Wrap it Up: Condoms 101

By Jandra Mueller

Here at PHRC we talk a lot about birth control. Primarily, hormonal oral contraceptives, but there are so many other options. This post will take an in-depth look at one of our favorite contraceptives: condoms.

HISTORY

Yes, jimmy hats, rubbers, french letters. They have been called many names, but at the end of the day the condom is one of the first forms of contraceptive. The name “condom” comes from Dr. Colonel Condom, who would prescribe lamb skin sheaths to King Charles II because of all of his illegitimate children. Yet, the first condom use that has been documented was King Minos of Crete in 3000 BC because his semen was thought to contain scorpions and serpents that killed his mistresses.

Prepare to wow your friends with that fun condom fact y’all! Colored “condoms” were even a thing with the Ancient Egyptians, they used different colored linen sheaths over their penises to distinguish between social classes. Other interesting documented use of condoms were the use of animal intestines and bladders, silk paper, Kabuta-Gata (which is a tortoise shell or leather) was used to cover the glans and also found to treat erectile dysfunction.⁸

Flashforward to the Industrial Revolution, where Charles Goodyear (yes, you probably are thinking of the tires) created the first latex condom – this was important because sheepskin is actually porous and was only recommended for use in monogamous couples as they do not prevent the spread of disease, but are still effective (approximately 98% with proper use) at preventing pregnancy. He was able to create this condom because of a process called vulcanization, which is the process of transforming rubber into malleable structures, to produce latex condoms.⁷

There were two major booms of condom use in the US, as well as the rest of the world. The first was in the 1950’s, or the post-war era, because men would have sex with women overseas and condoms were primarily used to prevent venereal disease as well as illegitimate children. The second was in the 1980’s because of HIV. In 2015 it was estimated that 18 billion condoms would be used globally. Today, there are many options available for contraception, but the condom still remains the only to prevent against sexually transmitted infections (STIs).⁸

Many of us have been in that moment where things are getting hot and heavy, you planned on waiting until the third date but things keep progressing and that moment comes where you need to ask “do you have a condom?” How many of you reading this blog have been in that situation where you think, “will this ruin the moment?” How many have been in the situation where you have not had the conversation with your new partner about whether they have an STI? How about asking about current birth control? Here are some stats from a survey of 11,300 and 9,321 heterosexual women and men, respectively, aged 15-44 in the United States between 2011-2015.⁴

Stats about the use of condoms ⁴

• 19% of men and 14.8% of women used a condom every time they had intercourse in the previous 12 months.
• Condom use every time decreased with age.
• The percentage of men with higher education (bachelor’s degree or higher) were more likely to use a condom every time they had intercourse. (This was not the case for us ladies).
• Men were more likely to use a condom every time with a partner that was considered “once in a while/just friends/had just met.” Again, this was not the case with women.
• Men who had more than one sexual partner were more likely to use a condom every time compared to only one partner. Sadly, this was again, not the case for women.
• 59.9% of men and 47.3% of women reported not using a condom at all.
  • This percentage increased with older age.
  • This percentage decreased with higher education levels.
• Women and men with one steady partner were more likely to not use a condom than if they had more than one partner.
• Only 6.5% women reported the condom broke or fell off during intercourse (only 1.1% said it actually broke).
• Approximately 25% of women reported use of condom only part of the time during intercourse.

Bottom line: data shows that men use condoms more often than women.

But it’s 2018. Why aren’t more women using condoms? Meika Hollender, CEO and founder of Sustain Natural, a company that produces all natural tampons, lubricant and condoms shares her thoughts:

“Women are still stigmatized when it comes to buying and carrying condoms. Up until a few years ago in New York, a woman could be arrested on suspicion of prostitution for carrying a condom. We’re such a puritanical culture, and we’re so sexually repressed, yet sex is everywhere. Women have come so far when it comes to getting on top of their careers but when it comes to sex, the traditional roles still exist. Although our society is hyper-sexualized, women are still taught to be repressed sexually.”¹³

Meika is correct, on June 21, 2013 New York passed Assembly Bill 2736 that stated:¹

“[Assembly Bill 2736] provides that possession of a condom may not be received in evidence in any trial, hearing or proceeding as evidence of prostitution, patronizing a prostitute, promoting prostitution, permitting prostitution, maintaining a premises for prostitution, lewdness or assignation, or maintaining a bawdy house.”

Polly Rodriguez, CEO and Co-founder of Unbound, a company that creates and curates sex positive subscription boxes, agrees with Meika but points out that the future is bright:

“I think the stigmas surrounding women carrying condoms are decreasing, but they’re definitely still there. One of the best things about the age of e-commerce is that women can shop from the comfort of their home instead of having to go in-store. There are also some more female focus and gender neutral brands like Lovability, Maude, and IMHO, and Unbound’s Party Hats. But ultimately, if someone is judging a woman for carrying condoms then that person is an idiot. That’s like judging someone for carrying an umbrella when it’s forecasted for rain.”  

We couldn’t agree more. Being prepared and practicing safe sex should be applauded. In fact the need for people to be using condoms and practicing safe sex is essential right now as the CDC recently reported a rise in cases of sexually transmitted diseases, primarily gonorrhea, syphilis and chlamydia in 2017. This report, along with the fact that gonorrhea is becoming more resistant to antibiotics and that many cases of STIs go undiagnosed, means that people need to take appropriate precautions when it comes to appropriate contraceptive use.  

Now, let’s talk about the effectiveness of condom use on prevention of STIs and pregnancy. Condoms are about 98% effective for preventing pregnancy if used correctly; however, this estimate is actually about 85% due to incorrect use. ¹¹ The most commonly noted incorrect use is to not use a condom throughout the entirety of the sexual act, from start to finish. Here’s some data from the CDC and if you click here, you can view their fact sheet.

The facts³

• Consistent and correct use of latex condoms is highly effective in preventing sexual transmission of HIV, the virus that causes AIDS
• Consistent and correct use of latex condoms reduces the risk for many STIs that are transmitted by genital fluids (STIs such as chlamydia, gonorrhea, and trichomoniasis)
• Consistent and correct use of latex condoms reduces the risk for genital ulcer diseases, such as genital herpes, syphilis, and chancroid, only when the infected area or site of potential exposure is protected.
• Consistent and correct use of latex condoms may reduce the risk for genital human papillomavirus (HPV) infection and HPV-associated diseases (e.g., genital warts and cervical cancer).

The CDC fact sheet also lists how to properly use a condom. Now, at first many people may think “everyone knows how to use a condom,” but that is often not the case. With many schools teaching abstinence only sex education, which means proper condom use, may not be discussed. In some cases sex education is being left to parents and guardians, and many folks may not be prepared to show their son or daughter how to roll a rubber onto a banana. Luckily now, there are so many resources online where you can find this info, including this blog!

How to Use a Condom Consistently and Correctly³

• Use a new condom for every act of vaginal, anal and oral sex throughout the entire sex act (from start to finish). Before any genital contact, put the condom on the tip of the erect penis with the rolled side out.
• If the condom does not have a reservoir tip, pinch the tip enough to leave a half-inch space for semen to collect. Holding the tip, unroll the condom all the way to the base of the erect penis.
• After ejaculation and before the penis gets soft, grip the rim of the condom and carefully withdraw. Then gently pull the condom off the penis, making sure that semen doesn’t spill out.
• Wrap the condom in a tissue and throw it in the trash where others won’t handle it.
• If you feel the condom break at any point during sexual activity, stop immediately, withdraw, remove the broken condom, and put on a new condom.
• Ensure that adequate lubrication is used during vaginal and anal sex, which might require water-based lubricants. Oil-based lubricants (e.g., petroleum jelly, shortening, mineral oil, massage oils, body lotions, and cooking oil) should not be used because they can weaken latex, causing breakage.

Remember, condoms can only protect against STIs and pregnancy when used correctly and consistently for the entirety of intercourse! Watch this video for more information about how to correctly use a condom!

Again, condoms can be very effective; however, like most things there is always room for user error. According to a study in 2002, typical errors of condom use among college men at Indiana University showed:⁵

• Technical errors such as expired condoms (61%), put condoms on wrong side up (30%), or using a condom stored in a wallet >1 mo. (8%)
• Availability errors: wanted to use them but didn’t have one readily available (42%)
• Communication errors: did not discuss condom use beforehand with partner (59.6%)

So, make sure your condoms are fresh because like most things they too have a shelf life. Pay attention when you put it on and as always communication is key. Make sure you establish who is in charge of getting the sexytime supplies beforehand and when in doubt it never hurts to have some on hand.

Condoms Today

Fast forward to 2018, where our society is recognizing the importance of knowing what chemicals are in our beauty products and food. People want more “natural” products, as we are recognizing that our bodies can actually absorb some of these ingredients. We now have organic tampons and pads, period underwear, natural lubricants, and even condoms are joining the all “natural” movement. But, in order to determine if these more natural products are better and healthier we need to ask the big question: What is in condoms?

Well, that question seems like a simple google search, but instead lead to spending a wild Saturday night down a cyber rabbit hole. In general, condoms are typically made of either: polyurethane (a thin plastic), sheep intestine (not skin) and of course the most common, latex. Unsurprisingly, most latex condoms, are made primarily of natural rubber latex.  Yet, the process a company may follow to make the latex can vary and may involve different chemicals. Other materials that can vary are the dusting agent and/or type of lubricant used. Some condoms contain a spermicide called Nonoxynol-9 which many people are sensitive too which is why condoms companies are required to indicate on the packaging if the product contains this substance.⁶ Some condoms are processed with casein, a protein found in milk, so something to keep in mind if you are vegan or sensitive to dairy products.⁶ Some condoms contain chemicals to make them flavored or different dyes to make them fun colors, because apparently even intercourse needs some added decor. That sounds like a lot of stuff that could be coming to your roll in the hay!

Don’t worry, any condom out on the market has to go through an approval process through the FDA before it can hit the shelves. A company has to show that the condom adheres to standards set forth by the FDA and that it is similar to the industry standard. Condom companies are required to include a description of the device and the composition of the latex used. There are regulations regarding what must be on the packaging and the type of safety testing the contraceptive must undergo and pass.⁹ One of which is called the inflation test where the condom is filled with air until it bursts. A condom needs to be able to basically stretch to the size of a watermelon before breaking. So unless someone has a melon sized member, the excuse that a condom is “too small” for them won’t fly.

But let’s rewind. So a condom can be made with different materials and chemicals? How do I know what mine are made of? Condom companies include the exact materials used when they apply to the FDA. You can see the full list here. However, a company can state that the composition of their condom is the same as the predicate, which means you would need to go find that document and that can sometimes be a challenge. Many condom companies report they follow the standards indicated by the American Society for Testing and Materials (ASTM) which is available for purchase here. Some companies include that information on their website or you can contact them directly for that information.

In general most condoms are made the same way. The raw materials are collected, such as rubber latex and then chemicals are added in a process called compounding. This chemical and latex compound is stored for about a week and a process mentioned earlier, vulcanization (sadly not a Star Trek term) occurs. This chemical process strengthens the bonds of the rubber which is then added to a dipping machine. Glass rods are dipped into the rubber and allowed to dry before being dipped again. Then the condoms are placed in a machine where they are coated in a dusting powder, so that they won’t stick together when it’s time for the rubber to hit the road.⁶ Then they go to school, just kidding, but they do undergo a ton of testing to make sure they are safe. If they pass the test, any lubricant or sometimes numbing agents are added at this point before they are packaged and sent to serve and protect!

Many people are concerned about allergies to latex and report that they get “irritated” by condoms. This can be from many ingredients that are added to the condoms during the manufacturing process. Regarding latex, many of the natural proteins that cause allergies are removed during a process called leaching and there have not been significant reports of actual known allergies from condoms.⁶ As previously mentioned, some people are sensitive to spermicide that is combined with the lubricant on condoms. Another area of concern is the dry powders that are used in the dusting process. The most commonly used dry powders are cornstarch, talc, mica, calcium carbonate, silicon dioxide, magnesium carbonate, lycopodium, dry silicone and other powders, with cornstarch currently the most commonly used.⁶
There have been concerns with the use of talc in regards to women’s fertility along with reports of potential toxicity when it comes into contact with mucosal surfaces, and if you follow this blog you know that the vagina is a mucosal surface. Previously, talc was the preferred powder used, but recently there has been a shift to cornstarch; however, it has been shown that cornstarch may bind to latex proteins and may cause a direct contact reaction, or it can become airborne and induce a reaction in another person.⁶

Why buy natural?

There are now many companies that market themselves as manufacturing “natural” condoms. Some report that they are non-GMO, vegan, paraben free, nitrosamine free, gluten free, and cruelty free, all while being FDA approved. A lot of these terms we’ve heard lately in the media, our friends, magazines, labels, etc. So these condoms would naturally resonate well with many that have concerns about what chemicals they are being exposed to and care about where products come from. But let’s talk about two terms being used by some companies that many people may not know: paraben free and nitrosamine free. Well, nitrosamines are considered to be carcinogenic and are found in natural rubbers, they have also been used as preservatives in foods to increase shelf life or cured meats.¹⁴ The Word Health Organization (WHO) recommends manufacturers work to minimize the amount of nitrosamines that are present in their condoms, but point out that the amount that is present in condoms is low, and constitutes only a small amount of the normal nitrosamine exposure a person experiences.¹⁵ Nitrosamines become present in condoms due to the chemical reaction between an accelerant used during production with the air.

How about parabens? We hear about these a lot in our beauty products. Parabens are another preservative used in food and beauty products. Parabens can cause skin irritation to people who have paraben allergies, they are also a synthetic estrogen and are considered to be an endocrine disruptor.¹² They are thought to potentially have estrogenic effects which may not be good for those at risk for breast cancer or others with conditions like endometriosis that are estrogen driven conditions. We’ve previously talked about parabens in lubricants. Depending on the company, lubricants containing parabens may be added to condoms.  

Previously, condoms were also known to contain mercaptobenzothiazole (MBT or ZMBT) a chemical that is a potential carcinogen. However, the World Health Organization indicates that none of the major manufacturers of condoms use MBT or ZMBT in their condoms. The WHO states that even if a condom did contain MBT or ZMBT the time of exposure would be short enough to indicate low risk.¹⁵

So, now what?

Well, that was probably more information about condoms then you ever thought you wanted to know. Yet, as fun as it is to know all these facts and figures it is much more important to put this knowledge to use. So, if you are engaging in oral, anal or penetrative vaginal intercourse use a condom. This is especially important when engaging in sexual activity with a new partner. If there comes a time when you want to skip the condom, talk to your partner first and consult a healthcare provider to determine what STI testing you should undergo and if preventative measures such as pre-exposure prophylaxis is warranted.  A provider would also be able to help determine other options regarding birth control to prevent pregnancy. Again, condoms are the only contraceptive that help prevent against certain STIs, in addition to pregnancy. Just remember as a wise man once said “No glove, no love.”

Ready to stock up on rubbers? Here are a few options, but know that this is in no way a comprehensive list:

Trojan
Durex
Kimono
Sustain Natural
Unbound
Lelo-Hex
One
Lifestyles
Royal
Hanx
Lovability
Glyde America

References:

1. Assembly.state.ny.us. (2013). New York State Assembly | Bill Search and Legislative Information. [online] Available at: http://assembly.state.ny.us/leg/?bn=A02736&term=2013
2. CDC (2018). Press Release 2018 STD Prevention Conference. [online] Available at: https://www.cdc.gov/nchhstp/newsroom/2018/press-release-2018-std-prevention-conference.html
3. Condom fact sheet in brief. (2018). [PDF] Department of health and human services, pp.1-2. Available at: https://www.cdc.gov/condomeffectiveness/docs/condomfactsheetinbrief.pdf
4. Copen C. Condom Use During Sexual Intercourse Among Women and Men Aged 15-44 in the United States: 2011-2015 National Survey of Family Growth. National Health Statistics Reports[serial online]. August 2017;(105):1-18. Available from: MEDLINE, Ipswich, MA.
5. Crosby R, Sanders S, Yarber W, Graham C, Dodge B. Condom use errors and problems among college men. Sexually Transmitted Diseases [serial online]. September 2002;29(9):552-557. Available from: MEDLINE, Ipswich, MA.
6. Gilmore, C. (2018). How a Latex Condom is Made. [online] Nzdl.org. Available at: http://www.nzdl.org/gsdlmod?e=d-00000-00—off-0unaids–00-0—-0-10-0—0—0direct-10—4——-0-1l–11-en-50—20-about—00-0-1-00-0–4—-0-0-11-10-0utfZz-8-00&cl=CL1.4&d=HASH0115ab05b24805f8ae736ba5.6.2&gt=1
7. How condoms work [Audio podcast].  (2012, Dec 13). Retrieved from: https://www.stuffyoushouldknow.com/podcasts/how-condoms-work.htm.
8. Khan F, Mukhtar S, Dickinson I, Sriprasad S. The story of the condom. Indian Journal Of Urology: IJU: Journal Of The Urological Society Of India [serial online]. January 2013;29(1):12-15. Available from: MEDLINE, Ipswich, MA. Accessed September 2, 2018.
9. Latex Condoms for Men Information for 510(k) Premarket Notifications: Use of Consensus Standards for Abbreviated Submissions. (2018). [PDF] Food and drug administration. Available at: https://www.fda.gov/downloads/MedicalDevices/DeviceRegulationandGuidance/GuidanceDocuments/ucm084912.pdf
10. Male Latex Condom Specification, Prequalification and Guidelines for Procurement, 2010. (2013). [PDF] World Health Organization. Available at: http://apps.who.int/iris/bitstream/handle/10665/44383/9789241599900_eng.pdf?sequence=1
11. Plannedparenthood.org. (2018). What Is the Effectiveness of Condoms?. [online] Available at: https://www.plannedparenthood.org/learn/birth-control/condom/how-effective-are-condoms
12. Pycke BF, Geer LA, Dalloul M, Abulafia O, Halden RU. 2015. Maternal and fetal exposure to parabens in a multiethnic urban U.S. population. Environ Int 84:193-200.
13. Romm, A. (2017). Why condoms are a women’s issue. [podcast] Natural MD radio. Available at: https://avivaromm.com/condoms-womens-issue/
14. Scanlan, R. (2003). NITROSAMINES. Encyclopedia of Food Sciences and Nutrition, pp.4142-4147.
15. World Health Organization. (2013). Condoms. [online] Available at: http://www.who.int/reproductivehealth/topics/family_planning/condoms-safety/en/