My fiancee and I have been having sex now for some time and are not well versed in good birth control. She has always wanted me to ejaculate inside of her, but I will not. How safe is it for me to ejaculate inside of her if we are using foam or if we are using spermicidal inserts?
A spermicide is a method of birth control that works both to stop sperm from moving and to block the cervix so the sperm can't join with the egg. Spermicides contain chemicals and come in different forms, including foams, gels, creams, film, and suppositories. Spermicides can be used alone, but are most effective at preventing pregnancy when combined with other birth control methods. When deciding "how safe" it is to ejaculate inside a woman's vagina when using a spermicide, two issues must be considered: pregnancy and sexually transmitted infections (STIs).
As is the case with other contraceptive methods, there is a range of pregnancy prevention effectiveness when using spermicides. The percentage of women who experience an unintended pregnancy when using spermicide alone is between 18 and 28 percent. Common issues that contribute to the higher failure rate include using spermicide incorrectly, not using enough, forgetting to check the expiration date, or choosing not to use it on a particular night for one reason or another. Correct and consistent use is the most important factor in minimizing failure with spermicides.
As for STIs, spermicide may offer limited protection against gonorrhea and Chlamydia, but is not a protection against all STIs, including HIV. In fact, there have been studies showing that the spermicide nonoxynol-9 may increase the risk of HIV infection because it can irritate sensitive genital tissues, leaving them susceptible to infection. (Note: spermicides can also make women more susceptible to urinary tract infections because of the irritation they sometimes cause around the genitals.) To increase contraceptive efficacy as well as to protect against STIs, it's useful to combine spermicide with condoms. Planned Parenthood also provides information on spermicide, including a discussion of advantages and disadvantages, as well as some considerations for use.
Fortunately, if you and your girlfriend agree you want to ejaculate inside of her, spermicide is not your only option for pregnancy prevention. A number of birth control methods are available that have higher effectiveness rates than spermicide and would allow you to ejaculate inside your fiancée without worrying about pregnancy (assuming the methods are used correctly). Birth control pills, the ring, the patch, the shot, and IUDs (intra-uterine device) are all methods that work well in preventing pregnancy. If STIs are not a concern for the two of you, these methods would allow you to have sex and ejaculate inside your partner without using a condom.
As you and your partner continue to discuss your contraceptive options, she might like to make an appointment with a gynecologist or other ob/gyn provider. If she is a student at Columbia, she can contact Medical Services (Morningside) or the Student Health Service (CUMC) to schedule an appointment. You might offer to go with her, and if it's OK with her, you may be invited into the room when contraception is discussed. That way, you can both be informed of the risks and advantages of different methods, and can choose a method that is right for you as a couple.Alice!