Condom Sense

In recent years, as a result of misinformation and insufficient research, the efficacy of condoms, especially in terms of STD prevention, has been debated in many forums.

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

The U.S. Food and Drug Administration (FDA) regulates manufacturers who sell condoms in the United States. As a quality assurance step, condom manufacturers sample each lot of finished packaged condoms and examine them for holes using a water leak test. The FDA recognizes domestic and international standards that specify that the rate of sampled condoms failing the water leak test, for each manufactured lot of condoms, must be less than one in 400.

Manufacturers also test lots for physical properties using the air burst test and the tensile (strength) property test. In order to test condoms’ ability to prevent the passage of viruses, FDA researchers developed a test using high concentrations of a laboratory created virus that is the same size as STD pathogens.

The FDA tested many different types of male condoms and showed that they are highly effective barriers to virus passage with a very small chance of leakage. Intact condoms (those that pass the water leak test) are essentially impermeable to particles the size of STD pathogens. Moreover, these studies show that fluid flow, not virus size, is the most important determinant of viral passage through a hole.

The male condom is a barrier method of contraception that is placed over the glans and shaft of the penis. Male condoms are available in latex, lambskin, and polyurethane. Condoms manufactured from latex are the most popular, and studies conducted on the ability of condoms to prevent the transmission of STDs and HIV most often involve latex condoms. Condoms manufactured from lambskin, also known as natural skin, or natural membrane, are made from the intestinal lining of lambs. While these condoms can prevent pregnancy, they contain small pores that may permit passage of some STDs, including HIV, the hepatitis B virus, and the herpes simplex virus.

Condoms manufactured from polyurethane are thinner and stronger than latex condoms, provide a less constricting fit, are more resistant to deterioration, and may enhance sensitivity. Polyurethane condoms are also recommended for those who have latex allergies. Polyurethane condoms have not been studied for their effectiveness in the prevention of STD transmission. In addition, condoms made of polyurethane are compatible with oil-based lubricants, unlike latex condoms which must be used with water-based lubricants.

In order to benefit from the protection that condoms provide, individuals must use them consistently and correctly. This means they must use a condom with every act of sexual intercourse, from start to finish, including penile-vaginal intercourse as well as oral and anal intercourse. In addition, individuals must understand how to properly use a condom. Studies of hundreds of couples show that consistent condom use is possible when sexual partners have the skills and motivation to use them.

CORRECT USE OF THE 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.
• Check the expiration date.
• Carefully open the condom package -- teeth or fingernails can tear the condom.
• Use a new condom for each act of sexual intercourse.
• 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.
• Use only water-based lubrication. Do not use oil-based lubricants such as cooking/vegetable oil, baby oil, hand lotion, or petroleum jelly -- these will cause the condom to deteriorate and break.
• 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 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 or the female condom to be pushed in.

Available under the brand name Reality, the female condom is made of polyurethane and provides protection against pregnancy and STDs, including HIV.22 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.

• The first-year effectiveness rate of preventing pregnancy among typical condom users averages about 79 percent for female (Reality) condoms. This includes pregnancies resulting from errors in condom use.
• The female condom Reality is estimated to reduce the risk of HIV infection for each act of intercourse by 97.1 percent when used consistently and correctly.
• Laboratory studies have shown Reality to be an effective barrier to microorganisms including HIV and including a bacteriophage smaller than hepatitis B, the smallest virus known to cause an STD.

• 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.
• Use a new condom for each act of sexual intercourse.
• 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 opening 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.
• Be sure that the penis is not entering the vaginal canal outside of the condom before intercourse.
• 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.
• Do not use 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 or the female condom to be pushed in.