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Unintended pregnancies account for about 49% of pregnancies in the United States.1 About half of these unintended pregnancies result in abortions.1 Currently, it has been reported that over 11.2 million women in the United States use oral contraceptives and reported that about 20% of women use condoms.2,3 Whether contraceptive methods are over the counter or prescription only, pharmacists play an important role in providing contraception counseling for proper use and adherence to attain desired outcomes.

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There are a variety of contraceptives available. Over-the-counter (OTC) contraceptives commonly include condoms and spermicides. Prescription contraceptives are usually hormone based. There are a variety of factors that go into method selection. Factors to consider 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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Nonhormonal Contraception

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Most nonhormonal contraceptives are OTC with the exception of the copper-T (ParaGard) intrauterine device (IUD) and diaphragm. One of the more common nonhormonal contraceptives is the condom. Male latex condoms are the most common and protect the best against sexually transmitted infections (STIs).4 However, use of oil-based lubricants can breakdown latex condoms and should not be used together. For those with allergies to latex, polyurethane and lamb cecum condoms are available. Both of these condoms are thought to increase heat conduction and provide more sensitivity.5 They can both be used with water-based or oil-based lubricants.6 Polyurethane condoms may break easier than latex condoms.7,8 Lamb cecum condoms are porous, cost more than the others, and do not protect against some STIs such as human immunodeficiency virus (HIV).9 Overall, male condoms have typical use failure rate of about 15% in preventing pregnancy.5,6 This percentage may decrease if spermicides are used in conjunction.

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The female condom (Reality) is also an option for contraception and prevention of STIs. The female condom is made of polyurethane and is inserted vaginally. Female condoms have a 21% typical use failure rate in preventing pregnancy.6 In addition, the condom may be worn up 8 hours prior to intercourse. Only one condom should be used for each act of intercourse and then discarded carefully by closing the bottom of the condom and removing it from the vagina while closed. Disadvantages of the product include its "squeaks“ during intercourse, appearance, irritation, decreased sensitivity, and difficulty inserting the condom.5,6 Male and female condoms should not be used together as they stick together causing friction and may break.

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Spermicides are also available OTC in a variety of formulations. These include jellies, gels, foams, suppositories, and films. The active ingredient in spermicides available in the United States is nonoxynol-9. Nonoxynol-9 is a noniconic detergent that inhibits sperm motility and function.6 Nonoxynol-9 is not a microbicide and does not kill viruses such as HIV.10 In some reports, ...

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