To summarize the currently available phase I and II clinical trials of the effects of nonoxynol-9 (N-9) on human sperm structure and functions.
A systematic review and meta-analysis aiming to evaluate the spermicidal activity of N-9 on motility, was conducted in PubMed, EMBASE, and Cochrane databases by 10 March 2021. The counted numbers of progressive motile (PR) sperm in cervical mucus and the vanguard sperm penetration distances were analyzed. Other effects on sperm structures and physiological activities were reviewed as well.
In the pooled results, percentages or counted numbers of PR sperm decreased after the treatment of N-9. Vanguard sperm penetration distance was shortened in treated groups. N-9 has been confirmed to damage the structures of sperm, as well as other organelles like acrosome and mitochondria. The physiological activities such as generation of reactive oxygen species, superoxide dismutase activity, acrosin activity, and hemizona binding were all inhibited in the reviewed studies.
N-9 has several impacts on sperm owing to its potency in reducing sperm motility and cervical mucus penetration, as well as other functional competencies.
Nonoxynol-9 (N-9) has been used worldwide as a spermicide to kill sperm for more than 60 years but can cause side effects including vaginal irritation and can increase the rate of contraceptive failure. A detailed analysis of published literature aiming to evaluate the spermicidal activity of N-9 on sperm was carried out. In the pooled results, N-9 reduced the number of active sperm and the distance they traveled. It also caused damage to the structures of sperm and to the way the sperm acted and interacted with the egg. In conclusion, N-9 impacts on sperm in a number of ways that lead to sperm death and dysfunction.

Our primary objective was to evaluate whether new types of single-size diaphragms or cervical caps differ in prevention of pregnancy compared with older types of diaphragms, and whether different types of gels differ in their ability to prevent pregnancy. A secondary aim was to evaluate method discontinuation and complications.
A comprehensive search was conducted in PubMed, Embase and the Cochrane Library. The certainty of evidence was assessed according to the GRADE system.
Four randomised controlled studies were included in the assessment. When comparing the new and old types of female barrier contraceptives the 6-month pregnancy rate varied between 11%-15% and 8%-12%, respectively. More women reported inability to insert or remove the FemCap device (1.1%) compared with the Ortho All-Flex diaphragm (0%) (p<0.0306). Urinary tract infections were lower when using the single-size Caya, a difference of -6.4% (95% CI -8.9 to -4.09) compared with the Ortho All-Flex diaphragm. The 6-month pregnancy rate for acid-buffering gel and spermicidal nonoxynol-9 gel varied between 10% and 12%. The discontinuation rate was lower in women who used acid-buffering gel compared with nonoxynol-9 gel (risk ratio (RR) 0.77, 95% CI 0.68 to 0.97).
Pregnancy rates were generally high in women using female barrier contraceptives. There was no difference in the efficacy for pregnancy prevention between the new types of diaphragms and cervical caps and the older diaphragms. The new types of diaphragms and cervical caps resulted in fewer urinary tract infections. Acid-buffering gels did not differ from spermicidal nonoxynol-9 gels regarding pregnancies but seemed to be better tolerated.

Today, rape and sexual assault cases are mainly solved using evidence such as medical evidence or DNA analysis. Condom traces have been found to be present in 10% of assaulted women, when no DNA is found [1]. Numerous studies have emphasized the interest of analysing the composition of male condoms and their traces, and developing specific methods for the analysis of this type of evidence. However, transfer and persistence of condom traces in a specific matrix are rarely referenced. Therefore, forensic scientists have no complete knowledge of the trace and what could be expected in a real case. The purpose of this article is to review the literature addressing the composition of condoms and their traces as well as its influence on the transfer and persistence from a forensic point of view. Peer-reviewed literature, patents, professional literature, data from international administrations and international organisations\' reports have been used to track the composition and the problematics of transfer and persistence of condom traces. The results of this review show that the composition of male condoms and their traces are complex systems, with numerous compounds originating from the condom at the moment of the transfer and evolving over time according to specific persistence patterns. Although numerous types of analyses have already been proposed and tested for condom traces, forensic evidence considerations have not been fully studied yet. Considering the fact that sexual assaults without the detection of DNA are increasingly frequent, there is a definite medical and forensic need to improve our knowledge of the processes involved in the development of condom traces in order to better understand analytical results.

OBJECTIVE: ACIDFORM is a candidate microbicide with spermicidal properties. A large Phase 3 trial is underway, and it is anticipated that this product will be approved for contraceptive use and marketed soon in the United States. The goal of this article is to critically review the evidence supporting the properties, safety profile and different uses of ACIDFORM gel.
METHODS: We searched PubMed and Medline for any published literature on ACIDFORM.
RESULTS: ACIDFORM is an acidifying agent that works by lowering the vaginal pH to enhance the normal vaginal defenses. In addition to strong acid-buffering properties, ACIDFORM has high bioadhesive and viscosity-retaining properties. Several Phase 1 clinical trials have demonstrated the vaginal safety of ACIDFORM used alone or in combination with a diaphragm, although dose-dependent side effects appear to be present. Studies investigating the efficacy of ACIDFORM against sexually transmitted infections (STIs) are promising, but further trials are needed.
CONCLUSIONS: The properties of ACIDFORM offer many advantages for use, either alone or in combination with another active ingredient, such as Tenofovir. Potential applications for ACIDFORM include use as a personal lubricant, a vaginal contraceptive (alone or with a barrier method) and a microbicidal product or as a formulation vehicle for an active ingredient.
CONCLUSIONS: ACIDFORM is a candidate female-controlled vaginal preparation with microbicidal and spermicidal properties. A dual protection method could prevent unwanted pregnancies and reduce the risk of STI acquisition.

Over 50% of the 33.3 million HIV-positive persons are women within the reproductive age group. With increasing availability and use of highly active antiretroviral therapy (HAART), the prognosis, life expectancy and quality of life of infected persons has improved. HIV-positive women, like their uninfected counterparts, may desire to plan pregnancies, limit their families, or avoid pregnancy. The effective use of contraception by HIV-positive clients can contribute significantly to reduction in both sexual and vertical transmission of the virus. HIV-positive clients can use most of the available contraception methods including barrier, hormonal, intrauterine devices and sterilization. However, some antiretroviral drugs interact with hormonal contraceptives with potentials for reduction in efficacy. Dual protection with concomitant use of a more effective contraceptive method and male or female condom to prevent HIV and Sexually transmitted infections (STIs) is the standard. It is necessary to make provision for contraceptive service as part of comprehensive care for the HIV-positive client.

Sexually transmitted infections (STIs) and human immunodeficiency virus (HIV), the causative agents of acquired immunodeficiency syndrome (AIDS), are two great concerns in the reproductive health of women. Thus, the challenge is to find products with a double activity, on the one hand having antimicrobial/antiviral properties with a role in the reduction of STI, and on the other hand having spermicidal action to be used as a contraceptive. In the absence of an effective microbicide along with the disadvantages of the most commonly used spermicidal contraceptive worldwide, nonoxynol-9, new emphasis has been focused on the development of more potential intravaginal microbicidal agents. Topical microbicides spermicides would ideally provide a female-controlled method of self-protection against HIV as well as preventing pregnancies. Nonoxynol-9, the only recommended microbicide spermicide, damages cervicovaginal epithelium because of its membrane-disruptive properties. Clearly, there is an urgent need to identify new compounds with dual potential microbicidal properties; antimicrobial peptides should be candidates for such investigations. Dermaseptins and magainins are two classes of cationic, amphipathic alpha-helical peptides that have been identified in the skin extracts of frogs Phyllomedusa sauvagei and Xenopus laevis. Regarding their contraceptive activities and their effect against various STI-causing pathogens, we believe that these two peptides are appropriate candidates in the evaluation of newer and safer microbicides spermicides in the future.

Currently there exists increasing preoccupation concerning sexual and reproductive health among teenagers; in spite of the availability of different contraceptive methods, the number of undesired pregnancies is steadily increasing. Among the products presently available for birth control, spermicides are a means that can be totally controlled by the woman and are very reliable compared to other contraceptives in common use. However, they cause irritation in the vaginal epithelium due to their tensoactive effect on cellular membranes which might enhance the risk of acquiring sexually transmissible diseases. In searching for new alternatives, it was observed that a wide variety of plants have spermicidal activity. Hence it is interesting to consider potential contraceptives of vegetable origin, as they may constitute a key tool to prevent undesired pregnancies in general, and in particular in vulnerable groups such as teenagers and young women.

Colposcopy has been adapted from cervical cytology screening as a tool to assess the tolerance of vaginal products in development for anti-infective and contraceptive indications. As the vagina is poorly enervated, symptoms do not correlate well with visual findings, which increases the importance of secondary assessment. Dysplasia screening has used biopsy liberally to verify the colposcopic diagnostic impression. The few studies that include correlative biopsy with colposcopy performed for product development are reviewed. A recent study of the reproducibility of two observations at a single visit by a single or two different physicians is discussed. The review points to magnification and experience of the observer as factors in improving the agreement between observations. Observers are more likely to agree on areas greater than 1 cm in diameter. Variation is reduced when fewer observers are used and they report findings as dichotomous or categorical data.

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The contraceptive vaginal sponge was developed as an alternative to the contraceptive diaphragm. Unlike the diaphragm, the sponge can be used for more than one coital act within 24 h without the insertion of additional spermicide, and it does not require fitting or a prescription from a physician. We conducted a systematic review of randomized controlled trials that compared the vaginal contraceptive sponge with the diaphragm used with a spermicide in order to evaluate the efficacy and continuation rates of the two devices. The sponge was statistically significantly less effective in preventing overall pregnancy than was the diaphragm in the two trials that met our inclusion criteria. The 12-month cumulative life table termination rates per 100 women for overall pregnancy were 17.4 for the sponge versus 12.8 for the diaphragm in the larger US trial, and 24.5 for the sponge and 10.9 for the diaphragm in the UK trial. Similarly, discontinuation rates at 12 months were higher with the sponge than with the diaphragm [odds ratio 1.3; 95% confidence interval (CI) 1.1-1.6]. Allergic-type reactions were more common with the sponge in both trials, although the frequency of discontinuation for discomfort differed in the two trials. Other randomized controlled trials will be needed to resolve the role of spermicides in preventing sexually transmitted infections or in causing adverse effects.