How Effective Are Condoms

Condoms

What Are Condoms?

A condom is a tube commonly used during sexual intercourse to reduce the probability of pregnancy and spreading sexually transmitted diseases. It is put on a man's erect penis and physically blocks ejaculated semen from entering the body of a sexual partner. Condoms are also used for collection of semen for use in infertility treatment.

Because condoms are waterproof, elastic, and durable, they are also used for non-sexual purposes such as creating waterproof microphones and protecting rifle barrels from clogging. In the modern age, condoms are most often made from latex, but some are made from other materials such as polyurethane, polyisoprene, or lamb intestine. A female condom is also available, often made of nitrile.




Birth Control

As a method of birth control, male condoms have the advantage of being inexpensive, easy to use, having few side effects, and offering protection against sexually transmitted diseases. With proper knowledge and application technique—and use at every act of intercourse—women whose partners use male condoms experience a 2% per-year pregnancy rate with perfect use and a 15% per-year pregnancy rate with typical use.
 
Condoms have been used for at least 400 years. Since the 19th century, they have been one of the most popular methods of contraception in the world. While widely accepted in modern times, condoms have generated some controversy, primarily over what role they should play in sex education classes.

A condom is a tube made of thin, flexible material. It is closed at one end. Condoms have been used for hundreds of years to prevent pregnancy by keeping a man's semen out of a woman's vagina. 

 

Condoms also help prevent diseases that are spread by semen or by contact with infected sores in the genital area, including HIV. Most condoms go over a man's penis. A new type of condom was designed to fit into a woman's vagina. The "female" condom can also be used to protect the rectum. 

          

What Are They Made Of?

Condoms used to be made of natural skin (including lambskin) or of rubber. That's why they are called "rubbers." Most condoms today are latex or polyurethane. Lambskin condoms can prevent pregnancy. However, they have tiny holes (pores) that are large enough for HIV to get through.

Lambskin condoms do not prevent the spread of HIV.

Latex is the most common material for condoms. Viruses cannot get through it. Latex is inexpensive and available in many styles. It has two drawbacks: oils make it fall apart, and some people are allergic to it.




Polyurethane is an option for people who are allergic to latex. One brand of female condom and one brand of male condom are made of polyurethane.

How Are Condoms Used?

Condoms can protect you during contact between the penis, mouth, vagina, or rectum. Condoms won't protect you from HIV or other infections unless you use them correctly and consistently.

• Store condoms away from too much heat, cold, or friction. Do not keep them in a wallet or a car glove compartment.
• Check the expiration date. Don't use outdated condoms.
• Don't open a condom package with your teeth. Be careful that your fingernails or jewelry don't tear the condom. Body jewelry in or around your penis or vagina might also tear a condom.
• Use a new condom every time you have sex, or when the penis moves from the rectum to the vagina.
• Check the condom during sex, especially if it feels strange, to make sure it is still in place and unbroken.
• Do not use a male condom and a female condom at the same time.
• Use only water-based lubricants with latex condoms, not oil-based. The oils in Crisco, butter, baby oil, Vaseline or cold cream will make latex fall apart.
• Use unlubricated condoms for oral sex (most lubricants taste awful).
• Do not throw condoms into a toilet. They can clog plumbing.

Using a Male Condom

• Put the condom on when your penis is erect -- but before it touches your partner's mouth, vagina, or rectum. Many couples use a condom too late, after some initial penetration. Direct genital contact can transmit some diseases. The liquid that comes out of the penis before orgasm can contain HIV.
• If you want, put some water-based lubricant inside the tip of the condom.
• If you are not circumcised, push your foreskin back before you put on a condom. This lets your foreskin move without breaking the condom.
• Squeeze air out of the tip of the condom to leave room for semen (cum). Unroll the rest of the condom down the penis.
• Do not "double bag" (use two condoms). Friction between the condoms increases the chance of breakage.
• After orgasm, hold the base of the condom and pull out before your penis gets soft.
• Be careful not to spill semen onto your partner when you throw the condom away.

Using a Female Condom

• The female condom is a sleeve or pouch with a closed end and a larger open end. Some female condoms have flexible rings at each end. Others have a flexible v-shaped frame.
• Put the condom in place before your partner's penis touches your vagina or rectum.
• For use in the vagina, insert the narrow end of the condom, like inserting a diaphragm. The larger end goes over the opening to the vagina to protect the outside sex organs from infection.
• Guide the penis into the large end to avoid unprotected contact between the penis and the partner's rectum or vagina.
• Some people have used the Reality condom in the rectum after removing the smaller ring. Put the condom over your partner's erect penis. The condom will be inserted into the rectum along with the penis.
• After sex, remove the condom before standing up. Twist the large end to keep the semen inside. Gently pull the condom out and throw it away.

Nonoxynol-9

Nonoxynol-9 is a chemical that kills sperm (a spermicide). It can help prevent pregnancy when it is used in the vagina along with condoms or other birth control methods. Nonoxynol-9 should not be used in the mouth or rectum.

Because nonoxynol-9 kills HIV in the test tube, it was considered as a way to prevent HIV infection during sex. Unfortunately, many people are allergic to it. Their sex organs (penis, vagina, and rectum) can get irritated and develop small sores that actually make it easier for HIV infection to spread. Nonoxynol-9 should not be used as a way to prevent HIV infection.

Condom Myths

Studies show condoms are 80% to 97% effective in preventing HIV transmission if they are used correctly every time you have sex.

"Condoms break a lot:" Less than 2% of condoms break when they are used correctly: no oils with latex condoms, no double condoms, no outdated condoms.

"HIV can get through condoms:" HIV cannot get through latex or polyurethane condoms. Don't use lambskin condoms.

When used correctly, condoms are the best way to prevent the spread of HIV during sexual activity. Condoms can protect the mouth, vagina or rectum from HIV-infected semen. They can protect the penis from HIV-infected vaginal fluids and blood in the mouth, vagina, or rectum. They also reduce the risk of spreading other sexually transmitted diseases.
Condoms must be stored, used and disposed of correctly. Male condoms are used on the penis. Female condoms can be used in the vagina or rectum.

Miscellaneous

Most condoms have a reservoir tip or teat end, making it easier to accommodate the man's ejaculate. Condoms come in different sizes, from oversized to snug and they also come in a variety of surfaces intended to stimulate the user's partner. Condoms are usually supplied with a lubricant coating to facilitate penetration, while flavored condoms are principally used for oral sex. As mentioned above, most condoms are made of latex, but polyurethane and lambskin condoms also exist.

Materials

Natural latex

Latex has outstanding elastic properties: Its tensile strength exceeds 30 MPa, and latex condoms may be stretched in excess of 800% before breaking. Every latex condom is tested for holes with an electrical current. If the condom passes, it is rolled and packaged. In addition, a portion of each batch of condoms is subject to water leak and air burst testing.


While the advantages of latex have made it the most popular condom material, it does have some drawbacks. Latex condoms are damaged when used with oil-based substances as lubricants, such as petroleum jelly, cooking oil, baby oil, mineral oil, skin lotions, suntan lotions, cold creams, butter or margarine.

Contact with oil makes latex condoms more likely to break or slip off due to loss of elasticity caused by the oils. Additionally, latex allergy precludes use of latex condoms and is one of the principal reasons for the use of other materials. In May 2009 the U.S. Food and Drug Administration granted approval for the production of condoms composed of Vytex, latex that has been treated to remove 90% of the proteins responsible for allergic reactions. An allergen-free condom made of synthetic latex (polyisoprene) is also available.

Textured

Textured condoms include studded and ribbed condoms which can provide extra sensations to both partners. The studs or ribs can be located on the inside, outside, or both; alternatively, they are located in specific sections to provide directed stimulation to either the g-spot or frenulum. Many textured condoms which advertise "mutual pleasure" also are bulb-shaped at the top, to provide extra stimulation to the male. Some women experience irritation during vaginal intercourse with studded condoms.

Boosting condom

June 2011: An erection-enhancing condom recommended for European approval and will take around one month to receive CE mark certification after recommendation. In a double blind test the boosting condom gave a significant proportion that it was better than a standard condom which increased the penis size and longer lasting sexual experience for women. The boosting condom used gel in its tips that dilates the arteries and increased blood flow to penis make a firmer and bigger erection.

Adolescent and teenage condoms

In March 2010, the Swiss Government announced that it was planning to promote smaller condoms intended for boys of 12–14 years old following concern about the pregnancy rate among adolescent girls, and also about the potential spread of AIDS among this age group. This was due to the fact that standard condoms were too wide and consequently failed to afford protection to adolescent boys during vaginal and anal intercourse.

 

Family planning groups and the Swiss Aids Federation had campaigned to have a narrower condom produced for adolescent use after a number of studies, including a government study researched at the Centre for Development and Personality Psychology at Basel University, found that standard condoms were unsuitable for boys in this age range, and that the condoms either failed during use or that the boys rejected them altogether because they were too wide, and consequently they used no protection at all.


 

As a result of these studies, a condom aimed at 12 to 14 year old boys is now produced and is available in Switzerland and in certain other countries. Manufactured by Ceylor, the 'Hotshot' is a lubricated, teat-ended latex condom which is narrower than a standard condom and has a tight band at the opening to ensure that it remains on the boy's penis during intercourse. A standard condom has a diameter of 2 inches (5.2 cm) whereas the Hotshot has a diameter of 1.7 inches (4.5 cm). Both are the same length– 7.4 inches (19 cm).

 

In a German study of 12,970 13 to 19-year-olds, a quarter of the boys surveyed also said a standard condom was too large. Other manufacturers, such as Durex, also produce smaller than average condoms such as Durex Love which is aimed at this end of the teenage market.

Female condom

Male condoms have a tight ring to form a seal around the penis while female condoms typically have a large stiff ring to keep them from slipping into the body orifice. The Female Health Company produced a female condom that was initially made of polyurethane, but newer versions are made of nitrile. Medtech Products produces a female condom made of latex.

Effectiveness

In preventing pregnancy

The effectiveness of condoms, as of most forms of contraception, can be assessed two ways. Perfect use or method effectiveness rates only include people who use condoms properly and consistently. Actual use, or typical use effectiveness rates are of all condom users, including those who use condoms incorrectly or do not use condoms at every act of intercourse. Rates are generally presented for the first year of use. Most commonly the Pearl Index is used to calculate effectiveness rates, but some studies use decrement tables.



 

The typical use pregnancy rate among condom users varies depending on the population being studied, ranging from 10–18% per year. The perfect use pregnancy rate of condoms is 2% per year. Condoms may be combined with other forms of contraception (such as spermicide) for greater protection.

In preventing STDs

Condoms are widely recommended for the prevention of sexually transmitted diseases (STDs). They have been shown to be effective in reducing infection rates in both men and women. While not perfect, the condom is effective at reducing the transmission of organisms that cause AIDS, genital herpes, cervical cancer, genital warts, syphilis, chlamydia, gonorrhea, and other diseases.

Condoms are often recommended as an adjunct to more effective birth control methods in situations where STD protection is also desired.

Causes of failure

Condoms may slip off the penis after ejaculation, break due to improper application or physical damage (such as tears caused when opening the package), or break or slip due to latex degradation (typically from usage past the expiration date, improper storage, or exposure to oils). The rate of breakage is between 0.4% and 2.3%, while the rate of slippage is between 0.6% and 1.3%.

Even if no breakage or slippage is observed, 1–2% of women will test positive for semen residue after intercourse with a condom. "Double bagging", using two condoms at once, is often believed to cause a higher rate of failure due to the friction of rubber on rubber.

This claim is not supported by research. The limited studies that have been done on the subject support that double bagging is likely not harmful and possibly beneficial.
Different modes of condom failure result in different levels of semen exposure. If a failure occurs during application, the damaged condom may be disposed of and a new condom applied before intercourse begins – such failures generally pose no risk to the user.

 One study found that semen exposure from a broken condom was about half that of unprotected intercourse; semen exposure from a slipped condom was about one-fifth that of unprotected intercourse.

Standard condoms will fit almost any penis, with varying degrees of comfort or risk of slippage. Many condom manufacturers offer "snug" or "magnum" sizes. Some manufacturers also offer custom sized-to-fit condoms, with claims that they are more reliable and offer improved sensation/comfort. Some studies have associated larger penises and smaller condoms with increased breakage and decreased slippage rates (and vice versa), but other studies have been inconclusive.

Condom thickness is not associated with condom breakage, thinner condoms are as effective as thicker ones. Nevertheless, it is recommended for condoms manufactures to avoid very thick, or very thin condoms, because they are both considered less effective. Some authors even encourage users to choose thinner condoms "for greater durability, sensation, and comfort", but others warn that "the thinner the condom, the smaller the force required to break it".

Experienced condom users are significantly less likely to have a condom slip or break compared to first-time users, although users who experience one slippage or breakage are more likely to suffer a second such failure. An article in Population Reports suggests that education on condom use reduces behaviors that increase the risk of breakage and slippage.

A Family Health International publication also offers the view that education can reduce the risk of breakage and slippage, but emphasizes that more research needs to be done to determine all of the causes of breakage and slippage.

Among people who intend condoms to be their form of birth control, pregnancy may occur when the user has sex without a condom. The person may have run out of condoms, or be traveling and not have a condom with them, or simply dislike the feel of condoms and decide to "take a chance." This type of behavior is the primary cause of typical use failure (as opposed to method or perfect use failure).


Another possible cause of condom failure is sabotage. One motive is to have a child against a partner's wishes or consent. Some commercial sex workers from Nigeria reported clients sabotaging condoms in retaliation for being coerced into condom use. Using a fine needle to make several pinholes at the tip of the condom is believed to significantly impact their effectiveness.

Prevalence

The prevalence of condom use varies greatly between countries. Most surveys of contraceptive use are among married women, or women in informal unions. Japan has the highest rate of condom usage in the world: in that country, condoms account for almost 80% of contraceptive use by married women. On average, in developed countries, condoms are the most popular method of birth control: 28% of married contraceptive users rely on condoms. In the average less-developed country, condoms are less common: only 6-8% of married contraceptive users choose condoms.^[80]

Use

Male condoms are usually packaged inside a foil wrapper, in a rolled-up form, and are designed to be applied to the tip of the penis and then unrolled over the erect penis. It is important that some space be left in the tip of the condom so that semen has a place to collect; otherwise it may be forced out of the base of the device. After use, it is recommended the condom be wrapped in tissue or tied in a knot, then disposed of in a trash receptacle.

Some couples find that putting on a condom interrupts sex, although others incorporate condom application as part of their foreplay.

Some men and women find the physical barrier of a condom dulls sensation. Advantages of dulled sensation can include prolonged erection and delayed ejaculation; disadvantages might include a loss of some sexual excitement.

Advocates of condom use also cite their advantages of being inexpensive, easy to use, and having few side effects.

Role in sex education

Condoms are often used in sex education programs, because they have the capability to reduce the chances of pregnancy and the spread of some sexually transmitted diseases when used correctly. A recent American Psychological Association (APA) press release supported the inclusion of information about condoms in sex education, saying "comprehensive sexuality education programs... discuss the appropriate use of condoms", and "promote condom use for those who are sexually active."
In the United States, teaching about condoms in public schools is opposed by some religious organizations.

Planned Parenthood, which advocates family planning and sex education, argues that no studies have shown abstinence-only programs to result in delayed intercourse, and cites surveys showing that 76% of American parents want their children to receive comprehensive sexuality education including condom use.

Infertility treatment

Common procedures in infertility treatment such as semen analysis and intrauterine insemination (IUI) require collection of semen samples. These are most commonly obtained through masturbation, but an alternative to masturbation is use of a special collection condom to collect semen during sexual intercourse.
 

Collection condoms are made from silicone or polyurethane, as latex is somewhat harmful to sperm. Many men prefer collection condoms to masturbation, and some religions prohibit masturbation entirely.

Also, compared with samples obtained from masturbation, semen samples from collection condoms have higher total sperm counts, sperm motility, and percentage of sperm with normal morphology. For this reason, they are believed to give more accurate results when used for semen analysis, and to improve the chances of pregnancy when used in procedures such as intracervical or intrauterine insemination.

Adherents of religions that prohibit contraception, such as Catholicism, may use collection condoms with holes pricked in them.

For fertility treatments, a collection condom may be used to collect semen during sexual intercourse where the semen is provided by the woman's partner. Private sperm donors may also use a collection condom to obtain samples through masturbation or by sexual intercourse with a partner and will transfer the ejaculate from the collection condom to a specially designed container.

The sperm is transported in such containers, in the case of a donor, to a recipient woman to be used for insemination, and in the case of a woman's partner, to a fertility clinic for processing and use. However, transportation may reduce the fecundity of the sperm. Collection condoms will not be used where semen is produced at a sperm bank or fertility clinic.

Condom therapy is sometimes prescribed to infertile couples when the female has high levels of antisperm antibodies. The theory is that preventing exposure to her partner's semen will lower her level of antisperm antibodies, and thus increase her chances of pregnancy when condom therapy is discontinued. However, condom therapy has not been shown to increase subsequent pregnancy rates.

Other uses

Condoms excel as multipurpose containers because they are waterproof, elastic, durable, and will not arouse suspicion if found. Ongoing military utilization begun during World War II includes:

• Tying a non-lubricated condom over the muzzle of the rifle barrel in order to prevent barrel fouling by keeping out detritus.
• The OSS used condoms for a plethora of applications, from storing corrosive fuel additives and wire garrotes (with the T-handles removed) to holding the acid component of a self-destructing film canister, to finding use in improvised explosives.
• Navy SEALs have used doubled condoms, sealed with neoprene cement, to protect non-electric firing assemblies for underwater demolitions—leading to the term "Dual Waterproof Firing Assemblies."

Other uses of condoms include:

• Covers for endovaginal ultrasound probes. Covering the probe with a condom reduces the amount of blood and vaginal fluids that the technician must clean off between patients.
• Condoms can be used to hold water in emergency survival situations.
• Condoms have also been used to smuggle cocaine, heroin, and other drugs across borders and into prisons by filling the condom with drugs, tying it in a knot and then either swallowing it or inserting it into the rectum. These methods are very dangerous and potentially lethal; if the condom breaks, the drugs inside become absorbed into the bloodstream and can cause an overdose.
• Condoms are used by engineers to keep soil samples dry during soil tests.
• Condoms are used in the field by engineers to initially protect sensors embedded in the steel or aluminum nose-cones of Cone Penetration Test (CPT) probes when entering the surface to conduct soil resistance tests to determine the bearing strength of soil.
• Condoms are used as a one-way valve by paramedics when performing a chest decompression in the field. The decompression needle is inserted through the condom, and inserted into the chest. The condom folds over the hub allowing air to exit the chest, but preventing it from entering.

Religious

Roman Catholic Church opposes all kinds of sexual acts outside of marriage, as well as any sexual act in which the chance of successful conception has been reduced by direct and intentional acts
.
The use of condoms to prevent STD transmission is not specifically addressed by Catholic doctrine, and is currently a topic of debate among theologians and high-ranking Catholic authorities. A few, such as Belgian Cardinal Godfried Danneels, believe the Catholic Church should actively support condoms used to prevent disease, especially serious diseases such as AIDS.

However, the majority view—including all statements from the Vatican—is that condom-promotion programs encourage promiscuity, thereby actually increasing STD transmission. This view was most recently reiterated in 2009 by Pope Benedict XVI.

The Roman Catholic Church is the largest organized body of any world religion. The church has hundreds of programs dedicated to fighting the AIDS epidemic in Africa, but its opposition to condom use in these programs has been highly controversial.

In a November 2011 interview, the Pope discussed for the first time the use of condoms to prevent STD transmission. He said that the use of a condom can be justified in a few individual cases if the purpose is to reduce the risk of an HIV infection.

He gave as an example male prostitutes. There was some confusion at first whether the statement applied only to homosexual prostitutes and thus not to heterosexual intercourse at all. However, Federico Lombardi, spokesman for the Vatican, clarified that it applied to heterosexual and transsexual prostitutes, whether male or female, as well.

He did, however, also clarify that the Vatican's principles on sexuality and preservatives had not been changed.

Scientific and environmental

More generally, some scientific researchers have expressed objective concern over certain ingredients sometimes added to condoms, notably talc and nitrosamines. Dry dusting powders are applied to latex condoms before packaging to prevent the condom from sticking to itself when rolled up. Previously, talc was used by most manufacturers, but cornstarch is currently the most popular dusting powder.

Talc is known to be toxic if it enters the abdominal cavity (i.e. via the vagina). Cornstarch is generally believed to be safe, however some researchers have raised concerns over its use as well.

Health problems

Condoms may interfere with the process of paternal tolerance, by which exposure of a woman's immune system to semen during unprotected sex may decrease the risk of pregnancy complications in subsequent pregnancies.

The use of latex condoms by people with an allergy to latex can cause allergic symptoms such as skin irritation. In people with severe latex allergies, using a latex condom can potentially be life-threatening. Repeated use of latex condoms can also cause some people to develop an allergy to latex.

Cultural barriers to condom use

In much of the Western world, the introduction of the pill in the 1960s was associated with a decline in condom use. In Japan, oral contraceptives were not approved for use until September 1999, and even then access was more restricted than in other industrialized nations.

 Perhaps because of this restricted access to hormonal contraception, Japan has the highest rate of condom usage in the world: in 2008, 80% of contraceptive users relied on condoms.

Cultural attitudes toward gender roles, contraception, and sexual activity vary greatly around the world, and range from extremely conservative to extremely liberal. But in places where condoms are misunderstood, mischaracterised, demonised, or looked upon with overall cultural disapproval, the prevalence of condom use is directly affected.

In less-developed countries and among less-educated populations, misperceptions about how disease transmission and conception work negatively affect the use of condoms; additionally, in cultures with more traditional gender roles, women may feel uncomfortable demanding that their partners use condoms.