Condom testing for anal sex finds very low failure rates

15 January 2020

The largest-ever study examining the effectiveness of condoms for anal sex finds remarkably low levels of failure, and calls to label their use in this way.

coloured condoms

In a trial involving 500 men, split evenly between men who have sex with men and men who have sex with women, condoms used during anal sex failed less than 1% of the time. By comparison, condoms failed during vaginal sex in 1.9% of cases. The trial, which took place between 2016 and 2017 in Atlanta, USA, recorded a total of 4,884 sex acts during the study period.

Condom use for anal sex is recommended by international bodies such as the World Health Organization and UNAIDS. Findings from this trial suggest condoms should also be ‘label indicated’ by regulatory agencies for anal sex, which is not currently the case. A label indication means that something has been approved by a regulator, such as the United States’ Food and Drug Administration (FDA), as being clinically proven – for instance, insulin is ‘indicated’ to control diabetes – which enables manufactures to market their drug or commodity as such.

The FDA will indicate condoms when failure is below 5%. In the past 40 years, over 300 condom-types have been indicated for vaginal sex but, due to a lack of data, none have been indicated for anal sex. In a separate study published in June, the same authors found 69% of men who have sex with men would be more likely to use condoms frequently if they were FDA label-indicated for anal sex.

In this study, researchers asked participants to keep a daily diary on their phone to record number and type of sex acts, whether they were using standard condoms, thin condoms or fitted condoms – all of which were provided throughout the study – and whether lubricant was used. Clinical failure was defined as the condom slipping and/or breaking during sex.

Three-quarters of participants rated themselves as “very experienced” in using condoms. Despite this, around a third had experienced condom failure in the six months prior to the study. To meet FDA requirements, all participants received guidance on correct condom use before the trial. However, this suggests the findings are not necessarily translatable to a real-world setting.

Further analysis suggests the higher condom failure level for vaginal sex was connected to lubricant use. All of those having anal sex were advised to use lubricant, resulting in use during 98% of anal sex, whereas those engaging in vaginal sex were advised to use it only when needed or desired, resulting in 42% usage. But when only analysing sex acts in which lubricant was used, no difference was found in condom failure levels between anal and vaginal sex.

These findings contradict previous studies, which found higher condom failure for anal sex compared to vaginal sex. This may be due to the study’s design, which used daily diaries to enable immediate reporting, rather than less accurate reporting mechanisms, and also resulted in near-total lubricant use for anal sex. The link between lubricant use and condom effectiveness found in this study raises the question of whether the billions of condoms distributed each year as part of global HIV and STI prevention efforts should always be accompanied by lubricant to minimise potential failure for both anal and vaginal sex.

Written by Hester Phillips