A new loose-fitting male latex condom and a standard straight-shaft condom have similar rates of breakage and slippage, according to results of a randomized crossover study. However, participants said that the baggy condom, which creates more friction for both partners, feels more natural during sex and makes intercourse more enjoyable than the conventional one. As the researchers observe, since many couples are reluctant to use condoms or do not use them consistently because they reduce pleasure during intercourse, the development of a more acceptable version could be a key factor in increasing use of the method.¹

Study participants were recruited at two university health centers in 1999. After completing an interview to provide baseline data, they were randomly assigned to use one type of condom and then the other. They were given five condoms of the first type and a log, or questionaire, for each, requesting detailed information about their experience with its use. After they had used the five condoms, they returned to the center to turn in the log, participate in a follow-up interview and receive a set of the second type of condoms and a log. A final interview took place when participants returned the log for the second set of condoms.

To be eligible, couples had to be mutually monogamous and using a nonbarrier method of contraception; they also had to have intercourse an average of five times a month. Couples were excluded if either partner was allergic to latex or had had a sexually transmitted disease in the past two years. The analyses are based on 102 couples (represented in interviews by one partner each) who followed the prescribed protocol, completed the logs and participated in all interviews; together, they used 510 condoms of each type.

On average, participants were in their early 30s and had had nearly 16 years of education; most (87% of men and 84% of women) were white and had a college or graduate degree (64% of men and 71% of women). Virtually all couples (96%) had used condoms at some time, although few (17%) had used them in the preceding 30 days. Thirty-seven percent had experienced condom breakage.

In all, participants reported that eight loose-fitting and six standard condoms broke. The resulting breakage rates were 1.6 and 1.2 per 100 uses, respectively; the difference was not statistically significant, and a fairly narrow confidence interval around the difference (ranging from -1.0% to 1.8%) supports the similarity of the two rates. Although the logs asked about when breakage occurred, the number of condoms that broke was too small for analysis.

Similarly, the number of times that condoms slipped (50 for baggy and 58 for standard condoms) yielded statistically indistinguishable rates of this event--9.8 and 11.4 per 100 uses, respectively. In most cases, condoms slipped less than an inch; rates of more severe slippage, including instances when the condom slipped completely off the penis, were therefore much lower than overall rates--2.2 per 100 uses for the baggy condom and 3.5 per 100 for the conventional one. Again, the difference between rates was not statistically significant, and the confidence interval was small (-5.4% to 2.2%).

Of the 10 couples who had a condom break, only one reported multiple breakages. By contrast, 26 of the 45 couples who experienced slippage said that this occurred more than once. Participants reported more clustering of slippage with standard condoms than with loose-fitting ones, but 16 couples experienced slippage with both condom types. Logistic regression analyses that took into account the correlation of breakage and slippage within couples confirmed that these events were not associated with the type of condom used.

Finally, the researchers asked participants to rate the relative acceptability of the two types of condom with respect to nine features. The responses showed that couples considered the baggy condom to have an advantage in four areas: It makes sex more enjoyable, feels more natural during intercourse, is easier to keep on during sex and is not as disruptive during intercourse as the standard condom. Couples gave both condoms comparable ratings on the remaining features (how easy the condom is to learn to use, to put on and to remove, messiness and the sense of safety the condom imparts).

Commenting on their findings, the researchers note that the study design and a high level of compliance with the protocol lend "high credibility" to the comparisons of breakage and slippage rates between the two types of condoms. Furthermore, they suggest that the higher acceptability ratings that participants gave to the baggy condom may mean that couples will find it easier to use for long periods than the standard condom. This, in turn, is "likely to lead to higher typical use efficacy, even if the failure rates of the new condom are similar to those of other condoms."--D. Hollander

REFERENCE

1. Macaluso M et al., Safety and acceptability of a baggy latex condom, Contraception, 2000, 61(3):217-223.