10 Things You May Not Know About Condoms

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Condoms Have Some Unique Advantages

Condoms can do some things that alternative methods of HIV prevention can't: They can protect against a range of sexually transmitted infections (STIs), especially those like gonorrhea and chlamydia that are transmitted in genital fluids or discharge (they are not quite as effective for STIs transmitted through skin-to-skin contact). They can also prevent unwanted pregnancy.

Other methods including pre-exposure prophylaxis (PrEP) and antiretroviral therapy require prior HIV testing, medical supervision, decent health coverage and taking medication on an on-going basis.

Condoms are much simpler, cheaper and more readily available. They are particularly suitable for individuals who don't have sex often or who need protection only from time to time.

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Condoms Have a Long History

Some people think they can see contraceptive sheaths in pre-historic cave paintings from France (11th century BC) and condoms made of oiled paper may have been used around the same time in Asia. Faced with a syphilis epidemic in 1564, an Italian physician conducted scientific trials of condoms made from thin sheets of linen, soaked with chemicals and held in place with ribbons. In 1763 the author James Boswell grumbled that condoms made from pig or sheep guts only gave him a "dull satisfaction." Mass-produced rubber condoms arrived in the 1850s and thinner latex condoms followed in the 1920s.

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New Condoms Are in the Pipeline

The Bill & Melinda Gates Foundation is one of the world's most generous funders of HIV programs and research. Always interested in technological solutions, they are supporting several different researchers and manufacturers to improve the design of male and female condoms.

Several projects are looking into new materials for condoms that may feel more like human skin, enhance sensation or provide a closer fit. Others are trying to develop applicators that could make it quicker and easier to insert female condoms. But these products are unlikely to be available any time soon -- the process of getting new products through U.S. Food and Drug Administration (FDA) trials and to the market is long and expensive.

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In Real Life, Condoms Aren't 100% Effective

Laboratory tests show that HIV cannot get past an intact condom, but real-life effectiveness figures are lower. Studies show that heterosexual couples who say they use condoms every time they have sex have around 80% fewer cases of HIV infection than couples who say they never use condoms. Similarly, gay couples who say they consistently use condoms have around 70% fewer cases of HIV than couples who don't use them.

How come condoms don't prevent more infections? Some people who tell researchers they "always" use condoms may in fact use them a little less often. People sometimes use condoms the wrong way (for example, using the wrong lube). And we don't always notice when a condom has slipped or broken.

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You Need to Find the Right Size

One of the key reasons why condoms sometimes come off or break is that men do not always choose a condom that is the right size for them. An ill-fitting condom may also reduce sexual pleasure or make it harder to maintain an erection.

Penises come in different shapes and sizes and so do condoms. Specialized online retailers are good places to find a range of sizes. If you find that a condom is too tight, too loose or too short, try another brand or a more suitable size.

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More Couples Will Use Female Condoms if They Are Properly Demonstrated

"Female" condoms that can be inserted into the vagina (or rectum) are an alternative for couples who don't like "male" condoms.

It's true female condoms have a poor reputation with some women and health care providers. But the experience of dedicated programs around the world shows that when they are properly explained and demonstrated, many couples appreciate and use the product.

Trainings should make sure users understand their own anatomy and allow them to practice inserting a condom on a plastic dummy, while challenging concerns about the product's size and noise. Educators need to engage both men and women. Examples of countries where female condoms have been promoted successfully include Brazil, India, South Africa and Zimbabwe.

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If You or Your Partner Is Taking HIV Treatment, Condoms Might Not Be Needed

If one member of a monogamous couple is living with HIV and is stable on HIV treatment, then the risk of HIV transmission is so infinitesimally low that condoms may be considered superfluous. Anti-HIV drugs are a more effective form of HIV prevention than condoms.

Don't take it from us, take it from leading HIV physician Joel Gallant of Santa Fe, New Mexico: "[I]n talking to a stable and monogamous discordant couple in which the positive partner's viral load is suppressed, I present condoms as an option, but I tell them that having sex without condoms is a perfectly reasonable choice to make."

But condoms might still be important to prevent STIs, especially if you or your partner has casual partners.

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People Often Use Them in the Wrong Way

Studies show that there are hosts of ways in which people use male condoms incorrectly.

Not everyone makes these kind of mistakes, but in some studies around a quarter of people report sometimes taking the condom off and then carrying on with intercourse, similar numbers don't leave space at the tip of the condom, three-quarters of people don't check the expiration date or check the condom for damage, and around one-in-five people don't use any lubrication.

These errors are associated with condoms splitting, coming off or otherwise failing.

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Improved Female Condoms Are Available in Other Parts of the World

For every 60 male condoms that are distributed in the world, just one female condom is provided. Whereas male condoms are well known and have been promoted throughout the world, there has been much less investment in marketing female condoms.

There is still only one design of female condom that is FDA approved and marketed in the United States, although alternative designs are available in other countries. For example, the Woman's Condom has been designed to address problems with female condoms -- it has a more pleasing appearance, is easier to insert and doesn't have the inner ring that some women find uncomfortable.

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The Take-Up of Condoms by Gay Men in the 1980s Is Part of Public Health History

Faced with the unprecedented health crisis of AIDS in the 1980s, gay men had to work out for themselves how to protect themselves and their partners. Public health agencies were slow to respond and many people in the wider society thought that gay sex itself was the problem. Condom use was promoted in How to Have Sex in an Epidemic, one of the early safer sex manuals, published in 1983. Over several years, condoms went from almost never being used by gay men to becoming a community norm. This was behavior change coming from the grassroots.

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