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By Medical Author: Shaziya Allarakha

By Medical Reviewer: Pallavi Uttekar

Condoms are, without doubt, the most effective means for preventing human immunodeficiency virus (HIV) and other sexually transmitted infections (STIs), provided they are used in the right manner and during every sexual encounter. 

HIV attacks the body’s immune system. About 37,968 people were diagnosed with HIV in the United States and dependent areas in 2018, causing the number of people with HIV to increase to about 1.2 million.

Condoms, both female (internal condoms) and male (external condoms), are advocated as the best protection from HIV. They reduce the risk of HIV transmission by more than 90 percent if used consistently and the instructions are followed. They can be used during vaginal, anal and oral sex. 

HIV can be transmitted through blood, semen, rectal and vaginal fluids. An intact latex condom, a polyurethane external condom (although they are more likely to break than latex condoms) or a polyurethane internal condom will not allow any of these fluids to pass through, thereby preventing the transmission. Animal skin condoms are not as effective as latex or polyurethane condoms in preventing HIV.

For preventing HIV, not only the use of condoms but also their proper use matters. A few points must be considered when using external (or male) condoms for HIV prevention.

• Check the expiration/expiry date on the condom pack before use. Beyond the expiration/expiry date, condoms are more likely to become dry and crack.

• Store condoms away from light and heat to prevent them from drying or cracking.

• A latex condom is preferred because it is more effective in preventing HIV (and even pregnancy) than a polyurethane condom. If, however, you have a latex allergy, a polyurethane condom is a good alternative.

• Choose condoms with reservoir tips meant for catching semen after ejaculation.

• Condoms must be put on before any sexual contact. This is because HIV can be passed on through pre-cum, vaginal fluid and anal mucus.

• Open the condom pack carefully with your hand and not your teeth or scissors to avoid breaking or tearing the condom.

• Lightly pinch the tip of the condom (reservoir tip) and place it at the top of the penis. This helps remove trapped air at the top that may lead to condom breakage.

• Only use water-based or silicone-based lubricants while using a condom.

• Avoid using lotion, petroleum jelly and oil-based lubricant, including baby oil and massage oil, with condoms because they can cause condom breakage.

• Roll the condom down on the hard penis until it is completely rolled out. If you are uncircumcised, pull back the foreskin first. If you have placed it inside out by mistake, throw it away and use another condom. This is because some of the secretions may be passed on the other surface of the condom that comes in contact with the vagina or anal or oral mucosa of your partner leading to the transmission of infection.

• While withdrawing the penis after you are done, hold the condom at the base of the penis. This prevents slipping of the condom. Carefully remove the condom and throw it in the trash.

• If the condom slips or breaks during sex, contact your health-care provider to discuss emergency contraception. Additionally, you and your partner must get tested for STIs including HIV.

If you are using an internal condom:

• Ensure that the condom has not crossed its expiration/expiry date.

• Carefully remove the condom from its package.

• You may use any type of lubricant with an internal condom. Using lubricant is advised because it keeps the internal condom at its place and prevents breakage.

• Hold the condom at its closed end, squeeze the sides of the inner ring together and insert it into the vagina or anus.

• Using your finger, push the inner ring upward so that it rests against the cervix (neck of the uterus) in the vagina or as far into the anus as it can go.

• Do not twist the condom and ensure that its thin, outer ring remains outside the vagina or anus.

• After ensuring that the condom is inserted properly, guide your partner’s penis into the condom opening.

• After you are done, gently twist the outer ring and pull the condom out.

• Throw the condom into the trash after a single use.

• If you feel the penis has slipped between the condom and vaginal/anal walls or if the outer ring is pushed into the vagina/anus, stop intercourse.

• If the condom slips or breaks during sex, contact your health-care provider to discuss emergency contraception. Additionally, you and your partner must get tested for STIs including HIV.

The most definitive way of preventing HIV is complete abstinence from vaginal and anal sex. This is, however, not a practical approach because most people will have sex sometimes in their lives. Thus, using condoms is the most effective way for preventing the spread of HIV. 

If you think you or your partner have been exposed, get tested for HIV. Take proper treatment if you are tested positive for HIV because it helps keep you healthy and reduces the transmission risk to your partner as well. If you are at a high risk of HIV, discuss pre-exposure prophylaxis (PrEP) and post-exposure prophylaxis (PEP) with your doctor.