Being Smart About Condoms

Lack of arousal, sensation, and enjoyment in the female partner are some reasons why people don't use condoms during sex

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In many cases, men report losing erections prematurely as a consequence of this feeling that "I am not experiencing the sensation of sex," because the condom has become dry. That may also cause lack of arousal, sensation, and enjoyment in the female partner. I think it's important to always purchase lubricated condoms. But for many couples, the amount of lubrication that is provided with condoms when they're sold in a package is not enough, and they may need to add lubrication at some point during sexual intercourse.

Dry condoms can lead to increased friction, which may facilitate the process of the latex breaking down and the condom breaking. Dry condoms can also potentially cause slippage of the condom (perhaps to the point of falling off) during intercourse. Importantly, couples also need to know that only water-based lubricants can be used on condoms because oil-based lubricants will deteriorate latex and grossly compromise any protective value of the condom.

Access is also an issue that deserves some attention. There are some studies suggesting that although cost may not be a primary issue relative to using condoms, general access may be. For example, it may be that people simply are not prepared for sex in terms of having a condom available. And obtaining a condom after the sexual interlude has begun may be something that just doesn't happen.

Do you think most people underestimate their risk of STDs and HIV? There are some studies that show it's not unusual at all for people to underestimate their risk of acquiring an STD or HIV. There is something that has been termed optimism bias, which suggests that people inherently feel that they are somehow protected against maladies as compared to their peers who are like them and who may practice the same forms of risky sex. It's important for couples to realize that regardless of perceptions that one another may be healthy, the vast majority of sexually transmitted infections are asymptomatic, meaning that symptoms, if they're present at all, may not be noticeable to the person. It's not like having a cold. And in many cases, the symptoms may not even be noticeable clinically.

Is it known if people are getting tested for STDs and HIV? The Centers for Disease Control and Prevention estimates that approximately one-third of United States residents currently infected by HIV are unaware of their status, so the lack of HIV testing is an important public health concern. Unlike HIV, however, testing for STDs has not been a "stand alone" health behavior. Instead, people are often tested for STDs only when they experience an otherwise unexplained symptom. An exception of great importance is that testing for HIV and STDs in the first trimester of pregnancy has become a common practice in the United States.

What are some common mistakes people make when they use condoms? One of the most common mistakes that couples make when it comes to using condoms is they fail to use the condom from start to finish of penetrative sex. There's a perception that it's only the moment of ejaculation that creates risk, so what couples will do is use the condom only long enough to catch, if you will, the ejaculation. But before and after ejaculation occurs, there is potential for infectivity.

Other examples would be using condoms that are not stored properly or that for any reason have been damaged. Couples who use condoms correctly should store the condoms in a cool, dry place. They should make sure the condom is not damaged in any way, whether that's a puncture hole through the package or even opening the package incorrectly. Teeth, sharp fingernails, scissors and other objects should never come near a condom.

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I again want to provide a caveat here that I think is critical, and that is the most common error of all errors is not using a condom at all.

When do you think couples should talk about condom use? It's critical for couples to have that discussion before they become sexually aroused. When couples have already entered a stage of foreplay, it's much more difficult for most people to really slow down and talk about something as seemingly mundane as the prevention of disease.

This discussion about disease is in fact antithetical to the whole scenario of love, romance, trust, intimacy. And so certainly, having the discussion during the sexual interlude or preceding the sexual interlude is highly problematic.

Do you have any advice for how people can best broach the subject? Unfortunately, we really have very little research to suggest that one approach is better than another. I can only suggest that couples entering the conversation in the spirit of mutual decision-making are going to be way ahead compared to couples where one person is making the sexual decisions.

Next: A Condom Tutorial

Last updated: 10/05

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