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Spermicidal Contraception

Spermicides are composed of a spermicidal agent in a carrier that allows dispersion and retention of the agent in the vagina.

Nonoxinol-9 is the most commonly used spermicidal agent and is the active component in the prescribable spermicidal agents available in the UK. Spermicidal contraceptives are useful additional safeguards, but do not give adequate protection if used alone, except where fertility is already significantly diminished. They are suitable for use with barrier methods such as the cap and diaphragm.1,2

Available preparations

Spermicides are available as:

  • Aerosol foam
  • Jelly
  • Cream1
  • Film
  • Sponge
  • Pessary
Efficacy

It is no longer recommended to use condoms with spermicides, as they are neither necessary for contraceptive efficacy of condoms nor useful for infection protection.

  • Because of poor trial quality, how well various spermicides work in preventing pregnancy is unclear. However, it is known that gel with the smallest amount of nonoxinol-9 is less effective in preventing pregnancy than products containing more of the same ingredient.3
  • Two recent large randomized controlled trials in developing countries compared whether protection was provided against gonorrhoea, chlamydial infection, and HIV-1 infection with gel formulations containing nonoxinol-9.4,5 The studies found that the spermicidal agent offered no clinical benefit; and so currently the extent to which protection may be provided by use of spermicidal agents is inconclusive.
  • Avoid spermicides in men and women who might be at high risk of infection, as multiple use of spermicide may cause irritation to the vagina and rectum, increasing the chance of infection.
  • Spermicides should be used by women at low risk of infection who wish to use a barrier method (except condoms).
Mode of action

Diaphragms and caps are barrier methods of contraception and therefore prevent fertilisation. They cover the cervix, acting as a barrier blocking the cervix as well as providing a reservoir for spermicide. When used correctly with spermicide:

  • Diaphragms have a first year failure rate of between 4 and 8%.
  • Caps have a first year failure rate of between 9 and 26%.6

Spermicide works by:

  • Altering the integrity of the sperm cell membrane
  • Altering the vaginal pH, causing a hostile environment for sperm

Advantages

  • They provide lubrication.
  • Spermicides are thought to increase the effectiveness of the diaphragm, and it remains common practice to use a spermicide with a diaphragm. However, a recent Cochrane review only found one (under-powered) study that indicated a trend towards lower pregnancy rates with this strategy.7

Disadvantages

  • They may cause irritation and rarely allergy.6
  • They can be perceived as messy.
  • They may have an unpleasant odour or taste.6,8
Cautions and contraindications

The Committee on Safety of Medicines has issued this advice:

  • Products such as petroleum jelly (Vaseline®), baby oil and oil-based vaginal and rectal preparations are likely to damage condoms and contraceptive diaphragms made from latex rubber. They may render them less effective as a barrier method of contraception and as a protection from sexually transmitted diseases, including HIV.
  • There is no evidence of harm to latex condoms and diaphragms with the products listed here: Gynol II™; Ortho-Creme™; Orthoforms™.

Document references
  1. Summary of Product Characteristics - Ortho-Creme® Contraceptive Cream, (2.0% w/w of nonoxinol-9) Janssen-Cilag Ltd, Updated Oct 2002; electronic Medicines Compendium.
  2. Female barrier methods of contraception, Faculty of Family Planning and Reproductive Health Care RCOG (June 2007)
  3. Grimes DA, Lopez L, Raymond EG, Halpern V, Nanda K, Schulz KF. Spermicide used alone for contraception. Cochrane Database of Systematic Reviews 2005, Issue 4. Art. No.: CD005218. DOI: 10.1002/14651858.CD005218.pub2
  4. Roddy RE, Zekeng L, Ryan KA, et al; Effect of nonoxynol-9 gel on urogenital gonorrhea and chlamydial infection: a randomized controlled trial.; JAMA. 2002 Mar 6;287(9):1117-22. [abstract]
  5. Van Damme L, Ramjee G, Alary M, et al; Effectiveness of COL-1492, a nonoxynol-9 vaginal gel, on HIV-1 transmission in female sex workers: a randomised controlled trial.; Lancet. 2002 Sep 28;360(9338):971-7. [abstract]
  6. Belfield, T. (Ed.) FPA contraceptive handbook: a guide for family planning and other health professionals. 3rd edn. London: Family Planning Association. (1999)
  7. Cook L, Nanda K, Grimes D; Diaphragm versus diaphragm with spermicides for contraception.; Cochrane Database Syst Rev. 2003;(1):CD002031. [abstract]
  8. The Consensus Committee of the Society of Obstetricians and Gynaecologists of Canada (1998) The Canadian consensus conference on contraception. Journal SOGC 20(8), 1-75.
Internet and further reading AcknowledgementsEMIS is grateful to Dr Hayley Willacy for writing this article. The final copy has passed scrutiny by the independent Mentor GP reviewing team. ©EMIS 2008.
DocID: 410
Document Version: 3
DocRef: bgp25244
Last Updated: 7 Apr 2008
Review Date: 7 Apr 2009
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See also MAKEPOVERTYHISTORY North East for details and links to campaigns against poverty.

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