VAGINAL SPERMICIDES

DEFINITION

Vaginalspermicidesarefemalebarriercontraceptiveswhichcoatthecervixandinactivatespermby dissolvingthelipidcomponentsintheircellwalls.Manydifferentvaginalspermicidalagentsare available,includingfoams,jellies,creams,suppositories,spongesandfilms. In theUS,all spermicides useNonoxynol-9(N-9)astheiractiveingredient.Thetypicalusefirst yearfailureratewithspermicides isquotedtobeabout28%butrecentstudiessuggestthatthefirstyeartypicalusefailureratemaybeas highas40%.Thefailureratewithcorrectandconsistentuseis18%.Spermicideswithlower concentrationsofN-9havehigherfailurerates. Spermicidesareoftenusedinconjunctionwithother barriermethods,suchasdiaphragms,cervicalcapsandmalecondoms. Spermicidesdonotreducethe riskofSTIs and transmission of the Zika virus.In fact,multipleusesdailyofnonoxynol-9spermicidesmayincreasetheriskofHIV infectionacquisitionortransmissioninat-riskwomen.Newercompoundsarebeingtestedforuseas spermicides.

SUBJECTIVE

Mustinclude:

  1. LMP
  2. Zika Risk Assessment

a. Travel-self and partner(s)

1)Past travel –last 8 months –where and when

2)Plans for future travel –where and when

Mustexclude:

Contraindications

  1. Allergy or history of significant skin irritation with acute or chronic exposure tospermicides
  2. Significant Risk Factors that make the use of nonoxynol 9 inappropriate
  3. High risk for HIV (CDC 4)
  4. HIV infection (CDC 3)
  5. AIDS (CDC 3)
  6. Antiretroviral (ARV) therapy (CDC 3)
  7. History of Toxic Shock (Sponge only CDC 3)

Mayexclude:

  1. Inabilityorunwillingnesstotouchgenitals.
  2. Intenttouseformultipleactsofintercourseonadailybasis(N-9couldincreaseriskofHIVtransmissionin atriskcouples)unlessmalecondomsareconsistentlyused.

OBJECTIVE

Pelvicexamshouldbeencouragedtoruleoutabnormalitieswhichwouldinterferewiththeuse oreffectivenessofspermicide(e.g.,vaginalsepta). However,if thepatientdeclinespelvicexam,shemay stillusespermicides.

LABORATORY

Not applicable

ASSESSMENT

Candidate for vaginal spermicide

PLAN

  1. Prescribeappropriateformofvaginalspermicideforpatientand teachherhowtouseit.
  2. Offeremergencycontraceptioninadvanceofneed(seeEmergencyContraception[EC]protocol).
  3. SuggestthatpartnerusemalecondomstoincreasecontraceptiveefficacyandreduceSTIrisk.

PATIENT EDUCATION

  1. AdvisepatientthatvaginalspermicidesareavailableOTCasa suppository,jelly,cream,foam,film andsponge.
  2. Counselpatienttoplacespermicidepriortogenitalcontactandallowappropriatetimeforonsetof actionpriortointercourse.

Type of Spermicide / Onset of Action / Duration of Action
Foam in aerosol container / Immediate / Up to 8 hours
Cream and Jellies / Immediate / Up to 8 hours
Sponge / Immediate after wetting / Up to24hours
Suppositories/Tablets / 10-15 minutes / Up to 60 minutes
Film / 15 minutes / Up to 50 minutes
  1. Forcontraceptivespongeusers,therearespecialinstructionsforspongepreparation, placementandremoval:
  2. Use:Tellthepatienttoremovethespongefromitspackage.Sheshouldmoistenitwithabout2 tablespoonsofcleanwater,andsqueezeitoncetoseethefoamdevelop,thenplacethesponge intohervaginaandslideitalongthebackwallofthevaginauntilitcovershercervix.The dimpledsideofthespongeshouldfacehercervix,withtheloopawayfromhercervix.Instruct thepatienttocheckwithherfingertobesurethathercervixiscoveredbythesponge.The spongecanbeleftinplaceforupto24 to30hoursandcanbeusedformultipleactsof intercourse.
  3. Removal:Thespongeshouldbeleftinplaceforatleast6 hoursfollowingthelastactof intercoursetoallowadequatetimeforspermicidalaction.Beforeremoval,havethepatient checkthepositionofthesponge. Ifthespongehasbeendislodged,orseemstobeoutofplace, haveherconsiderusingemergencycontraceptionassoonaspossible(seeEmergency Contraception[EC]protocol).Toremovethesponge,havethewomangraspthelooponthe spongewithonefingerandgentlypullitoutofhervagina.Itisimportanttochecktobesure thespongeisintactbeforeitisthrownaway. Ifitistorn,removeallthepiecesfromthevagina.
  4. Advisethatspermicideshavelimitedtimeofaction.If thepatienthasintercourseaftertheduration ofactionlistedintheabovetable,anotherdoseofspermicidemustbeplacedandgiventimeto activatepriortocoitus.ThemanufacturerofAdvantage24claimsitmaybeusedforupto24 hours;however,supportingdataarequestionableforitsefficacybeyond60minutes.
  5. Remindpatienttouseanadditionalapplicationofspermicidewitheachactofintercourse.
  6. However,encourageuseofanothermethodifthewomanexpectstousespermicidesmorethan onceaday,especiallyifsheisatriskforSTIs.
  7. Advisepatienttoavoiddouchingfor8 hoursafterintercourse.
  8. Instructpatientthatsomemenandwomenareallergictospermicide.Adviseherthatifsymptoms ofbothersomeirritationofhervulvaorvaginaorpartner’sgenitalsoccur,sheshouldstopusing thatparticulartypeofspermicide. Ifgenitalirritationissevere,she/heshouldseekmedicalcare promptly.
  9. Ifpatientsask,counselthemthatspermicideusedoesnotcauseanycervicaldysplasiaandmay providelubricationforcondomusers.
  10. Advise sponge users that vaginal dryness may develop with sponge use. Other forms of spermicide may cause an increase in vaginal secretions.
  11. Remind patient that spermicides do not protect against sexually transmitted infections, including HIV/AIDS and Zika.
  12. Zika virus education and prevention strategies
  13. Avoid traveling to impacted areas
  14. Avoiding mosquito bites if traveling to impacted areas
  15. Using condoms to prevent transmission of virus
  16. Avoiding pregnancy if infected or partner infected

1)Risk to unborn fetus

REFER TO MD/ED

Signs or symptoms of Toxic Shock Syndrome.

REFERENCES

1.CentersforDiseaseControl/andPrevention(CDC)USMedicaleligibilityCriteriaforContraceptiveUse,2016-

2.Centers for Disease Control and Prevention (CDC). Zika Virus Homepage

3.HatcherRA,etal(editors).ContraceptiveTechnology,20thEd.NewYork:ArdentMedia. 2011; 391-405.

Reviewed/Revised 2018

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