A condom is a sheath, usually latex, that fits snugly over the erect penis and prevents sperm from entering the vagina. Male condoms are an ancient method of contraception. The earliest ones, made of animal skin, gave some protection, although they probably did not fit well and must have leaked.

Figure Male condoms offer the best protection against sexually transmitted diseases including human immunodeficiency virus. When used correctly together with a spermicide, they are also an effective means of contraception.

Condoms got a big technological boost in 1839 when Charles Goodyear invented vulcanization, a process that made rubber stronger and more resilient. Today they come in all sorts of sizes, shapes, and colors, some with little dots, ticklers, or other devices to enhance sexual pleasure. Some are coated with spermicides, which may offer extra protection, though it is safer to use an additional spermicide in the vagina. Some are prelubricated. However, a basic plain latex condom will certainly suffice.

Certain condoms are still made of animal skin (usually lamb membrane), but these are less effective and more expensive (around four dollars apiece) than the latex ones. Buy latex condoms that are labeled disease protectant. If you are allergic to latex, polyurethane condoms, which cost one to two dollars apiece, are available.

How do you use a male condom properly?

Use a new condom for each act of intercourse, whether oral, anal, or vaginal. Be careful when opening the package, so that you do not tear the condom inside.

Unroll the condom approximately one-half inch, then place the open end over the erect penis. This extra half inch should hang loosely past the head of the penis to catch the semen. Many condoms have reservoir tips that serve the same purpose. Squeeze the end to make sure no air is trapped inside. Then unroll the condom all the way down to the base of the penis, being careful that your fingernails do not puncture or tear the latex. The rolled rim should be on the outside. If the condom is not prelubricated, or if you want additional lubrication, choose a water-based lubricant such as Aqualube or Astroglide, available at many pharmacies. Oil-based lubricants (petroleum jelly, cold cream, hand lotion, cooking oil, or baby oil) can weaken the latex and cause condom failure.

The man should withdraw his penis from his partner while it is still erect (to keep the condom from leaking), holding the condom firmly to keep it from slipping off. Throw away the used condom, preferably wrapping it first in a tissue so that others do not need to handle it; do not flush it down the toilet. Never reuse a condom. And do not use a condom after the expiration date or if it is damaged.

Store condoms in a cool place away from direct sunlight (which also causes the latex to deteriorate). Extreme temperatures — especially heat — can make latex brittle or gummy (like an old balloon). Don’t keep them in a hot glove compartment in the car. If you want to keep one with you, put it in a loose pocket, wallet, or purse.

What should I do if a condom breaks or comes off during intercourse?

Insert spermicide into your vagina as soon as possible. If you are at midcycle, near ovulation, talk with your caregiver about morning-after contraception.

How reliable are condoms?

In theory, male condoms used along with a spermicidal jelly or foam are 98 percent reliable. Condoms used alone, without a spermicide, are said in published studies to have a reliability of about 88 percent, although my medical experience suggests that they are more reliable, perhaps 96 percent.

What are their advantages and disadvantages?

Latex condoms have one very important attribute that many other forms of birth control lack: they protect against sexually transmitted diseases as well as pregnancy. Since the active ingredient in many spermicides, nonoxynol-9, is thought to reduce your chance of contracting an sexually transmitted disease, condoms plus spermicide give you the best available protection (except, of course, for abstinence) against sexually transmitted diseases. Other advantages include reliability, availability (you don’t need a prescription), and low cost. Depending on where you buy them, how many you buy at once, and how plain or fancy they are, condoms can cost from less than forty cents to more than a dollar apiece. Spermicides cost seven to ten dollars for a 3.8-ounce tube.

On the negative side, your partner needs to use a condom for each and every occasion of intercourse. Condoms do interfere with spontaneity, but some couples deal with this by having the woman put the condom on the man. Some men dislike them and complain that they dull sensation, but as I say to my patients, if he won’t wear a condom to protect you (and himself) against disease, you don’t need him.


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