Health Square: Barrier Contraceptives,Spermicides

Like condoms, spermicides are widely available. They come in foam, suppositories, cream, or jelly. For best effectiveness, all of these forms must be used with a condom, diaphragm, or cervical cap.

How they work. Spermicides contain a chemical that kills sperm. When you insert spermicidal foam or suppositories into the upper part of your vagina, the medication kills most sperm and helps prevent those that survive from entering your cervix. A diaphragm or cervical cap will hold spermicidal creams or jellies in place over the cervix. You can also use them to coat a condom.

Many brands of spermicide now contain nonoxynol­9, a chemical that helps protect against some types of STDs. Spermicidal foams and suppositories have a failure rate of about 21 percent.

How to use them. Spermicidal foams, creams, and jellies come with a plastic applicator threaded at one end to fit the mouth of the container. The creams and jellies come in tubes, the foam in an aerosol can.

To fill an applicator with cream or jelly, thread it onto the end of the tube with the plunger pushed all the way in. Holding the tube straight up with the applicator on top, gently squeeze until the cream or jelly fills the applicator and the plunger is pushed all the way out.

To load an applicator with spermicidal foam, first shake the can well, then put the applicator on top of it and bend it to one side (or, with some products, push it down) to trigger the valve and fill the applicator.

To apply the spermicide, lie down, insert the applicator into your vagina, and push in the plunger. The goal is to deposit the spermicide as close to the opening of your cervix as possible. Do not pull on the plunger to remove the applicator—this can remove some of the spermicide from the vagina.

You can insert spermicidal suppositories with your fingers or with the applicator that comes with the product. Place the suppository high up in your vagina, as close as possible to the cervix. Once it is in place, the natural secretions of the vagina will dissolve the suppository and make it foamy.

As with other barrier contraceptives, timing is important when using a spermicide. Follow the instructions on the package. Insert jelly and cream as shortly before intercourse as possible—no more than 15 minutes beforehand. You can apply foam up to 30 minutes in advance. You need to insert a vaginal suppository at least 10 minutes before intercourse to allow it to dissolve, but no more than 30 minutes in advance, or it will lose its effectiveness.

Each act of intercourse requires additional spermicide. Never douche right after using spermicide—this can push any remaining live sperm up into the cervix. Wait at least 6 hours before douching. Using a panty liner will keep you more comfortable if the spermicide leaks out of your vagina.

Pros and cons. Spermicides are readily available without a doctor's prescription and are easy to use. Look for those that contain nonoxynol­9, which gives added protection against sexually transmitted disease.

The biggest drawback of spermicides is their low effectiveness when used alone. This is particularly true of jelly and cream, but even foam and suppositories prevent pregnancy only about 79 percent of the time. For this reason, couples who need highly effective contraception should combine spermicide with another method, such as a condom, diaphragm, or cervical cap.

Some people are allergic to spermicides. If you experience burning or irritation in the genital area after using one, consult your doctor. You may need to switch brands or use another form of birth control.

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