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ORIGINAL PAPER
Understanding Problems with Condom Fit and Feel:
An Important Opportunity for Improving Clinic-Based
Safer Sex Programs
Richard A. Crosby •Robin R. Milhausen •
Kristen P. Mark •William L. Yarber •
Stephanie A. Sanders •Cynthia A. Graham
ÓSpringer Science+Business Media New York 2013
Abstract The purpose of this study was to investi-
gate gender differences and other demographic corre-
lates of condom fit and feel problems among a diverse
sample of adult condom users and to examine men’s
and women’s perceptions and experiences with con-
dom fit and feel problems. Participants were recruited
from an electronic mailing list. The analytic sample
(N=949) included self-identified heterosexual men
(n=771) and women (n=178) who reported using
condoms for penile–vaginal or penile–anal intercourse
in the past 3 months. Both quantitative and qualitative
methods were applied. Of the sample, 38.3 % reported
experiencing at least one condom fit or feel problem.
Problems with condom fit during sex did not differ
significantly by gender (p=.73). Perceptions of
specific condom use problems were organized into
five themes: (1) decreased sensation, (2) lack of
naturalness, (3) condom size complaints, (4) decreased
pleasure, and (5) pain and discomfort. In this diverse
sample, there was a high prevalence of condom fit and
feel issues among women as well as men. These
issues, mostly focused on loss of pleasure, represent a
substantial public health problem and thus warrant
attention in safer sex programs.
Keywords Condoms Condom use Condom fit
Condom feel
R. A. Crosby R. R. Milhausen W. L. Yarber
S. A. Sanders C. A. Graham
The Kinsey Institute for Research in Sex, Gender, and
Reproduction, Indiana University, Bloomington, IN, USA
R. A. Crosby R. R. Milhausen W. L. Yarber
S. A. Sanders C. A. Graham
Rural Center for AIDS/STD Prevention,
Indiana University, Bloomington, IN, USA
R. A. Crosby (&)
Department of Health Behavior, College of Public Health,
University of Kentucky, 121 Washington Ave.,
Lexington, KY 40506, USA
e-mail: crosby@uky.edu
R. R. Milhausen
Department of Family Relations and Applied Nutrition,
University of Guelph, Guelph, Canada
K. P. Mark W. L. Yarber
Department of Applied Health Science,
Indiana University, Bloomington, IN, USA
W. L. Yarber S. A. Sanders
Department of Gender Studies, Indiana University,
Bloomington, IN, USA
C. A. Graham
Department of Psychology, Brunel University,
Uxbridge, UK
123
J Primary Prevent
DOI 10.1007/s10935-013-0294-3
Introduction
The use of male latex condoms remains highly
important in the prevention of sexually transmitted
infections (STIs), including HIV (Centers for Disease
Control and Prevention, 2010). Recent data suggest
that, in the United States, sexually active people are
using condoms at least sporadically (on average, males
use a condom during 25 % of intercourse events and
females during 22 %; Reece et al., 2010). Although
consistent condom use can be highly protective
against STIs, a rapidly expanding body of evidence
suggests that user errors and problems may greatly
compromise the effectiveness of condom use (Crosby,
Noar, Head, & Webb, 2011; Crosby, Sanders, Yarber,
& Graham, 2003; Sanders et al., 2012). Thus, under-
standing and correcting these user errors and problems
are key aspects of effective safer sex programs
(Crosby, DiClemente, Charnigo, Snow, & Troutman,
2009; Jemmott, Jemmott, & O’Leary, 2007; Kamb
et al., 1998; Shain et al., 2004).
A primary source of condom use errors and
problems may be the lack of acceptable ‘‘fit and feel.’’
In a recent study, for example, one of the most
commonly cited complaints with male condom use
was that ‘‘the condom just didn’t feel right’’ (Crosby,
Milhausen, Yarber, Sanders, & Graham, 2008). Poor
condom fit and feel has been associated with breakage
(Crosby, Yarber, Graham, & Sanders, 2010; Crosby
et al., 2007); slippage (Crosby et al., 2007,2010);
condom-associated erection loss (Crosby et al., 2010;
Graham et al., 2006); incomplete use of condoms
(Yarber et al., 2007); and lack of sexual pleasure
(Crosby et al., 2010). Although the prevalence of fit
and feel complaints has been extensively documented
in the published literature (Crosby et al., 2008,2010;
Reece et al., 2007; Reece, Herbenick, & Dodge, 2009;
Sturges et al., 2009), little is known about the specific
issues surrounding people’s reports of poor fit and feel.
Furthermore, most of the research conducted to date
has been focused solely on men. The relatively limited
research available on women suggests that lack of
sensation may be an important problem associated
with condom use, as well as pain and discomfort (Von
Sadovszky, Ryan-Wenger, Germann, Evans, & Fort-
ney, 2008; Williamson, Buston, & Sweeting, 2009).
For both men and women, then, problems with
condom fit and feel may interfere with sexual pleasure,
increase improper condom use, and/or lead to
discontinuation or avoidance of subsequent condom
use (Crosby et al., 2010; Williamson et al., 2009).
Thus, understanding the specific concerns associated
with condom fit and feel may be an important aspect of
improving both the consistency and correctness of
condom use. Furthermore, identifying subpopulations
of people most likely to experience problems with
condom fit and feel may lead to improved targeting
and tailoring of clinic-based safer sex programs. This
is especially true for women, as they have been
historically neglected in studies of condom use
problems. Accordingly, the purposes of this study
were to compare condom fit and feel problems
between women and men and to identify demographic
correlates of condom fit and feel problems among a
diverse sample of condom users. An in-depth inves-
tigation and comparison of men’s and women’s
perceptions and experiences with condom fit and feel
problems were also conducted.
Methods
Study Sample
Individuals were recruited from an electronic mailing
list for a large, Internet-based sexual enhancement
product company. Individuals were included on the
mailing list if they had previously purchased products
online from the company, or if they had e-mailed the
company with a question about one of their products.
The mailing list comprised 65,859 e-mail addresses.
An e-mail invitation contained an embedded link to
the study website. Each link included a random
number code that could only be activated one time;
this prevented individuals from participating in the
study multiple times or forwarding the e-mail invita-
tion to allow others to participate.
Clicking on the study link directed individuals to
the Study Information page. The page summarized the
study procedures and details about participant rights.
Only individuals who were over the age of 18 and were
able to read English were eligible to participate in the
study. Individuals gave their consent to participate by
clicking on a link. All study procedures were anon-
ymous, and approved by the Human Subjects Com-
mittee at the University of Windsor, Ontario, Canada.
Nearly 2,000 (N=1,987) individuals completed the
survey. The analytic subsample (n=949) included
J Primary Prevent
123
only self-identified heterosexual men and women who
reported using condoms for penile–vaginal or penile–
anal intercourse in the past 3 months.
Measures
In addition to gender, demographic correlates assessed
were: age, education, income, marital status, and
number of lifetime sexual partners. Condom use
assessments were limited to the last time a condom
was used for vaginal or anal intercourse within the past
3 months. Participants were first asked if there was a
problem with the way the condom fit. They were also
asked if they or their partner experienced a problem
with the way the condom ‘‘felt during sex.’’ For those
answering yes to either question, a text box was
provided for them to type in what kind of prob-
lem(s) they or their partner had with the fit or feel of
the condom.
Data Analysis
Age, education, income, and number of lifetime sexual
partners were dichotomized using the median split, as
these variables were not normally distributed. Age was
dichotomized as 35 or younger versus 36 or older.
Education was dichotomized as less than a bachelor’s
degree versus a bachelor’s degree or higher. Income was
dichotomized as less than $50,000 versus $50,000 or
more. Number of lifetime sexual partners was dichoto-
mized as 7 or fewer partners versus 8 or more partners.
Chi square tests were conducted to determine associa-
tions between the assessed demographic correlates and
condom fit and feel problems. All comparisons were
evaluated using the .05 level of significance. Responses
to the two questions regarding condom fit and feel were
coded by two independent raters and grouped into
themes using Braun and Clarke’s (2006)approachto
thematic analysis. Rare disagreements were resolved
through discussion until consensus was reached.
Results
Characteristics of the Sample
The analytic sample consisted of 771 men and 178
women. Participants ranged in age from 18 to 69, with
most participants (60 %) being between the ages of
27 and 44. The mean age of participants was
35.9 years (SD =9.7). Two-thirds of participants
(64.9 %) were married; 21.6 % were seriously dating
or living with a partner. A minority of participants
indicated that they were single (4.2 %), casually
dating one or more people (3.6 %), separated or
divorced (5.6 %), or widowed (.1 %). The majority of
participants identified as White (82.6 %), with a
minority identifying as Hispanic, Black, Asian, or
Biracial/Multiracial. Men and women did not differ in
their geographical location or their rural/urban status.
Most participants lived in the United States (90.7 %),
with a minority reporting that they lived in Canada, the
British Isles, Australia, New Zealand or Hawaii, or
Western Europe. The majority of participants reported
living in a ‘‘large city or the suburban area surrounding
it’’ or a ‘‘medium city or the surrounding area’’
(66.8 %). Most participants had an education level
beyond high school (59.4 %). Participants varied in
terms of how important religiosity or spirituality was
to them, with 20.1 % indicating that it is ‘‘very
important,’’ 30.2 % indicating that it is ‘‘important,’’
31.1 % indicating that it is ‘‘slightly important,’’ and
18.5 % indicating that it is ‘‘not important at all.’’
Religious affiliation varied widely between Protestant
(22.1 %), Catholic (20.4 %), Other Christian
(22.1 %), Agnostic/Atheist/Irreligious (15.5 %), Jew-
ish (2.3 %), and Other (17.5 %).
Demographic Correlates of Condom Fit and Feel
Problems
Almost 1 in 10 participants (9.5 %; n=90) reported
that condom fit was a problem the last time a condom
was used. Problems with condom fit during sex did not
differ significantly by gender (p=.73), age (p=
.87), education (p=.37), income (p=.11), marital
status (p=.46), or number of lifetime sexual partners
(p=.10).
Nearly one in three participants (31.0 %; n=294)
reported that they had a problem with how condoms
felt during sex. Problems with the way the condom felt
during sex were reported significantly more often by
participants who had 8 or more lifetime sexual
partners compared with those who had 7 or fewer
(36.3 vs. 26.7 %, respectively; p\.01), and by
participants who were married compared with those
who were not (27.1 vs. 20.4 %, respectively; p=.02).
However, problems with condom feel did not differ
J Primary Prevent
123
significantly by gender (p=.11), age (p=.12),
education (p=.50), or income (p=.40).
About one in five participants (20.8 %; n=197)
reported that their partner had a problem with how
condoms felt during sex. Women were significantly
more likely than men to report that their partner
experienced discomfort (36.4 vs. 19.7 %, respec-
tively; p\.01). Partner problems with condom feel
were reported more often by those who were 35 or
younger compared with those who were 36 or older
(28.3 vs. 15.5 %, respectively, v
2
=20.18, p\.01).
However, problems with condom feel for the partner
did not differ significantly by education (p=.95),
income (p=.06), marital status (p=.20), or number
of lifetime sexual partners (p=.19).
Perceptions Related to Condom Fit and Feel
Problems
Of the 949 participants, 363 (38.3 %) indicated
experiencing at least one of the three condom fit or
feel problems. Of these, 342 (94.2 %; 273 men and 69
women) used the text box provided in the survey to
elaborate on their fit or feel problems. Five distinct,
overarching themes were identified: (1) decreased
sensation, (2) lack of naturalness, (3) condom size
complaints, (4) decreased pleasure, and (5) pain and
discomfort. Of note, some participants gave more than
one reason for the fit or feel problem; thus, the
percentages that follow do not sum to 100 %.
The predominant theme was decreased sensation,
accounting for 54.1 % of the responses. Most of these
participants explicitly stated that condoms markedly
decreased sensation. Representative statements for
this category included ‘‘serious loss of sensation for
both parties,’’ ‘‘I get almost no sensation when
wearing a condom,’’ ‘‘I felt a dulling of sensation,’’
‘‘condoms deaden sensation for me,’’ ‘‘decrease of all
tactile sensations,’’ and ‘‘lack of stimulation.’’
Lack of naturalness was a concern for 16.1 % of
participants. This theme reflected comments regarding
the loss of a ‘‘natural’’ feeling associated with sex
while using a condom. Specifically, participants made
references to disliking rubber or plastic, and being
‘‘unable to feel’’ their partner. Representative state-
ments for this category included ‘‘don’t like the
rubbery feel,’’ ‘‘did not feel as natural or as arousing as
skin,’’ ‘‘just not as natural as without,’’ ‘‘it felt like I
was being penetrated by a water balloon,’’ ‘‘not
natural—feels like a plastic bag,’’ and ‘‘he compared
it to a sausage casing.’’
Condom size complaints werereported by 15.5 % of
participants. These responses typically involved prob-
lems with condom width, length, and shape. Represen-
tative comments in this category included ‘‘condom too
loose,’’ ‘‘condom too snug,’’ ‘‘the condom felt too tight
on the base of my penis,’’ ‘‘it never seems to fit right,’’
‘‘need more slim condoms so they won’t slip off,’’ and
‘‘it bunched up a bit around the head of the penis.’’
Decreased pleasure was described by 8.8 % of
participants. Most comments in this category referred
to condom use leading to sex not feeling as good,
thereby, reducing sexual pleasure. Typical statements
were ‘‘it’s better without,’’ ‘‘obviously not as good as
without,’’ ‘‘much less pleasure with condom,’’ and ‘‘I
felt less pleasure than usual.’’
Pain and discomfort were reported by 7.3 % of
participants. This theme was predominantly mentioned
by women. Representative responses in this category
included ‘‘soreness from the rubbing of the latex’’; ‘‘I
have a little itch in vagina afterwards’’; ‘‘after sex with a
condom, I feel burning in my vagina’’; ‘‘my wife feels
vaginal tugging when using condoms’’; ‘‘female does
not like the way it rubs/drags inside’’; ‘‘condoms stick
and they make me sore afterwards’’; and ‘‘burning
sensation from the chemicals.’’
Discussion
Overall, almost 40 % of this sample reported experi-
encing at least one condom fit and feel problem during
the last time they used one for penile–vaginal or
penile–anal intercourse. Given the use of such a
narrow period of recall (i.e., the last time sex occurred
within the past 3 months), this high prevalence of
condom fit and feel problems is a potential public
health issue that warrants intervention. The findings of
this study further suggest that any corresponding
intervention efforts may need to target women as well
as men, and that women should be targeted for
intervention relative to condom fit and feel issues
regardless of age, education, income, marital status,
and number of lifetime sexual partners. In addition,
this is the first study that provides data pertaining to
men’s and women’s perceptions about the specific
issues underlying their reasons for reporting poor fit
J Primary Prevent
123
and feel of condoms. Lack of sensation was a feel
issue, for example, that could become the focal point
of intervention efforts, especially structural-level
efforts focused on the design of condoms and the
accessibility of water-based lubricants. These efforts
are clearly well placed in the context of clinics that
diagnose and treat STIs. Rather than simply supplying
men and women with a limited selection of low-bid
condoms, a more progressive approach would be to
offer an extremely large selection of condoms of
varying sizes, shapes, and brands. This large selection
can then be used as a teaching tool by providing
counseling about condom fit and feel while patients
select a maximum number of condoms as dictated by
clinic resources. The same logic applies to single-use
vials of water-based lubricants.
Although it is reasonable to expect that condom fit
and feel issues differ between men and women, the
only significant difference by gender was that women,
more often than men, reported that their partners
experienced problems with the way condoms felt
during sex. Essentially, women in this study reported
that their partners had issues with poor condom feel.
Indeed, when given the opportunity to elaborate on the
problems stemming from poor fit or feel of condoms,
women were more likely to do so than were men.
With the exception of younger age being associated
with increased prevalence of partner-reported condom
fit and feel issues, and the exception of issues with
condom feel being more prevalent among those who
had a relatively greater number of lifetime sexual
partners and those who were married, the findings
suggest that condom fit and feel problems may be
ubiquitous. Thus, although young men’s complaints
about condom use problems are well documented in
the literature (Bell, 2009; Crosby et al., 2007; East,
Jackson, O’Brien, & Peters, 2007; Sanders et al., 2012;
Sturges et al., 2009), our findings suggest that both
men and women of all ages experience these prob-
lems. The null findings regarding demographic differ-
ences are important and facilitative because they
imply the potential use of universal interventions such
as condom manufacturer’s placing more design
emphasis on proper fit and enhanced overall sensa-
tion/feeling.
Of great interest, each of the five themes identified
can be viewed as being amenable to intervention.
Thus, the myriad of safer sex programs that promote
condom use could potentially be expanded to
transcend the often singular goal of using condoms
to a more comprehensive goal of using condoms
without losing pleasure. This sex-positive approach to
prevention is important given the unyielding incidence
rates of STIs worldwide. For example, only a limited
range of condom sizes currently exists (Reece et al.,
2009). Even if a broader selection of condom sizes
were developed and marketed, men may be uncertain
about their own size or unaware of their size options,
thus, purchasing sizes that fit poorly. As another
example, intervention opportunities exist regarding
the use of water-based lubricants to compensate for the
dulling sensation associated with condom use, and
possibly even the pain and discomfort, reported in this
study. Thus, clinic-based counseling interventions
may benefit sexually active people by emphasizing
that adding sufficient lubrication to the inside and
outside of condoms will enhance pleasure. These same
programs may emphasize that experimenting with
different sizes and types of condoms may resolve
condom feel issues and enhance overall sexual plea-
sure for both partners. In addition, intervention
approaches may benefit sexually active people by
facilitating communication between partners about
preferences for types, brands, and sizes of condoms, as
well as lubricants.
One obstacle to having sexually active people
experiment with different types of condoms and
lubricants may be cost and availability. Another
obstacle may be the embarrassment associated with
shopping for condoms (Bell, 2009). For example,
condoms are not typically sold in variety packs that
would enable couples to easily try out a range of
products. Condom manufacturers should consider
developing such variety packs (complete with lubri-
cants) and making them readily available at stores and
on the Internet. Clinics and community-based organi-
zations that distribute condoms could also offer a
broader selection of condoms and lubricants to women
as well as men.
Limitations
The current study is limited by the use of an online
convenience sample. The study is also limited to
heterosexual couples and is, therefore, not generaliz-
able to all condom users. Further research is needed to
determine whether men who have sex with men
experience similar problems with condom use that
J Primary Prevent
123
may affect their sexual health risk. In addition,
differences in condom fit and feel experiences
between individuals who reported vaginal versus anal
intercourse at last sex were not assessed. Furthermore,
participants were recruited from an electronic mailing
list of a sexual enhancement product company. Thus,
this sample may be particularly attuned to sexual
sensation and prioritize sexual pleasure during sex.
This sample may also be particularly comfortable
experimenting with condoms; thus, it is intriguing that
they nonetheless reported so many issues with condom
fit and feel, and that nearly 4 in 10 participants had an
issue with fit and feel during the last time a condom
was used. This research should be extended to other
populations of sexually active people.
Conclusion
In this diverse sample of condom-using adults, we
found a high prevalence of condom fit and feel issues
that may represent a substantial public health problem.
These issues appear to be universal across subpopu-
lations, meaning that women as well as men can
potentially benefit from intervention efforts designed
to rectify issues with condom fit and feel. Specific
perceptions surrounding condom fit and feel issues
were largely based on loss of pleasure. Consequently,
it is possible that sex-positive intervention approaches
that facilitate pleasurable sex for condom-using men
and women may be extremely useful in the prevention
of STIs, HIV, and even unintended pregnancy.
Acknowledgments Support for this project was provided, in
part, by The Social Justice and Sexual Health Research Centre at
the University of Windsor, Ontario, The Kinsey Institute for
Research in Sex, Gender, and Reproduction, Indiana University,
and the Rural Center for AIDS/STD Prevention, a joint project
of Indiana University, the University of Colorado, and the
University of Kentucky.
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