Condom

From Wikipedia, the free encyclopedia

Condom
A rolled-up condom
Background
B.C. type	Barrier
First use	1994 (polyurethane) 1920 (latex) 1855 (rubber) Ancient (other materials)
Pregnancy rates (first year, latex)
Perfect use	2%
Typical use	10–18%
Usage
User reminders	Damaged by oil-based lubricants
Advantages and Disadvantages
STD protection	Yes
Benefits	No external drugs or clinic visits required

A condom is a device most commonly used during sexual intercourse. It is put on a man's erect penis and physically blocks ejaculated semen from entering the body of a sexual partner. Condoms are used to prevent pregnancy and transmission of sexually transmitted diseases (STDs—such as gonorrhea, syphilis, and HIV). Because condoms are waterproof, elastic, and durable, they are also used in a variety of secondary applications. These range from creating waterproof microphones to protecting rifle barrels from clogging.

Most condoms are made from latex, but some are made from other materials. A female condom is also available. As a method of contraception, male condoms have the advantage of being inexpensive, easy to use, having few side-effects, and of offering protection against sexually transmitted diseases.^[1][2] With proper knowledge and application technique—and use at every act of intercourse—users of male condoms experience a 2% per-year pregnancy rate.^[3]

Condoms have been used for at least 400 years.^[4] Since the nineteenth century, they have been one of the most popular methods of contraception in the world.^[5] While widely accepted in modern times, condoms have generated some controversy. Improper disposal of condoms contributes to litter problems, and the Roman Catholic Church generally opposes condom use.

Contents 1 History 1.1 Antiquity through Middle Ages 1.2 Renaissance 1.3 18th century 1.4 Expanded marketing and introduction of rubber 1.5 Increased popularity despite legal impediments 1.6 World War I to present 1.7 Etymology and other terms 1.8 Major manufacturers 2 Varieties 2.1 Latex 2.2 Polyurethane 2.3 Lambskin 2.4 Experimental 2.5 Collection condom 3 Effectiveness 3.1 In preventing pregnancy 3.2 In preventing STDs 3.3 Causes of failure 4 Female condoms 5 Use 5.1 Prevalence 5.2 Role in sex education 5.3 Infertility treatment 5.4 Other uses 6 Debate and criticism 6.1 Disposal and environmental impact 6.2 Position of the Roman Catholic Church 6.3 Health issues 7 See also 8 References 9 Footnotes 10 External links

History

Antiquity through Middle Ages

Whether condoms were used in ancient civilizations is debated by archaeologists and historians.^[6] The oldest claimed representation of condom use is a painting in the French cave Grotte des Combarrelles;^[6] the paintings in this cave are 12,000–15,000 years old.^[7] Societies in the ancient civilizations of Egypt, Greece, and Rome preferred small families and are known to have practices a variety of birth control methods.^[8] However, these societies viewed birth control as a woman's responsibility, and the only well-documented contraception methods were female-controlled devices (both possibly effective, such as pessaries, and ineffective, such as amulets).^[9] The writings of these societies contain "veiled references" to male-controlled contraceptive methods that might have been condoms, but most historians interpret them as referring to coitus interruptus or anal sex.^[10]

The loincloths worn by Egyptian and Greek laborers were very spare, sometimes consisting of little more than a covering for the glans of the penis. Records of these types of loincloths being worn by men in higher classes have made some historians speculate they were worn during intercourse;^[11] others, however, are doubtful of such interpretations.^[12] Historians may also cite one legend of Minos, related by Antoninus Liberalis in 150 AD, as suggestive of condom use in ancient societies. This legend describes a curse that caused Minos' semen to contain serpents and scorpions. To protect his sexual partner from these animals, Minos used a goat's bladder as a female condom.^[13][12]

Contraceptives fell out of use in Europe after the decline of the Roman Empire in the 400s; the use of contraceptive pessaries, for example, is not documented again until the fifteenth century. If condoms were used during the Roman Empire, knowledge of them may have been lost during its decline.^[14] A contributing factor to the loss of contraceptive knowledge was the rise of the Christian religion, which considered all forms of birth control to be sins.^[15] In the writings of Muslims and Jews during the Middle Ages, there are some references to attempts at male-controlled contraception, including suggestions to cover the penis in tar or soak it in onion juice. Some of these writings might describe condom use, but they are "oblique", "veiled", and "vague".^[16]

Renaissance

Prior to the 15th century, some use of glans condoms (devices that covered only the head of the penis) is recorded in Asia. These devices appear to have been used for birth control, and seem to have only been known by members of the upper classes. In China, they may have been made of oiled silk paper, or of lamb intestines. In Japan, they were made of tortoise shell or animal horn.^[17]

The first well-recorded outbreak of what is now known as syphilis occurred in 1494 when it broke out among French troops.^[18] From this centre, the disease swept across Europe. As Jared Diamond describes it, "when syphilis was first definitely recorded in Europe in 1495, its pustules often covered the body from the head to the knees, caused flesh to fall from people's faces, and led to death within a few months." In this outbreak, the disease was more frequently fatal than it is today.^[19] By 1505, the disease had spread to Asia, and within a few decades had "decimated large areas of China".^[20]

In 16th century Italy, Gabriele Falloppio authored the earliest uncontested description of condom use. De Morbo Gallico ("The French Disease", referring to syphilis) was published in 1564, two years after Fallopio's death. In this tract, he recommended use of a device he claimed to have invented: linen sheaths soaked in a chemical solution and allowed to dry before use. The cloths he described were sized to cover the glans of the penis, and were held on with a ribbon.^[4][21] Fallopio claimed to have performed an experimental trial of the linen sheath on 1100 men, and reported that none of them had contracted the dreaded disease.^[12]

After the publication of De Morbo Gallico, use of penis coverings to protect from disease is described in a wide variety of literature throughout Europe. The first indication these devices were used for birth control, rather than disease prevention, is the 1605 theological publication De iustitia et iure (On justice and law) by Catholic theologian Leonardus Lessius: he condemned them as immoral.^[22] The first explicit description that un petit linge (a small cloth) was used to prevent pregnancy is from 1655: a French novel and play titled L'Escole des Filles (The Philosophy of Girls). In 1666, the English Birth Rate Commission attributed a recent downward fertility rate to use of "condons", the first documented use of that word (or any similar spelling).^[23]

In addition to linen, condoms during the Renaissance were made out of intestines and bladder. Cleaned and prepared intestine for use in glove making had been sold commercially since at least the 13th century.^[24] Condoms made from bladder and dating to the 1640s were discovered in an English privy; it is believed they were used by soldiers of King Charles I.^[25] In the late 15th century, Dutch traders introduced condoms made from "fine leather" to Japan. Unlike the horn condoms used previously, these leather condoms covered the entire penis.^[26]

18th century

Written references to condom use became much more common during the eighteenth century. Not all of the attention was positive: in 1708, John Campbell asked Parliament (unsuccessfully) to make the devices illegal.^[27] Noted English physician Daniel Turner condemned the condom, publishing his arguments against their use in 1717. He disliked condoms because they did not offer full protection against syphilis. He also seems to have argued that belief in the protection condoms offered encouraged men to engage sex with unsafe partners - but then, because of the loss of sensation caused by condoms, these same men often neglected to actually use the devices. The French medical professor Jean Astruc wrote his own anti-condom treatise in 1736, citing Turner as the authority in this area. Physicians later in the 18th century also spoke against the condom, but not on medical grounds: rather, they expressed the belief that contraception was immoral.^[28]

The condom market grew rapidly, however. Eighteenth century condoms were available in a variety of qualities and sizes, made from either linen treated with chemicals, or "skin" (bladder or intestine softened by treatment with sulphur and lye).^[29] They were sold at pubs, barbershops, chemist shops, open-air markets, and at the theater throughout Europe and Russia.^[30] The first recorded inspection of condom quality is found in the memoirs of Giacomo Casanova (which cover his life until 1774): to test for holes, he would often blow them up before use.^[12][31]

Couples in colonial America relied on female-controlled methods of contraception, if they used contraceptives at all. The first known documents describing American condom use were written around 1800, two to three decades after the American Revolutionary War.^[32] Also around 1800, linen condoms lost popularity in the market and their production ceased: they were more expensive and were viewed as less comfortable when compared to skin condoms.^[33]

Up to the nineteenth century, condoms were generally used only by the middle and upper classes. One reason for the lack of condom use was that the working classes tended to lack education on the dangers of sexually transmitted infections. Perhaps more importantly, condoms were unaffordable for many: for a typical prostitute, a single condom might cost several months' pay.^[34]

Expanded marketing and introduction of rubber

The early nineteenth century saw contraceptives promoted to the poorer classes for the first time: birth control advocates in England included Jeremy Bentham and Richard Carlile, and noted American advocates included Robert Dale Owen and Charles Knowlton. Writers on contraception tended to prefer other methods of birth control, citing both the expense of condoms and their unreliability (they were often riddled with holes, and often fell off or broke), but they discussed condoms as a good option for some, and as the only contraceptive that also protected from disease.^[35] One group of British contraceptive advocates distributed condom literature in poor neighborhoods, with instructions on how to make the devices at home; in the 1840s, similar tracts were distributed in both cities and rural areas through the United States.^[36]

From the 1820s through the 1870s, popular women and men lecturers traveled around America teaching about physiology and sexual matters. Many of them sold birth control devices, including condoms, after their lectures. They were condemned by many moralists and medical professionals, including America's first woman doctor Elizabeth Blackwell. Blackwell accused the lecturers of spreading doctrines of "abortion and prostitution".^[37] In the 1840s, advertisements for condoms began to appear in British newspapers, and in 1861 a condom advertisement appeared in the New York Times.^[38]

The rubber vulcanization process was invented by Charles Goodyear in 1839, and patented in 1844.^[39] The first rubber condom was produced in 1855,^[40] and by the late 1850s several major rubber companies were mass producing, among other items, rubber condoms. A main advantage of rubber condoms was their reusability, making them a more economical choice in the long term. Compared to the nineteenth century rubber condoms, however, skin condoms were initially cheaper and offered better sensitivity. For these reasons, skin condoms remained more popular than the rubber variety. However, by the end of the nineteenth century "rubber" had become a euphemism for condoms in countries around the world.^[41] For many decades, rubber condoms were manufactured by wrapping strips of raw rubber around penis-shaped molds, then dipping the wrapped molds in a chemical solution to cure the rubber.^[42] The earliest rubber condoms covered only the glans of the penis; a doctor had to measure each man and order the correct size. Even with the medical fittings, however, glans condoms tended to fall off during use. Rubber manufacturers quickly discovered they could sell more devices by manufacturing full-length one-size-fits-all condoms to be sold in pharmacies.^[43]

Increased popularity despite legal impediments

Distribution of condoms in the United States was limited by passage of the Comstock laws, which included a federal act banning the mailing of contraceptive information (passed in 1873) as well as State laws that banned the manufacture and sale of condoms in thirty states.^[44] In Northern Ireland the 1889 Indecent Advertisements Act made it illegal to advertise condoms, although their manufacture and sale remained legal.^[45] Contraceptives were illegal in nineteenth century Italy and Germany, but condoms were allowed for disease prevention.^[46] Despite legal obstacles, condoms continued to be readily available in both Europe and America, widely advertised under euphemisms such as male shield and rubber good.^[47] In late nineteenth century England, condoms were known as "a little something for the weekend".^[48] Only in the Republic of Ireland were condoms effectively outlawed. There, their sale and manufacture remained illegal until the 1970s.^[49]

Opposition to condoms did not only come from moralists: by the late 1800s the feminist movement in both Europe and America was decidedly anti-condom. Feminists wanted birth control to be exclusively in the hands of women, and disapproved of male-controlled methods such as the condom.^[50] Despite social and legal opposition, at the end of the nineteenth century the condom was the Western world's most popular birth control method. Two surveys conducted in New York in 1890 and 1900 found that 45% of the women surveyed were using condoms to prevent pregnancy.^[5] A survey in Boston just prior to World War I concluded that three million condoms were sold in that city every year.^[51]

1870s England saw the founding of the first major condom manufacturing company, E. Lambert and Son of Dalston.^[52] In 1882, German immigrant Julius Schmidt founded one of the largest and longest-lasting condom businesses, Julius Schmid, Inc. (he dropped the 't' from his name in an effort to appear less Jewish). This New York business initially manufactured only skin condoms (in 1890 he was arrested by Anthony Comstock for having almost seven hundred of the devices in his house).^[53] In 1912, a German named Julius Fromm developed a new, improved manufacturing technique for condoms: dipping glass molds into a raw rubber solution.^[40] Called cement dipping, this method required adding gasoline or benzene to the rubber to make it liquid.^[54] In America, Schmid was the first company to use the new technique. Using the new dipping method, French condom manufacturers were the first to add textures to condoms.^[55] Fromm was the first company to sell a branded line of condoms, Fromm's Act, which remains popular Germany today.^[40] The condom lines manufactured by Schmid, Shieks and Ramses, were sold through the late 1990s.^[53] Youngs Rubber Company, founded by Merle Youngs in late nineteenth century America, introduced Trojans.^[56]

Beginning in the second half of the nineteenth century, American rates of sexually transmitted diseases skyrocketed. Causes cited by historians include effects of the American Civil War, and the ignorance of prevention methods promoted by the Comstock laws.^[57] To fight the growing epidemic, sexual education classes were introduced to public schools for the first time, teaching about venereal diseases and how they were transmitted. They generally taught that abstinence was the only way to avoid sexually transmitted diseases.^[58] Condoms were not promoted for disease prevention; the medical community and moral watchdogs considered STDs to be punishment for sexual misbehavior. The stigma on victims of these diseases was so great that many hospitals refused to treat people who had syphilis.^[59]

World War I to present

The German military was the first to promote condom use among its soldiers, beginning in the second half of the nineteenth century.^[60] Early twentieth century experiments by the American military concluded that providing condoms to soldiers significantly lowered rates of sexually transmitted diseases.^[61] During World War I, the United States and (at the beginning of the war only) Britain were the only countries with soldiers in Europe who did not provide condoms and promote their use.^[62] By the end of the war, the American military had diagnosed almost 400,000 cases of syphilis and gonorrhea, a historic high.^[56]

From just before 1900 through the beginning of World War I, almost all condoms used in Europe were imported from Germany. Germany not only exported condoms to other European countries, but was a major supplier to Australia, New Zealand, and Canada. During the war, the American companies Schmid and Youngs became the main suppliers of condoms to the European Allies.^[63] In 1918, just before the end of the war, an American court overturned a conviction against Margaret Sanger. In this case, the judge ruled that condoms could be legally advertised and sold for the prevention of disease.^[64] Condoms began to be publicly, legally sold to Americans for the first time in forty-five years.^[51]

Latex, rubber suspended in water, was invented in 1920. Youngs Rubber Company was the first to manufacture a latex condom, an improved version of their Trojan brand. Latex condoms required less labor to produce than cement-dipped rubber condoms, which had to be smoothed by rubbing and trimming. Because it used water to suspend the rubber instead of gasolene and benzene, it eliminated the fire hazard previously associated with all condom manufacturers. Latex condoms also performed better for the consumer: they were stronger and thinner than rubber condoms, and had a shelf life of five years (compared to three months for rubber). Europe's first latex condom was an export from Youngs Rubber Company in 1929. In 1932 the London Rubber Company, which had previously served as a wholesaler for German-manufactured condoms, became Europe's first manufacturer of latex condoms, the Durex.^[65]

During World War II condoms were heavily promoted to American soldiers, with one film exhorting "Don't forget — put it on before you put it in."^[7] In part because condoms were readily available, soldiers found a number of non-sexual uses for the devices, many of which continue to be utilized to this day.

By the 1930s, the manufacturing process had improved to produce single-use condoms almost as thin and inexpensive as those currently available.^[21]

Etymology and other terms

Etymological theories for the word "condom" abound. By the early 1700s, the invention and naming of the condom was attributed to an associate of England's King Charles II, and this explanation persisted for several centuries. However, the "Dr. Condom" or "Earl of Condom" described in these stories never existed, and condoms had been used for over one hundred years before King Charles II ascended to the throne.^[66]

A variety of Latin etymologies have been proposed, including condon (receptacle),^[7] condamina (house),^[67] and cumdum (scabbard or case).^[68] It has also been speculated to be from the Italian word guantone, derived from guanto, meaning glove.^[69] William E. Kruck wrote an article in 1981 concluding that, "As for the word 'condom', I need state only that its origin remains completely unknown, and there ends this search for an etymology."^[70] Modern dictionaries may also list the etymology as "unknown".^[71]

Other terms are also commonly used to describe condoms. In North America condoms are also commonly known as prophylactics, or rubbers. In Britain they may be called French letters.^[72] Additionally, condoms may be referred to using the manufacturer's name.

Major manufacturers

One analyst described the size of the condom market as something that "boggles the mind". Numerous small manufacturers, nonprofit groups, and government-run manufacturing plants exist around the world.^[73] Within the condom market, there are several major contributors, among them both for-profit businesses and philanthropic organizations.

In 1882, German immigrant Julius Schmidt founded one of the largest and longest-lasting condom businesses, Julius Schmid, Inc., based in New York City (he dropped the 't' from his name in an effort to appear less Jewish). The condom lines manufactured by Schmid included Shieks and Ramses.^[53] In 1932, the London Rubber Company (which had previously been an wholesale business importing German condoms) began to produce latex condoms, under the Durex brand.^[74] In 1962 Schmid was purchased by London Rubber. In 1987, London Rubber began acquiring other condom manufacturers, and within a few years became an important international company. In the late 1990s, London Rubber (by then London International Limited) merged all the Schmid brands into its European brand, Durex.^[75] Soon after, London International was purchased by Seton Scholl Healthcare (manufacturer of Dr. Scholl's footcare products), forming Seton Scholl Limited.^[76]

Youngs Rubber Company, founded by Merle Youngs in late nineteenth century America, introduced the Trojan line of condoms.^[56] In 1985, Youngs Rubber Company was sold to Carter-Wallace. The Trojan name switched hands yet again in 2000 when Carter-Wallace was sold to Church and Dwight.^[77]

The Australian division of Dunlop Rubber began manufacturing condoms in the 1890s. In 1905, Dunlop sold its condom-making equipment to one of its employees, Eric Ansell, who founded Ansell Rubber. In 1969, Ansell was sold back to Dunlop.^[76] In 1987, English business magnate Richard Branson contracted with Ansell to help in a campaign against HIV and AIDS. Ansell agreed to manufacture the Mates brand of condom, to be sold at little or no profit in order to encourage condom use. Branson soon sold the Mates brand to Ansell, with royalty payments made annually to Virgin's Healthcare Foundation charity.^[78] In addition to its Mates brand, Ansell currently manufactures Lifestyles for the U.S. market.^[79]

In 1934 the Kokusia Rubber Company was founded in Japan. It is now known as the Okamoto Rubber Manufacturing Company.^[80]

In 1970 Tim Black and Philip Harvey founded Population Planning Associates (now known as Adam & Eve). Population Planning Associates was a mail-order business that marketed condoms to American college students, despite U.S. laws against sending contraceptives through the mail. Black and Harvey used the profits from their company to start a non-profit organization Population Services International. By 1975, PSI was marketing condoms in Kenya and Bangladesh,^[81] and today operates programs in over sixty countries.^[82] Harvey left his position as PSI's director in the late 1970s,^[83] but in the late 1980s again founded a nonprofit company, DKT International.^[81] Named after D.K. Tyagi (a leader of family planning programs in India),^[84] DKT International annually sells millions of condoms at discounted rates in developing countries around the world. By selling the condoms instead of giving them away, DKT intends to make its customers invested in using the devices. One of DKT's more notable programs is its work in Ethiopia, where soldiers are required to carry a condom every time they leave base. The rate of HIV infection in the Ethiopian military, about 5%, is believed to be the lowest among African militaries.^[81]

Varieties

Most condoms have a reservoir tip or teat end, making it easier to accommodate the man's ejaculate. Condoms come in different sizes, from oversized to snug and they also come in a variety of surfaces intended to stimulate the user's partner. Condoms are usually supplied with a lubricant coating to facilitate penetration, while flavoured condoms are principally used for oral sex. As mentioned above, most condoms are made of latex, but polyurethane and lambskin condoms are also widely available.

Latex

Latex has outstanding elastic properties: Its tensile strength exceeds 30 MPa, and latex condoms may be stretched in excess of 800% before breaking.^[85] In 1990 the ISO set standards for condom production (ISO 4074, Natural latex rubber condoms), and the EU followed suit with its CEN standard (Directive 93/42/EEC concerning medical devices). Every latex condom is tested for holes with an electrical current. If the condom passes, it is rolled and packaged. In addition, a portion of each batch of condoms is subject to water leak and air burst testing.^[86]

Latex condoms used with oil-based lubricants (e.g. vaseline) are likely to slip off due to loss of elasticity caused by the oils.^[87]

Some latex condoms are lubricated at the manufacturer with a small amount of a nonoxynol-9, a spermicidal chemical. According to Consumer Reports, spermicidally lubricated condoms have no additional benefit in preventing pregnancy, have a shorter shelf life, and may cause urinary-tract infections in women.^[88] In contrast, application of separately packaged spermicide is believed to increase the contraceptive efficacy of condoms.^[89]

Nonoxynol-9 was once believed to offer additional protection against STDs (including HIV) but recent studies have shown that, with frequent use, nonoxynol-9 may increase the risk of HIV transmission.^[90] The World Health Organization says that spermicidally lubricated condoms should no longer be promoted. However, they recommend using a nonoxynol-9 lubricated condom over no condom at all.^[91] As of 2005, nine condom manufacturers have stopped manufacturing condoms with nonoxynol-9, Planned Parenthood has discontinued the distribution of condoms so lubricated,^[92] and the Food and Drug Administration has proposed a warning regarding this issue.^[93]

Polyurethane

See also: AT-10 Resin

Polyurethane condoms tend to be the same width and thickness as latex condoms, with most polyurethane condoms between 0.04 mm and 0.07 mm thick.^[94] Polyurethane is also the material of many female condoms.

Polyurethane can be considered better than latex in several ways: it conducts heat better than latex, is not as sensitive to temperature and ultraviolet light (and so has less rigid storage requirements and a longer shelf life), can be used with oil-based lubricants, is less allergenic than latex, and does not have an odor.^[95] Polyurethane condoms have gained FDA approval for sale in the United States as an effective method of contraception and HIV prevention, and under laboratory conditions have been shown to be just as effective as latex for these purposes.^[96]

However, polyurethane condoms are less elastic than latex ones, and may be more likely to slip or break than latex,^[95][97] and are more expensive.

Lambskin

Condoms made from one of the oldest condom materials, labeled "lambskin" (made from lamb intestines) are still available. They have a greater ability to transmit body warmth and tactile sensation, when compared to synthetic condoms, and are less allergenic than latex. However, there is an increased risk of transmitting STDs compared to latex because of pores in the material, which are thought to be large enough to allow infectious agents to pass through, albeit blocking the passage of sperm.^[98]

Experimental

The Invisible Condom, developed at Université Laval in Québec, Canada, is a gel that hardens upon increased temperature after insertion into the vagina or rectum. In the lab, it has been shown to effectively block HIV and herpes simplex virus. The barrier breaks down and liquefies after several hours. As of 2005, the invisible condom is in the clinical trial phase, and has not yet been approved for use.^[99]

Also developed in 2005 is a condom treated with an erectogenic compound. The drug-treated condom is intended to help the wearer maintain his erection, which should also help reduce slippage. If approved, the condom would be marketed under the Durex brand. As of 2007, it was still in clinical trials.^[100]

As reported on Swiss television news Schweizer Fernsehen on November 29, 2006, the German scientist Jan Vinzenz Krause of the Institut für Kondom-Beratung ("Institute for Condom Consultation") in Germany recently developed a spray-on condom and is test-marketing it. Krause says that one of the advantages to his spray-on condom, which is reported to dry in about 5 seconds, is that it is perfectly formed to each penis.^[101][102]

Collection condom

A collection condom is used to collect semen for fertility treatments or sperm analysis. These condoms are designed to maximize sperm life.

Effectiveness

In preventing pregnancy

The effectiveness of condoms, as of most forms of contraception, can be assessed two ways. Perfect use or method effectiveness rates only include people who use condoms properly and consistently. Actual use, or typical use effectiveness rates are of all condom users, including those who use condoms improperly, inconsistently, or both. Rates are generally presented for the first year of use.^[3] Most commonly the Pearl Index is used to calculate effectiveness rates, but some studies use decrement tables.^[103]

The typical use pregnancy rate among condom users varies depending on the population being studied, ranging from 10–18% per year.^[104] The perfect use pregnancy rate of condoms is 2% per year.^[3] Condoms may be combined with other forms of contraception (such as spermicide) for greater protection.^[89]

Several factors account for typical use effectiveness being lower than perfect use effectiveness:

• mistakes on the part of those providing instructions on how to use the method
• mistakes on the part of the user
• conscious user non-compliance with instructions.

For instance, someone might be given incorrect information on what lubricants are safe to use with condoms, mistakenly put the condom on improperly, or simply not bother to use a condom.

In preventing STDs

See also: HIV#Transmission

Condoms are widely recommended for the prevention of sexually transmitted diseases (STDs). They have been shown to be effective in reducing infection rates in both men and women. While not perfect, the condom is effective at reducing the transmission of HIV, genital herpes, genital warts, syphilis, chlamydia, gonorrhea, and other diseases.^[105]

According to a 2000 report by the National Institutes of Health, correct and consistent use of latex condoms reduces the risk of HIV/AIDS transmission by approximately 85% relative to risk when unprotected, putting the seroconversion rate (infection rate) at 0.9 per 100 person-years with condom, down from 6.7 per 100 person-years. The same review also found condom use significantly reduces the risk of gonorrhea for men.^[106]

A 2006 study reports that proper condom use decreases the risk of transmission for human papilloma virus by approximately 70%.^[107] Another study in the same year found consistent condom use was effective at reducing transmission of herpes simplex virus-2 also known as genital herpes, in both men and women.^[108]

Although a condom is effective in limiting exposure, some disease transmission may occur even with a condom. Infectious areas of the genitals, especially when symptoms are present, may not be covered by a condom, and as a result, some diseases can be transmitted by direct contact.^[109] The primary effectiveness issue with using condoms to prevent STDs, however, is inconsistent use.^[86]

Causes of failure

Condom users may experience slipping off the penis after ejaculation,^[110] breakage due to faulty methods of application or physical damage (such as tears caused when opening the package), or breakage or slippage due to latex degradation (typically from being past the expiration date or being stored improperly). The rate of breakage is between 0.4% and 2.3%, while the rate of slippage is between 0.6% and 1.3%.^[106] Even if no breakage or slippage is observed, 1–2% of women will test positive for semen residue after intercourse with a condom.^[111][112]

Different modes of condom failure result in different levels of semen exposure. If a failure occurs during application, the damaged condom may be disposed of and a new condom applied before intercourse begins - such failures generally pose no risk to the user.^[113] One study found that semen exposure from a broken condom was about half that of unprotected intercourse; semen exposure from a slipped condom was about one-fifth that of unprotected intercourse.^[114]

Standard condoms will fit almost any penis, although many condom manufacturers offer "snug" or "magnum" sizes. Some studies have associated larger penises and smaller condoms with increased breakage and decreased slippage rates (and vice versa), but other studies have been inconclusive.^[87]

Experienced condom users are significantly less likely to have a condom slip or break compared to first-time users, although users who experience one slippage or breakage are at increased risk of a second such failure.^[115] An article in Population Reports suggests that education on condom use reduces behaviors that increase the risk of breakage and slippage.^[116] A Family Health International publication also offers the view that education can reduce the risk of breakage and slippage, but emphasizes that more research needs to be done to determine all of the causes of breakage and slippage.^[87]

Among couples that intend condoms to be their form of birth control, pregnancy may occur when the couple does not use a condom. The couple may have run out of condoms, or be traveling and not have a condom with them, or simply dislike the feel of condoms and decide to "take a chance." This type of behavior is the primary cause of typical use failure (as opposed to method or perfect use failure).^[117]

Another possible cause of condom failure is sabotage. One motive is to have a child against a partner's wishes or consent.^[118] Some commercial sex workers report clients sabotaging condoms in retaliation for being coerced into condom use.^[119] Placing pinholes in the tip of the condom is believed to significantly impact their effectiveness.^[112][120]

Female condoms

Main article: Female condom

"Female condoms" or "femidoms" are also available. They are larger and wider than male condoms but equivalent in length. They have a flexible ring-shaped opening, and are designed to be inserted into the vagina. They also contain an inner ring which aids insertion and helps keep the condom from sliding out of the vagina during coitus. One line of female condoms is made from polyurethane or nitrile polymer. A competing manufacturer makes a line of female condoms out of latex. The latex female condom has been available for several years in Africa, Asia, and South America, although one more clinical trial is required before it can be submitted for FDA approval in the United States.^[121]

Use

Male condoms are usually packaged inside a foil wrapper, in a rolled-up form, and are designed to be applied to the tip of the penis and then unrolled over the erect penis. After use, it is recommended the condom be wrapped in tissue or tied in a knot, then disposed of in a trash receptacle.^[122]

Some couples find that putting on a condom interrupts sex, although others incorporate condom application as part of their foreplay. Some men and women find the physical barrier of a condom dulls sensation. Advantages of dulled sensation can include prolonged erection and delayed ejaculation; disadvantages might include a loss of some sexual excitement.^[2]

Prevalence

The prevalence of condom use varies greatly between countries. Japan has the highest rate of condom usage in the world, with condoms accounting for almost 80% of contraceptive use. In the average developed country, 22% of contraceptive users rely on condoms as their primary method of birth control. In the average less-developed country, only 5-6% of contraceptive users choose condoms.^[123] In a few countries, such as Somalia, condoms are illegal.^[124]

Role in sex education

Condoms are often used in sexual education programs, because they have the capability to reduce the chances of pregnancy and the spread of some sexually transmitted diseases when used correctly. A recent American Psychological Association (APA) press release supported the inclusion of information about condoms in sex education, saying "comprehensive sexuality education programs... discuss the appropriate use of condoms", and "promote condom use for those who are sexually active."^[125]

In the United States, teaching about condoms in public schools is opposed by some religious organizations.^[126] Planned Parenthood, which advocates family planning and sexual education, argues that no studies have shown abstinence-only programs to result in delayed intercourse, and cites surveys showing that 75% of American parents want their children to receive comprehensive sexuality education including condom use.^[127]

Infertility treatment

Common procedures in infertility treatment such as semen analysis and intrauterine insemination (IUI) require collection of semen samples. These are most commonly obtained through masturbation, but an alternative to masturbation is use of a special collection condom to collect semen during sexual intercourse.

Collection condoms are made from silicone or polyurethane, as latex is somewhat harmful to sperm. Many men prefer collection condoms to masturbation, and some religions prohibit masturbation entirely. Also, compared with samples obtained from masturbation, semen samples from collection condoms have higher total sperm counts, sperm motility, and percentage of sperm with normal morphology. For this reason, they are believed to give more accurate results when used for semen analysis, and to improve the chances of pregnancy when used in procedures such as intracervial or intrauterine insemination.^[128] Adherents of religions that prohibit contraception, such as Catholicism, may use collection condoms with holes pricked in them.^[120]

Condom therapy is sometimes prescribed to infertile couples when the female has high levels of antisperm antibodies. The theory is that preventing exposure to her partner's semen will lower her level of antisperm antibodies, and thus increase her chances of pregnancy when condom therapy is discontinued. However, condom therapy has not been shown to increase subsequent pregnancy rates.^[129]

Other uses

Condoms excel as multipurpose containers because they are waterproof, elastic, durable, and will not arouse suspicion if found. Ongoing military utilization begun during World War II includes:

• Tying a non-lubricated condom around the muzzle of the rifle barrel in order to prevent barrel fouling by keeping out detritus.^[130]
• The OSS used condoms for a plethora of applications, from storing corrosive fuel additives and wire garrotes (with the T-handles removed) to holding the acid component of a self-destructing film canister, to finding use in improvised explosives.^[131]
• Navy SEALs have used doubled condoms, sealed with neoprene cement, to protect non-electric firing assemblies for underwater demolitions—leading to the term "Dual Waterproof Firing Assemblies."^[132]

Other uses of condoms include:

• Condoms can be used to hold water in emergency survival situations.^[133]
• Condoms have also been used in many cases to smuggle cocaine and other drugs across borders and into prisons by filling the condom with drugs, tying it in a knot and then either swallowing it or inserting it into the rectum. These methods are very dangerous; if the condom breaks, the drugs inside can cause an overdose.^[134]
• In Soviet gulags, condoms were used to smuggle alcohol into the camps by prisoners who worked outside during daylight. While outside, the prisoner would ingest an empty condom attached to a thin piece of rubber tubing, the end of which was wedged between his teeth. The smuggler would then use a syringe to fill the tubing and condom with up to three litres of raw alcohol, which the prisoner would then smuggle back into the camp. When back in the barracks, the other prisoners would suspend him upside down until all the spirit had been drained out. Aleksandr Solzhenitsyn records that the three litres of raw fluid would be diluted to make seven litres of crude vodka, and that although such prisoners risked an extremely painful and unpleasant death if the condom burst inside them, the rewards granted them by other prisoners encouraged them to run the risk.^[135]
• In his book entitled Last Chance to See, Douglas Adams reported having used a condom to protect a microphone he used to make an underwater recording. According to one of his travelling companions, this is standard BBC practice when a waterproof microphone is needed but cannot be procured.
• Condoms are used by engineers to keep soil samples dry during soil tests.^[136]
• Condoms are used in the field by engineers to initially protect sensoring equipment embedded in the steel or aluminium nose-cones of CPT (Cone Penetration Test) probes when entering the surface to conduct soil resistance tests to determine the bearing strength of soil.^[137]
• Condoms are used as a one way valve by paramedics when performing a chest decompression in the field. The decompression needle is inserted through the condom, and inserted into the chest. The condom folds over the hub allowing air to exit the chest, but preventing it from entering.^[138]

Debate and criticism

Disposal and environmental impact

Experts recommend condoms be disposed of in a trash receptacle. Flushing down the toilet may clog plumbing or cause other problems.^[122]

While biodegradable,^[122] latex condoms damage the environment when disposed of improperly. According to the Ocean Conservancy, condoms, along with certain other types of trash, cover the coral reefs and smother sea grass and other bottom dwellers. The United States Environmental Protection Agency also has expressed concerns that many animals might mistake the litter for food.^[139]

Condoms made of polyurethane, a plastic material, do not break down at all. The plastic and foil wrappers condoms are packaged in are also not biodegradable. However, the benefits condoms offer are widely considered to offset their small landfill mass.^[122] Frequent condom or wrapper disposal in public areas such as a parks have been seen as a persistent litter problem.^[140]

Position of the Roman Catholic Church

See also: Catholic teachings on sexual morality#Prophylactic condom use

The Roman Catholic Church directly condemns any artificial birth control or sexual acts aside from intercourse, between married heterosexual partners. However, the use of condoms to combat STDs is not specifically addressed by Catholic doctrine, and is currently a topic of debate among theologians and high-ranking Catholic authorities. A few, such as Belgian Cardinal Godfried Danneels, believe the Catholic Church should actively support condoms used to prevent disease, especially serious diseases such as AIDS. However, to date statements from the Vatican have argued that condom-promotion programs encourage promiscuity, thereby actually increasing STD transmission.^[141] Papal study of the issue is ongoing, and in 2006 a study on the use of condoms to combat AIDS was prepared for review by Pope Benedict XVI.^[142]

The Roman Catholic Church is the largest organized body of any world religion.^[143] This church has hundreds of programs dedicated to fighting the AIDS epidemic in Africa,^[144] but its opposition to condom use in these programs has been highly controversial.^[145]

Health issues

Dry dusting powders are applied to latex condoms before packaging to prevent the condom from sticking to itself when rolled up. Previously, talc was used by most manufacturers, however cornstarch is currently the most popular dusting powder.^[146] Talc is known to be toxic if it enters the abdominal cavity (i.e. via the vagina). Cornstarch is generally believed to be safe, however some researchers have raised concerns over its use.^[146][147]

Nitrosamines, which are potentially carcinogenic in humans,^[148] are believed to be present in a substance used to improve elasticity in latex condoms.^[149] A 2001 review stated that humans regularly receive 1,000 to 10,000 times greater nitrosamine exposure from food and tobacco than from condom use and concluded that the risk of cancer from condom use is very low.^[150] However, a 2004 study in Germany detected nitrosamines in 29 out of 32 condom brands tested, and concluded that exposure from condoms might exceed the exposure from food by 1.5- to 3-fold.^[149][151]

See also

• Condom fatigue
• Female condom
• Male contraceptive
• Safe sex
• Anti-rape condom
• State of Louisiana v. Frisard

References

• Collier, Aine (2007). The Humble Little Condom: A History. Amherst, NY: Prometheus Books. ISBN 978-1-59102-556-6. 
• Kippley, John; Sheila Kippley (1996). The Art of Natural Family Planning, 4th addition, Cincinnati, OH: The Couple to Couple League. ISBN 0-926412-13-2. 

Footnotes

External links

• Male Latex Condoms and Sexually Transmitted Diseases — from the US Center for Disease Control.

v • d • e Birth control Comparison: Comparison of birth control methods Behavioral: Avoiding vaginal intercourse: Anal sex, Oral sex, Non-penetrative sex, Masturbation, Abstinence Including vaginal intercourse: Fertility awareness, Rhythm Method, Withdrawal, Breastfeeding infertility Barrier: Condom, Female condom, Diaphragm, Cervical cap, Lea's Shield Spermicide: Contraceptive sponge Hormonal: Combined: Combined oral contraceptive pill ('the Pill'), Contraceptive patch, NuvaRing, Combined injectable contraceptive Progestogen only: Progestogen only pill ('minipill'), Depo-Provera, Norplant/Jadelle, Implanon Anti-estrogen: Ormeloxifene (a.k.a. Centchroman) Intra-uterine: IUD (copper or progestogen), IUS (progestogen) Post-intercourse: Contraception: Emergency contraception (pills or copper IUD) Abortion: Surgical abortion, Medical abortion (RU-486/abortion pill) Sterilization: Male: Vasectomy Female: Tubal ligation, Essure

v • d • e Sex Sexual acts Sexual intercourse (foreplay, positions) · Oral sex · Anal sex · Anal-oral sex · Group sex · Sexual sublimation · Barebacking · Dirty talk · Facial · Fingering · Fisting · Masturbation · Handjob · Non-penetrative sex · Sumata · Quickie Adult entertainment Artificial vagina · Dildo · Erotica · Gel · Paddle · Pornography · Vibrator · Sex doll · Sex toys · Sex shop · Adult video game Health & education Birth control · Erectile dysfunction · Gynaecology · Hypersexuality · Sexual dysfunction · Sex education · Sexually transmitted disease History History of human sexuality · History of erotic depictions · Sexual revolution Identity Sexual identity ·Sexual orientation Law Age of consent · Obscenity · Public indecency · Rape · Sexual assault · Sexual abuse · Sexual harassment Physiological events Ejaculation · Erection · Insemination · Orgasm · Pregnancy · Sexual arousal Relationships and society BDSM · Incest · Marriage · Paraphilia · Prostitution · Religion and sexuality · Romance · Sexual abstinence · Sexual attraction · Sexual ethics · Sexual objectification · Sex surrogate · Sex tourism · Abortion See also Human sexual behavior · Human sexuality · Sexology · Sexual slang · Animal sexual behavior