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Advice for serodiscordent couple (PROPER CONDOM USE, 2010) (PROPER CONDOM TECHNIQUE, 2010)
Jul 2, 2010

Dear Dr. Frascino,

About two weeks ago, my boyfriend (negative, insertive partner) and I (undetectable viral load, Atripla, CD4 740, receptive partner) were having sex and the condom broke. He immediately pulled out and that day he started PEP with Truvada once a day.

He has tested negative, and we just went to my doctor's appointment where we learned everything is going great with me. Today we had sex and the condom broke again... this time he thinks he "pumped" a few times before he noticed.

Questions: 1. he's got 13 days of Truvada left. Should he continue that for another month? 2. What's the transmission risk? 3. What's wrong?? I've checked the condoms, they haven't expired. I've checked the lube, it's meant for latex condoms... what can we do to avoid these condom breaks... it's really stressful and is beginning to put a damper on our sex life because we're nervous...

Thanks for your perspective!

Response from Dr. Frascino

Hi,

1 I would suggest he complete the 13 days (28 days total) and then stop. The Truvada he had on board would act as "PrEP" (pre-exposure prophylaxis).

2. Very low.

3. Review proper condom technique (see below). Remember, "lubrication is your friend." Also, you might switch to an extra-strength brand.

Good luck.

Dr. Bob

protected oral sex with old condom (CONDOM IN CAR, 2009) (PROPER CONDOM USE, 2009) Sep 7, 2009

I received a protected oral sex in a massage parlor for a minute or two. But the condom I used was in my car for 2 months. It has been exposed to heat over 100F. However it did not break while I received the oral sex. Does the exposure to heat any way cause the condom to fail by making the pores larger and the virus to pass through condomn. I appreciate your answer greatly.

Response from Dr. Frascino

Hi,

Your condom was in the car for two months? Wow, that's quite a dry spell, dude. Do you happen to resemble Dick Cheney or something like that?

Your worries are unwarranted. Heat can denature latex, making it more likely to break. Luckily your baked condom did not. So you're safe. Your problem is not unique. See below.

Dr. Bob

Condom in Car Aug 18, 2009

Hi Dr. Frascino.

First allow me to say my previous sexual encounter was May 10 of this year. This last Wednesday (August 13), I went in for my 90-day HIV screening - nice and negative. Or as you might say, "Whoo Hoo!"

Someone new Ive been dating and I finally decided to take the sexual plunge a couple of weeks ago. We used condoms every time, being my standard practice and apparently hers too. One of the condoms I used, though, had been in my car for a couple of months prior, from maybe June on. For the time of night my friend and I were together, replenishing stock wasn't possible, so we chanced it (my faulty logic being using one made more sense than not). I inspected the condom, it seemed fine.

I had in fact pulled out before ejaculation each time too, just as an extra "safely measure." Before tossing the condom in question out, I filled it with water - no leaks, no tears.

So my question succinctly is this: how dumb was it using a condom that had not been kept not in a recommended room temperature environment? The condom was well within its recommended use-by date, FYI. Should I be concerned about another 90-day screening, barring my girlfriend getting her test (hopefully soon)? Or should I take a deep breath and relax.

My health care advisor told me the latter, stating condoms, if made by a reputable company (as this one was) are surprisingly durable, so while not advised to keep one in weather extremes, Im probably OK.

Your opinion has been trusted, Id very much like to know your take.

Thank you again.

Take care.

Response from Dr. Frascino

Hi,

Heat can denature latex increasing the likelihood the condom will fail (break). Yours did not and consequently I see no cause for concern.

I'll repost below one of my favorite posts from the archives dealing with condom storage.

Be well. Stay safe.

Dr. Bob

manbag condoms Jul 6, 2006

Hey Dr. McHandsome,

I'm about to enter into the sexually active period of my life.I'm 25 and I can't wait to impress the ladies with my wit and fashion! I'm writing because I'm concerned about carrying condoms in my pocket or wallet. Should i carry them in my man-bag instead or would that be too ticky-tacky?

Thanks for your prompt repy,

Sincerely yours,

Sergio-Gaylord

Response from Dr. Frascino

Hello,

You refer to me as Dr. McHandsome; you're 25 but only now about ready to enter into the sexually active period of your life; you expect to impress ladies with your wit and fashion; you carry a man-bag and your name is Sergio-Gaylord????? Whoa! There are so many rainbow flags waving in that message that it's only one penis Popsicle away from a Gay Day parade.

Dude, first off, when someone mentions man-bag on this site, I think scrotum.

To answer your question, condoms can be comfortably carried in your pockets or attaché case or stored for handy use in your nightstand "goody drawer."

Next, you may well be as straight as a lawn dart, but the tone of your post makes me wonder if you could bottom for Liberace. Either way, of course, it's fine with me. I just want you to be safe and sexually content and never-ever ticky-tacky.

Good luck.

Dr. Bob

Condom question Jun 10, 2009

Hi Dr. Bob

You always state that condoms provide effective prevention when used correctly and consistently. My question to you is how are condoms not used correctly? I always practice safe sex and use a condom from absolute start to finish - would you consider this the correct way?

I would greatly appreciate any advice you have to share.

thanks

Response from Dr. Frascino

Hi,

There are lots of ways condoms are not used properly! For example:

1. Using the wrong kind of condom: Natural skin condoms are made from lamb intestines and do not protect against HIV, although they are effective in preventing pregnancy.

2. Using outdated condoms.

3. Using condoms that have been damaged by excessive heat (stored in the glove compartment of your car).

4. Using the wrong kind of lubrication with condoms (oil-based lubricants can denature latex).

5. Using two condoms for extra protection. "Double bagging" can lead to condom failure, because the latex-on-latex friction can affect the integrity of the condom.

6. Applying the condom only just before ejaculation rather than from start to finish.

7. Damaging the condom as you try to tear open the foil packet.

This is only a partial list. I'll reprint below some information from the archives about proper condom usage.

Stay safe. Stay well.

Dr. Bob

PEP Treatment HELP? (PROPER CONDOM USE, 2009) Feb 20, 2009

Hi there,

I found your contact details online and your help would be very much appreciated as I am currently in a panic mode!

Here it goes:

1. I had anal sex (me top HIV neg) with a partner (bottom HIV pos with viral load 20k 26k copies) unfortunately the condom broke but I did not ejaculate.I am concerned that I might be exposed to infection and therefore I received PEP treatment from my local hospital on the 02.02.2009.

I had to travel to South Africa for 10days on the 03.02.2009 and I was due to go back to the hospital for tests and to receive my 2nd dosis of the PEP treatment (another 2weeks supply to make up a total of 4weeks/ 28 days) on the 12.02.2009. Unfortunately my flight had to be rescheduled and I only returned back to the UK on Wednesday the 18.02.2009. My medication ran out on Monday evening the 16.02.2009.

2. On Wednesday I had intercourse again with the same person and the condom broke again! Once again I did not ejaculate and penetration was only for a few seconds!

3. Thursday 19.02.2009. I returned to my local hospital to receive my further 2 weeks supply of PEP. By this time I missed 2 an half days worth / 60 hours of medication. I explained this to the doctor and there was explained to me that the PEP might not be effective. I am quite concerned about this...? 4. I did not tell the Doctor about the 2nd occasion on my return when the condom broke again. Now I would like to know if my PEP treatment needs to be increased or do I just continue with the normal dosage of 28days keeping in mind that I missed 60hours of treatment two weeks into the course and then their might be a second chance of infection at the time when my medication ran out.

I would appreciate if you could please get back to me ASAP with further thoughts on this.

Many thanks.

Response from Dr. Frascino

Hi,

First off, what's up with your condoms? Did you buy them during the Reagan era? Have you been storing them in the glove box of your car parked in sweltering heat? Are you using oil-based lubricant (incompatible with latex)? I think it's time you reviewed proper condom technique. (See below.)

Next, as I have mentioned previously in this forum, anyone who has had an HIV exposure significant enough to warrant PEP should be followed by an HIV specialist. I suggest you contact an HIV specialist. Tell him the whole story. And I do mean the whole truth and nothing but the truth! He will evaluate your current PEP regimen and possible need for an additional course.

I'll repost below some information about the role of HIV specialists for folks taking PEP.

Good luck.

Dr. Bob

Chihuahua guy again (PROPER CONDOM USE, 2008) Oct 16, 2008

Protected" sex is indeed protected, if the latex condom was used properly and did not break. HIV cannot permeate intact latex (or polyurethane). No way. No how. This is the answer that you gave me, but can you clarify this: 1. - What is the proper use of a condom? In my case I pull it off the envelop, I put it in my penis till the base of it, I didnt take it off right after I cum but my penis was still hard when I take it off (about a minute or so, after cum), then with my hands I kind of squeeze it a little bit to look for any leak, which wasnt any, then into the garbage bowl. Is this a proper use? 2. is there any risk of hiv acquisition for touching the exterior side of the condom and manipulated it whit my hands? 3. Am I paranoid?

Thank you so much doctor you are such a wonderful person

Response from Dr. Frascino

Hi,

1. The description of your use of the latex condom suggests proper usage. (See below.)

2. No.

3. Yes.

Dr. Bob

Another question and problem caused by Bush's abstinence policy (PROPER CONDOM USE) May 23, 2008

Basically, I'm 19, and we never had sex ed in high school. Specifically I never learned how to use a condom. I go off to college and I start dating this girl. Now the reason I am worried is that one of her ex's was found to be HIV positive. As such I was scared of having sex with her and still haven't. But I did have oral with her, but I made sure we used a condoms as in the archives it says if condoms are used correctly there is no chance of HIv transmission. Now this is what scares me, after she gave me oral I checked to see there were no breaks, and I didn't think there were because it appeared to be intact and there was no semen around me. But then I found a bit of I guess rubber on the tip of my penis. Could this be a sign the condom broke, as it did not appear broken, and furthermore if it broke wouldn't it just be a tear, like a bit of it just wouldn't fall off? Anyway this happened 4 weeks ago and I now have tonsillitis, a bit of eczema, a fever, and I feel dizzy. I am worried out of my mind and I am angry as I may get HIV due to not being taught how to use a condom properly. I think I did use it properly I just want reassurance on my risk and whether I did.

Thankyou so much in advance

Response from Dr. Frascino

Hi,

You never had sex education in high school and now you're in college and "worried out of (your) mind "that you may have contracted HIV "due to not being taught how to use a condom properly." Yours is another prime example of how Dubya's sex-phobic, anti-science policies have placed people at risk for unwanted pregnancies as well as STDs, including HIV. I can assure you President Obama and a strongly democratic House and Senate will help rectify this (as well as many other) disastrous policies. (I'm counting on you to rally your college buddies to vote for Obama and the democrats!!!)

Here's the scoop on condoms. HIV cannot permeate intact latex or polyurethane. No way. No how. However, condoms are not 100% effective, because they are often used improperly and also extremely rarely they can fail (break). When a condom breaks, it is usually very obvious. The thin piece of latex or polyurethane is stretched tightly over a throbbing tallywhacker. Consequently, when it tears, it rips dramatically and Mr. Happy's head usually comes poking out, similar to your head poking out of a turtleneck sweater. Regarding what you should have been taught in school about proper use of condoms, see below. You can also read much more about condoms in the archives and also in the chapter titled "HIV Prevention Basics" on this site.

Regarding your HIV risk, it remains exceedingly low. Oral sex, even unprotected, carries only a very low risk for HIV transmission.

"Symptoms" are notoriously unreliable in predicting who is or is not HIV infected. The reason to get tested or even to worry about HIV would be having placed yourself at risk for possible acquisition of the virus. I would not be concerned that your bout of tonsillitis, bit of eczema, fever or feeling dizzy might be HIV related. These are extremely common symptoms and certainly not HIV specific.

If after reviewing the information below, you feel you may have been exposed to HIV, a single simple rapid HIV test at the three-month mark will provide you with an accurate test result in as few as 20 minutes. From what you've told me, the results would undoubtedly be negative.

Good luck. Get informed. Stay safe. And remember to vote Democratic to prevent others having to endure what you are currently experiencing.

Dr. Bob

Condoms April 12, 2007

What Are Condoms?

A condom is a tube made of thin, flexible material. It is closed at one end. Condoms have been used for hundreds of years to prevent pregnancy by keeping a man's semen out of a woman's vagina. Condoms also help prevent diseases that are spread by semen or by contact with infected sores in the genital area, including HIV. Most condoms go over a man's penis. A new type of condom was designed to fit into a woman's vagina. This "female" condom can also be used to protect the rectum.

What Are They Made Of?

Condoms used to be made of natural skin (including lambskin) or of rubber. That's why they are called "rubbers." Most condoms today are latex or polyurethane. Lambskin condoms can prevent pregnancy. However, they have tiny holes (pores) that are large enough for HIV to get through. Lambskin condoms do not prevent the spread of HIV. Latex is the most common material for condoms. Viruses cannot get through it. Latex is inexpensive and available in many styles. It has two drawbacks: oils make it fall apart, and some people are allergic to it.

Polyurethane is an option for people who are allergic to latex. One brand of female condom and one brand of male condom are made of polyurethane.

How Are Condoms Used?

Condoms can protect you during contact between the penis, mouth, vagina, or rectum. Condoms won't protect you from HIV or other infections unless you use them correctly.

Store condoms away from too much heat, cold, or friction. Do not keep them in a wallet or a car glove compartment.

Check the expiration date. Don't use outdated condoms.

Don't open a condom package with your teeth. Be careful that your fingernails or jewelry don't tear the condom. Body jewelry in or around your penis or vagina might also tear a condom.

Use a new condom every time you have sex, or when the penis moves from the rectum to the vagina.

Check the condom during sex, especially if it feels strange, to make sure it is still in place and unbroken.

Do not use a male condom and a female condom at the same time.

Use only water-based lubricants with latex condoms, not oil-based. The oils in Crisco, butter, baby oil, Vaseline or cold cream will make latex fall apart.

Use unlubricated condoms for oral sex (most lubricants taste awful).

Do not throw condoms into a toilet. They can clog plumbing.

Using a Male Condom:

Put the condom on when your penis is erect -- but before it touches your partner's mouth, vagina, or rectum. Many couples use a condom too late, after some initial penetration. Direct genital contact can transmit some diseases. The liquid that comes out of the penis before orgasm can contain HIV.

If you want, put some water-based lubricant inside the tip of the condom.

If you are not circumcised, push your foreskin back before you put on a condom. This lets your foreskin move without breaking the condom.

Squeeze air out of the tip of the condom to leave room for semen (cum). Unroll the rest of the condom down the penis.

Do not "double bag" (use two condoms). Friction between the condoms increases the chance of breakage.

After orgasm, hold the base of the condom and pull out before your penis gets soft.

Be careful not to spill semen onto your partner when you throw the condom away.

Nonoxynol-9

Nonoxynol-9 is a chemical that kills sperm (a spermicide). It can help prevent pregnancy when it is used in the vagina along with condoms or other birth control methods. Nonoxynol-9 should not be used in the mouth or rectum. Because nonoxynol-9 kills HIV in the test tube, it was considered as a way to prevent HIV infection during sex. Unfortunately, many people are allergic to it. Their sex organs (penis, vagina, and rectum) can get irritated and develop small sores that actually make it easier for HIV infection to spread. Nonoxynol-9 should not be used as a way to prevent HIV infection.

Condom Myths

Condoms don't work: Studies show condoms are 80% to 97% effective in preventing HIV transmission if they are used correctly every time you have sex. Condoms break a lot: Less than 2% of condoms break when they are used correctly: no oils with latex condoms, no double condoms, no outdated condoms.

HIV can get through condoms: HIV cannot get through latex or polyurethane condoms. Don't use lambskin condoms.

The Bottom Line

When used correctly, condoms are the best way to prevent the spread of HIV during sexual activity. Condoms can protect the mouth, vagina or rectum from HIV-infected semen. They can protect the penis from HIV-infected vaginal fluids and blood in the mouth, vagina, or rectum. They also reduce the risk of spreading other sexually transmitted diseases. Condoms must be stored, used and disposed of correctly. Male condoms are used on the penis. Female condoms can be used in the vagina or rectum.

For more information, see Condomania's World of Safer Sex at www.condomania.com or the FDA's condom brochure at www.fda.gov/oashi/aids/condom.html.

Where the Rubber Meets the Road

April 1997

When used correctly, latex and polyurethane condoms stop the spread of HIV almost 100% of the time. Condoms are like cars: If you have an accident with one, the cause is almost certainly operator error, not mechanical failure. The estimated failure rate of latex and polyurethane condoms is between 2% and 5% -- and when a condom does tear during sex, the break is usually the result of misuse, not a defect in the condom itself. The Food and Drug Administration -- which considers condoms to be "medical devices," regulates their production, and makes frequent, unannounced inspections of condom-manufacturing plants -- has declared that the difference in quality between the best and worst condoms on the market "is tiny compared with the problems that users introduce." Condoms are like cars in another respect: They work best when you follow the manufacturer's instructions. The most common cause of condom failure is a simple mistake, one that people make almost as soon as the condom is out of the wrapper: They place the rolled condom on the head of the penis upside down. In this position the condom looks like a mushroom cap, and it can be unrolled down the shaft of the penis only with difficulty.

You may have to wedge your fingers between the condom and your penis to unroll it this way. The condom will still cover the penis, but because it is inside out, the ring at the base will usually be tangled, not snug and secure. This makes the condom more likely to slip off or tear during sex.

The rolled condom should be placed over the head of the penis the same way that a knit cap is placed on your head, with the rolled "brim" outside the cap, not tucked under. This way it rolls easily down the shaft of the erect penis. The condom ends up right-side out. The ring at bottom of the condom fits snugly at the base of the penis, and the condom stays in place during sex.

There's one more way in which a condom is like a car: You need to keep a condom well-lubricated. If you never change the oil in your car, the parts will grind against each other and break. A condom that is not kept lubricated is also much more likely to break -- but you should never use oil to lubricate a condom. Oil-based lubricants like Vaseline, cooking oil, Crisco, baby oil, suntan lotion, and most skin moisturizers will dissolve a latex condom, creating tiny holes. You can't see these holes, but they are there, and HIV can get through them.

For this reason you should always use water-based lubricants with condoms. And you should always use condoms made of latex or polyurethane, because non-latex condoms have pores that HIV can get through. Check the label. If the condom does not have the word LATEX or the word POLYURETHANE clearly printed on it, don't use it. And check the labels on all lubricants. Most lubricants designed specifically for sex -- brands like KY, ForPlay, and Astroglide -- are water-based, and the labels will clearly say so.

Many of these lubricants also contain an ingredient called nonoxynol-9 which may increase someone's risk of HIV. Using a lubricant that contains nonoxynol-9 without a condom will not prevent the transmission of HIV, and should be avoided because it could increase your risk of getting HIV.

Generously apply a water-based lubricant to your penis (or to the inside of the condom) before putting the condom on. (This allows the penis to move around slightly within the condom.) Once the condom is securely in place, rub lubricant on its outer surface, then apply more of the lubricant to your partner's vagina or anus. During sex, rub on more lubricant at frequent intervals. Keeping everything well-lubed cuts down on friction and puts less strain on the condom, making it even less likely that the condom will tear.

There is no such thing as a learner's permit for condom users, as there is for beginning drivers, and there are no mandatory driver- education programs for condom users either. That's too bad, because learning how to handle a condom with skill and confidence takes practice. Condoms do work. But they only work when they are used consistently and correctly.

Both women and men should study the following diagrams and instructions, and both should know that a newly developed "female condom," which is inserted directly into the vagina instead of placed on the penis, offers the same effective protection as a regular condom. Learning how to use condoms is like learning how to achieve sexual fulfillment. In both situations experience is the best teacher.

Correct Use of Condoms Condoms Worn by Men 1. Always use a new latex or polyurethane condom each time you have vaginal or anal sex. (Condoms are also recommended for oral sex with a partner who is known to be, or is suspected to be, HIV-positive.) Open the package carefully, so that you do not tear the condom.

2. Place a few drops of water-based lubricant on the inside of the condom or on the penis itself.

3. Before any form of direct sexual contact with your partner, place the condom over the head of the erect penis, leaving about a half-inch of empty condom at the end (Figure 1). Note: On an uncircumcised penis, pull back the foreskin to expose the head of the penis before you place the condom over it.

4. Gently squeeze the tip of the condom to force out any trapped air. The condom should fit over the head of the penis like a small rubber cap, with the rolled "brim" outside the "cap" -- so that it will unroll easily down the shaft of the penis.

5. Hold the tip of the condom against the head of the penis and unroll the rest of the condom all the way down to the base of the penis (Figure 2). Rub water-based lubricant over the condom-covered penis and, for extra safety and comfort, apply additional lubricant to your partner's vagina or anus.

6. Slowly insert the covered penis into the vagina or anus. If at any point you feel the condom break -- or you even think it may be broken -- pull the penis out immediately. If broken, throw the condom away and use a new one.

7. After you ejaculate (cum), hold the condom to the base of the penis while pulling out of your partner. This keeps the condom from coming off while it is still in your partner's vagina, anus, or mouth. Gently peel the used condom off the tip of your penis (Figure 3) and throw it away. Never use a condom more than once.



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