Spermicide

Spermicide
Background
Birth control type	Spermicide
First use	Ancient
Failure rates (first year)
Perfect use	18%
Typical use	29%
Usage
Reversibility	Immediate
User reminders	More effective if combined with a barrier method
Advantages and disadvantages
STD protection	No
Weight gain	No
Benefits	Provides lubrication
Risks	Genital irritation; increased risk of HIV infection due to irritation openings; not recommended by the World Health Organization for persons outside of a monogamous relationship.

Spermicide is a contraceptive substance that eradicates sperm, inserted vaginally prior to intercourse to prevent pregnancy. As a contraceptive, spermicide may be used alone. However, the pregnancy rate experienced by couples using only spermicide is higher than that of couples using other methods. Usually, spermicides are combined with contraceptive barrier methods such as diaphragms, condoms, cervical caps, and sponges. Combined methods are believed to result in lower pregnancy rates than either method alone.^[1]

Spermicides are unscented, clear, unflavored, non-staining, and lubricative.

Types and effectiveness

The most common active ingredient of spermicides is nonoxynol-9. Spermicides containing nonoxynol-9 are available in many forms, such as jelly (gel), films, and foams, but not recommended by the CDC. Spermicides cause irritation and according to the CDC, studies have shown that spermicides increase the risk of HIV. Contraceptive Technology states that spermicides have a failure rate of 18% per year when used correctly and consistently, and 29% under typical use.^[2]

Menfegol is a spermicide manufactured as a foaming tablet.^[3] It is available only in Europe.

Octoxynol-9 was previously a common spermicide, but was removed from the U.S. market in 2002 after manufacturers failed to perform new studies required by the FDA.^[4]

The spermicides benzalkonium chloride and sodium cholate are used in some contraceptive sponges.^[5] Benzalkonium chloride might also be available in Canada as a suppository.^[6]

The 2008 Ig Nobel Prize (a parody of the Nobel Prizes) in Chemistry was awarded to Sheree Umpierre, Joseph Hill, and Deborah Anderson, for discovering that Coca-Cola is an effective spermicide,^[7] and to C.Y. Hong, C.C. Shieh, P. Wu, and B.N. Chiang for proving it is not.^[8][9]

Lemon juice solutions have been shown to immobilize sperm in the laboratory,^[10] as has Krest Bitter Lemon drink.^[11] While the authors of the Krest Bitter Lemon study suggested its use as a postcoital douche, this is unlikely to be effective, as sperm begin leaving the ejaculate (out of the reach of any douche) within 1.5 minutes of deposition. No published studies appear to have been done on the effectiveness of lemon juice preparations in preventing pregnancy, though they are advocated by some as 'natural' spermicides.^[12]

Lactic acid preparations have also been shown to have some spermicidal effect, and commercial lactic acid-based spermicides are available.^[13][14] However, no published studies on the effectiveness of lactic acid in preventing pregnancy appear to have been done since 1936.^[15] Thomas Moench, a former assistant professor of medicine, has said that research into acids as spermicides has "pretty much been abandoned."^[16]

Extractives of the neem plant such as neem oil have also been proposed as spermicides based on laboratory studies.^[17] Animal studies of creams and pessaries derived from neem have shown they have contraceptive effects,^[18] however trials in humans to determine its effectiveness in preventing pregnancy have not yet been conducted.

Use with condoms

Spermicides are believed to increase the contraceptive efficacy of condoms.^[1]

However, condoms that are spermicidally lubricated by the manufacturer have a shorter shelf life ^[19] and may cause urinary-tract infections in women.^[20] The World Health Organization says that spermicidally lubricated condoms should no longer be promoted. However, they recommend using a nonoxynol-9 lubricated condom over no condom at all.^[21]

Side effects

Nonoxynol-9 has a number of possible side effects. These include irritation, itching, or the sensation of burning of the sex organs (either partner), and in women, urinary tract infections, yeast infection, and bacterial vaginosis.^[22] These side effects are uncommon; one study found that only 3-5% of women who try spermicides discontinue use due to side effects.^[23]

Concern has been raised over possible increased risk of birth defects in children conceived despite spermicide use, and also in children of women who, not yet aware of their condition, continued spermicide use during early pregnancy.^[24] However, a review in 1990 of large studies on spermicides concluded "there appears to be no increased risk of congenital anomalies, altered sex ratio, or early pregnancy loss among spermicide users."^[25]

History

The first written record of spermicide use is found in the Kahun Papyrus, an Egyptian document dating to 1850 BCE. It described a pessary of crocodile dung and fermented dough.^[26] It is believed that the low pH of the dung may have had a spermicidal effect.^[27]

Further formulations are found in the Ebers Papyrus from approximately 1500 BCE. It recommended mixing seed wool, acacia, dates and honey, and placing the mixture in the vagina. It probably had some effectiveness, in part as a physical barrier due to the thick, sticky consistency, and also because of the lactic acid (a known spermicide) formed from the acacia.^[27]

Writings by Soranus, a 2nd century Greek physician, contained formulations for a number of acidic concoctions claimed to be spermicidal. His instructions were to soak wool in one of the mixtures, then place near the cervix.^[26]

Laboratory testing of substances to see if they inhibited sperm motility began in the 1800s. Modern spermicides nonoxynol-9 and menfegol were developed from this line of research.^[26] However, many other substances of dubious contraceptive value were also promoted. Especially after the prohibition of contraception in the U.S. by the 1873 Comstock Act, spermicides—the most popular of which was Lysol—were marketed only as "feminine hygiene" products and were not held to any standard of effectiveness. Worse, many manufacturers recommended using the products as a douche after intercourse, too late to affect all the sperm. Medical estimates during the 1930s placed the pregnancy rate of women using many over-the-counter spermicides at seventy percent per year.^[28]

See also

• Personal lubricant

Footnotes

1. ^ ^{a b} Kestelman P, Trussell J (1991). "Efficacy of the simultaneous use of condoms and spermicides". Fam Plann Perspect 23 (5): 226–7, 232. doi:10.2307/2135759. JSTOR 2135759. PMID 1743276. 
2. ^ Hatcher, RA; Trussel J, Stewart F, et al. (2000). Contraceptive Technology (18th ed.). New York: Ardent Media. ISBN 0-9664902-6-6. http://www.contraceptivetechnology.com/table.html. 
3. ^ "Spermicides: Neo-Sampoon (Menfegol)". RemedyFind. Archived from the original on September 28, 2007. http://web.archive.org/web/20070928090505/http://www.remedyfind.com/treatments/77/1301/. Retrieved 2006-10-01. 
4. ^ "Status of Certain Additional Over-the-Counter Drug Category II and III Active Ingredients". Federal Register. Food and Drug Administration. May 9, 2002. http://www.fda.gov/ohrms/dockets/98fr/050902b.htm. Retrieved 2006-08-18. 
5. ^ "Sponges". Cervical Barrier Advancement Society. 2004. http://www.cervicalbarriers.org/information/sponges.cfm. Retrieved 2006-09-17. 
6. ^ "Spermicides (Vaginal)". MayoClinic.com. August 1997. Archived from the original on July 8, 2006. http://web.archive.org/web/20060708030353/http://www.mayoclinic.com/health/drug-information/DR202531. Retrieved 2006-10-16. 
7. ^ Umpierre, Sheree; Hill, Joseph; Anderson, Deborah (November 21, 1985). "Correspondence: Effect of 'Coke' on sperm motility". NEJM (Massachusetts Medical Society) 313 (21): p. 1351. http://content.nejm.org/cgi/content/citation/313/21/1351. Retrieved 2008-10-03. 
8. ^ Hong, C.Y.; Shieh, C.C.; Wu, P.; Chiang, B.N. (September 1987). "The spermicidal potency of Coca-Cola and Pepsi-Cola". Human Toxicology (Macmillan Publishers, Scientific and Medical Division) 6 (5): pp. 395–6. doi:10.1177/096032718700600508. http://www.ncbi.nlm.nih.gov/pubmed/3679247. Retrieved 2008-10-03. 
9. ^ Mikkelson, Barbara (March 16, 2007). "Killer Sperm: Coca-Cola Spermicide". http://www.snopes.com/cokelore/sperm.asp. Retrieved 2008-10-03. 
10. ^ Roger Short, Scott G. McCoombe, Clare Maslin, Eman Naim and Suzanne Crowe (2002) (PDF). Lemon and Lime juice as potent natural microbicides. http://www.aids.net.au/aids-lemons.pdf. Retrieved 2006-08-13. 
11. ^ Nwoha P (1992). "The immobilization of all spermatozoa in vitro by bitter lemon drink and the effect of alkaline pH". Contraception 46 (6): 537–42. doi:10.1016/0010-7824(92)90118-D. PMID 1493713. 
12. ^ "MoonDragon's Contraception Information: Spermicides". MoonDragon Birthing Services. 1997?. http://www.moondragon.org/obgyn/contraception/spermicides.html. Retrieved 2006-08-13. 
13. ^ "Femprotect - Lactic Acid Contraceptive Gel". Woman's Natural Health Practice. Archived from the original on June 1, 2006. http://web.archive.org/web/20060601030433/http://www.naturalgynae.com/nav6_fact19.html. Retrieved 2006-09-17. 
14. ^ "Contragel Green". Condomerie Webshop. http://condomerie.com/webshop/product_info.php?products_id=1392. Retrieved 2006-09-17. 
15. ^ Stone H (1936). "Contraceptive jellies: a clinical study". J Contracept 1 (12): 209–13. PMID 12259192. 
16. ^ Venere, Emil (September 1996). "On Research: New Contraceptive Gel Prevents Pregnancy and STDs". The Gazette, The Newspaper of the Johns Hopkins University. http://www.jhu.edu/~gazette/julsep96/sep3096/sexgel.html. Retrieved 2006-08-13. 
17. ^ Sharma S, SaiRam M, Ilavazhagan G, Devendra K, Shivaji S, Selvamurthy W (1996). "Mechanism of action of NIM-76: a novel vaginal contraceptive from neem oil". Contraception 54 (6): 373–8. doi:10.1016/S0010-7824(96)00204-1. PMID 8968666. 
18. ^ Talwar G, Raghuvanshi P, Misra R, Mukherjee S, Shah S (1997). "Plant immunomodulators for termination of unwanted pregnancy and for contraception and reproductive health". Immunol Cell Biol 75 (2): 190–2. doi:10.1038/icb.1997.27. PMID 9107574. 
19. ^ "Spermicide (Nonoxynol-9)". Other disadvantages. http://www.condomjungle.com/Spermicidal_Nonoxynol_9_Lubricated_Condoms_s/61.htm. Retrieved 2008-04-23. 
20. ^ "Condoms: Extra protection". ConsumerReports.org. February 2005. Archived from the original on June 26, 2006. http://web.archive.org/web/20060626055716/http://www.consumerreports.org/cro/health-fitness/health-care/condoms-and-contraception-205/overview/index.htm. Retrieved 2006-08-06. 
21. ^ "Microbicides". World Health Organization. 2006. Archived from the original on August 4, 2006. http://web.archive.org/web/20060804135456/http://www.who.int/hiv/topics/microbicides/microbicides/en/. Retrieved 2006-08-06. 
22. ^ "Drug Information: Nonoxynol-9 cream, film, foam, gel, jelly, suppository". Medical University of South Carolina. March 2006. http://www.muschealth.com/cds/CPDrugInfo.details.aspx?cpnum=1477&language=english. Retrieved 2006-08-06. 
23. ^ Xu J, Shi L, Zhou X, Xiao Z (2003). "Contraceptive efficacy of bioadhesive nonoxynol-9 Gel: comparison with nonoxynol-9 suppository". Zhonghua Fu Chan Ke Za Zhi 38 (10): 629–31. PMID 14728869. 
24. ^ "Study raises question of spermicide safety". Contracept Technol Update 2 (5): 57–61. 1981. PMID 12265917. 
25. ^ Huggins G, Cullins V (1990). "Fertility after contraception or abortion". Fertil Steril 54 (4): 559–73. PMID 2209874. 
26. ^ ^{a b c} "Evolution and Revolution: The Past, Present, and Future of Contraception". Contraception Online (Baylor College of Medicine) 10 (6). February 2000. http://www.contraceptiononline.org/contrareport/article01.cfm?art=93. ^{[dead link]}
27. ^ ^{a b} Towie, Brian (January 19, 2004). "4,000 years of contraception on display in Toronto museum". torontObserver. Centennial College journalism students. http://observer.thecentre.centennialcollege.ca/features/condom_museum011904.htm. 
28. ^ Tone, Andrea (Spring 1996). "Contraceptive consumers: gender and the political economy of birth control in the 1930s". Journal of Social History. http://findarticles.com/p/articles/mi_m2005/is_n3_v29/ai_18498205/pg_1. Retrieved 2006-10-21. 

Roddy R, Zekeng L, Ryan K, Tamoufe U, Weir S, Wong E. A controlled trial of nonoxynol-9-film to reduce male-to-female transmission of sexually transmitted diseases. N Engl J Med 1998;339:504—10