CONDOMS - a patient's guide
Dr Brian King - Family Doctor

What are condoms?

Condoms are used for either contraception or STD prevention or both. In most cases they provide the only effective strategy against the spread of many common STDs.

Right throughout the HIV/AIDS epidemic, the consistent prevention message has been 'use condoms and water-based lubricant every time.'

Research indicates that people do experience some practical difficulties when using condoms, namely:

Condom size and fit

Slippage and breakage

Putting condoms on

Access to condoms

If problems are experienced, then the condoms may be less effective or couples may be less likely to use them next time.

Condom size and fit

One size doesn't fit all!

Penises come in a range of shapes and sizes - so do condoms. The erect penises of 75% of men measure between 12.5 to 17.5cm (5-7 inches), but for the larger or smaller penises there are roomier and snugger condoms. For men who prefer a looser fit, especially around the head of the penis, may find a flared condom more comfortable and easier to put on.

Thicker condoms ie: DUREX Ultrastrong are recommended for heavy duty sex and anal intercourse.

Men are encouraged to experiment in order to find the condom that best suits their needs.

Slippage and breakage

Several factors are associated with breakage:

1. Thickness of the penis rather than length may cause condoms to break. Again experiment with condom size.

2. Lubrication - lack of lubrication and excessive friction encourages rupture of the condom. Use plenty of water-based lubricant. Oil-based lubricants such as baby oil, vegetable oils, butter, petroleum jelly, hand creams and body lotions will perish the condom to breaking point within seconds. Note also vaginal anti-fungal cream preparations may cause the condom to rupture.

3. Expired use by date and inappropriate storage. Keep them in a cool place and always check the expiry date has not passed.

Slippage can be prevented by using the right sized condom, avoiding too much lubricant on the penis before putting on the condom (although a drop on the tip of the penis will increase sensitivity) and holding on to the base of the condom and penis when pulling out.

Putting condoms on

Having trouble putting a condom on then try pulling the condom over the top rather than rolling it down. Start by unrolling the condom about 1cm and put two fingers from each hand under either side. Stretch it over the head of the penis and part way down the shaft. Then unroll to the base of the penis.

For men with short or medium foreskins retract the foreskin before rolling the condom on. For those with a long foreskin (ie. still covers the head when erect) leave it forward otherwise the condom could roll off when the foreskin slides back into place.

Which way a condom unrolls? The ring should be on the outside. Try unrolling a little onto the finger first.

Access to condoms

Condoms are available and cheaper on prescription. 144 can be dispensed if the prescription is endorsed 'Regular User' by your doctor.

Get into the habit of asking the doctor for condoms at each contraception and sexual health consultation.

The Community Education Team of the New Zealand AIDS Foundation, Te Tuuaapapa mate aaraikore o Aotearoa, and the HARDWEAR campaign helped provide this information.