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Condoms 101: Taking A Closer Look

October 7, 2016

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safe sex concept

Credit: EtoileArk for iStock via Thinkstock

For three decades, condoms have been the mainstay of what we think of as safer sex. They don't just prevent HIV transmission, they also stop several other sexually transmitted infections (STIs) and prevent unwanted pregnancy.

Condoms can be found in a range of sizes and materials. As well as "male" condoms that go on a penis, there are "female" condoms that are worn by the receptive partner in vaginal or anal sex.

Condoms are (relatively) cheap and readily available. They are a simple and practical way to protect yourself and your partners if you only need protection from time to time.

Unlike newer prevention methods, no one needs to put a drug in their body. But condoms are not, in real world conditions, as effective in stopping HIV transmission as an HIV-positive person taking HIV treatment or an HIV-negative person taking pre-exposure prophylaxis (PrEP).

Laboratory studies do, however, show that condoms provide a highly effective physical barrier against even the smallest sexually transmitted pathogens. Bacteria and viruses (including HIV) cannot pass through latex, polyurethane, polyisoprene or nitrile -- the materials that condoms are made from. If an intact condom is in the right place throughout sexual intercourse, HIV won't be passed on.

Both male and female condoms provide a barrier between a body fluid containing HIV and the mucous membrane of another person. Mucous membranes are those moist body tissues that are susceptible to HIV infection -- the foreskin and urethra of the penis, the vagina and cervix, the anus and rectum.


Other Sexually Transmitted Infections?

Condoms can also provide substantial protection against a number of other STIs besides HIV. How much protection depends on how the STI is transmitted.

Gonorrhea, chlamydia and trichomoniasis are -- like HIV -- infections in body fluids (such as a genital discharge or genital secretions), so a condom will provide a high level of protection.

But if a sexually transmitted infection is transmitted through skin-to-skin contact, a condom cannot provide as much protection. STIs that are passed on by skin-to-skin contact include genital herpes, syphilis, genital warts, anal warts and chancroid.

For these infections, condoms will only be effective if they prevent contact with the skin, sores or ulcers that are infectious. However, frequently they will do so -- for example, a male condom will cover a sore on a penis.

Female condoms have an advantage here, as they cover a greater surface area, including both the internal and external female genitalia.

Nonetheless, a condom may not cover other or all infectious skin.

In considering condoms and STIs, it's also important to remember oral sex. Many STIs are much more easily transmitted during oral sex than HIV is. If you use condoms for vaginal or anal intercourse only, you could still pick up an STI during oral sex.

Although condoms can't prevent all cases of STI transmission, they do provide a substantial level of protection. People who use them consistently get far fewer cases of STIs (especially chlamydia and gonorrhea) than other people.

Putting Things Into Practice

Using condoms is not just a question of having a technical understanding of them. They need to be remembered and put on at the time of having sex, in the heat of the moment. If you treat putting on the condom as part of the foreplay, rather than as an interruption of it, things may well be easier. With plenty of practice, many people find that condom use becomes an integral part of sex.

But it takes two to tango: How you and your sexual partner interact will be crucial to whether a condom is used. Rather than it just coming down to you or the other person, the way the two of you communicate is what matters. Not all of that communication will be verbal.

In many situations, both partners will want protection to be used, and it will be reassuring for both to see that a condom is in place. But in other situations, this will be tricky. You may want to use protection, but your partner may be unconvinced, uninterested or hostile.

This can especially be a problem as you get to know a partner. Newly formed couples often find that it's harder to continue using condoms as their relationship develops -- the growing feeling of trust may make one or both partners feel that condoms aren't necessary. This may be despite no up-front discussion about HIV status and how recently each person tested. Thus, the risk may be as great as the first day you met.

Using Them Properly

Another reality of using condoms is that, on occasion, they break or come off. Research suggest that this can happen around 2.5% of the time.

Condoms are more likely to break, leak or come off if they are used incorrectly. And studies show that incorrect usage is quite common.

But condom failure happens to some people far more than it does to others. That shows that by learning the right way to use condoms and getting plenty of practice, it is possible to have a far lower failure rate.

Some things that people do wrong with male condoms include using condoms that are too small or too large for them, unrolling condoms before putting them on, using sharp objects to open condom packages, not using enough lubrication and letting the penis go soft before pulling out. Also, it may be that a person cannot maintain an erection while using a male condom -- so in that case, it's not that they've doing something wrong -- and using a female condom in the insertive partner can be helpful as an alternative strategy.

Another important reason for condom failure is not using a condom throughout penetrative sex. Putting one on after penetration has begun or taking it off before you have finished could allow an infection to be passed on. Pre-cum, the fluid that may be produced before ejaculation, can carry infections. Equally, an uncovered penis could be exposed to an infection in the receptive partner.

You can find step-by-step instructions on using a male condom here.

"Female" condoms work in a different way and have their own instructions. One of the key points is to make sure that the penis goes inside the condom -- it should not slip in between the condom and the side of the vagina.

Different Materials, Different Sizes

There is a wide range of condoms out there. While most male condoms are made from latex, some people have an allergy or sensitivity to this type of rubber. If that's the case, try a condom made from polyurethane or polyisoprene.

You may find that condoms from these materials have other advantages -- they are thinner and transmit heat better, making sex feel more natural. They don't have the same smell as latex condoms. But some polyurethane or polyisoprene condoms marketed as being especially thin may be more likely to break.

Another important difference is that polyurethane products are the only male condoms that can be used with an oil-based lubricant (such as Vaseline). Male condoms from other materials should only be used with a water-based or silicone-based lube.

You might also see male condoms made from a thin membrane of sheep intestine, called lambskin condoms. They can prevent pregnancy but are not recommended to prevent HIV or STIs. Viruses and bacteria can pass through the membrane.

You can obtain male condoms in a range of sizes. If you feel that condoms are too tight, too loose or too short, try to find a size that suits you better. Condoms should be tight enough that they aren't easily pulled off, but not uncomfortable or so tight they tear. Ill-fitting condoms make it harder for some men to maintain an erection. Specialized online retailers are good places to find a range of sizes.

Female Condoms: Not Just for Women

Although other female condoms are available in other countries, there is just one brand approved by the U.S. Food and Drug Administration and sold in the United States. Called the FC2, it is an improvement on the original model introduced in the 1990s. As it is made from nitrile, it has a softer feel and makes less noise. You can use oil-based lubricants with it.

At first the look and feel of female condoms can be surprising -- it's worth practicing the insertion method before having sex and also trying them a few times before deciding whether you like them or not. Couples who find male condoms uncomfortable or difficult may find that they prefer female condoms for either vaginal or anal sex.

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