August 11, 2011

Condoms are one of the oldest forms of contraception and the best recognized forms of protection against sexually transmitted infections (STIs), including human immunodeficiency virus (HIV). The continued high prevalence of STIs has resulted in a substantial increase in condom use over the past decades. The 1995 report from the National Survey of Family Growth (NSFG), a survey of women 15-44 years of age, found that condom use at first intercourse increased from 18% in the 1970s to 36% in the late 1980s to 54% in the 1990s. The NSFG noted that 7.9 million women, 15-44 years of age, use condoms for pregnancy prevention and an additional 4.2 million women use condoms for protection from STIs. Research indicates that about a third of women have partners who use condoms consistently, a third use condoms occasionally, and a third never use condoms for protection against STIs. Understanding factors associated with noncondom use is essential for the design of effective condom promotion efforts.

Considerable research has examined factors that are associated with the use and nonuse of condoms. Several studies have demonstrated an association between nonuse of condoms and having personal attitudes and beliefs that were not supportive of safer sex, consuming alcohol, using noninjection drugs, being unemployed, and having a limited education. Numerous studies have examined relational barriers associated with condom nonuse. Having poor communication skills, having an older male partner, a male partner who abuses drugs or alcohol, or is abusive significantly increase women’s risk of STIs. Research has also demonstrated that condom use is dependent on women’s relationship status. Specifically, women in committed relationships are significantly less likely to use condoms compared with women in casual or new relationships. These studies highlighted that women’s risk for HIV is largely attributed to the attitudes and behaviors of their male partner.

An estimated 1-3% of the general population is allergic to latex, the material from which condoms are traditionally made. To address complaints regarding allergies to latex and decreased sexual enjoyment from use of latex condoms, a male condom made of polyurethane was developed. Polyurethane is a strong, impermeable material with good heat transfer that is less susceptible to deterioration during storage than latex. Subjectively, users express greater preference for the polyurethane condom over latex in regard to appearance, lack of smell, comfort, sensitivity, and natural look and feel. If preference translates to greater use, the male polyurethane condom may address important barriers that have been linked with nonuse of condoms.

A novel development in condoms is the female condom. The Reality female condom was approved by the Food and Drug Administration (FDA) in 1993 as a method to protect against unplanned pregnancy and STIs, including HIV. The Reality female condom is a silicon-lubricated, intravaginal barrier consisting of a soft, loose-fitting polyurethane sheath with a flexible ring at each end. The device is inserted similar to a diaphragm, the inner ring is compressed and is pushed into the vaginal cavity. The external ring and 1-2 inches of the sheath remain outside the vagina, partially covering the labia. Although the female condom requires male cooperation, it does not require male initiative. Notable features of the female condom are: (a) the fact that women can place it autonomously and can trust that it is not torn or taken off by the male partner, (b) the high level of protection it can afford when used correctly, and (c) the increased sexual pleasure it affords women. Since the outer ring of the female condom partially covers the external genitalia, the female condom may be particularly beneficial in preventing infections. Unlike the male condom, women are more likely to use the female condom with a steady partner, compared to a new or casual partner. The less desirable features of the female condom are: (a) the need to touch one’s genitalia to insert the female condom, (b) the need to practice insertion and to use the device several times before mastering it, (c) the fact that it can be seen by the partner, (d) the disagreeable look of the device, (e) the occurrence of vaginal bleeding (nonmenstrual), (f) the discomfort as experienced by the male and/or female partner, and (g) the noise made by the female condom. Moreover, female condoms cost about $2.75 each in the U.S. retail stores and $0.63 for the public sector. By comparison, the wholesale price per male condom is $0.04.

Significant research has been conducted to examine the effectiveness of condom promotion efforts for women. These programs often emphasize enhancing women’s sexual communication skills, promoting attitudes that are supportive of condom use, enhancing healthy relationship norms, mastering condom application skills, and identifying triggers that make using condoms challenging. However, maximally effective condom use promotion programs need to go beyond enhancing women’s attitudes, intentions, and skills, and foster change in social structures or policies that affect condom use practice as an innovative method of reducing women’s risk of unplanned pregnancy and STIs, including HIV.

SEE ALSO: Acquired immunodeficiency syndrome, Birth control, Lubricants, Safer sex, Sexually transmitted diseases


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