Indications: - as a primary method of contraception to prevent pregnancy at times when oral contraceptives or intrauterine devices may not be effective or are contraindicated or as an adjuvant to the periodic abstinence (rhythm) method of contraception.

Also for prevention (prophylactic) of Sexually transmitted diseases (STDs)

Cautions: - in medical or psychosocial conditions where a critical need exists for highly effective contraception. Patients must be sufficiently counseled regarding the need for consistent and correct use of condoms if they are to be effective in preventing pregnancy.

Contraindication: - sensitivity to latex condom

Side effect: - Burning, stinging, warmth, itching, other irritation of the Skin, penis, rectum, or vagina, vaginal dryness or malodor, allergic vaginitis, contact dermatitis.

Note: - Condoms should be completely unrolled into the penis before any genital contact occurs and remain intact throughout intercourse

Copper T 380 A

Indications: - Copper T 380 A is an intra-uterine device used for prevention of pregnancy, most suitable in parous women but should be a last-resort contraceptive for young nulliparous women because of the increased risk of pelvic inflammatory disease and infertility.

Cautions: - caution should be taken in those with anaemia, heavy menses, history of pelvic inflammatory disease, diabetes, valvular heart disease (antibiotic cover needed) - avoid if prosthetic valve or past attack of infective endocarditis; epilepsy, increased risk of expulsion if inserted before uterine involution; there should be gynaecological examination before insertion, 6 weeks after (or sooner if there is a problem), then after 6 months, then yearly. The IUD should be removed if pregnancy occurs.

Contraindications - Pregnancy, severe anaemia, known HIV infection very heavy menses, history of ectopic pregnancy or tubal surgery, distorted or small uterine cavity, genital malignancy, pelvic inflammatory disease, immunosuppressive therapy, copper allergy, Wilson's disease, medical diathermy.

Side effect: - Uterine or cervical perforation, displacement, pelvic infection may be exacerbated, heavy menses, dysmenorrhoea, allergy, some pain on insertion (pain helped by giving NSAIDs half an hour before insertion) bleeding, occasionally, epileptic seizures, vasovagal attack.

Note: - Copper T 380A should be fitted into uterine cavity after the end of menstruation and before the calculated time of implantation.

An intrauterine device should not be removed in mid cycle unless an additional contraceptive was used for the previous 7 days.

Diaphragm with spermicides

Indications: - Diaphragm is a mechanical barrier method of contraception designed to hold spermicides near the cervical os, which is particularly important in the event that the diaphragm is dislodged or does not form a complete seal around the cervix.

Cautions: - Caution is required in cases where there was recent abortion or parturition, in chronic allergic conditions, in genital contact dermatitis.

Drug interactions: - Avoid use of diaphragm (with spermicides) with vaginal or topical medications, and vaginal douch products.

Contraindications: - Allergy to spermicides (Nonoxinol, octoxinol), menstruation, toxic-shock syndrome.

Side effects: - Vulvovaginal candidiasis (thick, white or curd like vaginal discharge), toxic shock syndrome (dizziness, fever, lightheadedness, chills, sunburn-like rash followed by peeling of the skin, muscle aches, hypotension, unusual redness of the mucous membrane inside of the mouth, nose, throat, vagina or conjunctiva; confusion)

Dose and Administration -

Nonoxinol 9 vaginal cream with diaphragm - Intravaginal, Initially 1 applicatorful (approximately 1 teaspoonful of 0.5% cream placed into cup (diaphragm) and additional spermicides spread along the rim of diaphragm just before insertion of diaphragm and not longer than six hours prior to intercourse. An additional applicatorful should be inserted into the vagina just prior to each repeat act of intercourse or if intercourse occurs later than six hours after initial diaphragm placement.

Nonoxinol 9 vaginal foam with diaphragm - Intravaginal, initially 1 applicatorful placed into vagina and additional spermicide spread along the rim of diaphragm just before insertion of diaphragm and not longer than one hour prior to intercourse. An additional applicatorful should be inserted into vagina just prior to, and not longer than one hour before, each repeat of intercourse.

Nonoxinol 9 vaginal gel with diaphragm - Intravaginal, initially 2 teaspoonful of a 2% gel placed into cup and additional spermicide spread along the rim of diaphragm just before insertion of diaphragm and not longer than six hours prior to intercourse. An additional applicatorful should be inserted into vagina, just prior to each repeat act of intercourse or if intercourse takes place later than six hours after initial diaphragm placement.

Octoxinol 9 vaginal cream with diaphragm - Intravaginal, initially 2 teaspoonful placed into cup and additional spermicide spread along the rim of diaphragm just before insertion of diaphragm and not longer than six hours prior to intercourse. An additional applicatorful should be inserted into vaginal just prior to each repeat act of intercourse or if intercourse occurs later than six hours after initial diaphragm placement.

Octoxinol 9 vaginal jelly with diaphragm - Intravaginal, initially 1 applicatorful placed into cup and additional spermicide spread along the rim of diaphragm just before insertion of diaphragm and not longer than six hours prior to intercourse. An additional applicatorful should be inserted into vagina just prior to each repeat act of intercourse or if intercourse occurs later than six hours after initial diaphragm placement.

Storage: - at room temperature.

Spermicides
(Menfegol), tablet (foaming), 60mg
(Nonoxinol, octoxinol),Creams, Foams, Gels

Indications: - Vaginal spermicides are used as chemical barrier contraceptive for prevention of pregnancy.

Also used for prevention of sexually transmitted diseases when used in combination with latex condoms.

Cautions: - Caution is required in chronic allergy (local), genital contact dermatitis, in medical or psychosocial conditions where a critical need exists for highly effective contraception. Caution should also be taken in recent parturition or abortion.

Drug interactions - vaginal or topical medication, especially those containing aluminium, citrate, cotton dressing, hydrogen peroxide, iodide, lanolin, nitrates, permanganates, salicylates, silver salts, sulfonamides. Avoid also use of spermicides with vaginal douche products or other vaginal or local cleansing products.

Contraindications - allergy to octoxinol, nonoxinol, and benealleonium chloride, menstruation, history of toxic-shock syndrome, Genital ulcer, vaginal epithelial irritation.

Side effects - burning, stinging, warmth, itching, or other irritation of the skin, penis, rectum, or vagina, vaginal discharge (transient), vaginal dryness or odor, Allergic vaginitis (persistent vaginal redness, irritation, rash, dryness, or whitish discharge), contact dermatitis (persistent skin rash, redness, irritation or itching), urinary tract infection (female) - due to change in vaginal flora.

Dose and Administration -

Nonoxinol 9 vaginal cream - Intravaginal, 1 applicatorful of 5% cream inserted just prior to intercourse. An additional applicatorful should be inserted into vagina just prior to each repeat act of intercourse.

Nonoxinol 9 vaginal Foam - Intravaginal, 1 applicatorful of inserted just prior to and not longer than one hour prior to each act of intercourse.

Nonoxinol 9 vaginal Gel - Intravaginal, 1 applicatorful of a 4% gel inserted just prior to and not longer than one hour prior to intercourse.

Storage: - at room temperature, in a well-closed container (cream and gel), protect from freezing.