Spermicides (Vaginal)

Proper Use of This Medicine

Make sure you carefully read and follow the directions that come with each spermicide product. Each product may have different directions for using the product. The directions tell you how much to use, how long you must wait before having intercourse, and how long you must leave it in the vagina after intercourse.

Vaginal douching is not needed or advised after using these medicines . When using a spermicide, douching within 6 to 8 hours after the last sexual intercourse (even with just water) may stop the spermicide from working properly. Also, washing or rinsing the vaginal or rectal area may wash the spermicide away before it has had time to work properly.

Cervical caps and diaphragms are not recommended for use during your menstrual period because of an increased chance of developing toxic shock syndrome. Your doctor may advise you to use condoms with a spermicide instead during your menstrual periods when protection is needed.

For proper use of spermicide when used alone :

• Follow directions carefully to make sure the spermicide is properly placed in the vagina. The spermicide should be inserted deep into the vagina, directly on the cervix (opening to the uterus).
• Use the correct amount, according to the product directions.
• Use another dose for each act of intercourse.
• After you have applied or inserted the spermicide, wait the correct amount of time before having intercourse so that the spermicide can begin to work.
• If you do not have intercourse within half an hour, read the product directions to see if you need to apply more spermicide.

For proper use of spermicide with cervical caps, condoms, or diaphragms :

• Make sure the directions for the spermicide you choose state that it is safe for use with latex cervical caps, condoms, or diaphragms. If the directions do not say the spermicide is safe to use with latex products, the spermicide may cause cervical caps, condoms, or diaphragms to weaken and leak or cause condoms to break during intercourse.
• If there is a leak or break during intercourse, it may be a good idea for the female partner to immediately place more spermicide in the vagina.
• If you need an extra lubricant, make sure it is a water-based product safe for use with cervical caps, condoms, or diaphragms . Spermicides, especially gels and jellies, provide some lubrication during sexual intercourse.
• Oil-based products such as hand, face, or body cream; petroleum jelly; cooking oils or shortenings; or baby oil should not be used because they weaken the latex rubber. (Even some products that easily rinse away with water are oil-based and should not be used.) Use of oil-based products increases the chances of the condom breaking during sexual intercourse. These products can also cause the rubber in cervical caps or diaphragms to break down faster and wear out sooner.

For patients using spermicides with a cervical cap :

• To be most effective at preventing pregnancy, the cervical cap must always be used with a spermicide . Both must be used every time you have sexual intercourse.
• Before inserting the cervical cap, inspect it for holes, tears, or cracks. If there are holes or defects, the cervical cap will not work effectively, even with a spermicide. It must be replaced.
• Before you put the cervical cap over the cervix (opening to the uterus), a spermicide cream, foam, gel, or jelly should be put into the cup of the cervical cap. Follow the manufacturer's directions on how long before sexual intercourse you may apply the spermicide. Fill the cervical cap one-third full with spermicide.
• To insert the cervical cap, squeeze the rim between your thumb and forefinger so that it is narrow enough to fit into the vagina. While in a comfortable position, push the cervical cap as deeply into the vagina as it will go. Release the rim and press it into place around the cervix with your finger. The rim should be round again and be directly on the cervix. The cervical cap is held onto the cervix by suction.
• Some doctors may recommend that you put more spermicide into the vagina each time you repeat sexual intercourse using a cervical cap. You should also check to make sure the cervical cap is in the proper position on the cervix before and after each time you have intercourse. You may wear the cervical cap for up to 48 hours (2 days).
• Do not remove the cervical cap if it has been less than 8 hours since the last time you had sexual intercourse . For the cervical cap to be most effective at preventing pregnancy, it must remain in the vagina for at least 8 hours after sexual intercourse.
• To remove the cervical cap, use 1 or 2 fingers to push the rim away from the cervix. This will break the suction seal with the cervix. Then gently pull the cervical cap out of the vagina. Call your doctor if you have trouble removing the cervical cap .

For patients using spermicides with condoms :

• Condoms do not have to be used with spermicides, but the spermicide may provide a back-up birth control method in case the condom breaks or leaks.
• Spread some spermicide on the outside of the condom, after it is unrolled over the penis. It is even more important that the female partner also use a spermicide inside the vagina.
• Each time you repeat intercourse, a new condom must be used. Condoms should never be reused . Spermicide should also be applied to the outside of the new condom. The female partner must also put more spermicide in the vagina each time she has intercourse.

For patients using spermicides with a diaphragm :

• To be most effective at preventing pregnancy, diaphragms must always be used with a spermicide . Some women may choose to insert a diaphragm every night, to avoid the chance of unprotected sexual intercourse and unplanned pregnancy happening.
• Inspect the diaphragm for holes by holding it up to a light. If there are holes or defects, the diaphragm will not work effectively, even with a spermicide. It must be replaced.
• Before you put the diaphragm over the cervix (opening to the uterus), a spermicide cream, foam, gel, or jelly should be put into the cup of the diaphragm. Follow the manufacturer's directions on how much spermicide to use and how long before sexual intercourse you may apply the spermicide. Also, spread some spermicide all around the rim of the diaphragm that will be touching the cervix. Some doctors also advise spreading more spermicide on the outside of the cup of the diaphragm.
• To insert the diaphragm, squeeze the rim between your thumb and forefinger so that it is narrow enough to fit into the vagina. While in a comfortable position, push the diaphragm as deeply into the vagina as it will go. (Some women use a special applicator that makes it easier to insert the diaphragm.) Release the rim. The diaphragm rim should be round again and be directly on the cervix.
• Each time you repeat sexual intercourse, you should put more spermicide into the vagina. Do not remove the diaphragm if it has been less than 6 or 8 hours (depending upon which brand of spermicide you use) since the last sexual intercourse . For the diaphragm to be most effective at preventing pregnancy, it must remain in the vagina for at least 6 or 8 hours (depending upon which brand of spermicide you use) after sexual intercourse. Be careful not to move the diaphragm out of place while you are applying more spermicide.
• Do not wear the diaphragm for more than 24 hours, since doing so increases the risk of getting toxic shock syndrome or a urinary tract (bladder) infection.
• To remove the diaphragm, hook one finger over the rim nearest the front. Pull the diaphragm downward and out of the vagina. Call your doctor if you have trouble removing the diaphragm .

Dosing - Follow your doctor's orders or the directions on the label . The following information includes the usual way that spermicides are used.

For benzalkonium chloride
• For preventing pregnancy:
  • For vaginal suppositories dosage form:
    • Adults and teenagers:
      • For use alone: One suppository inserted into the vagina at least ten minutes but not longer than four hours before each time you have sexual intercourse.
      • For use with a diaphragm: After the diaphragm with spermicide has been placed into the vagina, insert one suppository at least ten minutes, but not longer than four hours, before each time you have sexual intercourse. Also, insert another suppository before sexual intercourse if six hours have passed since you inserted the diaphragm.

For nonoxynol 9
• For preventing pregnancy:
  • For vaginal cream dosage form:
    • Adults and teenagers:
      • For use alone: One applicatorful of a 5% cream inserted into the vagina just before each time you have sexual intercourse.
      • For use with a diaphragm: One applicatorful of a 2 or 5% cream inserted into the cup of the diaphragm. Spread more spermicide along the rim of the diaphragm. Insert the diaphragm into the vagina just before, but not longer than six hours before, sexual intercourse. Also, insert one applicatorful just before each time you have intercourse or if six hours have passed since you inserted the diaphragm.
  • For vaginal film dosage form:
    • Adults and teenagers - One film inserted into the vagina from five to fifteen minutes (but not longer than one and one-half hours) before each time you have sexual intercourse.
  • For vaginal foam dosage form:
    • Adults and teenagers:
      • For use alone: One applicatorful inserted into the vagina just before, but not longer than one hour before, each time you have sexual intercourse.
      • For use with a diaphragm: One applicatorful inserted into either the vagina or into the cup of the diaphragm, depending on the product. Spread more spermicide along the rim of the diaphragm. Insert the diaphragm into the vagina just before, but not longer than one hour before, sexual intercourse. Also, insert another applicatorful into the vagina just before, but not longer than one hour before, each time you have sexual intercourse.
  • For vaginal gel dosage form:
    • Adults and teenagers:
      • For use alone: One applicatorful of a 3.5, 4, or 5% gel inserted into the vagina before each time you have sexual intercourse. The 3.5% gel may be used up to twenty-four hours before each act of intercourse. The 4% gel may be used up to one hour before each act of intercourse. The 5% gel must used just before intercourse.
      • For use with a diaphragm: One or two teaspoonfuls (depending on the product) or the contents of one packet of gel is placed into the cup of the diaphragm. Spread more spermicide along the rim of the diaphragm. Insert the diaphragm into the vagina just before, or up to six hours before, sexual intercourse. Also, insert another applicatorful or the contents of one packet into the vagina before each time you have sexual intercourse or if six hours have passed since you inserted the diaphragm.
  • For vaginal jelly dosage form:
    • Adults and teenagers:
      • For use alone: One applicatorful of 2.2 or 3% jelly inserted into the vagina just before each time you have sexual intercourse. The contraceptive effect of the 2.2 or 3% jelly will last one hour.
      • For use with a diaphragm: One applicatorful or two teaspoonfuls of jelly (depending on the product) placed into the cup of the diaphragm. Spread more spermicide along the rim of the diaphragm. Insert the diaphragm into the vagina just before, but not longer than six hours before, sexual intercourse. Also, insert another applicatorful before each time you have sexual intercourse or if six hours have passed since you inserted the diaphragm.
  • For vaginal suppositories dosage form:
    • Adults and teenagers:
      • For use alone: One suppository inserted into the vagina from ten to fifteen minutes (depending on the product) before, but not longer than one hour before, each time you have sexual intercourse.
    • Adults and teenagers:
      • For use with a diaphragm: After the diaphragm with spermicide has been placed into the vagina, insert one suppository into the vagina from ten to fifteen minutes (depending on the product) before, but not longer than one hour before, sexual intercourse. Also, insert another suppository before each time you have sexual intercourse or if six hours have passed since you have inserted the diaphragm.

For octoxynol 9
• For preventing pregnancy:
  • For vaginal cream dosage form:
    • Adults and teenagers:
      • For use with a diaphragm: Two teaspoonfuls placed into the cup of the diaphragm. Spread more spermicide along the rim of the diaphragm. Insert the diaphragm into the vagina just before, but not longer than six hours before, sexual intercourse. Also, insert one applicatorful of the vaginal cream just before each time you have sexual intercourse or if six hours have passed since you inserted the diaphragm.
  • For vaginal jelly dosage form:
    • Adults and teenagers:
      • For use with a diaphragm: One applicatorful placed into the cup of the diaphragm. Spread more spermicide along the rim of the diaphragm. Insert the diaphragm into the vagina just before, but not longer than six hours before, sexual intercourse. Also, insert another applicatorful just before each time you have sexual intercourse or if six hours have passed since you inserted the diaphragm.

Storage - To store this medicine:

• Keep out of the reach of children.
• Store away from heat and direct light.
• Do not store in the bathroom, near the kitchen sink, or in other damp places. Heat or moisture may cause the medicine to break down.
• Do not refrigerate.
• Do not keep outdated products or products no longer needed. Be sure that any discarded products are out of the reach of children.