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This Is Not Your Dad’s Talk About Condoms

This Is Not Your Dad’s Talk About Condoms
This Is Not Your Dad’s Talk About Condoms
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Do condoms work? Yes, they do. Most emphatically: they do. They work better at preventing STIs (sexually transmitted diseases) than as a contraceptive but, when used properly, they work almost 98% of the time to prevent pregnancy. But when you use them out in the field, not so much. That’s why, for purely contraceptive purposes, I recommend the IUD or long acting injectable hormones over condoms.

But, even when you have pregnancy prevention covered, you have to protect yourself against STIs. And, apart from abstinence, condoms are your only good bet. I always tell my patients the only sexual history you ever really know is your own. After twenty-odd years in acute care medicine, I’ve delivered babies for women who claimed to be virgins and diagnosed HIV in men who were adamant their only partner in twenty years was their wife. It’s an even tougher sell when their wife is HIV negative. You get the picture: nobody knows anybody when it comes to sex.

So how good are condoms at preventing STIs? The answer is: depends. Depends on if you actually put one on, when you put it on, and if you put it on and take it off right. Every guy thinks that because he’s a guy he knows how to put on a condom.  And yet, I’ve treated a ton of men with STIs. So, my first piece of advice to all you guys reading this is to practice. Yes, practice – before the big show and preferably without an audience.

Think of it: during the main event, the pressure is on. You’re all excited, caught up in the moment. The good-looking guy or gal is staring, waiting…”Let’s do it already.” No wonder the fumble happens: you roll it on backwards, you forget to leave space at the tip for the pressure to get out as you thrust in and out and for the inevitable fluid.  So, I recommend you masturbate in a condom from start to finish. This way you get used to how it feels–and more importantly, you learn how to pull it off when it’s “full.” Pulling off a full condom is as tricky as putting one on. You have to hold the base so nothing leaks, otherwise you might as well have gone  bareback.

The other disaster is to dip into the pool for a quick look around then get out and glove-up for the main event. That’s a big no no no and bad bad bad. Why? Well, the medical term is “exchange of body fluids” and, at this party, there are all kinds of fluids besides semen. Think vaginal secretions and, during anal play, frequently blood. This means no dipping into the pool guys. Glove-up before the penis explores any orifice even for a few thrusts. And remember, STIs can be spread orally too. It’s uncommon, but it happens.

So, what kind of condoms should you buy? Latex are the best, provided you’re not allergic. And be sure to get the right size. Not too small or they will burst as you thrust in and out, and not too big or you’ll slip out of it. Don’t keep them in your wallet as it messes them up and, like all things in this world, condoms have an expiration date. Never, of course, open them with your teeth. Holes in condoms do not improve their success rate, but they do increase your chance of being called dad or seeing a guy like me with a white coat because it burns when you pee. Not fun.

You should also know that condoms are more effective at preventing fluid borne STIs, like chlamydia or gonorrhea, versus ones that present as painful sores, like herpes. That’s why I think you should talk to your partner, even if it’s just a “sex buddy,” and ask if they’ve ever had anything “down there” that you need to worry about. Granted, this is an awkward conversation, but well worth it.  Keep in mind, we docs can cure chlamydia, gonorrhea and syphilis. Herpes and the much more serious HIV can be managed but not cured–you don’t want to be in either boat. Believe me.

So. picture this: you’ve done everything right but the condom bursts. What then? In heterosexual sex, the morning after pill will prevent a pregnancy provided the woman takes it within 48 hours of the event. The quicker she takes it, the better it works. And remember this: it’s a contraceptive, not an abortifacient. In other words, it prevents a woman from getting pregnant. It doesn’t abort a fetus already implanted. Ignore the propaganda out there.

The good news is the morning after pill is available in your local friendly pharmacy without a prescription, so you don’t need to see a doctor. They’re there for you when you need them as soon as you need them. Keep in mind though, the morning after pill is the same as the regular pill except that it’s a much bigger dose. Consequently, bad nausea is a common side effect. And gals, this is for emergency use only; it’s not something you want to do on a chronic basis because of the doses involved.

And what if the condom bursts and you’re engaged in high-risk sex, whether gay or straight? HIV prophylaxis is available. In other words: powerful anti-viral agents that will prevent you from getting an HIV infection. Check out my Truvada podcast if you want to learn more. Your local, friendly ER will help you with the logistics of that one.

Finally, I don’t need to tell you that where there are people, there is sex. Always was, always will be. It’s part—an essential part—of how we connect with each other. So go. Connect. Have fun. But be smart. Use a condom. Use it well. Use it always.


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