The Skinny on Condoms

Safe sex is synonymous with using condoms. Whether you choose to use a traditional condom (for men) or the larger female condoms, a barrier method is the only way to currently protect against bacterial or viral infections being passed from one partner to another. Remember that sexual contact even one time with a partner can result in a sexually transmitted infection, and you can't always tell who has an infection or who doesn't. Sometimes a person may not even know if they themselves have an infection (such as HPV, Chlamydia, Gonorrhea, trichomonas, or HIV) when they meet a new partner, so you should be responsible to protect yourself.

Although condoms are the gold standard for STI prevention, there are several things that cause people to shy away from using condoms. Some of these complaints are decreased sensitivity, difficulty in keeping an erection while using a condom, discomfort in wearing a condom, and irritation during or after using a condom. It may take a little trial and error, but most of these issues can be overcome with some practical information and practice.

Firstly, in order to put on a condom, a man should already have an erection that is satisfactory. If you attempt to put on a condom before a man has a complete erection, the pressure from the condom could actually prevent having sufficient blood filling the penis for a good erection. Once a man has an erection, however, this pressure does not effect the hardness of the erection. Some men, however, find that they start to lose their erection when they put on a condom. This is usually related to their thoughts about condoms which can cause anxiety or negative ideas, or is a combination of those psychological factors combined with physical factors.

If a condom does not fit well, it can result in decreased sensitivity, discomfort, or even pain. For most men, finding a condom that has the proper width (yes they vary in how wide they are as well as how long) makes all the difference. If a condom ring is too tight around the shaft of the penis, it may be too uncomfortable to get lost in the moment and really enjoy sex. If the width seems to be ok, but there is still a considerable decrease in sensitivity, try using condoms that have a wider area around the tip, so that there is movement around the most sensitive part of the penis during penetration, which feels more natural. Regardless of what style of male condom you choose, you should leave some extra space at the tip of the condom to give room for the semen to collect after ejaculation. If your erection is a little shorter than the condom, it is better to leave more extra space at the top, since you should be able to unroll the condom completely for comfort and effective use. With practice, you will know just how much to leave for yourself.

If you are finding that male-style condoms are too constricting for comfortable sex, then you may benefit from trying female condoms. They are condoms designed to be inserted into the vagina and stay put with a ring that holds onto the cervix. They are inserted all the way into the vagina with the outer ring covering part of the labia first, then pushing the rest of it up as far as it will go and having the inner ring surround the cervix. The outer ring always stays on the outside and actually provides more coverage of the labia, which can decrease those sexually transmitted infections that are passed on with skin to skin contact (like genital warts and Herpes). Since the female condom is much wider, it doesn't cause the squeezing that is uncomfortable for men who are very wide. The female condom does take some practice to use effectively, and you must ensure that the outer ring doesn't slip into the vagina during penetration (sometimes you may need to adjust it).

One of the great drawbacks of using condoms is that people may experience more irritation during or after sex. It is important to use lubrication on the outside of the condom and should be reapplied regularly during sex. Keeping the lube within arm's reach during sex helps keep the action moving right along. Since condoms are destroyed by oils, choose only water-based lubricants. Also, keep in mind that many people find glycerin to be be irritating to their mucosal tissues, so finding a glycerin-free lube is always best. Never use lotions, creams, or any other type of lube not specifically designed for sex since they may contain oils in them and can be very irritating inside. Stay away from condoms that contain nonoxynol-9 spermicide, since this is particularly irritating.

If you find that latex condoms are the cause of your irritation (or you just don't care for the taste, smell, or feel), find yourself condoms made of polyurethane or polyisoprene. Both of these are thinner than latex, so provide a more natural feel. Polyurethane is much less stretchy than polyisoprene (which is a great plus for some people), but transfers body heat pretty well. These are all options to consider when finding the condom that you like the best. By finding the condom that works best with your anatomy and preferences, many of the complaints often heard with condom use can be eliminated for a safe, pleasurable sexual experience. And don't forget your "Kiss of Mint" for safe sex while giving a blowjob!

Knowledge is Power

To have health and balance in our lives, we have to be able to give ourselves permission to have pleasure and fun, but at the same time be aware of and take responsibility for our actions. Because of this, when we have knowledge, we are in a position of power to make the best decisions for ourselves. This is true for every aspect of life including our sex lives and decisions related to it. And I would briefly like to comment on how this relates to new recommendations announced today from the American College of Obstetrics and Gynecology for PAP smears (unfortunately timed just after the new recommendations for mammograms).

The ACOG is 'simplifying' PAP guidelines by stating that women do not need to get their first PAP until age 21 years old. Furthermore, they are recommending that now women only need to have a PAP smear every 2 years (instead of yearly) if their test results have been normal. There used to be additional recommendations related to the age that a woman becomes sexually active, but these are now being touted as 'confusing.' The new recommendations have been established after years of studies and data collection and there is validity to the points being made by the ACOG. But what I see missing here is the element of patient education and information.

We know that girls are becoming sexually active at an earlier age than a decade ago. We also have studies that show increasing incidence of Chlamydia and even Syphilis (up 36% in women in the US!). Also, a recent study from the Univ. of Waterloo in Canada found that an increasing number of seniors are contracting HIV from unprotected sex - possibly because they don't believe that they are at risk for such STDs.

Women need to know the facts about sexual activity and how it related to cervical cancer risk, as well as risk for all STDs and complications that accompany them. They need to be told (repeatedly) that the more sexual partners they have, the increased risk for developing cervical cancer. Education is the key for them to understand their risk so that they can make smart decisions both about their sexual activity and their medical care related to it. If teenage girls are starting to have sex at an earlier age (sometimes 7 years before they hit the age of 21), they need to know that they should be going to the ObGyn for a pelvic exam and a PAP smear. And girls who have received the HPV vaccine should not consider themselves 'protected' since the injection does not protect against all strains of HPV known to cause cancer. I do not think that we can teach abstinence with the hope that it will work. So instead, we need to have an over-abundance of education about risks and responsibilities that come with being sexually active. Knowing when your need for PAP is increased because of your sexual activity is one of those responsibilities and leaving it up to statistics is dicey.