Table of Contents
Abstract
The Condom Use Errors/Problems Survey (CUES) is a comprehensive behavioral assessment tool designed to identify and quantify specific errors and difficulties encountered by individuals when using male condoms. Recognizing that most condom failures result from user error rather than product defect, the CUES aims to measure both forms of incorrect use (e.g., putting the condom on too late) and mechanical or physiological problems (e.g., slippage, breakage, or erection difficulties).
The survey is crucial for public health research focused on improving the quality and effectiveness of condom use as a preventative measure against Sexually Transmitted Infections (STIs), including HIV infection, and unintended pregnancy. The CUES exists in two validated versions: the M-CUES (for men who apply the condom themselves) and the W-CUES (for women who apply the condom to their male partners).
Keywords
Condom Use Errors, Condom Failure, Sexual Health, STI Prevention, Behavioral Assessment, M-CUES, W-CUES, Contraception
Authors
Richard A. Crosby, Cynthia A. Graham, Robin R. Milhausen, Stephanie A. Sanders, William L. Yarber
Purpose
The primary purpose of the Condom Use Errors/Problems Survey (CUES) is to systematically identify and measure the prevalence of specific user behaviors and associated problems that compromise the effectiveness of male, latex condoms. While consistent condom use is vital for preventing STIs and pregnancy, correct use is equally important.
By quantifying the frequency of various errors (such as incorrect application or removal) and problems (such as breakage, slippage, or erection loss), the CUES provides researchers and public health professionals with actionable data. This data can then be used to tailor intervention and education programs aimed at promoting improved quality of condom use among sexually active populations.
Construct
The CUES measures the behavioral construct of Condom Use Fidelity, specifically focusing on deviations from recommended usage guidelines. It assesses two distinct domains of experience related to the last three times a condom was used:
Error Items: These measure incorrect application or handling behaviors that increase the risk of failure (e.g., putting the condom on the wrong side up, using oil-based lubricants, or incomplete use).
Problem Items: These measure undesirable outcomes or physiological difficulties encountered during use (e.g., breakage, slippage, erection difficulties, or discomfort related to fit or feel).
The scale is designed as a direct measure of recent behavioral experience, rather than an assessment of a stable psychological trait or attitude toward condom use.
Validity
The CUES demonstrates strong evidence of content and face Validity, primarily because the survey items were developed directly from established, widely cited condom use guidelines published by authoritative bodies, such as the Centers for Disease Control and Prevention (CDC). This ensures that the instrument measures critical behaviors known to impact condom efficacy.
Empirical studies utilizing the CUES further support its validity by demonstrating expected correlations between variables. For example, research has shown that respondents who reported receiving prior instruction on correct condom use subsequently reported lower error scores (Crosby, Sanders, et al., 2002). Furthermore, specific behavioral errors have been linked to distinct problems, such as incomplete use correlating with erection difficulties (Graham et al., 2006), and the use of sharp objects to open packages correlating with condom breakage (Yarber et al., 2004).
Reliability
Traditional psychometric measures of Reliability, such as internal consistency (Cronbach’s alpha) and test-retest reliability, are not easily applicable to the CUES. This is due to the nature of the instrument as a measure of specific, distinct behavioral experiences rather than a single underlying psychological trait or construct.
Since the items measure discrete events—for instance, making one type of error is not assumed to correlate with making another error—internal consistency measures are inappropriate. Similarly, test-retest reliability may be low unless an individual experiences the exact same situational and behavioral events over time. Longitudinal evaluation of the CUES has not been widely reported, meaning the stability of reported error/problem patterns over extended periods remains an area for further investigation.
Factor Analysis
The CUES is fundamentally a checklist of specific behavioral events and problems, rather than a scale intended to measure latent factors through factor analysis. Researchers typically analyze the individual items or calculate two main summative scores: the Error Score and the Problem Score.
The Error Items (1, 2, 3, 4, 6, 7, 9, 10, 11) focus on application and handling mistakes. The Problem Items (5, 8, 12, 13, 14, 15, 16) focus on negative outcomes or physiological issues experienced during use. This structure suggests the instrument is designed for descriptive epidemiology of usage behavior rather than psychometric factor modeling.
Instrument
Test Type: Behavioral assessment checklist (Self-report survey)
Format: Fixed-choice response mode indicating occurrence (Yes/No) and frequency (1, 2, or all 3 occasions) across the recall period.
Language Available: English (as presented in the source text).
Population Group: Sexually active men and women, including adolescents and adults.
Age Group: Adolescents and Adults.
Population Details: Samples used in refinement studies included participants from STI clinics, college students, rural men from random telephone sampling, and participants recruited via online surveys.
Test Methodology: Respondents recall and report errors/problems during the last three times a male condom was used, typically within the past 3 months. Completion time averages 10 minutes. Scoring allows for both analysis of individual items and calculation of summative error and problem scores. Items 1, 3, and 4 are reversed scored in the summative calculation.
Keywords
Condom Use Errors/Problems Survey, CUES, Sexual Risk Behavior, Erection Difficulties, Condom Slippage, Public Health, Behavioral Epidemiology, Contraceptive Failure
Authors
Author ORCID Identifier: Not provided in source.
Affiliation Email addresses: Not provided in source, but correspondence is directed to William L. Yarber.
Correspondence Address: William L. Yarber, Department of Applied Health Science, Indiana University, Bloomington, Indiana 47405; e-mail: [email protected]
Permissions & Fee and Test Year
Information regarding permissions, licensing fees, or specific test year of initial publication is not provided in the source material. However, key publications detailing the use and validation of the CUES date back to at least 2002 (Crosby, Sanders, et al., 2002).
Reference’s
Centers for Disease Control and Prevention. (1998). Facts about condoms and their use in preventing HIV infection and other STDs. Atlanta, GA: U.S. Department of Health and Human Services.
Centers for Disease Control and Prevention. (2009). Condoms and STDs: Fact sheet for public health personnel. Retrieved May 18, 2009, from http://www.cdc.gov/condomeffectiveness/latex.htm
Crosby, R., Milhausen, R., Sanders, S., Graham, C., & Yarber, W. (2008). Two heads are better than one: The association between condom decision-making and condom use errors and problems. Sexually Transmitted Infections, 84, 196–201.
Crosby, R. A., DiClemente, R. J., Holtgrave, D. R., & Wingood, G. M. (2002). Design, measurement, and analytic considerations for testing hypotheses relative to condom effectiveness against nonviral STIs. Sexually Transmitted Infections, 32, 513–515.
Crosby, R. A., Sanders, S. A., Yarber, W. L., Graham, C. A., & Dodge, B. (2002). Condom use errors and problems among college men. Sexually Transmitted Diseases, 29, 552–557.
Crosby, R. A., Yarber, W. L., Sanders, S. A., Graham, C. A., & Arno, J. N. (2008). Slips, breaks and “falls”: Condom errors and problems reported by men attending an STD clinic. International Journal of STD and AIDS, 19, 90–93.
Graham, C. A., Crosby, R. A., Sanders, S. A., & Yarber, W. L. (2005). Assessment of condom use in men and women. Annual Review of Sex Research, 16, 1–33.
Graham, C. A., Crosby, R. A., Yarber, W. L., Sanders, S. A., McBride, K., Milhausen, R. R., et al. (2006). Erection loss in association with condom use among young men attending a public STI clinic: Potential correlates and implications for risk behavior. Sexual Health, 3, 255–260.
Holmes, K. K., Levine, R., & Weaver, M. (2004). Effectiveness of condoms in preventing sexually transmitted infections. Bulletin of the World Health Organization, 82, 454–461.
Milhausen, R. R., Wood, J., Sanders, S. A., Crosby, R. A., Yarber, W. L. & Graham, C. A., (2009). A novel, self-guided home-based intervention to promote condom use among young men: A pilot study. Manuscript submitted for publication.
Sanders, S. A., Graham, C. A., Yarber, W. L., Crosby, R. A., Dodge, B., & Milhausen, R. R. (2003). Condom use errors and problems among women who put condoms on their male partners. Journal of the American Medical Women’s Association, 58, 95–98.
Sanders, S. A., Milhausen, R. R., Crosby, R. A., Graham, C. A., & Yarber, W. L. (2009). Do phosphodiesterase type 5 inhibitors protect against condom-associated erection loss and condom slippage? Journal of Sexual Medicine, 6, 1451–1456.
Steiner, M., Cates, W., & Warner, L. (1999). The real problem with male condoms in non-use. Sexually Transmitted Diseases, 26, 459–462.
Warner, D. L., & Hatcher, R. A. (1999). Male condoms. In R. A. Hatcher, W. Cates, Jr., J. Trussell, F. Stewart, F. Guest, G. K. Stewart, et al. (Eds.), Contraceptive technology (17th ed., pp. 325–352). New York: National Academy Press.
Yarber, W. L., Graham, C. A., Sanders, S. A., & Crosby, R. A. (2004). Correlates of condom breakage and slippage among university students. International Journal of STD and AIDS, 15, 467–472.
Yarber, W. L., Kennedy, J., Sanders, S. A., Crosby, R. A., Graham, C. A., Heckman, T. G., et al. (2005). Prevalence of condom use errors and problems among Indiana rural men: An exploratory telephone survey. The Health Education Monograph, 22(3), 36–38.
Items of the Condom Use Errors/Problems Survey
Condom Use Errors/Problems Survey—Men (M-CUES)
Directions: The questionnaire is designed for a man who has used male condoms at least three times in the past three months for [Researchers choose penile-vaginal (penis in vagina) or penile-anal (penis in rectum/butt)] intercourse and who put the condom on his penis all of the three times. Thinking about the last three times you (not your partner) put the condom on your penis, indicate whether or not you engaged in the behavior or if the event happened and, if so, how often it occurred.
For the last three times you used a condom for [Researchers choose: penile-vaginal or penile-anal] intercourse, did you check for visible damage before having intercourse?
no
if yes, did you do it on 1 occasion, on 2 occasions, or on all 3 occasions?
I did it on 1 occasion
I did it on 2 occasions
I did it on all 3 occasions
For the last three times you used a condom for intercourse, did you put it on the wrong side up and have to flip it over?
no
if yes, did you do it on 1 occasion, on 2 occasions, or on all 3 occasions?
I did it on 1 occasion
I did it on 2 occasions
I did it on 3 occasions
For the last three times you used a condom for intercourse, did you leave space at the tip of the condom when putting it on?
no
if yes, did you do it on 1 occasion, on 2 occasions, or on all 3 occasions?
I did it on 1 occasion
I did it on 2 occasions
I did it on 3 occasions
For the last three times you used a condom for intercourse, did you squeeze the air out after putting it on?
no
if yes, did you do it on 1 occasion, on 2 occasions, or on all 3 occasions?
I did it on 1 occasion
I did it on 2 occasions
I did it on 3 occasions
For the last three times you used a condom for intercourse, did you lose or start to lose your erection while putting it on?
no
if yes, did you do it on 1 occasion, on 2 occasions, or on all 3 occasions?
I did it on 1 occasion
I did it on 2 occasions
I did it on 3 occasions
For the last three times you used a condom for intercourse, did you use a condom without a water-based lubricant such as K-Y jelly or spermicidal cream (meaning the condom did not have lubricant on it and you or your partner did not put any on it)?
no
if yes, did you do it on 1 occasion, on 2 occasions, or on all 3 occasions?
I did it on 1 occasion
I did it on 2 occasions
I did it on 3 occasions
For the last three times you used a condom for intercourse, did you also use an oil-based lubricant, such as Vaseline or baby oil, with the condom?
no
if yes, did you do it on 1 occasion, on 2 occasions, or on all 3 occasions?
I did it on 1 occasion
I did it on 2 occasions
I did it on 3 occasions
For the last three times you used a condom for intercourse, did you lose or start to lose your erection after intercourse had begun while using the condom?
no
if yes, did you do it on 1 occasion, on 2 occasions, or on all 3 occasions?
I did it on 1 occasion
I did it on 2 occasions
I did it on 3 occasions
For the last three times you used a condom for intercourse, did you let it contact sharp jewelry, fingernails, piercings, or teeth anytime before or during intercourse?
no
if yes, did you do it on 1 occasion, on 2 occasions, or on all 3 occasions?
I did it on 1 occasion
I did it on 2 occasions
I did it on 3 occasions
For the last 3 times you used a condom for intercourse, did you start having intercourse without the con- dom and then put it on later and continued intercourse?
no
if yes, did you do it on 1 occasion, on 2 occasions, or on all 3 occasions?
I did it on 1 occasion
I did it on 2 occasions
I did it on 3 occasions
For the last time you used a condom for intercourse, did you start having intercourse with it on and then take it off and continue having intercourse without it on?
no
if yes, did you do it on 1 occasion, on 2 occasions, or on all 3 occasions?
I did it on 1 occasion
I did it on 2 occasions
I did it on 3 occasions
For the last three times you used a condom for intercourse, did it break during intercourse?
no
if yes, did it do it on 1 occasion, on 2 occasions, or on all 3 occasions?
it did it on 1 occasion
it did it on 2 occasions
it did it on 3 occasions
For the last three times you used a condom for intercourse, did it slip off during intercourse?
no
if yes, did it do it on 1 occasion, on 2 occasions, or on all 3 occasions?
it did it on 1 occasion
it did it on 2 occasions
it did it on 3 occasions
For the last three times you used a condom for intercourse, did it slip off as you were taking your penis out of the
[vagina or anus/rectum/butt]?
no
if yes, did it do it on 1 occasion, on 2 occasions, or on all 3 occasions?
it did it on 1 occasion
it did it on 2 occasions
it did it on 3 occasions
For the last three times you used a condom for intercourse, did you have any problems with the way it fit?
no
if yes, did I on 1 occasion, on 2 occasions, or on all 3 occasions?
I did on 1 occasion
I did on 2 occasions
I did on 3 occasions
For the last three times you used a condom for intercourse, did you or your partner have any problems with the way it felt?
no
if yes, did it happen on 1 occasion, on 2 occasions, or on all 3 occasions?
it happened on 1 occasion
it happened on 2 occasions
it happened on 3 occasions
Condom Use Errors/Problems Survey—Women (W-CUES)
Directions: The questionnaire is designed for a woman who has used a male condom at least three times in the past three months for
[Researchers choose penile-vaginal (penis in vagina) or penile-anal (penis in rectum/butt)] intercourse and who put the condom on her partner’s penis all of the three times. Thinking about the last three times you (not your partner) put the condom on his penis, indicate whether or not you engaged in the behavior or if the event happened and, if so, how often it occurred.
For the last three times you used a condom for [Researchers choose: penile-vaginal or penile-anal] intercourse, did you check for visible damage before having intercourse?
no
if yes, did you do it on 1 occasion, on 2 occasions, or on all 3 occasions?
I did it on 1 occasion
I did it on 2 occasions
I did it on all 3 occasions
For the last three times you used a condom for intercourse, did you put it on the wrong side up and have to flip it over?
no
if yes, did you do it on 1 occasion, on 2 occasions, or on all 3 occasions?
I did it on 1 occasion
I did it on 2 occasions
I did it on 3 occasions
For the last three times you used a condom for intercourse, did you leave space at the tip of the condom when putting it on?
no
if yes, did you do it on 1 occasion, on 2 occasions, or on all 3 occasions?
I did it on 1 occasion
I did it on 2 occasions
I did it on 3 occasions
For the last three times you used a condom for intercourse, did you squeeze the air out after putting it on?
no
if yes, did you do it on 1 occasion, on 2 occasions, or on all 3 occasions?
I did it on 1 occasion
I did it on 2 occasions
I did it on 3 occasions
For the last three times you used a condom for intercourse, did your partner lose or start to lose his erection while you were putting it on his penis?
no
if yes, did he do it on 1 occasion, on 2 occasions, or on all 3 occasions?
he did it on 1 occasion
he did it on 2 occasions
he did it on 3 occasions
For the last three times you used a condom for intercourse, did you use a condom without a water-based lubricant such as K-Y jelly or spermicidal cream (meaning the condom did not have lubricant on it and you or your partner did not put any on it)?
no
if yes, did you do it on 1 occasion, on 2 occasions, or on all 3 occasions?
I did it on 1 occasion
I did it on 2 occasions
I did it on 3 occasions
For the last three times you used a condom for intercourse, did you also use an oil-based lubricant, such as Vaseline or baby oil, with the condom?
no
if yes, did you do it on 1 occasion, on 2 occasions, or on all 3 occasions?
I did it on 1 occasion
I did it on 2 occasions
I did it on 3 occasions
For the last three times you used a condom for intercourse, did your partner lose or start to lose his erection after
intercourse had begun while using the condom?
no
if yes, he did on 1 occasion, on 2 occasions, or on all 3 occasions?
he did it on 1 occasion
he did it on 2 occasions
he did it on 3 occasions
not sure
For the last three times you used a condom for intercourse, did you let it contact sharp jewelry, fingernails, piercings, or teeth anytime before or during intercourse?
no
if yes, did you do it on 1 occasion, on 2 occasions, or on all 3 occasions?
I did it on 1 occasion
I did it on 2 occasions
I did it on 3 occasions
For the last three times you used a condom for intercourse, did you start having intercourse without the condom and then put it on later and continued intercourse?
no
if yes, did you do it on 1 occasion, on 2 occasions, or on all 3 occasions?
I did it on 1 occasion
I did it on 2 occasions
I did it on 3 occasions
For the last time you used a condom for intercourse, did you start having intercourse with it on and then take it off and continue having intercourse without it on?
no
if yes, did you do it on 1 occasion, on 2 occasions, or on all 3 occasions?
I did it on 1 occasion
I did it on 2 occasions
I did it on 3 occasions
For the last three times you used a condom for intercourse, did it break during intercourse?
no
if yes, did it do it on 1 occasion, on 2 occasions, or on all 3 occasions?
it did it on 1 occasion
it did it on 2 occasions
it did it on 3 occasions
not sure
For the last three times you used a condom for intercourse, did it slip off during intercourse?
no
if yes, did it do it on 1 occasion, on 2 occasions, or on all 3 occasions?
it did it on 1 occasion
it did it on 2 occasions
it did it on 3 occasions
not sure
For the last three times you used a condom for intercourse, did it slip off while your partner was taking his penis out of your [vagina or anus/rectum/butt]?
no
if yes, did it do it on 1 occasion, on 2 occasions, or on all 3 occasions?
it did it on 1 occasion
it did it on 2 occasions
it did it on 3 occasions
not sure
For the last three times you used a condom for intercourse, did your partner have any problems with the way it fit?
no
if yes, did he on 1 occasion, on 2 occasions, or on all 3 occasions?
he did on 1 occasion
he did on 2 occasions
he did on 3 occasions
not sure
For the last three times you used a condom for intercourse, did you or your partner have any problems with the way it felt?
no
if yes, did it happen on 1 occasion, on 2 occasions, or on all 3 occasions?
it happened on 1 occasion
it happened on 2 occasions
it happened on 3 occasions
Cite this article
Mohammed looti (2025). Condom Use Errors/Problems Survey. Psychological Scales & Instruments Database. Retrieved from https://db.arabpsychology.com/scales/condom-use-errors-problems-survey/
Mohammed looti. "Condom Use Errors/Problems Survey." Psychological Scales & Instruments Database, 23 Oct. 2025, https://db.arabpsychology.com/scales/condom-use-errors-problems-survey/.
Mohammed looti. "Condom Use Errors/Problems Survey." Psychological Scales & Instruments Database, 2025. https://db.arabpsychology.com/scales/condom-use-errors-problems-survey/.
Mohammed looti (2025) 'Condom Use Errors/Problems Survey', Psychological Scales & Instruments Database. Available at: https://db.arabpsychology.com/scales/condom-use-errors-problems-survey/.
[1] Mohammed looti, "Condom Use Errors/Problems Survey," Psychological Scales & Instruments Database, vol. X, no. Y, ص Z-Z, October, 2025.
Mohammed looti. Condom Use Errors/Problems Survey. Psychological Scales & Instruments Database. 2025;vol(issue):pages.