Condoms

mural-44A male or external condom is a covering that fits over an erect penis, almost like a second skin. A female, or internal condom, is a soft, loose-fitting polyurethane plastic pouch that is inserted into the vagina before intercourse.

Both prevent pregnancy and STIs when used vaginally and can also be used for anal sex to provide protection against STIs. If used perfectly, male/external condoms can be up to 98% effective at preventing pregnancy. In reality they are only 85% effective – an average of 15 women out of 100 get pregnant when using condoms as their only form of protection for a year. Female/internal condoms are slightly less effective – 95% effective when used perfectly and 79% in reality. On average 21 women out of 100 get pregnant when using them for a year.

Condoms need to be used every time and from the very beginning of intercourse to most effectively prevent pregnancy. If you are only using condoms sometimes or on certain days of a woman’s cycle or if you start having intercourse and then put on a condom before ejaculation then you will be at higher risk of pregnancy. If you need strong protection or if you or your partner is not willing to use condoms every time you have sex then condoms on their own may not be the right choice for you.

Condoms protect against sexually transmitted infections (STIs) including Chlamydia, Gonorrhea and HIV. Other contraceptive methods do not prevent STIs.

Are condoms all you need?

Although on their own condoms have a relatively high failure rate, condoms are an excellent method to use in combination with something else. For example:

  • Spermicides: Spermicides can be used to make condoms more effective. Applying a spermicidal foam, film, gel or sponge close to the cervix (the opening of the uterus at the top of the vagina) before intercourse is more effective than having spermicide on the actual condom. Always check the expiry on the package and read the instructions.
  • Fertility Awareness Method: the Rhythm method (counting safe days and using condoms on the “unsafe” days) has a relatively high failure rate, because you can ovulate (release an egg) at any time during your cycle. Fertility Awareness Method – which in addition to counting days also includes checking ones cervical mucous and body temperature every day to determine when ovulation is occurring – can provide more protection. The most effective way to use this method is with condoms during “safer” times (when you are less likely to be fertile) and having no sex during less safe times (when you are more likely to be fertile).
  • Withdrawal or “the Pull-Out Method”: this involves withdrawing the penis and ejaculating away from the vagina. This method has a relatively high failure rate on its own – it is only 73% effective in actual use, meaning that 27 women out of 100 will get pregnant while using it for a year. However, using this with a condom (ejaculating into a condom away from the vagina or pulling out after using an internal condom) makes condom use more effective.
  • Birth Control Pill, Patch, Ring or Shot: Because the pill, patch, and ring have room for human error, eight women out of 100 will get pregnant while using them for a year. Using these methods with condoms makes them extremely effective at preventing pregnancy. Condoms will also reduce the small risk of pregnancy with the Depo Shot.
  • IUDS: IUDs are small devices a doctor implants into the uterus, and are extremely effective methods of birth control (over 99% in actual use). Condoms used with an IUD lower risk of a rare pregnancy. Copper IUDs are also the most effective emergency birth control. See the section on “If a condom breaks or slips off” for more information.
  • Plan B/Emergency Pills: Plan B is the most common form of emergency contraceptive pill (sometimes called the “morning after pill”) available in Canada at pharmacies without a prescription. See the section on “If a condom breaks or slips off” for more information.

What kind of condoms should you use?

  • All brands of condoms are quality tested in Canada, so will be of high quality. However, sometimes condoms are novelty or joke items. Always look to see if the package says the condom will protect against pregnancy and sexually transmitted infections (STIs), including HIV.
  • Male/external condoms are available in different sizes. Regular sized condoms will fit most people, but if condoms are breaking or slipping off regularly then you may need larger or smaller sized condoms. Sometimes this problem can be solved with more lubrication (see the section about “using a male/external condom” for more information).
  • Most condoms are made of latex. Some people have latex allergies or sensitivities, so there are condoms made with different materials that you can try. The most common latex alternative is polyurethane (all female/internal condoms are made from polyurethane and some male/external ones are too). There are also some condoms made from animal skin – however, these only protect against pregnancy and not against STIs.
  • Male condoms are the most commonly used. However, with female or internal condoms, women can have more control over condom use. They can even sometimes be used without a partner knowing, if negotiating condom use is difficult. They are also less likely to break and transfer heat better which for some people can increase sensation. However, they are slightly less effective, more expensive and can also sometimes make noise during intercourse.

Before using a condom

    • Get familiar with condoms ahead of time. It is best if the first time you see, touch or use a condom is before rather than during sex. Take a condom out of its package, get used to it, and try putting it on yourself or on a vegetable or fruit. The more comfortable you are with condoms, the better chance you will be able to use them successfully.
    • Condoms are most effective when both partners are familiar with them and how they are used.  
    • Communicate with your partner about birth control and condoms before, during and after sex. It is best to make sure you are on the same page about condom use and the amount of risk you are comfortable with ahead of time. It is also important that both of you know that a condom is being used and if it has broken or slipped off so that you can take extra precautions if needed (see the section about “if a condom breaks or slips off” for more information).
    • Store condoms somewhere cool and dry. Heat and sunlight can damage condoms.
    • Always check the expiry date before using a condom. If the expiry date has passed do not use the condom.
    • “Pillow test” the condom – before opening it, fold and squeeze the package together into a U-shape. If air escapes and the package gets flat rather than pillowy when folded, then do not use it as there may be tears in the package.
    • Open the package down the jagged edge and remove it gently. Using teeth or long nails can tear a condom.
    • Look at the condom to make sure there is no discolouration or flakiness. If there is, throw it away.
    • Have more than one condom handy – you need to use a new condom for each new act of sexual intercourse and the first one may break, slip off, or get put on the wrong way.

Using a male/external condom

          • Use water-based lubricant (lube) to help condoms feel better and be less likely to break or slip off. Use a lubricated condom and add more to the outside of the condom as well as a few drops in the tip before it is rolled on.
          • Never use two condoms at the same time because this will make them more likely to break.
          • Do not get oil-based products (ex. hand lotion, Vaseline, and lipstick or lip balm) on a condom or it may break.
          • Put the condom onto the tip of the penis with the rolled up rim facing outward. If you put the condom on the wrong way, it will not roll down. Discard it because there might already be fluid on it (preejaculate or precum) that can get someone pregnant or give them an STI.
          • Pinch the tip so there is no air inside and room for the ejaculate (fluid) and roll the condom down to the base of the penis.
          • Note: It can be good to check the condom during sex to make sure it is not breaking or slipping off. This can be done regularly throughout intercourse, when shifting positions and/or if the sensation changes (i.e. you start having more or less feeling, the condom feels pulled too tight or so on).

Removing and discarding a male/external condom

            • Withdraw the penis while it is still hard so there is less chance of fluids leaking and move away from the vagina before taking the condom off.
            • Hold the condom while slowly pulling it off bit by bit, keeping the semen inside. Do not pull from the tip.
            • Check the condom to see if it is broken. Observe whether fluids are leaking out or if it has any obvious tears.
            • Throw the condom away in the garbage. Do not flush it down the toilet.

Using a female/internal condom

            • Insert the condom before intercourse begins – it can be inserted up to 6 hours before, but most people insert it between 2 to 20 minutes before.
            • Squeeze the loose inner ring together and insert the closed end of the condom high in the vagina.
            • The outside ring of the condom then lies against the outer lips of the vagina, providing additional protection against STIs.
            • Hold the outside ring when the penis is first inserted to ensure it goes inside the condom (not along the side) and to prevent the condom from being pushed into the vagina.
            • If the condom makes noise during sex try changing positions or adding lubricant inside the condom.


Removing and discarding a female/internal condom

            • After intercourse is finished and before standing up, squeeze and twist the outer ring to keep fluids inside and pull the condom out gently. Be careful not to spill semen near the vagina when you are removing the condom.
            • Throw the condom away in the garbage. Do not flush it down the toilet.

If a condom breaks or slips off

          • Discard condom (see above). Use a new condom if you are going to continue having intercourse.
          • Plan B: back up with Plan B or another emergency pill as soon as possible. You can take it up to 5 days after sex, but the longer you wait the less likely it is to work. The best chance of preventing pregnancy is to use it right away. Plan B is only meant as a back up method – in actual use it has a relatively high failure rate, so it is not good to rely on it as your main form of birth control. It is available at pharmacies without a prescription and you can buy it in advance to have at home. Plan B is less effective for women who weigh over 165lbs.
          • Copper IUD: a Copper IUD is the most effective form of emergency birth control – it is over 99% effective at preventing a pregnancy if inserted any time within 7 days after unprotected sex. If you leave the IUD in, it will continue to provide very effective (over 99%) protection. If you do not like it or want to get pregnant, you can have it taken out any time after your next period.
          • Reassess: if a condom breaks or slips off, it can be a good time to think about whether you want to do something differently with regards to birth control. Is there something you could do to make condoms work better for you? Are condoms the right method for you in your current circumstances? Do you need a more effective method of contraception or something to use in combination with condoms?

 

Questions about condom use or birth control? Make an appointment at Everywoman’s Health Centre by calling 604-322-6692 or talk to someone at the Sex Sense Line at 604-731-7838 or 1-800-SEX-SENSE.