In the 1970s, condoms were the contraceptive underdog in much of the world. During World War II, military leaders had tried to curb venereal disease (as it was known then) by distributing condoms to Allied troops and promoting them with slogans like "Put it on before you put it in." When the soldiers returned home, condom popularity skyrocketed among civilians. But by the '60s, condoms were taking a back seat to a new contraceptive, the pill. And since most of the sexually transmitted infections (STIs) of the day were easy to treat with antibiotics, fewer people relied on condoms to prevent them.
In the '80s, all that changed. The threat of AIDS put condoms back in the spotlight, and more people started to use them to protect themselves from HIV. The latex sheaths made headlines, alternately praised as a tool for safer sex and criticized as an enabler of immoral behavior.
History had repeated itself. In the late 15th and early 16th centuries, ships returned to Europe from the New World bearing a new disease -- syphilis. Syphilis had no cure at the time, and the people of Europe and Asia had no natural immunity. Known as "the Great Pox," "the Portuguese Pox," "the French Disease," and a host of other names, syphilis spread along trade routes, causing dementia, debilitating sores and death.
People made the connection between sex and syphilis, and the condom became a tool for disease protection. In 1546, Gabriele Falloppio, discoverer of the fallopian tubes, penned the oldest known written description of the condom, recommending it as a syphilis preventive. But not everyone hailed the condom as a way to stave off disease. French theologian Leonard Lessius, for example, condemned the condom as immoral in 1605.
The condoms of Falloppio's era bore little resemblance to the foil-wrapped rolls found in grocery stores, health clinics and vending machines today. And, in spite of his claims to the contrary, Falloppio didn't invent the condom. Read on to find out where condoms came from and why they've been around longer than people have known exactly how babies are made.
Sausages, Horns and Other Milestones in Condom History
Today, it's common knowledge that babies come from the union of egg and sperm. But this idea is fairly recent, the product of numerous discoveries spanning the 17th, 18th and 19th centuries. The basic concept that contributions from a man and a woman during sexual activity can lead to a baby, though, is much older -- and so are contraceptive barrier methods. For thousands of years, people around the world have used a variety of devices to physically keep these contributions away from each other. The two main historical contenders were pessaries, or objects placed in the vagina, and condoms.
Nowadays, pessaries are vaginal inserts that support a woman's pelvic organs when her muscles can no longer do so by themselves. But in many historical accounts, they had a clear contraceptive objective. There are also historical depictions of penile sheaths, but whether they had a prophylactic purpose is often unclear. The oldest known image of sheathed penis is found in cave paintings dating as far back as 15,000 B.C. [source: Allen]. Penile sheaths, garments and decorations also appear in the art and literature of ancient Egypt, Greece and India. In Japan, some men used thin, rigid sheaths called kabuto-gata, which were made from horns, during intercourse.
While people may have been using prophylactic condoms for much longer, there's not a lot of clear documentation on the topic until the time of the Roman Empire. Condoms were common in Europe by Shakespeare's day. The first documented condoms were hand-sewn pieces of linen that fit over either the entire penis, over the tip or into the urethra. A drawstringlike ribbon held the condom onto the penis during intercourse.
By the mid-1700s, people started using condoms made from animal membranes, still tied with a ribbon. Condom-makers -- many of whom also made gloves -- purchased intestines and bladders from butchers. Making guts into condoms required cleaning, scraping, exposure to burning sulfur, inflating, drying, molding, cutting and sewing.
These resulting prophylactics were expensive and often full of holes, which led to Casanova's famous technique of inflating them with air to test them before use. And like the first rubber condoms, their reliability was suspect -- and they were reusable.
The Birth of the Modern Condom
Tapping rubber trees was a long-held tradition among South American indigenous peoples before the arrival of European explorers. But it wasn't until Charles Goodyear discovered vulcanization in 1839 that rubber took its place in contraceptive history. Straight from the Hevea brasiliensis tree, liquid rubber, or latex, turns into a substance that's bouncy but brittle. Goodyear used sulfur and lead oxide to strengthen the bonds between the rubber's molecules, which made it stronger, more elastic and less likely to break down over time. You can read about exactly how and why vulcanization works in How Rubber Works.
Buying one of the earliest rubber condoms wasn't always as simple as taking a trip to the local pharmacy. Often, men had to visit their doctors to be professionally fitted. Rubber condoms were considerably thicker and rougher than the condoms used today. Some of the earliest covered only the glans, or tip, of the penis. Rubber condoms were often advertised as reusable, wash-and-wear prophylactics. They had a relatively short practical life, however, especially if used with oil-based lubricants, which broke down the rubber.
In 1919, Frederick Killian broke away from the original method of rubber condom-making, which involved molding vulcanized rubber. Instead, he dipped molds directly into liquid latex. This led to thinner, cheaper latex condoms, and they had a longer shelf life. Soon, factories were mass-producing condoms by dipping glass molds in vats of latex and using ovens to vulcanize the material.
Latex condoms dominate the market today. Natural membrane condoms are still around as well. They're often known as "sheepskin," although they're made from intestinal linings rather than skin. The newest condom materials include polymers like polyisoprene and polyurethane. Today, doctors typically recommend natural membrane and polymer condoms only when one partner has a latex allergy or when disease prevention isn't a priority, such as in monogamous couples who have no sexually transmitted infections (STIs).
Today, latex condoms make up more than 99 percent of condom sales worldwide [source: Gerofi]. In the next few sections, we'll focus on how they are made, tested and marketed.
The Anatomy of a Latex Condom
The latex condom is a pretty basic invention. It's a baglike tube that's closed on one end -- typically with a small reservoir to hold semen -- and open on the other. The open end has a thin rim that helps hold the condom in place and makes it easier to roll the condom during manufacturing. Some condoms are flared, gradually widening from the closed end to the open one. Others are contoured to fit the shape of the glans and shaft of the penis.
The condom's primary purpose is to keep bodily fluids from different people separate. This helps prevent pregnancy by keeping sperm away from eggs, and it helps prevent diseases that are transmitted mainly through contact with sexual fluids, like semen and vaginal lubricant. To do this, the condom must cover the penis from the tip to the base. It has to be tight enough to stay in place and prevent leakage, but it can't be so tight that it inhibits function. The latex must be thin enough to allow sensation but not thin enough to risk breakage. For this reason, many nations set standards that govern condoms' exact dimensions and materials. The dimensions of today's typical latex condom are:
- Length: at least 160 millimeters
- Width: 52 millimeters (when laid flat)
- Thickness: 0.07 millimeters
Powders like cornstarch, silica or magnesium carbonate typically coat the final product to help keep the latex from sticking to itself and make it easier to unroll. Lubricated condoms have a slippery fluid, typically made from silicone, applied at the factory. Spermicidally lubricated condoms have an ingredient that kills sperm, like nonoxynol-9 (N9), in the lubricant. However, medical research suggests that the amount of N9 used in condoms has little effect during sexual activity [source: Jeffries and Aitken]. Since it can cause vaginal irritation, which can make disease transfer more likely, it can do more harm than good.
Next, we'll look at the latex condom's journey from tree sap to foil-wrapped package.
Latex Condom Manufacturing, from Tap to Foil
The latex used to make condoms comes from tapping rubber trees in Brazil, Southeast Asia or West Africa. The sap runs down from spiral grooves in the trees to be collected in buckets. But sap isn't the only ingredient in the latex condom. When it's ready to be made into condoms, the latex can contain:
- Antifungal and antibacterial compounds
- Zinc oxide, a vulcanization accelerator
- Potassium laurate, a stabilizer
- Sulfur, a vulcanizing agent
- Ammonia, an anticoagulant
- Other preservatives and pigments
Many of these ingredients add to the shelf life of the latex, but they also make rubber -- a naturally biodegradable substance -- harder to break down. That's why used condoms should go in the trash, not down the toilet, where they can wreak havoc with plumbing, septic and sewer systems.
In the factory, the liquid latex goes into vats. Glass or ceramic molds, or formers, suspended from a conveyor belt dip into the vats, turning as they go so the latex coats them evenly. The latex-coated formers are dried, and they take a second -- and sometimes a third -- trip through the vats to make the condoms thick enough to use. The amount of water in the latex also affects the condoms' thickness -- the more water, the thinner the condom.
A brush rolls down the latex at the tops of the formers to create the rim at the open end of the condom. Once the dip-and-dry process is done, the formers travel through a tunnel oven, which uses heat to vulcanize the condoms. From there, the condoms are removed and washed in large washing machines to remove odors, allergens and pathogens.
After quality testing, which we'll discuss in the next section, the condoms are ready for packaging. Machines apply lubricants as the very last step before the condoms go into their foil wrappers. Typically, the condoms are sandwiched between two layers of laminated foil. The packaging has to keep out air and ultraviolet light, or the condoms will deteriorate. The condoms also have to include an expiration date within five years of the condoms' manufacture.
Machines seal the foil and make perforations where necessary, and the last step on the conveyor is into the condoms' exterior packaging, typically a cardboard box.
So how do manufacturers know that these foil-packaged condoms are free from holes and defects that could kill their prophylactic potential? Read on to find out.
Zapping, Popping, Rolling and Other Condom Testing Tools
There are three basic things that can go wrong with a condom during use. Starting with the worst, they are:
Manufacturers test random samples or whole batches of condoms to cut down on the chance of breakage and leakage. Since the heat and sharp edges required to package condoms could also damage them, a second set of quality assurance tests takes place at the end of the line, before the condoms leave the factory.
Several tests focus on condoms' tensile strength, or strength during stretching. In one test, a pair of rollers moves apart, stretching a ring cut from the middle of the condom to make sure it can stretch far enough before breaking. Inflation tests also evaluate condoms' strength -- if the inflated condom bursts before it's reached the right volume, it fails the test.
To test condoms for leaks, technicians fill them with water and hang them up for a few minutes. Workers can visually inspect the condoms for signs of leaks, but a more accurate test involves rolling the filled condom on absorbent paper.
Another leak test, which has a wet and a dry mode, requires electricity. In the wet test, condoms form an insulating layer on metal rods dipped into a conductive solution. When electricity passes through the solution, it also passes through any holes or thin spots in the condoms. A computer detects the current and determines which condoms fail the test. The dry test uses a more powerful jolt of electricity. A conductive material passes over condoms on electrified metal rods, and current passes through holes or thin spots, melting or burning the affected condom.
Third parties and medical researchers also evaluate the materials used to make condoms and whether condoms are effective in use. For example, a medical researcher might evaluate the size of any tiny plastic spheres that penetrate a condom to make sure any holes are too small to allow pathogens to pass through.
These tests don't focus on condom slippage -- that has more to do with how the condom is used than the condom itself. So what's the best way to use a condom so it doesn't slip?
How to Use a Condom
Lab tests show that latex condoms are effective barriers against sperm and microorganisms. But in practice, whether they prevent sexually transmitted infections (STIs) and unwanted pregnancy has a lot to do with whether people use them consistently and correctly. Here are the basic steps, which should begin before sexual contact with the penis:
- Start with proper condom storage -- keep them away from heat and light. Wallets, pockets and glove compartments expose condoms to temperatures that can cause them to break down.
- Look at the package to make sure it isn't damaged and the condom isn't past its expiration date. If it's expired or damaged, throw the condom away and get a new one.
- Open the foil package by tearing it carefully along one side. Some packages have a notch that serves as a starting point. Don't use teeth or sharp fingernails.
- Make sure the condom is right-side up. The tip should stick up from the center of the condom. If it's upside down, it won't unroll correctly.
- If the penis is uncircumcised, gently pull the foreskin back to reveal the glans.
- Squeeze the end of the condom so there is no air in the reservoir, and place it on the tip of the erect penis.
- Carefully unroll the condom down the length of the penis. Be careful not to pull the unrolled portion over the rolled portion -- this will make it difficult to unroll the condom the rest of the way.
- If additional lubricant is needed, use one that's water-based. Petroleum jelly, baby oil and hand lotion are oil-based and will break down the condom. Additional lubrication may reduce the likelihood of condom breakage during anal penetration but may increase it during vaginal penetration.
- After ejaculation, hold the rim of the condom to keep it from slipping off, and withdraw the penis before the erection is lost.
- Remove the condom carefully, wrap it in tissue, and place it in a garbage can -- not in a toilet. Never reuse condoms.
Condoms break more often if they're blown up, filled with water or unrolled before use, or if they are used for very prolonged or aggressive activity [source: Spencer and Gerofi]. If the condom breaks, stop and replace it with a new one. If a broken condom is discovered after ejaculation and pregnancy is a concern, speak to a medical professional about emergency contraception. If STIs are a concern, speak to a doctor about screening.
Condom Use for Contraception and Disease Prevention
According to the World Health Organization, more than 30 types of bacteria, viruses and parasites can move from person to person as a result of sexual activity. Among the most common are:
Fluid exchange is behind the transmission of most of these diseases during sex. Condoms physically block the fluids, preventing disease spread. Although condoms can break or have manufacturing defects, latex doesn't have pores that can allow microorganisms to pass through [source: FHI].
However, some STIs, including genital warts, genital herpes and pubic lice, are present in and on an infected person's skin or hair, areas that aren't covered by condoms. These conditions can be transmitted even with perfect condom use.
So what does that boil down to in terms of actual risk? UNAIDS reports a study of serodiscordant couples -- one person in the couple is HIV positive, and the other is HIV negative. Over a two-year period, the people in the study who used condoms correctly for every sexual encounter had almost no chance of contracting HIV. The participants who were inconsistent in their condom use had a 14 to 21 percent chance of contracting HIV.
The statistics for pregnancy prevention are similar. Over the course of a year, a woman using a condom correctly for every act of sexual intercourse with a man has a 3 percent chance of becoming pregnant. With typical use -- which isn't perfect -- the risk of unplanned pregnancy is 12 percent [source: WHO]. A woman using no contraception has an 85 percent chance of becoming pregnant [source: Trussell].
Condoms' health benefits are clear -- but some argue that making them available encourages promiscuity. One study suggests that this is not the case. The study observed 4,018 teenagers between 1994 and 2002. By the end of the study, all of the participants were sexually active. The teenagers who used condoms during their first sexual intercourse were not more likely to have had more partners than those who didn't. However, the condom-using teens were less likely to have been diagnosed with chlamydia or gonorrhea [source: Shafii et al].
Condoms' ability to prevent the spread of disease makes them an important tool for public health -- which has a big impact on how they're marketed.
Free Condoms vs. Cheap Condoms: Social Marketing
If you see a condom ad in a magazine, bus station or doctor's office, it might not have anything to do with a condom-maker looking to turn a profit. Organizations that have no financial stake in the condom business want people to buy and use condoms for the sake of public health. This use of marketing tools to change social behavior is called social marketing.
The social marketing of condoms has two main components. First, a government agency or other organization buys condoms to sell at a discount or works with manufacturers to subsidize their cost, absorbing some of the financial burden so the public has to spend less money. The goal is for condoms to be affordable rather than free since people are more likely to use something they paid for. The rule of thumb is that a year's supply of condoms should cost no more than 1 percent of the target country's per-capita gross national product (GNP) [source: Harvey].
The next step is to spread the word about condoms and their use. This part is as important to the campaign as the condoms themselves. For example, the government of Thailand used a marketing campaign to encourage commercial sex workers to use condoms in 100 percent of their sexual encounters. In 1989, before the campaign started, 14 percent of sex workers consistently used condoms. By 1994, that number had risen to 94 percent. During the same period, bacterial STD cases diagnosed among sex workers fell from 410,406 per year to 29,362 [source: UNAIDS].
In some parts of the world, particularly in developing nations, most condom marketing is social marketing. For example, in 2000, the government of South Africa purchased 290 million condoms for social marketing; the government of Botswana purchased 12 million. The same year, social marketing was responsible for the distribution of 450 million condoms in India [source: Allen].
Of course, condom manufacturers also have a hand in marketing their products. In addition to following applicable truth-in-advertising laws, manufactures in most parts of the world have to adhere to decency and morality laws because of the nature of their product. Failure to comply runs the risk of everything from banning to legal action. In addition, many nations classify condoms as drugs because of their role in preventing disease. For this reason, advertisements and packing often have to carry specific language or warnings. Similar regulations apply to everything from what condoms are made of to how they are manufactured.
Condom Regulations, Standards and Rules
Until the 1980s, there weren't many rules governing condoms and their quality, and the rules that did exist weren't always enforced. All that changed with the AIDS epidemic, when using poor-quality condoms could lead to death.
Current regulations start with manufacturing. Good manufacturing practices (GMP) rules are standards for factories that make drugs, including products like condoms and hand sanitizers that play a role in preventing disease. In the United States, GMP rules fall under the jurisdiction of the Food and Drug Administration (FDA). Internationally, the International Organization for Standardization has created a standard called ISO 9000. Another ISO standard, ISO13485, covers medical devices and is used in many areas to regulate condom production. These sets of rules cover everything from manufacturing methods to record keeping in ways that can apply to all drugs. What they don't do is govern the specifications of the condoms that leave the factory. That's where specific condom standards come in.
While many countries have their own standards, a couple of international standards set guidelines for everything from how condoms are tested to what color they are. The primary international standard is ISO 4074:2002. The World Health Organization (WHO) Male Latex Condom Specification uses ISO standards as a foundation for its guidelines on purchasing condoms for health promotion.
The ISO and WHO specifications for condoms include parameters for:
- Acceptable quality levels (AQLs), or the maximum number of condoms that can be defective in each batch
- Accreditation for laboratories that test condoms
- Procedures for the tests
- Materials, shelf life and stability
The ISO and WHO standards also outline passing and failing grades for the tests described in Zapping, Popping, Rolling and Other Condom Testing Tools.
Finally, there are rules about how, where and when condoms can be distributed and sold, and these vary from place to place. The purchase and sale of condoms is often a clandestine affair because of cultural or religious taboos. Catholicism and Orthodox Judaism prohibit contraceptive use, including condoms. Islam allows the use of contraception within the context of married heterosexuals who have a reason to prevent pregnancy. Some conservative Christian groups also promote abstinence rather than the use of condoms [source: Allen]. On the other side of the coin are laws requiring condom use -- for example, they have been mandatory in brothels in Nevada since 1988 [source: Grudzen].
Condom Statistics: Who Uses Condoms?
According to United Nations estimates, two-thirds of the people in the world have ready and easy access to condoms. In the U.N.'s definition, "ready and easy" means that it takes less than two hours a month to buy condoms, and it costs less than 1 percent of a person's monthly take-home pay [source: Schellstede]. But how and by whom these condoms are used varies dramatically from country to country based on a number of factors.
In general, the number of sexually active people using condoms has increased since the 1980s due to the spread of HIV. It's hard to tell exactly how the statistics have changed, though, since many studies before the '80s, especially those involving women, focused only on married people. British surveys report that in 1950, about 30 percent of men and women used a condom during their first intercourse. By 1990, that number had more than doubled. Here are some other general trends in Europe and the United States:
- Living arrangements: People who live with their partners typically use condoms less often than people who don't.
- Number of partners: In surveys conducted in the Netherlands, France, Belgium and Britain, the more partners a person had, the more likely he or she was to use condoms.
- Age: Fewer people who have their first intercourse before the age of 16 use condoms during that experience. In general, the older people get, the less likely they are to use condoms, in part because of entry into long-term, monogamous relationships [source: Grunseit and Johnson].
People with latex allergies often choose not to use condoms or to use condoms made from natural membrane or a polymer. People who seek contraception sometimes choose other birth control methods because they are more convenient than condoms, do not require interrupting sexual activity for use, and do not decrease sensation. These are among the reasons for some new condom developments, which we'll look at next.
Almost all condoms sold and used around the world are latex condoms that fit over the penis. However, these have a few drawbacks. In some regions, social expectations make it difficult or impossible for women to insist that their male partners wear condoms. This can also be true among commercial sex workers in some parts of the world, whose clients may refuse to wear condoms. The female condom, which helps address some of these concerns, made its debut in Switzerland in 1992. In the United States, the FDA approved it for distribution in 1993.
The female condom is a polyurethane sheath that is closed at one end and open at the other. Each end has a ring that holds the condom in place. The ring that fits inside the vagina, holding the closed end near the cervix, is smaller than the one that holds the condom on the outside of the body. It also provides women with a barrier method they have complete control over and can help protect against HIV and pregnancy.
The female condom has several other advantages over male condoms. It covers part of the labia, which can help protect against the transmission of some STIs that live on the skin. A woman can insert the condom before any sexual activity begins, while a male condom can be applied only after a man has an erection. Since the female condom is made from polyurethane, it can also be used with oil-based lubricants, unlike latex condoms. Finally, one study suggests that supplying commercial sex workers with both male and female condoms reduces the number of unprotected sex acts overall [source: UNAIDS via Young].
However, the female condom also has some disadvantages:
- It's more expensive than the male condom, which has led women in some parts of the developing world to wash and reuse it. One study suggests that washing the female condom up to 10 times does not significantly break down the condom [source: FHI].
- In clinical trials, it appears to be slightly less effective at preventing pregnancy and sexually transmitted infections (STIs) than male condoms. However, it is significantly safer than unprotected sex.
- Many users find it more difficult to insert than male condoms are to unroll.
Other Types of Condoms
Although the World Health Organization (WHO) standards describe a colorless, odorless condom that's shaped like a simple sheath with a reservoir at the end, a range of other condoms are available on the market. This includes colored and flavored models as well as ones adorned with everything from faces to studs. Many of these aren't recommended for contraception or disease prevention because their varying thicknesses of latex can lead to breakage.
Other condoms' innovations are for practicality or efficacy rather than fun. Since inside-out condoms are impossible to roll, some condoms come with applicators or are packaged in such a way that they always emerge right-side up. Another alternative is the spray-on condom, a canister that fits over the penis and coats it evenly with a mist of latex. The benefit is twofold -- the novelty of a spray-on condom might encourage use, and the custom-sprayed condom will fit the user perfectly. However, the spray-on condom isn't yet available in most of the world [source: Time].
Anti-rape condoms use plastic barbs or hooks along the inside of a sheath in an attempt to deter rape. A prototype of one such condom, designed to be worn in a woman's vagina, was launched in South Africa in 2005 [source: Rapex].
One condom isn't for human use at all. In parts of Africa, a tied-on device called an olor acts as a contraceptive for goats. The olor hangs from beneath the abdomen of a male goat, blocking his access to a female goat's vagina during mating. This barrier method helps control goat populations during drought, potentially saving herds from starvation.
This isn't the only inventive use of a contraceptive. Because of condoms' ability to block fluids, people have used them to protect everything from microphones in sports stadiums to gun barrels in combat. But their off-label uses have a nefarious side as well -- people have used them to smuggle drugs in the stomachs of human couriers. Just like when they're used as directed, these condoms are acting as barriers, blocking their cargo from stomach acids, and vice versa.
Birth control has been part of human life since the beginning. But some approaches to preventing pregnancy have been crazier than others.
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More Great Links
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