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Condoms

Definition

A condom is a type of birth control (contraceptive) that is worn during intercourse to prevent pregnancy and the spread of some sexually transmitted diseases (STDs), such as:

• Chlamydia
• Gonorrhea
• HIV

See also: Female condoms

Alternative Names

Prophylactics; Rubbers; Male condoms

Information

Other than a vasectomy, the condom is the only available method of birth control for men.

A condom blocks sperm from coming in contact with the inside of the vagina, where it could reach an egg. (If sperm reaches an egg, pregnancy can result.) A condom also prevents disease-causing substances from spreading from one person to another.

The male condom is a thin cover that fits over a man's erect penis. Condoms are made of:

• Animal skin (does not protect against the spread of infections)
• Latex rubber
• Polyurethane

HOW WELL DOES A CONDOM WORK?

If a condom is used regularly and correctly, it should prevent pregnancy 97% of the time, and prevent the spread of most STDs. The actual effectiveness among users, however, is only 80 - 90%. This is due to:

• Break in condom due to manufacturing problems (rare)
• Failure to use a condom during each act of intercourse
• Occasional tear of a condom during intercourse
• Semen spilling from a condom during withdrawal
• Waiting too long to put a condom on the penis (penis comes into contact with vagina before condom is on)

Condoms that contain spermicides may slightly further reduce the risk of pregnancy. However, they are no more likely to reduce the risk of HIV or STDs than condoms lubricated with other substances.

Condoms are available without a prescription and are inexpensive. You can buy them at most drugstores, in vending machines in some restrooms, by mail order, and at certain health care clinics.

DISADVANTAGES

• Allergic reactions to latex condoms are rare, but they do occur. (Changing to condoms made of polyurethane or animal membranes may help.)
• Friction of the condom may reduce stimulation of the clitorus and lubrication, making intercourse less enjoyable or even uncomfortable. (Lubricated condoms may reduce this problem.)
• Intercourse also may be less pleasurable because the man must pull out his penis right after ejaculation.
• Since the condom must be put on when the penis is erect, but before contact is made between the penis and vagina, there is usually a brief interruption during foreplay. Many couples solve the problem by making the process of placing the condom on the penis part of foreplay.
• The woman is not aware of warm fluid entering her body (important to some women, not to others).

HOW TO USE A MALE CONDOM

For the best protection, the condom must be put on before the penis comes into contact with or enters the vagina (because pre-ejaculation fluids carry both sperm and disease).

• Remove the condom from its package, being careful not to tear or poke a hole in it while opening the package.
• If the condom has a little tip (receptacle) on the end of it (to collect semen), place the condom against the top of the penis and carefully roll the sides down the shaft of the penis. If there is no tip, be sure to leave a little space between the condom and the end of the penis. Otherwise, the semen may push up the sides of the condom and come out at the bottom before the penis and condom are pulled out. Be sure there is not any air between the penis and the condom. This can cause the condom to break.
• Some people find it helpful to unroll the condom a little before putting it on the penis. This leaves plenty of room for semen to collect and prevents the condom from being stretched too tightly over the penis.
• After ejaculation, remove the condom from the vagina. The best way is to grasp the condom at the base of the penis and hold it as the penis is pulled out.

IMPORTANT TIPS

• Make sure condoms are available and convenient. If no condoms are handy at the time of a sexual encounter, you may be tempted to have intercourse without one.
• Use each condom only once.
• Do not carry condoms in your wallet for long periods of time. Replace them every once in a while. Friction from opening and closing your wallet, and from walking (if you carry your wallet in your pocket) can lead to tiny holes in the condom. Nevertheless, it is better to use a condom that has been in your wallet for a long time than to not use one at all.
• Don't use a condom that is brittle, sticky, or discolored. These are signs of age, and old condoms are more likely to break.
• If a condom package is damaged, don't use the condom because it also may be damaged.
• Do not use a petroleum-based substance such as Vaseline as a lubricant. These substances break down latex, the material in some condoms.
• If you feel a condom break during intercourse, stop right away and put on a new one. Remember, ejaculation does not have to occur for a pregnancy to result (pre-ejaculatory fluids can contain active sperm), or for a disease to be transmitted.
• If ejaculation occurs with a broken condom, insert a spermicidal foam or jelly to help reduce the risk of pregnancy or passing an STD. You can also contact your health care provider or pharmacy about emergency contraception ("morning-after pills").
• Store condoms in a cool, dry place away from sunlight and heat.

References

Espey E, Ogburn T, Fotieo D. Contraception: What every internist should know. Med Clin North Am. 2008; 92:1037-1058.

Faculty of Family Planning and Reproductive Health Care Clinical Effectiveness Unit. Male and female condoms. London (UK): Faculty of Family Planning and Reproductive Health Care: 2007 Jan 17. Accessed 2/12/2010.