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FOUNDATION OVERVIEW

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Contraception implies the prevention of pregnancy following sexual intercourse by inhibiting viable sperm from coming into contact with a mature ovum or by preventing a fertilized ovum from implanting successfully in the endometrium. Additional benefits of contraception include improvements in menstrual cycle regularity and prevention of sexually transmitted ­diseases. Contraceptive methods are available as nonprescription or by prescription. Nonprescription contraceptives include condoms and spermicides and Prescription contraceptives are ­usually hormone based. There are a variety of factors that go into method selection and include effectiveness, cost, accessibility, side effects, return to fertility rate, frequency of sexual activity, sexually transmitted infection prevention, past medical history, and concomitant medications.

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PRODUCT OVERVIEW

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Nonhormonal Contraception

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A condom is one of the most common nonhormonal contraceptives and is available over the counter. Male latex condoms protect against sexually transmitted infections (STIs); however, oil-based lubricants breakdown latex condoms and should not be used concurrently. Latex allergic individuals may use polyurethane, polyisoprene, and lamb cecum condoms. Nonlatex condoms increase heat conduction, increase sensitivity, and can be used with water- or oil-based lubricants. Additionally, polyurethane condoms break easier than latex condoms, and lamb cecum condoms are porous, expensive, and do not protect against select STIs. Overall, male condoms have a 15% failure rate in preventing pregnancy. This percentage may decrease if spermicides are used in conjunction.

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The female condom (FC2) is an option for contraception and prevention of STIs. The female condom is made of polyurethane, inserted vaginally and may be worn up to 8 hours prior to intercourse. The condom should be discarded by closing the bottom of the condom and removing it from the vagina. Disadvantages include squeaking during intercourse, appearance, irritation, decreased sensitivity, difficulty inserting the condom, and a 21% failure rate in preventing pregnancy. Male and female condoms may not be used together because they stick together causing friction and may break.

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Spermicides are also available OTC in a variety of formulations including jellies, gels, foams, suppositories, and films. The active ingredient in spermicides available in the United States is nonoxynol-9. Nonoxynol-9 is a nonionic detergent that inhibits sperm motility and function. The failure rate of spermicides when used alone is reported to be 5% to 29%. ­Nonoxynol-9 is not a microbicide and does not kill viruses such as human immunodeficiency virus (HIV). In some reports, it has been shown to increase the risk of HIV transmission by causing irritation to the mucosal lining of the vagina or rectum, which may allow passage of the virus into the bloodstream. Key counseling points for spermicides include no douching within 6 hours of use, apply within 1 hour of intercourse, and each application only works for one act of intercourse. In addition, the vaginal film and suppository must dissolve completely for at least 15 minutes before intercourse. The film is activated by the female secretions; therefore, it is not best ...

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