Roundups Sexual Health

One Study Raises Questions About Anti-Depressants in Pregnancy; Another Says Depressed Women Use Birth Control Less Consistently

Martha Kempner

A new study comes out strongly against the use of anti-depressants during pregnancy which is causing controversy as many experts believe that depression itself is even more dangerous; an unrelated study suggests that stressed and depressed women don't use birth control consistently, and researchers find a link between literacy and teen childbearing.  

New Study Causes Controversy over Anti-Depressants during Pregnancy

A new study reviews the existing research on the use during pregnancy of Selective Serotonin Reuptake Inhibitors (SSRI), the most common type of anti-depressants, on women with fertility issues. The researchers say their findings confirm that:

“antidepressant use during pregnancy is associated with increased risks of miscarriage, birth defects, preterm birth, newborn behavioral syndrome, persistent pulmonary hypertension of the newborn and possible longer term neurobehavioral effects.” 

The author’s more controversial suggestion, however, is that: “There is no evidence of improved pregnancy outcomes with antidepressant use.”

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While the current consensus among obstetricians and mental health experts is that depression itself is bad for both a mother and a developing embryo or fetus, and that continuing medication can be the healthiest choice, the authors of this review strongly disagree. They say there is no evidence that depression itself is bad for pregnancy or that SSRIs are good. Dr. Alice Domar, executive director of the Domar Center for Mind/Body Health at Boston IVF and one of the authors argued:

“There is really no conclusive evidence that SSRIs are better than placebo. I don’t want women to stay on this medication thinking it’s as safe as a sugar pill because it’s not.”

Domar and her co-authors say that many women on SSRIs are only mildly depressed and suggest that they should rely on talk therapy, especially cognitive behavior therapy, instead. 

Many experts disagree and say these suggestions could be dangerous to depressed mothers-to-be. Gregory Moore, director of health services at Georgia Tech in Atlanta and a member of the American College of Obstetricians and Gynecologists’ (ACOG) committee on ethics said: “I would say the authors of this article went overboard in terms of their negativity. Depression can be a fatal disease.” Other experts remind us that depressed mothers may forget to eat or be unable to sleep which has negative implications for the fetus. Dr. Kimberly Yonkers, a mental health expert at Yale University, agrees that some women with mild depression may be able to wean themselves off of medication during pregnancy but warns:

“It’s a dangerous message for women who are pregnant and depressed to say that antidepressants don’t benefit them. To take someone who is stable (on medications) and tell them they shouldn’t take it because of all the harm is ridiculous.”

Women Who Are Stressed or Depressed Don’t Use Birth Control Consistently

An unrelated piece of research that is being presented at this week’s American Public Health Association annual meeting, suggests that depression and stress may interfere with correct and consistent use of birth control. Researchers followed 689 non-pregnant Michigan women ages 18 and 19 for a year. Participants answered questions about their mental health and filled out a weekly journal about their sexual behavior and contraceptive use. About 25 percent of women had moderate to severe depression, and 25 percent had moderate to severe stress.

Participants in the study used contraception (mostly the pill and condoms) consistently about 72 percent of the time. The researchers found that women with depression were 47 percent less likely to use contraception consistently each week than their peers with less severe symptoms. Similarly, women who were stressed were 69 percent less likely to use contraception consistently.      

Though the research doesn’t specifically explain why these differences exist, one of the authors suggests that mental health issues may impair a woman’s decision-making ability or that the depression may be caused by other issues in their life such as unemployment that get in the way of using contraception effectively. 

The researchers fear that unintended pregnancy could make these women’s situations worse and suggest that women who are depressed or highly stressed might be good candidates for long-acting reversible contraceptive methods (such as implants and IUDs) that are highly effective but do not require users to take any action every day or even every time they have sex. 

Girls with Low Literacy More Likely to Give Birth as Teens

A new study also being released at the American Public Health Association’s annual meeting looks at how literacy levels impact teen pregnancy. The study out of the University of Pennsylvania School of Nursing compared the reading scores and birth records of over 12,000 girls enrolled in the Philadelphia public schools between 1996 and 2002. The study found that “girls who had below-average reading skills were 2.5 times more likely to bear a child during their teen years as compared to preteens who had average reading skills.”  Specifically, 21 percent of girls with below-average reading levels had one live birth during the six-year examination period, while three percent of girls with below-average reading levels had two or more live births within that period. Only 12 percent of girls with average reading skills had one live birth and only one percent had two or more live births. In contrast, of the girls with above-average reading skills, 5 percent had one live birth and only 0.4 percent had two or more live births.

The study also found that a higher percentage of African-American and Hispanic girls had below-average reading skills and that the impact of low literacy on teen birth was greater in Hispanic and African-American girls than those who identified themselves as white. Dr. Rosemary Frasso, one of the researchers on the study, gives this explanation for the connection between race, literacy, and early childbirth:

“It is quite possible that adolescent girls who experience a daily sense of rejection in the classroom might feel as though they have little chance of achievement later on in life. Our findings underscore the role of literacy as its own social risk factor throughout the life-course.”

Reading ability is not something parents and pre-teens usually discuss with their health care provider, but Frasso believes that this should change.  She feels that it is important for doctors to help their preteen girl patients get connected with literacy it programs.  Frasso explains:

“Public health and healthcare providers and policy makers should recognize the very strong link between early education and teen childbearing when considering interventions to reduce this outcome. More collaboration between educators and healthcare providers would also be a good idea.”

Forget About Abortion, Let’s Focus on the Mental Health Effects of Pregnancy and Parenting

Amie Newman

Enough with the studies on the adverse effects of abortion on mental health. If you're really interested in helping women, study the mental health effects of pregnancy and parenthood.

Here’s an idea courtesy of the Guttmacher Institute:

The body of evidence [Editor’s note: related to abortion and mental health] is now so robust that researchers should consider shifting their focus to related issues that might be more valuable to explore, such as the factors that cause women to experience mental health problems in the first place.

The latest study in a long history of rigorous research (on which we’ve reported most recently here and here) revealing a lack of cause and effect between abortion and mental health has been released to much media hoo-ha and predictable anti-choice defensiveness. The American Psychological Assocation, as far back as 1989, found that legal abortion “does not pose a psychological hazard for most women.” In 2008, an APA task force, according to the Guttmacher Institute, concluded that:

“the best scientific evidence indicates that the relative risk of mental health problems among adult women who have an unplanned pregnancy is no greater if they have an elective firsttrimester abortion than if they deliver the pregnancy.”

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But here we are. It’s 2011 and we’re still undertaking studies to confirm what we already know. This most recent study, carried out by Danish researchers and published in this month’s New England Journal of Medicine, tracked a whopping 84,620 girls and women in Denmark who had a first trimester abortion or who had birthed a baby (for the first time). Researchers found that those women and girls who had an abortion sought mental health treatment at approximately the same rate both prior- and post-abortion while women who had a baby sought counseling at increased rates, post-partum. Shocked? No, neither was I.

Those who identify politically – first and foremost – as “pro-life,” even if they are public health professionals or healthcare providers, have attempted to dismantle the methodology in this recent Danish study with the precision one might use to carefully dismantle a house of cards, with the goal of discrediting the conclusions. But, at what point do we, as the Guttmacher Institute points out in a more diplomatic way, put this issue to rest?

Perhaps most harmful to women is the fact that we allow crisis pregnancy centers to continue operating using the underlying misrepresentation that abortion causes psychological trauma. It is, in fact, a foundational value for CPCs. Most recently, a report undertaken in Washington State found that every single crisis pregnancy center investigated offered false or misleading information on pregnancy and birth to the young women who visit the centers. Central to the misinformation? The post-abortion stress disorder claim. Center staff told patients, in an effort to scare them away from choosing abortion, to beware of “post-abortion syndrome.” There is no such syndrome which exists and neither the APA nor the American Psychiatric Association recognizes such a disorder.

The Danish study actually confirms that in fact childbirth is more psychologically traumatic for women than is abortion; a significantly well-researched idea that I assume crisis pregnancy centers don’t choose to share with the women they see. Yet, we have heaps of evidence that reveal how much effect childbirth can have on a woman’s mental health – we’ve been advocating long and hard for the research and studies necessary to shine a light on post-partum mood disorders and to find resources to help treat those disorders. Women who decide to carry their pregnancies to term face a greater chance of experiencing some sort of mental health issue than women who choose to have an abortion. Many still don’t know enough about post partum mood disorders as they should. That goes for both mothers-to-be and new parents, as well as providers.

And though this has historically been a less welcomed discussion in all but the most intimate of circles, we must be willing to confront the less comfortable reality that unwanted pregnancies may have a long term mental health consequence as well. As Delia Lloyd writes on Politics Daily:

I’m sure there are many women who’ve had abortions that they regret.

But…I’m also sure that there are many women who regret having had children they’re incapable of raising.

That’s an uncomfortable truth. But that doesn’t make it any less true.

Here lies another inconvenient truth, so to speak. While pregnancy and birth have been presented to girls and women on a silver platter from an early age, we as women understand that the “gift” of pregnancy is not always a welcome one. Deciding to carry a pregnancy to term when you don’t want to may turn out to be the most wondrous experience one could ever hope to have; and it may be an awful nightmare.

Even when it is the most unimaginably blissful of offerings in the form of a wanted pregnancy, childbirth brings with it the risk of postpartum mood disorders ranging from depression and anxiety for many women, to full-blown psychosis for a relatively small few. Postpartum mood disorders are very real for hundreds of thousands of women each year. Given the stunning lack of focus on the issue, however, you’d be hard pressed to know this. In fact, approximately 950,000 women each year suffer from some sort of post-partum mood disorder. And, to be clear, this is the number of women who self-report a mental health struggle postpartum. Clearly, the number is even higher. Still, if that’s a difficult number to put in perspective, allow the expert behind the blog Postpartum Progress to put it into context for you:

How does that compare with the incidence among women of other major diseases in America?

  • Each year less women — approximately 800,000 — will get diabetes. (Nat’l Diabetes Information Clearinghouse)
  • Each year about 300,000 women suffer a stroke.  (Centers for Disease Control)
  • Each year approximately 205,000 women are diagnosed with breast cancer.  (National Cancer Institute)

In fact, more women will suffer from postpartum depression and related illnesses this year than the combined number of new cases for men and women of tuberculosis, leukemia, multiple sclerosis, Parkinson’s disease, Alzheimer’s disease and epilepsy. 

So isn’t it obvious that those who are opposed to women having access to safe, legal abortion in this country have very little concern for the psychological well-being of women and girls? In fact, I’d argue they have a complete disregard for it. How else to explain the exploitation of a non-existent diagnosis to manipulate women into a particular decision – childbirth – which does carry a very real risk of mental health issue for millions of women?

Please don’t misunderstand. I have two children and if a woman wants to be a parent, understanding the risks and benefits for her particular situation and what types of support and resources are available can help immensely. But how is it that we get to the present day, enmeshed in a political battle which uses immense political capital, time and money to present a false case to women that accessing safe, legal abortion care will harm us psychologically, to the point where we should outlaw even the option, while we struggle to find the resources and funding to address real, honest struggles facing women who chose to carry a pregnancy to term?

If these types of studies can do anything to move us towards a more realistic portrait of the impact of women’s reproductive and sexual health decisions upon our psychological health, they can be used to do two things. One, these studies allow us to recognize the range of emotions and experiences women have whether we’re talking about pregnancy, childbirth, abortion, offering a child up for adoption, adopting a child, experiencing a stillbirth of a baby, a miscarriage – in effect, any number of experiences related to pregnancy and procreation. Secondly, the Danish study, by comparing the psychological struggles related to both abortion and childbirth, can help strengthen the case for more funding and support towards postpartum research and treatment.

Love the Glove: Ten Great Reasons to Use Condoms You Might Not Have Heard Yet

Heather Corinna

At the present time, the United States now leads the world when it comes to sexually transmitted infections (STIs). And not in a Whoohoo, go USA! kind of way.

This article is published in partnership with  It is also part of a series on global AIDS issues, sexual and reproductive health and prevention issues to be published by RH Reality
Check throughout December 2009.  Other articles in the series can be
found here.

The U.S. Centers for Disease Control recently released data showing that sexually transmitted infections (STIs) are on the increase in the United States, and that we now have among the highest rates of any developed country in the world. You’ve probably also heard that the rate of sexually
transmitted infections in people 15-24 years old is exceptionally high.

Figuring out why isn’t tricky for those who work in sexual health.
Some people will say this is because teens are having more sex than
ever (not true: you’re having less sex than teens a generation or two
before you did), or because people are having sex outside marriage (a
fine fairy tale for those who don’t see lab results for STIs among some
married people or who don’t know about the history of STIs). But those
of us who work in direct care know why STI rates are so high and why
they’re so disproportionate in young people right now.

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It’s primarily because so many young people are not using latex or
polyurethane condoms and other barriers to protect themselves and their
partners, or are not using them correctly and consistently. As someone
who talks with people every day about their sexual behavior, and who
also tracks young people’s sexual behavior and health over time, I know
this all too well. We observe users who come to Scarleteen and see that
those who have not used latex barriers at all or consistently are
overwhelmingly the same users who eventually come to report an STI.
Sure, every now and then we do hear from a user who always used condoms
properly and who still got an STI. But that happens about as often as I
find a $5 bill on the sidewalk.

There are other reasons the STI rate is so high in younger
people. Cervical cell development of younger women isn’t complete,
making the cervix more prone to infection. People in your age group
often tend to have more sexual partners and shorter relationships than
older people. The overall rate of STIs is higher than it used to be,
making it easier to land one. But we know that the main reason
is that overwhelmingly, many people in your age group are either not
using latex barriers at all, or are not using them all the time, every
time, correctly. While many older adults aren’t much better with condom
use, it does matter more what you do because two thirds of all individuals who acquire STIs are younger than 25 years old.

It’s not complicated: most people who acquire a sexually transmitted
infection are simply not using condoms or are not using them every time
and properly.

A report from Child Trends DataBank
in October of 2008 (based on data from the CDC) found "53 percent of
teen boys say they don’t always use a condom. Among girls, about
two-thirds say a condom isn’t always used. Sexually transmitted
infections (STIs), including HIV/AIDS, and unintended pregnancy are
major health consequences associated with unprotected sexual activity.
Although a similar percentage of teens are sexually active in the
United States as in western European countries, the U.S. has much
higher teen pregnancy and STI rates than does Western Europe. This is
due to lower consistency and effectiveness of contraceptive use in the
U.S." They add that "Condom use is higher among younger students than
it is among older students. In 2007, 69 percent of sexually active
ninth grade students, compared with 62 percent of eleventh graders and
54 percent of twelfth graders, used condoms. Part of this drop is due
to higher levels of use of other forms of birth control among older
students, although it is still a cause for concern since condoms are
the only form of effective control against STIs for those who are
sexually active."

Condoms work very well at reducing STI transmission:
According to a 2000 report by the National Institutes of Health (NIH),
correct and consistent use of latex condoms reduces the risk of
HIV/AIDS transmission by approximately 85% relative to risk when
unprotected, putting the seroconversion rate (infection rate) at 0.9
per 100 person-years with condom, down from 6.7 per 100 person-years.
Analysis published in 2007 from the World Health Organization found
similar risk reductions of 80–95%. The 2000 NIH review concluded that
condom use significantly reduces the risk of gonorrhea for men. A 2006
study reports that proper condom use decreases the risk of transmission
of human papillomavirus (HPV) to women by approximately 70%.

Testing is
also critical, but testing doesn’t prevent infections: it just tells us
when we have one or not. Limiting partners is important, but many young
people get STIs from their first or second partner. If we have no sex
at all, that would make a huge difference in STI rates, and having no
sex at all is certainly the best way to prevent STI transmission.
However, most people in their lifetimes, and over 90% once they’re 22, will have genital sex with partners, as has always been the case. So if we want to be genitally sexual with partners and prevent infection, latex barriers are the tools we have to do that with. Condoms work. Anyone who tells you different is either misinformed or is intentionally misinforming you.

You can read more about STIs all over Scarleteen, like here and here and here and here
and… you get the picture. But you probably already know why you
should use condoms. Our users generally report higher use of condoms
than the overall demographic, so maybe you don’t even need to read what
I’m about to say. But you’ve probably also heard or thought some things
about condoms that might be keeping you or others from using them or
from using them consistently, and I’m willing to bet you haven’t heard
everything I’m about to say. Even if you’re already using condoms and
using them every single time properly, I bet you know someone — a
sibling, a friend, maybe even a sexual partner — who could stand to
hear some of this. So, why use condoms and other barriers?

1. Because it can help you to get closer

I know: I’ve heard some people say that condoms and other barriers
keep people from getting close, too. But the folks I hear say that
rarely seem to be the folks whose relationships are all that close or
intimate. The people I hear from who DON’T say that about condoms, and
who practice safer sex in their relationships seem to be the ones
getting closer and feeling closer to each other.

Avoiding potentially sticky or difficult conversations doesn’t bring
us closer: it keeps us apart. Asking someone to care for you in any way
is not a barrier to intimacy: it’s not asking that keeps space between
you and yours. Having to discuss sexual anatomy, sexual health or even
just how to use condoms and use them in a way that works for both of
you is not something that keeps people apart, but that brings people
closer together. Talking about these things together, working through
any misunderstandings or emotional issues around them and having
something that adds extra communication to any sex you’re having are
all the kinds of things that nurture closeness and real intimacy. Silence doesn’t bring people closer: communication does.

A lot of what we hear young people say about not using condoms has
to do with one or both partners finding it hard to assert themselves,
or being worried about a negative reaction: that’s not about closeness.
Even more troubling is a conversation about condoms that starts with "I don’t want to use them because I want to be close," and often leads to a bigger discussion in which what comes out is, "I’m scared to ask him to wear a condom."

Being outright afraid to ask someone to do something to help
safeguard the health of you both shows a serious LACK of getting close
(or a desire to avoid getting close enough to find out if someone is or
isn’t the person you currently think they are or hope them to be). We
can’t say we and someone else are very close and at the same time say
we feel scared of, with or around them. When we’re earnestly close to
someone, we feel able to say or ask things when we don’t know if we’re
going to get a positive response. If we want a close relationship, we
have to not only say or bring up the things we know they’ll like
hearing, or have a positive reaction to, but the things when we’re not
so sure they’ll like or which we know are loaded, but that we need to
say and talk about for our well-being and health and the quality of our

2. Because barebacking isn’t as cool as you think.

I’ve been having a sense of déjà vu lately when hearing some hetero
girls say they’re "not into condoms" with a wink and a grin, or that
they, unlike those other girls who use condoms and who they
tend to frame as killjoys, are willing to go without condoms, in this
way that rings of trying to aim for a certain social status by being
the one willing to risk health and life for… well, a whole lotta
nothing much.

Why I’m having déjà vu is because I’m old enough to remember when
some gay guys were all about that. I remember seeing how many of them
died and were part of others dying because of it, as well as how many
of the men who who barebacked only because they didn’t know
what we and you know now about how to protect ourselves died from
barebacking. That trend in the gay community was not only lethal, it
also resulted in those who were the least responsible defining a whole
group of people culturally in a very negative way that is still
strongly harming the GLBT community. It hurt all of us, not just the
people it hurt directly.

On top of risking your life and health, any social status you might
get from being the girl who’ll take big risks other girls don’t is
likely to be temporary, and will also change very radically when you go
from "That hottie who doesn’t make guys use condoms," to "That who gave everyone Chlamydia."

Not a pretty thing to say, I know. But it is what tends to wind up
happening in the real world. The tide turns very quickly on girls who
are sexually active PERIOD in our culture, even responsibly, but all
the more so for those who aren’t responsible in their sexual behavior.
I don’t like that or the misogyny it’s based in, as guys are rarely
treated or talked about like that, but it’s out there. It’s tenuous
enough to be a sexually active young woman, but when things go amiss
and you do wind up with and spread an STI, it’s usually going to be
framed as being YOUR doing, not the doing of everyone or anyone else
who had sex with you and made their choice not to use condoms, too.
Those are strongly sexist double standards, but they are out there and
they can really hurt when directed at you, especially if you have to
suffer in silence alone, knowing part of that result had to do with
your own choices and actions.

From my point of view, what I see in these cases is a young woman
having some big esteem issues and who seems to feel it’s worth it to
risk her life and health for a temporarily increased sexual appeal.
While our sexuality and our sexual relationships can support our
self-esteem, they tend to be poor places to try and get
self-esteem, especially if our sex lives involve a habit or precedent
of not caring for ourselves and inviting or allowing others to treat us
without real care. Lack of self-care and solid self-esteem can’t
coexist. If we have good self-esteem, we see ourselves as valuable and
worthy of care. If your esteem isn’t so great, and you want it to be
better, then insisting others treat us you care is one way to improve
it: accepting or advertising yourself as open to being treated like a
throwaway is a way to make sure your esteem gets even lower.

3. Because chances are good that eventually, you’re going to either
have to use condoms or knowingly be putting partners or yourself at a
high risk of infection.

If you have sex with others without using condoms or other barriers
correctly and consistently, you are likely to wind up with an infection
at some point. And if you and your partner(s) don’t also get tested
regularly, you — like most people with an STI — won’t even know you
have one that you’re spreading around.

When we have users who interact with us at the boards talking about
how they’re not using condoms, it’s a bit like being able to see into
the future. Because inevitably, someone like that who sticks to that
habit of going without will eventually post about an STI they wound up
with within a few years, if not sooner.

A lot of people have a false sense of security based on not having
gotten an STI yet. Mind, some of those people haven’t been tested to
know their status, but some have. If you go without condoms or other
latex barriers for a few months or a few years and didn’t get an STI,
it can be easy to believe that not using condoms is going to work out
fine for you. But because we don’t wind up with an infection in a month
or a year or two of not using barriers doesn’t mean we won’t in time.
The studies and statistics on STIs also tend to reflect that very
clearly. The highest STI rates in young adults usually aren’t in the
youngest sexually active teens: the group with the highest rates is
usually those 18 and over who have often been sexually active for a
year or two already.

And of course, if and when your luck runs out and you get an STI,
especially if it’s one you can’t get treated and which is then out of
your system via that treatment, you will then either need to use
condoms or be purposefully putting others at risk (and yourself at risk
of infections you didn’t get yet).

It’s a lot easier to establish your sex life in the habit of using
safer sex practices than it is to add them later. If you start using
condoms (and getting tested) early in your sex life, continuing to do
so is a no-brainer. You get to be an ace at using barriers sooner, get
to learn how to have conversations about safer sex as you’re learning
to have all kinds of conversations about sex, and the more you do it
and the sooner you start, the tougher it gets to space out safer sex,
and the less and less it seems like any big deal. When it’s a solid
habit, you just reach for that condom instinctively. And when you reach
for it like that? Partners tend to react just as instinctively and just
put it on with no fuss.

Most people will need to use condoms at some point to avoid
infections. If you’re going to need to eventually anyway, why put it
off, especially during the time in your life when you’re at the highest
risk of infections and most likely to get one?

Just in case someone filled your head with B.S. about how latex barriers work at preventing infections, a few words from our friends at the CDC:
"Laboratory studies have demonstrated that latex condoms provide an
essentially impermeable barrier to particles the size of STD pathogens.
Overall, the preponderance of available epidemiologic studies have
found that when used consistently and correctly, condoms are highly
effective in preventing the sexual transmission of HIV infection and
reduce the risk of other STDs. Consistent and correct use of male latex
condoms can reduce (though not eliminate) the risk of STD transmission.
To achieve the maximum protective effect, condoms must be used both
consistently and correctly. Inconsistent use can lead to STD
acquisition because transmission can occur with a single act of
intercourse with an infected partner. Similarly, if condoms are not
used correctly, the protective effect may be diminished even when they
are used consistently."

4. Because it pays it forward

Younger people are particularly prone to monkey-see/monkey-do. In
other words, if you and yours don’t use condoms, your friends are also
less likely to. And then so are their friends. And theirs. And all
young people.

Using condoms not only protects your health, it protects and can
improve our global health. If you don’t get and spread an STI, you’re
part of the solution to the problem: you, all by yourself, literally
can help improve the public health just by not getting sick. Sexually
transmitted infections impact our public health deeply. While many are
easy to treat (once you get tested to know you have one, that is), and
many won’t impact the individual health of most who get them, we’re not
all at the same level of health nor do we all have the same level of
access to healthcare and treatment. Some STIs that are no-big to most
of us can be life-threatening to others because of preexisting
conditions or suppressed immune systems. You might be able to get
something treated easily because you have health insurance, but someone
who winds up with an STI from your now-ex you gave one to might not
have those same resources.

One thing I’ve always liked about using condoms is that I not only
get to know I’m caring for my health and that of my partners, but that
I am caring for your health, her health, his health and everyone’s
health. Using condoms is one way I can to care for the whole planet
while at the same time caring for myself. And that’s pretty awesome to
be able to do with just a little piece of latex and an orgasm.

5. Because it feels good.

Say what? You thought condoms made things feel less good, right? Actually some studies (Sexual Pleasure and Condom Use, Mary E. Randolph, Steven D. Pinkerton, Laura M. Bogart, Heather Cecil, and Paul R. Abramson)
find that those who report that are often those who do not use condoms,
haven’t in a while or who don’t use them often. They have also found
that men believe this is so (even without any actual experience) more
than women do, and that belief influences men’s experiences
with condoms and whether or not men will use condoms. While yes, many
people do report that unprotected sex feels better than protected sex,
overall, people who use condoms and are used to using them tend to
report experiencing greater pleasure with protected sex than those who
often go without protection. In other words, people who use condoms
often — most likely because they have better attitudes walking in the
door, and because they learn what condoms they like and how to use them
well — don’t really express that using condoms decreases their overall
pleasure or satisfaction. The more you use them, the more they feel
good, and it’s the people who don’t use them at all who tend to
complain about them the most.

Even for males who report a difference in pleasure between condom
and no condom, though, the differential is pretty minor between them
and those who don’t report a difference. And in studies on women,
there’s most often no real difference in sensation reported at all.
Physically — when we’re talking only about physical sensation — for
most men, condoms slightly decrease sensation. For women, that’s rare,
which isn’t a shocker since unlike the clitoris, the vagina has few
sensory nerve endings. The vagina tends to feel pressure, but not fine
sensations, like the diff between a condom and bare skin. Mind, for
some men, that decrease can be a bonus: for those who are looking to
keep an erection around for longer, a decrease in sensation and the
pressure a condom puts at the base of the penis can extend erection
time for some men.

People who say they "can’t feel anything" with a condom on are
either a) being dishonest or b) not using condoms properly. While a lot
of people are dishonest, a lot of people also don’t know how to use
condoms properly and what can help with pleasure. For instance, thinner
condoms are just as safe as thicker ones. There are more condom types
than what your average drugstore carries, and some kinds of condoms
have all kinds of neat stuff going on to help increase pleasure, like
extra headroom, textured dots on the inside, the works. Putting a few
drops of lube inside the condom before it goes on as well as some lube
outside the condom makes a big difference with sensation and can make
sex feel better, full-stop. Having a partner put on a condom for you as
part of the sex you’re having — rather than as an interruption — is
something a lot of people find enjoyable and sexy.

How something makes us feel with sex is also bigger than physics. A Kinsey Institute study in 2008 (Relationships
between condoms, hormonal methods, and sexual pleasure and
satisfaction: an exploratory analysis from the Women’s Well-Being and
Sexuality Study, Jenny A. Higgins, Susie Hoffman, Cynthia A. Graham and
Stephanie A. Sanders, Sexual Health, Volume 5, Number 4)
found that
women who use both hormonal contraception (for those with male partners
who need it) and condoms report higher overall sexual satisfaction
than women who go without condoms or only use a hormonal method of
birth control. In that study, women who used hormonal methods alone
were least likely to report decreased pleasure, but they also had the lowest overall scores of sexual satisfaction
compared with condom users. What does that mean? That pleasure as a
whole is more than just mechanics or vaginal/penile sensation.

Sex is about our whole bodies, as well as other parts of our
genitals than a condom touches and it’s also about how we feel
emotionally and intellectually and how sex is part of our whole
relationships and our whole lives. It feels good to know you’re taking
care of yourself and others, and to have a partner give a hoot about
your health and peace of mind. It feels good to have the self-esteem
and the confidence to stand up for ourselves and what we need to stay
healthy, and to only be in relationships where caring for ourselves is
in alignment with what a partner wants: if that’s at odds with what
they want, we can’t possibly expect to have a healthy, happy
relationship with that person.

It feels good to approach partnered sex smartly and soundly. Knowing
we’ll be protected well before sex even starts is going to incline us
to be more interested in having sex in the first place. When we know
our risks of infections are highly reduced, it’s much easier to relax
before, during and after sex, and being able to relax more means our
sexual response systems work better so we can get more sexually aroused
and enjoy sex more. Worry and anxiety inhibits sexual response and
limits pleasure.

6. Because it helps you learn to be truthful in and with your sexuality and about sexuality in general

Let’s tell the truth right now. You don’t want to risk getting an
infection. You don’t want to feel like you can’t ask to be cared for
and treated with care with anyone you’re sexually intimate with. You
don’t want to argue about condoms when you want to be sexual. You don’t
want to be with someone even casually who cares more about getting
themselves off than if they make you really sick in the process of
doing it. You don’t want to have a sex life where it’s not okay to
press pause for a sec for any reason, whether that’s about a condom
being put on or adjusting to find a position that feels best. You don’t
want to have to risk your health to prove your love to someone else.

There are some fictions that avoiding safety behaviors like condom
use holds up, like the lie that sex should be all about either what
pleases men, first and foremost, or about men calling all the shots,
just because they can. Again, we’re dropping denial here: many guys who
say they can’t get off with condoms are not telling the truth. Some
haven’t even used condoms, and are just saying what they think they’re
supposed to or because they’re embarrassed to admit they’re newbies
with condoms, but some are outright lying. They have used condoms
before and gotten off just fine, and they haven’t refused to use them
with other partners who they know won’t have sex with them without a
condom. And some, when they say they can’t get off with condoms mean
something else: that what they get off on is seeing if you’ll sacrifice
your health and life just to get them off. Not only does anyone want to
avoid having sex without a condom with a partner like that, you don’t
want to sleep with someone like that, period. Heck, you probably are
safest just staying off their block.

Many people still believe the propaganda that there are microscopic
holes in condoms that pathogens can get through easily: but that isn’t
true, and we have always had every evidence that wasn’t so. Some people
have the idea that people only use condoms with partners they feel or
think are "dirty," with sex workers, or for extramarital affairs. But
in fact, even many married couples use condoms: according to a
Population Reference Bureau survey in 2008, in developed countries
condoms are the most popular method of birth control: around 28% of
married people use condoms.

Another whopper? Only "promiscuous" people get STIs. I put that in
quotes because we don’t ever know what that term means. To one person,
that means 300 partners, to another, 20, to another, anything more than
one. Many people get an STI from just a first or second partner, and
some people who have had 50 or even 100 partners have never had an STI.
Plenty of unmarried people have never had an STI, while plenty of
married people have: one of the first big waves of sexually transmitted
infections here in the states after WWI was among marrieds. ALL kinds
of people get STIs. The idea that no one can or is likely to get an STI
through first-time sex, or sex with a first partner reminds me of the
idea my mother’s generation had that no one could get pregnant with
first-time intercourse. It’s understandable given how much cultural
messaging cultivates this idea, but it’s also just not true. People of
all stripes get STIs every day: good people and not-so-good people.
People of all colors and genders and orientations. People who grew up
on this side of the tracks and people who grew up on that one. People
who have had five or twenty partners and people who have had but one.

Then there’s the fiction that it’s not young people, or people who
with their first or second partnership have to worry about STIs, but
older people. You already saw the stats about who has the highest rate
of STIs, so we’ve hopefully shredded that myth already. How about the
one that says only gay men need to worry about STIs? Nope: the highest
rates of STIs are in young, heterosexual women. Even HIV, once
ignorantly called "the gay plague," is more likely to be transmitted via heterosexual partnerships than homosexual ones, and worldwide, heterosexual women account for around half of all cases of HIV: 98% of which are in developed nations like the U.S.

People say
IF you only have one sexual partner who ALSO has only you as a sexual
partner AND you both ONLY have each other as sexual partners for your
lifetime, you have no risk of STIs. Sparing STIs which can be acquired
nonsexually (like oral Herpes, HIV or Hepatitis), we can safely say
that if all of those ifs are so, your STI risk would indeed be very low
(not none: very low). But. The average age of first marriage right now
is around 26: few people — less than 10%, according to the National
Center for Health Statistics — have ever not had genital sex by that
age. Many people also do not stay monogamous for a lifetime: The
University of Washington’s latest research on infidelity shows the
infidelity rate for married men alone to be 28% at a minimum. Only 20%
of American men and 31% of American women report having only one
partner in a lifetime. If you and your partner feel lifelong monogamy,
from minute one, is a sound reality for you and in alignment with what
you want, we support you in this approach. Just know that overall, an
abstinence/lifelong-monogamy based approach is unlikely to be a sound
safer sex plan for a majority of people, and that you may need to adapt
it at some point in your life.

Let’s not forget the one about how as long as people love and trust
each other, or as long as people are lucky, no one is going to get
sick; that STI transmission is all about luck or love or trust and not
about something much more tangible and less arbitrary.

We can love someone all we want, but there are some things we can’t
control — like how many of us are exposed to STIs via rape before we
ever chose to have consensual sex, like how often partners — even in
otherwise loving relationships — are dishonest or unfaithful, like how
many people have already had sexual partners before they met a person
they want to spend a life with. It’s important that we don’t base our
ideas about STIs on a minority group or an unrealistic or unattainable

Viruses and bacteria don’t care who loves who or who trusts who. If
we’re exposed to the genitals or fluids of others, we’re potentially
exposed to STIs. If we reduce that exposure either by not having
genital sex or by using latex barriers when we do, we’re much less
exposed. If we go without, we’re wide open to this stuff, just like we
are when someone coughs in our face. If your partner has a cold, we may
get it whether they love us or not. If our partner has Chlamydia, we
may get it whether they love us or not.

If we can’t be truthful in our sexual lives about our sexual health
and about how we want support from partners in staying healthy, we’re
unlikely to be able to tell the much harder truths that are part of a
great sex life: like to talk about what we like, what we fantasize
about, what we’re afraid of, what we’re feeling emotionally, what we
don’t like. If we can’t say no to sex without condoms, we also are
unlikely to be able to say no to sex we don’t want, full-stop. Asking
someone to put on a condom is one of the easier things to ask for in
our sex lives. If we can do that, asking for the other stuff also gets
easier. The more truthful we can be about all aspects of our sexuality,
including things like STIs and condoms, the better our sex lives are,
both when it comes to our health and also when it comes to our sexual

7. Because it can keep you from proving people right who say you don’t have the maturity or the ability to have sex responsibly.

Abstinence-only initiatives, for instance, get away with what they
do in part because some of the things they say are true. Some young
people really don’t — they say can’t, and in certain numbers, it sure
starts to look like a can’t — make smart choices with sex, even when
they know better. If you read any newspapers or listen to any news, you
know that the standard way teen and young adult sex gets presented is
as a giant public health problem and a big, scary panic. When you face
discrimination about your age and sexuality, that has a lot to do with
that presentation.

Some of why it’s presented and interpreted that way is because it is
that way: not because young people are having sex, but because so many
are without using safer sex and contraception. Right now, and over the
last ten years, as a generation your sex life really is
becoming a serious public health problem, primarily because you have
not been using condoms, or using condoms consistently and correctly.

Do you really want to prove those folks right? Really?
Do you want to be the person or group of people who they can use as
evidence to show that people in their teens and twenties should be
treated like children? I sure wouldn’t want to help anyone
disrespecting me to be able to keep on doing it, and doing it with
evidence I’m handing right over to them wrapped in a bow. As a youth
advocate, I can’t tell you how many times I have had to argue that
despite the way some youth behave, I know in my guts that you are all
capable of handling your sexuality with care and maturity. It’s so
frustrating, because I really do know that you are that capable: I see
plenty of young people doing a better job with their sexuality than
plenty of older adults are, but what I see and know is continually
overshadowed by those who don’t have sex with care and caution and the
reality of the level of STIs in your age group. Yep: I admit, I am
asking you to use condoms to help make my job of advocating for you
easier on me.

Perhaps your competitive spirit might also get riled by knowing my
generation did a better job than yours with condom use. From that same AAP report I linked to earlier:
"Among sexually active adolescent males 17 to 19 years old living in
metropolitan areas, reported condom use at last intercourse increased
from 21% in 1979 to 58% in 1988. Reported condom use at first
intercourse among adolescent women 15 to 19 years old increased from
23% in 1982 to 47% in 1988. Data from the 1988 and 1995 National
Surveys of Adolescent Males indicate that these increases continued,
with reported condom use at last intercourse among 15 to 19-year-olds
increasing from 57% in 1988 to 67% in 1995. The CDC data indicate
increases in reported condom use at last intercourse from 38% to 51%
among females and from 56% to 63% among males for those in grades 9
through 12 between 1991 and 1997."

What about after the mid-to-late nineties? By 2003 (when we
were still around that 73%), those increases in condom use started to
come to a standstill then backpedal. Current data shows that "only 45%
of adolescent males report condom use for every act of intercourse and
that condom use actually decreases with age when comparing males 15 to
17 years old with males 18 to 19 years old. Also, females report less
frequent use of condoms during intercourse than males, presumably
because many adolescent females are sexually active with older
partners. Rates of pregnancies and STDs in females are unlikely to
decrease beyond current levels unless condom use by adolescents and
young adults continues to increase significantly in the years ahead. Condom
use by one half to two thirds of adolescents is not sufficient to
significantly decrease rates of unintended pregnancy and acquisition of

8. Because if you’re male, you can help to show men are better than the lowest common denominator.

In a nationally representative sample of more than 3,000 U.S. men interviewed about condoms, the most frequently cited negative reactions were:
reduces sensation, requires being careful to avoid breakage, requires
withdrawing quickly, embarrassing to buy, difficult to put on, often
comes off during sex, embarrassing to discard, shows you think partner
has AIDS, and makes partner think you have AIDS.

Let’s briefly deconstruct these:

  • Gander, meet goose. If we’re going to talk about condoms changing
    how sex feels, we need to remember that something like the pill does
    too, and, unlike condoms, it changes how a woman feels all the time,
    both during and outside of sex. And as someone who has had a barrier
    over a much more sensitive part than a penis (the clitoris) and has
    also used hormonal medication can tell you (and that’s on top of
    knowing the data I do as a sex educator) a latex barrier, when used
    properly doesn’t change sensations more than most methods do for women.
    Other methods of contraception can cause pain and cramping,
    unpredictable bleeding, urinary tract infections, depression and a
    whole host of unpleasant side effects. Condoms are the LEAST intrusive
    and demanding of all methods of contraception, even though some guys
    talk about them — without considering this perspective — like they’re
    the most. If guys could feel what life can be like on the pill, use a
    cervical barrier or get a Depo shot, they’d easily see condoms for the
    cakewalk they are.
  • You have to be no more careful to avoid condom breakage than you
    have to be careful with someone’s body during sex. If you’re engaged
    with someone’s genitals and treating them the way they need to be
    treated to avoid pain or injury, you’re already being just as careful
    as you need to be with condoms. And if you’re not treating someone
    else’s body with care overall, you need to step it up and start doing
    that anyway.
  • You also always have the option of putting a new condom on and going back inside the vagina if that’s what the both of you want.
  • Condoms are no more embarrassing to buy than tampons: at least
    someone thinks you’re about to get lucky. For that matter, they’re not
    more embarrassing to buy than the magazines some of you read. And as
    you grow older, your "embarrassing purchases" list will increase,
    anyway: from Rogaine to hemorrhoid cream, denture cleaner to adult
    diapers, condoms are hardly the only thing you’ll need to purchase in
    public sometimes you really wish you could buy privately. Welcome to
    adult life, folks. That said, you always have the option of buying
    condoms online if you want.
  • They’re only difficult to put on if you don’t learn how. Practice makes perfect.
  • They don’t come off often during sex unless you’re not putting them
    on properly, not adding lube when you need to (and when your partner
    would then likely need you to as well for he or she to still have sex
    feel good) and when you’re using a condom that isn’t too big or too
    small for you.
  • Again, if tossing a condom in the trash is embarrassing, how about
    tampons, the medication you’re taking for Gonorrhea or a dirty diaper?
  • Condom use does not say you think someone has AIDS. What it says to
    a smart partner is that you have a head on your shoulders, you care
    about them, and that you have the maturity to recognize that they
    shouldn’t carry the responsibilities of sex all by themselves.

While some of these attitudes come from guys who are simply
uninformed or misinformed, for those who know better or should, some of
this stuff is just plain foolish. And THAT’s embarassing, no? Male
attitudes about condoms have more influence on whether or not condoms
get used than female attitudes do. That’s because a) women’s attitudes
tend to be better, b) men as a class still have more power than women
(and men influence other men more than women do), and c) you’re most
often the ones wearing them or the ones who make a fuss about wearing

Here are some reasons some Scarleteen fans say they use condoms:
• I saw that going without condoms was dangerous because of the risk of
STIs and I realized that a caring and loving partner would never put me
at risk like that or put me through that emotional torture of not
knowing and worrying.
• Because my demographic has the highest rate of STDs in the country.
• Accidentally on purpose letting a guy get a glimpse of the condoms I
have on hand is one way of giving my consent and gauging his.
• Because I care.
• Because I didn’t want to get anything from him or unknowingly give something to him.
• I think unwanted children and potentially lethal STDs are among the
most effective and easily avoidable ways to mess up my life.
• Because using protection is just plain sexy.
• Because I have the knowledge, ability, and access to technology that
greatly reduces transmission of STIs, therefore it is irresponsible and
grossly negligent NOT to use those technologies, especially since they
are available so cheaply (if not for free) to those of us in developed

9. And if you’re all hung up on what’s sexy….

Being open about all parts of sex, not just about what you might do
to someone to get them off, is sexy in most people’s books. Being all
ooh-ahh about giving a blow job or going down on someone, but then
recoiling like a kid with mushy peas on their dinner plate about
condoms doesn’t tend to be a turn on for a lot of people. For some —
including the person with that response themselves — it can be a
pretty serious turn OFF. I’m older than our readers, but speaking for
myself, when someone reacts that way when I pull out a condom (and they
rarely do), I’m just done. It feels seriously uncomfortable, like I was
about to be sexual with someone who isn’t really ready for all of sex;
like I was about to be with someone who is emotionally and
intellectually many steps behind me. That’s not sexy to me at all: it
sends a very clear message to my brain — the organ that drives most of
our sexuality — that turns all of my turn-on signals into turn-off
signals in two seconds flat.

Assertiveness is sexy: look at who you and the world as a whole
tends to find sexy and that’s obvious. Being confident about caring for
yourself and the firm belief and insistence anyone else you are sexual
with must treat you with that same respect and care is sexy. Caring
about yourself and your health, and caring about the health of others
is sexy. Having limits and boundaries you don’t let anyone else trample
on is sexy. Coming to, addressing and responding to the things that
keep everyone as safe as possible during sex is sexy. Being confident
in yourself and someone else that they’ve got some real maturity and
smarts when it comes to sex is sexy. And there is absolutely,
positively, nothing UNsexy about handing someone a condom or a dental
dam that you’re giving them as a way of cementing a great, big,
wholehearted "yes" to you two being sexual together. What could be
unsexy about that?

Sexy is as sexy does. There is no one way to be sexy, no matter what
anyone says. Being sexy is about how you feel sexy and sexual, and how
you project those feelings to others when you’re feeling them. So, for
sure, if when it comes to safer sex you are a shrinking violet, that’s
probably not very sexy. But if you pull out or put on a condom with
confidence and a smile, and if you get it in your head firmly that this
is sexy, then it’s likely to be perceived as sexy. If you feel sexy in
it, and it’s sexy to you, it’s going to be to someone else. To everyone
else? Probably not, especially since there is absolutely nothing in the
world that is sexy to absolutely everyone. But.

People who claim their own sexuality in a real way and feel
confident in it, which includes taking care of themselves and insisting
on the same from others, tend to be the people who both express feeling
the most sexy and who others perceive as sexy.

10. Because I love you.

I’d hope that at this stage of my career as an educator, it’s
obvious that the primary reason I do what I do is simply out of love
for all of you. The benefits are nonexistent, the pay blows chunks and
sometimes I have to take a whole lot of crap from people who think I’m
Satan incarnate for helping you out with sexuality: if I didn’t love
you and think that a good way for me to express that was by doing what
I could to help you take care of yourself and have a healthy, happy
sexuality, I wouldn’t do this job at all.

Getting an STI is rarely the end of the world. While a couple are
literally deadly serious, most are treatable and most will not have
that great an impact on your life if you find out you have one early
and get treated. But I don’t want you to be sick if you can avoid it.
If it can be avoided, I don’t want you to have to deal with the
negative feelings around an STI that are tough to avoid in a world that
really stigmatizes STIs and the people who have them. I don’t want you
to have to get extra pap smears, to have to endlessly experiment with
new drugs for HIV or to have to tell a potential partner you have a
genital herpes outbreak. I’ll support you if you do, and know that I
don’t think anything different about you than I think about someone who
has the flu or leukemia, but whatever I can do to help prevent it in
the first place is something I want to do.

I know that if you just don’t have sex that you are even less likely
to get an STI than if you use condoms. But I don’t just tell you not to
have sex because a) I know that most people, once they are into or past
puberty, will have and want a sexual life with partners, b) I think
that sexuality is part of who we are and can be a great part of our
lives and c) I know that you can reduce our risks of unwanted
consequences very well and still be sexual when that’s what you want. I
also know that a truly great sex life includes protecting yourself and
others as best you can from negative or unwanted consequences of sex.

I know from my work and my own sexual life how much more enjoyable
and less stressful sex is when you’re safe and smart about it. Not
having to worry about the complications of an infection, about giving
an infection to someone else, or about taking huge risks with infection
is nice: it’s much less stressful than the alternative. It’s often
amazing to me, as someone who has had more sexual partners than most of
you ever will given generational differences, to talk with many of you
who are terrified about the risks you’ve taken after the fact within
sexual lifestyles and scenarios that are comparatively more
conservative than mine have been, but far less safe as far as
protecting your sexual health goes. I don’t panic after sex, and that’s
not because I have some secret or don’t care about the bad stuff that
can happen: I don’t panic because I know I can keep myself very safe
and still have the sex I want to, and I have more than two decades of
doing so to look back on and see how well that’s worked. I can see the
same with the people I work with as users or clients in my sexual
health work.

When it comes to sexuality, here’s what I want for the people I
love: I want it to be great for them and anyone they are sexual with. I
want them to feel good about their sexual lives, not scared, freaked
out, panicked or upset. I want them to stay healthy. I want them to
feel empowered by their sexual choices, whatever they are. And I’m not
sure how all of that can happen if and when anyone is taking
unnecessary risks or avoiding asking for, and insisting on, sexual
partners treating them with care, which certainly includes not exposing
them to illness when that can be avoided. Because I love you, if and
when you want a sex life with others, I want you to have one that is
wonderful and enjoyable, but also as safe as it can be so that it can
keep ON being wonderful and enjoyable.

I love you, so I want you to use condoms and other barriers if
you’re going to be sexually active, and to chillax with the genital sex
that presents possible STI risks if you can’t. It’s just that simple

A Safer Sex Wrapup

Safer sex is a group of practices of which condom/latex barrier use
is one part. The standard guidelines for safer sex suggested by public
health agencies are that any two (or more) people who are new partners
use condoms or other latex barriers for all vaginal, anal and/or oral
sex for at least six months, and then only ditch them (if you want to)
AFTER each has had a new round of testing for all STIs with negative
results AND those two people have been sexually exclusive for six

If you and/or a partner didn’t have previous sexual partners for ANY
genital sex of any kind or it’s been longer than those six months since
either or both of you did, then if you get tested straightaway
w/negative results if you had no partners or tested when it’s been more
than six months since a previous partner, then your risks are already
very low. That doesn’t mean after all that you’ll have NO risks:
rather, it means that so long as you both stay sexually exclusive
afterward, at that point, your risks are likely very minimal.

To completely eliminate our risks of STIs, we need to not have sex.
With anyone. Ever. We’d need to avoid the nonsexual behaviors that can
transmit some infections, like IV drug use. We’d also need to avoid
sharing towels and linens, kissing our aunt Mabel who has the cold
sores sometimes, and a whole bunch of other things very few of us who
live outside a hermetically-sealed bubble will be able to avoid.

If you want to see the safer sex guidelines other sound sexual health organizations advise, here are a few for you to peek at:

Very few people will not have sex with anyone in a lifetime: most
young adults will also have at least one sexual partner before their
20’s. If we’re going to be sexual with partners, to reduce our risks
and make oral, vaginal and/or anal sex safer we need to use latex
barriers, get tested (and treated if we have any infections) and limit
our number of sexual partners. Doing just one of any of those things
can help some, but it’s all three of those together that public health
agencies make clear have been shown to be most effective.

We have much bigger piece on safer sex here. You can also find out about how to use condoms properly here, and find out what all your options are with condoms here. Have questions? Come on over to our message boards and we’re glad to talk things over with you.