The Bitter Truth About Condoms

Condoms are still one of the most effective ways to reduce the risk of pregnancy, sexually transmitted infections (STIs), and HIV-- if used correctly. But people don't use condoms nearly as much as they should. And the reason some choose not to use condoms is simple: comfort. Most people do not like them.

Condom Aisle

Slate recently published a in-depth article on the state of condoms -- and found surprising stats about about the use of condoms (or lack thereof). According to Slate, a comprehensive 2010 National Survey of Sexual Health and Behavior revealed the following:

They also don’t use [condoms]. In the 2010 National Survey of Sexual Health and Behavior, the largest-ever nationally representative sexuality study, 45 percent of men and 63 percent of women who’d most recently had sex with a “new acquaintance” hadn’t used a condom. More alarmingly, 75 percent of women who weren’t using a back-up birth control method reported not using a condom the last time they’d had sex. Adults who’d had anal sex in the past year—the highest-risk sexual act with regard to HIV transmission—said they’d used condoms only 20 percent of the time.

Unsurprisingly, there’s a correlation between not liking condoms and not using them: The authors of a 2007 study of condoms and sexual pleasure wrote, “Men who believed that condoms reduced pleasure were less likely to use them.” And in a 2013 study in which researchers interviewed men who used condoms inconsistently, “By far the most frequently reported downside of using a condom was diminished physiological sensation.”

There is a long history of condom-like apparatuses, which according to Planned Parenthood may go back thousands of years. In modern condom history, rubber and latex condoms were invented in 1855 and 1920 respectively. Once the latex condom came on the market, there hasn't been much innovation to make using them a more pleasurable experience. This is in part because the male latex condom is already effective at what it is actually intended to do: prevent pregnancy, STIs, and HIV. But the most effective product in the world is meaningless unless it is comfortable enough to make people actually want to use it. In fact one researcher theorized that even a less effective condom could be more useful overall if it was comfortable enough that people would use it more often:

Ron Frezieres, a Gates grantee who has designed and executed clinical contraceptive trials for more than 30 years, says, “Even if a condom had twice the breakage rate … but everybody loves it, it enhances sex—maybe that’s really incredible, to get 100 percent product utilization of a product that breaks 2 percent [instead of] a 50 percent utilization of a condom that breaks 1 percent.”

Why aren't companies creating condoms that people actually want to use?

Unfortunately condom companies don't have much incentive to innovate their product. Condom sales are pretty static, making large, condom companies more interested in investing in marketing and finding new customers than in taking on the larger financial gamble of making a new product. Smaller condom companies find it difficult to enter the market with innovative products, in part because of the way that the Federal Drug Administration (FDA) regulates the testing of condoms. The FDA testing process is long and expensive (which is probably a good thing, since consumers really want their condoms to work). But the FDA requires that all new condoms meet the same testing standards as the latex condom.

Condoms made of different materials might be more effectively tested in methods that are specific to their type, material, and usage. For example, "They Fit" condoms, which came in a range of custom sizes, were removed from the market in the U.S. because the smaller condoms could not be tested using existing methods. (They are still sold in the U.K.) The smaller sizes were too small to fit on to the standard testing equipment. However, a condom that fits properly is much more effective than one that is too large and slips off (or one that a man will not use at all because it is too large or too small). If the FDA is unwilling to change its testing requirements to fit the ways in which condoms are actually used in the field, what good is a rigorously tested condom to a man who can't find one that fits?

Bill Gates wants you to have safer sex.

To help create incentive for innovation, the Bill and Melinda Gates Foundation held a contest to find and fund innovators who could create a better condom -- one that sexually active people might actually use. The goal is to stem the spread of STIs in the developing world. The winners included a graphene condom, made of a form of carbon that is only one atom thick; a plant-based condom; and one made of polyethylane, a type of plastic, among others. Outside of the competition, there was also an IndieGoGo campaign to develop a "cap" condom that is only worn on the head, leaving the shaft bare.

Danny Resnic, the maker of the "origami condom," which unfolds rather than rolls out, originally intended to create his condom out of silicone, which he believed would be stronger, equally as effective as the latex condom, more pleasurable, more affordable, and tested and approved for use during anal sex (currently latex condoms are not). Unfortunately, the FDA mandated process made producing the silicon condom too difficult, and he is currently developing his origami condom in latex using research funds from the Gates foundation.

It may be awhile before we get a new, mass-produced, non-latex condom. In the meantime here are the pros and cons of current condom options:

Without a condom, each individual unprotected sex act carries a one in 20 chance of resulting in a pregnancy (which varies greatly depending on when the act takes place during the menstrual cycle). STIs can be transmitted without a condom at anywhere between one and 50 percent of the time depending on the infection (and for each infection, women are at greater risk than men).

Male Latex Condom

Pro: If used correctly, these are very effective at preventing pregnancies (98 percent effective), STIs (97 percent effective against most), and HIV (98-99 percent effective). They're also cheap and easy to buy anywhere.

Cons: People don't like them (get over it); it can be hard for some men to find a good fit (try harder); a small number of people have latex allergies (but not as many as are saying they do).

Price: Less than $1 each

Lambskin Male Condom

Pro: Effective at preventing pregnancies, natural.

Cons: More expensive and harder to find than latex condoms, and they're not as effective as latex condoms at preventing STIs and HIV. (Although some researchers claim they they are more effective than the labels the FDA requires them to carry would suggest, and they are obviously far more effective than not using condoms at all.) They smell weird.

Price: About $3 each

Polyurethane or Polyisoprene Condoms

Pros: Nearly as effective as latex condoms (though, they have been tested less). Also, some find synthetic condoms more pleasurable because they transfer heat more easily. They also provide a good option for people allergic to latex.

Cons: Less readily available and more expensive than latex condoms.

Price: Less than $2 each

Female Condoms

Pros: Gives women contraceptive control, and are very effective in preventing pregnancy and STIs (failure rate of only 5%, when used properly). Some find that the outer ring provides clitoral stimulation (and who wouldn't like more of that). They are also less likely than male condom to fail due to fit, size, or erection issues.

Cons: Despite the fact that they are less likely to fail, they are still slightly less effective than male latex condom that doesn't fail -- and they're a little pricier. They are also more likely than the male condom to be used incorrectly.

Price: About $2-$4 each (However, they are always begging you to take free ones at Planned Parenthood and on the campus of every college ever.)

Currently the male latex condom is still the most effective product on the market. Hopefully the Gates' Foundation project will lead the FDA to consider making the market more hospitable to innovation. Because the best condom is one that people can, and want to, use every time.