Spermicides mechanism of action. The role of spermicides in barrier methods of female contraception. Use of spermicides: side effects and contraindications

Spermicides are one of the methods of chemical contraception and are substances that effectively destroy sperm. The effectiveness of spermicides as a contraceptive is low. Of one hundred women who used spermicides as a means of protection against unwanted pregnancy for a year, 18-30 became pregnant. Therefore, to increase the level of reliability, spermicides are recommended to be used in combination with other methods of contraception.

The contraceptive effectiveness of spermicides largely depends on the correct use of them and compliance with the instructions attached to them.

The principle of action of spermicide.
The composition of the new generation of spermicides includes two components: a chemical substance that has a detrimental effect on the sperm, and a base that is responsible for the distribution of spermicide in the vagina. The base envelops the cervix in such a way as to prevent contact of the sperm with the spermicide. As a rule, the active, potent substance included in most spermicides is nonoxylon-9, which, in fact, kills sperm. But instead there may be other substances that have a similar effect. These include: benzalkonium chloride, octoxylon, menfegol. Mercury compounds were previously used as spermicides, the use of which was not entirely desirable due to possible complications, so today their use has been abandoned.

Spermicides can be used by women of any age as a means of contraception. In addition, this method of contraception can be used after childbirth, abortion, and also during lactation.

Today, spermicides have several forms of release: cream, foam, gel, foaming tablets and suppositories, spermicidal condoms, melting suppositories, soluble films, contraceptive sponges. Differences in shape suggest differences in spermicide use.

Gels, creams and foam.
Creams and gels can be used alone or in combination with a vaginal diaphragm or cervical cap. Due to its high contraceptive effectiveness, the foam can be used separately. The effect of creams and gels begins from the moment they are inserted into the vagina and continues for an hour. When spermicidal creams or gels are used in combination with a diaphragm or cervical cap, their period of action increases to six hours. In addition, the contraceptive effect also increases. Gels, creams and aerosol foams can be produced either for single use or for combined use with a diaphragm or caps. The use of foam requires a special aerosol container.

Spermicidal suppositories tablets.
Spermicidal suppositories can be used either alone or in combination with a condom. Spermicidal suppositories and tablets begin to act only 15 minutes after they are inserted into the vagina, so the onset of coitus is possible only 15 minutes after the introduction of the contraceptive. Incomplete dissolution of a tablet or suppository significantly reduces the contraceptive effect, and can also cause discomfort during sexual intercourse. The contraceptive effect of spermicidal suppositories and tablets lasts for an hour.

Spermicidal condom.
Manufacturers of contraceptives produce special latex condoms treated with spermicide.

Soluble film.
Disposable, disposable spermicidal films can be used alone or in combination with a diaphragm. When using it, you must strictly follow the instructions supplied with it. The spermicidal film should be inserted as deep into the vagina as possible. The film begins to act in the same way as cream or suppositories, 15 minutes after its introduction. The vaginal film has a contraceptive effect for an hour.

Contraceptive sponges.
Contraceptive sponges are a means of contraception that combines mechanical and chemical methods of contraception. The contraceptive sponge protects the cervical canal from sperm entering it, retaining it in the sponge while simultaneously releasing the spermicidal substance contained in it. Typically, spermicidal sponges are made of polyurethane and impregnated with nonoxylone-9 or benzalkonium chloride. Its use eliminates the need for additional spermicide administration during repeated sexual intercourse.

The sponges have a sealed container that provides the necessary moisture. It should be administered immediately before sexual intercourse. The spermicidal sponge is inserted into the vagina and located in front of the cervix, which provides some protection against the penetration of any microorganisms into the cervix, and as a result, reduces the risk of diseases of the pelvic organs and the development of cervical pathology.

The sponge should not be removed from the vagina immediately after sex; it is recommended to wait at least six hours to be more sure that the sperm have lost viability. The sponge can only be used once, as washing it removes huge amount spermicide, which significantly reduces its effectiveness. The contraceptive sponge can be inserted into the vagina 24 hours before sexual intercourse and left there for up to thirty hours.

Benefits of spermicides:

• possibility of permanent use;
• do not contain hormones;
• can be used during breastfeeding, since their use has only a local effect;
• are a simple and accessible tool to use;
• reduces the likelihood of contracting STDs in combination with other methods of contraception (the active component of spermicides kills gonococci, trichomonas, genital herpes virus, treponema pallidum), but does not completely protect against them;
• dispensed without a doctor's prescription;
• their use is absolutely harmless;
• have moisturizing properties, which is important when there is a lack of natural lubrication;
• can be used as emergency contraception if the condom breaks, but the spermicide must be applied very quickly;

• most spermicides require a certain amount of time before sexual intercourse;
• restrictions in hygienic terms, that is, you cannot use the shower before the time specified in the instructions for this spermicide;
• the presence of side effects such as allergies to spermicide and skin irritation.

The effectiveness of spermicides may be reduced due to improper administration of these drugs, a history of toxic shock syndrome, as well as abnormalities in the development of the genitals that prevent the correct placement of spermicides.

How to administer spermicide?
First, you need to know exactly how much spermicidal you have left, since each sexual intercourse requires a new dose of the drug. It's best to have a spare pack on hand. Before using the spermicide, you should carefully study the instructions supplied with it. In addition, you should wash your hands thoroughly with soap.

When using a suppository or tablet, immediately after removing it from the package, insert it as deep as possible into the vagina along the back wall so that the suppository or tablet is located on the cervix or very close to it.

When using foam, shake the bottle vigorously before using it. Then fill the applicator with foam and insert it as deep as possible into the vagina, pressing the plunger to inject the foam. Then remove the empty applicator and wash it with soap. The effect of the foam begins immediately after its introduction, so no waiting is required.

If you are using a cream or gel, you need to squeeze it into the applicator and insert it deep into the vagina. Then press the plunger of the applicator and squeeze the gel or cream into the vagina. After this, the applicator is also removed and washed thoroughly. This way the cream or gel begins to act immediately after administration, so no waiting time is required.

Chemical contraceptives are not limited to hormonal drugs. In the West, for several decades, women have been using spermicides, which are considered barrier methods of protection against unwanted pregnancy. This material is devoted to the features of the use of spermicides, their advantages and disadvantages.

Spermicides are chemical female contraceptives containing an active substance that can destroy sperm in a short period of time (up to 60 seconds). The need for a quick reaction is explained by the ability of sperm after ejaculation to immediately penetrate the cervical canal and reach the fallopian tubes in 90 seconds, and then provide pregnancy without using hormonal drugs impossible.

Doctors do not recommend considering vaginal spermicides as an independent method of contraception, since their effectiveness is not high enough. It is advisable to combine these substances with other contraceptives, for example, condoms or oral contraceptives.

Benefits of spermicides:

• ease of use;
• reduce the risk of contracting sexually transmitted diseases and some other infections (genital herpes, gonococci, trichomonas);
• do not disrupt hormonal levels;
• suitable for pregnant and breastfeeding women;
• can be used as contraceptives for women after 35 years of age;
• have a moisturizing effect when there is a lack of natural lubrication;
• sold in pharmacies without a prescription.

Disadvantages of spermicides:

• some drugs require application 10-15 minutes before sexual intercourse, which is inconvenient;
• not recommended as a separate means of contraception due to relatively low reliability;
• after sexual intercourse, you should not shower for the period of time specified in the instructions;
• some women experience side effects spermicides (allergic reactions and skin irritation), in such situations you should immediately consult a doctor.

Spermicides come in the following types (forms):

• foams and jelly;
• vaginal suppositories (suppositories that melt at body temperature);
• sponges;
• foaming tablets;
• soluble films.

The use of spermicides is justified in the following situations:

1. To increase the reliability of condoms (Dutch method of contraception);
2. At the beginning of taking hormonal contraceptives, which begin to act after some time.
3. If a woman forgot to take an oral contraceptive as scheduled, and more than 12 hours have passed since that moment.
4. Together with any other contraceptives to prevent sexually transmitted infections, if you are not sure that the partner is absolutely healthy.

General instructions for administering spermicides

Each sexual intercourse requires a new dose of the substance, even if only a couple of minutes have passed. Before administration, it is recommended to read the manufacturer's instructions, since the use of each drug is individual, depending on the active substance and form of distribution.

Tablets and suppositories are administered immediately after removal from the package to the uterus itself along the back wall of the vagina (see figure). Next, you should wait the specified time before having sexual intercourse.


When applying foam, gel or cream, you first need to shake the bottle, fill it and insert the applicator deep into the vagina. Next, squeeze out all the contents. After this, wash the applicator in soap and water.

Gels, foams and creams are considered the best forms of spermicides because they are easy to apply and work immediately.

Names of spermicides (brands)

To compare the drugs available in Russia, we suggest taking a look at the following table.

Barrier methods of contraception can be defined as protection against unwanted pregnancy by preventing sperm from entering the vagina or cervix by chemical or mechanical means, or a combination of both.

None of the currently proposed methods of birth control can be considered ideal for all life situations. Of the variety of contraceptive methods offered, only condoms and spermicides (vaginal tablets, creams, suppositories, tampons) can be included in any distribution system. They may be the optimal method of contraception for any couple in certain circumstances at any given time in life.

Women's methods:

• female condom;
• diaphragm;
• cervical contraceptive cap;
• spermicidal foam;
• spermicidal suppositories and tablets;
• spermicidal creams and gels;
• sponges, tampons.

Male method:

• male condom.

Condoms

Despite the fact that in given time there are a number of more effective modern methods contraception, the use of condoms remains very important, as they are one of the few contraceptives that can prevent the transmission of HIV infection and sexually transmitted diseases.

The vast majority of modern condoms are made of special rubber - latex.

Condoms vary in size. The most common condoms coated with special lubricant are about 170 mm long. and a diameter of about 52 mm. To prevent basal syphilis, some companies produce larger condoms - 200 mm long, 56 mm wide.

Certain brands of condoms contain spermicide when 0.5 g of nonoxynol-9 spermicide is added to the lubricant. The lubricant is distributed over both the inner and outer surfaces of the condom, making it easier to put on the penis and preventing increased friction and tearing during sexual intercourse.

It is the use of a condom as a means of preventing unwanted pregnancy that makes it possible to actively involve men in family planning.

It should be noted that in some countries the female condom is used. It is longer and wider than the male one. Using it, a woman does not depend on a man and is more confident about her health.

When condoms are used correctly, their contraceptive effect is quite high. For people using this type of protection against unwanted pregnancy, “contraceptive failure” is about 10.5%.

The male condom is a thin sheath, usually made of rubber (latex) and can be treated with spermicide for added protection. A condom is placed on the erect penis.

Condoms vary in shape, color, lubricant, thickness, material composition and the addition of spermicide. Designed for genital, oral, anal sexual intercourse.

Mechanism of action:

• prevents sperm from entering the female reproductive organs;
• prevents the transmission of microorganisms, sexually transmitted diseases and HIV infection.

Advantages of the method:

• sold without a prescription;
• widely available (it is preferable to purchase products in pharmacies, where storage conditions are strictly observed);
• immediate effect;
• does not affect breastfeeding;
• there is no health risk associated with the method;
• can be used as a safety method in parallel with other contraceptives;
• no medical examination required before use;
• the method is inexpensive;
• promotes the involvement of men in family planning;
• one of the few methods that protect against sexually transmitted diseases;
• helps reduce the risk of developing cervical cancer;
• during sexual intercourse in men, the period before ejaculation lengthens;
• can be used in the treatment of immunological forms of infertility (for 3-6 months), to prevent sperm antigens from entering the vagina;
• can be used if a woman experiences allergic reactions to seminal fluid and/or sperm of a sexual partner;
• can be used to improve erection in men with relative erectile dysfunction (the condom ring acts as a weak tourniquet).

Disadvantages of the method:

• average efficiency up to 89% or more during the first year of use;
• contraceptive effectiveness depends on the couple's willingness to follow instructions;
• it is necessary to have appropriate conditions for storing condoms at home;
• Constant use of condoms can slightly reduce the sensitivity of the penis, thereby making it difficult to maintain an erection;
• a condom or spermicide included in the lubricant can cause irritation of the genitals in both men and women;
• It is necessary to have a sufficient supply of condoms before engaging in sexual intercourse.

The method is suitable:

• men who want to take part in family planning;
• couples who need a contraceptive method immediately;
• couples who need a safety net;
• couples who have rare sexual intercourse;
• groups at increased risk of contracting sexually transmitted diseases.

The method is not suitable for couples:

• in which one of the partners (or both) is allergic to the materials from which condoms are made;
• who want to use a method that does not involve sexual intercourse;
• in which pregnancy poses a serious danger to the woman’s health and it is necessary to select the most highly effective contraceptive method.

Instructions for use:

• use a condom during every sexual intercourse;
• use a condom with a water-emulsion-based spermicide (pharmatex) for maximum effectiveness and protection (the so-called “double Dutch” method of protection against pregnancy);
• do not open the package with your teeth or sharp objects, so as not to damage the integrity of the condom;
• the condom must be placed on the erect penis before it is inserted into the woman’s vagina, since pre-ejaculatory sperm contains active sperm;
• if the condom does not have a reservoir at the end, a 1-2 cm cavity should be left at the end for sperm;
• After ejaculation, holding the base (ring) of the condom, remove the penis from the vagina while it is still erect. This prevents the condom from slipping and sperm from entering the woman’s genitals;
• each condom should only be used once;
• Always have a supply of condoms available. Do not store them in a warm place, as this will destroy the material, which may lead to the integrity of the condom being damaged during use;
• do not use a condom if its packaging is torn or if the condom appears damaged or brittle;
• Do not use mineral oil, cooking oil, baby cream or petroleum jelly to lubricate the condom - this will quickly destroy the material. If lubrication is required, use saliva, vaginal fluid, or lubricant.

Diaphragms

This form of pregnancy prevention is less effective than using condoms due to the higher chance of error when using a diaphragm. At the same time, the combination of using a diaphragm with spermicides significantly increases the effectiveness of this method and the degree of protection against sexually transmitted diseases.

Modern diaphragms are made of rubber and latex. They differ in size, which is determined by the diameter of the rim in millimeters.

There are four main types, depending on the structural features of the rim:

• diaphragm with flat spring rim;
• diaphragm with coil spring;
• diaphragm with arc-shaped spring;
• diaphragm with a rim in the form of a jumper.

The diaphragm with a flat spring rim is used for nulliparous women with good vaginal muscle tone and comes in various sizes, from 50 to 90 mm. It is convenient for a woman, as it can be inserted using a special instrument. For installation, the diaphragm is pre-lubricated.

The diaphragm with a coil spring rim is comfortable for most women with moderate vaginal muscle tone. It is also convenient for insertion using a special instrument. There are sizes from 50 to 95 mm.

The arc spring diaphragm is characterized by the presence of a strong rim with spring force, which allows it to be recommended for most women. For insertion, the product is folded into an arc. Due to the density of the rim this type the contraceptive can be used by women with reduced tone of the vaginal muscles, with recto- and cystocele. Diaphragms range in size from 55 to 95 mm.

The diaphragm with a rim with a wide bridge has a flexible border up to 1.5 cm wide, which connects to inner edge rim. The border is intended to maintain spermicide and better contact with the vaginal walls.

Selection of the type of diaphragm for women and training in its insertion must be carried out medical worker family planning services. In this case, the individual anatomical characteristics of each specific patient should be taken into account. The specialist should also have a set of special rings that help you choose the optimal size.

The diaphragm is inserted into the vagina so that the back part of the rim is in the posterior vaginal fornix, and the front part tightly covers the cervix directly behind the pubic bone. Thus, the dome of the diaphragm covers the cervix, and the spermicidal paste or gel placed inside the dome before insertion of the diaphragm comes into contact with the surface of the cervix. If desired, the diaphragm can be inserted 6 hours before sexual intercourse.

The contraceptive effect of the diaphragm is determined partly by its barrier function, which prevents sperm from entering the cervix, and partly by its function as a spermicide reservoir. The presence of a spermicidal agent in the dome of the diaphragm is important for achieving maximum contraceptive effect.

The effectiveness of using various modifications of diaphragms ranges from 82-86%.

Cervical caps

Compared to other contraceptives, they are not widely used. They are made from latex rubber. There are currently three types of birth control caps: the recessed hollow cap with a rim (or "cervical cap"), the Vimule cap, and the domed cap.

Prentif's soft rubber cap, recessed with a rim, is thimble-shaped and fits snugly around the cervix. It is produced in four sizes with internal diameters of 22,25,28 and 31 mm. respectively. This cap covers the entire length of the cervix. Of all the types of caps mentioned, this is the most common.

The Vimule cap is bell-shaped with a flared open end. It is produced in three sizes: with an outer diameter of 42, 48 and 52 mm, respectively. This cap also directly covers the cervix, but its open end also covers part of the vaginal vault. The Vimule is more comfortable than a recessed hollow cap when the cervix is ​​irregular or too short or too large to fit the largest recessed hollow cap tightly. The Vimule cap ranks second in popularity.

The dome-shaped cap is relatively shallow. It is produced in five sizes - from 50 to 70 mm. (outer diameter), with each subsequent size by 5 mm. more than the previous one. It has the shape of a wide flat dome and resembles a diaphragm. It is made of a heavier material than the diaphragm and does not have a spring in its rim.

When in place, it covers the upper end of the vagina, including the cervix and fornix. It is held in place primarily by the vaginal walls rather than by adhering to the cervix.

Mechanism of action: prevents sperm from entering the uterus and fallopian tubes, serves as a container for spermicide.

Advantages of diaphragms and caps:

• have an immediate effect;
• the method is not associated with sexual intercourse (can be administered 6 hours before sexual intercourse);
• no systemic side effects;
• the method is inexpensive;
• provides protection against sexually transmitted infections, especially when using Farmatex spermicidal cream containing benzalkonium chloride, which even destroys HIV infection.

Disadvantages of diaphragms and caps:

• For initial and postpartum fittings, a gynecological examination by a qualified healthcare professional is required;
• should not be removed within 6 hours after sexual intercourse;
• in some cases does not protect against sexually transmitted infections;
• for greater efficiency, you should study and follow the instructions;
• a large diaphragm and cap can interfere with (interfere with) quality sexual intercourse;
• the diaphragm and cap may become dislodged during sexual intercourse;
• they must be washed and stored in compliance with all conditions, otherwise the properties of the material will deteriorate;
• a woman should clearly know the expiration dates of the diaphragm or cap and the criteria for their replacement;
• the average effectiveness of methods using spermicide is 82-92% during the first year of use.

The diaphragm and cap are safe contraceptives. However, their use may cause problems side effects:

• allergic reactions of the skin and mucous membrane to rubber or to a spermicidal substance in a woman or her partner;
• if the diaphragm or cap remains in the vagina for too long, then copious discharge with an unpleasant odor appears;
• if the diaphragm is poorly washed and stored in unhygienic conditions, candidal colpitis may develop;
• as a result of the pressure of the diaphragm rim on urethra recurrent cystitis may develop;
• Cases of the development of toxic shock syndrome have been noted in both menstruating and non-menstruating women who used the diaphragm.

A cause-and-effect relationship between the use of a diaphragm and the development of toxic shock syndrome has not been established. However, it is recommended that you do not leave the diaphragm or cap in your vagina for more than 24 hours.

If toxic shock syndrome is suspected, the patient should be referred to a facility that has intravenous fluids and antibiotics. In the presence of a high temperature (> 38 °C), a rehydration agent and a non-narcotic analgesic are also recommended.

The diaphragm and cap can be used:

• women who prefer not to use (or have contraindications to) hormonal methods (for example, women over 35 who smoke);
• women who do not want or are not indicated to use an IUD;
• nursing mothers in need of inexpensive contraception;
• couples having rare sexual intercourse;
• women whose partners do not want to use condoms and want protection against sexually transmitted diseases;
• couples who need an additional safety net.

Diaphragm and cap not shown:

• women whose age, number of births in history, or health problems make pregnancy extremely dangerous (in this case, a specialist will help you choose an alternative, highly effective method of contraception);
• women with recurrent urinary tract infections;
• women who experience difficulties or inconvenience in connection with the use of this method;
• women with pronounced cystocele or rectocele;
• couples wishing to use another, more highly effective method of contraception;
• women with genital anomalies.

Instructions for using the method:

• use a diaphragm or cap during every sexual intercourse;
• Empty your bladder and wash your hands before use;
• check for holes in the diaphragm or cap by stretching the rubber and holding it up to the light or filling it with water;
• Squeeze a small amount of spermicidal cream (for example, Pharmatex) into the cup of the diaphragm or cap. Bring the edges of the diaphragm together;
• You can insert the diaphragm or cap in one of the following positions:

One leg raised on a chair or toilet seat;

Lying on your back with your knees bent;

Squatting.

• taking one of the positions listed above, spread the edges of the vagina;
• insert the diaphragm or cap with cream deep into the vagina and push the front edge behind the pubic bone;
• insert your finger into the vagina and feel the cervix through the rubber to make sure it is completely closed;
• The diaphragm or cap must be inserted into the vagina no earlier than 6 hours before sexual intercourse. If sexual intercourse takes place later than 6 hours, it is necessary to introduce an additional portion of spermicide into the vagina;
• After the last sexual intercourse, the diaphragm or cap remains in the vagina for at least 6 hours and no more than 24 hours. (Douching is not recommended at any stage);
• remove the diaphragm or cap by picking it up with your finger at the front edge and pulling it out;
• After use, they are thoroughly washed and dried before storing in the box.

These are chemicals that inactivate or kill sperm in the vagina before they can penetrate the upper female reproductive tract.

Modern spermicides typically contain two components: sperm-damaging chemicals and a base (carrier).

Vaginal spermicides

As a rule, spermicides differ according to the type of carrier they contain and are available in the form of:

• aerosols (foam);
• pastes, creams;
• gels;
• vaginal tablets;
• suppositories;
• soluble films;
• substances used to lubricate condoms;
• sponges, tampons.

The role of the carrier in spermicidal products is to ensure the dispersion of the chemical agent in the vagina by enveloping the cervix and holding it in place so that no sperm escapes contact with the spermicidal ingredient and its harmful effects.

When using creams and gels, it is possible to use them either independently or in combination with a vaginal diaphragm or cervical cap.

Spermicides are also used with condoms, which provides a more pronounced contraceptive effect and also serves as reliable protection against sexually transmitted diseases.

Douching with spermicides after sexual intercourse is not a reliable contraceptive method, since it does not exclude the possibility of sperm entering the cervical canal in the interval between ejaculation and subsequent douching.

The mechanism of action of spermicides is the destruction of the sperm membrane, which sharply reduces their motility and ability to fertilize an egg.

Vaginal tablets, tampons and suppositories are easy to store and transport. The onset time and duration of action are given in the table above.

Spermicidal gel is usually used only in combination with a diaphragm or cap.

Benefits of spermicides:

• easy to use;
• there is no health risk;
• no systemic side effects;
• effective immediately (foam, cream, tampon);
• do not affect breastfeeding;
• can be used as a safety method in parallel with other methods of contraception;
• tampons and creams act immediately after administration;
• additional hydration during sexual intercourse;
• do not require medical examination before use;
• sold without a prescription;
• are protection against sexually transmitted diseases, including HIV infection.

Disadvantages of spermicides:

• average efficiency up to 85% during the first year of use;
• for the method to be effective, you must know and strictly follow the instructions;
• tablets and suppositories are administered 5-10 minutes before sexual intercourse and are effective for 3-4 hours;
• You should not use alkaline soap before or after using spermicides (Farmatex foaming agent is recommended for hygienic care).

• women who do not want to use or are not indicated for hormonal methods (for example, women over 35 who smoke);
• women who do not want or are not indicated to use intrauterine devices;
• women who want to protect themselves from sexually transmitted diseases;
• couples who need temporary contraception while choosing another method;
• couples in need of a safety net;
• couples who rarely have sexual intercourse.

Spermicides are contraindicated:

• women whose age, number of births, or health problems make pregnancy extremely dangerous;
• women who experience difficulty using this method or discomfort;
• those who are allergic to spermicides.

Instructions:

• it is necessary to administer spermicide before each sexual intercourse;
• after inserting a vaginal tablet, suppository or film, you must wait 5-10 minutes; when using tampons, creams, aerosols (foam), no waiting is required;
• it is necessary to follow the recommendations of the spermicide manufacturer for the proper storage and use of each drug;
• it is necessary to administer an additional dose of spermicide before each repeated sexual intercourse;
• In order for the cervix to be completely closed, it is very important to insert the spermicide deep into the vagina;
• For intimate hygiene, when using spermicides, use only running water or the foaming product “Farmatex”.

Aerosol (foam)

• shake the container 20-30 times before use
• place the applicator on the valve of the container, then fill it with foam
• while lying on your back, insert the applicator into the vagina so that its end is in contact with the cervix, press the trigger and release the foam, the effect occurs immediately
• After use, the applicator must be washed with warm water and soap, rinsed and dried; for ease of washing, it must be disassembled; the applicator is intended for individual use only.

Vaginal tablets and suppositories (suppositories)

• remove the vaginal tablet or suppository from the package;
• lying on your back, insert it deep into the vagina until it touches the cervix;
• wait 5-10 minutes before having sexual intercourse.

Cream

• to administer a contraceptive cream, squeeze it into the applicator until it is full, insert it into the vagina until it comes into contact with the cervix, press the tube and release the cream, do not wait for the action to begin - the effect occurs immediately;
• after use, disassemble the applicator, wash with warm water and soap, rinse and dry;
• Do not allow anyone to use your applicator.

Sponges (tampons)

They are a small cushion-shaped polyurethane sponge containing the spermicide benzalkonium chloride.

The sponges come in one size and are sold without a prescription. Before use, it is inserted deep into the vagina. Once inserted into the vagina, the sponge provides continuous protection for 24 hours, so no additional action is required if sexual intercourse is repeated during this time. After use, the sponge is thrown away.

Mechanism of action:

• The sponge prevents sperm from entering the woman's upper reproductive tract (uterus and fallopian tubes) and serves as a container for spermicide.

The contraceptive effectiveness of sponges does not exceed 85-90% during the first year of use.

Advantages of sponges:

• have an immediate effect;
• do not affect breastfeeding;
• the method is not associated with sexual intercourse (can be administered 2-6 hours before sexual intercourse);
• no systemic side effects;
• the method has no health risks;
• retain menstrual blood during menstruation;
• protect against the development of cervical dysplasia (precancerous condition);
• provide partial protection against sexually transmitted diseases and HIV infection.

Disadvantages of the method:

• sometimes the sponge causes irritation;
• The sponge may become dislodged;
• sometimes vaginal dryness occurs due to the absorption of secretions;
• the sponge should be in the vagina for at least 2-4 hours after intercourse;
• Remember to remove the sponge.

The use of a sponge is shown:

• women who do not want or are not indicated for hormonal methods (for example, women over 35 who smoke);
• women who do not want or cannot, for a number of reasons, use an intrauterine device;
• nursing mothers in need of contraception;
• women who want to avoid contracting sexually transmitted diseases;
• couples for the period of selection of another contraceptive;
• couples who need an additional safety net;
• couples who have infrequent sexual intercourse.

The use of a sponge is contraindicated:

• women whose age, number of births, or health problem make pregnancy extremely dangerous;
• women suffering from inflammatory diseases of the genitals;
• women who experience difficulty or discomfort when using this method;
• women with uterine prolapse (prolapse of the uterus into the vagina);
• women with a history of toxic shock syndrome;
• women with vaginal stenosis (narrowing of the vaginal canal);
• women with genital anomalies;
• couples needing a more highly effective method of contraception;
• couples wishing to use a method that does not involve intercourse.

Spermicides are chemical agents that inactivate sperm in the vagina and prevent it from passing into the uterus.

Modern spermicides consist of two components: a chemical that inactivates sperm and a base responsible for distributing the spermicide into the vagina. One of the most common active ingredients in spermicides today is benzalkonium chloride.

At the same time, there are contraceptives that use nonoxynol and other drugs as the active component. The effectiveness of spermicides when used correctly and regularly reaches 82%. IN recent years Studies have appeared indicating the likelihood of damage to the epithelium of the vagina and rectum with long-term and frequent use of nonoxynol, and therefore it is not recommended for the prevention of STIs.Spermicidal substances are available in various forms:

• jelly;
• foam;
• melting candles;
• foaming candles;
• foaming tablets;
• soluble films;
• sponges.

Depending on the form, the way spermicides are used may vary. Creams and jellies are used both separately and together with mechanical female contraceptives (diaphragm or cervical cap). This combination allows you to provide a contraceptive effect for up to 6 hours from the start of use. Foams (aerosols) are used separately. The effect of the foam begins immediately after administration and lasts about an hour. Spermicidal suppositories and tablets begin to act in approximately 10 minutes, as it takes time for the suppository or tablet to dissolve or foam. The effect of such spermicides lasts no more than 1 hour.

The contraceptive sponge has a combined effect: mechanical and chemical, preventing sperm from entering the cervical canal and releasing the spermicidal substance contained in the sponge. The sponges consist of polyurethane impregnated with benzalkonium chloride (nonoxynol). When using such sponges, there is no need to additionally administer spermicide during repeated sexual intercourse.

The main advantages of spermicides over well-proven hormonal and IUDs are protection to a certain extent from STIs and the absence of a systemic effect on woman's body.

In addition, spermicides:

• can be used at any period in the life of a sexually active woman, including sexually active teenage girls, nursing mothers after the birth of a child and women in late reproductive age and perimenopause;
• can be used for a long time;
• can be combined with other methods of contraception, including barrier mechanical means (caps, diaphragms, condoms);
• can be used as a lubricant.

The main disadvantages of spermicides:

• the need to maintain a 10-15 minute interval before each sexual intercourse (when using suppositories, tablets and films);
• delayed implementation of hygienic procedures (toilet of the external genitalia and vagina can be performed no earlier than 6 hours after sexual intercourse).

Restrictions on the use of spermicides:

• anatomical features that complicate the administration of the drug (stenosis, vaginal strictures, etc.);
• spicy inflammatory diseases genitals.

Side effects of spermicides may include:

• irritation of mucous membranes;
• allergy to spermicide.

Method of application of spermicides:

• When using suppositories or tablets, the drug is inserted into the vagina along the back wall as far as possible so that the suppository (tablet) is placed on the cervix or very close to it. Exposure - 10–15 minutes before sexual intercourse, necessary for the dissolution of the suppository (tablet).
• When using foam, shake the bottle vigorously, then fill the applicator with foam and insert it as deep as possible into the vagina. The contraceptive effect develops immediately. For repeated sexual intercourse, the foam is reintroduced.

Despite their lower contraceptive effectiveness compared to other modern contraceptives, barrier methods can be successfully used by couples either alone or in combination with other contraceptives.

New versions of already well-known tools. At the same time, the usual condoms to prevent the spread of infections and oral contraceptives to help prevent unwanted pregnancy, the choice is not limited - many are looking for other methods of protection. Let's figure out what spermicides are - and whether they should be used.

In the text We are talking about penetration sex and drugs that are inserted into the vagina. As a reminder, not all people with vaginas identify as women and not all women have vaginas.

Alexandra Savina

What are spermicides

Spermicides are one of the most ancient means of contraception. IN Ancient Egypt, for example, women used honey, leaves and agave fruits for contraception in a similar way, in Ancient Rome and Greece - olive oil, and later, in the 17th century, lemon was used for this purpose. For obvious reasons, we do not recommend repeating this today.

Modern spermicides, fortunately, have become less extreme. Today they are found in a variety of formats - there are, for example, creams, gels, foams and suppositories (that is, suppositories that melt at body temperature). There are even spermicides in the form of a transparent film that dissolves inside the vagina. Spermicides based on benzalkonium chloride and nonoxynol-9 are sold in Russia; the second type of drugs is popular in the world.

The Latin suffix "-cid" means "kill", but the contraceptive does not kill sperm - instead it simply limits their mobility. Spermicides are substances that immobilize sperm, preventing them from reaching the egg. This is how they prevent unwanted pregnancy: if the sperm does not reach the egg, fertilization does not occur.

How to use spermicides

Spermicides are used alone or together with other forms of contraception, such as caps and diaphragms or condoms. In addition, spermicides are part of contraceptive sponges. Spermicides are different, but they have a common method of application: you need to take a comfortable position and insert the product deep into the vagina with your fingers or using an applicator, like a tampon. The main thing to remember is that you need to take care of the spermicide before penetration. Some drugs take ten to fifteen minutes to completely dissolve and begin to act - so you should carefully study the instructions (this rule works not only for spermicides!).

The duration of action of spermicides is also limited; many only work for an hour. If penetration is delayed, check the instructions and promptly administer another dose of the drug - however, remember that repeated use of spermicide during the day may cause irritation. Another important principle: one portion of spermicide is designed for only one penetration. Even if the instructions say that the contraceptive is designed to last for several hours, this does not mean that you can forget about contraception: introduce a new dose.

There is no need to remove or try to somehow wash spermicide out of the vagina after sex: for the contraceptive to work and help prevent pregnancy, it must be in the body for at least six hours. And in general, douching is worth it: there is no benefit from this procedure, but it can drive an infection already existing in the body higher, to other organs.

Things to remember

Spermicides have understandable bonuses: they are easy to use and inexpensive, which is also suitable for those who are not ready to consider hormonal contraception. However, this is where the benefits of spermicides end.

Their main disadvantage is their low efficiency. Even with ideal use, their Pearl index (failure rate) is 18% - that is, 18 out of 100 people who used only this method of protection will find themselves pregnant in a year, despite the contraception. If used less than ideally (let's be honest, anything can happen in life and sex rarely takes place under ideal conditions), it is even more difficult: in a year, 28 out of 100 people will experience pregnancy when using spermicide. By comparison, oral contraceptives are 99% effective when used ideally, and 91% effective when used normally. Condoms that fit over the penis are 98% effective when used ideally, and about 82% effective when used effectively.

Spermicides also do not protect against sexually transmitted infections at all - so they will most likely have to be combined with a condom. When developing spermicides, researchers initially hoped that nonoxynol-9-based products would protect against infections - but later clinical trials showed that they were ineffective in this regard. Moreover, today the WHO states that spermicides may increase the risk of contracting HIV and other sexually transmitted infections. This happens, apparently, due to the fact that frequent use spermicides can irritate the walls of the vagina - and it is easier for infections to enter the body.

Due to the irritating properties of spermicides, they are not recommended for use during anal sex. It is impossible to get pregnant from anal sex in itself, so injecting spermicide into the rectum is pointless (which, of course, is not a reason to refuse, for example, condoms). Remember that anal sex does not eliminate the risk of pregnancy in principle: sperm can enter or leak onto the vulva, and it can also be transferred to the vulva with your fingers or hand.

Spermicides also have other unpleasant features, albeit smaller ones than poor effectiveness. For example, there are allergies to them - so if you, your partner or partner feel irritated after sex, this is a reason to think about other methods. Other minor annoyances: Spermicide may leak from the vagina, which can be uncomfortable. And some people don't like its taste.

Of course, even a low-effective contraceptive will be more useful than complete absence protection. But we advise you to consider more reliable options - and first of all think about your own safety.