Abstract: Many authorities allow the use of spermicides when contraception is halachically permitted. Spermicides should be considered for use in combination with the Lactational Amenorrhea Method, or for short term use instead of condoms.

Discussion: Jewish law proscribes the purposeful emission of semen outside the context of marital relations. Nevertheless, most halachic authorities permit the creation of a hostile environment for sperm prior to intercourse. Therefore, with rabbinic approval, spermicide can be used when delaying pregnancy is halachically permitted. Those forms of spermicide that create a physical barrier (e.g., foam) may be less halachically desirable than forms that dissolve (e.g., films and suppositories).

The main drawback of spermicides is their minimal efficacy [1][2][3]. However, as a backup method for women relying on the Lactational Amenorrhea Method (LAM), they can be considered a viable option that avoids the breakthrough bleeding common with progesterone only pills. They are also an option when short term contraception is needed for halachically approved reasons, but the consequences of unintentional pregnancy are not life threatening. This is particularly important because condoms cannot be used for this purpose in this patient population.

Implications for Patient Care:  Many authorities permit spermicide use where delaying pregnancy is halachically permitted. Spermicides should be considered for use as a backup method in combination with LAM. Because condoms are halachically prohibited, spermicides should also be considered for short-term contraception in this patient population.

Medical References

[1] Grimes DA, Lopez L, Raymond EG, Halpern V, Nanda K, Schulz KF. Spermicide used alone for contraception. Cochrane Database Syst Rev 2005 Oct 19;(4):CD005218.

[2] Gupta K et al. International clinical practice guidelines for the treatment of acute uncomplicated cystitis and pyelonephritis in women: A 2010 update by the Infectious Diseases Society of America and the European Society for Microbiology and Infectious Diseases. Clin Infect Dis. 2011;52:e103-20. http://cid.oxfordjournals.org/content/52/5/e103.long

[3] Trussell J. Contraceptive Efficacy. In Hatcher RA, Trussell J, Nelson AL, Cates W, Kowal D, Policar M. Contraceptive Techology: Twentieth Revised Edition. New York NY: Ardent Media, 2011

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