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Contraception. 1982 Oct;26(4):347-59.

The effectiveness of barrier methods of contraception with and without spermicide.

Abstract

This paper reviews trials of the effectiveness of barrier contraception with and without spermicide, and discusses the advantages and disadvantages of using spermicides with barriers. There is very little evidence to allow comparison of the effectiveness of barriers with and without spermicide. Little or no evidence could be found to support many of the instructions given to users of barrier contraception. The lack of scientific data on this subject has prompted us to recommend research in specific areas. Until the findings of such research are available, the information which has emerged from this review suggests that the recommendations issued to users of barrier contraception should be brought up-to-date.

PIP:

This paper reviews trials of the effectiveness of barrier contraception with and without spermicide and recommends research in specific areas. Only 1 study of use of the condom with spermicide was found. The only comparative trial of the use of the diaphragm with and without spermicide has been criticized for its method of follow-up, but it has provided the basis for all subsequent recommendations that a spermicide be used with cervical barriers. Studies of the use of barriers without spermicide have given widely varying results, but the principal factor influencing failure is believed to be inconsistent use because of the messiness and inconvenience of spermicide usage. 10 pregnancies were reported in 997 users of a non-spermicide diaphragm between 1974-78. Spermicide is believed to provide extra protection if the diaphragm loses contact with the vaginal walls and if the condom leaks, breaks, or comes off. Disadvantages of spermicides include messiness, cost, genital irritation in some users, possible adverse effects of absorption by pregnant women, and possible damage to sperm and ova resulting in defective conceptions. Rimming of the diaphragm with contraceptive cream or jelly has been demonstrated to contribute to loss of correct placement. No evidence was found to support many of the recommendations issued by family planning authorities for the use of barriers. Research is needed on sperm survival in the vagina when the cervix is occluded, the sperm content of the pre-ejaculatory fluid, the optimal dose of spermicide to be placed on the cervical barrier, the length of time during which the spermicide is effective, the risk of infection and toxic shock, and liquefaction of spermicide inside the cervical barrier. Based on currently available knowledge, it is concluded that condoms and cervical barriers provide effective contraception without spermicides although they may be used if desired, and that post-coital contraception should be available in case of failure. The cervical barrier can probably be removed 3 hours after coitus without increasing pregnancy risk. Cervical barriers may be worn almost continuously in non-menstruating women. Rimming of the barrier with spermicide should be avoided, the amount of spermicide should be limited, and no additional spermicide need be used if the barrier is inserted in advance or if coitus is repeated.

PMID:
6759027
[Indexed for MEDLINE]

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