Pregnant women and their partners who are at risk for sexually transmitted infections (STIs) should strongly consider using condoms during sex. Doing so will decrease the chance of getting infected and the risk of any complications from infection during your pregnancy. Choose a condom that gives you protection from STIs and has the least potential to cause harm to you or your baby.
Safety and Risks
Though there are studies on the contraceptive effectiveness and STI protection of condoms, little is known about the risks of male and female condom materials or their additives on pregnancy outcomes in babies or mothers. Beyond listing the condom material, manufacturers don't reveal much about substances added to enhance the appeal of their condoms on either the packaging or on their websites. Because of this, it is difficult to do independent clinical research on the safety and risks of condom use during pregnancy.
Substances added to condoms may include chemicals, talc or starch to decrease the condom material from sticking to itself, spermicides, lubricants, and preservatives, as well as other substances added to heighten sensation and sexual response. There is little information on risks to the developing fetus for many of the following additives but some may raise the risk for cervical, vaginal or vulvar inflammation and infections, which could increase the risk for STIs.
The vaginal environment becomes more alkaline in pregnant women, which can lead to overgrowth of yeast and other vaginal bacteria; these additives may increase alkalinity.
Some condoms are lubricated with spermicides for added contraceptive protection. One study at The University of Texas School of Public Health looked at the outcome of babies born to mothers who continued to use condoms with spermicides before they realized they were pregnant. There was a small increase in membranous ventricular septal defect (VSD - a hole in the heart), but the authors found no other newborn birth defects.
Spermicides such as nonoxyl-9 (N-9) are detergents that kill sperm. They can decrease the storage life of latex condoms and therefore decrease safety against STIs. Nonoxyl-9 can also cause allergic and irritant inflammation in the vagina and cervix, which can increase the risk of contracting an STI if the condom breaks.
Contrary to earlier lab studies, N-9 does not provide protection against HIV or other STIs, according to the World Health Organization so will not give any added protection during pregnancy.
Some condoms are lubricated with oil-based lubricants, which can deteriorate some condom materials and decrease the condom's effectiveness against STIs and put pregnant women at risk. Others are lubricated with water-based lubricants, such as glycerin or silicone, which don't damage condoms but might also cause irritant reactions and reduce STI protection. They can also make the vagina more alkaline and increase the risk for yeast infections and other infections.
There is no evidence that glycerin and silicone can be absorbed into the uterus or into the blood stream to cross the placenta to harm to a baby.
Latex Compounding Chemicals
Chemicals are added at the first stage of manufacturing to compound the liquid latex to add strength and other properties to it. Manufacturers do not reveal what these chemicals are, so the potential risks to mother or baby are not known.
Talcum Powder and Starch
There is some evidence that using talcum powder in the genital area might increase the risk of ovarian cancer, however there is no information on potential risks of talc or starch to a fetus. Talc and starch in the vagina could also increase the risk of vaginal inflammation and yeast infections in a pregnant woman and therefore increase STI risk.
The Sir Richard's Condoms website mentions that their condoms are paraben-free. It may then be likely that other condom manufacturers add parabens or other preservatives to extend the shelf life of their condom lubricants.
Parabens can act like estrogens and are known to be toxic to cells. It is not known, however, if parabens are absorbed in the vagina and transferred into the blood stream to cross the placenta to the fetus, which could potentially affect the development of a male baby's sexual organs.
Flavorings and Sugar
Flavorings and sugar added to enhance oral sex could cause overgrowth of yeast. Yeast causes vaginal or vulvar irritation and inflammation, which can increase the risk for STIs. There is no information on what the specific ingredients are, or their potential to cause harm to a developing fetus.
Warming and Tingling Agents
Companies add warming and tingling agents to add fun and enhance arousal and sensation. The specific agents added are not known but could include glycerin, menthol, capsaicin or botanical extracts.
There are no studies on the potential for these agents to cross the placenta and harm a baby. Any of these substances could cause an allergic reaction or cervical, vaginal and vulvar inflammation and increase the risk of infections in a pregnant woman.
Color and Fragrances
Color and fragrance are also added to condoms for appeal, fun and fantasy. Dyes and fragrances can cause allergic and irritant reactions, which could also increase the chances for infections. There are no studies on the potential of dyes and fragrances to be absorbed from the vagina to reach the fetus.
A few products such as Durex™ Performa and Trojan™ Extended Condom have added benzocaine, a local anesthetic, to prolong a man's sexual performance. Though the benzocaine is coated on the inside of the condom, it is not known if there is potential for harm if the condom breaks.
There is a potential risk for benzocaine to be absorbed from the vagina into the blood and cross the placenta, but there are no adequate studies on potential risks to a developing baby. There is also the potential for benzocaine to cause an allergic reaction or inflammation in the vagina and increase the risk for a yeast infection and STIs in a pregnant woman.
Choosing Condoms During Pregnancy
Without access to a more complete list of specific additives in condoms or clinical studies to assess maternal and fetal risks completely, pregnant women and their partners who need to use them should choose condoms that have as few additives as possible.
Latex and non-latex condoms made from various synthetic materials all provide effective protection from STIs. Pregnant women, however, should not use lambskin "natural" condoms for STI protection. They are made from sheep's intestine and are thought to have pores large enough for STIs to pass through, including HIV.
You can choose from the following types of condoms that are the most available types on the market.
Latex condoms, made from natural rubber, are the strongest and most widely used condoms. They provide the best protection from STIs. In one review reported in Contraception, the authors found that latex condoms rarely broke or slipped off during sex or withdrawal, making the risk of STI exposure during use in pregnancy small.
Latex condoms, however, are more likely to deteriorate during storage, on exposure to heat, or to oil-based lubricants such as Vaseline, mineral, baby oils and over-the-counter vaginal treatments such as anti-yeast medicines. This can lead to breakage and STI exposure if used. Pregnant women should take care not to use condoms exposed to these conditions and to use only water-based lubricants.
Non-latex condoms are made from polyurethane, a petroleum-based synthetic plastic or other synthetic materials. Polyurethane condoms, marketed since 1994, are the most commonly used non-latex condoms. Though they are thinner and less elastic than latex condoms, they are also very strong and provide effective STI protection.
Pregnant women should be aware that, in general, non-latex condoms are more likely to break or slip off during intercourse or withdrawal than latex condoms, possibly exposing them to STIs. Note, though, that one study reported in Contraception suggests that the polyurethane condoms studied were not more likely to break or slip off than latex condoms but you should still take precautions against breakage.
Non-latex condoms are less likely than latex condoms to deteriorate with storage or exposure to oil-based lubricants.
Polyisoprene Synthetic Latex
Marketed since 2009, synthetic latex condoms are made from the chemical polyisoprene, one of the naturally occurring substances in natural rubber. They are softer and more elastic, but are more likely to slip off than latex condoms.
Like natural latex, polyisoprene condoms deteriorate with oil-based lubricants so pregnant women should be cautious about the lubricants they use.
Female condoms are made from the synthetics, nitrile and polyurethane. and provide effective STI protection. They were approved by the Food and Drug Administration (FDA) in 1994, with a newer version approved in 2009 for contraception and protection against STIs.
They are coated with silicone, which is a water-based lubricant. Do not use a female condom with a male condom because both could break because of friction between them.
Pregnant women who have a latex allergy should not use latex condoms. A vaginal or vulvar allergy could cause itching and inflammation, increasing the risk of STIs. There is also a risk of an allergic anaphylactic shock and death of mother and baby. Allergic reactions may be to rubber proteins or by-products from the chemicals added in the manufacturing of the latex.
Polyisoprene and polyurethane condoms do not have the latex allergens. A brand of natural rubber latex condoms, called Vytex, has had 90% of the protein allergens removed. These condoms are good alternatives for pregnant women who are allergic to traditional latex condoms.
Protection from Sexually Transmitted Infections During Pregnancy
Pregnant women and their partners who are at risk for STIs should use condoms during all parts of vaginal, anal or oral sex. There is some evidence that pregnant women may be even more at risk for STIs from semen.
Pregnancy decreases a woman's immune response so that her body does not attack her baby as an allergen. Some studies show that the semen of a woman's partner might play a role is this decreased immune response. The modified immune response to semen might decrease a woman's ability to fight sexually transmitted diseases.
It is important also to note that male and female condoms do not protect areas that they don't cover during sex. You and your partner might not be protected from organisms that infect from skin-to-skin contact, such as herpes, human papilloma virus and syphilis.
Who Should Use Condoms During Pregnancy
Pregnant women and their partners with the following risk factors should use condoms:
- You or your partner has a history of sexually transmitted disease.
- You or your partner currently has an STI - though it is better to avoid sex during an active infection.
- You and your partner are not in a mutually monogamous relationship.
- You have intercourse with a new partner after getting pregnant.
Safety and Protection
In the absence of clinical studies to examine safety and risks, choose a condom that you are comfortable with that has few or no additives. Don't use a latex condom if you are allergic to latex. Talk to your doctor or midwife about your risks for STIs and the benefits and safety of the use of condoms during pregnancy, preferably before you get pregnant.