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Questions and Answers — Condoms

 

What are condoms?

Male condoms are a sheath or pouch that fits over an erect penis.  Condoms may be made out of latex (a type of rubber), polyurethane, or lambskin.

Condoms are a barrier method of contraception that, when used consistently and correctly, can prevent pregnancy by blocking the passage of semen into the vaginal canal. Condoms can also prevent the exchange of blood, semen, and vaginal secretions, which are the primary routes of STD transmission.

Research continues to show that condoms are one of the best methods of preventing unintended pregnancy and are one of the only methods for sexually active individuals to protect themselves against STDs, including HIV.

Are condoms effective in preventing STDs?

Condoms have been proven to reduce the transmission of STDs. Condoms provide different levels of risk reduction for different STDs because infections are spread differently—some STDs are spread by contact with bodily fluids while others are spread by skin to skin contact.  In general, research shows that condoms are most effective in preventing those STDs that are spread by bodily fluids, such as HIV.  Condoms can reduce the risk of contracting diseases spread by skin-to-skin contact, such as Herpes, as well. However, they may be less effective because contagious sores and lesions can occur outside of the area covered by the condom.

These are prevention messages recently developed by the CDC:

  • Latex condoms, when used consistently and correctly, are highly effective in preventing the transmission of HIV, the virus that causes AIDS. In addition, correct and consistent use of latex condoms can reduce the risk of other STDs.
  • Latex condoms, when used consistently and correctly, can reduce the risk of transmission of Gonorrhea, Chlamydia, and Trichomoniasis.
  • Latex condoms, when used consistently and correctly, can reduce the risk of Genital Herpes, Syphilis, and HPV only when the infected areas are covered or protected by the condom.

Are condoms effective in preventing pregnancy?

When used correctly and consistently, condoms are extremely effective in preventing pregnancy.  Numerous studies show that with perfect use condoms are 98% effective in preventing pregnancy, and with typical use they are 86% effective.

The most important thing to understand is the difference between method failure and user failure. Perfect use rates are based on method failure which refers to failure resulting from a defect in the product (such as a tear in a condom). This is very rare. Experts estimate that condoms break or slip only 2% of the time.

User failure refers to failure resulting from incorrect or inconsistent use and determines typical failure rates. User failure is calculated by looking at 100 couples who use condoms as their primary method of birth control. About 14 of these couples will experience an unintended pregnancy during their first year of condom use. It is important to remember that these couples may not have been using a condom or may have been using a condom incorrectly during the act of intercourse that resulted in an unintended pregnancy.

Do condoms frequently break or slip off?

No.  It is not common for a condom to break or slip off.

  • A study published in the American Journal of Public Health observed female sex workers in Nevada brothels, where condom use is required by law, and found that of 353 condoms used by the sex workers during the study, none broke or fell off during intercourse, and only two (0.6%) slipped off during withdrawal.
  • Studies have reported breakage rates during vaginal intercourse ranging from 0% to 6.7%. Most studies report that condoms break less than 2% of the time during intercourse or withdrawal.
  • Condoms fall off the penis in 0.6% – 5.4% of acts of vaginal intercourse and may slip down the penis without falling off in 3.4% – 13.1% of acts of vaginal intercourse.
  • Breakage rates during anal sex for men who have sex with men in four prospective studies ranged from 0.5% to 12%, with rates less than 2% in three of the studies.

What is the proper way to use a male condom?

  • Store condoms in a cool place out of direct sunlight (not in wallets or glove compartments). Latex will become brittle from changes in temperature, rough handling, or age. Don’t use damaged, discolored, brittle, or sticky condoms.
  • Use a new condom for each act of sexual intercourse.
  • Check the expiration date.
  • Carefully open the condom package—teeth or fingernails can tear the condom
  • Put on the condom before it touches any part of a partner’s body.
  • Hold the condom over an erect penis.
  • If a penis is uncircumcised, pull back the foreskin before putting on the condom.
  • Put on the condom by pinching the reservoir tip and unrolling it all the way down the shaft of the penis from head to base. If the condom does not have a reservoir tip, pinch it to leave a half-inch space at the head of the penis for semen to collect after ejaculation.
  • In the event that the condom breaks, withdraw the penis immediately and put on a new condom before resuming intercourse.
  • Withdraw the penis immediately after ejaculation: while the penis is still erect, grasp the rim of the condom between the fingers and slowly withdraw the penis (with the condom still on) so that no semen is spilled.
  • Remove the condom, making certain that no semen is spilled.
  • Carefully dispose of the condom. Do not reuse it.
  • Do not use two male condoms or a male condom along with a female condom. If the two condoms rub together, the friction between them can cause the male condom to be pulled off, the female condom to be pushed in, or either condom to break.

Is it safe to use lubricant (lube) with condoms?

With most latex condoms it is safe to use water-based lubricant.  In fact, using water-based lubricant during sexual intercourse, especially anal sex, will reduce the risk of breakage.  However, it is unsafe to use oil-based lubricants as they may weaken the condom. Carefully read the labels and instructions on all condom wrappers and lubricant packages you are planning to use to make sure that they are compatible.

What are female condoms?

The female condom is made of polyurethane and provides protection against pregnancy and STDs, including HIV. It consists of a tube-like sheath with one flexible polyurethane ring at each end. One ring is placed inside the vaginal canal and is closed off by polyurethane, collecting the ejaculate. The other ring remains outside the vagina and the penis enters the vagina through this ring. The female condom is coated with a silicone-based lubricant. Additional lubricant can be added as necessary. The female and male condom should not be used together as they can adhere to each other, causing slippage or displacement.

What is the proper way to use a female condom?

  • Use a new condom for each act of sexual intercourse.
  • Do not use damaged, discolored, brittle, or sticky condoms.
  • Check the expiration date.
  • Carefully open the condom package—teeth or fingernails can tear the condom.
  • First, inspect the condom and make certain it is completely lubricated on the outside and the inside.
  • The female condom is inserted into the vagina with fingers, much like a tampon that has no applicator. To do so:
  • Hold the condom at the closed end and squeeze the flexible inner ring with thumb and middle finger so it becomes long and narrow. With the other hand, separate the outer lips of the vagina.
  • Gently insert the inner ring end as far into the vagina as possible, using the index finger to push up the inner ring until the finger reaches the cervix (similar to how a diaphragm would be inserted).
  • Before having intercourse, make certain the condom is in place. When in place, it will cover the pening of the cervix and line the vaginal walls. A general indicator of correct insertion is that the individual will no longer feel the ring. The open end of the condom must always remain outside the vaginal opening. Before having intercourse, make certain that the condom is straight and not twisted.
  • Add water-based lubricant onto the penis and/or the inside of the female condom to increase comfort and decrease noise. It is important to use enough lubricant so that the condom stays in place during sex. If the condom is pulled out or pushed in, that is an indicator that there is not enough lubricant.
  • During intercourse, be sure that the penis is not entering the vaginal canal outside of the condom.
  • To remove the condom, twist the outer ring and gently pull the condom out to avoid any spillage.
  • Carefully dispose of the condom. Do not reuse it.

[1] U.S. Centers for Disease Control and Prevention (CDC), Latex Condoms and Sexually Transmitted Diseases-Prevention Messages (Atlanta, GA: CDC, 2001), p. 2.
[2] Ibid.
[3] R. A. Hatcher, et al., Contraceptive Technology, 17th revised Edition (New York: Ardent Media, Inc., 1998), p.326.
[4] Ibid.
[5] Ibid.
[6] Ibid.
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