Description
Vaginal spermicides
are a type of contraceptive (birth control). These products are inserted into
the vagina
before
any genital contact occurs or
sexual intercourse begins. They work by damaging and killing sperm in the
vagina. Therefore, the sperm are not able to travel from the vagina into the
uterus and fallopian tubes, where fertilization usually takes place.
Vaginal spermicides when used alone are much less effective in preventing
pregnancy than birth control pills or 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 of each 100 women during the first year of spermicide
use
. The number of pregnancies is reduced when spermicides are used
with another method, especially the condom. Discuss with a doctor what your
options are for birth control and the risks and benefits of each method.
Laboratory studies
have shown that 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). Benzalkonium chloride also
killed the AIDS virus in laboratory studies. Although this has
not
been proven in
human
studies, 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 or rectum (lower bowel).
The most effective way to protect yourself against STDs (such as AIDS)
is by abstinence (not having sexual intercourse) or by having one partner
who you can be sure is not already infected or is not going to get an STD.
However, if either of these methods is not likely or possible, using latex
(rubber) condoms with a spermicide is the best way of protecting yourself.
The use of a spermicide is recommended even when you are using nonbarrier
methods of birth control such as birth control pills (the Pill) or intrauterine
devices (IUDs), since these do not offer any protection from STDs.
The safety of using spermicides in the rectum (lower bowel), anus, or rectal
area is not known. However, no side effects or problems have been reported
that are different from those reported for use in the vagina.
Vaginal spermicides are available without a prescription, in the following
dosage forms:
Vaginal
-
Benzalkonium chloride
-
Nonoxynol 9
-
Cream (U.S. and Canada)
-
Film (U.S.)
-
Foam (U.S. and Canada)
-
Gel (U.S. and Canada)
-
Jelly (U.S.)
-
Suppositories (U.S. and Canada)
-
Octoxynol 9
-
Cream (U.S.)
-
Jelly (U.S. and Canada)
Before Using This Medicine
In deciding to use vaginal
spermicides, the risks of using them must be weighed against the good they
will do. This is a decision you and possibly your doctor will make. The following
information may help you in making your decision:
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 before using vaginal spermicides.
Pregnancy--Many studies have shown that the use of vaginal spermicides
does not increase the risk of birth defects or miscarriage.
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 exactly as they are supposed to be
used so they will work properly.
Other medicines--If you are using this medicine without a prescription,
carefully read and follow any precautions on the label. For spermicides, the
following should be considered:
-
Salicylates used on the skin (e.g., some types of ointments for muscle
aches) or
-
Sulfonamides (sulfa medicine) for use in the vagina or
-
Chemicals or substances such as aluminum, citrate, cotton dressings,
hydrogen peroxide, iodides, lanolin, nitrates, permanganates, some forms of
silver, soaps, detergents, or tartrates--Benzalkonium chloride may not
work if it comes in direct contact with these as well as many other chemicals
-
Vaginal douches and rectal or vaginal cleansing products--For
spermicides to work properly to prevent pregnancy, they must stay in contact
with the sperm in the vagina for at least 6 or 8 hours (depending upon which
brand of spermicide you use) after sexual intercourse.
Vaginal douching is not necessary after use of these medicines
. Douching
too soon (even with just water) may stop the spermicide from working. Also,
washing or rinsing the vaginal or rectal area may also make the spermicide
ineffective in helping to prevent sexually transmitted diseases
Medical problems--The presence of certain medical problems may affect the use of vaginal
spermicides. Since in some cases spermicides should not be used, check with
your doctor if you have any of the following:
-
Allergies, irritations, or infections of the genitals--Using
vaginal spermicides may cause moderate to severe irritation in these conditions.
Also, benzalkonium suppositories may be less effective in women with vaginal
infections
-
Conditions or medical problems where it is important that pregnancy
does not occur--Vaginal spermicides when used alone are much less effective
than birth control pills or the IUD or spermicides used with another form
of birth control such as cervical caps, condoms, or diaphragms. Discuss with
your doctor what your options are for birth control and the risks and benefits
of each method
-
Recent childbirth or abortion or
-
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) or
-
Irritation of the vagina--It is not known whether spermicides
can cause breaks in the skin that could increase the chances of getting a
sexually transmitted disease, especially AIDS. Discuss this with a doctor
if you have any questions
If you develop any medical problem or begin using any
new medicine
(prescription or nonprescription) while you are using
this medicine, you may want to check with your doctor.
Proper Use of This Medicine
Make sure you carefully read
and follow the directions that come with each spermicide product. Each product
may have different directions for using the product. The directions tell you
how much to use, how long you must wait before having intercourse, and how
long you must leave it in the vagina after intercourse.
Vaginal douching is not needed or advised after using
these medicines
. When using a spermicide, douching within 6 to 8 hours
after the last sexual intercourse (even with just water) may stop the spermicide
from working properly. Also, washing or rinsing the vaginal or rectal area
may wash the spermicide away before it has had time to work properly.
Cervical caps and diaphragms are not recommended for use during your menstrual
period because of an increased chance of developing toxic shock syndrome.
Your doctor may advise you to use condoms with a spermicide instead during
your menstrual periods when protection is needed.
For proper use of spermicide when used alone
:
-
Follow directions carefully to make sure the spermicide is properly
placed in the vagina. The spermicide should be inserted deep into the vagina,
directly on the cervix (opening to the uterus).
-
Use the correct amount, according to the product directions.
-
Use another dose for
each
act of intercourse.
-
After you have applied or inserted the spermicide, wait the correct
amount of time before having intercourse so that the spermicide can begin
to work.
-
If you do not have intercourse within half an hour, read the product
directions to see if you need to apply more spermicide.
For proper use of spermicide with cervical caps, condoms,
or diaphragms
:
-
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 say the spermicide is safe to
use with latex products, the spermicide may cause cervical caps, condoms,
or diaphragms to weaken and leak or cause condoms to break during intercourse.
-
If there is a leak or break during intercourse, it may be a good
idea for the female partner to immediately place more spermicide in the vagina.
-
If you need an extra lubricant, make sure it
is a water-based product safe for use with cervical caps, condoms, or diaphragms
. Spermicides, especially gels and jellies, provide some lubrication
during sexual intercourse.
-
Oil-based products such as hand, face, or body cream; petroleum jelly;
cooking oils or shortenings; or baby oil should
not
be used because they weaken the latex rubber. (Even some products that easily
rinse away with water are oil-based and should not be used.) Use of oil-based
products increases the chances of the condom breaking during sexual intercourse.
These products can also cause the rubber in cervical caps or diaphragms to
break down faster and wear out sooner.
For patients using spermicides with a cervical cap
:
-
To be most effective at preventing pregnancy,
the cervical cap must always be used with a spermicide
. Both must be
used every time you have sexual intercourse.
-
Before inserting the cervical cap, inspect it for holes, tears, or
cracks. If there are holes or defects, the cervical cap will not work effectively,
even with a spermicide. It must be replaced.
-
Before you put the cervical cap over the cervix (opening to the uterus),
a spermicide cream, foam, gel, or jelly should be put into the cup of the
cervical cap. Follow the manufacturer's directions on how long before sexual
intercourse you may apply the spermicide. Fill the cervical cap one-third
full with spermicide.
-
To insert the cervical cap, squeeze the rim between your thumb and
forefinger so that it is narrow enough to fit into the vagina. While in a
comfortable position, push the cervical cap as deeply into the vagina as it
will go. Release the rim and press it into place around the cervix with your
finger. The rim should be round again and be directly on the cervix. The cervical
cap is held onto the cervix by suction.
-
Some doctors may recommend that you put more spermicide into the
vagina each time you repeat sexual intercourse using a cervical cap. You should
also check to make sure the cervical cap is in the proper position on the
cervix before and after each time you have intercourse. You may wear the cervical
cap for up to 48 hours (2 days).
-
Do not remove the cervical cap if it has been
less than 8 hours since the last time you had sexual intercourse
. For
the cervical cap to be most effective at preventing pregnancy, it must remain
in the vagina for at least 8 hours after sexual intercourse.
-
To remove the cervical cap, use 1 or 2 fingers to push the rim away
from the cervix. This will break the suction seal with the cervix. Then gently
pull the cervical cap out of the vagina.
Call your doctor
if you have trouble removing the cervical cap
.
For patients using spermicides with condoms
:
-
Condoms do not have to be used with spermicides, but the spermicide
may provide a back-up birth control method in case the condom breaks or leaks.
-
Spread some spermicide on the outside of the condom, after it is
unrolled over the penis. It is even more important that the female partner
also use a spermicide inside the vagina.
-
Each time you repeat intercourse, a new condom must be used.
Condoms should never be reused
. Spermicide should also
be applied to the outside of the new condom. The female partner must also
put more spermicide in the vagina each time she has intercourse.
For patients using spermicides with a diaphragm
:
-
To be most effective at preventing pregnancy,
diaphragms must always be used with a spermicide
. Some women may choose
to insert a diaphragm every night, to avoid the chance of unprotected sexual
intercourse and unplanned pregnancy happening.
-
Inspect the diaphragm for holes by holding it up to a light. If there
are holes or defects, the diaphragm will not work effectively, even with a
spermicide. It must be replaced.
-
Before you put the diaphragm over the cervix (opening to the uterus),
a spermicide cream, foam, gel, or jelly should be put into the cup of the
diaphragm. Follow the manufacturer's directions on how much spermicide to
use and how long before sexual intercourse you may apply the spermicide. Also,
spread some spermicide all around the rim of the diaphragm that will be touching
the cervix. Some doctors also advise spreading more spermicide on the outside
of the cup of the diaphragm.
-
To insert the diaphragm, squeeze the rim between your thumb and forefinger
so that it is narrow enough to fit into the vagina. While in a comfortable
position, push the diaphragm as deeply into the vagina as it will go. (Some
women use a special applicator that makes it easier to insert the diaphragm.)
Release the rim. The diaphragm rim should be round again and be directly on
the cervix.
-
Each time you repeat sexual intercourse, you should put more spermicide
into the vagina.
Do not remove the diaphragm if it has
been less than 6 or 8 hours (depending upon which brand of spermicide you
use) since the last sexual intercourse
. For the diaphragm to be most
effective at preventing pregnancy, it must remain in the vagina for at least
6 or 8 hours (depending upon which brand of spermicide you use) after sexual
intercourse. Be careful not to move the diaphragm out of place while you are
applying more spermicide.
-
Do not wear the diaphragm for more than 24 hours, since doing so
increases the risk of getting toxic shock syndrome or a urinary tract (bladder)
infection.
-
To remove the diaphragm, hook one finger over the rim nearest the
front. Pull the diaphragm downward and out of the vagina.
Call your doctor if you have trouble removing the diaphragm
.
Dosing--Follow your doctor's orders
or the directions on the label
. The following information includes
the usual way that spermicides are used.
For benzalkonium chloride
-
For preventing pregnancy:
-
For
vaginal suppositories
dosage form:
-
Adults and teenagers:
-
For use alone: One suppository inserted into the vagina at least
ten minutes but not longer than four hours before each time you have sexual
intercourse.
-
For use with a diaphragm: After the diaphragm with spermicide has
been placed into the vagina, insert one suppository at least ten minutes,
but not longer than four hours, before each time you have sexual intercourse.
Also, insert another suppository before sexual intercourse if six hours have
passed since you inserted the diaphragm.
For nonoxynol 9
-
For preventing pregnancy:
-
For
vaginal cream
dosage form:
-
Adults and teenagers:
-
For use alone: One applicatorful of a 5% cream inserted into the
vagina just before each time you have sexual intercourse.
-
For use with a diaphragm: One applicatorful of a 2 or 5% cream inserted
into the cup of the diaphragm. Spread more spermicide along the rim of the
diaphragm. Insert the diaphragm into the vagina just before, but not longer
than six hours before, sexual intercourse. Also, insert one applicatorful
just before each time you have intercourse or if six hours have passed since
you inserted the diaphragm.
-
For
vaginal film
dosage form:
-
Adults and teenagers--One film inserted into the vagina from
five to fifteen minutes (but not longer than one and one-half hours) before
each time you have sexual intercourse.
-
For
vaginal foam
dosage form:
-
Adults and teenagers:
-
For use alone: One applicatorful inserted into the vagina just before,
but not longer than one hour before, each time you have sexual intercourse.
-
For use with a diaphragm: One applicatorful inserted into either
the vagina or into the cup of the diaphragm, depending on the product. Spread
more spermicide along the rim of the diaphragm. Insert the diaphragm into
the vagina just before, but not longer than one hour before, sexual intercourse.
Also, insert another applicatorful into the vagina just before, but not longer
than one hour before, each time you have sexual intercourse.
-
For
vaginal gel
dosage form:
-
Adults and teenagers:
-
For use alone: One applicatorful of a 3.5, 4, or 5% gel inserted
into the vagina before each time you have sexual intercourse. The 3.5% gel
may be used up to twenty-four hours before each act of intercourse. The 4%
gel may be used up to one hour before each act of intercourse. The 5% gel
must used just before intercourse.
-
For use with a diaphragm: One or two teaspoonfuls (depending on the
product) or the contents of one packet of gel is placed into the cup of the
diaphragm. Spread more spermicide along the rim of the diaphragm. Insert the
diaphragm into the vagina just before, or up to six hours before, sexual intercourse.
Also, insert another applicatorful or the contents of one packet into the
vagina before each time you have sexual intercourse or if six hours have passed
since you inserted the diaphragm.
-
For
vaginal jelly
dosage form:
-
Adults and teenagers:
-
For use alone: One applicatorful of 2.2 or 3% jelly inserted into
the vagina just before each time you have sexual intercourse. The contraceptive
effect of the 2.2 or 3% jelly will last one hour.
-
For use with a diaphragm: One applicatorful or two teaspoonfuls of
jelly (depending on the product) placed into the cup of the diaphragm. Spread
more spermicide along the rim of the diaphragm. Insert the diaphragm into
the vagina just before, but not longer than six hours before, sexual intercourse.
Also, insert another applicatorful before each time you have sexual intercourse
or if six hours have passed since you inserted the diaphragm.
-
For
vaginal suppositories
dosage form:
-
Adults and teenagers:
-
For use alone: One suppository inserted into the vagina from ten
to fifteen minutes (depending on the product) before, but not longer than
one hour before, each time you have sexual intercourse.
-
Adults and teenagers:
-
For use with a diaphragm: After the diaphragm with spermicide has
been placed into the vagina, insert one suppository into the vagina from ten
to fifteen minutes (depending on the product) before, but not longer than
one hour before, sexual intercourse. Also, insert another suppository before
each time you have sexual intercourse or if six hours have passed since you
have inserted the diaphragm.
For octoxynol 9
-
For preventing pregnancy:
-
For
vaginal cream
dosage form:
-
Adults and teenagers:
-
For use with a diaphragm: Two teaspoonfuls placed into the cup of
the diaphragm. Spread more spermicide along the rim of the diaphragm. Insert
the diaphragm into the vagina just before, but not longer than six hours before,
sexual intercourse. Also, insert one applicatorful of the vaginal cream just
before each time you have sexual intercourse or if six hours have passed since
you inserted the diaphragm.
-
For
vaginal jelly
dosage form:
-
Adults and teenagers:
-
For use with a diaphragm: One applicatorful placed into the cup of
the diaphragm. Spread more spermicide along the rim of the diaphragm. Insert
the diaphragm into the vagina just before, but not longer than six hours before,
sexual intercourse. Also, insert another applicatorful just before each time
you have sexual intercourse or if six hours have passed since you inserted
the diaphragm.
Storage--To store this medicine:
-
Keep out of the reach of children.
-
Store away from heat and direct light.
-
Do not store in the bathroom, near the kitchen sink, or in other
damp places. Heat or moisture may cause the medicine to break down.
-
Do not refrigerate.
-
Do not keep outdated products or products no longer needed. Be sure
that any discarded products are out of the reach of children.
Precautions While Using This Medicine
During
use of spermicides, either partner may feel burning, stinging, warmth, itching,
or other irritation of the skin, sex organs, anus, or rectum. 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.
Side Effects of This Medicine
Along with its needed effects, a medicine may cause some unwanted effects.
Although not all of these side effects may occur, if they do occur they may
need medical attention.
Also, check with a doctor as soon as possible if any of the
following side effects occur:
Rare
For females and males
Skin rash, redness, irritation, or itching that does not subside
or go away within a short period of time
For females only
Cloudy or bloody urine; increased frequency of urination; pain
in the bladder or lower abdomen; pain on urination; thick, white, or curd-like vaginal discharge--with
use of cervical caps or diaphragms only; vaginal
irritation, redness, rash, dryness, or whitish discharge
Other side effects may occur that usually do not need medical
attention. However, check with a doctor if any of the following side effects
continue or are bothersome:
Other side effects not listed above may also occur in
some people. If you notice any other effects, check with your doctor.