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Recommendations for Contraceptive Use |
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Barrier Methods |
Q.2. How often can spermicide be used
in a given time period?
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| a) Continued spermicide use as
frequently as once or twice a day may cause some tiny breaks in the vaginal lining,
whereas use every other day does not cause significant irritation. If irritation is
detected upon examination and if a reasonable alternative is available, then the client
should be advised to discontinue the spermicidal product until healing is complete. |
a) The active ingredients of
most spermicide products are surfactants that disrupt cell membranes of spermatozoa,
pathogens and genital epithelium. In one study of frequent nonoxynol-9 (N-9) insertion,
erythema and microscopic epithelial lesions were equally frequent among women inserting
N-9 every other day as among placebo users. The rate of irritation was twice as high among
women inserting N-9 once or twice daily, and five times higher among women inserting four
N-9 suppositories daily than among placebo users. Similar findings have been reported in a
World Health Organization (WHO) sponsored study of the spermicide menfegol. Experts fear that the epithelial lesions of spermicide-associated
irritation may increase the risk of contracting human immunodeficiency virus (HIV)
infection if exposure to HIV occurs. This has not been demonstrated in a human study, but
it is plausible, and local irritation should be avoided.
- Roddy RE, Cordero M, Cordero C,
Fortney JA. A dosing study of nonoxynol-9 and genital irritation. International Journal of
STDs and AIDS 1993;4:165-70.
- Goeman J, Ndoye I, Sakho LM, Mboup S,
Piot P, Karam M, et al. Frequent use of menfegol spermicidal vaginal foaming tablets
associated with a high incidence of genital lesions. Journal of Infectious Diseases
1995;171:1611-4.
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| b) Discomfort with spermicide
use is uncommon when used at typical family planning (FP) frequencies of once per day or
less. If discomfort is reported, a different spermicide product with different ingredients
may solve the problem. If discomfort persists, a different contraceptive method is
indicated. |
b) In studies of spermicide use
(approximately one to two times per day) for FP purposes, roughly 5% to 10% of women have
symptoms of discomfort after use. The clinical significance of discomfort is unclear,
because discomfort is a self-perceived problem and it may not be correlated with signs of
vaginal or cervical irritation detected during examination.
- Roddy RE, Cordero M, Cordero C,
Fortney JA. A dosing study of nonoxynol-9 and genital irritation. International Journal
STD & AIDS 1993;4:165-70.
- Feldblum P, Morrison C, Roddy R, Cates
W Jr. The effectiveness of barrier methods of contraception in preventing the spread of
HIV. AIDS 1995;9(Suppl A):S85-S93.
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| c) A woman should insert a new
dose of her spermicide product before each act of intercourse. Furthermore, a woman should
insert a new dose of spermicide if intercourse takes place an hour or more after initial
insertion. |
c) In order to be effective, the
spermicide must be high in the vagina near the cervix, with a sufficient concentration of
the active ingredient. Due to different delivery formulations, some products leak down
toward the vulva more quickly than others; some spread better than others. Manufacturers
of suppositories, gels and film generally claim that their product is effective for up to
one hour after insertion, but the period of effectiveness might be longer. Since
spermicides are typically less effective in preventing pregnancy than other methods, it is
prudent to insert a new dose for each intercourse.
- Hatcher RA, Trussell J, Stewart F,
Stewart GK, Kowal D, Guest F, et al. Vaginal spermicides. In: Contraceptive Technology.
New York: Irvington Publishers, 1994:179-90.
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