A lot of people think they are, and this causes problems. Too small, and condoms break. Too large, and they slip off. Either way feels far less comfortable than with a properly fitting condom. This ultimately leads to less usage.
Condom boxes have something called "nominal width" on the side. To fit properly, you or your partner need to take a precise measure of the penis circumference, then match that to the appropriate width:
Note that you have to double check the comdoms. For instance, magnums list 58mm, but actually are 54mm at the base, which is the most important place.
Fitted properly, latex condoms will feel significantly better and work better.
Wow. So they were forced to take these off the market because they didn't conform to a completely irrelevant FDA standard....
The article touches the issue of sensitivity and the need to develop a condom that makes sex more enjoyable. So does the comic at the link above, if in a slightly different way.
In case of markets and products, one can rely on cynicism and economics. In case of sex, we should be able to rely on hedonism.
(Are there any other SL fans?)
And yes, SexyLosers is the funniest "adult" comic I've ever read.
They feel so close to nothing that someone unwilling to wear one with an unknown partner is shocking to me, yet even in Japan, condom use is extremely low.
On a side note, I'm surprised that so many people take their life in their hands to slightly improve the sensory feel of sex, and yet circumcision, which removes a huge percentage of the nerve endings in the area, remains popular in the US.
If you ask me, we can get more people to use condoms if we develop a condom that feels even better than not wearing one. If we can combine a sex toy and contraceptive together that works during sex basically, it might be hard to get people to NOT use condoms. Some people swear that fleshlights feel better than actual sex in itself, so who knows if we could develop advanced haptics for condoms or something down the road?
-People don't use condoms mostly because they are uncomfortable
-Current condoms are highly suboptimal for anal sex in particular
-Materials other than latex are generally difficult to get to pass FDA tests, and it looks like there is some disagreeing science about why. All condoms seem to be good at blocking pregnancy, some, like polyurethane and lambskin condoms, have disagreeing science about how well they stop the transmission of STDs (including HIV).
-New condoms sometimes get blocked because of somewhat antiquated tests (specifically sizing tests)
Overall there was not a lot of information here. It follows someone named Resnic, loosely, who claims to be making a new revolutionary condom, but who ultimately decides to change his condom back to latex because it's so much easier to manufacture in the US. It's not clear what his key innovations are that will make his condom more useful/comfortable to more people.
Overall the point that a better condom would get more people to use it makes sense, but the article doesn't make the case that one is on the way, or explain what one even would be. Yes, a better material might transmit heat better, but there are obvious downsides, especially with regards to Africa, where STD transmission is the primary concern, not pregnancy.
If there is one conclusion I take from this article it's that if you are in a committed relationship where you are not worried about STD transmission and are primarily concerned about pregnancy prevention, and do not like latex condoms, give lamb skin or polyurethane condoms a shot. Otherwise you're probably best sticking to latex.
So often, it seems that's what is meant by "long-form article."
This misses the point by a mile. Particularly for someone complaining about the article having too much unnecessary information, it's bizarre that you missed the ~3 paragraphs following this that describe _why_ it's a problem that they haven't changed: low rates of satisfaction and usage for something that has considerable public health implications (particularly in the developing world).
> Medical gloves (whose technology derives from condom manufacturing) haven't changed much for decades either.
....and if more than 50% of doctors weren't using medical gloves (regulation aside) due to evidently significant issues with comfort and convenience, this would be a cause for complaint too.
> The basic problem is that condoms work well enough for most people and so there isn't that much economic incentive to launch different kinds
This is a particularly ignorant claim, even if you hadn't read the article. Low rates of condom use in situations where they're extremely important is something that any informed person is aware of (again, this is most dramatically true for things like AIDS crises in developing countries like many in Sub-Saharan Africa). As the article establishes, usage isn't great even in the developing world:
"5 percent of men and 63 percent of women who’d most recently had sex with a “new acquaintance” hadn’t used a condom. More alarmingly, 75 percent of women who weren’t using a back-up birth control method reported not using a condom the last time they’d had sex. Adults who’d had anal sex in the past year—the highest-risk sexual act with regard to HIV transmission—said they’d used condoms only 20 percent of the time."
It should go without saying that economic incentives aren't a panacea for reaching global optima: Sometimes you end up in local optima, as in this case where the risk of doing research to potentially tap into the vast market of non-condom users may not be worth it. That's not to mention the systematic under-emphasis that economic incentives have on externalities, as in this case where the public health effects of more universal condom usage wouldn't all be captured by condom manufacturers.
I'm not saying they're perfect, by any means. But when you get down to it, they're not hard to use and have a high success rate when used properly. Governments and aid agencies already substantially subsidize the distribution of condoms, which subsidies should easily be enough to offset the non-capture of positive externalities by manufacturers (as if the positive externality of repeat demand due to people living longer healthier lives were not sufficient incentive).
The biggest failure in managing the spread of AIDS in Africa has not been the ongoing deficiency of condoms but the apparently completely wasted expenditure of $1.3 billion in aid monies spent on promoting sexual abstinence instead of harm reduction over the last 15 years: http://www.nytimes.com/2015/02/27/health/american-hiv-battle...
We spent over a dollar on every person in Africa to tell them we don't think they should be having sex, in defiance of all the evidence about the inefficacy of such programs, so as to satisfy a small political faction of religious extremists who also support things like instituting the death penalty for homosexuality (https://www.academia.edu/1053858/Locating_Neocolonialism_Tra... ); meanwhile suspending other kinds of educational programs. And then we look at the low rates for condom use and we conclude that the deficiency is with the condoms? Please.
Could we and should we be working to improve condoms? Of course. Are such improvements subject to the law of diminishing returns? Also, of course. You're just not going to get paradigm shifting results through busywork, any more than you're going to get order-of-magnitude improvements in wheel design. A condom is always going to be basically an elastic tube that's closed on one end, just as a wheel is always going to be a circular structure that rotates around a central axle.
I feel for the guy in the article who got unlucky and contracted HIV, but when he's talking about people iterating on things like salt, pepper, and olive oil every year - no they're not. They market it slightly differently, the basic product has seen very little change in thousands of years - much like condoms. Unless we discover drugs that are cheap and have a broad-spectrum prophylactic effect against STDs and pregnancy, we have to be realistic about the prospect of small incremental improvements rather than great leaps forward in this area.
"if it is possible to cut a word out, cut it out."
- Government regulations have stifled innovation, thereby making existing products less safe, less comfortable, and less used than they would be otherwise.
In other words, nothing new.
I'm not sure that the article provides much support for the broad claim, implied by your comment, that government regulation is always a bad idea, or that the government should get out of the condom regulation business. I for one think it's a pretty good idea for a regulator to ensure that condoms (like other health-related products) perform up to some minimum standard. The social impact of sub-standard products is too significant to leave to the market and there is good reason to think that the market would not adequately communicate the signals that consumers need in order to make rational condom-purchasing decisions in the absence of regulation.
I agree with your narrower claim that the existing condom regulations seem to be badly in need of reform. But I'm not at all convinced that they are worse than having no regulations at all.
The article implied this in tone, but in facts reported within did not make a slam dunk case. Latex is probably significantly safer in terms of blocking STD transmission, and it's also heavily understudied whether or not the sizing differences matter. I wouldn't say it's obvious government regulation is really the devil here.
Government is lazy and callus about updating regulations regarding to development and testing of prophylactics. Innovative and better alternatives were taken off the market due to said regulations.
The commentary was spot on. The point of the original comment was to provide bullets without lengthy justification and citation and it was upvoted.
Then this "lazy" bullet was added and all the sudden the author needs to back up his assertion with detailed arguments? The pro-government bias here is insane.
As I said, don't be critical of government on HN unless you don't care about the group think popularity karma contest going on here.
For anyone interested in living in a country where there is little to no government intervention are more than welcome to move to Central Africa to see what they're missing out on.
Seriously, don't you all get tired of burning the same straw man over and over again? I'm sure you don't support every possible kind of government, including Pinochet's Chile and the Khmer Rouge. It must also be democratic, somewhat respect human rights and such, no? Likewise, people who argue against them also have conditions they believe would be necessary for a stable country. You may think they are wrong, and point out why, but just saying "look at <country in shitty conditions>" is not a good argument.
It's ridiculous to me how people talk like they're so far apart on their views of what a government should be, but when we really get to the nuts and bolts we're all pretty much after the same thing.
My post had nothing to do with agreeing or not with you. I expressed no opinion on the issue. I was just trying to explain why I think the "why don't you move to Somalia?" is a bad argument.
Without the FDA and its outmoded regulations, there would be a flourishing of condoms for people to choose from, instead of just the three entrenched companies that can afford to deal with the gov't. If nothing else, the article details the fact that there are a LOT of people who care deeply about and are trying to solve this problem (and should be left largely unconstrained to do so).
What I do see is HN not taking lightly claims that someone just makes out of hand without evidence as if they are obviously the truth, no further proof needed.
I dont think anyone would make the claim that any government is beyond reproach. If you have been paying attention to the recent snowden or schwartz or any of the recent police action related articles posted on here, you would see criticism of the government hitting very high levels of (well deserved) vitriol.
Really? Last time I checked, most HN users subscribed to the notion that the government is slow and inefficient and does not do as good of a job as private companies in most fields.
Libertarian viewpoints tend to be heavily downvoted though, and for good reason. There are some people whose love for private enterprise and the "invisible hand of the market" blinds them to reality.
> The United Nations Development Programme stated that "the 21-year regime of Siyad Barre had one of the worst human rights records in Africa."
edit: it's one, single country that has had a very violent history, not a case study in deregulation of markets.
Think back to news you've read about the deployment of improved mosquito netting and the like, which is tried out in Africa because that's where the greatest need exists.
Don't want to get into a bunch of inappropriate talk but suffice to say much better for both parties.
I'd encourage you to talk. The more people know about it, the more they will use effective contraception and the fewer HIV (and other STD) infections there will be. And people who read it from you will tell others. We're all adults here; I don't think it's inappropriate.
Women don't seem to mind using it either (and it is actually marketed or was marketed at one point as women taking control).
All in all to me no comparison to a traditional condom for men. Edit: And after using it it's hard for me to understand why it's not more widely known. 
The only drawback is the cost, about $2 each at retail.  In theory it can be re-used as well since it's not stretchy but simply a large sheath like protection.
 Planned parenthood gives them and and sells them. If you are nice to them they will give you a bunch at no cost for a small donation. (Call it $5).
 My guess is that it lacks the marketing budget to take off. The local pharmacy used to carry them but then stopped for lack of demand which mystifies me given my personal experience. Not a new product by the way has been around for quite some time but as I said primarily distributed by PP and to women, not men.
And even if we aren't, kids have sex too!
Almost certainly not true.
"the female condom experience was definitely a letdown."
My startup is helping to tackle this problem by trying to inform people that menstrual cycle data, on its own, can help prevent pregnancy with the same efficacy as hormonal contraception (and this isn't the rhythm method, despite the common misconception). While it doesn't prevent the spread of STIs like condoms, tech that replaces "modern" methods for women could change the industry.
We actually just released a marketing campaign for that exact purpose:
I'm really looking forward to the much-needed innovation in this industry.
I think you should be very careful with making unqualified statements like that. If it isn't the rhythm method then you should explain exactly what it is because the 'common misconception' requiring you to distance yourself from the rhythm method before someone even brings it up is alive and kicking and it is up to you to provide the evidence that it isn't so by explaining how it does work.
Your marketing video certainly does nothing to clarify, and the app description on your website screams 'rhythm method in an app' from every page.
If you read our "App" page, you would have seen 'sympto-thermal method of fertility awareness' mentioned at least once. Check out "Learn" for a literal book's worth of information (complete with references) about how this works. We've taken an approach of trying to ease people into this, but maybe that hasn't come across in this instance.
How would you suggest we introduce the topic without scaring people off with such scientifically dense-sounding terms as "sympto-thermal method"? Is anything we can say going to be believable to our target customer off the bat?
You're going to run smack into the wall of terminology here.
The 'rhythm method' or 'calender method' was a Rome sanctioned family planning method whose only ingredient was a calendar. The fact that it had a spectacular failure rate as an anti-conceptive method must not have been lost on the promotors.
But since a calendar is part of pretty much any fertility/anti-conception scheme you'd do well to highlight the differences rather than the similarities with the rhythm method.
Using clever marketing words isn't going to work here, just stick to the cold hard facts and assume that the women and men you're trying to address here don't need to be talked down to but are perfectly capable of understanding what you're trying to say if you are un-ambiguous and direct about it.
You're talking about people that are having intercourse, the least you could do is treat them as the adults they think they are.
Historically plenty of couples that used the rhythm method added a thermometer or other symptoms to increase reliability complicating your quest for proper terminology even further.
> You're talking about people that are having intercourse, the least you could do is treat them as the adults they think they are.
That's pretty much exactly the point here though, no? I think we all agree it's reckless/irresponsible to make any decision without being adequately informed. All these apps can do is tell you "hey, we need more data from you if you want us to be accurate". Scientific terms don't need to be bandied about, but they can be tucked into KB/FAQ pages if people really want to delve. It simply becomes a UX issue at that point - driving people into regularly entering necessary information for accurate insights.
Our product tries to be very matter-of-fact, and treat our users with dignity and respect. Viva adulthood!
My intention definitely wasn't to imply that you're not an adult, so apologies if what I said offended you. My statement was simply based on hundreds of conversations I've had with individuals who immediately jump to asking "Isn't that the rhythm method?" when I explain our concept using direct, accurate, and scientific terminology.
We are, however, incredibly direct with our users.
Point taken, though.
Seems to be readily available under medicaid. But you have to keep you income under $15K or ($10K in non-Obamacare states) to qualify.
Kidney failure in a small set of patients. Typically urine/blood samples are taken for the first few months to check for this. There's some evidence of bone degradation in long term use (think 10+ years) but its mitigated with regular strength exercises. Beyond that not much else the formula has been altered a few times to make it pretty safe to take regularly.
Some people experience gastrointestinal distress from it but that usually passes after a month. If it doesn't they usually just stop taking it.
All of the side effects stop if you stop taking it.
You buy one, they give one away model.
They also use less toxic ingredients in general.
And let's not forget the machines in a huge number of gas station rest rooms across the country. Most of them are $0.75.
If a person cannot find free or ultra-cheap condoms today, the person really is not trying and probably should be doing other things.
Also, as many of the folks at work discovered, the free contraceptives were accompanied with a larger than cost increase in premiums.
We can go around hand-waving and saying how irresponsible people are, or we can recognize how people are, were and will be and make sure they don't accidentally reproduce for no good reason.
We know how, we just need to stop expecting people to be other than they already are for a minute and start a world-wide free-condoms campaign. Where's Bill Gates, make it happen! :)
Because you know who's supporting that single mother and all the difficulty that ensues? You and I, with our tax dollars and otherwise.
That is the problem that condom availability will not fix. The only system solutions are pushing girls into sports and other extra curricular activities, and getting more male teachers in elementary schools to provide proper role models. I'm well away from my desk so I don't have the study references, but both help in this regard.
People who are at risk for having unprotected sex probably need the condoms to be easily available (i.e free in high-schools, free in bars/nightclubs, etc.). If they have enough forethought in order to make a trip to one of the places where they are free, they probably have enough forethought to buy them themselves without problems.
However, my experience living in Chile is that in countries that often need it more, they are much more expensive to get. In Chile, they were roughly twice as expensive as in my home country Belgium. Add in the big difference in wages and we're at approx. 4x difference. The argument that they are available for free is a joke, since it requires people to go to a doctor instead of simply a pharmacy.
I also believe that for many people, the difference between cheap and free is a big one.
Besides, I don't want to use condoms that came from a bowl at a public place. I remember the first time I bought a bunch of condoms at a young age, not only was it terribly embarrassing and expensive at that time (I wasn't working, try explaining to your parents you need money for sex), it wasn't fun hiding them from my parents either.
I imagine this is a bigger problem for women - imagine a mother finds a dozen condoms in her 15 year old's purse.
Because I do agree that not many people are going to make a trip to Planned Parenthood, park, and go in just to get some free condoms.
I don't see a problem with condoms from a public bowl. I used them throughout my freshman year without a problem. As for your embarrassment factor, that's a problem regardless of free or paid. That's just the stigma around sexual activity in general.
Polyurethane is definitely superior in many regards, but they are less stretchy than latex and if you're not used to them they can be a little frustrating.
Though it wouldn't help on the disease transmission front.
That's basically worthless because after 13 uses there is a 50/50 chance of infecting someone.
They are more effective with HIV only because HIV is not as infective, not because the condom is more effective.
So the problem with the condom is not the design, but that they are not as effective as people think. Couples using them consistently every time still have a good lifetime chance of transmitting HIV if their partner is infected.
Well, there's 50/50 chance of not infecting anybody vs infecting at least one person from 13. That's a much better chance than say 50% chance of infecting at least 10 person from 13. When you are thinking about spreading a disease, this matters a lot. Sure, for couples, the chances of infection after N use is high, but that's not the only use case. (E.g. one night stands.)
Telling someone there is a tool to reduce risk, that doesn't actually reduce risk (enough), actually makes things much much worse.
Condom usage decreases the prevalence and spread of STDs. That is a very hard fact. Therefore I guess that in this specific case increased risk taking does not offset the advantages of decreased risk. (Same seems to be true for things like airbags or seat belts in cars. You could not possibly argue that we should remove these from cars because we end up with more fatalities with them as it is simply not the case.)
I am no aware of the state of the debate of this effect on condoms or STIs/STDs.
At any rate, HIV is a much much larger virus than Ebola, and cannot get through micropores in the condom as easily. This contributes to the high rate of transmission prevention.
So far no upper limit is known.
The ability to go from foreplay to sex without stopping
The ability to switch between oral and penetrative sex
I can't find the link on the Gates Foundation site now (dead links on Google) but this is some press around it and mentions the 11 finalists:
So I guess better condoms are in the works already?
At a minimum you are looking at a couple of million in research, more if you want to go crazy with material science. Then you have the cost of testing, approval etc. After that you have marketing. It's a great project that will save many lives but the cost/risk analysis alone would put off any for profit organization.
The fact that the Gates Foundation is having to get involved is a sign that the market simply isn't going to solve this one.
(Government research probably won't deliver it either, at least in the US, due to the politics around contraception)
That says nothing about the potentially enormous profits to be made if your redesigned condom beats the competition and becomes a new consumer favorite. Condoms are purchased by people in a wide age range, income bracket, geographic location, etc. Even a small percentage of the total market would be an enormous amount of money.
You might as well have said that Tesla Motors was a terrible idea, arguing that there's no money to be made in automobiles because of all the upfront costs of designing cars, building factories, and obtaining regulatory permission.
In fact, the entire point of starting any business is to overcome upfront costs by seeking long-term profits.
claims that "The global condom industry has been forecast to hit a market value of US$5.4 billion by 2018". If you have the material science worked out you're mass producing a few grams of latex, selling to non-price sensitive customers, and can even market it as an "entertainment product" as the article states.
If you want to try out a similar condom that is the best one out there in my opinion, check out nakedcondoms.com
> He learned how latex condoms are made (by dipping phallic molds into vats of liquid latex, which is peeled off after it dries), and how they are regulated (the Food and Drug Administration considers condoms medical devices and dictates how they are manufactured and labeled).
edit: Main points seem to be that the FDA
- encourages latex, through labeling and testing requirements
- limits the range of sizes of condoms
- tests only vaginal intercourse, there can be no anal-sex specific condoms
The work I recall from the '90's (I was a post-doc there, working in a different field) involved changes to both shape and design, with some kind of extra band around the base to prevent leakage and accidental slip-off.
As near as I can tell, none of this research has had any impact on condoms as they are manufactured and sold. The best you see is a non-latex condom being sold now and then, but they never seem to stay on the market very long (they are generally more expensive).
So the most pressing topic for research would seem to be going after the question, "We know all kinds of things about building a better condom, and have for decades, so why haven't the condoms we buy changed appreciably?"
Some of this will be due to the difficulties of getting things past the FDA, particularly for smaller operations as the article suggests, but since we do see non-latex condoms from major manufacturers (http://www.walgreens.com/q/non-latex-condoms) it is clearly not the case that the FDA makes stuff impossible. It may be there are economic issues at work as well, but I don't think the situation is so obvious that we can just apply $IDEOLOGY_OF_YOUR_CHOICE and say we're done. This is particularly true because condom availability isn't great outside the US, either (although what the US approves does have an influence on what gets sold elsewhere, I'm sure.)