Three types of condoms--one latex and two synthetic--had similar failure rates in a crossover study conducted in California, and overall, users had no preference among them.1 On most measures of acceptability, participants gave comparable ratings to a well-known latex condom and a new nonlatex one that has been approved by the Food and Drug Administration but is not yet commercially available. The exceptions were that men preferred the sensitivity afforded by the synthetic (42%) over that of the latex (15%), and they considered latex safer than the new material (43% vs. 18%). As the researchers observe, the development of new effective and acceptable condoms could lead to more consistent use of the method and would thereby represent a "major contribution to public health."
The study enrolled 54 couples aged 18-45 who were monogamous and were using condoms. At each of three visits to the study site, participants were given three condoms of a particular type: latex, polyurethane or a new synthetic (styrene ethylene butylene styrene). They were asked to use all three condoms of a given material before returning for the next set of condoms; the sequence of condom types was determined randomly. For each condom they used, couples were requested to complete a form that addressed the conditions of use, their impressions and any problems that occurred. Additional information was gathered in interviews during visits to the study site. A fourth visit, after couples had used each type of condom, included an interview that asked about their preferences among them.
The analyses are based on data from 51 couples who provided information on all three condom types. These couples were predominantly 25 or older (72%), married or living together (68%) and white (61%); 85% had more than a high school education. Four-fifths of couples said that they had used condoms together more than 50 times, and one-third said that they had had a condom break.
Couples reported having significantly more problems using polyurethane condoms than using latex or the new nonlatex ones. They were more likely to say that they had had difficulty donning polyurethane condoms (53%) than others (12-13%) and that polyurethane condoms had slipped during intercourse (17%, compared with 3-6% for the others). Additionally, polyurethane condoms were more likely to stretch out of shape or bunch up during sex (13-17%) than were condoms made of the other materials (3-8%).
Total failure rates ranged from 2% for the new condom to 7% for polyurethane condoms; the differences were not statistically significant. No more than 2% of any type of condom broke during intercourse, and no more than 3% slipped; 1% or fewer failed for other reasons (e.g., could not be unrolled).
When asked to rate several features of each type of condom on a scale of one (indicating "very unfavorable/worst") to 10 ("very favorable/best"), participants generally gave all three comparable ratings. However, men rated polyurethane condoms as significantly more difficult to put on (mean score, 4.6) than either of the other types (7.1-7.6), and they rated latex lower than polyurethane for smell (4.5 vs. 5.9). Women also gave polyurethane the lowest score for ease of donning (4.2, compared with 7.1-7.3 for the others); as regards smell, they gave both latex and the new synthetic lower ratings (4.9-5.0) than polyurethane (6.5). In addition, women gave polyurethane a higher score than latex for sensitivity (6.5 vs. 5.5).
Overall, roughly 25-35% of both men and women preferred each type of condom; differences between types were not statistically significant. Likewise, preferences regarding specific features of the condoms varied little by type. Men were more likely to favor the safety of latex (43%) over that of polyurethane (12%) or the new synthetic (18%). They preferred the new condom to latex for sensitivity (42% vs. 15%), and the new synthetic to polyurethane for noise during use (27% vs. 10%) and for fit (45% vs. 27%). Higher proportions of men preferred latex or the new synthetic for the ease with which the condom is unrolled (37-45%) than favored polyurethane for this feature (10%).
Among women, even fewer differences emerged. Like men, women were less likely to consider the polyurethane condom easy to unroll (6%) than they were to prefer the other types for this reason (32-42%). They favored latex over polyurethane for safety (35% vs. 14%) and considered the lubricant on both latex and new synthetic condoms less messy (29% each) than the lubricant coating the polyurethane condom (10%).
Given the "satisfactory performance of all three condom types," the researchers conclude that "condoms made of new materials can compete successfully with conventional latex condoms." In light of the need for nonallergenic condoms that are acceptable to potential users, the new synthetic condom that was assessed in this evaluation could be a valuable addition to the market.--D. Hollander
1. Frezieres RG and Walsh TL, Acceptability evaluation of a natural rubber latex, a polyurethane, and a new non-latex condom, Contraception, 2000, 61(6):369-377.