Keeping the Condom Window Open, A Little Longer

Pogotskiy for iStock via Thinkstock

I became a teenager at the beginning of the HIV/AIDS epidemic. I remember when my seventh grade health teacher, Miss Hodes, stood next to the overhead projector and explained that there was a virus that could cause your immune system to stop working. It was deadly and it was transmitted through sex. It was very important, she explained, that when we started having sex, we always used condoms.

That message got repeated and clarified in health classes throughout junior high and high school. We were told in no uncertain terms that we should use condoms until we had a steady (presumably heterosexual) monogamous partner and both of us had been tested for HIV. Then -- and only then -- could we get rid of the latex in favor of the pill, the diaphragm or the then-popular (and surprisingly ineffective) contraceptive sponge. Peer educators in college elaborated on the message, presenting joint HIV testing as a rite of passage for a relationship, and even suggesting that we make it a romantic date night at the University Health Center.

My peers and I followed this norm religiously, and we noticed something interesting: The only partners who ever balked at following this standard were those who were older than us by even just a few years. They'd come of age sexually before there was a deadly STI to worry about and had not had the condoms-until-testing rule presented early and repeated often.

Clearly from the research, those who came of age after us didn't get that message either. It's not surprising; some of them grew up in the age of abstinence-only-until-marriage programs that replaced suggestions of safer sex with the absolutism of no sex before marriage. Moreover, as treatment for HIV advanced, the fear subsided. Without that, and with other ways to prevent HIV -- treatment as prevention (TasP), pre-exposure prophylaxis (PrEP) or serosorting -- the condom message has been muted at best.

But HIV is still a threat, with 44,000 new cases diagnosed in 2014, and other STIs are on the rise, especially among young people. In 2014, cases of chlamydia, gonorrhea, and syphilis increased for the first time since 2006 with approximately 1.4 million cases of chlamydia, over 350,000 cases of gonorrhea and almost 20,000 cases of primary and secondary syphilis.

In addition, as recently reported, young people aren't getting tested for STIs. A study of over 5,000 18-25 year olds found that only 11.5% had gotten tested for STIs in the past 12 months. When asked why they hadn't been tested, a large portion (41.8%) said they didn't think of themselves as being at risk.

Sex educators and researchers tend to agree that lengthening the "condom window" -- the period of time at the beginning of a relationship during which many heterosexual couples use condoms for protection against both sexually transmitted infections (STIs) and pregnancy -- would be an important step in reducing STI risk. There has not been much research into the condom window, but what has been done suggests that it is likely too short to protect couples from the possibility of STIs and HIV. One of the earliest studies on the condom window looked at young people who visited an STI clinic between 1995 and 1999. It found that new couples were more likely to use condoms (66% of first coital acts) compared with established couples (54%). However, the percentage of coital events that were protected decreased over the first few weeks of a relationship to the point that, by the 21st day, researchers could not distinguish new relationships from established relationships.

The National Survey of Sexual Health Behavior (NSSHB) looked at the condom window in terms of number of sex acts rather than relationship length. A majority of men (79%) and women (59%) used a condom the first time they had sex with a partner. This percentage, however, went down rapidly thereafter: The second time they had intercourse with a partner 59% of men and 38% of women used a condom; the third through tenth time 53% of men and 29% of women used a condom; but from the tenth act forward only 17% of men and 19% of women still used a condom.

It's unclear why the condom window closes so quickly, though it seems likely that as straight couples feel that they know each better they become less worried about STIs. It may also be that not using condoms is seen as a sign of trust -- the flip side of this would mean that continuing to ask your partner to use condoms suggests you do not trust him or her. While couples may feel closer to each other after having a handful of sexual encounters, many still have not discussed their sexual history, whether they've been tested for STIs or HIV or if they have any other current partners.

Condoms are the only method of birth control that also prevents STIs and, as such, the longer couples use them, the less risk they have. This is not to say that all couples should use condoms in perpetuity. While some may choose condoms as their primary form of pregnancy prevention (or as an additional method to ensure contraception), there are many forms of birth control to choose from, and many couples will eventually move away from condoms.

It's hard to agree on what the ideal condom window would be. After all, each couple has a different level of risk, and each relationship follows its own path. Ten sex acts could be a particularly good weekend for one couple and six months for another (think of the dreaded long-distance relationship). Three months could mean one couple was out of STI risk, but other couples (those with concurrent partners, for example) could remain at risk for the first year or longer.

When I think about the condom window, I don't think about any specific length of time or number of sexual encounters. Instead, I think about that relatively simple social norm that was in place for me and my peers: Use condoms until you get tested.

Maybe it's time we bring back the condoms-until-testing rule. It makes no judgement about causal sex but reminds us of the risk of STIs and the importance of condoms for protection. And, couples can go at their own pace -- for some couples testing could be a second date, for others it could come in the third, fourth or sixth month. Some couples might want to continue using condoms for pregnancy prevention as they are an easily accessible and inexpensive option. Others might want to close the condom window as soon as they can -- but at least they would know they were safe in doing so.