FHI - Condom Breakage and Slippage

How frequent is condom breakage/slippage? International research indicates that male condom breakage ranges from zero to 12 percent, with both breakage and slippage occurring around 2 percent of the time. The percent of condoms that slip off the penis during or after intercourse is similar.

A 1993 FHI study showed that most condom users rarely experience condom breakage and/or slippage. A small group of users is often responsible for a majority of the breaks and slips. In the study, 177 couples used 1,947 condoms and reported a combined breakage/slippage rate of 8.7 percent. If every couple were equally likely to experience condom breakage/slippage, then each couple would have been expected to have about 1 out of 11 condoms either break or slip off. However, in this study, 16 couples (less than 10 percent of participants) were responsible for 50 percent of all the breakage/slippage. Well over half the couples did not experience any condom breakage/slippage among the 11 condoms each couple used.

Observed vs. Expected Number of
Condom Breakage/Slippage 177 Couples

Number per Couples	Observed # of Couples	Expected # of Couples
0	110	65
1	26	68
2	17	33
3	8	9
4+	16	2

In this study, four factors for men were significantly associated with increased condom breakage and slippage:

no condom experience in the past year;
condom breakage in the past year;
not living with partner;
12 or fewer years of schooling.
Several other reasons for condom failure have been mentioned in the literature:

opening the package with sharp objects or teeth;
incorrect methods of putting on the condom, such as pulling it on like a sock;
use of oil-based lubricant;
lengthy and vigorous intercourse;
using condoms for non-vaginal intercourse;
not holding rim of condom during withdrawal;
re-use of condoms.
In addition to presenting overall percentages of breakage and slippage, it also may be informative to present their distribution among study participants (i.e., the percentage of users with no breaks, the percentage with one break, etc.). This illustrates that for a majority of condom users, condom breakage and slippage are rare events.

It is equally important to understand that not all breakage/slippage exposes the condom user to the same risks. Researchers have begun to distinguish between clinical and non-clinical breakage. Clinical breakage occurs when condoms break during intercourse or withdrawal and are the only type of break that directly put the couple at risk of pregnancy and/or sexually transmitted diseases (STD). Nonclinical breaks occur when opening the package and putting on the condom and do not expose the couple to pregnancy or STD. In a recent review of ten FHI condom studies, about one-third of the breaks were classified as non-clinical.

Although the condom literature mentions relatively high breakage and slippage rates, it is important to remember that:

these rates may be caused by certain behaviors and certain characteristics of a very small proportion of users;
about one-third of the breaks do not put the users at risk of pregnancy and disease transmission because they occur prior to intercourse.
Condoms are an effective method of preventing pregnancy and sexually transmitted diseases if they are used correctly and consistently during each act of intercourse. The dissemination of condom use instructions must be a high priority in service delivery programs to assure that maximum protection is provided by the use of condoms.

Condom Instructions

A multitude of condom instructions have been developed over the years by various organizations. The following instructions are based on FHI research findings.

Follow these guidelines for proper use:

Carefully open package so condom does not tear.
Do not unroll condom before putting it on.
Put the condom on end of hard penis.
Unroll condom until it covers all of penis.
Always put condom on before entering partner.
After ejaculation (coming), hold rim of condom and pull penis out before penis gets soft.
Slide condom off without spilling liquid (semen or come) inside.
Throw away or bury condom.
Other considerations:

Do not use grease, oils, lotions or petroleum jelly to make condoms slippery, only use a jelly or cream that does not have oil in it.
Use a condom each time you have sex.
Use a condom only once.
Store condoms in a cool, dry place.
Do not use condoms that may be old or damaged; do not use a condom if:

the package is broken
the condom is brittle or dried out
the color is uneven or changed
it is unusually sticky

Breakage and Slippage of Male Condoms: What Do We Know?

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