"not based on science or evidence"

Oh really.

FAILURES OF THE MEMBRANE OF THE CONDOM
1) Permeability of the latex membrane for microparticles, STD agents and
HIV
In 1977 D.Barlow v advanced the hypothesis of the existence of some pores
in
the latex membrane of a condom in order to explain why this did not appear
to protect
against non-gonococcal urethrites and genital infections with Condylomata
acuminata.
This hypothesis has been revived in order to account for HIV infections
acquired during
sexual intercourse "protected" by use of a condomvi.
S.G.Arnold et al. (1988) vii have examined latex gloves from four
manufacturers using scanning electron microscopy and X-ray analysis. They
found that all of the gloves had pits 3-15µm wide and up to 30µm deep on
both interior and exterior
surfaces. Irregular particles (30-50µm) containing silicon and magnesium
were embedded in the latex deeply enough to cause pits themselves.
__________
REF: -
Freeze-fractured
1 Pontifical Council for the Family, Rome. Current adress: 18 via della
Traspontina, Roma, 00193, Italy.
2 English translation by D.E.Parry from the revised original article « Le
"sexe sûr" et le préservatif face au défi du Sida», Medicina e Morale,
n°4, 1997, pp.689-726.
2 sections of all gloves showed cavities throughout the matrix and
tortuous channels
(5µm) penetrating the entire thickness of the glove.
__________
Such irregularities in latex membrane surface and structure do not seem to
be encountered in condoms, at least when they are new, and have not been
exposed to heat, oxygen, or ozone. However, under scanning electron
microscopy, the surface of a latex condom membrane is not uniformly
smooth: it appears made of smooth areas separated by puckers and dimples
scattered across the specimen (viii). There are hollows and irregular
projections on this surface, with irregular, dense inclusions (ix).
Although numerous pores are visible in scanning electron microscopy of
natural condoms (x,) no
evidence of breaks, fissures or pores have yet been reported in the few
published
transmission electron microscope studies of latex condoms (xi).
Some authorities have concluded that latex membranes of condoms, despite
their nonhomogeneous structure and the irregularity of their surface,
could be considered free of microscopic pores, of a size down to that of
the smaller virus.
However, these results have been put in question.
First, as Rosenzweig et al.(xviii) say it, all the aboved mentioned
electron microscopic studies of condoms have been "predominantly
anecdotal". These later authors, in their own study of thirty samples from
fifteen non-lubricated Trojan condoms, did find that a large proportion of
these samples have visible surface abnormalities, with only 30% of all
condoms tested completely free of detectable defects under all
magnifications. 50% of the samples
revealed a surface abnormality interpreted as either cracking, melting or
both.
Second, in vitro studies about the grade of impermeability of condoms
membranes to microorganisms, using a condom plunged into a culture medium,
are few, and limited to small sample sizes. Confidence intervals
constructed around reported failure rates indicate that "true"
permeability rates could be quite high, and
new data suggest that some condom do leak HIV and that leakage is not
necessarily
related to whether or not they are made of late (xxix).
Moreover, experience with STDs shows the need for prudence in
extrapolating results obtained in vitro to situations in (vivoxx).
Third, optimism about condoms membrane integrity has been shaken after
closely controlled condoms, coming from known manufacturers, had shown a
permeability to microspheres of greater size than that of HIV (6 condoms
out of 69)xxi.
Carey et al.(xxii) observed the passage of polystyrene microspheres, 110
nm diameter (
HIV diameter is from 90nm to 130 nm) across 33% of the membranes of the
latex
condoms which they studied (29 over 89 nonlubricated latex condoms). More
recently,
Lytle et al., while criticizing the "exaggerated conditions" of the in
vitro, polystyrene
3
microspheres test carried out by Carey et al., found that 2,6% (12 of 470)
of the latex
condoms did allow some virus penetration, with no difference between
lubricated and
nonlubricated condoms (xxiii).
It has been said that since HIV in semen is associated with white blood
cells
(and, may be, also with spermatozoa) and since neither spermatozoa nor
white cells
can pass through these very small hypothetic "pores" in the latex, then
HIV itself cannot
pass. So these "pores", even if they do exist, could not therefore be of
such
importance. But this is deceptive. In fact HIV is present in sperm in two
forms:
associated with white blood cells and as free virus particles (xxiv); And
C.J.Miller et al.
have demonstrated that cell-free virus preparations are capable of
producing HIV
infection by the genital routexxv.
Given their size, such free viruses from semen could transit through the
smallest defect of the membrane of a condom and reach, in the
organism of the sexual partnerxxvi, CD4 in Langerhans, lymphocytes and
macrophages
cells. They may also potentiate indirectly the infectivity of HIV-1 in
semen, regardless of
HIV-1 source (xxvii).

A - THE PERFORMANCE OF THE CONDOM AS A CONTRACEPTIVE
The Pearl contraceptive index is in fact relatively high for the condom,
being
between 8 and 15 (with extremes reaching up to 28)li lii.
The failure rate of the condom
in preventing pregnancy, defined as the probability of pregnancy over one
year for a
woman for whom the condom is the only means of contraception is of the
order of
15%liii liv. If the admitted failure rate of condom used as a method of
contraception is (5)
said to be 3% for couples using condoms "perfectly" (both consistently and
correctly)lv,
this failure rate is found to be 4% with couples highly motivated lvi and
rise to 12% in
"typical couples experience"(Albert and Hatcher, 1991)lvii.
Moreover, these contraceptive failure rates are conservative estimates,
since each exposure does not result in pregnancy lviii.
This condom failure may explain the relationship between condom use and
teen age pregnancy ratelix. 11% of the women's unplanned pregnancies at
the Grady Memorial Hospital in Atlanta, USA, were attributed to condom
failurelx. 27% of the abortions performed at the hôpital Saint Louis in
Paris are said to be requested
because of condom failure lxi.
Of the 4,666 women who came to be aborted at the Marie Stopes Centre in
Leeds, England, between 1989 and 1993, 40% of them blamed
condom failure for their pregnancyl xii.
In the study reported by M.Gabbay et al.(1996)lxiii,
83% of female students presenting for post-coital contraception at the
Rusholme Health Centre, Manchester, claimed condom failure as the cause.
One of the factors for contraceptive failure when using a condom is
certainly the
inexperience of the users lxiv. A large scale American study on the
efficiency of different
condoms to prevent pregnancies showed a failure rate of 15% among young
users in
their first year of use, a rate which reduces to 2% among couples who are
expert in the use of this device lxv.

If we now consider the efficiency of the condom when used as a
prophylactic
against STDs, we find a significant failure rate which appears roughly
inversely
proportional to the size of the pathogenic agentlxvi.
N.J.Fiumaralxvii reckons that the condom, which is in theory useful
against STDs,
is, in practice, inefficient. J.Pemberton et al. (1972)lxviii, while
examining 2,093 STD
cases diagnosed in Belfast found a lower percentage of syphilis and
gonorrhea among
condom users, but a higher proportion of non-gonococcal urethrites and
idiopathic
STDs.
W.M.McCormack et al.lxix, studying a group of 140 students who were
carriers of
urethral T-Mycoplasmas following sexual relations, found 14.3%
colonization among
those students who always used a condom.
D.Barlow (1977)lxx, for a total of 3,543 diagnoses of gonorrhea in a
six-month
period among 3300 patients, found that condom users (247) only had
slightly fewer
STD cases (259) compared to non-users.
Non-specific urethrites (mainly due to
Chlamydia trachomatis and Ureaplasma urealyticum, 200nm in diameter), were
found
in this series with the same frequency for both users and non-users of
condoms.
Infections with Condylomata acuminata (genital warts) were more frequent
(5%) among
condom users than among non-users (4.6%).
Cohen et al. (1992)lxxi, made a study in which those patients who had
contracted
an STD received instruction in condom usage. In the nine months after this
instruction,
19.9% of the males and 12.6% of the females returned with a fresh STD,
some
returning several times. In fact, STD reinfection rate increased even
among females
after this instruction.
A study made in a genitourinary clinic in London (Evans et al. 1995)lxxii
showed that an increase in the use of condoms from 1982 to 1992 from 4% to
21% did not have an effect on the number of viral STDs observed during
this same period. The
same authors found that increasing condom use with regular partners
correlated with
decreasing incidence of gonorrhea, chlamydial infections, and
trichomoniasis in women
having regular partners, but did not show that trend with non-regular
partners.
Moreover, condom use was ineffective in the prevention of non-gonococcal
urethritis,
candidosis, genital herpes and genital wartslxxiii.
J.M.Zenilman et al. (1995) lxxiv, studying the self-reported use of
condoms, and
the occuring sexually transmitted diseases in a cohort from a high-risk
population,
comprising 323 males and 275 female, found, surprisingly, that 15% of the
men who
were "always" condom users had incident STDs, compared with 15.3% of the
"never
users"; 25.5% of the women who were "always" users had incident STDs,
compared
with 26.8% of "never" users.
This obvious lack of correspondence between the selfreported "always"
condom use and an effective prevention of STDs left these authors
rather perplexed, and they questioned the quality of self-reporting.
However, a recent
study of M.Shew et al.(1997)lxxv on condom use among adolescents found
that selfreported
condom use was valid, at least in this sample, although consistent condom
use did not eliminate STDs (one STD for 20 respondents for one in five
when no
condom was used).
K.M.Stone et al.(1986)lxxvi, in a review of statistical differences on
prevention of
STDs, recommended condom use in "at risk" sexual relations, while at the
same time
indicating the limits of the protection thus obtained: one simply finds
"less risk" of
acquiring an urethral gonorrhea gonococcal urethrite, a urethrite from
Ureaplasma
urealyticum, or other venereal diseases among condom users than among
non-users.
The condom, in the cases examined by K.M.Stone, seems particularly
effective against
gonococcal urethrites, while not protecting against non-gonococcal
urethrites.
J.Sanchez et al.lxxvii, in a one-year survey of the prevalence and
determinats of
STDs among 435 female sex workers attending the Centro antivenereo of Lima
(Perú),
found that consistent condom use during the past year was associated with
somewhat
decreased risk of gonorrhea and with VDRL titer>=1:4, but not with a
decrease in
chlamydial infection.

This study did not show statistically significant relationship of longterm
consistent condom use with antibody to either Herpes simplex virus type 2
or H.ducreyi infection.