title: Assessing male condom failure and incorrect use.
abstract: BACKGROUND
  It has not been well established whether common indices of male condom failure are valid predictors of biologically meaningful exposure during condom use.
  
  
  METHODS
  To address this gap, the authors compared self-reported condom malfunctions (i.e., breakage and slippage) and incorrect condom practices to 2 following objective measures of failure: prostate-specific antigen (PSA) detected in vaginal swabs collected after condom use and structural integrity of used condoms. The study, conducted in 2000-2001, evaluated 635 male condoms used by 77 women attending an outpatient, reproductive-health clinic in Birmingham, AL.
  
  
  RESULTS
  Women reported breakage or slippage for 7.9% of condoms; 3.5% of postcoital swabs had moderate or high levels of PSA; and laboratory testing of used condoms revealed breaks (1.1%) and leaks (2.0%). Self-reported breakage and slippage was associated with moderate/high PSA concentrations in postcoital swabs only when the malfunctions were not accompanied by reports of corrective actions to reduce exposure (adjusted odds ratio [aOR], 6.9; 95% confidence interval [CI], 1.8-26.2). Defects observed in postcoital laboratory testing were related to PSA detection (aOR, 8.0; 95% CI, 1.5-42.6). Incorrect practices defined on the condom label were frequent, but not all types were associated with semen exposure. Furthermore, other practices not currently label-defined were associated with semen exposure: touching the tip of the penis with his hands (aOR, 6.2; 95% CI, 2.3-17.0) or with her hands (aOR, 2.8; 95% CI, 1.1-72) before donning the condom.
  
  
  CONCLUSIONS
  Used correctly, male condoms afforded good protection based on objective measures of failure.
authors.affiliation: Division of Clinical Research and Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, WA, USA.
authors.forename: Ann
authors.initials: A
authors.lastname: Duerr
authors.forename: Maria F
authors.initials: MF
authors.lastname: Gallo
authors.forename: Lee
authors.initials: L
authors.lastname: Warner
authors.forename: Denise J
authors.initials: DJ
authors.lastname: Jamieson
authors.forename: Andrzej
authors.initials: A
authors.lastname: Kulczycki
authors.forename: Maurizio
authors.initials: M
authors.lastname: Macaluso
mesh_terms: D000328:Adult; D017280:Condoms / Q000592:standards / Q000706:statistics & numerical data*; D004868:Equipment Failure; D005260:Female; D006801:Humans; D008297:Male; D017430:Prostate-Specific Antigen / Q000032:analysis*; D021841:Safe Sex; D012661:Semen / Q000737:chemistry*; D014621:Vagina / Q000737:chemistry
chemical_list: D017430:Prostate-Specific Antigen