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Booklet - "Use a condom for safer sex guidebook"

 

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Use a condom for safer sex guidebook

What is Condom?

Condom is a flexible sheath that fits over the penis or covers the vagina during sexual intercourse to prevent contact of body fluid (Sperm, vaginal fluid and blood) with mucosa of sex organs.

Purpose of using condom

Contraception

Condoms can effectively prevent conception if they are used consistently and correctly. According to the World Health Organization, when male condoms are used inconsistently, there is a 14% chance of having a pregnancy in the first year. The corresponding figure for female condoms is higher at 21%. However, if condoms are used consistently, the failure rate is reduced to 3% for male condoms and 5 % for female condoms.

Prevention of Sexually Transmitted Infections (STIs) and Human Immunodeficiency Virus (HIV)

Condoms were invented for prevention of STIs. Its contraceptive effect was discovered only later. Since the Acquired Immune Deficiency Syndrome (AIDS) epidemic in 80s, condoms have been investigated again for prevention of the spread of HIV.

Condoms, when used consistently and correctly, are highly effective in preventing transmission of HIV and other STIs including gonorrhea, chlamydia and trichomoniasis which cause genital discharge. Condoms also effectively prevent other STIs that cause genital ulcers, such as herpes, syphilis and chancroid only when the infected area or site of potential exposure is protected.

Condom use has been associated with a lower rate of cervical cancer. Cervical cancer is associated with infection of human papilloma virus.

Other than abstinence, or an enduring and exclusively monogamous relationship with a non-infected person, proper and persistent use of condom provides the only protection against STIs and HIV.

Different kinds of condoms / Types of condoms

Condoms can be divided into male type and female type. In Hong Kong, the majority of condoms that are on sale are of the male type and are commonly made of latex. In Europe and America, male condoms made of polyurethane are also commonly available. Most female condoms are made of polyurethane.

There are different designs of condoms. Examples include the ribs and dots types which are claimed to be able to arouse special feelings during sexual intercourse. Consumers should however be aware that some specially designed condom-like products are only toys for enhancing sexual enjoyment and are not effective for contraception or prevention of STIs. Consumers should pay attention to labels such as "This is a toy" or "Not for birth control or Sexually Transmitted Infections prevention" on the products package before any purchase.

Some condom products contain additives. Condoms with spermicide are claimed to be more effective in preventing pregnancy and those with local anesthesia claim increased potency. Some may have colouring and flavouring agents added. However, these additives may lead to allergic reactions in susceptible people. If the allergic reactions break the mucous membrane of penis or vagina, there may be an increased chance of HIV or other STIs. If in doubt, consumers may wish to consult health care professionals before use.

Tips when buying condoms

  • The Consumer Council conducts tests on condoms regularly, and consumers may make reference to the test results published in the Council's CHOICE magazine (issues numbered 345, 280 and 242).
    Models, which performed satisfactorily in all test items should be the better choices.
  • Some models have been on the market for years and did well in all the rounds of test. Their quality should be relatively stable.
  • Consumers may purchase a small number of each model from reputable drug stores or chain stores, and select the model which suits them most after trials.
  • Check the expiry date and package condition first. Do not purchase products which have expired or the packages of which are torn.
  • Condoms will age more quickly if they are stored in places of high temperature or strong light, under the spotlight over shelves for example. Aging adversely affects the elasticity and tensile strength of latex. Consumers should pay attention to the product display location when selecting condoms.
  • Beware of the risks of buying damaged condoms. Some retailers put anti-shoplifting devices which contain metal strips inside the package of condom products. If condoms or their individual packages are broken by the metal strips, do not use the condoms.
  • Read the labelling carefully and do not misuse sex toys as condoms.

The proper use of male and female condom

Proper use of male condom
  • Use a new, good quality condom and check the expiry date every time before use
  • Put the condom on before you enter your partner
  • With care, hold the tip of the condom to squeeze out the air. This leaves some room for the semen when you ejaculate.
  • Soon after ejaculation, hold on the rim of the condom and pull out while the penis is still erect.
Proper use of female condom
  • Use a new, good quality condom and check the expiry date every time before use.
  • Identify the inner ring located at the closed end of the female condom. Use the thumb, the index finger and the middle finger to squeeze the lower part of the condom
  • Insert the inner ring into the vagina
  • Put a finger inside the female condom to push the inner ring further inside the vagina. The outer ring would be left outside of the vagina.
  • After intercourse, twist the outer ring two to three rounds before pulling out the condom to avoid spillage of the semen.

Negotiation skills about using condoms

It might not be easy to negotiate with your partner about using condoms. Here are some tips, which may be helpful:

Select an appropriate time:
It is difficult to talk about using condoms when you are "in the heat of the moment". A better way is to bring up the subject in a frank and honest manner when you are relaxed together, like over lunch or while taking a walk.
Give a clear message:
Tell your partner about your need and expectation, making the message clear and to the point. Let your partner know that you care about health and encourage him/her to do the same. For example you may say, "I want to have sex with you, but I won't unless we use protection." Or "I have decided to use condoms because I don't want to risk getting Sexually Transmitted Infections or getting pregnant."
Make condom use fun:
With a bit of creativity, you and your partner can make it fun to use a condom. Try a variety of different condoms, experiment with the size, shape, texture and thickness and look for different colors and flavors until you find the ones that you both prefer. Also, putting on a condom can be made part of your foreplay: for instance, just before putting on the condom, spread some lubricant on the head of the penis and gently massage the penis to get sexually aroused. Keep in mind that your health and your life are more important than a few moments of embarrassment.

What if your partner says "NO"?

  • Common excuses for not using condoms:
    - "Don't you trust me?"
    - "It's like having a shower while wearing a raincoat!"
    - I am already using other contraception."
    - "It spoils the mood."
    - "I thought we loved each other."

We tend to please the person we care about, so being firm may not be easy. If your partner resists or pressurizes you, you need to repeat the message and use more "I" statements. For example:

"When you say this, I feel upset. Although I do trust you, I don't trust your previous partner(s). I think it's better that we use a condom."

"When you say that putting on a condom is like having sex with a raincoat on, I feel frustrated because we both know the risks of not using a condom. I just want us to include condom use in our sexual activity. There are so many condom styles, let's choose one together!"

"When you only care about contraception, I still feel worried as there are other risks to think of and I would like us to use a condom as well."

"When you say the condom will spoil your mood, I feel cross because it seems like you are using that as a threat. I don't enjoy sex when I don't feel safe and I'd like us to think about all this before we do anything."

"When you complain about using condoms, I feel upset because I really care about you and I was preparing for something that concerns us both. I think it's time for us to talk about our relationship."

Act on your decision:
Following through on your decision is a continuous process that may not be easy, but once you have decided "No condom, No sex", you must act according to your resolution in spite of your own sexual feelings and/or pressure from your partner.

Frequently asked questions

Q1. Why do condoms fail?
  • The condoms are expired.
  • The condoms are not used consistently
  • The condoms are not used correctly. The most common faults are:
        - condoms not covering the whole length of penis
        - condoms not withdrawn right after ejaculation
        - condoms not withdrawn with its rim tightly held against the penis.
Q2. Are lubricated condoms preferred to unlubricated ones?
Lubricated condoms are less likely to break than unlubricated ones. They give a moist, natural feeling to the skin and create greater sensation for most wears. Unlubricated condoms are used principally in oral sex.
Q3. Should we test a condom before use to make sure it is not defective?
No, you should never pre-test a condom. You may damage the condom in doing so.
Q4. Is it better to use more than one condom at a time?
No, using more than one condom is not better. Using more than one condom at a time would create friction and increase chance of breaking.
Q5. Can condoms be reused?
No, condoms cannot be reused. You should use a new and good quality latex condom without defect every time having sex.
Q6. Is Nonoxynol-9 (N-9) containing condom more effective in preventing pregnancy, STIs or HIV?
No, there is no evidence to suggest that N-9 containing condoms provide any additional protection against pregnancy, HIV or STIs. On the contrary, it may cause irritation to the skin resulting in allergic reaction. CDC does not recommend the use of N-9 containing condoms.

Protected sex is more relaxed and enjoyable since we need not worry about unwanted pregnancy and disease.

Reference:

  • Nonoxynol-9 Spermicide Contraception Use- United States, 1999. MMWR 2002;51 (18); 389-392
  • Fact Sheet for Public Health Personnel: Male Latex Condoms and Sexually Transmitted Diseases, CDC. Available at www.cdcnpin.org

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