History of the Condom
The earliest known illustration of a man using a condom during sexual intercourse is painted on
the wall of a cave in France. It is 12,000-15,000 years old (Parisot, 1987). We know that condoms
have been used to protect against sexually transmitted infection since the sixteenth century and
to prevent unwanted pregnancy since the eighteenth century (Himes, 1963). Since the 19th
century, American moralists - who have misunderstood or denied its public health benefits -
have attacked condom use (Brodie, 1994).
As a result, those who cared more about the control of human sexuality than about the prevention
of sexually transmitted infection and unwanted pregnancy have stymied public health efforts
toward increased condom use in the U.S for most of the 20th century. During World War I, for
example, U.S. allies, such as New Zealand, gave their troops condoms to prevent sexually
transmitted infection. But social hygienists in the U.S. forced the American Armed Expeditionary
Forces to adopt a chastity campaign - they were opposed to any prophylactic prevention of
sexually transmitted infection. Consequently, in 1919 alone, U.S. troops reported a yearly
admissions rate of 766.55 per 1,000 for sexually transmitted infection (Brandt, 1985).
In the last several years, anti-sex, anti-choice radicals have reverted to a shameless distortion of
scientific fact in order to discourage condom use. Three myths propagated by this anti-condom
misinformation campaign are particularly dangerous. The first myth 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; Cantu &
Farish, 1999). These outrageous myths are now so widespread that they are recited in Congress
and have infected the sexuality education programs of more than a third of U.S. schools (Lerner,
1999; Landry et al., 1999).
However, as this fact sheet will make clear, the effectiveness of condoms against unintended
pregnancy and sexually transmitted infection has long been established (see below). Further,
information about and access to condoms clearly do not increase sexual activity among
adolescents (Kirby, 1997; Schuster et al., 1998). One World Health Organization review of 19
studies found no evidence that sexuality education programs lead to earlier or increased sexual
activity among teens (NCHSTP, 1996). But easy access to condoms does encourage use among
teens that are already sexually active (Schuster et al., 1998). And teens need protection - at
least 60.9 percent of twelfth-graders report having had sexual intercourse (AGI, 1999; Kann et al.,
1998).
The truth about condoms is that they offer the best protection for the sexually active (Stone et al.,
1999; CDC, 1998).
Condom Use is a National Public Health Goal
The U.S. Public Health Service has included increased condom use as part of Healthy People
2000 and Healthy People 2010 - the national health promotion and disease prevention
objectives. The federal government plans to "increase to at least 50 percent the proportion of
sexually active, unmarried people who used a condom at last sexual intercourse." Another goal
will "increase to at least 60 percent the proportion of sexually active, unmarried young women
aged 15-19 whose partner used a condom at last sexual intercourse." For adolescent men, usage
will go even higher - "to at least 75 percent" (NCHS, 1999). Increased condom use can reduce
the skyrocketing incidence of sexually transmitted infection among sexually active teens (KFF,
1998; Felman, 1979).
Condoms as Birth Control
Condoms are an effective, inexpensive form of birth control. Of 100 women whose partners use
condoms inconsistently or imperfectly, 14 will become pregnant in the first year of use. Only three
will become pregnant if condoms are used perfectly (Warner & Hatcher, 1998). Unlike many other
forms of birth control, condoms also protect against sexually transmitted infection. Additional
advantages of condoms as birth control include: low cost, easy access, simple disposal, minimal
side effects, and longer-lasting sex play. Using condoms can also enhance sexual pleasure by
reducing anxieties about the risk of infection and pregnancy (Warner & Hatcher, 1998).
Condoms and Sexually Transmitted Infection
Condoms offer effective protection against most serious sexually transmitted infections by
preventing the exchange of body fluids (Cates & Stone, 1992; CDC, 1998; Stone et al., 1999).
Such fluids - semen, genital discharge, or infectious secretions - are the primary routes of
transmission (Stone et al., 1999). While latex condoms may not completely prevent skin-to-skin
contact, they offer the best protection possible since most sexually transmitted infections attack
areas of the penis covered by the condom (Stone et al., 1999). (In order to be effective, condoms
must be used consistently and correctly, put on prior to genital contact, and used throughout
contact (Cates & Stone, 1992; CDC, 1998)).
Condoms and Fertility
Condoms can help protect fertility by preventing transmission of sexually transmitted infections
that cause infertility, such as chlamydia and gonorrhea. Women whose partners use condoms are
at much lower risk of hospitalization for pelvic inflammatory disease - a condition that causes
infertility - than those whose partners do not (Kelaghan et al., 1982). And women whose
partners use condoms are at 30 percent less risk of infertility due to sexually transmitted infection
(Cramer et al., 1987).
Condoms and Bacterial Infections
Condoms offer good protection against sexually transmitted bacterial infection - chlamydia,
gonorrhea, trichomoniasis, and syphilis (Stone et al., 1999; Judson et al., 1989). During the
1980s, genital chlamydia became the most prevalent bacterial STI in the U.S., and in 1996 there
were an estimated 3 million new cases - this made chlamydia the most frequently reported
infectious disease in the country (KFF, 1998). Increased condom use will help reduce the
incidence of these infections (Stone et al., 1999; Cates & Stone, 1992). The national goals to
double condom use were based on the condom's proven ability to reduce gonorrhea, chlamydia,
and HIV infection (NCHS, 1999).
Condoms and Viral Infections
Condoms are effective against viral infections such as HIV, hepatitis B, cytomegalovirus, and
herpes simplex virus 2, which are transmitted by semen, urethral fluids, and genital sores (Judson
et al., 1989; Cates & Stone, 1992).
HIV
Given the serious consequences of HIV infection, much of the research about condom efficacy
has focused on HIV transmission. The condom is recognized as a highly effective barrier against
HIV infection (CDC, 1998).
Condom-use opponents, however, have manipulated the findings of flawed laboratory tests to
create public doubt about the condom's effectiveness against HIV. For example, one study
erroneously concluded that latex condoms leak HIV virus even though it used particles that were
100 million times smaller than the HIV particles found in semen (Stone et al., 1999). In fact, the
risk of HIV transmission with a condom is reduced - as much as 10,000-fold (Carey et al., 1992;
Cavalieri d'Oro et al., 1994; Weller, 1993).
In a recent study of couples in which one partner was HIV positive, only one case of infection (2
percent) occurred among those who remained sexually active and used condoms consistently
and correctly. In contrast, the incidence of HIV infection was 14 percent with inconsistent use
(Deschamps et al., 1996). A similar study showed a 10-percent infection rate without consistent
condom use (de Vincenzi, 1994). A meta-analysis of 25 studies on HIV transmission and
condoms found that efficacy rates ranged from 87 percent to 96 percent against HIV infection
(Davis & Weller, 1999).
HPV and Herpes
Condoms provide some protection against viruses such as human papilloma virus (HPV) and
herpes simplex virus (HSV), that infect the general genital area (CDC, 1998). The Centers for
Disease Control and Prevention recommend condom usage as a way to reduce the risk of both
infections (CDC, 1998). Since HPV and herpes viruses "shed" beyond the covered area,
however, condoms do not provide as complete protection as they do for other pathogens.
However, condoms can decrease the risk of infection. Condom use directly correlated with a
lower risk of herpes infection in Costa Rican women whose partners wore condoms (Oberle et al.,
1989). And failure to use condoms has been shown to be among the most significant risk factors
for pre-cancerous conditions related to HPV (Wang & Lin, 1996).
Unlike HIV, most HPV and HSV infections do not have catastrophic health consequences. In
general, HPV and HSV are not as dangerous as HIV or chlamydia, which condoms can more
successfully prevent - HIV infection is considered fatal, and chlamydia can result in infertility or
permanent disability (Friedman et al, 1998; Howell et al., 1998; OWH, 1997).
HPV and Cervical Cancer
Few HPV infections lead to cervical cancer. It is estimated that 75 percent of women will have
HPV at some point in their lives, but only two percent to five percent will ever have an abnormal
Pap test result because of HPV infection. Even fewer will develop cervical cancer. (CDC, 1999;
Lytwyn & Sellors, 1997). Most HPV infections are short-lived, and many women appear to
develop immunity to different HPV infections. Nearly a third of women may recover from the
infection within six months, and after two years, more than 90 percent of HPV infections clear.
Persistent infection seems to be the higher risk factor for cervical cancer (Elfgren et al., 2000; Ho
et al., 1998).
The claims of condom-use opponents regarding HPV are false and alarmist. Condom use cannot
be blamed for the high prevalence of HPV or cervical cancer among women in the U.S. While
condoms may not eliminate the risk of transmitting the HPVs that cause cancer, the CDC
recommends them for risk reduction (CDC, 1998).
Condom Effectiveness
Condoms are effective because they block contact with body fluids that cause pregnancy and
sexually transmitted infection. Most reports of condom failure are the result of inconsistent or
incorrect use, not breakage (Macaluso et al., 1999). In the U.S., the actual breakage rate is a low
two per 100 condoms (CDC, 1998). High failure rates in some studies occur because many
people lie about contraceptive use to shift the responsibility for an unintended pregnancy to a
"faulty" contraceptive. Such over-reporting artificially inflates failure rates (Trussell, 1998).
Additional Resources
American Medical Association. Guidelines for Adolescent Preventive Services
www.ama-assn.org/adolhlth/recomend/monogrf1.htm
Recommendation 9 includes guidelines for making latex condoms available to adolescents.
Centers for Disease Control and Prevention, Division of HIV/AIDS Prevention.
www.cdc.gov/nchstp/hiv_aids/pubs/facts.htm
provides access to a number of CDC publications, including Condoms and Their Use in Preventing HIV Infection and Other STDs
and Patterns of Condom Use Among Adolescents: The Impact of Mother-Adolescent Communication.
Cited References
AGI - Alan Guttmacher Institute. (1999, accessed 2000, February 1). Facts in Brief: Teen Sex and Pregnancy, 1999 [Online].
http://www.agi-usa.org/pubs/fb_teen_sex.html.
A.L.L. - American Life League. (No date, accessed 2000, January 27). Birth Control [Online]. http://www.all.org/issues/se04.htm.
Brandt, Allan M. (1985). No Magic Bullet: A Social History of Venereal Disease in the United States Since 1880. New York: Oxford
University Press.
Brodie, Janet F. (1994). Contraception and Abortion in Nineteenth Century America. Ithaca, New York: Cornell University Press.
Cantu, Yvette C. & Heather E. Farish. (1999, accessed 2000, January 27) The Human Papillomavirus (HPV) Epidemic: Condoms
Don't Work [Online]. http://www.frc.org/insight/is99flab.html.
Carey, Ronald F., et al. (1992). "Effectiveness of Latex Condoms as a Barrier to Human Immunodeficiency Virus-Sized Particles
under Conditions of Simulated Use." Sexually Transmitted Diseases, 19(4), 230-234.
Cates, Willard & Katherine M. Stone. (1992). "Family Planning, Sexually Transmitted Diseases and Contraceptive Choice: A
Literature Update - Part I." Family Planning Perspectives, 24(2), 75-84.
Cavalieri d'Oro, Luca, et al. (1994). "Barrier Methods of Contraception, Spermicides, and Sexually Transmitted Diseases: A
Review." Genitourinary Medicine, 70(6), 410-417.
CDC - Centers for Disease Control and Prevention. (1998, January 23). "1998 Guidelines for the Treatment of Sexually
Transmitted Diseases." Morbidity and Mortality Weekly Report, 47(RR-1), 1-116.
Cramer, Daniel W., et al. (1987). "The Relationship of Tubal Infertility to Barrier Method and Oral Contraceptive Use." JAMA,
257(18), 2446-2450.
Davis, Karen R. & Susan C. Weller. (1999). "The Effectiveness of Condoms in Reducing Heterosexual Transmission of HIV."
Family Planning Perspectives, 31(6), 272-279.
Deschamps, Marie-Marcelle, et al. (1996). "Heterosexual Transmission of HIV in Haiti." Annals of Internal Medicine, 125(4), 324-
330.
de Vincenzi, Isabelle. (1994). "A Longitudinal Study of Human Immunodeficiency Virus Transmission by Heterosexual Partners."
New England Journal of Medicine, 331(6), 341-346.
Felman, Yehudi M. (1979). "A Plea for the Condom, Especially for Teenagers." JAMA, 241(23), 2517-2518.
Friedman, Stanford B., et al. (1998). Comprehensive Adolescent Health Care, 2nd ed. St. Louis, MO: Mosby.
Hartigan, John D. (1997, accessed 2000, January 27). The Disastrous Results of Condom Distribution Programs [Online].
http://www.frc.org/infocus/if97k1ab.html.
Himes, Norman E. (1963). Medical History of Contraception. New York: Gamut Press, Inc.
Ho, Gloria Y.F., et al. (1998). "Natural History of Cervicovaginal Papillomavirus Infection in Young Women." New England Journal
of Medicine, 338(7), 423-428.
Howell, M. René, et al. (1998). "Screening for Chlamydia Trachomatis in Asymptomatic Women Attending Family Planning
Clinics: A Cost-Effectiveness Analysis of Three Strategies." Annals of Internal Medicine, 128(4), 277-284.
Judson, Franklyn N., et al. (1989). "In Vitro Evaluations of Condoms with and Without Nonoynol 9 as Physical and Chemical
Barriers Against Chlamydia Trachomatis, Herpes Simplex Virus Type 2, and Human Immunodeficiency Virus." Sexually
Transmitted Diseases, 16(2), 51-56.
Kann, Laura, et al. (1998, August 14). "Youth Risk Behavior Surveillance - United States, 1997." Morbidity and Mortality Weekly
Report, 47(SS-3), 1-89.
Kelaghan, Joseph, et al. (1982). "Barrier-Method Contraceptives and Pelvic Inflammatory Disease." JAMA, 248(2), 184-187.
KFF - Kaiser Family Foundation. (1998). Sexually Transmitted Diseases in America: How Many Cases and at What Cost? Menlo
Park, CA: Kaiser Family Foundation and American Social Health Association.
Kirby, Douglas. (1997). No Easy Answers: Research Findings on Programs to Prevent Teen Pregnancy. Washington, DC: The
National Campaign to Prevent Teen Pregnancy.
Kiviat, Nancy, et al. (1999). "Cervical Neoplasia and Other STD-Related Genital Tract Neoplasias." In King K. Holmes et al., eds.,
Sexually Transmitted Diseases, 3rd edition. New York: McGraw-Hill.
Koutsky, Laura A. & Nancy B. Kiviat. (1999). "Genital Human Papillomavirus." In King K. Holmes et al., eds., Sexually Transmitted
Diseases, 3rd edition. New York: McGraw-Hill.
Landry, David J., et al. (1999). "Abstinence Promotion and the Provision of Information About Contraception in Public School
District Sexuality Education Policies." Family Planning Perspectives, 31(6), 280-286.
Lerner, Sharon. (1999, November 9). "Condomnation." The Village Voice, p. 26.
Macalusco, Maurizio, et al. (1999). "Mechanical Failure of the Latex Condom in a Cohort of Women at High STD Risk." Sexually
Transmitted Diseases, 26(8), 450-458.
NCHS - National Center for Health Statistics. (1999). Healthy People 2000 Review, 1998-99. Hyattsville, Maryland: Public Health
Service.
NCHSTP - National Center for HIV, STD, & TB Prevention. (1996, accessed 1999, December 2). Condoms and Their Use in
Preventing HIV Infection and Other STDs [Online].
http://www.cdc.gov/nchstp/hiv_aids/pubs/facts/condoms.pdf.
Oberle, Mark W., et al. (1989). "Herpes Simplex Virus Type 2 Antibodies: High Prevalence in Monogamous Women in Costa
Rica." American Journal of Tropical Medicine and Hygiene, 41(2), 224-229. OWH - Office of Women's Health. (1997, accessed
1999, June 14). Sexually Transmitted Diseases [Online].
http://www.cdc.gov/od/owh/whstd.htm.
Parisot, Jeannette. (1987). Johnny Come Lately: A Short History of the Condom. Translated and enlarged by Bill McCann.
London: Journeyman.
Schuster, Mark A., et al. (1998). "Impact of a High School Condom Availability Program on Sexual Attitudes and Behaviors."
Family Planning Perspectives, 30(2), 67-72 & 88.
Stone, Katherine M., et al. (1999). "Barrier Methods for the Prevention of Sexually Transmitted Diseases." In King K. Holmes et
al., eds., Sexually Transmitted Diseases, 3rd edition. New York: McGraw-Hill.
Trussell, James. (1998). "Contraceptive Efficacy." In Robert A. Hatcher et al., eds., Contraceptive Technology, 17th edition. New
York: Ardent Media.
Wang, Pair Dong & Ruey S. Lin. (1996). "Risk Factors for Cervical Intraepithelial Neoplasia in Taiwan." Gynecological Oncology,
62(1), 10-18.
Warner, D. Lee & Robert A. Hatcher. (1998). "Male Condoms." In Robert A. Hatcher et al., eds., Contraceptive Technology, 17th
edition. New York: Ardent Media.
Weller, Susan C. (1993). "A Meta-Analysis of Condom Effectiveness in Reducing Sexually Transmitted HIV." Social Science and
Medicine, 36(12), 1635-1644.
Media Contacts
New York:212/261-4660
Washington, DC: 202/785-3351
Public Policy Contact
Washington, DC: 202/785-3351
Fact Sheet
Published by the Katharine Dexter McCormick Library
Planned Parenthood Federation of America
810 Seventh Avenue, New York, NY 10019
212-261-4779
Current as of December 2000.
|
