How Do You Evaluate the HEX Condom?

Unless we come up with a vaccine for every sexually transmitted infection (STI), condoms aren’t going anywhere. We’ve said as much before. In one national study that gave data on men, one in five men with a regular partner reported using a condom during their last time having sex. Among men with a casual partner, the rate was two out of three men. That adds up to a lot of condom use.

So we’re happy to see innovation, like the HEX condom from LELO. Yes, LELO the sex toy company. Innovation has otherwise been in short supply. The latex condom came out nearly a hundred years ago in 1920. Polyurethane condoms came out in 1994. Innovation is needed. That the HEX condom had over 14,000 backers for its Indiegogo crowdfunding campaign says something about the demand for that innovation.

That’s not to say there haven’t been some advances. Many modern condoms are much thinner than their ancestors. And we’ve talked about the Galactic Cap, which doesn’t use a sheath. There was also an interesting Origami silicone condom, but that project went downhill after charges of embezzlement. Very unfortunate for condom wearers everywhere.

Given that the HEX condom just came out, let’s talk more about that. It’s a latex sheath integrated with a hexagonal structure. These hexagons create a raised surface on the inside of the condom. The developers went in with three main goals in mind:

1. increase comfort
2. reduce breakage, and
3. reduce slippage.

LELO attributes all three of these qualities to the HEX’s hexagonal/lattice design. Here’s their description: “We took the thinnest, strongest material known to science — graphene — and integrated its hexagonal molecular structure into the latex condom.”

Because of the design, LELO claims its condom is able to have a good fit and keep its strength. And because the textured portion is on the condom’s inside, it creates friction between the penis and condom to reduce slippage. At least that’s the thinking.

Those three goals are actually pretty good since they can be specifically targeted and play a role in the condom’s effectiveness. Perhaps one of the few other targetable goals would be to reduce interruption of intercourse.

A big question is whether these claims are verifiable. And how easy would that verification be? That question turns out to be more involved. We’re led to investigate which condom qualities are important and how those qualities can be tested to provide meaningful information.

Increasing comfort is a good area to focus because of its potential to increase consistent use. Consider that the easiest way to make a condom fail is to use it inconsistently. One study looking at patients at an STI clinic found that among men not using a condom one in five reported not using a condom because he disliked the feel. In another study among college students, “disliked feel” was the reason one in eight men said they didn’t use a condom. Another study sampling men in Sub-Saharan Africa found disfavor towards condoms as the main reason for not using a condom. The rates for men giving this reason varied from one in ten to one in three, with the reason being more prevalent in casual relationships.

What about beyond the feel? Breakage and slippage get into the condom’s ability to actually do its job. Can it keep a constant barrier between the penis and vagina? It’ll need to in order to prevent STIs and pregnancy. On average, condoms break about 2% of the time and slip off also about 2% of the time, according to the chapter review on condoms in Contraceptive Technology (20th Edition). Note that there’s evidence that even failed condoms can significantly reduce exposure. So this small associated risk isn’t a reason to throw your condoms away. (Because how else are you going to protect yourself?)

And that’s not to say it’s all the condom’s fault. There’s evidence indicating that many condom failures may come from a small percentage of users. And some studies show a potential relationship between condom fit and slippage, which may also be related to comfort and erection quality.

Even so, under perfect use, the annual pregnancy rate for a condom is 2%. That means there’s room for improvement in the condom itself. Condoms have been tested on strength in clinical studies, and they’re regularly tested by regulation. But the method of testing is important. That’s because not all testing methods correspond to breakage during actual sex.

On feel, it may be that some condoms do feel better than others. But data are hard to come by and often aren’t adequate to make confident conclusions. Testing feel may indeed be the most difficult because it’s so subjective. Minus an Internet Movie Database (IMDB) for condoms, it’s difficult to create any reasonable assessment here. And just as with IMDB, we’re likely to have our own personal taste.

Of course, the best way to estimate breakage and slippage is actual use by couples in clinical studies. Those studies use a swab to detect semen (or, more specifically, a type of protein found in prostate fluid). But that gets expensive because you have to pay couples for their time to participate in these studies. And the few studies that have been done haven’t found any differences between the brands they tested, though that’s perhaps due to a low sample size — you can need rather large samples to provide the necessary statistical power to detect small differences.

And even with clinical studies, good luck hiding the type of condom from the participants. (Go ahead with your thought experiments.) This means it’s not that easy to do a double-blind comparison — the gold standard for medical data.

It would be nice to test condoms in a more cost effective way, but we have to be careful. For instance, one idea would be to test tension to determine average breaking point. But this approach to determine their tensile strength isn’t very predictive of condom breakage in actual use. Current water tests for leakage would also be a poor measure because these tests require a standard fill and then test for leakage, i.e. holes in the condom, rather than the condom actually tearing or breaking apart. So that doesn’t work.

One study found a couple of standard approaches that could offer predictive value of a condom’s strength, i.e. resistance to breakage, particularly with the percentage that a condom was able to elongate. Elongation percentage had an R2 of 0.81, which means that a condom’s elongation was able to predict 81% of what occurred in actual condom failure during intercourse (technically referring to explaining its variance of failure during intercourse). Surprisingly, airburst volume alone wasn’t a very useful predictor. The most useful predictor was actually the age of the condom. Latex deteriorates over time and with exposure to heat. So check those expiration dates, and don’t leave your condoms in your wallet or a hot car!

For slippage, there doesn’t appear to be an alternative procedure to measure this efficiently. So we’re still stuck with couples studies. It may be that the best approach here is to encourage men to use better fitting condoms and remind them to hold the base of the condom during withdrawal.

So without a clinical study using actual couples or proxy data looking at elongation, it’s difficult to know just how the HEX stacks up. To know for sure, it looks like we’ll just have to try it out. The Hex condom isn’t yet available to US retailers, but you can purchase it off their site. Then give it a comparison. Have fun and let us know what you think!

Note: We haven’t received anything from LELO to post this blog entry, and the above is not meant as an endorsement. We’re not aware of any scientific evidence that the HEX condom is more comfortable or more effective than any other brand of latex condoms. But we applaud companies that work to develop new male contraceptives, and we hope that the HEX condom lives up to its marketing.

Originally published at www.malecontraceptive.org on August 31, 2016.