tag:theconversation.com,2011:/au/topics/condom-10827/articlesCondom – The Conversation2023-08-15T09:14:08Ztag:theconversation.com,2011:article/2075722023-08-15T09:14:08Z2023-08-15T09:14:08ZFive old contraception methods that show why the pill was a medical breakthrough<figure><img src="https://images.theconversation.com/files/532664/original/file-20230619-15-aihcw9.jpg?ixlib=rb-1.1.0&rect=2%2C13%2C1531%2C1004&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">The wishbone pessary didn't look comfortable </span> <span class="attribution"><a class="source" href="https://collection.sciencemuseumgroup.org.uk/objects/co96426/wishbone-%20stem-pessary-intracervical-device-europe-1880-1940-intra-uterine-device">Science Museum Group Collection</a>, <a class="license" href="http://creativecommons.org/licenses/by-nc/4.0/">CC BY-NC</a></span></figcaption></figure><p>If you have access to it, it’s easy to take today’s contraception for granted. But key discoveries over the last century or so changed the lives of women. </p>
<p>Before the invention of modern intra-uterine devices (IUDs) or hormonal contraception, most products had low effectiveness, and were more useful for delaying pregnancy than preventing it. </p>
<p>When the contraceptive pill became available in the early 1960s, it marked a turning point. Its very low failure rate of <a href="https://www.nhs.uk/conditions/contraception/how-effective-contraception/">less than 1%</a> when used properly, helped put control of contraception firmly in women’s hands. </p>
<p>While the pill can have some serious side-effects, for many women it still provides a much less uncomfortable experience than many of the methods that preceded it.</p>
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<img alt="" src="https://images.theconversation.com/files/542294/original/file-20230811-4652-hn8w80.png?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/542294/original/file-20230811-4652-hn8w80.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=600&fit=crop&dpr=1 600w, https://images.theconversation.com/files/542294/original/file-20230811-4652-hn8w80.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=600&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/542294/original/file-20230811-4652-hn8w80.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=600&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/542294/original/file-20230811-4652-hn8w80.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=754&fit=crop&dpr=1 754w, https://images.theconversation.com/files/542294/original/file-20230811-4652-hn8w80.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=754&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/542294/original/file-20230811-4652-hn8w80.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=754&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<p><em>This article is part of <a href="https://theconversation.com/uk/topics/womens-health-matters-143335">Women’s Health Matters</a>, a series about the health and wellbeing of women and girls around the world. From menopause to miscarriage, pleasure to pain the articles in this series will delve into the full spectrum of women’s health issues to provide valuable information, insights and resources for women of all ages.</em></p>
<p><em>You may be interested in:</em></p>
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<p><em><a href="https://theconversation.com/the-orgasm-gap-and-why-women-climax-less-than-men-208614">The orgasm gap and why women climax less than men</a></em></p>
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<h2>1. Reusable condoms</h2>
<p>People have used sheaths since at least the 17th century, mostly to prevent sexually transmitted infections. Initially these were made of <a href="https://wellcomecollection.org/articles/W88vXBIAAOEyzwO_">natural material such as animal intestines or linen</a>.</p>
<p>Just a few years after the <a href="https://www.pbs.org/wgbh/theymadeamerica/whomade/goodyear_hi.html#:%7E:text=A%20dogged%20experimenter%20with%20no,%2D%2D%20a%20key%20industrial%20substance.&text=Charles%20Goodyear%20and%20his%20family,viable%20as%20an%20industrial%20material">invention of synthetic rubber</a> (1844), the rubber condom was created. It was <a href="https://daily.jstor.org/short-history-of-the-condom/">designed to be rinsed and re-used</a>, but as a result it was thicker and less comfortable than today’s male condoms. </p>
<p>The <a href="https://daily.jstor.org/short-history-of-the-condom">disposable latex condom</a> was not invented until the 1930s. These were thinner, more comfortable and, of course, used only once. Later that decade, US courts overturned a ban on the sale of “immoral goods”, which helped make condom use more widespread.</p>
<h1>2. Acid-soaked sponges</h1>
<p>Since acid kills sperm, one traditional home-made method of contraception <a href="https://artsci.case.edu/dittrick/online-exhibits/history-of-birth-control/contraception-in-america-1900-1950/condoms-and-sponges/">involved inserting a vinegar-soaked sponge</a> into the vagina. Purpose-designed sponges became <a href="https://collection.sciencemuseumgroup.org.uk/objects/co96354/contraceptive-sponge-united-kingdom-1901-1930-contraceptive-sponge">commercially available</a> at the beginning of the 20th century and contained chemical spermicide. </p>
<p><a href="https://youtu.be/VrwpX1EgQck">Variations of the spermicidal sponge</a> are still available. However, less than <a href="https://digital.nhs.uk/data-and-information/publications/statistical/sexual-and-reproductive-health-services/2021-22/data-tables">1% of women in the UK</a> use the sponge today. </p>
<p>The typical failure rate, particularly for young women, is about <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3638209/">12%-24% per year</a>. In general, younger women are more likely to get pregnant while using less effective methods because they are more fertile than older women. </p>
<figure class="align-left zoomable">
<a href="https://images.theconversation.com/files/532682/original/file-20230619-15-yqy28y.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Large orange sponge in a net" src="https://images.theconversation.com/files/532682/original/file-20230619-15-yqy28y.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/532682/original/file-20230619-15-yqy28y.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=900&fit=crop&dpr=1 600w, https://images.theconversation.com/files/532682/original/file-20230619-15-yqy28y.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=900&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/532682/original/file-20230619-15-yqy28y.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=900&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/532682/original/file-20230619-15-yqy28y.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=1131&fit=crop&dpr=1 754w, https://images.theconversation.com/files/532682/original/file-20230619-15-yqy28y.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=1131&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/532682/original/file-20230619-15-yqy28y.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=1131&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
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<span class="caption">Contraceptive sponge, 1901-1930.</span>
<span class="attribution"><a class="source" href="https://wellcomecollection.org/works/m4smgwfy">Science Museum, London</a>, <a class="license" href="http://creativecommons.org/licenses/by/4.0/">CC BY</a></span>
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<h2>3. Diaphragms and caps</h2>
<p>Diaphragms and their <a href="https://pubmed.ncbi.nlm.nih.gov/7099129/">smaller cousins, called caps</a>, were invented in the early 19th century. Like condoms, they work as physical barriers to sperm, and like sponges are also used with chemical spermicide. They are inserted before sex into the vagina and should stay in place for a least six hours afterwards to <a href="https://www.nhs.uk/conditions/contraception/contraceptive-diaphragm-or-cap/">allow the spermicide to kill sperm</a>. </p>
<p>The cap and diaphragm were widely used in the US and Europe before the second world war. But the <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3638209/">typical failure rate for young women</a> using these methods is about 12%. Partly as a result, <a href="https://www.un.org/development/desa/pd/data/world-contraceptive-use">less than 1% of women worldwide</a> use them today. </p>
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<a href="https://images.theconversation.com/files/532684/original/file-20230619-21-isechv.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Thick rubber cap with pull cord" src="https://images.theconversation.com/files/532684/original/file-20230619-21-isechv.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/532684/original/file-20230619-21-isechv.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=900&fit=crop&dpr=1 600w, https://images.theconversation.com/files/532684/original/file-20230619-21-isechv.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=900&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/532684/original/file-20230619-21-isechv.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=900&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/532684/original/file-20230619-21-isechv.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=1131&fit=crop&dpr=1 754w, https://images.theconversation.com/files/532684/original/file-20230619-21-isechv.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=1131&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/532684/original/file-20230619-21-isechv.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=1131&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
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<span class="caption">Rubber cervical cap.</span>
<span class="attribution"><a class="source" href="https://iiif.wellcomecollection.org/image/L0065292/full/760%2C/0/default.jpg">Science Museum, London</a>, <a class="license" href="http://creativecommons.org/licenses/by/4.0/">CC BY</a></span>
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<p>The high failure rates of barrier methods are partly because they don’t stop women ovulating. If sperm manage to get through the barrier, the chances of fertilisation are high. The other drawback is that they are difficult to fit and must be in place before sex, at a time the woman would probably prefer to be thinking of other things.</p>
<h2>4. Douching with antiseptic</h2>
<p>Rinsing the vagina after intercourse, often with antiseptic solution, was used as <a href="https://artsci.case.edu/dittrick/online-exhibits/history-of-birth-control/contraception-in-america-1900-1950/douching-and-spermicides/">contraception in the early 20th century</a>. Douching does not affect sperm which has already started on its journey through the cervix. So the efficacy of vaginal douching was very low. </p>
<p>Today health professionals <a href="https://www.womenshealth.gov/a-z-topics/douching">strongly discourage</a> douching because of the harm it does to vaginal flora (the natural protective bacteria in the vagina), which can lead to vaginal irritation and infection. </p>
<h2>5. Silkworm gut IUDs</h2>
<p>Intra-uterine devices (IUDs) <a href="https://digital.nhs.uk/data-and-information/publications/statistical/sexual-and-reproductive-health-services">remain popular</a> but they didn’t always work the same way as modern products.</p>
<p>Early intrauterine methods worked on the (partially correct) belief that any device sitting inside the womb is likely to stop a fertilised egg from implanting and developing in the womb. In the 19th century, wishbone pessaries (so called because of their shape) were used to prevent pregnancy. </p>
<p>These devices had two arms which protruded through the cervix into the vagina, and a button ending which covered the cervix. It is hard to imagine <a href="https://collection.sciencemuseumgroup.org.uk/objects/co96426/wishbone-%20stem-pessary-intracervical-device-europe-1880-1940-intra-uterine-device">that these were comfortable</a>. </p>
<p>Polish gynaecologist Richard Richter <a href="https://pubmed.ncbi.nlm.nih.gov/1093589/#:%7E:text=PIP%3A%20The%20first%20published%20p">published a paper in 1909</a> about how he inserted a ring of silkworm gut into a patient’s womb, with two protruding strings to allow removal. At the time a lot of gynaecologists were discreetly using their own versions of such devices, because of <a href="https://www.mtsu.edu/first-amendment/article/983/birth-control">laws against promoting contraception</a> in many countries.</p>
<p>The Graefenberg ring replaced the silkworm gut with a metal alloy ring in the 1920s. German gynaecologist Ernst Graefenberg first tried pure silver, but the body <a href="https://www.reproductiveaccess.org/2013/01/a-history-the-iud/">absorbed it</a> and turned the women’s gums blue. </p>
<p>All kinds of <a href="https://artsci.case.edu/dittrick/online-exhibits/history-of-birth-control/contraception-in-america-1950-present-day/intrauterine-device-iud/">materials and shapes of IUDs</a>, from leaf shapes to spirals, were used throughout the fifties, sixties and seventies until researchers realised copper improved the effectiveness of the devices. By the 1970s there were about 70 different intra-uterine devices on the market in the USA. </p>
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<a href="https://images.theconversation.com/files/532677/original/file-20230619-29-abqt5w.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Sketch of a Dalkon shield IUD" src="https://images.theconversation.com/files/532677/original/file-20230619-29-abqt5w.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/532677/original/file-20230619-29-abqt5w.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=554&fit=crop&dpr=1 600w, https://images.theconversation.com/files/532677/original/file-20230619-29-abqt5w.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=554&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/532677/original/file-20230619-29-abqt5w.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=554&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/532677/original/file-20230619-29-abqt5w.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=697&fit=crop&dpr=1 754w, https://images.theconversation.com/files/532677/original/file-20230619-29-abqt5w.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=697&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/532677/original/file-20230619-29-abqt5w.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=697&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
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<span class="caption">dalkon shield.</span>
<span class="attribution"><a class="source" href="https://en.wikipedia.org/wiki/Dalkon_Shield#/media/File:Sketch_of_a_Dalkon_Shield_IUD-_2013-04-9_05-16.jpg">Andy Ratchick</a>, <a class="license" href="http://creativecommons.org/licenses/by-nc-sa/4.0/">CC BY-NC-SA</a></span>
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<p>But one of these copper coils, the infamous <a href="https://www.britannica.com/science/Dalkon-Shield">Dalkon shield, allowed</a> bacteria to ascend into the womb, because of the design of the threads used to retrieve it. This was responsible for high numbers of infections and made acceptance of intrauterine methods plummet in the 1970s. </p>
<p>Modern intrauterine devices (IUDs) sit fully in the womb, contain either copper or slow-release progesterone-type hormones, and are much safer and more effective than older devices. Infections due to <a href="https://www.healthline.com/health/birth-control/iud-infection#risk-factors">IUDs are rare now</a> but occasionally happen in the first few weeks after insertion. Both hormonal and copper coils now have <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3638209/">failure rates of less than 1%</a>. </p>
<p>We now have several methods of contraception which, if used correctly, rarely fail, but women still struggle to find a method that suits them. New research is focused on reducing the side effects of contraception but in the meantime governments should invest in sexual health services to give people better, faster access to contraceptives and advice to choose the method that suits them best.</p><img src="https://counter.theconversation.com/content/207572/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Susan Walker has received funding from Bayer PLC and has been a consultant to NaturalCycles. </span></em></p>Contraception today may not be perfect but it’s better than methods of the past.Susan Walker, Reader in Contraception, Reproductive and Sexual Health, Anglia Ruskin UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1334152020-08-18T19:46:17Z2020-08-18T19:46:17ZCondoms are the best defence against rising sexually transmitted infections<figure><img src="https://images.theconversation.com/files/353488/original/file-20200818-16-1v7faxy.jpg?ixlib=rb-1.1.0&rect=0%2C1056%2C6709%2C3410&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Clear and accurate information about condoms and sexually transmitted infections is one of the best tools to avoid sexual health risks.</span> <span class="attribution"><span class="source">(Shutterstock)</span></span></figcaption></figure><p>Rates of sexually transmitted infections in Canada have increased dramatically over the past decade, despite earlier public health and sexuality education interventions that reduced the rate of sexually transmitted infections (STI). Between 2008 and 2017, the rates of <a href="https://www.canada.ca/en/public-health/services/publications/diseases-conditions/report-sexually-transmitted-infections-canada-2017.html#f23">chlamydia increased 39 per cent, gonorrhea 109 per cent and infectious syphilis 167 per cent, according to the Public Health Agency of Canada</a>. </p>
<p>A variety of factors has contributed to the increase, such as changing societal and cultural norms, barriers to accessing condoms and changes in diagnostic and screening practices. </p>
<p>Although PHAC tracks STIs, it doesn’t track the most important tool we have in preventing the spread of STIs: condom use. Instead, occasional government surveys and university-based research fill the gaps. People may not be using condoms at the same rate as before, but it is difficult to know for sure because there is a lack of data. </p>
<p>As sociologists of sexualities, we collected data on condom use as a part of a larger, first-of-its-kind study on sex and sexuality in Canada. Our findings show that about <a href="https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0228981">one-third of adult Canadians who engaged in penile-vaginal intercourse during their sexual encounters used condoms</a>. One survey can’t track changes over time, but it can be an important piece of the puzzle of understanding who uses condoms, in what types of sexual encounters they are used, and why. </p>
<h2>Sex in Canada study</h2>
<p>Younger adults use condoms more often than older Canadians, even when accounting for other demographic characteristics: 42 per cent of 19- to 29-year-olds used condoms in their most recent sexual encounters, compared to 31 per cent of 30- to 49-year-olds and 19 per cent of 50- to 64-year-olds. Seniors (65 and older) were the least likely to use condoms: 11 per cent.</p>
<p><a href="https://theconversation.com/older-people-still-have-sex-but-its-the-intimacy-and-affection-that-matters-more-70196">Seniors are often thought of as non-sexual</a>, but they continue to be sexually active. They may not, however, <a href="https://theconversation.com/think-teens-need-the-sex-talk-older-adults-may-need-it-even-more-103815">have access to the information about condoms and safer sex that young people have in school</a>. Older adults should use condoms to protect themselves from STIs, but not enough research, resources or public policy initiatives are encouraging safer-sex practices within this group.</p>
<p>We find that condom use is also higher (31 per cent) among those with university degrees compared those without (22 per cent). These institutions may be offering effective sexual health education and initiatives, such as providing free and easy access to condoms, which may lead to increased condom use among graduates.</p>
<p>Our results also suggest that when people use other forms of birth control, condom use decreases. This may be because pregnancy prevention is a greater concern for Canadians than avoiding STIs, or that sex education does not focus sufficiently on STI prevention. </p>
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Read more:
<a href="https://theconversation.com/fun-sex-is-healthy-sex-why-isnt-that-on-the-curriculum-81020">Fun sex is healthy sex: Why isn't that on the curriculum?</a>
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<p>Last, we find that informal and formal sexual health education is associated with increased condom use. This includes men who learn about condoms formally, such as through school-based sex education, or informally, such as through friends or the internet. Women’s increased condom use was only associated with formal sex education during middle and high school. Without formal sex education that covers condom use, women may be more at risk of STIs.</p>
<p><a href="http://educ.queensu.ca/sites/webpublish.queensu.ca.educwww/files/files/Research/SPEG/SPEG%20Canadian%20Youth%2C%20Sexual%20Health%20and%20HIV.pdf">Sex education advocates and public health experts consistently report</a> that clear and accurate information about condoms and sexually transmitted infections is one of the best tools to avoid sexual health risks. Our findings give credence to those experts who have advocated for increased sex education curriculum in schools. </p>
<h2>More data needed</h2>
<p>Keeping sexually transmitted infection rates low is an important public health goal. For example, PHAC recently launched a <a href="https://www.canada.ca/en/public-health/services/reports-publications/accelerating-our-response-five-year-action-plan-sexually-transmitted-blood-borne-infections.html">five-year action plan</a> to monitor sexually transmitted and blood-borne illnesses. Although condom use cannot prevent the transmission of STI’s in all types of sexual encounters, they are an important prevention tool. Our study focused on penile-vaginal sex, but <a href="https://www.healthline.com/health/lgbtqia-safe-sex-guide#Overview">many other groups, sexual pairings and sexual activities would benefit from using condoms</a>.</p>
<p>Even though condom use is a key part of the plan to reduce STI transmission, measuring it has not been. We should know whether Canadians’ use of condoms is increasing or decreasing over time, and the best way to get that data is to include questions on condom use every year on annual surveys like the <a href="https://www.canada.ca/en/health-canada/services/food-nutrition/food-nutrition-surveillance/health-nutrition-surveys/canadian-community-health-survey-cchs.html">Canadian Community Health Survey</a>.</p>
<p>Our research also emphasizes the need for more data on people’s attitudes about condoms, their knowledge of proper condom use and the conditions that promote or inhibit the use of condoms. Future research should assess the implications of sex education curricula on young adults’ use of and perspectives about condoms, access to ongoing sexual health education and age-specific resources, and gendered attitudes and beliefs about negotiating condom use during partnered sex between men and women.</p><img src="https://counter.theconversation.com/content/133415/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>This research was supported by Social Sciences and Humanities Research Council of Canada Insight Grant 435-2017-0369: Tina Fetner (PI), Michelle Dion (co-I) and Melanie Heath (co-I).
</span></em></p><p class="fine-print"><em><span>Nicole Andrejek does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>People may not be using condoms at the same rate as before, but it is difficult to know for sure because there is a lack of data.Nicole Andrejek, Research Assistant, Sociology, McMaster UniversityTina Fetner, Associate Professor, Sociology, McMaster UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1183432019-08-16T04:44:11Z2019-08-16T04:44:11ZCase in Victoria could set new legal precedent for stealthing, or removing condom during sex<figure><img src="https://images.theconversation.com/files/288275/original/file-20190816-136176-baug7b.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">A surgeon has been committed to stand trial next year in a case involving stealthing, believed to be the first of its kind in Australia.</span> <span class="attribution"><span class="source">Shutterstock</span></span></figcaption></figure><p>In September 2018, a prominent Melbourne surgeon and academic was <a href="https://www.theage.com.au/national/victoria/top-surgeon-charged-with-rape-after-removing-condom-without-permission-20190530-p51sxh.html">charged with rape and sexual assault</a> for alleged offences committed a year earlier against a male doctor. </p>
<p>The surgeon and doctor had gone out for dinner and returned to the doctor’s home and had intercourse. Despite assuring the doctor he would use a condom, the surgeon is alleged to have removed it without consent, a practice known as “<a href="https://www.psychologytoday.com/au/blog/married-and-still-doing-it/201809/stealthing-what-you-need-know">stealthing</a>”. The doctor later made a complaint to police and the surgeon was charged with one count of sexual assault and one count of rape. </p>
<p>In late July, a <a href="https://www.alrc.gov.au/publications/23.%20General%20Issues%20of%20Evidence%20and%20Procedure/committal-proceedings">committal proceeding</a> took place in the Magistrates Court of Victoria to determine whether there was enough evidence to require the surgeon to stand trial. The surgeon was <a href="https://www.theage.com.au/national/victoria/stealth-rape-accused-surgeon-allowed-to-keep-treating-patients-20190813-p52gil.html">committed to stand trial</a> next year. </p>
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Read more:
<a href="https://theconversation.com/womens-reproductive-lives-are-being-interfered-with-on-a-large-scale-new-study-109375">Women's reproductive lives are being interfered with on a large scale – new study</a>
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<p>This week, an <a href="https://www.theage.com.au/national/victoria/stealth-rape-accused-surgeon-allowed-to-keep-treating-patients-20190813-p52gil.html">appeal from the Medical Board of Australia was dismissed</a> and the surgeon was permitted to continue treating patients while the criminal case makes its way through the courts. Justice Richard Niall <a href="https://www.theage.com.au/national/victoria/stealth-rape-accused-surgeon-allowed-to-keep-treating-patients-20190813-p52gil.html">said that immediate action</a> against the surgeon was not in the public’s interest.</p>
<p>From a legal standpoint, the case brings up an important question about how this offence should be classified under the law. At the moment, no criminal law in Australia explicitly identifies stealthing as a sexual offence. </p>
<h2>What is stealthing?</h2>
<p>Sexual violence is becoming increasingly prevalent in Australian society, with <a href="https://www.aihw.gov.au/reports/domestic-violence/family-domestic-sexual-violence-australia-2019/contents/table-of-contents">nearly one in five women (18%) and one in 20 men (4.7%)</a> experiencing sexual assault and/or threats in their lifetime. </p>
<p>Stealthing, an emerging area within criminal law, is believed to happen even more frequently. According to a recent joint <a href="https://www.researchgate.net/publication/329926736_Non-consensual_condom_removal_reported_by_patients_at_a_sexual_health_clinic_in_Melbourne_Australia">study</a> between the Melbourne Sexual Health Centre and Monash University, one in three women and nearly one in five men in Australia have reported being stealthed.</p>
<p>The study found that most women who had been stealthed met the perpetrators through friends (29%) or sex work (23%). Male victims of stealthing, meanwhile, tended to meet their partners (also mostly male) through dating apps or online. </p>
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<a href="https://theconversation.com/victorian-rape-law-needs-reform-to-protect-sex-workers-39460">Victorian rape law needs reform to protect sex workers</a>
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<p>Unfortunately, the statistics for reporting stealthing mirror reporting rates for sexual offences more generally, with the study finding that only 1% of respondents indicated they had reported stealthing incidents to police. </p>
<p>Stealthing poses a <a href="https://www.tandfonline.com/doi/abs/10.1080/10345329.2019.1604474">multitude of risks</a> to both physical and psychological health, including the transmission of sexually transmitted infections and HIV, as well as unplanned pregnancies, depression, anxiety, and in some cases post-traumatic stress disorder.</p>
<h2>Current approach to stealthing under criminal law</h2>
<p>Despite the <a href="https://www.lawreform.vic.gov.au/content/sexual-offences-recommendations">decades of extensive reform</a> of laws governing sexual offences in Australia, significant gaps remain in the legislative provisions governing consensual intercourse. </p>
<p>Definitions of rape in Victoria and sexual assault in other states mandate an assessment of whether or not an individual understands the sexual nature of the act and whether or not full consent has been given prior to engaging in intercourse. Under current laws, this consent cannot be granted without “<a href="http://classic.austlii.edu.au/au/legis/vic/consol_act/ca195882/s36.html">free agreement</a>”. </p>
<p>The real issue with the laws as they stand is that stealthing just doesn’t fit into the current definition of rape. The current definition is simply about whether or not the victim, in this case the doctor, understands that the act that they have consented to is sexual in nature, not whether any other conditions, such as condom usage, have been met.</p>
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<a href="https://theconversation.com/everyday-rape-lets-turn-the-spotlight-on-known-perpetrators-39437">Everyday rape: let's turn the spotlight on known perpetrators</a>
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<p>Situations where those conditions have changed – such as when a condom has been removed – should require “fresh consent” from both partners. As Lina Howlett, a NSW sex crimes squad commander, <a href="https://www.abc.net.au/triplej/programs/hack/stealthing-and-the-law/8489348">explains</a>,</p>
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<p>sex turns into assault when consent is not given or [is] withdrawn, e.g. they are having consensual sex and one party becomes aware that the condom was removed and tells the partner to stop and the partner continues.</p>
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<p>The problem is, there is no legal precedent for such a case in Australia.</p>
<h2>Other cases around the world</h2>
<p>Switzerland is out in front on this issue globally, with <a href="https://www.news.com.au/lifestyle/relationships/sex/swiss-court-upholds-sentence-in-stealthing-condom-case/news-story/56e4801cb63bc3c288e1f3a6bf2b609b">courts there upholding a 12-month suspended</a> sentence for a man convicted of stealthing. The Swiss case is <a href="https://www.elle.com.au/news/stealthing-not-rape-switzerland-court-rules-13045">believed to be the first</a> to specifically deem the removal of a condom without a partner’s consent to be a criminal act. The could provide some preliminary insight into how the courts in Australia will view this sexual crime. </p>
<p>There is no current call by legislators in Australia to update the laws against sexual assault to include stealthing. However, there is some movement in other jurisdictions around the world. In the US, <a href="https://www.buzzfeednews.com/article/briannasacks/stealthing-laws">Wisconsin and California</a> have both attempted to change the laws with bills in recent years. </p>
<p>A judgement in the case against the surgeon accused of stealthing in Victoria should provide some legal clarity on the issue, hopefully providing impetus for a move to change the laws here.</p><img src="https://counter.theconversation.com/content/118343/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Brianna Chesser does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>There is currently no law that specifically outlaws stealthing in Australia. A case making its way through the courts in Victoria could provide legal clarity on the issue.Brianna Chesser, Senior Lecturer in Criminology and Justice, RMIT UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/594672016-05-17T02:46:42Z2016-05-17T02:46:42ZAntiviral condoms will help protect Australian Olympians from STIs – here’s how<figure><img src="https://images.theconversation.com/files/122770/original/image-20160516-15912-ina5q.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">The antiviral condoms help protect against HIV, herpes and HPV.</span> <span class="attribution"><a class="source" href="http://www.shutterstock.com/pic-187292438/stock-photo-vegetables-close-up.html?src=1590PSzzj_tr2gL_CgyVAw-1-6">Shutterstock</a></span></figcaption></figure><p>This August, Australia will send a team to compete at the <a href="http://rio2016.olympics.com.au/">Olympic Games</a> in Rio de Janeiro. As well as providing our athletes all the necessary resources to compete at their best, we will also be doing everything we can to look after their health. This includes supplying them with condoms and antiviral lubricant that provide an extra level of protection over regular condoms.</p>
<p>The condoms and lubricant will <a href="http://dx.doi.org/10.1371/journal.pone.0024095">help protect against sexually transmitted diseases</a> including human immunodeficiency virus (<a href="https://theconversation.com/au/topics/hiv">HIV</a>), genital herpes, and human papillomaviruses (HPV). They might also protect against the <a href="https://theconversation.com/au/topics/zika">Zika virus</a>. </p>
<h2>The science behind the condoms</h2>
<p>The condoms help prevent infection through a combination of defences.</p>
<p>The first layer of protection is the physical barrier provided by the condom itself. An intact condom is effective against all bacteria and viruses, and only loses its protection when it breaks or develops a hole. But the condom is not itself antiviral.</p>
<p>The second layer of protection is the lubricant, called <a href="http://starpharma.com/vivagel">VivaGel</a>, which is provided for use with the condoms. The condoms are only antiviral when used in combination with the lubricant.</p>
<p>The lubricant uses a special type of compound called a <a href="http://www.starpharma.com/technology/what_are_dendrimers_">dendrimer</a>. In this case, it is a sphere-shaped polymer, mostly made up of the amino acid <a href="http://www.drugs.com/npc/lysine.html">lysine</a>, that acts as a polyanion-based entry inhibitor. This means the active ingredient in the gel can bind to various viruses and stop them from attaching and getting into human cells. The dendrimer used in the VivaGel is called astodrimer sodium.</p>
<p>The gel was only <a href="http://www.starpharma.com/news/201">approved by the Australian Therapeutic Goods Administration</a> in 2014 and gained European approval in 2015. Several clinical trials are ongoing in the United States.</p>
<h2>What does it protect against?</h2>
<p>The manufacturer, Starpharma, claims the condoms with antiviral lubricant provide added protection against HIV, the cause of AIDS, and herpes simplex virus 2, the cause of genital herpes. </p>
<p>The VivaGel lubricant also potentially provides added protection against HPV which is a causative agent in the development of cervical cancer. While men who become infected by HPV can not develop cervical cancer, and may show no signs they are carrying the virus, they can act as a carrier and pass it to women. </p>
<p>As HPV is also a <a href="http://www.cancervic.org.au/about-cancer/cancer_types/anal_cancer">risk factor for anal cancer</a>, the virus can also potentially be transferred to other men and women. The lubricant may help prevent infection in this way.</p>
<p>While the company has not conducted clinical trials on the <a href="http://www.cdc.gov/zika/about/index.html">Zika virus</a>, the results of laboratory tests also show that it is possible that the condom and lubricant may also provide added protection against this infection. </p>
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<p>Read more of The Conversation’s Zika coverage <a href="https://theconversation.com/au/topics/zika">here</a>.</p>
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<p>There are no treatments or vaccines against Zika, so protection against infection is important. While the virus is principally transmitted through the bites of infected mosquitoes, it is also possible <a href="http://www.who.int/mediacentre/factsheets/zika/en/">Zika can be transmitted through sexual intercourse</a>.</p>
<p>Of course, like any medical treatment there are potential risks. The <a href="https://aidsinfo.nih.gov/drugs/524/astodrimer/0/professional">side effects of the dendrimer</a> in VivaGel have been reported to include irritation, vaginal pain, bleeding, burning, or itching when applied internally as a gel. </p>
<p>We want our Australian athletes to have a great time, both in and out of competition, and the provision of these condoms with antiviral lubricant seems a prudent move to help safeguard their health while they compete.</p><img src="https://counter.theconversation.com/content/59467/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Dr Wheate in the past has received funding from the ACT Cancer Council, Tenovus Scotland, Medical Research Scotland, Scottish Crucible, and the Scottish Universities Life Sciences Alliance. Dr Wheate has previously undertaken research on the medical applications of dendrimers.</span></em></p>The active ingredient in the gel can bind to various viruses and stop them from attaching and getting into human cells.Nial Wheate, Senior Lecturer in Pharmaceutics, University of SydneyLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/448662015-07-30T05:16:51Z2015-07-30T05:16:51ZCould HIV-prevention pills actually increase infection risk by cutting condom use?<figure><img src="https://images.theconversation.com/files/89491/original/image-20150723-22811-1qtowp4.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption"></span> <span class="attribution"><span class="source">Shutterstock</span></span></figcaption></figure><p>It’s been hailed as a major breakthrough and one of the much-needed tools to “<a href="http://www.theguardian.com/commentisfree/2015/feb/26/hiv-treatment-game-changer-truvada-nhs-trial">end HIV</a>”. But there are <a href="http://betablog.org/re-thinking-risk-compensation-conversation-kim-koester/">also concerns</a> about pre-exposure prophylaxis (PrEP), the use of antiretroviral drugs by HIV-negative people to prevent them from becoming infected with the virus. Will people taking PrEP stop using condoms and could this actually lead to an increase in HIV and sexually transmitted infections (STIs)?</p>
<p>PrEP appears to be a highly effective method of reducing risk of HIV transmission. Adding to growing <a href="http://www.cdc.gov/hiv/prevention/research/prep/">international evidence</a>, the <a href="http://www.aidsmap.com/Pre-exposure-prophylaxis-PrEP-stops-86-of-HIV-infections-in-PROUD-study/page/2947319/">Proud trial</a> tested the use of PrEP with gay and bisexual men in England and found a reduction in HIV transmission of 86% amongst men who took PrEP every day. Truvada, the drug used in the Proud trial, is not currently licensed for use as PrEP in the UK. However, as a result of the findings, there has been a <a href="http://www.independent.co.uk/life-style/health-and-families/health-news/make-new-hiv-protection-pill-available-on-the-nhs-say-sexual-health-campaigners-9387332.html">concerted effort</a> by HIV policymakers and community activists to make Truvada available as PrEP on the NHS as soon as possible.</p>
<p>Evidence to date has shown mixed results when it comes to continued condom use with PrEP. The Proud trial, which recruited participants reporting some but not exclusive use of condoms, found the number of people not using condoms remained the same throughout the study. STI rates across both trial arms – the group that received PrEP immediately and the group that had to wait 12 months – also remained similar. Evidence from three locations from the <a href="http://www.aidsmap.com/How-will-people-use-PrEP-iPrEx-users-talk-condoms-pills-anxiety-and-relief/page/2894961/">iPrEX study</a> in the US suggests that, although some younger participants reduced condom use, in most cases PrEP did not reduce condom use but did reduce stress, fear, and guilt.</p>
<p>We need to consider who might be willing to use PrEP. A <a href="http://www.bhiva.org/140404JamieFrankis.aspx">number of surveys</a> with gay and bisexual men in the UK have shown that men reporting lower levels of condom use and who are at higher risk of HIV are interested in PrEP. Introducing PrEP to this group might not necessarily reduce condom use, but could protect against HIV infections where condoms are not already being used. In this way, PrEP could fill a gap in HIV prevention for those individuals who find it difficult, or are unable, to use condoms as their main means of preventing HIV.</p>
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<img alt="" src="https://images.theconversation.com/files/90161/original/image-20150729-30862-1b3wme4.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/90161/original/image-20150729-30862-1b3wme4.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/90161/original/image-20150729-30862-1b3wme4.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/90161/original/image-20150729-30862-1b3wme4.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/90161/original/image-20150729-30862-1b3wme4.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/90161/original/image-20150729-30862-1b3wme4.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/90161/original/image-20150729-30862-1b3wme4.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<span class="caption">Tried and tested protection.</span>
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<p>Our <a href="http://bmjopen.bmj.com/content/4/11/e005717.full">PrEP research</a> in Scotland with gay and bisexual men, and men and women from migrant African communities, found that concerns about PrEP went beyond condom use. Participants in our qualitative study highlighted anxieties around the immediate and long-term side-effects of PrEP, a lack of trust that PrEP would work, and a belief that they were not at high-enough risk to merit taking a daily pill to prevent HIV. In addition, given that PrEP is not 100% effective, skills amongst participants in calculating risk reduction in relation to PrEP appeared to be mixed and will be an important factor in the effective “real-world” use of PrEP.</p>
<p>But our study also highlighted the fear that others would stop using condoms as a result of PrEP. One man compared the impact of PrEP to “women burning their bras” because he was concerned that other men would stop using condoms and threaten a 30-year history of HIV-prevention based on condom use. This suggests that many people still see condoms as the main HIV-prevention tool and demonstrates the need to engage with these fears and identify how PrEP might fit into, rather than disrupt, existing HIV prevention strategies.</p>
<p>Given the <a href="http://www.independent.co.uk/news/uk/home-news/pride-in-london-nhs-to-come-under-pressure-to-provide-miracle-hiv-prevention-pill-10349303.html">likely introduction</a> of PrEP in the UK in the not-too-distant future, we need to draw on existing evidence to encourage its equitable introduction into health services and access by those most at risk of HIV. There needs to be clear guidance and support for using PrEP in combination with existing HIV-prevention strategies, including condoms. We need to find acceptable, effective and clear ways of explaining PrEP to potential users and work to improve understandings and skills in assessing and reducing risk. </p>
<p>Finally, we need to address existing – and sometimes conflicting – <a href="http://www.aidsmap.com/PrEP-wars-debating-pre-exposure-prophylaxis-in-the-gay-community/page/2572027/">community concerns</a> about PrEP . We need to find ways of talking openly about what a range of HIV prevention options might look like, without moralising or judging individual practices. Good sexual health needs to recognise the dynamic lives of people affected by HIV. No matter how well PrEP might work, it alone will not be the magic bullet to end HIV.</p><img src="https://counter.theconversation.com/content/44866/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Lisa McDaid receives funding from the UK Medical Research Council, Scottish Chief Scientist Office and the National Institute for Health Research.</span></em></p><p class="fine-print"><em><span>Ingrid Young holds a fellowship funded by the Scottish Chief Scientist Office (CSO).</span></em></p>PrEP drugs to prevent people contracting HIV mustn’t disrupt existing sexual health strategies.Lisa McDaid, Programme leader, MRC/CSO Social and Public Health Sciences Unit, University of GlasgowIngrid Young, Research fellow, MRC/CSO Social and Public Health Sciences Unit, University of GlasgowLicensed as Creative Commons – attribution, no derivatives.