Contraceptive sponges combine a barrier with a spermicide.[1] Like diaphragms, they are inserted vaginally before intercourse and must be placed over the cervix to be effective.[27] Typical failure rates during the first year depend on whether or not a woman has previously given birth, being 24% in those who have and 12% in those who have not.[2] The sponge can be inserted up to 24 hours before intercourse and must be left in place for at least six hours afterward.[27] Allergic reactions[58] and more severe adverse effects such as toxic shock syndrome have been reported.[59]