Guidelines 2016 – Contraceptive Spermicides and Condoms
Guidelines for Nurse Practitioners in Gynecologic Settings 2016
■ SPERMICIDES
I. DEFINITION
spermicides are substances used alone or with a vaginal barrier to prevent sperm from reaching the uterus. all contain an inert base or carrier sub- stance and an active ingredient, most commonly the surfactant nonoxynol-9 or octoxynol, which disrupts the integrity of the sperm cell membrane.
II. EFFECTIVENESS AND BENEFITS
a. Method: 96% effectiveness rate
B. User: 60% effectiveness rate
C. inexpensive and readily available
III. SIDE EFFECTS AND DISADVANTAGES
a. local irritation from spermicide or allergy to spermicide or carrier substance
B. Can necessitate interruption of intercourse for application
C. emotional reaction to touching or inserting a substance into one’s own body
IV. TYPES
a. Creams, jellies, gels (some flavored and nontoxic if ingested, some colored)
B. foams
C. foaming tablets
d. suppositories
e. Vaginal contraceptive film
f. Bioadhesive gel
g. Water-soluble lubricant with spermicide
V. HOW TO USE
a. instructions should be read carefully prior to using any spermi- cide. Method of insertion, time of effectiveness, time recommended prior to intercourse, and other instructions vary with each type. Concentration of the spermicide varies among products.
B. a new insertion of spermicide is needed before each act of intercourse.
C. Wash the applicator with soap and water after each use.
d. When the woman uses a spermicide alone, the partner should always use a condom.
e. frequent use of nonoxynol-9 can cause genital and rectal lesions and increase the risk of hiV and other stis.
VI. FOLLOW-UP
follow up per aCog annual Women’s health Care guidelines (2013)
See Appendix I for patient handout on spermicides and condoms. See Bibliographies.
■ CONDOMS
I. DEFINITION
Condoms are thin sheaths, most commonly made of latex and sheep intes- tine or polyurethane, designed to prevent the transmission of sperm from the penis to the vagina. the female condom (vaginal pouch) is made of polyurethane.
II. EFFECTIVENESS
a. Method: 97% to 98% effectiveness rate
B. User: 70% to 94% effectiveness rate; 85% for female condom (range 74%–91.1%)
C. inexpensive and readily available
d. offer protection against stis, including the aids virus (hiV)
e. encourage male participation with birth control (conventional male condom)
f. female condom is polyurethane (fewer allergic reactions as compared with latex).
g. Use of both vaginal spermicides and condoms has an effectiveness rate in the high 90% range when both methods are used correctly.
III. SIDE EFFECTS AND DISADVANTAGES
a. allergic reactions to latex, lubricant, or spermicide on products with either of these in place
B. Use necessitates interruption of intercourse for application
C. May decrease tactile sensation
d. psychological impotence may occur.
e. latex condoms provide the best protection against hiV; however, polyurethane (plastic) or polyisoprene (synthetic rubber) condoms are good options for people with latex allergies. the natural mem- brane (such as lamb skin/sheep intestines) condoms are porous, and infectious agents can pass through them.
f. polyurethane male condoms are more likely than latex to break or slip off, but they are useful for persons who do not like latex condoms or are latex sensitive.
IV. TYPES
Condoms (male) vary in color, texture (smooth, studded, or ribbed), shape, size, and price. they come lubricated or nonlubricated, impregnated with spermicide, flavored, or plain. some are extra strength, some are sheerer and thinner, and some are uniquely shaped or scented. the new eZ•on male con- dom is made of polyurethane, a thin, strong, 100% latex-free material. it is designed to go on in either direction and has no reservoir tip.
V. HOW TO USE
a. Male condom
1. the male condom should always be put on an erect penis before there is any sexual contact and used in every act of intercourse.
2. the male condom should not be pulled tightly over the end of the penis; about 1 inch (2.54 cm) should be left for ejaculation fluid and to avoid breakage; some condoms have a reservoir tip.
3. the penis should be withdrawn before it becomes limp, and the open end of the male condom should be held tightly while with- drawing to prevent spilling the contents
4. the partner should always use a contraceptive spermicide when a male condom is used.
5. Condoms should be used only once.
B. female condom (comes prelubricated)
1. pinch ring at closed end of pouch and insert like a diaphragm, covering the cervix; adding one or two drops of additional lubri- cant makes insertion easier and decreases or eliminates squeaking noise and dislocation during intercourse.
2. adjust other ring over labia
3. Can be inserted several minutes to 8 hours prior to intercourse
4. remove after intercourse before standing up by squeezing and twisting the outer ring and pulling out gently
VI. FOLLOW-UP
a. annual examination, pap smear per the american society for Colposcopy and Cervical pathology (asCCp) guidelines
B. appendix i has information on contraceptive spermicides and con- doms that you may wish to photocopy for distribution to your patients.
See Bibliographies. Website: www.asccp.org