Episode 29: Talking to our Children About Condoms and “Safe Sex”

“Dad, how effective is the condom in preventing sexually transmitted infections (STIs)?”

This was a question my teens asked me one day after a sex education class they had attended in school. I was really glad they had asked me that question, as it gave me the opportunity to discuss the topic with them in greater depth.

Let me clarify: the sex education class they attended did mention that abstinence and faithfulness to a non-infected spouse was the best way to avoid STIs. But in case they were unable to refrain from sex before getting married, then “safe sex” with the condom was the proposed option.

As parents, it is useful for us to be prepared for such a scenario, and to be ready with the right questions, and the right answers. There are two aspects to cover with our children – the medical as well as the human aspects.

Medical Concerns

How effective is the condom, really, in preventing pregnancy and STIs? Why or why not? Let us explore this a little bit more.

As mentioned, it has often been suggested that using the condom will help prevent STIs among teens should they engage in sex. Such a proposition is premised on 2 main presuppositions:

1. That contraceptives are 100% effective in reducing pregnancy and STIs, and
2. That teens will use the condom correctly and consistently, that is, all the time

Both these presumptions are not well supported by the data available at this time.

First, the condom does not offer 100 percent protection. Check any condom packet and we will very likely find this disclaimer, or something that sounds like this: “Latex condoms do not completely eliminate the risks of pregnancy and STIs”.

When it comes to preventing pregnancy, the condom has been touted to have a 98 percent effectiveness rate. This means that for every 100 women who use it, 2 women will get pregnant in one year. But that is, if it is used perfectly all the time. In reality, however, and understandably, this is not the case. With typical use, about 14 women out of 100 who use the condom will get pregnant in one year.[i]

Infections

What about the effectiveness of the condom in preventing STIs?
According to the June 2004 Bulletin of the World Health Organization, consistent use of the condom may reduce the risk of HIV transmission by about 80 percent,[ii] but not 100 percent. When scientists refer to an 80 percent risk reduction in HIV transmission, they do not mean that every act of sexual intercourse with a HIV infected person carries with it a 100 percent chance of getting infected while using the condom reduces that risk to 20 percent.

Rather, the number was arrived at through studies like the one conducted by Weller and Davis which studied HIV sero-discordant couples, that is, couples in which one partner was HIV-positive and the other was not. For the group of HIV sero-discordant couples who used the condom consistently, the number that became infected was 1.14 per 100 person years, that is, in one year, 1.14 persons would be infected out of 100 sero-discordant couples.

Put in another way, out of 10,000 sero-discordant couples who used the condom consistently, 114 persons would be infected by the end of one year. For the sero-discordant couples who did not use the condom, the infection rate was 5.75 per 100 person years. 1.14 is approximately one-fifth or 20 percent of 5.75. Hence the figure of 80 percent risk reduction with consistent use of the condom.

Now we should note that this figure is typically applicable to so-called discharge STIs (that is STIs that are transmitted mainly through genital secretions), like HIV, Gonorrhoea and Chlamydia.[iii] The condom actually offers much less protection against STIs that are spread by skin-to-skin contact, such as Herpes and Human Papilloma Viruses, the family of viruses that can cause cervical cancer and genital warts. Why? According to the Centers for Disease Control and Prevention, or CDC, this is because “Condoms may not cover all infected areas or areas that could become infected.”[iv]

Accidents

Furthermore, in order to have any meaningful effectiveness in reducing STI transmission, the condom needs to be used consistently and correctly. In reality, many people, especially youth, fail to do so. Studies have shown that only between 8% and 48.4% of those surveyed use the condom consistently.[v] On top of that, one local survey of “at-risk youth” found that about 42 percent had experienced slippage while using the condom, and about 32 percent had experienced breakage. [vi]

What do these data tell us? Simply that an adequate response to the issue of teen sex must go beyond this merely biological response. Which is why, and it is interesting to note, that a contributor to the British Medical Journal, Dr Stephen Genuis, once remarked that merely promoting condoms “disregards the complex nature of human sexuality and fails to tackle the underlying social and emotional needs of young people, who are often trapped in high-risk sexual behaviour as a consequence of difficult life circumstances.”[vii]

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[i] Ask a Doctor: “How Often Do Condoms Fail?” eMedicineHealth

[ii] Weller S, Davis, K. Condom effectiveness in reducing heterosexual HIV transmission (Review), The Cochrane Library 2005, Issue 3.

[iii] The June 2004 Bulletin of the World Health Organization noted that with consistent use of the condom, the risk of acquiring chlamydial infection was reduced by about 26 percent, and that for gonorrhoea by 62 percent. Bulletin of the World Health Organization Vol. 82 Number 6, Genebra, June 2004.

[iv] This is largely due to the fact that “Genital ulcer diseases, like syphilis can occur in both male and female genital areas that are covered or protected by a latex condom, as well as in areas that are not covered.” CDC Fact Sheet.

[v] “Are condoms the answer to rising rates of non-HIV sexually transmitted infection? No.” – Stephen J Genuis, British Medical Journal. BMJ. 2008 Jan 26; 336(7637): 185.

[vi] Wong ML, Chan RK, Tan HH, Sen P, Chio M, Koh D. J Pediatr 2013;162:574-80

[vii] “Are condoms the answer to rising rates of non-HIV sexually transmitted infection? No” – Stephen J Genuis, British Medical Journal. BMJ. 2008 Jan 26; 336(7637): 185