The male condom is a soft, flexible cover that fits over the penis. It may be made of latex, polyurethane, Tactylon, or treated animal tissue that is thin, strong, and flexible. (The female condom is described in Chapter 3.) Because a condom prevents semen from entering the vagina, it is a very effective barrier to pregnancy. Except for those made of animal skin, condoms also act as a barrier to viruses and bacteria, protecting both partners from sexually transmitted diseases such as syphilis, chlamydia, gonorrhea, genital warts, genital herpes, candidiasis, trichomoniasis, and AIDS. Some of these diseases may make you very sick—and some can make you infertile.
Unless you are in a mutually monogamous, long-term relationship, you use a condom not only to protect against pregnancy, but because it is possible for any sexually active person to have an STD and not know it. Many STDs have no symptoms, especially in the early stages. It is simply common sense to protect yourself and your partner.
Next to abstinence, condoms are the best protection against AIDS, a fatal disease that today is the number one killer of U.S. men aged 25 to 44 and the third leading killer of U.S. women aged 25 and 44. The majority of people who have AIDS were infected through sex, and many men and women who die of AIDS in their twenties were infected during their teens. Today it is a disease of heterosexuals as well as homosexuals.
To improve their effectiveness as well as prevent STDs, condoms can be used with a spermicide—a sperm-killing jelly or cream.
Condoms are easy to use and do not require a physical exam or a doctor's prescription. Furthermore, they are available in small packages that can be tucked into a pocket or purse or stored in a bedside table or bathroom cabinet. They are sold in many types of stores and at health centers. Individually they cost very little, but if they are used often, the cost can add up.
It is not unusual today for women who use other birth control methods like the Pill or Depo-Provera, or men who have had a vasectomy, to use a condom as well—for protection against STDs, including AIDS. To protect against infection, condoms should be used for oral and anal sex as well as vaginal intercourse.
Male condoms are available in dozens of brands and models, ranging from plain to those that come in different thicknesses, textures, and colors. Condoms that are slightly thicker are less likely to break than thinner ones. Those with a reservoir tip also may be less likely to break or overflow when filled with semen. Some are coated with a lubricant or a spermicide.
Both latex and lambskin condoms are available in several shapes: tapered, flared, or contoured for a tighter fit. Polyurethane and Tactylon condoms are so new they are currently available in only one shape and are either lubricated or plain. Because so many brands and styles are available, the best way to find the type that works best for you is by trying various kinds.
Condoms are usually made in the same basic shape. Most measure between 6 and 8 inches long and are approximately 2 inches in diameter. Because they generally are so flexible, and an exact fit is unnecessary, most condoms are not sold by size. Several brands, however, do offer a large size. If a condom seems too loose or too tight, or you are having problems with it slipping off, try other types or brands until you get a fit you like. Most condoms are not expensive, and it is worth experimenting with different ones if it makes a difference in how you feel about using them.
IN A NUTSHELL
The male condom is a birth control method used by a man. He puts it on his penis before having sex. It catches the sperm when he "comes" (ejaculates) so the sperm does not go into the woman's body. Latex and polyurethane condoms not only prevent pregnancy, they also are the best protection against STDs, including AIDS.
Condoms are not very expensive. You can buy them at a drugstore or large discount store without anyone asking questions. You do not need to be a certain age or have a prescription. Some health centers and clinics will give you condoms for free.
You should remember not to touch a latex condom with anything greasy because oil weakens the rubber and the condom might break. You can buy special creams or, even better, use a spermicidal foam or gel with a condom. Condoms do not break often but for extra protection, in case one does, the woman can also put spermicide (a sperm-killing product) into her vagina before having sex.
To protect yourself and your partner, you must use a latex or polyurethane condom every time you have sex.
Although some men complain that wearing a condom diminishes their pleasure, others find that a small decrease in stimulation allows them to prolong their sexual play because they stay hard longer. This seldom-mentioned aspect of condoms is particularly useful if you are easily aroused or ejaculate prematurely.
Almost half the condoms sold today are bought by girls and women. Instead of thinking of the condom as an unwelcome interruption, many savvy couples make the act of putting the condom on the penis a part of their lovemak-ing. In fact, a recent survey discovered that, in many cases, both partners found it sexually stimulating.
Latex condoms are readily available and are the least expensive. Extra thin latex condoms may permit more sensation, but they also tear more easily and must be handled carefully. It is worthwhile noting that some condoms that are advertised as "thin" are not truly thinner, and some latex condoms promoted as "stronger"
proved not to be as sturdy as others when they were tested by Consumers Union. The laboratory test results of many brands of condoms were published in the May 1995 issue of Consumer Reports magazine.
Latex condoms that glow in the dark, are flavored, or are brightly colored may not be as protective as plain, ordinary condoms. The flavoring or coloring process may have a negative effect on the quality of the latex. If you are interested in using them, read the labels carefully for information about protection against disease and pregnancy. Many are sold as novelties and are not for use to prevent pregnancy or disease.
Allergy to products made of latex is on the rise, particularly among people who must use rubber gloves or other latex products. Because allergies build up over time, and there are so many latex products used today, experts are expecting more people to develop this allergy.
The most common form of the allergy is like the reaction to poison ivy—the skin turns red and swells anytime up to 2 days after exposure to a latex product, including a condom. Allergic reactions that occur immediately after contact with latex or spermicide can be more serious and require medical treatment. Fortunately, such reactions are rare.
Either partner can have an allergic reaction to condoms, and the cause may not always be the latex. There also can be a reaction to the spermicide or the lubricant that coats some condoms. Sometimes a perfume in the spermicide or lubricant is the culprit. Switching to another brand of condom may prevent this type of reaction. If that does not work, then the active ingredient in the spermicide, nonoxynol-9, may be the cause. Spermicide allergy can be averted by using plain condoms with no spermicide coating.
If you suspect that the latex is the source of your irritation, you can try other brands of latex condoms—in the hope of finding a better manufactured latex—or else move to the new nonlatex condoms that are now available.
New to the market are condoms made of a thin, clear, soft polyurethane. They recently have been approved for sale by the FDA, mostly for people who are sensitive to latex and cannot use latex condoms. Polyurethane condoms are too new to have been included in any long-term studies of condom effectiveness in actual use. Laboratory tests, however, have shown that sperm, viruses, and bacteria cannot pass through this material.
Because they are thin and transparent, polyurethane condoms may be more comfortable to use. In addition, polyurethane transfers body heat more readily, so there is more sensation during sex. In a survey of users, more than half the men and women who tried these new condoms said they liked them better than latex. Polyurethane condoms are sold in most large drugstore chains under the brand name "Avanti."
Another new, nonlatex condom is made of a material called Tactylon, a thermoplastic polymer. Like latex and polyurethane, in lab tests Tactylon did not permit the passage of sperm, viruses, or bacteria, and should provide good protection against disease.
Tactylon condoms are very thin, soft, strong, and extremely stretchy. They allow greater sensitivity during use than do latex condoms. They also tend to maintain their strength and are not easily degraded by temperature, sunlight, or other storage conditions that reduce the durability of latex condoms. In addition, Tactylon is not damaged by oils.
Tactylon condoms will reach drugstores in early 1998. The brand name that will be used has not yet been decided; however, the condoms will be identified on the package as being made of Tactylon.
Skin condoms are made from treated lamb membranes. They are thinner and stronger than latex, and some men believe they permit more sensation. Because they are not made from latex, they are an option for men and women who are allergic to that rubber product. Skin condoms, however, do not protect against diseases. The membrane has tiny pores that are too small for sperm to get through but are large enough to allow the passage of the viruses and bacteria that cause STDs, including AIDS. The U.S. Food and Drug Administration (FDA) does not allow skin condoms to be labeled as protection against sexually transmitted diseases.
Studies of actual condom use reveal a failure rate that ranges from 3 to 12 percent. In other words, 3 to 12 pregnancies can be expected among every 100 women whose partners use condoms for 1 year. For birth control, condoms are more protective in typical use than a diaphragm but less effective than the Pill. They may offer greater protection from pregnancy and from disease if they are used with a spermicide. As with most contraceptives, the greatest number of condom failures occur during the first year of use. Experience in using a condom reduces the likelihood of it slipping or breaking. Condoms that have been stored for a long while are more likely to break than condoms that were manufactured recently. Check the expiration date before you buy, and avoid old condoms.
As with any birth control method, effectiveness also depends a great deal on how committed the users are to preventing pregnancy. Obviously, couples who use a condom perfectly and use it every time they have sex will have the fewest failures. Using a spermicide plus a condom may improve the condom's effectiveness in preventing both pregnancy and disease. When used in anal sex, however, a condom is more likely to break and slip than when used for vaginal sex, although these problems still occur infrequently.
The FDA regulates condoms as medical devices and sends inspectors unannounced to factories to test condoms with an air-burst test: condoms are inflated until they pop and a computer records the air pressure they withstand. The amount of air pressure a condom can take indicates its strength and flexibility. This allows inspectors to test samples from a production run and from their performance
WHO SHOULD NOT DEPEND ON CONDOMS?
Condoms may not be the best birth control method for you if (1) you tend to forget to keep a supply on hand, (2) you are inclined to skip using protection 'just this once," or (3) you or your partner are still embarrassed or uncomfortable using condoms after you have tried them several times.
(It is worth making an extra effort to learn to use and become comfortable with this method, however, because a condom is the best disease protection available.)
estimate the failure rate for the entire lot. (Do not test a condom yourself by filling it with water or air before you use it. You will weaken it.)
USING A CONDOM
• Do not tear the package open with your teeth—you could tear the condom as well.
• If condoms are new to you, it is a really good idea to practice putting one on before you need it. You can practice on an erect penis or on cylinder-shaped objects such as a slim cucumber or banana. (Throw out the practice condoms.)
• A condom comes rolled up in a package. For it to work right, it must be unrolled all the way up the erect penis (Figure 2.1). If you are not circumcised, pull back the foreskin before putting on the condom. If the condom does not unroll easily, you may be doing it backwards. The rolled-up rim should always be on the outside of the condom.
• If you have unrolled the condom the wrong way, do not try to use it. Throw it away and start over with a new one.
• If the brand you are using does not have a reservoir tip (it will say so on the package), grasp about half an inch of the condom's tip between two fingers while you roll it on with the other hand. This makes sure there is room at the tip for semen and lessens the chance that the condom will be stressed and break or overflow when it is full. You will also be pinching out any air at the tip, which helps
keep the condom from breaking. And as you handle a condom, be careful not to tear it with your fingernails or rings.
• Until the condom is securely in place, keep the penis away from the vagina—drops of semen may leak from the penis before ejaculation and can cause pregnancy or carry HIV.
• Keep at least one or two extra condoms with you for backup.
Use a new condom every time you have sex. This is the most important rule in the successful use of condoms. The average man produces millions of healthy, active sperm every day, and the supply is seldom diminished by frequent ejaculations. No matter how many times you have sex, even during a fairly short period of time, use a new condom each time. And use a condom for oral and anal sex— STDs can be transmitted via the mouth or anus.
Do not begin intercourse until the vagina is well lubricated.
When a woman is sexually aroused, the vagina naturally lubricates. Without this slipperiness to help the penis slide in, the condom can tear. If you are using a latex condom and want more lubrication, use water, the spermicidal cream or gel made for diaphragms, or a water-based lubricating jelly such as K-Y Jelly, Women's Health Institute Lubricating Gel, or the lubricating jelly of any major drugstore brand. They are sold in the feminine hygiene or family planning section of drugstores. The packages usually say they are oil free and made to be used with a diaphragm or condom. If you are in doubt about any product, the list of ingredients on the package indicates whether it contains any oil.
If the condom starts to slip off, stop and check it. Replace it with a new one if necessary and think about buying a different brand next time.
After climax (ejaculation or coming), withdraw your penis while it is still erect, or the condom will slip off and sperm will spill out. Pull the penis and the condom slowly from the vagina while holding the rim of the condom against the base of the penis. Look at the condom for signs of a leak.
Remove it carefully, away from your partner's genital area. Wrap it in a tissue and throw it away.
If the condom breaks, slips, or leaks, there are a couple of things you can do to prevent pregnancy. If you have spermicide handy, immediately insert an applicator full of it well up into the vagina if you did not do so earlier. This is not a guarantee against pregnancy or infection, but it does provide some protection nevertheless. As soon as possible, talk to your nearest family planning clinic or your doctor about emergency contraception. Emergency contraception is simply the use of conventional contraceptive pills in high doses within 72 hours after intercourse. It is safe and effective but needs to be prescribed by a health care professional. (For more information on emergency contraception, see Chapter 16.)
Oils and grease are dangerous to latex condoms. When oils, oil-based lotions, or greasy hands touch latex they react with the rubber and weaken it. Then the condom is more likely to rip during use or develop tiny holes you may not see. Keep baby oils, hand lotions, face creams, ointments, petroleum jelly, massage oil, grease, or butter away from condoms and other latex contraceptives such as diaphragms or cervical caps. Even grease from french fries or makeup can damage latex, so both partners should wash their hands before touching a condom.
For additional protection, before intercourse, insert into the vagina an applicator of spermicidal foam, jelly, or gel made to be used with a diaphragm or a contraceptive film. Although some condoms are pretreated with a similar spermicide, there may not be enough to offer adequate protection. Spermicide use is an especially good idea during the most fertile time in the menstrual cycle. If either of you is allergic to spermicide, however, you can use the condom alone.
Condoms can last for several years if they are kept sealed in their packages and stored away from light and heat. The refrigerator is a good place to keep condoms—and any other latex rubber contracep-tive—especially in hot weather. Condoms deteriorate fast if kept in the glove compartment of a car, for instance, or in a purse or coat that is hung in a warm closet or left for a while in the sun or over a radiator. Condoms can also weaken if they are exposed to body heat for some time by being carried in an inside pocket.
If you have been carrying a condom around with you for several months, particularly in the summer, throw it out and replace it with a new one. This is especially important if you carry a condom in your wallet, because it is exposed to a lot of mechanical stress as well. The cost of a new package is a small price to pay for good protection. And do not remove the condom from its sealed packet until you are ready to use it.
You can get latex condoms for as little as three for $2.50 (about 84 cents each) at large chain drugstores or discount stores. Buying in large quantities, however, is by far the best approach—some brands offer 36 latex condoms for $18.99, which brings the cost to just over 50 cents each. Nonlatex condoms are more expensive—they currently sell at three for $6.00 and six for $10.50 at large drugstore chains. Lambskin condoms are the most expensive: three for $12.00 and twelve for $35.00 are typical prices.
Although the price for a single condom or even one package may seem low, if they are used many times a week, month after month, the cost is similar to that of the Pill. Condoms are not covered by insurance. Over the long term, the IUD or the Pill would be much cheaper and more likely to be paid for by insurance or Medicaid; however, these methods do not protect against STDs. Today, for the best protection, many couples use condoms plus a second method.
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