Condoms: a wider range needed.

In England, 281 men attending a genitourinary clinic in south London completed a questionnaire designed to allow researchers to better understand condom failure. This area has one of the highest incidences in the UK of HIV seropositive pregnant women. 25% (70) faced difficulties putting on condoms. 52 of these men (19% of all men) said the condoms were too tight. These men were more likely to have condoms slip off than those who did not find condoms to be too tight (73% vs. 52%). Some men frequently had condoms coming off (8% for Blacks, 2% for Whites, and 21% for Asians). Condom splitting occurred sometimes for 18% of Blacks and 7% of Whites, but not for Asians. During the last year, 56% of all men, especially Black men (70% vs. 53% for Whites and 36% for Asians) had had intercourse with at least two partners. 22% of all men always used condoms. Black men were less likely to always use condoms than Whites and Asians (9% vs. 27% and 36%, respectively). These results indicate that many men may have penises too large for condoms to be placed on with ease. These men tend to experience the condom slipping off or splitting. These difficulties may affect their acceptability of condoms. Condom failure linked to tightness reinforces negative images of condoms. WHO's guidelines show that more than 33% of penises are larger than the British Standard Institute's standard dimensions for condoms (a flat width of 52 [SD 2] mm). Thus, the standard limits the production of an appropriate range of condom sizes. Further research is needed in condom design. The findings suggest that Blacks are at particular risk of HIV infection and that condom promotion efforts should target them.