What are the failure rates of condoms in preventing pregnancy and sexually transmitted infections (STIs)?

Condom Failure Rates for Pregnancy and STI Prevention

Male condoms have a typical-use failure rate of 18% for pregnancy prevention and approximately 2% breakage rate per 100 uses, while female condoms have higher failure rates of 21% with typical use. 1, 2

Pregnancy Prevention Effectiveness

• Perfect use vs. typical use:

  • Male condoms: 2% failure rate with perfect use vs. 18% with typical use 1
  • Female condoms: 5% failure rate with perfect use vs. 21% with typical use 1
  • These rates represent the percentage of women experiencing an unintended pregnancy within the first year of use

• Continuation rates:

  • Male condoms: 43% of users continue use at 1 year
  • Female condoms: 41% of users continue use at 1 year 1

STI Prevention Effectiveness

• Consistent and correct use of male latex condoms significantly reduces the risk for STI/HIV transmission 1, 2
• Condoms provide varying levels of protection depending on:
  • Type of STI (more effective against fluid-transmitted STIs than those transmitted by skin-to-skin contact)
  • Consistency of use (must be used with every sexual encounter)
  • Correctness of use (proper application and handling) 2

Factors Affecting Condom Failure

Common Causes of Failure

1. Incorrect application and use 2, 3:

   • Not using a new condom with each act of intercourse
   • Improper handling during application
   • Not holding the condom during withdrawal

2. Lubricant issues 2, 3:

   • Using oil-based lubricants with latex condoms (weakens the latex)
   • Inadequate lubrication during intercourse

3. User characteristics 4:

   • Breakage is more common among younger, less experienced users
   • Slippage is more common among married women with children

4. Behavioral factors 5, 6:

   • Substance use (amphetamines and heavy alcohol use associated with increased failure)
   • High-intensity sexual activity
   • Reuse of condoms

Breakage and Slippage Rates

• Overall breakage rate: approximately 2.3% of condoms break during intercourse 4
• Overall slippage rate: approximately 1.3% of condoms slip during intercourse 4
• Combined mechanical failure rate: approximately 3.6% 4

Improving Condom Effectiveness

1. Proper usage techniques 2:

   • Use a new condom with every act of intercourse
   • Handle carefully to avoid damage
   • Use adequate water-based lubrication with latex condoms
   • Apply before any genital contact
   • Hold the condom during withdrawal

2. Consistency of use 2:

   • Use condoms for every sexual encounter
   • Failure rates decrease with experience and regular use 4

3. Complementary protection 2:

   • Consider dual method use (condoms plus hormonal contraception) for optimal protection against both pregnancy and STIs
   • Regular STI screening for sexually active individuals

Special Considerations

• Condoms do not cover all potentially infectious areas, which limits protection against STIs transmitted through skin-to-skin contact 2
• Limiting the number of sexual partners and avoiding sexual contact with individuals who have visible lesions can provide additional protection 2
• For individuals at high risk for both pregnancy and STIs, using both condoms and a non-barrier contraceptive method provides optimal protection 2

Remember that most condom failures result from incorrect use rather than product defects, highlighting the importance of education on proper condom application and use techniques 2, 3.