Condoms Reduced female condom failure rates, South Africa A randomised, crossover study among 170 women in Durban, South Africa, assessed preference, safety, acceptability and function of three new female condoms (WC, FC2 and V-Amour) over time. The study was conducted between March 2007 and April 2008, with women recruited from a family planning clinic where male and female condoms are available at no cost. It measured whether, and to what extent, women using the condoms had decreasing failure rates over time. Women were given five condoms of the same type to use over a three-week period, one sexual act per condom. On return to the clinic, they were then assigned a second condom type for the same use and then the third condom type after that. Women were randomly assigned the three different condom types in different order. Of the 2,411 condoms used during intercourse, 96 failures (breakage, slippage and misdirection) occurred in 86 condoms (77 condoms had one failure, eight had two failures, one had three failures), comparable across condom types. Failure rates decreased markedly after use of the first five condoms (7% failure rate), regardless of condom type. Failure rates stabilised at second (2.6%) and third condom use periods (2.1%). Female condom trials should consider the number of condoms used to ensure that failure rates are not inflated by limiting the numbers of condoms used by novices.1 1. Beksinska M, Smit J, Joanis C, et al. Practice makes perfect: reduction in female condom failures and user problems with short-term experience in a randomized trial. Contraception 2012;86(2):127–31.
Masculinities and condom use, South Africa A survey of 1,219 men aged 15–26 years in rural Eastern Cape, South Africa, explored whether gender and relationship constructs are associated with condom use. Analysis of condom use patterns assessed the factors associated with inconsistent, consistent and non-condom use. Nearly half (47.7%) of men never used condoms, 36.9% had used them inconsistently and 15.4% had used them consistently with any partner in the past year. There was a link between condom use patterns and attitudes to 228
gender relations. Inconsistent users were most physically or sexually violent and sexually risky. Those who never used them had more conservative gender attitudes, but were less violent and sexually risky. Consistent users were less conservative, less violent and less sexually risky, with notably fewer sexual partners than inconsistent users.1 1. Shai NJ, Jewkes R, Nduna M, et al. Masculinities and condom use patterns among young rural South Africa men: a cross-sectional baseline survey. BMC Public Health 2012;12:462.
Influence of condom type on sexual behaviour and ejaculation A secondary data analysis of a randomized crossover trial of male and female condoms among 108 couples from Alabama, US, evaluated whether possible mediators of condom effectiveness differed between uses of the female condom and male condom. Condom failures were measured with self-reports of malfunctions and measurement of semen exposure, detected in post-coital vaginal swabs. Selfreported duration and activeness of coital acts were significantly different for uses of the male condom, compared to uses of the female condom. Fewer individuals reported ejaculation occurring with the female condom. However, self-reports of whether ejaculation had occurred or not often did not tally with the absence or presence of markers of semen detected inside used male and female condoms. Acts in which the male condom was used were associated with more ejaculation (based on either selfreports or biological evidence of semen in the used condom), very active intercourse, multiple changes in position, less use of extra lubrication and longer coital duration than acts in which the female condom was used. Studies should consider sexual behaviour when evaluating condom effectiveness and would be strengthened by the use of a biological marker of semen to determine whether ejaculation, and therefore a true risk of exposure, occurred.1 1. Haddad L, Gallo MF, Jamieson DJ, et al. Condom type may influence sexual behavior and ejaculation and complicate the assessment of condom functionality. Contraception 2012;86(4):391–6.