Condoms and STIs: The Space Between Us

Love is an intimate act, and it demands vulnerability. It is visceral, intoxicating, and, at times, painful. Physical love (aka sex) is an ideal opportunity for disease transmission, and many pathogens take advantage of it. While sexually transmitted infections (STI) are incredibly common (see my previous post on HPV), many are preventable. Barrier contraception, especially the male condom, is highly effective against STI, and consequently, has become an entrenched part of our love lives.

History of the condom

While the creator of the first condom is lost to antiquity, the history of the male condom dates back to at least the 16th century and the Italian anatomist, Gabriello Fallopius2. In 1564, Fallopius, made famous for his study of Fallopian tubes (which were named in his honor), discovered that a linen sheath on the penis could prevent the spread of syphilis. This breakthrough was followed in the late 18th century by sheaths of sausage skin6, usually made from lamb intestines. Both linen and lambskin condoms were popularized by another celebrated Italian, Casanova, in his autobiography Historie de ma Vie2.

condoms
Casanova: Making condoms cool since 1725.

Before 1844 and the vulcanization of rubber, London was the international trade center for most things, including condoms. As their empire expanded, the British took condoms all over the globe2. Once rubber was vulcanized, latex condoms could be mass-produced internationally, and they quickly became the most popular type. Their use increased until the mid 20th century, when an effective treatment for syphilis (penicillin) was discovered, and female hormonal birth controls, such as the pill, were developed. The AIDS epidemic in the 1980s revived condom use2.

Condoms, pregnancy, and STI

Condoms gained popularity not only because of their ability to prevent disease, but also prevent pregnancy. While still fairly effective (ideal use: 3% failure rate, typical use: 18%)8, condoms are less effective than other common contraceptive approaches, including short and long-term female hormonal contraceptives, such as the pill or IUDs, which have typical use failure rates of 9% and 0.2%, respectively8. However, it is difficult to assess the relative failure rates of contraceptives in the general population, as the results of clinical trials are often not representative of real life. Studies tend to have lower failure rates across the board, because participants use contraceptives in a manner closer to the “ideal” (which maximizes effectiveness) than the average or “typical” user. Studies are also constrained, and have difficulty accounting for potential differences in effectiveness due to the age, ethnicity, socioeconomic status, and education of the user7.

Whatever condoms lack when it comes to pregnancy prevention, they make up for in STI protection. They are the only form of contraception that prevents STI. Condoms’ 0.03-0.09mm thick sheet of latex provides 80-95% protection against HIV/AIDS (depending on how close use is to the “ideal”: using a condom properly, every time you have sex)1. The contrast between condoms’ abilities at blocking STI and pregnancy may explain why, as the length of a relationship increases, so does the likelihood of switching from condoms to a long-term method of contraception. Condoms remain more common in short-term or casual relationships, where the risk of STI is perceived to be greater5.

Gender gap

With the switch to hormonal contraceptive methods, comes greater female responsibility for contraception in heterosexual couples. This transition likely reflects the biological wrinkle that only females can bear children, and that the costs and social ramifications of an unplanned pregnancy will fall to the woman, if her partner leaves. The unequal burden of pregnancy has made contraception into a women’s rights issue3, and the greater availability of family planning options into a form of female empowerment (and most women are extremely glad to have more control over contraception). In an ideal world, this shift wouldn’t result in further problems, but as mentioned above, we don’t live in an ideal world.

Society’s gendered perspective on contraception affects both men and women. We are not just expanding the rights of women, we are also making contraception a women’s problem. Condoms are not recommended for pregnancy prevention internationally, not only because they are less effective, but also because they require male participation1,4. The assumption is that men are not willing to take part in pregnancy prevention, leaving it to women to take on all of the responsibility (and risks) of contraception.

There is a downside for men as well. By placing contraception decidedly into the women’s sphere, we have disempowered men. Although many men want to be involved in contraceptive decisions, they often don’t know what form of contraception, if any, is being used or if it is being used properly in their relationships. An unhealthy dynamic is created by this situation, where men’s participation in contraception is contingent on female permission and inclusion3.

The issues around contraception use illustrate an important aspect of disease: it’s hard to talk about. Even discussing the risk of illness can be a loaded conversation. But it is also an opportunity to get closer, to create a space of compassion, honesty, and trust. To make room for love.

References

1. Agboghoroma, CO. (2011). Contraception in the contect of HIV/AIDS: A review. African Journal of Reproductive Health, 15(3): 15-23.

2. Dirubbo, NE. (1987). The condom barrier. The American Journal of Nursing, 87(10):1306-1309.

3. Fennell, JL. (2011). Men bring condoms, women take pills: Men’s and women’s roles in contraceptive decision making. Gender & Society, 25: 496-521.

4. Gillespie, RM, & R Hubbard. (1986). Contraception in context. Frontiers: A Journal of Women Studies, 9(1):3-8.

5. Higgins, JA, & AD Cooper. (2012). Dual use of condoms and contraceptives in the USA. Sexual Health, 9:73-80.

6. Lieberman, JJ. (1973). A short history of contraception. The American Biology Teacher, 35(6):315-318+337.

7. Mansour, D, P Inki, & K Gemzell-Danielsson. (2010). Efficacy of contraceptive methods: A review of the literature. The European Journal of Contraception and Reproductive Health Care, 15(S2): S19-S31.

8. Reproductive Health: Contraception. Centers for Disease Control and Prevention. 28 August 2013. Web. 1 March 2014. http://www.cdc.gov/reproductivehealth/unintendedpregnancy/contraception.htm

Image source: http://en.wikipedia.org/wiki/File:Calonghi.jpg

HPV: Tainted Love.

Aliases: human papillomavirus, HPV

Sometimes love sucks. Along with causing emotional tumult, love can literally lay you low. Diseases have made use of the acts of love; capitalizing on our kinder (or at least most human) instincts by using them as an opportunity for transmission. One of the most successful of this suite of pathogens is human papillomavirus (HPV).

In the opening monologue of the film Love Actually, Hugh Grant’s character posits that “love actually is all around”. While that may or may not be true, HPV really is ubiquitous. Nearly all sexually active adults (even those who have only had one sexual partner) will contract the virus at some point in their lives. In the US alone, there are approximately 79 million people currently infected, and about 14 million new infections each year1.

hpv
HPV is all around. Actually.

But while love is good for HPV, it is bad for love. Oncogenic HPV infection (being infected with a strain of HPV related to cancer) has negative psychological impacts on women, and negatively affects their sex lives, with cascading effects on their relationships3,4. It can also put love to the test; women who felt better about their relationships were more likely to confide in their partners about the infection4.

Cause: As there are many types of love, so too with HPV. There are more than 40 strains of the virus, which are passed by “genital contact”, mostly during vaginal and anal sex. A person may contract more than one strain, and asymptomatic carriers can pass it on to sexual partners. Rarely, it is passed to a baby by its mother during birth1.

Consequence: HPV can result in a variety of illnesses. The virus can infect the mouth and throat, as well as the genital region, and it can cause genital warts, recurrent respiratory papillomatosis (RRP; warts in the throat), and several types of cancer. In fact, nearly all cases of genital warts, RRP, and cervical cancer are cased by HPV. The types of HPV that cause warts are not the same as those that cause cancer1.

Cure: There is no cure for HPV. But most of the time nothing needs to be done: most people (90%) who contract it will flush the virus from their system on their own within two years. However, it is impossible to predict whose immune system will be up to the challenge and whose won’t1. There are two vaccines (Cervarix and Gardasil) that protect against strains of the virus related to cervical cancer. Gardisil also protects against strains related to genital warts, and anal, vaginal, and vulvar cancers. Vaccination is recommended for girls and boys ages 11-12, to allow time for an immune response to develop before sexual activity begins2.

References

1. Genital HPV Infection- Fact Sheet. Centers for Disease Control and Prevention. 25 July 2013. Web. 7 February 2014.

2. Human Papillomaviurs (HPV). Centers for Disease Control and Prevention. 5 February 2014. Web. 20 February 2014. http://www.cdc.gov/hpv/vaccine.html

3. Jeng, CJ, H Lin, & LR Wang. (2010). The effect of HPV infection on a couple’s relationship: A qualitative study in Taiwan. Taiwanese Journal of Obstetrics & Gynecology, 49: 407-412.

4. Lin, H, CJ Jeng, & LR Wang. (2011). Psychological responses of women infected with cervical human papillomavirus: A qualitative study in Taiwan. Taiwanese Journal of Obstetrics & Gynecology, 50: 154-158.

Image source: http://www.usatoday.com/story/life/movies/2012/11/14/producersguild-bevan-fellner-annakarenina-lesmiserables-award/1705047/ (Photo credit: Peter Mountain)