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1 Fact Sheet Published by the Katharine Dexter McCormick Librar y Planned Parenthood Federation of America rd Street, New York, NY 10001 434 West 33 212-261-4716 www.plannedparenthood.or g Current as of July 2011 The Truth About Condoms . Cantu & Farish , 1999) These myths are now so History of the Condom widespread that they are recited in Congress and have been incorporated into the sexuality education The earliest known illustration of a man using a programs of more than a third of U.S. schools condom during sexual intercourse is painted on (Darroch et al., 2000; Lerner, 1999; Landry et al., the wall of a cave in France. It is 12,000–15,000 1999). But none of these myths are true. We know that condoms years old (Parisot, 1987). have been used to protect against sexually th As this fact sheet will make clear, the effectiveness century and to transmitted infection since the 16 th of condoms against unintended pregnancy and prevent unwanted pregnancy since the 18 century th sexually transmitted infection has long been (Himes, 1963). Since the 19 century, American established (see below). Further, information about moralists — who have misunderstood or denied its and access to condoms clearly do not increase public health benefits — have attacked condom use sexual activity among adolescents (Kirby, 1997; (Brodie, 1994). Schuster et al., 1998). One World Health Organization review of 19 studies found no evidence As a result, those who promoted an abstinence- that sexuality education programs lead to earlier or until-marriage agenda stymied public health increased sexual activity among teens (NCHSTP, efforts toward increased condom use in the U.S th 1996). century. During World War I, for most of the 20 for example, U.S. allies, including New Zealand, But easy access to condoms does encourage gave their troops condoms to prevent sexually condom use among teens that are already sexually transmitted infection. But social hygienists in the active (Blake et al., 2003). A study of more than U.S. forced the American Expeditionary Forces to 4,000 sexually active adolescents showed that adopt a chastity campaign — they were opposed to condom use at sexual debut is associated with a any prophylactic prevention of sexually transmitted twofold increased likelihood of subsequent condom infection . Consequently, in 1919 alone, U.S. troops use (Shafii et al., 2004). In fact, adolescents who reported a yearly admissions rate of 766.55 per use condoms the first time they have vaginal 1,000 for sexually transmitted infection (Brandt, intercourse do not have more partners, are more 1985, ). likely to protect themselves and their partners, and are less likely to get an STI than adolescents who In the last several years, certain anti-choice don’t use condoms the first time they have vaginal radicals have even distorted scientific fact in intercourse (Shafii et al., 2007). And teens need order to discourage condom use. Three myths protection — more than 60 percent of young women propagated in this anti-condom misinformation and men in the United States have had sexual campaign are particularly dangerous. The first myth intercourse by the age of 19 (Hebernick et al., 2010). 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;

2 2 The truth about condoms is that they offer the Condom Effectiveness (Stone et best protection for the sexually active al., 1999; CDC, 1998). Condoms are effective because they block contact with body fluids that cause pregnancy and sexually Nevertheless, scientifically based information transmitted infection. Most reports of condom failure about condoms that was available on ent or incorrect use, not are the result of inconsist government health websites has been either breakage (Macaluso et al., 1999). A recent study of taken down or replaced with politically driven, college students found that condom use errors were censored pages that emphasize abstinence and very common — 40 percent of the young men have an exaggerated focus on the potential risks surveyed reported that, within the previous three . For example, the Centers for of condom use months, they had not left space for ejaculate at the Disease Control and Prevention (CDC) website tip of a condom, and 15 percent had taken a expunged information showing that education about condom off before completing intercourse (Crosby et condoms does not result in increased or earlier al., 2002). In the U.S., the actual breakage rate is a sexual activity (Clymer, 2002). low two per 100 condoms (CDC, 1998). High failure rates in some studies occur because Condom Use Is a National Public Health Goal many people over-report contraceptive use to shift the responsibility for an unintended pregnancy to a The U.S. Public Health Service has included “faulty” contraceptive . Such over-reporting artificially increased condom use as an objective in its Healthy inflates failure rates (Trussell, 1998). Condom People 2000 and 2020 campaigns to promote health failure rates are also inflated because some young and prevent disease. The federal government plans to people have been shown to inaccurately report “increase the proportion of sex ually active persons 15 to condom uses, use condoms incorrectly, and 19 years who use condoms to both effectively prevent respond to survey questions with what they perceive pregnancy and provide barrier protection against to be socially desirable answers (Rose et al., 2009). disease at first intercourse and at last intercourse In fact, most people who use condoms do not In fact, condom use among (DHHS, 2010).” experience breakage or slippage. Most condom adolescent women and men has increased from failures occur among a minority of users because 1991 to 2010, during which time 58.1 percent of they are less experienced and/or less careful about women and 79.1 percent of men reported using using condoms than more successful users (Steiner condoms at last intercourse. And black and Latino et al., 1993, Steiner et al., 1994). women and men report more condom use than their white counterparts (Reece et al., 2010). Condoms as Birth Control In June 2000, a number of federal agencies including the CDC, National Institutes of Health Condoms are an effective, inexpensive form of (NIH), U.S. Food and Drug Administration (FDA), . Of 100 women whose partners use birth control and the U.S. Agency for International Development condoms inconsistently or imperfectly, 18 will (USAID) sponsored a workshop to look at the become pregnant in the first year of use. Only two he effectiveness of latex scientific evidence of t will become pregnant if condoms are used perfectly condom use to prevent the spread of STIs during (Trussell, 2011). Unlike many other forms of birth vaginal intercourse. The report that resulted from control, condoms also protect against sexually this meeting confirmed that condoms are the best transmitted infection. Additional advantages of method for sexually active people to prevent STIs. It condoms as birth control include low cost, easy states that research shows condoms to be effective access, simple disposal, minimal side effects, and against pregnancy, HIV, and gonorrhea, and that longer-lasting sex play. Using condoms can also while there is research that finds condoms to be enhance sexual pleasure by reducing anxieties , more research needs to effective against other STIs about the risk of infection and pregnancy (Warner & be conducted to more firmly establish condom Hatcher, 1998). In fact, the CDC, efficacy (NIAID et al., 2001). which is the agency responsible for prevention messages, continues to promote condom use Condoms and Fertility for general STI protection (CDC, 2004).

3 3 Condoms can help protect fertility by preventing urethral fluids, and genital sores ( CDC, 2004; transmission of sexually transmitted infections, such Judson et al., 1989; Cates & Stone, 1992). as chlamydia and gonorrhea, that cause infertility. Women whose partners use condoms are at much Herpes lower risk of hospitalization for pelvic inflammatory disease — a condition that causes infertility — than Herpes simplex virus (HSV) type 2 causes those whose partners do not (Kelaghan et al., 1982). genital herpes. Studies have shown that And women whose partners use condoms are at 30 opposite sex couples who used condoms percent less risk of infertility due to sexually during one out of four acts of intercourse transmitted infection (Cramer et al., 1987). reduced the risk of infection with HSV 2 for the woman — but not the man — by 92 percent. Infection was even rarer among Condoms and Sexually Transmitted Infection women and men who used condoms during every act of intercourse (Holmes et al., 2004) Condoms offer effective protection against most The Centers for Disease Control and serious sexually transmitted infections by Prevention has long recommend condom preventing the exchange of body fluids (Cates & usage as a way to reduce the risk of herpes Stone, 1992; CDC, 1998; Stone et al . , 1999). Such infections (CDC, 1998). In fact, using fluids — semen, genital discharge, or infectious condoms for every act of intercourse secretions — are the primary routes of transmission significantly reduces the risk of infection (Stone et al., 1999). While latex condoms may not (Wald, 2005). completely prevent skin-to-skin contact, they offer the best protection possible because the glans and shaft of the penis are the major portals of exit and . ed infections (Stone et al entry of sexually transmitt , HIV 1999). (In order to be effective, condoms must be Given the serious consequences of HIV used consistently and correctly, put on prior to infection, much of the research about roughout contact [Cates genital contact, and used th condom efficacy has focused on HIV & Stone, 1992; CDC, 1998]). transmission. The condom is recognized as a highly effective Condoms and Bacterial Infections barrier against HIV infection (CDC, 2004). Condoms offer good protection against sexually transmitted bacterial infection — chlamydia, Condom-use opponents, however, gonorrhea, trichomoniasis, and syphilis (Stone have manipulated the findings of et al., 1999; Judson et al., 1989). During the flawed laboratory tests to create 1980s, genital chlamydia became the most prevalent public doubt about the condom’s bacterial STI in the U.S., and by 1996 there were an . For effectiveness against HIV estimated three million new cases — this made example, one study erroneously ly reported infectious chlamydia the most frequent concluded that latex condoms leak HIV disease in the country (KFF, 1998). A 2006 review virus even though it used particles that of the literature on condom use to prevent were 100 million times smaller than the transmission of chlamydia and gonorrhea found that HIV particles found in semen (Stone et most studies associated condom use with al., 1999). In fact, the risk of HIV demonstrable risk reduction (Warner et al., 2006). transmission with a condom is reduced Increased condom use will help reduce the — as much as 10,000-fold (Carey et . incidence of all these infections (Stone et al , 1999; al., 1992; Cavalieri d’Oro et al., 1994; Cates & Stone, 1992). Weller, 1993). Condoms and Viral Infections In a study of couples in which one partner was HIV positive, only one Condoms are effective against viral infections such case of infection (two percent) as HIV, hepatitis B, cytomegalovirus, and herpes occurred among those who simplex virus 2, which are transmitted by semen,

4 4 remained sexually active and used associated with cervical cancer (Kiviat et al., . condoms consistently and correctly 1999; Koutsky & Kiviat, 1999). Most HPV In contrast, the incidence of HIV infections are short-lived, and many women appear infection was 14 percent with to develop immunity to different HPV infections. inconsistent use (Deschamps et al., Nearly a third of women may recover from the 1996). A similar study that followed infection within six months. Persistent infection and couples for an average of 20 months reinfection seems to be the higher risk factor for found there were no new cases of cervical cancer (Ho, et al., 1998). infection among couples who used condoms consistently (de Vincenzi, The claims of condom use opponents regarding 1994). Another study found that HPV are false and alarmis t. Condom use cannot be among a group of couples who used blamed for the high prevalence of HPV or cervical condoms consistently, two percent of cancer among women in the U.S. In fact, studies the uninfected part ners contracted HIV have shown an association between condom use over the course of the two-year study. and a reduced risk of HPV-associated diseases, This contrasts with 12 percent of including cervical cancer (CDC, 2004). As stated partners who became infected in above, condom use has been shown to clear HPV couples that reported inconsistent or no infections and the abnormal cell growth they cause condom use (Saracco et al., 1993). A on the cervix and on the peni s (Bleeker et al., 2003; meta-analysis of 25 studies on HIV Hogewoning et al., 2003). While condoms may not transmission and condoms found an eliminate the risk of transmitting the HPVs that average efficacy rate of 87 percent cause cancer, the CDC recommends condoms for against HIV infection. However, risk reduction (CDC, 1998). efficacy rates can range from 60 percent to 96 percent (Davis & Weller, Failure to use condoms has been shown to be 1999). among the most significant risk factors for pre- cancerous conditions related to certain types of HPV (Wang & Lin, 1996). HPV Condoms provide some protection Clearly, despite the claims of abstinence-until- against the human papilloma viruses marriage proponents, condoms offer the best (HPV) that infect the general genital risk reduction for sexually transmitted infections area (CDC, 2004). The Centers for among sexually active women and men. They Disease Control and Prevention also provide significant protection against recommend condom usage as a way to unintended pregnancy. reduce the risk of HPV infections (CDC, 1998). Since HPV and herpes viruses ‘shed’ beyond the covered area, Double Bagging however, condoms do not provide as complete protection as they do for Many myths about condoms are not political. One other pathogens, but two recent Dutch popular myth is that using more than one condom at studies have found that condom use a time — double bagging — will cause condoms to has been shown to clear HPV break. infections in women as well as the abnormal cell growths they cause on Even popular wisdom among health educators has it the cervix and penis (Hogewoning et that double bagging — using more than one condom al., 2003; Bleeker et al., 2003). at a time — is not more effective than using just one, and doing so may cause condom breakage. Wikipedia, for example, asserts that double bagging breaks condoms (Wikipedia, 2009). Many online health information resources, including About.com, AIDS.org, and the Texas Department of State Health HPV and Cervical Cancer Services, make the same assertion (About.com, 2008; AIDS.org, 2008; TDSHS, 2008). Few HPV infections lead to cervical cancer. Of at least 100 types of HPV, only a handful are Online health information centers that make this

5 5 claim offer no scientific evidence for their claims. Cited References Wikipedia offers two citations to support the About.com. (2008). Does usi ng two condoms provide better assertion, but they are both two popular health pregnancy protection that just one? information websites: Go Ask Alice and the New http://contraception.about.com/od/malecondom/f/twocondom York University Student Health Center (Wikipedia, s.htm accessed December 30 , 2008. aids.org/factSheets/153- AIDS.org. (2008). Condoms. www. 2009). Neither offer citations for the claims they Condoms.html. make (Go Ask Alice, 2009; NYUSHC, 2009). The Albert, Alexa E., et al. (1995). Condom Use among Female Control and Prevention is U.S. Centers for Disease Commercial Sex Workers in Nevada’s Legal Brothels. silent on the subject (CDC, 2009). So is the current American Journal of Public Health, 85(11), 1514–20. th A.L.L. — American Life League. (No date, accessed 2000, (19 (Hatcher Contraceptive Technology ) edition of th January 27). Birth Control [Online]. et al., 2007). Interestingly, however, the 17 and www.all.or http:// g/issues/se04.htm. th 18 editions both suggested using two condoms at a Blake, Susan M., et al. (2003). “Condom Availability Programs in time to increase effectiveness (Hatcher et al., 1998; Massachusetts High Schools: Relationships with Condom Use and Sexual Behavior.” American Journal of Public Hatcher et al., 2004). , 93(6), 955–962. Health Bleeker, Maaike C.G., et al. (2003). “Condom Use Promotes Five scientific studies have been published in peer- Regression of Human Papillomavirus-Associated Penile Lesions in Male Sexual Partners of Women with Cervical reviewed journals about multiple condom use. International Journal of Cancer Intraepithelial Neoplasia.” , Three demonstrate that double bagging is not 107, 804–810. uncommon among gay men in the U.S. (Wolitski et Brandt, Allan M. (1985). No Magic Bullet: A Social History of al., 2001) and sex workers in Cambodia (Morineau New the United States Since 1880. Venereal Disease in York: Oxford University Press. et al., 2007) and Nevada (Albert et al., 1995). Three Brodie, Janet F. (1994). Contraception and Abortion in also showed that double bagging significantly New York: Cornell Nineteenth Century America. Ithaca, reduced the risk of condom breakage (Albert, et al, University Press. 1995; Rugpao et al., February 1997 and October Cantu, Yvette C. & Heather E. Farish. (1999, accessed 2000, January 27) The Human Papillomavirus (HPV) Epidemic: 1997). Condoms Don’t Work [Online]. http://www.frc.org/insight/is99flab.html. Only one of the five studies commented on the (1992). “Effectiveness of Latex Condoms Carey, Ronald F., et al . effectiveness of double bagging. It concluded that as a Barrier to Human I mmunodeficiency Virus-Sized Sexually Particles under Conditions of Simulated Use.” “Multiple condom use significantly decreased the 19(4), 230–234. Transmitted Diseases, risk of potential exposure to HIV/sexually transmitted Cates, Willard & Katherine M. Stone. (1992). “Family Planning, disease (STD) by decreasing the probability of and Contraceptive Choice: A Sexually Transmitted Diseases exposure breakage ... from 1.8 percent to 0.2 Family Planning Perspectives, Literature Update — Part I.” 24(2), 75–84. percent (Rugpao et al., October 1997).” . (1994). “Barrier Methods of Cavalieri d’Oro, Luca, et al , and Sexually Transmitted Contraception, Spermicides And only one of these studies reiterated the popular , 70(6), 410– Genitourinary Medicine Diseases: A Review.” wisdom that double bagging causes condom 417. CDC — Centers for Disease Control and Prevention. (1998, breakage. Its authors offer three citations for their January 23). "1998 Guidelines for the Treatment of Sexually caution against double bagging. Two are websites Transmitted Diseases." Morbidity and Mortality Weekly mounted by health educator s and students that can Report , 47(RR-1), 1–116. no longer be found with the URLs that the authors _____. (2004, accessed 2004, June 7). Fact Sheet for Public Health Personnel: Male Latex Condoms and Sexually provide. The third is the NYU Student Health Center Transmitted Diseases. [Online]. (Morineau et al., 2007). (See above.) http://www.cdc.gov/nchstp/od/latex.htm _____. U.S. Centers for Disease Control and Prevention (2009). It seems that there is no evidence-based information Male Latex Condoms and Sexually Transmitted Diseases. http:// www.cdc.gov /condomeffectiveness/brief.html#Consiste to support advising against double bagging. On the nt accessed January 12, 2009. other hand, the evidence to support double bagging Clymer, Adam. (2002, December 27). “U.S. Revises Sex is limited, but positive. It may be best to advise that The New York Times Information, and a Fight Goes On.” , p. if double bagging increases a person’s sense of 17. Contraceptive Technology Update. (2011). What’s the evidence comfort and security, there is no harm in using more for using two condoms? January, 8–9. than one condom, and there may be benefits. One Cramer, Daniel W., et al (1987). “The Relationship of Tubal . recent review of this evidence even suggests that Infertility to Barrier Method and Oral Contraceptive Use.” “When clinicians see women and men who have 257(18), 2446–2450. JAMA , Crosby, Richard, et al. (2002). “Condom Use Errors and experienced multiple breaks or slippage, it would be Problems Among College Men.” Sexually Transmitted wise to encourage them to use two condoms Diseases , 29(9), 552–557. (Contraceptive Technology Update, 2011).” Darroch, Jacqueline E., et al. (2000). “Changing Emphases in Sexuality Education in U.S. Public Secondary Schools,

6 6 , 32(5), 204– 1988-1999.” Family Planning Perspectives School District Sexuality Education Policies.” Family 211& 265. Planning Perspectives , 31(6), 280–286. Lerner, Sharon. (1999, November 9). “Condomnation.” The Davis, Karen R & Susan C. Weller. (1999). “The Effectiveness . Village Voice , p. 26. of Condoms in Reducing Heterosexual Transmission of HIV.” Macalusco, Maurizio, et al . (1999). “Mechanical Failure of the Family Planning Perspectives, 31(6), 272–279. Latex Condom in a Cohort of Women at High STD Risk.” al. (1996). “Heterosexual Deschamps, Marie-Marcelle, et Sexually Transmitted Diseases, 26(8), 450–458. , Annals of Internal Medicine Transmission of HIV in Haiti.” Morineau, Guy, et al. (2007). Simultaneous Use of Multiple 125(4), 324–330. Condoms among Male Cambodian Military Personnel de Vincenzi, Isabelle. (1994). “A Longitudinal Study of Human Visiting Female Sex Workers. 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7 7 http:// www.ds hs.state.tx.us/hivstd/info/edmat/condoms.pdf , Weller, Susan C. (1993). “A Meta-Analysis of Condom accessed December 30, 2008. Effectiveness in Reducing Sexually Transmitted HIV.” Social Trussell, James. (1998). Contra ceptive Efficacy. In Robert A. 36(12), 1635–1644. Science and Medicine, , Contraceptive Technology , 17th edition. Hatcher et al., eds., Wikipedia. (2009) Condom. http://en.wikipedia.org/wiki/Condom accessed January 9, 2009. New York: Ardent Media, 779–801. Wolitski, Richard J. et al. (2001). Awareness and Use of _____. (2011). "Contraceptive Failure in the United States." Untested Barrier Methods by HIV-Seropositive Gay and Contraception, 83, 397–404. Trussell, James, et al. (2004). AIDS Education and Prevention Bisexual Men. , 13(4), 291– “Contraceptive Efficacy.” in Robert A. Hatcher et al., eds. th edition. New York: Ardent 301. , 18 Contraceptive Technology Media, 773–793. Wald, Anna, et al. (2005). The Relationship Between Condom Use and Herpes Simplex Virus Acquistion. Annals of Internal Medicine , 143(10), 707–714. URLs offered by authors that no longer function Wang, Pair Dong & Ruey S. Lin. (1996). “Risk Factors for Cervical Intraepithelial Neoplasia in Taiwan.” Gynecological http://66.102.7.104/search /q=cache:wnky1X0LfP8J: Oncology , 62(1), 10–18. www.mnschoolhealth.com/article/pubs/0305281636 Warner, D. Lee & Robert A. Hatcher. (1998). "Male Condoms." , et al In Robert A. Hatcher ., eds., Contraceptive Technology 49-356891/050223151226- 17th edition. New York: Ardent Media. 655844/cdocumentsandsetting.pdf+double- Warner, Lee et al, (2006). Condom Use and Risk of Gonorrhea bagging+condom+breakage&hl=en&ct=clnk&cd=95 and Chlamydia: A Systematic Review of Design and Measurement Factors Assessed in Epidemiologic Studies. , 33(1), 36–51. Sexually Transmitted Disease http://studenthealth.sa.ucsb.edu/HealthEducation/Se xual Health/SaferSexS exualHealthandSTIs.asp ® ® c. All rights reserved. Planned Parenthood © 2011 Planned Parenthood Federation of America, In , PPFA , and the logo of “nested Ps” are regi stered service marks of PPFA. Media Contacts — New York, NY: 212-261-4433

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