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Why Are Condoms Still a Thing?

I know they work, but shouldn't we have an STI-blasting laser or something by now?
February 13, 2015, 8:20pm

Before everyone freaks out, I know why condoms are still a thing. They're affordable, effective, and the only contraceptive that also protects against STIs and HIV. And let me make it clear that I am very pro-condom. Don't be a fool, wrap your tool.

That said, you have to admit that it's kind of crazy that a piece of technology that was possibly used by Cleopatra is still the only contraceptive that also protects against STIs and HIV. And while we've certainly made improvements to the design over the years (more on that in a bit), the basic concept is the same. Why haven't we ever come up with anything more sophisticated than sticking some latex around your dick or up your vagina? It's 2015! Shouldn't we have some kind of STI-blasting laser by now?

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"It's absolutely not for a lack of trying," Fred Wyand, the director of communications for the American Sexual Health Association, told me.

Wyand said there have been a number of attempts to create a condom alternative, particularly post AIDS epidemic, but none of them ever came close to the all-in-one protection of the condom. There's the HPV vaccine, which is highly-effective and actually trumps condoms on preventing spread of the disease (condoms are only about 70 percent effective at preventing HPV). But it only protects against one STI and doesn't prevent pregnancy.

Wyand also told me about a spermicide with an antimicrobial agent that was developed to block STIs and, in particular, HIV.

"That had a lot of hype but what they found was not only was it ineffective, it actually made things worse," Wyand said. "They found it might increase the risk of infection because it caused the skin to break down a little bit, which may have actually made it a little easier for the pathogens to penetrate."

Studies showed Nonoxynol-9 (the name of the antimicrobial spermicide) increased the risk of STIs and wasn't even very effective as a contraceptive, according to the World Health Organization. However, the WHO said these results shouldn't discourage researchers from seeking other antimicrobials as possible STI preventive measures.

There are also antiretroviral pills and gels as a way of preventing HIV, which can be used to prevent transmitting to a negative partner or from mother to child, with some pretty good success rates. One study found ARV treatment can reduce transmission to partners by 96 percent and both the National Institutes of Health and the Center for Disease Control recommend it to reduce the risk of transmission. There's also Truveda, an HIV-preventative pill, which HIV-negative individuals can take to reduce their risk of contracting the virus.

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But there are limitations like cost and access to medication, as well as the fact that these therapies doesn't necessarily prevent transmission of other STIs (and, obviously, don't protect against pregnancy either).

"It's not just creating an intervention that works, it's creating one that people actually use and use consistently in the right way. That's sort of the other piece of the puzzle," Wyand said.

In thousands of years, we really haven't been able to beat the one-stop-shop technology of the condom, but we have made several advancements. While early condoms were made of linen, then animal intestines, and eventually thick, vulcanized rubber, we now enjoy condoms made of thin, flexible latex that come in every size, color, and flavor imaginable.

And condoms are not only remarkably effective for both preventing pregnancy and STIs (98 percent effective with perfect use), they're also pretty foolproof. The most common issues are putting the condom on too late, taking it off too soon, or puncturing it while opening the package, Wyand said. If you can manage not to do any of those things, you're very well protected.

The condom's long legacy in society also helps make it familiar, making people more likely to use it, Wyand told me. A deadly syphilis outbreak among the troops in WWI quickly persuaded the military (which had previously only recommended abstinence) to urge their soldiers to use condoms. By WWII, condom use was less taboo and much more openly encouraged. But despite their ubiquity, some studies show condom use has been declining the United States.

"Now we live in this day of very highly-effective birth control pills and even long-acting contraceptives like implants and IUDs that can work for years. Those things are absolutely wonderful but they really only work to prevent pregnancy," Wyand said.

"Let's not forget about condoms. We need to keep that first and forefront, making sure we don't just toss the condom aside."

At least not until after you've used it—correctly of course.

This story is part of Motherboard's Sex Ed Week, a series of sex-focused science and technology stories. Check out more stories here.