The article by Crosby and colleagues1 in the current edition of the journal suggests that the use of phosphodiesterase 5 inhibitors (PDE5i) (sildenafil, tadalafil and vardenafil) by men is associated with a significantly increased rate of condom breakage compared with men who use condoms but not PDE5i. This seems biologically plausible in that whatever the degree of a man’s natural penile rigidity, PDE5i use can enhance that intensity of tumescence.2

The use of PDE5i in HIV and other sexually transmitted infection (STI) acquisition and transmission is of importance, particularly in men who have sex with men (MSM). In clinical practice it would seem logical …