Overview
Condoms, when used correctly and consistently, are safe and highly effective in preventing transmission of sexually transmitted infections, including HIV, and unplanned pregnancies. Condoms are safe, inexpensive and widely available.
There are both external (male) condoms and internal (female) condoms (also called external condoms and internal condoms, respectively), which are effective when used correctly. External condoms are most common and are sheaths or coverings that fit over a man’s erect penis before penetration. Internal condoms are also available and are sheaths or linings that fit loosely inside the vagina before penetration.
When using condoms, personal lubricants (also known as lube) make it less likely that the condom will break, slip or fall off, which increases protection against unintended pregnancy and most STIs, including HIV. Use of a water- or silicone-based lube is recommended, as other types may cause the condom to break down, such as kitchen oil, butter and hand lotion.
Lubricants can make sex with a condom satisfying and effective, during vaginal and particularly anal sex. Unlike the vagina or penis, the anus often does not provide adequate natural lubrication during sex. Plenty of lubricant should always be used during anal sex. Lubricants may also be helpful for individuals experience vaginal dryness associated with menopause. In general, lubricant use is associated with reduced sexual pain and discomfort, and improved female sexual satisfaction.
Effectiveness
The effectiveness of condoms depends on their correct use. The risk of pregnancy or sexually transmitted infection (STIs), including HIV, is greatest when condoms are not used properly with every act of sex. Very few pregnancies or infections occur due to slips or breaks. Condoms significantly reduce the risk of STIs when used consistently and correctly during vaginal, oral and anal sex. They protect against STIs that spread via discharge, such as HIV, gonorrhoea and chlamydia. They also protect against STIs that spread by skin-to-skin contact, such as syphilis, genital herpes and human papillomavirus (HPV) when the lesion occurs in the area covered by the condom. When used correctly with every act of sex, 98% of women whose male partners use male condoms will be protected from unplanned pregnancy; when female condoms are used, 95% of them will be protected against unplanned pregnancy.
To assure the effectiveness, condoms need to follow ISO standards and WHO/UNFPA specifications.
Global impact
Condoms continue to be an essential and effective tool in the prevention packages for HIV, other STIs and unplanned pregnancy. Condom use has been a significant tool to decrease transmission of HIV globally. A modelling study that examined the impact of past and future condom use on the AIDS epidemic in 77 high-burden countries noted that increased condom use since 1990 has averted an estimated 117 million new HIV infections, close to half (47%) of them in sub-Saharan Africa and more than one third (37%) in Asia and the Pacific (1).
In addition, over 300 million unplanned pregnancies are estimated to be prevented each year by using contraceptives, including condoms.
WHO response
WHO’s work on condoms is covered by its overarching mandate to provide technical guidance and support Member States to strengthen programmes related to sexual and reproductive health and rights. This includes both the prevention and control of STIs, including HIV, as well as contraception and family planning services. Condoms are also included in other WHOs programs such as comprehensive sexual education and gender-based violence.
WHO is also 1 of 5 cosponsors of the Human Reproduction Programme (HRP), which is the main instrument within the United Nations system for research in human reproduction to identify and address priorities for research to improve sexual and reproductive health.
WHO’s work on controlling the spread of STIs, including HIV, is guided by the Global health sector strategy on HIV, Hepatitis and Sexually Transmitted Infections, 2022–2030. This includes the scale-up primary prevention such as condom availability and use. In addition, WHO supports countries’ efforts to create an encouraging environment allowing individuals to discuss STIs, adopt safer sexual practices, seek treatment and provide accessibility of people-centred quality STI care.
WHO also includes condoms use as part of its contraception and family planning portfolios, ensuring that all people have access to their preferred contraceptive methods and the ability to determine if, when and how often to reproduce. This includes producing evidence-based guidelines on the safety and effectiveness of contraceptive methods and their provision, developing quality standards for their manufacture, providing pre-qualification of approved contraceptive commodities and helping countries introduce these methods.
References
- Stover J, Teng Y. The impact of condom use on the HIV epidemic. Gates Open Res. 2022 Feb 11;5:91. doi: 10.12688/gatesopenres.13278.2. PMCID: PMC8933340.