Problems With Use

May or may not be due to the method.

• Problems with condoms affect clients’ satisfaction and use of the method. They deserve the provider’s attention. If the client reports any problems, listen to the client’s concerns and give advice and support. Make sure he understands the advice and agrees.
• Offer to help the client choose another method—now, if he or she wishes, or if problems cannot be overcome—unless condoms are needed for protection from STIs, including HIV.

Condom breaks, slips off the penis, or is not used

• ECPs can help prevent pregnancy in such cases (see Chapter 3 – Emergency Contraceptive Pills). If a man notices a break or slip, he should tell his partner so that she can use ECPs if she wants.
• Little can be done to reduce the risk of STIs if a condom breaks, slips, or is not used (see Question 7). If the client has signs or symptoms of STIs after having unprotected sex, assess or refer.
• If a client reports breaks or slips:
  
  • Ask clients to show how they are opening the condom package and
    putting the condom on, using a model or other item. Correct any errors.
  • Ask if any lubricants are being used. The wrong lubricant or too little
    lubricant can increase breakage (see Lubricants for Latex Condoms). Too much lubricant can cause the condom to slip off.
  • Ask when the man withdraws his penis. Waiting too long to withdraw, when the erection begins to subside, can increase the chance of slips.

Difficulty putting on the condom

• Ask clients to show how they put the condom on, using a model or other item. Correct any errors.

Difficulty persuading partner to use condoms or not able to use a condom every time

• Discuss ways to talk about condoms with partner (see Bringing Up Condom Use) and also dual protection rationales (see Choosing a Dual Protection Strategy, in Chapter 22 – STIs, Including HIV).
• Consider combining condoms with:
  
  • Another effective contraceptive method for better pregnancy protection.
  • If no risk of STIs, a fertility awareness method, and using condoms only during the fertile time (see Chapter 18 – Fertility Awareness Methods).
• Especially if the client or partner is at risk for STIs, encourage continued condom use while working out problems. If neither partner has an infection, a mutually faithful sexual relationship provides STI protection without requiring condom use but does not protect against pregnancy.

Mild irritation in or around the vagina or penis or mild allergic reaction to condom (itching, redness, rash, and/or swelling of genitals, groin, or thighs during or after condom use)

• Suggest trying another brand of condoms. A person may be more sensitive to one brand of condoms than to others.
• Suggest putting lubricant or water on the condom to reduce rubbing that may cause irritation.
• If symptoms persist, assess or refer for possible vaginal infection or STI as appropriate.
  
  • If there is no infection and irritation continues or recurs, the client may have an allergy to latex.
  • If not at risk of STIs, including HIV, help the client choose another method.
  • If the client or partner is at risk for STIs, suggest using female condoms or plastic male condoms, if available. If not available, urge continued use of latex condoms. Tell the client to stop using latex condoms if symptoms become severe (see "Severe allergic reaction to condom").
  • If neither partner has an infection, a mutually faithful sexual relationship provides STI protection without requiring condom use but does not protect against pregnancy.