Your clinic can boost condom use
Does the condom program at your clinic consist of filling a bowl with one style of condoms in the waiting room? If so, you may want to rethink your strategy.
According to research by Richard Crosby, PhD, associate professor in the College of Public Health at the University of Kentucky in Lexington, men who experience problems with the fit or feel of condoms are more likely to encounter breakage and be less motivated to continue using them.1
Men have preferences for different shapes, degrees of lubrication, and even scent when it comes to condoms, notes Crosby. Since penis sizes vary, it is important to offer a variety of sizes of condoms as well, he adds. Purchase several different types of condoms for a "cafeteria" of condom selections, rather than buying a bulk order of one style of condoms, Crosby suggests.
"Often it's the case whoever is paying the bill will go low bid," he says. "That is fine if you're putting up a building or if you're installing an air conditioning system, but it's not the way to go if you want to prevent sexually transmitted diseases. The cost of buying even the most expensive condom on the market in bulk is miniscule compared to the cost of what it takes, for example, to treat a case of gonorrhea."
In one study of condom use in college-age students conducted by Crosby and research associates, nearly one-third reported discomfort with use, including tightly fitting condoms, vaginal irritation, and loss of sensation.2 Students who reported discomfort were 3.6 times more likely to also report breakage.2
When providing condoms, also provide additional water-based lubricants, suggests Crosby. Be sure that patients know the importance of using water-based lubrication — oil-based lubricants such as petroleum jelly and baby oil can reduce latex condom integrity and facilitate breakage.3,4 Lubricants such as Astroglide (BioFilm, Vista, CA) and Wet Original and Wet Light (Trigg Laboratories, Valencia, CA) now are available in convenient personal-size packs that are good for one or two acts of intercourse.
"Women don't have a problem putting a toothpaste-size tube of water-based lubricant in their purse, but men typically don't have that type of room in their jeans." Crosby notes. By offering the personal-size packs, men will be more likely to carry — and use — lubricant, he says.
Banish the myths
Oregon State University in Corvallis provides information on correct condom usage in several ways, reports Lora Jasman, MD, the school's director of student health services.
"We typically provide written information that accompanies any brochures that are given out, whether in a class, one-on-one consultation and clinic visits, and during outreach events," she notes. "When appropriate, some of our outreach also involves how to put on and take off a condom properly."
Such education is important, says Crosby. Be sure that patients know that a condom should be donned before the penis comes in contact with the partner's mouth, anus, or vagina.5 Soon after ejaculation, the penis should be withdrawn while it still is erect. The condom should be held firmly against the base of the penis to prevent slippage and leakage of semen.5
"All of my studies tell me the same thing — men typically cheat when it comes to condom use," observes Crosby. "They will use the condom, but not necessarily from start to finish of sex."
Ask men about their previous condom use, Crosby says. If a man has experienced an erection loss while wearing a condom, he may associate condom use with diminished sexual prowess. Note that erection loss is a common occurrence, and encourage continued use of condoms. "In some of the studies I am doing, we are finding that when there is erection loss during condom use, it is important to counter any perceptions that men might have which would preclude their future condom use, based one or two episodes of erection loss," he states.
According to Contraceptive Technology, condom use can be fun for both partners when it is made part of sexual intercourse.5 Be sure to include this fact in your counseling, Crosby advises." I think more than anything that patients need to understand that condoms don't have to take away from the pleasure of sex," he states.
References
1. Crosby RA, Yarber WL, Sanders SA, et al. Men with broken condoms: Who and why? Sex Transm Infect 2006 Jul 26; [Epub ahead of print].
2. Crosby R, Yarber WL, Sanders SA, et al. Condom discomfort and associated problems with their use among university students. J Am Coll Health 2005; 54:143-147.
3. Voeller B, Coulson AH, Bernstein GS, et al. Mineral oil lubricants cause rapid deterioration of latex condoms. Contraception 1989; 39:95-102.
4. Steiner M, Trussell J, Glover L, et al. Standardized protocols for condom breakage and slippage trials: A proposal. Am J Public Health 1994; 84:1,897-1,900.
5. Hatcher RA, Trussell J, Stewart F, et al. Contraceptive Technology: 18th revised edition. New York City: Ardent Media; 2004.
Resources
- To get an idea of different styles of condoms now available on the market, check Internet web sites such as Condomania (www.condomania.com) and Condom Depot (www.condomdepot.com).
- For more information on Astroglide, contact: BioFilm, 3225 Executive Ridge, Vista, CA 92081. Telephone: (800) 848-5900. E-mail: customer. [email protected]. Web: www.astroglide.com.
- For more information on Wet lubricants, contact: Trigg Laboratories, 28650 Braxton Ave., Valencia, CA 91355-4163. Telephone: (661) 775-3100. E-mail: [email protected]. Web: www.stayswetlonger.com.
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