Appendix A: Canadian Guidelines on Sexually Transmitted Infections – Patient counselling guide on condom use

Section VII

Appendix A: Patient Counselling Guide on Condom Use

Essential Information on Condoms and Patient Counselling Guide

Check the label
  • The most common type of condom is the latex condom, but synthetic (polyurethane) condoms also offer protection against unintended pregnancies as well as sexually transmitted infections (STIs), including HIV.
  • Natural membrane condoms (also called “sheepskin”) are not recommended for use in protection against certain viral diseases such as hepatitis and HIV.
  • Novelty condoms, such as “edible condoms,” do not offer pregnancy or STI prevention.
Store condoms properly and check them before use
  • Condoms should be stored in a cool, dry place out of direct sunlight (i.e., do not store in wallet, in automobile or any place where condoms will be exposed to extreme heat or cold).
Always check the expiry date before using the condom; expired condoms should not be used
  • Condoms in damaged packages or those that show obvious signs of age (e.g., those that are brittle, sticky or discoloured) should not be used, because they cannot be relied upon to prevent infection.
  • Condoms should be put on before any genital contact to prevent exposure to body fluids that may contain infectious agents. Nonoxynol-9 (N-9) is not recommended as an effective means of HIV or STI prevention. The best STI and HIV barrier is a latex or polyurethane condom without N-9.
    • If N-9 is used as an aid to contraception, its benefit should be carefully considered in light of the increased risk of genital lesions and the resulting potential for an increased risk of HIV transmission.Footnote 1
Suggestions for Enhancing Adherence to Condom Use for STI Prevention
  • Routinely recommend “dual protection” — using condoms together with oral contraceptives — for STI prevention and highly effective birth control.
  • Prepare a “Prescription Pad Counseling Guide” as followsFootnote 2:

If you or your partner has ever had another sexual partner, we strongly recommend that you make one of these safer-sex choices:

  • Use a condom consistently to prevent pregnancy and STIs.
  • Always use a condom for the first 3 months of a sexual relationship with a new partner, and then come in with your partner for STI and HIV testing. If your tests are negative, you can quit using condoms, as long as you and your partner feel that you are willing and able to remain monogamous and take appropriate birth control measures.

Barriers to Condom Use and Means to Overcome Them

Table 1. Perceived barrier and proposed intervention strategy

Decreases sexual pleasure or sensation

  • Often perceived by those who have never used a condom
  • Encourage patient to try the following:
    • Put a drop of water-based lubricant or saliva inside the tip of the condom or on the glans of the penis prior to putting on the condom
    • Try a thinner latex condom
    • Try different brands
    • Try more lubrication

Decreases spontaneity of sexual activity

  • Encourage incorporation of condom use during foreplay
  • Remind patient that peace of mind may enhance pleasure for self and partner

Embarrassing, juvenile, “unmanly”

  • Remind patient that it is “manly” to protect oneself and others

Poor fit (too small or too big, slips off, uncomfortable)

  • Smaller and larger condoms are available

Requires prompt withdrawal after ejaculation

  • Reinforce the protective nature of prompt withdrawal
  • Suggest substitution of other postcoital sexual activities

Fear of breakage may lead to less vigorous sexual activity

  • With prolonged intercourse, lubricant wears off and condom begins to rub. Have a water-soluble lubricant available to reapply

Non-penetrative sexual activity

  • Condoms are advocated for use during fellatio; non-lubricated condoms may prove best for this purpose
  • There are flavoured condoms now on the market, but they should not be confused with edible condoms found in some novelty sex shops
  • Other barriers, such as dental dams or a non-lubricated condom cut down the middle to form a barrier, have been advocated for use during certain forms of non-penetrative sexual activity (e.g., cunnilingus and anilingual sex).

References

Report a problem or mistake on this page
Please select all that apply:

Privacy statement

Thank you for your help!

You will not receive a reply. For enquiries, contact us.

Date modified: