Counsel on correct, consistent condom use
When men leave your family planning clinic, they may leave with a supply of condoms in hand. But do they leave with good information on the importance of correct, consistent condom use?
Many clinicians may talk about using condoms consistently, but don't spend much time talking about correct use, says William Yarber, HSD, senior director of the Rural Center for AIDS/STD Prevention at Indiana University in Bloomington and lead author of a new research paper on condom use. Incomplete use of condoms is a "big issue," Yarber notes, because it can lead to exposure to sexually transmitted disease and unintended pregnancies.
Results from the new study indicate that men who are highly motivated to wear condoms are more likely to put the condom on before having sex with a woman.1 However, men who have trouble with the fit and feel of their condoms or experience an erection loss while wearing protection are more likely to take the condom off prior to the end of intercourse, data suggest.
Ask the questions
In the study, investigators focused on the factors involved in why male patients at an urban Midwestern STD clinic would don condoms after initiation of vaginal intercourse and remove them before sex ended. A total of 278 male patients participated in the survey.
Nearly one in five men (18.7%) reported starting sex prior to donning a condom in the past three times a condom was used. Of the 278 participants, 88 reported that their condom had broken on one or more occasions; of the remaining 190 men, 23.7% said they had removed the condom before sex ended during at least one of the past three times they used condoms.
Engage patients in a discussion about how condoms are used, suggests Richard Crosby, PhD, professor in the College of Public Health at the University of Kentucky, Lexington and a co-author of the current paper. Ask questions such as "Have you ever noticed that your partner or yourself may sometimes put the condom on after sex begins?" Crosby advises.
If the patient acknowledges this fact, Crosby suggests to affirm the condom use by saying, "You know, it's wonderful that you're using condoms, and as long as you're using condoms, it makes so much sense to go the extra effort that it takes to make sure that the condom is on before you first penetrate, and make sure it stays on until that penetration ends."
While it is important to tailor messages to individual patients, Crosby says one objective about condom use needs to be stressed with all condom users: Condoms don't work well unless they are used from start to finish of penetrative sex.
"That's a very clear and concise message for anyone in a clinic. I think saying it any other way leaves too much of a loophole for people," Crosby reflects. "The word 'penetrative' is fairly easy for just about anyone to understand when it comes to sex, and it suggests that when the penis goes in the vagina, there needs to be a condom on and it needs to stay on until that penetration ends."
Take a positive approach when it comes to condom counseling, advises Crosby. Counseling messages may go further if delivered in a positive manner, he notes. "Most STD clinics require long waiting periods, so people may be irritated, frustrated, and it is all too common that they feel judged," says Crosby. "With an STD, people feel stigmatized, so the last thing we want to do as providers is add to that. We want to emphasize the positive."
Mix styles, sizes
If there's just one choice when it comes to sizes and styles of male condoms at your clinic, check into expanding your selection, advises Yarber. Men reporting difficulties with the fit and feel of condoms in the new research were 2.5 times more likely to remove condoms early.1
"We found out that a lot of people have their own style [of condom] that they like, and once they find that, they like to use that," says Yarber. "If the clinic has a variety, patients have a greater chance of acquiring that — at least it gives them some choices."
Provide patients with printed information on correct condom use, advises Yarber. (The Center for Health Training in Oakland, CA, offers a male condom information sheet for free download on its site, www.centerforhealthtraining.org. Click on "Materials & Resources," "Contraceptive Fact Sheets," and "Male Condom.") Penile models also help demonstrate correct condom usage, notes Yarber.
- Yarber WL, Crosby RA, Graham CA, et al. Correlates of putting condoms on after sex has begun and of removing them before sex ends: a study of men attending an urban public STD clinic. Am J Men's Health 2007; 1:190-196.