I am wondering how the spermicides on condoms affect my vagina. Is there a condom that is more vagina friendly?
— Dominique McGrady, Comox, Canada
[Have a question about women’s health? Ask Dr. Gunter yourself.]
Short Take
Spermicide can have negative effects on the vagina, and — maybe surprisingly — it doesn’t increase how well a condom can prevent pregnancy. A spermicide-free condom (either latex or polyurethane) with liberal use of an appropriate lubricant is the best choice for vaginal health.
Tell Me More
The spermicide typically used on external male condoms is called nonoxynol-9. This substance is meant to have a dual role as both a lubricant and a sperm-killing contraceptive.
Studies show nonoxynol-9 has the potential to damage beneficial bacteria in the vagina and increases the risk of bacterial vaginosis, a bacterial imbalance that causes vaginal discharge, irritation and odor. However, it is not clear if the relatively low amount of spermicide on condoms can have all of these negative effects.
Nonoxynol-9 can also can irritate vaginal and anal tissues, causing discomfort and increasing the risk of acquiring H.I.V. if exposed.
Moreover, nonoxynol-9 hasn’t been shown to improve the effectiveness of a condom either as a contraceptive or as a means of protection against sexually transmitted diseases, as it is primarily used as a lubricant. So, there is essentially no reason to use condoms with spermicide. Condoms with spermicide are often more expensive than those without and they have a shorter shelf life (five years without spermicide versus two years with).
The World Health Organization (W.H.O.) doesn’t recommend condoms with spermicide. However, if the only option is a condom with spermicide, that is preferable than sex without a condom.
Note: If you don’t find them irritating, vaginal spermicides that contain nonoxynol-9 are still an option for contraception when used infrequently and when the risk of H.I.V. or other S.T.I.s is low, although they are less effective than many other methods of contraception.
Preventing Irritation
Condoms are meant to be used with a lubricant. The friction of the condom rubbing against vaginal or anal tissues can be painful. Lubricant also lowers the risk of condom breakage. There may not be enough lubricant with a pre-lubricated condom, so keep some on hand so you can add more of your own as needed.
For women with condom-related vaginal irritation, I recommend a condom lubricated with silicone (with extra added on the side as needed) or a non-lubricated condom with the lubricant that works best for you.
The feel of a lubricant is very personal — what is right for one person may feel slimy or tacky to someone else. Try several to find the one that feels just right for you. From a vaginal-health standpoint, if a water-based lubricant is your preference, look for one with an osmolality (a measure of concentration) less than 1,200 mOsm/kg (look for one less than 380 mOsm/kg if you are more sensitive to irritation or want a lubricant closer to the osmolality of vaginal secretions) and a pH around 4.5. For anal sex, the pH should be 5.5 to 7.
Unfortunately, there is no requirement for water-based lubricants to list osmolality and pH, so finding this information can be challenging. The W.H.O. lists information for some brands here and some stores that sell lubricants may have data. More information on ingredients and their impact on vaginal health can also be found in my book, “The Vagina Bible.” As formulations can change, these kinds of lists are unfortunately the best we have. Silicone lubricants are also a good option, and there are no issues regarding pH and osmolality (they don’t contain water), but they can be more expensive. Do not use oil-based lubricants with latex condoms, as the oil can weaken the latex.
Personal Note
What about condoms with special lubricants that promise a warm or tingling sensation? These are typically untested medically and the ingredients are often not listed, so making even a general statement about their safety isn’t possible. Some of the lubricants on these condoms are not optimal for vaginal health. But be aware that even natural ingredients that create a burning or tingling feeling, like menthol or capsaicin, may leave the skin irritated.
If you are curious about these products, they are best used in situations where the risk of H.I.V. is low, for example in a mutually monogamous relationship with a partner who has no risk factors for H.I.V.
Dr. Jen Gunter, Twitter’s resident gynecologist, is teaming up with our editors to answer your questions about all things women’s health. From what’s normal for your anatomy, to healthy sex, to clearing up the truth behind strange wellness claims, Dr. Gunter, who also writes a column called The Cycle, promises to handle your questions with respect, forthrightness and honesty.
Source : Nytimes
