The condom is a sheath (cover) that forms a barrier to prevent pregnancy or the transfer of the human immunodeficiency virus (HIV) and other sexually transmitted diseases (STDs) during sexual intercourse. There are male and female versions, but the male condom is more commonly used.

Male condoms are placed over the male’s erect penis before the penis comes into contact with any part of the partner’s body. They are made of latex rubber, lamb intestines (lambskin or natural condoms) or a type of plastic known as polyurethane. Lambskin condoms are not recommended for disease prevention because they have tiny holes that allow viruses to pass through.

Currently, there is only one female condom available. Made of polyurethane, the female condom consists of an inner ring and an outer ring. The inner ring, which has a closed end, is placed inside the vagina. The outer ring, which is the condom’s open end, is left outside the vagina.

The Food and Drug Administration (FDA) estimates that in the United States, the failure of male condoms results in about 11 pregnancies per 100 women. However, the female condom is less effective. It is linked with approximately 21 pregnancies out of every 100 women. The female condom also offers less protection against disease. According to the FDA, the male latex condom is the most effective method for reducing the risk of infection from HIV and other STDs (with the exception of abstinence). However, the risk of pregnancy or contracting a disease relies on correct and consistent use of condoms.

Women who use other forms of contraception, such as birth control pills or a diaphragm, are encouraged to have their partner use condoms as well. Condoms should be used with other forms of birth control because they offer the best protection against STDs.

A condom is a sheath, or cover, commonly used as a contraceptive. Using a condom is an effective method of preventing sexually transmitted diseases (STDs) as well as preventing pregnancy. With the exception of vasectomy, condoms are the only method of birth control available to men.

The condom acts as a barrier. It provides women with protection from contact with semen, which can result in pregnancy. It also protects women from pre-ejaculatory fluid and penile lesions that may carry STD-causing agents. Men are also protected from disease-causing agents that may be present in their partner’s vagina, rectum or mouth. Condoms come in a variety of sizes, textures and colors, and there are male and female forms.

When placed over an erect penis before penetration, the male condom prevents pregnancy by blocking the passage of sperm. Some condoms have added spermicide that destroys sperm. However, the addition of spermicide to a condom has not been proven to provide additional protection over use of a condom alone.

Male condoms are designed for one-time use. The majority of male condoms are made of latex rubber. However, individuals with latex allergies may benefit from alternatives, such as condoms made from lamb intestines, known as lambskin condoms or natural condoms, and condoms made from a type of plastic known as polyurethane. Polyurethane condoms are a good alternative for contraception or STD prevention. However, lambskin condoms are generally not recommended for STD prevention. Although they provide protection against pregnancy, they have microscopic holes that allow viruses to pass through to the organs.

According to the Food and Drug Administration (FDA), with the exception of abstinence (abstaining from sex), male latex condoms are the most effective method for reducing the risk of infection from HIV and other STDs, including gonorrhea, chlamydia and trichomoniasis. When used consistently and correctly, latex condoms offer protection during all sexual activities, whether vaginal, oral or anal. They can also protect fetuses from STDs when an uninfected pregnant woman engages in sexual intercourse. 

Latex condoms also reduce the risk of contracting genital herpes, syphilis, chancroid and the human papillomavirus (HPV), which significantly increases a woman’s risk of developing cervical cancer. However, to provide protection from these viruses and, in the case of HPV, cervical cancer also, the infected areas must be fully covered or protected by the condom. Condoms do not offer protection from infections spread from sores on the base of the penis, scrotum or other areas not covered by the sheath.

There are also a variety of novelty condoms available, as well as condoms that do not cover the entire penis. These types of condoms may not provide protection from diseases or pregnancy. Condoms that provide adequate protection should have this information on the label. Unless a condom’s label states that it provides protection against disease and/or pregnancy, it should not be used for these purposes.

Approved in 1993 by the FDA, the female condom is a soft, thin polyurethane sheath shaped similarly to a male condom. It features two flexible rings – an outer ring and an inner ring. The inner ring has a closed end that is inserted into the vagina. It helps to hold the condom in place during intercourse and creates a barrier between the sperm and the cervix. The outer ring is the condom’s open end. It remains outside the vagina, covering the area around the opening of the vagina. Like male condoms, the female condom is designed for one-time use. Female condoms are not approved for anal intercourse.

Condoms are available without a prescription in numerous locations, such as pharmacies and grocery stores. Additionally, many community health centers and organizations distribute free condoms to individuals. Male condoms are available in a variety of lengths, widths and thicknesses. The fit of a condom is important because a condom that is too tight is likely to break, and a condom that is too loose may slip off the penis. Male condoms are available with or without lubrication. Currently, there is only one female condom available, and it is available only with a lubricant. The lubricants and spermicides that are present in some condoms may cause irritation of the vagina or penis. If any irritation occurs with either partner, condoms should be used without the spermicide or lubricant.

Both the male and the female condoms are reversible forms of contraception. They do not affect the long term reproductive function of either partner, so conception is possible immediately after the condom is removed with subsequent intercourse.

With the exception of abstinence, condoms are the least expensive and most available method of contraception and disease protection. For women using other forms of contraception, such as birth control pills or a diaphragm, condoms should always be used in combination with these methods with high-risk partners to protect against HIV and other STDs.

The FDA estimates that in the United States, use of the male condom results in approximately 11 pregnancies per 100 women each year. However, the female condom offers less protection. The FDA estimates that approximately 21 out of every 100 women become pregnant while using a female condom each year.

Condoms greatly reduce STD-infection risk, but they do not provide 100 percent protection from STDs. Though sex with a condom is often referred to as “safe sex,” “less risky sex” is a more accurate term. While it offers some protection against disease, the female condom is less effective than the male latex condom in preventing disease. 

The risk of pregnancy or contracting an STD relies on using condoms correctly and consistently. There is also a risk of a condom tearing or breaking during use. To evaluate the quality of condoms, the FDA conducts a “water spot” test. In this test, a random sample of condoms are selected from a manufacturer and filled with water. An average of 996 out of 1,000 condoms must pass this test. Several studies indicate that about 2 percent of condoms will break during use. The risk of tearing may be reduced by using condoms that are lubricated or applying lubricant to non-lubricated condoms. The FDA links the use of drugs and alcohol with an increased risk of using a condom incorrectly or forgetting to use one at all.

To ensure maximum protection against pregnancy, human immunodeficiency virus (HIV) and other sexually transmitted diseases (STDs), condoms must be used correctly.

To use a male condom:

1. The condom should be put on after the penis is erect, and before the penis makes contact with any part of the partner’s body. This will prevent exposure to body fluids that may cause pregnancy or carry disease.
   
   
2. If using spermicide or lubricant, put some inside the tip of the condom.  
   
   
3. If the condom does not have a reservoir tip, pinch the tip enough to leave a half-inch (1 centimeter) space. This will create a space in which the sperm can be collected.
   
   
4. If the penis has a foreskin, pull it back before putting on the condom.
   
   
5. Squeeze the tip of the condom to remove any air that may be trapped inside. While pinching the half-inch tip, place the condom on the erect penis and unroll it all the way to the base of the penis. The rolled up ring should be on the outside. If it is not, the condom is on wrong. Throw it away and apply a new one. If the condom does not unroll, it is on the penis incorrectly. Throw it away and place a new condom on the penis. All condoms must be thrown away in these situations because once they are in place, they may contain semen.
   
   
6. Use your hand to smooth out any air bubbles. This will ensure that the condom fits the penis correctly. Removing the air also makes it less likely for the condom to break or come off.
   
   
7. Put more spermicide or lubricant on the outside of the condom prior to intercourse to prevent possible tearing or breakage.  
   
   
8. After ejaculation, remove the penis while it is still erect. Firmly grip the base of the condom and carefully withdraw from the partner’s body. This will prevent the condom from slipping off the penis and spilling semen into the vagina.
   
   
9. To remove the condom from the penis, pull it off gently. Be cautious not to spill any semen out of the condom.
   
   
10. Wrap the condom in a tissue and throw it in the trash where others will not handle it. Condoms should not be flushed in the toilet because they may cause problems in sewers.
    
    
11. Wash hands with soap and water.

Additional steps to using a male condom correctly include:

• Do not reuse a condom. A new condom should be used with every sexual act.
  
  
• Open the condom wrapper carefully. Do not use teeth, fingernails or other sharp objects to open the wrapper. This may cause the condom to tear. Jewelry, zippers and belt buckles can also cause a tear.
  
  
• Do not use a condom that looks defective. The condom should not stick to itself or appear gummy. The tip of the condom should also be checked for flaws, such as brittleness, tears or holes. The condom should not be unrolled when checking for damage. This could cause the condom to tear.
  
  
• Do not use oil-based lubricants. Condoms should not come into contact with oil in any form. Lubricants that contain oils, fats or grease, such as petroleum jelly, baby oil and hand and body lotions should never be used. These products can deteriorate the rubber and cause it to break. Only condom-friendly, water-based lubricants should be used.
  
  
• Store condoms correctly. Condoms should be stored in a cool, dry place away from extreme temperatures. They should be kept in their package and away from direct sunlight. When stored incorrectly, condoms may become brittle or gummy, making them likely to break. A closet or drawer is a good place to store condoms. They may also be carried in a loose pocket, wallet or purse, but only for a few hours. Condoms should not be placed in a hot location, such as a car’s glove compartment.
  
  
• Always check the expiration date before using a condom. Expired condoms should not be used.
  
  
• Do not use a damaged condom. A condom should not be used if it appears sticky, stiff or looks damaged in any other way.
  
  
• Stop intercourse immediately if the condom breaks. If the condom breaks, the man should immediately withdraw from his partner. Protection from pregnancy and STDs may have been compromised. A new condom should be put on and additional spermicide should be used.

Unlike the male condom, the female condom may be inserted up to eight hours before intercourse. To use a female condom:

1. While holding the condom at its closed end, grab the flexible inner ring and squeeze it closed with the thumb and second or middle finger. This will make the ring long and narrow.
   
   
2. Assume a comfortable position for insertion. The woman can squat, raise one leg, sit or lie down for insertion.
   
   
3. Gently insert the inner ring into the vagina. The woman should feel the ring move up and set into place.
   
   
4. Place the index finger into the condom, and use the finger to push the inner ring up as far as it will go. Caution should be taken not to puncture or tear the condom during this step.
   
   
5. Be sure the condom is not twisted, and that the outer ring is outside the vagina.
   
   
6. Use a hand to gently guide the penis into the opening of the condom. Be sure the penis is entering the condom correctly, and not entering between the side of the condom and the vaginal wall. Appropriate lubrication may help prevent any tearing of the condom.
   
   
7. After intercourse, remove the condom by twisting the outer ring and gently pulling the condom out. This will prevent the semen from spilling out. The condom does not need to be removed immediately after intercourse, but should be removed before the woman stands up to avoid spilling the semen.
   
   
8. Wrap the condom in its original packaging or in a tissue and throw it in the garbage where others will not handle it. Condoms should not be flushed in the toilet because they may cause problems in sewers.

Like the male condom, the female condom should be opened carefully to avoid tearing. The female condom should be used only once, and never used past its expiration date. The Food and Drug Administration (FDA) has approved a shelf life for female condoms of five years past the date of manufacture. Unlike male condoms, the female condom does not require special storage. The polyurethane it is made from is much more resistant to temperature and other conditions. The female condom can also be used with either water-based or oil-based lubricants.

Male and female condoms should not be used at the same time. The condoms may get stuck together, causing one or the other to slip out of place during intercourse.

Preparing questions in advance can help patients have more meaningful discussions with their physicians regarding their conditions. Patients may wish to ask their doctor or healthcare professional the following questions regarding condoms:

1. How effective is a condom in preventing pregnancy?
   
   
2. Will a condom protect me from all STDs?
   
   
3. Are certain condoms better than others for protection?
   
   
4. Should I consider using another form of contraception in addition to a condom?
   
   
5. What are my alternatives if my partner or I am allergic to latex?
   
   
6. What is the difference between latex and other types of condoms?
   
   
7. What should I do if the condom breaks?
   
   
8. What should I do if the condom falls off during sex?
   
   
9. Will any lubricants or gels make the condoms more likely to break or reduce their protection?
   
   
10. Why should I use a condom for oral or anal sex?
    
    
11. What should I do if I develop irritation from condom use?
    
    
12. Can a condom become “lost” if it falls off during intercourse?