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Topics In Brief

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Condoms

In celebration of National Condom Week, the February 2001 edition of ReCAPP focuses on condoms and the importance of educating sexually active teens about their correct use. This edition of Topic in Brief includes the following:

Definitions

A condom is a sheath that fits over the penis for the purpose of the catching the semen when a male ejaculates ("comes"). Condoms are made of latex, plastic (polyurethane), or natural skin (animal tissue). Some condoms have a nipple-shaped (reservoir) tip to hold the semen. Latex condoms now come in a variety of shapes, scents, flavors, textures, dimensions, and colors. However, most condoms are a dull translucent tan color.


History of the Condom

Condoms have actually been used for centuries. Covering the penis with a barrier to protect against disease dates back to at least 1350 BC, and for pregnancy prevention, at least to the 16th century AD. Latex condoms have been available since the 1930s, but in most parts of the world they have never been widely used. In the 1960s and 70s, other forms of contraception, such as the "pill," became very popular. However, in the 80s, the worldwide epidemic of STIs, including HIV, prompted renewed interest in latex condoms which, to date, remain the most effective method of preventing disease transmission during intercourse. (The Latex Condom, Recent Advances, Future Directions, Family Health International, 1998)


What Protection is Offered by Condoms

Condoms make sex safer for both partners by helping to prevent pregnancy as well as sexually transmitted infections (STIs). They protect partners during vaginal and anal intercourse as well as oral sex.

Condoms help prevent pregnancy by keeping the sperm from entering the vagina. When used correctly and consistently, condoms are an effective means of preventing pregnancy. Pregnancy rates range from about three percent to 14 percent. This means 3 to 14 out of 100 women become pregnant in a year using only condoms for contraception. (The Latex Condom Recent Advances, Future Directions, Family Health International, September, 2000) However, these 3 to 14 pregnancies are usually not due to condom failure. User failure (using condoms incorrectly or inconsistently) accounts for the majority of these pregnancies. (The Latex Condom, Recent Advances, Future Directions, Family Health International, 1998)

Latex condoms help protect against many sexually transmitted infections (STIs), including HIV. Because latex condoms block exchange of body fluids, they offer better protection against STIs than any other birth control method. Latex condoms offer good protection against:

  • Vaginitis caused by infections like trichomoniasis
  • Vaginitis caused by changes in the pH balance of the vagina that can be triggered by semen
  • Hepatitis-B virus
  • Gonorrhea
  • Chlamydia
  • Syphilis
  • Chancroid
  • HIV

Latex condoms offer some protection against:

  • Herpes simplex virus (HSV) that can cause genital herpes
  • Human papilloma virus (HPV) that can cause genital warts and/or cervical cancer

Condoms are a barrier between the skin of the penis and the skin of the vagina. If HSV or HPV is present in the pubic area or the scrotum, skin-to-skin contact with those areas cannot be prevented with most condoms and can therefore be risky. (Sexual Health Update, Volume 8, No. 3, The Medical Institute for Sexual Health, Fall, 2000.) However, the female condom covers more of the external genital area and may offer greater protection against HPV and HSV.

Plastic and natural skin condoms are not recommended for protection against STIs. While promising, plastic condoms (i.e. synthetic elastomer condoms) have not yet been through rigorous testing for effectiveness. (The Latex Condom, Recent Advances, Future Directions, Family Health International, 1998)

As for condoms made of natural skin (animal tissue), these have pores through which some viruses (such as HIV and hepatitis-B) can pass. (www.plannedparenthood.org/bc/condom.htm)


The Female Condom

The relatively new "female condom" fits inside the vagina like a diaphragm and also covers the vulva. It consists of a soft, loose-fitting polyurethane sheath and a flexible ring at each end. It has the advantage of not restricting the penis as most male condoms do. As a result, some couples prefer the sensitivity it offers. It can be inserted up to eight hours prior to intercourse and has a shelf life of up to five years. (The Latex Condom, Recent Advances, Future Directions, Family Health International, 1998)

In addition, the female condom is a valuable option for women who want to prevent some types of STIs, particularly the human papilloma virus (HPV) and some herpes infections. For more information on the female condom, check out the following website: www.femalecondom.org/.


Dental Dams

A dental dam is a square piece of latex that people can use for safer oral sex. Dental dams are used to cover a female's genital area (vulva and clitoris), providing a barrier between the female's genitals and her partner's mouth. Dental dams can be found at condom stores, dentists' offices, and some drugstores. However, a latex condom can also be used by cutting it and laying it out flat. For more information on dental dams and other barriers to prevent STIs, check out the website for the Coalition for Positive Sexuality (CPS): www.positive.org/JustSayYes/moresafe.html.

Overview of the Issues

Current Use

  • Only about one-third (37%) of teenage women using contraceptives choose condoms as their primary method.

  • The proportion of female contraceptive users relying on condoms increased between 1988 and 1995 — from 15% to 20% among all women, from 20% to 30% among never-married women, and from 33% to 37% among adolescents.

  • Of the 9.8 million using barrier contraceptives such as the male condom, the female condom and the diaphragm, one-third report not using their method every time they have intercourse.

  • Fewer than 1% of contraceptive users say their primary method is the female condom.

    (Alan Guttmacher Institute)

Attitudes Toward Condoms

Today's condoms are very reliable and effective if used correctly and consistently. Still, many people do not like or trust condoms for a variety of reasons. In a sample of over 3,000 men interviewed about condoms, the most frequently given reasons for dislike of condoms were that they:

  • reduce sensation
  • require being careful to avoid breaking
  • require withdrawing quickly
  • are embarrassing to buy
  • are difficult to put on
  • often come off during sex
  • are embarrassing to discard, and
  • show you think your partner has AIDS or make your partner think you have AIDS.

    (Grady et al. Condom Characteristics: the perceptions and preferences of men in the United States. Family Planning Perspective, 1993;25:67-73.)

Obviously, attitudes toward condom use vary, but most experts agree that better communication between partners about condoms will lead to increased use and safer sexual practices in general.

Importance of Communication

Adults, including parents, can play an important role in persuading teens to use condoms. According to a study published in the American Journal of Public Health, discussions between mothers and their adolescent children about condoms have an effect on teens' behavior. This study found that mother-adolescent discussions about condoms before teens' first experience of sexual intercourse greatly increased their condom use, not just for their first sexual experience but for subsequent ones as well.

This study provides proof that parents are in a unique position to engage their teens in discussions about STI and pregnancy prevention, and furthermore, that teens are influenced by their parents when it comes to using protection. ("Patterns of Condom Use Among Adolescents: The Impact of Mother-Adolescent Communication" American Journal of Public Health, October 1, 1998)

How to Use Condoms

Using a condom correctly is more complicated than it may seem. There are many ways to get it wrong. Several websites offer complete information and directions for using condoms. One to check out is Planned Parenthood Federation of America's www.plannedparenthood.org/BC/condom.htm.

Additionally, research findings highlighted by Family Health International (FHI) provide some new details, including information on:

  • Lubricants — There is no evidence that condoms lubricated with spermicide offer better protection from disease or pregnancy than condoms without spermicide. If you want to use lubricants, choose water-based lubricants (e.g. K-Y jelly) rather than oil-based lubricants (e.g. vaseline) which can break down latex.

    Many condoms and lubricants contain a spermicide called Nonoxynol-9 (N-9). Recent studies have found that N-9 can cause irritation for some people. Ironically, this can put users at greater risk for exposure to STIs, so N-9 is no longer advised for use by many experts. (The Latex Condom, Recent Advances, Future Directions, Family Health International, 1998)

  • Latex sensitivity — A small percentage of users (1%) can be allergic to the latex condom itself due to the proteins in natural latex. Some condom packages warn about latex allergy, which causes redness, itching and swelling. For those having reactions to latex, non-latex (polyurethane) condoms are a good option to try. (The Latex Condom, Recent Advances, Future Directions, Family Health International, 1998)

What Educators Can Do

Observing National Condom Day/Week

Awareness campaigns such as National Condom Day and/or National Condom Week have helped "break the ice" to start discussions about condoms and condom use, especially among young people. For the past ten years, the American Social Health Association (ASHA) has promoted National Condom Day on Valentine's Day to remind people to "love responsibly" by protecting one another's sexual health. ASHA's Linda Alexander claims that "with an estimated 15.3 million cases of sexually transmitted infections (STIs) diagnosed annually in the U.S., condoms offer the best protection for people who have sex . . . (and to) avoid getting or transmitting an infection that you might not even know you have." Check out ASHA's website: www.ashastd.org for more information about National Condom Day.


Making Condoms Available in the Schools

More and more communities have been prompted by increasing STI rates to take action to protect their youth. One proven method is to provide comprehensive sexuality education along with school-based programs that make condoms available to sexually active youth. Many national health organizations have adopted policies in support of school condom availability as a component of comprehensive sexuality education. One organization, Advocates for Youth, maintains that condom availability programs are becoming more common due to their success (decrease in sexual activity and increase in condom use) as well as evidence that, despite fears to the contrary, such programs do not promote an increase in sexual activity. (See the Advocates for Youth website: www.advocatesforyouth.org)

Teaching Communication Skills

Educators can always help youth develop their communication skills. Typically, teens benefit by increasing their skills in negotiating condom use. Talking about sensitive issues, such as persuading a partner to use a condom, takes practice. Communicating about STIs and sexual health is essential to developing a healthy relationship and preventing STIs. A teen may want to think twice about becoming sexually active with a partner who does not value these types of discussions. Ask teens you're involved with, "How would you begin a conversation with your partner about STIs?" (Also check out Planned Parenthood's website which offers other good tips: www.plannedparenthood.org/BC/condom.htm)

More Information/Resources

Hotlines

Educators can request free information on condoms from any of the following Hotlines:

CDC National STD and AIDS Hotline: 1-800-342-2437 or 1-800-227-8922 (24 hrs/day, 7 days/week).

For information in Spanish: 1-800-344-7432 (8 am - 2 pm, Eastern Time, 7 days/week).

National Organizations with Additional Information on Condoms
  • Family Health International
    P.O. Box 13950
    Research Triangle Park, NC 27709
    (919) 544-7040
    www.fhi.org

  • Advocates for Youth
    1025 Vermont Avenue, Suite 200
    Washington, DC 20005
    (202) 347-5700
    www.advocatesforyouth.org

  • Alan Guttmacher Institute (AGI)
    120 Wall Street
    New York, NY 10005
    (212) 248-1111
    www.agi-usa.org

  • American Social Health Association (ASHA)
    PO Box 13827
    Research Triangle Park, NC 27709
    (919) 361-8400
    www.ashastd.org

  • Centers for Disease Control and Prevention (CDC)
    1600 Clifton Rd.
    Atlanta, GA 30333
    (404) 639-3534
    (800) 311-3435
    www.cdc.gov

  • ETR Associates
    4 Carbonero Way
    Scotts Valley, CA 95066
    (831) 438-4060
    www.etr.org

  • Kaiser Family Foundation
    2400 Sand Hill Road
    Menlo Park, CA 94025
    (650) 854-9400
    www.kff.org
  • Planned Parenthood Federation of America
    810 Seventh Ave.
    New York, NY 10019
    (212) 541-7800
    www.plannedparenthood.org

  • Sexuality Information and Education Council of US (SIECUS)
    130 W. 42nd Street
    Suite 350
    New York, NY 10036-7802
    www.siecus.org

  • The Coalition for Positive Sexuality (CPS)
    PO Box 77212
    Washington, DC 20013-7212
    (773) 604-1654
    www.positive.org

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