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Learning and Teaching
the Use of Condoms

Barnaby B. Barratt

Barnaby is certified by the ‘American Association of Sexuality Educators, Counselors, and Therapists’ as a Sexuality Educator and Sex Therapist. This article has also been published in their journal, “Contemporary Sexuality.” A more extensive version of this essay, along with other useful material, is to be found in Barnaby’s small book, “The Ten Keys to Successful Sexual Partnering” (Xlibris, 2005).

The use of barrier protection is crucial for sexual health. Given that current estimates conservatively suggest that well over 20% of the population of the United States now actively carries a sexually transmissible infection, it is essential that everyone, young and old, partnered or not, knows the basics of enjoying sexual expression risk reductively. And this means the use of barrier protection.

Barrier protection is the use of a sheet of latex or polyurethane to prevent a risky fluid passing from one body to another. A risky fluid is one that plays a significant role in bacterial, viral, fungal or parasitic transmission. Most people take barrier protection to mean use of a male condom. Condoms are highly effective not only in preventing pregnancy, but also in reducing the risk of disease transmission.
Although male condoms do not always cover enough of the genitals to entirely prevent the transmission of some viruses – notably, herpes and human papilloma virus (HPV) – if properly used, they reduce the likelihood of such transmission, and additionally they have been shown to be highly effective in reducing the risk of HIV infection, which leads to AIDS. They should be used diligently and consistently for all penile vaginal and penile anal sex acts, as well as for penile oral contact.

These are my “top ten tips” for using condoms. I present them here very much in the manner that I teach them to students, patients, clients, colleagues, family and friends:

1. Make condoms sexy! Learn to enjoy using condoms. Talk about them, put them on ourselves in a way that feels sexy, or – if our partner is a man – put them on our partner in a way that is sexy. If we choose to adopt a positive attitude, condoms can be exciting and pleasurable. Worrying about catching a disease is not an aphrodisiac it is a drag. Knowing that we are protected, and that our partners are protected, permits us to relax into the sexual excitement of the moment.
2. Use latex or polyurethane condoms. Latex condoms are the most frequently used, and are very effective. However, you may find that you are allergic to latex – the head of the penis may feel irritable after a latex condom is used, or the vaginal mucosal tissue may react uncomfortably to the contact with latex. If either you or your partners experience discomfort with latex use, consider switching to a polyurethane condom or – if you or your partner is a woman – to the “female condom,” which I will discuss below. Do not use a natural skin condom for the prevention of disease transmission. These condoms feel good and are effective for preventing pregnancy, but they are not adequate to prevent viral transmission. Finally, try to buy from a reputable pharmacy and try to find a well known brand to suit your needs. Condom sales via the internet and through the mail can be a problem; manufacturers who are not subject to stringent quality testing can also be a problem.
3. Experiment to find the best condom for your penis. The size and shape of an erect penis varies from one individual to another. Find the brand of condom that is best for your erection, or for the erection of your partner(s). Condoms do vary in shape and size and there are many types available. For example,
   1. If you are uncircumcised, you may need to find a variety that is wider at the head.
   2. If your condom tends to slip off during sex, you may need to search for one of the types of condom that has a sticky, elasticized band at the base, or you may need to be sure to hold the condom on the base of the shaft of the penis during sex.
   3. If your erect penis is unusually thick or long, you may need to find a condom that is labeled “extra large.” But do not kid yourself – and do not let your partner kid you – there is no such thing as a penis that is “too big for a condom”!
   4. Finally, if you are carrying condoms for a partner, whose erect penis you do not yet know, carry at least two standard size latex condoms and one extra large one – this strategy will keep you safe in most, but not all, situations.
4. Practice putting condoms on! Do not wait until you are in a hot sexual situation to try putting on your chosen variety of condom. Get accustomed to putting one on your erect penis; practice frequently before you are with a partner. Obviously, this is especially important advice for young men who have not yet had much experience with partners.
5. Take care of your condoms. Store your condoms somewhere convenient - you never know when you may need them. Make sure this is a dry place where the temperature is reasonably cool, because latex perishes if heated. Check the expiration date on the package – again because the lifespan of condoms is limited. Never use condoms from a package that has been opened by someone else, or that have been left out of their package. And never reuse condoms.
6. Roll the condom on carefully. As soon as the penis becomes erect, the condom should be rolled on carefully, all the way down the shaft. No air bubble should be left in the top of the condom, even if a reservoir is provided for the ejaculate – this is because air bubbles can sometimes strain the condom and cause breaking. If you are uncircumcised, you will probably need to pull back your foreskin before putting on the condom. Be careful if you are wearing jewelry or have sharp fingernails, because these can cause small rips or tears in a condom that can later lead to breakages.
7. Keep the condom firmly on your penis. Until you ejaculate, the condom needs to be kept firmly on your erection. Taking the condom off and then putting it back on is not advisable. Once ejaculation has occurred, the condom needs to be removed and disposed of carefully. Put on a new condom every time you enter your partner.
8. Lubricate well! Most condoms come with some lubrication, and some even contain a chemical disinfectant that kills sperm as well as viruses and bacteria. However, for the pleasure of intercourse, additional lubrication is often helpful and sometimes lubricants that protect against diseases are also useful. Most important here is that all lubricants need to be water soluble (rather than based on oil or petroleum). This is because lubricants that are not water soluble damage a condom’s latex and this can cause breakages. With penile vaginal intercourse, it is also because oil and petroleum agents harm the delicate environment of the vaginal canal.
9. Consider condoms for oral sex. Condoms are typically used for penile vaginal and penile anal contact. However, they provide excellent protection against disease transmission during oral penile sex – that is, whenever a mouth sucks on a penis. Special non-lubricated or dry condoms – and even flavored condoms are sold for this purpose. If the taste of latex seems unpleasant, the partner offering oral pleasures can always suck on a hard candy, such as a peppermint, at the same time as taking in the penis. For oral vulval sexual contact, a condom can be cut open to provide a different sort of barrier, called a “dam,” which I will discuss this shortly.
10. Talk about condoms! It is healthy – and can be fun – to talk with your partners about condom use. And as with conversation about sexuality in general, talking with your friends and family can be a great antidote to all the shame and guilt that so often surrounds our sexual pleasures. Tell your partner that you insist on using condoms because you value yourself, and you value him or her. If your partner is a man, tell him that you like men who care about risk reductive pleasure – that is, men who use condoms and know how to use them! If your partner is a woman, tell her that you care about her too much not to be fully protective of your shared pleasures by using a risk reductive procedure!

In addition to the male condom, there are two other modes of barrier protection that need to be mentioned.

• The Female Condom. Compared with the male condom, the female condom is a relatively new device for the prevention of pregnancy and disease transmission. It was invented by a Danish physician and finally brought onto the American market in the 1990s. It is a wonderful device that has, very regrettably, not yet become popular in this country. So it is not always easy to find in pharmacies, and sometimes it is best purchased through a reliable mail order company that specializes in helping women with their sexual lives.
  
  The female condom is a polyurethane pouch that fits snugly in the vagina, held in position by an inner ring that goes past the pubic bone to nestle around the cervix. There is also an outer ring that remains outside the vaginal entrance, over the vulva. Instructions for inserting the female condom are always found inside every package and, although it takes a little practice to become accustomed to using this device, it is very advantageous and many women come to enjoy using it.
  
  The female condom gives women freedom to carry their own device, and to be in control of their own protection. It is very effective against unwanted pregnancy and disease control. It can also be used with extra lubricant, and even with the man using a male condom at the same time. For women who like to have genital intercourse several times, perhaps with different partners, the device can be inserted at the beginning of a sexual event and left in place for several hours.
  
  The only disadvantages of this device are that, being unfamiliar to most people, some individuals feel that it “looks or feels funny.” It can also make a little noise if thrusting during penile vaginal intercourse is vigorous. For some women, the inner ring puts some pressure against their cervix, which can be uncomfortable. If this is a serious problem, or if the woman has no cervix because she has had a total hysterectomy, then the inner ring can be removed and the device used as a loose internal pouch. If this is done, however, great care must be used to ensure that the condom does not work its way out of the orifice. The inner ring can also be removed so that this condom can be inserted anally – by men as well as women – as a protective device during penile anal sex.
• Dams. Dams are simply strips of latex that are placed over the vulva or anus when these areas are to be licked, kissed, or caressed with the mouth. So, like the use of non lubricated condoms for oral penile sex, these are simple barrier devices for use during oral vulval and oral anal contact. Dams are now sold in flavors by some sexually oriented retailers. However, ordinary kitchen wrap – or a condom cut open – can always be used. If kitchen wrap is used, it needs to be realized that the type of wrap recommended for use in microwave ovens has “micropores” in it, which make it permeable to viruses and bacteria. If such wrap has to be used, it needs at least to be doubled over. Other materials can also provide the protection of a dam if necessary – for example, the plastic bags used as wrapping by many dry cleaners.

Finally, everyone needs to learn and be able to teach some basics about the use of lubricants that contain a “chemoprophylactic” agent. Disinfection or chemoprophylaxis means that the water soluble lubricant used during sex contains a chemical agent that destroys viruses and bacteria.

A lubricant containing “nonoxynol” is very effective for this purpose, but only if it is used in the correct manner. Nonoxynol kills the microbes that infect disease, but it can also irritate the soft mucosal tissue of the vagina or anus in such a way that it makes these surfaces more receptive to viral infection – thus any microbe that is not destroyed by the chemical is liable to have an easier passage of access into the recipient’s body. So it is best either to use nonoxynol on surfaces where this problem is not relevant – for example, putting a drop inside the male condom – or to use nonoxynol in a lubricant that combines it with an agent such as “avena sativa” that serves to counteract the irritation problem. The latter is, however, difficult to find in most retail outlets.

Other microbicidal lubricants that do not have the negative qualities of nonoxynol – are being researched, but have not yet been approved by the U.S. authorities and thus are not yet on the market. Such alternatives are sometimes available in Europe and elsewhere.

In general, it is very important to use lubricant generously during vaginal or anal sex, and during any type of genital pleasuring. Do not use petroleum based lubricants, but only ones that are water soluble. Water soluble lubricants add a pleasurable slipperiness to genital stimulation, and reduce friction that can be uncomfortable or damage the soft delicate tissue of the inner orifices. It is advisable to experiment with lubricants to find one that suits your individual needs, that is to your liking, and that can be kept readily available for any sexual encounter.

We all need to learn as much as we can about risk reductive sexual practices, and the above information about barrier protection and lubricants is a helpful start. Barrier protection should be used for every sexual act in which a fluid might be passed from one body to the receptive tissue of another body. Too many sexually active people rely on assessing their partner’s sexual health as a way to protect themselves from disease transmission. But the fact is that assessing a partner’s sexual health is perhaps the most frequent way in which many people delude themselves into believing that they are safe from sexually transmitted infections. Unfortunately, people often imagine that because a partner looks healthy, says they have had few or no other partners, or has not been in a sexual relationship for “quite some time,” it is okay to proceed to engage in a risky sexual act. Such foolishness is the preeminent reason that sexually transmitted infections are increasing nationally.

The risk reductive methods of barrier protection need not only to be known by every medical and mental health professional, they need to be taught in every school and in every home across the country.

Adapted from Ten Keys for Successful Sexual Partnering
Published by Xlibris (a division of Random House), 2005
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Questions for educational credit:

Answers: (1) F (2) T (3) F (4) F (5) T (6) F
(7) T (8) F (9) F (10) T (11) T (12) F