Correct and consistent use of condoms

Sir,

Condom use can be traced back to several thousand years. It is known that around 1000 BC, the ancient Egyptians used a linen sheath for protection against disease, which was found useful for prevention. Later on, the usefulness of condom for pregnancy prevention was recognized. From the early 1960s, use of condoms as a contraceptive device was declined, as pills, coils, and sterilization became more popular. The emergence of HIV and identification of sexually transmitted infections (STIs) as a co-factor have revived our interest in condoms.[1] The condom usage in India has increased from 2.1% in 1992–93 National Family Health Survey- 1 (NFHS-1) to 5.2% in 2005–06 (NFHS-3) among males, aged between 15–54 years.[2] However, condoms are not 100% safe, but if used consistently and correctly, will reduce the risk of pregnancy and/or STIs significantly. Of 100 women whose partners use condoms, approximately 15 will become pregnant during the first year of typical use, but only two women will become pregnant with perfect use. Typical use means when usage is not consistent or always correct, whereas perfect use refers to consistent and always correct usage.[3] Although, many people wrongly assume that all men know the correct way to use condoms, but the fact is, incorrect usage is common and it is a major cause of condom failure. The majority of these failures are caused by human errors, including-not using enough lube and creating microscopic tears with rings; using long, sharp, or jagged fingernails; unrolling a condom backwards and not towards the base of penis; not leaving a half-inch of empty space at the tip of the condom; and not holding the rim of the condom down along the base of the penis when removing the penis after ejaculation. Inconsistent condom use means–not using a condom every time you have sex (vaginal, anal, or oral); or not putting the condom on right time (such as right before ejaculation instead of at the beginning of intercourse), before the penis comes in contact with your partner's genitals. A survey on condom usage revealed that, 42% of the surveyed males did not use a condom from the start and/or to completion of penetrative sex; 23% did not leave a space at the receptacle tip; and 81% did not use a water-based lubricant.[4] Similar results were observed in a US-based study.[5] Studies have shown that people who make more errors have higher rates of STD infection.[4] Hence, the tendency to assume that condom users are using them correctly and consistently, seriously under estimates their risk of transmitting or contracting STDs or becoming pregnant unintentionally. Thus, it is not enough to encourage people to use the condoms, but they should be guided on the correct usage too.