Background and objectives: Mechanical failure may reduce the efficacy of condoms. Little is known about frequency and determinants of condom failure in groups at high risk of sexually transmitted diseases (STD).
Goal: To measure condom breakage and slippage rates and evaluate potential determinants of failure among women attending a public STD clinic.
Study design: Women attending an STD clinic participated in a 6-month prospective study of barrier contraception for the prevention of STD. They completed sexual diaries that were reviewed at monthly follow-up visits. No data were collected from the male partners. Baseline characteristics of the participants and time-dependent behaviors were evaluated as potential determinants of condom failure.
Results: Of 21,852 condoms used by 892 women, 500 broke during intercourse (2.3%) and 290 slipped (1.3%). Breakage was more common among young, black, single nulliparae who engaged in high-risk behavior. Slippage was more common among married women with children. Failure rates decreased with condom use, with coital frequency, and with use of spermicides.
Conclusion: User characteristics and experience are determinants of breakage and slippage, which are often regarded only as the effect of product design flaws. Attention to modifiable determinants of failure may improve user counseling and product labeling.
PIP: This paper presents information obtained from a large prospective study of a cohort of women at high risk who used condoms for protection against sexually transmitted diseases (STDs). The objectives of the study were to measure condom breakage and slippage rates, and to examine the possible determinants of failure. The participants were women aged 18-34 years who attended an STD clinic 6 months prior to the study. They were asked to record information about all sexual activities and barriers used in a sexual diary, which was then reviewed in a monthly follow-up visit. A total of 21,852 condoms were used by 892 women, of which 500 broke during intercourse (2.3%) and 290 slipped off (1.3%). Breakage was more common among young, Black, single nulliparas who engaged in high-risk behavior. The failure rate decreased with condom use, with coital frequency, and with use of spermicides. In conclusion, condom breakage and slippage were generally low in women at high risk for STDs. Both indices of condom failure decreased significantly with increasing condom use during the study, and both were associated with specific user characteristics.