Use protection. It's a concept that's been hammered into the general consciousness for decades but still seems to be a major cause for concern. In the context of this article, safe sex is sexual activity that involves the use of barrier methods. The skyrocketing rates of sexually transmitted infections (STIs) in the United States show that sex with barrier methods is still not occurring as frequently as it should. While the general idea is that individuals who do not use protection while engaging in sex are "reckless," that's not entirely true. There are many situations where individuals desire to use sexual protection but might not. In many of those situations, a lack of empowerment might be what stands between them and risks to their health.
What causes individuals who desire protection to forgo using it? And why, despite the physical and mental benefits of using their own preferred form of protection, do people not feel empowered enough to use it?
Individuals struggling with insecurity are at high risk for not using protection, according to Marya Shegog, Ph.D., director of health programs and assistant professor at the University of Nevada, Las Vegas Lincy Institute and School of Public Health. A request to use protection is "often dependent on a person's sense of self and being comfortable in their skin," she says. People may think that "asking about HIV, condom use, or PrEP [pre-exposure prophylaxis] can make [them] seem anxious and worried, rather than strong and confident, adds Margaret Higham, M.D., medical director of Health Services at Tufts University. For people who are not fully secure with themselves or their sexuality, their boundaries may not be strong enough to make a case with their partners about the need for protection.
Robert Kandell, relationship expert and host of the TuffLove podcast, says many people feel fear "that talking about sex diminishes the excitement or romance of the act." He also states that people believe that if we "rock the boat, speak our desire, then there is a chance that we will lose the opportunity for sexual contact with our current partner." Ken Blackman, an intimacy, relationship, and sex expert, adds that people may avoid raising protection before sex because they might be reluctant to introduce a "downer topic" like pregnancy or STIs.
According to Shegog, when the "perception of love" is present, requesting protection can challenge that sentiment. According to at least one study, some black gay and bisexual men who felt trust with their partner sometimes opted to not use condoms because of their trust level with their partner.
The fear of potentially offending a partner can sometimes drive people to dismiss their own desire to use sexual protection. According to Shegog, people are often concerned about the "statement" that asking for protection might make to a potential partner. Because safe sex is often promoted in the context of nonmonogamous or "open" relationships, people -- particularly those in committed relationships -- may feel using a condom implies a lack of trust in their partner. Blackman concurs that some relationships have a "Don't you trust me?" dynamic, in which they're afraid of what it seems to imply about their partner or the relationship. Certain people also have partners who make it precarious for them to ask. According to Kandell, certain people are in "a hierarchical relationship where the partner does not make it safe or even [makes it] dangerous to ask for what they want in terms of safe-sex practices." Hierarchical relationships, particularly when there is a significant age gap, are often more likely to involve a lack of protection, because younger partners may not feel comfortable expressing their needs.
Some people, especially women and queer men, may feel that asking for protection affects how people perceive them. For instance, some women who pre-emptively push for protection may fear being seen as hypersexual or promiscuous. Some men who participate in sexual activity with other men, but are not yet ready to identify their sexual orientation, may feel using a condom pushes them to identify with a sexual orientation when they are not ready to do so.
So then how should people approach asking for protection? If you're hesitant, how do you broach the conversation about protection with partners? Fortunately, there are many tactical strategies to empower individuals to demand the best for their sexual health.
We all know knowledge is power, but in the context of health, knowledge is vitality. Understanding what different STIs are out there and their effects on the body can strengthen people's resolve to protect their health when engaging with partners. Understanding the different forms of protection out there is also beneficial. Much of the general gist revolves around putting external condoms on penises. But if you are looking for barrier methods, internal condoms, inserted in vaginas or anuses, are just as effective. Dental dams are another important barrier method, too.
Talk as Early as You Can
People should attempt to have straightforward conversations with their partners about their preferred safe sexual practices as early as possible. Shegog recommends having a discussion "before the heat of passion." Kandell agrees. People should "be willing to have a conversation before they enter the bedroom," he says. Blackman agrees that it's never too early."Bringing it up way before it's necessary is usually much easier and smoother than when it's close to decision time." Having a conversation about safe sex practices further away from the actual acts makes it more possible to speak, think, and act logically. It also helps prevent the worry of killing the mood, which is a common factor associated with high-risk sexual activity.
However, "It's never too late to change up how you've been doing things," stresses Higham. If you want to start using protection with a partner you already are engaging with, then the present is as good a time as any to bring it up. Higham recommends diving right in with, "I've been thinking about my health and want to be more careful about STIs. Let's start using condoms. It's important to me."
When it is time to have the conversation, it's important to be as open and honest as you can with your partner. Talking about safe sex should be an important factor, regardless of the nature of the encounter. Kandell has helpful conversation starters for individuals not sure how to start the topic.
For those engaging in a one-night hookup or unplanned encounter, Kandell recommends a conversation opener like, "Can we take a breather for a moment? I'd love to just speak frankly about safe sex. Are you willing to have that conversation?"
For those in casual or committed relationships, Kandell recommends using a conversation opening such as, "Hey, can we talk about something for a moment? I am loving the pace of relating and loving getting to know you. There is a feeling that we are moving closer to having a deeper sexual relationship, and it's important to me that both of us feel safe. Would you be willing to have a safe sex conversation?"
If you are HIV positive, you absolutely have the right to advocate for use of barrier methods to protect yourself against other STIs. Higham recommends a conversation opener as simple as, "Hey, I want to do this, but I want you to know that I'm HIV positive. Just to be safe, I always like to use condoms. That OK?"
Shegog recommends "date night testing," where people can go for dinner, have the discussion, conduct the testing -- even with over-the-counter tests -- and decide what type of protection you and your partner want to use.
For individuals who prefer to get testing done by professionals, they can go with a partner to a walk-in STI testing clinic. And for individuals who might not have insurance or the financial resources for a full walk-in STI testing visit with a date, they can still check out a handful of clinics that offer free, rapid HIV testing for couples.
Consider Talking to a Professional
If you still feel uncomfortable or anxious speaking with partners about safe-sex practices, reaching out to a counselor or mental health professional could be a good step. We must take our health into our own hands, and if you currently don't feel comfortable doing so, reaching out to a professional to uncover and help you move toward that self-assuredness could be a pivotal step for your health.