Editing Condom (section)

== Medical uses ==

=== Birth control ===
{{See also|Comparison of birth control methods#Effectiveness of various methods|l1=Comparison of birth control methods: Effectiveness of various methods}}
The effectiveness of condoms, as of most forms of [[contraception]], can be assessed two ways. ''Perfect use'' or ''method'' effectiveness rates only include people who use condoms properly and consistently. ''Actual use'', or ''typical use'' effectiveness rates are of all condom users, including those who use condoms incorrectly or do not use condoms at every act of intercourse. Rates are generally presented for the first year of use.<ref name="hatcher">{{cite book |first1=RA |last1=Hatcher |last2=Trussel |first2= J |last3=Nelson |first3= AL |year=2007 |title=Contraceptive Technology |edition=19th |publisher=Ardent Media |location=New York |isbn=978-1-59708-001-9 |url=http://www.contraceptivetechnology.com/table.html |access-date=26 July 2009|archive-url = https://web.archive.org/web/20080531095926/http://www.contraceptivetechnology.com/table.html |archive-date = 31 May 2008 |url-status=dead|display-authors=etal}}</ref> Most commonly the [[Pearl Index]] is used to calculate effectiveness rates, but some studies use [[decrement table]]s.<ref name="kippley">{{cite book |first1=John |last1=Kippley |last2=Kippley |first2= Sheila |year=1996 |title=The Art of Natural Family Planning |edition=4th addition |publisher=The Couple to Couple League |location=Cincinnati, OH |isbn=978-0-926412-13-2}}</ref>{{Rp|141}}

The typical use pregnancy rate among condom users varies depending on the population being studied, ranging from 10 to 18% per year.<ref name="Kippley1996">{{cite book |first=John |last=Kippley |author2=Sheila Kippley |year=1996 |title=The Art of Natural Family Planning |edition=4th addition |publisher=The Couple to Couple League |location=Cincinnati, OH |page=146 |isbn=978-0-926412-13-2}}, which cites:
:{{cite journal |last=Guttmacher Institute |title=Choice of Contraceptives |journal=The Medical Letter on Drugs and Therapeutics |volume=34 |pages=111–114 |year=1992 |pmid=1448019 |issue=885}}</ref> The perfect use pregnancy rate of condoms is 2% per year.<ref name="hatcher" /> Condoms may be combined with other forms of contraception (such as [[spermicide]]) for greater protection.<ref name="simultaneous">{{cite journal |doi=10.2307/2135759 |jstor=2135759 |title=Efficacy of the Simultaneous Use of Condoms and Spermicides |journal=Family Planning Perspectives |volume=23 |issue=5 |pages=226–232 |last1=Kestelman |first1=Philip |last2=Trussell |first2=James |year=1991 |pmid=1743276 |issn = 0014-7354}}</ref>

=== Sexually transmitted infections ===
{{See also|Safe sex}}
[[File:Condom on Obelisk, Buenos Aires.jpg|thumb|upright|A giant replica of a condom on the [[Obelisk of Buenos Aires]], Argentina, part of an awareness campaign for the 2005 [[World AIDS Day]]]]
Condoms are widely recommended for the prevention of [[sexually transmitted infection]]s (STIs). They have been shown to be effective in reducing infection rates in both men and women. While not perfect, the condom is effective at reducing the transmission of organisms that cause [[AIDS]], [[genital herpes]], [[cervical cancer]], [[genital wart]]s, [[syphilis]], [[chlamydia]], [[gonorrhea]], and other diseases.<ref name="planned parenthood">{{cite web |title=Condom |publisher=Planned Parenthood |year=2008 |url=http://www.plannedparenthood.org/health-topics/birth-control/condom-10187.htm |access-date=19 November 2007 |archive-date=20 August 2011 |archive-url=https://web.archive.org/web/20110820174700/http://www.plannedparenthood.org/health-topics/birth-control/condom-10187.htm |url-status=live }}</ref> Condoms are often recommended as an adjunct to more effective birth control methods (such as [[IUD]]) in situations where STI protection is also desired.<ref name=DualProtection>{{cite journal |pmid=11875378 |title=Dual Protection Against Unintended Pregnancy and Sexually Transmitted Infections: What is the Best Contraceptive Approach? |journal=Sexually Transmitted Diseases |volume=29 |issue=3 |pages=168–174 |date=March 2002 |last1=Cates |first1=Willard |last2=Steiner |first2=Markus J. |doi=10.1097/00007435-200203000-00007|s2cid=42792667 |doi-access=free }}</ref>

According to a 2000 report by the [[National Institutes of Health]] (NIH), consistent use of latex condoms reduces the risk of [[HIV transmission]] by approximately 85% relative to risk when unprotected, putting the seroconversion rate (infection rate) at 0.9 per 100 person-years with condom, down from 6.7 per 100 person-years.<ref name="workshop">{{cite conference |last=National Institute of Allergy and Infectious Diseases |author-link=National Institute of Allergy and Infectious Diseases |title=Workshop Summary: Scientific Evidence on Condom Effectiveness for Sexually Transmitted Disease (STD) Prevention |pages=13–15 |date=20 July 2001 |location=Hyatt Dulles Airport, Herndon, Virginia |url=https://www.niaid.nih.gov/about/organization/dmid/documents/condomreport.pdf |access-date=22 September 2010 |url-status=dead |archive-url=https://web.archive.org/web/20101009022150/http://www.niaid.nih.gov/about/organization/dmid/documents/condomreport.pdf |archive-date=9 October 2010}}</ref> Analysis published in 2007 from the [[University of Texas Medical Branch]]<ref>{{Cite journal |last1=Weller |first1=S. |last2=Davis |first2=K. |date=2002 |title=Condom effectiveness in reducing heterosexual HIV transmission |journal=The Cochrane Database of Systematic Reviews |volume=2012 |issue=1 |pages=CD003255 |doi=10.1002/14651858.CD003255 |issn=1469-493X |pmid=11869658|pmc=8407100 }}</ref>and the [[World Health Organization]]<ref>{{cite book |author=World Health Organization Department of Reproductive Health and Research (WHO/RHR) & Johns Hopkins Bloomberg School of Public Health/Center for Communication Programs (CCP), INFO Project |year=2007 |title=Family Planning: A Global Handbook for Providers |publisher=INFO Project at the Johns Hopkins Bloomberg School of Public Health |url=http://www.infoforhealth.org/globalhandbook/index.shtml |page=200 |url-status=dead|archive-url=https://web.archive.org/web/20090827081805/http://www.infoforhealth.org/globalhandbook/index.shtml|archive-date=27 August 2009}}</ref> found similar risk reductions of 80–95%.

The 2000 NIH review concluded that condom use significantly reduces the risk of gonorrhea for men.<ref name="workshop" /> A 2006 study reports that proper condom use decreases the risk of transmission of [[human papillomavirus]] (HPV) to women by approximately 70%.<ref>{{cite journal |doi=10.1056/NEJMoa053284 |pmid=16790697 |title=Condom Use and the Risk of Genital Human Papillomavirus Infection in Young Women |journal=New England Journal of Medicine |volume=354 |issue=25 |pages=2645–2654 |year=2006 |last1=Winer |first1=Rachel L. |last2=Hughes |first2=James P. |last3=Feng |first3=Qinghua |last4=O'Reilly |first4=Sandra |last5=Kiviat |first5=Nancy B. |last6=Holmes |first6=King K. |last7=Koutsky |first7=Laura A.|doi-access=free }}</ref> Another study in the same year found consistent condom use was effective at reducing transmission of [[herpes simplex virus-2]], also known as genital herpes, in both men and women.<ref>{{cite journal |doi=10.7326/0003-4819-143-10-200511150-00007 |pmid=16287791 |title=The Relationship between Condom Use and Herpes Simplex Virus Acquisition |journal=Annals of Internal Medicine |volume=143 |issue=10 |pages=707–713 |year=2005 |last1=Wald |first1=Anna |last2=Langenberg |first2=Andria G.M. |last3=Krantz |first3=Elizabeth |last4=Douglas |first4=John M. |last5=Handsfield |first5=H. Hunter |last6=Dicarlo |first6=Richard P. |last7=Adimora |first7=Adaora A. |last8=Izu |first8=Allen E. |last9=Morrow |first9=Rhoda Ashley |last10=Corey |first10=Lawrence |s2cid=37342783}}</ref>

Although a condom is effective in limiting exposure, some disease transmission may occur even with a condom. Infectious areas of the genitals, especially when symptoms are present, may not be covered by a condom, and as a result, some diseases like HPV and herpes may be transmitted by direct contact.<ref>{{cite web |last=Villhauer |first=Tanya |title=Condoms Preventing HPV? |publisher=University of Iowa Student Health Service/Health Iowa |date=20 May 2005 |url=http://www.uistudenthealth.com/question/default.aspx?q=738 |access-date=26 July 2009 |url-status=dead |archive-url=https://web.archive.org/web/20100314084306/http://www.uistudenthealth.com/question/default.aspx?q=738 |archive-date=14 March 2010}}</ref> The primary effectiveness issue with using condoms to prevent STIs, however, is inconsistent use.<ref name="badnews" />

Condoms may also be useful in treating potentially [[cervical cancer|precancerous cervical changes]]. Exposure to human papillomavirus, even in individuals already infected with the virus, appears to increase the risk of precancerous changes. The use of condoms helps promote regression of these changes.<ref name="Hogewoning2003">{{cite journal |doi=10.1002/ijc.11474 |pmid=14566832 |title=Condom use promotes regression of cervical intraepithelial neoplasia and clearance of human papillomavirus: A randomized clinical trial |journal=International Journal of Cancer |volume=107 |issue=5 |pages=811–816 |year=2003 |last1=Hogewoning |first1=Cornelis J.A. |last2=Bleeker |first2=Maaike C.G. |last3=Van Den Brule |first3=Adriaan J.C. |last4=Voorhorst |first4=Feja J. |last5=Snijders |first5=Peter J.F. |last6=Berkhof |first6=Johannes |last7=Westenend |first7=Pieter J. |last8=Meijer |first8=Chris J.L.M. |s2cid=12065908 |doi-access=free}}</ref> In addition, researchers in the UK suggest that a hormone in semen can aggravate existing cervical cancer, condom use during sex can prevent exposure to the hormone.<ref>{{cite news |title=Semen can worsen cervical cancer |publisher=Medical Research Council (UK) |url=http://www.mrc.ac.uk/NewsViewsAndEvents/News/MRC002621 |access-date=2 December 2007 |url-status=dead |archive-url=https://web.archive.org/web/20080804173650/http://www.mrc.ac.uk/NewsViewsAndEvents/News/MRC002621 |archive-date=4 August 2008}}</ref>

=== Causes of failure ===
[[File:Condom on penis 1.jpg|thumb|Condom fitting in size over a silicone dildo]]
Condoms may slip off the penis after [[ejaculation]],<ref>{{cite journal |doi=10.1016/0010-7824(94)90048-5 |pmid=7956211 |title=Breakage and slippage of condoms in family planning clients |journal=Contraception |volume=50 |issue=2 |pages=117–129 |year=1994 |last1=Sparrow |first1=Margaret J. |last2=Lavill |first2=Kay}}</ref> break due to improper application or physical damage (such as tears caused when opening the package), or break or slip due to latex degradation (typically from usage past the expiration date, improper storage, or exposure to oils). The rate of breakage is between 0.4% and 2.3%, while the rate of slippage is between 0.6% and 1.3%.<ref name="workshop" /> Even if no breakage or slippage is observed, 1–3% of women will test positive for semen residue after intercourse with a condom.<ref>{{cite journal |doi=10.1016/j.contraception.2004.05.008 |pmid=15504381 |title=Effectiveness of the male latex condom: Combined results for three popular condom brands used as controls in randomized clinical trials |journal=Contraception |volume=70 |issue=5 |pages=407–413 |year=2004 |last1=Walsh |first1=Terri L. |last2=Frezieres |first2=Ron G. |last3=Peacock |first3=Karen |last4=Nelson |first4=Anita L. |last5=Clark |first5=Virginia A. |last6=Bernstein |first6=Leslie |last7=Wraxall |first7=Brian G.D.}}</ref><ref name="pinhole">{{cite journal |doi=10.1016/S0010-7824(99)00098-0 |pmid=10717781 |title=Evaluation of prostate-specific antigen as a quantifiable indicator of condom failure in clinical trials |journal=Contraception |volume=60 |issue=5 |pages=289–298 |year=1999 |last1=Walsh |first1=Terri L. |last2=Frezieres |first2=Ron G. |last3=Nelson |first3=Anita L. |last4=Wraxall |first4=Brian G.D |last5=Clark |first5=Virginia A.}}</ref> Failure rates are higher for [[anal sex]], and until 2022, condoms were only approved by the FDA for [[vaginal sex]]. The [[One Male Condom]] received FDA approval for anal sex on 23 February 2022.<ref name="FDA_releases" >{{cite web |url=https://www.fda.gov/news-events/press-announcements/fda-permits-marketing-first-condom-specifically-indicated-anal-intercourse |title=FDA Permits Marketing of First Condom Specifically Indicated for Anal Intercourse |author=Alison Hunt |date=23 February 2022 |website=fda.gov |publisher=U.S. Food and Drug Administration |access-date=25 February 2022 |archive-date=24 February 2022 |archive-url=https://web.archive.org/web/20220224220856/https://www.fda.gov/news-events/press-announcements/fda-permits-marketing-first-condom-specifically-indicated-anal-intercourse |url-status=dead }}</ref><ref name="The_Hill_approves" >{{cite news |last=Dress |first=Brad |date=25 February 2022 |title=FDA approves first condom meant for anal sex |url=https://thehill.com/policy/healthcare/595847-fda-approves-first-condom-meant-for-anal-sex |work=The Hill |location=Washington, DC |access-date=25 February 2022 |archive-date=25 February 2022 |archive-url=https://web.archive.org/web/20220225202754/https://thehill.com/policy/healthcare/595847-fda-approves-first-condom-meant-for-anal-sex |url-status=live }}</ref>

Different modes of condom failure result in different levels of semen exposure. If a failure occurs during application, the damaged condom may be disposed of and a new condom applied before intercourse begins&nbsp;– such failures generally pose no risk to the user.<ref>{{cite journal |doi=10.1177/095646249300400206 |pmid=8476971 |title=How Often do Condoms Break or Slip off in Use? |journal=International Journal of STD & AIDS |volume=4 |issue=2 |pages=90–94 |year=1993 |last1=Richters |first1=Juliet |last2=Donovan |first2=Basil |last3=Gerofi |first3=John |s2cid=40148918}}</ref> One study found that semen exposure from a broken condom was about half that of unprotected intercourse; semen exposure from a slipped condom was about one-fifth that of unprotected intercourse.<ref>{{cite journal |doi=10.1016/S0010-7824(02)00478-X |pmid=12586324 |title=Use of prostate-specific antigen (PSA) to measure semen exposure resulting from male condom failures: Implications for contraceptive efficacy and the prevention of sexually transmitted disease |journal=Contraception |volume=67 |issue=2 |pages=139–150 |year=2003 |last1=Walsh |first1=Terri L. |last2=Frezieres |first2=Ron G. |last3=Peacock |first3=Karen |last4=Nelson |first4=Anita L. |last5=Clark |first5=Virginia A. |last6=Bernstein |first6=Leslie |last7=Wraxall |first7=Brian G.D}}</ref>

Standard condoms will [[Human penis size|fit almost any penis]], with varying degrees of comfort or risk of slippage. Many condom manufacturers offer "snug" or "magnum" sizes. Some manufacturers also offer custom sized-to-fit condoms, with claims that they are more reliable and offer improved sensation/comfort.<ref name="cbstheyfit">{{cite news |url=https://www.cbsnews.com/news/for-condoms-maybe-size-matters-after-all/ |title=For Condoms, Maybe Size Matters After All |access-date=11 November 2008 |date=11 October 2007 |work=CBS News |url-status=live |archive-url=https://web.archive.org/web/20081018232455/http://www.cbsnews.com/stories/2007/10/11/business/main3358444.shtml |archive-date=18 October 2008}}</ref><ref>{{cite news |url=http://www.cbsnews.com/stories/2007/10/11/business/main3358444.shtml |title=Next big thing, why condom size matters |access-date=11 November 2008 |publisher=Menstruation.com |date=11 October 2007 |url-status=dead |archive-url=https://web.archive.org/web/20081018232455/http://www.cbsnews.com/stories/2007/10/11/business/main3358444.shtml |archive-date=18 October 2008}}</ref><ref>{{cite web |url=http://www.theyfit.ch/launch/ |title=TheyFit: World's First Sized to Fit Condoms |access-date=11 November 2008 |url-status=dead |archive-url=https://web.archive.org/web/20081023203354/http://www.theyfit.ch/launch/ |archive-date=23 October 2008}}</ref> Some studies have associated larger penises and smaller condoms with increased breakage and decreased slippage rates (and vice versa), but other studies have been inconclusive.<ref name="fhi3" />

It is recommended for condoms manufacturers to avoid very thick or very thin condoms, because they are both considered less effective.<ref>{{cite book |last=World Health Organization |first= Department of Reproductive Health and Research |title=The male latex condom: specification and guidelines for condom procurement 2003 |year=2004 |url=https://www.who.int/reproductivehealth/publications/family_planning/9241591277/en/index.html |url-status=dead|archive-url=https://web.archive.org/web/20090809013157/http://www.who.int/reproductivehealth/publications/family_planning/9241591277/en/index.html|archive-date=9 August 2009}}</ref> Some authors encourage users to choose thinner condoms "for greater durability, sensation, and comfort",<ref>{{cite book |last=Corina |first= H. |year=2007 |title=S.E.X.: The All-You-Need-To-Know Progressive Sexuality Guide to Get You Through High School and College |publisher=Marlowe and Company |location=New York |pages=207–210 |isbn=978-1-60094-010-1}}</ref> but others warn that "the thinner the condom, the smaller the force required to break it".<ref>{{cite report |author=World Health Organization and The Joint United Nations Programme on HIV/AIDS |title=The male latex condom |url=https://pdf.usaid.gov/pdf_docs/PNACM645.pdf|url-status=dead|archive-url=https://web.archive.org/web/20090325173328/http://data.unaids.org/Publications/IRC-pub01/JC003-MaleCondom-FactSheets_en.pdf|archive-date=25 March 2009 |access-date=18 August 2009}}</ref>

Experienced condom users are significantly less likely to have a condom slip or break compared to first-time users, although users who experience one slippage or breakage are more likely to suffer a second such failure.<ref>{{cite journal |doi=10.1097/01.olq.0000148295.60514.0b |pmid=15614119 |title=Female Condom and Male Condom Failure Among Women at High Risk of Sexually Transmitted Diseases |journal=Sexually Transmitted Diseases |volume=32 |issue=1 |pages=35–43 |year=2005 |last1=Valappil |first1=Thamban |last2=Kelaghan |first2=Joseph |last3=MacAluso |first3=Maurizio |last4=Artz |first4=Lynn |last5=Austin |first5=Harland |last6=Fleenor |first6=Michael E. |last7=Robey |first7=Lawrence |last8=Hook |first8=Edward W. |s2cid=1218353|doi-access=free }}</ref><ref>{{cite journal |doi=10.2307/2136075 |jstor=2136075 |title=Can Condom Users Likely to Experience Condom Failure be Identified? |journal=Family Planning Perspectives |volume=25 |issue=5 |pages=220–226 |last1=Steiner |first1=Markus |last2=Piedrahita |first2=Carla |last3=Glover |first3=Lucinda |last4=Joanis |first4=Carol |year=1993 |pmid=8262171}}</ref> An article in ''Population Reports'' suggests that education on condom use reduces behaviors that increase the risk of breakage and slippage.<ref>{{cite journal |last1=Liskin |first1=Laurie |last2=Wharton |first2=Chris |last3=Blackburn |first3=Richard |title=Condoms&nbsp;– Now More than Ever |journal=Population Reports |volume=H |issue=8 |date=September 1991 |url=http://go.galegroup.com/ps/anonymous?id=GALE%7CA10968291&sid=googleScholar&v=2.1&it=r&linkaccess=fulltext&issn=08870241&p=AONE&sw=w&authCount=1&isAnonymousEntry=true |access-date=13 February 2007 |url-status=live |archive-url=https://web.archive.org/web/20160918025414/http://go.galegroup.com/ps/anonymous?id=GALE%7CA10968291&sid=googleScholar&v=2.1&it=r&linkaccess=fulltext&issn=08870241&p=AONE&sw=w&authCount=1&isAnonymousEntry=true |archive-date=18 September 2016}}</ref> A [[Family Health International]] publication also offers the view that education can reduce the risk of breakage and slippage, but emphasizes that more research needs to be done to determine all of the causes of breakage and slippage.<ref name="fhi3" />

Among people who intend condoms to be their form of birth control, pregnancy may occur when the user has sex without a condom. The person may have run out of condoms, or be traveling and not have a condom with them, or dislike the feel of condoms and decide to "take a chance". This behavior is the primary cause of typical use failure (as opposed to method or perfect use failure).<ref>{{cite journal |doi=10.1097/00007435-199909000-00007 |pmid=10494937 |title=The Real Problem with Male Condoms is Nonuse |journal=Sexually Transmitted Diseases |volume=26 |issue=8 |pages=459–462 |year=1999 |last1=Steiner |first1=Markus J. |last2=Cates |first2=Willard |last3=Warner |first3=Lee|doi-access=free }}</ref>

Another possible cause of condom failure is [[Birth control sabotage|sabotage]]. One motive is to have a child against a partner's wishes or consent.<ref>{{cite web |title=Childfree And The Media |publisher=Childfree Resource Network |year=2000 |url=http://www.freewebs.com/childfreelinks/paper.htm |access-date=8 April 2007 |archive-url=https://web.archive.org/web/20070312214534/http://www.freewebs.com/childfreelinks/paper.htm |archive-date=12 March 2007 |url-status=dead}}</ref> Some commercial sex workers from [[Nigeria]] reported clients sabotaging condoms in retaliation for being coerced into condom use.<ref>{{cite web |last1=Beckerleg |first1= Susan |last2=Gerofi |first2= John |title=Investigation of Condom Quality: Contraceptive Social Marketing Programme, Nigeria |publisher=Centre for Sexual & Reproductive Health |date=October 1999 |url=http://www.jsieurope.org/docs/condom_quality.pdf |access-date=8 April 2007 |pages=6, 32 |url-status=live |archive-url=https://web.archive.org/web/20070614112129/http://www.jsieurope.org/docs/condom_quality.pdf |archive-date=14 June 2007}}</ref> Using a fine needle to make several pinholes at the tip of the condom is believed to significantly impact on their effectiveness.<ref name="kippley" />{{Rp|306–307}}<ref name="pinhole" /> Cases of such condom sabotage have occurred.<ref>{{cite web |title=Canadian man who poked holes in condoms to impregnate girlfriend loses appeal |work=New York Daily News |date=7 March 2014 |url=http://www.nydailynews.com/news/crime/man-put-holes-condoms-sex-girlfriend-loses-appeal-article-1.1714830 |access-date=15 August 2014 |url-status=live |archive-url=https://web.archive.org/web/20141120103130/http://www.nydailynews.com/news/crime/man-put-holes-condoms-sex-girlfriend-loses-appeal-article-1.1714830 |archive-date=20 November 2014}}</ref>