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All methods of contraception are used to prevent pregnancy, but condoms have the added advantage of providing protection against infection and the spread of sexually transmitted diseases (STDs). How effective are condoms at doing these two things? Are they really as effective as other contraceptive methods at preventing pregnancy? And since one of the most common reasons for using a condom is to provide protection against infection, are they really an effective barrier against being infected by STDs?
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In this article we look at some of these questions.
Does using a condom prevent pregnancy?
Condoms are an extremely effective means of preventing pregnancy. Of course, no method of contraception is 100% effective because there will always be instances of incorrect or inconsistent use. This is as true of “the pill” or any other form of contraception as it is of condoms. However clinical studies have shown that high quality condoms, when used consistently and correctly, provide an excellent barrier against pregnancy. These trials have shown that correct and consistent use of condoms can have between 95% and 98% contraceptive efficacy rate.
How often do condoms fail?
The main reason that condoms “fail” to prevent pregnancy or infection is not because the condom itself has “failed”, but because of incorrect or inconsistent use. Latex condoms can be weakened by oil-based lubricants like petroleum jelly. They can also be weakened by exposure to sunlight or by age. Sometimes they are torn by teeth or fingernails. But putting these incorrect uses aside, condoms almost ever “fail”.
How often do condoms break or slip off?
In the United States, most studies of breakage caused by fault in the condom itself have shown breakage rate is less than 2 condoms out of every 100. Studies also indicate that condoms slip off the penis in about 1-5% of acts of vaginal intercourse and slip down (but not off) about 3-13% of the time. Again, these rates are influenced by the care one takes when using a condom.
Are condoms effective at preventing infection from HIV or STDs?
Studies have shown that if a latex condom is used correctly and consistently (every time you have sex), they are a highly effective barrier against infection. This has been demonstrated most clearly by studies of “discordant” couples in Europe. A “discordant” couple is one in which one partner in infected with HIV and the other one is not. In a study of 123 couples in which condoms were used consistently, none of the infected partners became infected.
Do thinner condoms give less protection against pregnancy and STDs?
Thinner condoms are equally effective as a protection against both pregnancy and infection by STDs. However they may be more easily damaged by fingernails, teeth, jewelry and other incorrect uses, so extra care should be taken when using a thinner condom.
Are all condoms thoroughly tested before being sold?
All brand name condoms are subjected to rigorous quality control tests at every stage of the manufacturing process. In the US, each condom is electronically tested for holes and defects. Samples are taken from each lot and visually examined using a water leak test. In this test the samples are filled with 300 ml of water and suspended for 3 minutes.
Samples from each lot are also subjected to an Air Inflation Test. This involves filling the test condoms with air until they reach the bursting point. They typically will hold about 40 liters of air — the equivalent of 9 gallons of water!
Other samples are checked for size and thickness, some are tested to destruction for physical strength, and still others are prematurely aged by applying high temperatures to ensure that they will retain their quality well beyond their 5 year product life.
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In all regards, condoms have been shown to be an effective way to prevent pregnancy as well as being a highly effective way of guarding oneself against HIV or STD infection.
Personal relationships can be seriously compromised by a continuing sexual problem. Such sexual dysfunction can cause terrible distress and can disrupt or even spell the end of personal relationship, regardless of which partner has the problem. Sexual dysfunction may be caused through physical problems but anxiety will often aggravate the dilemma.
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Sexual relationships are never entirely simple but they are very important and a source of much happiness for those in long term relationships. Many things, both physical and psychological, can go wrong and can threaten the fibre of the relationship if not dealt with in a proper manner.
It is important for people to have some knowledge of what can impact on failure to achieve satisfactory sexual fulfillment. Such things can be caused by physical problems on the part of either partner or may be psychosomatic. Whatever the case, the problem affects both partners as such a relationship involves intense emotions and other mental factors. Factors such as faulty expectations, poor communication of sexual needs, ignorance, and concern over ability to perform can affect sexual function and satisfaction.
Male Sexual Dysfunction
Male dysfunction is most commonly in the form of the inability to achieve an erection or the inability to maintain an erection sufficiently to allow normal intercourse. This condition is known as impotence and can cause great distress to the male, not only because it prevents satisfying sexual intercourse but also because many men think it indicates a lack of masculinity.
Most men suffer episodes of impotence at some time and these episodes are almost always of a psychological origin. Very few are attributable to disease and those cases that are, are usually among older men. Psychogenic impotence happens quite often because of performance anxiety. However, the majority of women do not place a great deal of importance on the occasional episode of impotence and are usually sympathetic and understanding rather than critical of their partner. They do not normally see it as a deficiency in the man’s masculinity. Sometimes, organic impotence can be helped by drugs like Viagra. In fact, it was only when Viagra was introduced to the market, the true prevalence of erectile dysfunction was revealed.
Premature ejaculation, as its name implies, is when the male orgasm happens too early, thus depriving both partners of sexual satisfaction. This can even happen before penetration and is normally due to excessive excitement. This is fairly common in inexperienced men but will settle down as they become more sexually skilled.
There is also a condition called Priapism that is potentially dangerous to the man. It is a rare condition in which the erection does not subside after he reaches orgasm. It is important that he seek immediate treatment as the blood in the penis will usually clot after about four hours, forming damaging internal scar tissue. The condition is usually treated by draining the blood under anaesthesia. Priapism has been known to be caused by drug abuse.
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Another disorder of the penis is Peyronie’s disease of which the cause is unknown. This disorder is characterized by a thickening and rigidity of tissue, resulting in a bend in the penis on erection. This can interfere with normal intercourse by causing discomfort to both partners. It may also prevent sexual intercourse from happening at all. The condition is often helped by steroid injections but surgical removal of the thickened areas is usually needed.
Genital Herpes
An estimated 724,000 new cases of genital herpes, are reported annually in the U.S. with a cumulative prevalence of over 20 million infected persons.
An estimated 3%-5% of infants born through an infected birth canal will acquire a neonatal herpes infection. The incidence of neonatal herpes infection is estimated to be between 1 in 3,000 and 1 in 20,000 live births.
Human Papilloma Virus
The incidence and prevalence of human papilloma virus infections (genital warts) is unknown; however, it is estimated that nearly 12 million visits to private physicians offices occurred in 1984 for genital warts.
Public and Professional Awareness
In 1982, 66% of metropolitan school systems provided systematic instruction on sexually transmitted disease.
6.7% of single sexually active females aged 20-24, a group at high risk of contracting sexually transmitted diseases, used condoms as a method of birth control in 1982.
Rates of teenage venereal disease were noted to increase after implementation of legislation that decreased classroom education in veneral disease. The trend reversed when the legislation was rescinded.
Service Delivery
The U.S. Department of Health and Human Services allocated $73,136,900 in 1984 for sexually transmitted disease control, a 17% increase over the 1983 level of funding.
The total cost of PID and PID-associated ectopic pregnancy and infertility exceeded $2.6 billion in 1984.
In 1984, there were an estimated 10 million visits to private physicians for vaginitis and 1 million visits for male urethritis.
It is estimated that over 2.5 million outpatient visits for PID are made each year, and 267,200 hospitalizations for PID occur yearly.
Significant Trends
Gonorrhea
The 1984 gonorrhea rate of 374.8 cases/100,000 population is 2.4 times the 1964 rate of 159.0, but 12.5% lower than the 1974 rate of 428.2.
Penicillin-resistant gonorrhea was first noted in the U.S. in 1976 when 98 cases were reported. Since then infection due to penicillinase producing Neisseria gonorrhea increased to a high of 4,464 cases in 1982, then declined to 4,122 cases in 1984.
Syphilis
From 1964 to 1984 the rate of syphilis (all stages) declined by 50% from 60.4 to 29.8 per 100,000. However, the rates of primary and secondary syphilis for 1964 (12.1) and 1984 (12.2) remain the same.
Chlamydia
Chlamydial trachomatis is not a notifiable disease in this country; however, in England where nongonococcal urethritis is reportable and is caused by chlamydia in 50% of cases it is estimated that the incidence of chlamydial infections doubled in the 10 years from 1972 to 1982. Sentinel studies in this country show that chlamydia now accounts for 2.6 times as many endocervical infections and 1.4 times as many urethral infections as N. gonorrhea.
Pelvic Inflammatory Disease
Setween 1970 and 1977, the rates of PID among women aged 15-44 rose 33%, then declined slightly to level off at a rate that is 27% above the 1970 rate.
Genital Herpes
The number visits to private physicians’ offices for genital herpes infections nearly tripled in the ten years up to 1984, when 450,000 visits occurred.
Human Papilloma Virus
From 1965 to 1984, visits to private physicians’ offices for genital warts (caused by human papilloma virus) increased fivefold to nearly 12 million visits per year.
Special Issues
Chlamydia
Chlamydia trachomatis infection is the most common of all sexually transmitted diseases in the United States, causing approximately 4.65 million infections each year. Detection is difficult since 70% of females are assymptomatic and since no inexpensive diagnostic test is widely available. The CDC is recommending treatment of presumptive cases despite lack of confirmation of diagnosis, as well as screening of high-risk groups.
Asymptomatic Carriers of Infection
The spread of sexually transmitted disease is difficult to control since many carriers of infection have no symptoms. 70% of lower genital tract infections in women with Chlamydia trachomatis cause no symptoms. 30% of men and women with gonorrhea can be assymptomatic carriers. It is estimated that less than 25% of patients with genital herpes infections have symptoms. Preliminary results from one study suggest that 71% of cases of primary genital herpes were acquired from a partner who had no symptoms at the time of exposure.
Cervical Cancer
Cervical dysplasia or carcinoma-in-situ increases with increasing number of sexual partners and earlier age of first intercourse. The causal role of genital herpes and human papilloma virus to cervical cancer is under investigation.
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