Birth Control Options for Women - Spermicidal and Barrier Contraception

The Sponge

The sponge (Today, Protectaid) is a disposable form of barrier contraception. It is made of soft polyurethane, is round in shape, and fits over the cervix like a diaphragm, but is smaller and easily portable. In 1994, the popular OTC contraceptive was taken off the U.S. market because of problems at the company's manufacturing facility. A new company has since acquired the rights to manufacture the sponge, and has been selling it in Canada and online since 2003. In April 2005, the FDA granted re-approval for the Today sponge to return to the U.S. market.

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Use and Insertion. To use the sponge, the woman first wets it with water, then inserts it into the vagina with a finger, using a cord loop attachment. It can be inserted up to six hours before intercourse and should be left in place for at least six hours following intercourse. The sponge provides protection for up to 12 hours. It should not be left in for more than 30 hours from time of insertion.

The sponge should not be used during menstruation, after childbirth, miscarriage, or termination of pregnancy, or by women with a history of toxic shock syndrome.

Advantages. Because the sponge is not felt during intercourse and can be inserted up to six hours before intercourse, it encourages spontaneity. It appears to protect against cervical gonorrhea and Chlamydia.

Disadvantages. Failure rates (about 10%) are higher than with the diaphragm. There is a very small risk for toxic shock using the sponge, as there is for other barrier methods of contraception. The sponge may increasethe risk for candidiasis (yeast infection). People who are allergic to spermicides should not use the sponge. The sponge does not protect against HIV or sexually transmitted diseases outside the cervix. The Today sponge contains ten times the amount of the spermicide, nonoxynol-9, than other products, and there is some evidence that this spermicide may increase the risk for HIV. The Protectaid sponge, available in Canada, contains a mix of three spermicides (nonoxynol-9, sodium cholate and benzal konium chloride).

Lea Shield

The Lea shield is made of silicone and its cup-shaped bowl completely surrounds the cervix without resting on it. The shield, therefore, does not need to be fitted, and manufacturers showed results equal to the diaphragm and cap when used with spermicide. Its advantages are as follows:

One size fits all.
Can be left for 48 hours after intercourse.
Reusable for six months.

The Male Condom

The condom is still the only reversible form of male contraception currently available.

Pregnancy Protection. The condom should be put on before intercourse when the penis is erect, long before ejaculation, since the male can discharge sufficient semen to cause pregnancy before ejaculation occurs. The average rate of pregnancy for couples that rely only on condoms for protection is higher--about 12%. In adolescents the risk with condoms is even higher, 18%. Even for those who use a good-quality condom correctly, the annual risk for pregnancy is 3%.

Prevention of Sexually Transmitted Diseases. Condoms are important in the prevention of sexually transmitted disease in both male and female partners but they have limitations. They are more protective in men against fluid-transmitted infections (e.g., gonorrhea, Chlamydia, trichomoniasis, and HIV) than in preventing those transmitted by skin-to-skin contact (e.g., herpes simplex virus HPV, syphilis, and chancroid). Male condoms, in fact, offer better protection against herpes for women than they do for men. (Men often shed the virus from the skin of the penis, which is covered by the condom. In women the virus is often shed from areas around their genitals, which can contact male skin outside the condom.)

Some condoms come prelubricated with the spermicide nonoxynol-9, which is no longer recommended with condoms because of a lack of protection and a higher risk for HIV infection. Its use in male condoms also promotes yeast and urinary tract infections in women.

A unique synthetic polymer gel (PRO 2000 Gel) interferes with viral infection itself--not the sperm--and is undergoing trials. Early studies suggest it is well tolerated although it does have some adverse effects, including vaginal discharge and bleeding.

Condom Materials.

Latex. Condoms made of latex rubber are the most common types. They are less likely to slip or break than those made of polyurethane (Avanti or eZ), and they are contoured for better fit they can provide fairly effective protection. Some people are allergic to latex, however, and in some cases the reaction can be very dangerous. The latex smell may also be unpleasant for some people.
Polyurethane. Polyurethane condoms (Avanti, eZ-on) are now available. It is hoped that eventually they will prove to be superior to latex in a number of ways, including strength, sensitivity, and durability. At this point, they have good acceptance by couples but have a higher breakage rate (6% to 7.2%) compared to the latex condom (1.1% to 2%). Other synthetic materials are under investigation.
Animal Membranes. Condoms made from animal membrane can prevent pregnancy, but sexually transmitted infections can permeate them.

Lubricants. Unlubricated condoms may injure vaginal tissue and make it vulnerable to infections. Only water-based lubricants (e.g., K-Y Jelly, Astroglide, AquaLube, glycerin) should be used.