Thursday January 24 2013
Condoms are the most effective protection against STIs
"Men and women enjoy sex just as much with condoms as they do without," the Daily Mail was delighted to report, covering a US study that appears to contradict one of the classic male excuses for not using a condom – "I lose sensitivity".
The study involved a survey of 1,645 men and women aged 18 to 59 in the US who were questioned about their use of condoms and lubricants during their most recent sexual encounter. The focus of the study was male-female penile-vaginal intercourse.
In particular, the study looked at whether condom use is related to how people rated their enjoyment of sex. The study found that there was no difference in how easily men achieved an erection if they used condoms compared with men who didn't use condoms.
Condom use also did not make a significant difference to whether couples rated their sex as arousing and pleasurable.
The study also looked at the use of lubricants and how much people knew about them. The researchers found a worrying lack of knowledge among women about the lubricant that they had used during intercourse. This is important, as some types of oil-based lubricants can damage latex condoms, making them more likely to split.
The results of this study appear to overturn the belief that condoms can interfere with sexual pleasure, which is good news.
Condoms may not be the most romantic or arousing thing in the world, but compared with an unwanted pregnancy or sexually transmitted infection (STI), they are up there with roses and champagne.
Where did the story come from?
The research was carried out by researchers from Indiana University, US. It was funded by Church & Dwight Co Inc, the maker of Trojan Brand Condoms, a leading brand of condoms in the US.
This arguably represents a potential conflict of interest, although there is no evidence that the results of the study were manipulated in any way.
The study was published in the peer-reviewed Journal of Sexual Medicine.
The Daily Mail reported the study uncritically, including comments comparing it with the famous Kinsey reports on human sexual behaviour, which is a little over the top. The Kinsey reports took several decades to complete and involved personal interviews with thousands of people.
Also, possibly due to its target audience, no mention was made of the fact that the study's findings may not apply to other sexual practices, such as anal or oral sex.
What kind of research was this?
The data used in the study was taken from a national cross-sectional survey of sexual health and behaviour carried out in the US in 2009.
This particular study aimed to look at the use of condoms and lubricants during the participants' most recent sexual event, and whether condom use was associated with how they rated this experience in terms of quality.
The authors say that more information is needed about whether the experience of sexual events is influenced by the use of condoms and/or lubricants.
They say that lubricant use among women and male-female couples is particularly poorly understood. Much of the literature about the use of lubricants covers men who have sex with men.
Little is known about the situations where lubricants, or condom and lubricants, are used, or how people feel about these.
This study is useful in that it informs us about the sexual health behaviour of a reasonably large group of US adults, covering their most recent sexual encounter and how pleasurable it was, but it tells us little more than that.
What did the research involve?
The researchers used data from a national survey of sexual health and behaviour. This involved an online questionnaire given to a nationally representative sample of US adults. The sampling frame the adults were recruited from was said to have captured 98% of all US households. Of the 6,182 adults invited to participate, 5,045 (82%) took part.
For this particular study, participants were asked to report on their most recent sexual event with a partner in the past year, and the sexual behaviour associated with this event (such as giving or receiving oral sex, vaginal intercourse, receptive or insertive anal intercourse). They were also asked about their partner's gender and their relationship with their partner (spouse, girlfriend/boyfriend, friend, or transactional sex partner).
They were asked whether they had used a condom and if so, what type (such as latex or polyurethane) and if the condom was lubricated or not. They were also asked if lubricant was used and if so, which type of lubricant and where it was applied.
Participants were also asked to rate their most recent sexual event in terms of pleasure, arousal and orgasm (their own and their partner's), as well as difficulties with pain or lubrication and erection. Pleasure, arousal, pain and lubrication difficulties were assessed using a five-point scale from 'not at all' to 'extremely'. Orgasm was assessed using three options: orgasm, no orgasm and unsure.
For the purposes of this study, only people aged between 18 and 59 who reported penile-vaginal intercourse at their last sexual event were included in the analysis. They numbered 1,645.
What were the basic results?
The sample was largely white, heterosexual and in very good or excellent health. Most reported a recent sexual event with a relationship partner (56% men, 54% women) or a casual/dating partner (21% men, 27% women). Almost half the participants (48%) indicated they were currently married, while a further 27% indicated they had never been married.
During their most recent sexual experience:
- 27.5% of men (237) and 22.3% of women (175) reported using a condom
- more than twice as many women as men were unsure whether the condom was lubricated (26.6% vs 11.4%) and what material it was made of (23.6% vs 8.9%)
- participants consistently rated sex as arousing and pleasurable regardless of whether they used condoms or lubricant
- no significant differences were found in men's ratings of the ease of maintaining their erection based on condom and lubricant use
- men who had sex without a condom or lubricant reported significantly greater arousal than men who used a condom without lubricant
- the arousal of men who had sex without a condom or lubricant was no different from men who used a lubricant with or without a condom
- overall, women reported lower arousal rates than men during their last sexual encounter
How did the researchers interpret the results?
The researchers say that despite common myths that suggest condoms make sex less pleasurable, condom and lubricant use are not associated with lower ratings of sexual enjoyment.
Women reported more often than men that they were unsure about the type of condom and lubricant used. This has important implications for health education, as some types of lubricants (oil-based) should not be used with certain types of condoms (such as latex).
Overall, most of the results of this survey appear to undermine the widespread belief that condoms can interfere with sexual pleasure. This is good news, as using condoms can protect against sexually transmitted infection (STI) as well as unwanted pregnancy.
It is important to note, however, that all this study can do is provide a limited snapshot of sexual behaviour based on an online questionnaire about one sexual encounter. The sample from which the US adults were recruited was reasonably large and appears to have been nationally representative, although it was limited to adults aged 18 to 59 and was a predominantly white, heterosexual sample.
It is also important to note that the results are only based on people who reported having penile-vaginal intercourse in their last 'event', and not those who reported same-sex encounters.
The study also found that a large majority of men and women did not use condoms in their most recent sexual encounter. The study does not tell us why this might be, or whether men and women who did not use condoms were in long-term relationships or using other methods of contraception.
Overall, this study simply informs us of the sexual behaviour of a group of US adults during their last sexual encounter.
The sexual health message remains the same: condoms are one of the best ways of protecting against STIs and unwanted pregnancy.
Analysis by Bazian. Edited by NHS Choices. Follow Behind the Headlines on Twitter.