Errors and problems associated with condom use are common among single, male college students, a cross-sectional survey shows.¹ Sizable proportions of college men who had used condoms in the three months before the survey reported that they had not checked a condom for visible damage (75%) and had not checked the expiration date (61%). In contrast, they rarely reported that they had knowingly used a damaged or expired condom (1-2%), or reused a condom (1%). Three in five men had not discussed condom use with their partner before intercourse, and two in five had wanted to use a condom on an occasion when one was not available. Thirty-five percent of men reported that a condom had broken or slipped off during intercourse; respondents who encountered these problems reported significantly more errors in condom use than those who did not.

To investigate if college men use condoms correctly, researchers administered an anonymous questionnaire survey to male students attending introductory health science classes at Indiana University from November 2000 through January 2001. The survey included questions on demographic characteristics (including previous instruction about condom use), sexual history (e.g., frequency of intercourse and frequency of condom use) and a range of potential errors and problems related to condom use. The study evaluated mainly technical mistakes that occurred during condom use, but errors related to availability and partner communication also were assessed.

Among the respondents, the researchers identified 158 unmarried heterosexual men who had put condoms on themselves and had engaged in sexual intercourse (insertion of the penis into a partner's mouth, anus or vagina) during the three months before the study. The mean age of these respondents was 20, and most (90%) were white. Each man had had intercourse, on average, 17 times and had been fairly consistent in using a condom--doing so 74% of times he had sex. On most occasions of condom use (97%), the man had placed the condom on himself. Four in five respondents had ever received instruction on how to use a condom. Thirteen percent of men had ever unintentionally caused a partner to become pregnant, and just 3% had ever had a sexually transmitted disease (STD).

Large proportions of respondents reported that they had not inspected a condom for damage or checked the expiration date (75% and 61%, respectively). Other common technical mistakes were putting on a condom after starting sex (43%), not leaving a space at the tip (40%) and flipping over a condom that had been applied inside out (30%). Condom storage errors, however, were uncommon--for example, using a condom that had been in a wallet for more than one month or not storing a condom in a cool, dry place (8% and 3%, respectively). Other uncommon errors were using an oil-based lubricant, unrolling a condom before putting it on and touching a condom with a sharp object (2- 5%). Respondents also rarely reported that they had knowingly used a condom that had been damaged or expired (1-2%), or that they had reused a condom (1%).

Three in five men had not talked to their partner about condoms before having sex. Two in five respondents had wanted to use a condom but not had one available, and one in five had had a problem with a condom but could not find a replacement. More than half of respondents had ever switched between vaginal, anal and oral sex, but four-fifths of this group reported that they had not changed condoms before switching. Thirty-five percent of men reported condom breakage or slippage during sex, but a lower proportion (13%) reported slippage during withdrawal. One in three respondents reported having lost their erection either before putting on a condom or after putting one on and commencing intercourse.

By assigning one point to each of 23 specific errors occurring at least once and calculating summative error scores, the investigators were able to compare subgroups of men by their mean number of condom use errors. The overall mean score was 4.5 (range, 0-10). Men who had experienced condom breakage or slippage during sex reported a significantly higher number of errors than those who had not encountered these problems (5.5 vs. 4.1). In contrast, the number of errors was similar among men who had had an erection problem during condom use and those who had not (5.1 vs. 5.5), showing that erection problems may happen independently of condom application, according to the researchers. Furthermore, unintentional pregnancy but not STD history was associated with whether condoms were used correctly: Respondents who had ever unintentionally made a partner pregnant reported significantly more condom use errors than those who had not (5.5 vs. 4.4). Although men who had received any education about condom use made slightly fewer errors than those who had not (4.4 vs. 5.1), the difference did not reach significance. Finally, correlation analysis showed no significant association between the consistency of condom use and error scores.

The researchers conclude that a substantial proportion of college men experience "a variety of errors and problems that could contribute to condom failure," and that consistent condom use does not ensure correct use. They note, however, that the findings may not apply to other populations. The researchers recommend that college programs promoting correct condom use include education on partner communication and planning, and on condom use when switching between vaginal, oral and anal sex. Two potential implications cited are that clinic-based counseling and community-based education could be improved through the inclusion of instruction on correct condom use. Furthermore, according to the authors, "Given that condoms are an important means of preventing STD/HIV infection, substantial public health benefit could accrue from further research assessing condom use errors and problems."--T. Lane

REFERENCE

1. Crosby RA et al., Condom use errors and problems among college men, Sexually Transmitted Diseases, 2002, 29(9):552-557.