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Male and Female Condoms
 Male
condoms
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 and other STIs.
Effectiveness of male condoms
Effectiveness 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.
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 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 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.
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.
Use of male condoms
Because 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 condoms
Female 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.
© 2007 EngenderHealth
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