The newest type of birth control device to become widely available (approved by the Food and Drug Administration in April 1983) is a soft, disposable contraceptive sponge, which is inserted into the vagina. Now sold exclusively under the "Today" brand name, the two-inch-by-one-inch round product is made of polyurethane permeated with the commonly used spermicide, nonoxynol-g. The contraceptive sponge is sold over the counter in drugstores and doesn't require a prescription or need to be fitted by a physician. Its early reception by consumers has been enthusiastic.

There are three different ways in which the sponge functions. First and most important, it carries the spermicidal effect of nonoxynol-g (which is the active chemical ingredient in many contraceptive creams, foams, and gels). Second, the sponge also functions as a mechanical barrier, partially preventing sperm from entering the mouth of the cervix. Finally, the sponge is also thought to trap and absorb sperm, although the importance of this action is uncertain.

The contraceptive sponge is inserted into the vagina before intercourse. The sponge is first dampened with about two tablespoons of water and then squeezed gently until foam appears (this activates the spermicide in the sponge). Many users report that it is considerably easier to insert than a diaphragm and, since it can be inserted up to eighteen hours before intercourse, it is convenient as well. (Insertion can be done either manually or with an applicator.) As another major advantage, the sponge retains its contraceptive effectiveness for twenty-four hours without any need for the reapplication of spermicide, so it provides contraceptive protection regardless of how many times the user has intercourse. The sponge is removed by pulling on a small ribbon attached to one of its sides.

The sponge has been found to have an actual failure rate of about 15 percent, according to the F.D.A., which makes it approximately equivalent to a diaphragm in this regard. As with the diaphragm or spermicides, many of the failures are due to improper use — such as removing the sponge too soon after intercourse — and the user's motivation also seems to play a role. The effectiveness rate can be materially improved by combining use of the sponge with use of a condom.

Women who have used the sponge report a number of distinct advantages compared to the diaphragm. In addition to mentioning how easy it is to insert (which is nearly a universal reaction), many women are pleased to have an inexpensive, disposable, contraceptive method available that is unobtrusive, tasteless, and odorless, and lasts for twenty-four hours. In addition, the sponge reportedly isn't as messy or drippy as some spermicidal products.

The commonest side effect of the sponge is mild irritation of the vagina or penis, which occurs in about 3 to 5 percent of users. Although the sponge hasn't been in widespread use for a long enough time to assess its safety fully, the only serious health risk to come to attention at the time of this writing is the rare occurrence of toxic shock syndrome in a few women who used the sponge. Whether this was a coincidental finding or a direct relationship isn't clear at present; thus, users should read the package insert carefully to determine if any new information arises on this (or other) health effects.

Because the sponge can be inserted either hours before sexual activity or at the last moment before intercourse, convenience makes it especially advantageous from a sexual viewpoint. In addition, men and women who have tried the sponge almost invariably say they don't feel it during intercourse, and many couples also report that it doesn't interfere with cunnilingus. But the sponge's most noticeable sexual benefit may be that once it is inserted, it provides protection for multiple acts of intercourse. As one woman told us, "That means we can make love at night and then again in the morning without my having to get up and get ready all over again."


Men's Health Erectyle Dysfunction