Wednesday, September 14, 2011

Condom History,Effectiveness, and Testing

Where and when were condoms first used? Are condoms effective? Do condoms fail?
How are condoms tested? What are the levels of condom availability in low income
and developing countries?

The condom history
- 1000 BC
Condom use can be traced back several thousand years. It is known that around 1000 BC the ancient Egyptians used a linen sheath for protection against disease.
- 100 - 200 AD
The earliest evidence of condom use in Europe comes from scenes in cave paintings at Combarelles in France. There is also some evidence that some form of condom was used in imperial Rome.
- 1500's
The syphilis epidemic that spread across Europe gave rise to the first published account of the condom. Gabrielle Fallopius described a sheath of linen he claimed to have invented to protect men against syphilis. Having been found useful for prevention of infection, it was only later that the usefulness of the condom for the prevention of pregnancy was recognised.
Later in the 1500s, one of the first improvements to the condom was made, when the linen cloth sheaths were sometimes soaked in a chemical solution and then allowed to dry prior to use. These were the first spermicides on condoms.
- 1700's
The first published use of the world 'condum' was in a 1706 poem. It has also been suggested that Condom was a doctor in the time of Charles II. It is believed that he invented the device to help the king to prevent the birth of more illegitimate children.
Even the most famous lover of all, Casanova, was using the condom as a birth control as well as against infection.
Condoms made out of animal intestines began to be available. However, they were quite expensive and the unfortunate result was that they were often reused. This type of condom was described at the time as "an armour against pleasure, and a cobweb against infection".
In the second half of the 1700's, a trade in handmade condoms thrived in London and some shops where producing handbills and advertisements of condoms.
- 1800's
The use of condoms was affected by technological, economic and social development in Europe and the US in 1800s.
Condom manufacturing was revolutionized by the discovery of rubber vulcanisation by Goodyear (founder of the Tyre company) and Hancock. This meant that is was possible to mass produce rubber goods including condoms quickly and cheaply.
Vulcanization is a process, which turns the rubber into a strong elastic material.
In 1861,the first advertisement for condoms was published in an American newspaper when The New York Times printed an ad. for 'Dr. Power's French Preventatives.'
In 1873, the Comstock Law was passed. Named after Anthony Comstock, the Comstock Law made illegal the advertising of any sort of birth control, and it also allowed the postal service to confiscate condoms sold through the mail.
- 1900's
Until the 1920's, most condoms were manufactured by hand-dipping from rubber cement. These kinds of condoms aged quickly and the quality was doubtful.
In 1919, Frederick Killian initiated hand-dipping from natural rubber latex in Ohio. The latex condoms had the advantage of ageing less quickly and being thinner and odourless. These new type of condoms enjoyed a great expansion of sales. By the mid-1930s, the fifteen largest makers in the U.S. were producing 1.5 million condoms a day.
In 1957, the very first lubricated condom was launched in the UK by Durex.
From the early 1960s, use of condoms as a contraceptive device declined as the pill, the coil and sterilisation became more popular.
The use of the condom increased strikingly in many countries following the recognition of HIV/AIDS in the 1980's. Condoms also became available in pubs, bars, grocery stores and supermarkets.
The female condom has been available in Europe since 1992 and it was approved in 1993 by the US Food and Drug Administration (FDA). Find more information about female condoms.
In 1994, the world's first polyurethane condom for men was launched in the US.
The 1990s also saw the introduction of coloured and flavoured condoms.

Present day
In more recent years, improved technology has enabled the thickness of the condom to decrease. Also, condom manufacturers have recognised that one size of condom does not fit all. You can now find condoms that are different shapes, widths and lengths.

Are condoms effective? Do condoms fail?
Are condoms effective at preventing infection with the HIV and sexually transmitted diseases (STDs)?
Yes. Studies have shown that if a latex condom is used correctly every time you have sex, this is highly effective in providing protection against HIV.
The evidence for this is clearest in studies of couples in which one person is infected with HIV and the other not. i.e. "discordant couples" In a study of discordant couples in Europe, among 123 couples who reported consistent condom use, none of the uninfected partners became infected. In contrast, among the 122 couples who used condoms inconsistently, 12 of the uninfected partners became infected.
In addition, correct and consistent use of latex condoms can reduce the risk of other STDs.
As these studies indicate, condoms must be used consistently and correctly to provide maximum protection. Consistent use means using a condom from start to finish with each act of intercourse.
Correct condom use should include:
Use a new condom for each act of intercourse
Put on the condom as soon as erection occurs and before any sexual contact (vaginal, anal or oral).
Hold the tip of the condom and unroll it onto the erect penis, leaving space at the tip of the condom, yet ensuring that no air is trapped in the condom's tip.
Adequate lubrication is important, but use only water-based lubricants on latex condoms. Oil-based lubricants such as petroleum jelly (vaseline), cold cream, hand lotion or baby oil can weaken the latex condom and are not recommended. However, oil-based lubricants can be used with condoms made of polyurethane.
Withdraw from the partner immediately after ejaculation, holding the condom firmly to keep it from slipping off.

Find more information about using condoms.
- How often do condoms fail?
There is no one answer to this, as different studies have shown different results. Many studies of condom effectiveness have counted how often women have become pregnant when their partners have used condoms for birth control. This "failure rate" includes cases where the couple did not use a condom every time they had sex, or they did not use the condom correctly. Some studies have included the times the condom was torn accidentally by people using it.
The main reason that condoms sometimes fail to prevent HIV/STD infection or pregnancy is incorrect or inconsistent use, not the failure of the condom itself. Using oil-based lubricants can weaken the latex, causing the condom to break.
Condoms can also be weakened by exposure to heat or sunlight or by age, or they can be torn by teeth or fingernails. Also, remember to check the expiry date of your condom.
- How often do condoms break or slip off?
In the United States, most studies of breakage caused by fault in the condom itself have shown breakage rate is less than 2 condoms out of every 100 condoms. Studies also indicate that condoms slip off the penis in about 1-5% of acts of vaginal intercourse and slip down (but not off) about 3-13% of the time.
- How are condoms tested?
In the United States, the Food and Drug Administration (FDA) regulates condoms to ensure their safety and effectiveness. Different countries have different regulatory agencies. For example, condoms in Europe that have been properly tested and approved should carry the CE Mark. Elsewhere in the world, you can find that condoms are ISO approved. Also, individual countries may have their own approval marks for condoms, for example, the Kitemark in the UK.
In the US, each condom is electronically tested for holes and defects.Also, condom manufacturers sample each lot of finished packaged condoms and visually examine them for holes using a water leak test. Condom manufacturers also tests lots for physical characteristics using the air burst test and the tensile (strength) test.
The FDA, for example, recognises domestic and international standards that specify that the rate of sampled condoms failing the water leak test, for each manufacturing lot of condoms, be less than 1 condom in 400.

Condom availability in low income and developing countries
In most countries where the HIV prevalence rate is high many people cannot afford to purchase condoms. Sexually active adults and teenagers need to rely on condoms provided to them for free. Governments often provide and promote condoms, but the poorest countries rely almost totally on donations from outside agencies such as the U.S. Agency for International Development (USAID) and the United Nations Population Fund (UNPFA).
The UNPFA records information on the quantities of condoms donated to countries worldwide by a range of organisations. Analysis of data collected between 1990 and 2002, as displayed in the graph on the left, shows that the number of condoms donated worldwide rose dramatically between the year 2000 and 2002. Before 1996 however, the supply of condoms was always able to meet the demand, yet in 2002 that was no longer the case. Whilst 2.5 billion condoms were donated in 2002, the UNFPA estimated that 9.9 billion were needed in order to significantly reduce the spread of HIV.
For 120 of the countries that receive condom donations, Population Action International calculated the average number of condoms donated annually per male aged 15 – 59 between 1998 and 2002. It was found that 22 countries receive more than 5 condoms per male annually, the majority of which are in Sub-Saharan Africa whilst 55 countries receive only one or less condoms per male a year. Those countries such as Zambia and Namibia with the highest prevalence rates and whose financial need is greatest do receive the most donations. The highest amount of condoms donated to any country was to Swaziland, which received an average of 16 condoms per male per year.

Tuesday, September 13, 2011

The Female Condom

The female condom is a polyurethane sheath or pouch about 17 cm (6.5 inches) in length. It is worn by a woman during sex. It entirely lines the vagina and it helps to prevent pregnancy and sexually transmitted diseases (STDs) including HIV.
A female condom at each end of the condom there is a flexible ring. At the closed end of the sheath, the flexible ring is inserted into the vagina to hold the female condom in place. At the other open end of the sheath, the ring stays outside the vulva at the entrance to the vagina. This ring acts as a guide during penetration and it also stops the sheath bunching up inside the vagina.
There is silicone-based lubricant on the inside of the condom, but additional lubrication can be used. The condom does not contain spermicide. The female condom should not be used at the same time as a latex male condom because the friction between the two condoms may cause the condoms to break.
The female condom has been available in Europe since 1992 and it was approved in 1993 by the US Food and Drug Administration (FDA). It is available in many countries, at least in limited quantities, throughout the world. The female condom carries various brand names in different countries including, FC Female Condom, Reality, Femidom, Dominique, Femy, Myfemy, Protectiv' and Care.
How do you use the Female Condom?
Open the package carefully. Choose a position that is comfortable for insertion - squat, raise one leg, sit or lie down. Make sure the condom is lubricated enough. Make sure the inner ring is at the bottom closed end of the sheath, and hold the sheath with the open end hanging down.
Squeeze the inner ring with thumb and middle finger (so it becomes long and narrow), and then insert the inner ring and sheath into the vaginal opening. Gently insert the inner ring into the vagina and feel it go up. Place the index finger inside of the condom and push the inner ring as far as it will go. Make sure the condom is inserted straight, and is not twisted inside the vagina.
The outer ring should remain on the outside of the vagina. The penis should be guided into the condom in order to ensure that the penis does not slip into the vagina outside the condom. Use enough lubricant so that the condom stays in place during sex.
If the condom slips during intercourse, or if it enters the vagina, then you should stop immediately and take the female condom out. Then insert a new one and add extra lubricant to the opening of the sheath or on the penis.
To remove the condom, twist the outer ring gently and then pull the condom out keeping the sperm inside. Wrap the condom in the package or in tissue and throw it away. Do not put it into the toilet. It is generally recommended that the female condom should not be reused.
The female condom may feel unfamiliar at first. The female condom may feel different and some people find it difficult to insert. Some women find that with time and practice using the female condom becomes easier and easier.
What are the benefits?
- Opportunity for women to share the responsibility for the condoms with their partners
- A woman can use the female condom if her partner refuses to use the male condom
- The polyurethane, the material the female condom is made of, is less likely to cause an allergic reaction than a male latex condom. It is not clear whether latex or polyurethane condoms are stronger. There are studies suggesting that either is less likely to break. With both types, however, the likelihood of breakage is very small, if used correctly
- The female condom will protect against most STDs and pregnancy if used correctly
- It can be inserted up to 8 hours before intercourse so it does not interfere with the moment
- The polyurethane is thin and conducts heat well so sensation is preserved
- The female condom can be used with oil-based lubricants
- No special storage requirements are needed because polyurethane is not affected by changes in temperature and dampness. The expiry date for female condoms is 5 years from the date of manufacture
What are the disadvantages?
- The outer ring is visible outside the vagina, which can make some women feel self-conscious
- The female condom can make noises during intercourse. Adding more lubricant can help this problem
- Some women find the female condom hard to insert and to remove
- It has a higher failure rate in preventing pregnancy than non-barrier methods such as the pill
- It is relatively expensive and relatively limited in availability in some countries
- It is recommended that the female condom is only used once
Can I reuse the female condom?
It is believed that limited availability and high cost have led some women to reuse female condoms in some countries. The World Health Organisation (WHO) recommends use of a new male or female condom for every act of intercourse for those people who use condoms for pregnancy prevention and/or STI/HIV prevention.
WHO does not recommend or promote reuse of female condoms but has released a document together with guidelines and advice for programme managers who may consider reuse of female condoms in local settings. The document 'The safety and feasibility of female condom reuse: Report of a WHO consultation' can be found at
Using the female condom for anal sex
Some people use the female condom for anal sex. Although it can work effectively, it is difficult to use and can be painful. There is also the risk of rectal bleeding which increases the risk of contracting HIV. So it's better to use the male condom for anal sex with plenty of lubricant NOT containing Nonoxynol 9.
Support for the female condom
WHO and UNAIDS are encouraging the introduction of the female condom as a new method of preventing both pregnancy and infection and as an additional tool in efforts to respond to the needs of women and men in sexual and reproductive health. The female condom is also effective part of the solution in prevention of HIV/AIDS/STD in high prevalence areas.
Worldwide use and availability
The female condom is widely used in countries that actively promote its use, such as South Africa, Ghana and Zimbabwe. However in other countries, such as the USA, it isn't as popular. To become an accepted and available form of contraception, an effort needs to be made worldwide to promote the female condom and make it more available.

Monday, August 8, 2011

Bladder Cancer

What is Bladder Cancer?

The bladder is an expandable, hollow organ in the pelvis that stores urine (the body's liquid waste) before it leaves the body during urination. The urinary tract, made up of the kidneys, ureters, bladder, and urethra, is lined with a layer of transitional cells called the urothelium. This layer of cells is separated from the bladder muscles (called the muscularis propria) by a thin, fibrous band called the lamina propria. The lamina propria separates tumors that have spread into muscle (called invasive cancer) from those that have not (superficial or non-invasive cancers).

Bladder cancers are malignant tumors that begin in the bladder. Different bladder cancers are described by how deep they grow and if they grow into the bladder or through the muscles around the bladder (superficial or invasive).

There are three types of bladder cancer: transitional cell carcinoma, or TCC (about 90% of bladder cancer cases); squamous cell carcinomas (about 8%); and adenocarcinomas (about 2%). There are other less common types of cancer that arise in the bladder, including sarcomas (which begin in the muscle layers of the bladder) and small cell anaplastic cancers (a rare type very likely to spread to other parts of the body).

All three types can metastasize beyond the bladder. The tumor can grow into the surrounding organs (uterus and vagina in women; prostate in men), called locally advanced disease. It can also spread to the nearby lymph nodes, and/or into the liver, bones, or lungs; this is called distant metastasis. In some cases, it can spread to other parts of the body.

As we well know, there are many kinds of cancer; unfortunately they all come about because of the out-of-control growth of abnormal cells.

Leading Cancers in Women, Men, & Children

For Women: Breast cancer is the leading cancer for women in the US. Lung cancer is the second most common form of cancer and colorectal cancer is third among white women. The number 2 and 3 cancers are reversed among black and Asian/Pacific Island women. For all women, the fourth leading cancer is cancer of the uterus.

For Men: Prostate cancer is the leading cancer for men in the US. It is followed by lung cancer and then colorectal cancer. The fourth most common cancer is race-dependent. It is bladder cancer for white men, cancer of the mouth and throat for black men; and stomach cancer for Asian/Pacific Island men.

For Children: The most common malignancies in childhood are leukemia, followed by brain tumors, and lymphoma.

Cancer that is confined to the lining of the bladder is called superficial bladder cancer. Cancer that begins in the transitional cells may spread through the lining of the bladder and invade the muscle wall of the bladder or spread to nearby organs and lymph nodes; this is called invasive bladder cancer.

Bladder cancer is a fairly common form of cancer in the United States. Whites contract bladder cancer twice as often as blacks, and men are affected two to three times as often as women. Most bladder cancers occur after the age of 55, but the disease can also develop in younger people.

Each year, more than 50,000 people in the United States find out they have bladder cancer. The outlook for patients with early bladder cancer is very good. The chances of recovery from more advanced bladder cancer are improving as researchers continue to look for better ways to treat this disease.

Smoking, gender, and diet can affect the risk of developing bladder cancer.

Risk factors include the following:

- Smoking.
- Being exposed to certain substances at work, such as rubber, certain dyes and textiles, paint, and hairdressing supplies.
- A diet high in fried meats and fat.
- Being older, male, or white.
- Having an infection caused by a certain parasite.

Possible signs of bladder cancer include blood in the urine or pain during urination.

These and other symptoms may be caused by bladder cancer or by other conditions. A doctor should be consulted if any of the following problems occur:
- Blood in the urine (slightly rusty to bright red in color).
- Frequent urination, or feeling the need to urinate without being able to do so.
- Pain during urination.
- Lower back pain.

What is hematuria?

Hematuria means blood in the urine. Microscopic hematuria indicates that the blood is only seen when the urine is examined under a microscope, while gross hematuria means that there is enough blood in the urine so that it can be seen with the naked eye. Despite the quantity of blood in the urine being different, the types of diagnoses that can cause the problem are the same, and the workup or evaluation that is needed is identical.

Since blood in the urine must come from one of the organs involved in making or transporting the urine, the evaluation of hematuria requires that we consider the entire urinary tract. This organ system includes the kidneys, ureter (the tube that carries the urine from the kidney to the bladder), bladder, prostate, or urethra (tube leading out of the bladder). It must be emphasized that even a single episode of hematuria requires evaluation, even if it resolves spontaneously.

What are the causes of hematuria?

There are multiple causes of hematuria. Some are serious, including cancers, trauma, stones, infections, and obstructions of the urinary tract. Others are less important, and may require no treatment. These may include viral infections, nonspecific inflammations of the kidney, medications which thin the blood's clotting ability, and benign prostate enlargement.

How is hematuria evaluated?

The evaluation for hematuria consists of taking a history, performing a physical examination, evaluating the urine under a microscope, and finally, obtaining a culture of the urine. A significant history would include whether or not there was any pain or discomfort associated with the hematuria; whether the blood was in the beginning, end, or throughout the urinary stream; and finally, whether there is a personal history of smoking, kidney stones, injuries to the urinary tract, trouble urinating, or previous urologic evaluation.

No matter how obvious the reason for hematuria appears to be, a complete evaluation is almost always necessary to rule out a serious underlying disease, such as a cancer. There are usually three diagnostic tests necessary to give us a look at the entire urinary tract, and these include the intravenous pyelogram (IVP), cystoscopy, and urine cytology.

The intravenous pyelogram, or IVP, is an x-ray evaluation of the urinary tract. In this procedure, a dye is injected into the veins, and this is filtered by the urinary tract. A series of x-rays are then taken over a thirty-minute period, looking for abnormalities. This study is especially useful for evaluating the kidneys and ureter, but not the bladder, prostate, or urethra. Therefore, a second examination called a cystoscopy is necessary. In this procedure, a small viewing tube, or cystoscope, is used to visually inspect the bladder and the urethra. In most instances, this can be done without discomfort by the use of local anesthetic jelly. The cystoscope is passed up the urethra into the bladder, and the inspection is carried out. The entire examination takes less than ten minutes. The final test is a urine cytology, which involves voiding urine into a cup and having that urine examined by a pathologist to look for cancer cells.

How is hematuria treated?

Management of hematuria depends upon the underlying cause. Many times a cause cannot be found, which is fortunate, because it generally suggests that there is not a harmful situation present. Remember that the real reason for a hematuria workup is not to prove a specific cause, but to rule out a serious problem. If no cause is found for the hematuria, the urine should be checked on a yearly basis to make certain that no changes are occurring. However, if gross hematuria were to recur, repeat evaluation may be necessary, and a physician should be consulted. A blood test to check kidney function and a blood pressure check should be done as well. Men over fifty should have a yearly PSA, or prostate specific antigen, to screen for prostate cancer.

Further discussion of the treatment for hematuria would depend upon the results of the previously mentioned workup and the exact cause for the hematuria. The urologist who performs this examination would direct any further treatment or workup that would be necessary.

Tests that examine the urine, vagina, or rectum are used to help detect (find) and diagnose bladder cancer.

The following tests and procedures may be used:
- CT scan (CAT scan): A procedure that makes a series of detailed pictures of areas inside the body, taken from different angles. The pictures are made by a computer linked to an x-ray machine. A dye may be injected into a vein or swallowed to help the organs or tissues show up more clearly. This procedure is also called computed tomography, computerized tomography, or computerized axial tomography.
- Urinalysis: A test to check the color of urine and its contents, such as sugar, protein, blood, and bacteria.
- Internal exam: An exam of the vagina and/or rectum. The doctor inserts gloved fingers into the vagina and/or rectum to feel for lumps.
- Intravenous pyelogram (IVP): A series of x-rays of the kidneys, ureters, and bladder to find out if cancer has spread to these organs. A contrast dye is injected into a vein. As the contrast dye moves through the kidneys, ureters, and bladder, x-rays are taken to see if there are any blockages.
- Cystoscopy: A procedure to look inside the bladder and urethra to check for abnormal areas. A cystoscope (a thin, lighted tube) is inserted through the urethra into the bladder. Tissue samples may be taken for biopsy.
- Biopsy: The removal of cells or tissues so they can be viewed under a microscope to check for signs of cancer. A biopsy for bladder cancer is usually done during cystoscopy. It may be possible to remove the entire tumor during biopsy.
- Urine cytology: Examination of urine under a microscope to check for abnormal cells.

Certain factors affect prognosis (chance of recovery) and treatment options.

The prognosis (chance of recovery) depends on the following:
- The stage of the cancer (whether it is superficial or invasive bladder cancer, and whether it has spread to other places in the body). Bladder cancer in the early stages can often be cured.
- The type of bladder cancer cells and how they look under a microscope.
- The patient’s age and general health.

Treatment options depend on the stage of bladder cancer.