Condom discomfort and associated problems with their use among university students.
ABSTRACT In addition to consistent use, condoms must be used correctly. The purpose of this study was to identify prevalence and types of condom-associated discomfort among university students, the outcomes of this discomfort, and the role of discomfort in condom breakage. We conducted a cross-sectional study of 206 students attending a private university in the southern United States. We assessed 3 potential outcomes: breakage, not using condoms throughout sex, and low condom-use motivation. Nearly one third reported discomfort, including tightly fitting condoms, vaginal irritation, and loss of sensation. Discomfort was associated with breakage (p = .0001), incomplete use (p = .0001), and less motivation to use condoms (p = .018). Gender moderated the latter 2 findings. Adjusted findings indicate that students reporting discomfort were 3.6 times more likely to also report breakage (p = .0009). Continued investigation of this topic is warranted. Prevention education may benefit university students by promoting several key practices, such as adding lubricant to condoms before they dry out and acquiring condoms that fit properly.
- SourceAvailable from: Eric Julian Manalastas[Show abstract] [Hide abstract]
ABSTRACT: How common are problems with condom use during sex? We examined Filipino men's negative experiences with male condoms using data from a sample of 1,010 sexually active Filipino men ages 15 to 54 who participated in the 2003 National Demographic and Health Survey. Results indicated that majority (80%) of Filipino condom users reported no problems with condoms. Among those who did experience problems, the most frequently cited were: pleasure reduction, inconvenience of use, and spoiled mood. Having problems with condom use was associated with men' s increasing age and with subjective beliefs that condoms would diminish pleasure, but not with men's socioeconomic status, educational attainment, knowledge of condoms' disease-protective properties, or sexual-minority status. Subjective beliefs appear to be more important than sheer knowledge about the protection provided by condoms. These beliefs may serve to create negative expectations about condoms and later, to legitimize non-use.Philippine Population Review 01/2013; 12(1):1-16.
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ABSTRACT: Objectives Male condom use in conjunction with other contraceptives increases protection against pregnancy and STIs. However, few analyses contextualize dual method use within the sexual episode, include reports from men, or explore gendered patterns in reporting. Study Design We analyzed dual method use patterns using a nationally representative dataset of 18-44 year-olds in the US (N = 404 men, 416 women). Respondents indicated contraceptive method(s) used at last penile-vaginal intercourse, condom practices, and relationship and sexual information about that particular partner. Results More than one-in-three penile-vaginal intercourse episodes (40%) involved male condom use: 28% condom only and 12% condom plus a highly effective method. Dual method reporting did not differ significantly by gender. Among dual method users, only 59% reported condom use during the entire intercourse episode, while 35% began intercourse without one and 6% removed the condom during intercourse. A greater proportion of men than women reported incorrect use of condoms (49% versus 35%), though this difference was not statistically significant. Only 50% of dual method users reported condom use in all of their last 10 intercourse episodes. Conclusions Many people classified as “dual users” in previous studies may not be using dual methods consistently or correctly. Researchers and practitioners should inquire how and how often condoms are used when assessing and addressing dual method use. Furthermore, though men have rarely been surveyed about dual method use, they can provide consistent contraceptive estimates, and may be more likely to report condom practices such as late application or early removal.Contraception 10/2014; · 3.09 Impact Factor
- Sexual Health 02/2014; · 1.58 Impact Factor
Condom Discomfort and Associated
Problems With Their Use Among University
Richard Crosby, PhD; William L.Yarber, HSD; Stephanie A. Sanders, PhD;
Cynthia A. Graham, PhD
Abstract. In addition to consistent use, condoms must be used
correctly. The purpose of this study was to identify prevalence and
types of condom-associated discomfort among university students,
the outcomes of this discomfort, and the role of discomfort in con-
dom breakage. We conducted a cross-sectional study of 206 stu-
dents attending a private university in the southern United States.
We assessed 3 potential outcomes: breakage, not using condoms
throughout sex, and low condom-use motivation. Nearly one third
reported discomfort, including tightly fitting condoms, vaginal
irritation, and loss of sensation. Discomfort was associated with
breakage (p = .0001), incomplete use (p = .0001), and less moti-
vation to use condoms (p = .018). Gender moderated the latter 2
findings. Adjusted findings indicate that students reporting dis-
comfort were 3.6 times more likely to also report breakage (p =
.0009). Continued investigation of this topic is warranted. Preven-
tion education may benefit university students by promoting sev-
eral key practices, such as adding lubricant to condoms before they
dry out and acquiring condoms that fit properly.
Key Words: breakage, condoms, pregnancy, sexually transmitted
ealthy Campus 2010 delineates several objectives
pertaining to decreased incidence rates of sexually
transmitted diseases (STDs) among college students
in the United States.1In addition, a recent report summarized
the epidemic of STDs among America’s young people (ie,
persons aged under 25 years). The report clearly documented
the broad-reaching scope of the epidemic and its economic,
social, and personal consequences for young people.2Thus,
without question, preventive behaviors that contribute to
reduction of STD incidence among defined populations of
young people (eg, college students) are important. Of these
behaviors, the consistent and correct use of condoms is a
potentially efficacious strategy to avert many of the STDs
commonly diagnosed in the United States.3
Although many researchers have investigated the consis-
tency of using the male condom among heterosexuals,4far
fewer have assessed condom-use errors and problems. Of
these, several studies have focused primarily on condom
breakage and slippage.5–7A few studies have addressed a
broader array of issues, including incorrect application of
condoms, incomplete use of condoms, and erection prob-
lems associated with condom use.8–12One potentially
important aspect of individuals’experiences with condoms,
however, has not been sufficiently addressed by previous
research: discomfort associated with condom use.
Discomfort may be an important consideration when
couples decide to use or not use condoms.13Discomfort
may also be clinically important in that it could signal fit-
ting problems that may contribute to breakage.14Another
study found alternatively that ill-fitting condoms may con-
tribute to less frequent use of condoms (although the same
study did not find an association between ill-fitting con-
doms and condom failure).7
We report here the findings from an exploratory study of
young, condom-using university students who provided
responses to an open-ended question regarding recent dis-
comfort experienced when using condoms during sex.
Because the data were collected in the context of a quantita-
tive study, we were also able to determine whether discomfort
problems were associated with increased reporting of con-
dom breakage. Finally, we identified associations between
reported discomfort and personal motivation to use condoms
and between discomfort and incomplete use of condoms.
Richard Crosby is an associate professor in the College of
Public Health at the University of Kentucky in Lexington, KY.
William L. Yarber is a professor in the Department of Applied
Health Science at Indiana University in Bloomington, IN.
Stephanie A. Sanders is an associate professor at The Kinsey
Institute for Research in Sex, Gender, and Reproduction in
Bloomington, IN. Cynthia A. Graham is a clinical psychologist at
Werneford Hospital at Oxford University in England.
JOURNAL OF AMERICAN COLLEGE HEALTH, VOL. 54, NO. 3
From February through May 2003, a research assistant
enrolled university students (aged 18 to 25 years) in an
anonymous, cross-sectional survey of condom-use errors
and problems. She recruited students consecutively, on arbi-
trary days, from the student health center (79%) and resi-
dence halls (21%), and she asked the students individually to
participate in the study. Eligibility criteria were: (1) being
aged 18 years or older and (2) having used a condom at least
once in the past 3 months. A screening of 444 students yield-
ed 233 who were eligible to participate. Of these, 206 (88%)
provided written informed consent and returned a complet-
ed questionnaire to the research assistant. The research assis-
tant handed the questionnaire directly to participants and
instructed them that they could ask clarifying questions (eg,
if they needed help with any of the reading) as needed. The
Institutional Review Board approved the study protocol. We
did not provide incentives for participation.
Students completed a questionnaire that assessed social
demographic variables, recent sexual behavior (eg, frequen-
cy of condom use), and a broad range of potential condom
use errors and problems. The questionnaire was a slightly
modified version of an instrument used in similar studies of
condom use errors and problems among university stu-
dents.10–12We used a 3-month recall period. We assessed
discomfort using the following survey question: “In the past
3 months did you or your partner have problems with the
way a condom fit or felt (for example, the condom was too
large or too small, it was the wrong shape, it caused irrita-
tion of your skin or genitals or your partner’s genitals, it
caused loss of erotic sensation for you or your partner)?”
We presented students with questions that assessed
whether condoms had broken during sex, slipped off during
sex, or slipped off during withdrawal. We also assessed
incomplete use of condoms. Incomplete use was defined as
students answering “yes” to at least 1 of 2 questions: (1)
“Did you start having sex without the condom, then put the
condom on later?” and (2) “Did you start having sex with
the condom on, then take it off before sex was over?” Sex
was clearly defined as placing the penis in the partner’s
mouth, vagina, or rectum (anus, butt). We assessed person-
al motivation to use condoms using the following survey
item: “I am highly motivated to use condoms.” Students
responded to the statement using a 5-point Likert-type
scale, ranging from strongly agree to strongly disagree.
Because the resulting distribution for this measure was
markedly skewed, we performed a median split, resulting in
a comparison of those indicating strongly agree (56.6%) to
the remaining sample. Two survey items assessed lubrica-
tion practices. One asked whether unlubricated condoms
had been used and the other asked whether Vaseline or other
oil-based substances (eg, mineral oil, baby oil, cooking oil)
had been used to lubricate condoms.
We organized open-ended responses to the question
assessing discomfort into categories based on a review of
the comments. We listed verbatim comments that were
clearly legible and pertained to condom discomfort. Next,
we grouped comments by their shared meanings (eg, we
grouped together all comments suggesting that the condom
fit too tightly) and we took a frequency count for each of the
We determined associations between condom discom-
fort and the 3 hypothesized outcomes (breakage, incom-
plete use, less motivation) by chi-square tests. We used
significant bivariate associations, followed by layered chi-
square tests, to determine whether gender moderated the
observed association. Finally, because we also assessed
students’ condom lubrication practices, we constructed a
multiple logistic regression model to determine the inde-
pendent contribution of discomfort to condom breakage
within the context of demographic variables and lubrica-
tion variables achieving bivariate significance with con-
dom breakage. For all analyses, we defined significance
as having an alpha value of .05.
Characteristics of the Sample
The average age of the students was 20.3 years (SD =
2.1). Just over half (55.3%) of the students were female.
The majority identified as White (80.4%), 5.9% identified
as African American, 5.4% as Asian, and the remainder
identified as members of other races. Fifteen percent were
graduate students, and the remainder were undergradu-
ates. Seven students indicated they were bisexual, 3 men
identified as gay, and 2 were uncertain of their sexual ori-
One hundred and ninety-four students responded to the
question that assessed discomfort with condom use. Of
these, 31.4% indicated having a recent problem with the
way a condom fit or felt. Men (29.2%) and women (33.3%)
were equally likely to report discomfort (p = .54). White
students (28.6%) and racial minority members (39.5%)
were equally likely to report discomfort (p = .19). The mean
age of those reporting discomfort (20.5 years) did not differ
from the mean age of those who indicated they had not had
discomfort problems: 20.3 years, t(192) = .84, p = .40.
We organized into categories the 33 comments from
men who provided written comments regarding their dis-
comfort. Among these men, the most common form of
discomfort described was that the condom was too tight
(36%). The next most frequent comment was that con-
doms caused a loss of sensation (30%). As one male
noted, “loss of sensation—sex becomes boring.” Other
comments (provided by 3 or fewer men) included erection
problems, allergies to latex, condoms are too big, and con-
doms cause dryness.
144JOURNAL OF AMERICAN COLLEGE HEALTH
CROSBY ET AL
We organized into categories the 44 comments from
women who provided written comments regarding their dis-
comfort. Among these women, the most common form of
discomfort described was that the vagina became irritated
(43%). The next most frequent comment was that male part-
ners complained the condom was too tight (27%). Twenty
percent of the comments indicated that the man lost his sex-
ual pleasure as a result of condom use. Other comments
(made by 1 woman each) were that the condom was too big
for the male partner and that condoms made sex uncom-
fortable for both partners.
Table 1 displays a summary of the bivariate correlations
between experiencing discomfort using condoms and the
hypothesized outcomes. Discomfort was significantly asso-
ciated with condom breakage, incomplete condom use, and
less motivation to use condoms. Among those reporting dis-
comfort, 4 of every 10 reported that a condom had broken
on at least 1 occasion in the past 3 months. Conversely, only
one sixth of those who did not indicate discomfort reported
breakage. Gender did not moderate this association. Among
those reporting discomfort, 6 of every 10 of those surveyed
reported incomplete use of condoms in the past 3 months as
compared with one third who did not indicate discomfort.
This association was significant only for women. Among
those reporting discomfort, less than one half indicated that
they were highly motivated to use condoms. In comparison,
nearly two thirds of those who did not experience discom-
fort indicated they were highly motivated to use condoms.
This association, however, was moderated by gender; the
association was significant only for men.
Of the 197 students responding to the discomfort item on
the questionnaire, 22.8% reported condom breakage on at
least 1 occasion in the past 3 months. Gender (p = .24) and
minority status (p = .20) were not associated with condom
breakage. Those reporting breakage were significantly
younger (M = 19.8 years of age) than those not reporting
breakage (M = 20.5 years of age) (p = .016). Whether stu-
dents had used condoms without a lubricant (reported by
18.4%) was not associated with breakage (p = .13). Howev-
er, use of an oil-based lubricant (reported by 7.8%) was
associated with breakage (p = .0001) in the expected direc-
tion, given that oil-based lubricants lead to the deterioration
of latex. Thus, we constructed a logistic regression model
using direct entry of 3 variables: students’ age, use of oil-
based lubricants, and discomfort.
The model correctly classified 79.1% of the cases, was
significant, χ2(3, N = 29.4), p < .0001, and achieved sat-
isfactory fit with the data, goodness of fit χ2(7, N = 6.64),
p = .47. Table 2 displays the significant multivariate asso-
ciations between condom breakage and correlates achiev-
ing bivariate significance. Compared to their counterparts
who did not indicate discomfort, students reporting dis-
comfort were about 3.6 times more likely also to report
breakage. Students reporting the use of an oil-based lubri-
cant were about 6.1 times more likely to report breakage.
Finally, for each advancing year of age, students were
0.25 times less likely to report breakage.
Findings from this exploratory study of university stu-
dents suggest that men and women may experience prob-
lems with the fit and feel of condoms. The observation
that discomfort occurred at least once, in a brief recall
period (ie, 3 months), for nearly one third of the students
suggests that the problem may be common. Specifically,
condoms may often be perceived as fitting too tightly,
indicating that students may not know where to acquire
larger sized condoms (or even that larger sizes are avail-
able). Responses also suggest that condoms may com-
monly be perceived as the cause of vaginal irritation.
Indeed, this irritation may occur if condoms are not ade-
quately lubricated or if they lose substantial amounts of
lubrication during sex. It is plausible that tightly fitting
condoms and vaginal dryness may foster breakage
(because of increased stress on the condom); the observed
association between discomfort (ie, fit and feel) and
breakage supports this proposition. This possibility clear-
ly deserves more extensive investigation, preferably in the
context of a study that collects event-specific data (ie,
events specific to the episode of intercourse when the con-
dom broke are identified).
The loss of pleasurable sensation resulting from
condom use was also a common concern. The extent to
which this loss of sensation is attributable to tightly fitting
VOL 54, NOVEMBER/DECEMBER 2005 145
TABLE 1. Bivariate Associations Between
Condom Discomfort and Hypothesized Outcomes
TABLE 2. Significant Multivariate Associations
Between Assessed Correlates and Condom
Use of an oil-based
Note. AOR = adjusted odds ratio; CI = confidence interval.
condoms or vaginal irritation/dryness should be deter-
mined (as both problems can be rectified by teaching con-
dom users to purchase condoms that fit and to add water-
based lubricant to condoms as they dry out during sex).
Some loss of sensation, alternatively, may be inevitable
given that skin-to-skin contact is lost when condoms are
used. Future investigations might benefit from determin-
ing how this loss of sensation may factor into students’
decisions about using condoms. Our findings also suggest
the possibility that condom discomfort may be associated
with incomplete use of condoms (at least as reported by
young women). It is conceivable that discomfort with the
fit and feel of condoms may affect decisions that couples
make about whether to start sex without using condoms or
to remove condoms before sex is over.
Our findings also suggest that male students experienc-
ing condom discomfort may subsequently become less
motivated to use condoms than their counterparts who
have not recently experienced discomfort. Given the rela-
tively wide range of discomforts reported by men,
researchers should further attempt to identify specific
problems with condom use (eg, too tight, loss of sensation)
that may result in less motivation to use condoms. Recti-
fying these problems through education or clinic-based
counseling programs may be an important part of campus-
wide efforts aimed toward reducing incidence of pregnan-
cy and STDs among students. Moreover, if condoms are
provided to students at a campus health center, then mak-
ing a variety of sizes available (and small packages of
additional lubrication) may be a beneficial practice.
To the best of our knowledge, this is the first study to
report that discomfort is associated with condom breakage
after accounting for competing variables, such as age and
the use of oil-based lubrication. Because discomfort was
also associated with incomplete use and less motivation to
use condoms, education and counseling programs may sub-
stantially reduce typical condom-user failure rates (for both
pregnancy and STDs) by helping young men and women to
rectify any problems they may experience relative to the fit
and feel of condoms.
Findings are limited by several factors, including the
inherent limitations of a cross-sectional study design. This
is particularly problematic because temporality between
events cannot be established. The exception to this is the
measure of motivation (an outcome representing students’
evaluation after the events occurring in the past 3 months).
Prospective studies are clearly needed to establish cause
and effect. The small sample size also precluded quantita-
tive analysis of the separate coded categories of condom
discomforts. In a larger study, categories (eg, fit too tight,
loss of sensation) should be treated as separate variables in
analyses designed to identify antecedents of breakage,
incomplete use, and less motivation. Another important lim-
itation is reliance on the validity of students’ self-reports
and the retrospective nature of the assessments.
Finally, the use of a convenience sample limits generaliz-
ability of the study. Although the minority versus nonminori-
ty composition of the sample approximated that of the uni-
versity (approximately 25% of students at the university are
members of ethnic or racial minorities), the use of a nonprob-
ability sampling method clearly implies that sampling bias
may have occurred. This is reflected, for example, by the fact
that about 6% of the sample identified as African American,
compared to 12% shown by university census.
Findings from this exploratory study suggest the possi-
bility that a substantial proportion of young men and
women may experience discomfort during sex when con-
doms are used. Observed associations suggest that discom-
fort could be a potential antecedent of condom breakage,
incomplete use, and less motivation to use condoms. Given
further investigation establishing the causal nature of these
associations, prevention education may benefit young men
and women by promoting key practices, such as adding
lubricant to condoms before they dry out and cause vaginal
irritation and acquiring condoms that fit properly.
The authors gratefully acknowledge Ms. Tammi Gibson, MPH,
for her work collecting the data.
For comments and further information, please address correspon-
dence to Richard Crosby, PhD, School of Public Health, University
of Kentucky, 121 Washington Ave., Room 111C, Lexington, KY
40506-0003 (e-mail: email@example.com).
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