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  • Title: [Vaginal contraception: mechanical or chemical?].
    Author: Monard S.
    Journal: NPN Med; 1983 May 02; 3(50):591-6. PubMed ID: 12313043.
    Abstract:
    Vaginal contraception is the oldest method of protection against pregnancy. Current methods operate on the same principles as those mentioned in ancient Egyptian papyrus: stopping the migration of sperm with mechanical barriers or destroying them with spermicidal substances. The combination of diaphragm and spermicide was among the most widely used methods before 1960, and recently has been regaining popularity because of fear of side effects of oral contraceptives and IUDs. Diaphragms and cervical caps are vaginal mechanical methods used by the female. Diaphragms must be fitted individually and the woman must be instructed to use them properly. Both devices must be used each time intercourse takes place, always with a spermicide, and must be left in place for 3-8 hours afterwards. Diaphragms and caps are difficult to prescribe because they are time consuming to fit and require a high degree of motivation. Local chemical methods are composed of 1 of a number of active ingredients which have antiinfectious effects, sperm immobilizing action, and lytic power. Spermicides cause the permeability of the cell membrane to increase until rupture occurs. Spermicides may be used with a diaphragm or, less surely, by themselves. They are available in foam, gel, cream, or vaginal tablets, and should be applied 3-5 minutes before intercourse. A vaginal tampon containing spermicide which could be left in place for 3 days and is as easy to use as a menstrual tampon is under study. Side effects of spermicides are minor and no contraindications have been identified. Spermicides have a bactericidal action against some sexually transmitted diseases, and 2 studies have indicated lower rates of cervical cancer in diaphragm users. A Pearl index of 1.5-3 is possible if vaginal contraception is used correctly and consistently. The acceptability of vaginal methods is limited by psychological resistance on the part of both partners. The diaphragm in particular must be inserted each time and the spermicide may cause an exaggerated lubrication in some women.
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