• grayduck

    As usual, Heather Corinna is short on facts and long on hype. Some of her statements might mislead the questioner and other readers into believing that condoms are more effective than a dispassionate analysis of the data would conclude.

     

    For example, the following statements imply that user error is always avoidable by the condom user: "In case someone’s filled your head with the idea that even when used properly, condoms are highly likely to fail, know that’s just not true" and "You both knowing [how to put on and remove a condom] not only will help assure condoms are always used and used properly…" Some, if not most, of the difference between perfect-use and typical-use failure rates is caused by factors that are outside the control of the user but not included in perfect-use studies. For example, woman might be raped by an attacker who refuses to use a condom, the store might run out of condoms, be closed, or refuse to sell condoms, the condom might have been tampered with, the user may have misunderstood the directions on how to use the condom ("…participants in clinical trials are usually self-selected, and they often have received more intense patient education and clinical attention than the typical user experiences once a method is widely available"), the user and her sexual partner may miscommunicate with one another, or the user’s partner might do something to defeat the effectiveness of the condom- including refusing to use it altogether. Even forgetting to use a condom is not entirely controllable by a user. Everyone makes mistakes. No study, at least of which I am aware, has found that any particular large demographic of users is/are able to use contraceptives at a lower rate of user error than reflected in typical-use failure rates.

     

    http://www.guttmacher.org/pubs/journals/3105699.html

     

    Second, the latest data show that condoms have a one-year, typical-use failure rate of 17.4 percent, not 15 percent as she claims.

     

    http://www.guttmacher.com/pubs/fb_contr_use.html

     

    Another way that Corinna’s response hyped condoms is by using a time duration for measuring effectiveness that is unrealistically brief for most users. A typical woman, according to the Guttmacher Institute, is sexually active but trying to avoid pregnancy for thirty years of her life. Therefore, thirty years would be a meaningful time duration. Unless the questioner intends to engage in sexual intercourse for a single year and then stop and never have sex again, the use of a single year of use when describing failure rates is of questionable value and yields a misleadingly low failure rate. Extrapolating the 17.4 percent failure rate across thirty years yields a failure rate of 99.7 percent! (1-(1-0.174)^30) Even the perfect-use failure rate is 45 percent when extrapolated across thirty years.

     

    A fourth reason why Corinna’s piece functioned more as an advertisement for condoms than an unbiased offering of assistance is that she assumed her own values regarding the consequences of contraceptive failure rather than attempting to assess the consequences for the questioner. Maybe the questioner’s health would be threatened by a pregnancy. Maybe she is unwilling to obtain an abortion, not ready to raise a child, and unwilling to put a child up for adoption. Without knowing the consequences of failure for the particular user, Ms. Corinna has no reliable basis for assuming that even a two-percent failure rate is acceptable for the questioner.

     

    Fifth, the following assertion was a meaningless declaration masquerading as an argument for engaging in sexual intercourse with a condom. "If we use a condom as contraception when we have sex, and we don’t become pregnant, then that condom was 100% effective." Such a statement is like writing "If we play Russian Roulette and survive, then playing Russian Roulette was perfectly safe."

     

    A sixth way that she encouraged use of condoms rather than providing useful, impartial information was by not mentioning the most effective alternative to condoms- Implanon.

     

    Seventh, she offers no evidence for the following assertion. "Condoms are also very highly effective at preventing STIs…" I have not seen any evidence to confirm that claim.

     

    Finally, Heather Corinna presented no reliable basis for her assertion that avoding an STI is "just as important as preventing unwanted pregnancy." Her comment just served to urge the questioner to use condoms rather than a more effective contraceptive method.

     

    In my opinion, Heather Corinna did a disservice to this questioner.

     

    http://www.abortiondiscussion.com

  • anonymous99

    GrayDuck, We can all see through this lame attempt to discredit Heather.  We weren’t born yesterday.  To come on this site and assert that Heather should tell a young woman who wants to have sex with her boyfriend for the first time that she should expect a 99% failure rate with condoms is truly absurd.  I find most disturbing your insinuation that there’s no scientific evidence that condoms prevent STIs.  I surely hope there weren’t any young people who happened upon your response and left with the idea that condoms don’t prevent STIs.  You surely know they do!  Even amateurs like you and me can do a Google search.  Can’t we?  And had you bothered to check out the links that were provided you would see a comprehensive discussion re: birth control methods beyond condoms – including abstaining.  I sure hope this isn’t the way you’re handling these types of questions and concerns from your own kids.   If so, you’re doing them a great disservice.

  • bebebeyondbirdsbeesdotcom

    GrayDuck,

     

    You make your agenda perfectly clear–you don’t believe in condoms. It’s fine for you to have this opinion. You may, in fact, hold any opinion you’d like, including the opinion that the world is flat or that dinosaurs and humans co-existed.

     

    But you’re not going to have much luck in convincing anyone that your opinion is valid when you so grossly misuse statistics and bash one of the hardest-working most knowledgable educators in the country.

     

    ——

    <a href="http://beyondbirdsbees.com">Beyond the Birds and the Bees</a>

  • heather-corinna

    Most of this is just plain nonsense, and I think even you know that it is, GrayDuck.  You also say some things that are just patently not true, and which any readers can baldly see are not, such as stating I did not discuss other methods of contraception with this user.  I also can only answer what I am asked, based on the information I’m given.  I’m not psychic, after all. I provided her information and extended sources of information where she, perhaps knowing her own situation more specifically than she told me, can make her own choices about what she’s most comfortable with, a message I sent her quite clearly.

     

    Just a few brief bits:

    1) That "latest data" on condoms you linked to is from a single source and study: I base the effectiveness rates I use for all methods on several reliable sources, which always include Contraceptive Technology and Planned Parenthood (sources which also review all new information constantly, and adjust their info when it’s sage to), sources you’ll have a hard time finding sexual healthcare pros who aren’t on board with.

     

    Also?  When you say things like:

    Some, if not most, of the difference between perfect-use and
    typical-use failure rates is caused by factors that are outside the
    control of the user but not included in perfect-use studies. For
    example, woman might be raped by an attacker who refuses to use a
    condom, the store might run out of condoms, be closed, or refuse to
    sell condoms…the user may
    have misunderstood the directions on how to use the condom, the user and her sexual partner may miscommunicate with
    one another…Even forgetting to use a condom is not entirely controllable by a user.

     

    You actually disprove some of your own argument with these kinds of statements.  We aren’t talking about rape, or about not having condoms, and I have GIVEN this user much of the information to avoid many of the scenarios you describe.

     

    2) This user didn’t ask me for the rate over her lifetime.  But you know that already, unless you just didn’t really read any of this (which seems possible).  Why you think no one else reading would is beyond me.  The rates we get on effectiveness for contraception ARE usually calculated for periods of one year, and I don’t think you can make the mathematical extrapolations you do from those one-year use rates alone. If you want accurate lifetime rates, we’ll need lifelong studies.

     

    3) If you haven’t seen data that has shown condoms are effective at protecting against STIs than a) you didn’t read some of the links right within the piece or b) you haven’t looked for it.

     

    4) I’m not hawking or advertising condoms: the user ASKED me about condoms.  Are you advertising Implanon?  Because that’s a pretty weird leap. It’s not the only method with that effectiveness rating, after all. As well, as is the case with any method, no one method is right for everyone or affordable for everyone. But if she was interested in an implant, she would have found information on it in the link I gave her giving information on all methods.

     

    5) We have had data over the years for several methods — if not all — that shows us some groups do better with one method than others, and some are easier for a given group to use properly.  For instance, we know the perfect use rate of oral contraceptives is lower for adolescents than for adults, and that cervical caps are less effective for women who have given birth.  I’ve been working in and around sexual health and contraception full-time for over a decade, as well (and that combined with the fact that via my job, I look at these kinds of data all the time), so have what is likely a much better wealth of experience to draw upon about what methods tend to work best for people, and how they most often fail, than I suspect you do.

  • crowepps

    Finally, Heather Corinna presented no reliable basis for her assertion that avoding an STI is “just as important as preventing unwanted pregnancy.”

    Do I correctly understand from this statement that you think getting an STI is perfectly okay? I’m not sure why you would be so hostile as to demand someone present a ‘reliable basis’ for saying it’s important not to catch a disease.

  • grayduck

    "I find most disturbing your insinuation that there’s no scientific evidence that condoms prevent STIs."

     

    I insinuated no such claim.

     

    http://www.abortiondiscussion.com

  • grayduck

    "You also…stat[ed that] I did not discuss other methods of contraception with this user."

     

    My post included no such statement.

     

    "I base the effectiveness rates I use for all methods on several reliable sources, which always include Contraceptive Technology and Planned Parenthood…"

     

    Then why not cite those sources? Listing "Contraceptive Technology" and "Planned Parenthood" is equivalent to citing Google.

     

    "We aren’t talking about rape, or about not having condoms…"

     

    Rape and unavailability are, indeed, factors affecting the effectiveness of different forms of contraception. As I stated, they are neither controllable by the user nor acknowledged in studies of perfect-use effectiveness.

     

    "…I have GIVEN this user much of the information to avoid many of the scenarios you describe."

     

    The only scenarios you addressed, as far as I can see, were proper use of condoms and communication with the partner. Regarding the former, you only included a link to your own article in a bibliography. Regarding the latter, your advice is not impervious to failure.

     

    "This user didn’t ask me for the rate over her lifetime."

     

    Correct; she asked about how effective the condom can be to prevent her from getting pregnant. She did not say that the duration of use would be limited to one year.

     

    "The rates we get on effectiveness for contraception ARE usually calculated for periods of one year…"

     

    Only because the research is usually limited to approximately one-year periods. She was looking for information that she could apply to her life, not raw data.

     

    "I don’t think you can make the mathematical extrapolations you do from those one-year use rates alone. If you want accurate lifetime rates, we’ll need lifelong studies."

     

    My extrapolations may be far from perfect, but we hardly need to make baseless assumptions about duration of use until lifetime studies are completed. Even if, or when, those studies are compeleted, they will have problems of their own.

     

    http://www.abortiondiscussion.com

  • heather-corinna

    I’m not going to address denials of your own statements or inferences we can all read, nor your ideas of what the user was asking for and what she needed, especially since I have this funny feeling this isn’t work you yourself actually do to have the vaguest notion of what teens generally want and need in this respect.  As well, in the links I provided her were plenty of additional information on proper condom use.

     

    However, per citations?  I often don’t cite things in advice articles which are in the additional materials I am sending users to in any answer in the links.  Our pages on birth control all contain those citations.  However, suggesting finding the condom effectiveness rating in any edition of CT is as blind a thing as Google is ridiculous: methinks you’ve never cracked open a copy of the most widely-used professional contraception healthcare resource there is. Which is pretty strange for someone who apparently knows so much about contraception.

  • grayduck

    "If you haven’t seen data that has shown condoms are effective at protecting against STIs than a) you didn’t read some of the links right within the piece or b) you haven’t looked for it."

     

    Again, here is what you actually said. "Condoms are…very highly effective at preventing STIs…" If the available evidence leads to such a definitive conclusion, someone in your position should be able to cite reliable sources in support of the conclusion. Those sources should demonstrate the effectiveness of condoms relative to both other available STI avoidance strategies and the needs or expectations of the questioner. Moreover, studies cited should not assume factors that are uncontrollable by the condom user.

     

    "Are you advertising Implanon?"

     

    In a sense, yes. But more to the point, I suspect that the questioner may have welcomed knowledge about a contraceptive that is substantially more effective than are condoms. She said she was seeking "…guarantee[d] 100% protection…;" Implanon comes much closer to that ideal than condoms do.

     

    "…I…have what is likely a much better wealth of experience to draw upon about what methods tend to work best for people, and how they most often fail, than I suspect you do."

     

    Then please draw upon that wealth of experience to prove me wrong. The internet is a good venue for demonstrating knowledge but an unconvincing means of claiming authority.

     

    http://www.abortiondiscussion.com

  • heather-corinna

    I’m actually just starting some substantial time off, but so this doesn’t sit while I’m away, I think all there really is to say to this is that it seems your reading comprehension could use some improvement.

     

    Because I DID talk to her about other methods of contraception besides condoms right in this piece, and also provided her with a link that would get her to in-depth information on all available methods. I also DID link to very reliable and credible sources which detail the efficacy of condoms when it comes to STIs. As well, any user reading the original piece is at Scarleteen, where with the easy use — and for our users who grew up with the net, it is intituitve and easy, I don’t need to explain it to them like I apparently do for you — of links and tags provided, they can get to countless sources of this kind of additional information should they want it.

  • grayduck

    "As well, in the links I provided her were plenty of additional information on proper condom use."

     

    That point is not relevant to any assertion in my posts.

     

    "However, per citations? … Our pages on birth control all contain those citations.  However, suggesting finding the condom effectiveness rating in any edition of CT is as blind a thing as Google is ridiculous…"

     

    Alright, I goofed. Let me start again. Contraceptive Technology does claim the fifteen percent figure, but bases its assertion on fourteen-year-old data. My source used a newer, but equally reliable, source of data.

     

    http://www.contraceptivetechnology.com/table.html

     

    Scarleteen’s link to Planned Parenthood as a reference regarding the effectiveness of condoms is dead. The page at Planned Parenthood’s site on condoms fails to cite any research at all.

     

    http://www.scarleteen.com/birth_control_bingo_condoms

     

    http://www.plannedparenthood.org/health-topics/birth-control/condom-10187.htm

     

    Another link on Scarleteen also contains no research.

     

    http://www.birth-control-comparison.info/condom.htm

     

    http://www.abortiondiscussion.com

  • grayduck

    "…I DID talk to her about other methods of contraception besides condoms right in this piece,…"

     

    Yes, but not Implanon.

     

    "…and also provided her with a link that would get her to in-depth information on all available methods."

     

    What is your point? My requests for citations were intended to obtain references here on RH Reality Check, not Scarleteen. It was a request for future listings of links or other sources, not an implied criticism of your past work.

     

    "I also DID link to very reliable and credible sources which detail the efficacy of condoms when it comes to STIs."

     

    Of the links you listed, all but two were to your own web site. Of those two, both assume perfect use on the part of the user which, as I have pointed out, probably cannot be achieved for sizeable populations. Moreover, none of the studies that were used by the links to draw conclusions about the effectiveness of condoms for STI prevention were designed to compare the effectiveness of condoms versus other available methods, such as lifetime monogamy. Futhermore, neither of those pages uses words as unqualified as the "…very highly effective at preventing STIs…" wording in your article. Finally, their assessments of the effectiveness of condoms for preventing STIs were based on their own values and judgments about empirical studies rather than based on the needs or expectations of the questioner or people like her.

     

    http://www.abortiondiscussion.com

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