Sometimes I feel a conflict between what I know I should say as a doctor, and what I want to say as a woman. My patient J. came in on Friday for her annual, and joyfully told me that the guy she's been dating for four months "might be the one." She's been on the Pill and they've been using condoms, and J. wanted to know if they could pass on the latex now that they've been together for a while.

My internal dialogue, conducted while J. was undressing, went something like this:

Cautious Doctor: Excellent! J. found someone she's happy with!
Trusting Female Friend: I know, and now she can stop using condoms--sex is so much nicer without them.

CD: Not so fast! Just because she says they're both monogamous, doesn't mean that he is saying the same thing to his doctor, or friends, or the woman in the bar...
TFF: You're such a cynic! Don't you believe in love?
CD: I totally do.  And I believe in J. But it's my job not to believe in her boyfriend--that's how I can best keep her safe.
TFF: What, so married couples have to use condoms, too? When does it end?
CD: When you stop caring about safety!
TFF: Stop being a prig! We have tests for STDs, you know.
CD: I know, but certain tests like HIV can take months to come back positive.
TFF: So let her get tested now, and again in a few months.
CD: Hmmm. Well, there's also the issue of pregnancy. Using two methods is even safer than using one.
TFF: True. But the Pill used correctly is still pretty safe, and J. may think the trade-off is worth it.

I've called a truce between CD and TFF. What I tell my patients who are going steady and want to deep-six the Trojans:

• Use condoms EVERY TIME you have sex for the first six months.
• After six months, both of you should be tested for STDs--HIV, chlamydia, hepatitis, the works. If you both test negative, you may decide to forego the condoms. 
• If you don't want to get pregnant, you'll need to use a very effective method of birth control, very consistently.
• You have to trust that your partner is truly monogamous--if you have any doubts, back on with the latex.
  

Nothing is foolproof, but this seems to be the best compromise. What do you think? When do you stop using condoms in a monogamous relationship?