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PubMed2005

Problems with condoms -- a population-based study among Finnish men and women.

OBJECTIVE: This study evaluates men's and women's opinions of condom use and problems with it in real life. METHODS: Random samples of men and women, aged 18-50 years, were drawn from the Finnish Population Register and were mailed a questionnaire on family planning. Response rates were 36% for men (706) and 58% for women (1136). Respondents were asked e.g. about condom use, whether they had had problems with it and why they used condoms. Moreover they were asked if they had received advice on how to use condoms. RESULTS: Among both men and women 87% had at some time used condoms. Of all men 37% and of women 34% reported that they had at some time had a failure with condom use; among both men and women one in four had experienced condom breakage. The use of condoms with the main purpose of preventing sexually transmitted diseases was somewhat low. The proportion of respondents having received advice on condom use was greater among younger men and women. CONCLUSION: A patient with problems in condom use is not uncommon in consultations in primary health care, and thus personnel working there hold a key position in promoting condom use. The role of school health care should be assured to offer basic sexual and reproductive counselling to every generation.

Adult↗
PubMed1990

Factors influencing condom use in a sample of homosexually active men.

A sample of 502 homosexually active men were recruited from genitourinary medicine clinics and non clinic sources and interviewed in relation to their sexual behaviour and factors that might influence their use of condoms. Three hundred and eighty three men (76%) reported penetrative anal sex in the previous year. Ninety four (25%) had not used condoms in penetrative sex. Failure to use condoms was associated with unfavourable attitudes to them, not knowing close friends or partners who had HIV-related health problems, having fewer sexual partners and being in a closed monogamous relationship. On the other hand levels of awareness about the risks of unprotected anal sex and involvement in gay networks and social groups were not predictors of condom use.

Acquired Immunodeficiency Syndrome↗
PubMed2002

Hands-on is better than look-on: condom use.

OBJECTIVES: To compare knowledge about condoms, attitude towards condom use and skill in condom application between the experimental group who received hands-on and the control group who had look-on demonstrations of condom application onto the penile model of third year male primary vocational students. METHOD: Self administered questionnaire was used to collect data about knowledge and attitude. Skill was separately evaluated by a skill evaluation form. Pretest and posttest of knowledge, attitude and skill were done separately at 2 week intervals in the same subjects. The pretest and posttest scores were expressed as the mean and standard deviation. Statistic analysis used unpaired t-test for comparing scores between the two groups using SPSS. RESULTS: Comparison of pretest with pretest, posttest with posttest and the different mean score of posttest with pretest between the two groups of knowledge and attitude about condoms were not significantly different in both groups but the skill in condom application score was significantly different (p-value < 0.001). However, the skill score increased in the experimental group more than in the control group. CONCLUSIONS: This study suggested that condom application skill increased with the hands-on than look-on instructional model. It was concluded that hands-on should be used to improve skill to prevent condom user failure and nonuse.

Adolescent↗
PubMed2006

[Use of condoms during sexual intercourse: a population-based study].

OBJECTIVE: To describe characteristics associated with failure to use condoms during sexual intercourse by women. METHODS: We conducted a cross-sectional population-based study including 1,026 women aged 20-60 years living in the urban area of a city in Southern Brazil, in 2003. Cluster sampling was carried out by randomly selecting 40 of the city's 270 census sectors. We performed logistic regression analysis of failure to use condoms in relation to socioeconomic, demographic, obstetric, and health care usage variables. RESULTS: Among studied women, 867 (84.5%) reported being sexually active; of these, 252 (29.1%) wore condoms during sexual intercourse. Logistic regression showed that the most vulnerable groups were women who were married or in stable partnerships, and women aged more than 40 years. We found no associations with the other variables explored. CONCLUSIONS: Prevalence of condom use was low; we were able to identify a group of women that needs to be targeted by health policies and services in order to improve perception of the risk of acquiring sexually transmitted diseases.

Adult↗
PubMed1996

The perimenopause and contraception.

OBJECTIVES: To review the implications of pregnancy in women in their forties and the contraceptive options open to them. METHOD: Medline and popline reviews of the literature. RESULTS: Women in their forties are still potentially fertile, and pregnancy in this age group is attended with increased maternal mortality, spontaneous abortion, fetal anomalies and perinatal mortality. In developing countries, these risks are compounded by high parity and poor medical care. Contraception for women in this age group has special risks and benefits, both should be balanced to choose between the different options available. Recent epidemiological and clinical pharmacology studies have indicated the safety of extending the use of combined oral contraceptives (COCs) beyond the age of 35 years and up to menopause. The improved picture of COCs has largely resulted from the use of low-dose-formulations, and avoidance of their use in women with risk factors for developing cardiovascular diseases. Besides their high reliability, which is desirable at this age, COCs will prevent the occurrence of climacteric symptoms and menstrual irregularities which are frequently complained of in the premenopausal years. Moreover, the use of COCs has a substantial protective effect against ovarian and endometrial cancers. Women who have reasons for avoiding COCs can use progestogen-only contraceptives like pills, depot injectables and implants. Norplant combines high efficacy and the long-term effect. Both copper-releasing and levonorgestrel-releasing IUDs (LNG-IUD) combine the advantages of high efficacy and long term effect. The reduced fecundity above the age of forty can allow extending the use beyond the accepted term, and up to one or two years beyond the menopause without the need for replacement. The levonorgestrel IUD has the advantage of reducing the amount of menstrual bleeding. The extent of use of barrier methods will depend upon the availability of a back-up by abortion service in case of failure. The condom has the added benefit of protection against STDs. Male or female sterilization is an excellent contraceptive option, provided that this approach is culturally acceptable and available at reasonable cost and low risk. CONCLUSION: Increasing the number of contraceptive options available to premenopausal women will improve proper counseling and enhance compliance.

Adult↗
PubMed1999

Optical testing of condoms.

Condoms provide one of the most important means of preventing pregnancy and the spread of human immunodeficiency virus (HIV) and other sexually transmitted diseases. Pinhole defects may lead to the passage of sperm or viruses through the condom wall. Embedded particles, which may become dislodged in handling or use, may represent latent pinhole defects. Thin regions in the condom wall may lead to breakage in use. Testing for such defects in regulatory laboratories, or in the factories as part of production screening or quality assurance efforts, is a major tool for ensuring condom reliability. A new optical method for testing condoms is presented, sensitive to pinholes, thin regions, and embedded particles. The method could supplement or replace the existing, less powerful, electrical test techniques in either regulatory testing laboratories or in the factory. The optical techniques presented provide quantitative data on the condoms tested, rather than just accept/reject decisions. They thus support detailed monitoring of production or lot characteristics that is generally not possible with existing electrical techniques. The ability of the optical techniques to separately test for and identify not only pinholes, but also thin regions and embedded particles, which are not separately tested for with the electrical technologies, is an especially important new capability. Further, the new optical techniques allow the locations of defects found to be precisely marked, making possible a microscopic examination of defects useful in studying their structure and possible causes. The optical technique is also totally nondestructive, in that it does not alter the defects whose structures are of interest. Initial results are reported on the testing of latex condoms purchased in retail stores. Condoms identified optically as being potentially defective were subjected to industry standard leak and burst testing. Results of the various tests are summarized. The data suggest that use of the new optical test techniques could have prevented an unexpectedly large number of condoms with significant pinhole and thin region defects from reaching the public. Optical test systems could be used to support either regulatory, quality assurance, or clinical field testing of latex or nonlatex condoms. Due to their high rate capability and level of automation, they could also be applied to 100% screening testing in the factory. The new test techniques could also be used to detect defects in a wide range of other thin sheets and membranes.

Condoms↗
PubMed1998

Does additional lubrication affect condom slippage and breakage?

The risk of condom slippage (1.94%) and breakage (0.89%) among 3607 condoms was analysed with respect to the use of additional lubricant. Whether or not lubricant was used, the site at which it was applied and the type of lubricant used were all found to vary significantly with the type of sexual act(s) for which the condoms were used. Little evidence was found for differing effects of type of additional lubricant (water-based, saliva or other) or site of lubricant use (on penis/inside condom, on condom, in vagina/anus). The use of lubricant more than doubles the risk of slippage for vaginal sex. While anal sex is associated with much higher risks of slippage the use of lubricant for this practice actually reduces the risk of slippage to that similar for vaginal sex where lubricant is used. No significant effect of additional lubricant on condom breakage was observed. It is recommended that education messages concerning the use of additional lubricant may need to change to take into account the varied nature of lubricant use practices and the differential effects of lubricant with respect to sexual practices. Specifically, if the use of additional lubricant has little or no impact on condom breakage but increases condom slippage then encouraging its use may be counterproductive if condom users consider slippage to be a reason not to use condoms.

Adult↗
PubMed1991

[Voluntary abortions in 1979-1989--what does their number indicate?].

The number of women aged 15-44 years increased by 110,000 in Norway from 1979 to 1989, while the number of abortions increased by less than 1,900. Adjusting for these demographic changes, the general rate of induced abortion among married women decreased by 17% from 1979 to 1989, while there was no change in the rate of induced abortion among unmarried women. The magnitude of the rate of induced abortion among married women correlates with the accepted rate of failure for copper IUDs, while the magnitude of the rate of induced abortion for unmarried women is lower than the rate of failure for condoms. Among married women the rate of induced abortion in the age groups over 30 years of age has declined throughout the study period. In the other age groups of married women the abortion rate has been relatively constant after 1979. After introduction of self-determined abortion in 1979, the rate of induced abortion for unmarried women under 25 years of age has increased, while only minimal changes have occurred in the rate for older unmarried women. When adjusted for age and marital status, there have been no major changes in the general rate of induced abortion in Norway after introduction of self-determined termination of pregnancy in 1979.

Abortion Applicants↗
PubMed1997

Contraceptive practices of women requesting termination of pregnancy: a study from China.

In order to develop a program for prevention of unwanted pregnancies, we conducted a survey of contraceptive practices and reasons for contraceptive failures of 1520 women seeking abortion at eight large hospitals in Zheng Zhou City, Henan Province, P.R. China, during the period from March 1996 to May 1996. The most frequent cause of the unplanned pregnancy was contraceptive failure (71.9%) 61.7% (938) of these current pregnancies were potentially predictable by virtue of nonuse of contraception (427) or by recognition of contraceptive failures (511). Among the contraceptive failures, the proportion of condom mishaps was the highest (29.7%), next was IUD failures (23.5%), then rhythm miscalculation (15.9%). Most of abortion seekers (77.1%) used some contraceptive methods previously. But only 19.7% of them used a contraceptive method at the first sexual intercourse. Among 1520 abortion seekers. 57.6% had used condoms previously; 50.9% of the condom users had at least one instance of condom mishap. The rhythm method had been used by 31.7% of abortion seekers previously; 59.1% of the rhythm users had at least one instance of rhythm failure. Of the 16.8% of abortion seekers who had used pills, 58.0% of them had pill failures Among condom and pill failures, most of them (46.4% condom users and 56.0%, pill users) belonged to the users failure category (poor compliance). Of those seeking abortion 56.4% had experienced at least one instance of previous abortion; 5.3% had experienced previous abortions at least two times. Emergency contraception had been utilized by only 10 subjects prior to this current pregnancy.

Abortion, Induced↗
PubMed1993

Information needs on emergency contraception not being met.

During the 1980s, there was 2 prominent changes in family planning: more women went to general practitioners (GPs) for contraceptive advice and there was an upturn in the use of condoms due to safer sex campaigns in the mid-80s. In this study of 769 women requesting a pregnancy termination, the author's found that the greater use of condoms had appeared to increase the need for information about emergency contraception, but this was not being met. Patients advised by their GPs seemed to have a lower level of knowledge than those who obtained their contraception from clinics. The study, carried out at St. James's University Hospital in 1991-92, is compared with several studies in the 1970s and 80s which look at contraceptive usage by women with unwanted pregnancies. Differences were found between those receiving contraceptive advice from different sources (i.e. GPs, clinics, no medical source). Failure of the pill was more frequent in the GP-advised group, but failure of the diaphragm was more frequent in the clinic-advised group. Failure of non-use of condoms did not differ according to the source of advice. Knowledge of and use of emergency contraception was low. Only 14.5% of those using no contraception or recognizing a condom failure attempted to use a secondary or emergency method. Condoms should be used as well as rather than instead of other methods of contraception, and knowledge and availability of emergency contraception should be increased and promoted, recommend the authors. They concluded that problems arising from family planning provision by untrained and uncommitted doctors should be addressed urgently. (Bromham and Cartmill, British Journal of Family Planning, vol. 19, 1993, pp179-183). Commenting on the study findings, FPA Medical Information Office Jane Urwin said: "This study has furthered our knowledge in this area. It also highlights the need for further study of risk-taking behavior in relation to contraceptive use's.

Ambulatory Care Facilities↗
PubMed1999

Relationship of amphetamine and other substance use to unprotected intercourse among young men who have sex with men.

OBJECTIVES: To analyze temporal trends in drug use and the relationship between drug use before or during sex and unprotected intercourse among a sample of young gay and bisexual men. METHODS: Data were obtained from cross-sectional surveys of 9 annual cohorts. Respondents were 877 13- to 21-year-old gay and bisexual male volunteers. Trends in the use of substances before or during sex were analyzed. Univariate and multivariate measures of the association between substance use before or during sex and unprotected anal intercourse were calculated. RESULTS: Between 1994 and 1997, the use of marijuana, cocaine, amphetamines, and mean scores on a measure of overall drug use severity increased significantly in a sample of young gay and bisexual men. Significant univariate associations were found between drug use before or during sex and unprotected anal intercourse for the following substances: alcohol, marijuana, cocaine, amphetamines, barbiturates, heroin, LSD, volatile nitrites, tranquilizers, and methaqualone. In multivariate analyses, however, only cocaine use predicted failure to use condoms during anal intercourse. CONCLUSION: Although amphetamine and other drug use increased among young gay and bisexual men, only cocaine use was a significant, independent predictor of the failure to use condoms during anal intercourse.

Adolescent↗
PubMed1994

Young adults, alcohol and condom use: what is the connection?

PURPOSE: Concern about HIV in adolescents and young adults has led a number of investigators to examine the link between drinking and risky behavior, including failure to use condoms. Most of the studies that conclude that this link exists have used global measures of both variables and have not investigated drinking and use of condoms on the same occasion. If drinking leads to low condom use, both behaviors must occur together and the failure to find that they do weakens the hypothesis that they are causally related. METHODS: Data from three separate studies on different adolescent and young adult populations are reported. In each study the relationship between drinking behavior and condom use at last intercourse was examined. RESULTS: Drinking was not related to lower condom use in any of the populations studied. CONCLUSIONS: This negative result implies that the dis-inhibiting effect of alcohol is not a major factor in the failure of young adults to use condoms.

Adolescent↗
PubMed2002

Unprotected sex among African-American adolescents: a three-year study.

This study examined the cumulative change of unprotected sex over a period of three years among 383 African American youth ages 9 to 15 at baseline who participated in a trial of a Human Immunodeficiency Virus (HIV) risk reduction intervention. Cumulative scores of sexual intercourse and failure to use condoms were compared between intervention and control groups. The results indicate that cumulatively over the three-year period, intervention youth reported significantly lower rates of failure to use a condom. The findings indicate that face-to-face interventions may offer significant cumulative protection from unprotected sex over the long-term.

Adolescent↗
PubMed2004

Condom use in multi-partnered females.

Many women attending sexual health clinics have multiple partners, and determining factors associated with condom use may provide useful information for health promotion strategies. Demographic and sexual data were obtained from computerized records at the Sydney Sexual Health Centre from 1991 to 1999. Females with >2 partners were categorized according to their condom use in the last three months and compared using chi-squared (chi2) tests and logistic regression. Of the 2198 women identified, 22% did not use condoms, 28% reported consistent condom use and 50% inconsistent use. Variables independently associated with failure to use condoms included older age and being in a regular relationship. Women with more partners were more likely to use condoms. Students [odds ratio (OR)=0.7 (95% confidence interval (CI) 0.5-0.9)] and those in employment [OR=0.7 (95% CI 0.5-0.9)] were more likely to use condoms than the unemployed. Focusing health promotion on multi-partnered women who fail to use condoms consistently may help in reducing sexually transmitted infections.

Adolescent↗
PubMed1999

Risk factors for the acquisition of genital warts: are condoms protective?

OBJECTIVES: To characterise risk factors for the acquisition of genital warts and specifically to determine whether condoms confer protection from infection. METHODS: A retrospective case-control study comparing demographic, behavioural, and sexual factors in men and women with and without newly diagnosed genital warts, who attended Sydney Sexual Health Centre (SSHC), an inner city public sexual health centre, in 1996. Data were extracted from the SSHC database. Crude odds ratios (OR) were calculated to compare cases and controls and significant factors were then controlled for using multivariate logistic regression to obtain adjusted odds ratios (ORs). RESULTS: 977 patients with warts and 977 controls matched by sex and date of attendance were included. In both sexes, univariate analysis revealed that younger age, more lifetime sexual partners, failure to use condoms, greater cigarette smoking and alcohol consumption were associated with warts, and there was a negative association with previous infection with Chlamydia trachomatis, Neisseria gonorrhoeae, hepatitis B, and genital herpes. In males, on multivariate analysis, factors which remained significant were younger age, more lifetime sexual partners; failure to use condoms, greater cigarette smoking, and previous chlamydia. In women, factors which remained significant were younger age, more lifetime sexual partners, condom use, marital status, and previous infections with Chlamydia trachomatis and herpes. CONCLUSIONS: Independent risk factors for genital warts include younger age, greater number of lifetime sexual partners, and smoking. Consistent condom use significantly reduces the risk of acquiring genital warts.

Adolescent↗
PubMed1993

The effectiveness of condom use in heterosexual prostitution in The Netherlands.

OBJECTIVES: To assess the extent to which condoms are used effectively in commercial heterosexual intercourse. Data on the number of condoms that had broken or slipped off, the sexual technique during which this had occurred and the perceived cause of failure were collected. The use of non-water-soluble lubricants and non-fortified condoms during anal intercourse, and the demand for a greater variety of condom sizes were also examined. SUBJECTS AND METHODS: One hundred and twenty-seven female prostitutes and 91 male clients from different parts of The Netherlands were interviewed face-to-face between July 1990 and March 1991. RESULTS: Of those who used condoms during vaginal intercourse, 49% of the prostitutes had experienced condom breakage in the previous 6 months, and 16% of the clients in the previous 12 months. The breakage rate was 0.8% for prostitutes and 1.5% for clients. Condom quality was seldom reported as the cause; breakage was generally attributed to human factors, such as rough or prolonged intercourse, incorrect handling of the condom or the use of insufficient lubricant. Prostitutes also identified penis size as a cause. Condoms slipping off before or after ejaculation was reported less frequently than breakage. Thirteen per cent of clients and 36% of prostitutes expressed a need for either smaller or larger condoms. Of the prostitutes, 9% used oil or vaseline as a lubricant. CONCLUSIONS: In view of the low rate of condom failure in heterosexual prostitution in The Netherlands, the potential spread of HIV by this means is small. The use of a greater variety of condom sizes may further reduce the failure rate. Few prostitutes remain ignorant about the adverse effects of oil-based lubricants on condoms.

Condoms↗
PubMed1991

Overcoming denial and increasing the intention to use condoms through the induction of hypocrisy.

Feelings of hypocrisy were induced in college students to increase condom use. Hypocrisy was created by making subjects mindful of their past failure to use condoms and then having them persuade others about the importance of condoms for AIDS prevention. The induction of hypocrisy decreased denial and led to greater intent to improve condom use relative to the control conditions. The implications of these findings for AIDS prevention are discussed.

Adult↗