FAQ's
FACT SHEET - The Truth About Condoms
History of the Condom
The earliest known illustration of a man using a condom during sexual intercourse is painted on the wall of a cave in France. It is 12,000-15,000 years old (Parisot, 1987). We know that condoms have been used to protect against sexually transmitted infection since the sixteenth century and to prevent unwanted pregnancy since the eighteenth century (Himes, 1963). Since the 19th century, American moralists — who have misunderstood or denied its public health benefits — have attacked condom use (Brodie, 1994).
As a result, those who cared more about the control of human sexuality than about the prevention of sexually transmitted infection and unwanted pregnancy have stymied public health efforts toward increased condom use in the U.S for most of the 20th century. During World War I, for example, U.S. allies, such as New Zealand, gave their troops condoms to prevent sexually transmitted infection. But social hygienists in the U.S. forced the American Armed Expeditionary Forces to adopt a chastity campaign — they were opposed to any prophylactic prevention of sexually transmitted infection. Consequently, in 1919 alone, U.S. troops reported a yearly admissions rate of 766.55 per 1,000 for sexually transmitted infection (Brandt, 1985).
In the last several years, anti-sex, anti-choice radicals have reverted to a shameless distortion of scientific fact in order to discourage condom use. Three myths propagated by this anti-condom misinformation campaign are particularly dangerous. The first myth purports that talking about condoms or giving people condoms will make them sexually promiscuous (Hartigan, 1997). The second claims that condoms cause AIDS because HIV allegedly passes through microscopic pores in the latex (A.L.L.). The third blames condoms for cervical cancer (Lerner, 1999; Cantu & Farish, 1999). These outrageous myths are now so widespread that they are recited in Congress and have infected the sexuality education programs of more than a third of U.S. schools (Lerner, 1999; Landry et al., 1999).
However, as this fact sheet will make clear, the effectiveness of condoms against unintended pregnancy and sexually transmitted infection has long been established (see below). Further, information about and access to condoms clearly do not increase sexual activity among adolescents (Kirby, 1997; Schuster et al., 1998). One World Health Organization review of 19 studies found no evidence that sexuality education programs lead to earlier or increased sexual activity among teens (NCHSTP, 1996). But easy access to condoms does encourage use among teens that are already sexually active (Schuster et al., 1998). And teens need protection — at least 60.9 percent of twelfth-graders report having had sexual intercourse (AGI, 1999; Kann et al., 1998).
The truth about condoms is that they offer the best protection for the sexually active (Stone et al., 1999; CDC, 1998).
Condom Use is a National Public Health Goal
The U.S. Public Health Service has included increased condom use as part of Healthy People 2000 and Healthy People 2010 — the national health promotion and disease prevention objectives. The federal government plans to “increase to at least 50 percent the proportion of sexually active, unmarried people who used a condom at last sexual intercourse." Another goal will “increase to at least 60 percent the proportion of sexually active, unmarried young women aged 15-19 whose partner used a condom at last sexual intercourse." For adolescent men, usage will go even higher — “to at least 75 percent" (NCHS, 1999). Increased condom use can reduce the skyrocketing incidence of sexually transmitted infection among sexually active teens (KFF, 1998; Felman, 1979).
Condoms as Birth Control Condoms are an effective, inexpensive form of birth control. Of 100 women whose partners use condoms inconsistently or imperfectly, 14 will become pregnant in the first year of use. Only three will become pregnant if condoms are used perfectly (Warner & Hatcher, 1998). Unlike many other forms of birth control, condoms also protect against sexually transmitted infection. Additional advantages of condoms as birth control include: low cost, easy access, simple disposal, minimal side effects, and longer-lasting sex play. Using condoms can also enhance sexual pleasure by reducing anxieties about the risk of infection and pregnancy (Warner & Hatcher, 1998). (Added by the NCCC: Of course, abstinence, until marriage is always the preferred choice.)
Condoms and Sexually Transmitted Infection
Condoms offer effective protection against most serious sexually transmitted infections by preventing the exchange of body fluids (Cates & Stone, 1992; CDC, 1998; Stone et al., 1999). Such fluids — semen, genital discharge, or infectious secretions — are the primary routes of transmission (Stone et al., 1999). While latex condoms may not completely prevent skin-to-skin contact, they offer the best protection possible since most sexually transmitted infections attack areas of the penis covered by the condom (Stone et al., 1999). (In order to be effective, condoms must be used consistently and correctly, put on prior to genital contact, and used throughout contact (Cates & Stone, 1992; CDC, 1998)).
Condoms and Fertility
Condoms can help protect fertility by preventing transmission of sexually transmitted infections that cause infertility, such as chlamydia and gonorrhea. Women whose partners use condoms are at much lower risk of hospitalization for pelvic inflammatory disease — a condition that causes infertility — than those whose partners do not (Kelaghan et al., 1982). And women whose partners use condoms are at 30 percent less risk of infertility due to sexually transmitted infection (Cramer et al., 1987).
Condoms and Bacterial Infections
Condoms offer good protection against sexually transmitted bacterial infection -— chlamydia, gonorrhea, trichomoniasis, and syphilis (Stone et al., 1999; Judson et al., 1989). During the 1980s, genital chlamydia became the most prevalent bacterial STI in the U.S., and in 1996 there were an estimated 3 million new cases — this made chlamydia the most frequently reported infectious disease in the country (KFF, 1998). Increased condom use will help reduce the incidence of these infections (Stone et al., 1999; Cates & Stone, 1992). The national goals to double condom use were based on the condom’s proven ability to reduce gonorrhea, chlamydia, and HIV infection (NCHS, 1999).
Condoms and Viral Infections
Condoms are effective against viral infections such as HIV, hepatitis B, cytomegalovirus, and herpes simplex virus 2, which are transmitted by semen, urethral fluids, and genital sores (Judson et al., 1989; Cates & Stone, 1992).
HIV
Given the serious consequences of HIV infection, much of the research about condom efficacy has focused on HIV transmission. The condom is recognized as a highly effective barrier against HIV infection (CDC, 1998).
Condom-use opponents, however, have manipulated the findings of flawed laboratory tests to create public doubt about the condom’s effectiveness against HIV. For example, one study erroneously concluded that latex condoms leak HIV virus even though it used particles that were 100 million times smaller than the HIV particles found in semen (Stone et al., 1999). In fact, the risk of HIV transmission with a condom is reduced — as much as 10,000-fold (Carey et al., 1992; Cavalieri d’Oro et al., 1994; Weller, 1993).
In a recent study of couples in which one partner was HIV positive, only one case of infection (2 percent) occurred among those who remained sexually active and used condoms consistently and correctly. In contrast, the incidence of HIV infection was 14 percent with inconsistent use (Deschamps et al., 1996). A similar study showed a 10-percent infection rate without consistent condom use (de Vincenzi, 1994). A meta-analysis of 25 studies on HIV transmission and condoms found that efficacy rates ranged from 87 percent to 96 percent against HIV infection (Davis & Weller, 1999).
HPV and Herpes
Condoms provide some protection against viruses such as human papilloma virus (HPV) and herpes simplex virus (HSV), that infect the general genital area (CDC, 1998). The Centers for Disease Control and Prevention recommend condom usage as a way to reduce the risk of both infections (CDC, 1998). Since HPV and herpes viruses “shed" beyond the covered area, however, condoms do not provide as complete protection as they do for other pathogens.
However, condoms can decrease the risk of infection. Condom use directly correlated with a lower risk of herpes infection in Costa Rican women whose partners wore condoms (Oberle et al., 1989). And failure to use condoms has been shown to be among the most significant risk factors for pre-cancerous conditions related to HPV (Wang & Lin, 1996).
Unlike HIV, most HPV and HSV infections do not have catastrophic health consequences. In general, HPV and HSV are not as dangerous as HIV or chlamydia, which condoms can more successfully prevent — HIV infection is considered fatal, and chlamydia can result in infertility or permanent disability (Friedman et al, 1998; Howell et al., 1998; OWH, 1997).
HPV and Cervical Cancer
Few HPV infections lead to cervical cancer. It is estimated that 75 percent of women will have HPV at some point in their lives, but only two percent to five percent will ever have an abnormal Pap test result because of HPV infection. Even fewer will develop cervical cancer. (CDC, 1999; Lytwyn & Sellors, 1997). Most HPV infections are short-lived, and many women appear to develop immunity to different HPV infections. Nearly a third of women may recover from the infection within six months, and after two years, more than 90 percent of HPV infections clear. Persistent infection seems to be the higher risk factor for cervical cancer (Elfgren et al., 2000; Ho et al., 1998).
The claims of condom-use opponents regarding HPV are false and alarmist. Condom use cannot be blamed for the high prevalence of HPV or cervical cancer among women in the U.S. While condoms may not eliminate the risk of transmitting the HPVs that cause cancer, the CDC recommends them for risk reduction (CDC, 1998).
Condom Effectiveness
Condoms are effective because they block contact with body fluids that cause pregnancy and sexually transmitted infection. Most reports of condom failure are the result of inconsistent or incorrect use, not breakage (Macaluso et al., 1999). In the U.S., the actual breakage rate is a low two per 100 condoms (CDC, 1998). High failure rates in some studies occur because many people lie about contraceptive use to shift the responsibility for an unintended pregnancy to a “faulty" contraceptive. Such over-reporting artificially inflates failure rates (Trussell, 1998).
Additional Resources
American Medical Association. Guidelines for Adolescent Preventive Services — www.ama-assn.org/adolhlth/recomend/monogrf1.php — Recommendation 9 includes guidelines for making latex condoms available to adolescents.
Centers for Disease Control and Prevention, Division of HIV/AIDS Prevention. Prevention of HIV/AIDS — www.cdc.gov/nchstp/hiv_aids/pubs/facts.php — provides access to a number of CDC publications, including Condoms and Their Use in Preventing HIV Infection and Other STDs and Patterns of Condom Use Among Adolescents: The Impact of Mother-Adolescent Communication.
Cited References
AGI - Alan Guttmacher Institute. (1999, accessed 2000, February 1). Facts in Brief: Teen Sex and Pregnancy, 1999 [Online]. http://www.agi-usa.org/pubs/fb_teen_sex.html.
A.L.L. - American Life League. (No date, accessed 2000, January 27). Birth Control [Online]. http://www.all.org/issues/se04.php.
Brandt, Allan M. (1985). No Magic Bullet: A Social History of Venereal Disease in the United States Since 1880. New York: Oxford University Press.
Brodie, Janet F. (1994). Contraception and Abortion in Nineteenth Century America. Ithaca, New York: Cornell University Press.
Cantu, Yvette C. & Heather E. Farish. (1999, accessed 2000, January 27) The Human Papillomavirus (HPV) Epidemic: Condoms Don’t Work [Online]. http://www.frc.org/insight/is99flab.html.
Carey, Ronald F., et al. (1992). “Effectiveness of Latex Condoms as a Barrier to Human Immunodeficiency Virus-Sized Particles under Conditions of Simulated Use." Sexually Transmitted Diseases, 19(4), 230-234.
Cates, Willard & Katherine M. Stone. (1992). “Family Planning, Sexually Transmitted Diseases and Contraceptive Choice: A Literature Update - Part I." Family Planning Perspectives, 24(2), 75-84.
Cavalieri d’Oro, Luca, et al. (1994). “Barrier Methods of Contraception, Spermicides, and Sexually Transmitted Diseases: A Review." Genitourinary Medicine, 70(6), 410-417.
CDC - Centers for Disease Control and Prevention. (1998, January 23). “1998 Guidelines for the Treatment of Sexually Transmitted Diseases." Morbidity and Mortality Weekly Report, 47(RR-1), 1-116.
Cramer, Daniel W., et al. (1987). “The Relationship of Tubal Infertility to Barrier Method and Oral Contraceptive Use." JAMA, 257(18), 2446-2450.
Davis, Karen R. & Susan C. Weller. (1999). “The Effectiveness of Condoms in Reducing Heterosexual Transmission of HIV." Family Planning Perspectives, 31(6), 272-279.
Deschamps, Marie-Marcelle, et al. (1996). “Heterosexual Transmission of HIV in Haiti." Annals of Internal Medicine, 125(4), 324-330.
de Vincenzi, Isabelle. (1994). “A Longitudinal Study of Human Immunodeficiency Virus Transmission by Heterosexual Partners." New England Journal of Medicine, 331(6), 341-346.
Felman, Yehudi M. (1979). “A Plea for the Condom, Especially for Teenagers." JAMA, 241(23), 2517-2518.
Friedman, Stanford B., et al. (1998). Comprehensive Adolescent Health Care, 2nd ed. St. Louis, MO: Mosby.
Hartigan, John D. (1997, accessed 2000, January 27). The Disastrous Results of Condom Distribution Programs [Online]. http://www.frc.org/infocus/if97k1ab.html.
Himes, Norman E. (1963). Medical History of Contraception. New York: Gamut Press, Inc.
Ho, Gloria Y.F., et al. (1998). “Natural History of Cervicovaginal Papillomavirus Infection in Young Women." New England Journal of Medicine, 338(7), 423-428.
Howell, M. René, et al. (1998). “Screening for Chlamydia Trachomatis in Asymptomatic Women Attending Family Planning Clinics: A Cost-Effectiveness Analysis of Three Strategies." Annals of Internal Medicine, 128(4), 277-284.
Judson, Franklyn N., et al. (1989). “In Vitro Evaluations of Condoms with and Without Nonoynol 9 as Physical and Chemical Barriers Against Chlamydia Trachomatis, Herpes Simplex Virus Type 2, and Human Immunodeficiency Virus." Sexually Transmitted Diseases, 16(2), 51-56.
Kann, Laura, et al. (1998, August 14). “Youth Risk Behavior Surveillance - United States, 1997." Morbidity and Mortality Weekly Report, 47(SS-3), 1-89.
Kelaghan, Joseph, et al. (1982). “Barrier-Method Contraceptives and Pelvic Inflammatory Disease." JAMA, 248(2), 184-187.
KFF - Kaiser Family Foundation. (1998). Sexually Transmitted Diseases in America: How Many Cases and at What Cost? Menlo Park, CA: Kaiser Family Foundation and American Social Health Association.
Kirby, Douglas. (1997). No Easy Answers: Research Findings on Programs to Prevent Teen Pregnancy. Washington, DC: The National Campaign to Prevent Teen Pregnancy.
Kiviat, Nancy, et al. (1999). “Cervical Neoplasia and Other STD-Related Genital Tract Neoplasias." In King K. Holmes et al., eds., Sexually Transmitted Diseases, 3rd edition. New York: McGraw-Hill.
Koutsky, Laura A. & Nancy B. Kiviat. (1999). “Genital Human Papillomavirus." In King K. Holmes et al., eds., Sexually Transmitted Diseases, 3rd edition. New York: McGraw-Hill.
Landry, David J., et al. (1999). “Abstinence Promotion and the Provision of Information About Contraception in Public School District Sexuality Education Policies." Family Planning Perspectives, 31(6), 280-286.
Lerner, Sharon. (1999, November 9). “Condomnation." The Village Voice, p. 26.
Macalusco, Maurizio, et al. (1999). “Mechanical Failure of the Latex Condom in a Cohort of Women at High STD Risk." Sexually Transmitted Diseases, 26(8), 450-458.
NCHS - National Center for Health Statistics. (1999). Healthy People 2000 Review, 1998-99. Hyattsville, Maryland: Public Health Service.
NCHSTP - National Center for HIV, STD, & TB Prevention. (1996, accessed 1999, December 2). Condoms and Their Use in Preventing HIV Infection and Other STDs [Online]. http://www.cdc.gov/nchstp/hiv_aids/pubs/facts/condoms.pdf
Oberle, Mark W., et al. (1989). “Herpes Simplex Virus Type 2 Antibodies: High Prevalence in Monogamous Women in Costa Rica." American Journal of Tropical Medicine and Hygiene, 41(2), 224-229. OWH - Office of Women’s Health. (1997, accessed 1999, June 14). Sexually Transmitted Diseases [Online]. http://www.cdc.gov/od/owh/whstd.php
Parisot, Jeannette. (1987). Johnny Come Lately: A Short History of the Condom. Translated and enlarged by Bill McCann. London: Journeyman.
Schuster, Mark A., et al. (1998). “Impact of a High School Condom Availability Program on Sexual Attitudes and Behaviors." Family Planning Perspectives, 30(2), 67-72 & 88.
Stone, Katherine M., et al. (1999). “Barrier Methods for the Prevention of Sexually Transmitted Diseases." In King K. Holmes et al., eds., Sexually Transmitted Diseases, 3rd edition. New York: McGraw-Hill.
Trussell, James. (1998). “Contraceptive Efficacy." In Robert A. Hatcher et al., eds., Contraceptive Technology, 17th edition. New York: Ardent Media.
Wang, Pair Dong & Ruey S. Lin. (1996). “Risk Factors for Cervical Intraepithelial Neoplasia in Taiwan." Gynecological Oncology, 62(1), 10-18.
Warner, D. Lee & Robert A. Hatcher. (1998). “Male Condoms." In Robert A. Hatcher et al., eds., Contraceptive Technology, 17th edition. New York: Ardent Media.
Weller, Susan C. (1993). “A Meta-Analysis of Condom Effectiveness in Reducing Sexually Transmitted HIV." Social Science and Medicine, 36(12), 1635-1644.
Fact Sheet
Published by the Katharine Dexter McCormick Library
Planned Parenthood Federation of America
810 Seventh Avenue, New York, NY 10019
Current as of December 2000.
