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Current advice on spermicides
| Last updated: 25.06.04 |
All currently available spermicides are based on nonoxynol-9 (N-9). It has always been known that spermicides can cause irritation and should not be used by women who are sensitive or allergic to the chemicals. One study showed irritation in 7% of women followed for a total of 186 weeks. Irritation generally occurs within the first three weeks of use, and the product should be discontinued if this happens.
Nonoxynol-9 blocks HIV infection of cells in the test tube. However, it causes inflammation of the vagina and cervix and shedding of cells from the lining of the rectum (Phillips). There is no evidence that it reduces the incidence of any sexually transmitted infections and its use can actually increase the likelihood of HIV transmission (WHO/CONRAD). Since this evidence has been gained as a part of microbicide research, it is discussed further in relation to microbicides.
There is now a consensus among organisations concerned with sexual and reproductive health that nonoxynol-9 has no role in preventing HIV and other sexually transmitted infections, and its use should be discouraged by anyone perceived to be at risk. At the same time, there continues to be a role for spermicides containing N-9, as readily-available but moderately effective non-hormonal contraceptives, for women and couples who are at very low risk of HIV or other STIs (WHO/CONRAD).
It is particularly important that products containing N-9 should not be used for anal sex, and several companies that used to include N-9 in sexual lubricants have now agreed to remove it.
There has been resistance from condom manufacturers to calls to remove 'spermicidal lubrication' with N-9 from their products, as they perceive that it 'meets a demand' for 'extra safety' from some users. Expert opinion is that the low dose of N-9 in that lubricant does not add to their contraceptive value and might even distract women from the need for emergency back-up contraception if condoms fail.
The dose of N-9 in spermicidally lubricated condoms might still cause problems if such condoms are used for anal sex. Since many heterosexual couples practise anal sex on occasion, it seems unreasonable to expect them to decide in advance, when buying condoms, on what sort of sex they are going to have.
There is an even greater risk for gay men, since in many settings they are more likely to be exposed to HIV, yet there is evidence that gay men continue to use N-9 products despite publicity that these are dangerous.
A survey of gay men in San Francisco was carried out in 2001, a year after the publication of data showing that nonoxynol-9 increased the risk of HIV transmission. This found 349 men out of 573 had heard of nonoxynol-9. Among these, 55% had used products containing it in the previous year, for anal sex. In fact, it had been used in a median of 50% of acts of anal sex in the past twelve months. 23% had used it without a condom in the belief that it reduced their risk of HIV infection. On being informed that N-9 exposure caused disruption of the rectal mucosa, the great majority said they would be less likely to use it. This points both to the messages that would be most effective and to the need for additional action to reduce the use of this high-risk or counter-productive strategy (Mansergh).
In these circumstances, it might be hoped that the condom manufacturers will change their position and agree to remove spermicides from all condoms, until such time as products are identified which are safe and may provide real protection against HIV and other STIs.