Get Real! How Well Will Condoms Really Work?


Lary2211 asks:

I’m 19
years old. My boyfriend and I want to have sex. He is not a virgin, but
I am. The only thing that I’m scared of is getting pregnant. We will
use condoms for sure and as my boyfriend has had intercourse before,
I’m assuming he knows how to use them. How effective can the condom be
to prevent me from getting pregnant since I will be having sex for the
first time?

Another issue that is freaking me out is what if the condom tears or
comes off? Can I guarantee 100% protection and rely on my boyfriend’s
experience with condoms? I’m worrying a little bit too much, but I
really want to experience sexual intercourse with someone I really
love. I would really appreciate your help and advice because I’m in
need of some.

Heather Corinna replies:

There are a bunch of things you can know and do that I think are going to help you feel a lot better.

When we talk about the effectiveness of any kind of contraception,
including condoms, we reference two different groups of figures. One is
perfect use: that means a person always uses their method and
always uses it correctly. These results are often figured via lab
studies, where perfect use can be verified. The other is typical use:
how your average person generally uses a method. For instance, it’s
typical use for women to take a birth control pill late or miss one now
and then, have a patch slip off, or only put a condom on after
intercourse has already begun. Typical use rates also include not using
a given method at all. In other words, the typical use rate for condoms
is about people who, when asked what method of birth control they use,
say condoms, even if they only use a condom one out of every three
times they have intercourse.

In typical use, condoms are around 85% effective, or present a
15% risk of pregnancy. But in perfect use, they’re about 98% effective,
or present about a 2% risk of pregnancy.
That’s the case whether
it’s the first time someone is having sex or the 201st: what sexual
experience you have or have not had does not change the effectiveness
rate of a contraceptive.

To give you a couple methods to compare that to, spermicides are 85%
effective in perfect use and 71% effective in typical use. The birth
control pill is 99.7% effective in perfect use and 92% effective in typical use. An IUD is over 99% effective in both typical and perfect
use.

No one method is 100% effective in perfect or typical use over time.
If you want 100% protection from pregnancy, the only way to get that is
by not having the kinds of sex (genital intercourse or other direct
genital-to-genital contact) that present risks of pregnancy.

But both kinds of effectiveness statistics for methods are about
effectiveness of use over one year: that means that in single incidents
of sex, condoms absolutely can be 100% effective. After all, we either
become pregnant or we don’t: it’s not like we can become only 13%
pregnant. If we use a condom as contraception when we have sex, and we
don’t become pregnant, then that condom was 100% effective.

It might help to know that young women who use NO method of
contraception have about a 90% chance of becoming pregnant in one year.
Once more with feeling, women using condoms have only a 15% chance at a
maximum. As you can see, using condoms and/or other methods of
contraception makes a huge difference, even just in typical use, but all the better with perfect use, when that risk is only around 2%.

In case someone’s filled your head with the idea that even when used
properly, condoms are highly likely to fail, know that’s just not true.
According to the CDC (via Avert)
"in the United States, most studies of breakage caused by fault in the
condom itself have shown breakage rate is less than 2 condoms out of
every 100 condoms. Studies also indicate that condoms slip off the
penis in about 1-5% of acts of vaginal intercourse." When condoms break
or slip off, it’s usually because they weren’t put on, used, taken off
or stored properly. Condom failure is usually due to user error.

And while we’re at it, as the CDC also explains,
"laboratory studies have demonstrated that latex condoms provide an
essentially impermeable barrier to particles the size of STD
pathogens." Condoms are also very highly effective at preventing STIs,
which is just as important as preventing unwanted pregnancy.

Seeing all those figures, it’s probably obvious that using condoms consistently and correctly makes a world of difference.

You don’t need to just assume or guess your partner knows how to use
condoms correctly: this is something that you both can talk about with
him, and should be talking about, all the more if condoms are going to
be your only or primary method of birth control. So, check in. Make
sure you’re both on the same page that you’re always going to use a
condom, from start to finish. Ask if he feels like he has condom use
down, and review, together, what correct use is and is not. Make sure
you know for yourself how to use condoms properly, and see with other
sexual activities you might already be engaging in, like oral sex, if
you both DO know how to use them properly. Both of you should know how
to put on and remove a condom, after all, not just him. You both
knowing that not only will help assure condoms are always used and used
properly, but sometimes you’ll find it’s simply more convenient,
depending on whose hands are where doing what, for you to put the
condom on him than it is for him to do it. Some couples also find that
makes condom use more exciting for them.

Some STIs are just as big a deal as pregnancy, but assuring you two
know how to use a condom correctly when only one of those things are on
the line, rather than both, is smart. You can take some turns putting
the condom on him with the activities you’re doing now that do pose
risks of STIs (which you should be doing anyway), but not of pregnancy,
to be sure you both know how to use them right before you have
intercourse, rather than relying on him being the only one who knows
how, or finding out if he is or isn’t an ace at it later on.

You also don’t have to only use condoms for intercourse if
you want more protection from unwanted pregnancy than condoms offer.
When we pair up any two methods together, even if we don’t use EITHER
perfectly, you’ll have no less than 92% effectiveness. When we pair any
two and use them perfectly, no two methods combined offer less than 97%
effectiveness, and most combined with perfect use offer over 99%
protection.

You have many options for second methods. You can talk to your
doctor about getting a prescription for a hormonal method, like the
pill or Nuvaring, you could ask about cervical barriers if you want
something non-hormonal, or could add a second method that doesn’t
require consulting with a healthcare provider at all, like natural
family planning, withdrawal or spermicides.

You also always have the option of getting yourself a pack of Plan B
to have around just in case a condom should slip off or break. If a
condom does break or slip into your vagina, that’s something you can
use to help prevent a pregnancy when a condom has failed. You can go to
a pharmacy and get it after-the-fact, it’s just more convenient and can
give you more peace of mind to already have a pack handy. That way, you
can take it right away so it can be most effective. and you also don’t
have to run yourself ragged trying to find it if and when you’re in the
time crunch of needing it pronto.

I’d also like to mention that sometimes when we find ourselves
really freaking out about this stuff, it can be because while we want
to do something, we need more time to prepare, assess our readiness, to
be in a relationship or talk through all of this stuff with a partner,
friends, family or someone else we trust and get good support from.

So, even if knowing what I’ve told you about condoms, assuring you
both know how to use them, and/or adding a second method still leaves
you feeling really scared, you can always hold off on intercourse until
that’s less scary for you, and you feel more prepared to handle it as a
possible outcome. Even if your boyfriend isn’t scared the way you are,
if you’re still feeling this scared, and this is someone who loves you
and cares for you, he should have no problem holding off until you feel
more ready. Any partner who pushes when their partner says they don’t
feel totally okay with sex and all it can entail yet, or who even likes
the idea of having sex with someone who is scared is someone to steer
clear of if you want to assure healthy sexual partnerships.

On top of the emotional and interpersonal toll it can take on you,
feeling scared or panicked also doesn’t tend to result in great sex for
anyone. Stress and anxiety usually keep our bodies and minds from
becoming fully aroused, and make it much harder to experience pleasure
and to reach orgasm. Plus, I always hope that anyone who is sexually
active is feeling just as good after sex as they did during: if
afterwards, you think you’re going to be sweating bullets until your
next period arrives, I’d suggest you give some thought to if now is
really the best time for you to add intercourse to your life.

If you’re feeling that way, what you might want to do before
intercourse is some more of your own thinking, then talk with your
partner about an unwanted pregnancy. What do you think you’d want to do
if that happened? While our ideas about what we might do in the
abstract aren’t always the same as when we’re actually pregnant at any
given time, you certainly can get some sense of what choice you think
would be best for you. How would he feel about it? Does he feel like
he’d be able to be supportive, including of what reproductive choice
you think you’d want to make? Talk about what you feel like you need to
feel comfortable with any risk of pregnancy, and you can work together
to get there.

I’ll leave you with a few extra links for all of this, including our
system to help users find out what methods of contraception will likely
be best for them, a page that can show you the effectiveness rates when
you combine methods as well as instructions on how to use condoms
properly, and so that they feel best for both of you.


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To schedule an interview with contact director of communications Rachel Perrone at rachel@rhrealitycheck.org.

Follow Heather Corinna on twitter: @Scarleteen

  • grayduck

    As usual, Heather Corinna is short on facts and long on hype. Some of her statements might mislead the questioner and other readers into believing that condoms are more effective than a dispassionate analysis of the data would conclude.

     

    For example, the following statements imply that user error is always avoidable by the condom user: "In case someone’s filled your head with the idea that even when used properly, condoms are highly likely to fail, know that’s just not true" and "You both knowing [how to put on and remove a condom] not only will help assure condoms are always used and used properly…" Some, if not most, of the difference between perfect-use and typical-use failure rates is caused by factors that are outside the control of the user but not included in perfect-use studies. For example, woman might be raped by an attacker who refuses to use a condom, the store might run out of condoms, be closed, or refuse to sell condoms, the condom might have been tampered with, the user may have misunderstood the directions on how to use the condom ("…participants in clinical trials are usually self-selected, and they often have received more intense patient education and clinical attention than the typical user experiences once a method is widely available"), the user and her sexual partner may miscommunicate with one another, or the user’s partner might do something to defeat the effectiveness of the condom- including refusing to use it altogether. Even forgetting to use a condom is not entirely controllable by a user. Everyone makes mistakes. No study, at least of which I am aware, has found that any particular large demographic of users is/are able to use contraceptives at a lower rate of user error than reflected in typical-use failure rates.

     

    http://www.guttmacher.org/pubs/journals/3105699.html

     

    Second, the latest data show that condoms have a one-year, typical-use failure rate of 17.4 percent, not 15 percent as she claims.

     

    http://www.guttmacher.com/pubs/fb_contr_use.html

     

    Another way that Corinna’s response hyped condoms is by using a time duration for measuring effectiveness that is unrealistically brief for most users. A typical woman, according to the Guttmacher Institute, is sexually active but trying to avoid pregnancy for thirty years of her life. Therefore, thirty years would be a meaningful time duration. Unless the questioner intends to engage in sexual intercourse for a single year and then stop and never have sex again, the use of a single year of use when describing failure rates is of questionable value and yields a misleadingly low failure rate. Extrapolating the 17.4 percent failure rate across thirty years yields a failure rate of 99.7 percent! (1-(1-0.174)^30) Even the perfect-use failure rate is 45 percent when extrapolated across thirty years.

     

    A fourth reason why Corinna’s piece functioned more as an advertisement for condoms than an unbiased offering of assistance is that she assumed her own values regarding the consequences of contraceptive failure rather than attempting to assess the consequences for the questioner. Maybe the questioner’s health would be threatened by a pregnancy. Maybe she is unwilling to obtain an abortion, not ready to raise a child, and unwilling to put a child up for adoption. Without knowing the consequences of failure for the particular user, Ms. Corinna has no reliable basis for assuming that even a two-percent failure rate is acceptable for the questioner.

     

    Fifth, the following assertion was a meaningless declaration masquerading as an argument for engaging in sexual intercourse with a condom. "If we use a condom as contraception when we have sex, and we don’t become pregnant, then that condom was 100% effective." Such a statement is like writing "If we play Russian Roulette and survive, then playing Russian Roulette was perfectly safe."

     

    A sixth way that she encouraged use of condoms rather than providing useful, impartial information was by not mentioning the most effective alternative to condoms- Implanon.

     

    Seventh, she offers no evidence for the following assertion. "Condoms are also very highly effective at preventing STIs…" I have not seen any evidence to confirm that claim.

     

    Finally, Heather Corinna presented no reliable basis for her assertion that avoding an STI is "just as important as preventing unwanted pregnancy." Her comment just served to urge the questioner to use condoms rather than a more effective contraceptive method.

     

    In my opinion, Heather Corinna did a disservice to this questioner.

     

    http://www.abortiondiscussion.com

  • anonymous99

    GrayDuck, We can all see through this lame attempt to discredit Heather.  We weren’t born yesterday.  To come on this site and assert that Heather should tell a young woman who wants to have sex with her boyfriend for the first time that she should expect a 99% failure rate with condoms is truly absurd.  I find most disturbing your insinuation that there’s no scientific evidence that condoms prevent STIs.  I surely hope there weren’t any young people who happened upon your response and left with the idea that condoms don’t prevent STIs.  You surely know they do!  Even amateurs like you and me can do a Google search.  Can’t we?  And had you bothered to check out the links that were provided you would see a comprehensive discussion re: birth control methods beyond condoms – including abstaining.  I sure hope this isn’t the way you’re handling these types of questions and concerns from your own kids.   If so, you’re doing them a great disservice.

  • bebebeyondbirdsbeesdotcom

    GrayDuck,

     

    You make your agenda perfectly clear–you don’t believe in condoms. It’s fine for you to have this opinion. You may, in fact, hold any opinion you’d like, including the opinion that the world is flat or that dinosaurs and humans co-existed.

     

    But you’re not going to have much luck in convincing anyone that your opinion is valid when you so grossly misuse statistics and bash one of the hardest-working most knowledgable educators in the country.

     

    ——

    <a href="http://beyondbirdsbees.com">Beyond the Birds and the Bees</a>

  • heather-corinna

    Most of this is just plain nonsense, and I think even you know that it is, GrayDuck.  You also say some things that are just patently not true, and which any readers can baldly see are not, such as stating I did not discuss other methods of contraception with this user.  I also can only answer what I am asked, based on the information I’m given.  I’m not psychic, after all. I provided her information and extended sources of information where she, perhaps knowing her own situation more specifically than she told me, can make her own choices about what she’s most comfortable with, a message I sent her quite clearly.

     

    Just a few brief bits:

    1) That "latest data" on condoms you linked to is from a single source and study: I base the effectiveness rates I use for all methods on several reliable sources, which always include Contraceptive Technology and Planned Parenthood (sources which also review all new information constantly, and adjust their info when it’s sage to), sources you’ll have a hard time finding sexual healthcare pros who aren’t on board with.

     

    Also?  When you say things like:

    Some, if not most, of the difference between perfect-use and
    typical-use failure rates is caused by factors that are outside the
    control of the user but not included in perfect-use studies. For
    example, woman might be raped by an attacker who refuses to use a
    condom, the store might run out of condoms, be closed, or refuse to
    sell condoms…the user may
    have misunderstood the directions on how to use the condom, the user and her sexual partner may miscommunicate with
    one another…Even forgetting to use a condom is not entirely controllable by a user.

     

    You actually disprove some of your own argument with these kinds of statements.  We aren’t talking about rape, or about not having condoms, and I have GIVEN this user much of the information to avoid many of the scenarios you describe.

     

    2) This user didn’t ask me for the rate over her lifetime.  But you know that already, unless you just didn’t really read any of this (which seems possible).  Why you think no one else reading would is beyond me.  The rates we get on effectiveness for contraception ARE usually calculated for periods of one year, and I don’t think you can make the mathematical extrapolations you do from those one-year use rates alone. If you want accurate lifetime rates, we’ll need lifelong studies.

     

    3) If you haven’t seen data that has shown condoms are effective at protecting against STIs than a) you didn’t read some of the links right within the piece or b) you haven’t looked for it.

     

    4) I’m not hawking or advertising condoms: the user ASKED me about condoms.  Are you advertising Implanon?  Because that’s a pretty weird leap. It’s not the only method with that effectiveness rating, after all. As well, as is the case with any method, no one method is right for everyone or affordable for everyone. But if she was interested in an implant, she would have found information on it in the link I gave her giving information on all methods.

     

    5) We have had data over the years for several methods — if not all — that shows us some groups do better with one method than others, and some are easier for a given group to use properly.  For instance, we know the perfect use rate of oral contraceptives is lower for adolescents than for adults, and that cervical caps are less effective for women who have given birth.  I’ve been working in and around sexual health and contraception full-time for over a decade, as well (and that combined with the fact that via my job, I look at these kinds of data all the time), so have what is likely a much better wealth of experience to draw upon about what methods tend to work best for people, and how they most often fail, than I suspect you do.

  • crowepps

    Finally, Heather Corinna presented no reliable basis for her assertion that avoding an STI is “just as important as preventing unwanted pregnancy.”

    Do I correctly understand from this statement that you think getting an STI is perfectly okay? I’m not sure why you would be so hostile as to demand someone present a ‘reliable basis’ for saying it’s important not to catch a disease.

  • grayduck

    "I find most disturbing your insinuation that there’s no scientific evidence that condoms prevent STIs."

     

    I insinuated no such claim.

     

    http://www.abortiondiscussion.com

  • grayduck

    "You also…stat[ed that] I did not discuss other methods of contraception with this user."

     

    My post included no such statement.

     

    "I base the effectiveness rates I use for all methods on several reliable sources, which always include Contraceptive Technology and Planned Parenthood…"

     

    Then why not cite those sources? Listing "Contraceptive Technology" and "Planned Parenthood" is equivalent to citing Google.

     

    "We aren’t talking about rape, or about not having condoms…"

     

    Rape and unavailability are, indeed, factors affecting the effectiveness of different forms of contraception. As I stated, they are neither controllable by the user nor acknowledged in studies of perfect-use effectiveness.

     

    "…I have GIVEN this user much of the information to avoid many of the scenarios you describe."

     

    The only scenarios you addressed, as far as I can see, were proper use of condoms and communication with the partner. Regarding the former, you only included a link to your own article in a bibliography. Regarding the latter, your advice is not impervious to failure.

     

    "This user didn’t ask me for the rate over her lifetime."

     

    Correct; she asked about how effective the condom can be to prevent her from getting pregnant. She did not say that the duration of use would be limited to one year.

     

    "The rates we get on effectiveness for contraception ARE usually calculated for periods of one year…"

     

    Only because the research is usually limited to approximately one-year periods. She was looking for information that she could apply to her life, not raw data.

     

    "I don’t think you can make the mathematical extrapolations you do from those one-year use rates alone. If you want accurate lifetime rates, we’ll need lifelong studies."

     

    My extrapolations may be far from perfect, but we hardly need to make baseless assumptions about duration of use until lifetime studies are completed. Even if, or when, those studies are compeleted, they will have problems of their own.

     

    http://www.abortiondiscussion.com

  • heather-corinna

    I’m not going to address denials of your own statements or inferences we can all read, nor your ideas of what the user was asking for and what she needed, especially since I have this funny feeling this isn’t work you yourself actually do to have the vaguest notion of what teens generally want and need in this respect.  As well, in the links I provided her were plenty of additional information on proper condom use.

     

    However, per citations?  I often don’t cite things in advice articles which are in the additional materials I am sending users to in any answer in the links.  Our pages on birth control all contain those citations.  However, suggesting finding the condom effectiveness rating in any edition of CT is as blind a thing as Google is ridiculous: methinks you’ve never cracked open a copy of the most widely-used professional contraception healthcare resource there is. Which is pretty strange for someone who apparently knows so much about contraception.

  • grayduck

    "If you haven’t seen data that has shown condoms are effective at protecting against STIs than a) you didn’t read some of the links right within the piece or b) you haven’t looked for it."

     

    Again, here is what you actually said. "Condoms are…very highly effective at preventing STIs…" If the available evidence leads to such a definitive conclusion, someone in your position should be able to cite reliable sources in support of the conclusion. Those sources should demonstrate the effectiveness of condoms relative to both other available STI avoidance strategies and the needs or expectations of the questioner. Moreover, studies cited should not assume factors that are uncontrollable by the condom user.

     

    "Are you advertising Implanon?"

     

    In a sense, yes. But more to the point, I suspect that the questioner may have welcomed knowledge about a contraceptive that is substantially more effective than are condoms. She said she was seeking "…guarantee[d] 100% protection…;" Implanon comes much closer to that ideal than condoms do.

     

    "…I…have what is likely a much better wealth of experience to draw upon about what methods tend to work best for people, and how they most often fail, than I suspect you do."

     

    Then please draw upon that wealth of experience to prove me wrong. The internet is a good venue for demonstrating knowledge but an unconvincing means of claiming authority.

     

    http://www.abortiondiscussion.com

  • heather-corinna

    I’m actually just starting some substantial time off, but so this doesn’t sit while I’m away, I think all there really is to say to this is that it seems your reading comprehension could use some improvement.

     

    Because I DID talk to her about other methods of contraception besides condoms right in this piece, and also provided her with a link that would get her to in-depth information on all available methods. I also DID link to very reliable and credible sources which detail the efficacy of condoms when it comes to STIs. As well, any user reading the original piece is at Scarleteen, where with the easy use — and for our users who grew up with the net, it is intituitve and easy, I don’t need to explain it to them like I apparently do for you — of links and tags provided, they can get to countless sources of this kind of additional information should they want it.

  • grayduck

    "As well, in the links I provided her were plenty of additional information on proper condom use."

     

    That point is not relevant to any assertion in my posts.

     

    "However, per citations? … Our pages on birth control all contain those citations.  However, suggesting finding the condom effectiveness rating in any edition of CT is as blind a thing as Google is ridiculous…"

     

    Alright, I goofed. Let me start again. Contraceptive Technology does claim the fifteen percent figure, but bases its assertion on fourteen-year-old data. My source used a newer, but equally reliable, source of data.

     

    http://www.contraceptivetechnology.com/table.html

     

    Scarleteen’s link to Planned Parenthood as a reference regarding the effectiveness of condoms is dead. The page at Planned Parenthood’s site on condoms fails to cite any research at all.

     

    http://www.scarleteen.com/birth_control_bingo_condoms

     

    http://www.plannedparenthood.org/health-topics/birth-control/condom-10187.htm

     

    Another link on Scarleteen also contains no research.

     

    http://www.birth-control-comparison.info/condom.htm

     

    http://www.abortiondiscussion.com

  • grayduck

    "…I DID talk to her about other methods of contraception besides condoms right in this piece,…"

     

    Yes, but not Implanon.

     

    "…and also provided her with a link that would get her to in-depth information on all available methods."

     

    What is your point? My requests for citations were intended to obtain references here on RH Reality Check, not Scarleteen. It was a request for future listings of links or other sources, not an implied criticism of your past work.

     

    "I also DID link to very reliable and credible sources which detail the efficacy of condoms when it comes to STIs."

     

    Of the links you listed, all but two were to your own web site. Of those two, both assume perfect use on the part of the user which, as I have pointed out, probably cannot be achieved for sizeable populations. Moreover, none of the studies that were used by the links to draw conclusions about the effectiveness of condoms for STI prevention were designed to compare the effectiveness of condoms versus other available methods, such as lifetime monogamy. Futhermore, neither of those pages uses words as unqualified as the "…very highly effective at preventing STIs…" wording in your article. Finally, their assessments of the effectiveness of condoms for preventing STIs were based on their own values and judgments about empirical studies rather than based on the needs or expectations of the questioner or people like her.

     

    http://www.abortiondiscussion.com