Dear Dr. Myrtle,
I would like to know more about the use of spermicidal condoms. What are the health implications of using one, and what are the alternatives?
We recommend that people who use condoms for sexual intimacy do not use condoms with spermicide. There are several reasons for this.
1. First, spermicides are chemical detergents. Nonoxynol-9, the most commonly used spermicide, helps to prevent pregnancy by dissolving the fatty tip of sperm and breaking their "skin". Since sperm need to keep their contents (mostly DNA) inside before they engage with an egg, this keeps fertilization from occuring.
If the spermicide only came into contact with sperm, we’d have few problems. But consider that spermicide contacts the vaginal (or anal) skin tissue as well. Detergents partially "dissolve" skin cells, which have many oils in their membranes. These damaged cells can break down, causing small tears and friction irritation that can be very uncomfortable for the person being penetrated. Many people who believe themselves to be "allergic" to latex condoms have actually experienced a skin sensitivity to the spermicide on the condom (or they were using the condom with too little extra lubricant applied).
2. Also, spermicides taste terrible. Anyone who has accidentally gotten a bit of dishwashing detergent in their mouth knows this is an unpleasant sensation and taste. Oral sex on a man (mouth-to-penis contact) or a woman (mouth-to-vulva contact) is safest with a condom or other barrier (for contact with a woman, the condom can be split open length-wise for coverage). Flavored sex dams (Glyde Dams), flavored condoms, or even plain condoms with tasty lubes are much more pleasurable experiences for the "taster" and for the "tastee" than barriers with spermicide. So, if you want more oral sex performed on you, provide your willing partner with barriers that taste good.
3. The third major reason not to use spermicides is recent research that suggests that spermicides such as nonoxynol-9 may INCREASE the transmission of HIV.
While it has been observed that HIV exposed to nonoxynol-9 in a test tube is less able to cause infections, the scientific world hasn’t known whether using spermicide would reduce HIV transmission in the "real world". Unfortunately, when female commercial sex workers agreed to use either a placebo gel or a spermicidal gel (they didn’t know which they were using) before they had sex with condoms, more of the women who used the spermicide contracted HIV. When the women used only the spermicidal gel (without condoms, their choice), their rates of contracting HIV were even higher. The study also showed that women who used the spermicidal gel had more vaginal lesions than those who used condoms and lube alone, which suggests that the spermicide damaged their vaginal walls.
This is not what anyone had expected to happen (the women, or the researchers). Even if you discount the study because commercial sex workers have more sexual intimacy than women who are not sex workers, this study showed that nonoxynol-9 "has been proven ineffective against (preventing) HIV transmission..." and "...that nonoxynol-9 should not be recommended as an effective means of HIV prevention...."
What does this mean for those who want to reduce their risk of sexually transmitted infections (and possibly pregnancy)?
Fresh condoms that stay intact during intimacy are the best protection from sexually transmitted infections. If you are using condoms, the condom itself is your best protection.
Keep your condoms from breaking by adding a dollop of lubricant to the outside of the condom shaft, to reduce friction and increase pleasure for the person being penetrated.
Also, add a dime-sized drop of lubricant inside the tip of the condom. This dramatically adds to the pleasure of the person wearing the condom, because it allows the condom to slip and rub against the sensitive nerve endings at the tip of the penis. Many men who try this for the first time, report back that they can’t believe that someone didn’t tell them this years ago. It’s a lot easier to wear a condom when it feels good to the wearer.
Another option to increase pleasure and reduce your exposure to spermicides is to use the female condom. Men and women enjoy the silky sensation, reduced vaginal friction, and absence of nonoxynol-9.
Keep in mind also that many "toy cleaner" products contain nonoxynol-9 as a main ingredient. All you need to effectively clean most of your toys is soap and warm water. Steer clear of specialty toy cleaners and instead grab yourself a bottle of fragrance-free, dye-free soap!