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These products are available without prescription, are easy to use, and are fairly effective, with typical failure rates of 10 22% All contain the spermicide nonoxynol-9, which also has some virucidal and bactericidal activity Nonoxynol-9 does not appear to adversely affect the vaginal colonization of hydrogen peroxide-producing lactobacilli A 2002 study suggests that nonoxynol-9 is not protective against HIV infection, particularly in women who have frequent intercourse
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Raymond EG et al Contraceptive effectiveness and safety of five nonoxynol-9 spermicides: a randomized trial Obstet Gynecol 2004 Mar;103(3):430 9 [PMID: 14990402]
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The male condom of latex or animal membrane affords good protection against pregnancy equivalent to that of a diaphragm and spermicidal jelly; latex (but not animal membrane) condoms also offer protection against many sexually transmitted diseases, including HIV When a spermicide, such as vaginal foam, is used with the condom, the failure rate approaches that of oral contraceptives The disadvantages of condoms are dulling of sensation and spillage of semen due to tearing, slipping, or leakage with detumescence of the penis A female condom made of polyurethane is available in the United States The reported failure rates range from 5% to 21%; the efficacy is comparable to that of the diaphragm This is the only female-controlled method that offers significant protection from both pregnancy and sexually transmitted diseases
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The diaphragm (with contraceptive jelly) is a safe and effective contraceptive method with features that make it acceptable to some women and not others Failure rates range from 6% to 16%, depending on the motivation of the woman and the care with which the diaphragm is used The advantages of this method are that it has no systemic side effects and gives significant protection against pelvic infection and cervical dysplasia
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8 Contraception Based on Awareness of Fertile Periods
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These methods are most effective when the couple restricts intercourse to the postovular phase of the cycle or uses a
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barrier method at other times Well-instructed, motivated couples may be able to achieve low pregnancy rates with fertility awareness methods However, properly done randomized clinical trials comparing the efficacy of most of these methods with other contraceptive methods do not exist
Grimes DA et al Fertility awareness-based methods for contraception: systematic review of randomized controlled trials Contraception 2005 Aug;72(2):85 90 [PMID: 16022845]
CMDT 2008
E TwoDay Method
The TwoDay method requires that women be able to identify cervical secretions by observation or touching them in underwear or toilet paper, by touching the genitals, or by the sensation of wetness in the genital area or on underwear The woman then uses a two-question algorithm to determine whether she is fertile She asks herself: 1) Did I note secretions today and 2) Did I note secretions yesterday If the answer to either of these questions is yes, she should consider herself fertile In a multicenter study of 450 women, effectiveness with perfect use was 965% and with typical use 763%
Arevelo M et al Efficacy of the new TwoDay Method of family planning Fertil Steril 2004 Oct;82(4):885 92 [PMID: 15482764]
A Symptothermal Natural Family Planning
The basis for this approach is patient-observed increase in clear elastic cervical mucus, brief abdominal midcycle discomfort ( mittelschmerz ), and a sustained rise of the basal body temperature about 2 weeks after onset of menstruation Unprotected intercourse is avoided from shortly after the menstrual period, when fertile mucus is first identified, until 48 hours after ovulation, as identified by a sustained rise in temperature and the disappearance of clear elastic mucus
9 Emergency Contraception
If unprotected intercourse occurs in midcycle and if the woman is certain she has not inadvertently become pregnant earlier in the cycle, the following regimens are effective in preventing implantation These methods should be started as soon as possible and within 120 hours after unprotected coitus (1) Levonorgestrel, 075 mg given in two doses 12 hours apart (available in the United States prepackaged as Plan B), has a 1% failure rate, when taken within 72 hours, and is associated with less nausea and vomiting than the following combination regimen A recent study has demonstrated that levonorgestrel, 15 mg as a single dose, given within 72 hours after intercourse, is slightly more effective than the two-dose regimen It remains efficacious up to 120 hours after intercourse, though less so compared with earlier use (2) Ethinyl estradiol, 50 mcg, with 05 mg norgestrel (available in the United States prepackaged as Preven), given in a regimen of two tablets initially followed by two tablets 12 hours later A comparable regimen includes four pills 12 hours apart of Lo/Ovral, Nordette, or Levlen, or the same regimen with the yellow pills of Triphasil or Tri-Levlen The failure rate is approximately 3%, and antinausea medication should be provided (3) Mifepristone, 10 mg as a single dose, has been shown to have the same failure rate as the levonorgestrel regimen It is not currently available at this dose in the United States (4) IUD insertion within 5 days after one episode of unprotected midcycle coitus will also prevent pregnancy; copper-bearing IUDs have been tested for this purpose Information on clinics or individual clinicians providing emergency contraception in the United States may be obtained by calling 1-888-668-2528
American College of Obstetricians and Gynecologists ACOG Practice Bulletin Clinical Management Guidelines for Obstetrician-Gynecologists, Number 69, December 2005 Emergency contraception Obstet Gynecol 2005 Dec;106(6):1443 52 [PMID: 16319278] von Hertzen H et al Low dose mifepristone and two regimens of levonorgestrel for emergency contraception: a WHO multicentre randomized trial Lancet 2002 Dec 7;360(9348):1803 10 [PMID: 12480356]
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