Get Real! How Exactly Can Condoms Protect Me from Infection?

Heather Corinna

Condoms can reduce our risks: they cannot eradicate them nor provide absolute protection, ever. They make sex safer for us and for our partners: they don't make sex safe without possibility of error.

fox asks:

I’m unclear on how condoms are supposed to be effective in preventing female-to-male contamination during “plain” sex, I mean insertion of the penis into the vagina. Let me explain.

Latex is an effective barrier to virii and germs. I get that. As far as protecting the woman is concerned, I’ve no trouble believing it works. The STD virii or germs are present in the semen and/or pre-cum; these are “emprisoned” by the condom, don’t get out, and don’t get into contact with any part of the anatomy of the woman. She’s protected. The sweat of the man does not contain these virii or germs and thus no risk with the rest of the skin-to-skin contact. But in the other direction, I don’t quite get it.

From what I understand, when a woman gets sexually excited, she secretes some kind of lubrification in her vagina. I presume that for STDs, the virus / germ is present in that natural lubricant, and that the contact with that lubricant is what’s dangerous. But a condom covers only the shaft of the penis. Couldn’t the lubrication “drip” out a bit and land on the man’s crotch area, not covered by the condom? And here you are, infection! Or, similarly, your article here says that vaginal discharge / secretions will end up on the woman’s labia; when thrusting “till the end”, penis shaft completely inserted, wouldn’t these labia come into contact with the men’s uncovered crotch and, again, infect him?

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If my premise is wrong and vaginal discharge/lubrification does not contain the STD virii/germs, then how does STD transmission from woman to man (during unprotected sex) happen in the first place?

Heather Corinna replies:

In the early 80’s, safer sex was called safe sex. That language was changed to reflect the knowledge that these practices — namely, latex barrier use, STI testing and limiting the number of sexual partners — couldn’t make sex “safe.” They could only make sex safer. So, know above and beyond all else that what condoms can do is reduce our risks: they cannot eradicate them nor provide absolute protection, ever. They make sex safer for us and for our partners: they don’t make sex safe such that there is no possibility of error.

Not all men and not all women have the same kinds of bodies or genitals. Some people who identify as men have a vulva. Some people who identify as women have a penis. But for the purpose of this question, and what is almost always a given in studies about transmission via vaginal intercourse, when I say “men” here I will mean people with a penis, and when I say “women” I’ll mean people with a vagina.

Let’s start with some STI (sexually transmitted infection) basics. While STIs tend to differ in a lot of ways — some are parasites, some viruses, some bacteria, some are more easily transmitted than others — on the whole, we divide them into two basic groups: those transmitted by fluids, like HIV, gonorrhea, chlamydia and trichomoniasis, and those transmitted just by bodily contact, like HPV, herpes, syphilis, molluscum, chancroid and scabies.

With fluid-borne infections, infection occurs not because fluids have contact with skin like that on the thighs or testes, but with parts of the body which can or do provide a direct route to the bloodstream. So, for instance, in vaginal intercourse, your sexual fluids, and any infections they may be carrying, can or do reach the inside of the vagina, the cervix, the uterus and beyond: all places with direct routes to the bloodstream. On a female partner’s part in intercourse, her fluids, any any infections she’s got, could reach your urethra, which is often the only direct route into the bloodstream through the penis, particularly for men who are circumcised (uncircumcised men may have higher risks than men who are not). For men and women alike, other pathways to the bloodstream that can be other possible routes of fluid-borne infection are the anus, the mouth, and any shaving cuts or other skin abrasions or wounds on the body, including on or inside the genitals. Unless you have a cut or abrasion on the base of your penis, testicles or “crotch area,” these are not going to be sites for fluid-borne infection transmission. If we’re only talking vaginal intercourse, the anus is a non-issue.

You’re asking specifically about how you’d be protected during vaginal intercourse with condoms: the simplest answer is that condoms cover the opening of your urethra completely, the orifice through which you would be most likely to acquire a fluid-borne infection with that activity. So, the answer for the most part is that you’d be protected very well, especially from fluid-borne infections.

However, not all sexually transmitted infections are transmitted by body fluids. Some infections spread by only contact between or to mucous membranes like genital tissue, the mouth, the inside of our noses. Fluids are a non-issue with these kinds of infections. Condoms reduce risks of STI transmission for these kinds of infections well, well, but not as well as they can reduce risks of fluid-borne infections, primarily because condoms, dental dams or latex gloves often don’t provide a barrier to the whole genital or oral area. These are the infections to figure you, as person with a penis, have less protection from when using condoms.

When you’re expressly asking about penis-in-vagina intercourse, women tend to be a lot more susceptible to acquiring most infections than men. That’s because of physiological differences and also because of common social/gender inequities that often impact women’s health, like men as a group being tested less often for STIs, having sex more often outside relationships understood to be monogamous and more frequent refusal to use condoms. If you spend time with studies on latex barrier use and STIs, one common finding you’ll see is that men are frequently afforded better protection from condoms with most infections than women are. That does not mean you shouldn’t be concerned about your own health: you so should! I encourage everyone to protect themselves as best they can. However, I think it’s also important to just know, in having the facts, that female partners you have for intercourse will usually be at a higher risk than you will of acquiring an infection.

Another a having-the-facts riff: women can and often do produce several different fluids. Self-lubrication from arousal, menstrual fluids, and fluids produced by the cervix and the vagina that are part of the fertility cycle and/or the way the vagina keeps itself clean are all typical. Some women also ejaculate. For men, the genital fluids at play are ejaculate and/or pre-ejaculate, and any fluids/oils produced by the foreskin if you have one. Both your bodies produce urine and fecal matter, and both of you have blood. Nursing or lactating women also produce breast milk. With fluid-borne infections, the fluids which typically transmit STIs are primarily vaginal fluids, penile fluids, blood and/or breast milk. Fecal matter is another biggie in terms of bacterial infections and hepatitis, but that’s not something you or a partner are likely to be exposed to with vaginal intercourse.

So, just how effective ARE condoms for you per infections? If you read public health information, you will most typically see them stated as “highly effective,” which we know them to be. Reliably expressing just how highly effective in numbers is harder to do outside any one specific study.

With fluid-borne infections, condoms have typically been found in studies to reduce the risk of infection by as much as 99%, and as little as around 50%, with both figures largely influenced by how consistently and correctly condoms are used. With skin-to-skin infections, findings for protection range from around 30% to around 90%. Again, proper use and consistency is a factor. Specifically addressing HIV protection, the UNFPA states an effectiveness rate of 90-96%, Family Health International states a rate of 80% – 97% protection. The CDC does not tend to state mathematical figures, but instead say that “consistent condom use is highly effective in preventing HIV transmission.”

That substantially lower rate of protection listed for infections like HPV and Herpes is because of what you said about how condoms do not completely cover the genital area, just not because of contact with fluids, as those infections don’t require fluids for transmission. Here’s what the CDC has to say on that, “Correct and consistent use of latex condoms can reduce the risk of genital herpes, syphilis, and chancroid only when the infected area or site of potential exposure is protected. While the effect of condoms in preventing human papillomavirus infection is unknown, condom use has been associated with a lower rate of cervical cancer, an HPV-associated disease.” For the record, the female condom covers the vulva more than male condoms, so it is currently being studied to see if it provides better protection against infections like Herpes and HPV. It might, it might not. We don’t know yet.

Some of the language I’m using is imprecise, and I know how frustrating that is. I’d like one easy, firm number as much as the next guy. But because the effectiveness condoms may or do provide at reducing the risk of infection varies a good deal from infection to infection, person to person and from area to area, based on a lot of different factors, we can really only give broader estimates. Around ten years ago, the NIH did an extensive review of 138 peer-reviewed articles on condom effectiveness per infection and disease. That review found that 90% of the studies done demonstrating condom effectiveness per STIs were sound. You can access that review here, and if you want to look at the range of what each of the studies found — not all on the same infections, but on a range of different infections — you can take a peek at page 3 of the report, which offers an excellent chart of the findings.

The CDC also addresses this factual mushiness when they say, “Accurately estimating the effectiveness of condoms for prevention of STDs is methodologically challenging. Well-designed studies address key factors such as the extent to which condom use has been consistent and correct and whether infection identified is incident (i.e. new) or prevalent (i.e. pre-existing). Of particular importance, the study design should assure that the population being evaluated has documented exposure to the STD of interest during the period that condom use is being assessed. Although consistent and correct use of condoms is inherently difficult to measure, because such studies would involve observations of private behaviors, several published studies have demonstrated that failure to measure these factors properly tends to result in underestimation of condom effectiveness.” One of the toughest parts of determining condom effectiveness in study is how very often people do not use them consistently and correctly, and figuring out when and if they actually have. No one is watching people every time they have sex in these studies to find out if they really are or are not using condoms, or to check for correct use.

Consistent — as in, you always use’em — and correct — as in, you use quality condoms properly — use of condoms is a super-duper big deal. For example, this study on men and gonorrhea showed that men who did not use condoms consistently or correctly had more than a 90% risk of contracting the infection than those who did use them consistently and correctly. This study on HPV transmission showed that “the incidence of genital HPV infection was 37.8 per 100 patient-years at risk among women whose partners used condoms for all instances of intercourse during the eight months before testing, as compared with 89.3 per 100 patient-years at risk in women whose partners used condoms less than 5 percent of the time.”

However difficult it can be to quantify this in clear numbers, consistent and correct use of condoms greatly reduces the risk of sexually transmitted infections. That’s something people in public health can and do say with certainty, and from a medical/health standpoint, that’s not in question. We can also say with certainly that men are generally at a lower risk of STI acquisition than women when it comes to vaginal intercourse, and that it’s most sound to be concerned with the way you are using condoms — Are you using them every time? Are you using them properly? — rather than if condoms can or can’t work: we know they can, and that they are a lot more likely to prevent infection with proper, consistent use.

If you are going to engage in sex with others, there are three parts of safer sex practice we know make a profound difference in the spread of infection and disease: consistent and correct latex barrier use, regular STI testing and limiting the number of sexual partners. Just any one of those things can reduce risks, though with testing, that can only help if and when it is paired both with treatment of any STIs that can be treated, and with adjusted behaviors on the part of anyone infected like using condoms, informing partners (so they can also be treated or choose not to have sex), and/or making choices not to have sex, particularly during treatment or if an infection is not treatable. If we want to be sexually active and reduce our risks as best we can, ideally, we’ve got to do all three parts of those practices, not just one, like only using condoms.

Anyone who wants to have absolutely NO risks of sexually transmitted infections, will need to opt out of ANY of the kinds of sex where transmission can occur.

Something we often find with Scarleteen users is that while so many are great about condom use, fewer are so great about talking to partners about STIs; asking about a partner’s status, disclosing their own or insisting on testing for partners and getting regularly tested themselves. That’s a big, big piece of prevention missing. So, I encourage you to talk about testing. If either you or a current or potential partner have not been tested or aren’t getting regularly tested, step it up and ask they do. Make sure you’re doing your own part by getting your own tests. It’s something you can do together, or can offer to keep a partner company while they do, if you already have had your own recent screenings. People can feel pretty scared about testing, especially if they aren’t already in the habit of going, and having someone to provide emotional support can make a huge difference. Should you ever have a potential partner who refuses to be tested, my best advice is to just nix sex with that partner. Should you refuse testing, I’d give any potential partner of yours the same advice. As well, I’m a big fan of encouraging people with sex to do our best to think of everyone involved: of both what best protects us and our partners. Partnered sex is something where we’re supposed to be thinking about everyone involved, not just ourselves, and safety in that is no exception.

You should also know that most infections, so long as they are quickly diagnosed and quickly and effectively treated, do not pose giant health risks to most people. A lot of the scary things said about some infections are fears we inherited from times past when we did not know how to test or have the ability to, or did not have access to treatment or effective treatments like we do today for so many infections, or from propaganda that is not in alignment with what scientists, doctors and other people working in public health with STIs know.

HIV is not in that group, because we do not yet have medicines which can rid the body of HIV infection like we do for infections like chlamydia or gonhorrhea. HPV and herpes are also exceptions, but for otherwise healthy people, when HPV infections are not those associated with cancers, there, too, are often benign infections. So, again, testing is such a big deal, and so is treatment: people who work in infectious disease who you talk to about this will generally agree that our biggest challenges to reducing STIs are a) all people using barriers consistently and correctly, and b) all people having access to testing and treatment and getting testing and treatment.

You can always ask your sexual healthcare provider the same sorts of questions you’re asking me. A lot of folks don’t realize that it’s not just their job to take care of your body and your health, it’s also their job to provide patient education. As a sexuality and sexual health educator, I benefit incredibly by talking to providers about all of this, a skill and a practice that is just as important for all of us as patients.

Here are a few extra links to help you out:

Roundups Sexual Health

This Week in Sex: The Sexually Transmitted Infections Edition

Martha Kempner

A new Zika case suggests the virus can be transmitted from an infected woman to a male partner. And, in other news, HPV-related cancers are on the rise, and an experimental chlamydia vaccine shows signs of promise.

This Week in Sex is a weekly summary of news and research related to sexual behavior, sexuality education, contraception, STIs, and more.

Zika May Have Been Sexually Transmitted From a Woman to Her Male Partner

A new case suggests that males may be infected with the Zika virus through unprotected sex with female partners. Researchers have known for a while that men can infect their partners through penetrative sexual intercourse, but this is the first suspected case of sexual transmission from a woman.

The case involves a New York City woman who is in her early 20s and traveled to a country with high rates of the mosquito-borne virus (her name and the specific country where she traveled have not been released). The woman, who experienced stomach cramps and a headache while waiting for her flight back to New York, reported one act of sexual intercourse without a condom the day she returned from her trip. The following day, her symptoms became worse and included fever, fatigue, a rash, and tingling in her hands and feet. Two days later, she visited her primary-care provider and tests confirmed she had the Zika virus.

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A few days after that (seven days after intercourse), her male partner, also in his 20s, began feeling similar symptoms. He had a rash, a fever, and also conjunctivitis (pink eye). He, too, was diagnosed with Zika. After meeting with him, public health officials in the New York City confirmed that he had not traveled out of the country nor had he been recently bit by a mosquito. This leaves sexual transmission from his partner as the most likely cause of his infection, though further tests are being done.

The Centers for Disease Control and Prevention (CDC)’s recommendations for preventing Zika have been based on the assumption that virus was spread from a male to a receptive partner. Therefore the recommendations had been that pregnant women whose male partners had traveled or lived in a place where Zika virus is spreading use condoms or abstain from sex during the pregnancy. For those couples for whom pregnancy is not an issue, the CDC recommended that men who had traveled to countries with Zika outbreaks and had symptoms of the virus, use condoms or abstain from sex for six months after their trip. It also suggested that men who traveled but don’t have symptoms use condoms for at least eight weeks.

Based on this case—the first to suggest female-to-male transmission—the CDC may extend these recommendations to couples in which a female traveled to a country with an outbreak.

More Signs of Gonorrhea’s Growing Antibiotic Resistance

Last week, the CDC released new data on gonorrhea and warned once again that the bacteria that causes this common sexually transmitted infection (STI) is becoming resistant to the antibiotics used to treat it.

There are about 350,000 cases of gonorrhea reported each year, but it is estimated that 800,000 cases really occur with many going undiagnosed and untreated. Once easily treatable with antibiotics, the bacteria Neisseria gonorrhoeae has steadily gained resistance to whole classes of antibiotics over the decades. By the 1980s, penicillin no longer worked to treat it, and in 2007 the CDC stopped recommending the use of fluoroquinolones. Now, cephalosporins are the only class of drugs that work. The recommended treatment involves a combination of ceftriaxone (an injectable cephalosporin) and azithromycin (an oral antibiotic).

Unfortunately, the data released last week—which comes from analysis of more than 5,000 samples of gonorrhea (called isolates) collected from STI clinics across the country—shows that the bacteria is developing resistance to these drugs as well. In fact, the percentage of gonorrhea isolates with decreased susceptibility to azithromycin increased more than 300 percent between 2013 and 2014 (from 0.6 percent to 2.5 percent).

Though no cases of treatment failure has been reported in the United States, this is a troubling sign of what may be coming. Dr. Gail Bolan, director of CDC’s Division of STD Prevention, said in a press release: “It is unclear how long the combination therapy of azithromycin and ceftriaxone will be effective if the increases in resistance persists. We need to push forward on multiple fronts to ensure we can continue offering successful treatment to those who need it.”

HPV-Related Cancers Up Despite Vaccine 

The CDC also released new data this month showing an increase in HPV-associated cancers between 2008 and 2012 compared with the previous five-year period. HPV or human papillomavirus is an extremely common sexually transmitted infection. In fact, HPV is so common that the CDC believes most sexually active adults will get it at some point in their lives. Many cases of HPV clear spontaneously with no medical intervention, but certain types of the virus cause cancer of the cervix, vulva, penis, anus, mouth, and neck.

The CDC’s new data suggests that an average of 38,793 HPV-associated cancers were diagnosed each year between 2008 and 2012. This is a 17 percent increase from about 33,000 each year between 2004 and 2008. This is a particularly unfortunate trend given that the newest available vaccine—Gardasil 9—can prevent the types of HPV most often linked to cancer. In fact, researchers estimated that the majority of cancers found in the recent data (about 28,000 each year) were caused by types of the virus that could be prevented by the vaccine.

Unfortunately, as Rewire has reported, the vaccine is often mired in controversy and far fewer young people have received it than get most other recommended vaccines. In 2014, only 40 percent of girls and 22 percent of boys ages 13 to 17 had received all three recommended doses of the vaccine. In comparison, nearly 80 percent of young people in this age group had received the vaccine that protects against meningitis.

In response to the newest data, Dr. Electra Paskett, co-director of the Cancer Control Research Program at the Ohio State University Comprehensive Cancer Center, told HealthDay:

In order to increase HPV vaccination rates, we must change the perception of the HPV vaccine from something that prevents a sexually transmitted disease to a vaccine that prevents cancer. Every parent should ask the question: If there was a vaccine I could give my child that would prevent them from developing six different cancers, would I give it to them? The answer would be a resounding yes—and we would have a dramatic decrease in HPV-related cancers across the globe.

Making Inroads Toward a Chlamydia Vaccine

An article published in the journal Vaccine shows that researchers have made progress with a new vaccine to prevent chlamydia. According to lead researcher David Bulir of the M. G. DeGroote Institute for Infectious Disease Research at Canada’s McMaster University, efforts to create a vaccine have been underway for decades, but this is the first formulation to show success.

In 2014, there were 1.4 million reported cases of chlamydia in the United States. While this bacterial infection can be easily treated with antibiotics, it often goes undiagnosed because many people show no symptoms. Untreated chlamydia can lead to pelvic inflammatory disease, which can leave scar tissue in the fallopian tubes or uterus and ultimately result in infertility.

The experimental vaccine was created by Canadian researchers who used pieces of the bacteria that causes chlamydia to form an antigen they called BD584. The hope was that the antigen could prompt the body’s immune system to fight the chlamydia bacteria if exposed to it.

Researchers gave BD584 to mice using a nasal spray, and then exposed them to chlamydia. The results were very promising. The mice who received the spray cleared the infection faster than the mice who did not. Moreover, the mice given the nasal spray were less likely to show symptoms of infection, such as bacterial shedding from the vagina or fluid blockages of the fallopian tubes.

There are many steps to go before this vaccine could become available. The researchers need to test it on other strains of the bacteria and in other animals before testing it in humans. And, of course, experience with the HPV vaccine shows that there’s work to be done to make sure people get vaccines that prevent STIs even after they’re invented. Nonetheless, a vaccine to prevent chlamydia would be a great victory in our ongoing fight against STIs and their health consequences, and we here at This Week in Sex are happy to end on a bit of a positive note.

Commentary Sexual Health

Don’t Forget the Boys: Pregnancy and STI Prevention Efforts Must Include Young Men Too

Martha Kempner

Though boys and young men are often an afterthought in discussions about reproductive and sexual health, two recent studies make the case that they are in need of such knowledge and that it may predict when and how they will parent.

It’s easy to understand why so many programs and resources to prevent teen pregnancy and sexually transmitted infections (STIs) focus on cisgender young women: They are the ones who tend to get pregnant.

But we cannot forget that young boys and men also feel the consequences of early parenthood or an STI.

I was recently reminded of the need to include boys in sexual education (and our tendency not to) by two recent studies, both published in the Journal of Adolescent Health. The first examined young men’s knowledge about emergency contraception. The second study found that early fatherhood as well as nonresident fatherhood (fathers who do not live with their children) can be predicted by asking about attitudes toward pregnancy, contraception, and risky sexual behavior. Taken together, the new research sends a powerful message about the cost of missed opportunities to educate boys.

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The first study was conducted at an adolescent medicine clinic in Aurora, Colorado. Young men ages 13 to 24 who visited the clinic between August and October 2014 were given a computerized survey about their sexual behavior, their attitudes toward pregnancy, and their knowledge of contraception. Most of the young men who took the survey (75 percent) had already been sexually active, and 84 percent felt it was important to prevent pregnancy. About two-thirds reported having spoken to a health-care provider about birth control other than condoms, and about three-quarters of sexually active respondents said they had spoken to their partner about birth control as well.

Yet, only 42 percent said that they knew anything about emergency contraception (EC), the only method of birth control that can be taken after intercourse. Though not meant to serve as long-term method of contraception, it can be very effective at preventing pregnancy if taken within five days of unprotected sex. Advance knowledge of EC can help ensure that young people understand the importance of using the method as soon as possible and know where to find it.

Still, the researchers were positive about the results. Study co-author Dr. Paritosh Kaul, an associate professor of pediatrics at the University of Colorado School of Medicine, told Kaiser Health News that he was “pleasantly surprised” by the proportion of boys and young men who had heard about EC: “That’s two-fifths of the boys, and … we don’t talk to boys about emergency contraception that often. The boys are listening, and health-care providers need to talk to the boys.”

Even though I tend to be a glass half-empty kind of person, I like Dr. Kaul’s optimistic take on the study results. If health-care providers are broadly neglecting to talk to young men about EC, yet about 40 percent of the young men in this first study knew about it anyway, imagine how many might know if we made a concerted effort.

The study itself was too small to be generalizable (only 93 young men participated), but it had some other interesting findings. Young men who knew about EC were more likely to have discussed contraception with both their health-care providers and their partners. While this may be an indication of where they learned about EC in the first place, it also suggests that conversations about one aspect of sexual health can spur additional ones. This can only serve to make young people (both young men and their partners) better informed and better prepared.

Which brings us to our next study, in which researchers found that better-informed young men were less likely to become teen or nonresident fathers.

For this study, the research team wanted to determine whether young men’s knowledge and attitudes about sexual health during adolescence could predict their future role as a father. To do so, they used data from the National Longitudinal Study of Adolescent Health (known as Add Health), which followed a nationally representative sample of young people for more than 20 years from adolescence into adulthood.

The researchers looked at data from 10,253 young men who had completed surveys about risky sexual behavior, attitudes toward pregnancy, and birth control self-efficacy in the first waves of Add Health, which began in 1994. The surveys asked young men to respond to statements such as: “If you had sexual intercourse, your friends would respect you more;” “It wouldn’t be all that bad if you got someone pregnant at this time in your life;” and “Using birth control interferes with sexual enjoyment.”

Researchers then looked at 2008 and 2009 data to see if these young men had become fathers, at what age this had occurred, and whether they were living with their children. Finally, they analyzed the data to determine if young men’s attitudes and beliefs during adolescence could have predicted their fatherhood status later in life.

After controlling for demographic variables, they found that young men who were less concerned about having risky sex during adolescence were 30 percent more likely to become nonresident fathers. Similarly, young men who felt it wouldn’t be so bad if they got a young woman pregnant had a 20 percent greater chance of becoming a nonresident father. In contrast, those young men who better understood how birth control works and how effective it can be were 28 percent less likely to become a nonresident father.9:45]

Though not all nonresident fathers’ children are the result of unplanned pregnancies, the risky sexual behavior scale has the most obvious connection to fatherhood in general—if you’re not averse to sexual risk, you may be more likely to cause an unintended pregnancy.

The other two findings, however, suggest that this risk doesn’t start with behavior. It starts with the attitudes and knowledge that shape that behavior. For example, the results of the birth control self-efficacy scale suggest that young people who think they are capable of preventing pregnancy with contraception are ultimately less likely to be involved in an unintended pregnancy.

This seems like good news to me. It shows that young men are primed for interventions such as a formal sexuality education program or, as the previous study suggested, talks with a health-care provider.

Such programs and discussion are much needed; comprehensive sexual education, when it’s available at all, often focuses on pregnancy and STI prevention for young women, who are frequently seen as bearing the burden of risky teen sexual behavior. To be fair, teen pregnancy prevention programs have always suffered for inadequate funding, not to mention decades of political battles that sent much of this funding to ineffective abstinence-only-until-marriage programs. Researchers and organizations have been forced to limit their scope, which means that very few evidence-based pregnancy prevention interventions have been developed specifically for young men.

Acknowledging this deficit, the Centers for Disease Control and Prevention and the Office of Adolescent Health have recently begun funding organizations to design or research interventions for young men ages 15 to 24. They supported three five-year projects, including a Texas program that will help young men in juvenile justice facilities reflect on how gender norms influence intimate relationships, gender-based violence, substance abuse, STIs, and teen pregnancy.

The availability of this funding and the programs it is supporting are a great start. I hope this funding will solidify interest in targeting young men for prevention and provide insight into how best to do so—because we really can’t afford to forget about the boys.