Please note: This archive was last updated in 2005.

RHO archives : Topics : Contraceptive Methods

Male Condoms

Overview

A male condom is a sheath designed to fit over a man's erect penis and prevent passage of sperm into the female reproductive tract. Most condoms are made of thin latex rubber; some are made of animal tissue or of polyurethane. Condoms come dry or lubricated with a water-based lubricant or spermicide. (See the condoms and nonoxynol-9 discussion below.) Condoms can be very effective in preventing pregnancy when used correctly and consistently with every act of intercourse (perfect use); however, they are less effective with typical use. A meta-analysis of the male condom in preventing HIV suggests that their effectiveness at preventing HIV is 87 percent (with a range from 60 to 95 percent depending on the incidence among nonusers) (Davis 1999). Condoms do not affect breastfeeding or have hormonal side effects; no medical condition restricts a client's eligibility for use of the method except allergy to latex. In addition to preventing pregnancy, latex condoms are effective in protection against sexually transmitted infections (STIs). Male condoms may be less effective in protecting against those STIs that are transmitted by skin-to-skin contact, since the infected areas may not be covered by the condom (WHO 2001; NIAID/NIH/DHHS 2001).

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Characteristics of condoms

Effectiveness

3% to 12% failure rate during first year of typical use; 3% failure rate during first year of perfect use.

Age limitations

No restrictions.

Parity limitations

No restrictions on use.

Mode of action

By preventing sperm from reaching the female reproductive tract.

Effect on STI risk

Protective against most STIs, including HIV.

Drug interaction

None.

Duration of use

Most clients can use condoms safely throughout their reproductive years (if they are satisfied with the method and have no problems with it).

Return to fertility

Immediately upon discontinuation.

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User issues

Condoms in various forms have been used for centuries. Since the 1930s latex condoms have been used, though generally not extensively, in many parts of the world to prevent both pregnancy and STIs. The promotion of condoms for HIV prevention led to an increase in research and technical knowledge during the past decade and the first substantial modifications in manufacturing of condoms since the 1930s.

If used consistently and correctly, condoms can be very effective. Reviews of literature confirm that condoms can prevent both pregnancy and STIs, including HIV (Lisken 1990; FHI 1998; PATH/Outlook 1994; Gardner 1999). Laboratory studies show that sperm and disease organisms cannot pass through an intact latex condom. Consistent condom use is very effective at preventing HIV infection, even among serodiscordant couples, where one partner is infected and the other is not. Studies have confirmed that, with consistent condom use, the HIV infection rate among the uninfected partners was less than 1 percent per year (de Vincenzi 1994). Where one partner is definitely infected, however, inconsistent condom use can be as risky as not using condoms at all.

In actual use, however, couples relying on condoms generally are not as successful at preventing unwanted pregnancy as users of many other methods. Evidence suggests that the individual—not the condom—is usually responsible for most condom failures and to inconsistent use, incorrect use, and breakage due to improper use. Breakage rates for high-quality condoms are quite low (less than 1 to 12 per 100 condoms) during either vaginal or anal intercourse. Substandard products, either manufactured badly or stored badly, may have holes or defects that lead to tearing the condom or leakage. Failure also may be caused by the condom user's behavior. A recent study found that breakage related to: (1) having a male sexual partner, (2) infrequent condom use, (3) having the condom partially slip, and (4) the technique use to don the condom (Richters 1995). Slippage was related to: (1) young age, (2) having less lifetime condom experience, (3) being circumcised, and (4) the donning technique. These researchers suggest that condom counseling protocols should acknowledge the complexity of condom use.

To improve user acceptability, researchers have developed improved condoms made of nonlatex materials, such as polyurethane, that are thinner, and offer improved sensitivity and comfort (FHI 1998). As of 1997, the U.S. Food and Drug Administration had approved five male synthetic condoms. Studies evaluating whether synthetic condoms have higher breakage and slippage rates than latex condoms have been ongoing. In a randomized controlled trial among 901 couples, the polyurethane condom was found not as effective as the latex condom for pregnancy prevention, but the reported risk fell within the established range of other barrier methods (Steiner 2003). The six-month typical-use pregnancy rates were 9.0 percent for the polyurethane and 5.4 percent for the latex. The total clinical failures (slippage and breakage) were 8.4 percent for the polyurethane and 3.2 percent for the latex condom. In a different study, authors analyzed results of 10 trials comparing the non-latex with latex condoms in terms of contraceptive efficacy, breakage, slippage, safety, and user preferences (Gallo 2003). One product (eZ.on condom) did not protect as well as the latex comparison condom, but other studies found no significant difference in typical-use rates for the other nonlatex condoms (Avanti and the Standard Tactylon). Although nonlatex condoms were associated with higher rates of clinical breakage, a substantial proportion of participants reported preferring nonlatex condoms. For people with latex sensitivity or for those who find latex condoms unacceptable, a polyurethane condom represents a viable alternative.

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Condoms and nonoxynol-9

Results of several recent studies on the effects of the spermicide nonoxynol-9 have led to a rethinking of the policy and recommendations about spermicidally-coated condoms in family planning and HIV prevention programs (AGI 2002). Providers should inform women and men at risk for HIV/STIs that nonoxynol-9 contraceptives do not protect against these infections. Clients should be informed that latex condoms—when used consistently and correctly—are effective in preventing transmission of HIV and can reduce the risk for other STIs. Female condoms also can reduce risk of infection. In a recent revision to the WHO List of Essential Medicines, WHO stated that nonoxynol-9 coated condoms are no longer recommended (unless there is no alternative condom available) because nonoxynol-9 does not provide additional protection against pregnancy or STIs, and could perhaps be harmful by causing epithelial disruption on frequent exposure, resulting in an increased risk of STI and HIV infection. In particular, recent findings suggest that products containing N-9 should not be used during rectal intercourse, as they cause rectal epithelial cells to slough off and therefore increase susceptibility to infection with HIV (Phillips 2000).

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Allergies to latex condoms

With reports from the health care field of allergic reactions to latex (primarily latex gloves), concerns have developed about reactions to latex condoms as well. In fact, the nonreactive nature of synthetic polymers is viewed as one of the advantages of the new generation of male condoms (FHI 1998). However, reports of latex allergies are rare among the general population. In the United States, where 1 to 2 billion condoms are used annually, the U.S. FDA received only 44 reports of allergic reactions associated with condom use between October 1988 and December 1991. The U.S. Centers for Disease Control has estimated that the population risk of an allergic reaction to latex is 0.08 percent. In addition, the nature of the reaction tends to be very mild. Sexually active people who are at risk of pregnancy and STIs should not allow concerns about latex allergies to prevent them from using condoms. The risks associated with unprotected sexual contact far exceed those from exposure to latex (WHO 2000).

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