Condoms: Am I really having safe sex?
Condoms are one of the most popular, affordable, and effective forms of contraception that people use to practice safe sex. There are tons of brands out there — Trojan, Durex, and many others that offer different flavors, levels of pleasure, and more to try to entice different corners of the market. Yet, I don’t know about you — but using a strangely colored condom that smells like strawberries started to weird me out. Since I became more aware of the ingredients inside my food, I began to look at the ingredients in all my personal care products as well. One day, I realized I had no idea what was in a typical condom that gave it that strange plastic smell, so I went to look for the ingredients. It took me a few seconds to realize that the ingredients were nowhere to be found on the outer or individual packaging, so I ventured online to see if any condom companies list the ingredients there — and nothing! I could not believe that I had no idea what was going inside the most intimate part of my body. I figured that if the companies weren’t transparent enough to list their ingredients anywhere, then there must be something they’re hiding from their consumers. Hence, my investigation into the condom industry began. I wanted to find out what was inside condoms, if anything was potentially harmful, and if so, are there any good alternatives out there?
Condoms have been used for many centuries, and companies have only recently began manufacturing condoms from latex in the last century [4]. According to the Indian Journal of Sexually Transmitted Diseases and AIDS, “the introduction of liquid latex in the mid‑1930’s made possible greater tensile strength and longer shelf life of 5 years instead of 3 months,” which made latex condoms extremely favorable over less pleasurable, less effective and more expensive forms of contraception such as polyurethane and animal gut (intestines) condoms [4]. Yes, you heard that correctly. People used to use animal intestines as condoms…no wonder a more effective (and less disgusting) alternative was highly in demand. Thus, latex condoms became the most prevalent in the marketplace, and companies sought to produce these highly demanded products in bulk for its consumers. Mass production often leads to companies cutting corners and prioritizing low cost over the quality of their product. As I quickly found out, condom companies are not required to disclose the ingredients in their products, so many chemicals and unwanted additives are often included without our knowledge — and it was very difficult to find what exactly these chemicals are.
After reading dozens of articles and even reading some condom patents available on Google, it became clear that the additives in typical latex condoms may include lidocaine (Xylocaine) to use as a local anesthetic (typically 10 mg) to help intercourse last longer, capsaicin or other stimulants to counteract the anesthetic and induce warmth and pleasure, an anti-inflammatory agent to counteract the stimulants, spermicides and lubricants (mainly silicone) to decrease friction and kill sperm (several ingredients can be in these alone!), and many others that are difficult to find given the limited research in this area [12]. More recently, several researchers found that “volatile N-nitrosamines have been found in rubber products including gloves, balloons, toys, baby bottle teats, soothers, and condoms” [11]. Nitrosamines are a known carcinogen that instigate tumor growth [2].
Additionally, many healthy living blogs and new condom company websites mention that other strange additives may include casein (a milk protein), glycerin (a sweet-tasting preservative), parabens (a common preservative), and Nonoxynol-9 (a spermicide). Casein is extremely problematic for anyone with a milk allergy or an ethical vegan lifestyle, and these are among the several ingredients that are not identified in condoms. If you are either of those, there are several condom brands out there that are certified vegan — so they don’t use any casein in their products. I will provide an in-depth list of these companies at the end of this article. Glycerin or Glycerol is a sugar alcohol — it can create immense bacterial growth and give women severe yeast infections, which makes both partners more susceptible to other STI’s. Parabens are very controversial right now; many people are arguing that they can exacerbate cancerous growths after being exposed to them regularly through personal care products (like condoms). As a consumer, it’s never comforting to see a long list of confusing ingredients that have extremely technical names and are coming into contact with the most sensitive parts of our bodies. It’s even less comforting to know that the massive condom companies we “trust” (i.e. “Trojan: America’s #1 Most Trusted Condom Brand”) are aware of what we’re consuming, and still don’t feel the need to disclose the ingredients anywhere. Among all these chemicals found in condoms, the most dangerous to human health are nitrosamines and spermicides (namely, Nonoxynol-9), which will be discussed in detail.
Since condoms became so widely used and advocated after the AIDS epidemic in the 1980’s, more research was conducted on their possible side effects, since very little was known about the chemical additives in condoms. The potential health effects of these several elusive condom ingredients has since become a topic of interest for researchers in academia. To begin with, studies first look into how to mass produce condoms — first, natural rubber must undergo a process called vulcanization in order to create thin and elastic latex, which can then be morphed into the packaged condoms we see on the shelves at our local CVS [1]. This vulcanization process is what many researchers are focusing on because of the several controversial chemicals involved, and since it is the most complicated part of creating a condom. According to researchers, condom manufacturers use something called an accelerator in order to speed up the condom-making process, and these accelerators such as ZDEC, ZDBC, ZMBT, and dialkylamines are the precursors to the creation of cancerous nitrosamines [1]. There is a definitive way to vulcanize rubber to get it elastic and durable without using these harmful accelerators that are primarily used to save money and time [10]. Several condom companies today pride themselves in not cutting corners to ensure the healthiest, safest forms of contraception on the market. Yet, the reality is that large condom companies control a vast majority of the market, and therefore most exposed to these controversial chemicals.
The concern for the potentially carcinogenic effects of nitrosamine are so dire because of the fact that “condoms are intended for close contact with the skin and mucous membranes,” [6] which have a high tendency to transfer directly into our circulatory system — which is even more risky since the chemicals are not naturally metabolized first [13]. The most worrisome chemical of all — nitrosamines — have been proven to migrate from condoms into physiological liquids such as saliva, vaginal mucus, or sweat, meaning that they have the clear ability to rub off from the condom into our bodies. Depending on your level of sexual activity and how long each sexual encounter lasts, your individual exposure varies widely. No matter what, you have an extremely high probability of being exposed, depending on what condom company you use [3]. Several studies have looked into the specifics of migration of carcinogenic nitrosamines into our bodies — particularly into human sweat and saliva — two bodily secretions that frequently come into contact with condoms.
To begin with, the in-depth study by H. Biaudet et. al. extracted nitrosamines and nitrosatable compounds (the compounds that readily become nitrosamines) from artificial saliva, cattle and goat vaginal secretions, and human cervical mucus in a laboratory from dozens of different samples [3]. First off, the artificial saliva was formed in the laboratory to imitate the chemical makeup of human saliva, but without needing to extract saliva from human subjects. The cattle and female goat vaginal secretions were also used in this experiment to supplement the low number of female cervical mucus these researchers had available, and chose these two animals because of the similar composition to human vaginal secretions. Overall, these three bodily fluids were tested on to see if and where nitrosamines would travel in the human body when it came into contact with condoms. As a result of their study, the researchers found that out of all volatile nitrosamines and nitrosatable compounds, NDBA (a nitrosamine) was found at the highest levels in the artificial saliva [3]. This artificial saliva was made to very accurately represent real human saliva — so this study shed light on how human saliva could be exposed to high levels of nitrosamines after in direct contact with condoms, such as during oral sex.
Additionally, a study was performed on 37 different condoms (all different companies) in China by Di Feng et. al., where they aimed to see how nitrosamines were released after in contact with artificial sweat for ten minutes (while being vigorously shaken to mimic sexual activity). Only ten minutes were used in this study to help more accurately represent typical sex — this is the average time for humans. The previous study incubated their bodily fluid samples for 24 hours — a less likely situation for human exposure (although 24 hours of sex would be very, very impressive). Di Feng et. al. found that in 17 of the total 37 condoms, the total nitrosamines and nitrosatable substances released varied widely, but all of them were far above the “safe” amount recommended by the European Union. Yet, it is something to note that the governing bodies in the EU care much more about human health than we do here in the U.S., and thus have much stricter laws and recommendations for exposure. The European Union’s specific Directive states that the release of nitrosamines “should not exceed 10 mg/kg material and nitrosatable substances should not exceed at 100 mg/kg material” [2]. You are by no means expected to remember these seemingly arbitrary values, but just know that according to this directive, all 17 of the 37 condoms that showed significant nitrosamine levels were well above the legal limit of 10 mg/kg material — which could be very dangerous [2]. This concludes that approximately 46% of prevalent condoms on the market contain dangerously high levels of chemicals that are known to cause cancer. This is a bit terrifying when you think about your exposure to carcinogens through condoms being the same as your odds of landing on heads instead of tails when flipping a coin.
In case you weren’t convinced yet, there is one more prestigious study that was done to further provide evidence against the migration of nitrosamines in the human body from condoms. W. Altkofer et. al. created an experiment in which they surveyed 32 completely randomly chosen condom packages. Also important to note: a study can only be statistically significant when there are at least 30 subjects — in this case, the subjects being condoms. Differing from the previous two studies, this one looked at the interaction of artificial sweat with condoms and incubated it for approximately one hour (instead of 24 hours or 10 minutes). Again, artificial sweat was used since it is easily created and makes a decent model of human sweat. Scientists can produce this in bulk rather than going around and forcing people to sweat and somehow collecting large quantities. Ultimately, the results of this experiment showed that approximately 1.4 mg nitrosamines per condom was released into the sweat [6]. This level of nitrosamines is under the EU Directive’s limit of 10 mg/kg material, but when the product is something you use regularly, multiplying 1.4 mg by the average number of condoms used for an individual (for example, in one year) will result in a significantly larger number. On a more uplifting note, this experiment also discovered that 3 out of the 32 condoms resulted in negligible (almost zero) levels of nitrosamine contamination, which shows that some condoms on the market are much safer than others to use — which is great news! According to the Center for Environmental Health, “since nitrosamines can be readily removed from the condom manufacturing process — and several types of condoms are already available that do not leach nitrosamines — condoms without detectable levels of nitrosamines should be the new norm” [13]. Honestly, if you’re only saving a bit of money and greatly reducing the public health risk, this should be a worthwhile investment. It’s also really important to know that nitrosamines are also created in many other industries, where the most substantial numbers are from food, tobacco smoke, and cosmetics [11]. In the US, nitrosamines can be found in a lot of drinking water, too. Since there are various pathways to exposure, additional exposure from condoms makes it all the more dangerous for an average consumer who eats, smokes, drinks water from the tap, and wears makeup.
Since experiments on condoms have repeatedly found that nitrosamines have a tendency to be released into the human body (whether it be through saliva or sweat), it is safe to conclude that there’s a correlation between condom usage and nitrosamine exposure in humans. Therefore, it is seems safe to say that since nitrosamine is a known carcinogen, frequent exposure to this chemical in sensitive portions of the body can potentially increase your risk of cancer. Overall, it is not established that condoms cause cancer, but an increase in tumors and cancers are known to be positively correlated with the presence of nitrosamines, and therefore an increase in cancer diagnoses are also positively correlated to the usage of condoms. In other words, frequent condom use could be linked to increasing your cancer risk! Based on this, it seems very logical to remove these carcinogens from condoms on the market to improve their overall safety.
Now that we’ve concluded that nitrosamines are something we do not want in our condoms, we also have to think about the lubricants and spermicides people often use when they’re having sex. In the past, use of spermicides such as Nonoxynol-9 were encouraged by officials in order to prevent the spread of HIV and AIDS, in addition to being a preventative method for other sexually transmitted infections (STIs). Yet, in 2010, the World Health Organization came out and stated that “spermicides containing Nonoxynol-9 do not protect against HIV infection and may even increase the risk of HIV infection in women using these products frequently” [9]. Wait a minute…just to be clear, our government recommended the use of this spermicide to stop the spread of a deadly disease, but then retracted that statement, and said that it can actually increase your chances of contracting the disease. Yet, this chemical is still in so many condoms and lubricants that people buy. The World Health Organization also came out and said that spermicides with nonoxynol-9 “do not protect against two other common sexually transmitted infections” [9]— namely gonorrhea and chlamydia. Basically, all the original hopes for the preventative methods in nonoxynol-9 had been diminished. To make matters even worse, the Center for Disease Control in the US stated that researchers found that a lubricant they were testing that contained nonoxynol-9 actually made women become “ infected with HIV at approximately a 50% higher rate than women who used the placebo gel” [7]. According to NPR.org, medical professionals say that spermicides such as nonoxynol-9 can be very safe if they’re used as directed: “not used more than once a day, and not used for anal intercourse, with multiple partners or with a partner who has HIV” [5]. The fact that the use of this spermicide can be safe is a relief, but these stringent cautions should be placed on the label of all spermicides sold in store, because this is clearly not common knowledge. If people purchasing spermicide with N-9 in it are using it incorrectly, they can be at a higher risk of contracting diseases when they are hoping it will lower their risk. The more transparency there is in the condom and spermicide market, the better decisions consumers will make regarding the products they buy.
Finally: the good stuff! I know at this point you’re probably googling different IUD’s or birth controls to use since this article painted condoms in a bad light, but there are so many incredibly transparent and safe condom companies out there. Rejoice! First and foremost, there is a new company called LOLA that first began by developing 100% organic cotton tampons once the founders realized what nasty chemicals exist in normal tampons. Soon enough, they spread into the all-natural condom market. LOLA’s condoms only have a few ingredients — natural rubber latex and cornstarch powder in the condom, and silicone oil as a lubricant [14]. On LOLA’s website, they also have an entire section of chemicals that are absolutely never included in their condoms. These include “parabens, nitrosamines, casein, gluten, glycerin, synthetic colorants, synthetic flavor, and fragrance” [15] — all the additives that seem to be legitimately unnecessary. Their transparent list of ingredients shows their commitment to being honest with their customers, and the fact that nitrosamines and other potentially irritating and harmful chemicals are not added in their condoms makes this company very appealing. In addition to condoms, they also have organic Aloe Barbadensis Leaf Juice lubricant and all-natural bamboo cleansing wipes available.
In addition to LOLA, the company Sustain Natural also produces all-vegan, fair-trade, non-gmo verified condoms. If there’s a certification out there, Sustain Natural has it. This company is similar to LOLA in that they also advertise their exclusion of bad ingredients such as nitrosamines, parabens, and gluten — but have a much longer list of ingredients in the condom (still all transparently listed) that are not all instantly familiar, so they may or may not necessarily be 100% “natural”. Yet, the ingredients they have are far superior to most brands on the market.
Furthermore, another up-and-coming condom company called Sir Richard’s similarly displayed their vegan certification for their all-natural latex condom and all-natural silicone lubricant ingredients on their website. Sir Richard’s website also notes that their condoms are also free of “glycerin, parabens, spermicide and petrochemicals,” and specifically mention that their condoms lack Nonoxynol-9. To add to the already impressive product, Sir Richard’s also pledges to donate a condom to a person in need for every condom purchased — a great humanitarian impact in promoting safe sex worldwide.
Lastly, one of the first sustainable condom companies to exist is GLYDE, which is the “first ethical, vegan & fair-trade condom” company, according to their website [17]. Additionally, the twenty-year old company prides itself in being glycerin-free, paraben-free, casein-free and “void of all risky chemicals including talc, nonoxynol-9 and benzocaine” [17]. Altogether, these four incredible alternatives all come at a reasonable price (as you can see for yourself!) and have proven to be high-quality condoms with several legitimate certifications and transparent ingredient lists. The fact that all four companies outwardly advertise to be free of these controversial chemical additives sheds light on the compromised integrity of the ingredients used in the massive condom industry today. Buying more natural and certified condoms will ensure a healthier and safer sex life, and will help profit ethical and transparent companies that do their best to educate and protect their consumers.
For a more in-depth look into all these wonderful condom alternatives, please read this article here.
Citations
[1] Baker, C. S., Fulton, W. S., & Wiley Online Library. (2012, October 19). Rubber, Natural. Retrieved June 19, 2018, from https://onlinelibrary.wiley.com/doi/10.1002/0471238961.1821020202011105.a01.pub2
[2] Feng, D., Zhou, Q., Cheng, X., Wang, J., & Yang, Q. (2010). Analysis of Nitrosamines Migration from Condoms in the Chinese Market Using a Proper Migration Experiment. Bulletin of Environmental Contamination and Toxicology, 84(4), 373–377. doi:10.1007/s00128–010–9949–4
[3] Biaudet, H., L. Mouillet, and G. Debry. “Migration of Nitrosamines from Condoms to Physiological Secretions.” Bulletin of Environmental Contamination and Toxicology 59, no. 6 (December 1, 1997): 847–53. https://doi.org/10.1007/s001289900559.
[4] Pandya, I., Marfatia, Y., & Mehta, K. (2015). Condoms: Past, present, and future. Indian Journal of Sexually Transmitted Diseases and AIDS, 36(2), 133. doi:10.4103/0253–7184.167135
[5] Kroen, G. C. (2012, February 06). What Spermicide Users Should Know, But Often Don’t. Retrieved June 19, 2018, from https://www.npr.org/sections/health-shots/2012/02/06/146343080/what-spermicide-users-should-know-but-often-dont
[6] Altkofer, W., Braune, S., Ellendt, K., Kettl‐Grömminger, M., Steiner, G., & Bulletin of Environmental Contamination and Toxicology; New York. (2005, January 25). Migration of nitrosamines from rubber products — are balloons and condoms harmful to the human health? Retrieved June 19, 2018, from https://onlinelibrary.wiley.com/doi/abs/10.1002/mnfr.200400050
[7] Center for Disease Control. (2000, August 11). Notice to Readers: CDC Statement on Study Results of Product Containing Nonoxynol-9 | Morbidity and Mortality Weekly Report. Retrieved June 19, 2018, from https://www.cdc.gov/mmwr/preview/mmwrhtml/mm4931a4.htm
[8] Motsoane, N. A., Bester, M. J., Pretorius, E., & Becker, P. J. (2003). An in vitro study of biological safety of condoms and their additives. Human & Experimental Toxicology, 22(12), 659–664. doi:10.1191/0960327103ht410oa
[9] World Health Organization, Powell, C., & Farley, T. (2010, December 07). Nonoxynol-9 ineffective in preventing HIV infection. Retrieved June 19, 2018, from http://www.who.int/mediacentre/news/notes/release55/en/
[10] Chemical and Veterinary Investigation Institute in Stuttgart. (2004, May 28). Carcinogenic N-nitrosamines in condoms. Retrieved June 25, 2018, from http://www.cvuas.de/pub/beitrag.asp?subid=1&Thema_ID=3&ID=168&Pdf=Yes&lang=DE
[11] Proksch, E. (2001). Review Toxicological evaluation of nitrosamines in condoms. International Journal of Hygiene and Environmental Health, 204(2–3), 103–110. doi:10.1078/1438–4639–00087
[12] Kakonyi, A. (1997, August 19). US6536438B1 — Condoms with improved security. Retrieved June 25, 2018, from https://patents.google.com/patent/US6536438B1/en
[13] Reproductive Health Technologies Project, & Center for Environmental Health. (2014, September). Making a Good Thing Even Better: Removing NITROSAMINES from CONDOMS. Retrieved June 26, 2018, from http://rhtp.org/wp-content/uploads/2016/08/MakingAGoodThingEvenBetter.pdf
[14] LOLA. (2018). LOLA: 12-pack (standard size) Ultra-thin lubricated condoms. Retrieved June 26, 2018, from https://www.mylola.com/products/lubricated-condoms
[15] Sustain Natural. (2018). Sustain Natural: Ultra-Thin Condoms. Retrieved June 26, 2018, from https://www.sustainnatural.com/products/condoms?variant=30030004233
[16] Sir Richard’s. (2017, April 26). Sir Richard’s: CHEMICAL-FREE CONDOMS: OUR NATURAL LATEX CONDOMS ARE CLEAN. Retrieved June 26, 2018, from https://www.sirrichards.com/news/chemical-free/
[17] GLYDE. (2015, April 21). Certified Vegan, Fair Trade, Non-GMO | GLYDE Condoms. Retrieved June 26, 2018, from https://www.glydeamerica.com/the-glyde-difference/
