Nonoxynol-9: Harmful or Helpful?

ver the years, public health experts have recom­mended using condoms containing the spermicide nonoxynol-9 (N-9) to decrease the possibility of preg­nancy. Although N-9 is an effective spermicide, several studies have raised red flags about its effectiveness and safety when it comes to protection from sexually transmit­ted infections. Research has found that spermicides con­taining nonoxynol-9 do not effectively protect against many sexually transmitted infections, including gonorrhea, chlamydia, or HIV infection (Boonstra, 2005; Workowski & Levine, 2002). In fact, HIV transmission was found to be higher in a population using N-9 than in another popula­tion using a placebo (Boonstra, 2005). This may be due to the fact that N-9 may cause irritation of the cervix, vagina, and rectum, which may aid in the transmission of sexually transmitted infections. In fact, N-9 did not protect women from gonorrhea and chlamydial infections any better than if condoms were used alone (Roddy et al., 2002), and it in-

creased the risk of acquiring a urinary tract infection (Handley et al., 2002).

Because of these studies, the U. S. Centers for Disease Control concluded that N-9 was ineffective against HIV (Workowski & Levine, 2002). The World Health Organization also concluded that N-9 was only "moderately effective" for pregnancy prevention (World Health Organization, 2001). In 2002, Planned Parenthood Federation of America decided to cease production of their self-branded line of condoms that included N-9.

Concern over the use of N-9 has spurred development of new products, microbicides, which can reduce the risk of sexually transmitted infections. Scientists have identified over 60 substances as possible microbicides; 45 of these are in animal trials, 17 are in human testing phases, and 5 are in the final stages of testing (see FDA approval process on page 410). It is possible that microbicides will be available as early as 2010 (INFO Project, 2005).

There are many different types of male condoms on the market, including lubri­cated, colored, spermicidal, reservoir tip, and ribbed texture condoms. For protection from STIs, the most effective condoms are rubber (latex) and contain a spermicide called nonoxynol-9, although there is some controversy over this spermicide (see the accompanying Sex in Real Life, “Nonoxynol-9: Harmful or Helpful?”).

The female condom is inserted into the vagina prior to penile penetration. The in­ner ring is squeezed between the thumb and middle finger, making it long and thin, and then inserted into the vagina. Once this is done, an index finger inside the condom can push the inner ring up close to the cervix. The outer ring remains outside the vagina. During intercourse, the penis is placed within the condom, and care should be taken to make sure it does not slip between the condom and the vaginal wall. It’s important that the vagina is well-lubricated so that the female condom stays in place. Female and male condoms should never be used together, because they can adhere to each other and cause slippage or breakage.

Effectiveness

Latex condoms are between 85% (typical use) and 98% (perfect use) effective. If used properly and in conjunction with spermicidal jelly, this method approaches 100% effec­tiveness (Hatcher et al., 2004). Polyurethane condoms have equivalent levels of con­traceptive protection to latex condoms, whereas female condoms have a 79% (typical use) to 95% (perfect use) effectiveness rate.

Latex and polyurethane condoms have been found to be effective barriers against the transmission of herpes, chlamydia, gonorrhea, and HIV. Although lambskin condoms block sperm, they may have microscopic holes big enough for the transmission of certain viruses. Research has found that the pores in lambskin condoms may be large enough to permit passage of HIV, hepatitis B virus, and herpes (Hatcher et al., 2004).

Some couples worry that condoms will break. All condoms made in the United States are tested and must meet very stringent quality control requirements. Studies

30.6% ‘Includes sponge, cervical cap, female condom and other methods Figure 13.3 Contraceptive method choice among U. S. women, in 2002. Source: Adapted from Alan Guttmacher Institute (2005b). Contraceptive use. Retrieved August 13, 2005, from http://www. agi-usa. org/pubs/fb_contr_use. html

Figure 13.4 Women’s choice of contra­ceptive method worldwide, in 1999. Adapted from Sharing Responsibility: Women, Society, and Abortion Worldwide, Chart 2.4, p. 15. Reproduced with permis­sion of The Alan Guttmacher Institute.

Global contraceptive use

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