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How to Use Condoms Correctly

Latex Barriers -- for Men and Women -- Prevent Transmission of HIV Virtually 100% of the Time

October 2008

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Condoms are like cars: If you have an accident with one, the cause is almost certainly operator error, not mechanical failure. Indeed, the estimated failure rate of latex condoms is between 2% and 5% -- and when a condom does tear during intercourse, that failure is most likely the result of misuse, not a manufacturing defect. The federal Food and Drug Administration -- which regards condoms as "medical devices," regulates their production, and makes frequent, unannounced inspections of condom-manufacturing facilities -- 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 they are used according to the manufacturer's instructions. The most common cause of condom failure is almost embarrassingly obvious: If the condom is placed on the penis upside down and unrolled from the inside out, it is more likely to slip off or tear during intercourse. (It should fit over the head of the penis like a dunce's cap, with the rolled "brim" outside the "cap" -- so that it will unroll easily down the shaft of the penis.) This fundamental error occurs far more often than it should, and it reveals the degree to which ignorance and embarrassment contribute to condom failure.

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There is no such thing as a learner's permit for condom users, and there are no mandatory driver's education programs -- and that's too bad, because learning how to handle a condom with skill and confidence requires a degree of familiarity with the device. Most sexually-active Americans -- like most practicing physicians -- came of age after the widespread introduction of oral contraceptives. The advent of the birth-control pill eliminated the need for condoms as a means of preventing pregnancy, and the condom -- which was regarded as inhibiting and cumbersome -- fell from favor.

Birth-control pills do prevent pregnancy, but they do not prevent the spread of sexually-transmitted disease like AIDS. Only condoms (and abstinence) do that, and condoms do it remarkably well -- if they are used consistently and correctly. The proper use of latex and polyurethane condoms is the keystone of all programs to prevent the transmission of HIV infection. All sexually-active individuals who have sexual relations, however infrequent, with anyone whose HIV status is not known to them should therefore use a new, latex condom for every act of vaginal or anal intercourse.

Condoms do work. But they only work when they are used consistently and correctly. Women as well as men should familiarize themselves with the following diagrams and instructions, and both should know that a newly developed "female condom" offers couples the same effective barrier protection -- with what many users regard as superior comfort and convenience. Familiarity with the use of condoms -- for men and for women -- is like familiarity with sex itself: Experience is the best teacher. And what experience will teach even the most reluctant condom user is that protective latex barriers can be successfully and safely incorporated into the most pleasurable and life-affirming form of human contact.


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This article was provided by San Francisco General Hospital. It is a part of the publication HIV Newsline.
 
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