https://doi.org/10.33698/NRF0218 – Hemant Kumar, Karobi Das, Avinash Kaur Rana, Dipankar De, P.K. Saha
Abstract : Background: Though many methods of prevention of unintended pregnancy, sexually transmitted infections (STIs) and Human Immunodeficiency Virus (HIV) are available, condoms remain of utmost importance. It is most popular forms of mechanical barriers as it provides protection by preventing exchange of body fluids. Objective: To determine the prevalence of factual errors among sexually active men Methodology : Quasi experimental study was conducted on 102 sexually active men, mean age of group 29.23±3.5 ranged 20-41 years to assess the prevalence of factual errors. Data was collected by interviewing than between July to September, 2016 at Family Planning (FP) and Sexually Transmitted Infection (STI) clinics of PGIMER, Chandigarh. Results: Although majority of respondents had heard of and/ or knew about the purposes of condoms, around 60% of participants had adequate information regarding condom use. Despite good knowledge 54.9% subjects reported errors (breakage, slippage, or both). However, 29.4% participant successfully pinched the reservoir tip during condom application. The study confirmed that knowledge only is not enough to bring change in practices. It was reported that 90.2% subjects had easy access to condom while 78.4% had used condoms. The results depict that prevalence of condom use errors in present study was 54.9%. Conclusion:- The current study shows that the majority of subjects (90%) knew the purpose of condom. Incorrect condom use is frequent among sexually active men and this may translate into substantial number of unintended pregnancies, STIs and HIV transmission. Hence, the educative session regarding practices must be considered in the promotional strategies to get the best out of this dual protection method.
Keywords
Condom, factual errors, breakage, slippage
Correspondence at
Dr. Karobi Das
Lecturer
National Institute of Nursing Education (NINE), PGIMER, Chandigarh
PIN-160012
Introduction
The male condom is probably the most widely used mechanical contraceptive in the world today. When used consistently and correctly, male condoms are 98% effective in preventing pregnancy but with typical use (which includes incorrect and inconsistent use) the failure rate is 18%.1 Unwanted pregnancy, sexually transmitted diseases (STDs) and their adverse health consequences are widespread public health problems worldwide.2
Evidence from literature suggests that errors may commonly occur when male condoms are used. Common user errors reported were failure to leave space at the tip of the condom, breakage, slippage and putting the condom on the wrong side (Inside out). Several studies have assessed whether adults use condom correctly, but limited researchers assessed condom use errors among rural adults. Unintended pregnancies, sexually transmitted infections (STIs) and HIV represents substantial problems throughout India. The use of condoms has been an important and successful intervention for sexually active people.3 An estimated 44 million couples STIs, HIV and unintended pregnancies. They also offer protection in scenarios when alternate sexual practices are adapted. Typical use (both incorrect and inconsistent use) of the male condom has a failure rate of approximately 14%. Efficacy is 97% with perfect use (correct and consistent use) and 86% with typical use. Graphene and Nano lubricated condoms are new in the market and others in futuristic approach may include wearable technology/Technology driven condom and invisible Condoms. Both Correct and Consistent use of condoms needs to be promoted to prevent unwanted pregnancies, STIs and HIV. Hence, the educative session regarding practices must be considered in the promotional strategies to get best out of this dual protection method.5 worldwide use condom for family planning while as many as 50% of all condoms are used to prevent cross infections. The effectiveness of condom in preventing pregnancies or STIs depends on the users. Literature revealed that pregnancy rate among correct condom users is about 2% per year. The risk of pregnancy or STI is greater when condoms are not used correctly and consistently with every sexual act. However, when it’s used every time and in the approved manner it could prevent up to 80 to 95% of HIV/STIs transmission.4
There is a long way from the oiled silk paper used by the Chinese and the hard sheaths made of tortoise- shell used by the Japanese to the latex condoms of today. The breakthrough came when the rubber vulcanization process was invented by Charles Goodyear and eventually the first rubber condom was made. The condom offers maximum protection (>90%) against
The failure of all condoms is due to imperfections of manufacturer (about 3 per 1000); and errors in technique. The centre for disease control and prevention provide instructions for correct use of condom. A new condom should be used with each act of sexual intercourse, careful handling to avoid damaging it with fingernails, teeth or other sharp object, condoms should be put on after the penis is erect and before any genital contact with the partner, it should be ensured that no air is trapped in the tip of the condom.6 Laboratory studies have demonstrated that latex and polyurethrane condoms provide the best available protection against many STIs, including HIV. Effective condom use is recommended for people who engage in sex with multiple sexual partners hence, condom use is highly recommended and encouraged. The major risk that they face places more responsibility on men to ensure that condoms are used appropriately and effectively. The effectiveness of condoms is based on the fact that they provide a more direct protection to both partners. The emphasis on condom use is based on its practicability and its reported effectiveness in providing protection against STIs, unwanted pregnancies including HIV.7
Observational and prospective studies have estimated failure rates at 1%–13% during condom use.8 Condom failure is likely to occur in situations of poor condom fit, rough, lengthy or intense intercourse, or if the condom comes in contact with sharp edges object.9 Higher rates of condom failure are identified among less- experienced users.10 Additional advantages of condoms as birth control include low cost, easy access, simple disposal, its non-systemic action and minimal side effects, non-interference with breastfeeding. It can also enhance sexual pleasure by reducing anxieties about the risk of sexually transmissible infections and pregnancy.11
Regular use of condom can prevent unwanted pregnancies and sexually transmitted infections among sexually active population. There are a substantial proportion of men who do not know how to use condoms correctly and are at risk of condom failure (error). If these factual errors and reasons for it are identified, it will be easy to educate men on the correct usage of condom.
Objective
To determine the prevalence of factual errors among sexually active men.
Method
Quantitative research study was conducted at Family Planning & STI Clinics of a tertiary care hospital of North India. Ethical approval was obtained from Institute Ethics Committee, PGIMER, Chandigarh and written permission was taken from Head Department of Obstetrics & Gynecology and Dermatology for conducting the present study. One hundred and two sexually active men were recruited through purposive sampling technique. Tool used for data collection was interview schedule that comprised of (A) socio demographic variables, (B) sexual behaviour of participants (C) Factual errors during condom use. After detail explanation an informed written consent was obtained. They had been informed that the participation in the study is completely voluntary that they had right to interrupt the interview or not to participate in the study at any stage. Data was collected through the face to face interview method from each subject from July-September, 2016. Data was entered in the Microsoft excel sheet and explored with statistical package for social sciences (SPSS version 16.0 Inc,IL) for analysis. Descriptive and inferential statistics was applied on the data.
Results
Table:1 summarized socio demo graphic data of the subjects. Among the 102 participants more than 61% were in the age group of 20-30 years. Majority of participants were Hindus (70.5%), literate (95.2), and out of them, more than sixty percentages of were educated up to 10+2 and 31.3% were graduate and above, 91% were married. Three fourth of participants belonged from joint families and 66.6% of them were from rural background. More than half (53.9%) participants had less than Rs. 5000/- rupees per capita income.
Table: 1 Socio demographic profile of subjects.
N=102
Factual errors
Table:2 It was observed that 83.3% subjects used condom in last three months and 86% admitted easy accessibility. Factual errors were reported by 60% of men which included breakage (37.2%) i.e. condom is open or split any time from opening the package to removing the condom from the penis. Another reported error was slippage (17.6%) i.e. partial or complete fall-off of a condom from a penis. Few subjects reported unwanted pregnancies (05.8%) these include both undesired and mistimed pregnancies.
|
Table:-2 Factual errors in condom use reported by subjects.
N=102
| Errors | n (%) |
| Breakage | 38 (37.2) |
| Slippage | 18 (17.6) |
| Unwanted pregnancies | 06 (05.8) |
| Total errors | 62 (60.7) |
Table: 3 Depicts the sexual behavior of subjects. It was observed that two third of participants were recruited from family planning clinic and 31.3% from STI clinic.Among them 17.6% of subjects admitted that they had multiple sexual partners.
Table: 3 Sexual behaviors of subjects
N=102
| Variables | n (%) |
| Clinics | |
| Family planning | 70 (68.6) |
| Sexually Transmitted Infections | 32 (31.3) |
| No. Sexual partner | |
| One | 84 (82.3) |
| Multiple | 18 (17.6) |
Table: 4 Higher percentages of subjects having multiple partners and the subjects attending STI clinic has reported high prevalence of factual errors (breakage & slippage) as compared to their counterparts. Though the difference was statistically not significant. Significantly higher percentage of subjects having single partner reported unwanted pregnancy as compare to subjects having multiple partners. No subjects attending STI clinic reported unwanted pregnancy.
Table: 4 Reported numbers of factual errors from subjects N
(N=132)
| Variables | No. of sexual partners
One Multiple |
z2 df p | Clinics
Family Planning |
STIs |
z2 df p | |
| Breakage | 3.13 | 0.22 | ||||
| Yes | 28 (33.3) | 10(55.5) | 1 | 25(35.7) | 13(40.6) | 1 |
| No | 56(66.6) | 08(44.4) | 0.07 | 45(64.2) | 19(59.3) | 0.63 |
| Slippage | 1.54 | 1.73 | ||||
| Yes | 13(15.4) | 05(27.7) | 1 | 10(14.2) | 08(25.0) | 1 |
| No | 71(84.5) | 13(72.2) | 0.21 | 60(85.7) | 24(75.0) | 0.18 |
| Unwanted pregnancies | 5.8 † | 1.08 # | ||||
| Yes | 05(05.9) | 01(05.5) | 1 | 06(08.3) | — | 1 |
| No | 79(94.0) | 17(94.4) | 0.01* | 64(91.4) | 32(31.3) | 0.29 |
† Yete correction# Fisher exact*Significant
Discussion
India ranks second populous country in the world after China. The literature suggests that incidence of condom failure are worldwide (1-13%) whereas it’s almost double in developing countries. Condom has been found to be most commonly used method and have negligible side effects with fairly good success rate. It is easy to use and not only prevents unwanted pregnancies, but protects against risk of cross infection of practice of correct and consistent condom use among sexually active men.
This study shows high prevalence of factual errors (60.7%) i.e. condom breakage (37.2%) slippage (17.6%) and unwanted pregnancies (05.8%) among sexually active men attending family planning and STIs clinics at PGIMER, Chandigarh. A study conducted in China reported similar prevalence of condom slippage (36.2%) and higher prevalence of condom breakage sexually transmitted diseases in people (34%).13
Another study by crosby et al. indulging in sexual act.12 It is well known fact that correct condom use are of utmost importance for preventing unwanted pregnancy and sexually transmitted infections. Therefore, general awareness about the factual errors is necessary to concluded that 35% of study subjects reported breakage or slippage during sex.14 A recent systematic review investigated the prevalence of condom use errors and found that there is a variety of ways in which condoms are being used incorrectly and the prevalence of factual errors is surprisingly high.(Breakage – 11% to 41%,Slippage – 13% to 19%) present study results were also consistent with this systematic review as high level of factual errors reported by participants.15
Henshaw et al. revealed that the percentage of unwanted pregnancies were the result of condom failure ranges from 8- 22% unwanted pregnancies and abortions have grave consequences for women, families and nation as a whole.16 It was found in present study that incidences of unwanted pregnancies were lesser (05.8%) in numbers. Although the prevalence of condom use errors varies in literature, but there is a fundamental understanding that a condom use factual error remains a threat against STIs and HIV preventive efforts. Factual errors increase the risk of exchange of body fluids among condom users. Unfortunately, condom failure always coexists with condom usage, misuse and condom use factual errors. The findings of this study revealed that condom breakage and slippage (condom failure) is common among sexually active men. According to a study conducted by Crosby et al, high levels of condom failure reported (41.3%) among condom users.17
Another study by Crosby et al. observed that 15% condom user men reported breakage, 08% encountered slippage during withdrawal, and 07% during sex. Findings of current study reported high number of factual errors where 60.7% subjects reported condom use factual errors of different kinds. Majority of men indicated that they had ever been taught how to use condoms.18 In study conducted by Warner et al. Findings suggests that the factual errors such as breakage and slippage were associated with deficient knowledge, experience and inappropriate use of lubricants. The present study revealed that 39.2% of subjects admitted that they had used non water based lubricants due to ignorance might caused factual errors.19
The current study revealed high prevalence of condom use errors among the study population. In addition, condom use skills of sexually active men should be addressed and this is most optimally done through a combination of demonstration and practice. Therefore, health professionals need to use advanced educative technologies to reach positive outcome and to develop personal skills of handling this contraceptive and preventive method of sexually transmitted Infections (STIs).
In addition sincere efforts such as periodic condom promotional activities should be done at family planning, STI clinics and ICTCs to emphasis consistent and correct use of condoms among users. Men should be made to understand that they might be creating serious risk for self as well as partner, hence there is need to use condom for each sexual act, educative sessions regarding practices must be considered in the promotional strategies to get best out of this dual protection method, the key message is habit of correct condom use must be acquired irrespective of the partner. Further study may be replicated on larger population and couples.
References
- ACOG Barrier methods of contraception 2011 [Retrieved June 2017]. Available at https://www.acog.org
- Public Health Service Progress Review (2005). Sexually transmitted diseases: US department of health and human services. [Cited on 8 July 17] Available at http://www.hhs.gov/review,STIs
- Technical Issue Condom Use: how it relates to hiv and sti prevention. The U.S. Agency for International Development .September 2013 [cited 2 0 1 5 O c t 2 2 ] A v a i l a b l e f r o m . https://www.usaid.gov/sites/default/files/documen ts Condom STI Issue brief. Pdf
- USAIDS, Family planning a global handbook for providers. 2014:202-10. [Cited on 10 July 17] R e t r i e v e d f r o m www.who.int./reproductivehealth/public
- Lewis MA. Brief history of condoms. In Mindel Condoms. London. 2000 BMJ: 1-16.
- Centre for Disease Control and Guidelines for treatment of sexually transmitted diseases. MMWR 1998 ;(471): 1-116.
- Kamal N. Huda Determinants of condom use in India 2009.[Cited on 8 Aug 17] Retrieved From.http://centers.iub,edu.bd.
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- Trussell Contraceptive failure in the United States Contraception 2011; 83(5): 397-404
- Sanders S, Yarber W, Kaufman E, Crosby R, Graham C, Milhausen Condom use errors and problems: A global view. Sex Health. 2012;9(1):81-86.
- Choi S, Chen KL, Jiang ZQ. Client-perpetuated violence and condom failure among female sex workers in Southwestern China. Sex Transm Dis. 2008;35(2):141-147.
- Sanders SA, Yarber WL, Kaufman EL, Crosby RA, Graham CA, Milhausen Condom use errors and problems: a global view. Sexual Health. 2012 Feb 17;9(1):81–95.
- Steiner M, Piedrahita C, Glover L, Joanis C. Can Condom Users Likely to Experience Condom Failure Be Identified?. Family Planning Perspectives. 1993;25(5):220-226.
- Henshaw SK, Singh S, Haas The Incidence of unintended pregnancy Worldwide. International Family Planning Perspectives, 1999, 25(Supplement):S30–S38
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- CArronsobJyNR. ,SYliparsb, ebrreWakLs, aSnadnd′fearlsls′S: AC,onGdroahmamerrCoArs, and problems reported by men attending an STD Int J STD AIDS 2008;19:90-93.
- Warner L, Newman DR, Kamb ML, Fisbein M, Douglas JM, Zenilman J et al. Problems with condom use among patients attending sexually transmitted disease clinics: prevalence predictors and relation to incident gonorrhea and Am J Epidemiol 2008; 167 (3):341-349