Monday, April 28, 2008

Alternatives in Gay Safe Sex

The hell?! Female condoms?! Yup, you bet your bottom loving ass! There are other alternatives to gay safe sex which hardly get noticed. Discussion of the Female Condoms used for safe gay sex have been popping up left and right lately and it's time this conversation gets some legs.

When you have 5 minutes it's imperative that you go over to Bstewart23 and read his blog post about female condoms. This post is thoroughly detailed, honest and skips all the bullshit. It's essential this gets a look.
From the BStewart23 man himself:

You know me as a pretty easygoing kinda guy, but I must confess: nothing drives me crazier than the phrase “condom fatigue”, especially when it’s used to rationalize the stupid risks gay men take when it comes to their health and the health of those for whom they claim love and community. Do you hear about “seatbelt fatigue”? How about “not-drinking-gasoline fatigue”? Come on, grow the fuck up.

So, as I mentioned a couple of days ago, as I left my doctor’s office, after receiving the results of my 30th (or so) HIV test, my doc pressed a fistful of female condoms into my hand. “Now, more than ever,” he said. I replied with a “thanks, but… what are you talking about, the continuing — and very depressing — seroconversion rates among gay men?”

He said: “Well, there is that, but I’m talking about increasing stories from bottom guys who report that the condoms they thought were tightly rolled down their penetrators mysteriously disappear at some point in the action.”

The fuck? No, really. THE FUCK?!?

If you’re an HIV-negative gay man who wants to stay HIV-negative — and if you also like buttfucking — you have exactly two options:

  1. Find yourself an HIV-negative partner with whom you trust your life and make a strict, no-exceptions monogamy pact — for the life of your relationship. Both of you get tested, both of you get tested again three months later, both of you get tested again three months after that and lose the condoms with the proviso that neither of you ever, ever strays, not even once. Ever.
    Good luck on that, by the way. I suppose it’s possible, in the same way that there are some truly extraordinary things possible in this world, but I’m realist enough to not bet my life on it. Whether you do or not is your choice. I’ve been around the block. I know how this gay monogamy thing usually works and, man, would it ever suck to find out your totally-monogamous boyfriend’s been messing around on you by finding out you just seroconverted.
  2. Barrier protection, always following the proper usage guidelines to ensure maximum effectiveness.

I sincerely do wish there was a less blunt way to illustrate the situation and I totally wish there were more options to offer you, but there simply aren’t at this time, so make your choice now.

Actually, hold on, there’s more to Option #2 than you might be thus far aware. And, for the life of me, I can’t figure out why that is.

But first… I get it. Traditional condoms are a pain. They can tear, they’re constrictive, you’re limited to water-based lubricants, you’re allergic to latex. I know, I’ve heard it all. And my response is: replace the torn condom immediately, buy a bigger condom, buy a better water-based lube and use a polypropylene condom.

“I really want the intimacy of sex without condoms.” Good for you! I really want to win the lottery, pal, but the chance of doing that (without risking far more than I’m willing to risk) approaches zero. Besides, you’re side-tracking this discussion in 2008 with your unrealistic dreams. Wake the fuck up.

And now you’re thinking “okay, b, I know your drill, what are you getting at? It’s not like I didn’t see the mock ad at the top of the post, anyway, so spill.”

So, yeah, what you probably haven’t heard, or what you might’ve heard and haven’t yet seriously considered, is that there’s another form of barrier protection for Men Who Like To Stick Their Wieners In Other Men’s Buns, and that form of protection is…

Female Condoms.

Huh? Female condoms? Simply (and, again, bluntly) stated, they’re bags you stick in your butt so the guy porking you doesn’t need to wear one. And the receptive partner has more control than with regular condoms. They’re made of polypropylene, they’re stronger than latex and they transmit body heat better than latex. When used properly — more on that in a mo’ — they’re as safe as traditional condoms. Provided you’re using traditional condoms properly, too, that is.

Now, what I’ve just told you is my opinion. If you’re interested in seriously investigating these dealios, you absolutely must arm yourself with as much information as possible and you absolutely must consult with your health care practitioner. I’ll get to the conflicting information is a moment. But you need to talk to your doctor if you’re at all skeptical about my Professor Harold Hill-ish enthusiasm for this product. I mean, you should be talking to your health care practitioner on a regular basis about safer sex anyway, right? Right?

So, yeah. Female condoms are marketed in North America under the brand name Reality™. Made for a woman but strong enough for a man. They’re made of polypropylene, approximately as thick as latex condoms but about three times as wide and a little longer. There’s a flexible rubber ring around the open end — that’ll stay on the outside of your butthole — and there’s another flexible rubber ring, loose, in the bottom of the bag. You squeeze that ring to insert it in your bum. You push the whole contraption inside with your finger or, I dunno, can you think of anything longer than it is thick? Use one of those.


UrBear said...

I've been evangelizing the hell out of female condoms for years. I've made a few converts, too. Ask for a personalized demonstration!

David said...

I saw them years ago when I was up in P-town. Now I'm intrigued. My big question is "do they stay in place during all that thrusting?"

Chuck from PA said...

What amazes me is how what is considered safe sex changes depending on what country you are in. Once you cross the border to Canada, oral sex is fine.
In Switzerland they believe that if you are on AIDS drugs and test undetectable, you can't pass the virus.

I was just wondering if these "female condoms" were still around. I remember these back in 1995 and was told that although they haven't been approved for anal sex that they were fine and to take out the ring on the inside. Do they mention anal sex in the instructions nowdays?

Anonymous said...

chuck from pa, I know you know this, but it's important to make the distinction between the labels "safe" and "safer". If there's a geographic variation in the proscribed safety of unprotected, pre-ejaculatory oral sex, I'm pretty sure that up here in Canada you'll find it's placed on the "probably safe" list, which is not what I'd call "fine", more like "you guys really need to discuss this". "Probably safe" provided, of course, there's been no trauma to the lining of the oral cavity, no precum, etc, etc.

I hate to self-pimp my own post too much, but I do speak to the "acceptable risk" of oral sex (on withdrawal from the female condom) and of the choice to keep or remove the inner ring in the link to the original which Mr. Leven has provided.

And, david, they do occasionally pull out, if you're not keeping things slippery with lube. Use lots. And, for the record, I have no affiliation with WET. ;-)

Anonymous said...

They also make a really squeaky noise. Think "cellophane".

Jim Pickett said...

There are reports of the Reality Condoms causing rectal bleeding - not a good thing.

Read these abstracts:

1: AIDS. 2003 Mar 28;17(5):727-31.

Safety and acceptability of the Reality condom for anal sex among men who have
sex with men.

Renzi C, Tabet SR, Stucky JA, Eaton N, Coletti AS, Surawicz CM, Agoff SN,
Heagerty PJ, Gross M, Celum CL.

Department of Medicine, University of Washington, Seattle 98104, USA.

OBJECTIVES: To assess safety and acceptability of Reality condoms for anal sex
among men who have sex with men. METHODS: Crossover study among
HIV-seroconcordant (33 HIV-negative and 5 HIV-positive) monogamous male couples,
randomized to latex male and Reality condom use with anal sex. RESULTS: Slippage
with removal was reported more frequently with Reality than male latex condoms
[odds ratio (OR), 2.7; 95% confidence interval (CI), 1.2-5.8 for receptive
partners and OR, 34.1; 95% CI, 13.8-84.1 for insertive partners]. Receptive
partners more frequently reported pain or discomfort (OR, 5.0; 95% CI, 2.6-9.4)
and rectal bleeding (OR, 1.9; 95% CI, 0.9-4.1) with Reality condoms than male
condoms. Over 20% reported willingness to use the Reality condom in the future
with a partner of unknown HIV status; willingness was associated with past
problems with male condoms and no problems with Reality condoms among receptive
partners, and with past use of Reality condoms and HIV seropositivity among
insertive partners. CONCLUSIONS: Men reported more frequent problems with Reality
condoms than male latex condoms used for anal intercourse, particularly slippage,
discomfort, and rectal bleeding. Design modifications, training, and research on
the clinical significance of safety outcomes are needed for use of Reality
condoms with anal sex.

Publication Types:
Clinical Trial
Randomized Controlled Trial
Research Support, U.S. Gov't, P.H.S.

PMID: 12646796 [PubMed - indexed for MEDLINE]

2: AIDS Educ Prev. 1999 Feb;11(1):65-71.

Experiences of 100 men who have sex with men using the Reality condom for anal

Gibson S, McFarland W, Wohlfeiler D, Scheer K, Katz MH.

HIV Seroepidemiology Unit, San Francisco Department of Public Health, CA
94102-6033, USA.

A self-administered, anonymous questionnaire examining opinions and experiences
of using Reality, the "female" condom, for anal sex was completed by a
convenience sample of 100 men who have sex with men (MSM). Eighty-six percent of
respondents said they would use Reality again; 54% would rather use Reality than
penile condoms. Acceptability was higher among MSM who were HIV positive, in
nonmonogamous relationships, or who had serodiscordant partners. Negative
experiences included: difficulty inserting (33%), irritation (17%), bunching up
(12%), unpleasant texture (10%), and noise (9%). Breakage was reported three
times in 334 episodes of use. Although no available data compare preferences and
efficacy of Reality to penile condoms, Reality is a welcome alternative for some
MSM who have difficulty consistently using penile condoms and probably reduces
HIV transmission compared with unprotected anal sex. Research to more
definitively assess Reality as a risk reduction method for MSM is greatly needed.

PIP: Men who have sex with men (MSM) in gay male communities do not always use
condoms when having anal sex. Reasons for such risky behavior include men's
objections to the lack of spontaneity demanded from condom use, decreased
sensation, and condom breakage. Reality, a polyurethane pouch designed to line
the vagina, was developed mainly to provide women with a contraceptive and STD
prevention option. A removable inner ring and fixed outer ring keep the device in
place. Some MSM use Reality when having anal sex. 750 free Reality kits were
distributed by the STOP AIDS Project in San Francisco at venues frequented by
MSM. Kits included 2 female condoms, instructions, a self-administered
questionnaire on the users' experiences with Reality, and a stamped return
envelope. 108 surveys were returned, with 100 MSM reporting use of Reality during
the past 6 months in 147 episodes of insertive and 187 episodes of receptive anal
sex. 86 men reported that they would use Reality again, and 54 said they would
rather use Reality than conventional male condoms. Generally most liked about
Reality were its heightened sensitivity and spontaneity, while insertion
difficulties and high cost were the factors least liked. Acceptability was higher
among MSM who were HIV-positive, in nonmonogamous relationships, or who had
serodiscordant sex partners. Negative experiences included difficulty inserting
(33%), irritation (17%), bunching up (12%), unpleasant texture (10%), and noise
(9%). Breakage was reported 3 times in 334 episodes of use. Reality appears to be
a welcome alternative for some MSM who do not consistently use penile condoms.
Although use of the method probably reduces HIV transmission compared to
unprotected anal sex, more research is needed to definitively assess its
effectiveness as a risk reduction method for MSM.

PMID: 10070590 [PubMed - indexed for MEDLINE]

3: Am J Public Health. 1999 Nov;89(11):1739-41.

Use of reality "female condoms" for anal sex by US men who have sex with men.
HIVNET Vaccine Preparedness Study Protocol Team.

Gross M, Buchbinder SP, Holte S, Celum CL, Koblin BA, Douglas JM Jr.

Abt Associates, Inc, Cambridge, Mass., USA.

OBJECTIVES: This study assessed use of Reality "female condoms" for anal sex by
HIV-seronegative men who have sex with men and are at high risk for HIV
infection. METHODS: Self-administered questionnaires were completed by 2277
participants in a 6-city prospective cohort study. RESULTS: Of the 1084 (48%) men
who had heard of using the female condom for anal sex, 145 (13%) reported using
it in the prior 6 months. Users were at greater risk than nonusers: 47 receptive
and 35 insertive users reported problems, including bleeding by the receptive
partner (4). CONCLUSIONS: Redesign of the female condom could increase
acceptability and use by men who have sex with men and could address possible
safety concerns.

Publication Types:
Research Support, Non-U.S. Gov't
Research Support, U.S. Gov't, P.H.S.

PMID: 10553399 [PubMed - indexed for MEDLINE]

Anonymous said...

Thanks, jim, for repeating much of what I wrote in my original post (which is much longer than what Eric quoted and deals with several of the issues you mention).

I notice that while you quote from Source: AIDS 2003; 17(5):727-731:

"Men reported more frequent problems with Reality condoms than male latex condoms used for anal intercourse, particularly slippage, discomfort, and rectal bleeding." seem to have left off this part of the report:

"Our preliminary findings are that condom breakage and rectal bleeding were not significantly different for male and Reality condoms, but slippage of the Reality condom was common." (emphasis mine)

Shall we now detail all the problems with regular latex condoms -- and especially their misuse -- and conclude that they shouldn't be used, either?

I applaud your work toward finding an antimicrobobial solution to this problem, but dismissing female condoms outright, on the basis of statistically small differences -- or on the basis of nonoptimal use -- is, I think, counterproductive.

Anonymous said...

we called 'em shake and bake back in the day 'round '95... they were ok, not much better than regular condoms and frankly they made the bottoms hole look odd with the plastic bag stickin' out of it. not very erotic to see that. as a top, i enjoy seeing the guy's hole expand and contract on my cock as i pull out and push in.

but hey, give it a try, couldn't hurt. i'll stick to regualr 'ole Trojan Ultrathins and Eros.

Anonymous said...

The more weapons in the prevention arsenal the better; but seriously, fucking with a female condom creates a loud, extremely unappealing sound that I think is a little like what fucking with a Hefty bag might sounds like. Seriously.

jim pickett said...

I was by no means dismissing them outright - merely sharing info. Let me be absolutely clear - It is not my mission to dismiss any type of prevention that may work for people.

If regular condoms work for you - they are still the very best option to avoid sexual transmission of HIV and I fully endorse their use.

If you love Reality Condoms and they don't hurt your booty - rock em.

When we have microbicides and other new prevention technologies at our disposal, it will never be me to pit or another against each other. But I will most definitely try to share the risks and benefits to each - and people can then at least make choices with some good info.

We need lots of items on our prevention buffet - just having one or two to choose from is absolutely ridiculous.


Anonymous said...

Thanks for clarifying, Jim. I think we're totally on the same page. And if the (occasional) crinkly sound is off-putting, it's time to turn up the Nine Inch Nails fuckmusic, isn't it? ;-) Seriously, you ARE more aware of female condoms -- sight and sound -- than with traditional condoms. But for me, the easy flippability, safety, cleanliness and versatility make them my #1 choice. Also, I dunno, I just feel... kinkier using them.

Andrew B said...

I'm negative in a long-term exclusive relationship with a positive partner and for me the female condom is a godsend. We'd love to not have to wear protection and, for my partner, putting on a condom before sex just reminds him of the virus, which is a mood-killer. The result: he can't sustain an erection in a condom. (And no, me being infected is not an option for either of us.) It was taking it's toll on our relationship, and I wound up writing to Dan Savage at Savage Love who put me onto them. The female condom is looser, so it feels better for him, lets him forget about our status difference and we can both enjoy ourselves. I'm not the most natural bottom, so it's also good for me with less wear-and-tear on my ass, plus it's cleaner. The only downsides are the cost and the fact that he's squeamish about wearing one himself! But that will change. Oh yes, that will change. Mua-ha-ha...

Dr. Frieda Fries said...

I've been a long-time fan of the female condom and have NEVER experienced the mythological squeaking that so many people talk about. Use more lube, loud moaner, turn up the music and fuck.

Anonymous said...

I am a poz top living with a neg bottom. I swear by Avanti polyurethane condoms and silicone-based lubricant, as it has no flavor. The polyurethane condoms feel good, and the heat transfer from my partner and the increased sensation are great. Yes, lots of lubricant is a must.

mr pinky

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