FLASHBACK FRIDAY: Condom effectiveness: What’s brand name got to do with it?

This blog was originally posted on April 25, 2012 and was written by Diana Sanchez.

Condoms are one of the most commonly used contraceptive/STD prevention products used worldwide. The United Nations Population Fund estimated that over 10 billion condoms were used in 2005.  Here on campus, Campus Health Services provides thousands of condoms to students each year.

As a sexual health counselor, I have noticed that many people’s preferences for certain condom brands are based (almost entirely) on their perception of that condom brand’s effectiveness. We offer a variety of condom brands for free to students through Campus Health Services. Occasionally, when people check out the condoms we have available, they’ll ask: “are those safe to use?”, and “don’t those break more than [other condom brand]?”.

So, do some condoms in fact perform better than others in terms of STD/pregnancy prevention?

The answer is no, not really. Condoms are regarded by the United States Food and Drug Administration (FDA) as “Class II medical devices”, a designation that includes pregnancy tests and powered wheelchairs.  Products in this category have to meet special labeling requirements and performance standards. For condoms, the FDA standards include systematic “water leak” tests to ensure that no fluid can leak out of the condoms. To meet standards, all condoms must have at least 996 out of 1,000 condoms, on average, pass this test. This means that FDA-approved condoms must be at least 99.6% effective in laboratory tests to be available to consumers.

In a 2004 publication, Walsh and colleagues used condom use data from trials of three bands of condoms, including Trojan, LifeStyles and Ramses – all of which are FDA-approved condom brands. Out of 3,677 condom-protected sex acts analyzed in the study, the authors found that 55 condom acts failed, either due to breaking (16 condoms broke; break rate = 0.04%) or slipping (39 condoms slipped; slip rate = 1%). The likelihood of condoms breaking during sex was not statistically associated with condom brand.

FDA-approved condoms are all quite effective at preventing pregnancy and STD, and performance is probably not related to brand type. You might be wondering if the condoms you’re using are FDA-approved. With the exception of novelty condoms (which are pretty uncommon), just about all of the condoms you’ll come across in the United States are approved by the FDA.  All the condoms we provide through Campus Health Services are FDA-approved, and same goes for places like Planned Parenthood and local STD/HIV clinics. If you’d like to be certain, you can check the condom packet to look for wording about STD and pregnancy prevention. If it’s on the packet, those condoms meet federal regulations for quality and safety.

Check out the following pictures to see how we’ve looked for this language on some condoms we provide at Campus Health Services:

If you can’t find language about STD/HIV prevention on condom packaging, then it’s not FDA approved.
If you can’t find language about STD/HIV prevention on condom packaging, then it’s not FDA approved for STD/HIV and pregnancy prevention.

All of this said, although condoms must be at least 99.6% effective in safety trials, testing conditions do not necessarily mean 99.6% real-life effectiveness for any condom brand. But here’s the good news:  there’s a lot you can do to increase the effectiveness of condoms. One of the biggest challenges to condom effectiveness is correct use.  Some of the most common errors with condom use are: using the wrong lubricant (water-based, NOT oil-based, lubricants should be used with condoms); incorrect storage (ie, storing a condom in a hot place, like a glove compartment, or in a place with lots of friction, like a wallet or pocket); and not checking the expiration date.

FLASHBACK FRIDAY: Barriers to using barrier methods?

This blog is a guest blog from Ruth Abebe, a UNC graduate interested in HIV and sexual health, and was originally published on April 1, 2013.

College is a time when many students are discovering and exploring ourselves and the condomsworld around us. This world may include sexuality.

Many college students choose to be sexually active, and college-aged students are particularly likely to engage in risky sexual behaviors and are disproportionately affected by negative sexual health outcomes such as STI or unintended pregnancy.  According to national surveys, many college students are engaging in sexual activity without protection. In a 2011 survey of undergraduate students across the US, approximately 70% of sexually active students reported using condoms inconsistently or not at all during sex in the last 30 days. With all the information out there regarding sexually transmitted infections (STI), unintended pregnancy and ways to prevent them, why do college students still put themselves at risk?

As a college student myself, I have heard several of my peers talk about why they don’t use condoms.  But, there are ways to go beyond these barriers and make sure sexual experiences are safe and pleasurable.

1. Cost — Most of us are on a budget, and the cost of safer sex supplies like condoms is still an obstacle for students when deciding to use protection. However, this is a problem that can be easily remedied. Here at UNC, we have access to free safer sex supplies. Condoms, both male and female, and dental dams, as well as lube, are available to us through UNC Student Wellness and at several residence halls around campus. Furthermore, with the introduction of Wellness’s free condom dispensers, cost will be even less of an issue (update: These condom dispensers are now in service! They are located around campus, including in the Union and the Rams Head Recreation Center, and are refilled frequently). Click here for more information on where you can currently access safer sex supplies throughout Campus Health Services.

2. Many consider only pregnancy risk—Some students only consider pregnancy as a possible consequence of unprotected sex. For this reason, many believe they will be able to protect themselves using prescription contraceptives (examples: the pill, patch, ring, IUD, etc.). However, STI risk and protection should be considered in every sexual partnership.  Aside from abstinence, condoms are the only method which can protect against both pregnancy and STIs, including HIV/AIDS. They can also be converted to a dental dam.

3. “Oral sex isn’t sex.” – Many are under the false impression that oral sex is “safe sex.” Oral sex, just like anal and vaginal sex, carries a risk for STI transmission.  Condoms and dental dams can protect against the risk of STI transmission during oral sex.

4. Pleasure Factor— Some college students don’t use condoms during sexual activity because they believe “it doesn’t feel the same.”  But you can do things to make sex with condoms feel just as good. Plus, knowing that you have the protection of a condom can help you to relax and enjoy the moment.  There are several kinds of condoms out there, including “ultra-sensitive” condoms that enhance the feeling of both parties during sex. Using lube can also make sex more pleasurable for both partners. In addition, there are condoms and other safer sex supplies geared toward making sex more pleasurable. Explore different condom styles and protect yourself!

5. “It’ll ruin the moment.” – Some college students are not protecting themselves for fear of ruining the mood of the moment. There are ways around this too. If you are having sex with someone, you can talk about condom use beforehand. Of course, I realize that not all sexual activity will be between two people in either a romantic or ongoing sexual relationship. In these cases, it’s important to place your sexual health above any potential awkwardness. Cases of STIs are on the rise, and aside from the dangers to your health, having an STI can make your sex life more difficult in the future. So, why not protect and enjoy yourself?

Despite these barriers, there are several ways to allay your fears and hesitations about using protection. As college students, preventing against STIs and pregnancy by using condoms is essential to protecting our sexual health.

What to Expect From Your First Gynecologist Appointment

Dentist by Lee Mack (flickr creative commons)

For many people, seeing a gynecologist for the first time can be a nerve-wracking and scary experience. However, it doesn’t have to be—the more informed you are, the less scary it is. Knowing what to expect means you can advocate for yourself and be an informed patient. So why see a gynecologist, you may ask? Perhaps you are thinking about having sex and want to discuss contraception or you want to talk about pain during sex. Maybe you have an infection and want to get it checked out or your periods are irregular and you want more information. As you can see, there are so many reasons people go to the gynecologist! You don’t have to be sexually active to see a gynecologist, either. The most recent recommendation is that people see a gynecologist for a first pap smear at 21 and every three years after. Here are some things to know ahead of time:

  • Schedule an exam during a time when you are not menstruating
  • You can request a provider of the same gender if you want
  • It can be helpful to write questions down ahead of time in case you forget anything
  • When you get there you will fill out some forms answering questions about if you are sexually active, the date of your last period, and what brings you to the appointment
  • Wear comfortable clothing because you may have to remove them (including underwear) to change into a gown

Once you get there, you will have a conversation with a healthcare provider about why are you there and about your sexual history. Being honest is important and this information helps inform the provider about what kind of care you need. Their job is to provide care, not judge you. While people don’t always talk openly about gynecological health, your doctor has heard every question out there and seen many patients for gynecological exams. Nothing is too embarrassing or uncomfortable. Remember, it’s their job and they see patients with similar concerns all the time! If you have experienced trauma, this can be a time to tell the doctor that you might be nervous and discuss strategies for getting through an exam (here is an article with some tips to help you through the appointment).

Depending on why you are there, here are some things that could occur:

  • The provider performing a breast exam
  • The provider having you lie you down and put your feet in stirrups to examine the external genital area
  • The provider using a speculum, an instrument that allows for the provider to view inside the vagina and see the cervix, to perform the internal exam
  • The provider taking a swab of your cervix
  • The provider inserting a gloved finger into the vagina while feeling your abdomen—this is to examine your internal organs that they can’t examine with the speculum (the uterus, ovaries, and fallopian tubes)

Throughout all this, nothing should hurt. You may feel some discomfort and pressure, and if you are feeling pain you should tell your provider. While it can be difficult, the more relaxed you are the more comfortable the exam will be. Taking deep breaths can help you try to relax. While it sounds like a lot, this part of the exam only takes a few minutes and will be over before you know it. Sometimes people like to know what is going on, have a conversation with the provider, or not talk at all. It’s up to you! It’s also totally fine to ask the provider to talk you through what they are doing.

Also, remember to speak up–you have the right to ask for explanations or stop any part of the exam at any point. It’s your body and you have the right to advocate for yourself! If you have questions, you can email Student Wellness at LetsTalkAboutIt@unc.edu to set up a sexual health appointment with our trained health educators. We are here to help make you feel as informed as possible when you seen a gynecologist for the first time!

I Hate These Blurred Lines….

You know the tune, you’re probably singing it right now…. So let’s talk about it!  Not about the video, the lyrics, or implications of it — other people have done a great job analyzing that- but let’s talk about the content matter. Continue reading

How to have a better hookup?

After last semester’s “Orgasm? Yes Please!” performance, we received feedback that you wanted to learn more about communicating about sex during hookups.  In our program, we showed couples in committed relationships working out how to have safer & better sex.  Y’all let us know that you want to see how that works in less committed relationships, too.
What are the difficult conversations with hookups? What do you wish you could express? How could you picture your hookups being safer and sexier? Your questions will help us bring you a fresh, updated OYP in Fall 2013!
Let us know what you think on this anonymous survey.
Stay tuned to the Healthy Heels Blog for information on the upcoming Orgasm? Yes, Please performance! Put it on your calendar: Friday October 25, 2013 7-9pm.

Lingering questions from “Orgasm? Yes Please!”

Your Questions from “Orgasm? Yes, Please!” 

We had a great time hosting “Orgasm? Yes Please!” a couple of Fridays ago to a rowdy audience of over 300 UNC students! Big thanks for The Daily Tarheel for sending some love our way, to our co-sponsors Project Dinah, UNC Panhellenic Council, and to our collaborators on stage, Interactive Theater Carolina.

During the presentation, the audience texted in their anonymous questions. We didn’t have time to answer everything at the event, so we’re here today to  address some of your questions that we missed. Some of them we’ve blogged about before!

You asked, “G-spot, fact or fiction?”

Recent research has shown that “even though the majority of women believe that the G-spot exists, even if they don’t have one, we’ve all been fooled.  Sort of.” Read more!

You asked, “Is having sex while on your period really an option? How is that sanitary?”  

It’s entirely a matter of taste, and “if you are worried about the aesthetics of it, you can always throw down a towel first and then go for it!” Read more!

You asked, “Are Trojans the most effective condom? 

All condoms whose labels indicate they are for sexual use (aka, not “novelty items”) are required to pass the same tests for efficacy as they are “regarded by the United States Food and Drug Administration (FDA) as Class II medical devices, a designation that includes pregnancy tests and powered wheelchairs.  Products in this category have to meet special labeling requirements and performance standards.”  Read more!

You asked, “Are STI tests on campus free?”

The Sexual Wellness Specialists (formerly CHECS)  office offers a free blood HIV test! Otherwise, the price depends on your insurance. Campus Health website has information on pricing without insurance! Read more!

Free Oraquick rapid test will be available on World AIDS Day, being celebrated 11/30/12 on the UNC Campus. Free testing will be available on a walk-in basis from 11am-5pm in the UNC Student Union.

You asked, “Would you rather fight 100 duck sized horses or one horse size duck?”

You know, I’m going to have to think about that one.

Stay tuned for more! We’ll be answering other questions from “Orgasm? Yes Please!” in upcoming blog posts.

A Different Kind of Abuse: Reproductive Coercion in Abusive Relationships

People often associate intimate partner violence with images of physical abuse.  However more and more research illustrates the prevalence of reproductive coercion in abusive relationships. Reproductive coercion includes contraceptive sabotage (like throwing away birth control pills or hiding them), refusal to wear condoms, demanding unprotected sex, and preventing (or in some cases forcing) abortion.

Often when hearing of an unintended pregnancy or contraction of an STD, folks  blame individuals for not being responsible for their own sexual health.  We need to examine coercion in relationships because often, survivors in abusive relationships have no say negotiating contraceptive use or in the case of female-identified survivors, have their birth control methods sabotaged.

Along with unintended pregnancy increases, abusive, sexually coercive relationships also lead to increased rates of STDs.  Dr. Anne Teitelman is an expert on partner abuse and on HIV risk found that female identified survivors of partner abuse are significantly more likely than others to be diagnosed with an STD.

So what can we do? A joint study by the Harvard School of Public HealthFamily Violence Prevention Fund, and the National Institute of Health found that simply asking young women during clinic visits if they experienced reproductive coercion dramatically reduced the odds of their male partners attempting to force them to become pregnant by 70%.  The study found that participants who were asked about reproductive coercion and then counseled about harm-reduction strategies including switching to longer-acting contraceptives and contacting domestic and sexual assault resources were also 60% more likely to report ending a relationship because it felt unsafe or unhealthy. While this study applied specifically to women in heterosexual relationships, clinicians in the field of sexual health can also ask LGBTQ survivors about contraceptive coercion in their relationship. These questions are important because they identify a solution that can be implemented easily.  By being active bystanders and by increasing education about DV issues, sexual health care practitioners can dramatically decrease reproductive coercion.

We can all work to be active bystanders and intervene when we see someone in trouble.  Often just asking “Are you alright?” or “Do you need to talk?” can be the first step to someone getting the help they need.

If you’re interested in learning more about preventing abusive relationships or how to help a friend in an abusive situation check out safe.unc.edu to register for upcoming HAVEN and One ACT trainings.

Upcoming  HAVEN Training Dates:

October 2 5:00- 9:00 PM (Student)

October 16 12:30-4:30 PM (Faculty and Staff)

October 30 5:00- 9:00 PM (Student)

November 13 5:00- 9:00 PM (Student)

Upcoming One Act Training Dates:

September 26 from 5 pm – 9 pm on North Campus

October 22 1:00 pm- 5 pm

November 8 3:30 pm- 7:30 pm

“Can you get pregnant while breastfeeding?”

Last semester, I overhead some students talking about how Tori Spelling got pregnant one month after giving birth even though she was breastfeeding. I’ve never really understood breastfeeding-as-contraception, so I did some research about LAM, aka Lactational Amenorrhea Method.

My hope is to provide an overview of LAM to folks who are unfamiliar with this method and blew it off as just another sexual health acronym (IUD, NFP, PID, HIV, HPV, HSV, etc). If you are interested in using this method, please consult your health care provider for more detailed guidance. Check out my last blog entry Are you pregnant or parenting at UNC? for more info on resources available UNC.

What is Lactational Amenorrhea Method? Lactational Amenorrhea Method is a contraception method where a woman relies on exclusive breastfeeding to change her body’s hormonal balance to prevent pregnancy. This method can work up to the first six months of the infant’s life, which is also the duration for which the WHO and American Academy of Pediatricians recommends exclusive breastfeeding.

How does LAM work? Time to get your Anatomy & Physiology extra credit! Continue reading

Skipping Your Period for Summer Time Fun

It’s summer time! That means vacations, swimming and perhaps, periods coming at inconvenient times. Have no fear! It is possible to skip or reschedule periods!

Before we get started, if this is something you are interested in, I encourage you to talk to your clinician or healthcare provider before you skip your period. Your health care provider is most familiar with you and the medications you are taking.

That being said, there are things everyone should know about the process of scheduling/skipping your period.  If you are already on the birth control pill and been taking it for a few cycles, then you should be able to skip your period.  Also note, this blog post is focused solely on using combined oral contraceptives, which is a type of birth control pill, to reschedule periods. This type of pill uses a combination of hormones (estrogen and progestin) in order to prevent pregnancy.

Many packages of birth control pills contain 21 hormone pills (also known as active pills) followed by 7 pills, which contain no hormones (also known as placebo or spacer pills). This means a person taking birth control pills usually takes 21 days of hormone pills followed by 7 days of no hormone pills. The period usually happens during the 7 days of no hormone pills. Many of the newer pill formulations have more active pills and fewer no hormone pills, for example 24 active pills and 4 placebos. Continue reading

Are you pregnant or parenting at UNC?

What an impressive juggling act! Hats off to you. You’re doing important work!

Let me tell you about a few of the resources available for you locally:

UNC Student Parent Association
UNC Parenting Resource Guide is a great way to get oriented about services available to you through UNC and in the community at large.
List of lactation spaces on UNC Campus
La Leche League of Chapel Hill is a group where experienced mothers support women who are figuring breastfeeding out.

Personally, I didn’t really know much about breastfeeding until I trained as a doula (a doula stays with a laboring woman, not as part of the healthcare team, but as an attendant who provides emotional, physical & informational support). I was blown away when I learned about the emotional, nutritional, and health benefits for women & children that come through breastfeeding.
• The physical contact helps women and babies bond.
• The baby receives IgA antibodies through the mother’s breast milk that provide a natural passive immunity while the baby’s own immune system gets up & running.
• Babies instinctively drink the right quantity of breast milk, so they reduce their risk of over-nourishment.
• When babies latch on to the nipple, breast milk goes right down their throats without lingering in the mouth so the risk of dental cavities is reduced.
• Breastfeeding helps women lose weight after pregnancy and reduces risk of breast cancer and ovarian cancer.

Even if you aren’t thinking about having kids right now, it’s valuable for everyone to understand breastfeeding and benefits in order to be more supportive of nursing women. Breastfeeding can be challenging; many women have a difficult time with various parts of breastfeeding including latching, production, emotions, balance, and more. In other words, nursing women need all the support they can get!

FYI, in North Carolina it’s legal for a woman to breastfeeding in any public or private location without being in violation of indecent exposure laws. On top of that legal foundation, I hope we can have a culture on campus where all nursing Tarheels feel comfortable and respected breastfeeding their children.

Stay tuned for more! My next project is to examine a birth control method I’ve never understood: LAM, aka Lactational Amenorrhea Method, aka breastfeeding-as-contraception.