Introduced in 1983, the Today Sponge was once the most popular over-the-counter female contraceptive choice. It was taken off the market in 1995 because of problems that were found at the factory where it was made, but the rights to the sponge were bought by another company, and the sponge was re-released in 2005. The Today Sponge, which is about 89% to 91% effective, consists of polyurethane foam with spermicidal nonoxynol-9. Once moistened and inserted into the vagina, where it works as a physical barrier to the cervix and as a sperm killer, the sponge protects against pregnancy for 24 hours even with repeated intercourse. It is currently available at some retail and online pharmacies and at www.thetodaystore.us for around $30 for a 12-pack. Women who are allergic to nonoxynol-9 should not use the Today Sponge. In addition, women who use barrier methods such as the sponge, a diaphragm, or a cervical cap are at an increased risk of urinary tract infections.
It should be noted that use of nonoxynol-9 has not been shown to reduce the risk of transmission of HIV. In fact, in some studies, it has been associated with a higher HIV infection rate.
Permanent birth control
Until fairly recently, permanent birth control for women — tubal ligation — required surgery and general anesthesia. The Essure system, however, requires no incision and can be put into place in as little as 35 minutes, and it requires only local anesthesia, intravenous sedation, or, in some cases, no anesthesia at all. The system consists of small metal and polyester-fiber coils that are threaded into a woman’s Fallopian tubes through the vaginal opening via catheter. Scar tissue eventually forms over the coils, blocking the Fallopian tubes so that fertilization cannot take place. The scarring process takes about three months, during which a backup birth control method must be used. Clinical studies have shown the Essure System to be 99.8% effective after two years (data for more than two years is not yet available). The method should be used only by women who are certain that they do not wish to have children (or more children). Although information is not available on the safety or effectiveness of reversal, it is clear that an attempt would require major abdominal surgery and would likely be ineffective. The Essure system itself costs $980, but there may be other, associated costs.
Natural family planning aid
The necklace-like CycleBeads were developed by the Institute for Reproductive Health at Georgetown University to be used in conjunction with the Standard Days Method, a natural family planning method that grants a fairly wide window for conception possibility. CycleBeads consist of a string of 32 color-coded beads that correspond with levels of fertility throughout a woman’s cycle, and a ring to keep track of the passing days. Since this method is more calendar than contraception, there are no side effects. It should be used only by women whose regular cycles are 26 to 32 days long, and who are willing to abstain from intercourse or use a reliable contraceptive during their fertile days. CycleBeads cost about $13 and are available at retailers and pharmacies, as well as online at www.cyclebeads.com.
Women are not the only ones for whom new methods of birth control are being developed. A small polymer mechanism known as Vasclip now offers men who desire permanent birth control an alternative to a vasectomy. This device, which is about the size of a grain of rice, locks around each vas deferens, the vessel that transports sperm from the testes to the urethra, thereby preventing the passage of sperm to the urethra and out of the body. The procedure to insert the Vasclip devices involves making a small incision in the scrotum to access the vas deferens and then positioning the clips. The entire process takes only about 15 minutes from start to finish, and because there is no cutting or cauterizing of the vas deferens, complications such as swelling and infection are generally reduced. After the procedure, a couple still must use a backup form of birth control until it is confirmed by a doctor that the man no longer has any sperm in his semen; as with a vasectomy, it is expected that the majority of men who undergo the procedure will achieve infertility within three months. Because the operation is considered permanent, only men who are sure they do not want any (or more) children should consider having it. (In the future, the company that makes Vasclip intends to conduct studies to explore the possibility of reversing the procedure.) The device generally costs $400 to $500, plus the cost for insertion, which varies.