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This article is about the contraceptive device. For the town in France, see Condom, France.

A condom is a device, usually made of latex, that is used during sexual intercourse to reduce the risk of pregnancy and/or sexually transmitted diseases (STDs) such as gonorrhea, syphilis and HIV. Condoms are also often used to keep a sex toy clean, such as a strap-on dildo, both making cleanup easier, and in cases of toys shared between partners, helping provide STD protection. Condoms do not protect against all forms of STDs. They are also known as prophylactics, as well as a number of colloquial or slang terms, such as rubbers.

Folk etymology claims, without basis, that the word "condom" is derived from a purported "Dr. Condom" or "Quondam", who made the devices for King Charles II of England. There is no evidence that any such "Dr. Condom" existed.

Overview

The first efforts at making condoms involved the use of woven fabrics. These were not effective, as both disease-carrying virii as well as sperm could fit between the woven fibers. The earliest effective condoms were made of sheep gut or other animal membrane. These are still available today because of their greater ability to transmit body warmth and tactile sensation, when compared to synthetic condoms, but they are not as effective in preventing pregnancy and disease. Mass production of condoms started in the mid-19th century, shortly after the invention of the rubber vulcanization process. Until the 1930s, condoms were made from rubber; they were still quite uncomfortable and expensive (though reusable) and thus only available to a small part of the population. When latex condoms at last became available in late 1930s, it was a leap forward in effectiveness and affordability. However, before the middle of the 20th century, many places outlawed the sale of condoms, and many subsequently allowed their sale "only for the prevention of disease". During this ban, they come under many aliases such as "rubber sponges". One of the early condom brands was called "Merry Widows".

Latex condoms are packaged in a rolled-up form, and are designed to be applied to the tip of the penis and then rolled over the erect penis. They have a "right side" and a "wrong side" when rolled up, and the first thing the user must do is to determine which side is which before attempting to apply them. Any touching of the penis to the wrong side of the rolled-up condom before application potentially contaminates the outside with bodily fluid, defeating the condom's purpose.

Early latex condoms were very similar, but later some came to have reservoir tips to contain ejaculated semen. One relatively early innovation, the 'short cap', only covered the head of the penis. These were not useful condoms, as there was still contact between the partners' genitals, and bodily fluids could easily spill out of the cap.

In recent decades, however, condom makers have diversified in colors, sizes and shapes. Flavors or designs thought to have stimulating properties are sometimes added. Such stimulating properties include enlarged tips or pouches to more fit the glans penis better and textured surfaces such as ribbing or studs (small bumps). Many condoms have spermicidal lubricant added, but it is not an effective substitute for separate spermicide use.

Condoms made from natural materials (such as those labeled "lambskin", made from lamb intestines) are not as effective at preventing disease. A few companies are today also making condoms from polyethylene and polyurethane, expected to be as effective as, but less tested than, latex. These condoms have the advantage of being compatible with oil-based lubricants. They can also be used by people who have a latex allergy.

As a method of contraception, condoms have the advantage of being easy to use, having few side-effects, and of offering protection against sexually transmitted diseases. With typical use, condoms have an 85% success rate per year in regard to preventing pregnancy - but with proper knowledge and application technique, the success rate climbs to over 98%, with near-total success when combined with a vaginal spermicide or oral contraception.

Among their disadvantages, many complain that putting them on can interrupt foreplay and lovemaking. (Others who have integrated wearing a condom as part of the entire process for sexual activity, however, do not consider this bothersome.) Because of an obvious barrier of the skins, sensory stimulation is sacrificed, causing some people to dismiss condoms as limiting their pleasure (though this effect can be largely overcome by properly applying lubricants internally and externally). However, a woman can partially solve this problem by training her vaginal muscles, specifically the pubococcygeus. These drawbacks of condoms, among others, are often cited as reasons by those who decide not to use them.

Condom failure

Most condom failures are due to misuse. This has led some researchers to suggest age-appropriate sex education that includes how to use a condom properly. A 1994 FHI study showed that most condom users rarely experience condom breakage or slippage. According to the World Health Organization , condoms currently work successfully 97% of the time at twelve months, when used properly and consistently.

Another possible, though rare, cause of condom failure is outright sabotage. One motive is to have a child against a partner's wishes, known to be done by men and women alike. Saboteurs usually pierce the condom's tip multiple times before intercourse. As this can result in pregnancies unwanted by one of the participants, it is generally seen as a deceitful and unethical act. However, at least one website is set up to provide advice on sabotage to women who want a child against their male partner's wishes.

One method of testing condoms for microscopic holes involves placing the condom being tested over one conducting form with another on the other side of the condom. If the condom does not prevent an electric current from flowing between the two conducting forms, it fails the test. Holes in condoms are unlikely if proper handling conditions (see below) are followed.

Effectiveness of condoms in preventing STDs

According to a study by the National Institutes of health, correct and consistent condom use:

• reduces the risk of HIV/AIDS transmission by approximately 85%.
• reduces the risk of gonorrhea for men by approximately 71%.
• may reduce the risk of HPV-associated diseases.

Other STDs may be affected as well, but they could not draw definite conclusions from the research they were working with.

An article in The American journal of gynecologic health showed that "all women who correctly and consistently used Reality were protected from Trichomonas vaginalis" (referring to a particular brand of female condom).

Prevalence of condoms

Condoms are most accessible in developed countries. In various cultures, a number of social or economic factors make access to condoms prohibitive. In some cases, cultural beliefs may cause some persons to shun condoms deliberately even when they are available.

Furthermore, regardless of culture and availability, many men shun condoms simply because they dislike using them. This dislike may be due either to a belief that condoms reduce sexual pleasure or to practical problems, e.g. difficulty in sustaining an erection hard enough for effective condom use. Embarrassment about actually purchasing condoms in the first place also occurs, but such privacy concerns are answered when condoms can be sold in vending machines in public toilets, and later through the Internet.

Female condoms

Recently "female condoms" or "femidoms" (not to be confused with femdoms) have become available. They are larger than male condoms and have a stiffened ring-shaped opening, and are designed to be inserted into the vagina. The female condom also contains an inner ring which keeps the condom in place inside the vagina - inserting the female condom requires squeezing this ring. Sales of these have been disappointing in developed countries, though increasingly developing countries are using them to complement already existing family planning and HIV/AIDS programming. Probable causes for poor sales are that inserting the female condom is a skill that has to be learned and that female condoms can be significantly more expensive than male condoms (upwards of 2 or 3 times the cost). Also, reported "rustling" sounds during intercourse turn off some potential users, as does the visibility of the outer ring which remains outside the vagina. This type of condom is made from polyurethane, though newer iterations are made from nitrile.

In September 2005, the primary global manufacturer of female condoms - the Female Health Company of Chicago, Illinois - announced the introduction of a second-generation FC2 Female Condom made from nitrile. The Female Health Company noted that the second-generation nitrile female condom performs statistically the same as its polyurethane precursor in preventing the transmission of HIV, sexually transmitted infections, and unintended pregnancy. The nitrile female condom has also been designed to mitigate the "rustling" noise that some consumers have attributed to the polyurethane female condom. The nitrile material of the second-generation female condom will also allow for significant reductions in female condom pricing because it can be produced with a new manufacturing process that allows for efficient economies of scale when made in mass quantities.

On November 22, 2005, the World YWCA issued an international Call to Action for the Female Condom that called on national health ministries and international donors to commit to purchasing 180 million female condoms for global distribution in 2006. The World YWCA statement, which was signed by General Secretary Musimbi Kanyoro and World YWCA affiliates in six African nations, noted that the female condom is the only available form of woman-initiated protection against HIV but remains virtually inaccessible to women in the developing world due to its high unit cost of 72 cents per female condom. The World YWCA noted that if the global public health sector will commit to buying at least 180 million female condoms in bulk, the price of the female condom will immediately decline by more than two-thirds - to 22 cents per female condom. Currently, only 12 million female condoms are distributed to women in the developing world on an annual basis. By comparison, between 6 and 9 billion male condoms are distributed.

Female condoms have the advantage of being compatible with oil-based lubricants as they are not made of latex. The external genitals of the wearer and the base of the penis of the inserting partner are more protected than when the male condom is used. Inserting a female condom does not require male erection. (Boston Women's Healthbook Collective, 2005: 336-337)

The instructions for use of female condoms are of necessity different from those of male condoms, since they are inserted rather than worn, and designed to drape around the penis, rather than to fit tightly over it. They are as follows:

• The condom should be removed carefully from the packaging;
• The small inner ring should be squeezed closed;
• The inner ring should be pushed into the vagina, the outer ring remaining outside;
• The penis should be guided through the outer ring to ensure that it is not pushed aside.
• Before removing the condom, the outer ring should be squeezed and twisted (while the wearer is still lying down, if applicable) to ensure that semen does not leak out of the pouch. Pull to remove the condom.
• Any "rustling" can be counteracted by applying extra lubricant to the inside of the condom; this is also the course of action to take if the outer ring is pulled into the vagina during intercourse. (Boston Women's Health Book Collective, 2005: 337-338)

A new, updated female condom is being developed by PATH, a medical technologies NGO, that would be easier to put in as well as less awkward to use. A second iteration of the original female condom is also in development by the Female Health Company that would be cheaper and easier to use.

"French Letter"

Condom is sometimes considered a clinical expression. In Britain a condom is also named a French letter, much like the colloquial German word for a condom, "Pariser". The English phrase "French letter" expresses the old image (or prejudice of Brits) that anything coming from France is decadent and has to do with sex. According to British military history, a Britain´s Royal Guards Colonel named Condum, in 17th century (when Anglo-Fench enmity was at its mutual height) devised the French letter to protect his troops from the French by using it. According to colloquial French, however, a condom is named an "English letter".

Religious attitudes towards use of condoms

Main article: Religious and cultural attitudes toward birth control

Condoms and other mechanisms of contraception, along with abortion, are condemned by the Roman Catholic Church, some conservative Protestants, and many Hindus for moral reasons relating to their beliefs regarding the purpose of the sexual faculty. Opinions of Orthodox Christian bishops, Jewish authorities, Muslims, Buddhists, and many Christian denominations vary on the matter.

Condemnations of contraception are typically based on the belief that sex has both procreative and unitive aspects; and that to restrict the procreative aspect requires grave matter and should be practiced through natural family planning (NFP) methods such as the Billings or sympto-thermal methods.

Religious approval is often based on the belief that the choice of contraceptive use lies with individual conscience, or is not significantly different from natural family planning to warrant condemnation; while other religious authorities view contraception from the angle of stewardship of the Earth, viewing overpopulation abatement as part of good stewardship and contraception (including limiting sexual activity) as serving this purpose.

Groups such as Planned Parenthood, which advocate family planning and sexual education, feel that religious opposition confounds attempts at public contraceptive education, which they see as a necessity to help prevent unwanted pregnancies or the spread of STDs. At the same time, religious opponents to contraceptive use often oppose public contraceptive education or the availability of contraceptives such as condoms at schools on the grounds that education in sexuality should remain a personal affair, or that sexual education programs should exclusively teach abstinence. Other religious groups do not oppose contraceptive education but believe that abstinence should be given a greater focus in such programs.

Social Factors Influencing Condom Use

Most research has revealed, through survey, four factors which establish the minimal use of condoms: various encumbering beliefs, reduced sexual pleasure, adverse experiences, and fears related to gender and tensions. However, as new technology and beneficial studies come forth that combat these various factors, there is still a substantially low amount of individuals world-wide who practice safe sex. This noticeable gap has lead several investigators to analyze perhaps social factors becoming involved such as a residual social stigma attached to condoms. At the same time, anti-condom movements like barebacking are remarkable social trends of simple, yet unsafe, defiance or an unnecessary precaution.

In broad detail, social factors range from geographical location to race, and become as specified as methamphetamine versus non-drug users, so correlations within this research are not always strong and accurate, but it does establish that correlations do exist.

Geographic Location

Several regions provide examples of social factors influencing the use of condoms within their populous. Two examples which contrast the effects of similar problems are South Africa and rural Lebanon.

Unfortunately, South Africa has some of the highest HIV rates in the world, so there the statistics on condom use are being studied heavily. As of 2001, the 21-25 year age group has the peak rate of infection at 43.1% (Campbell & MacPhail 2001). These studies became more specified and it was discovered that despite all the information known today about HIV and the spread of infection, many young people of the study did not feel that they were in danger of contracting this disease. In fact, only 30% of people, males and females, felt they had any risk of contracting HIV at all. Of those that said they felt there was any chance of contracting HIV, only 12.9% thought there was a moderate chance, and 17.6% thought they had a good chance of infection. It seems that even though the youth of South Africa do have a relatively high level of knowledge concerning the risk factors of getting HIV, many feel that is simply won't happen to them. Many of the factors found in South Africa apply to well developed countries of the world and these new findings hopefully will help shape future campaigns against decreased condom use in the future.

Another end of the spectrum are the rural areas of Lebanon in the Middle East. Generally, the use of condoms and other forms of contraceptives in the Middle East is low even though there is a growing awareness of sexually transmitted diseases and HIV/AIDS (Kulczycki, 2004). A study revealed that only twenty-four percent of the women in the regions ever used a condom. A household survey was also done on condom use which found that ninety-eight percent of women had indeed heard of contraceptive methods, but only eighty-five percent of the women had heard of condoms. Some things to keep in mind also are that women in this culture are not expected to have knowledge or express openly knowledge of contraceptives or even sexuality. Also some background that is needed on the group surveyed is that the marital fertility rate of the surveyed women were about five children per woman, and each of the women had a different level of education. About sixty-one percent had intermediate-level education, twenty percent had a primary education, and eighteen percent had trouble reading or could not read at all. This provides evidence that condom use varies dependant on social factors like the area’s cultural background and education.

It should be noted that largely the variances in geographical location are highly affected by culture and cultural beliefs, as well as class and race, but also have dynamic influences resounding from economic yield for the area, use and expansion of communication, and other criteria. These social factors can again be examined in South Africa and rural Lebanon:

An example is that in South Africa, it was discovered (Campbell & MacPhail 2001) that condom availability is a problem for young adults. Although condoms are given away by local clinics, many participants stated that there are instances when they found themselves without condoms because they never know when they are going to need one. Thus, this higher economic region has properly developed health services; they are just not being properly utilized by the public.

Opposing in the lower economic region of rural Lebanon, another reason for the lack of condom use is that public health services and family planning services are very inadequately developed. A health service that is trying to help is the Lebanese Family Planning Association but their funding is very limited and recently they have not been able to increase its budget to promote more complete reproductive health service.

Despite these specific social factors contributing to the differences between these regions and others, most research has identified issues such as trust and gender power in relationships and others as socially relevant to almost all countries worldwide.

Drug Use

The use of methamphetamines is shown to dramatically increase one’s desire to have sex, which can lead to unwanted pregnancy and/or the transmission of sexually transmitted diseases. Some injection drug users allege to have changed their sexual behavior since the AIDS pandemic, but still a relatively few percentage (6% - 44%) of injectors use condoms while averaging twelve partners per year.

Amphetamine use has been associated with stronger sexual excitement, longer duration of intercourse, and intensified orgasms among male injectors. A study showed that methamphetamine users entering treatment had three times the prevalence of HIV than other drug users.

Only 99 of 699 male Out-of-Treatment Injection Drug Users (OTIDUs) that took part in the study reported to have always used a condom. Of the 232 women OTIDUs, 22 claimed their male partner always used a condom. However, when the study was restricted to methamphetamine users only, these numbers dropped to a mere one third and one fourth of the above statistics, respectively.

From this research (Grant, Patterson, Semple, 2004), correlations can be drawn through profiling methamphetamine users against non users as specific relationships can be drawn. While not always, drug abuse will often identify a lower economic status as well as certain minority groups which could add other specific social factors that are need further research to make better correlations.

Anti-Condom Trends

There are several situations and groups who knowingly choose to not use a condom during sex for various reasons. The two largest groups currently studied are the barebacking group and the current baby boomer generation.

Barebacking is depicted as a conscious decision by gay men. Research from Michele L. Crossley on bare-backing reveals that the gay community had an increasingly hostile and skeptical stance towards the continuing and relentless efforts of the health promoters. Thus a sect of the gay community began to have unsafe sex not only for previous reasons, but also as a kind of symbolic act of rebellion and transgression. An idea began to develop that one of the main reasons why some gay men feel drawn to 'risky' sexual practices is because they provide a psychological feeling of rebellion against dominant social values, which, in turn, creates a sense of freedom, independence and protest. To have unsafe sex is an act of 'self expression', 'enlightenment' and 'empowerment'. The person doing the 'barebacking' 'prides' himself on the performance of conscious, premeditated unprotected intercourse. Another problem associated with technological progress is antibiotics as they provided an alternative to safe sex. Since simple antibiotics were discovered to clear up STDs, much of the gay community believed themselves invulnerable to many diseases and again reinforced their barebacking ideals.

The "baby boomer" generation also acts in a similar fashion of a predetermined choice not to use condoms during sex. Studies have shown baby boomers are increasingly contracting sexually transmitted infections because they choose not to wear condoms. Many have been married and separated and now have random sexual partners (Watt, 2005). Since the women are no longer capable of becoming pregnant, they do not see the large risk in not protecting themselves, and thus the importance of a condom becomes minimal. Also, since many of them have just come out of a long term relationship, they are starting over and they are too uncomfortable with their new partner to ask them to use a condom.

See also

• Safe sex
• Durex
• Trojan Condoms
• State of Louisiana v. Frisard
• Male oral contraceptive

References

Boston Women's Health Book Collective, 2005. Our Bodies, Ourselves: A New Edition for a New Era. New York: Touchstone.

MacPhail, Catherine and Campbell, Catherine (2001 Jun). “I think condoms are good but, aai, I hate those things: condom use among adolescents and young people in a Southern African township.” Social Science and Medicine, 2001, 52, 11, 1613-1627

Kulczycki, Andrzej. "The Sociocultural context of condom use within marriage in rural Lebanon. Studies in Family Planning 35.4 (Dec 2004): 246(15).

Crossley, Michele L. (2004). "Making sense of 'barebacking': Gay men's Narratives, unsafe sex and the 'resistance habitus'. British Journal of Social Psychology, 43, 225-244.

Watt, Emily (2005 April 24). "Older Adults Shy Away From Safe Sex Advice". The Sunday Star-Times (Auckland, New Zealand).

Semple, S.J., Patterson, T.L., & Grant, I. (2004). Determinants of condom use stage of change among heterosexually-identified methamphetamine users. AIDS & Behavior, 8 (4), 391-400.

External links

• Planned Parenthood of America — Provides information and training for all forms of birth control from their website and locations across the U.S.
• Condom Research from FHI - Family Health International's topic page on condoms.
• Fact sheet on condoms and sexually transmitted diseases - from the US Center for Disease Control
• Condomania (commercial) website — including They Fit - condoms available in a wide variety of lengths and widths with a print-out size chart.
• Hot Rod Condoms (manufacturer) website — Makers of the first condom fitted with an easy-on applicator.
• CondomHall Condoms (commercial) website — Provides condoms and condom education to students. It includes condom facts and how to put on a condom. It has ways to get free condoms.
• Condom USA (commercial) website — Provides free condoms to the public. It includes all the condoms that are available in US. It has description and picture of each condom.
• Condoms UK (commercial) website — A range of condoms available to those in the UK.
• Condoms FR (commercial) website — A range of condoms available to those in France.
• Spotlight: How to Choose and Use Condoms — directed at gay men, but contains advice applicable to all
• Condom use — In french, but with many pictures.
• Condoms & Sexy Lingerie Frequent asked questions about condoms.

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• Barrier contraception
• Sexual health
• Sexually-transmitted diseases
• HIV/AIDS