SPERMICIDES (Vaginal)

Some commonly used brand names are:

In the U.S.?

• Advantage 24 ²
• Because ²
• Conceptrol Contraceptive Inserts ²
• Conceptrol Gel ²
• Delfen ²
• Emko ²
• Emko Pre-Fil ²
• Encare ²
• Gynol II Extra Strength Contraceptive Jelly ²
• Gynol II Original Formula Contraceptive Jelly ²
• Koromex Cream ³
• Koromex Crystal Clear Gel ²
• Koromex Foam ²
• Koromex Jelly ²
• K-Y Plus ²
• Ortho-Creme ²
• Ortho-Gynol ³
• Ramses Crystal Clear Gel ²
• Semicid ²
• Shur-Seal ²
• VCF ²

In Canada?

• Advantage 24 ²
• Delfen ²
• Emko ²
• Encare ²
• Ortho-Gynol ³
• Pharmatex ¹
• Ramses Contraceptive Foam ²

Category

• Contraceptive, vaginal?Benzalkonium Chloride; Nonoxynol 9; Octoxynol 9

Description

Vaginal spermicidesare a type of contraceptive (birth control). These products are inserted intothe vagina before any genital contact occurs orsexual intercourse begins. They work by damaging and killing sperm in thevagina. Therefore, the sperm are not able to travel from the vagina into theuterus and fallopian tubes, where fertilization usually takes place.

Vaginal spermicides when used alone are much less effective in preventingpregnancy than birth control pills or the IUD or spermicides used with anotherform of birth control, such as cervical caps, condoms, or diaphragms. Studies have shown that when spermicides are used alone, pregnancyusually occurs in 21 of each 100 women during the first year of spermicideuse. The number of pregnancies is reduced when spermicides are usedwith another method, especially the condom. Discuss with a doctor what youroptions are for birth control and the risks and benefits of each method.

Laboratory studies have shown that nonoxynol9 kills or stops the growth of the AIDS virus (HIV) and herpes simplex I andII viruses. It was also shown to be effective against other types of organismsthat cause gonorrhea, chlamydia, syphilis, trichomoniasis, and other sexuallytransmitted diseases (venereal disease, VD, STDs). Benzalkonium chloride alsokilled the AIDS virus in laboratory studies. Although this has not been proven in human studies, somescientists believe that if spermicides are putinto the vagina or on the inside and outside of a latex (rubber) condom, they may kill these germs before they are able to comein contact with the vagina or rectum (lower bowel).

The most effective way to protect yourself against STDs (such as AIDS)is by abstinence (not having sexual intercourse) or by having one partnerwho you can be sure is not already infected or is not going to get an STD.However, if either of these methods is not likely or possible, using latex(rubber) condoms with a spermicide is the best way of protecting yourself.

The use of a spermicide is recommended even when you are using nonbarriermethods of birth control such as birth control pills (the Pill) or intrauterinedevices (IUDs), since these do not offer any protection from STDs.

The safety of using spermicides in the rectum (lower bowel), anus, or rectalarea is not known. However, no side effects or problems have been reportedthat are different from those reported for use in the vagina.

Vaginal spermicides are available without a prescription, in the followingdosage forms:

Vaginal
• Benzalkonium chloride
  • Suppositories (Canada)
• Nonoxynol 9
  • Cream (U.S. and Canada)
  • Film (U.S.)
  • Foam (U.S. and Canada)
  • Gel (U.S. and Canada)
  • Jelly (U.S.)
  • Suppositories (U.S. and Canada)
• Octoxynol 9
  • Cream (U.S.)
  • Jelly (U.S. and Canada)

Before Using This Medicine

In deciding to use vaginalspermicides, the risks of using them must be weighed against the good theywill do. This is a decision you and possibly your doctor will make. The followinginformation may help you in making your decision:

Allergies?If you have ever had any unusual or allergic reactionto benzalkonium chloride, nonoxynol 9, or octoxynol 9, it is best to checkwith your doctor before using vaginal spermicides.

Pregnancy?Many studies have shown that the use of vaginal spermicidesdoes not increase the risk of birth defects or miscarriage.

Breast-feeding?It is not known if vaginal spermicides pass intobreast milk in humans. However, their use has not been reported to cause problemsin nursing babies.

Children?These products have been used by teenagers and have not beenshown to cause different side effects or problems than they do in adults.However, some younger users may need extra counseling and information on theimportance of using spermicides exactly as they are supposed to be used sothey will work properly.

Other medicines?If you are using this medicinewithout a prescription, carefully read and follow any precautions on the label.For spermicides, the following should be considered:

• Salicylates used on the skin (e.g., some types of ointments for muscleaches) or
• Sulfonamides (sulfa medicine) for use in the vagina or
• Chemicals or substances such as aluminum, citrate, cotton dressings,hydrogen peroxide, iodides, lanolin, nitrates, permanganates, some forms ofsilver, soaps, detergents, or tartrates?Benzalkonium chloride may notwork if it comes in direct contact with these as well as many other chemicals

• Vaginal douches and rectal or vaginal cleansing products?Forspermicides to work properly to prevent pregnancy, they must stay in contactwith the sperm in the vagina for at least 6 or 8 hours (depending upon whichbrand of spermicide you use) after sexual intercourse. Vaginal douching is not necessary after use of these medicines. Douchingtoo soon (even with just water) may stop the spermicide from working. Also,washing or rinsing the vaginal or rectal area may also make the spermicideineffective in helping to prevent sexually transmitted diseases

Other medical problems?The presence of certain medicalproblems may affect the use of vaginal spermicides. Since in some cases spermicidesshould not be used, check with your doctor if you have any of the following:

• Allergies, irritations, or infections of the genitals?Usingvaginal spermicides may cause moderate to severe irritation in these conditions.Also, benzalkonium suppositories may be less effective in women with vaginalinfections

• Conditions or medical problems where it is important that pregnancydoes not occur?Vaginal spermicides when used alone are much less effectivethan birth control pills or the IUD or spermicides used with another formof birth control such as cervical caps, condoms, or diaphragms. Discuss withyour doctor what your options are for birth control and the risks and benefitsof each method

• Recent childbirth or abortion or
• Toxic shock syndrome (history of)?Cervical caps or diaphragmsshould not be used in these cases because there is an increased chance ofdeveloping toxic shock syndrome

• Sores on the genitals (sex organs) or
• Irritation of the vagina?It is not known whether spermicidescan cause breaks in the skin that could increase the chances of getting asexually transmitted disease, especially AIDS. Discuss this with a doctorif you have any questions

If you develop any medical problem or begin using anynew medicine (prescription or nonprescription) while you are usingthis medicine, you may want to check with your doctor.

Proper Use of This Medicine

Make sureyou carefully read and follow the directions that come with each spermicideproduct. Each product may have different directions for using the product.The directions tell you how much to use, how long you must wait before havingintercourse, and how long you must leave it in the vagina after intercourse.

Vaginal douching is not needed or advised after usingthese medicines. When using a spermicide, douching within 6 to 8 hoursafter the last sexual intercourse (even with just water) may stop the spermicidefrom working properly. Also, washing or rinsing the vaginal or rectal areamay wash the spermicide away before it has had time to work properly.

Cervical caps and diaphragms are not recommended for use during your menstrualperiod because of an increased chance of developing toxic shock syndrome.Your doctor may advise you to use condoms with a spermicide instead duringyour menstrual periods when protection is needed.

For proper use of spermicide when used alone:

• Follow directions carefully to make sure the spermicide is properlyplaced in the vagina. The spermicide should be inserted deep into the vagina,directly on the cervix (opening to the uterus).
• Use the correct amount, according to the product directions.
• Use another dose for each act of intercourse.
• After you have applied or inserted the spermicide, wait the correctamount of time before having intercourse so that the spermicide can beginto work.
• If you do not have intercourse within half an hour, read the productdirections to see if you need to apply more spermicide.

For proper use of spermicide with cervical caps, condoms,or diaphragms:

• Make sure the directions for the spermicide youchoose state that it is safe for use with latex cervical caps, condoms, ordiaphragms. If the directions do not say the spermicide is safe touse with latex products, the spermicide may cause cervical caps, condoms,or diaphragms to weaken and leak or cause condoms to break during intercourse.
• If there is a leak or break during intercourse, it may be a goodidea for the female partner to immediately place more spermicide in the vagina.
• If you need an extra lubricant, make sure itis a water-based product safe for use with cervical caps, condoms, or diaphragms. Spermicides, especially gels and jellies, provide some lubricationduring sexual intercourse.
• Oil-based products such as hand, face, or body cream; petroleum jelly;cooking oils or shortenings; or baby oil should notbe used because they weaken the latex rubber. (Even some products that easilyrinse away with water are oil-based and should not be used.) Use of oil-basedproducts increases the chances of the condom breaking during sexual intercourse.These products can also cause the rubber in cervical caps or diaphragms tobreak down faster and wear out sooner.

For patients using spermicides with a cervical cap:

• To be most effective at preventing pregnancy,the cervical cap must always be used with a spermicide. Both must beused every time you have sexual intercourse.
• Before inserting the cervical cap, inspect it for holes, tears, orcracks. If there are holes or defects, the cervical cap will not work effectively,even with a spermicide. It must be replaced.
• Before you put the cervical cap over the cervix (opening to the uterus),a spermicide cream, foam, gel, or jelly should be put into the cup of thecervical cap. Follow the manufacturer's directions on how long before sexualintercourse you may apply the spermicide. Fill the cervical cap one-thirdfull with spermicide.
• To insert the cervical cap, squeeze the rim between your thumb andforefinger so that it is narrow enough to fit into the vagina. While in acomfortable position, push the cervical cap as deeply into the vagina as itwill go. Release the rim and press it into place around the cervix with yourfinger. The rim should be round again and be directly on the cervix. The cervicalcap is held onto the cervix by suction.
• Some doctors may recommend that you put more spermicide into thevagina each time you repeat sexual intercourse using a cervical cap. You shouldalso check to make sure the cervical cap is in the proper position on thecervix before and after each time you have intercourse. You may wear the cervicalcap for up to 48 hours (2 days).
• Do not remove the cervical cap if it has beenless than 8 hours since the last time you had sexual intercourse. Forthe cervical cap to be most effective at preventing pregnancy, it must remainin the vagina for at least 8 hours after sexual intercourse.
• To remove the cervical cap, use 1 or 2 fingers to push the rim awayfrom the cervix. This will break the suction seal with the cervix. Then gentlypull the cervical cap out of the vagina. Call your doctorif you have trouble removing the cervical cap.

For patients using spermicides with condoms:

• Condoms do not have to be used with spermicides, but the spermicidemay provide a back-up birth control method in case the condom breaks or leaks.
• Spread some spermicide on the outside of the condom, after it isunrolled over the penis. It is even more important that the female partneralso use a spermicide inside the vagina.
• Each time you repeat intercourse, a new condom must be used. Condoms should never be reused. Spermicide should alsobe applied to the outside of the new condom. The female partner must alsoput more spermicide in the vagina each time she has intercourse.

For patients using spermicides with a diaphragm:

• To be most effective at preventing pregnancy,diaphragms must always be used with a spermicide. Some women may chooseto insert a diaphragm every night, to avoid the chance of unprotected sexualintercourse and unplanned pregnancy happening.
• Inspect the diaphragm for holes by holding it up to a light. If thereare holes or defects, the diaphragm will not work effectively, even with aspermicide. It must be replaced.
• Before you put the diaphragm over the cervix (opening to the uterus),a spermicide cream, foam, gel, or jelly should be put into the cup of thediaphragm. Follow the manufacturer's directions on how much spermicide touse and how long before sexual intercourse you may apply the spermicide. Also,spread some spermicide all around the rim of the diaphragm that will be touchingthe cervix. Some doctors also advise spreading more spermicide on the outsideof the cup of the diaphragm.
• To insert the diaphragm, squeeze the rim between your thumb and forefingerso that it is narrow enough to fit into the vagina. While in a comfortableposition, push the diaphragm as deeply into the vagina as it will go. (Somewomen use a special applicator that makes it easier to insert the diaphragm.)Release the rim. The diaphragm rim should be round again and be directly onthe cervix.
• Each time you repeat sexual intercourse, you should put more spermicideinto the vagina. Do not remove the diaphragm if it hasbeen less than 6 or 8 hours (depending upon which brand of spermicide youuse) since the last sexual intercourse. For the diaphragm to be mosteffective at preventing pregnancy, it must remain in the vagina for at least6 or 8 hours (depending upon which brand of spermicide you use) after sexualintercourse. Be careful not to move the diaphragm out of place while you areapplying more spermicide.
• Do not wear the diaphragm for more than 24 hours, since doing soincreases the risk of getting toxic shock syndrome or a urinary tract (bladder)infection.
• To remove the diaphragm, hook one finger over the rim nearest thefront. Pull the diaphragm downward and out of the vagina. Call your doctor if you have trouble removing the diaphragm.

Dosing?Follow your doctor's ordersor the directions on the label. The following information includesthe usual way that spermicides are used.

For benzalkonium chloride
• For preventing pregnancy:
  • For vaginal suppositories dosage form:
    • Adults and teenagers:
      • For use alone: One suppository inserted into the vagina at leastten minutes but not longer than four hours before each time you have sexualintercourse.
      • For use with a diaphragm: After the diaphragm with spermicide hasbeen placed into the vagina, insert one suppository at least ten minutes,but not longer than four hours, before each time you have sexual intercourse.Also, insert another suppository before sexual intercourse if six hours havepassed since you inserted the diaphragm.

For nonoxynol 9
• For preventing pregnancy:
  • For vaginal cream dosage form:
    • Adults and teenagers:
      • For use alone: One applicatorful of a 5% cream inserted into thevagina just before each time you have sexual intercourse.
      • For use with a diaphragm: One applicatorful of a 2 or 5% cream insertedinto the cup of the diaphragm. Spread more spermicide along the rim of thediaphragm. Insert the diaphragm into the vagina just before, but not longerthan six hours before, sexual intercourse. Also, insert one applicatorfuljust before each time you have intercourse or if six hours have passed sinceyou inserted the diaphragm.
  • For vaginal film dosage form:
    • Adults and teenagers?One film inserted into the vagina fromfive to fifteen minutes (but not longer than one and one-half hours) beforeeach time you have sexual intercourse.
  • For vaginal foam dosage form:
    • Adults and teenagers:
      • For use alone: One applicatorful inserted into the vagina just before,but not longer than one hour before, each time you have sexual intercourse.
      • For use with a diaphragm: One applicatorful inserted into eitherthe vagina or into the cup of the diaphragm, depending on the product. Spreadmore spermicide along the rim of the diaphragm. Insert the diaphragm intothe vagina just before, but not longer than one hour before, sexual intercourse.Also, insert another applicatorful into the vagina just before, but not longerthan one hour before, each time you have sexual intercourse.
  • For vaginal gel dosage form:
    • Adults and teenagers:
      • For use alone: One applicatorful of a 3.5, 4, or 5% gel insertedinto the vagina before each time you have sexual intercourse. The 3.5% gelmay be used up to twenty-four hours before each act of intercourse. The 4%gel may be used up to one hour before each act of intercourse. The 5% gelmust used just before intercourse.
      • For use with a diaphragm: One or two teaspoonfuls (depending on theproduct) or the contents of one packet of gel is placed into the cup of thediaphragm. Spread more spermicide along the rim of the diaphragm. Insert thediaphragm into the vagina just before, or up to six hours before, sexual intercourse.Also, insert another applicatorful or the contents of one packet into thevagina before each time you have sexual intercourse or if six hours have passedsince you inserted the diaphragm.
  • For vaginal jelly dosage form:
    • Adults and teenagers:
      • For use alone: One applicatorful of 2.2 or 3% jelly inserted intothe vagina just before each time you have sexual intercourse. The contraceptiveeffect of the 2.2 or 3% jelly will last one hour.
      • For use with a diaphragm: One applicatorful or two teaspoonfuls ofjelly (depending on the product) placed into the cup of the diaphragm. Spreadmore spermicide along the rim of the diaphragm. Insert the diaphragm intothe vagina just before, but not longer than six hours before, sexual intercourse.Also, insert another applicatorful before each time you have sexual intercourseor if six hours have passed since you inserted the diaphragm.
  • For vaginal suppositories dosage form:
    • Adults and teenagers:
      • For use alone: One suppository inserted into the vagina from tento fifteen minutes (depending on the product) before, but not longer thanone hour before, each time you have sexual intercourse.
    • Adults and teenagers:
      • For use with a diaphragm: After the diaphragm with spermicide hasbeen placed into the vagina, insert one suppository into the vagina from tento fifteen minutes (depending on the product) before, but not longer thanone hour before, sexual intercourse. Also, insert another suppository beforeeach time you have sexual intercourse or if six hours have passed since youhave inserted the diaphragm.

For octoxynol 9
• For preventing pregnancy:
  • For vaginal cream dosage form:
    • Adults and teenagers:
      • For use with a diaphragm: Two teaspoonfuls placed into the cup ofthe diaphragm. Spread more spermicide along the rim of the diaphragm. Insertthe diaphragm into the vagina just before, but not longer than six hours before,sexual intercourse. Also, insert one applicatorful of the vaginal cream justbefore each time you have sexual intercourse or if six hours have passed sinceyou inserted the diaphragm.
  • For vaginal jelly dosage form:
    • Adults and teenagers:
      • For use with a diaphragm: One applicatorful placed into the cup ofthe diaphragm. Spread more spermicide along the rim of the diaphragm. Insertthe diaphragm into the vagina just before, but not longer than six hours before,sexual intercourse. Also, insert another applicatorful just before each timeyou have sexual intercourse or if six hours have passed since you insertedthe diaphragm.

Storage?To store this medicine:

• Keep out of the reach of children.
• Store away from heat and direct light.
• Do not store in the bathroom, near the kitchen sink, or in otherdamp places. Heat or moisture may cause the medicine to break down.
• Do not refrigerate.
• Do not keep outdated products or products no longer needed. Be surethat any discarded products are out of the reach of children.

Precautions While Using This Medicine

Duringuse of spermicides, either partner may feel burning, stinging, warmth, itching,or other irritation of the skin, sex organs, anus, or rectum. Using a weakerstrength of vaginal spermicide or one with different ingredients may be necessary.If you are using benzalkonium chloride suppositories, it may help to wet thembefore they are inserted into the vagina. If any of these effects continueafter you have changed products, you may have an allergy to these productsor an infection, and should contact a doctor as soon as possible.

Side Effects of This Medicine

Along with its needed effects, a medicine may cause some unwanted effects.Although not all of these side effects may occur, if they do occur they mayneed medical attention.

Check with a doctor immediately if any of the following side effects occur:

Rare

Signs of toxic shock syndrome?for cervical caps or diaphragms

Chills; confusion; dizziness; fever; lightheadedness; muscleaches; sunburn-like skin rash that is followed bypeeling of the skin; unusual redness of the insideof the nose, mouth, throat, vagina, or insides of the eyelids

Also, check with a doctor as soon as possible if any of thefollowing side effects occur:

Rare

For females and males

Skin rash, redness, irritation, or itching that does not subsideor go away within a short period of time

For females only

Cloudy or bloody urine; increased frequency of urination; painin the bladder or lower abdomen; pain on urination; thick, white, or curd-like vaginal discharge?withuse of cervical caps or diaphragms only; vaginalirritation, redness, rash, dryness, or whitish discharge

Other side effects may occur that usually do not need medicalattention. However, check with a doctor if any of the following side effectscontinue or are bothersome:

Less common

Vaginal discharge (temporary)?for creams, foams, and suppositories; vaginal dryness or odor

Other side effects not listed above may also occur insome people. If you notice any other effects, check with your doctor.