Male Contraception Without Prescription a Reevaluation of the Condom and Coitus Interruptus
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Male Contraception Without Prescription A Reevaluation of the Condom and Coitus Interruptus MICHAEL J. FREE, PhD, and NANCY J. ALEXANDER, PhD CONTRACEPTIVE METHODS imple- the stigma of being associated with mented by the male were among promiscuity and venereal disease- the first birth control procedures. an association stamped on them by Even today these methods have sig- the military services and the "old nificance for almost every sexually morality" and perpetuated until active person during some stage of life, and they constitute the main or only birth control methods prac- D Dr. Free is senior research scien- ticed by many couples. Therefore tist, biology department, Battelle physicians, in particular, should Pacific Northwest Laboratories, know the background, subtleties, Richland, Wash. Dr. Alexander, strengths, and shortcomings of these associate scientist in reproductive nonprescription methods for male physiology, Oregon Regional Pri- use. mate Research Center, Beaverton, is director, Infertility Laboratory The Condom at the University of Oregon Often denigrated by being cate- Health Sciences Center, Portland. gorized as a "traditional" contra- This paper is Oregon Regional ceptive method and accorded only Primate Research Center Publica- the cursory interest given to his- tion No. 836, whose preparation torical artifacts, the condom is was supported in part by National clearly not a symbol of our times. Institutes of Health grants Nos. HD Because condoms must be used at 05969 and RR 00163. Tearsheet re- the time of coitus, in the past they quests to Dr. Michael J. Free, were perhaps too personally and Biology Department, Battelle Pacific graphically sexual for Western Northwest Laboratories, Battelle sensibilities. They have also retained Blvd., Richland, Wash. 99352. September-October 1976, Vol. 91, No. 5 437 recently in the United States by the IUD. It therefore merits the 1. The Food and Drug Admin- anachronistic State and Federal attention and sanction of the medi- istration (FDA) had become in- laws requiring condom labels to cal profession and of married volved in the quality control of indicate that the devices were for couples as a highly effective, non- condoms under the Federal Food, disease prevention only. Condoms systemic method of long-range birth Drug, and Cosmetic Act of 1938. must be disposed of, and like empty control, devoid of side effects, The first formal regulatory program beer cans and cigarette butts, they which in some cases can prolong was introduced in 1949, and when can be painful reminders of mind- intercourse and prevent premature it was revised in 1957, stricter lim- less indulgence. Also, condoms do ejaculation. For sexually active peo- itations were placed on defects. not easily meld into teenage fan- ple other than married couples, the These programs resulted in sta- tasies about sexual opportunity and condom is readily accessible and has tistically based sampling methods the unplanned encounter. They the distinctly separate advantage of and the testing of samples by water are not part of the family physi- affording protection against the filling. The tolerance for defective cian's repertoire, and by default transmission of venereal disease. condoms was lowered from 5 per- they do not receive his blessing. cent in the 1940s to 1 percent in Family planning clinics, whose The Condom as Contraceptive 1957. In 1968, FDA tolerance principal clients are women, do not Our general impressions of the levels were decreased still further often promote their use, apparently condom's effectiveness as a contra- to allow the seizure of shipments favoring the more sophisticated ceptive are based largely on surveys with more than 0.25 percent defec- chemical and surgical methods for and clinical records from the 1930s, tive units. birth control. The condom, being 1940s, and 1950s. These studies 2. Manufacturers mechanized and basically a contraceptive method (1,2) were usually of populations automated the dipping process, for the male, has been upstaged by in which one-half to two-thirds of controlling flows, viscosity, and the the emergence of the woman as the the condom users varied that use pH of the latex so that a much agent of contraception. The rela- with other contraceptive methods more uniform product of higher tive ease with which the female or with no method at all. The total quality was produced. reproductive system lends itself to pregnancy rates per 100 woman 3. Automatic drying in a dust- systemic contraception also has re- years of condom use, given as 6 to duced the emphasis on the condom. free and temperature- and humid- 30 pregnancies (Pearl formula), ity-controlled environment was in- Because of all these strikes have been repeated in handbook against them, it has been only with troduced, so that in the better after handbook. Thus, the condom grades of condoms, pinholes caused great difficulty that condoms have was assigned to an ever-lower rank been brought from behind the by dust settling on the drying latex on the list of effective contraceptive were virtually eliminated (3). pharmacist's barricade and dis- measures, while orally administered played as nonprescription nondrugs, drugs, modern intrauterine devices, 4. When automatic electronic advertised discreetly in a few maga- and surgical sterilization successive- testing of each condom became a zines, and given serious attention ly emerged to take the spotlight in part of the production process in by some contraceptive researchers. the birth control movement of the the 1950s, quality control was sig- In the absence of up-to-date infor- 1960s. Because the condom could nificantly improved. Upon recom- mation on their usefulness, the not be separated from sexual activ- mendation of the Food and Drug textbooks of contraception have ity and it was also an effective Administration, water or air infla- continued to pass on the results of prophylactic against venereal dis- tion tests also are now performed one or two limited studies done in ease, the condom became firmly on samples. the 1930s and 1950s, when mate- associated in the minds of the pub- 5. The introduction of semi-dry rials, testing procedures, and quality lic with promiscuity, prostitution, silicone lubrication around 1960 in- controls were so crude and disre- and venereal disease. creased the appeal of the lubricated gard for the consumer was so com- Moreover, during the early condom, since this material en- mon as to be unacceptable by 1960s, when the condom was held hanced sensitivity and reduced the present standards. When we com- in such low regard that there was probability of tearing. pare the figures from these old no support for its reevaluation as a 6. studies on the effectiveness of con- contraceptive device, contraceptive Sealed foil packages, which doms with the effectiveness figures measures for females were attract- slowed the degradation of the latex, from a vast array of up-to-date ing the attention of social scientists gave condoms a shelf life of up to studies on the pill and IUDs (intra- in the field of family planning. 5 years. uterine devices), the data in the During this period, however, sev- 7. In the United Kingdom in older studies lose by default. eral things happened to condoms 1964, the British Standards Insti- Actually, the efficacy of the con- that affected both method effective- tute published a set of quality dom is in the same range as that of ness and use effectiveness. standards for condoms and began 438 Public Health Reports Table 1. Effectiveness of the condom in 4 recent British studies Years Total Method Author of study and method Total Method failure fallure yeatrofpubication People surveyed used to failures failures rate per rate per nearest year 100 years 100 years Peel (6), 1969 .......... Group of highly fertile couples in Hull. 127 4 1 3.1 0.8 Peel (7), 1972 .......... Couples married in Hull, 1965-66. 308 12 5 3.9 1.6 John (8), 1973 .......... National Health Service patients of Shep- 248 12 1 4.8 0.4 shed practice. Glass, Vessey, and Wig- gins (9), 1974 ........ Married patients of British Family Planning 1,543 62 .. 4.0 Clinic who used oral contraceptives dia- phragm, or IUD before study. Aggregate of above studies . ..................................... 2,226 90 7 4.0 1.0 giving products conforming to them ginning at marriage, of contracep- The Condom as Prophylactic its seal of approval. tive use by urban couples (7). Even though in the history of the 3. A study of contraceptive usage condom, venereal disease preven- The Food and Drug Administra- in a small town medical practice tion estimated that 75 percent of tion and contraception became the condoms produced in the (8). inextricably interwoven, in previous 4. A large study of married pa- centuries use of the device was un- United States in 1939 were defec- tients of family planning clinics tive; between 1942 and 1960, this doubtedly a prerogative of rich men, who had substituted the condom who cared less about what they proportion declined to 4 percent for the pill, diaphragm, or IUD (3) and in 1961, to between 0.4 would leave behind than what they and 0.7 percent (4). Between 1969 (9). might bring home. Moreover, since and 1972, even with the new, more The results of these studies (table in recent times in the United States stringent standards that permitted 1) suggest combined use plus meth- the law permitted the condom no the FDA to seize condom shipments od failure rates of 3.1 to 4.8 per other image than that of a prophy- containing more than 0.24 percent 100 woman years and rates based lactic, this image of the condom of defective units, the proportion of on method alone of only 0.4 to 1.6 seems to have persisted in the minds promiscuous, who, questionable shipments was only per 100 woman years.