That safe-sex conversation should be a simple one. Who doesn't want to protect themselves against sexually transmitted infections?
Yet for many people, it can be an uncomfortable negotiation. Perhaps that's because men and women seem to approach the discussion about condom use from different angles.
That's the conclusion of a recent study that examined condom negotiation in men and women ages 18 to 25. The researchers found that heterosexual men, heterosexual women and men who have sex with men all used different strategies when negotiating condom use with a new partner.
Overall, the findings are in line with what my colleagues and I have noticed in our practices: Straight men tend to be more willing to have sex without a condom, while women may withhold sex if their partner refuses to use one, and men who have sex with men aim for a balance between these approaches. There's a lot to unpack here, so let's take a look.
Relationships affect risk-taking
This study found that heterosexual women might be more willing to take risks when they have stronger relationship motivation and view their partner as having more relationship potential. That makes sense, sex researcher Kristen Mark said.
"Other data suggest that women often work to please their male partners due to strong social scripts that encourage that," she explained. "Perhaps these women are assuming that men don't want to use condoms, and when they are relationally motivated, they are more likely to take risks with that partner in the form of not demanding condom use."
Likewise, men might care less about the consequences of sex when they're not motivated to be in a relationship. "It sounds like an oxymoron, but it appears that men who have higher relationship motivation tend to take less risk when it comes to protecting themselves and partners from unintended pregnancies and STIs," sex therapist Renée D. Burwell said. "Men who don't really care about their relationship becoming serious tend to be riskier and more dependent on their partner to protect them."
Instead, we should all be viewing condom use less as a sign of trust and more as a universal safety behavior. "Putting on a condom needs to be as normalized as washing your hands or putting on a seat belt," Burwell said. "Just because you trust the person driving a car doesn't mean you don't wear a seat belt."
It's not just about HIV
This study found that men who have sex with men are more likely to verbalize their negotiations about condom use than their heterosexual peers, possibly because they may view themselves on a more equal playing field with their partners.
But this group experiences its own pitfalls. Since the advent of pre-exposure prophylaxis or PrEP, a daily pill that can help prevent HIV, condom use by gay men appears to have dropped.
"Many who are on PrEP feel like it gives them license to engage in unprotected intercourse," clinical sexologist Lawrence Siegel said. "Of course, we've already begun to see increases in other STIs, such as HPV, syphilis, gonorrhea and chlamydia."
It's time to normalize condoms
A fair number of the younger men I see in my practice report experiencing erectile dysfunction when they use condoms, which they say affects sensation. But is this phenomenon actually caused by condoms?
"Condom use often produces its own kind of performance anxiety in men who begin to worry about losing feeling and maintaining their erection," Siegel explained. "But it's not the condom; it's the discomfort with their use and the distractions that discomfort produces."
One way to address that is to reframe the way we view condoms. "Some people may think that a condom is a barrier to being 'fully' with someone," Mark said. "But what's sexier than someone wanting to protect your sexual health? We should be reconceptualizing condoms not just as objects but as the sexiest thing your partner can do for you."
For men who are still uncomfortable with condoms, practice can't hurt. "I recommend that people use solo sex as a time to get used to whatever barrier methods they are likely to use with a partner," sex therapist Rosara Torrisi said.
Negotiate pleasure, not just safety
Despite its intriguing results, the recent study neglected another important aspect of intimacy: pleasure. "Balancing sexual pleasure and safety is at the heart of sexual health," sex therapist Doug Braun-Harvey said. "By focusing on 'sexual risk-taking intentions,' the study marginalizes the all-too-human balancing act between safety and pleasure."
In other words, safe sex is important -- and so is sexual pleasure. They don't have to be mutually exclusive, and it's perfectly possible for you to enjoy both.
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