Condom errors common among college-age men

In discussing condom use, your college-age male patient tells you that he uses protection on a regular basis. But is he using condoms correctly?

Don’t be surprised if he is not: Results from a small sample of sexually active heterosexual college men show that condom use errors are frequent.1 While the researchers note that the findings cannot be generalized to a broader population, they say the results point to a clear need for better condom education and instruction.

"Assuming that the errors and problems are as common as we found here, I think the following step is to create an awareness among health professionals and health educators that there is a strong need to not just promote condom use, but promote their correct use," says the study’s lead author, Richard Crosby, PhD, assistant professor of behavioral sciences and health education at the Rollins School of Public Health at Emory University in Atlanta.

The study, conducted from November 2000 through January 2001, explored condom use errors and problems among college men at Indiana University in Bloomington. Of 362 men, 158 met the study inclusion criteria, which included reported use of a condom for sex at least once in the past three months.

Here are some of the basic condom errors reported by the college age men:

  • not checking the condom for visible damage (74%);
  • not checking the expiration date (61%);
  • not discussing condom use with their partner before sex (60%).

In addition, various technical errors were found, including putting on the condom after starting sex (43%), not leaving a space at the tip of the condom (40%), placing the condom incorrectly on the penis and then having to flip it over (30%), and taking off the condom before sex was over (15%).

About 30% of study participants reported condom breakage, and 13% reported that the condom slipped off during sex. Such errors are not surprising since those who reported slippage or breakage also had significantly higher error scores, note researchers.

How can you help?

So how can you become a better condom coach? Crosby says that in his experience of working as a health educator, he has found that young men, as well as young women, are very receptive to open and honest discussions about sex. The key to such discussion is to keep it interactive and nonjudgmental, he stresses.

When discussing how to use a condom, keep in mind its context in use, advises Jane Bogart, MA, CHES, director of the Center for Health Promotion at New York University Health Center in New York City. Counsel men and women to practice putting the condom on in the dark to prepare them for actual use situations, she notes. Also, advise masturbating with a condom on, so that keeping an erection doesn’t become an issue, she says.

Lubrication is a problem for many condom users, says Bogart. According to A Pocket Guide to Managing Contraception, plain condoms may decrease lubrication and provide less stimulation for the woman. If patients use latex condoms, be sure to advise on the need to use water-based, rather than petroleum-based, lubricants.

If your facility provides free or reduced-price condoms, check to see if a variety of styles are available. Advise clients that condoms come in a number of sizes and colors, so they should look for ones that are comfortable in fit and style, says Bogart.

Check the package

Before a condom is used, be sure to check its date, says Bogart. According to A Pocket Guide to Managing Contraception, the date on a condom may be its expiration date (marked as EXP) or a date of production.2 If it is an expiration date, the condom must not be used beyond the stated date. If it is a date of production, the condom may be used for several years past the date: three years for spermicidal condoms, and five years for nonspermicidal latex condoms.2

Bogart says she’d like to see condom manufacturers add two features to condom packaging: instructions for use on the individual packages, and some form of identification to mark the right and wrong side of a condom. While some may argue that such instructions may be disregarded in the heat of the moment, she says some users may benefit from the reinforcing information.

"Sometimes when you open a condom, it is hard to tell which way is the right way and the wrong way on," she notes. "Even if it is something as simple as putting an arrow on the up side, or a dot on the right side, something you could physically feel or something that tells you the right side, it would be helpful."

References

1. Crosby RA, Sanders SA, Yarber WL, et al. Condom use errors and problems among college men. Sex Transm Dis 2002; 29:552-557.

2. Hatcher RA, Nelson AL, Zieman M, et al. A Pocket Guide to Managing Contraception. Tiger, GA: Bridging the Gap Foundation; 2001.