title: Practice makes perfect: reduction in female condom failures and user problems with short-term experience in a randomized trial.
abstract: BACKGROUND
  Female condom (FC) failure (breakage, slippage, invagination and misdirection) declines with user experience. Participants in FC performance trials are commonly novice users, and failure rates may be inflated related to inexperience.
  
  
  METHODS
  This was a randomized, crossover study assessing preference, safety, acceptability and function of three new FCs (WC, FC2 and V-Amour) among 170 women in Durban, South Africa. FC failure by condom type use period was investigated in women using five FCs of each type.
  
  
  RESULTS
  Of the 2411 condoms used during intercourse, 96 failures (breakage, slippage, invagination and misdirection) occurred in 86 condoms (77 condoms had one failure, 8 condoms had two failures, and 1 condom had three failures). Total clinical failure was comparable across FC types. The number of failures in the first condom use period was 58 (7.0%), and this decreased to 21 events (2.6%) in the second and, finally, 17 (2.1%) in the last condom use period. No failures were reported in the last use of the FC in the final condom use period.
  
  
  CONCLUSIONS
  FC failure rates decreased markedly after use of the first five condoms, regardless of FC type, and stabilized in the second and third use periods. Consideration should be given to the number of condoms used in trials to ensure that failure rates are not inflated by limiting the numbers of condoms used by novice users.
authors.affiliation: MatCH [Maternal, Adolescent and Child Health], Department of Obstetrics and Gynaecology, University of the Witwatersrand, Overport 4091, South Africa. mbeksinska@match.org.za
authors.forename: Mags
authors.initials: M
authors.lastname: Beksinska
authors.forename: Jenni
authors.initials: J
authors.lastname: Smit
authors.forename: Carol
authors.initials: C
authors.lastname: Joanis
authors.forename: Catherine
authors.initials: C
authors.lastname: Hart
mesh_terms: D000328:Adult; D019111:Single-Use Internal Condom / Q000009:adverse effects; D003268:Contraception Behavior / Q000208:ethnology; D018592:Cross-Over Studies; D019544:Equipment Failure Analysis; D005193:Family Planning Services; D005260:Female; D005500:Follow-Up Studies; D007722:Health Knowledge, Attitudes, Practice / Q000208:ethnology; D006801:Humans; D008422:Materials Testing; D010353:Patient Education as Topic; D017060:Patient Satisfaction / Q000208:ethnology; D021841:Safe Sex / Q000208:ethnology; D012736:Sex Education; D013019:South Africa; D014504:Urban Health / Q000208:ethnology; D055815:Young Adult