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  • Title: Vaginal contraception--an update.
    Author: Edelman DA, Thompson S.
    Journal: Contracept Deliv Syst; 1982 Apr; 3(2):75-81. PubMed ID: 12338173.
    Abstract:
    A number of new and innovative methods of vaginal contraceptive have been developed in recent years and are currently being evaluated. Some of these methods are described briefly and the available data on their safety and efficacy are presented. 3 types of contraceptive sponges have been developed--collagen sponge, intravaginal insert, and Secure sponge--and are now being evaluated. The collagen sponge, a cylindrical-shaped disk, exerts its contraceptive effect by acting as a physical barrier to the sperm and through its ability to absorb semen much in excess of its own weight. Preliminary data confirm the effectiveness of the sponge obtained from post-coital tests. The intravaginal insert (IVI) is made of a polyester material incorporating the spermicide nonoxynol-9. In a small clinical evaluation of the IVI, 49 women were followed up for 1 month. No pregnancies or unexpected adverse reactions were reported. The Secure sponge is made of polyurethane and incorporates 1 g of the spermicide nonoxynol-9. Its primary mode of action in preventing pregnancy is through the release of nonoxynol-9. In a multiclinic phase 2 evaluation of the Secure, which included 382 women, the 6-month gross life-table pregnancy rate was 3.8 +or- 1.3/100 women; the 6-month gross discontinuation rate for all reasons was 26.2 +or- 3.4/100 women. Sufficient data from the comparative trials of the Secure and Neo Sampoon foaming suppository studies conducted in Yugoslavia, Taiwan, and Bangladesh have been reported to the International Fertility Research Program (IFRP). The 12-month life-table rates for reasons leading to discontinuation of the contraceptive methods were not significantly different except for the category of "other personal reasons." The advantages Secure provides over other vaginal contraceptives are identified. Foaming vaginal suppositories similar to Neo Sampoon but containing 100 mg nonoxynol-9 are being developed and evaluated in the U.S. Clinical data on these products are not yet available. A non-fitted, spermicide-releasing diaphragm is now being tested that obviates the need for a separate spermicidal supply. The diaphragm has been designed to be a 1-use only product. There has been an increasing demand for cervical caps in the U.S. The cervical caps now used are only available in a limited number of sizes. A custom-fitted cervical cap has been developed to overcome some of the disadvantages of the cervical caps available. An improved model of the cap is now being evaluated by the IFRP in a limited phase 2 multiclinic trial. This trial should give lower pregnancy rates because of the improvements that have been made in the design and fabrication of the caps. The newly developed vaginal contraceptives, such as the sponges and custom-fitted cervical cap, appear to offer several significant advantages over the available vaginal contraceptives. These advantages, such as their ease of use and potential not to interfere with the spontaneity of intercourse, will probably result in further increases in the numbers of women who choose to use vaginal contraceptives as their only contraceptive method. An additional benefit of the use of spermicides is that they provide a high degree of protection against some of the sexually transmitted diseases.
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