Correct and consistent use of the condom is essential for its effectiveness, but studies of college students have found that user error is common. Putting a condom on after vaginal penetration but before ejaculation is a common error that increases the risk of pregnancy and STI transmission (Barclay, 2010). The Let’s Talk About It box discusses the importance of condom use and provides some suggestions for communicating more effectively about their use.
Condoms are available in different sizes. A man may benefit from trying different sizes to find what fits him best, because poor fit increases the likelihood of the condom’s breaking or slipping off (Hollander, 2008b). Most condoms are packaged rolled up. Correct use includes unrolling the condom over the erect penis before any contact between the penis and the vulva occurs. Sperm in the Cowper’s gland secretions (the prejack) or in the ejaculate can travel from the labia into the vagina. For maximum comfort and sensation, an uncircumcised man can retract the foreskin before unrolling the condom over the penis (Bolus, 1994). When using a plain-end condom (without the reservoir tip), the end needs to be twisted before unrolling the condom over the penis, as shown in I Figure 10.3. Doing this leaves some room at the end for the ejaculate and reduces the chances of the condom breaking. In the unusual case that a condom breaks
or slips off during intercourse, contraceptive foam, cream, or jelly should be inserted into the vagina immediately (Walsh et al., 2004).
A condom breaks more easily without lubrication than with it, so if the condom is nonlubricated, put some saliva or water-based lubricant on the vulva and on the outside of the condom before inserting the penis into the vagina. Do not use oil-based lubricants, because they reduce the condom’s integrity and increase the chances of breakage (Spruyt et al., 1998). See ■ Table 10.5 for a detailed list of safe and unsafe lubricants to use with condoms.
Because the penis begins to decrease in size and hardness soon after ejaculation, it is important to hold the condom at the base of the penis before withdrawing from the vagina. Otherwise the condom can slip off and spill semen inside the vagina. Condoms are best disposed of in the garbage rather than the toilet, because they can clog plumbing.