The Complete Book of Men's Health - Part 1: Sexual Health

  ^•Source: The Durex Report 1994.

Previous research showed that 1 in 10 males rely on the female to provide the condoms!

The failure rates of different methods of contraception are detailed on the opposite page. The figures given are numbers of pregnancies per 100 women using the method for one year, so are effectively percentages.

COITUS INTERRUPTUS

Coitus interruptus, also known as the Withdrawal Method, is one of the oldest male methods of contraception. It received a bad press in Biblical days when Onan 'spilled his seed' on the ground rather than fulfil his obligation to impregnate his dead brother's wife. For this defiance of the Torah he was struck down on the spot.

Coitus interruptus involves the male withdrawing his penis from the female just before ejaculation. Withdrawal requires strong motivation as the instinctive male reaction at impending orgasm is to thrust as far into the female as possible.

Timing is also important. If withdrawal occurs too early, orgasm will fail. If too late, semen will enter the vagina. Even if the timing is right, often some sperm are released early along with the lubricating secretions from Cowper's glands. Withdrawal should not be relied on if it is imperative that pregnancy is avoided.

Having said that, if practised carefully coitus interruptus is surprisingly effective. Some studies have found no difference in failure rates between the withdrawal method and barrier methods such as the diaphragm. Although there are many better methods of contraception available, withdrawal is better than nothing in an emergency situation.

The effectiveness of coitus interruptus is improved with the additional use of spermicides.

THE CONDOM

History

The (male) condom was supposedly invented by the Italian anatomist, Fallopius, in the sixteenth century. He prescribed linen sheaths impregnated with lotion to protect uncircumcised males from the ravages of syphilis. These were fitted over the tip of the penis (glans) and the foreskin was pulled over them. The contraceptive side-effect was only noticed later by accident.

By the eighteenth century, condoms were still used against syphilis, although Casanova donned condoms made from sheep intestines or fish skin '... to put the fair sex under shelter from all fear'.

A mid-nineteenth-century recipe for a condom commanded a man to:

Take the caecum of a sheep; soak it first in water, turn it on both sides, then repeat the operation in a weak solution of soda, which must be changed every four or five hours, for five or six successive times; then remove the mucous membrane with the nail; sulphur, wash in clean water, and then in soap and water; rinse, inflate and dry. Next cut it to the required length and attach a piece of ribbon to the open end. Use to prevent infection or pregnancy.

Interestingly, five antique condoms recently went up for auction at Christie's. Three painted with erotic scenes from the mid-nineteenth century fetched prices of £2,400 each, and an illustrated French version attracted a record sum of £3,300.

The modern sheath was supposedly invented by a Dr Condom, court physician to King Charles II. It is more likely that the term condom derives from the Latin for receptacle ­ condus.

In the 1880s the birth rate in Britain and Europe declined. One suggested reason was the availability of reusable contraceptive prophylactics which were sensually acceptable, relatively unobtrusive and not malodorous, although they did not fit at all well. Their respectability was presumably enhanced by sporting full-colour pictures of Queen Victoria on the packaging.

Modern Condoms

Modern condoms are made from highest quality pre-lubricated latex. Worldwide, there are two standard widths (52 mm and 49 mm) and several different lengths. Non-lubricated condoms are also available, as are condoms lubricated with nonoxynol-9 spermicide, or with a non-spermicidal lubricant (sk-70) for those allergic to spermicides. They can sport ribs and knobbles, feature a variety of colours or flavours and some even glow in the dark. Perhaps the ultimate invention is the musical condom. Designed for the tone-sensitive, it contains a piezoelectric sound transducer microchip and can play any melody or voice message. A US patent has been granted. There is even a condom just invented which plays a tune if it breaks during intercourse!

With careful use, condoms have a 2 per cent failure rate. If roughly handled or not put on as soon as sexual activity is started, failure rates can soar to 15 per cent. Approximately one in 12 male sheaths burst during use, despite electronic testing of integrity. Bursting is more likely during dry sex when a water-based lubricant has not been used. Sheaths are best used with a water-based spermicidal jelly to provide additional protection in the case of condom failure.

Only water-based lubricants (e.g. KY Jelly) are recommended for use with latex condoms. Mineral-based oils (e.g. baby oil, petroleum jelly, some spermicidal creams) weaken latex and may even dissolve it. Tests have shown that mineral oils can reduce condom strength by up to 95 per cent within 15 minutes.

Assessing Condom Reliability

In the UK, quality condoms carry a British Standards Institute Kite Mark BS 3704 (1989) or the stricter European Standard (ISO 4074). A new, stricter British Standard has also just been agreed. Those that glow in the dark ('fundoms'), sport 'go-faster' stripes or are labelled 'not to be used as a barrier' should not be relied upon.

How to Use a Condom

It may seem obvious how to use a condom, but a study involving almost 300 men asked to put a condom on a model penis showed that:

• 16 men had not used condoms before, yet only one of these read the instructions. Overall, only 1.7 per cent bothered to read the instruction leaflet supplied.

• 13 per cent of men were careless when opening the foil wrapper, increasing the risk of tearing the condom.

• 20 per cent of men tried unrolling the condom inside out.

• 3 per cent of men unrolled the condom over their finger and tried pulling it on like a sock.

• Nearly 40 per cent of men did not squeeze the teat. If the teat is not squeezed, air gets trapped in the condom, increasing the risk of semen leakage along the condom.

• Only 50 per cent of the men tested were assessed as having no problem putting the condom on the model.

• 12 per cent of men (mostly aged 16­24) were assessed as having obvious difficulty in using a condom.

• 20 per cent of men who had never used a condom before ­ or who had not used one within a year ­ had difficulty applying the condom to the model.

What to Do

1. Avoid any genital-to-genital contact until the condom covers the penis, as some sperm are released early during sexual activity.

2. Always check the use-by (expiry) date on the packet.

3. Open the foil packet carefully so the condom isn't damaged. Once an airtight wrapping is opened deterioration is rapid, so don't use a condom whose wrapping is cracked or torn. Ultraviolet light, heat, humidity and ozone can all cause latex to deteriorate.

4. Squeeze the teat of the condom to expel any air.

5. While still squeezing the teat, unroll the condom over the erect penis using your other hand. Don't attempt to apply it if the penis is not fully erect and don't unroll the condom before trying to put it on.

6. Make sure the condom is completely rolled down and extends to the base of the penis. This is important ­ if not pulled down completely it may ruck up during intercourse and come off.

7. If a lubricant is needed, make sure it is water-based (e.g. KY Jelly).

8. Immediately after ejaculation, grasp the penis and condom near the base and hold firmly while withdrawing the penis.

9. Don't continue penetration until you lose erection as this increases the risk of spilling sperm.

10. Gently slide the condom off, taking care not to spill any sperm. Wrap the used condom in a tissue and dispose of it hygienically. If you tie a knot in it, it will not flush down the toilet very easily.

11. Use each condom only once.

Tips

• If you are not confident using a condom, try practising alone first.

• Don't put a condom on until the penis is fully erect.

• Don't initiate genital-to-genital contact until the condom is on.

• Always use a spermicidal jelly with condoms. This greatly increases their protection against pregnancy. Nonoxynol-9 also helps to protect against gonorrhoea, Chlamydia (NSU), syphilis, herpes and HIV.

• Only use water-based lubricants.

• Carry several condoms, not just one.

• Use a condom for protection against sexually transmissible diseases, even if contraception is not necessary.

Condom Size

A tightly fitting condom is more likely to burst than one that fits correctly. One study suggested that the British standard condom width of 52 mm measured flat is too small for approximately half of Western penises, who need a flat condom width of 64 mm.

A UK questionnaire of 281 males found that 25 per cent had difficulty putting condoms on, and of these, 19 per cent admitted it was because they were too tight. As a result, 73 per cent had experienced a condom coming off and 68 per cent had experienced condoms splitting on them. There is a strong case for condoms to be manufactured in a wider range of sizes.

A new polyurethane condom that is twice as strong as a latex one as well as being thinner, non-allergenic and which will not dissolve in petroleum jelly is being tested in the US. It should be on general sale in the UK in 1995.