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Male and Female CondomsMale condoms
Effectiveness of male condomsEffectiveness against HIV transmission. When used consistently and correctly, latex condoms have been shown to be highly effective in preventing sexual transmission of HIV. Latex condoms protect against HIV by covering the penis and providing a barrier against exposure to genital secretions, such as semen and vaginal fluids. The virus cannot penetrate the latex condom.
Effectiveness against transmission of other STIs. It is believed that condoms are also highly effective for reducing transmission of other STIs; however, the degree of risk reduction varies depending on the STI, and there is insufficient data at this point to be conclusive about the degree of protection that condoms provide against most STIs. For infections transmitted through discharge, such as gonorrhea, chlamydia, and trichomonas infection, condoms provide a barrier to exposure, and organisms are too large to penetrate the latex or polyurethane. Theoretically, condoms provide very good protection against these infections. For STIs that cause genital ulcers, such as syphilis, herpes, and chancroid, and for human papillomavirus (HPV) infection, the degree of protection that condoms provide is lower since these infections are transmitted through contact with genital skin and mucosal surfaces. This contact can occur in areas that the condom does not cover. However, consistent and correct use of condoms can still significantly reduce the risk of transmission of these STIs.
Use of male condomsBecause of the high effectiveness of condoms with consistent and correct use, and the relatively low level of effectiveness with incorrect use, it is essential to teach clients how to use condoms consistently and correctly.
For oral sex, the best methods available are using a condom over the penis and using plastic wrap or a cut-open condom to cover the vagina or anus. While some condoms come prelubricated, others are not, and some people may need to use additional lubrication to increase comfort and prevent breakage, which is particularly important for anal sex. If using lubricant with a latex condom, use only water-based lubricants, such as K-Y jelly or saliva. Oil-based lubricants, such as Vaseline, petroleum jelly, creams, lotions, or cooking oil, damage the condom and make it significantly less effective and more likely to break during use. Female condomsFemale condoms are made of polyurethane and like polyurethane or latex condoms, they cannot be penetrated by sperm, STIs, or HIV. Studies of contraceptive efficacy and disease transmission show similar rates to those of male condoms. One advantage of the female condom over the male condom is that its size and shape enable it to cover a wider surface area, including some of the external genitalia. Thus, the female condom may offer additional protection against infections that can be transmitted by contact with skin normally not covered by a male condom. A variety of complex social, cultural, and behavioral issues present advantages and disadvantages to female condom use. For example, while the female condom can be inserted prior to erection to avoid interruption of the sexual act, it is sometimes considered awkward or unsightly. Currently, the female condom is being used in a variety of developing and developed countries, and acceptability studies conducted so far often show positive results. However, the female condom is expensive and, thus, not very accessible in many resource-poor settings.
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Most
male condoms are made of latex, which cannot be penetrated by HIV or any
other STI. Some are made of polyurethane, which also cannot be penetrated
by HIV and STIs, although they are not widely available. With perfect
use (consistent and correct use), latex and polyurethane condoms
can be highly effective against HIV, many other STIs, and pregnancy; however,
typical use effectiveness is much lower. It is important
to note that most condom failure is due to incorrect usage, not due to
flaws in the product itself. Lubricated condoms with Nonoxynol-9 spermicide
have not been shown to offer any increased protection. Some infectious
organisms can pass through condoms made of lamb’s intestines (“natural
skin” condoms) and so they are not reliable for preventing HIV/STIs.
Studies
of HIV discordant couples (one partner is HIV-positive; the other partner,
negative) have found less than 1% HIV transmission with consistent and
correct use. Other studies have found condoms to be 96% effective against
HIV transmission with consistent and correct use, nearly identical to
the rates of protection against pregnancy.
Effectiveness
for pregnancy prevention. Most
studies of condom efficacy have examined pregnancy rates. With perfect
use, pregnancy rates are about three pregnancies per 100 women. This translates
into one pregnancy per 2,800 acts of intercourse based on typical coital
frequency of 83 acts per year (among U.S. women). Typical use effectiveness
varies; studies show that between six and 16 pregnancies per 100 women
have occurred. 
