Women's preferences regarding the formulation of over-the-counter vaginal spermicides

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There is an urgent need for safe, effective and acceptable vaginal barrier methods for the prevention of sexually transmitted diseases (STD), including HIV. As product acceptability ultimately determines use-effectiveness, developing microbicidal vaginal products requires insight into users' perspectives [1]. We sought to explore the characteristics of existing vaginal products that influence user preferences for various formulations.
A diverse group of study sites was included: Projet RETRO-CI (Abidjan, Côte d'Ivoire), Siriraj Family Health Research Centre (Bangkok, Thailand), University of Zimbabwe (Chitungwiza, Zimbabwe), University of Khon Kaen (northeastern Thailand), and Columbia University School of Public Health (New York City, New York, USA). Women were recruited via fliers and word of mouth or through health-care facilities (e.g., antenatal/maternal-child health clinics). Study participants used a vaginal contraceptive film containing 70 mg nonoxynol-9 (Apothecus Pharmaceutical Corp., Oyster Bay, New York, USA), a vaginal suppository (Ortho Conceptrol Vaginal Inserts, Ortho Pharmaceutical Corp., Raritan, New Jersey, USA) with 150 mg nonoxynol-9, and a vaginal gel in a pre-filled applicator (Ortho Conceptrol Gel, Ortho) containing 200 mg nonoxynol-9 (in our laboratory we found that only 100–120 mg was actually dispensed from the applicator).
A crossover study design ensured that every woman used each of the products for 4 weeks. Women were advised to use the products together with a male latex condom whenever possible. Prior to and following product use, women participated in focus group discussions and structured interviews to assess their knowledge, practices and preferences regarding each vaginal formulation. Women were asked to record each act of intercourse in a daily log book in which they also noted whether the study product/condoms were used. They returned every 2 weeks for an interview and pelvic and speculum examination. Women's experiences with product use, as well as any evidence of vulvar, cervical or vaginal abnormality were recorded.
Selected characteristics of the study populations are described in Table 1. When asked whether they were able to use the study products without their partner's knowledge, most women in this study (approximately 75%) reported that they preferred to inform their partners that they were using vaginal products, both in the context of the study and in the future. They preferred telling their partners at the outset, in case they or their partners subsequently experienced problems with a particular product. Some were particularly concerned about having to explain the presence of a product if her partner detected its use. Others said that their partners supported them in using vaginal products, especially if it was perceived to enhance sexual frequency or pleasure. There was no correlation between formulation preferences and the desire to hide product use from one's partner.
When asked why they might use vaginal products in the future, among the four sites that reported data for this question, women reported that the primary reason would be from infection alone (40%), protection from pregnancy alone (13%), or both (44%).
In most cases, women found the suppository to be the messiest and, therefore, least desirable of the formulations (it tended to melt at the tropical ambient temperatures of several of the study sites and consequently needed refrigeration to prevent melting prior to insertion). Film was the overall preferred formulation in three of the five sites and was liked by many of the women's partners. The film was considered the most difficult to insert by many users; however, their confidence and ability to use this product increased substantially with experience and supportive counseling. Women in Khon Kaen, Bangkok, Chitungwiza, and Abidjan all stated that they especially liked the film, due to the fact that it left the vagina feeling ‘tight’ or ‘fit’.
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