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 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?

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

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

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

* 5. What brand of condom is your preference?

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

* 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?

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

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

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