Spermicides - A Review

[Brandye]

Many posts on the forums here recommend the use of vaginal spermicides along with condoms as effective protection against pregnancy. Using condoms alone, but properly, for each sex act for a year for 100 women will result in about fifteen pregnancies. Using vaginal spermicide, alone, will result in about 18 pregnancies. Using them both together will yield about three pregnancies, or the same as using most hormonal systems. There is a sticky on various systems of birth control.
There have also been many posts on just what is a spermicide. A spermicide is a substance that will kill sperm on contact that is inserted into the vagina before the penis is inserted. The most common chemical used is Nonoxynol-9, which has been in use since the middle of the twentieth century. Ancient texts reveal that lemon juice, tobacco juice, honey and various other natural substances have been used as long history has records. Because Non-9 is a detergent, some women have an allergic reaction to it. There are products that use alternatives such as Octoxynal-9, Benzalkonium Chloride, Sodium Cholate (usually with another spermicide) and Menfegol. If you react to Non-9, look around and you will find another spermicide that you will tolerate.

All the products listed below have about the same effectiveness but differ in their convenience and method of insertion. Each has some advantages and each woman has to determine which she prefers. 100-150 mg in the vagina is required to be effective. That is 100 mg of the active ingredient, not of the product! The spermicidal lubrication on condoms is not sufficient to be effective and should not be depended upon in lieu of vaginal spermicide. What is available (brands are only the most common; other brands may be available in different countries):

1. Vaginal jelly. (Gynol II, K-Y+, Koromex). Jelly comes in a tube similar to tooth paste and requires an applicator. This places the greatest amount of spermicide in the vagina, helps with lubrication and is preferred by many when it does not have to be carried around. This system is rather bulky to have in your purse. The first tube you buy should be “with applicator.” The applicator is screwed onto the tube and filled by squeezing the tube. Diaphragms and cervical caps require jelly for their effectiveness. Effective as soon as you put it in.

2. Foam. (Delfen, Ortho Foam). Comes in a bottle with an applicator. The applicator is pressed onto the spring loaded top of the bottle and the product, under pressure, foams into the applicator. Foam is not lubricating and is also bulky to carry with you. Effective as soon as you put it in.

3. Film. (VCF). Comes in thin sheets that are inserted with your fingers into the vagina. It is rather convenient to carry in a purse but can be damaged if it is in there a long time. The film melts with body heat and vaginal juices. Many women like the film for its convenience without an applicator; many dislike it because it becomes very sticky very quickly and they have difficulty inserting it deeply. Effective within a minute of insertion.

4. Suppositories. (Encare, Norforms). These are the most convenient form of spermicide to carry with you and are packaged in a metallic or plastic wrapper. They are inserted by pressing in as deeply as possible with a finger. Suppositories require fifteen to twenty minutes to melt and become effective.

5. Prefilled applicator. (Conceptrol). This is a single use applicator slightly smaller than a tampon with applicator that is effective as soon as inserted. Not as convenient as suppositories but handier than most to carry with you.

6. Sponge. (Today). This is a small sponge impregnated with two or three different spermicides. It must be moistened and inserted to cover the cervix. The idea is that the sponge will absorb the sperm rich semen and the sperm will be immobilized. If the sponge is displaced, the protection is reduced. This is a fairly expensive option that is slightly more effective than other spermicides.

All of these except the sponge recommend re-application for each act. The sponge is effective for 24 hours no matter how often. If you have a home and regular spot for sex, any of these systems is quite effective. If you are dating about, convenience of carrying them has got to be considered. With this, the suppositories win. As a teen, whilst attending a German school with real sex education, many of the women found a handy helper from a tampon company. One of the tampon manufacturers was giving away tampon carriers that held two standard tampons. What was discovered was that if we used non-applicator tampons, the case would carry a few tampons, a few suppositories and two folded condoms in their envelopes. There was nothing unusual about a fifteen year old woman having tampons in her purse and these never caught anyone’s attention. Not even mum’s!

Words of caution: Spermicides offer only slight protection against STDs (consider it as none). Condoms are still required for disease protection. Many spermicides and condoms with spermicide now carry warnings about not to be used more than once a day. This warning is self-protection for the manufacturer. Whilst testing spermicides for HIV protection, it was discovered that the spermicide (specifically Non-9) would cause the skin to tear more easily and this, it was inferred, would make transmission of HIV more likely. This is true for anal sex but there is essentially no effect for vaginal sex. The thinner, less elastic tissue of the rectum does tear easily. The thicker, more elastic tissue of the vagina is unaffected.

For a woman for whom pregnancy is more than an inconvenience, spermicides are not adequately effective alone but, with a condom, are very good protection.

[Gueifu]

Thank you very much! I can sort of hear the final i on chiisai, though it's very faint. Having the romaji makes memorizing so much easier.

[RedRoses]

I've looked and asked around; spermicides are not so popular around here. Local drug stores do sometimes sell condoms with spermicides, but no spermicide sold separately. Local pharmacies can get it for you, mostly by pre-order (the customers that ask for it are few since not many use diaphragms any more). Some webshops do sell it, off course; you can get anything via internet. And like any internet-purchase, you'd have to be extra careful where to buy or you won't be that safe on the actual contents of the package.

ContraGel Green, which is lactic acid based, is recommended by the local pharmacies I visited and most easiest obtained (also at a few reliable webshops that surprisingly don't sell any other). From what I've been told and have read about it; the idea would be it lowers PH in the vagina, immobilizing the sperm (see: The Natural Alternative To Spermicide)

Now, my question is: how does ContraGel Green relate to those mentioned above?

[Brandye]

Interesting. As is so often true with "natural alternatives" they spend much space bad mouthing the traditional, chemical or medical but spend very little space really showing the effectiveness of their product. I can find no research results documenting the efficacy of this. From the ingredients alone, it would appear to be moderately effective and not dissimilar from home remedies used for this purpose before the discovery of Nonoxynol-9. Various acidic compounds have been used over the years - especially citric acid from lemon and tobacco juice.

Read "natural" with a bit of mistrust. Yes, everything they list can be found naturally; everything can also be manufactured in a laboratory. I am not against this stuff; I simply want to see their results rather than the evils of the competition.

Holland includes homeopathic medicine with allopathic medicine. Homeopathic or naturopathic apothecaries are more likely to carry the alternatives rather than the chemical potions. So, I do not know the comparative effectiveness and note that it is intended to be used with a pessary (cervical cap) that has been withdrawn from some markets. So long as used with a barrier method such as a diaphragm or condom, this will improve the protection. Just do not picture a little cabin in the woods with a group of leprechauns making this from natural ingredients.

[RedRoses]

LOL, I wasn't expecting any leprechauns!

My primary motivation in this case was not because it's supposed to be "natural" (I know I have a bit of a reputation on that ). In this case; it's just because I discovered spermicides are hardly for sale and only with effort, you can obtain ContraGel Green. When it comes to condoms; a popular brand like Durex is available in every drugstore. But they decided in 2004 to stop producing condoms and lubes with Nonoxynol-9, along with most other producers, due to the possible increased risk of transmitting of HIV. The decision was applauded by organizations that try to raise HIV-awareness. I've read the above comments on this; but however unjust it may be, it apparently did lead to stopping the sale here. I'll see if the pharmacy can provide me with any additional information on how reliable this "green" stuff is...

[Brandye]

Let me review the bidding on the warnings of a few years ago on Nonoxynol-9:
It was posited by some in the medical community that Non-9 may actually help prevent the spread of HIV/AIDS. This led to several studies around the world in which it was found that Non-9 actually increased the spread of HIV! Many of the regulatory agencies around the world, including the WHO, over-reacted and all products containing Non-9 must now be labeled with the danger and a warning not to use Non-9 more often than once each day. What had actually been found was a bit different. Non-9 had no effect on HIV spread in vaginal sex; it did increase the spread in anal sex.
Non-9 has been the leading spermicide world wide for more than fifty years. Many women, especially prostitutes, have always had Non-9 in them. There is really no reason to change this. For anal sex, the physiology is a bit different. The rectum is one cell thick, as opposed to the vagina’s forty cells, and the anus/rectum is not elastic as is the vagina. Non-9 is a detergent and can be an irritant that makes it more likely that small tears will occur in the rectum. These small tears admit the virus and increase the likelihood of HIV (or other STD) spreading. The site for the stuff above, ContraGel Green, states that Non-9 is abrasive. Not so! It is simply astringent and has a drying effect.
If a woman shows no reaction to products containing Non-9, itching, burning, there is no reason to limit its use. For anyone, man or woman, receiving anal sex, condoms with Nonoxynol-9 as a lube should not be used. Buy the dry condoms and use a non-spermicidal lubricant.

[RedRoses]

I did some more digging (I'm sometimes feeling like a leprechaun, or are those that dig in mines for diamonds called dwarfs? )

I just found out that Contragel Groen was launched as Contracep Groen by the Centraal Middelen Depot of the NVSH. The NVSH isn't "just" some organization; it had a major impact on our sexual health caresystem, sexual education, but also: acceptance of gays, laws to allow abortion, etc! NVSH stands for Dutch Association for Sexual Reformation, founded after WorldWarII. Actually they are a resurrection of the Nieuw-Malthusiaanse Bond; the first Dutch organization on family planning with Aletta Jacobs as one of it's prominent members (the one that every woman here owes it to that girls can go to university!)

The NVSH are the ones that launched sexual health care centres, that later became part of the famous Rutgers Stichting (Jan Rutgers being one of their prominent members). Apart from education and care, they also launched products through the Centraal Middelen Depot. They were the first to introduce and produce condoms in the Netherlands, developing rules for the product standards. And the first to produce Contracep Groen and Contracep Rood (containing Non-9), which were designed to be used along with a diaphragm. Seems like CG is a typical Dutch product; perhaps that's why we take pride in selling it The official distributors of FemCap in the Netherlands (Medical Dynamics) puts Contragel Green with FemCap. The NVSH has become a very small organization ever since their centers became obsolete by standard governmental health care (perhaps they should rebuilt them since our health care is becoming a victim of cut-backs...). The same formula of CG is now produced by Memidis. I'm hoping they will tell me more on the effectiveness and studies.

To be continued...

[Brandye]

Thanks, Red, for the interesting background and, I believe, it is dwarfs who do the diamond mining. Leprechauns are more into gold! With the rise of national health plans (which I advocate), some non-profit organisations, such as NVSH, have been left behind. These often are organisations dedicated to women's health. It happened slowly but definitely in the UK and is happening in Germany even with the health plan based on private insurance. Somehow, these things are believed to be well covered by NHS, so why bother? I have been appalled by the news on CNN International regarding the budget confusion in the States (which I do not understand). It finally boiled down to a trivial amount of money dedicated to women's health care being the divisive issue. No matter how far we have come, our unique female parts seem to be bargaining chips for male politicians! What is the real difference from being stoned for adultery?

I checked out your links. The Femcap was briefly available in the UK but seems to have disappeared and I note that Contragel is made in Germany. I shall have to go looking.

[Brandye]

I have found no medical research on the effectiveness of ContraGel. There are many testimonials but research results. The manufacturer specifically recommends that it be used with a barrier device - diaphragm, cap, condom. It has been approved for use all over Europe and in Canada. I do not know about other nations.

Relate? It is being presented as doing the same thing as traditional spermicides but without "chemical ingredients." The "natural" movment has responded but I am uncertain of the efficacy.

[RedRoses]

Usually I dislike members like Blogs who simply re-quote what I've written in a previous post. But in this case; serves as a reminder!
Contragel Groen is also know as Contracep Groen, Contracep Grün or Contracep Green, depending on where you live, so let's call it CG.

I have in the meanwhile received copies from Memidis of the IPPF-testing protocols, certificate and an exert of an independent study on spermicides including CG, as performed by Prof. Dr. H.C. Friedrich of the Philipps-University Marburg-Lahn in 1989.

Since the composition of neither spermicides nor CG has changed over the years, these results should still hold. The study basically says CS is equally reliable to regular spermicide. For those interested I've pasted it below (it took some tricks to copy and paste it, so it could be some diacritics didn't stick. Please notify me when you can understand German, but can't read what is says ):

"4.2.2 "Contracep"-Präparate
Die beiden Präparate "Contracep"(l)(rot= A> und "Contracep"(2) (grün = F> weisen praktisch gleiche Wirksamkeit auf; diese ist deutlich abgesetzt gegenüber der des "Zitronen-Gel", und in den stärkeren Konzentrationen, insbesondere in Kl, ist ihr
immobilisierender Effekt den herkömmlichen Präparaten "Ortho- Creme" und "Ortho-Gynol" vergleichbar. Sie haben im Gegen- satz zUm "Zitronen-Gel" ein gleichmäBiges Verteilungsmuster des Abfalls der Spermatozoen-Immobilisierung bei fallender Präparate- Konzentration (vgl.Abb.4-6),d.h.derWirkungsverlustinnerhalb der getesteten Konzentratiopen ist relativ linear bei gleichmäBig abfallender Wirkstoffmenge. Diese Tatsaehe versprieht eine höhere Zuverlässigkeit in der Kontrazeption als das Vorliegen von sprunghaftem Wirkungsabfall.
In dieser Hinsicht verhalten sieh die beiden holländischen Präparate auch besser gegenüber den oberfläehenwirksamen Gemi- sehen, wenngleieh auf einem insgesamt niedrigerem Immobilisa- tionsniveau. Die nieht-oberfläehenaktive Wirksamkeit wird dureh den Akrosomtest dokumentiert.
Hinsichtlieh der b-Werte liegen die beiden holländischen Präparate zwischen denen des "Zitronen-Gel" und den "Ortho"- Produkten, allerdings mehr zu ersterem tendierend. Dieser Urnstand kann für einen mehr motilitätshemmenden EinfluB spreehen als für eine primär spermizide Eigenschaft."

CG is especially popular in Germany, where cervical caps are more popular than in the Netherlands. In the Netherlands the standard gel to be prescribed with diaphragms and cervical caps is CG. On request, you could off course still get a spermicide with Nonoxynol-9. This does seem proof of how effective CG is considered by medical professionals.

The people who've kindly provided me with the copies, told me it should be noted that should one chose to use a spermicide without a barrier method (cervical cap/diaphragm or condom) spermicides with nonoxynol-9 are slightly more effective than CG. Even though my pharmacist claims that both are equally effective and neither should be used without a barrier.

The use of spermicides is highly unpopular in the Netherlands and not easy to come by. I haven't found a drugstore or adult-store that sells it. I have found a reliable condomerie with webshop in Amsterdam that sells CG to accompany condoms. Other than that, I'd need to rely on my pharmacist.