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Tuesday, January 20, 2009 - ore 14:23 rimedi della nonna sul british journal of medicine Published 17 December 2008, doi:10.1136/bmj.a2873 Cite this as: BMJ 2008;337:a2873 Feature Christmas 2008: Food and Drink Coca-Cola douches and contraception Deborah J Anderson, professor of obstetrics/gynaecology and microbiology, lecturer in medicine1,2 1 Boston University School of Medicine, 670 Albany St, Suite 516, Boston, MA 02118, USA, 2 Harvard Medical School, Boston, MA 02115, USA Deborah.Anderson@BMC.org Deborah Anderson explains why women really shouldn’t rely on Coca-Cola for family planning Coca-Cola douches were a part of folklore about birth control during the 1950s and 1960s, before effective contraceptive methods were readily available.1 It was rumoured that the acidity of Coca-Cola killed sperm, and the classic coke bottle provided a convenient "shake and shoot" applicator. Recently, an old study from our group confirming the spermicidal effects of various Coca-Cola formulations2 was awarded the 2008 IgNobel prize in chemistry.3 The press releases surrounding our IgNobel award might have repopularised this method, and soft drink douches are apparently still used to prevent pregnancy in resource-poor settings.4 There are, however, many reason why women should not rely on this method. Coca-Cola is not a strong spermicide In our study we mixed Coca-Cola with human semen (5:1 ratio) and reported that sperm were immobilised within one minute. A subsequent toxicology study found that Coca-Cola has only a weak spermicidal effect.5 Sperm can out race Coca-Cola Data from computerised analysis of semen indicate that the forward velocity of human spermatozoa can exceed 18 cm/hour.6 Therefore, a well placed sperm can reach the cervical canal within seconds, thus escaping the effect of postcoital douching solution. To improve efficacy, some Coca-Cola would have to be instilled into the vagina before ejaculation, but that would undoubtedly be messy. In addition, as anyone who has ever attempted sexual intercourse in a swimming pool or the sea can testify, excess watery intravaginal fluid can adversely affect lubrication. Coca-Cola use during intercourse would probably affect the mucinous biofilm that protects the vaginal epithelium, thereby increasing friction, trauma, and risk of infection. Coca-Cola and the vaginal epithelium As Coca-Cola is said to tenderise steaks and remove corrosion from car bumpers,7 we tested its effect on human vaginal tissue in vitro using an established toxicology test.8 Brief exposure to Coca-Cola visibly damaged the top layer of cells (figure) and decreased transepithelial electrical resistance (TEER), an inverse measure of epithelial barrier permeability (mean TEER after 30 minutes’ exposure to Coca-Cola 380 (SD 87) v mean TEER untreated cultures 548 (SD 41) , P<0.005). Epithelial damage and increased permeability could enhance a woman’s susceptibility to sexually transmitted infections such as HIV/AIDS.9 View larger version (210K): [in this window] [in a new window] [PowerPoint Slide for Teaching] Scanning electron micrograph of surface of human vaginal tissue exposed in vitro for 30 minutes to tissue culture medium (top) or Coca-Cola (bottom) Coca-Cola might affect the vaginal flora Sugar facilitates fungal and bacterial growth, so the high sugar content of Coca-Cola could promote vaginal yeast and bacterial infections. This might be avoided by using Diet Coke, but carbonated beverages could have detrimental effects on lactobacilli, beneficial bacteria that colonise the healthy vagina and are essential for maintaining the normal vaginal ecosystem. Douching might promote ascending infections Douching has been associated with an increased risk of pelvic inflammatory disease and ectopic pregnancy,10 although it is unclear as to whether this is cause or consequence.11 Unknown teratogenic potential The Coca-Cola formula is a well guarded secret and is purported to include "a mix of exotic spices and vegetable extracts from around the world." Because of the secrecy, it has not been possible for scientists to conduct a systematic study of potential teratogenic effects of the ingredients. User failure Implementation of the Coca-Cola douche requires dexterity and skill and might be unreliable, especially when practised in the dark. A BMJ article cautioned that misplaced bottle caps can cause serious medical problems.12 Better methods are available The efficacy of the Coca-Cola douche method of birth control has never been tested in a placebo controlled clinical trial, and probably never will be. Early epidemiological studies, however, reported that postcoital douching was no more effective than "rhythm" or "penile withdrawal" methods, which are unreliable.13 Several current contraceptive approaches, including barrier methods (condoms and diaphragms), the intrauterine device, birth control pills, and injectable hormonal methods are significantly more effective than these methods.14 The Coca-Cola company states that Coca-Cola is not intended for medicinal purposes. Yet, workers in sexual health services should be aware, as the Coca-Cola company continues to use such sexually charged marketing messages as: "Things go better with Coke," and invites internet literate youngsters to "Discover more at www.letsgettogether.co.uk." Cite this as: BMJ 2088;337:a2873 -------------------------------------------------------------------------------- A special thanks to Joseph Politch, Jeffrey Pudney, Caitlin Blaskewicz , Marc Abrahams, and Peter Greenhouse for their encouragement and scientific input. Competing interests: None declared. Ethical approval: The original research described was reviewed by the Boston University Medical Campus Human Subject’s Institutional Review Board and was deemed exempt. References The Fugs. Coca-Cola Douche. Virgin Fugs Album, 1966. Umpierre SA, Hill JA, Anderson DJ. Effect of "Coke" on sperm motility. N Engl J Med 1985;313:1351.[ISI][Medline] Tanne JH. Crackly crisps taste better, costly placebos work better, and fleas jump higher on dogs than cats. BMJ 2008:337:a1992. Nwoha PU. The immobilization of all spermatozoa in vitro by bitter lemon drink and the effect of alkaline pH. Contraception 1992;46:537-42.[Medline] Hong CY, Shieh CC, Wu P, Chiang BN. The spermicidal potency of Coca-Cola and Pepsi-Cola. Human Toxicol 1987;6:395-6.[ISI][Medline] Cooper TG, Yeung CH. Computer-aided evaluation of assessment of grade A spermatozoa by experienced technicians. Fertil Steril 2006;85:220-4.[Medline] Mythbusters, Cola Myth. Discovery Channel, November 10, 2006. http://video.google.com/videoplay?docid=2083844365552082242&q=mythbusters&hl=en Ayehunie S, Cannon C, Lamore S, Kubilus J, Anderson DJ, Pudney J. Klausner M. Organotypic human vaginal-ectocervical tissue model for irritation studies of spermicides, microbicides and feminine-care products. Toxicol In Vitro 2006;20:689-98.[CrossRef][Medline] Myer L, Kuhn L, Stein ZA, Wright TC, Denny L. Intravaginal practices, bacterial vaginosis and women’s susceptibility to HIV infection: epidemiological evidence and biological mechanisms. Lancet Infect Dis 2005;5:786-94.[CrossRef][ISI][Medline] Zhang J, Thomas AG, Leybovich E. Vaginal douching and adverse health effects: a meta-analysis. Am J Public Health 1997;87:1207-11.[Abstract/Free Full Text] Ness RB, Hillier SL, Kip KE, Richter HE, Soper DE, Stamm CA, et al. Douching, pelvic inflammatory disease, and incident gonococcal and chlamydial genital infection in a cohort of high-risk women. Am J Epidemiol 2005;161:186-95.[Abstract/Free Full Text] Douglas, RJ. Champagne: the safer choice for celebrations. BMJ 2007;335:1281.[Free Full Text] Tietze C. The clinical effectiveness of contraceptive methods. Am J Obstet Gynecol 1959;78:650-6.[Medline] Trussell J, Vaughan B. Contraceptive failure, method-related discontinuation and resumption of use: results from the 1995 National Survey of Family Growth. Fam Plann Perspect 1999;31:64-72.[CrossRef][ISI][Medline] LEGGI I COMMENTI (6) PERMALINK |
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