Being Smart About Condoms

For some, Valentine's Day is an important reminder to romance your loved one. But February 14, which is also National Condom Day, should also serve as reminder of the importance of protecting yourself and your partner from sexually transmitted disease (STD).

According to the American Social Health Organization, there are an estimated 15.3 million cases of STDs diagnosed every year in the United States. And many of these men and women don't know that they have an STD. As a result, people—especially those in committed relationships—tend to underestimate their risk of transmitting or acquiring an STD and are often lax about condom use. By developing a sense of "negotiated safety," couples often come to the unfounded conclusion that they are not putting each other at risk for an STD.

Other couples avoid discussing condom use until they're just about to have sex—and are less likely to make a reasonable decision. And still others use condoms incorrectly, sometimes making sex less enjoyable and the condom less effective.

Below, Richard Crosby, PhD, of the College of Public Health at the University of Kentucky in Lexington, discusses common barriers to condom use and why couples need to make decisions about condom use together.

Are more people using condoms today than they were 10 years ago? There have been some increases and some general trends towards stability, with very little evidence of decline. We have some evidence that condom use among adolescents increased substantially in the 1990s and is now relatively stable. But among young gay men evidence suggests the possibility of decreases in condom use. These are men who have always known AIDS, and who, in a sense, may have accepted AIDS as a normal part of gay life. And it's these men who we're particularly worried about in public health.

What are the main factors that influence use? I think the answer is really a function of whom we're talking about. The factors that influence use for adolescents are going to be quite different than those that influence use for adults. Among adolescents, factors like peer norms are important. For example, adolescents who have friends who use condoms are more likely to use condoms themselves. And there's also evidence suggesting that once pregnancy concerns are addressed with oral contraception, for example, condoms may no longer be used.

In adults, a lot of factors have been studied, and probably one of the most commonly reported findings is adults in steady relationships are far less likely to use condoms than those who are having sex within non-steady relationships.

Why are committed couples less likely to use condoms?Trust may be part of it. Some couples will eventually get to a point where there is some mutual testing for HIV or STDs. But couples may be more likely to develop a sense of negotiated safety, where they may make some agreement not to have sex with others and they may in a sense make some unfounded judgments about the other person's risk of transmitting an STD or HIV. There's also some evidence that at some point people in a steady relationship subsequently decide to abandon condom use altogether. Although the evidence is not definitive, their thinking may be: "If we were going to have a problem as a result of having unprotected sex, that problem would have occurred by now." That's an unfounded judgment as well.

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Is forgoing condom use actually discussed? We have evidence showing that some of that negotiated safety is something that partners discuss and the decision is a mutually agreed-upon decision by the couple. In other cases, though, the decision may be unilateral. It may be a decision that is made by a female or a male partner. In many cases, the evidence suggests that male partners make this decision more often than female partners. This form of unilateral decision-making is clearly problematic if the male partner is unconcerned about transmitting HIV, STDs or causing a pregnancy.

Why don't people like using condoms? Lack of pleasure and irritation caused by condoms are very common. But because people often have very little instruction on the correct use of condoms at all, they wind up experiencing problems related to fit, irritation, and dryness. I want to add that the correct use of condoms and lubrication for condoms can dramatically diminish those pleasure barriers.

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Written in: 2/05. Last Reviewed: 10/05.

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