Spermicides do what their name implies: they kill sperm. These chemicals are put into the vagina just before intercourse to prevent pregnancy. Most have nonoxynol-9 as their active ingredient. They come as creams, jellies, foams, and suppositories (Semicid, Intercept, and the Encare Oval) and are packaged in tubes or aerosol cans with special plastic applicators. Spermicides are also available as films (VCF), which are inserted directly into the vagina.

How do you use a spermicide?

Insert spermicidal creams, jellies, and foams into your vagina no more than fifteen minutes before intercourse. Suppositories and films can be inserted as long as half an hour before (though it is always best to read the product instructions), but they remain effective for only about an hour. A new suppository or film should be used for each separate act of intercourse.

If the cream or jelly comes in a tube, screw the plastic applicator onto the end of the tube, and squeeze the tube until the applicator is full. Some brands require two tubefuls for each separate act of intercourse, so read the directions. If you are using a foam, shake the can, put the applicator on top of the can, and press down until the foam fills the applicator, pushing the plunger all the way out.

To use a suppository, simply push it into the vagina. Allow the recommended time for the suppository to melt or foam up before you have intercourse. To use a contraceptive film, wrap it around a finger and push it all the way into the vagina to cover the cervix. Do not remove the suppository or film for at least six hours.

If you are using a spermicide with a diaphragm or cervical cap, apply a teaspoonful inside the diaphragm and insert the diaphragm as usual (see the section on diaphragms), then squirt more spermicide into the vagina outside the diaphragm. If you are using it with a male or female condom, or without any mechanical barrier, use the plastic plunger that comes with the product to squirt it up into the vagina.

For any of these methods, you may find it preferable to sit on the toilet, lie in bed with your knees bent, or squat. Remember that you have to reapply the spermicide for each separate act of intercourse. Leave the spermicide in place for at least six hours before washing the vagina.

How reliable are spermicides?

Used alone, in theory they are 80-90 percent effective. But combined with other barrier methods (condoms, diaphragms, or cervical caps) contraceptive foams, creams, and jellies are extremely effective and are appropriate if you need a very high rate of reliability.

Do spermicides protect against STDs?

Although we have no solid data, there is evidence that spermicides do help prevent infection. However, if you are using a spermicide with a cervical cap or a diaphragm and you put the spermicide only inside the cup, it does not protect against Acquired immunodeficiency syndrome, herpes, or genital warts. If you put the spermicide into the vagina outside the cervix, then it may protect you.

What are the differences between brands of contraceptive creams, foams, and jellies?

All these products rely on nonoxynol-9 to kill sperm, but they have different bases and perfumes. Unless you are allergic to the perfume or the base in which the spermicide is dissolved, the choice is a matter of aesthetics — of color, smell, consistency, and taste. Try different brands, buying only a small quantity until you find one you like. If you do have an allergic reaction (for example, itching, burning, or an unpleasant odor), the culprit is probably the perfume or the base, not the nonoxynol-9, which is rarely allergenic. Ortho makes an unscented product, a good choice if you have allergies.

What are the advantages and disadvantages of spermicides?

Spermicidal products are easy to use, either with or without another barrier method. They are available at your local pharmacy without a prescription; they are not expensive (seven to ten dollars for a 3.8-ounce tube with applicator, less for refills). They have no side effects (unless you have an allergic reaction). They do not interfere with later fertility. On the down side, you must use a spermicide for each and every act of intercourse. Used alone, they have a relatively high rate of failure. They can be messy; after intercourse, they can drip out onto your underwear. Occasionally they cause allergic reactions.

Is a spermicide right for you?

Judy is 45 years old, married, and monogamous. She has two children and does not intend to have any more. She uses a contraceptive foam for protection against pregnancy. The 80-90 percent effectiveness rate of a spermicide used alone is probably adequate for Judy, since she is in her mid-40s and her fertility has been reduced by time. She has only one sexual partner; if her husband is also monogamous, she has no need for protection against sexually transmitted diseases.

The effectiveness rate that suits Judy would not be adequate for a young, fertile woman who wants to avoid pregnancy. Teenage women whose partners refuse to wear condoms sometimes rely on spermicides alone because these products are easy to get and easy to use. Doing so is risky, in terms of both preventing pregnancy and protecting against sexually transmitted diseases.

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