Condom
| Condom | |
|---|---|
 A rolled-up condom | |
| Background | |
| Pronunciation | /ˈkɒndəm/ KON-dəm or UK: /ˈkɒndɒm/ KON-dom |
| Type | Barrier |
| First use | Ancient[1] Rubber: 1855[2] Latex: 1920s[3] Polyurethane: 1994 Polyisoprene: 2008 |
| Pregnancy rates (first year, latex) | |
| Perfect use | 2%[4] |
| Typical use | 18%[4] |
| Usage | |
| Reversibility | Yes |
| User reminders | Latex condoms are damaged by oil-based lubricants[1] |
| Advantages and disadvantages | |
| STI protection | Yes[1] |
| Benefits | No health care visits required and low cost[1] |
A condom is a sheath-shaped barrier device used during sexual intercourse to reduce the probability of pregnancy or a sexually transmitted infection (STI).[1] There are both external condoms, also called male condoms, and internal (female) condoms.[5]
The external condom is rolled onto an erect penis before intercourse and works by forming a physical barrier which limits skin-to-skin contact, exposure to fluids, and blocks semen from entering the body of a sexual partner.[1][6] External condoms are typically made from latex and, less commonly, from polyurethane, polyisoprene, or lamb intestine.[1] External condoms have the advantages of ease of use, ease of access, and few side effects.[1] Individuals with latex allergy should use condoms made from a material other than latex, such as polyurethane.[1] Internal condoms are typically made from polyurethane and may be used multiple times.[6]
With proper use—and use at every act of intercourse—women whose partners use external condoms experience a 2% per-year pregnancy rate.[1] With typical use, the rate of pregnancy is 18% per-year.[4] Their use greatly decreases the risk of gonorrhea, chlamydia, trichomoniasis, hepatitis B, and HIV/AIDS.[1] To a lesser extent, they also protect against genital herpes, human papillomavirus (HPV), and syphilis.[1]
Condoms as a method of preventing STIs have been used since at least 1564.[1] Rubber condoms became available in 1855, followed by latex condoms in the 1920s.[2][3] It is on the World Health Organization's List of Essential Medicines.[7] As of 2019, globally around 21% of those using birth control use the condom, making it the second-most common method after female sterilization (24%).[8] Rates of condom use are highest in East and Southeast Asia, Europe and North America.[8] About six to nine billion are sold a year.[citation needed]
Medical uses
Birth control
The effectiveness of condoms, as of most forms of contraception, can be assessed two ways. Perfect use or method effectiveness rates only include people who use condoms properly and consistently. Actual use, or typical use effectiveness rates are of all condom users, including those who use condoms incorrectly or do not use condoms at every act of intercourse. Rates are generally presented for the first year of use.[9] Most commonly the Pearl Index is used to calculate effectiveness rates, but some studies use decrement tables.[10]: 141
The typical use pregnancy rate among condom users varies depending on the population being studied, ranging from 10 to 18% per year.[11] The perfect use pregnancy rate of condoms is 2% per year.[9] Condoms may be combined with other forms of contraception (such as spermicide) for greater protection.[12]
Sexually transmitted infections
Condoms are widely recommended for the prevention of sexually transmitted infections (STIs). They have been shown to be effective in reducing infection rates in both men and women. While not perfect, the condom is effective at reducing the transmission of organisms that cause AIDS, genital herpes, cervical cancer, genital warts, syphilis, chlamydia, gonorrhea, and other diseases.[13] Condoms are often recommended as an adjunct to more effective birth control methods (such as IUD) in situations where STI protection is also desired.[14] For this reason, condoms are frequently used by those in the swinging community.[citation needed]
According to a 2000 report by the National Institutes of Health (NIH), consistent use of latex condoms reduces the risk of HIV transmission by approximately 85% relative to risk when unprotected, putting the seroconversion rate (infection rate) at 0.9 per 100 person-years with condom, down from 6.7 per 100 person-years.[15] Analysis published in 2007 from the University of Texas Medical Branch[16]and the World Health Organization[17] found similar risk reductions of 80–95%.
The 2000 NIH review concluded that condom use significantly reduces the risk of gonorrhea for men.[15] A 2006 study reports that proper condom use decreases the risk of transmission of human papillomavirus (HPV) to women by approximately 70%.[18] Another study in the same year found consistent condom use was effective at reducing transmission of herpes simplex virus-2, also known as genital herpes, in both men and women.[19]
Although a condom is effective in limiting exposure, some disease transmission may occur even with a condom. Infectious areas of the genitals, especially when symptoms are present, may not be covered by a condom, and as a result, some diseases like HPV and herpes may be transmitted by direct contact.[20] The primary effectiveness issue with using condoms to prevent STIs, however, is inconsistent use.[21]
Condoms may also be useful in treating potentially precancerous cervical changes. Exposure to human papillomavirus, even in individuals already infected with the virus, appears to increase the risk of precancerous changes. The use of condoms helps promote regression of these changes.[22] In addition, researchers in the UK suggest that a hormone in semen can aggravate existing cervical cancer, condom use during sex can prevent exposure to the hormone.[23]
Causes of failure
Condoms may slip off the penis after ejaculation,[24] break due to improper application or physical damage (such as tears caused when opening the package), or break or slip due to latex degradation (typically from usage past the expiration date, improper storage, or exposure to oils). The rate of breakage is between 0.4% and 2.3%, while the rate of slippage is between 0.6% and 1.3%.[15] Even if no breakage or slippage is observed, 1–3% of women will test positive for semen residue after intercourse with a condom.[25][26] Failure rates are higher for anal sex, and until 2022, condoms were only approved by the FDA for vaginal sex. The One Male Condom received FDA approval for anal sex on 23 February 2022.[27][28]
Different modes of condom failure result in different levels of semen exposure. If a failure occurs during application, the damaged condom may be disposed of and a new condom applied before intercourse begins – such failures generally pose no risk to the user.[29] One study found that semen exposure from a broken condom was about half that of unprotected intercourse; semen exposure from a slipped condom was about one-fifth that of unprotected intercourse.[30]
Standard condoms will fit almost any penis, with varying degrees of comfort or risk of slippage. Many condom manufacturers offer "snug" or "magnum" sizes. Some manufacturers also offer custom sized-to-fit condoms, with claims that they are more reliable and offer improved sensation/comfort.[31][32][33] Some studies have associated larger penises and smaller condoms with increased breakage and decreased slippage rates (and vice versa), but other studies have been inconclusive.[34]
It is recommended for condoms manufacturers to avoid very thick or very thin condoms, because they are both considered less effective.[35] Some authors encourage users to choose thinner condoms "for greater durability, sensation, and comfort",[36] but others warn that "the thinner the condom, the smaller the force required to break it".[37]
Experienced condom users are significantly less likely to have a condom slip or break compared to first-time users, although users who experience one slippage or breakage are more likely to suffer a second such failure.[38][39] An article in Population Reports suggests that education on condom use reduces behaviors that increase the risk of breakage and slippage.[40] A Family Health International publication also offers the view that education can reduce the risk of breakage and slippage, but emphasizes that more research needs to be done to determine all of the causes of breakage and slippage.[34]
Among people who intend condoms to be their form of birth control, pregnancy may occur when the user has sex without a condom. The person may have run out of condoms, or be traveling and not have a condom with them, or dislike the feel of condoms and decide to "take a chance". This behavior is the primary cause of typical use failure (as opposed to method or perfect use failure).[41]
Another possible cause of condom failure is sabotage. One motive is to have a child against a partner's wishes or consent.[42] Some commercial sex workers from Nigeria reported clients sabotaging condoms in retaliation for being coerced into condom use.[43] Using a fine needle to make several pinholes at the tip of the condom is believed to significantly impact on their effectiveness.[10]: 306–307 [26] Cases of such condom sabotage have occurred.[44]
Side effects
The use of latex condoms by people with an allergy to latex can cause allergic symptoms, such as skin irritation.[45] In people with severe latex allergies, using a latex condom can potentially be life-threatening.[46] Repeated use of latex condoms can also cause the development of a latex allergy in some people.[47] Irritation may also occur due to spermicides that may be present.[48]
Use
External condoms are usually packaged inside a foil or plastic wrapper, in a rolled-up form, and are designed to be applied to the tip of the penis and then unrolled over the erect penis. It is important that the closed end or the teat of the condom is pinched when the condom is placed on the tip of the penis. This will ensure that air is not trapped inside the condom which could cause it to burst during intercourse. In addition, this leaves space for the semen to collect which reduces the risk of it being forced out of the base of the device. Most condoms have a teat end for this purpose. Soon after ejaculating, the male should withdraw from his partner's body. The condom should then be carefully removed from the penis away from the other partner. It is recommended that the condom be wrapped in tissue or tied in a knot, then disposed of in a trash receptacle.[49] Condoms are used to reduce the likelihood of pregnancy during intercourse and to reduce the likelihood of contracting sexually transmitted infections (STIs). Condoms are also used during fellatio to reduce the likelihood of contracting STIs.
Some couples find that putting on a condom interrupts sex, although others incorporate condom application as part of their foreplay. Some men and women find the physical barrier of a condom dulls sensation. Advantages of dulled sensation can include prolonged erection and delayed ejaculation; disadvantages might include a loss of some sexual excitement.[13] Advocates of condom use also cite their advantages of being inexpensive, easy to use, and having few side effects.[13][50]
Adult film industry
In 2012 proponents gathered 372,000 voter signatures through a citizens' initiative in Los Angeles County to put Measure B on the 2012 ballot. As a result, Measure B, a law requiring the use of condoms in the production of pornographic films, was passed.[51] This requirement has received much criticism and is said by some to be counter-productive, merely forcing companies that make pornographic films to relocate to other places without this requirement.[52] Producers claim that condom use depresses sales.[53]
Sex education
Condoms are often used in sex education programs, because they have the capability to reduce the chances of pregnancy and the spread of some sexually transmitted infections when used correctly. A recent American Psychological Association (APA) press release supported the inclusion of information about condoms in sex education, saying "comprehensive sexuality education programs ... discuss the appropriate use of condoms", and "promote condom use for those who are sexually active."[54]
In the United States, teaching about condoms in public schools is opposed by some religious organizations.[55] Planned Parenthood, which advocates family planning and sex education, argues that no studies have shown abstinence-only programs to result in delayed intercourse, and cites surveys showing that 76% of American parents want their children to receive comprehensive sexuality education including condom use.[56]
Infertility treatment
Common procedures in infertility treatment such as semen analysis and intrauterine insemination (IUI) require collection of semen samples. These are most commonly obtained through masturbation, but an alternative to masturbation is use of a special collection condom to collect semen during sexual intercourse.
Collection condoms are made from silicone or polyurethane, as latex is somewhat harmful to sperm.[57] Some religions prohibit masturbation entirely. Also, compared with samples obtained from masturbation, semen samples from collection condoms have higher total sperm counts, sperm motility, and percentage of sperm with normal morphology. For this reason, they are believed to give more accurate results when used for semen analysis, and to improve the chances of pregnancy when used in procedures such as intracervical or intrauterine insemination.[58][59] Adherents of religions that prohibit contraception, such as Catholicism, may use collection condoms with holes pricked in them.[10]: 306–307
For fertility treatments, a collection condom may be used to collect semen during sexual intercourse where the semen is provided by the woman's partner. Private sperm donors may also use a collection condom to obtain samples through masturbation or by sexual intercourse with a partner and will transfer the ejaculate from the collection condom to a specially designed container. The sperm is transported in such containers, in the case of a donor, to a recipient woman to be used for insemination, and in the case of a woman's partner, to a fertility clinic for processing and use. However, transportation may reduce the fecundity of the sperm. Collection condoms may also be used where semen is produced at a sperm bank or fertility clinic.[citation needed]
Condom therapy is sometimes prescribed to infertile couples when the female has high levels of antisperm antibodies. The theory is that preventing exposure to her partner's semen will lower her level of antisperm antibodies, and thus increase her chances of pregnancy when condom therapy is discontinued. However, condom therapy has not been shown to increase subsequent pregnancy rates.[60][61][62]
Other uses
Condoms excel as multipurpose containers and barriers because they are waterproof, elastic, durable, and (for military and espionage uses) will not arouse suspicion if found.
Ongoing military utilization began during World War II, and includes covering the muzzles of rifle barrels to prevent fouling,[63] the waterproofing of firing assemblies in underwater demolitions,[64] and storage of corrosive materials and garrotes by paramilitary agencies.[65]
Condoms have also been used to smuggle alcohol, cocaine, heroin, and other drugs across borders and into prisons by filling the condom with drugs, tying it in a knot and then either swallowing it or inserting it into the rectum. These methods are very dangerous and potentially lethal; if the condom breaks, the drugs inside become absorbed into the bloodstream and can cause an overdose.[66][67]
Medically, condoms can be used to cover endovaginal ultrasound probes,[68] or in field chest needle decompressions they can be used to make a one-way valve.[69]
Condoms have also been used to protect scientific samples from the environment,[70] and to waterproof microphones for underwater recording.[71]
Types
Most condoms have a reservoir tip or teat end, making it easier to accommodate the man's ejaculate. Condoms come in different sizes and shapes.[72][73][74]
They also come in a variety of surfaces intended to stimulate the user's partner.[73] Condoms are usually supplied with a lubricant coating to facilitate penetration, while flavored condoms are principally used for oral sex.[73] As mentioned above, most condoms are made of latex, but polyurethane and lambskin condoms also exist.
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