If used regularly and correctly, latex condoms are very reliable and effective, a
powerful means to prevent pregnancy and disease. However, condoms are not being used as
much as they should be, mainly because of negative perceptions among users and health-care
providers alike. Here are several good reasons to have greater confidence in latex
condoms:
When used correctly and consistently, condoms are an effective means of preventing
pregnancy. Pregnancy rates for condoms range from 3 percent to almost 14 percent. This
means three to 14 out of 100 women get pregnant in a year using only condoms for
contraception. However, these pregnancies are not due primarily to condom failure. Higher
pregnancy rates during typical condom use reflect inconsistent and incorrect use. If a
women does not use a condom during just one fertile phase in a year, she has a four-times
higher risk of becoming pregnant than if she uses condoms consistently and experiences
occasional breakage. Moreover, the risk of breakage is concentrated in certain couples.
This means that the majority of couples who use condoms consistently are at very low risk
of pregnancy.
When used correctly and consistently, condoms are an effective means of preventing
STD/HIV. A woman's fertile period is intermittent, but men and women can be at risk of
contracting an STD, including HIV, at every intercourse. Study after study has shown that
condoms are extremely effective against STDs if they are used consistently and correctly.
In many cases, a person does not know his or her partner's STD status. In cases where
partners are not infected, intermittent condom use will seem to protect against
transmission in a proportion of cases since no STD was in fact present. However, if one
partner is HIV-positive, then there is a guaranteed risk of exposure to infection at every
unprotected intercourse, and inconsistent condom use offers little protection against HIV,
compared with nonuse.
Latex condoms provide an impermeable mechanical barrier. Latex condoms are
impermeable to bacteria, viruses and sperm. Therefore, unless a condom breaks or
completely slips off in a clinically significant manner, i.e., during or after
ejaculation, or has manufacturing defects such as pinholes (which are extremely rare),
users are not exposed to semen or viral particles. (Condoms only form a barrier between
the penis and vagina, yet some sexually transmitted viruses, such as human papilloma
viruses, or genital warts, can be transmitted via skin-to-skin contact between the scrotal
skin and the perineum. Therefore, even intact condoms cannot prevent the transmission of
all organisms. The female condom, which covers more of the external genitalia, may afford
greater protection.) Broken or leaky condoms certainly expose couples to risks, but not
using condoms exposes people to a far higher magnitude of risk.
Most users do not break condoms, and a proportion of breakage is preventable. Most
people who use condoms, especially once they gain experience with them, rarely experience
breakage or slippage; condom failure is actually concentrated among a small percentage of
users. Studies have identified characteristics of condom users that seem to be associated
with more frequent condom breakage and slippage. A history of condom failure and
inexperience in using condoms are the characteristics most strongly associated with condom
failure. Some research also suggests that young age, not living with one's sexual partner,
low level of education, having multiple sexual partners, low income and large penis size
are correlated with increased risk of condom breakage or slippage. Studies also suggest
that certain behaviors are associated with increased breakage or slippage, including:
improper storage, rough handling of condoms, improper technique in putting on a condom,
not encouraging natural vaginal lubrication, using excessive added lubricants (especially
oil-based), lengthy or vigorous sex, anal intercourse, loss of erection prior to
withdrawal, and re-use of condoms. Some failures may be prevented through counseling to
avoid obvious problems like opening condom packages with sharp objects.
Today's condom is manufactured with greater precision. Latex condoms are better
formulated, processed, finished and packaged than they have ever been. During formulation,
there is greater control over the chemical processes of oxidation and vulcanization, which
reduces the risk of condom failure due to aging. Also, current knowledge about stress and
strain properties during use enables manufacturers to adjust the latex formulation in ways
that optimize condom performance. In recognition of a growing concern about latex allergy
from a variety of other products, condom manufacturers are making greater efforts to
remove latex protein allergens during processing. Manufacturers are also aware of the
potential risk posed from using talc as a dry lubricant, and many are shifting to
cornstarch. However, since cornstarch may not be entirely without risk, the search for a
better and safer dry finishing powder continues.
Condom use is improved by the right lubricant. Wet lubricants placed on finished
condoms prior to packaging include water-based lubricants, alone or with spermicide added,
and liquid silicone. The evidence suggests that using appropriate quantities of the right
types of lubricant (in manufacturing and during use) decreases breakage and increases
satisfaction with condoms. Use of water-based lubricants may increase slippage, but data
suggest that the protective effect against breakage may outweigh any risk of increased
slippage. There is no evidence that spermicidally-lubricated condoms confer any advantage
by increasing efficacy against pregnancy or disease, in spite of a consumer perception
that spermicidal lubricant ought to do this. Indeed, there is some preliminary evidence
that spermicidal lubrication may promote leaching of latex allergens, thereby potentiating
the risk of allergy. Since spermicidally-lubricated condoms also have a shorter designated
shelf life, silicone is a preferable lubricant.
Condoms in intact foil packages last at least five years. Adequate packaging is
crucial to the long-term integrity of latex condoms. Plastic packages expose condoms to
greater and more rapid deterioration from oxidation, humidity, ozone and ultraviolet light
than do foil packages. When properly sealed in foil packages, modern latex condoms are
quite resistant to adverse environmental conditions and will retain their quality for at
least five years and probably longer. Thus, all condoms should be packaged in aluminum
foil, or foil-plastic laminate packages.
Quality control and post-production quality assurance help ensure a reliable
product. In addition to many specific improvements in all aspects of latex condom
manufacture, an extensive system of internal and external quality control and quality
assurance is now in place to ensure high quality of condoms. In the era of AIDS, the
condom is considered a potentially life-saving medical device, and as such is subject to
strict quality standards. Through both worldwide and regional standards bodies, minimum
acceptable quality levels are enforced, some by law and others through consensus
guidelines. The wide net cast by current standards bodies ensures that the great majority
of condoms (including condoms supplied by international donors) are manufactured to high
standards.
While it is not yet clear how well the test standards predict results during human
use, a combination of tests can provide clear guidance on the quality of condoms in the
field. The current battery of tests -- condom dimensions, package integrity, lubricant
quantity, water leakage, tensile properties, and air-burst properties -- assure that newly
manufactured condoms conform to international standards and specifications. But
uncertainty still surrounds the validity of these tests in assessing condom deterioration
over time and predicting performance in human use. For the time being, a combination of
condom age and relevant tests (air-burst, package integrity and lubricant quantity) should
be used to assess possible condom deterioration. No single laboratory test is an adequate
surrogate for condom performance during use.
In time, condoms made of non-latex, synthetic materials may replace latex condom use in
part or altogether. Synthetic condoms made from thermoplastic elastomers have several
advantages over latex condoms. They have more controllable physical properties such as
strength and can be fashioned in any shape and size. They may transmit heat better than
latex, allowing for greater sensitivity during intercourse. However, only two synthetic
condoms are being sold: the Avanti male condom (London International Group) and the female
condom (Female Health Company). Unfortunately, the limited availability and relatively
high cost of synthetic condoms mean that most consumers will need to rely on latex condoms
for the foreseeable future.
For more information, visit Family Health International's Website at www.fhi.org
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