You Ought To Know

• Contraceptives are the means of preventing an unwanted pregnancy.

• There is no medical contraindication to use of any contraceptive method by

adolescents or young people

• Condoms are effective means of contraception as they provide dual protection

against pregnancy and HIV transmission

• Oral contraceptive pills are another contraceptive method popular with young
people

• Emergency contraception refers to any device or drug that is used as an

emergency procedure to prevent pregnancy after unprotected sexual
intercourse

What is contraception?
Why do young people need contraceptives?
What are the common barriers to Contraceptive use by young people?
What are the various contraceptive options available for young people?
Which are the contraceptives recommended for use in young people?
What are the Barrier methods?
What are the various hormonal contraceptives?
What is an Intrauterine Device (IUD)?
What is an Emergency Contraceptive (Morning-After Pill)?

What is contraception?

By definition, contraception stands for some deliberate preventive methods that prevent conception
of women. These methods are called ‘contraceptives’ meaning ‘against conception’ or pregnancy.
These include all temporary and permanent measures to prevent pregnancy resulting from coitus.
Using contraceptives that are safe and reliable are a sign of responsibility and concern for oneself
and one’s partner.

Why do young people need contraceptives?

· Contraceptives like condoms reduce the risk of transmission of HIV (the virus that causes
AIDS) from one person to other. It could be said that use of condom during sex is a must for
two-way protection: first from unintended pregnancy and the other is the prevention of STIs
including HIV/AIDS.
· 40 women every minute undergo unsafe abortion and 200 die each day (ICPD report,
2004). Termination of pregnancies could be risky to a young woman’s health. Using
contraception to prevent unwanted pregnancies helps to reduce the toll of unsafe abortion.
· Very young, adolescent women who become pregnant face serious health risks because
their bodies may not be physically mature enough to handle the stress of pregnancy and
childbirth. For them, use of contraception methods is a better and safe practice.
 · Contraceptive use also can help improve quality of life. Access to contraceptives allows
women to decide if they want to have children or not and when to have them.

What are the common barriers to Contraceptive use by adolescents?

Generally speaking, adolescent are less likely than those over the age of 20 to use contraceptive
methods. Reasons for this include lack of information, misinformation, and fear of side effects, along
with geographic, social, cultural and economic barriers to access and use of contraceptive methods.
Unmarried adolescents may find it difficult to access contraceptives, especially where strong cultural or
religious beliefs condemn sexual activity among unmarried adolescents. Teenagers may be unwilling to
disclose their sexual activity to parents or service providers. Also, the sporadic and unplanned nature of
adolescent sexual activity can be an obstacle to consistent contraceptive use.

Discontinuation of contraceptives may be a particularly significant issue for adolescents, who have
more limited access than adults to contraceptive services, and more unpredictable and irregular sexual
encounters. Adolescents also often have inadequate or incorrect knowledge about the reproductive
cycle and about effective use of contraceptives. They are more likely to abandon contraceptive use for
reasons such as side effects and health concerns, desire for a more effective and convenient method,
problems of access or their partner’s disapproval.

Sometimes married females seek contraceptive services in conservative, high-fertility societies, they
encounter substantial, often explicit, provider resistance, as providers are sometimes influenced by
cultural mores that prohibit contraceptive use among adolescents.

Given that contraceptive methods like condoms are a male controlled method, a woman’s ability to
negotiate for their use may be inhibited by gender –related power imbalances in sexual relationships. In
many societies, the low status of women and the tolerance of male promiscuity are other related factors
that hinder a woman’s ability to insist on condom use. In addition, lack of knowledge about STD/HIV
transmission and the cultural norms regarding the discussion of sexual matters and the rights of the
partners to initiate or refuse physical activity can further hamper the ability to protect them from
infection.The inability to negotiate use of contraceptives is a major barrier for adolescent women, who
are less likely to discuss the use of contraceptives with their partners.

What are the various contraceptive options available for young people?

When prescribed and used properly, all currently available contraceptives are safe and effective for
healthy adolescents.

Healthy adolescents are medically eligible to use any of the methods that are
currently available. Some concern does exist regarding the use of certain methods
(for instance intrauterine devices), but this must be balanced with the advantages of
avoiding pregnancy. However age, is an important social factor to take into account
when considering irreversible methods, such as sterilization.

Which are the contraceptives recommended for use in adolescents?

Sexually active adolescents need to be aware of the importance of the protection against both
pregnancy and STI/HIV. When used correctly and consistently, male condoms are the most
effective method of preventing infections for those engaging in sexual intercourse, and can
be highly effective in protecting against pregnancy as well. Another option for dual protection is
to use condom in conjunction with the other methods, such as combined oral contraceptives or
injectables.

While adolescents may choose to use any one of the methods available to them, some methods
may be more appropriate for a variety of reasons. For example, using a method that does not
require a daily regimen, as oral contraceptive pills do, may be more appropriate choice for an
adolescent. For all women, side effects are a major reason for discontinuation of contraception, and
this is true for adolescents as well.

Much of the advice regarding adolescents and contraceptive use has focused on unmarried
adolescents, but many of those seeking family planning services are married.
Married adolescents may be particularly concerned about early return to fertility and may prefer to
avoid injectable contraceptives. Young married women may ,in some cases, feel a pressure to
have children and , thus , may want to keep their contraceptive use private from their spouse or in –
laws. They may also knowingly or unknowingly be in a relationship where they are at risk for
STI/HIV.

For unmarried adolescents, non-penetrative sexual activity can be a option, even with those who
have already commenced sexual intercourse. For those who desire to have sexual intercourse,
condoms, or condoms in combination with another method for dual protection –are the best
recommendation. For adolescents who are not in monogamous relationship, sexual activity may be
sporadic and unplanned. In these circumstances, condoms are a good choice because they are
widely available- easily and inexpensively –and can be used when needed. Adolescents, especially
those in monogamous relationships may also desire to use other long acting methods. However the
risk of contacting STI/HIV still remains and the option of using dual methods can be considered.

What are the Barrier Methods?

The aim of the various methods that come under this is to prevent the living sperm from meeting the
ovum. A variety of barrier methods are available both for men and women. The available options
include condoms, spermicidal (foam suppositories, tablets, creams, soluble films and jellies),
diaphragms, cervical caps, and sponges. These methods act by mechanically or chemically
preventing sperm from entering the uterus. The major benefit to users is the absence of long-term
side effects and complications. In addition, the use of condoms, and to some extent other barrier
methods, reduces the risk of STD transmission. Except for diaphragms and cervical caps, which
require an initial examination and fitting by the provider, barrier methods can be obtained through
non-medical suppliers.

Male condoms:
Condom is a thin rubber sheath, which is pulled over the erected penis. After ejaculation, semen
stays in the condom and sperm does not get into the vagina. The size and thickness vary.
Condoms are available in different colours, smooth and patterned and with different flavours.
Usually condoms are lubricated, which makes it easier for the penis to penetrate into the vagina.
Condom needs to be used during the entire intercourse because even the first drops appearing on
the tip of the penis (pre-cum or the pre-seminal fluid) may contain a large amount of sperm.

Effectiveness:

When used correctly and consistently, the condom is an effective contraceptive. It is the best
protection against sexually transmitted infections. This is why condom should always be used
during temporary relationships even if some other contraceptives are used simultaneously.

Even one single intercourse without as condom could lead to the infection of sexually transmitted
diseases. Although many sexually transmitted infections are symptomless in early stages, in the
long run they may cause infertility.

Female condoms
A female condom is a new method of contraception. It consists of a sheath made of thin,
transparent, soft plastic. There are two rings in it, one at either end. At one end of the condom,
there is a flexible plastic ring that is inserted into the vagina before sex so that, the penis goes
inside the female condom. At the other end, a soft plastic ring or -triangle (often corresponding to
the size of the pubic triangle) covers the vulva. The effectiveness is similar to the male condoms.

Advantages:
· Use can be controlled by women
· Designed to prevent both pregnancy and STDs.
· No apparent side effects
· No medical condition appear to limit its use

Disadvantages:
· Expensive at this time and not available everywhere
· Some women might feel embarrassing as it indicates that “OK, now I am ready.”
· Sensitivity of the vulva, inner lips, clitoris and the genital wall, reduces significantly

To read more on condoms, click on ‘Safe sex’ in the Information Base.

Spermicides
Contraceptive foams, creams and jellies are all classified as spermicides, that is, sperm killers.
They come in a tube or a can, along with a plastic applicator.
They contain a chemical called Nonoxylol-9. Spermicides are applied inside the vagina at least 10
minutes before the ejaculation takes place depending on the melting time. They kill sperm or make
sperm unable to move toward the egg. Thus the spermicide is inserted much as a tampon is.
Spermicides consist of a spermicidal chemical in an inert base and they work in two ways: chemical
and mechanical. The chemicals kill the sperms, while the inert base itself mechanically blocks the
entrance to the cervix so that sperm cannot swim into it.
Spermicides are highly effective only when used with a diaphragm or a condom. It however does
not protect against STIs / HIV/AIDS.
Important Note
Spermicides must be inserted at least 10 minutes before the intercourse and the second dose will
be needed after one hour has passed.

What are the various hormonal contraceptive?

There are two kinds of contraceptive pills: combined pills containing progestin and estrogen and
progestin-only pills, which are called mini pills.

a) Combined oral contraceptive pills (COC). These pills contain

combination of both female hormones i.e. Oestrogen and Progestogen
b) Progestin only pill (Minipill) containing Progesterone only

The pill works generally by stopping ovulation (release of eggs from the ovaries). In natural
menstrual cycle, the low levels of estrogens during and just after the menstrual period trigger the
pituitary to produce Follicle Stimulating Hormone (FSH), which stimulates the process of ovulation.
The woman starts taking the pills on about day 5 of her cycle. Thus just when estrogens levels
would normally be low, they are artificially made high. This level of estrogens inhibits FSH
production, and the message to ovulate is never sent out.

It is an effective, safe and reversible contraceptive for women desiring to delay their first pregnancy
or space the next child.

Each packet has 28 tablets; first 21 of which are white hormonal tablets and remaining 7 are
coloured iron tablets for maintaining their continuity. The pill has to be taken daily and one must
follow instructions for optimum effectiveness.

Hormonally, the action of the pill produces a condition much like pregnancy, when hormones levels
are also high, preventing further ovulation and menstrual periods. Thus it is not too surprising that
some of the side effects of the pill are similar to the symptoms of pregnancy.

Advantages:
• Safe, effective and easily reversible
• Decision lies with woman herself
• Fertility returns soon after stopping pills
• Reduces menstrual blood loss and thus minimizes the chances of anaemia
• Relief from premenstrual symptoms (PMS) and menstrual pain
• Regulates irregular menstrual cycle
• Provides protection against pelvic infection
• Reduces chances of developing cancer of uterus and ovary and protects
tumours of breasts and ovarian cysts.

Disadvantages:
• No protection from STI/HIV transmission
• Not effective unless taken every day, which may be difficult to remember.
• Not recommended for women who smoke

Possible Side effects: Nausea, vomiting, Breast tenderness, Headache, Spotting or

bleeding between the periods, Slight Weight gain are some of the possible side effects
but do not necessarily manifest in every user.

Implants
The implant system that is available is called Norplant containing a set of 6 small plastic capsules.
Each capsule is about the size of a small matchstick.
The capsules are placed under the skin of a woman’s upper arm by surgical procedure. Norplant
contains progestin-only hormone that is released steadily into the body very slowly from all 6
capsules in a very low dose.
A set of norplant implant prevents pregnancy at least for 5 years. It works in the similar way as the
oral contraceptive pills.

Advantages:
• Very effective (1 pregnancy in every 1000 women in the first year of use) and
provide long term protection upto 5 years
• Does not interfere with sexual intercourse
• Fertility returns immediately after removal of capsules

Disadvantages:
• Changes in menstrual bleeding pattern, irregular bleeding, spotting, heavy
bleeding, longer periods, or amenorrhea
• Nausea
• Acne or skin rash
• Weight gain
• Hair loss or more hair growth on the face
• Do not protect against STIs/ HIV/AIDS

Important:
Most women do not have any of these side effects, and most of the side effects go away without
treatment within the first year.
Implants must be performed only at the hospital or a Health Center by a qualified trained medical
practitioner.

Injectable contraceptives

Injectable contraceptives are highly effective. Two kinds that have been approved for use in a large
number of countries are DMPA(depo-medroxyprogesterone acetate) ,used in some 90 countries
,and NET-EN(norethisterone enanthate) ,approved in some 40 countries. They work in the same
way as contraceptive pills by stopping ovulation and thickening cervical mucous plug making it
difficult for sperm to pass through. One single dose helps prevent pregnancy for at least 3 months.
Both DMPA and NET-EN produce amenorrohea (cessation of menstrual periods)in many users.
This effect is seen as a disadvantage by women who consider regular bleeding as a sign of good
health and use menstruation as an indicator that they are not pregnant. Although a return to fertility
following discontinuation can be delayed for 6-12 months, studies suggest that 60-78 % of women
conceive within one year of last injection.

What is an Intrauterine Device (IUD)?

The intrauterine device is a small piece of plastic; it comes in various shapes. Metal or hormone
may also be a part of the device.
The IUD is inserted by trained medical personnel and remains in place until the woman wants it
removed. The silk thread hangs outside the cervix that helps in its removal if there is a need.
The leading hypothesis is that the IUD produces changes in the uterus and in this environment;
sperm that reach the uterus are immobilized and cannot move into the fallopian tube. The egg may
also move more swiftly through the fallopian tube, reducing the chances of fertilization.

Advantages:

• Readily reversible – single decision leads effective long term prevention of

pregnancy
• Does not interfere with the sexual activities at all
• Long lasting – mostly for about 10 years
• No medicinal or hormonal side effects

Disadvantages
• Menstrual change in the first 3 months – heavier and longer menstrual periods
• Irregular bleeding and spotting between periods
• Medical and pelvic examination is a must before insertion

The IUD cannot be used under various conditions which include anaemia, excessive or irregular
menstrual bleeding, active genital tract infection (RTI), enlarged uterus, Previous history of ectopic
pregnancy or caesarean section and medical disorders e.g. diabetes, heart disease etc.
Note: IUD must be inserted only at the hospital or a Health Centre by a qualified
trained gynaecologist.

What are the Traditional or Natural Methods of Contraception?

There are some methods of contraception that are called natural methods of contraception. The
effectiveness of all methods depends on couples motivation to prevent pregnancy and the ability
to interpret symptoms of ovulation. In general, older and more experienced users have a low
failure rate.
• Abstinence
• Sex without penetrative intercourse
• Withdrawal method
• Fertility Awareness-Based Methods (FAM)
• Rhythm or Calendar method
• Cervical Mucous Method
• Basal Body Temperature (BBT) Method

Abstinence: If one abstains from sex or avoids sex, that is the safest contraceptive
possible. After all, the best way to avoid an effect is to avoid its cause. But it may not
be a feasible option for many adolescents and young people.

Sex without penetrative intercourse: One can express love and caring for one’s
partner through acts other than vaginal intercourse. These may indulge in hugging,
kissing, cuddling, light or heavy petting or mutual masturbation. From the point of
view of contraception, this is as safe as abstinence.
The danger, however, lies in the fact that one may find it difficult to control themselves in an
intimate situation and actually end up having penetrative sex.

Withdrawal method: Withdrawal is probably the most ancient form of birth control.
It is still widely used throughout the world. During sexual intercourse, when the penis
is withdrawn just before ejaculation and the semen is discharged outside the vagina,
fertilisation cannot occur. This method is known as “coitus interrupts” or “pulling
out”.

• This method calls for a great deal of self-control and mental strength from the
male partner.
• It is a risky method to use because even the pre-cum or the pre seminal fluid
contains sperms, which can lead to pregnancy or transmission of HIV.
• Does not protect against sexually transmitted infections or HIV
• Over long periods of time, withdrawal may contribute to sexual dysfunctions in
the man, such as premature ejaculation, and also sexual dysfunction in the
woman.

Fertility Awareness-Based Methods (FAM)

Rhythm or Calendar method

Before following this method, the woman records the number of days in each menstrual cycle for at
least 6 months. The first day of the menstrual bleeding is always counted as day 1.
The woman subtracts 18 from her shortest recorded cycle. This tells her the estimated first day of
her fertile time. Then she subtracts 11 days from her longest recorded cycle. This tells her the last
day of her fertile time. The couple avoids sex or use a barrier method or contraception during the
fertile period. The rest of the days are considered safe. However this method is not suitable for a
woman with irregular menstrual cycles.

Cervical Mucous Method:

This method is based on the fact that the cervical mucus becomes very resilient and transparent
just before ovulation making it easily penetrable for sperms. This method uses cervical secretions to
identify the beginning and end of the fertile time. However the method is not very reliable for young
users who cannot determine the consistency of the cervical secretions.

Basal Body Temperature (BBT) Method:

The BBT method uses body temperature to regulate fertility.
The woman must take her temperature in the same way, orally, rectally or vaginally, at the same
time each morning before she gets out of bed.
She must know how to read a thermometer and must record her temperature on a special graph.
About midway during the menstrual cycle, at the time of ovulation, a woman’s temperature rises
0.2° to 0.5°C (0.4 to 1.0°F).
The couple should avoid sex or use contraception from the first day of menstruation until her
temperature has risen above her regular temperature and stayed up for three full days. This means
that ovulation has occurred and passed.

What is an Emergency Contraceptive (Morning After Pill)?

Emergency contraception refers to any device or drug that is used as an emergency procedure to
prevent pregnancy after unprotected sexual intercourse. Synonymous terms for EC include "the
morning-after pill," post coital contraception, interception, postovulatory contraception, "visiting pill,"
and "vacation pill."

Emergency contraception is indicated for the prevention of pregnancy in women after a known or
possible contraceptive failure or unprotected sexual intercourse and for victims of sexual assault. It
is not recommended as a form of routine contraception. Although EC reduces the risk of pregnancy,
it is much less effective than the regular use of standard contraception.
They are thought to act primarily by inhibiting or disrupting ovulation. In addition, they may act by
interfering with tubal transport of the ova and/or sperm, thereby inhibiting fertilization, or by inhibiting
implantation through alteration of the endometrium.

Emergency contraception (EC) should be undertaken within 72 hours of unprotected sexual

intercourse; the sooner it is started, the more effective it will be in preventing pregnancy (recent data
indicate that EC is effective <120 hours). If emesis occurs within 1 hour after a dose, the dose
should be repeated.

The use of Emergency Contraception is generally not associated with any serious adverse effects,
even though the doses used are higher than those used for routine contraception. Pregnancy is a
contraindication to EC because EC is ineffective if a woman is pregnant. There is no significant
increase of teratogenic (leading to malformations or deformities) risk on fetal development
associated with the long-term use of oral contraceptives administered before pregnancy or taken
inadvertently during early pregnancy. Although EC is not intended for routine contraceptive use, its
use after failed contraception could minimize the number of unanticipated pregnancies, preventing
the physical and emotional burden of an unwanted pregnancy, in addition to reducing health care
costs.

Common adverse effects of EC include nausea, emesis, headache, irregular bleeding, breast
tenderness, and abdominal cramping. An antiemetic can be prescribed to prevent nausea and
emesis.

» FAQs
» Data on Young
» E-Counseling
» E-Library
» Publications
» Events
» Young Voices
Safe Sex......

You Ought To Know

♦ ‘Safe sex’ refers to sexual activities that do not involve any blood or
sexual fluid from one person getting into another person's body.

♦ ‘Safer sex’ is used to refer to a range of sexual activities that hold

little risk of HIV infection.

♦ Safer sex is often taken to mean using a condom for sexual

intercourse.

♦ Deep or open-mouthed kissing is considered a very low risk activity

for transmission of HIV.

♦ Anal sex is especially risky because it can result in tiny tears or cuts
in the rectum.

♦ Unprotected oral sex carries a lower risk but is not risk-free.

♦ A condom is a sheath, or covering made to fit over a man’s erect

penis and prevent semen from entering the vagina.

♦ Condoms help prevent both pregnancy and sexually transmitted

infections including HIV/AIDS

What does ‘safe sex’ mean?

What does ‘safer sex’ mean?

What is the most risky kind of sex?

What are some forms of safer sex?

Are there any risks involved in Kissing?

How safe is oral sex?

What is a condom?

How do condoms work?

Can adolescents use condoms?

What kind of condoms to use?

How to use a condom?

What is a female condom?

How to use the female condom?

What is the role of condoms in the prevention of HIV infection?

What does ‘safe sex’ mean?

‘Safe sex’ refers to sexual activities that do not involve any blood or sexual fluid
from one person getting into another person's body. This includes those practices
that enable people to reduce their sexual health risks and lower the likelihood of
infection with HIV and other Sexually Transmitted Infections. If two people are
having safe sex then, even if one person is infected, there is no possibility of the
other person becoming infected. Examples of safe sex are cuddling, mutual
masturbation, or petting.

What does ‘safer sex’ mean?

Safer sex principally means using condoms during penetrative sex or having non-
penetrative sex (where the penis does not penetrate the vagina or anus). Using
latex barriers for oral-genital contact is another form of safer sex.

While some use the term safe sex, others use the word “safer sex” in recognition
of the fact that all sexual practices can have consequences—whether in terms of
emotional consequences or in terms of infection and pregnancy—and that very few
practices are without any risk of infection transmission. For example, using a
condom correctly and every time for anal, oral, or vaginal sex greatly reduces but
does not totally eliminate the risk for transmission. For some STIs that produce
lesions outside of the area covered by the condom, such as chancroid or herpes,
exposure can still occur with condom use. Although condoms are highly effective,
breakage and slippage can occur, particularly if the condoms are used incorrectly.

What is the most risky kind of sex?

Unprotected anal and vaginal sex with an infected person carry a high risk for
disease transmission. Anal sex is especially risky because it can result in tiny tears
or cuts in the rectum. Viruses can enter the body more easily through these open
sores than through healthy skin. Unprotected oral sex carries a lower risk but is
not risk-free. The use of drugs or alcohol can increase the risk of getting an STI or
HIV/AIDS because people under the influence may be less careful about practicing
safer sex.

What are some forms of safer sex?

Sexual practices with very low or no risk include :

Kissing

Massage

Masturbation

Sexual stimulation using your hand on another person

Oral sex on a man who is wearing a condom

Oral sex on a woman using a sheet of latex or plastic wrap

Those with low risk are

Anal and vaginal sex using a latex or polyurethane male or female condom

Aside from abstinence or having sex with only one, uninfected partner,
using condoms is the most effective way of preventing sexual
transmission of HIV or other STIs.

Remember, it is necessary to have an HIV test three months after engaging in

risky sexual behaviors to be sure that you are HIV-negative. In addition, some
STIs do not have symptoms for a long time, so it is impossible to know for sure if
you are infected unless you are tested. It is important to learn about partners’
sexual history and risk for infection as well. However, getting a partner’s sexual
history can be difficult and unreliable. People may not be honest because of fear
or shame. Sometimes a partner may have an STI or HIV but is unaware of it
because he or she does not have any symptoms.
Are there any risks involved in Kissing?

Kissing someone on the cheek, also known as social kissing, does not pose any
risk of HIV transmission.

Deep or open-mouthed kissing is considered a very low risk activity for

transmission of HIV. This is because HIV is present in saliva but only in very
minute quantities, insufficient to lead to HIV infection alone.

However if there exists a possibility in case the infected blood gets into the mouth
of the other person during open-mouthed kissing, for example, in the instance
both partners had seriously bleeding gums. If you or your partner have blood in
your mouth, you should avoid kissing until the bleeding stops.

How safe is oral sex?

Although it is possible to become infected with HIV through oral sex, the risk of
becoming infected in this way is much lower than the risk of infection via
unprotected sexual intercourse with a man or woman.

When giving oral sex to a man (sucking or licking a man's penis) a person could
become infected with HIV if infected semen got into any cuts, sores or receding
gums a person might have in their mouth.

Giving oral sex to a woman (licking a woman's clitoris or vagina) is also

considered relatively low risk. Transmission could take place if infected sexual
fluids from a woman got into the mouth of her partner. The likelihood of infection
occurring might be increased if there is menstrual blood involved or the woman is
infected with another STD.

The likelihood of either a man or a woman becoming infected with HIV as a

consequence of receiving oral sex is low but risk definitely exists. Using a condom
during oral-genital contact can reduce this risk.

What is a condom?

A condom is a sheath, or covering made to fit over a man’s erect penis and
prevent semen from entering the vagina. Also called rubbers, sheaths, skins, and
prophylactics, and known by many different brand names. Most condoms are
made of thin latex rubber. Some condoms are coated with dry lubricant or
spermicide. Different shapes, colors, and textures may be available.

“Female condoms” that are inserted into a woman’s vagina before a sexual contact
are now available.

Facts (history and production, testing):

Mankind has probably used condoms for thousands of years to prevent unwanted
pregnancies and diseases. Lining from animals, shells from turtles and waxed rise
paper were some of the materials used as condoms in different cultures and
countries all over the world. A story exists of King Charles II of England (1523 –
1562) who asked his doctor to help him prevent unwanted children with all his
mistresses. The doctor’s name was Dr. Condom and hence this name for this
prevention method.

In the middle of the 17th century, Good Year started to vulcanize rubber and after
that they started to produce condoms made of rubber. These condoms were stiff
and thick and not so comfortable as those available today - just a thin, elastic,
0.06 mm thick, latex condom.

Condoms are made on individual moulds shaped like a penis. Each condom on
each mould passes through electronic beams that detect even very tiny holes or
defects, such as the latex being too thick or too thin.

When a defective condom passes through the electronic beam, an alarm is

sounded and the poor quality condom automatically falls off the assembly line.
Condoms are also tested for strength by being inflated with air and for
permeability by being filled with water. Laboratory tests also prove that viruses
cannot pass through the condom.

Condoms are made in different sizes. However manufacturers distribute only

certain sizes in certain areas of the world .The length of the condom may vary
from 150 mm to180mm and the width from 44 to 56 mm.

Female condoms have been developed and have undergone extensive testing.
They are available commercially in some countries. Laboratory studies have shown
that an unbroken polyurethane (plastic) female condom does not allow the
passage of sperm or viruses. The female condom is, at present less comfortable
to use than the male condom and is much more expensive. However, it may be
useful for vulnerable women when their male partners refuse to use them.

How do condoms work?

Condoms help prevent both pregnancy and sexually transmitted infections. Used
correctly, they keep sperm and any disease organisms in the semen out of the
vagina. Condoms also prevent any disease organisms in the vagina from entering
the penis.

How effective are condoms?

As with other barrier methods, the effectiveness of condoms depends on the
experience of the user and the consistency of use.

Effectiveness for preventing pregnancy:

As commonly used – 14 pregnancies per 100 women in the first year of use (1 in
every 8)

When correctly used every time –3 pregnancies per 100 women in first year of
use (1 in every 33)

Effectiveness for preventing STDs:

In general, studies show that condom users have about two –thirds as much risk
of getting gonorrhea, trichomoniasis, or chlamydial infection as people who never
use condoms. Condom users have less than half the risk of HIV infection , which
leads to AIDS .These studies included some people who used condoms incorrectly
or inconsistently , however.

Condoms probably protect somewhat, but not as well, against herpes, genital wart
virus (HPV), and some other diseases that can cause sores on skin not covered by
condoms.

What are the advantages of using a condom?

Condoms prevent STDs , including HIV/AIDS , as well as pregnancy , when used

correctly with every act of sexual intercourse.

Help protect against conditions caused by STDs-pelvic inflammatory disease ,

chronic pain , and possibly cervical cancer in women , infertility in both men and
women.

Safe - No hormonal side effects.

Use can be discontinued at any time.

Offer occasional contraception with no daily upkeep.

Easy to keep on hand in case sex occurs unexpectedly.

Can be used by men and women of any age

Can be used without seeing a health care provider first.

Usually easy to obtain and sold in many places.

Enable a man to take responsibility for preventing pregnancy and disease.

Increased sexual enjoyment because there is no worry about pregnancy or STD.

Often help prevent premature ejaculation.

What are some of the perceived barriers to condom use?

Many young people feel that condoms may decrease sensation, making sex less
enjoyable for either partner.

Couple must take time to put the condom on during the act.

Supply must be at hand even if sexual activity is not anticipated.

Small possibility that condom will slip off or break during sex or may break if
improperly stored.

A man’s cooperation is required and a woman may find herself helpless if he does
not cooperate.

Poor reputation - Many people connect condoms with immoral sex, sex outside
marriage, or sex with prostitutes.

May embarrass some people to buy, ask partner to use, put on, take off, or throw
away condoms.

Can adolescents use condoms?

Medical eligibility Checklist for condoms

Yes adolescents can use condoms. Only one medical condition prevents
use of condoms- severe allergy to latex rubber (severe redness,
itching, swelling after condom use).

In general, anyone CAN use condoms safely and effectively if not

allergic to latex.
What kind of condoms to use?

The best condoms to use are made of latex, have reservoir (nipple) ends and are
lubricated.

Always use a fresh, new latex condom for each act of sexual intercourse.

Do not use condoms that are brittle, unusually sticky or discolored (usually
the result of age) because these condoms may not prevent infection and may
break during the act. The manufacturing date on the package should not be more
than three years.

If extra lubrication is needed, only water-based lubricants should be used.

Good lubricants include spermicides, glycerine, and specially made products.
Water can be used also. Do not use petroleum or oil based lubricants, such as
petroleum jelly (Vaseline), skin lotions, baby oil and cooking oils, as they weaken
the latex.

How to use a condom?

Put on the condom after the penis becomes hard (erect) before any vaginal
contact.

Hold the pack at its edge and open by tearing from the ribbed edge.

Hold the condom so that the rolled rim is facing up, away from the penis.

Pull the foreskin back if penis is uncircumscribed.

Hold the tip of the condom between fingers and the thumb on one hand , leaving
space at the tip to collect the semen , but squeezing it to prevent air from being
trapped in the tip.

With the other hand put the condom on the end of the penis and unroll the
condom down the length of the penis by pushing down the round rim of the
condom. If this is difficult, the condom is “inside out”. Turn the condom the other
way round, take hold of the other side of the tip and unroll it.

When the rim of the condom is at the base of the penis, penetration can begin.

Soon after ejaculation, withdraw the penis while it is still hard , holding the bottom
of the rim of the condom to prevent it from slipping off the penis.

Do not let the penis go soft inside the partner because the condom may slip off
and spill semen on or near the vagina.

Do not allow the semen to spill on hands or other parts of the body , and wash
hands and other body parts if contact with semen occurs.

Wrap used condoms in waste paper before disposing them safely by flushing them
down a toilet, throwing them down a pit latrine, burying them or burning them.

Wash hands to remove vaginal secretions / semen which can also be infectious.

If a condom breaks during sexual intercourse,

Immediately insert a spermicide into the vagina, if it is available. Also, washing

both penis and vagina with soap and water should reduce the risk of STDs and
pregnancy.

Some clients may want to use emergency oral contraception to prevent

pregnancy.

What is a female condom?

Female condom –New method for women

A woman controlled method to protect against STDs including HIV/AIDS and

against pregnancy.

A sheath made of thin, transparent, soft plastic, which a woman places in her
vagina before sexual activity.

Effectiveness is similar to male condoms and other vaginal methods. Pregnancies

per 100 women in first year of use: As commonly used-21. Used correctly and
consistently-5

Some advantages:

Controlled by the woman.

Designed to prevent both STDs and pregnancy.

No medical condition appears to limit its use.

No apparent side effects; no allergic reactions.

Some disadvantages:

Expensive presently.
Only somewhat effective as commonly used.

Supply must be on hand.

Woman must touch her genitals.

How to use the female condom?

Some time before the act, the woman places the closed end of the sheath high in
her vagina.

The closed end contains a flexible, removable ring to help with insertion. A larger
flexible ring around the open end of the sheath stays outside the vagina.

Meant for one time use

Can be used with other family planning methods to add STD protection

What is the role of condoms in the prevention of HIV infection?

Prevention by avoiding exposure is the best strategy for controlling the spread of
HIV. Proper use of condoms provides an effective mechanical barrier against
sexually transmitted agents including HIV. For the wearer, condoms provide a
barrier that that reduces the risk of penile exposure to infectious secretions or
lesions of the cervix, vagina, vulva and anus. For the wearer’s partner, proper use
of condoms prevents semen deposition, contact with urethral discharge and
exposure to lesions on the penis.

Both laboratory and epidemiological studies suggest that the use of condoms can
effectively prevent the spread of HIV. Laboratory tests have shown that
intact latex condoms are impermeable to HIV but natural membrane
condoms, which contain small pores, may not, suggesting that Latex condoms
afford greater protection. Although condoms can occasionally break during
intercourse, available information suggests that this is usually the result of
deterioration of condoms either from age or improper storage. When condoms
leak, improper usage is probably the cause