Since the sexual revolution of the 1960s, when the diaphragm introduced instantly reversible, female-controlled contraception to the world, the demand for spermicide, a substance used for contraception that kills sperm, immediately followed.
To effectively prevent pregnancy, spermicide should be inserted into the vagina before sexual intercourse. However, most spermicides, except for Lanzas Contraceptive Jelly, are not strong enough to be used alone as the sole form of contraception. The failure rate of using only spermicide as contraception is higher than using other forms of birth control.
To achieve maximum effectiveness, spermicides are often used in combination with contraceptive barriers such as cervical caps, condoms, diaphragms, and sponges. The failure rate of spermicide when used with these barriers is significantly lower than when either is used alone.
Nonoxynol 9 (Nonionic surfactant) – or as some now call it, ‘Nasty-9’
Nonoxynol-9 (N-9) is the most prevalent active ingredient in spermicide. Spermicides containing N-9 come in various forms, including gels, films, and foams. Nonoxynol-9 is an organic compound used as a surfactant and belongs to the nonoxynol family of nonionic surfactants. It is also found in cleaning and cosmetic products.
Due to its potential to cause genital lesions, the use of N-9 has been a subject of controversy. Initially, researchers believed that N-9 could be used to prevent the transmission of sexually transmitted diseases (STDs). However, recent research has revealed that N-9 may actually increase a person’s risk of contracting STDs, particularly when used frequently. This conclusion was drawn after observing that N-9 causes tiny abrasions within the sensitive vaginal and anal walls.
The UN sponsored a study in several African locations from 1996 to 2000. Researchers followed 1000 sex workers who used Nonoxynol-9 (N-9) gels or a placebo before engaging in sexual intercourse. The HIV infection rate among N-9 users was approximately 50% higher compared to those who used the placebo. Additionally, N-9 users experienced more vaginal lesions, which may have contributed to the higher risk of HIV infection.
While these results may not apply to occasional N-9 users, the UN study led major health agencies to recommend discontinuing N-9 use for women at risk of HIV infection. The World Health Organization (WHO) stated that N-9 offers no protection against sexually transmitted infections like gonorrhoea or chlamydia.
Regular N-9 use may also increase the risk of contracting human papillomaviruses (HPVs), which are sexually transmitted. This risk is particularly concerning because HPV can lead to cervical cancer. Researchers at the National Cancer Institute reported that the risk of HPV infection from N-9 decreased when N-9 was combined with an equal amount of a carrageenan-based lubricant. Divine No. 9 and BIOglide are consumer products found to prevent detectable HPV infection in a study.
While condoms with spermicide are generally considered more effective than those without, this is not always the case. For instance, pre-lubricated condoms with spermicide do not contain sufficient spermicide to prevent pregnancy. These spermically lubricated condoms have a shorter shelf life and may cause urinary tract infections in women. The WHO no longer promotes this type of condom but recommends using them instead of no condom at all.
Although uncommon, Nonoxynol-9 has been linked to various possible side effects, including irritation, itching, or burning of the sex organs in both partners. Women may also experience urinary tract infections, yeast infections, and bacterial vaginosis after using N-9.
Another concern associated with N-9 spermicides is the increased risk of birth defects in children conceived despite spermicide use or those whose mother continued using spermicide while unaware of the pregnancy. Conversely, a comprehensive review of a large study of spermicides concluded that there appears to be no increased risk of congenital anomalies, altered sex ratio, or early pregnancy loss among N9 spermicide users. Toxic Shock Syndrome has also been associated with the use of N-9.
Due to its low cost and generally effective nature, health authorities in various countries have approved the use of N-9, including the NHS in the UK with Gygel and the FDA in the US with Gynol.
Octoxynol-9 (Nonionic surfactant)
Octoxynol-9 (also known as Triton X-100) is a different chemical from N-9 but is still a “nonionic surfactant.” Spermicides made with Octoxynol-9 may be suitable alternatives for individuals who experience unpleasant reactions or allergies to Nonoxynol-9. Products containing Octoxynol-9 include Koromex Cream and Ortho-Gynol Jelly, although these products can be challenging to find.
Benzalkonium Chloride (Cationic surfactant)
Benzalkonium Chloride (also known as alkyldimethylbenzylammonium chloride and ADBAC) is a mixture of alkylbenzyldimethylammonium chlorides of various even-numbered (alkyl) chain lengths. This product is a nitrogenous cationic surface-acting agent similar to Nonoxynol 9 and Octoxynol-9. ADBAC is most commonly found in vaginal suppositories, vaginal creams, and vaginal tablets manufactured in France by Pharmatex. ADBAC is also the active ingredient in Lanzas Contraceptive Cream, which is distributed in Spain by Faes Farm S.A.
Lactic acid based “natural alternatives” to spermicide
Lactic-acid-based spermicides, derived from natural ingredients, offer a safe alternative for individuals with adverse reactions to chemical-filled spermicides like N-9. ContraGel Green, sometimes rebranded as Caya Gel, stands as the most popular lactic-acid-based alternative on the market. Amphora is another new lactic acid gel that functions similarly.
Unlike other spermicides, lactic-acid-based alternatives like ContraGel Green, Caya Gel, and Amphora are water-soluble, making them safe for use with various rubber and silicone contraceptive devices, including natural latex rubber and polyurethane condoms, latex and silicon rubber diaphragms, and cervical caps. When applied with a diaphragm or cervical cap, these gels create a mechanical barrier with a low pH value in front of the cervix, effectively inhibiting and immobilizing sperm.
When combined with a diaphragm or cervical cap, ContraGel Green provides twice the level of contraceptive protection. This allows women to continue using their preferred contraceptive barrier device without compromising their health, offering a wider range of contraceptive choices.
For two decades David has been the owner and director of several marketing and distribution companies. During this time he has learned the indisputable benefits of looking after customers, colleagues, workers, suppliers and the local community, treating them all as respected stakeholders in a common project. Recently he consolidated his personal beliefs and business ethics by founding and developing several ethical companies.
