Why choose condoms?

Advantages — Male condoms offer several contraceptive and noncontraceptive benefits to users:

• Condoms are a coital-dependent reversible method of contraception that do not disrupt fertility.
• Condoms provide protection against STIs. 
• Condoms are readily accessible without a medical examination, prescription, or special fitting, and can be obtained from many sources, including drug stores, grocery stores, clinics, vending machines, gas stations, bars, and mail-order services.
• Condoms are among the most inexpensive and cost-effective coital-dependent contraceptives. Some programs offer them at no cost.
• Condoms can be easily and discretely carried by men or women.
• Condoms have minimal side effects since they are relatively inert and the body is exposed to them only with coitus, not at other times.
• For some men, condom use may help prevent premature ejaculation.

Disadvantages — Male condoms also have disadvantages that may result in inconsistent use, incorrect use, or nonuse. Allergy to latex is the only contraindication to latex condom use. 

• Using a condom requires partner cooperation. In some instances, men will not accept wearing a condom, thus making male condom use impossible.
• Many men and their partners complain of reduced sensitivity when condoms are used during intercourse.
• Foreplay is interrupted to put the condom on, although placing the condom can be incorporated into foreplay activity.
• Some men cannot consistently maintain an erection when wearing a condom.
• Some men and their partners feel embarrassed or uncomfortable when obtaining condoms or suggesting use of condoms.
• Some men have difficulty finding a condom with a proper fit, which may decrease satisfaction and increase problems such as breakage and slippage

Protection from STIs — The primary noncontraceptive benefit of condom use is the protection offered against STI acquisition. Patients (male and female) at risk for STIs benefit from male condom use (latex or synthetic), even if another contraceptive method is being used. A general consensus exists that male condoms should play a central role in any STI/HIV prevention program.

A condom placed on the penis before any genital contact and used throughout intercourse reduces the risk of partner-to-partner transmission of infectious pathogens associated with semen; penile, vaginal, cervical, and anal epithelium; and penile, vaginal, or anal discharges. Laboratory studies indicate that latex condoms provide an effective physical barrier against passage of even the smallest sexually transmitted pathogen (hepatitis B). The level of protection observed during actual use varies because STIs differ in their routes of transmission, infectivity, and prevalence.

Condoms greatly reduce the risk of STIs transmitted primarily to or from the penile urethra, including gonorrhea, chlamydia, trichomoniasis, hepatitis B infection, and HIV. Condoms should also reduce the risk of STIs transmitted primarily through skin or mucosal surfaces (eg, herpes simplex virus, syphilis, chancroid, and both human papillomavirus  and HPV-associated diseases) when these areas are covered by the condom. However, the protection may be less when condoms do not completely cover the entire infected area.

HIV – Well-designed clinical studies of discordant couples (where one partner is HIV-infected and the other is not) have reported that consistent use of latex condoms is highly effective against sexually acquired HIV infection . One meta-analysis reported that consistent condom use reduced the risk of acquiring HIV by approximately 80 percent. Across 13 cohort studies reviewed, only 11 seroconversions occurred among 587 couples reporting consistent use.

How A Condom Works

Mechanism and efficacy — The condom acts as a barrier by preventing direct contact with semen (and thus sperm), genital lesions, and subclinical viral shedding on the glans and shaft of the penis. It also prevents contact with penile, vaginal, or anal discharges.

Condom efficacy depends on the skill level and experience of the user . Couples vary widely in their ability to use male condoms consistently and correctly. An estimated 2 percent of women will become pregnant during the first year of perfect (ie, consistent and correct) use of the condom, and approximately 13 of every 100 will become pregnant during the first year of typical use, which places condoms in the moderate efficacy category.

INFORMATION FOR USE

1. Use a new condom for each act of intercourse if any risk of pregnancy or sexually transmitted infections (STIs) exists.

Patients should discuss condom use with their partner before intercourse and should have an adequate supply of condoms readily available. Extra condoms will be needed if the first is damaged, torn before use, or put on incorrectly.

The condom package should be opened carefully to avoid damaging it with fingernails, teeth, or other sharp objects. Condoms in damaged packages or that show obvious signs of deterioration (brittleness, stickiness, or discoloration) should not be used.

1. Before any genital contact, place the condom on the tip of the erect penis with the rolled side out.

Unrolling the condom a short distance helps to make sure the condom is being unrolled in the right direction. If the condom doesn’t unroll easily, it is probably inside-out and should be discarded because flipping it over and using it could expose the partner to infectious organisms contained in the pre-ejaculate.

1. Unroll the condom all the way to the base of the erect penis.

The condom should cover the penile glans and shaft.

Adequate, appropriate lubrication (natural or synthetic) is important before intercourse. 

1. Immediately after ejaculation, hold the rim of the condom and withdraw the penis while it is still erect.

The condom is held firmly against the base of the penis to prevent slippage and leakage of semen while the penis is withdrawn. The condom is then inspected for evidence of breakage or leakage. We educate patients who are using male condoms as their contraceptive method about the availability of emergency contraception should leakage occur.

1. Throw away the used condom safely. Condoms should not be flushed down a toilet.

After removing the condom, it should be checked for visible damage, and then wrapped in tissue and discarded. Condoms should not be reused.

A new condom should be used from “beginning to end” with each act of intercourse. If the condom breaks or falls off during intercourse but before ejaculation, it should be replaced with a new condom. New condoms should also be used for prolonged intercourse, and for different types of intercourse within a single session (eg, change the condom after anal sex if vaginal sex also is planned).

If the condom breaks, falls off, leaks, is damaged, or is not used, then pregnancy and infection are possible.

Concomitant use of lubricants and/or medications — Water-based lubricants (eg, K-Y, Astroglide, saliva, glycerine) and most silicone-based lubricants can be used with latex condoms, but oil-based lubricants reduce latex condom integrity and may facilitate breakage . Common oil-based products that should not come into contact with latex condoms include baby oil, cold creams, edible oils (olive, peanut, corn, sunflower, canola, coconut), butter, cocoa butter, margarine, whipped cream, hand and body lotions, massage oil, petroleum jelly, rubbing alcohol, suntan oil and lotions, and mineral oil.

Patients should be aware of whether the products they use (eg, lubricants, medications) that come into contact with their condoms contain oil. This cannot be determined reliably by the look, feel, or characteristics (eg, water soluble) of the product. Spermicides are water-based. Other vaginal medications, however, often contain oil-based ingredients that can damage latex condoms (eg, butoconazole contains mineral oil); therefore, patients using these medications should remain abstinent or use synthetic condoms until intravaginal medical therapy is fully completed. Oil-based products may be safely used with polyurethane and polyisoprene condoms.

Complications or failure — Although users often fear that the condom will break or fall off during use, these events are relatively rare. The majority of studies show that condoms break approximately 2 percent of the time during vaginal intercourse; a similar proportion slip off completely. However, these rates widely vary across some studies (0 to 22 percent for breakage; 0 to 9 percent for slippage)

During anal intercourse, rates of breakage and slippage may be slightly higher.

We advise users to have several condoms available in case a condom is torn, put on incorrectly, falls off, or repeated intercourse is desired. We also discuss treatment options the patient should be aware of in case a condom breaks, falls off, or is discovered to have a hole following intercourse, including

• Emergency contraception – Emergency contraception can be used as a backup method against pregnancy. We discuss availability and use of emergency contraception with all our patients who desire to avoid pregnancy.
• HIV and STI prevention – Patients at risk for HIV or STI exposure are evaluated for possible post-exposure prophylaxis against HIV and possible presumptive treatment against other STIs.

Storage and expiration — Condoms should be stored in a cool and dry place, out of direct sunlight, as excessive heat will weaken latex. However, latex condoms can probably be carried, for convenience, in a wallet for up to one month.

Patients should check the expiration or manufacture date on the box or individual package. Latex condoms should not be used beyond their expiration date or more than five years after the manufacturing date.

Inaccurate beliefs — Many misunderstandings exist about condom use. We ask patients what concerns they may have and attempt to address them all. We discuss the following points about male condoms:

• Do not make men sterile, impotent, or weak.
• Do not decrease men’s sex drive.
• Cannot get lost in the woman’s body.
• Do not have holes that HIV can pass through and are not laced with HIV.
• Do not cause illness in a woman. Exposure to semen or sperm is not needed for a woman’s good health.
• Do not cause illness in men by making sperm “back up.”
• Not only for use outside marriage. They are also used by married couples.
• Do not cause cancer and do not contain cancer-causing chemicals.