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Condoms Don't Work Upside Down, Other Use Secrets

Testing a condom for holes

Condoms are an effective form of birth control and are especially important for helping prevent the spread of sexually transmitted diseases (STDs). However, when condoms are used incorrectly, including upside down, then the benefits of condoms vanish, and this is a problem occurring around the world, according to new research.

The problem of condom use is explored

The new special issue of Sexual Health has brought together a collection of studies on condom use from around the world, and one thing appears clear: problems with use of this basic form of contraception and disease prevention know no boundaries.

More than 20 researchers from around the globe have presented their findings on topics such as counterfeit condoms in China, female condoms used in South Africa, and problems and misuse of condoms. The effort was led by The Kinsey Institute Condom Use Research Team (CURT).

Of special interest is a study entitled “Condom use errors and problems: a global view,” in which an international team of researchers evaluated 50 studies on the topic from 14 different countries. The studies spanned the period 1995 to 2011.

They pointed out the most common errors associated with condom use, including not using condoms throughout the entire sexual act, not squeezing air out of the tip, not leaving space at the top of the condom, putting the condom on upside down, withdrawing incorrectly, and not using water-based lubricants.

Other ways condoms are used incorrectly include unrolling the condom completely before putting it on, reusing a condom during the same sexual encounter, and not checking condoms for damage (e.g., holes, tears).

For example, in a US study of 221 university undergraduates, 38% reported they either put the condom on too late or removed it too early. In a Canadian anonymous survey among gay and bisexual men, nearly half of more than 6,000 men admitted late application of a condom during anal sex. These and other misuses of condoms expose users and their partners to disease.

Among the problems people most often reported with condom use was breakage, slippage, leaky condoms, erection problems associated with condom use, and difficulties with fitting the condom correctly and how the condom feels.

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A study from mainland China reflects a problem with condom breakage. In data taken from the National Survey of Fertility and Contraceptive Practice, condom failure was reported by 19% of 1,753 condom users.

A major concern that arises from the findings of this review about the errors and problems associated with condom use, according to the authors, is that they “may not only compromise condom efficacy, but may also discourage condom use if people become frustrated or have less pleasurable experiences as a result of them.”

The dangers of condom misuse
According to Richard Crosby, professor at the University of Kentucky, lead editor for Sexual Health’s special issue, and a member of CURT, “While we’d like to think the AIDS epidemic is going away, it’s not. In the US, it’s getting worse.” He and his fellow CURT researchers note the importance of ensuring condoms are used properly to reduce unplanned pregnancies and the spread of STDs.

Compared with the costs associated with unplanned births as well the medications and medical costs related to HIV and AIDS, condoms are an inexpensive solution and one that can be readily put into the hands of users. Crosby calls condoms “the vaccine we’ve been waiting for.”

Getting this vaccine into the hands of the men and women who need them is not enough, however, as the zone between correct use of condoms and how they are being used is full of potholes. Crosby pointed out the need for clinic-based counseling as well as public education and Internet-based instruction and discussion to help eliminate ignorance and embarrassment about condom use.

Although a condom appears to be a simple object to use, Crosby warned that “We chronically underestimate how complicated condom use can be.” All it takes is one incorrect use of a condom for disease to be transmitted or for an unplanned pregnancy to occur.

Tips on how to use a condom correctly are offered by the Centers for Disease Control and Prevention:

  • Use a new condom for every sexual act (vaginal, oral, anal) and throughout each entire sex act
  • Apply the condom before any genital contact is made.
  • A condom is put on the tip of the erect penis with the rolled side out.
  • For condoms that do not have a reservoir in the tip, pinch the tip to allow one-half inch space for semen to collect. Hold the tip while you unroll the condom down to the base of the erect penis
  • Do not remove the condom until ejaculation is complete but before the penis gets soft. Grip the rim of the condom and withdraw the penis from your partner.
  • Gently remove the condom from the penis, being careful to avoid spilling any semen.
  • Wrap the condom in a tissue and dispose of it in the trash.
  • If the condom breaks at any time during sexual activity, withdraw immediately and carefully, remove the broken condom, and put on a new one.
  • If you use lubricant, only apply water-based products, because oil-based lubricants can cause breakage of latex condoms.

Condoms are an inexpensive and readily available source of protection against STDs and unplanned pregnancies, but the secret to effective condoms is proper use. Condoms may not work when they are upside down, put on too late, removed too soon, or if they break, and the consequences could be dire.

Centers for Disease Control and Prevention
Sanders SA, Yarber WL, Kaufman EL, Crosby RA, Graham CA, Milhausen RR. Condom use errors and problems: a global view. Sexual Health 2012; 9(1): 81-95
Sexual Health. Condom use to prevent sexually transmitted infections: a global perspective. 2012, volume 9, number 1
University of Indiana

Image: Courtesy Wikimedia Commons