Condoms and Contraceptives: Are they effective?

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Condoms and Contraceptives: Are they effective?

Contraceptives have been touted as the optimal protection against unintended pregnancies. Some methods of contraception, especially barrier methods such as the male condom, have also been promoted as a protective device against sexually transmitted infections (STIs). Unfortunately, because contraceptives (hormonal or barrier) are not 100% effective, they cannot provide absolute protection against either pregnancy or STIs.

Condom effectiveness is the reduction in pregnancy or disease that is attributable to the use of male condoms. For example, the estimated risk reduction offered by consistent condom use for human papillomavirus (HPV) infection is only at best 70%,¹ and for HIV, 80%.² Risk reduction estimates for the more common STIs, gonorrhea and chlamydia, are even lower – at 50%.^3-5 Several studies show that condoms can partially reduce the risk of most STIs and pregnancy if used each and every time, but they cannot altogether eliminate the risk of STIs and pregnancy.^5,6

Even with 100% use, condoms do not completely eliminate the risk of STIs or pregnancy. Furthermore, inconsistent use appears to be the common practice among condom users, especially adolescents. Reported consistent condom use by adolescent females is only about 50%^8,9 and by adolescent males, 63%.⁸ Very few individuals manage to continue consistent and correct use for any period of time. Even in couples in which one partner is known to be infected with HIV, consistent use is reported by only about half.¹⁰

Besides consistent use, effectiveness rates of condoms also depend on correct use, i.e., user and method failure. Condom slippage and breakage rates range from 1-6%.^5-7 In a study that evaluated method failure (failures over which the user has no control), about 2 in 10 men reported their condom had broken or slipped off during use.¹¹

Other available methods of contraception also show less than perfect effectiveness for pregnancy prevention and offer limited risk reduction for STIs. Cervical cap, that is inserted as a mechanical barrier to sperm, has a failure rate in the range of 16%-32%.¹² About one in five women who use the female condom become pregnant in the first year of use.¹² The typical use failure rate for the diaphragm is 16%,¹² and for spermicides, 29%.¹² A common spermicide, Nonoxynol-9 may even increase the risk of HIV transmission in women.¹² About 8% of women become pregnant in the first year while on the pill.¹³ Teens are however, far more likely to get pregnant while using any contraceptive method; with a 25% greater risk of pregnancy than in adult women.¹⁴ Eleven percent of women using emergency contraception (Plan B) become pregnant in the first year of use.¹⁵

These data reinforce the fact that absolute protection from condoms and contraceptives against pregnancy and STIs is a myth. Risk avoidance (abstaining from sexual intercourse) until in a long term mutually monogamous relationship with an uninfected partner still remains the only 100% effective means of eliminating the risk of STIs and pregnancy.

References:

1. Winer RL, Hughes JP, Feng Q et al. Condom use and the risk of genital human papillomavirus infection in young women. N Engl J Med. 2006; 354(25):2645-2654.

2. Weller SC, Davis-Beaty K. Condom effectiveness in reducing heterosexual HIV transmission. Cochrane Database of Systematic Reviews 2007, Issue 4. Art. No.: CD003255.

3. Ahmed S, Lutalo T, Wawer M, et al. HIV incidence and sexually transmitted disease prevalence associated with condom use: a population study in Rakai, Uganda. AIDS. 2001; 15(16):2171-2179.

4. Warner L, Stone KM, Macaluso M, Buehler JW, Austin HD. Condom use and risk of gonorrhea and chlamydia: A systematic review of design and measurement factors assessed in epidemiologic studies. Sex Transm Dis 2006; 33(1):36-51.

5. National Institutes of Health. Workshop Summary: Scientific Evidence on Condom Effectiveness for Sexually Transmitted Disease Prevention. Bethesda, MD: National Institutes of Health, US Dept of Health and Human Services; 2001. Available at: http://www.niaid.nih.gov/about/organization/dmid/Documents/condomreport.pdf. Accessed May 18, 2011.

6. Steiner MJ, Dominik R, Rountree RW, Nanda K, Dorflinger LJ. Contraceptive effectiveness of a polyurethane condom and a latex condom: a randomized controlled trial. Obstet Gynecol. 2003; 101(3):539-547.

7. Warner L, Steiner MJ. Male condoms. In: Hatcher RA, Trussell J, Nelson AL, Cates W, Jr., Stewart FH, Kowal D, eds. Contraceptive Technology. New York, NY: Ardent Media, Inc; 2007:297-316.

8. Crosby RA, DiClemente RJ, Wingood GM, Lang D, Harrington KF. Value of consistent condom use: A study of sexually transmitted disease prevention among African American adolescent females. Am J Public Health. 2003; 93(6):901-902.

9. Manlove J, Ryan S, Franzetta K. Contraceptive use and consistency in U.S teenagers’ most recent sexual relationships. Perspect Sex Rep Health. 2004; 36(6):265–275.

10. Buchacz K, van der Straten A, Saul J, Shiboski SC, Gomez CA, Padian N. Sociodemographic, behavioral, and clinical correlates of inconsistent condom use in HIV-serodiscordant heterosexual couples. J Acquir Immune Defic Syndr. 2001; 28:289–297.

11. Crosby R, Yarber WL, Sanders SA, Graham CA, Arno JN. Slips, breaks and ‘falls’: condom errors and problems reported by men attending an STD clinic. Int J STD AIDS. 2008; 19:90–93.

12. Cates W, Raymond EG. Vaginal Barriers and Spermicides. In: Hatcher RA, Trussell J, Stewart F, et al, eds. Contraceptive Technology. 19th rev. ed. New York, NY: Ardent Media; 2007:317-335.

13. Nelson AL.. Combined Oral Contraceptives. In:Hatcher RA, Trussell J, Stewart F, et al, eds. Contraceptive Technology. 19th rev. ed. New York, NY: Ardent Media; 2007:193-270.

14. Blanc AK, Tsui AO, Croft TN, Trevitt JL. Patterns and trends in adolescents’ contraceptive use and discontinuation in developing countries and comparisons with adult women. Int Perspect Sex Reprod Health 2009; 35(2):63-71.

15. Stewart F, Trussell J, Van Look PFA. Emergency contraception. In: Hatcher RA, Trussell J, Stewart F, et al, eds. Contraceptive Technology. 19th rev. ed. New York, NY: Ardent Media; 2007:87-116.

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