A 34-year-old G1P1 with a history of pulmonary embolism presents to your office to discuss contraception. Her cycles are regular. She has a history of pelvic inflammatory disease (PID) last year, for which she was hospitalized. She has currently been sexually active with the same partner for 1 year. She wants to use condoms and a spermicide. You counsel her on the risks and benefits.
Which of the following statements correctly describes spermicides found in vaginal foams, creams, and suppositories?a. The active agent in spermicides is nonoxynol-9
Spermicides available in the United States contain nonoxynol-9, which immobilizes or kills sperm on contact. They do not provide protection against sexually transmitted infections. Spermicides provide a mechanical barrier (ie, gel, cream, foam, film) and need to be placed high in the vagina in contact with the cervix before each act of intercourse. They are available without a prescription. They are not highly effective when used alone, and effectiveness increases with concomitant use of barrier methods such as condoms. High pregnancy rates typically associated with spermicides are mostly due to inconsistent use rather than method failure. Their effectiveness increases with increasing age of the women who use them, probably because of increased motivation. The effectiveness of spermicides is similar to that of the diaphragm. Although it has been reported that contraceptive failures with spermicides may be associated with an increased incidence of congenital malformations, this finding has not been confirmed in several large studies and is not believed to be valid.