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Fungal vulvovaginitis remains one of the most frequent conditions affecting the lower genital tract. Recent advances in the understanding of the pathophysiology of the condition have improved our ability to treat recurrent or persistent cases. More clinical data have become available on the optimal duration of treatment with some of the newer antifungal agents.
Extensive testing of collagen sponge as a vaginal contraceptive (mechanical and chemical) showed that the original expectations regarding the safety, convenience, and efficacy were not met. The collagen sponge was tested both as a cylinder and as a diaphragm and used as such or impregnated with spermicidal detergent or with zinc salt. The collagen sponge must be larger than 6 cm in diameter in order to serve as a mechanical barrier that will not be dislodged during physical activity. This creates problems with the ease of insertion and with the partners' awareness of the barrier. When the collagen sponge containing ejaculate is left in the vagina greater than 48 hours, it develops an offensive odor. The original acidity of the collagen sponge (pH 3.5, 0.1 mol/L) is soon neutralized by the large volume of alkaline vaginal secretions. In vitro studies showed that up to 10 mg of nonoxynol 9 per milliliter of growth medium did not inhibit the growth of Staphylococcus aureus. These effects, as well as the large surface area of the resilient sponge, present a potential risk for growing staphylococci within the collagen sponge. The capacity of the collagen sponge to absorb a large volume of cervical and vaginal fluid produced two symptoms that were annoying to the volunteers: an awareness of either vaginal dryness during intercourse or, conversely, saturation of the sponge from the vagina. Postcoital studies showed viable spermatozoa in the cervical mucus in 25% of the tests with the nonmedicated cylindrical sponge but in only 6% of tests with the sponge containing nonoxynol 9. The results of clinical trials conducted at four centers support the view that collagen sponge as a vaginal contraceptive barrier method is inconvenient to both partners, not effective enough to compete with present methods of vaginal contraception, and possibly might be unsafe because of the capacity to grow bacteria. Despite the negative end result of this goal-oriented research, we believe that our studies have contributed to a better understanding of vaginal physiologic features, the safety and effectiveness of spermicidal detergents, and the mechanisms of vaginal malodor. Although the acceptability study showed some advantages of the collagen sponge over the rubber diaphragm, the overall acceptability of the collagen sponge diaphragm was no better than that of the rubber diaphragm. For all these reasons, including the possible risk of an increased incidence of toxic shock syndrome, we have discontinued further testing of either type of collagen sponge as a vaginal barrier method.
A trial of the contraceptive sponge was conducted at two clinics (403 subjects) in Yugoslavia. Women were periodically followed up for 1 year. The 1-year method pregnancy rate (life-table) was 5.6 per 100 women. Rates of other events leading to discontinuation of sponge use were similarly low. There were no serious complications. The results of the study show that the contraceptive sponge may be successfully used by a population of women with limited experience with the use of vaginal contraceptive methods.
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Explore the source record for details and available documents.
Explore the source record for details and available documents.
Explore the source record for details and available documents.
Forty-two percent of collagen sponges tested as an intravaginal barrier contraceptive method developed malodor when retained for 5 days. Only 4% developed odor when the sponge was removed within 24 hours after intercourse, rinsed, and reinserted. While sexually active volunteers found odor in 37% of the sponges, odor formed only in 4% of the sponges worn by sexually inactive users. No difference in the rate of odor formation was found when neutral pH (7.0) and acid pH (3.4) collagen sponges were tested, although we believe that a pH 3.4 is too acid and promotes odor formation. The optimal pH of the sponge should be 4.5 to 5.5. Malodor was efficiently extracted from sponges by washing in acid milieu of tap water and vinegar or 0.1 M acetate buffer, pH 4.0. Alkali extraction procedures were ineffective, and lukewarm water was slightly less effective than acid extraction of odor. At the time of malodor development, the high content of polyamines (putrescine, spermine, spermidine) in the ejaculate decreased to undetectable values. We conclude that the ejaculate is the major source of malodor formation in intravaginally worn collagen sponges. Removal, rinsing optimally in vinegar solution, and reinsertion within 24 hours after intercourse reduces the chance of malodor formation.
The authors describe their experience with a group of 49 sexually active, already protected women in order to evaluate the acceptability, side effects and post-coital spermicidal activity of a new vaginal contraceptive. The intravaginal insert (IVI) consists of a polyester resin plug (sponge) containing a 5% solution of nonoxynol-9 bound in a cold formation process, and having a cotton loop attached to the lower end. The results of this study indicate that this new vaginal contraceptive is free of major side effects, is well accepted by users, and has strong spermicidal and mechanical activity. Future clinical testing in order to try its anti-conceptive effectiveness is warranted.
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This study examined characteristic of the contraceptive sponge that were important in women's decisions to use the contraceptive sponge and reasons why women discontinued sponge use. A sample of 385 current sponge users and 407 former sponge users participated in a national telephone survey on sponge use. Important reasons for trying the sponge were effectiveness, comfort, convenience and ease of use and it "would not interfere with sexual pleasure." The media and physicians were of considerable influence in women's decisions to initiate sponge use, but sexual partners, friends, parents and relatives exerted little influence. The most important reasons for discontinuing use of the sponge were pregnancy, both planned and accidental, and irritation, discomfort or vaginal infection. Women may decide to use the sponge because they have unrealistically positive perceptions of sponge characteristics.