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Everything you need to know about condoms

Stuart Dimaline
NHS Business Development Manager
Pasanté Healthcare
Shoreham-by-Sea West Sussex
Stuart worked for Durex for 12 years in the NHS and retail sector, and has worked for Pasanté for three years
E:stuart@pasante.com

Condoms are as popular as ever, particularly in light of government statistics(*) on unplanned pregnancies and sexually transmitted infections (STIs). This is not surprising as they are the only method of contraception that also offers protection against infections. Although condoms are widely available in the NHS from family planning and genitourinary clinics, distribution in general practice is very patchy.

*Figures from Public Health Services Laboratory, Aug 2001.

Condoms are one of the barrier methods of contraception (along with the diaphragm, for instance). One advantage of barrier methods is that they are nonsystemic and have few side-effects. The condom acts as a physical barrier, and when placed over the erect penis, prevents the sperm from reaching the egg. Condoms are widely available on the high street and do not require a prescription or a potentially embarrassing appointment with a health professional.

You may think that condoms are a relatively new phenomena, but as "A brief history of the condom" shows, they have been around for longer than you think, and have come a long way since the use of silk and sheepgut sheaths.

Shapes, sizes and flavours
Condoms come in many shapes and sizes. A report published in the International Journal of STDs & AIDS showed that differences in condom shape seem to influence both men's and women's preferences.(1) It recommended that in order to encourage consistent use of condoms (vital for good efficacy), new and reluctant users should be encouraged to try a range of types to find one suitable.

Figure 1 is a shape and size chart showing some of the different shapes and sizes available in the UK. The average size of latex condoms in the UK is 104mm in circumference and 180mm in length. The female condom is wider and is designed to be inserted into the vagina to act as a barrier.

[[NIP09_fig1_21]]

Condoms can also come in different flavours and colours, neither of which  affect the efficacy. Provided that they carry a CE Mark and, preferably, also a British Standards Institution (BSI) Kitemark (see overleaf), they are suitable for ­penetrative use.

Condoms can be made of different materials, other than the traditional latex: for example, polyurethane (Durex Avanti, Pasanté eZon and the female condom). Polyurethane condoms are usually thinner and more sensitive than latex equivalents, and also offer an alternative to anyone who may be sensitive or have an allergy to latex.

Some people may be sensitive to nonoxynol-9, which is the spermicide used on most condoms in the UK. In this case they should be offered an alternative condom that does not have a spermicide.
 
Condom failures/problems
Used correctly, condoms offer a contraceptive efficacy rate of 98%. Condoms rarely fail, but it can happen sometimes. These are the most common reasons for condom failure (not in any particular order):

  • No form of protection used, but condom failure given as a "face-saving" reason when presenting at a clinic for emergency contraception.
  • The condom was put on inside out.
  • An oil-based lubricant was used.
  • The condom was out of date or incorrectly stored.
  • No lubrication used.
  • Damage by sharp object such as ring or ­fingernail.
  • The condom was an inappropriate size or shape, which caused slippage or an uncomfortable fit.
  • Body piercings caused it to rip.

The best way to avoid any of the above is for users to be given a correct demonstration of how to use a condom, and also information on which lubrication products may cause damage (Pasanté Healthcare produces a leaflet detailing which lubricants are safe to use - see Resources).

New products
Various products using materials other than latex are under development, and there is also work underway on a "spray-on" condom.

Recently, two types of condom have been launched by Safex and Durex that are designed to help prevent premature ejaculation. They contain benzocaine in the lubricant, which numbs sensation in the penis.

References

  1. Garside R. Condom shape: a neglected factor influencing use and acceptability? Int J STD AIDS 1999;10:785-90.
  2. National Survey of Sexual Attitudes and Lifestyles. Lancet 2001;358:1.

Resources
Ansell International
Manufactures numerous ­healthcare barrier protection ­products, ­including Mates condoms
W:www.ansell.com

Durex
Website provides information, ­products, ­questions ­regarding condoms, and health information
W:www.durex.com

Pasanté Healthcare Offers an extensive range of CE and Kitemarked condoms plus other related sexual healthcare products and resources. Also produces a "How to use a condom" leaflet in A4 and A3 poster size, and a leaflet/ poster on which products ­(including medicines and everyday items) may damage latex condoms
W:www.pasante.com

Useful contacts
Sexwise Advice about sex, relationships and contraception for the under-18s
T:0800 282930
W:www.ruthinking. co.uk

Family Planning Association
A nationwide ­information ­service supplying material ­concerning all methods of contraception
T:020 7837 4044
Mon-Fri 9am-7pm

Genitourinary ­clinics
W:www.shastd.org.uk