What to do when a condom breaks to prevent pregnancy, and when to get an STI test

Carla Delgado,Jason McKnightFeb 6, 2021, 02:47 IST

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If a condom breaks, emergency contraceptives can be used to prevent pregnancy.John Slater/ Getty Images

When a condom breaks during sex, you may be at risk for pregnancy and/or contracting an STI.
Emergency contraceptives like plan B and Ella can prevent pregnancy as can getting a copper-IUD.
You should get tested for an STI, though some STIs don't show up on lab tests for up to six weeks.

External, or "male", condoms break between 0.6% to 15% of the time, which increases the risk of unplanned pregnancy and exposure to sexually transmitted infections (STIs).

When a condom breaks during sex, you must take emergency contraceptives as soon as possible to minimize the risk of pregnancy. You should also get tested for STIs, which helps you get treated sooner rather than later.

Improper storage, incorrect application, and misuse of condoms during sex can all increase the likelihood of breakage.

All reasons for breakage of external condoms apply to internal or "female" condoms as well, says Lubna Pal, MD, professor of obstetrics, gynecology, and reproductive sciences at Yale School of Medicine.

Here's how to tell when a condom breaks and what to do at the moment and afterward.

How to know if the condom breaks

When wearing a condom, a key sign that it has broken is if you feel a loss of tension around the penis. For your partner, they may feel the leakage of semen if the break is large enough, says Pal.

"If the condom breaks pre-ejaculation and is identified, corrective measures (like removing the broken condom and wearing a new one) can be taken to decrease exposure to the semen," says Tania Basu Serna, MD, MPH, associate professor of obstetrics and gynecology at the University of California, San Francisco.

Some people don't notice the condom break until after the intercourse, so check for any damage before and after wearing the condom. Inspect it for obvious holes, tears, or leaks periodically during sex or when changing positions.

The risk of getting pregnant from pre-ejaculate (or pre-cum) is very low, but not completely zero. "If the condom breaks post ejaculation, there is a higher risk of semen exposure but it is still about 50% lower than not using a condom at all," says Serna.

If the person wearing the condom feels a change in sensation with how it fits, whether pre- or post-ejaculation, they should pull out immediately.

Preventing pregnancy after condom breakage

"The best preventive approach is to not solely rely on condoms for contraception," says Pal. If you're using another form of contraception, the risk of pregnancy is reduced but not completely eliminated.

For example, the birth control pill is 99% effective when used correctly. So, if you've been consistently taking the pill at the same time each day, every day, then your chances of becoming pregnant if a condom breaks are minimal. However, if you missed a birth control dose recently, your chances of accidental pregnancy jump from one to about nine %, says Serna.

In any case, to prevent pregnancy after condom breakage, you should take emergency contraceptives as soon as possible.

The two FDA-approved emergency contraceptive pills (or "morning-after pills") are:

Plan B One-Step, which is 95% effective when taken within 24 hours. You can take plan B up to 72 hours after condom breakage, though its effectiveness decreases to about 89%.
Ella, which you can take within five days of unprotected sex, is 85% effective.

The most effective method of emergency contraception is the copper intrauterine device (Cu-IUD), which is inserted in the uterus. You'd need to schedule an appointment with a health professional within five days of intercourse to get it inserted.

Unlike emergency contraceptive pills, the Cu-IUD also serves as a long-acting method of contraception and can prevent pregnancy up to 12 years, unless you have it removed before then.

"For all these methods, the sooner they are utilized, the more effective they are as emergency contraception," says Serna.

Getting tested for STIs if a condom breaks

Condom breakage, whether before or after ejaculation, puts both partners at risk for STIs, according to Pal. This means that you should get tested for STIs no matter what, unless you have been in a long-term mutually monogamous relationship.

Correct and consistent condom use doesn't completely prevent STIs because the only way to prevent STIs is to avoid sex altogether. However, practicing safe sex, getting tested regularly, and taking prescribed pre-exposure prophylaxis (PrEP) if you're at risk for HIV exposure, can reduce the risk of getting STIs.

You can also avoid contracting the human papillomavirus (HPV), the most common STI, by getting the HPV vaccine.

After condom breakage, you have to wait out a certain window period before getting tested to accurately detect the bacteria or virus. "The most reliable testing for gonorrhea and chlamydia is in two weeks. For syphilis, one week to three months. HIV, Hepatitis B, and C, it can take six weeks to three months," says Serna.

You might have been exposed to the human immunodeficiency virus (HIV) as well, so talk to a health professional about post-exposure prophylaxis (PEP). You should take it as soon as possible, or within three days, to prevent contracting HIV. If you are at risk of possibly getting exposed to HIV again in the future, you can start taking PrEP to prevent contracting the virus.

Why do condoms break?

Many factors increase the likelihood of condom breakage, which include:

Improper storage, like keeping the condom inside the wallet or exposing it to extreme temperatures. You should store condoms in a cool, dry place with ventilation and low humidity.
Incorrect application, such as using the wrong size, forgetting to leave space between the tip of the penis and the external condom, placing it hastily, putting it on inside out, or wearing two at a time. An external condom should cover the length of the penis, leaving a ½ inch gap at the top.
Misuse during sex, like reusing condoms, using it beyond the expiration date, using oils or lotions instead of water-based lubricants, and letting the condom come into contact with anything sharp during sex, such as nails, rings, or piercings.

Fact: With proper storage, external condoms have a shelf life of three to five years while internal condoms can remain effective for five years.

It's necessary to store, wear, and use a condom properly to minimize the risk of condom breakage. Read more about how to put on an external and internal condom correctly and tell if it's a good fit. When worn properly, condoms are 95% to 98% effective at preventing pregnancy.

Insider's takeaway

When a condom breaks due to improper storage, application, or use, the person wearing it may feel a loosening sensation around their penis. Condom breakage puts people at risk for pregnancy, so it's crucial to take emergency contraceptive pills or have a Cu-IUD inserted immediately.

There's also a risk of STI exposure, but you have to wait out a window period for the bacteria or virus to be accurately detected. Talk to your health care provider about taking PEP or the HPV vaccine to reduce your risk of contracting HIV and HPV.

Plan B One-Step can be bought over the counter, but Ella is only available by prescription from a health professional. "To improve having access to [emergency contraceptive] pills, especially if you cannot easily find the pill at your local pharmacy, talk to your health care provider about having an advanced prescription so you can have this in your medicine cabinet or purse, just in case," says Serna.

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