MALE AND FEMALE CONDOM
The male condom is the only method of contraception that has been shown to prevent transmission of sexually transmitted infections, so its use by individuals at risk for infection should be encouraged. The male condom should not be applied tightly against the tip of the penis, but rather the condom tip should extend beyond the end of the penis by about half an inch to collect the ejaculate. Care must be taken on withdrawal not to spill the ejaculate. When used by strongly motivated couples, the male condom is very effective. The male condom has a “typical use” failure rate of 14%. Recent studies have shown that teens were most likely to use condoms for birth control and that 66% used a condom when they became sexually active.7 The male condoms provide a physical barrier that prevents sperm and egg interaction. They are intended for one-time use only. Condoms also provide protection against HIV and STI.
Male condoms have been used since ancient times, with early condoms made from animal intestine. Mass production began in the 1840s with the advent of vulcanized rubber. Modern condoms are most often made of latex or polyurethane, but those made from animal intestine do still exist. Polyurethane condoms provide increased sensitivity for male partners, but the breakage and slippage rates are significantly higher (relative risk, 6.6 for breakage and 6.0 for slippage) compared with latex condoms (Frezieres et al., 1998) (Level of evidence: A). This suggests that latex condoms should be encouraged except for those with latex allergy/sensitivity.
Most male condoms are made of latex, which has the disadvantage of the potential for latex sensitivity, breakage when used with oil‐based lubricants, and decreased penile sensitivity. However, latex offers the advantage of protection from sexually transmitted infections including HIV. Condoms made of other materials such as polyurethane are expected to offer the same protection against STDs and HIV based on in vitro studies, but clinical studies have not been completed. “Natural skin” (lamb's intestine) condoms are available, but HIV and other organisms that cause STDs can penetrate condoms made from intestine.
The female condom consists of a pouch made of polyurethane that lines the vagina, with an internal ring in the closed end of the pouch that covers the cervix and an external ring that remains outside of the vagina, partially covering the perineum. These condoms are more cumbersome than male condoms, with relatively high rates of problems such as slippage. However, with experience, problems with use decrease. The female condom should be an effective barrier to STD infection; however, this issue has not been fully studied yet. This form of barrier contraception has the theoretical advantage of allowing the woman to have control in preventing STDs.
