Birth Control Spermicides

Spermicides are chemical barriers to conception. They are a reversible method of birth control, meaning that when a woman quits using them, full fertility returns. Vaginal spermicides are available in forms such as foam, cream, jelly, film, suppository, or tablet. Spermicides are not as effective as many other forms of birth control when used alone. They are often used with barrier methods of birth control and are much more effective when used in this context.

Spermicides contain a chemical that kills sperm or makes them inactive so they cannot enter a woman’s cervix. Nonoxynol-9 is the active chemical in most spermicide products in the United States. The concentration of the chemical depends on the product.

Several brands and types of spermicides are available over the counter. They can be obtained at drugstores, some supermarkets, and family planning clinics. Planned Parenthood lists the cost of applicator kits for foam and gel at about $8, and refills at about $4-8. Film and suppositories are priced similarly. In some states, the cost is covered by Medicaid when provided by clinics or authorized by a private doctor.

Spermicides are placed within the vagina, close to the cervix, before sex. Make sure your hands and any relevant equipment are clean before insertion. Follow package instructions carefully. Some spermicide products require the couple to wait 10 minutes or more after insertion for sex. One dose of spermicide usually lasts 1 hour. For repeated sex, use additional spermicide. After sex, the spermicide has to remain in place for 6-8 hours to make sure the sperm are killed. Do not douche or rinse the vagina during this time. (Douching is not recommended in general. See Birth Control Overview.)
 
For foams, shake the can vigorously, and fill the applicator. Insert the applicator into the vagina near the cervix. Push the plunger to deposit the spermicide in the vagina. According to the Northern Arizona University site on vaginal spermicides, 2 applicators full are needed for women at elevations higher than 3500 feet. Protection is immediate and lasts about an hour.
 
For gels or creams, fill the applicator by squeezing the tube. Insert the applicator as far as it will go without causing discomfort into the vagina, to make sure it is near the cervix. Hold the applicator still, and push the plunger to deposit the spermicide in the vagina. Protection is immediate and lasts about an hour.
 
For vaginal contraceptive film (VCF), hands must be dry before the product is touched. Remove the small thin sheet from its wrapper and insert it as far as you can into the vagina, so it is near the cervix. Protection begins in 15 minutes and lasts for no more than an hour.
 
For suppositories or tablets, remove the wrapper and insert into the vagina, near the cervix. Protection begins 10-15 minutes after insertion and lasts no more than an hour.

If any abnormality is present that may prevent proper placement of the spermicide, talk to a health care provider before using.
 
If irritation occurs after a spermicide is inserted, sensitivity to the product is possible. Changing to a different product may help. Consult a health care provider or pharmacist for advice. Do not continue to use the product.

Effectiveness 

Spermicides are not as effective as many other birth control methods, such as birth control pills or intrauterine devices (IUDs). How well spermicides prevent pregnancy when used alone is not certain. However, the FDA cites failure rates for typical users from 20-50%. Spermicides are most effective when used with a barrier method, such as a condom.   
 
Advantages
 
Spermicides are available over the counter. They do not usually affect other systems in the body. Women can use spermicides without involving their partners in the decision if they wish. When used with a condom, they are very effective. Spermicides may provide additional lubrication during intercourse.
 
Disadvantages
 
Some spermicides may be inconvenient, as they often require a waiting period of several minutes before they are effective. A woman must plan ahead and keep a supply available. The spermicide must be reapplied before each act of intercourse. Some women report messiness and leakage. Spermicides may irritate the vagina or penis. Switching brands may alleviate this problem. Serious medical risks are rare and include irritation, allergic reactions, and urinary tract infections.
 
Spermicides were once thought to provide minimal protection against STDs such as chlamydia and gonorrhea. However, this is no longer believed to be true. In fact, irritation of the vaginal surface may increase susceptibility to some STDs, especially HIV, when the spermicide is used several times a day. Women who want to reduce the risk of STDs should always use a latex condom. 
 
Women who should not use spermicides
 
Any woman with a history of toxic shock syndrome should not insert anything in the vagina that remains there for any length of time, including tampons, diaphragms, or sponges.

|Web Links|

U.S. Food and Drug Administration, Protecting Against Unintended Pregnancy: A Guide to Contraceptive Choices 
 
U.S. Food and Drug Administration, Birth Control Guide
 
Planned Parenthood, Facts About Birth Control, Reversible Non-Prescription Methods, Spermicide
 
American College of Obstetricians and Gynecologists, Barrier Methods of Contraception
 
Northern Arizona University, Vaginal Spermicides

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Author: Omnia M Samra, MD, Clinical Instructor, Department of Obstetrics and Gynecology, Medical College of Pennsylvania/Hahnemann University.

Editors: Suzanne R Trupin, MD, Clinical Professor, Department of Obstetrics and Gynecology, University of Illinois College of Medicine at Urbana-Champaign; Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, ; Lee P Shulman, MD, Professor of Obstetrics and Gynecology, Head, Section of Reproductive Genetics, Feinberg School of Medicine, Northwestern University, Chicago, Illinois.