Colourful condomsiStock

Have we fallen out of love with safe sex?

From erection issues to patchy sex ed, BBC Three explores why some young people are ditching condoms

Natasha Preskey

Hayley* was enjoying a typical post-break-up night out when she bumped into a guy she’d known at secondary school. She hadn’t seen Aaron*, who’d been away in the army, for years but soon they were chatting like no time had passed. Catching up with an old friend was just the distraction she’d been hoping for and, as the night went on, the conversation quickly turned flirty - and they ended up going home together.

“I was probably being a bit immature but I’d known this lad since I was in high school,” the 24-year-old tells me. “We were drunk and I guess I thought because it wasn’t a stranger that it would be fine not to use a condom and, obviously, it wasn’t - and then I started to get chlamydia symptoms.”

After being diagnosed with the STI, Hayley beat herself up over not having raised the subject of protection with her hook-up. “I was really frustrated at myself,” she recalls. “I was saying to myself, 'You're stupid, why do you trust people? You need to start growing up.'” But frustration turned to disbelief when she found out from a mutual friend that the guy had apparently been complaining about STI symptoms before their encounter. “That means he recklessly went out sleeping with people unprotected anyway,” she says.

During the time when Hayley was having casual sex before meeting her current partner, she was on the pill but didn’t use condoms more than a “handful of times”. She says this was partly because they caused her discomfort but also because she felt awkward bringing it up.

“At the time, I foolishly thought ‘I don’t want them to think I’m a prude or that I’m boring,’” she says. “I’m actually really anxious about STIs but I wasn’t confident enough to bring it up – I had this thing in my head of wanting to please men.”

For Hayley, getting an STI that, if untreated, could have affected her fertility, was a wake-up call: “I didn’t see it that way but, by not using one, you’re really trusting somebody and you shouldn’t do that so easily.”

STIsBBC Three / iStock

Despite the condom-on-a-banana lesson being a prevailing school sex education memory for many of us, Hayley isn’t alone in failing to practise safe sex. According to research by YouGov and Public Health England (PHE), almost half of 16 to 24-year-olds surveyed admitted to having sex with a new partner without using a condom. The same survey found that one in 10 sexually active 16 to 24-year-olds had never used a condom.

In 2003, more than 43% of men aged 16-24 who’d had sex in the previous four weeks said they’d used a condom every time, according to figures supplied to BBC Three by the National Survey of Sexual Attitudes and Lifestyles (Natsal). But, fast forward a decade to the most recent Natsal survey, and this figure had dropped to 36%. In the US, condom use among sexually active high school students also dropped from 62% to 54% between 2007 and 2017, according to Centers for Disease Control (CDC) data.

At the same time, rates of some STIs have soared. According to PHE, a young person in England is diagnosed with a new infection every four minutes. Their research also suggests that those aged 16-24 are most at risk of contracting an STI, and over half the reported cases of gonorrhoea and chlamydia in 2016 were in those aged 16-24, according to NHS figures.

Cases of ‘super gonorrhoea’, a strain of the disease that is resistant to the usual antibiotics used for treatment, were recorded in the UK this year and last year. And syphilis is also on the rise - in 2017 there was a reported 20% increase in cases between 2016 and 2017, part of a 10-year upward trend in England. While reported cases of chlamydia have dropped by 2%, sexual health experts have warned funding cuts may be preventing people from accessing services (though the government says that home-testing is now more widely available).

Condom BananaBBC Three / iStock

In an attempt to reduce STI rates, Public Health England launched a campaign at the end of 2017 to promote condom use and sexual health testing with people aged 16-24, recruiting reality star Sam Thompson to help spread the message. Government-backed 'C-Card' schemes also operate throughout the country, allowing young people to get free condoms from local pharmacies. So, if condoms are widely available and they're still the only form of contraception that can protect against most STIs - why aren’t we all using them?

One possible reason for condoms’ decline in popularity is that other forms of contraception have become more widely used over time. NHS sexual health services have seen a spike in uptake of long-acting reversible contraceptives (LARCs) like the implant, the injection and intrauterine devices (IUDs, better known as the coil), which don’t require us to remember to buy them, or correctly apply them in the dark. The percentage of women who visited NHS sexual and reproductive health services for contraception reasons that were using a LARC has risen from 23% to 41% in the past decade. The contraceptive implant was only made available in 1999 and has steadily grown in popularity since.

Meanwhile, the humble condom hasn’t had a major design change since the 1950s. Experts aren’t certain when the first condom was created but they do know that, back in the medieval era, they were made from animal intestines. The first rubber condoms were created in the mid-19th Century. Initially, these were designed to cover just the head of the penis – it wasn’t until a decade later that rubber condoms became full-length. The first latex versions - thinner and more natural-feeling than thick rubber - weren't produced until the early 20th Century.

These days, condoms do come in a wide variety of textures, such as ribbed and dotted, as well as different flavours (none of which really mixes well with rubber, let’s be honest). There are even, erm, helpful glow-in-the-dark versions, not forgetting female condoms, which launched in 1992 but never really took off, and dental dams (mouth condoms) - yes, really. But, these variations aside, condoms haven’t had a major redesign since 1957, when the first lubricated version was created. Why, then, is their popularity seemingly slipping now?

Condom use declineBBC Three /istock

“The first few years when I was sexually active, the spectre of HIV was pretty enormous,” Samuel*, now 27, says of the fear and stigma that surrounded the virus when he was in his late teens. “We'd heard from the older generation that it was this thing that would definitely kill you – so I think I used to be a lot more careful about using condoms when I started having sex [a decade ago] than I am now.”

As well as seeing less about the dangers of HIV in the media in recent years, Samuel, who’s gay, also points to the availability of PrEP (pre-exposure prophylaxis), a drug you can take to stop yourself contracting HIV, and the development of antiretroviral drugs that can make HIV undetectable and untransmittable. HIV diagnosis rates are at their lowest since the turn of the millennium.

Research published last year found a link between the uptake of PrEP and a decline in condom use among Australian men aged over 16. The study, which involved 17,000 men in Victoria and New South Wales who have sex with men, found that PrEP usage among HIV-negative men in the sample had risen from 1% to 16% between 2013 and 2017, while consistent condom use had dropped from 46% to 31%.

“Our findings suggest that the rapid uptake of PrEP disrupted condom use,” study lead Prof Martin Holt told the Guardian. “However, it’s too early to tell the long-term effects of increasing PrEP use.” PrEP is available from the NHS in Scotland and in some locations in Wales and England as part of a trial project, and it can also be legally purchased from private sellers online. 

“Other sexually transmitted infections don’t really feel as scary as HIV does, or they seem treatable by a round of antibiotics,” Samuel says. “If I’m having casual sex with someone, or with someone I'm not in an exclusive relationship with, I do feel bad if I don't use a condom but I tend to get wrapped up in the moment and forget about it. Then I remember afterwards and freak out.”

HIV MedsBBC Three / iStock

But throwing caution to the wind can actually be a turn-off in some cases. American research suggests that risk of unwanted pregnancy and STIs can also reduce arousal for some people, especially women.

That’s certainly the case for Laura*, 24. She’d always used condoms until she and a guy she’d recently started seeing didn’t have one to hand one night - resulting in her contracting genital warts. Now, she always uses one with a new partner, or anyone she isn’t in an exclusive relationship with. “There are so many things that can go wrong, and it kind of ruins it if that’s always in the back of your mind,” she tells me. “The condom thing is a real relief for me - it’s a safety net. I think people who don’t want to use one don’t always have the best intentions, so it kind of weeds those people out too.”

For some people, though, the embarrassment and anxiety they feel around using condoms can translate into performance issues. In the eight years since Josh* lost his virginity, the 26-year-old has used a condom just once. His dislike of using them came about after he tried using one with his first girlfriend, who was on the pill, a few months into their relationship. “We tried to use one but then I couldn’t get a proper erection - I think it was mostly because of nerves,” he recalls. “So that wasn't successful and then, for the next year or so - until we ended our relationship - we never used one.” He admits now that this was partly due to his worries about his performance.

Cynthia Graham, professor of sexual and reproductive health at the University of Southampton, explains that Josh isn't alone in struggling with his erection while using a condom. She says that what experts have dubbed condom-associated erection problems (CAEP) are “not uncommon” in both younger and older men. Triggers can include things like nerves, a condom being too loose or too tight, or anything psychological that affects men’s focus on sex. A 2015 study of 479 straight men aged 18-24 by American and British researchers suggested that nearly 62% of participants reported CAEP when putting on a condom, or during sex, or both.

Erectile ProblemsBBC Three / iStock

Worrying about condoms causing erection loss can be a self-fulfilling prophecy though, Prof Graham adds. “This is one of the myths about male sexuality – that you should always have a strong, reliable erection,” she tells me. “If an erection wanes a bit when they’re putting on the condom, that doesn’t mean it's not going to come back.”

One way to tackle the problem of erection loss when using a condom is finding a variety that works for you, says Prof Graham, whose latest research is focused on ways to encourage young men to use them. 

“Contraceptive pills are so different. If one doesn’t work, trial and error is the best suggestion for women on the pill who have a lot of problems but, with condoms, the same kind of thing applies,” she says, adding that a surprising number of people she surveys don’t know that different sizes and textures are available.

Some women also report experiencing soreness from condom use, says the expert. “Women talk about feeling real discomfort and sometimes pain – certainly irritation and discomfort.” Some report that condoms "dry out", something she says that using extra lubricant can help combat.

Another complaint that Prof Graham has heard regularly - from both men and women - is that condoms reduce feeling during sex. “Loss of sensation may reflect the fact that people aren't trying different kinds [of condoms],” she explains. “But this varies – some people don't complain about it much, while others do a lot.”

Even in 2019, Hayley feels there’s still stigma associated with buying condoms, especially for young women. “I don’t think lads are as bothered about walking into a shop and buying a pack of condoms but there’s this negative stigma with women having casual sex,” she says. “I worked in a shop and I noticed that the majority of the time that condoms were bought it was by men. Even if women want to take over control of the situation, it's having that confidence to go out and buy them yourself.”

Correct SizeBBC Three / iStock

This sense of shame and stigma for women can go further. According to Prof Graham, some are concerned that they may “potentially lose a partner” if they’re not willing to have condom-free sex. “There may be some women particularly vulnerable to that,” she says. “Those who are maybe less confident, less happy in themselves and with their body image that feel, in order for their partner to have 'good sex', they don’t want to be asked about using protection.”

Cicely Marston, professor of public health at the London School of Hygiene and Tropical Medicine, says that young people’s declining condom use isn’t necessarily due to a lack of information about the risks. “There is a stereotype of young people just being ignorant, and it's like, 'You've got a choice to use a condom or not, and you're making a stupid choice if you don’t,' and that seems to be as far as the conversation goes,” she explains. “That’s not considering the social situation that they might find themselves in. Maybe they worry that they'll seem to be ‘over-prepared’, or they know their partner is clean.”

According to Prof Marston, many people fear appearing presumptuous by carrying a condom. “If you talk about having a condom, you have to talk in advance about whether you're going to have penetrative sex or not,” she explains. “For some people, that can be a really awkward conversation and so it just doesn’t happen.”

As well as making their own risk assessments around STIs with new or casual partners, people are also aware that condoms are not the only form of pregnancy prevention. In fact, Prof Graham notes that “consistent findings” show that people in relationships tend to switch to another form of contraception once they’re established.

So, can anything be done to make condoms more appealing?

Condom DesignBBC Three / iStock

One person trying to answer that question is American entrepreneur Stacy Chin. Her company is developing a self-lubricating condom, funded by a grant from the National Institute of Health in the US. It’s designed to feel good and encourage people to have safe sex.

This condom will stay lubricated for at least 1,000 thrusts, removing the need to look for other ways of making sure sex is comfortable. The design is only at testing stage at the moment, but the company plans to apply for approval from the Food and Drug Administration (FDA) in the US.

Stacy’s company evolved from a Boston University research team, who responded to the Bill and Melinda Gates Foundation’s call for designs for the “next generation of condom” in 2013. The Foundation donated over a million dollars to condom research, but the process of developing a new product and securing medical approval can prove very expensive and take years.

One new design which is available to buy already is a condom made by a Swedish sex toy company which uses thin latex formed into a strong hexagonal structure. This helps to prevent breakages and slippage, and allows body heat to pass through the material. However, though this product can be bought online, it isn’t widely available in shops. 

While these designs will change the make-up of the condoms themselves, British entrepreneur Mike Hore’s invention alters the way we put them on. Packets of his condoms feature a pull tab for easy opening, and an applicator which allows it to be applied without touching the condom or the penis. That means no more putting the condom on upside-down by accident or, worse, accidentally tearing it by opening the packet with your teeth.

Mike Hore's easy to apply condomMike Hore

His goal, he says, was to make a condom that is more reflective of how, and when, they are actually used. According to Mike, condoms are often applied at times when people are distracted and “alcohol or even drugs could have been involved” - situations that school sex ed lessons don’t prepare us for. He believes the best solution is to tweak the design to ensure condoms are easy to use, even if someone is inexperienced or is fumbling around in the dark.

It seems that, 10 or 20 years from now, condoms could look different and be applied in new ways – but these models are still nowhere near being available on the High Street. So what can be done to help shift attitudes to safe sex in the meantime? 

Sex education should help us understand how to communicate well about sex, and teach us to look after our sexual health - but the current reality of school sex ed is often different. “The academic literature of the 80s and 90s talked about it being ‘prevention and plumbing’, and that's still kind of the case,” says Mark McCormack, professor of sociology at the University of Roehampton.

Young people that Prof McCormack interviewed for independent research by Durham University, funded by a condom company, told him that sex ed is too basic and taught them little beyond how to put a condom on – and even this lesson often came long after they’d had sex for the first time. The in-depth study involved 30 people, and issues raised included claims that lessons lacked discussion about emotions and that sex ed excluded information about non-heterosexual sex.

Colourful condomsiStock

Prof McCormack welcomes the government’s plans to introduce compulsory sex-and-relationships education for all schools in the UK from September next year, with relationships education beginning in primary school. He adds that sex education shouldn’t be solely focused on “reducing harm” but also involve discussions around pleasure, relationships and the impact of the internet. “If you just go in and say ‘you should use condoms’ in a way that doesn’t connect with young people's lives and experiences it loses credibility."

“I don’t think that sex ed encourages sex to be a comfortable topic,” says Hayley. “I think that it's more about being scaremongery with 'look at all these horrible diseases'.” If young people aren’t comfortable talking about sex from an early age, she adds, then it's unlikely they'll feel comfortable having the condom chat when they’re older.

When learning the condom basics isn’t accompanied by lessons on how to talk about safe sex and avoid feelings of awkwardness and embarrassment, it can feel like only being given the opening page of an instruction manual.

If next year’s reformed sex and relationships programme delivers a fuller picture, and those benefiting from it one day have access to the super-condoms of tomorrow, attitudes to safe sex could look very different a decade from now.

*Name has been changed