptive barrier methods
    1. Cervical Cap
    2. Contraceptive Diaphragm
  • Preparations
  1. Nonoxynol-9 (Gynol II)
    1. Only available Spermicide in U.S.
    2. Shortens Condom shelf life and is more costly
    3. Highest concentration (150 mg) is most efficacious
      1. Failure rate is still 14% at 150 mg
      2. Overall failure rate for all concentrations: 22%
      3. Raymond (2004) Obstet Gynecol 103:430-9 [PubMed]
    4. Do not use for STD protection
      1. Does not increase Condom efficacy
      2. Does not protect against Gonorrhea and Chlamydia
        1. Roddy (2002) JAMA 287:1117-22 [PubMed]
      3. Increases risk of Gonorrhea
        1. Richardson (2001) Sex Transm Dis 28:394-400 [PubMed]
      4. Increases HIV risk (disrupts vaginal epithelium)
    5. References
      1. Apgar (2003) AAFP Board Review, Seattle
  2. Octoxynol-9
  3. Benzalkonium
  4. Homemade Spermicide (anecdotal with unproven efficacy)
    1. Aloe Vera Gel: 1 Tablespoon
    2. Lemon juice: 3 drops
    3. Keep refrigerated for no longer than 72 hours
    4. Reference
      1. Summerhayes (1999) CMEA Women's Health, San Diego
      2. Oyelola (1987) Contraception 36(4):435-40 [PubMed]
  • Mechanism
  1. Spermicide attacks sperm acrosomal membranes
  2. Breakdown of membranes immobilizes sperm
  3. Spermicide delivered in base to adhere to Cervix
  • Efficacy
  1. Overall Failure rate: 21% (3-31%)
  • Technique
  1. Allow time for activation and well timed for sex
  2. Reapply Spermicide for repeat intercourse
  3. No douching for 6 hours post intercourse
  • Disadvantages
  1. Sex may need to be interrupted to apply
  2. Messy or difficult to apply
  3. Unpleasant smell or taste
  • Adverse Effects
  1. Allergy to Spermicide in 2-4% of men and women