women have over its use compared to the male condom. Other advantages include insertion before intercourse, it protects a greater area of the vagina, and it is less likely to break than the male condom (Gollub and Stein, 1993). The female condom is an effective mechanical barrier to viruses including HIV (CDC, 1993b). The Food and Drug Administration has recently approved labeling for the female condom to reflect annual pregnancy protection failure rates of 21 percent for "typical use" (the product is used inconsistently or incorrectly) and 5 percent for "perfect use" (the product is used consistently and correctly every time).5 These data are consistent with results of a multisite study that found a six-month 2.6 percent unintended pregnancy rate (and no STDs) for U.S. women who used the female polyurethane condom consistently and correctly (Farr et al., 1994). Although a percentage of women in this study reported liking the female condom, there is insufficient experience with the female condom to determine its long-term acceptability (IOM, 1996). Potential disadvantages of the female condom include its relatively high costs, its appearance, and its acceptance by women (Gollub and Stein, 1993). The female condom represents one of the few female-controlled contraceptive methods that are effective against STDs. Many factors may influence individual behavior related to condom use. Understanding the impact of these individual factors is important in effectively promoting condom use as a measure to prevent STDs. Although studies on condom use behavior have increased in the last decade, many of the determinants of correct and consistent condom use have not been adequately examined (Roper et al., 1993).

Adolescence. Behavioral factors that influence condom use among adolescents include sufficient knowledge and skills, perceptions of condoms, ability to communicate with partners, and perception of condom use by peers (Brown et al., 1992; Orr and Langefeld, 1993; AAP, Committee on Adolescence, 1995). Other major factors that influence whether condoms are used by adolescents include access, availability, confidentiality, and cost (Kirby et al., 1994; AAP, Committee on Adolescence, 1995). Magura and others (1994) found that male adolescents of certain ethnic groups in the juvenile justice system were more likely to report using condoms if condoms were accessible. A sample of college males reported that not having condoms available was a major factor in their lack of condom use (Franzini and Sideman, 1994). The importance of ready access to condoms was underscored by another study that found that adolescents who carry condoms are almost three times more likely to use a condom during sexual

5  

These failure rates may differ from those cited in package inserts of some earlier lots of female condoms. The original labeling indicated an annual pregnancy protection failure rate of 26 percent for "typical use" (a range of 21 to 26 percent is also cited) and did not give an estimate for "perfect use." The newer estimates reflect the Food and Drug Administration's approval for the manufacturer to cite the lower estimated failure rate under "typical use" and the rate under conditions of ''perfect use."



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