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Contraception - Management
What information should I give to a person who is considering the male condom?

  • Provide information on:
    • The advantages and disadvantages of the male condom.
    • Situations when the male condom is recommended.
    • Contraceptive efficacy of the male condom, and the method currently being used.
    • Correct use of the male condom, including do not use oil-based lubricants with latex condoms.
    • Lubrication and avoiding the use of spermicides.
    • The (rare) risk of latex allergy for either partner.
    • Should the condom slip or break, the need to consider the chance of:
      • Infection and the possible need for post-exposure prophylaxis against HIV infection.
      • Pregnancy and the possible need for emergency contraception (to be taken as soon as possible). See the CKS topic on Contraception - emergency.
    • The advisability of checking that the package has relevant safety markings (e.g. BS Kitemark) and appropriate expiry date.
  • Consider demonstrating use of the condom.
Clarification / Additional information
  • Situations in which the male condom is recommended:
    • When protection from sexually transmitted infections is required.
    • When contraception additional to a primary method of contraception is needed:
      • For example, women using hormonal contraception may need to consider also using condoms if the efficacy of the hormonal method is reduced on account of drug interactions, malabsorption, or missed pills, or if women are starting contraceptive methods at times in the menstrual cycle other than days 1 to 5.
  • Contraceptive efficacy:
    • When used consistently and correctly, the male condom can be up to 98% effective at preventing pregnancy [FFPRHC, 2007a]:
      • The true failure rate (method failure) for male condoms in the first year of use is 2%.
      • The typical use failure rate (method failure plus user failure) is 15%.
      • Pregnancy rates are similar for latex and non-latex condoms.
      • For comparison with other methods, see Effectiveness of contraceptives.
    • Users must be motivated to use the male condoms consistently and regularly to prevent pregnancy.
  • Condoms with spermicides are not recommended:
    • There is no evidence that condoms lubricated with nonoxinol-9 (spermicide) provide additional protection against pregnancy or sexually transmitted diseases compared to condoms lubricated with a non-spermicidal lubricant.
    • However, epithelial disruption in the vagina and rectum has been noted with the use of nonoxinol-9. The potential irritant effects of nonoxinol-9 on mucosa may increase the likelihood of sexually transmitted infection including HIV. Epithelial damage is more likely with frequent use.
  • Correct use of the male condom:
    • A new condom should be used for each episode of sex. All condoms should carry the relevant Kitemark and be within the use-by date.
    • After removing any trapped air, the condom should be placed on the penis before there is any contact with the partner's genital area.
    • After sex, the condom and penis should be kept away from the partner's genital area. Used condoms should be disposed of by wrapping in tissue and placing in the bin (not flushing down the toilet).
  • Lubrication:
    • Do not use oil-based products (e.g. baby oil, petroleum jelly, some vaginal medications) with latex or synthetic polyisoprene condoms [Farmer, Personal Communication, 2007; FFPRHC, 2007a]. Non-latex condoms made from polyurethane (male and female) are unaffected by oil-based lubricants.
    • Do not use condoms already containing a spermicide. These condoms are not recommended for the prevention of sexually transmitted infections including HIV [FFPRHC, 2007a].
    • Do not apply a lubricant to the penis under a male condom, as this can result in the condom slipping off.
    • Use a lubricant for anal sex (to prevent the condom from breaking).
  • Emergency contraception:
    • Women who rely solely on condoms for contraception should be informed where emergency contraception can be obtained in case they think that the condom might have failed (e.g. breakage or spillage).
    • They may be offered advance provision of oral levonorgestrel emergency contraception to use in these circumstances.
Basis for recommendation
  • These recommendations are based on guidelines published by the Faculty of Family Practice & Reproductive Health Care [FFPRHC, 2007a].

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