Male Condom

Aka: Male Condom, Condom

1. Efficacy
   1. Overall Failure rate: 10-14% (3% with perfect use)
   2. Sexually Transmitted Disease transmission
      1. Cervical gonorrhea Relative Risk < 0.97
      2. Urethral gonorrhea Relative Risk < 0.51
      3. Pelvic Inflammatory DiseaseRelative Risk < 0.6
      4. HIV Transmission to partner: 10% (86% if no Condom)
   3. Avoid Condoms with Nonoxynol-9 (Gynol II)
      1. See Spermicide
      2. Associated with irritation and no additional protection against pregnancy
      3. Increases risk of Gonorrhea and HIV Transmission
2. Risks Factors: Breakage (occurrence: 1 in 161 acts)
   1. Shearing (5.9% with anal sex)
   2. Lack of lubrication
   3. Petroleum based lubricants (Vaseline, oils, fungicides)
   4. Hot, humid climates
3. Types
   1. Latex
      1. Standard recommendation
      2. Best data in protection from Sexually Transmitted Infection and pregnancy
      3. Latex Condoms are effective in STD prevention in vaginal intercourse and anal intercourse
         1. Additional FDA approval for anal use (e.g. One Condom) applies more to marketing than efficacy
   2. Natural membrane
      1. Does not prevent Sexually Transmitted Disease
      2. Use inside of latex Condom if Latex Allergy
   3. Polyurethane (e.g. Avanti, Tactylon)
      1. Less biodegradable
      2. Consider in Latex Allergy, or when patients are on an oil based vaginal product (e.g. Clindamycin, Clotrimazole)
      3. Higher breakage rate (3.8% compared with 1.2% latex)
      4. Higher slippage rate (4.9% compared with 2.0% latex)
      5. Higher six month pregnancy rate
         1. Polyurethane Condoms: 9%
         2. Latex Condoms: 5.4%
      6. References
         1. Steiner (2003) Obstet Gynecol 101:539-47 [PubMed]
4. Preparation: Sizes
   1. Length: 160-180 mm
   2. Flat Width: 49-52 mm
   3. Thickness: 0.04 - 0.07 mm
5. Complications
   1. Allergic Reactions to latex
   2. Infection risk
      1. Risk if Condom left in vagina
      2. Urinary Tract Infection risk increased
6. Prevention: Condom breakage or slippage
   1. Be gentle
      1. Do not open package with knife or scissors
      2. Avoid tearing with teeth, rings or Fingernails
   2. Store in cool, dry place
      1. Do not store in glove compartment
      2. Avoid storing in wallet
      3. If kept in wallet, do not use after 1 month
   3. Check expiration date on package
   4. Hold Condom during withdrawal
   5. Apply Condom early in sexual encounter
   6. Avoid removing Condom until after ejaculation
   7. Have adequate Condom supply
   8. Do not reuse Condoms
   9. Consider using a water based lubricant (e.g. K-Y Jelly)
      1. Do not use oil based lubricants (breaks down Condom)
7. Management: Condom Problems
   1. Condom breaks
      1. Wash vulva and anus
      2. Insert Spermicide in vagina
      3. Consider Emergency Contraception
   2. Latex Allergy
      1. Use Polyurethane or polyisoprene Condom
      2. Woman latex allergic
         1. Use latex Condom inside of natural membrane Condom
      3. Man latex allergic
         1. Use natural membrane Condom inside of latex Condom
8. References
   1. (2022) Presc Lett 29(5): 30