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Steve Slack’s article on “condomophobia” (1) raises important issues about condom use and safer sex. However, it needs qualifying.
A phobia is an irrational fear. Not using condoms because of a fear of them must be very rare- I have never seen a case in 36 years of clinical practice. More likely is fear of erectile failure while putting on a condom. I would suggest another common scenario for no...
A phobia is an irrational fear. Not using condoms because of a fear of them must be very rare- I have never seen a case in 36 years of clinical practice. More likely is fear of erectile failure while putting on a condom. I would suggest another common scenario for not using a condom
(apart from not having one at hand as Slack correctly suggests may happen) it is that the person, partner or couple are carried away by the heightened feelings of the sexual event. Other possible reasons for not using condoms are fear of the partner’s reaction (“why are you using one
of those, I’m not infected- are you?”), that sex without a condom feels more pleasurable than wearing one, and being romantically in love with the partner (2).
Slack quotes from the ancient Egyptians. At about the same time (i.e. 1300BC) the Bible (Deuteronomy 21.10) discusses what an Israelite should do when he captures a woman in battle and “desires” her . Sexual desire
may be an almost overwhelming urge unless checked by restraining cognitive inputs. Romantic love, sexual desire and arousal are monoamine (principally dopamine and serotonin) associated events in cortical and
limbic system brain areas, some of which are very similar in terms of neurotransmitter profile to obsessive compulsive disorders (2) or hypomania. The themes of desire/arousal/love opposed by cognitive inputs condense at any one sexual scenario to form a final decision pathway i.e. the use or non use of condoms.
Slack sites car seat belt usage and inserting lipstick and mobile phones into personal bags as examples of common automatic practices. I would suggest that personal motivation lies behind most seat belt usage (“this might save my life”) and that anticipated pleasure lies behind
inserting the more personal objects into bags – back to dopamine again!
The war against unsafe sex was temporarily won in the early 1980s in the UK because people feared they would die of HIV. What higher motivation could there be for using a condom? Nowadays all STIs can be treated and have a relatively good prognosis. This means we must again increase
motivation- and this is really the linchpin underlying condom use. Motivational counselling for using condoms (3), as well as putting them in bags as Slack correctly suggests, is the correct way forward.
1. Slack S .“Condomophobia”. Sex Transm Infect 2007;83:246
2. Goldmeier D , Richardson D . Romantic love and sexually transmitted infection acquisition: hypothesis and review. Int J STD AIDS 2005;16:585-587
3. Petersen R, Albright J, Garrett JM, Curtis KM Pregnancy and STD prevention couseling using an adaptation of motivational interviewing: a randomised controlled trial. Perspect Sex Reprod Health 2007;39:21-28