Contraceptive Foams, Creams, and Gels
From Encyclopedia of Sex and Sexuality
Over-the-counter methods of birth control for women include chemical or physical barrier contraceptives, familiar to many people because they are displayed on American supermarket as well as drugstore shelves. (They should not be confused with feminine hygiene methods which cannot prevent either pregnancy or disease.) They are available without prescription and do not have any serious side effects, but they are not as effective as other contraceptives, and several of them are made to be used in combination with other barrier methods.
These products offer a certain amount of protection against sexually transmitted diseases, including HIV, but because aids is a deadly disease, the risks should be considered too high to rely on these methods exclusively when having sex with anyone but a long-term partner who is known to be disease free.
Vaginal contraceptive foam comes out of an aerosol can and is placed into an applicator, which is used to insert the foam into the vagina. (Some brands come prepackaged in one-unit doses inside an applicator.) Because of the bubbling action of the foam when inside the vagina it spreads evenly throughout the vagina, covering the cervix. The foam contains a spermicide which paralyzes sperm, preventing them from entering the uterus and fertilizing an egg. For proper use, the manufacturer’s instructions must be followed carefully.
For women who are uncomfortable about touching their genitals, foam offers the convenience of an easy-to-use applicator. Nor does foam have to be removed, as it washes out with the vagina’s natural secretions. Some women do find these foams messy and leaky, and since the foams must be inserted prior to each act of intercourse, they do remove some of the spontaneity of love-making, though the application process can also be included as a part of foreplay.
For women who use only foam as a method of contraception, 20 out of 100 will become pregnant at the end of one year of use. By combining foam with other methods of contraception, such as condoms or diaphragms, the rate of effectiveness rises significantly. Suppositories that release a spermicide when inserted into the vagina are less messy to use than foams and do not require applicators, a plus for some women. On the other hand, they must be placed into the vagina at least ten to fifteen minutes before intercourse, and no longer than forty-five minutes before intercourse has been completed, so that they definitely can affect spontaneity, though by integrating their use into foreplay, some of the fun can be restored. If the man has not ejaculated forty-five minutes after the suppository was first placed in the vagina, another suppository must be inserted, and another waiting period gone through.
Spermicides which come in cream and gel form are made to be used in combination with a diaphragm or cervical cap, though some do come with applicators so that they can be used without these physical barriers. This lowers their effectiveness to about 20 percent. Their low rate of protection against HIV makes them unacceptable for someone who has multiple partners, unless condoms are also used.
Creams and gels are less messy than foams although their application procedure is a bit more complicated because there are no bubbles to evenly spread the spermicide as with the foams. A fresh application of either of these products is required for each act of intercourse, and if intercourse has not occurred within thirty minutes another application is also required.
Like the others, 20 out of 100 women using these products can expect to become pregnant at the end of a year’s use, and while there is some protection from sexually transmitted diseases and HIV, it is not very effective, and unless the woman has a steady, monogamous partner, condoms should be used.
The vaginal contraceptive sponge combines both chemical and physical barrier methods of birth control. The sponge itself is round and doughnut-shaped, about two inches long, and made of a soft synthetic substance. It contains the spermicide nonoxynol-9, which it releases when the sponge is moistened prior to insertion. Because the spermicide is released gradually, and also because the sponge itself acts as a barrier, the sponge is effective for repeated acts of intercourse and can be left in place for up to twenty-four hours.
The sponge is less messy than the foams, creams, and gels because it releases its spermicide a little at a time, though it does require more genital manipulation both for the insertion process and for removal.
By itself, the sponge has an effectiveness rating of 18 percent over a year of use, though the sponge is more effective when used in combination with another product or with natural family planning. It is less effective for women who have already had a child.
Sponge users may be at increased risk of toxic shock syndrome, especially if they have already had it (in which case the sponge is completely contraindicated). The sponge should not be left in place for longer than twenty-four hours or during any vaginal bleeding. It would be best to check with a physician before opting for this method of over-the-counter contraception.