Kadın partnerin bildirimine göre erkek kondomu kullanım hataları

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Introduction
Condom is an effective family planning method
commonly being used all around the world and also
in Turkey. Condom is easily available and also easy to
use. It is the most suggested family planning method
(FPM) by the World Health Organization (WHO) and
health professionals to protect oneself against sexually transmitted infections (STI) such as HIV (1-3). Male
condom is the second rank method among most used
family planning methods (11%) in Turkey and 17%
of couples prefer to use condom (4) and it is preferred
especially by those who have kids (28.5%) (4-6).
Condom is one of the most preventive and most
used family planning method, and also makes men
have responsibility for family planning. Primary
health care centers (PHC) provide consulting services
about condom use and they deliver condoms free of
charge in Turkey. Therefore, the cost of condom is
not a problem for those who choose it (2). According
to Turkish Demographic and Health Survey 2003
(TDHS) 40% of the condom users stop using it within
twelve months. It is important to find out the reasons
of stopping the use of condom, although it is easy to
use and readily available (3).
Some of the problems in condom use are starting
sexual intercourse without wearing a condom or
taking it off during (7.8%) and continuation of intercourse without condom (2.6%), slippage during
intercourse or ejaculation (4.1-6.5%), slipping off
completely (1.5%), breakage (5.6%) or experiencing
all of them at the same time (10.9%). These problems
are experienced mostly by those who are young, have
low level of education and income and who are inexperienced in using condoms (7-10). Inexperienced
men need consulting services to decrease the problems such as slippage, breakage during condom use
and use the condom in a better way (11). Crosby et
al. report that 43% of men put condoms on during
sex, 32% of them report losing erection and one-
* Nursing Department, Faculty of Health Sciences, University of Selcuk
** Konya Primary Health Care Center, Number 15, Ministery of Health
This research was presented at the 10th Congress of the European Society
of Contraception in Prague, Czech Republic (30 April-3 May 2008)
Reprint request: Belgin Akın, Nursing Department, Faculty of
Health Sciences, University of Selcuk, Alaeddin Keykubad Kampüsü,
Selçuklu-42079, Konya
E-mail: belak1@hotmail.com
Date submitted: March 03, 2009 • Date accepted: May 07, 2010158 • September 2010 • Gulhane Med J Akın et al.
third report breakage or slippage during sex (12). The
reason of the problems, such as slippage, breakage
during sex and losing erection, was mostly related to
unproper use and could be prevented with sufficient
consulting (13).
Although there are a lot of studies on regular condom use (1,11,14-17), the number of studies related
to condom use errors is limited (1,12), Regular use of
condom does not mean free of errors. This study will
help to put forth condom use errors for consideration
so increase effective condom use, help prevent unwanted pregnancy and other related problems. The
aim of the study was to investigate male condom use
errors and risk factors according to the report of the
women among married couples.
Material and Methods
This was a descriptive study in order to discover
male condom use errors according to the report of
female partners who admit to PHC for getting free
condoms.
Study group: Study group consisted of 160 women
(15-49 years old), who admitted to the 15th PHC between April 1st and June 30
th
, 2007 for getting condom. Their husbands had used condom for at least
three months. In Turkey, the women apply to PHC
for utilizing family planning services mostly, so the
women were informed about male condom use instead of men. Therefore, it was prefered to ask women’s
view about their partner’s condom use errors in the
study.
Data collection: A questionnarie questionning the
socio-demographic and fertility characteristics and
also condom use errors was used to collect data. Sociodemographic characteristics were age of the women
and their husbands, level of education, monthly
income, perceived economical situation, length of
marriage and the number of children. The characteristics of condom use were having condom training,
pregnancy during use, breakage or slippage. Condom
use errors such as not examining expiration date, not
leaving a space in the condom tip, intercourse without any condom, condom breakage during sexual
intercourse and using the same condom more than
once were also questionned. Those who had one or
more errors were considered “having condom use errors” and those who had not any were considered
“having no condom use errors”.
Before the study written permission was taken from
the local health authority and informed consent was
taken from the women. Data were collected by two
researchers with face to face interviews in a private
room in the PHC.
Statistical analysis: SPSS 10.0 program was used to
analyse data. Percentage, X2
, Mann-Whitney U and
logistic regression analysis were used for statistical
analyses. Two-sided “p” value was used for statistical
significance and values below “0.05” were considered
significant.
Results
The mean age of the women and their husbands were
30.8 and 34.1 years, respectively. Fifty five per cent of
the women and 39.4 % of the men were literate or primary school graduates. Average monthly income was
487.9 $ and 62.4% of the women perceived their income moderate, 91.9% of them had health insurance.
Mean of the marriage time was 11.4±7.6 years and the
mean number of children was 2.3±1.0 (Table I).
Table I. Descriptive characteristics of women (n=160)
Sociodemographic and fertility
characteristics
N/Mean SD/%
Age 30.8 7.4
Age of husband 34.1 7.5
Education
Literate-primary school 88 55.0
Middle school 60 37.5
High school and ↑ 12 7.5
Education of husband
Literate-primary school 63 39.4
Middle school 48 30.0
High school and ↑ 49 30.6
Monthly income ($) 487.9 227.7
Perceived income
Good 22 13.8
Average 100 62.4
Worse 38 23.8
Social security
Yes 147 91.9
No 13 8.1
Length of marriage (Year) 11.4 7.6
Number of children 2.3 1.0
Regarding the characteristics of condom use, it was
found that the mean of the use time was 46.7 months
(median 24.0, mode 24) and 44.4% of women and
18.1% of men were informed about correct condom
use. It was found that 11.9% of the women experienced slippage-elusion, 10.0% of them experienced
problems of breakage, 5.6% of them experienced
pregnancy and 60.6% of them did not know how to
use condom. It was determined that 77.5% of them
had one or more condom use errors (Table II).Volume 52 • Issue 3 Errors in male condom use • 159
Regarding women’s views, it was found that 56.9%
of them did not check the expiration date, 52.5% of
them did not examine for breakage after sexual intercourse, 34.4% of them started sexual intercourse
without condom, 22.5% of them did not leave space
in the tip and 1.2% of them used the same condom
twice (Table II).
According to the Chi-Square test, relationship between condom use error and having instructions was
found statistically significant (p<0.0.5). The relationship between condom use errors and women’s and
men’s ages, their educational background, income
level, perceived income, the marriage time, the number of children were not found statistically significant (p>0.05) (Table III). Logistic regression analysis
showed that the risk associated with condom use error increased by 2.9 times in the men who did not
have condom use training (OR:2.906, CI: 1.112-
7.593) (Table III). It was seen that age age, level of
education and income, length of marriage, number
of children, length of condom use, correct condom
use education of women were not risk factors for condom use error (p>0.05).
Discussion
In the study, the length of condom use was approximately two years (mean 46.7±54.3, median 24, mode
24, minimum 3 and maximum 264 months) according to 160 women. It was found that only 18.1% of
the men received training about correct condom use.
Sixty point six per cent of the women had limited
contraception knowledge (Table I).
While most of the couples believed that correct
condom use helped prevent unwanted pregnancy
and prevent STI, they experienced some problems
while they were using condoms. The most commonly experienced problems were slippage-elusion
and breakage-tear. Our finding of slippage-elusion
(11.9%) was higher than those found in the other
studies (1,7,18). Also, the percentage of breakagetear (10.0%) found in our study was higher than
other similar studies (5.6% and 4.1%) (1,7). Although
finding related to elusion and breakage (23.0%) was
higher than those of the other studies, this was lower
than that of the study of Lindberg et al. (9) (Table
II). It could be said that condom use problems were
prevalent in our study group (8,12). Young couples
and those who used condom for a short time or did
not use condom regularly had a higher percentage of
condom use errors (9,10,13). Regular condom users as
sex workers had lower condom use errors (19). This
means that the regular use is a very important factor
to prevent condom use errors. Our study group was
not so young, and it is significant to state that some
couples had high percentage of condom use errors
although they were married and used condom for at
Table II. The characteristics and errors of condom use (n=160)
Condom use characteristics N/Mean %/SD
Length of condom use (month) 46.7 54.3
Receiving correct condom use training (yes) 71 44.4
Receiving correct condom use training of
husband (yes)
29 18.1
Slipped off during sex (yes) 19 11.9
Breakage during sex (yes) 16 10.0
Experiencing pregnancy (yes) 9 5.6
Knowledge of emergency contraception (yes) 63 39.4
Condom use errors (yes) 124 77.5
Condom use errors
Don’t check of expiration date 91 56.9
Don’t control for breakage after sex 84 52.5
Starting intercourse without a condom 55 34.4
Don’t leave space at the tip 36 22.5
Use condom more than ones 2 1.2
Table III. Logistic regression analyses for risk factors of condom use error
Independent variables Condom use error OR
Yes N (%) Mean (SD) No N (%) Mean (SD)
(CI % 95)
Age 31.3 ± 7.5 29.2 ± 6.9 0.910 (0.771-1:074)
Age of husband 34.7±7.6 32.0±7.0 1.047 (0:886-1.237)
Education (Primary school and ↓) 68 (77.3) 20 (22.7) 1.360 (0.501-3.690)
Education of husband (Primary school and ↓) 46 (73.0) 17 (27.0) 0.626 (0.233-1.680)
Monthly income ($) 620.8±299.7 555.1±210.4 1.001 (0.999-1.003)
Perceived income (worse) 30 (78.9) 8 (21.1) 1.029 (0.385-2.748)
Lenght of marriage (year) 12.0±7.7 9.4±7.0 1.066 (0.883-1.289)
Number of children (mean) 2.4±1.0 2.1±1.0 1.058 (0.591-1.896)
Lenght of condom use (Month)
a
50.3±59.0 34.1±31.0 1.004 (0.993-1.016)
Correct condom use training (Women) (no) 70 (78.7) 19 (21.3) 0.820 (0.358-1.880)
Correct condom use training (Husband) (no)
b, c
106 (80.9) 25 (19.1) 2.906 (1.112-7.593)
c
a
t: 2.186; p: 0.031,
b
X
2
: 4.837; p: 0.029,
c
: Exp(B): 2.906; p: 0.029160 • September 2010 • Gulhane Med J Akın et al.
least two years. Only a few of the men in the group
(18.1%) received training about correct condom use
and this might explain the high percentage of condom use errors. It is valuable to indicate that 5.6%
of the couples in our study experienced pregnancy
(Table II).
Most of the women (77.5%) stated that they had
one or more of the condom use errors and this
showed that condom use errors were common. The
two most common reported condom use errors were
“not checking the day of expiration” (56.9%) and
“not examining breakage-tear after sex” (52.5%)
similar to stated by Crosby et al. (12). In that study
(12), the most common experienced error was “not
checking the day of expiration” (61.0%) as in our
study. In the same study, the percentage of not examining breakage-tear (30.0%) was lower than our
finding. One of the most common experienced errors was “starting sexual intercourse without putting
on a condom” (34.4%). While our findings related to
the percentage of “starting sexual intercourse without putting on a condom” was similar to findings by
Crosby et al. (12) (42.8%) and Peltzer (19) (55.0%),
the percentage stated in one of the studies (7.8%) (20)
was quite low. The percentage (40%) of those who
did not leave space in the tip of the condom in study
by Crosby et al. (12) was higher than our finding
(22.5%). The least commonly experienced error was
using a condom more than once (1.2%) (12) (Table
II). Condom use errors in our study and other studies
were quite common. It can be concluded that using
condom will not help prevent pregnancy and STI unless condom is used in a correct way.
When condom use errors were analysed by ChiSquare test, the relationship between the length of
condom use and received training was found statistically significant (p<0.05). (Table III). It was seen
that the couples who used condoms for a longer time
and had instruction about condom use had less condom use errors. According to the results of logistic
regression the men who did not receive condom use
training were 2.9 times more likely to run the risk of
condom use compared to men who received training
(OR:2.906, CI: 1.112-7.593) (Table III). In one of the
studies (18), condom use errors were found related
to men’s insufficient instructions about condom use.
In another study (21), it was found that informing
women about condom use was effective in long term
use, but it did not decrease condom use errors. In the
present study, it was seen that the instructions about
correct condom use for women was not enough to
use a condom in a correct way.
Condom use errors are quite common. When men
do not receive training about correct condom use,
condom use errors increase significantly. Informing
women about condom use should not be considered sufficient to decrease condom use errors. Also it
would be a useful strategy to include correct condom
use in preparing the training programs about prevention of unwanted pregnancy and STI.