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Condom use 101: Basic errors are so common, study finds

Using a condom isn't as easy as it may seem. For instance, don't open the packet with a sharp object, researchers suggest.

By Stephanie Pappas
LiveScience senior writer

Condoms can't prevent unwanted pregnancy and sexually transmitted disease if they're used incorrectly. Unfortunately, a new review of research finds that condom use errors are all too common.

Some of the most frequent mistakes include putting a condom on partway through intercourse or taking it off before intercourse is over, failing to leave space at the tip of the condom for semen, and failing to look for damage before use. These errors can contribute to breakage or leakage, researchers reported in the journal Sexual Health.

"We chronically underestimate how complicated condom use can be," University of Kentucky professor Richard Crosby, who co-authored the study, said in a statement. "It involves the use of a condom, while negotiating the condom use and sex with a partner all at the same time."

With perfect use, condoms prevent pregnancy with 98 percent success, according to the World Health Organization. Typically, however, the rate of unintended pregnancy with condoms is around 15 percent. [The History & Future of Birth Control]

Led by Stephanie Sanders of The Kinsey Institute for Research in Sex, Gender, and Reproduction at Indiana University, the researchers pulled together 16 years of research on condom errors and failures going back to 1995. They found 50 studies from 14 countries, though western nations such as the United States and the United Kingdom predominated. The studies involved diverse groups of participants, from married individuals to sex workers to college students; as such, there were a range of condom use-error rates.

An analysis of all 50 studies found a laundry list of reported errors in condom use. For example, between 17 percent and 51.1 percent of people queried in the studies said they'd put on a condom partway through intercourse — negating any disease-controlling benefits, since fluids are exchanged throughout intercourse not just during ejaculation. Other studies found that between 1.5 percent and 24.8 percent of sexual experiences involved putting a condom on too late in the process of intercourse.

The research also turned up multiple mistakes in how people put condoms on. Up to 25.3 percent said they unrolled the condom's sheath before putting on the condom, rather than unrolling the condom on the penis. Between a quarter and almost half of respondents said they'd failed to leave room at the tip of the condom for semen to collect. About 75 percent of men and 82 percent of women failed to check condoms for damage before using them.

Between 0.8 percent and 40.7 percent of participants had experienced a condom break, and between 13.1 percent and 19.3 percent had one leak, depending on the study. Improper condom use, including the wrong kind of lubricant or storage, can contribute to these problems. For instance, oil-based lubricants will degrade latex condoms.

While perfect condom use has a 98 percent success rate at preventing pregnancy, errors can increase the risk of breakage, slippage or other condom failure. Here are the rates for those problems:

Breakage: In various studies, between 0.8 percent and 40.7 percent of participants reported the experience of a broken condom. In some studies, the rates of sex with a broken condom were as high as 32.8 percent.

Slippage: Between 13.1 percent and 19.3 percent of participants reported condom slippage.

Leakage: Condoms leaked in between 0.4 percent and 6.5 percent of sexual encounters studied, with 7.6 percent of men and 12.5 percent of women reporting an experience with a leaky condom.

"Closing the gap between perfect use and the errors characterizing typical use is one of the most crucial challenges of future condom promotion programs," the researchers wrote.

From the study, here are the top condom errors:

1. Late application: Between 17 percent and 51.1 percent of people reported putting a condom on after intercourse has already begun. Other studies found that late application happens in 1.5 percent to 24.8 percent of sexual encounters.

2. Early removal: Between 13.6 percent and 44.7 percent of individuals in the studies had taken a condom off before intercourse was over. Other studies found that early removal happens in between 1.4 percent and 26.9 percent of sexual encounters.

3. Unrolling a condom before putting it on: Between 2.1 percent and 25.3 percent of people reported completely unrolling a condom before putting it on.

4. No space at the tip: Failing to leave a reservoir for semen was reported by between 24.3 percent and 45.7 percent of respondents, depending on the study.

5. Failing to remove air: Almost half (48.1 percent) of women and 41.6 percent of men reported sexual encounters in which air wasn't squeezed from the tip of the condom.

6. Inside-out condoms: Between 4 percent and 30.4 percent of people reported rolling on a condom inside out and then flipping it the other way around, potentially exposing their partner to bodily fluids.

7. Failing to unroll all the way: 11.2 percent of women and 8.8 percent of men had started intercourse before a condom was unrolled all the way.

8. Exposure to sharp objects: Between 2.1 percent and 11.2 percent of people had opened condom packets with sharp objects or otherwise exposed the latex to tearing.

9. Not checking for damage: Meanwhile, 82.7 percent of women and 74.5 percent of men failed to check condoms for damage before use.

10. No lubrication: Between 16 percent and 25.8 percent of participants had used condoms without lubrication, increasing the risk of a break.

11. Wrong lubrication: In about 4.1 percent of sexual events, people used oil-based lubrications with latex, which can degrade the condom. About 3.2 percent of women and 4.7 percent of men reported this error.

12. Incorrect withdrawal: Failing to promptly and properly withdraw after ejaculation was a common mistake, occurring in up to 57 percent of encounters in one study. About 31 percent of men and 27 percent of women reported this error.

13. Condom reuse:  Between 1.4 percent and 3.3 percent of study respondents had re-used a condom at least twice during a sexual encounter.

14. Incorrect storage: Between 3.3 percent and 19.1 percent of people in the studies had stored condoms in conditions outside of the recommendations on the package.