What’s Right, Wrong, and Most Effective?

The low rate of efficacy with genital herpes and HPV accounts in part for why the diseases are so widespread in the United States. According to the National Center for Health Statistics, 1 in 9 people ages 14 to 49 have genital herpes, while 4 of every 10 adults have HPV.

How Different Condoms Look and Feel

Choosing the right condom can seem overwhelming, given that they come in many different brands, shapes, colors, types, and sizes. However, with a little education and insight, you can choose the one that best meets your needs and preferences.

Condom Materials

One of the first things to consider when buying a condom is the material it is made of, which can include latex, lambskin, polyurethane, polyisoprene, or nitrile.

Each material has its pros and cons, as follows:

• Latex: Latex is a natural rubber that most condoms are made of. While inexpensive and effective against pregnancy and STIs, they cannot be used in people with latex allergies. They also should never be used with an oil-based lubricant, which can degrade them and cause them to burst.
• Lambskin: Lambskin condoms are made from the intestinal membrane of a lamb. They are hypoallergenic (unlikely to trigger an allergic reaction) and can be used with any type of lubricant. While extremely effective against pregnancy, they offer no protection against STIs.
• Polyurethane: Made from a type of plastic, polyurethane condoms are thinner than latex and can be used with any lubricant. However, they are more expensive and prone to slippage due to a looser fit. Some research suggests they may be less effective than latex or polyisoprene.
• Polyisoprene: Polyisoprene is a petroleum-based material with the same chemical structure as latex but without the allergenic properties. These condoms fit tighter than polyurethane condoms but are also thicker than other condom types. Oil-based lubricants can also degrade them.
• Nitrile: Nitrile is a synthetic rubber used to make internal condoms and medical gloves. These condoms are hypoallergenic, effective against pregnancy and STIs, and compatible with silicone-, water-, and oil-based lubricants. Because of their loose fit, they are not used to make external condoms.

Condom Sizes

A common complaint about condoms is that they “reduce sensitivity.” However, the problem may not be the condom itself but rather the fit of the condom.

If an external condom is too tight, it can cause pain and increase the risk of bursting. If it is too loose, it may slip off or reduce sensitivity by bunching up. A condom that is too tight can also lead to problems like delayed ejaculation.

Fortunately, external condoms come in many sizes, usually with a size chart describing the range of sizes suitable for that condom in inches or millimeters.

To find the condom size that’s right for you, you need to measure the length and girth (circumference) of your penis while erect. You can do this with a flexible measuring tape as follows:

• For penis length, measure from the base of your penis to the tip. Measure along the top side of the penis, pressing the end of the measuring tape firmly against the pubic bone.
• For penis girth, measure around the thickest part of your penis shaft. The measuring tape should be snug but not tight.

Of the two measurements, girth is arguably the most important as it influences how comfortably and snugly the condom fits without the risk of bursting or slipping off.

Standards vary, but most U.S. manufacturers categorize condoms as being small/snug, regular/standard, large, and extra large.

Sensitivity

Condom size is only one of the factors that can influence sexual sensitivity; another is the condom material. In addition to allergies and lubricant restrictions, comfort may be one of the factors that affect your choice of condoms.

By comparison:

• Latex: These condoms have advantages over other condoms in that they are widely available in numerous varieties (including ultra-thin products like Trojan Bareskin Raw). While other condoms may be thinner or transmit heat better, latex condoms are the preferred product for most people.
• Lambskin: These condoms tend to be thinner and have a more natural feel than other condoms. They also transmit heat better, increasing sensitivity. If your sole aim is to prevent pregnancy, these may be the better option for you.
• Polyurethane: Though thinner and better able to transmit heat than latex or polyisoprene, these condoms have a baggier fit that some people find unappealing. The main drawback is that they are up to 4 times more likely to break or slip off.
• Polyisoprene: These condoms fit as snugly as latex but are far thicker than the other condoms, which can reduce sensitivity. Polyisoprene may be a better option if you want the fit of latex but have a latex allergy.

Novelty Features and Additives

Condoms come in many textures, colors, flavors, and scents, which may be sexually stimulating for some people but not for others.

The response to these novelty condoms is highly individual. While ribbed condoms may be pleasurable for some, they can irritate others who have sensitive genitals.

Similarly, flavored and scented condoms may hide the taste and smell of latex but may also contain chemicals that irritate the genitals, causing pain and redness. Some might even trigger an allergy or contact dermatitis.

Moreover, sweeteners like glucose or glycerin (commonly used in flavored condoms) can trigger the overgrowth of yeast, leading to a yeast infection.

Even lubricated condoms containing nonoxynol-9 can be irritating. While the spermicidal agent may provide added protection against pregnancy, it can also cause vaginal lesions if overused. This, in turn, can increase a woman’s risk of getting HIV or passing it to a partner.

Affordability

Cost is another factor people commonly consider when buying condoms.

As a general rule, lambskin condoms are the most expensive option, retailing at around $20 or more for a box of three. At the opposite end of the scale, latex condoms can be found online or through big-box retailers for as little as $3 for three. Polyisoprene and polyurethane fall somewhere in the middle, with polyurethane being slightly more expensive.

What’s important to remember when buying condoms is that “expensive” doesn’t necessarily mean “better.” Whether costly or not, all condoms sold in the United States—including novelty condoms—must adhere to standards issued by the Food and Drug Administration (FDA) as so-called “Class II medical devices.”

To meet FDA standards, all condoms sold must have at least a 99.6% rating. This means that 996 out of 1,000 condoms, on average, must pass the test.

How to Find Free Condoms

Despite the cost barriers, there are ways to find free condoms from governmental and nongovernmental health organizations in your area, such as:

• Planned Parenthood
• Community health clinics
• Student health services at colleges or universities
• Public health departments
• Your healthcare provider’s office

To assist with your search, the Centers for Disease Control and Prevention’s (CDC)s National Prevention Information Center offers a free online tool to locate organizations near you that provide condoms for free or at low cost. Some may even send you free condoms by mail—and even lubricant and other sexual health products.

How to Use Condoms

Once you have chosen the right condoms, the next step is to learn how to use them properly. As with anything, practice makes perfect once you learn the basics.

Putting on an External Condom

Steps to put on an external condom include:

1. Carefully open and remove the condom from its wrapper. To avoid putting a hole in the condom, do not tear the package open with your teeth.
2. Check that the condom is in the correct position. If it is correctly positioned with the reservoir tip up, you should be able to roll it down easily. If it doesn’t roll down easily, it likely is upside down.
3. Place the condom on the head of the erect, hard penis. If you are uncircumcised, pull back the foreskin first.
4. Pinch all of the air out of the reservoir tip.
5. Unroll the condom over the head and all the way down the shaft of the penis.
6. Apply the appropriate lubricant to reduce friction and the risk of tears.
7. After sex—but before pulling out—hold the base of the condom to prevent it from slipping off.
8. Carefully remove the condom and throw it away.
9. Before applying another condom, wash the penis with soap and water to avoid getting any ejaculated semen on the new condom.

Putting on an Internal Condom

Steps to put on an internal condom include:

1. Carefully open and remove the condom from its wrapper. To avoid tearing the condom, do not use your teeth to open the wrapper.
2. Look at the condom. The closed end with the thick ring holds the condom inside the vagina. The open end with the thin ring remains outside of the body and covers the vaginal opening.
3. Find a position that allows you to insert the condom comfortably.
4. Squeeze the thick inner ring between your thumb and forefinger into an hourglass shape.
5. Insert the closed end into the vagina as you would a tampon.
6. Place your forefinger into the condom and push it back as far as it can go until it rests against the cervix. The condom ring should spring into the correct position on its own.
7. Check that the condom is not twisted and that the thin outer ring is comfortably positioned outside of the vagina.
8. Lubricate your partner’s penis and guide it into the vagina to ensure that it doesn’t accidentally slip under the outer ring of the condom.
9. After sex, gently twist the outer ring and pull the condom out, throwing it away.
10. Before inserting another condom, carefully wash around the vagina with soap and water to avoid getting ejaculated semen into the vagina.

Number of Condoms to Use (and Other Dos and Don’ts)

As straightforward as condom instructions may seem, there are a number of mistakes people commonly make when using them.

The dos and don’ts include:

• Don’t use an expired condom: Check the expiry date and toss out any that have expired. This is especially true of lubricated or spermicidal condoms that tend to expire earlier than regular ones.
• Do take time to prepare: You don’t have to wait until the last moment to rip open a condom packet while in the throes of passion. You can open one or two before sex and leave them on the bedside table. This may help reduce the risk of tearing.
• Don’t reuse condoms: The rule is simple: one condom per ejaculation. If you switch between anal and vaginal sex, you need to put on a new condom. Reusing a condom in any form, even thicker polyisoprene ones, increases the risk of bursting or leakage.
• Do keep plenty on hand: Never assume that one condom is enough. There may be breakage. You may have multiple orgasms or switch between anal and vaginal sex. As a rule of thumb, keep at least three condoms on hand (ideally more) if you intend to have sex.
• Don’t double-bag: Double-bagging is the use of two condoms at once under the presumption it will increase your protection. It won’t. Doing so can generate friction that can cause them to burst. This risk includes using an internal condom with an external condom.
• Do store condoms correctly: Avoid storing condoms in your glove compartment, on a windowsill, or in your wallet. Exposure to high temperatures can rapidly degrade condoms and increase the risk of breakage.
• Don’t stint on the lube: Lubrication makes penetration easier and reduces friction that can cause condoms to burst. Even if you use lubricated condoms, it is a good idea to have extra lubricant on hand as they rarely have enough to last for very long.

Condom Irritation and Alternatives

As important as condoms are to your sexual health, some people dislike them and need alternatives that can offer ample protection against pregnancy or STIs.

To prevent pregnancy, there is a large number of reversible and permanent solutions to consider, including:

Alternative tools for STI prevention are few. While safer sex generally infers the use of condoms, there are other things you can do to significantly reduce your risk of infection, including:

• Sexual abstinence: Rather than engaging in anal, oral, or vaginal sex, explore low-risk activities like massage, masturbation, frottage (rubbing up against another person while clothed), and using (unshared) sex toys.
• HPV vaccination: This three-dose vaccine, called Gardisil 9, is available for adults who were not adequately vaccinated as a child. Discuss whether it is recommended in your situation with a healthcare provider.
• Hepatitis B vaccination: This three-dose vaccine is available to people of all ages, including adults 60 and over who are at risk of hepatitis B infection.
• Preexposure prophylaxis (PrEP): This drug strategy can reduce the risk of getting HIV from sex by as much as 99%. It is available as a daily pill or a bimonthly injection.

Summary

Condoms are an essential tool for the prevention of pregnancy or sexually transmitted infections. These include external condoms that cover a penis and internal condoms that are inserted into the vagina or anus.

Most condoms are made from latex, while others are made from lambskin, polyurethane, polyisoprene, or nitrile. Each has its benefits and drawbacks. While all condoms can protect against unintended pregnancy, lambskin condoms are ineffective against STIs.

Other strategies may help reduce the risk of STI, including a reduction in the number of sex partners, HPV and hepatitis B vaccination, and preexposure prophylaxis (PrEP) to prevent HIV.