Victor R. Claveau, MJ
7.3 million American women use barrier contraceptives, such as the male condom.[i] Condom use is especially common among teenagers, 20–24-year-olds, childless and never-married women.[ii] 27% of teenage women using contraceptives choose condoms as their primary method.[iii]
A variety of studies have found that condoms have an overall annual failure rate of 14%. That means each year about 1 in 7 condom users experience an unplanned pregnancy. Condoms have a lower annual failure rate of 10% for married couples, but a higher rate of 24% for cohabiting couples. Condoms are also less effective for people aged 18-24, with a failure rate of 18%.[iv]
There are several reasons for this such as breakage or slippage during use, some are defective because of damaged or from poor manufacturing, or those that have been subject to improper storage conditions such as being subject to heat or cold.
Sexually transmitted diseases (STDs) are very tiny organisms, minuscule in size compared to sperm. These super-small viruses can get through a hole in a condom much more easily than sperm. For example, HIV is a retrovirus that can lead to acquired immunodeficiency syndrome (AIDS), which is a condition in humans in which the immune system begins to fail, leading to life-threatening opportunistic infections. HIV so small that two million of the disease-causing agents could crowd on the period at the end of a sentence.
One reason condoms fail in preventing the transfer of AIDS is that latex condoms have tiny intrinsic holes called “voids.” Sperm is larger than the holes, but the HIV virus is 50 times smaller than these tiny holes, which makes it easy for the virus to pass through.[v] To give you an idea of how easy it would be for the virus to pass through these holes, just imagine a ping pong ball going through a basketball hoop.
Condoms provide considerably less protection against STDs than they do against pregnancy. That’s because a woman can get pregnant only at ovulation time (that’s two to three days each month) but STDs can pass from partner to partner at any time of the month. STDs are frequently passed through “skin to skin” contact even when condoms are used. This can happen because the bacterial or viral germs that cause many serious STDs (such as human papillomavirus, chlamydia, herpes, and syphilis) do not infect just one place on your body. They may infect anywhere in the male or female genital areas.
In March, at the 2008 National STD Prevention Conference, one study received considerable media attention. This study found that one in four (26 percent) young women between the ages of 14 and 19 in the United States–or 3.2 million teenage girls – is infected with at least one of the most common sexually transmitted diseases [human papillomavirus (HPV), chlamydia, herpes simplex virus, and trichomoniasis].[vi]
Results of a nationally representative study show that genital herpes infection is common in the United States. Nationwide, at least 45 million people ages 12 and older, or one out of five adolescents and adults, have had genital herpes simplex virus (HSV) infection.[vii]
The CDC also reports that 65 million Americans have an incurable STD. [viii] That means that close to 1 in 5 Americans are infected!
Sexually transmitted diseases (STDs) remain a major public health challenge in the United States. While substantial progress has been made in preventing, diagnosing, and treating certain STDs in recent years, the CDC estimates that approximately 18.9 million new infections occur each year, almost half of them among young people ages 15 to 24.[ix]In addition to the physical and psychological consequences of STDs, these diseases also exact a tremendous economic toll. Direct medical costs associated with STDs in the United States are estimated at up to $14.7 billion annually in 2006 dollars.[x]
Genital HPV is the most common sexually transmitted infection (STI). The virus infects the skin and mucous membranes. There are more than 40 HPV types that can infect the genital areas of men and women, including the skin of the penis, vulva (area outside the vagina), and anus, and the linings of the vagina, cervix, and rectum. You cannot see HPV. Most people who become infected with HPV do not even know they have it.[xi] Certain HPV types can cause cervical cancer and other less common cancers, such as cancers of the vulva, vagina, anus, and penis.[xii]
Birth control pills weaken the immune system’s ability to resist infection, and may enlarge the transformation zone on the cervix, which makes those cells more at risk for HPV infection.[xiii] (The transformation zone is a specific area of the cervix where almost all precancerous and cancerous changes occur. This is the area of the cervix in which Pap smear and biopsy samples are taken).
In trying to explain the failure rate of condoms I used the following analogy. Suppose you were going to take an airplane across the country and had your choice of ten different flights. Then you were told that at least one and possibly as many as three of the planes will crash resulting in the death of all the passengers. Would you be willing to take that gamble?
The condom is a barrier method of birth control and so theoretically it does not cause early abortion. At least one study has noted that women who use barrier methods (diaphragms, condoms, or the withdrawal method), or the intra-uterine device (IUD), had a 137% increased risk of developing preeclampsia in future pregnancies.[xiv] Preeclampsia is a condition that some pregnant women get which consists of a syndrome of high blood pressure, fluid retention, and kidney damage, which may eventually lead to prolonged seizures and/or coma called eclampsia. Preeclampsia complicates 5 to 10% of pregnancies and is a leading cause of maternal deaths in the developingworld, which threatens the lives of thousands of women and theirbabies and places a significant burden on health care systemsworldwide.[xv]
IUDs have been made in various shapes, including rings, loops, spirals, T-shapes, and 7-shapes. The materials used have included silver, copper, and plastic.
There are two categories of IUDs: those that are medicated and release hormones (progesterone) and those that are not medicated. Although it is not known for sure how the IUD works, Studies of MIRENA® (levonorgestrel-releasing intrauterine system) prototypes have suggested several mechanisms that prevent pregnancy: thickening of cervical mucus preventing passage of sperm into the uterus, inhibition of sperm capacitation or survival, and alteration of the endometrium,[xvi] which makes it an abortifacient.
Half of intrauterine pregnancies that do occur with the IUD in place end in spontaneous abortion.[xvii] [xviii] Women who become pregnant with an IUD in place risk septic abortion (septic shock and death may occur); removal of IUD may result in pregnancy loss.[xix]
In addition, miscarriage, premature labor, and premature delivery may occur if pregnancy is continued with IUD in place.[xx] Leaving the IUD in place during pregnancy also increases the risk that the mother will have severe pelvic infection that may lead to death.[xxi] Getting any vaginal infection while using an IUD can increase the risk of developing a serious pelvic infection. This can result in a loss of fertility.[xxii] Other serious side effects and complications from IUDs are spotting, bleeding, hemorrhage, anemia, uterine perforation, embedding, cervical perforation and pelvic inflammatory disease (PID).
Women who have in vitro fertilization or who have an IUD using progesterone also have an increased risk of ectopic pregnancy (pregnancy that occurs outside the womb).[xxiii] About 5% of women who become pregnant with an IUD in place will have an ectopic pregnancy,[xxiv] which has been associated with complications leading to loss of fertility.[xxv] Ectopic pregnancies cannot continue to term (birth), so the developing fetus must be removed to save the mother’s life.
The most common site of an ectopic pregnancy is within a Fallopian tube; however, ectopic pregnancies can occur in the ovary, the abdomen, and in the lower portion of the uterus (the cervix).
Tubal ligation does not always prevent conception. When conception does occur, it is associated with a much higher incidence of ectopic pregnancy.[xxvi] The risk of an ectopic pregnancy due to this procedure may reach as high as 60%. [xxvii]
Spermicides are chemical products inserted in a woman’s vagina before sex that damage or kill sperm. The most common active ingredient in spermicides is nonoxynol-9 (N-9). Spermicides containing nonoxynol-9 are available in many forms, such as jelly (gel), films, and foams, and as an ingredient in the vaginal sponge.
Although it was at one time widely promoted as a protection against sexually transmitted infections including HIV, Nonoxynol-9 gel does not protect against urogenital gonorrhea and chlamydial infection.[xxviii] Regular use of nonoxynol-9 likely increases the risk of infection with sexually transmitted human papillomaviruses (HPVs) that can cause cervical cancer.[xxix] [xxx] Studies have shown that it can in fact increase the risk of infection by damaging the physical barriers of the rectum or vagina.[xxxi]
Toxic Shock Syndrome has been associated with the spermicide sponge.[xxxii] In addition, at least one researcher has noted that couples who have used certain spermicides within a month of conception have experienced a doubling in the rate of birth defects as well as a doubling of the rate of miscarriage.[xxxiii]
[i] Facts on Contraceptive Use, http://www.guttmacher.org/pubs/fb_contr_use.pdf
[ii] Ibid.
[iii] Ibid.
[iv] N Ranjit, A Bankole, JE Darroch, S Singh, “Contraceptive Failure in the First Two Years of Use: Differences Across Socioeconomic Subgroups,” Family Planning Perspectives, 2001, 33(1):19-27.
[v] Dr. C. M. Roland, editor of Rubber Chemistry and Technology.
[vi] http://www.cdc.gov/stdconference/2008/media/summaries-11march2008.htm
[vii] Sexually Transmitted Diseases Surveillance and Statistics; U.S. Center for Disease Control and Prevention, 2008
[viii] STD Surveillance System, HCHSTP, CDC; MMWR Weekly, April 30, 2004/53 (16); 346-3.47.
[ix] Weinstock H, et al. Sexually transmitted diseases among American youth: incidence and prevalence estimates, 2000. Perspectives on Sexual and Reproductive Health 2004; 36(1):6-10.
[x] HW Chesson, JM Blandford, TL Gift, G Tao, KL Irwin. The estimated direct medical cost of STDs among American youth, 2000. 2004 National STD Prevention Conference. Philadelphia, PA. March 8–11, 2004. Abstract P075.
[xi] Genital HPV Infection – CDC Fact Sheet, http://www.cdc.gov/std/HPV/STDFact-HPV.htm#Whatis
[xii] Ibid.
[xiii] Madeleine MM, et al. (2001). Human papillomavirus and long-term oral contraceptive use increase the risk of adenocarcinoma in situ of the cervix. Cancer Epidemiology Biomarkers and Prevention, 10: 171–177.
[xiv] Klonoff-Cohen HS et al. An epidemiologic study of contraception and preeclampsia. JAMA. 1989; 262: 3143-3147.
[xv] American Journal of Pathology. April 13, 2007; 170:1903-1909.)
[xvi] Physician’s Desk Reference (2008), Thompson Healthcare Inc. Montvale, NJ, 2007, p. 765.
[xvii] Lewit S. Outcome of pregnancy with intrauterine device. Contraception 1970; 2:47-57.
[xviii] Vessey MP, Johnson B, Doll R, Peto R. Outcome of pregnancy in women using intrauterine device. Lancet 1974; 1:495-498.
[xix] Physician’s Desk Reference (2008), Thompson Healthcare Inc. Montvale, NJ, 2007, p. 766.
[xx] University of Maryland Medical Center (UMMC), http://www.umm.edu/altmed/drugs/levonorgestrel
[xxi] Bernstine RL. Review and analysis of the scientific and clinical data on the safety, efficacy, adverse reactions, biologic action, utilization, and design of intrauterine devices. Final Report, Department of Health, Education, and Welfare/Food and Drug Administration, Technical Resources Development. Seattle: Batelle Memorial Institute, 1975.
[xxii] http://www.birth-control-comparison.info/iudinfo.htm
[xxiii] Univ. Maryland Medical Cen.,
http://www.umm.edu/ency/article/000895.htm
[xxiv] Vessey MP, Johnson B, Doll R, Peto R. Outcome of pregnancy in women using intrauterine device. Lancet 1974; 1:495-498.
[xxv] Physician’s Desk Reference (2008), Thompson Healthcare Inc. Montvale, NJ, 2007, p. 766.
[xxvi] Gaeta TJ et al. Atypical ectopic pregnancy. Am J Emer Med. 1993; 11: 233-234.
[xxvii] http://www.utmedicalcenter.org/encyclopedia/?file=000895.htm
[xxviii] Roddy R E, etal,, Effect of nonoxynol-9 gel on urogenital gonorrhea and chlamydial infection: a randomized controlled trial. JAMA. 2002 Mar 6;287(9):1171-2.
[xxix] Marais D, Carrara H, Kay P, Ramjee G, Allan B, Williamson AL. The impact of the use of COL-1492, a nonoxynol-9 vaginal gel, on the presence of cervical human papillomavirus in female sex workers. Virus Res. 2006 Nov;121(2):220-2.
[xxx] Roberts, Jeffrey N; Christopher B Buck, Cynthia D Thompson, Rhonda Kines, Marcelino Bernardo, Peter L Choyke, Douglas R Lowy, John T Schiller (July 2007). “Genital transmission of HPV in a mouse model is potentiated by nonoxynol-9 and inhibited by carrageenan”. Nat Med 13 (7): 857–861. doi:10.1038/nm1598. “A widely used vaginal spermicide, nonoxynol-9 (N-9), greatly increased susceptibility to infection. … As expected, the CMC-based gel containing N-9 rendered the mucosa susceptible to significant HPV pseudovirus infection (P = 0.03), while the carrageenan-based gel prevented detectable infection. … Overall, these results raised the possibility that use of over-the-counter N-9-containing vaginal contraceptives is a risk factor for genital HPV infection in women”.
[xxxi] Kestelman P, Trussell J (1991). “Efficacy of the simultaneous use of condoms and spermicides”. Fam Plann Perspect 23 (5): 226–7, 232.
[xxxii] Faich G et al. Toxic shock syndrome and the contraceptive sponge. JAMA. 1986; 255: 216-218.
[xxxiii] Jick et al. Vaginal spermicides and congenital disorders. JAMA. 1981; 245:1329-1332.