Last week on Howard Stern, hip-hop star Flo Rida
said he always uses condoms, even when receiving blowjobs--said he'd never consider NOT using one. A confession like that (or shall we call it a proud boast?) was perfect timing to to kick off National Condom Week, which cheekily starts every year on Valentine's Day. The week is a time to reflect on how safe your sex is, brush up on your latex lessons, and stock up on high quality condoms that both fit well and feel good (guys AND gals). And so we thought we'd catch up with Dr. Kate for a refresher condom course...

Em & Lo: What do you think is the biggest error people make when using condoms?

Dr. Kate: Based on what I hear from patients, the biggest condom error is not using them. I know that sounds daft, but most people who "use" condoms as birth control don't use them with every sex act--and that accounts for most failures.  The next biggest problem is not taking the condom off before shrinkage (and spillage) occurs.

Em & Lo: Condom campaigns always seem to do well. But dental dams? We know of very, very few people who actually use them (despite our excessive encouragement to do so). So, tell us, as a doctor, how likely is it
that you'll give or get an STD from oral sex, in comparison to the likelihood of giving or getting something from penetrative genital sex?

Dr. Kate: It's a question that I'm asked all the time...the answer is "less likely, but we don't know how much less." In defense of my research colleagues, it's a tough thing to study--it's hard to find folks who are ONLY engaging in oral sex, to study what their rates of infection are.  So our message to use protection for all forms of sex hasn't changed.

Em & Lo: What do you think of the female condom? Do you know anyone (patients or friends) who actually use them? (Sadly, we don't.) Is it an option that will ever catch on?

Dr. Kate: I have had patients who have tried it, but I don't have any patients who use it regularly.  I'm not sure it will ever become popular (or even widely used), but I'm still glad the option is out there.

Em & Lo: Polyurethane condoms are only recommended for people with a latex allergy by the FDA; otherwise, they say, always go with latex, right? And that is because polyurethane condoms have a slightly higher
chance of breaking or falling off than their latex brothers, correct? But if we're talking correct usage--meaning the right fit for the guy and added water-based lube to keep things slick--shouldn't people who don't have latex allergies feel secure about using polyurethane condoms (as long as they do so "correctly") if they like the feel of them? (They're thinner and conduct body heat better.)

Dr. Kate: It's funny, some of my patients who use polyurethane condoms don't like them better, because they feel that the condoms are thicker, and don't feel as good.  But I agree that used correctly, poly condoms are a great option for everyone.  Women who use them (any condoms, really) should always keep planB in mind in case of breakage or spillage.

Em & Lo: We're in the "Just say no to Nonoxynol-9 spermicide" camp--if not for the possibility that it makes HIV easier to catch from an infected partner, just for the irritation it can cause women. How about you?

Dr. Kate: I'm actually not against non-9.  The studies looking at HIV infection studied women who had MULTIPLE sex acts per week--most of my patients are not having intercourse upward of 7-10 times every week (well, maybe early in a new relationship...).  And unless they're engaging in any other risky behavior--IV drug use and the like--I can't say for certain that their HIV risk is very increased.  I always promote the hormonal based birth control methods and condoms as the most effective, but for women who only want to use condoms, spermicides can decrease the chances of an unwanted pregnancy.  Though certainly, if irritation develops, I tell them to deep six the spermicide.

Em & Lo: We often recommend that women just avoid any lubricated condoms (or lubricant alone) that contains glycerin--why put anything with sugar in or on your most treasured bits and risk infection? Just seems like good sense, health-wise--kind of like eating organic. But how common are vaginal infections from lube with additives?

Dr. Kate: Unsurprisingly, there's not any good research done in this area, so all of the advice I give is anecdotal. I've never seen a patient with a vaginal infection from a flavored condom or the like, so I don't think the risk is very high.  But for women who are especially prone to infection--multiple infections in the past, or diabetic--I too tell them to steer clear of glycerin.

Em & Lo: We're all for promoting the consistent and widespread use of condoms, for sure. But you never really hear from the health education community about the infections you can get even when you wear condoms correctly every time. Why do you think that is?

Dr. Kate: I think that health educators want to maintain a clear simple message.  It's so much easier to say "Wear a condom to protect your health" than "Wearing a condom will keep you safe most of the time for most infections, though won't give you full protection for herpes and HPV." It's not nearly as snappy, and doesn't fit on a t-shirt.

Em & Lo: Agreed. But we worry that erring on the side of snappiness may give young people (and adults too) a false sense of security: as long as they wear a condom, they don't have to worry about, say, herpes or genital warts (false!) and thus don't have to have the conversation about sexual history and recent STD tests. We know that sounds like a tactic of the abstinence-only camp--emphasizing the negative--but accuracy and clarity seem key.

Dr. Kate: I totally agree.  Full disclosure before the full monty is vital.

Em & Lo: Speaking of abstinence-only programs, research has shown time and again they don't work--good information on sexual safety and health that includes info on abstinence does not make people more promiscuous. However, what do you think about making free condoms available to young people, like they're considering in the UK? Seems like the abstinence-only people could (and probably will) make a strong case that having something like a physical vending machine could put extra pressure on kids to have sex. Like, if you don't hang out the vending machine, you're not cool.

Dr. Kate: I think making condoms free and widely available is a fantastic idea.  The average age of first intercourse has risen only slightly in the past few decades.  Teens have always been having sex (it's hardly a new phenomenon)--programs like the UK one just increase the chance of that sex being safer.

Em & Lo: Do you have a favorite condom? Either a brand you currently use or used to use?

Dr. Kate: I was a big fan of Kimono condoms before I got married (and stopped using them)--they were the thinnest I had tried, but never broke. Not always easy to find, but they were worth the search!

Em & Lo: We're down with the Kimonos too, as well as Pleasure Plus and Inspiral.


Hildy said:

You mention eating organic is good sense - I use an organic lube, yes pure intimacy. They say it is the only one certified organic. It has no glycerin and no parabens and it feels sooooo good. You should check it out - They told me it is ok with condoms but you can't buy condoms with it on.
Happy condom week, H

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Em & Lo, more formally known as Emma Taylor and Lorelei Sharkey, are the self-proclaimed Emily Posts of the modern bedroom.

Dr. Kate is an OB/GYN at one of the largest teaching hospitals in New York City.

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