Hair loss Treatment Center

PARTICIPANTS Steven D. Spandorfer, MD New York Presbyterian Hospital - Weill Cornell Medical College

Joining me are two experts in this field.  Doctor Steven Spandorfer -- he's a reproductive endocrinologist at New York Presbyterian Medical Center.  Thank you for joining us.

STEVEN SPANDORFER, MD:  Thank you.

CHERYL WILLS:  Also, Doctor Margaret Polaneczky.  She's a gynecologist, also at New York Presbyterian Medical Center.  Thank you for joining us today.

MARGARET POLANECZKY, MD:  Glad to be here.

CHERYL WILLS:  This whole concept of barriers, what exactly does that mean?

STEVEN SPANDORFER, MD:  Well, just as you mentioned in the introduction, we know for fertilization and pregnancy to occur that the sperm and egg have to get together, and the two merge and fertilize and there can develop into a baby.

CHERYL WILLS:  Sure.

STEVEN SPANDORFER, MD:  Well, barrier contraception is the type that's going to prevent sperm and egg from being able to have access to one another.

There are different types of barriers.  Some depend on the male partner.  Some will actually depend on the female partner.  And they also have various different times where they have be put in place for the person to use, or for the couple to use, as far as how they work.

CHERYL WILLS:  Before we take each one, Doctor Polaneczky, what are the overall advantages of barriers?

MARGARET POLANECZKY, MD:  I think the most important advantage is that they can, in some of the barriers, protect against sexually transmitted diseases.  And primarily I'm speaking about the condom.  I think for young, single women, those who are not in mutually monogamous relationships, it's very important to protect themselves from sexually transmitted diseases.  And so, the condom is the one thing we know that will reduce the risk of transmission of most of the sexually transmitted diseases, including HIV.

The other advantage is they don't require hormones.  So, for women who don't want to interfere at all with their bodies' natural functioning, a barrier is an excellent option.

And finally, they're easy to use.  And they don't require a visit to the doctor, except perhaps to be fitted for a diaphragm.  You can buy condoms in the drugstore.  You can use it easily, as long as you understand how to use it.

CHERYL WILLS:  Sure.

STEVEN SPANDORFER, MD:  I think the ready availability of barrier, particularly the condoms, makes them wonderful, I think, particularly if you look at this country for preventing either teenage pregnancies or single-parents, it's excellent way.  And they're readily available.  And that makes it very advantageous.

CHERYL WILLS:  Sure.  Let's continue with condoms.  How effective are they in preventing pregnancy?

STEVEN SPANDORFER, MD:  Well, condoms themselves can be very effective.  However, a condom does require proper use, proper technique.  For example, it can't be used more than once, it should be put on at the proper time.  The effectiveness of it will vary depending on the partners, and actually how good they are at using the condom in an appropriate way.

If you look at actual use studies, and how most people utilize them, over a year, approximately 12 percent of couples will actually get pregnant while using a condom.  It sounds like a high number.

CHERYL WILLS:  How does that happen?

STEVEN SPANDORFER, MD:  Well, there are many different ways.  Obviously, people always say, "Well, the condom breaks," and maybe that does happen sometimes.  But it's probably got more to do with maybe they didn't use the condom every single time.  Every time you have intercourse, you have to put on a brand new condom.  Maybe that doesn't happen that way, or they forgot the one time.  Or perhaps they put the condom on too late, or they took the condom off too early.

CHERYL WILLS:  But there's no chance of anything leaking through a condom, right?

STEVEN SPANDORFER, MD:  Well, it depends on the type of condom that one uses.

CHERYL WILLS:  Right.  Because some are very thin.

STEVEN SPANDORFER, MD:  Right, right.  Some that are on the market, that are much more "sensitive," tend to be the ones made out of lambskin.  Those tend to be more likely to break.  And definitely studies have shown that those can break.  Obviously, if a condom breaks it's not gonna prevent sperm (which are very hearty swimmers) from finding their way up to find the egg.

CHERYL WILLS:  Sure.  Doctor Polaneczky, some condoms have spermicide.  What does that mean?

MARGARET POLANECZKY, MD:  The addition of spermicide is potentially advantageous if the condom should break.  But the truth is, it's probably not enough spermicide to really help.  And for some couples that spermicide can be irritating, particularly for the woman.  It acts as a lubricant though, which is an advantage to having the spermicide there.

CHERYL WILLS:   The spermicide kills...

MARGARET POLANECZKY, MD:  Sperm.

CHERYL WILLS:  Sperm.  What chemical is there in spermicide?

MARGARET POLANECZKY, MD:  Nonoxynol-9 is one of the most commonly used.  There are several others.

CHERYL WILLS:  Okay.  What is the proper use of a condom, doctor?  We always say: "People don't use it right, they may take it off," but, it's not entirely easy to put on.  There has to be some technique to it.

STEVEN SPANDORFER, MD:  There is absolutely a technique to it.  I think the first important thing is that it has to be used at every act of intercourse, and that it has to be a new condom at every act of intercourse.  I think, in my experience with my patients, those that have gotten pregnant accidentally while using the condom, those are the two most common errors.  But, other factors involved is that it has to be put onto the erect penis at the time, and then it has to be rolled all the way down to where the condom is at the end of the base of the shaft of the penis.  I think that by applying it in that way, that it's gonna be most effectively used.

The other thing is that at the tip there should be a little bit left at the tip so that there is some room for the ejaculate, during the intercourse act.

CHERYL WILLS:  What are some of the most common mistakes people make when using a condom?

STEVEN SPANDORFER, MD:  I think, once again it goes back to perhaps using a condom more than once.  But I think it's probably more likely that the couple just thought they would get away with having intercourse one time without actually using the condom.

CHERYL WILLS:  Doctor Polaneczky, let's move on to diaphragms.

MARGARET POLANECZKY, MD:  Can I just add one more thing about condoms?

CHERYL WILLS:  Oh, please do.

MARGARET POLANECZKY, MD:  I think the additional thing about technique that's got to be stressed is that the male partner needs to remove himself from the female while the penis is still erect -- and holding his fingers at the base of the penis while pulling out is gonna keep the condom from slipping off.  The common thing I've seen is that the male partner pulls out, and the condom is left in place.  Then leakage of sperm occurs, and the woman becomes pregnant.

CHERYL WILLS:  Sure, that's very common.  Yeah.  Let's move on to diaphragms.  Doctor Polaneczky, let me continue with you.  What is a diaphragm.

MARGARET POLANECZKY, MD:  A diaphragm is just a holder for spermicide.  That's all it is.  Without the spermicide, it's useless.  So it's a small cup that the woman applies spermicide around the rim, places it in the vagina, it covers the cervix.  And when sperm contact the spermicide, they become inactivated.

CHERYL WILLS:  How effective is it?

MARGARET POLANECZKY, MD:  It's about as effective as a condom would be, about 90 percent effective.  But again, effectiveness is gonna depend on the user.  In very well-motivated couples, it can be over 95 percent effective if used appropriately.

CHERYL WILLS:  How do use it?  How does a woman insert this?  Or does a doctor insert it?

STEVEN SPANDORFER, MD:  A very important part of the diaphragm is actually the initial learning how to use it and being fitted for a diaphragm.  A diaphragm is something that should be able to be worn by the woman where it's comfortable, where she doesn't actually notice that it's there, but is able to actually put it in herself.  So, most women will come and see their physician and will get fitted for a diaphragm.  They come in different sizes, depending on the size of the person.  The woman should be able to wear it comfortably, and then, very importantly, be able to feel comfortable putting it in and taking it out herself.

CHERYL WILLS:  How often do you have to put it in and take it out?

STEVEN SPANDORFER, MD:  Well, the nice thing about a diaphragm is that you don't have to put it in immediately prior to intercourse.  You could actually put it in many hours before, up to 24 hours -- and put the diaphragm in.  And then what is important to do is to apply the spermicide prior to the act of intercourse.  But you could actually have the diaphragm in, and you could also leave the diaphragm in place after intercourse, for hours afterward and don't have to immediately remove it.

CHERYL WILLS:  Really?

MARGARET POLANECZKY, MD:  In fact, you shouldn't immediately remove it.  You must leave it in place for six to eight hours, for the spermicide to complete its job. During that time, if you have intercourse again, you can simply reapply spermicide with an applicator inserted into the vagina.

CHERYL WILLS:  How often does the diaphragm itself have to be replaced?  Or does it?

MARGARET POLANECZKY, MD:  It does.  Certainly periodically the woman should check it, to make sure that there are no leaks, simply by filling it with water, and seeing if any water drips through.  Occasionally it will develop an odor and need to be replaced.  But generally, we say at minimum every three years, and ideally once a year.

CHERYL WILLS:  Why does it develop an odor?  What is it made out of?

MARGARET POLANECZKY, MD:  It's made of latex.  And over use with time, and if not properly cared for -- afterwards it needs to be dried, rinsed first, then dried, dusted perhaps with a little cornstarch, and then put away.  But make sure that it's completely dried before it's put away.  And if you put it away damp, it can develop an odor.

CHERYL WILLS:  Sure.  How long does it last?  How long does a diaphragm last, before that odor sets in and you have to replace it?

MARGARET POLANECZKY, MD:  Oh, it's going to vary.  If you take care of it properly, you might not have any odor.

CHERYL WILLS:  But what's the general time frame for replacing a diaphragm?

MARGARET POLANECZKY, MD:  Again, ideally once a year.  At minimum, I'd say, every three years.

CHERYL WILLS:  Okay.  And is it ever uncomfortable?

MARGARET POLANECZKY, MD:  It should not be.

CHERYL WILLS:  And if it is, that means you didn't put it in right?

MARGARET POLANECZKY, MD:  Either you didn't put it in right, or it wasn't fitted properly.

CHERYL WILLS:  How much does it cost?

STEVEN SPANDORFER, MD:  I actually don't know.

MARGARET POLANECZKY, MD:  When I used to buy them they were 20 dollars.  I imagine they're probably, at this point, probably closer to 30.

CHERYL WILLS:  Last question on the diaphragm.  How do you check for damage?  Just for the leaks, like you said, pouring the water in?

MARGARET POLANECZKY, MD:  Exactly.  And women with long fingernails need to be careful how they use the diaphragm because their fingernails can poke holes into the edges of the diaphragm.

CHERYL WILLS:  Okay.  Doctor Spandorfer, let's move on to the cap.  What is that?

STEVEN SPANDORFER, MD:  The cap is sort of like a diaphragm, in that it's a barrier device.  It's going to fit onto the cervix itself.  The cervix is the opening to the womb.  It's sort of the sperm's entryway to the uterus to find the egg.  So, it fits more directly onto the cervix itself, but once again, is utilized in conjunction with a spermicidal agent.

CHERYL WILLS:  And it blocks sperm?  What does it block?

STEVEN SPANDORFER, MD:  Well, it works several ways.  In one way, it's gonna clearly act as a method that's covering the cervix, so it's going to prevent or try to help block the sperm from having access to the cervical canal.  But also, by having the spermicidal around it works in that method as well by working on killing the sperm.

CHERYL WILLS:  The cap, Doctor Polaneczky, can also hold spermicide, is that right?

MARGARET POLANECZKY, MD:  Exactly.  Without the spermicide, again, it's not very useful.  Early trials found that the spermicide was absolutely necessary for high efficacy.  The difference between the cap and the diaphragm is that the cap is much smaller.  So, that women who perhaps can't wear a diaphragm anymore, or often, after they've had a child, the vagina becomes a little too lax to accommodate the diaphragm properly, can use a cap very easily.

CHERYL WILLS:  So, that's the advantage, for some women, over using it?

MARGARET POLANECZKY, MD:  Right.

CHERYL WILLS:  That's what I was going to ask.  I don't see the difference.

MARGARET POLANECZKY, MD:  Some women may get frequent urinary tract infections.  The diaphragm sits under the urethra, and it may irritate or block a little bit.  So for those women, the cap may be a better choice.

CHERYL WILLS:  Doctor Spandorfer, let's move on to the sponge.  A little controversial?

STEVEN SPANDORFER, MD:  A little bit.

CHERYL WILLS:  Yeah.  First of all, let's define it.  What is this sponge?

STEVEN SPANDORFER, MD:  The sponge is, again, another one of these devices that basically is inserted by the woman before intercourse and prevents, or tries to prevent, the sperm, but also works with spermicidal agents as well.

CHERYL WILLS:  Now, this was taken off the market?  Why?

STEVEN SPANDORFER, MD:  I'm not sure why.

MARGARET POLANECZKY, MD:  Actually, there was nothing wrong with the sponge.  It was a manufacturing issue.  There were problems with the quality of the water that was being used by the manufacturer.  The FDA went in and said "We'd like you to fix this".  And the company said, "You know what?  This isn't worth our time and our money, we're not gonna do it.  We'll just close the plant down."  So, there was really no problem with the sponge.  The FDA never withdrew its support for the sponge.  The good news is that there's a company now stepping in that has agreed to start manufacturing the sponge again.  And the sponge is coming back.

CHERYL WILLS:  They were very popular when they were out.

MARGARET POLANECZKY, MD:  Very popular.  For a certain group of women, it has been a very popular contraceptive.

CHERYL WILLS:  Now, tell me how it works.

MARGARET POLANECZKY, MD:  It's impregnated with spermicide.  It's dry.  The woman wets it with water.  That releases the spermicide.  And she places it in the vagina, and there it acts.

CHERYL WILLS:  Is it more comfortable than the cap or the diaphragm?

MARGARET POLANECZKY, MD:  All should be equally comfortable.

CHERYL WILLS:  Equally.  Now, how is it applied?  You wet it before?

MARGARET POLANECZKY, MD:  It's impregnated with spermicide, and you put it under the sink, you wet it.  It gets almost lathery.  And then you tuck it into the vagina. The advantage over a diaphragm is, it doesn't need to be fitted by a physician, it's available in the drugstore without a prescription, and it's as effective as a diaphragm.

CHERYL WILLS:  Are there any disadvantages to the sponge?

MARGARET POLANECZKY, MD:  For some women the spermicide could be a little bit irritating.  Some women, it may not fit properly and they may actually find it lying on the bed next to them, after they've had intercourse, whereas the diaphragm for those women may stay in place a little bit better.

CHERYL WILLS:  How long can you keep a sponge in?  Should this be removed immediately after?

MARGARET POLANECZKY, MD:  Again, you need to leave it in for a period of time to allow the spermicide to do its job.

CHERYL WILLS:  Are there any disadvantages connected to it?

MARGARET POLANECZKY, MD:  Spermicides for some women can be irritating.  I think that that's probably the major disadvantage of anything that uses a chemical.  For some women, they're very sensitive to certain chemicals.

CHERYL WILLS:  Okay.  Doctor Polaneczky, thank you.  Doctor Spandorfer, thank you also.  And thank you for tuning in to our webcast.  I'm Cheryl Wills.