Spermicide

Spermicide
A container of spermicide with a cervical cap
Background
Synonyms	Contraceptive gel[1]
Type	Spermicide
First use	Ancient[2]
Failure rates (first year)
Perfect use	16%[3]
Typical use	21%[3]
Usage
User reminders	More effective with a barrier method[3]
Advantages and disadvantages
STI protection	No[1]

Spermicide is a type of birth control placed in the vagina prior to sex.^[1] With typical use pregnancy occurs in about 21% in the first year, while with perfect use rates are about 16%.^[3] Some are effective immediately while others require 15 minutes to activate and they work for about an hour.^[3] They may be used with a barrier method such as a diaphragm, condom, or cervical cap which increases effectiveness.^[3]

Side effects include irritation, allergic reaction (3%), urinary tract infection, and an increased risk of HIV/AIDS.^[3][2] Douching, and possibly bathing, in the six hours after may decrease effectiveness.^[3] It does not prevent sexually transmitted infections (STIs).^[1] The active ingredient is generally nonoxynol-9 (N-9) which disrupts sperm; though, lactic acid/citric acid/potassium bitartrate is also avaliable.^[3] They come in a number of forms including foams, creams, films, and sponges.^[3]

Spermicide have been used for thousands of years.^[2] As of 2020 it is a relatively infrequently used method of birth control globally.^[4] In the United States they are available over the counter.^[3] The cost in the United States as of 2024 is generally 60 cents to 3 USD per dose.^[5]

Medical uses[edit | edit source]

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. Used alone, spermicides have a perfect use failure rate of 18% per year when used correctly and consistently, and 28% failure rate per year in typical use.^[2]

Condoms[edit | edit source]

Spermicides increase the effectiveness of condoms.^[3] However, condoms that are spermicidally lubricated by the manufacturer have a shorter shelf life^[6] and may cause urinary tract infections in women.^[7] 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.^[8]

Spermicides used alone are about 91 percent effective.^[9] When spermicides are used in conjunction with condoms and other barrier methods there is a 97 percent effective rate for pregnancy prevention.

Side effects[edit | edit source]

Temporary local skin irritation involving the vulva, vagina, or penis is the most common problem associated with spermicides.^[10]

Frequent use (two times or more a day) of nonoxynol-9 containing spermicide is inadvisable if STI/HIV exposure is likely, because in this situation there is increased vulvovaginal epithelial disruption and increased risk of HIV acquisition.^[10]

They do not prevent sexually transmitted infections (STIs)) including HIV/AIDS.^[11][12]

History[edit | edit source]

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.^[13] It is believed that the low pH of the dung may have had a spermicidal effect.^[14]

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.^[14]

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.^[13]

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.^[13] 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.^[15]

A misconception existed in the 1980s and 1990s. A 1988 review article noted that in vitro studies of nonoxynol-9 and other spermicides showed inactivation of STI pathogens, including HIV.^[16] But a 2002 review of vaginal nonoxynol-9 of more than 5,000 women (predominantly sex workers) found no reduction in risk of HIV and STIs, but a small increase in genital lesions among nonoxynol-9 spermicide users.^[17] And in a high-risk population using a nonoxynol-9 vaginal gel more than three applications per day on average, the risk of HIV acquisition was increased.^[10]

Society and culture[edit | edit source]

Nonoxynol-9 is the primary chemical in spermicides to inhibit sperm motility. Active secondary spermicidal ingredients can include octoxynol-9, benzalkonium chloride and menfegol.^[18] These secondary ingredients are not mainstream in the United States, where nonoxynol-9 alone is typical. Preventing sperm motility will inhibit the sperm from travelling towards the egg moving down the fallopian tubes to the uterus. The deep proper insertion of spermicide should effectively block the cervix so that sperm cannot make it past the cervix to the uterus or the Fallopian tubes. A study observing the distribution of spermicide containing nonoxynol-9 in the vaginal tract showed “After 10 min the gel spread within the vaginal canal providing a contiguous covering of the epithelium of variable thickness.”^[19] The sole goal of spermicide is to prevent fertilization.

Menfegol is a spermicide manufactured as a foaming tablet.^[20] 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.^[21]

The spermicides benzalkonium chloride and sodium cholate are used in some contraceptive sponges.^[22] Benzalkonium chloride might also be available in Canada as a suppository.^[23]

Brand names[edit | edit source]

Brand names include: Conceptrol, Crinone, Encare, Endometrin, First-Progesterone VGS, Gynol II, Prochieve, and Vagi-Gard Douche Non-Staining.^[24]

Alternatives[edit | edit source]

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,^[25] and to C.Y. Hong, C.C. Shieh, P. Wu, and B.N. Chiang for proving it is not.^[26][27]

Lemon juice solutions have been shown to immobilize sperm in the laboratory,^[28] as has Krest Bitter Lemon drink.^[29] 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.^[30]

Lactic acid preparations have also been shown to have some spermicidal effect, and commercial lactic acid-based spermicides are available.^[31][32] A contraceptive containing lactic acid, citric acid, and potassium bitartrate (Phexxi) was approved for use in the United States in May 2020.^[33]

Extractives of the neem plant such as neem oil have also been proposed as spermicides based on laboratory studies.^[34] Animal studies of creams and pessaries derived from neem have shown they have contraceptive effects;^[35] however, trials in humans to determine its effectiveness in preventing pregnancy have not yet been conducted.

See also[edit | edit source]

• Personal lubricant

References[edit | edit source]

External links[edit | edit source]