Here's How to Use a Condom Correctly—and Why
On April 11, the Centers for Disease Control and Prevention (CDC) released data that confirmed a continued surge.
In 2021, more than 2.5 million cases of chlamydia, gonorrhea and syphilis were reported in the United States, representing a 30 percent increase from 2015. Reported cases of syphilis saw the highest increase, jumping 32 percent between 2020 and 2021.
Considering the spike, you'd think condoms, which for sexually active people represent the most effective protection for avoiding STIs, would be flying off the shelves. The reality is quite the opposite, according to Joe Kort, Ph.D., a psychotherapist and the founding director of the Center for Relationship and Sexual Health in Royal Oak, Michigan.
"In 2011, condoms were the most common contraception for 75 percent of men. In 2021, that number dropped to 42 percent," said Kort, citing data from the Office of Population Affairs' 2021 Family Planning Annual Report.
The trend of declining condom sales was also highlighted by Church & Dwight, the manufacturer of Trojan condoms, in its 2021 annual investor report.
Among youths, condom usage is also waning. In 2019, only 54.3 percent of sexually active high school students reported they wear condoms, down from 61.1 percent in 2009, according to the Youth Risk Behavior Survey from the Centers for Disease Control and Prevention (CDC).
Why is condom use plummeting?
A number of factors may be contributing to the downswing in condom use, but a couple of them are also reasons to celebrate, said Gregory Paczkowski, M.D., a family medicine specialist in Minneapolis and the CEO and co-founder of Mona Health, a telemedicine platform.
"Better access to birth control probably is affecting people's choice to wear a condom," Paczkowski said, citing the many new methods of contraception approved by the Food and Drug Administration (FDA) in the past 30 years, including hormonal vaginal rings, intrauterine devices (IUDs), shots, patches and implants.
The advent of pre-exposure prophylaxis (PrEP)—a medication that, if taken correctly, reduces the risk of contracting HIV by 90 percent or more—may play a role in driving down condom use among men who have sex with men, Paczkowski added. Since the medication was approved in 2012 in the U.S., studies have suggested people who take the drug are less likely to use protection.
"Many men having sex with men are losing the fear of AIDS since it is becoming more treatable and preventable," Kort explained. "As a result, condom use is declining in this population because STD defenses are down."
Another element behind falling condom use is a lack of awareness.
"Public education is a barrier to properly educating young people about the benefits and importance of condoms," Paczkowski said.
While 37 states have ordinances requiring that abstinence is emphasized in sex education, only 18 states require schools to also share information about condoms and other types of birth control, he explained.
Why should condoms be used more often?
"Condoms are a remarkable thing," Paczkowski said. "They're the one birth control method that also prevents sexually transmitted infections."
Used correctly, condoms are 98 percent effective at preventing pregnancy. Human error decreases the efficiency to about 87 percent. Studies also have demonstrated condoms' effectiveness for STI and HIV prevention.
"There is not an alternative method that provides as much protection as a condom," Kort said. "It reduces the risk for many STDs that are transmitted by genital fluids, it reduces the risk for genital ulcer diseases, such as genital herpes, and it reduces the risk for HPV infection and HPV-associated diseases."
Both professionals recommended wearing a condom every time you have sex if you want to avoid pregnancy or STI transmission. However, condom use cannot provide absolute protection against STIs.
"Whenever your genital or anal areas are in contact, you should use a condom to prevent the risk of STDs or pregnancy," Kort said. "Wear a condom right before you start having sex and before your genitals come in contact with your partner's. If you put on a condom just before you ejaculate, you are not protected from STDs or pregnancy because fluids already may have been exchanged."
How do you use a condom correctly?
Kort detailed the process of putting on a condom the proper way.
Squeeze out the air
"Before putting on a condom, squeeze its tip to get rid of any air and leave space for semen to collect," Kort said. "If you don't leave 1 to 2 centimeters of space, the condom may break."
Put the condom on rolled-side out
"Make sure you are putting it on the right way, with the rolled side out," Kort emphasized. "Hold the tip and unroll the condom all the way to the base of the erect penis."
Throw the condom away if you put it on wrong. Having touched the penis, the outside of the condom may have come in contact with an infection or semen, which may put the partner at risk of pregnancy or STIs.
Remove the condom before the penis gets flaccid
"After ejaculation and before the penis gets soft, grip the rim of the condom and carefully withdraw," Kort said. "Then gently pull the condom off the penis, making sure that semen doesn't spill out."
Common condom errors to avoid
One study indicated an estimated 36 percent of women do not use condoms correctly, and other studies also point to frequent condom errors. Incorrect use can dramatically diminish their effectiveness, said Paczkowski, who approximates that the typical condom is only 87 percent effective at preventing STIs and pregnancy because of user error.
Kort provided some common errors to avoid when using a condom.
Using a damaged condom
"Look for holes or tears before using the condom," Kort said.
Check the expiration date.
"If the condom date is expired, it is not safe to use," he said.
Storing the condom incorrectly
"Condoms need to be stored in a cool, dry place," Kort said. "Condoms can get warm and worn in a wallet or pocket, causing damage."
If you keep them somewhere that gets too warm, such as in your wallet or a car's glove box, for a month or more, their efficacy is compromised. Don't use them.
Not opening the package correctly
"Before opening the wrapper, feel for the rib of the condom inside the packaging," Kort said. "Push it to the side so you don't tear the condom when opening it."
To prevent tearing, never use scissors, teeth or other sharp items to open a condom wrapper.
Not unrolling it all the way onto the penis
"When putting on a condom, make sure you unroll it all the way onto the penis for full protection," Kort said.
Not squeezing the tip of the condom before putting it on
As noted previously, if you don't squeeze the tip of the condom to get rid of air and create space for semen, it can break.
Using oil-based lubricants
"Don't use oil-based products such as baby oil, lotion, petroleum jelly, massage oils or cooking oil," Kort said. "They will weaken latex, causing breakage."
To prevent breakage, use a water- or silicone-based lubricant.
Not wearing a correctly sized condom
"If it is too big, it can slip off; if it is too small, it can tear, and your sexual pleasure will be compromised," Kort said.
Not changing condoms when switching orifices
If you switch from vaginal sex to anal or oral sex—or any combination of those—change the condom.
"By not using a new condom, you can introduce bacteria from the rectum into the vagina and cause an infection," Kort said.
Not using a new condom when you share sex toys
"Sex toys can pass on STDs if they are shared," he warned.
Doubling up on condoms
"You only need one condom," Kort said. "If you use two, breakage can occur."
How can you ask your partner to wear a condom?
Paczkowski acknowledged that asking a partner to use a condom can be awkward, "so kudos for bringing it up," he said.
"I would always try to couch the conversation as, 'I want to have sex with you but I want to be safe as well,'" he suggested.
"Communication is the key to any successful relationship, and this also applies to talking about condom use," Kort said.
When discussing condoms with your partner, Kort suggested outlining the benefits and framing it as something that can enhance intimacy rather than deter it.
"Sex often lasts longer with a condom," Kort explained. "Slowing down a man can close the orgasm gap and increase the chances of having a shared orgasm and an explosively satisfying experience."