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 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
1. 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.
2. 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.
3. 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.
4. 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. A water-based lubricant can be used at this point. However it is NOT recommended to use the lubricant and spermicide nonoxynol-9, which was not only found to be ineffective in preventing sexually transmitted diseases, but can in some circumstances actually increase the risk of HIV.
5. If you feel the condom break -- or think it may be broken -- withdraw immediately. Throw the condom away and use a new condom.
6. 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.
Correct Use of Condoms Worn by Women
1. Carefully remove the condom from its protective pouch. Use a few drops of the lubricant that comes with the condom to make the outer surface of the condom moist and slick for easy insertion. Add extra lubricant, if desired, to the inner and outer rings of the condom (Figure 1). Be sure NOT to use the lubricant and spermicide nonoxynol-9 which was found to possibly harm the cell lining of the vagina and cervix, possibly increasing the risk of sexually transmitted disease and HIV transmission in women.
2. To insert the condom, squat down, sit with your knees apart, or stand with one foot on a stool or low chair. Hold the condom with the open end hanging down. While holding the top ring of the pouch -- the closed end of the condom -- squeeze the ring between your thumb and middle finger (Figure 2).
3. Now place your index finger between your thumb and middle fingers. With your fingers in this position, keep the top of the condom squeezed in a flat oval. Use your other hand to spread the lips of your vagina and insert the closed end of the pouch (Figure 3). Female condoms are like tampons: they are easy to insert once you have had some practice.
4. Once you have inserted the closed end of the pouch, use your index finger to push the pouch the rest of the way up into your vagina (Figure 4). Check to be certain that the top of the pouch is up past your pubic bone -- which you can feel by curving your index finger upward once it is a few inches inside your vagina. You can insert the pouch up to eight hours before your have intercourse.
5. Make sure that the condom is not twisted inside your vagina. If it is, remove it, add a drop or two of lubricant, and reinsert. Note: About one inch of the open end of the condom will remain outside your body.
6. If your partner inserts his penis underneath or alongside the pouch, ask him to withdraw immediately. Remove the condom, discard it, and use a new pouch. Note: Until you and your partner become familiar with the female condom, it will be helpful if you use your hand to guide his penis into your vagina.
7. After your partner ejaculates and withdraws, squeeze and twist the open end of the pouch to keep the sperm inside. Pull out gently. Discard the used condom in a trash can, not in the toilet. Do not use the condom more than once, and do not use it if your partner uses a condom -- it will not stay in place.