Executive Summary
When used consistently and correctly, latex condoms are effective at preventing sexually transmitted infections (STIs), including HIV.
• The most recent national surveillance data indicate that sexually active adolescents and young adults are at increased risk for STIs when compared to older adults.
• Multiple types of condom-use errors and problems are prevalent among men at high risk of infection, including “fit-and-feel” problems, breakage, lost erection, and slippage. Proper counseling and provision of high-quality condoms and lubricants can help men and their partners have “better sex with latex.”
When used consistently and correctly, latex condoms are effective at preventing sexually transmitted infections (STIs), including HIV. But are young men getting the information they need to use condoms correctly?
Young men especially need to hear the condom message. The most recent national surveillance data from the Centers for Disease Control and Prevention indicate that sexually active adolescents and young adults are at increased risk for STIs when compared to older adults.1 Consider these statistics:
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In 2013, as in previous years, men ages 20-24 had the highest rate of chlamydia (1,325.6 cases per 100,000 males) among all male age groups.
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Men ages 20-24 had the highest rate of gonorrhea (459.4 cases per 100,000 males) in 2013 among all male age groups. During 2012–2013, the gonorrhea rate for men in this age group increased 1.3% over the previous year.
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In 2013, the rate of primary and secondary syphilis among men ages 15-19 was the highest reported since 1995: 6.4 cases per 100,000. Men ages 20-24 in 2013 had the highest rate since 1992: 27.7 cases per 100,000.1
Multiple types of condom-use errors and problems are prevalent among men at high risk of infection, including “fit-and-feel” problems, breakage, lost erection, and slippage.2 What are key points for providers to mention when it comes to correct application and proper lubrication?
First, emphasize that men and their partners — whoever the partner may be, male or female — must decide the right fit and feel of condom, says Richard Crosby, PhD, endowed professor and chair of the College of Public Health at the University of Kentucky in Lexington. There are too many types of condoms on the market today for men not to experiment with them, says Crosby, a member of the Bloomington, Indiana-based Kinsey Institute Condom Use Research Team, an international research group.
Much like trying on shoes, men should find the one type of condom that they like the best, the one that makes them feel confident, secure, and at the same time, comfortable knowing that they are protected, Crosby notes. “It shouldn’t feel like they are wearing something that is awkward,” states Crosby. “It would be like wearing the wrong size shoe.”
Remember that condoms come in different materials, says Anita Nelson, MD, professor in the Obstetrics and Gynecology Department at the David Geffen School of Medicine at the University of California in Los Angeles. Polyisoprene condoms (Durex RealFeel, RB plc, Slough, Berkshire, England and LifeStyles Skyn, Ansell Healthcare Products, Iselin, NJ) can help transmit body heat while protecting against STIs, especially for latex-allergic couples, she notes.
Include partners in choice
Equally important is that the selected condom be compatible with the fit and feel preferences of the sex partner, Crosby says. One style or make of condom might work well with one partner, but the same condom might not be as good for another partner, he notes. This search for the right fit and feel gives couples a chance to talk about condom use, which in essence also leads to more condom use, says Crosby.
“If they talk about condoms before they have sex, they’re more likely to actually use condoms during sex,” says Crosby. “It creates sort of a built-in mechanism for the couple to dialogue about safer sex, way before they have it.”
Be sure to offer ample supplies of high-quality lubricants to men and women. There are now silicone lubricants that last longer and feel better than traditional water-based lubricants, says Crosby. Lubricants come in different sensations, viscosities, and scents, and they are attractively packaged, says Crosby.
“Single-use lubrication vials should always be standard. Like a hamburger and fries at McDonald’s, you wouldn’t order one without the other,” notes Crosby. “When you’re giving people condoms, allow them to choose from an equal and high-end supply of lubricants.”
Recent studies have identified a number of potential safety issues with personal lubricants; data suggest that lubricants with high osmolality might cause vaginal and anal epithelial damage.3 Until definitive answers are reached, refer to an international technical advisory listing on commercial lubricants (http://bit.ly/1AdGZtB) to check osmolality of current options.
There is no reason to spare the expense when it comes to buying quality condoms and lubricants for clinic distribution, states Crosby. The argument of “we can’t afford them” does not hold up, he advocates. A 2011 estimate of costs for diagnosis and treatment of chlamydia offered figures of cost per case at $20 in males and $244 in females.4 Given those figures, providing high-quality condoms and lubricants is cost-effective, says Crosby.
Crosby suggests using the phrase “better sex with latex” to remind patients that protected sex is sex that is free of worries about giving or getting an STI. Without those anxiety feelings, patients can magnify the overall experience so it is more satisfying, focused, and less of a guilt experience afterward.
Ask the patient, “Do you want better sex?” says Crosby. This question leads into a discussion about the positive aspects of condom/lubricant use. By offering the patient a variety of quality condoms and lubricants for take-home use, it develops an ongoing relationship with the patient. This action turns the dynamic from “we don’t want to see you with another STI” to “we want to see you come back for refills on condoms and lubricants,” Crosby notes.
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Centers for Disease Control and Prevention. Sexually Transmitted Disease Surveillance 2013. Atlanta: U.S. Department of Health and Human Services; 2014.
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Crosby R, Yarber WL, Sanders SA, et al. Slips, breaks and “falls”: Condom errors and problems reported by men attending an STD clinic. Int J STD AIDS 2008; 19(2):90-93.
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World Health Organization, Department of Reproductive Health and Research, United Nations Population Fund, Family Health International. Use and procurement of additional lubricants for male and female condoms: WHO/UNFPA/FHI360. Accessed at http://bit.ly/1AdGZtB.
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Minnesota Chlamydia Partnership. The Minnesota chlamydia strategy: Action plan to reduce and prevent chlamydia in Minnesota. Accessed at http://bit.ly/1b0dKVd.
