Consumer Reports: How Reliable Are Condoms?

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This report looks at the reliability of condoms, and includes Ratings, recommendations, and sections on using condoms wisely, contraception and disease protection, condom failure, and two nonlatex options.


CONSUMER REPORTS RATINGS

The CR Ratings list the tested PRODUCTs in order of burst INDEX, the percentage of condoms that inflated to at least 25 liters in air-burst testing. Products with a higher index should offer greater assurance against breakage in use. Note: Products tested were manufactured prior to the U.S. Food and Drug Administration's (FDA) air-burst test requirements, which should reduce the defect rate.

LUBR (lubrication) feel indicates which substances feel like oil, glycerine or surgical jelly. A dash means the condom doesn't have lubrication. SPERM is the percentage concentration of spermicide nonoxynol-9 in the lubricant. It may offer some extra safety against disease and pregnancy if a condom breaks. The extent of the protection is unknown. A dash means the condom doesn't have spermicide. SIZE, in millimeters, was measured on unrolled, flattened condoms and are averages of several samples. Proper fit affects comfort and may help avoid breakage or slippage. THICK (thickness), in millimeters, is the average of three measurements along the length of the condom. The typical condom tested is about 0.07 millimeters thick. COST is the estimated average, based on a national survey. A * indicates the price CR paid. Except where noted, we purchased boxes of 12. The comments identify textured condoms (raised bumps or rings) and contoured condoms (flared out near the head).

Consumer Reports Ratings 37 tested
INDEX PRODUCT            LUBR   SPERM   SIZE   THICK   COST
 100  Excita Extra
        Ultra-Ribbed,
        spermicide     Glycerine  8    193x53   0.07  $1.00
 100  Ramses Extra Ribbed,
        spermicide     Glycerine  5    187x52   0.07    .99
 100  Sheik Elite        Oily     --   187x52   0.07    .53
  98  LifeStyles
        Vibra-Ribbed   Glycerine  --   188x54   0.08    .44
  98  Ramses Extra,
        spermicide     Glycerine  15   200x51   0.07    .75
  98  Ramses Sensitol    Oily     --   192x52   0.07    .83
  98  Sheik Elite Ribbed,
        spermicide       Oily     8    190x51   0.07    .68
  98  Sheik Elite,
        spermicide       Oily     8    190x51   0.07    .59
  98  Trojan-Enz Large  Jelly     --   214x56   0.07    .75
  98  Trojan-Enz
        NonLubricated     --      --   191x53   0.07    .47
  97  LifeStyles       Glycerine  --   186x54   0.07    .46
  97  Touch from Protex,
        A BEST BUY       Oily     --   193x52   0.07    .31
  97  Trojan-Enz,
        spermicide      Jelly     5    202x51   0.07    .64
  96  Saxon Gold
        Ultra Lube      Jelly     --   191x51   0.08    .43
  96  Trojan Magnum      Oily     --   205x55   0.07    .69
  96  Trojan Very
        Sensitive        Oily     --   206x50   0.07    .62
  93  LifeStyles,
        spermicide     Glycerine  7    189x54   0.06    .45
  92  Trojan Ribbed      Oily     --   199x53   0.07    .64
  91  Rough Rider
        Studded        Glycerine  --   186x53   0.10   1.04
  88  LifeStyles Extra
        Strength,
        spermicide       Oily     7    191x53   0.09    .65
  83  Gold Circle Coin
        Nonlubricated      --     --   184x52   0.09    .60
  83  Sheik Elite        Oily     --   188x51   0.06    .53
  83  Trojan Naturalube
        Ribbed          Jelly     --   205x53   0.07    .66
  83  Class Act Ultra
        Thin &
        Sensitive        Oily     --   193x53   0.06    .33
  83  Kimono           Glycerine  --   193x52   0.07    .39
  82  Pleasure Plus    Glycerine  --   197x51   0.09    .98
  78  Beyond Seven       Oily     --   194x50   0.05    .50
  78  Gold Circle
        Rainbow Coin
        Nonlubricated     --      --   180x51   0.08    .67
  77  Sheik Super
        Thin           Glycerine  --   193x51   0.05    .62
  64  Ramses Ultra
        Thin           Glycerine  --   190x51   0.05    .88

The following products, listed alphabetically, were downrated. They had an overall burst-volume defect rate that exceeded 1.5%.

LifeStyles Ultra
  Sensitive            Glycerine  --   187x53   0.06  $0.46
Trojan Extra Strength    Oily     --   198x53   0.07    .78
Trojan Mentor          Glycerine  --   181x52   0.07   1.08*
Trojan Plus              Oily     --   196x52   0.07    .66
Trojan Very Thin         Oily     --   195x53   0.06    .64
Trojan-Enz              Jelly     --   201x54   0.07    .58
Trojans Nonlubricated     --      --   200x53   0.06    .49

Note: Excita Extra Ultra-Ribbed, spermicide has been renamed Sheik Excita Extra Ribbed. Sheik Elite (renamed Sheik Classic) made in the U.S. is a higher-rated product. Sheik Elite made in Japan is lower-rated (box flaps are marked). Ramses Extra, spermicide now has 5% spermicide. Sheik Elite Ribbed, spermicide has been renamed Sheik Classic. Sheik Elite, spermicide has been renamed Sheik Classic. Touch from Protex is purchased in boxes of 13. Rough Rider Studded is purchased in boxes of 3. Gold Circle Coin Nonlubricated is purchased in boxes of 6. Sheik Elite is now discontinued. Sheik Elite made in the U.S. was a higher-rated product. Sheik Elite made in Japan was lower-rated (box flaps are marked). Class Act Ultra Thin & Sensitive is purchased in boxes of 13. Gold Circle Rainbow Coin Nonlubricated is purchased in boxes of 6. Trojan Mentor is purchased in boxes of 6.

Comments
Excita Extra Ultra-Ribbed, spermicide: Textured.
Ramses Extra Ribbed, spermicide: Textured.
LifeStyles Vibra-Ribbed: Wider than most. Textured.
Sheik Elite Ribbed, spermicide: Textured.
Trojan-Enz Large: Wider, longer than most.
LifeStyles: Wider than most.
Trojan-Enz, spermicide: Heavier lubrication than most.
Saxon Gold Ultra Lube: Contoured.
Trojan Magnum: Wider, longer than most. Heavier lubrication than most.
Trojan Very Sensitive: Longer but narrower than most.
LifeStyles, spermicide: Wider than most. Heavier lubrication than most.
Trojan Ribbed: Textured.
Rough Rider Studded: Textured. Heavier lubrication Than most.
Gold Circle Coin Nonlubricated: Shorter than most.
Trojan Naturalube Ribbed: Longer than most. Textured.
Class Act Ultra Thin & Sensitive: Wider than most
Kimono: Contoured. Lighter lubrication.
Pleasure Plus: Textured, with floppy pouch.
Beyond Seven: Narrower than most. Lighter lubrication than most.
Gold Circle Rainbow Coin Nonlubricated: Various colors, contoured.
Trojan Mentor: Contoured. Has applicator and adhesive band.
Trojan Plus: Contoured.
Trojan Very Thin: Lighter lubrication than most.
Trojan-Enz: Wider than most.
Trojan Nonlubricated: No reservoir tip.


CONSUMER REPORTS RECOMMENDATIONS

Latex condoms work well, both to prevent pregnancy and to avoid sexually transmitted diseases. Unless you know your partner is uninfected, the Federal Centers for Disease Control and Prevention (CDC) recommends for disease prevention that you use condoms, start to finish, for all sex: vaginal, anal and oral. There are important factors to consider when selecting a condom. They include strength, sensitivity, size, lubricant, spermicide and condom age.

Among the 30 products that passed CR's initial screening (in which no more than 1 1/2% of condoms fell short of government requirements), those with a higher Burst Index should minimize the possibility of breakage during sex. But CR's findings don't match the claims on several packages. Five tested condoms claim to be strong (or stronger than some other brand), but only Ramses Extra Ribbed Spermicidally Lubricated earned a top score on our Burst Index.

When researchers asked a national sample of men in their 20s and 30s about condoms, the biggest gripe concerned sensitivity: Three out of four complained that condoms reduce sensation. Some brands claim to enhance sensitivity, but it's not clear how they do. Some makers say a snug condom helps, but others say it's a looser fit (Pleasure Plus has a floppy pouch near the head, for instance). As a group, condoms promising sensitivity aren't especially thin, by CR's measurements.

Even if a thin condom does heighten sensitivity, thin isn't necessarily desirable. The following tested products were thinnest, but they had some of the lowest burst scores:

While these passed CR's minimum standards, they may not always hold up as well as higher-ranked condoms. When inflated, one- fourth to one-third of these thinner condoms did not reach the crucial 25-liter mark before bursting. If you want to try some "sensitive" products, it's safest to start with the higher- scoring condoms that make this claim (such as the top-rated Excita Extra Ultra-Ribbed) before trying thinner ones.

Condom size does matter. If a condom is too tight, it can be uncomfortable and more likely to break. If it's too loose, it's more likely to slip off. The width of the tested condoms varied by 12%, product to product. Length varied by almost 20%. (Trojan- Enz Large and Trojan Magnum claim to be larger than average. They were, in fact, longer and wider.)

Using a lubricated condom is largely a matter of preference. If couples wish to add their own lubricant, they should be certain not to use petroleum- or mineral-oil-based products, which rapidly weaken latex. Many condoms' lubricants include a small amount of nonoxynol-9, a spermicide that promises extra protection. But it's a promise without much proof. In the test tube, nonoxynol-9 does kill sperm and inactivate a range of microbes, including HIV. But no one knows if it works as well in real use and if there's enough of it to make a difference if the condom breaks.

As condoms age, the rubber in them may weaken, so it's a good idea to avoid packages that are more than a few years old. (CR found no sign of aging among the tested condoms, which were all less than three years old.) Unfortunately, different brands date products differently. Bear this in mind when you're checking the label: Products containing spermicide are given a shelf life of roughly two or three years (to assure that the spermicide still works), while other condoms are allowed as many as five years on the shelf.


USING CONDOMS WISELY

Most of the tested products provide adequate instructions, often including pictures. But some print the information on the inside surface of the box, which must be torn apart before the instructions can be read. That's unfortunate, as good instructions are key for people unaccustomed to using condoms. Here are the most important points to remember:

If a condom does fail, both partners should wash their genitals with soap and water. Urinating may also help to avoid infections. If the breakage is discovered after ejaculation, having a separate spermicide handy to apply quickly may help. Or a doctor can prescribe an intense dose of birth-control pills, which will block most pregnancies if used within 72 hours of intercourse.


CONTRACEPTION AND DISEASE PREVENTION

As a contraceptive, condoms are cheap and easy to obtain, and usually cause no side effects. But they're not perfect. The condom's reliability in preventing pregnancies depends on how it's measured. Researchers don't count the number of individual condoms that fail. They define contraceptive failure as the percentage of women who use a given method but who nonetheless become pregnant over a year's time.

For condoms, the typical failure rate is about 12%, somewhat worse than birth-control pills (8%), but better than the diaphragm (18%), withdrawal (19%) and rhythm (20%). [Source: "Contraceptive Technology," Irvington Press, and Family Planning Perspectives journal.] Researchers know that, as with other methods, the failure figures include many couples who don't use contraception every time. If couples used condoms consistently and correctly, researchers estimate, the condom's failure rate would plummet to 2% or 3%, or perhaps even less.

As a means of preventing the transfer of disease-causing microbes between sex partners, condoms have no equal. The condom shields the penis from cervical, vaginal, oral or rectal secretions. At the same time, the partner is protected from potentially infectious semen and any lesions on the penis. The odds of transmitting disease are cut nearly to zero if condoms are used consistently and correctly.

The need for protection is apparently greater than many people realize: Every year, 12 million Americans (one-fourth are teen- agers) contract sexually transmitted diseases. Chlamydia, the most common such disease but often unrecognized, can lead to tubal scarring that experts believe is a key factor in the quadrupling of ectopic pregnancies in the last 10 years. And AIDS is still increasing in the U.S., particularly among women. (Gay men still account for the largest number of AIDS cases. There's concern that condom use is falling among younger gay men.)

Sexually transmitted diseases are virtually 100% preventable with proper condom use. So well do latex condoms block germs that, since 1987, the FDA has allowed condom boxes to list all the diseases condoms help avert. More recently, the FDA told companies that the message was so crucial, they should also print it on the wrappers of individual condoms. Condom boxes warn that the product is intended for vaginal sex, but health officials say it's crucial to use condoms in anal and oral sex, too.

Over the decades since the latex condom's introduction, epidemiologists have amassed considerable evidence that it does cut disease rates, but not quite to zero. A 1992 review in the American Journal of Public Health found that condoms on average cut the risk of infection in half. But the authors said the studies included many couples who failed to use condoms properly or consistently. When couples are strongly motivated to use condoms every single time, the score greatly improves.

Herbert Peterson, chief of the CDC's women's health and fertility branch, cited two recent "blockbuster" studies on condoms' use against HIV. Both focused on heterosexual couples, with one partner carrying HIV at the start of the study, who continued to have sex regularly for two years or more. In the first study, Italian researchers followed more than 300 healthy women in stable, monogamous relationships with HIV-positive men, questioning the women closely about condom use and testing them periodically for HIV. In the Italian study, among women whose partners never or inconsistently used condoms, 12% eventually were infected with HIV. But fewer than 2% of the women whose partners always used condoms became infected. The second report, from the European Study Group, showed even better results for some 250 uninfected men and women with HIV-positive partners. Among the half who used condoms inconsistently, 10% of the previously uninfected partners acquired HIV. When condoms were used all the time, HIV was never passed on to the healthy partner, even though the average couple had sex about 120 times over the course of the study.


CONDOM FAILURE

An estimated 2% to 5% of condoms tear during use. Most of those failures are thought to stem from misuse, not inherent flaws. And misuse is common: When the British Consumers' Association asked some 300 English men to demonstrate putting a condom on a model penis, nearly one in five got it wrong. They tried to unroll the condom from the inside out. Bruce Burlington, who heads the FDA's Center for Devices and Radiological Health, told CR's reporter that the difference in quality between the best and worst condoms on the market is "tiny compared with the problems that users introduce."

When condoms do break despite being used correctly, it's probably caused by hidden weaknesses in the rubber. Both manufacturers and the government take steps to catch flawed condoms before they can leave the factory. Manufacturers test each lot of condoms for leaks and for strength, according to voluntary guidelines set by the American Society for Testing and Materials. But those tests, which destroy the condoms being examined, can be used only to spot-check a batch of condoms, not to check individual condoms before packaging and sale.

Companies can test every condom for leaks, with a gentler but telling electrical procedure. In one variant of the test, each condom is placed on a charged metal form and swept over by a soft, conductive brush. Minute holes in the condoms trip circuitry that shunts many "leakers" aside. Sometimes this test finds thin spots as well. The FDA, which regulates condoms as medical devices, sends inspectors to factories unannounced. They review production records and examine stock at random, checking for cracked, moldy, dry or sticky rubber. The inspectors also test the condoms, until recently primarily with a water-leakage test. In the water-leakage test, manufacturers pour 10 ounces of water into a condom, then press and roll it along blotter paper. If leaks turn up in the equivalent of more than 4 per 1,000 condoms in a run, the entire lot must be scrapped.

In 1993, the latest year for which CR could obtain data, the FDA rejected 2 of the 44 lots of domestic condoms it checked for leakage. The FDA tests every batch of imported condoms as well, though imports account for very few condoms used in this country. Although the smallest hole the water test can find is 100 times bigger than the HIV virus, officials believe the water test is sufficient. The laboratory and clinical studies of HIV persuade them that smaller holes are rare or possibly even nonexistent. But such minute holes are a problem for "skin" condoms, which are made from a natural pouch in lambs' intestines.


TWO NONLATEX OPTIONS

If latex condoms irritate your skin, the culprit may be the lubricant, the spermicide or the materials used in processing. Try switching brands. If that doesn't work, you may be among the small percentage of people whose skin is sensitive to latex itself. You have two other choices in condoms, each with pluses and minuses.

"Skin" condoms are made from a natural pouch in lambs' intestines, and cost several times as much as latex ones. The membrane is especially strong and may enhance sensitivity. The downside: They have small holes. The microscopic pores in "skin" condoms can be up to 1.5 microns across. Since sperm cells are twice as wide as that, skin condoms still make an effective contraceptive. But viruses and some bacteria are far smaller than these pores. Lab work has shown that HIV and the herpes and hepatitis-B viruses can pass through skin condoms. So these condoms must bear a warning that they're not intended for disease prevention.

CR examined Fourex and Kling-Tite Naturalamb brands. Fourex condoms come folded, not rolled, inside plastic capsules (the condom is pulled on, like a glove). We found the capsules surprisingly hard to open. Kling-Tite may be easier to don because it's rolled, like a latex condom. Skin condoms might slip off some men during intercourse because both Fourex and Kling- Tite are significantly wider than the latex condoms we tested: 78 and 68 millimeters, respectively (latex condoms average 52 millimeters). Fourex has a rubber band rolled onto the base of the condom to prevent slippage. The Kling-Tite's elastic band is sewn on more securely.

Last year, on the basis of limited testing, the FDA gave Schmid Laboratories approval to sell its new Avanti brand, a clear condom made of polyurethane. The agency justified approving the product because it felt a pressing public-health need to offer latex-sensitive people an alternative that could prevent disease as well as pregnancy. The Avanti condoms first appeared in Western states and should be available elsewhere by summer. But it's unclear just how much protection they offer.

A label on the Avanti's foil packet declares it "effective" against pregnancy and sexually transmitted diseases, while the label on the box warns that "the risks of pregnancy and STDs...are not known for this condom." The FDA says it has noted the discrepancy. The packet label will be changed to match the box. The manufacturer says it has demonstrated to the FDA that Avanti does block viruses and neither slips nor breaks more often than latex. Studies of its contraceptive value are under way.

CR bought Avanti and Avanti Super Thin, which cost us $1.75 each, more than the most expensive latex condoms. Both products are in fact the same condom. The Super Thins come with more lubricant. In the lab, we found the condoms thinner than any conventional condoms tested, roughly 0.04 millimeters (mm). They're also among the shortest of condoms but wider than even larger-size latex brands (60 mm versus 55 mm or 56 mm). That's probably because polyurethane doesn't stretch as much as latex.

Despite the company's statements to the contrary, CR suspects some men might have slippage problems. When we placed the Avanti on a model of an average-sized penis, the condom could be pulled off quite easily. Since Avanti isn't latex, the label claims that any lubricant may be used safely. We cannot comment on the Avanti's strength. Because synthetic condoms are so new, researchers don't know how to compare their performance in standard tests against that of latex condoms.

Copyright Consumers Union of U.S., Inc., May 1995


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