About 500000 American women are sp...

About 500000 American women are speculation to use vaginal spermicidal proceedss containing nonoxynol-9 for contraception, on the contrary data on the effectiveness of these agents are limited. Raymond and colleagues studied the effectiveness and safety of five productions (three gels, a film, and a suppository) containing from 525 to 150 mg of nonoxynol-9.

The researchers listed more than 1,500 women 18 to 40 years of age at 14 U sites. Participants were required to be healthy and to have a grave risk of sexually transmitted diseases and no evidence of subfecundity. Each woman and her partner were required to acquiescence to a moderate risk of pregnancy during the consideration Following an intake assessment that included physical examination, Papanicolaou smear, and screening for pregnancy, women were assigned randomly to single in kind of the five products. The women agreed to rely in succession this product for contraception during the reflection and were instructed in back-up necessity contraception.

Participants were asked to record use of contraception, proceedings of intercourse, and menstrual history in a symptom diary. All participants were reassessed at four, 17 and 30 weeks after hall to the study. Pregnancy testing was performed at each visit, and a replete pelvic examination was performed and a wet preparation was obtained at the final visit. Quizzes were used at intake and at the four-week visit to assess understanding of contraception, and use of spermicide and juncture contraception. At the four-week and final visits, questionnaires about the acceptability of the spermicide were complet hearth pregnancy tests were used by the agency of the patients at two, 10 and 23 weeks.

The assign places tos were comparable in baseline characteristics forward entry to the study. The median age was 26 years, and the median commonness of intercourse in the previous four weeks was twice weekly. About 60 percent of the women relied onward the spermicide for six month or became pregnant earlier. Between 7 and 17 percent of the women in each collection became pregnant while using the spermicide. Between 15 and 17 percent of each clump discontinued use of the spermicide early, and 22 percent were wasted to follow-up. The cumulative probability of pregnancy during six month of typical use ranged from 10 to 22 percent In the three disposes using 100 mg of nonoxynol-9 in gel film, or suppository forms, the probability ranged from 10 to 16 percent The probability rose to 22 percent in the form into groups using the gel containing 525 mg of the spermicide, and to 14 percent in the collection using the 150 mg gel juncture contraception was used 109 times during the studious mood Very few side effects were reported, and the commonness of monitored or reported adverse events was similar between groups.

The authors decide that spermicidal products are generally safe moreover are associated with higher pregnancy rates than other forms of contraception. Patients using preparations with the highest amounts of nonoxynol-9 had the lowest pregnancy rates.

ANNE D WALLING, MD Raymond EG et al. Contraceptive effectiveness and safety of five nonoxynol-9 spermicides: a randomized trial. Obstet Gynecol March 2004;103:430-9

EDITOR'S NOTE: calm the high pregnancy rates reported in the investigation may be underestimated, because no data are available for the women who discontinued early or were squandered to follow-up. In addition, the use of extremity contraception indicates other occasions of potential mode failure. Even more worrying, "typical-use" pregnancy rates for any contraceptive are always higher than those reported in studies because human behavior and shortcomings play a greatly larger role in real life. Clearly, spermicidal vaginal harvests cannot be recommended as a reliable form of contraception when used alone. Family physicians should discuss more effective measures with women who rely forward this method.

COPYRIGHT 2004 American Academy of Family Physicians

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