Condom Breakage Survey

Thank you for volunteering to take this survey! The purpose of the following survey is to assess the circumstances under which condom breakage can occur, to collect preliminary data on the subject and educate the public on how to avoid future condom breakage.

It is only ten questions and should not take more than 5 minutes of your time. Please be assured that all results will be kept confidential. You are not obligated to complete the study and may exit the survey at any time.

Thank you for your participation! Please go to http://scienceblogs.com/neurotopia for the results of the study, which will be up in a few days' time.

1. How often have your condoms broken during sexual intercourse?

How often have your condoms broken during sexual intercourse? Never

Rarely (less than once per year)

Fairly often (1-4 times per year)

Often (>4 times per year)

2. When a condom has broken, what was the break most commonly like?

When a condom has broken, what was the break most commonly like? small hole near the tip

small hole along the shaft

large hole near the tip

large hole along the shaft

full tearing with the head coming loose from the rest

peeling backward, banana-style

other

3. When a condom has broken, what was the general level of lubrication present? Please choose the closest approximation to the scenario.

When a condom has broken, what was the general level of lubrication present? Please choose the closest approximation to the scenario. High outside the condom, low inside (against the penis)

High outside the condom, high inside

Low outside the condom, low inside

Low outside the condom, high inside

4. When a condom has broken, what type of activity was generally occurring? You may choose more than one.

When a condom has broken, what type of activity was generally occurring? You may choose more than one. Vaginal intercourse, low athleticism

Vaginal intercourse, high athleticism

Anal intercourse, low athleticism

Anal intercourse, high athleticism

Oral sex

Other (please specify)

5. What brand of condom is your preference?

What brand of condom is your preference? Durex

Trojan

Lifestyles

Non-latex based

Other (please specify)

6. How would you generally describe the fit of the condom on yourself or your partner?

How would you generally describe the fit of the condom on yourself or your partner? Extremely tight

Tight fit

Good fit

Loose fit

Extremely loose

7. How would you describe the general fit of the penis, with condom attached, and the orifice used during episodes in which a condom has broken?

How would you describe the general fit of the penis, with condom attached, and the orifice used during episodes in which a condom has broken? Extremely/Uncomfortably tight

Tight

Normal/Comfortable

Loose

Extremely/Uncomfortably loose

8. During the most recent condom break, was space left in the reservoir at the tip of the condom?

During the most recent condom break, was space left in the reservoir at the tip of the condom? Yes

9. If you have experienced repeated condom breaks, what measures were taken to resolve the problem?

If you have experienced repeated condom breaks, what measures were taken to resolve the problem? None

Switched condom brands

Switched method or type of intercourse

Other (please specify)

10. Please include any other details on recent condom breaks that you feel would be helpful to the surveyors.

Please include any other details on recent condom breaks that you feel would be helpful to the surveyors.

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Condom Breakage Survey
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