When used correctly, condoms are among the safest and most effective methods of preventing both pregnancy and sexually transmitted infection (STI). However, for condoms to be effective, there’s a major hurdle to be overcome — condoms must be worn. Most men (and some women) claim condoms reduce sensation and pleasure during sex; condom users complain that condoms smell funny, taste bad, feel constricting, and, in this age of eco-consciousness, are entirely wasteful. With this list of grievances, it is only natural (albeit more than a little disturbing) that as few as five percent of men worldwide wear condoms during sex. Even more alarmingly, according to the 2010 National Survey of Sexual Health and Behavior, only 20 percent of those in the United States who have anal sex use condoms, and anal sex is the highest risk activity for sexually transmitted infection. Fortunately, new condoms are in development that are easier to use and more pleasurable to wear.

The Platonic Form of the Condom

For a condom to be widely used,

it has to be reliable; it shouldn’t break frequently It must be easy to put on, even in the heat of the moment when sexual partners fumble in the dark, sometimes while intoxicated It must not inhibit genital sensation so much that it ruins the sexual experience, or no one will want to wear it Perhaps most importantly, it must block transmission of sperm cells and smaller particles such as the bacteria and viruses that cause sexually transmitted infections.

As many of the condoms on the market demonstrate, optimizing for one property, such as sensation, tends to come at the cost of other properties, such as durability or impermeability.

The Condom of Today

Although condoms have been in use for well over a thousand years, the modern condom hasn’t changed very much over the last century. Here’s a survey of the condoms available today, and the science that supports their use.

Latex condom

The dominant condom technology currently on the market, developed in the 1920s, latex condoms and the synthetic-equivalent polyisoprene condoms are produced globally by a few large corporations that comprise an oligopoly in the sexual health market — Trojan, Durex, LifeStyles/Ansell, and Okamoto. Aside from the market pressures keeping latex dominant, there is regulatory hostility towards competing technologies as well. The FDA, Centers for Disease Control, and health departments across the country have promoted latex condoms as the gold standard of STI and pregnancy prevention for over 30 years. In many cases, the data just aren’t available to suggest that competing technologies are as safe and effective as latex condoms.

However, shockingly, in many cases the data aren’t really available to support the use of latex condoms either. Although the FDA regulates condoms as medical devices and therefore dictates how they are manufactured, labeled, and marketed, relatively few studies have actually been done on the safety and efficacy of condom use, particularly for high-risk populations such as men who have sex with men. Paradoxically, the FDA does not approve condoms for use during anal sex, and studies on condom durability are performed for vaginal sex only — despite the fact that condoms became high-profile in large part because of the HIV epidemic among men who had anal sex with other men.