Condoms

Condoms

Male CondomMale condoms are latex or (less commonly) polyurethane sheaths which are put on the erect penis prior to sexual activity. They provide a barrier to the mixing of the partners’ sexual fluids during sexual activity. Male condoms are more commonly used than their female counterparts (the female condom) and are usually referred to simply as condoms.

A male condom prevents the male partner’s semen from entering their partner’s vagina, anus or rectum, and also protects the male partner from coming into contact with a female partner’s vaginal fluids or male or female partner’s blood (e.g. from abrasions to the rectum which can tear easily during anal intercourse) during anal or vaginal penetration.

As semen and vaginal fluids are the predominate routes by which sexually transmitted infections (STIs) are spread, male condoms play an important role in preventing the spread of STIs, during heterosexual and homosexual intercourse. While condoms are primarily promoted as devices for preventing STIs, they are also an effective method of contraception.


History of the male condom

The use of condoms can be traced back to the ancient Egyptians, who used linen sheaths primarily as protection against disease. In the 1500s when syphilis was becoming an epidemic in Europe, the use of linen soaked in a solution of salt and herbs was documented. In the 1700s, condoms made from animal intestines became available but they were very expensive and often reused. The Chinese used oiled silk paper while the Japanese used leather and tortoise shell sheaths. It was not until 1839 and the development of rubber by Charles Goodyear that the first rubber condom was manufactured.

Since the nineteenth century, condoms have been one of the most popular methods of contraception in the world. Condom use as a contraceptive method declined after the advent of the oral contraceptive pill, sterilisation and other contraceptive methods. However, condom use for the prevention of STIs has increased significantly since the discovering in the early 1980s that HIV is sexually transmitted.


How the male condom works

The male condom works to prevent pregnancy and STIs because the latex or polyurethane with which it is made cannot be penetrated by sexual fluids. As it creates an impervious barrier, condoms provide protection against pregnancy and the spread of STIs which are transmitted via sexual fluids (e.g. HIV, hepatitis B, chlamydia and gonorrhoea).

While male condoms do protect against some skin to skin content, they do not provide complete anatomical coverage of the genital skin during sexual intercourse. This means they are less effective in preventing STIs transmitted through skin contact (e.g. herpes).


Who uses male condoms?

Male CondomMale condoms are used throughout the world as contraceptive and STI prevention devices. They are used by individuals who wish to prevent pregnancy and/or STI, either with steady or casual partners. More than 12 billion male condoms were distributed in 2007.

In Australia, individuals who are young and those who have sex with casual or non-cohabiting partners are more likely to use condoms than their older counterparts and those individuals who live with their sexual partners. Women who do not use other forms of contraception are also more likely to use condoms.

A recent study in Australia reported that about 7% of people used condoms consistently with regular partners and 40% used them with consistently with casual partners. While condom use in casual relationships is much higher than in steady relationships, it remains strikingly low, given Australia’s high prevalence of STIs (more than 50,000 cases of chlamydia were reported in Australia in 2007, and over 4% of Australian men and women report experiencing genital warts in their lifetime).


When should male condoms be used?

In order to protect against STIs, condoms should be used at every act of sexual intercourse (including vaginal, anal or oral sex). In order to protect against pregnancy, condoms should be used at every act of vaginal intercourse.


Effectiveness of male condoms

The effectiveness of male condoms depends on the purpose for which they are being used and the extent to which individuals use condoms correctly. While intact latex and polyurethane are completely impenetrable by sexual fluids, condoms may break or slip off during sexual activity, and are therefore not 100% effective.

Condom users should also be informed that, due to the limited anatomical coverage of condoms (they cover only the penis and not external genitalia), they provide much less effective protection against STIs which spread through skin contact (e.g. herpes).

Despite the incorrect use of condoms reducing their effectiveness as a contraceptive or STI prevention device, studies of condom use within sexual partnerships still report fairly high rates of effectiveness.

As a contraceptive device, condoms are typically regarded as being less effective than permanent contraceptive methods (in particular hormonal methods) when user error is taken into account but still provide a high level of protection compared to no contraceptive use. Condoms provide 98% contraceptive protection, when used consistently and correctly.

As an HIV prevention method for heterosexual couples, male condoms have been estimated to be 80% effective when used consistently and 95% effective when used correctly and consistently. These estimates are based on the study of infections in couples who use condoms consistently and where one partner is HIV positive and the other does not have HIV (sero-discordant couples).

While no studies have monitored the incidence of other STIs amongst sero-discordant couples, studies reporting lower incidence of chlamydia and gonorrhoea amongst consistent condoms users suggest that condoms are also effective in preventing these STIs. Condom use also reduces the risk of contracting herpes simplex virus type 2 in females by around 15%.


How should the male condom be used?

Male CondomAs condoms are more likely to break or slip off during sexual intercourse if they are used incorrectly, it is important that users are knowledgeable about their proper use. Health professionals should counsel their patients on the importance of correct and consistent use of condoms and other factors which can affect condom efficacy.


Expiry date

Condoms have a limited shelf life and an expiry date will be printed on each condom packet. Users should be advised to check the expiry date prior to use. They should also be advised that exposure to heat reduces the shelf life of condoms, and to discard any condoms that have been exposed to heat (e.g. in a pocket or in sunlight).


Packaging

Condoms come individually wrapped in foil packaging. Users should ensure that the packet is in good condition and has not been opened or damaged. They should open the packet carefully, taking care not to tear the condom with nails or teeth.


Appearance

The condom will be rolled up in the packet. There will be a thick rim and a circle of loose fine rubber.


Disposable

Condoms are designed for single use only. Users should never attempt to use a condom for more than one act of sexual intercourse in which the penis remains erect. If the penis loses its erection during sexual activity, the couple should remove the condom and wait until the penis is erect again, before applying a new condom. Men who suffer from erectile dysfunction may find female condoms more appropriate, as their use is not contingent on an erection.


Applying and using a condom

  1. Wait until the penis is fully erect before attempting to apply a condom.
  2. Hold the condom so that the rim can unroll towards you.
  3. The closed end of the condom will have a loose, nipple shaped tip. Hold and squeeze the tip between thumb and forefinger to remove any trapped air. This will create a space for the semen to collect.
  4. While holding the tip and with the condom still rolled up, place the condom on the head of the penis.
  5. Using the free hand, unroll the condom all the way down to the base of the penis. The condom should unroll easily. If it does not, the condom may be on backwards, may be damaged or too old. Discard the condom and use a new one.
  6. Lubricant can be put on the condom prior to sexual intercourse if desired although most brands of condoms are already lubricated. The lubricant may wear off during sexual intercourse. If this occurs, it is important to apply additional water based lubricant (not oil based lubricant as this can damage latex) to reduce the chance of the condom breaking. This point is particularly relevant for patients using condoms for protection during anal sex, as, unlike the vagina, the anus has no natural lubricating mechanism.
  7. The condom should be removed immediately after ejaculation and while the penis remains erect. The user should hold the condom at the base while withdrawing the penis from the vagina or anus, and carefully withdraw the penis, taking care not to spill any semen.
  8. The user should then remove the condom from the penis and tie a knot at the open end to keep the semen inside.
  9. Dispose of the condom by wrapping it in tissue and putting it in the bin. Do not flush it down the toilet.


Reasons for condom failure

The main reasons that a condom will fail to protect against STIs is because it either breaks or slips off during sexual intercourse. Condoms which become damaged prior to sexual intercourse (e.g. by teeth or fingernails while opening or applying the condom) will also provide inadequate protection. Factors which can increase the risk of slippage or breakage include:

  • Not holding the condom firmly at the base while the penis is being withdrawn from the vagina;
  • Not completely unrolling the condom onto the penis;
  • Using a condom which has been exposed to heat or sunlight (such as in a car’s glove box or individual’s pocket) or has passed its expiry date;
  • Using oil based lubricants, as this can weaken latex condoms and cause them to break more easily;
  • Use of some vaginal preparations or drugs at the same time as condoms.

It is also important to highlight to patients that condoms are only effective while they are being worn. If genital contact occurs prior to the application of a condom, there is a risk that STIs will be transmitted through this genital contact, even if the man has not yet ejaculated his semen. Current research indicates that in Australia, one in eight condoms used are not applied until after genital contact has occurred.

For greater protection against pregnancy, condoms can be combined with other forms of contraception such as the pill. They should not be used in conjunction with female condoms.


Vaginal drugs which weaken latex condoms

There are a number of vaginal preparations which may weaken latex condoms and increase the likelihood of a condom breaking. Women should not use latex condoms at the same time as any of the following preparations:

  • Dalacin V cream (clindamycin hydrochloride). (Metronidazole gel is safe.)
  • Nilstat vaginal cream (nystatin). (Canesten cream (clotrimazole) is safe.)
  • Fungilin (amphotericin)
  • Pro-feme (progesterone)
  • Monistat vaginal (miconazole nitrate)
  • Prevaryl vaginal (econazole nitrate)
  • Ecostatin (econazole)
  • Nizoral cream (ketoconazole)
  • Premarin (oestrogen cream). (Ovestin and Vagifem (oestradiol) are safe.)


What to do if a male condom breaks

If the condom breaks during intercourse, the penis should be withdrawn immediately. If the sexual partners still wish to continue having sex, a new condom should be applied prior to any further genital contact.

As a precautionary measure against unwanted pregnancy, women who experience condom breakage should visit their doctor to get a prescription for an emergency contraception pill which can be used up to 120 hours after intercourse, to reduce the risk of pregnancy.

Patients should also be informed to test for a range of STIs if they experience condom breakage. Many STIs are easily treated with antibiotics once detected. However, as many STIs remain asymptomatic for extended periods of time, leaving them untreated can lead to infertility and other complications.


Benefits of condoms


STI prevention

Male CondomThe male condom is one of only two biomedical devices (the other being the female condom) which provides a high level of protection against a range of STIs in sexually active individuals. Condoms enable individuals who choose to be sexually active, and particularly those who choose to be sexually active with multiple partners, to reduce the risk of adverse health effects associated with sexual activity. They offer a degree of sexual freedom to individuals living in a world characterised by numerous health risks stemming from sexual activity.


Widely and cheaply available

Male condoms are available from most pharmacies, supermarkets and even petrol stations, meaning that they can be accessed most of the time. Unlike most contraceptive methods, users do not require a prescription to purchase condoms. Free condoms are also distributed by many student services and family planning clinics for individuals with budget constraints.


Temporary or permanent use

As condoms are applied immediately prior to sexual intercourse, an individual does not need to plan condom use in advance as they do for many other methods of contraceptives (e.g. hormonal contraceptive pills must be taken for extended periods). When used consistently and correctly, condoms provide a high level of protection against unwanted pregnancy.


Limited side effects

The only known side effect of the male condom is allergic reaction to latex, which occurs in a small proportion of users (estimated 1-3%). On the contrary, many hormonal contraceptive methods produce a wide range of side effects.


Limitations and side effects

Condoms provide a theoretically high level of protection against both pregnancy and STIs, and the side effects of condom use are negligible. While a small proportion of condoms users (1-3%) report an allergic reaction to the latex with which condoms are made of, the allergic symptoms are temporary and there are no other known side effects of use.

There remain however, numerous barriers to the use of male condoms which mean that male condoms are often used inconsistently or not at all, even in situations where individuals are aware that their sexual activity may involve health risks (e.g. sexual activity with unknown partners) if a condom is not used. The key barriers which limit the use of condoms are discussed below.


User satisfaction

While user satisfaction with male condoms is higher than with female condoms, satisfaction remains poor, particularly amongst men. One study found that less than half of women reported the male condom felt “good” or “very good” during sexual intercourse and that women reported their partners were even less likely to be satisfied with the feel of male condoms. Common reasons cited for reduced satisfaction with male condoms is the associated reduction in sensitivity and sexual enjoyment and the disruption to natural sexual activity (i.e. the need to interrupt sexual activity to apply a condom).


Breakage and slippage

Even when used correctly, condoms can break or slip during sexual intercourse. In Australia, some 23.8% of male condom users responding to the Sex in Australia survey reported at least one incident of condom breakage during sexual intercourse in the year prior to the survey, while 18.1% reported at least one incident of a condom slipping off during sexual intercourse. Breakage and slippage was associated with less experience using condoms, indicating that a significant proportion of these failures were induced by user error.


Need for correct and consistent use

To effectively prevent STIs and pregnancy, condoms must be used correctly at every act of sexual intercourse and applied prior to any genital contact. While many Australians use condoms at some point in their life, only 40% use them consistently with casual partners and one in eight condoms are not applied until after genital contact has occurred.

Condom use is less likely when the sexual partners have consumed alcohol at intoxicating levels (according to Australian guidelines- for more information see Alcohol Intoxication).


Reliance on male partner

Condoms are user dependent and rely mainly on the male partner agreeing to use and applying the condom correctly (despite the female partner being at higher risk of STI and bearing most of the responsibility for unwanted pregnancy).


Latex or polyurethane condoms?

Condoms are available in variety of sizes, shapes, textures, colours and flavours to suit personal preference. The majority of condoms available are made of latex rubber.

Polyurethane condoms known as Duran (brand name: Avanti) were introduced to the market in the mid-1990s. They provided an alternative for those who were allergic to latex or who did not like the feel and reduced sensitivity that latex condoms produced.

In comparing latex to non-latex condoms, a large proportion of people appear to prefer polyurethane condoms. Polyurethane condoms are thinner, conduct heat better than latex and are less restrictive around the glans of the penis, therefore increasing sensitivity. Users report that the polyurethane condom has a more natural feel, look and smell than latex. Polyurethane is more durable than latex in that it can withstand exposure to heat and is suitable for use with oil or water based lubricants. One study reported no significant differences in the rate of breakage or slippage between latex and polyurethane male condoms.


Key points about male condoms

  • Male condoms provide effective protection against STIs and pregnancy when they are worn correctly and consistently.
  • Male condoms must be applied prior to every act of vaginal, anal or oral sex to provide protection.
  • Male condoms should be applied to a fully erect penis, prior to any genital contact.
  • A new condom should be applied if the condom slips or breaks.

 

More information

Contraception For more information on different types of contraception, male anatomy and related health issues, see Contraception.

 

Sexually transmitted infections (STIs)
For more information on different types of sexually transmitted infections, prevention of STIs, treatments and effects on fertility, see Sexually transmitted infections (STIs).

 

Reference

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