Q:A while back a friend of mine brought to my attention an item which you published on the possible link between condoms and cancer in women (WDDTY, vol 6 no 2). If this is true it must be the greatest medical scandal of all time. I would like to kn

A:The British "kite mark" is an assurance of quality control (ie, your condom is unlikely to break or leak). It does not necessarily ensure that your condom is free from harmful substances. Your GP should review articles published in the medical press recently which have concerned themselves with the process of moulding latex into things such as condoms and surgical gloves a process which involves the use of talc, cornstarch and other powders.

The truth is that no one knows what risks we may face because of the long term use of condoms. It has only been in the last few years, as condom use has increased due to the fear of sexually transmitted diseases, that it has become an issue.

Talc is used in the manufacture of latex goods both as a lubricant and to release the product from the mould used in its manufacture. The use of talc on surgical gloves was virtually eliminated early in the 1990s since there was evidence that it created inflammation and adhesions in some surgical patients (Arch Dermatol, 1994; 130: 48-53). Although some condom manufacturers still use talc as a dry lubricant, others use dry lubricants such as silicone and cornstarch.

The harmful effects of talc on human tissue were first recorded in the 1930s. Thirty years later there was a reported case of a woman who had a significant amount of talc in her peritoneal (abdominal) cavity talc which matched that found on the surface of her husband's condoms (Lancet, 1963; 1: 1295-6). The authors concluded that talc travelled up through the fallopian tubes and became implanted in the peritoneal cavity. They also predicted that talc might contribute to occlusion (blockage) and sterility.

A more ominous series of studies linked talc to ovarian cancer talc was observed in a number of ovarian and uterine tumours as well as in ovarian tissue (Lancet, 1979; 2: 349-51; J Ob Gyn Br Commonwealth, 1971; 78: 266-72) and it has since been confirmed that talc, either placed on the perineum (or on the surface of underwear, sanitary towels, diaphragms or condoms), can reach the ovaries via ascent through the fallopian tubes (Am J Epidem, 1989; 130-394; Ob Gyn, July 1992). There has been little attention paid to the possibility of damage to the male urogenital tract through regular condom use, although this also remains a distinct possibility.

In 1995, Dr Candace Sue Kaspar produced two reports on the possible adverse effects of talc in condoms (JAMA, 1995; 273: 846-7; JAMA 1995; 274: 1269-70). Many condom manufacturers were quick to get in touch with Dr Kaspar to point out that they no longer used talc or were phasing out its use.

Two interesting things emerged from these correspondences. First, under examination, many of these talc free condoms had other particles on them, such as vegetable starches, silica, mica and diatomaceous earth. One brand contained numerous lycopodium (club moss) spores. Spores of the club moss were used as absorbents in surgical glove donning powders earlier this century, but the practice was abandoned when it was shown that lycopodium caused granulomas (small fibrous growths) and peritoneal adhesions (the abdominal organs become inflamed and begin to stick together) (Arch Pathol, 1933; 16:326-31; J Cutan Pathol, 1988; 15: 120-3).

Moreover, as Kaspar and colleagues pointed out, lycopodium can be contaminated with talc, sulphur and/or gypsum. Lycopodium has not been linked with cancer, but is associated with inflammation of the soft tissues.

There are other problems with what is touted as the world's safest contraceptive device. Increasingly it is becoming associated with contact dermatitis in both men and women. In one study 24 per cent of those who regularly used condoms experienced local swelling and/or itching during intercourse (Contact Derm, 1989; 20: 360-4). There have also been reports of allergic reactions to talc substitutes, such as cornstarch, used in their production (Cutis, 1986; 38: 291-3).

In fact, cornstarch has been implicated in hypersensitivity reactions in patients whose surgeons use gloves dusted with it (Br J Surg, 1976; 63: 864-6) as well as granulomas in various organs throughout the body (Am J Surg, 1973; 125: 455-7; Surg Gyn Ob, 1974; 138: 385-8; Acta Pathol Microbial Scand, 1970; 64: 55-8; Am J Ob Gyn 1974; 118: 799-802).

In men, contact dermatitis from condom use is relatively easy to diagnose.

In women, diagnosis can be rather more difficult. Increased vaginal discharge, a burning sensation in the vagina, and itching in the vulva may all be present, yet when the woman comes to be examined by her practitioner these things may not be detectable by any laboratory investigation.

There are a few non rubber and non latex condoms on the market in the US, but none in the UK. Non rubber condoms such as Fourex Natural Lamb Skins (Schmidt, Sarasota, Florida) and Trojan Natural Lamb Skins (Young Drug Products, New York) are made of processed sheep intestine (caecum) and are, in themselves, hypoallergenic. However, they may contain a lubricant that includes perfume, preservative (Bronopol) and propylene glycol, which may cause allergic reactions in some individuals. These non rubber condoms can prevent transmission of sperm, but the FDA has ruled that they may be ineffective in preventing transmission of HIV.

Non latex synthetic condoms were first developed in 1992 in the US and made of Tactylon the same substance used to make some surgical gloves. They do protect against HIV and are well tolerated in individuals sensitive to rubber. A new polyurethane condom called Avanti is already on sale in America and is due to be launched in the UK next year. The female contraceptive "pouch" is also made of polyurethane.