Response from Dr. Frascino
No need to freak out. HIV cannot permeate intact latex. No way. No how. The reason condoms are not 100% protective has to do with many potential factors, such as:
Using the wrong kind of condom. Natural (lamb's skin) condoms do not protect against HIV.
Using condoms improperly. This is a biggy! You'd be amazed how many studs just don't know how to dress for success!
Condom failure. It's rare, but it can happen, especially if one is stingy with the lube.
I'll post some questions from the archives below that address condom efficacy. The "doctor chick" on the Today Show seems to be a bit of an alarmist. Chances are she voted for Dubya and his sex-phobic anti-science cronies.
Stay safe and you'll stay well.
What's the story with those new condoms?
Apr 3, 2006
Hey Dr Bob Thanks for answering our questions.
Recently I bought a Trojan condom and what I found written on it frightened me a lot.
The message written on the condom went something like, " although proper use of the condom may protect against HIV/Aids, it does not properly eliminate the risk".
That seemed a little bit in contradiction to what I have read from your archives here. My impression was that if the condom was used properly and does not break then you can count on 100% protection. Does this mean that those of us who had protected sex with people of unknown status should go for tests? I am confused.
Response from Dr. Frascino
". . . does not properly eliminate the risk???" I doubt that was the exact wording, but the take-home message you really need to hear is that if you're going to have sex, using a latex condom properly is the smartest thing you can do to prevent contracting HIV. I'll repost a question from earlier today that addressed condom efficacy.
not another hypothetical risk question Apr 3, 2006
Hi Dr Bob:
After finding out that my bf was HIV positive, I've been a regular in this great site, mining for as much information as I can find and process. I understand people's fears, but somehow I grow tired of the "5 years ago I touched a handkerchief that a prostitute had used to wipe her butt, I washed my hands with bleach 432 times after that and my ELISA, western and PCR came back negative 3, 6, 12 and 24 months after that, what should I do?" type of question. So here are my questions, from a neg. guy who regularly engages in protected sex with a pos. guy: 1- When they say that condoms offer at least 85% protection against HIV, do they mean that out of 100 episodes of protected sex with a pos. individual, 15 result in transmission? I guess not, but what do they actually mean? 2 - The HIV specialist my bf is seeing told him that there is no data to back up PEP, so she doesn't recommend it. Is this true? 3 - How often do you think I should be tested? Thank you so much for the amazing site, it goes to show that information is power.
Response from Dr. Frascino
Gosh, if you think you're tired of the "touched a hooker's hankie" type of question, you can just imagine how I must feel as I wade through literally thousands of such questions on a continual basis day after day. So let's proceed to your magnetic couple questions: 1. The bottom line here is that HIV cannot pass through intact latex. No way. No how. Condom statistics (like all statistics) can be a bit misleading. I'll repost below a few questions from the archives that address the condom-efficacy question. I also suggest you check the Planned Parenthood Web site and review their document, "The Truth about Condoms." It's well referenced. Now let me show you an example of how statistics can be misleading in a very Republican-NRA sort of way. Consider the following stats: Doctors: The number of doctors in the U.S. is 700,000 Accidental deaths caused by physicians per year are 120,000 Accidental deaths per physician is 17.14% (Statistics courtesy of the U.S. Dept. of Health & Human Services) Guns: The number of gun owners in the U.S. is 80,000,000 (yes that's 80 million) The number of accidental gun deaths per year is 1,500 The number of accidental deaths per gun owner is 0.001875% (Statistics courtesy of the FBI) Therefore, "statistically speaking," doctors are approximately 9,000 times more dangerous than gun owners, the logical conclusion being "guns don't kill people, doctors do!" See what I mean about statistics and how they can be manipulated to support an illogical conclusion?!?
Your boyfriend's HIV specialist doesn't recommend PEP? That's worrisome. The most direct evidence supporting the efficacy of PEP is a case-control study of needlestick injuries to health care workers. In that study the prompt initiation of AZT was associated with an 81% decrease in the risk of acquiring HIV. In the nonoccupational arena we have data from observational studies and registries. Although data from observational studies and case reports may not provide definitive evidence of PEP's efficacy in nonoccupational exposures, the overall cumulative data is so convincing that it would now be considered unethical to run a double-blind, placebo-controlled trial of PEP to scientifically verify what has now become standard of care for most HIV specialist practices. I would suggest you print out a copy of the recommendations from the U.S. Department of Health and Human Services entitled "Antiretroviral Postexposure Prophylaxis After Sexual, Injection-Drug Use, or Other Nonoccupational Exposure to HIV in the United States" (January 2005) and review it with your boyfriend's HIV specialist. If he/she doesn't promptly change his or her opinion on PEP, you might want to consider changing HIV specialists! I also bet that if that specialist found himself/herself on the wrong end of a broken condom with an HIV+ partner, he or she would have PEP meds swallowed faster than Bush can write " I souport publik edekasion"
That depends on your level of risk. For instance, some magnetic couples don't use condoms for oral sex, some may not use condoms "properly" each and every time, etc. Some HIV specialists suggest an every-six-month STD/HIV screen for the sexually active "at risk" population. Consequently the answer to how often I would recommend that you be tested would depend on a variety of variables. But remember, the option of testing is always open to you if you feel there has been a potential exposure. Yes, information is indeed power.
Stay well. I hope your magnetic coupling is as successful and satisfying as mine. I think we should change the terminology of "serodiscordant" to "serodiverse," as serodiscordant is so, well, discordant, and that certainly doesn't apply to my relationship!
With age comes wisdom, maybe? Jun 29, 2005
Has there been any known cases of persons getting infected with HIV even though they have consistently and correctly used a latex condom without any breakage of slippage? This may sound like a dumb question to you and others, but me and my friends at my high school are getting different answers from alot of adults here at school and elsewhere about condoms and there effectiveness against HIV. Thanks for reading this letter and it is important to have an expert opinion like yours, I know you know more than these so called other grown-ups.
David (still not sure if I'm bi or just gay) either way would like to do it right.
Response from Dr. Frascino
With age comes wisdom? Maybe. But far too often with age the broadness of the mind and narrowness of the waist change places. So, since I still have a narrow waist, I'll try to clear up the condom efficacy/effectiveness conundrum. Under controlled laboratory conditions, latex condoms are essentially impermeable to particles the size of STD pathogens, including HIV. However, when placed into the context of horned-up mattress mambo with the lights off after a few cosmopolitans, the "real life" large-scale epidemiological studies show condoms to be 80-95% effective in reducing HIV infection. Some folks think they are using condoms properly, when, in reality, they are not. I'll attach a few recent posts from the archives that also address this issue, OK?
David, bi, gay or whatever, it's cool with me. What's most important is that your facts are "straight!"
Stay well! Stay safe.
critical: have you shifted your opinion on condoms? Posted: Apr 6, 2005
I am a donor to your organization, a regular reader and an admirer. I have a question for you that has very important ramifications for myself and the entire population that frequents this site. For literally years, your position has been, simply stated, that the proper use of a condom prevents HIV transmission. While "proper use" is somewhat loaded phraseology, and you have always very candidly pointed out that humans are not always perfect, the gist of your position has been that proper use of a condom prevents HIV transmissions and obviates testing. Of course, I realize that this prevention statement incorporates assumptions, e.g., condom did not fall off, break, was not expired, and was put on properly. Now, however, I am reading your posts indicating that "large epidemiological studies" indicate that practically speaking, i.e., in the real world of human error and shortcoming, condoms are (I believe you stated) approximately 80% to 95% effective at preventing transmission. You still state, though, that they are nearly 100% efficacious in the laboratory world. Perhaps I am missing something, but to me, you seemed to have shifted considerably your views on the overall effectiveness (i.e., real world effectiveness) of condoms. The question to you that I think should clarify your position: if you were advising an individual, such as myself, on the safety of using a condom for intercourse with a partner of unknown statuts (and therefore, to error on caution's side, let's say positive); and assuming that I have used many condoms in the past and know how to use them "properly," i.e., leave room at tip, unroll to base, don't put on inside-out, etc.), then would you advise me that using a condom for intercourse with this partner will effectively prevent HIV transmission? I realize that large epidemiological studies are not necessarily reducible to the individual level. But I think your apparent shift (at least as perceived by me) merits elaboration to the "individuals" who visit your site. Thank you, and god bless you!!!!
Dr. Bob's reply:
No, my position on condoms has not changed at all over the years and I don't anticipate it will unless new scientific research evolves to support a change.
So, why the confusion??? Like many other current problems, it can be traced back to a "son of a Bush." In the context of U.S. Government policies and programs for combating HIV/AIDS domestically and internationally, a debate has resurfaced about the effectiveness of condoms in preventing sexual transmission of HIV infection. Some recent U.S. Government policies have begun to shift emphasis to the "lack of condom effectiveness" in educational materials and other publications that receive federal funds. This shift has caused confusion in the general public about whether condoms should be used and promoted for preventing HIV infection. I have consistently restated the scientific evidence related to condom efficacy and effectiveness for prevention of HIV/AIDS. You are correct that I have often quoted the scientific facts from laboratory studies, including those conducted by the FDA, concluding that latex condoms are impermeable to particles the size of STD pathogens, including HIV. Therefore, if you did use a latex condom properly and the condom did not fail, I do not believe HIV testing is warranted.
There are many reasons condom effectiveness in preventing HIV may be compromised. For instance, using natural skin rather than latex or polyurethane condoms, using the wrong type of lubricant (oil-based rather than water-based), not using the condom for the whole sex act (some folks put them on just before ejaculating), compromising the integrity of the condom (excessive heat if kept in the glove compartment of your car, tearing the condom when opening the foil packet, using condoms beyond their expiration date), etc., etc., etc. the list can go on and on and on.
Even with all these "real life" limitations of not using a condom "properly," condoms still remain 80-95% effective in reducing the risk of HIV infection if used consistently. I hope that helps clarify any confusion.
The real take-home message is that scientific evidence does not support the recent shift in U.S. Government policy that stresses lack of condom efficacy. Rather the scientific evidence clearly shows that both male and female condoms are highly effective in preventing the transmission of HIV/AIDS.
Gosh, if I'm getting this many questions about condoms, I can just imagine what the evolution and global warming experts are up against in refuting Dubya's faith-based science initiatives. Stay safe. Stay well.
I hope you won't be annoyed. Posted: May 14, 2005
You seem to imply that the catholic church's position re: rubbers is wrong. And I agree with you a 100%. However, what I disagree with is your counter-implication that condoms provide almost perfect protection. Fact is, in studies with discordant couples, there were always one or two that got infected with condoms (as opposed to 10 out of a 100 odd couples) implying that the risk is still significant. I want to know if I am misunderstanding you, or what your opinion is on this otherwise.
Thank you for educating us on these issues. You are the best!
Dr. Bob's response:
No, of course I'm not annoyed but I do think you are misinterpreting my "counter-implication." If you go back to the archives, what you will find is that my statements are very consistent and reflect what we know about how well condoms work for preventing HIV and other sexually transmitted diseases. Perhaps the easiest way to explain this is to make a distinction between efficacy and effectiveness. Efficacy can be defined as the protection the user would have under "ideal" conditions. Efficacy, therefore, is dependent on the properties of the device, in this case the condom, tested in controlled situations. Effectiveness can be defined as the protection the user would have under "actual" or "real life" conditions. Effectiveness, therefore, is dependent on both the properties of the device (condom) and the behaviors of the user. Laboratory studies, including those conducted by the FDA, have shown the latex condom to be essentially impermeable to particles the size of STD germs, including HIV. However, in large-scale, "real life" epidemiological studies, condoms are 80-95% effective in reducing HIV infection.
The bottom line is that condoms provide a highly effective barrier method when used correctly.
The Catholic Church is shamefully wrong in their condemnation of condoms. For example, in El Salvador the Church helped push through a law requiring condom packages to carry a warning label stating that condoms do not protect against AIDS. Studies now show fewer than four percent of Salvadoran couples use condoms the first time they have sex. The result will be more funerals. The Church must choose between obeying tradition and saving lives. Somehow the answer to the often quoted question "What would Jesus do?" seems painfully obvious.
Stay safe. Stay well.
CENTERS FOR DISEASE CONTROL AND PREVENTION Basic Facts About Condoms and Their Use in Preventing HIV Infection and Other STDs With more than 1 million Americans infected with HIV, most of them through sexual transmission, and an estimated 12 million other sexually transmitted diseases occurring each year in the United States, effective strategies for preventing these diseases are critical. The proper and consistent use of latex condoms when engaging in sexual intercourse--vaginal, anal, or oral--can greatly reduce a person's risk of acquiring or transmitting STDs, including HIV infection. In fact, recent studies provide compelling evidence that latex condoms are highly effective in protecting against HIV infection when used properly for every act of intercourse. Latex condoms are highly effective when used consistently and correctly-- new studies provide additional evidence that condoms work The protection that proper use of latex condoms provides against HIV transmission is most evident from studies of couples in which one member is infected with HIV and the other is not, i.e., "discordant couples." In a study of discordant couples in Europe, among 123 couples who reported consistent condom use, none of the uninfected partners became infected. In contrast, among the 122 couples who used condoms inconsistently, 12 of the uninfected partners became infected. As these studies indicate, condoms must be used consistently and correctly to provide maximum protection. Consistent use means using a condom from start to finish with each act of intercourse. Correct condom use should include the following steps: Use a new condom for each act of intercourse. Put on the condom as soon as erection occurs and before any sexual contact (vaginal, anal, or oral). Hold the tip of the condom and unroll it onto the erect penis, leaving space at the tip of the condom, yet ensuring that no air is trapped in the condom's tip. Adequate lubrication is important, but use only water-based lubricants, such as glycerine or lubricating jellies (which can be purchased at any pharmacy). Oil-based lubricants, such as petroleum jelly, cold cream, hand lotion, or baby oil, can weaken the condom. Withdraw from the partner immediately after ejaculation, holding the condom firmly to keep it from slipping off. Myths About Condoms There continues to be misinformation and misunderstanding about condom effectiveness. The Centers for Disease Control and Prevention (CDC) provides the following updated information to address some common myths about condoms. This information is based on findings from recent epidemiologic, laboratory, and clinical studies. Myth #1: Condoms don't work Some persons have expressed concern about studies that report failure rates among couples using condoms for pregnancy prevention. Analysis of these studies indicates that the large range of efficacy rates is related to incorrect or i inconsistent use. The fact is: latex condoms are highly effective for pregnancy prevention, but only when they are used properly. Research indicates that only 30 to 60 percent of men who claim to use condoms for contraception actually use them for every act of intercourse. Further, even people who use condoms every time may not use them correctly. Incorrect use contributes to the possibility that the condom could leak from the base or break. Myth #2: HIV can pass through condoms A commonly held misperception is that latex condoms contain "holes" that allow passage of HIV. Although this may be true for natural membrane condoms, laboratory studies show that intact latex condoms provide a continuous barrier to microorganisms, including HIV, as well as sperm. Myth #3: Condoms frequently break Another area of concern expressed by some is about the quality of latex condoms. Condoms are classified as medical devices and are regulated by the FDA. Every latex condom manufactured in the United States is tested for defects before it is packaged. During the manufacturing process, condoms are double-dipped in latex and undergo stringent quality control procedures. Several studies clearly show that condom breakage rates in this country are less than 2 percent. Most of the breakage is due to incorrect usage rather than poor condom quality. Using oil-based lubricants can weaken latex, causing the condom to break. In addition, condoms can be weakened by exposure to heat or sunlight or by age, or they can be torn by teeth or fingernails. Preventing HIV Infection And Other STDs Recommended Prevention Strategies Abstaining from sexual activity is the most effective HIV prevention strategy. However, for individuals who choose to be sexually active, the following are highly effective: Engaging in sexual activities that do not involve vaginal, anal, or oral intercourse Having intercourse only with one uninfected partner Using latex condoms correctly from start to finish with each act of intercourse Other HIV Prevention Strategies Condoms for Women The FDA recently approved a female condom, which will soon be available in the United States. A limited study of this condom as a contraceptive indicates a failure rate of about 26 percent in 1 year. Although laboratory studies indicate that the device serves as a mechanical barrier to viruses, further clinical research is necessary to determine its effectiveness in preventing transmission of HIV. Spermicides The role of spermicides in preventing HIV infection is uncertain. Condoms lubricated with spermicides are not likely to be more effective than condoms used with other water-based lubricants. Spermicides added to the tip of the condom are also not likely to add protection against HIV. Making Responsible Choices In summary, sexually transmitted diseases, including HIV infection, are preventable, and individuals have several responsible prevention strategies to choose from. But the effectiveness of each one depends largely on the individual. Those who practice abstinence as a prevention strategy will find it effective only if they always abstain. Similarly, those who choose any of the other recommended prevention strategies, including condoms, will find them highly effective if used correctly and consistently. For further information contact: CDC National AIDS Hotline: 1.800.232.4636 Spanish: 1-800-342-SIDA Deaf: 1-800-324-7889 U.S. Department of Health and Human Services Public Health Service Centers for Disease Control and Prevention July 30, 1993 ________________________________________ Our thanks to<> Centers for Disease Control and Prevention, which provided this article to The Body.
aids virus through condoms Oct 1, 2006
Someone stated that the Aids virus is smaller than the pores in latex condoms. So, a person could get aids while wearing a condom during sex. goggle sent me to a site posted by a Right to life group that sounds like they're trying to scare people into abstinance. My common sense and reading your opinion tell me those statements are false and misleading. Is there a definitive study by CDC or real science that covers this subject? I need to print a copy for this guy. Thanks, JC
Response from Dr. Frascino
Google sent you to a Right to Life group that said HIV can pass through "pores" in latex condoms??? Yikes! That means the rightwing religious zealot wing-nuts have taken control of Google!?!? Your "common sense and reading" are absolutely correct. Statements like the ones you read are both "false and misleading." I'd also add dangerous to that list! Check out the two links below for the truth one article is from the American Foundation for AIDS Research and the other is from Planned Parenthood. Both of these articles include references from the published scientific literature rather than gobbledygook fantasies from the Vatican and Bush/Cheney pseudo-science!
Stay informed. Stay safe. Stay well.
questions about condoms (CONDOMS)
Jul 6, 2007
Ok 2 quick question, 1- Are condoms intergrity jeopardized when the condom is stored in extreme weather, such as extremely hot or extremely cold tempatures? I have kept mine in the glove box of my car and i just wonder if the extreme heat in there during the summer would cause holes or anything else that could cause them to loose their protective qualities. Also how does one use a condom incorrectly? I have read on here that as long as a condom does not tear or isn't used incorrectly then HIV risk would be eliminated. You can only unroll it 1 direction, and other than that I couldn't imagine it being used incorrectly by anybody. God bless you and your work good doctor, it means a lot to us to have a place to come to recieve quality information about HIV prevention. Thank you very much
Response from Dr. Frascino
Extremes of temperature can affect latex condom integrity. They should not be kept in hot glove boxes in cars. (See below.)
Condoms can be used incorrectly in a variety of ways, beginning with using the incorrect condom for STD prevention! Natural condoms (lambskin) prevent pregnancy, but do not prevent HIV. There are also a variety of other potential human errors. See below.
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,
Response from Dr. Frascino
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.
condoms aren't totally safe (CONDOMS) (CONDOM EFFICACY) Jan 10, 2007
I don't really have a queston but rather a statement. i'm a 17 senoir in hight school and have done many essays throughout my high school career. when i was in the 11th grade i did a report on safe sex and the different types of condoms you can use. i quickly found out that, they may decrease the risk but they do NOT take that risk away. there are tiny tears in condoms that are not big enough for sperm to pass but, viruses can. i think you should better infor people on this subject and help me help people understand that there is always that chance that you could become infected.
Response from Dr. Frascino
You don't have a "queston," but rather a statement. OK. You're a "senoir" in "hight" school???? Hmmm . . . . Your many essays and 11th grade report on safe sex found that there are "tiny tears in condoms that are not big enough for sperm to pass, but viruses can."???? Consequently, you think I should better "infor" people on this subject . . . . Do I have that correct?????
OK, I'm delighted you have taken an interest in learning about safe(r) sex, including the use of condoms. However, if I graded your report, you would have flunked, because you did not use scientifically reliable sources for your information. I strongly urge you to go back and check your sources and your facts, not to mention your spelling and grammar!
I do agree with you that condoms, when used in real world situations, are not 100% effective, but not for the reasons that you imply. HIV and other viruses, such as hepatitis, cannot permeate intact latex or polyurethane. No way. No how! Condoms do not have tiny tears that allow HIV to pass through!!! Condoms are not 100% effective, because they can be used improperly and, rarely, they fail (break) during sex. I'll repost one item from the archives below. You can find many more by doing a simple search and following the related links. I'd advise steering clear of links to The Vatican or anything having to do with Fox News or any Bush Administration faith-based, science-phobic position papers on this topic, OK?
Finally, since you are still in high school, let me leave you with a quote form Mark Twain:
"It ain't what you don't know that gets you into trouble. It's what you know for sure that just ain't so."
Get the real facts. Stay safe.
Will you help a Republican in need ? Apr 18, 2006
Dear Dr Frascino,
Yes I am a Republican, but I am still human and I hope you will keep that in mind and answer my question. My question regards proper use of condoms. I am uncircumcised. I heard that it increases my risk for acquiring HIV. What happens when AFTER using the condom, when taking the condom OFF and I have either blood or vaginal secretons (from deep in the cervix) from the used condom and i touch the foreskin to clean it etc. Do I have a risk with this activity. I would appreciate an answer sire, It will help me in the future. I dont believe this question has been answered before.
Many Many thanks ...
Response from Dr. Frascino
You don't have to call me "sire." Sir will do just fine.
Basic facts about condoms and how to use them properly should not be a mystery. These should be taught to all potentially sexually active young adults. That means high school at the latest! Republicans seem to think that information is taboo and shouldn't be taught. Consequently, if I wasn't such a nice guy, I suppose I could give you a Republican answer and tell you that you don't need to know about nasty dirty stuff like condoms, and besides they don't work and they have more holes in them than Swiss cheese and if you use them, you're going to hell and what about that virginity pledge you made and here's a nice book about abstinence. You can read it on the way to church. But since I'm a nice guy (read Democrat) I'll happily supply you with the information you request. You can read all about the proper use of condoms on this site and related links. I'll post a few examples below. Please note we no longer recomend the use of nonoxyno-9!!! Just follow these guidelines and you'll be fine. Touching the outside of a condom while removing it and then touching your penis or foreskin would not constitute a significant HIV-transmission risk.
Now that I've answered your question, any chance you'll take a closer look at whom and what you've been voting for?
How to Use Condoms Correctly Latex Barriers -- for Men and Women -- Prevent Transmission of HIV Virtually 100% of the Time August 1996
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.
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 -- ideally, in combination with the spermicide nonoxynol-9, which kills all the HIV that is present in the condom -- 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.
Correct Use of Condoms Worn by Men
Always use a new latex or polyurethane condom for each act of vaginal or anal intercourse. (Condoms are also recommended for oral sex with a partner who is known to be HIV-positive or whose HIV status you do not know.) Open the package carefully, so that you do not tear the condom.
Before any form of direct sexual contact with your partner, place the condom over the head of your erect penis, leaving about a half-inch of space at the end (Figure 1). Note: If you are uncircumcised, pull back the foreskin before you place the condom over the head of your penis.
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. Gently squeeze the tip of the condom to remove any trapped air.
Hold the tip of the condom and unroll it all the way down to the base of your penis (Figure 2). A lubricant, applied to the outside of the condom, will make insertion easier. Use only a water-based lubricant. The lubricant nonoxynol-9, which is available without a prescription in most drug stores and pharmacies, should be used if you know you are HIV-positive or think you are HIV-positive -- because it will kill all the HIV that is released into the condom.
If you feel the condom break -- or think it may be broken -- withdraw immediately. Throw the condom away and use a new condom.
After you ejaculate, hold the condom to the base of your penis while you withdraw -- to keep it 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.
Basic Facts About Condoms and Their Use in Preventing HIV Infection and Other STDs
With more than 1 million Americans infected with HIV, most of them through sexual transmission, and an estimated 12 million other sexually transmitted diseases occurring each year in the United States, effective strategies for preventing these diseases are critical.
The proper and consistent use of latex condoms when engaging in sexual intercourse--vaginal, anal, or oral--can greatly reduce a person's risk of acquiring or transmitting STDs, including HIV infection. In fact, recent studies provide compelling evidence that latex condoms are highly effective in protecting against HIV infection when used properly for every act of intercourse. Latex condoms are highly effective when used consistently and correctly-- new studies provide additional evidence that condoms work The protection that proper use of latex condoms provides against HIV transmission is most evident from studies of couples in which one member is infected with HIV and the other is not, i.e., "discordant couples." In a study of discordant couples in Europe, among 123 couples who reported consistent condom use, none of the uninfected partners became infected. In contrast, among the 122 couples who used condoms inconsistently, 12 of the uninfected partners became infected.
As these studies indicate, condoms must be used consistently and correctly to provide maximum protection. Consistent use means using a condom from start to finish with each act of intercourse. Correct condom use should include the following steps:
Use a new condom for each act of intercourse.
Put on the condom as soon as erection occurs and before any sexual contact (vaginal, anal, or oral).
Hold the tip of the condom and unroll it onto the erect penis, leaving space at the tip of the condom, yet ensuring that no air is trapped in the condom's tip.
Adequate lubrication is important, but use only water-based lubricants, such as glycerine or lubricating jellies (which can be purchased at any pharmacy). Oil-based lubricants, such as petroleum jelly, cold cream, hand lotion, or baby oil, can weaken the condom.
Withdraw from the partner immediately after ejaculation, holding the condom firmly to keep it from slipping off.
Myths About Condoms
There continues to be misinformation and misunderstanding about condom effectiveness. The Centers for Disease Control and Prevention (CDC) provides the following updated information to address some common myths about condoms. This information is based on findings from recent epidemiologic, laboratory, and clinical studies.
Myth #1: Condoms don't work
Some persons have expressed concern about studies that report failure rates among couples using condoms for pregnancy prevention. Analysis of these studies indicates that the large range of efficacy rates is related to incorrect or i inconsistent use. The fact is: latex condoms are highly effective for pregnancy prevention, but only when they are used properly. Research indicates that only 30 to 60 percent of men who claim to use condoms for contraception actually use them for every act of intercourse. Further, even people who use condoms every time may not use them correctly. Incorrect use contributes to the possibility that the condom could leak from the base or break.
Myth #2: HIV can pass through condoms
A commonly held misperception is that latex condoms contain "holes" that allow passage of HIV. Although this may be true for natural membrane condoms, laboratory studies show that intact latex condoms provide a continuous barrier to microorganisms, including HIV, as well as sperm.
Myth #3: Condoms frequently break
Another area of concern expressed by some is about the quality of latex condoms. Condoms are classified as medical devices and are regulated by the FDA. Every latex condom manufactured in the United States is tested for defects before it is packaged. During the manufacturing process, condoms are double-dipped in latex and undergo stringent quality control procedures. Several studies clearly show that condom breakage rates in this country are less than 2 percent. Most of the breakage is due to incorrect usage rather than poor condom quality. Using oil-based lubricants can weaken latex, causing the condom to break. In addition, condoms can be weakened by exposure to heat or sunlight or by age, or they can be torn by teeth or fingernails.
Nonoxynol-9 Harmful, Should Not Be Used in Condoms, Lube
By John S. James
June 28, 2002
On June 25, 2002 the World Health Organization published a 27-page report summarizing what is known about nonoxynol-9 (N-9) -- the failed microbicide that actually increases risk of HIV transmission. They concluded that N-9 should never be used for preventing HIV transmission, has no value in preventing other sexually transmitted diseases, and should never be used rectally, where the problem may be much worse than with vaginal use. (The report acknowledges that women at low risk of HIV infection may use N-9 occasionally as a moderately effective, female-controlled form of birth control, when better means are not available to them.)
Condoms should not include N-9 for any use. However, if the only condom available has N-9, it is better than no condom. On May 10, 2002 the U.S. Centers for Disease Control and Prevention updated its Guidelines for the Treatment of Sexually Transmitted Diseases (PDF), also warning against using N-9 for STD prevention.
Background and Comment
N-9 kills HIV in the laboratory. But it also causes irritation in the vagina or rectum that can allow HIV to infect. A major clinical trial in women, reported two years ago at the International AIDS Conference in Durban, South Africa, studied over 800 sex workers randomly given either an N-9 or placebo gel, and found 48% more new HIV infections among those using N-9.
No one has done such a study with rectal use. But in both humans and animals the irritation is worse, with "sloughing of sheets of epithelium." The damage is later repaired, but by then HIV could have been transmitted.
A recent survey found that about 40% of condoms sold in the U.S. are lubricated with N-9, and about 40% of gay men look for it. Manufacturers of condoms and lube have no incentive to include N-9, except for this mistaken public demand; and all of these manufacturers also market parallel versions of their products without N-9. Now that there is a clear, official consensus that N-9 is harmful, especially for rectal use, it is likely to start disappearing from condoms and lubes.
The community will need to help get the word out, since no one has a commercial incentive to do so, and government agencies are reluctant to speak about anal sex.
References 1. WHO/CONRAD Technical Consultation on Nonoxynol-9, World Health Organization, Geneva 9-10 October 2001, Summary Report. (This is the report published June 25, 2002; the October 2001 meeting brought together experts to examine the evidence and prepare recommendations.) As we go to press the report is available through www.who.int/reproductive-health/rtis/index.htm and also through: www.conrad.org.
- "World Health Organization/Conrad Report Warns Against Use of Nonoxynol-9 As Microbicide," press statement issued June 25, available at the Web sites above.
Nonox-9 and "Non-Understanding"