Norplant implants and condom use
Year: 1999
Type: letter
Abstract: I applaud Darney et al (Darney PD, Callegari LS, Swift A, Atkinson ES, Robert AM. Condom practices of urban teens using Norplant contraceptive implants, oral contraceptives, and condoms for contraception. Am J Obstet Gynecol 1999;180:929-37) for attempting to resolve what has been a long-standing concern, namely, that long-acting hormonal contraception leads to decreased condom use and increased risk for sexually transmitted diseases. Their study gives us new and important information regarding the differences in relationship patterns between users of Norplant (registered trademark of the Population Council) implants, oral contraceptives, and condoms, variables that to date have been ignored but that are likely to be extremely important in determining condom use and risk for sexually transmitted diseases. Unfortunately, I do not think the current study design allows for firm conclusions about condom use behavior among Norplant implant users versus oral contraceptive and condom users. The authors addressed well the limitations inherent in any study examining longitudinal behavior among adolescent contraceptive users, namely, low numbers of continuing oral contraceptive and condom users in the follow-up analysis. I wish to address this important limitation in another way. The condom use analysis requires that both oral contraceptive and condom users be continuing their chosen method at follow-up. However, teens who discontinue their contraceptive method may also be those who are less likely to use condoms. The Norplant implant users in the analysis, on the other hand, are almost all continuing users, despite the fact that many were probably poorly compliant with oral contraceptives in the past. In other words, the authors have selected out the responsible oral contraceptive and condom users but not the more responsible Norplant implant users. This problem, which is inherent in any longitudinal study comparing long-acting hormonal methods to those requiring user compliance, is an extremely difficult one. Reducing follow-up intervals to be even as short as 1 month would not solve the problem, because as many as 25% of oral contraceptive “users” may never even start to take the pills.1Polaneczky M Slap G Forke C Rappaport A Sondheimer S. The use of levonorgestrel implants (Norplant) for contraception in adolescent mothers.N Engl J Med. 1994; 331: 1201-1206Crossref PubMed Scopus (150) Google Scholar Condom use is a complex phenomenon and is likely the result of various behavioral and relationship factors, only one of which may be contraceptive choice. The authors plan to include more behavioral factors in future studies, and this is, I believe, the right way to go. I look forward to their findings. One final variable that is extremely difficult to quantify but that appears clinically to be important is that some teenage girls, who themselves are monogamous, are in relationships with partners who do not behave in a monogamous fashion. Thus these teens, despite a perceived lack of need for condom use, may still acquire a sexually transmitted disease as a result of their partner’s behavior. 6/8/102149
Author: Margaret Polaneczky
Institution: NewYork–Presbyterian Hospital
Language: English
Field: Medicine
Domain: Health Sciences
Open Access status: hybrid
Estimated APC paid: $5,410
OpenAlex ID: W2098567871