Condom

A condom is a device most commonly used during sexual intercourse. It is put on a man's erect penis and physically blocks ejaculated semen from entering the body of a sexual partner. Condoms are used to prevent pregnancy and transmission of sexually transmitted diseases (STDs—such as gonorrhea, syphilis, and HIV). Because condoms are waterproof, elastic, and durable, they are also used in a variety of secondary applications. These range from creating waterproof microphones to protecting rifle barrels from clogging.

Most condoms are made from latex, but some are made from other materials. A female condom is also available. As a method of contraception, male condoms have the advantage of being inexpensive, easy to use, having few side-effects, and of offering protection against sexually transmitted diseases.^[1][2] With proper knowledge and application technique—and use at every act of intercourse—users of male condoms experience a 2% per-year pregnancy rate.^[3]

Condoms have been used for over 500 years.^[4][5] In the early twentieth century, with the invention of disposible latex condoms, they became one of the most popular methods of contraception. While widely accepted in modern times, condoms have generated some controversy. Improper disposal of condoms contributes to litter problems, and the Roman Catholic Church generally opposes condom use.

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History

Antiquity

  An Egyptian drawing of a condom being worn has been found to be 3,000 years old. It is unknown, however, if the Egyptian pictured wearing the device intended to use it for contraception, or for ritual purposes.^[4] The Greek legend of Minos as related by Antoninus Liberalis in 150 AD described the use of a goat's bladder as a protective measure during intercourse, although purpose or intent of the practice is not fully known.^[6]

In 16th century Italy, Gabriele Falloppio authored the first-known published description of condom use for disease prevention. He recommended soaking cloth sheaths in a chemical solution and allowing them to dry prior to use.^[5] He claimed to have performed an experimental trial of the linen sheath on 1100 men. His report of the experiment, published two years after his death, indicated protection against syphilis.^[6]

The oldest condoms found (rather than just pictures or descriptions) are from 1640, discovered in Dudley Castle in England. They were made of animal intestine, and it is believed they were used for STD prevention.^[4] In 19th century Japan, both leather condoms and condoms made of tortoise shells or horns were available.^[5] Similar devices made from oiled silk paper have also been described in China.^[6]

The often-reported invention of the condom by "Dr. Condom" or the "Earl of Condom" is believed to be fallacious (see etymology section below). However in the 18th Century, there are numerous literary references to condom use and sales, including in the memoirs of Giacomo Casanova.^[6]

19th century to present

The rubber vulcanization process was patented by Charles Goodyear in 1844, and the first rubber condom was produced in 1855.^[7] These early rubber condoms were 1-2mm thick and had seams down the sides.^[5] Although they were reusable, these early rubber condoms were also expensive.

Distribution of condoms in the United States was limited by passage of the Comstock Act in 1873. This law prohibited transport through the postal service of any instructional material or devices intended to prevent pregnancy. Condoms were available by prescription, although legally they were only supposed to be prescribed to prevent disease rather than pregnancy.^[4] The Comstock Act remained in force until it was largely overturned by the U.S. Supreme Court in 1936.

In 1912, a German named Julius Fromm developed a new manufacturing technique for condoms: dipping glass molds into the raw rubber solution. This enabled the production of thinner condoms with no seams. Fromm's Act was the first branded line of condoms, and Fromms is still a popular line of condoms in Germany today.^[7] By the 1930s, the manufacturing process had improved to produce single-use condoms almost as thin and inexpensive as those currently available.^[5]

Condoms were not made available to U.S. soldiers in World War I, and a significant number of returning soldiers carried sexually transmitted infections. During World War II, however, condoms were heavily promoted to soldiers, with one film exhorting "Don't forget — put it on before you put it in."^[4] In part because condoms were readily available, soldiers found a number of non-sexual uses for the devices, many of which continue to be utilized to this day.

Etymology of the term

Etymological theories for the word "condom" abound. It has been claimed to be from the Latin word condon, meaning receptacle.^[4] One author argues that "condom" is derived from the Latin word condamina, meaning house.^[8] It has also been speculated to be from the Italian word guantone, derived from guanto, meaning glove.^[9]

Folk etymology claims 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 verifiable evidence that any such "Dr. Condom" existed.^[9] It is also hypothesized that a British army officer named Cundum popularized the device between 1680 and 1717.^[10]

William E. Kruck wrote an article in 1981 concluding that, "As for the word 'condom', I need state only that its origin remains completely unknown, and there ends this search for an etymology."^[11] Modern dictionaries may also list the etymology as "unknown".^[12]

Other terms are also commonly used to describe condoms. In North America condoms are also commonly known as prophylactics, or rubbers. In Britain they may be called French letters.^[13] Additionally, condoms may be referred to using the manufacturer's name. For example, in India they may be called Nirodh, a government-promoted brand, or KS (after a condom brand name KamaSutra).

Varieties

Most condoms have a reservoir tip, making it easier to leave space for the man's ejaculate. Condoms also come in different sizes, from oversized to snug. As mentioned above, most condoms are made of latex, but polyurethane and lambskin condoms are also widely available.

Latex

Latex has outstanding elastic properties: Its tensile strength exceeds 30 MPa, and latex condoms may be stretched in excess of 800% before breaking.^[14] In 1990 the ISO set standards for condom production (ISO 4074, Natural latex rubber condoms), and the EU followed suit with its CEN standard (Directive 93/42/EEC concerning medical devices). Every latex condom is tested for holes with an electrical current. If the condom passes, it is rolled and packaged. In addition, a portion of each batch of condoms is subject to water leak and air burst testing.^[15]

Latex condoms used with oil-based lubricants (e.g. vaseline) are likely to slip off due to loss of elasticity caused by the oils.^[16]

Some latex condoms are lubricated at the manufacturer with a small amount of a nonoxynol-9, a spermicidal chemical. According to Consumer Reports, spermicidally lubricated condoms have no additional benefit in preventing pregnancy, have a shorter shelf life, and may cause urinary-tract infections in women.^[17] In contrast, application of separately packaged spermicide is believed to increase the contraceptive efficacy of condoms.^[18]

Nonoxynol-9 was once believed to offer additional protection against STDs (including HIV) but recent studies have shown that, with frequent use, nonoxynol-9 may increase the risk of HIV transmission.^[19] The World Health Organization says that spermicidally lubricated condoms should no longer be promoted. However, they recommend using a nonoxynol-9 lubricated condom over no condom at all.^[20] As of 2005, nine condom manufacturers have stopped manufacturing condoms with nonoxynol-9, Planned Parenthood has discontinued the distribution of condoms so lubricated,^[21] and the Food and Drug Administration has proposed a warning regarding this issue.^[22]

Polyurethane

See also: AT-10 Resin

Polyurethane condoms can be thinner than latex condoms, with some polyurethane condoms only 0.02 mm thick.^[23] Polyurethane is also the material of many female condoms.

Polyurethane can be considered better than latex in several ways: it conducts heat better than latex, is not as sensitive to temperature and ultraviolet light (and so has less rigid storage requirements and a longer shelf life), can be used with oil-based lubricants, is less allergenic than latex, and does not have an odor.^[24] Polyurethane condoms have gained FDA approval for sale in the United States as an effective method of contraception and HIV prevention, and under laboratory conditions have been shown to be just as effective as latex for these purposes.^[25]

However, polyurethane condoms may be more likely to slip or break than latex,^[24][26] and are more expensive.

Lambskin

Condoms made from one of the oldest condom materials, labeled "lambskin" (made from lamb intestines) are still available. They have a greater ability to transmit body warmth and tactile sensation, when compared to synthetic condoms, and are less allergenic than latex. However, there is an increased risk of transmitting STDs compared to latex because of pores in the material, which are thought to be large enough to allow infectious agents to pass through, albeit blocking the passage of sperm.^[27]

Experimental

The Invisible Condom, developed at Université Laval in Québec, Canada, is a gel that hardens upon increased temperature after insertion into the vagina or rectum. In the lab, it has been shown to effectively block HIV and herpes simplex virus. The barrier breaks down and liquefies after several hours. The invisible condom is in the clinical trial phase, and has not yet been approved for use.^[28]

As reported on Swiss television news Schweizer Fernsehen on November 29, 2006, the German scientist Jan Vinzenz Krause of the Institut für Kondom-Beratung ("Institute for Condom Consultation") in Germany recently developed a spray-on condom and is test-marketing it. Krause says that one of the advantages to his spray-on condom, which is reported to dry in about 5 seconds, is that it is perfectly formed to each penis.^[29][30]

Effectiveness

In preventing pregnancy

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 improperly, inconsistently, or both. Rates are generally presented for the first year of use.^[3] Most commonly the Pearl Index is used to calculate effectiveness rates, but some studies use decrement tables.^[31]

The typical use pregnancy rate among condom users varies depending on the population being studied, ranging from 10–18% per year.^[32] The perfect use pregnancy rate of condoms is 2% per year.^[3] Condoms may be combined with other forms of contraception (such as spermicide) for greater protection.^[18]

Several factors account for typical use effectiveness being lower than perfect use effectiveness:

• mistakes on the part of those providing instructions on how to use the method
• mistakes on the part of the user
• conscious user non-compliance with instructions.

For instance, someone using condoms might be given incorrect information on what lubricants are safe to use with condoms, or by mistake put the condom on improperly, or simply not bother to use a condom.

In preventing STDs

See also: HIV#Transmission

Condoms are widely recommended for the prevention of sexually transmitted diseases (STDs). 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 HIV, genital herpes, genital warts, syphilis, chlamydia, gonorrhea, and other diseases.^[33]

According to a 2000 report by the National Institutes of Health, correct and consistent use of latex condoms reduces the risk of HIV/AIDS transmission by approximately 85% relative to risk when unprotected. The same review also found condom use significantly reduces the risk of gonorrhea for men.^[34]

A 2006 study reports that proper condom use decreases the risk of transmission for human papilloma virus by approximately 70%.^[35] 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.^[36]

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 can be transmitted by direct contact.^[37] The primary effectiveness issue with using condoms to prevent STDs, however, is inconsistent use.^[15]

Causes of failure

Condom users may experience slipping off the penis after ejaculation,^[38] breakage due to faulty methods of application or physical damage (such as tears caused when opening the package), or breakage or slippage due to latex degradation (typically from being past the expiration date or being stored improperly). Even if no breakage or slippage is observed, 1–2% of women will test positive for semen residue after intercourse with a condom.^[39][40]

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.^[41] 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.^[42]

Standard condoms will fit almost any penis, although many condom manufacturers offer "snug" or "magnum" sizes. 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.^[16]

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 at increased risk of a second such failure.^[43] An article in Population Reports suggests that education on condom use reduces behaviors that increase the risk of breakage and slippage.^[44] 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.^[16]

Among couples that intend condoms to be their form of birth control, pregnancy may occur when the couple does not use a condom. The couple may have run out of condoms, or be traveling and not have a condom with them, or simply dislike the feel of condoms and decide to "take a chance." This type of behavior is the primary cause of typical use failure (as opposed to method or perfect use failure).^[45]

Another possible cause of condom failure is sabotage. One motive is to have a child against a partner's wishes or consent.^[46] Some commercial sex workers report clients sabotaging condoms in retaliation for being coerced into condom use.^[47] Placing pinholes in the tip of the condom is believed to significantly impact their effectiveness.^[40][48]

Female condoms

Main article: Female condom

"Female condoms" or "femidoms" are also available. They are larger and wider than male condoms but equivalent in length. They have a flexible ring-shaped opening, and are designed to be inserted into the vagina. They also contain an inner ring which aids insertion and helps keep the condom from sliding out of the vagina during coitus. One line of female condoms is made from polyurethane or nitrile polymer. A competing manufacturer makes a line of female condoms out of latex. The latex female condom has been available for several years in Africa, Asia, and South America, although one more clinical trial is required before it can be submitted for FDA approval in the United States.

Use

Male condoms are usually packaged inside a foil wrapper, in a rolled-up form, and are designed to be applied to the tip of the penis and then rolled over the erect penis. After use, it is recommended the condom be wrapped in tissue or tied in a knot, then disposed of in a trash receptacle.^[49]

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.^[2]

Prevalence

The prevalence of condom use varies greatly between countries. Japan has the highest rate of condom usage in the world, with condoms accounting for almost 80% of contraceptive use. In the average developed country, 22% of contraceptive users rely on condoms as their primary method of birth control. In the average less-developed country, only 5-6% of contraceptive users choose condoms.^[50] In a few countries, such as Somalia, condoms are illegal.^[51]

Role in sex education

  Condoms are often used in sexual education programs, because they have the capability to reduce the chances of pregnancy and the spread of some sexually transmitted diseases 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."^[52]

In the United States, teaching about condoms in public schools is opposed by some religious organizations.^[53] Planned Parenthood, which advocates family planning and sexual education, argues that no studies have shown abstinence-only programs to result in delayed intercourse, and cites surveys showing that 75% of American parents want their children to receive comprehensive sexuality education including condom use.^[54]

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. Many men prefer collection condoms to masturbation, and some religions prohibit masturbation entirely. Also, compared to 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 IUI.^[55] Adherents of religions that prohibit contraception, such as Catholicism, may use collection condoms with holes pricked in them.^[48]

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.^[56]

Other uses

Condoms excel as multipurpose containers because they are waterproof, elastic, durable, and will not arouse suspicion if found. Ongoing military utilization begun during World War II includes:

• Tying a non-lubricated condom around the muzzle of the rifle barrel in order to prevent barrel fouling by keeping out detritus.^[57]
• The OSS used condoms for a plethora of applications, from storing corrosive fuel additives and wire garrotes (with the T-handles removed) to holding the acid component of a self-destructing film canister, to finding use in improvised explosives.^[58]
• Navy SEALs have used doubled condoms, sealed with neoprene cement, to protect non-electric firing assemblies for underwater demolitions—leading to the term "Dual Waterproof Firing Assemblies."^[59]

Other uses of condoms include:

• Condoms can be used to hold water in emergency survival situations.^[60]
• Condoms have also been used in many cases to smuggle cocaine 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; if the condom breaks, the drugs inside can cause an overdose.^[61]
• In Soviet gulags, condoms were used to smuggle alcohol into the camps by prisoners who worked outside during daylight. While outside, the prisoner would ingest an empty condom attached to a thin piece of rubber tubing, the end of which was wedged between his teeth. The smuggler would then use a syringe to fill the tubing and condom with up to three litres of raw alcohol, which the prisoner would then smuggle back into the camp. When back in the barracks, the other prisoners would suspend him upside down until all the spirit had been drained out. Alexander Solzhenitsyn records that the three litres of raw fluid would be diluted to make seven litres of crude vodka, and that although such prisoners risked an extremely painful and unpleasant death if the condom burst inside them, the rewards granted them by other prisoners encouraged them to run the risk.^[62]
• In his book entitled Last Chance to See, Douglas Adams reported having used a condom to protect a microphone he used to make an underwater recording. According to one of his travelling companions, this is standard BBC practice when a waterproof microphone is needed but cannot be procured.
• Condoms are used by engineers to keep soil samples dry during soil tests.^[63]
• Foot travelers in Amazonic South America wear condoms when wading through water to prevent a small catfish known as candirú from swimming into the urethra. The fish is attracted to the scent of blood and urine.^[64]
• Condoms are used as a one way valve by paramedics when performing a chest decompression in the field. The decompression needle is inserted through the condom, and inserted into the chest. The condom folds over the hub allowing air to exit the chest, but preventing it from entering.^[65]

Debate and criticism

Disposal and environmental impact

Experts recommend condoms be disposed of in a trash receptacle. Flushing down the toilet may clog plumbing or cause other problems.^[49]

While biodegradable,^[49] latex condoms damage the environment when disposed of improperly. According to the Ocean Conservancy, condoms, along with certain other types of trash, cover the coral reefs and smother sea grass and other bottom dwellers. The United States Environmental Protection Agency also has expressed concerns that many animals might mistake the litter for food.^[66]

Condoms made of polyurethane, a plastic material, do not break down at all. The plastic and foil wrappers condoms are packaged in are also not biodegradable. However, the benefits condoms offer are widely considered to offset their small landfill mass.^[49] Frequent condom or wrapper disposal in public areas such as a parks have been seen as a persistent litter problem.^[67]

Position of the Roman Catholic Church

The Roman Catholic Church is the largest organized body of any world religion.^[68] This church has hundreds of programs dedicated to fighting the AIDS epidemic in Africa,^[69] but its opposition to condom use in these programs has been highly controversial.^[70] The Catholic Church directly condemns any artificial birth control or sexual acts aside from intercourse, between married heterosexual partners. However, the use of condoms to combat STDs is not specifically addressed by Catholic doctrine, and is currently a topic of debate among high-ranking Catholic authorities. A few, such as Belgian Cardinal Godfried Danneels, believe the Catholic Church should actively support condoms used to prevent disease, especially serious diseases such as AIDS. However, to date statements from the Vatican have argued that condom-promotion programs encourage promiscuity, thereby actually increasing STD transmission.^[71] Papal study of the issue is ongoing, and in 2006 a study on the use of condoms to combat AIDS was prepared for review by Pope Benedict XVI.^[72]

Health issues

Dry dusting powders are applied to latex condoms before packaging to prevent the condom from sticking to itself when rolled up. Previously, talc was used by most manufacturers, however cornstarch is currently the most popular dusting powder.^[73] Talc is known to be toxic if it enters the abdominal cavity (i.e. via the vagina). Cornstarch is generally believed to be safe, however some researchers have raised concerns over its use.^[73][74]

Nitrosamines, which are potentially carcinogenic in humans,^[75] are believed to be present in a substance used to improve elasticity in latex condoms.^[76] A 2001 review stated that humans regularly receive 1,000 to 10,000 times greater nitrosamine exposure from food and tobacco than from condom use and concluded that the risk of cancer from condom use is very low.^[77] However, a 2004 study in Germany detected nitrosamines in 29 out of 32 condom brands tested, and concluded that exposure from condoms might exceed the exposure from food by 1.5- to 3-fold.^[76][78]

See also

• Condom fatigue
• Male contraceptive
• Safe sex
• Something for the weekend
• State of Louisiana v. Frisard

References