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Condoms: Effectiveness, History and Availability
Effectiveness of condoms
Are condoms effective at preventing HIV and sexually transmitted diseases (STDs)?
The evidence for the effectiveness of condoms is clearest in studies of couples in which one person is infected with HIV and the other not (discordant couples). In a study of discordant couples in Europe, among 123 couples who reported consistently using condoms, none of the uninfected partners became infected. In contrast, among the 122 couples who used condoms inconsistently, 12 of the uninfected partners became infected.2 A recent review of 14 studies involving discordant couples concluded that consistent use of condoms led to an 80% reduction in HIV incidence.3 4
The male latex condom is the single, most efficient, available technology to reduce the sexual transmission of HIV and other sexually transmitted infections.UNAIDS, WHO and UNFPA7
Condoms must be used consistently and correctly to provide maximum protection. Consistent use of condoms means using a condom from start to finish with each act of intercourse. Correct condom use should include:8
- Use a new condom for each act of intercourse
- Put on the condom as soon as erection occurs and before any sexual contact (vaginal, anal or oral).
- Hold the tip of the condom and unroll it onto the erect penis, leaving space at the tip of the condom, yet ensuring that no air is trapped in the condom's tip.
- Adequate lubrication is important, but use only water-based lubricants on latex condoms. Oil-based lubricants such as petroleum jelly (vaseline), cold cream, hand lotion or baby oil can weaken the latex condom and are not recommended.
- Withdraw from the partner immediately after ejaculation, holding the condom firmly to keep it from slipping off.
Find more information about using condoms.
How often do condoms fail?
“The main reason that condoms sometimes fail is incorrect or inconsistent use, not the failure of the condom itself”
There is no one answer to this, as different studies have shown different results. Many studies of condom effectiveness have counted how often women have become pregnant when their partners have used condoms for birth control. This "failure rate" includes cases where the couple did not use a condom every time they had sex, or they did not use the condom correctly. Some studies have included the times the condom was torn accidentally by people using it.9
The main reason that condoms sometimes fail to prevent HIV/STD infection or pregnancy is incorrect or inconsistent use, not the failure of the condom itself. Using oil-based lubricants can weaken the latex, causing the condom to break. Condoms can also be weakened by exposure to heat or sunlight or by age, or they can be torn by teeth or fingernails. Also, remember to check the expiry date of your condom!
How often do condoms break or slip off?
A large body of research in the United States has shown that rates of breakage, caused by fault in the condom itself, are less than 2 condoms out of every 100 condoms. Studies also indicate that condoms slip off the penis in about 1-5% of acts of vaginal intercourse and slip down (but not off) about 3-13% of the time.10
Various studies have shown that knowledge and familiarity with the use of condoms reduce the likelihood of condom breakage and slippage during sex.11 A major factor that can lead to a condom breaking or slipping off during sex is it's size, as this can affect how easy it is to put on and how likely it is to stay on. Different sizes of condoms are available, and it is important to make sure that the condom being used is the correct fit.12
How are condoms tested?
Different countries have different regulatory agencies. In the United States, the Food and Drug Administration (FDA) regulates condoms to ensure their safety and effectiveness. Condoms in Europe that have been properly tested and approved should carry the CE Mark. Elsewhere in the world, you can find that condoms are approved by the International Organization for Standardization (ISO). Also, individual countries may have their own approval marks for condoms, for example, the Kitemark in the UK.
WHO guidelines set out a range of test requirements, which are necessary for ensuring the quality of each lot of condoms purchased. Based on international standards set out by the ISO,13 these include tests which establish bursting volume and pressure, and detect holes and other visible defects.14 Examples of the tests used by condom manufacturers include the 'water leak test', which reveals any holes in a condom, and the 'air burst test' or 'tensile test', which show whether a condom is likely to break during use.
How many condoms are used each year?
According to the United Nations Population Fund (UNFPA), an estimated 10.4 billion male condoms were used worldwide in 2005. Of these, around 4.4 billion condoms were used for family planning and 6.0 billion condoms for HIV prevention.15 It has been estimated that in 2015, nearly 18 billion condoms will be needed in low- and middle-income countries.16
Donor support for condoms
In most countries where the HIV prevalence rate is high many people cannot afford to purchase condoms. Sexually active adults and teenagers must rely on condoms that are provided for free or sold at a subsidised low price. Governments often supply and promote condoms, but many countries rely almost entirely on donations from outside agencies such as the UNFPA and the U.S. Agency for International Development (USAID).
The UNFPA records information on the quantities of condoms donated to countries worldwide by a range of organisations. Analysis of data collected between 1990 and 2008, as displayed in the graph, shows that the number of condoms donated has risen. Before 1996 however, the supply of condoms was always able to meet the demand, yet in recent years that has not been the case.
The UNFPA estimates that at least 13.1 billion condoms were needed in 2005 to significantly reduce the spread of HIV, and another 4.4 billion were required for family planning. The number of condoms donated in 2005 was only 2.3 billion - representing less than 15% of the need. Although numbers rose sharply to 3.1 billion in 2007, they have subsequently decreased again to 2.4 billion in 2008.17
Between 2000 and 2005, fourteen countries received an average of more than 10 donated condoms per man per year. All of these countries have widespread HIV epidemics and, with the exception of Haiti, all of them are in sub-Saharan Africa. At the very top of the list were Congo, Zimbabwe, Namibia and Cape Verde, each of which received more than 20 condoms per man per year.
Developing countries outside sub-Saharan Africa tend to receive much lower numbers of donated condoms per man, with an average below one condom per man per year.18
The history of condoms
The use of condoms has been traced back several thousand years. It is believed that around 1000 BC the ancient Egyptians used a linen sheath for protection against disease.19
100 - 200 AD
The syphilis epidemic that spread across Europe gave rise to the first published account of the condom. Gabrielle Fallopius described a sheath of linen he claimed to have invented to protect men against syphilis.22 Having been found useful for prevention of infection, it was only later that the usefulness of the condom for the prevention of pregnancy was recognised.
Later in the 1500s, one of the first improvements to the condom was made, when the linen cloth sheaths were sometimes soaked in a chemical solution and then allowed to dry prior to use. These were the first spermicides on condoms.23
The first published use of the world 'condum' was in a 1706 poem.24 It has also been suggested that Condom was a doctor in the time of Charles II. It is believed that he invented the device to help the king to prevent the birth of more illegitimate children.25
Even the most famous lover of all, Casanova, was using the condom as a birth control as well as against infection.26
Condoms made out of animal intestines began to be available. However, they were quite expensive and the unfortunate result was that they were often reused. This type of condom was described at the time as "an armour against pleasure, and a cobweb against infection".
In the second half of the 1700's, a trade in handmade condoms thrived in London and some shops where producing handbills and advertisements of condoms.27
Condom manufacturing was revolutionised by the discovery of rubber vulcanisation by Goodyear (founder of the tyre company) and Hancock. This meant that it was possible to mass produce rubber goods including condoms quickly and cheaply. Vulcanisation is a process, which turns the rubber into a strong elastic material.28
In 1861,the first advertisement for condoms was published in an American newspaper when The New York Times printed an ad. for 'Dr. Power's French Preventatives.'
In 1873, the Comstock Law was passed. Named after Anthony Comstock, the Comstock Law made illegal the advertising of any sort of birth control, and it also allowed the postal service to confiscate condoms sold through the mail.29
In 1919, Frederick Killian initiated hand-dipping from natural rubber latex in Ohio. The latex condoms had the advantage of ageing less quickly and being thinner and odourless. These new type of condoms enjoyed a great expansion of sales. By the mid-1930s, the fifteen largest makers in the U.S. were producing 1.5 million condoms a day.30
In 1957, the very first lubricated condom was launched in the UK by Durex.31
From the early 1960s, the use of condoms as a contraceptive device declined as the pill, the coil and sterilisation became more popular.32
The use of the condom increased strikingly in many countries following the recognition of HIV and AIDS in the 1980's. Condoms also became available in pubs, bars, grocery stores and supermarkets.
The female condom has been available in Europe since 1992 and it was approved in 1993 by the US Food and Drug Administration (FDA).
In 1994, the world's first polyurethane condom for men was launched in the US.
The 1990s also saw the introduction of coloured and flavoured condoms.
In more recent years, improved technology has enabled the thickness of the condom to decrease. Also, condom manufacturers have recognised that one size of condom does not fit all. You can now find condoms that are different shapes, widths and lengths.
- 1. CDC (2008) 'Male latex condoms and sexually transmitted diseases', Fact sheet for public health personnel
- 2. De Vincenzi I. (1994) 'A longitudinal study of human immunodeficiency virus transmission by heterosexual partners', the New England Journal of Medicine; 331:341-346
- 3. Weller SC & Davis-Beaty K (2007), 'Condom effectiveness in reducing heterosexual HIV transmission'.
- 4. CDC (2008) 'Male latex condoms and sexually transmitted diseases', Fact sheet for public health personnel
- 5. CDC (2008) 'Male latex condoms and sexually transmitted diseases', Fact sheet for public health personnel
- 6. Holmes K. (2004, June), 'Effectiveness of condoms in preventing STIs' Bulletin of the World Health Organization 82(6).
- 7. UNAIDS, WHO and UNFPA (2009), 'Position Statement on Condoms and HIV Prevention'.
- 8. CDC (2008), 'Male Latex Condoms and Sexually Transmitted Diseases: Condom Fact Sheet'
- 9. Sexuality Information and education Council of the United States (SIECUS) (2002) 'Fact Sheet: The truth about condoms', November
- 10. CDC (1999) 'Condoms and their use in preventing HIV infection and other STDs', September
- 11. National Institute of Allergy and Infectious Diseases, Department of Health and Human Services (2001, 20th July), 'Scientific Evidence on Condom Effectiveness for Sexually Transmitted Disease (STD) Prevention'.
- 12. UNAIDS (2001, May), 'The Male Latex Condom: 10 Condom Programming Fact Sheets'.
- 13. International Organization for Standardization, '4074: Natural latex rubber condoms - requirements and test methods'.
- 14. WHO (2010), 'The Male Latex Condom: Specification and Guidelines for Condom Procurement'.
- 15. UNFPA (2005) 'Donor Support for Contraceptives and Condoms for STI/HIV Prevention 2005'
- 16. Reproductive Health Supplies Coalition (2009), 'Contraceptive projections and the donor gap'.
- 17. UNFPA (2008) 'Donor Support for Contraceptives and Condoms for STI/HIV Prevention 2008'.
- 18. UNFPA (2005) 'Donor Support for Contraceptives and Condoms for STI/HIV Prevention 2005'
- 19. Youssef (1993), 'The history of the condom' Journal of the Royal Society of Medicine 86(4).
- 20. Allen D (2006), 'Condoms: From Inception to Now' Journal of the Health Resource Center 5(2).
- 21. Himes N.E. (1936) 'Medical history of contraception', Baltimore: Williams and Wilkins in Lewis M. 'A Brief history of condoms' in Mindel A. (2000) 'Condoms', BMJ books
- 22. Langley L. L. (ed)(1973) 'Contraception' Stroudsburg: Dowden, Hutchinson and Ross in Lewis M. 'A Brief history of condoms' in Mindel A. (2000) 'Condoms', BMJ books
- 23. Fryer P. (1965) 'the Birth controllers', London: Secker and Warburg and Dingwall EJ. (1953) 'Early contraceptive sheaths' BMJ, Jan 1: 40-1 in Lewis M. 'A Brief history of condoms' in Mindel A. (2000) 'Condoms', BMJ books
- 24. Fryer P. (1965) 'the Birth controllers', London: Secker and Warburg and Dingwall EJ. (1953) 'Early contraceptive sheaths' BMJ, Jan 1: 40-1 in Lewis M. 'A Brief history of condoms' in Mindel A. (2000) 'Condoms', BMJ books
- 25. Lewis M. 'A Brief history of condoms' in Mindel A. (2000) 'Condoms', BMJ books
- 26. Fryer P. (1965) 'the Birth controllers', London: Secker and Warburg and Dingwall EJ. (1953) 'Early contraceptive sheaths' BMJ, Jan 1: 40-1 in Lewis M. 'A Brief history of condoms' in Mindel A. (2000) 'Condoms', BMJ books
- 27. Himes N.E. (1936) 'Medical history of contraception', Baltimore: Williams and Wilkins in Lewis M. 'A Brief history of condoms' in Mindel A. (2000) 'Condoms', BMJ books
- 28. Durex, 'History of Condoms' (accessed 11/10/09) and Lewis M. 'A Brief history of condoms' in Mindel A. (2000) 'Condoms', BMJ books
- 29. Law Library - American Law and Legal Information, 'Comstock law of 1873'.
- 30. Lewis M. 'A Brief history of condoms' in Mindel A. (2000) 'Condoms', BMJ books
- 31. Durex, 'History of Condoms' (accessed 11/10/09).
- 32. Lewis M. 'A Brief history of condoms' in Mindel A. (2000) 'Condoms', BMJ books