Even Monogamous Couples May Need Protection Against Sexually Transmitted Diseases

In a conversation one of our colleagues had with a middle-aged male friend who is divorced and has been dating the same woman for eight months, the man asked a surprising question… When, he wanted to know, would it be considered “safe” for him to stop using a condom?

What a great question. To get more information, we talked to Barbara Bartlik, MD, a psychiatrist, sex therapist and voluntary attending psychiatrist at Montefiore Medical Center, Bronx, New York.

Dr. Bartlik’s answer to the question was “never“… and she acknowledged that she is taking an extreme (and probably unrealistic) position. But, she said, the chance of getting a sexually transmitted disease (STD), and the dangers to your health if you do get one, are far higher than even people in monogamous relationships realize. It’s a topic that Dr. Bartlik is quite passionate about.

So Much Unprotected Sex!

According to a recent study, there’s an awful lot of unprotected sex going on these days—much more than you might realize! A recent Indiana University School of Health, Physical Education, and Recreation national survey of 5,865 individuals (ages 14 to 94) covering condom use in heterosexual sex found that singles are using condoms only about one-third of the time! That’s a lot of people engaging in risky behavior.

Women tend to be more aware of the dangers of STDs, and Dr. Bartlik said that she believes men are way undereducated on the topic of sexually transmitted infections. The infections that can be transmitted by having sex without a condom are nearly 100% preventable by wearing one.

STD Dangers for Men

Chlamydia. Testing for chlamydia (usually involving a cervical swab) is a routine part of a gynecological exam, so women are more likely to get tested and treated for chlamydia. But that’s not the case for men — if they’re not told that they’ve been exposed, men may go on to infect other partners. Women with chlamydia who don’t get treated will often develop pelvic inflammatory disease (PID), which can result in scarring in their fallopian tubes that can cause infertility. Men with untreated chlamydia may eventually suffer urinary discomfort (itching, burning, discharge) and scarring of the prostate.

Herpes. A common misperception, even among people who have herpes, is that there’s no danger of infection if there are no active sores. That’s not so — herpes can be contagious even when the carrier of the virus has no visible sores.

Human papillomavirus (HPV). HPV is among the most dangerous STDs — in fact (depending on the type) one of the deadliest, because it often has no symptoms and can increase the risk for oral and anal cancer in both genders… cervical cancer in women… and penis cancer in men. According to Dr. Bartlik, HPV infection is so rampant that a person who has had unprotected sex with three or more partners has probably been exposed to it. She said that there are six millionnew genital HPV cases each year here in the US.

Human immunodeficiency virus (HIV). Obviously, the stakes are high with HIV. Dr. Bartlik said that, all other things being equal, in heterosexual sex, women are at higher risk for acquiring HIV than men because men are more likely to be asymptomatic carriers, and the mucous membrane of the vagina is more vulnerable than the outer skin of the penis. But, she noted, “Even for the man, the risk is not zero.”

Chronic prostate infections. Acknowledging that this is anecdotal and not yet confirmed with research, Dr. Bartlik said that she and other doctors are seeing more men with chronic prostate infections. She and her colleagues believe that this may be related to bacterial infections picked up during unprotected sex. “Although I’m speculating, perhaps regular condom use might cut down on some of these bacterial infections as well as on the standard STDs,” she said.

Should Committed Couples Use Condoms?

Dr. Bartlik believes that even couples who are in long-term, committed monogamous relationships ought to still use condoms. “The unexpected happens sometimes,” she said, noting that it’s not unusual to hear that people who never intended to have encounters or even affairs end up doing so. According to The Kinsey Institute , about 20% to 25% of men and 10% to 15% of women have extramarital sex at least once during their marriages. “Most of the time, these are not discovered,” she said. “Often, at the end of the affair, they simply pick up and continue with married life — meaning unprotected sex with their spouse or partner.”

Does the idea of using condoms forever make you feel glum? Dr. Bartlik outlined a strategy that allows a committed couple to make a safe segue from using condoms to enjoying the full intimacy of having nothing between you.

  • Couples making a commitment to a monogamous relationship can agree to get tested to confirm that neither partner is carrying an STD or, if there is evidence of one, to then make a rational decision about whether or not condoms are needed.
  • See your doctor (individually or together) to discuss the necessary steps, since there are several different types of tests involved, with varying degrees of reliability.
  • Share and discuss your results.
  • If you both agree that no infidelity will occur—and more importantly, that if it does, you both promise to be honest about it right away —then go ahead and stop using condoms…unless you use them to prevent unwanted pregnancy, of course.