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The Truth About Condoms

Back in 1986, Surgeon General C. Everett Koop spoke the truth when he said “....the best protection against [HIV] infection right now – barring abstinence – is use of a condom. A condom should be used during sexual relations, from start to finish, with anyone who you know or suspect is infected.” Lost in the controversy that has ensued during the two decades that have followed Dr. Koop’s courageous stand is the truth about this innovative piece of medical technology, not so much from intentional misstatement by its opponents as from editing and obfuscation that have confused what is a relatively simple issue.

What did the Egyptians use as condoms in 1000 B.C.?

What role does a vulcanizing accelerator play in the manufacturing of condoms?

What type of quality evaluation tests are condoms subjected to?

Do medical and governmental groups support condoms use as an effective way to prevent HIV?

According to studies, does making condoms available to adolescents increase the likelihood of early sexual activity?



What did the Egyptians use as condoms in 1000 B.C.?

Condoms go way, way back. The ancient Egyptians in and around 1000 B.C. fashioned the first-known prototypes out of linen sheaths. The Chinese did the same with silk paper. Other cultures adapted various materials over the centuries that followed, directed at a dual purpose -- preventing pregnancy and preventing disease. Gabrielle Fallopius was the first to formally study the effectiveness of these devices. In the 16th century, he noted that in 1,100 men using linen sheaths with intercourse, none developed syphilis. In the 17th century, the devices in Europe included linen and fish and animal intestine, and their usefulness as contraceptive devices was recognized in publications. Cost was an issue, causing condoms to be reused. Not until 1844 were they mass-produced with the invention of vulcanization, a process that converts rubber into a strong elastic, moldable material. That said, the original prototypes were more like inner tubes than the current transparent models, which only began to appear for single episode use around 1930. The reservoir tip was an innovation introduced in the 1950s with textured condoms added in 1973, and polyurethane alternatives to latex launched in 1994.


What role does a vulcanizing accelerator play
in the manufacturing of condoms?


Latex originates mainly in the tropical rubber tree, with the best quality found in Thailand and Malaysia. Latex itself is cis-polyisoprene, and it lies between the tree bark and wood. During its collection, a little ammonia is added to counteract bacteria that might curdle the mix. The liquid latex is 70 percent water and 30 percent dispersed rubber cells. Once the mix is centrifuged, it is 60 percent solid. It is then mixed with a variety of chemicals including an antioxidant, a sulfur-based vulcanizing agent, and a vulcanizing accelerator that increases the rate and extent of cross-linking of the compound.



What type of quality evaluation tests are condoms subjected to?

Plastic, ceramic, stainless steel or glass forms mounted on a conveyor belt are then dipped into the mix, generally twice, to spread the latex evenly and accomplish the proper thickness. After each dip, the layer is hot-air dried. The edge of the condom is rolled up by water jets to create the rim at the base, to hold the condom in place when used. The condoms are then dipped in water, sodium, or potassium hydroxide to remove excess latex proteins. They are then washed in a cornstarch mixture, dried in a commercial dryer, and tested electronically for the presence of any holes. They are then rolled into their final configuration, with most receiving an additional water lubricant. Most are a dull opaque tan, though different colours, shapes, textures, thicknesses and sizes abound.



Do medical and governmental groups support condoms use
as an effective way to prevent HIV?


As a piece of contraceptive technology, all agree that when used correctly, the condom is remarkably effective. Between 1990 and 2002, nearly $700 million worth of condoms were purchased for donations to nations struggling with population growth and/or sexually transmitted diseases. Quality evaluation typically took place at the time of contracting and again with product delivery. Tests include air burst integrity, tensile strength and electronic pinhole seal measures. The products perform at exceedingly high levels. Condoms are also extremely easy to use, do not require medical supervision, can be distributed effectively, and don’t cost very much. In fact, unit cost of a non-U.S. produced condom is only 3 cents. That’s an important consideration since it was estimated that in the year 2000, some 8 billion condoms should have been available for free distribution in Eastern Europe and the developing world of HIV/AIDS. Donors provided just 950 million that year.


What about condoms and STDs?

Well, everyone agrees with Dr. Koop when it comes to the prevention of HIV. By everyone I mean the World Health Organization, the CDC, the AMA, the American Academy of Pediatrics, the NIH, the RAND Corporation, and Institute of Medicine. As to other infections, all agree, as well, that condoms decrease risk. Even the CDC, which has been somewhat cautious of late, states, “Latex condoms, when used consistently and correctly, are highly effective in preventing transmission of HIV, the virus that causes AIDS. In addition, correct and consistent use of latex condoms can reduce the risk of other sexually transmitted diseases, including discharge and genital ulcer diseases.” So it’s fair to say that, at least when it comes to disease transmission, we all agree with Fallopius, now 500 years after his original finding, that condoms work pretty well.

According to studies, does making condoms available to adolescents increase the likelihood of early sexual activity?

So what’s the problem? The problem is that some believe that offering condoms to adolescents increases the likelihood of early sexual activity. Multiple studies have proven this to be false. The second problem is that some believe that abstinence, as the only absolutely foolproof way to avoid unwanted pregnancy and STDs, has been a poorly supported effort that deserves better funding. Maybe so. But studies are having some difficulty proving that abstinence-only programs actually deter sexual activity. Finally, talking about condoms is a bit embarrassing and is perceived by some to be undignified.

That last reason may in part explain why the CDC dropped “How to use a condom” from its fact sheet. In 1996, the words read: “Put on the condom after the penis is erect and before intimate contact. Place the condom on the head of the penis and unroll it all the way to the base. Leave an empty space at the end of the condom to collect semen. Remove any air remaining in the tip by gently pressing the air out toward the base of the penis.” In July 2001, the statement disappeared from the website as part of revisions the CDC’s deputy director of science explained this way, “We specifically tried not to nuance it in the direction either of encouraging or discouraging use of condoms.”


So what’s the truth about condoms?

First, the bad.
They are not perfect, or at least not as perfect as not having sex at all.

Now, the good.

They are an affordable, well-made, accessible, simple, useful, cross-cultural piece of proven technology that can prevent unwanted pregnancies and unwanted diseases. Making them available has not proven to increase promiscuity or sexual activity in adolescents. And, finally, it is possible to encourage the appropriate use of condoms while remaining true to the values of commitment to care in partner selection, mutual faithfulness, and avoidance of sexual activity until mature and fully developed as a human being.

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