Why Still So Few Use Condoms

By David Masciotra
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ryan.berry/Flickr

As the late author Norman Mailer put it, "The only thing you can depend on with condoms is that they will take 20 to 50 percent off your f***." In a conversation with Madonna on the topic, Mailer also condemned condoms for making people part of "the social machinery" and destroying "most of the joy of entrance." Madonna argued that condoms are "essential in the age of AIDS," but conceded, "they feel terrible."

If we're honest, many of us do see condoms as robbing us of pleasure, stealing some excitement and spontaneity from intimacy, and dulling the intensity of sexuality. It's okay to say that. These factors are the primary reasons that still only 60 percent of teenagers claim to use condoms. These factors warrant acknowledging. From there, condom usage declines as people grow older. The number one reason we have seen given time and again for refusal to wear condoms is the reduction of pleasure.

Anyone who dares criticize the condom is typically made the subject of demonization and condemnation.

It is politically incorrect to acknowledge the truth and simplicity of the condom's inadequacy. Criticism of the condom opens one to righteous demonization and condemnation. Condom defenders often stifle honest and helpful discussion about sexuality, unplanned pregnancy, and sexually transmitted infections.

Bill Gates has a foundation that works in Africa to treat AIDS and prevent HIV infection. His research demonstrates that most Africans -- like most Americans -- don't wear condoms because the primitive contraption, which has not appreciably changed in 50 years, steals their pleasure. Gates is a practical businessman and a creative inventor. He has proceeded with plans to make a better product after learning that there is widespread dissatisfaction with an existing product. His foundation will give a $100,000 grant to anyone with credible plans to make a condom that "is felt to enhance pleasure."

The foundation promises that such an innovation would "lead to substantial benefits for global health, both in terms of reducing the incidence of unplanned pregnancies and in prevention of infection with HIV."

Following the announcement, Gates came under ideological fireGawker called the argument that condoms reduce sensitivity one for "creeps" and "pervs," while Popular Science reacted by concluding "men are idiots." Salon likened any criticism of the condom's detrimental effect on sexuality to "whining."

Gates is working to open the conversation to the introduction of factual evidence and looking at what really drives behavior. The pleasure factor is an auspicious beginning, but a frank and honest discussion about condoms should not end there.

For decades, the myth that pre-ejaculate ("pre-cum") can impregnate women has been a reason people advocated condoms. The propaganda posits that pre-ejaculate fluid contains sperm, and therefore any penetration without a condom can cause pregnancy.

The truth is that the chance of pregnancy by pre-cum is so remote that it is a statistical nonfactor. Two separate studies conducted by the National Institutes of Health found no sperm in pre-ejaculate fluid, as did a study conducted by Connecticut State University in conjunction with Princeton University . The Department of Obstetrics and Gynecology at Rabin Medical Center in Petah Tikva, Israel also failed to find any trace of sperm in pre-ejaculate fluid, and the Kinsey Institute at Indiana University maintains that "pre-ejaculate rarely contains sperm." Despite the overwhelming evidence -- some of which is readily available at sources like WebMD -- some continue to propagate the myth, maybe because they believe the end justifies the means. But a serious problem warrants an honest discussion, even if not all of the evidence helps make a case for condoms.

By the study's measure, "pulling out" has a failure rate of four percent, while condoms have a failure rate of two percent.

Sex researcher Dr. Rachel Jones at the Guttmacher Institute recently published a study in the journal Contraception that found that the "withdrawal method of birth control is nearly as effective as condoms in preventing pregnancy." By the study's measures, "pulling out" had a failure rate of four percent, while condoms had a failure rate of two percent.

The conversation about sexually transmitted infections also benefits from the amplification of empirical evidence. HIV is a serious problem, and it demands medical vigilance in the search for a cure and the campaign for better treatments, drugs, and care. To pretend that simply telling people to wear condoms will work, however, is dangerously naïve.

According to the Center for Disease Control, in 2010, men who have sex with men accounted for 63 percent of HIV infections.

Despite widespread HIV awareness campaigns and knowledge about condoms, 50 percent of gay men do not use them, and the HIV rate among gay men is on the rise because of it. Mark S. King, an award winning author and leading advocate for AIDS awareness in the gay community, who is also gay and HIV positive, recently gave a perfect summary of the motivation behind unprotected sex: "We keep talking about barebacking as if it's some kind of psychosis, when really all it is is men behaving naturally."

It is natural for anyone of any sexual orientation to not only preserve, but maximize pleasure during sex. Bill Gates is one of the few public figures addressing "safe sex" in such a way that prioritizes pleasure, and his foundation appears alone in its work to honestly wrestle with the real reasons people don't like or use condoms. That makes Gates one of the only committed and serious people fighting the HIV/AIDS crisis -- in America and abroad.

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If the Gates initiative, for what his foundation calls the "next generation condom" succeeds, it will spark a new conversation on sexual issues -- one that acknowledges that the truth is always necessary to solve any social problem. No "progress" that uses a lie as an usher is worth welcoming. More importantly, if Gates succeeds, he will have also significantly increased people's chances of protecting themselves against the horror of AIDS, while empowering them to feel good in the process.

This article available online at:

http://www.theatlantic.com/health/archive/2013/04/why-still-so-few-use-condoms/275301/