Condoms and coercion: a gynecologist searches for good, clean fun #Relationships#birth control#dating#health#sex February 2 2017 | Guest post by Megan Swanson, MD, MPH Condom card from Etsy seller SuckyCards Hi. I'm an over-educated gynecological surgeon. I'm also divorced and now single… and I need to talk about condoms. I walked away from my divorce devastated, depressed and angry, a combination of feelings that proved rather incompatible with dating. Nevertheless, I was determined to get back on the horse, and did so about two months after signing our divorce papers. What you have to know about me is that, while I had always considered myself to be quite progressive sexually, I had been a serial monogamist and had only two lifetime sexual partners: my textbook-perfect college boyfriend, whom I had been with for seven years, and my shithead ex-husband, whom I’d been with for five. So, as a newly-single and sexually-frustrated 33 year-old liberal woman, I set out on the sexcapade that would consume the next year (maybe two) of my life. Casual sex was my jam, so of course I used condoms… half the time Apps like Tinder, Thrinder (yes, it is what it sounds like), Hinge, Coffee-Meets-Bagel, and OK-Cupid led me to a host of DTF suitors. “Dating” was not hard. I’ve since had my fair share of rejections, but in the beginning, I was on fire. I don’t think anyone, least of all me, really knew what my goals were, but I managed to catch plenty of dick with pretty minimal effort. Casual sex was my jam. I had a routine, and the whole thing took three, four hours, max. I prided myself on fitting everything I could ever need on a “date” into a surprisingly tiny cosmetic bag: toothbrush, toothpaste, face wash, eye makeup remover, washcloth, moisturizer, ibuprofen, Zofran, Xanax, iphone charger, extra pair of underwear, and condoms. I mean, of course condoms were in there. I was having casual sex, of course I was using condoms, that’s just what one does. Right? I mean, while it was always my intention to use one, in all honesty, a condom did not always make its way onto a penis prior to its arrival in my vagina. So, what’s wrong with me? I am a gynecologist. I have a Master’s degree in public health. If ANYONE knows better, it’s me. And I really know. I’ve done (and published!) research on attitudes about contraceptive methods and condom use. I know the risks and benefits of “barrier methods.” Nevertheless, my own condom-use was hardly better than 50%. Related Post What are your experiences with the new generation IUDs? as anyone used a new-generation intrauterine device (IUD)? My doctor brought it up, and it sounds like a great form of birth control. I like... Read more In the beginning, I had an IUD, so, while I was clearly putting myself at risk for all manner of STIs, there really wasn’t much of a chance of an unintended pregnancy (less than 1%, in fact). But, I took out my IUD when I was preparing to freeze my eggs and I did NOT significantly improve my condom-use, sometimes relying on the rhythm method and, sigh, the pull-out method to avoid an unintended pregnancy, not to mention taking my chances against Chlamydia, Gonorrhea, HIV and the like. …Did I mention that I’m a gynecologist?! I always intended to use a condom and I always had condoms in my little bag. But, I hate condoms. They are the worst. I was easily talked out of using a condom. But that’s the thing: I was always talked-out of condoms. The way I typically “asked” a guy if he wanted to fuck was by suggesting, “let me grab a condom,” which was frequently met with resistance. I found that single dudes reliably fall into two camps: they either always used a condom without any discussion or conversation (these were frequently the ones putting a condom on before I could even use my line because, duh, it’s casual sex, we don’t even know each other and of course we’re using condoms), or, way more commonly, they resisted and pouted, with varying degrees of explicitness. The reasons dudes use to avoid using condoms No glove no love crosstitch from Etsy seller Yesterday Today Shop I’ve heard and seen it all… The most subtle, yet insidious, was the sigh/eye-roll paired with the reluctant “okay.” This was probably the most effective way to get me to relinquish my condom request. I hate asking people to do things for me, even more than I hate condoms, and this subtle-yet-obvious disappointment made me uncomfortable, which too-often quickly manifested as complete abandonment of my condom plan. Some were more direct. I heard many versions of, “I mean, if we have to, but I just got tested and don’t have anything and, I mean, you’re a doctor, so I’m sure you’re clean.” Not untrue, but a fascinating assumption made by many. Another theme was the common inability to maintain an erection while sheathed in latex. Some would simply claim this plight, while others demonstrated it to me. Instead of pursuing non-penetrative sex activities, I rewarded and perpetuated this bad behavior by relinquishing and letting condoms slide off many a semi-erect dick. Sometimes I met his resistance with a firm, “yeah, we have to use a condom,” but, what I often found puzzling in this situation, was that, even in cases where a condom was on the dick as fucking started, he, whomever he was, would not infrequently continue to make a case for its discontinuation. Like, every time there was a position change or some break from penetration, the condom would conveniently fall off and dudes would be like, “do we still have to use a condom?” …As if circumstances had somehow changed since the time 20 minutes ago when I specifically asked him to use a condom. I am struck by general risk-perception among these dudes. They didn’t know me, no one ever asked me if I had any STIs or when I was last-tested, and seldom did they ask if I was on some reliable form of contraception. They knew I was a gynecologist and, perhaps, assumed I was on top of it. Now, what about that coercion? The most troubling part of the widespread resistance to condom use, especially after one’s partner explicitly requests that a condom be used, is the coercion embedded in the protests. Coercion grays the notion of consent. I mean, I ultimately, if not reluctantly, consented to having unprotected sex with nearly all these dudes, but the bare-backed nature of the event was never, ever, my idea, nor was it my preference. No one likes condoms. They smell bad, taste worse, and are just plain ugly. But, come on, casual sex necessitates their use! If your partner expresses his or her desire to use a barrier method during causal sex, or any kind of sex, for that matter, that is not a starting point for debate (!), it is a mandate to wrap up one’s dick prior to (and throughout the duration of) penetration. I’m working on my shit As a gynecologic surgeon, ridiculously over-educated about all risks and benefits associated with all the nuances of contraception-use and non-use, I am keenly aware of the hypocrisy associated with my imperfect condom-use. But, help me out! Grow the fuck up, boys! Don’t abuse centuries of socialization that have helped to shape me into a woman who, apparently and rather unfortunately, values people-pleasing above her own health and well-being. Be a respectful human and, if asked to use a condom, consider it a condition without which sex is not happening. Do not challenge or resist the request. Coercion undermines consent and insidiously contributes to rape culture in the United States. It’s taken me two years to recognize the pattern and identify the problem in my own sex life. While, as a doctor, I’ve offered much worthless advice to patients on the subject, I truly don’t know the secret to “successful condom negotiation.” But, I do know that the fact that “condom negotiation” is a fucking thing that we gynecologic public health nerds talk about, study and, all too-often, assign to women, is evidence of a problem. And this problem is not going to be solved by its description in weird jargon in medical journals. We need to stop assuming we’re all using or not using condoms during casual sex and start talking about it While public health nerds talk a lot about “risky” sex, in my experience, they are not generally having a lot of sex. So, while I’m grateful for the academic discourse, let’s move the conversation to the mainstream, specifically into the bedroom. Reporter Name * Reporter Email * Original text Enter the original text here. Edited text* Enter your suggested copyedit here. Notes You can add a note for the editor here. * Required information. Fix Typo Megan Swanson, MD, MPH Megan Swanson, MD, MPH, is currently a fellow in gynecologic oncology. She is Bay Area-educated: College at Stanford. Master of Public Health from the university of California, Berkeley, MD from UCSF and obstetrics and gynecology residency as UCSF. Her previous research has focused on optimizing reproductive health care, especially abortion care, for low-income women, both in the United States and abroad. She is currently spending a year in Kampala, Uganda, working on a project to improve cervical cancer care. She is pursueing a career in gynecologic oncology with a niche in advocacy for women with cervical cancer globally. PS: She's also working on a book about dating when you're a vagina doctor. PREVIOUS How to make wheat and dairy-free blender muffins NEXT What teachers want you to know about helping your kid with homework Show/Hide comments [ 33 ] As a fellow global public health nerd, thank you from the bottom of my heart for this. We talk so much about teaching condom negotiation skills to women in low-resource settings, but slack on doing the same domestically. We work on engaging men and boys in other countries in family planning discussions so they can support their partners, but in the US, the majority of men still react as you experienced. On a personal level, thank you for your work and dedication to women's health. Sexual/repro health and rights are close my heart, and in this environment that's becoming increasingly hostile to women's choices as well as international aid, we need doctors like you more than ever. Reply I think the fact that you even call it a discussion is where you went awry. I've always used condoms, and I've had casual partners. There has never been any doubt in my mind that he would glove up, and there has never been any dissent from them. Mayhap they sensed that you weren't firm on your stance? Not that this excuses them for not gloving up themselves, or to make it ok for them to argue such a point, safety is everyone's responsibility. I just think condom use should be framed more as an ultimatum than a discussion, 'Put this on or I leave' it's that simple, faced with a choice between no sex and safe sex, most guys will glove up lickedy split. Reply "'Put this on or I leave' it's that simple, faced with a choice between no sex and safe sex, most guys will glove up lickedy split." This has not been my experience. Reply I used the line "I know you don't like these, but we're using one if you want to do this" while holding it at the ready. It limited the discussion and fumbling involved. But I know that doesn't work for everyone, unfortunately. Reply I think a lot of this has to do with your personality and the personality of the guys you're with. We do a ton of communicating subconsciously with your bodies, our tones of voice. We don't always control it. We also attract different kinds of people. Not the same, but related, I'm a girl that never gets groped, cat called, followed or harassed. Never. But just because that's my experience, doesn't mean it doesn't happen to others. Do I know why it doesn't happen to me? Not really. Something about me? My nasty resting bitch face? Who knows. So it could be something about who you are that lets that line work, and other women it won't work for. Reply *raises hand* same. Dudes leave me alone. But I've never had trouble getting a boyfriend? I think I'm scary looking. I'm also pretty small in the T&A department which maybe leaves less to catcall. Never had a dude refuse to wear a condom, but I've been with guys who absolutely can't keep it up in one, and that's annoying. Generally during those periods of my life I wasn't on hormonal birth control so letting them know that THIS was the thing not getting me knocked up seemed to help limit discussion. Reply Absolutely a lot of it has to do with attitude. That was my point though, if you are approaching it with the attitude that it is up for discussion, then there will most likely be a discussion. Our 'self talk' plays a really important role in our reality and how we approach these things. Reply I have literally had a man LEAVE MY HOUSE rather than put on a condom. The issue clearly wasn't up for discussion, and my point just is that it's not as simple as "most guys will do it if it's clear it's a boundary." Some dudes are so unwilling to risk the vulnerability of going soft that they'll actually opt to just skip sex completely. Reply Wow that's very surprising to me, but hey I'd say you haven't missed out on much if that is his attitude. I wouldn't want to be with someone that won't consider my safety. I'd still say that is the exception and not the rule, I do think that how things are presented really does effect the outcome. Sent from my Bell Samsung device over Canada's largest network. I agree that it's generally best to get compliance by not even allowing it to be up for debate, but issuing ultimatums isn't going to go far either. My best strategy is to just automatically assume that it's a given that it will be happening, and act accordingly. If it's a casual relationship I'm always going to be supplying so I know their age, expiration, and that they've been treated right, so it's frequently as simple as asking "Are you ready and OK with sex?" and when you have consent, open the package and put it on their package. Or open it and hand it to them, already out of the wrapper, to put on. A lot more guys will push back of they think they have a good shot at getting away with not using them. But if they have to be the one deciding to pause things and confront you to go against the clear expectation, they are a whole lot less likely to do so. Most will just go with it. For those who use the limp excuse, buy a male anatomy ring (or maybe even one that's stretchy and one that's leather with snaps) and keep it in the box with them. If you are a bit shy with that sort of thing, even spencers sells them or make a new amazon account and it will never be on your regular one. Most guys, when instantly presented with an easy and painless solution to their presenting problem, will decide "well, let's try it first and see how it goes and see if we need it" and somehow the problem will never actually occur. If it gets down to having to make an ultimatum, that's about the point that I'd start really debating why he's in my bedroom. If I can't trust him enough to have him respect my reasonable desires without my having to getting harsh about it, I'm not thinking it's a good idea to trust him at all, especially while things are casual. If he didn't care how I felt on protecting myself with a condom when he didn't like my decision, he's too likely to not care what my decisions are when he doesn't like them on anything else either. Too risky for my safety in general, plus, he's rather likely to have done the same thing with every other girl he's been with, and thus be the worst risk for exposure to who-knows-what and so the worst person to consider allowing going without. "Next!!" Reply Former college campus sex educator here! I wholeheartedly agree with all of this. The complaints from men that you've listed here are all ones I've heard, and condoms breaking was a common one too. While they have their own problems, but I've always been a strong advocate for internal condoms (aka female condoms). They're latex-free, cover a lot more surface area than male condoms (built in dental dam!), can be worn a really long time (like put it in before the date even starts long), don't require a well-maintained erection for effectiveness, are useful for all types of insertion sex (just pull out the inner ring for anal!) making them great for all genders and orientations. Unfortunately, they're expensive and can be noisy and generally un-sexy. I really wish they were more mainstream, though, especially as science continues to prove things like cancer-causing STIs are pretty much endemic. Reply I'm perplexed about internal condoms: why aren't they more popular? I get that they're deeply unsexy, perhaps moreso than a traditional condom, but they just seem to answer a lot of the complaints. But bear in mind, I say this as someone who has never even seen one in person. I wouldn't know how to find one in a store (at least I've never mentally registered seeing them in the condom aisle…) Reply I have only ever seen a female condom once and the situation in which I saw it was comic. Someone brought one to my high school and placed it on the head of a statue in the school library. Mind you, I went to an all-girls' Catholic high school, where sex education was basically ABSTINENCE TILL YOU WED, IF YOU FORNICATE THERE ARE A HUNDRED DISEASES TO KIIIIIILL YOU! So I'd never even seen a male condom because I was getting zero game as a 16-year-old. But there it was, a female condom, looking like a winter hat on the head of this decorative statue on one of the library shelves. The library that was run by a nun. Word spread fast among us and soon all of us were finding an excuse to sneak into the library and giggle furiously at this condom-clad statue. I can't recall clearly but I feel like maybe the condom was pastel pink? Perhaps I'm just projecting what I wish its color were. Anyway. Somehow it escaped the library nun's attention for hours so it stayed on the statue ALL DAY. All day! It was kind of the best thing. Finally someone must have alerted the nun to it because it disappeared (imagining a nun dealing with the removal of a female condom makes me cackle), but unlike every other against-the-rules thing that happened at our school, it was never mentioned by the administration and I think that's because they were deeply embarrassed that a prophylactic made it into our school. This story literally has nothing to do with anything in this post save for the mention of female condoms and I acknowledge that it is 100% not useful, but I feel like it is too amusing not to share. (And thankfully, after escaping Catholic school, I educated myself on sex stuff and am well-armed and not-dangerous now. So perhaps this is also a comment to say that abstinence-only sex ed is a dreadful idea.) Reply This is the most important female condom story of all time. Reply I am so deeply glad that I had a place to share this valuable tale. i get why people don't use one. i tried one once with my boyfriend at the time, just to try it. it was totally awful. like…having sex through a raincoat? plus it was gross, way moreso than a regular condom because its way thicker latex. seriously try one and you'll see why they aren't catching on any time soon. Reply I'm going to say.. far more gay men I know use female condoms than women.. guys really like them Reply I have always been extremely cautious, with almost a zero percent no-condom rate, and have also been very sexually active most of my 35 year old life… BUT, now that I too am recently divorced (from a short marriage) with an IUD, I've been skipping the "get tested" request with my new partner, as well as the condoms. We are have not discussed being monogamous, though I think we are, but for some reason I just don't want to even approach it. I can't put my finger on that. Maybe self-destructive? Part of post-divorce depression reaction, compartmentalizing serious matters? It's unlike me, but VERY like all of my girlfriends, so in a small way I am comfortable with it. But there's a voice in the back of my head saying "idiot!" I have never been able to relate to my girlfriends who don't use protection until now. It's an odd feeling. I should probably go see a therapist and sort this out. Anyway, I'm just here to say sometimes all the smarts and logic in the world go out the window when we feel passion or want to forget our troubles. Reply This post means A LOT to me. I had a previous run in with someone who pouted about condom usage and it was such a shock I actually didn't know what to do. I had read about this trend in Scandinavia (about 20 & 30 somethings using condoms less) but to have it occur at home was really distressing. I had a great chat with a public health official recently about safer sex but the concept of condom negotiation didn't really come up (beyond the "you should be using a condom"). I think it's something that people maybe don't realize is kind of endemic? I've been despairing about the state of our local high school health classes for ages, but even if they were better I can't imagine they'd be covering contraceptive coercion much, if at all. I also feel like I should give my brothers the world's biggest lecture on how not to be a dick about it now. I really appreciate that you're talking about this issue and it's given me hope for the future. Reply Thanks much for this article!! I'm currently going to school to (hopefully) become an RN, though my ultimate goal is to (many years from now) get my Masters and become a CNM. So this topic speaks closely to me on a women' health level. I'm also taking Sociology this semester, so it of course speaks on the overall cultural aspect too. Shedding light on taboo topics and so important. Your personal experience and journey will help you interact with you patients in a more meaningful way; and will hopefully spark others to ponder the topic as well. Reply Thank you for this post! It is very insightful and breaks down a stereotype I've encountered that "only people who don't understand how STIs work don't use condoms." I also must be in the rare minority of people who prefer P in V sex with a condom. A slightly dampened sensitivity means he lasts longer! Cleanup is way easier, and there's no… seeping of fluids afterwards! Reply Omg yes! My husband and I are 100% monogamous, yet sometimes we use a condom anyway just because I can't stand having a leaky vag for the next few hours. And he NEVER complains or pouts and is happy to help me out in that regard. Just my naiveté speaking, but I find this attitude from men to push back to be such a turn off! It's childish! Maybe it's because I deal with 2 whiny, complaining, obstinate toddlers all day, I just want my partner to be supportive, compassionate and a damn adult! Reply Thank you for writing this article! I appreciate so much that even though you 'should know better' you are being open about falling prey to the coercion that some women experience. Thank you for letting us feel like we aren't failing when we don't 'practice safe sex' Reply It's been a long time since I've had a new partner, but EVERY new partner I ever had used a condom. Sometimes he supplied, other times it was mine. Where I started seeing drops in use was with repeat (sometimes still casual) partners. I found that I was more successful in getting partners to continue condom use when we used ultrathin or "fun" (ribbed, textured, sensational lube) condoms. I agree with a lot of the other commenters on here that it really does come down to insistence, although I don't think it should. BOTH parties should be on board and it really shouldn't EVER be a begrudged "okay…" between any casual partners (and even between serious partners, but that category should be having conversations about their sexual decisions, anyway.) Reply Chiming in on the lost-erection-due-to-condom argument: When my now-husband and I met, he had just left a seven-year marriage and I had just left a fiance. We were super into one another, but as soon as the condom went on and we got "started," he would lose his erection. We thought it was psychological or emotional or something… until we tried larger condoms. No more issues. Reply YES! So this is the one point that stuck in my head as I read this, because ALL OF THE YES about coercion and how shitty it is, but I don't have the spoons to add to what everyone else has so eloquently stated. My partner has a big dick. He's moderately long and VERY thick. And he had NO IDEA. I dunno, I guess it just isn't a thing for men to compare themselves with other guys by ACTUALLY comparing and looking at other penises. He was a religious condom user, though. He just put up with occasionally being uncomfortable in a condom and a growing fear that he may be suffering from ED. When he finally told me what was going on, I went to the store and bought large condoms. He was a little anxious about using one, because no guy likes to discover that he isn't 'big enough' for a condom. But he put it on . . . and was astonished by how much more comfortable he was. Now, he was, and is, as I said, a religious condom user. We have been monogamous for a year and he won't hear of PIV sex without a condom. That's just how he rolls. And I don't think that a bigger condom is gonna change every dude's attitude about barrier methods (although I'm sure for some of those for whom a larger condom would be more comfortable might enjoy the status of being in the 'large' category). But I also think that this issue is under explored – and it's little wonder why when we can barely disseminate information about how condoms work in our repressed society! Anyway. Just a thought. Reply It's also worth bearing in mind that as well as looking at other sizes, look at other materials. Not all condoms are latex – look for lambskins. They're more expensive, but are much better when it comes to sensation (and much less likely to trigger allergies). Slate had a great article a while back about the development of the condom, which explores the issues around condom use and the why we've ended up in a too-tight latex world. It feels like the reason there's a lack of movement in the condom industry is the vague sense that if people have comfortable, well fitting condoms that make sex more pleasurable, they might respond by having more sex, and no one wants to fund that. Reply Lambskin condoms protect against pregnancy but don't reliably protect against STIs. The tiny pores in lambskin don't allow sperm to pass through them but are porous enough to allow the passage of viruses and bacteria. If latex is an issue, try looking for polyurethane condoms. They do protect against STIs and don't tend to trigger allergies and sensitivities. They are also more affordable than lambskin. #TheMoreYouKnow! Reply True, but a lambskin used 100% of the time is still significantly better protection against STIs than a latex condom used 50% of the time. The original pore test involved stressing a condom beyond normal use, and though it's useful to know a latex condom will remain disease resistant when holding pints of cum for hours, it isn't entirely applicable to actual use. Either way, the best thing to do is for the OP to find a condom she likes, and is happy to advocate to sexual partners. Materials, textures, colours, flavours,shapes and sizes… There are a lot of options out there, and finding one she actively wants to use will make it easier to argue the point with sexual partners who pressure her not to. I used to hate condoms before I tried polyurethane ones. I'm not allergic to latex, but apparently a bit sensitive to it. The first time I tried a 'skyn' (UK brand) condom it was like silk after sandpaper. Also: not smelly and just seems much less gross than latex to me. I didn't know there were different shapes of condoms until I was having frequent condom issues with my current partner. The large size ones were too big and slipped off, the regular ones didn't have enough sensation and frequently broke, the thin ones were breaking every. Single. Freaking. Time. Regardless of how much lube we were using. Finally I looked into it and found out they have different shapes! Not just sizes. It makes so much sense and now we don't have any problems. Reply I don't understand why guys can be so blasé about condoms. I can imagine that they're uncomfortable and all that, but it's not like STI transmission is only male to female. They're taking a huge gamble, not just with STIs but pregnancy too. Wtf?! Coercion is such an important subject that I feel needs to be addressed WAY more, although sadly we're just starting to get to a point where even rape is taken seriously. When I was 19 or 20, I went home with a guy that I fully intended and wanted to have a one-night stand with. I was already pretty good about insisting on condom use despite the whining and protesting, and it usually worked. But with this guy he kept whining and protesting until he finally just penetrated me bareback. Being young, insecure, a people-pleaser, and in the throes of a severe depression, I just gave up and went with it, but during and afterward I felt very confused because I had very much wanted to have sex with this guy, but I still felt violated in a way. I called him the next morning and asked him if he had any STIs, and berated him for his coercion. Thank god when I got tested I was okay, and I was on birth control (unbeknownst to him) so no pregnancy. But ironically, when I was full-on raped by 2 guys a few months later, they wore condoms. Probably just because they didn't want me to be able to get a conclusive rape kit, but now 12 years later, I wonder if the guy I had WANTED to fuck had given me HIV, for example, if that would've been more traumatic. I've been through enough therapy that I've come to terms with and made peace with my rape, to the point that I rarely think about it. But if that guy had given me a life-long STI, it would still very much be a part of my life to this day. I lucked out, but I realize how close I came to my life being completely different. In any case, thank you to the doctor for admitting that even overly-educated people are imperfect, while reminding us that pleasing other people is not more important than our own health and well-being. It's so sad that women are socialized to value *not offending a man* over protecting herself. In the long run, a guy losing his hard-on or leaving our place is nothing compared to a STI that compromises our health and can be very expensive to treat and manage, an abortion, or a pregnancy we're not ready for. But just as important, if not more so, guys need to understand that by using coercion, they're not only putting themselves at risk, they're also not really getting full consent. Reply Thank you for this comment, Bee. Reply Join the conversation Cancel Reply Your email address will not be published. Required fields are marked *Comment Save my name, email, and website in this browser for the next time I comment. Notify me of follow-up comments by email. 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