The condom is used to prevent pregnancy and to prevent the spread of some sexually transmitted diseases (STDs) -- such as HIV, gonorrhea, and chlamydia -- from one partner to another. Other than a vasectomy, the condom is the only available method of birth control used by men.

The condom acts as a mechanical barrier, keeping sperm from coming into contact with the inside of the vagina and therefore from reaching the egg. Similarly, the condom prevents disease-causing organisms from coming into contact with a non-infected partner's skin. Until recently, the condom was used only by men. A female condom is now available.

The male condom is a thin sheath made of latex rubber, polyurethane, or animal membrane, that fits over the man's erect penis. To be most effective, it must be in place before the penis comes into contact with or enters the vagina (since pre-ejaculatory fluids carry both sperm and disease) and it must be carefully removed immediately after ejaculation. None of the semen should be allowed to come into contact with the vagina as the condom is being removed.

The female condom is the same type of contraceptive device, except that it fits inside the vagina with an inner ring over the cervix and an outer ring over the vulva. This keeps the condom from being pushed up into the vagina, and puts a protective covering over the outside of the vagina, preventing sperm from contacting the area.

HOW EFFECTIVE IS IT?

Theoretically, if the condom were used consistently and correctly, it should prevent pregnancy 97% of the time. The actual effectiveness among users, however, is only between 80% and 90%. This difference is due to:

• the occasional rupture of a condom during intercourse
• semen spilling from a condom during withdrawal
• delayed placement of a condom on the penis (penis comes into contact with vagina before condom is on)
• rupture due to manufacturing defects (rare)
• failure to use a condom during each act of intercourse

For the same reasons, the actual effectiveness of the condom against the transmission of STDs also drops.

It should be noted that only latex and polyurethane condoms, but not those made of natural animal membranes, effectively prevent the spread of viral infections such as HIV.

Lubricated condoms that have the spermicide (sperm-destroying agent) nonoxynol-9 can prevent help pregnancy, but nonoxynol-9 may also increase the chance of HIV transmission. Other spermicides are better.

The addition of spermicide to the lubricant is an extra precaution taken in case a small amount of semen does escape from the opening of the condom. Using these condoms alone is not as effective as using a condom along with a separate spermicide.

CONVENIENCE

• Condoms are available without a prescription; they are inexpensive; and they can be purchased at most drugstores, in vending machines in some restrooms, by mail order, and at venereal disease clinics or clinics specializing in family planning.
• Some pre-planning is needed in order to have a condom handy at the time of intercourse.
• Since the condom must be put on when the penis is erect, but before contact is made between the penis and vagina, there is usually a brief interruption during foreplay. Many couples solve the problem by incorporating the process of placing the condom on the penis into foreplay.

• Provides protection against pregnancy and sexually transmitted diseases.
• Prevents sperm from contacting the woman's tissue, therefore decreasing chances of her producing antibodies against the sperm. (This is one cause of infertility.)
• Condoms have a slight tourniquet effect on the outer veins of the penis. This may be beneficial for men who have difficulty maintaining an erection. (Seen with certain major abdominal operations and sometimes with advanced age)
• The condom frequently prolongs the man's plateau phase and increases enjoyment for both partners.

• A few men are unable to maintain an erection after putting on a condom.
• There is no direct contact between the penis and the vagina.
• The woman is not aware of warm fluid entering her body (important to some women, not to others).
• Friction of the condom may diminish clitoral stimulation and reduce lubrication making intercourse less enjoyable or even uncomfortable. (Lubricated condoms may alleviate this problem.)
• Intercourse may be less pleasurable since the man must withdraw his penis immediately after ejaculation.
• Allergic reactions to latex condoms are rare, but they do occur. (Changing to condoms made of polyurethane or animal membranes may help.)

• Remove the condom from its package, being careful not to tear it accidentally while opening the package or poke a hole in it while pulling it out.
• If the condom has a little receptacle at the end of it (to collect semen), place the condom against the tip of the penis and carefully roll the sides down the shaft of the penis. If there is not a receptacle end, be sure to leave a little space between the condom and the end of the penis. Otherwise, the semen may push up the sides of the condom and come out at the base of it before the penis and condom are withdrawn. Be sure there is not any air between the penis and the condom. This can cause it to break.

• After ejaculation the condom must be removed from the vagina. The best way is to grasp the condom at the base of the penis and hold it as the penis is withdrawn.

DISPOSING OF CONDOMS

You should always dispose of condoms appropriately. Keep in mind that flushing a condom down the toilet may clog plumbing.

Instead of flushing condoms, you can wrap them in toilet tissue or put them in plastic baggies before throwing them away. Remember that young children and pets sometimes go through the garbage for entertainment or in search of food. If necessary, put the condom in a garbage can that is out of reach of children and pets.

Sometimes, garbage from dumpsters and other outdoor garbage containers is spilled or strewn all over the ground by animals. Frequently, this occurs in public parks and on school grounds. It is always unpleasant to find used condoms lying on the ground and it can be unsanitary.

Be courteous. When disposing of condoms, keep in mind that nobody enjoys dealing with someone else's condom. Do your best to dispose of condoms carefully.

IMPORTANT TIPS

• Make sure condoms are available and conveniently located. If no condoms are handy at the time of a sexual encounter, you may be tempted to have intercourse without one.
• Immediately after ejaculation make sure the penis is carefully withdrawn so that semen cannot leak out of the condom as the erection is lost.
• Do not carry condoms in your wallet for long periods of time. Replace them every once in a while. Friction from opening and closing your wallet, and from walking (if you carry your wallet in your pocket) can cause tiny holes to develop in the condom. Nevertheless, it is better to use a condom that has been in your wallet for a long time than to not use one at all.
• Don't use a condom that is brittle, sticky, or discolored. These are signs of age, and old condoms are more likely to break.
• If a condom package is damaged, don't use the condom because it also may be damaged.
• Use each condom only once.
• Do not use a petroleum-based substance such as Vaseline as a lubricant. These substances break down latex. (They also promote yeast infections in women.)
• If you feel a condom break during intercourse, stop immediately and put a new one on. Remember, ejaculation does not have to occur for a pregnancy to result (pre-ejaculatory fluids can contain active sperm), or for a disease to be transmitted.
• If ejaculation occurs with a broken condom, insert a spermicidal foam or jelly to help reduce the risk of pregnancy or STD transmission. (Do NOT use nonoxynol-9.)
• Store condoms in a cool, dry place away from sunlight and heat.