Are there alternatives to nonoxynol-9 spermicide?

Dear Reader, 

Despite seemingly endless contraception methods available, options for spermicides are limited. Most spermicide products have nonoxynol-9 (N-9) as their active ingredient, with some exceptions outside the United States (US). There is a contraceptive gel available that does not have N-9, called Phexxi®. Like a spermicide, it can be put into the vagina before sexual intercourse to prevent pregnancy. Speaking to a health care provider can help you decide if this method is right for you. Read on to learn more! 

What are spermicides and how do they work? 

Spermicides are a method of contraception with ingredients that prevent sperm from reaching an egg. The most common active ingredient is N-9, which damages sperm cells’ membranes and is what prevents them from getting to an egg in the first place. Spermicides are available over the counter (OTC) in different forms, including gels, creams, films, foams, and suppositories (pills that dissolve or melt after being inserted in the body).  

In general, to properly use a spermicide, the product should be inserted into the vagina 15 to 60 minutes before sexual intercourse. After inserting the spermicide, it can restrict sperm for around one hour. If you’re still having sexual intercourse after an hour or if things heat up again, it’s advised to reapply or reinsert. When used as instructed, spermicides with N-9 are only around 79 percent effective at preventing pregnancy when used on their own.  

Are there alternatives to nonoxynol-9 (N-9) that are administered similarly? 

Some people experience vaginal irritation or itching when using N-9 spermicides, often caused by allergic reactions. However, that doesn’t mean your chance of using a vaginally administered product is ova!  

Depending on where you live, spermicides may be available that don’t contain N-9. In Europe, for example, there are OTC spermicides with benzalkonium chloride (BZK) as an active ingredient. BZK works in essentially the same way as N-9 and it’s about as effective at preventing pregnancy. BZK isn’t currently available in the US, but that’s not necessarily sperm-anent. 

Another alternative to N-9 spermicides is a vaginal pH modulator (VPM) marketed under the brand name Phexxi®. This VPM comes as a gel that can be inserted into the vagina up to one hour before sexual intercourse and remains effective for about one hour. Its active ingredients work by maintaining an acidic environment in the vagina which inhibits sperm’s ability to swim. Phexxi® is approximately 86 percent effective at preventing pregnancy when used on its own. The gel is available in the US but can be costly and requires a prescription from a health care provider. Similarly to N-9 and BZK spermicides, Phexxi® can lead to side effects such as vaginal irritation and urinary tract infections. However, unlike spermicides, Phexxi® can’t be used by people using vaginal rings for contraception. 

What are other contraception options? 

If you’re willing to consider contraceptive options aside from spermicides and contraceptive gels, there are also many alternatives. These include: 

• External and internal condoms: Condoms are placed either over the penis (external) or inside the vagina (internal) during sexual intercourse to act as a barrier between sperm and an egg. Unlike other contraception methods, condoms also provide protection against sexually transmitted infections (STIs). 
• Oral contraceptives: Commonly known as “the pill,” oral contraceptives use hormones to stop an egg from being released into the fallopian tubes, which prevents it from joining with sperm. Oral contraceptives must be taken daily and as directed to be effective. 
• Intrauterine devices (IUDs): IUDs are small devices inserted into the uterus by a health care provider, where they can remain effective at preventing pregnancy for several years. Most IUDs use hormones to prevent pregnancy, but there are also non-hormonal copper IUDs that work as spermicides. 
• Vaginal rings: Vaginal rings are inserted into the vagina and release hormones to prevent pregnancy. The rings are typically placed in the vagina for around three weeks, then removed for one week during menstruation, after which a new ring can be inserted. 
• Implants, injections, and patches: Hormones to prevent pregnancy can also be delivered through various methods such as a small rod inserted under the skin on your arm, which remains effective for several years. Injections are administered every 90 days and patches are replaced weekly with one patch-free week per month. 

To figure out which contraception method works best for your lifestyle and needs, you might find it helpful to meet with a health care provider. Consulting with a provider is especially important for accessing methods that require a prescription, such as Phexxi®. If you’re interested in learning more about contraception methods, including additional surgical, lifestyle, and emergency options, feel free to check out the Birth Control Basics fact sheet. You may also find it useful to compare contraception methods side-by-side. 

Best of luck,