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Monday, December 14, 2015

Layers of Protection - Condoms (and PrEP)

Condoms are a really big issue, no matter one's sexuality. They certainly have been for me, though not always in the best ways.

I think the first time I really thought about condoms was early in high school, during one of those really awkward, way-too-late "birds and the bees" conversations that we're stereotypically expected to have as kids. One frigid morning in the middle of winter (probably late January), my dad got me up reeeeeally early in the morning. He told me we should go for a drive (cue teenage apprehension). We got on the road, and got going a ways, before my dad tossed out the (basically expected) reason we were going for a drive. He asked me if I had any questions about sex (I didn't), and then told me if I ever needed condoms and was too embarrassed to buy them, to let him know. I got really nervous and mumbled some sort of thank you. To that point, I had never really thought about condoms at all - I was a nerdy kid who wasn't dating, and besides, was struggling to accept his sexuality.

Many of us don't think about condoms much, for a long time. Sure, we might hear about them awkwardly form our parents, or perhaps in Sex-Ed in school if we're lucky (I didn't, much), but in general discussing condoms is something we're really bad at in the United States. Worse, frequently when we do talk about them (at least among men), it's to rationalize why we should't/can't/won't wear them. I've had dozens of male friends who refuse to wear condoms for one reason or another. I'll admit (a little ashamedly) that all through my twenties I did that, too. I had a hard time finding ones that fit me, from the little bit I tried, and so pretty quickly I stopped bothering to even look. I just came up with excuses.

So yeah, for a long time, I didn't use condoms. Maybe the act "felt better", a little, but I didn't. Every time I had sex without a condom, I ended up going through a good week or two guilt period afterward. Sometimes that guilt would last even longer - until my next HIV/STI panel. Not knowing if you just got syphilis is not a happy place to be!

Working on stepping up my condom usage is something I've spent a lot of time on over the past few years or so. I started doing my research. I read articles, perused websites, but most importantly, I got small packs and samples of a bunch of different condoms and then tried I them on. Yep, I probably tried a dozen over the course of a few months, until I found a few brands and types that work really well for me.


Watch a really cute guy prove that you absolutely can't be too big for a condom.


I thought about a few big things - pros and cons, desired attributes, etc., - to condoms when I was making my decisions:


Risks and Rewards


Condoms aren't 100% fool-proof when used alone. They can break. They can come off. Other things can happen to them to make them unreliable (this is NO EXCUSE not to use them!)

Some people have latex allergies that make it difficult to wear typical condoms. Condoms made of natural materials can be more porous, and frequently only protect against pregnancy, but not HIV or other STI's.

Condoms need to be put on the moment you plan to start any sort of penetration. This is easily forgotten. And yeah, I get it, it's pretty gross to give a blow job on rubber (and sure, oral sex is less likely to transmit some Sexually Transmitted Infections,) but honestly, if you don't know your partner well, it's best to use a condom then, too.

Condoms can be really freaking hard to put on when drunk!

But on the flip side...

Condoms are pretty damn effective - they are among the cheapest and most effective forms of prevention against unwanted pregnancy and STI's around.

There are numerous alternative synthetic materials that condoms can be made of, ensuring that there is a safe, comfortable condom for nearly everyone.

Keeping a reasonable supply of non-expired condoms in different places (that aren't too hot or cold), such as by your bed, makes grabbing a condom easy.

For me, this one has become easy, since I've resolved to give up drinking for a while, but more importantly, if you're drunk (and particularly if your prospective partner is), you should probably reconsider having sex anyway, as consent can't be given by a drunk person.



Sizes and Shapes


Condoms come in a variety of shapes and sizes. I personally tend to need slightly smaller condoms for comfort and to make sure they fit snugly, but of course people are a variety of sizes, and ultimately the goal is to find a condom that fits properly and feels comfortable. According to some research, much of men's discomfort and trouble around wearing condoms may stem from using the wrong size on our... stems. For guys who are a bit larger, there are of course XL varieties of condom.



Where to Buy


I prefer to buy my condoms from Amazon (yes, Amazon sells condoms!) The advantage of Amazon is that you can buy from a variety of sellers, frequently in varying levels of bulk (and typically for very cheap), and if you're concerned about privacy, remember that your condoms will come in a smiling Amazon.com box. People are as likely to think you bought a new Blu Ray. I have Amazon Prime, so my condoms ship with free Two-Day Shipping, meaning if I get low, I can restock quickly and easily. It's super efficient!


Condoms and PrEP


As I move forward with starting a PrEP Truvada regimen, I absolutely have to continue my condom use. Just as condoms aren't 100% effective, nor is PrEP! Not to mention, PrEP only prevents HIV transmission, but not any of the other STI's out there. 

Just taking PrEP is NOT going to keep me from getting a nasty case of gonorrhea, or chlamydia, or syphilis. One major fear that many doctors still have in prescribing PrEP is that condom use will decline once patients are on it. Research is mixed (see here and here,) but in general, men seem to still continue to use condoms after beginning PrEP. There may be some decline, but condom use among men in the United States is drastically low to begin with - a much larger issue that needs to also be tackled.

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