Incorrect use of condoms is undermining their effectiveness in preventing pregnancies and the spread of sexually transmitted infections, an international team of researchers has found.
Their study found 14 common problems associated with condom use including:
- Late application and early removal of a condom.
- Failing to unroll the condom out fully.
- Incorrect storage.
- Re-use of condoms.
- Inside-out condom use.
Published in the current edition of Sexual Health, the study reviews research into condom use across 14 countries between 1995 and 2011.
Team leader Professor Stephanie Sanders, of the Kinsey Institute for Research in Sex, Gender, and Reproduction at Indiana University, says "closing the gap" between perfect use and typical use of condoms is one of the crucial challenges of future condom promotion programs and is critical to "greatly reducing the epidemics of STIs and unintended pregnancies."
Sanders and colleagues report that between 17 per cent and 51 per cent of respondents in the studies said they had put on their condom partway through intercourse; with between 13 per cent and 44.7 per cent reporting early removal.
The researchers highlight the late application or early removal of condoms negates its protection against sexually transmitted disease as fluids can be exchanged throughout intercourse not just during ejaculation.
The study also found:
- Up to 25.3 per cent of participants completely unrolled the condom before putting it on rather than unrolling it on the penis.
- Between 24.3 per cent and 45.7 per cent did not leave space at the tip where semen can be collected.
- Between 4 per cent and 30.4 per cent had put the condom on inside out and then flipped it over.
Exposing the condoms to sharp objects, such as teeth, while removing it from packaging was reported by 2.1 per cent to 11.2 per cent of participants while 74.5 per cent of men and 82.7 per cent of women revealed they did not check condoms for damage before use, the Australian Broadcasting Corporation reported.
Errors may affect millions
The respondents in the 50 studies reviewed included a diverse range of people including sex workers, STI clinic attendees, monogamous married couples, university students and adolescents.
The paper suggests that with common errors and problems in condom use cited by all participants in the studies, "these errors and problems may be affecting millions of people".
The researchers admit there are weaknesses in their findings with huge variations in reported problems between studies.
They also say the overwhelming majority of studies have been conducted in developed countries and mostly in North America.
"Therefore more research is needed on condom use errors and problems in a wider range of countries, particularly in developing countries, and among varying populations," they write.
"For example, reuse of condoms was rarely reported in the studies in this review, but may be more common in less economically developed countries or among the poor.
"Collecting data on condom use errors and problems among a larger diversity of populations may help better inform condom intervention strategies tailored to those populations."