Using contraception effectively

When you have sex, both of you are responsible for your sexual health – protecting yourselves against pregnancy and sexually transmitted infections (STIs).

Some people think it's acceptable to pressure their partner into having sex without a condom. It's not.

People might have several reasons for not wanting to use one. Dr Petra Boynton, agony aunt and psychologist, has heard them all before. In this article, she responds to the most common excuses to give you the confidence to insist on using a condom.

You can read the whole article or click on the links to go straight to the relevant section.

'I don't need a condom – I'm healthy. I haven't got any infections'

'I don't want to wear a condom – I like it natural'

'I can't be bothered using a condom'

'I don't like using condoms'

'I can't wear a condom – I lose sensitivity'

'I forgot to use a condom' 

'I can't wear a condom – it affects my performance'

'I can't wear a condom – they hurt. They're too small'

'I can't wear a condom – putting it on ruins the moment'

'I don't need a condom – I'm sterile' 

'I can't wear a condom – I've got no change for the machine'

'I don't need a condom – we've been seeing each other for a while'

'I can't wear a condom – I'm allergic to them' 

'I don't need a condom – I'm healthy'

It doesn't matter how healthy and fit you are: if you have unprotected sex, you're at risk of catching an STI and dealing with an unwanted pregnancy.

It's easy to think it won't happen to you, but it can.

Each year in Scotland around:

• 18,500 cases of genital chlamydia are diagnosed
• 188 cases of infectious syphilis cases are reported
• 367 cases of HIV infection are reported

You can't tell whether someone's got an infection by looking at them.

You or your partner may not realise that you have an STI because many people have no noticeable symptoms – around 70% of women with chlamydia and 50% of men with chlamydia don't have symptoms. Just because you can't see any obvious symptoms, such as sores or warts, it doesn't mean you're free from STIs.

'I don't want to wear a condom – I like it natural'

Sex with a condom can feel natural – you can try superfine condoms. Some men find using a condom can make their erections last longer. Having sex without a condom may seem natural, but it puts you and your partner(s) at risk of infection. Using a condom protects against unwanted pregnancies and STIs.

'I don't want to wear a condom – I can't be bothered'

You can get contraception at:

• most GP surgeries
• community contraception clinics
• some GUM clinics
• sexual health clinics
• some young people's services

Your response to this should be: "If you can't be bothered to use a condom, then I can't be bothered to have sex with you."

Using a condom is easier than having to visit a genitourinary medicine (GUM) clinic to treat an STI, which may have unpleasant symptoms.

It's easy to get into the habit of not using a condom and to think unprotected sex won't give you an infection or result in pregnancy. But condoms don't just cut the risk of pregnancy or infections: try a coloured condom for some fun, a textured condom for extra sensation, or a flavoured condom for oral sex.

'I don't want to wear a condom – I don't like them'

Some people don't like condoms because they've had a bad experience with them in the past. Perhaps they couldn't keep an erection with a condom on, or they found them difficult to use. Other people are told that they shouldn't like condoms, so they never try them.

There are plenty of brands that offer a variety of condoms to suit your needs. You can both get involved in putting the condom on so it becomes part of having sex together.

There are textured, flavoured and coloured condoms, condoms that make you and your partner tingle or feel hot, condoms that make you look bigger or help you stay erect longer. All these condoms protect you from STIs and unwanted pregnancy.

'I don't want to wear a condom – I lose sensitivity'

If condoms have made you lose sensitivity in the past, look for brands that sell light condoms. Some are very thin and it can feel as if you're barely wearing one.

Alternatively, you may want a textured condom to boost sensitivity for you and your partner. Some people prefer condoms that reduce sensitivity, which can be great if you're worried about coming too quickly.

'I forgot to use a condom'

Getting drunk is one of the most common reasons people give for forgetting to use a condom. No matter how much you know about the risks, drinking too much alcohol can make you ignore the consequences of having unprotected sex.

Keep a pack of condoms by your bed and carry some with you when you go out or go on holiday. Even if you're not planning to have sex, put a condom in your bag or pocket at the beginning of the night, just in case.

More about emergency contraception

'I don't want to wear a condom – it affects my performance'

Some people find it hard to keep an erection with a condom on. This is often because the first time they try to use a condom is when they're just about to have sex. They find that their erection starts to go, they get worried about it, then lose their erection and associate it with the condom. People can also feel anxious about what their sexual partner might think.

If this worries you, practise putting on a condom when you're not about to have sex with someone. Learn to enjoy sex while wearing a condom. Try masturbating with a condom on to help you learn to stay hard and have an orgasm. This way you'll feel confident about staying erect next time you have sex.

Putting on the condom with your partner can make it an enjoyable part of sex, rather than an interruption.

'I don't want to wear a condom – it ruins the moment'

People don't think of reaching for a sex toy or unappealing sexy underwear as a distraction, although they briefly interrupt sex – this is probably because they find it sexy. 

Get used to putting on a condom and thinking about sex while you're doing it (your partner can put it on for you, or you could watch your partner undress or masturbate as you're putting the condom on). This way, you'll stay aroused and it will become part of sex, not an interruption.

'I can't wear a condom – they hurt or they're too small'

A condom that's too tight may feel uncomfortable, but condoms come in a range of sizes, so you can easily find one that fits properly. A condom can hold around 24 cans of soft drink, so it should fit around your or your partner's penis. Find out more about penis size.

If the condoms you've been using are too small, look out for brands that come in a bigger size. Try one on before you have sex to see how it feels. Your GP, community contraception clinic or pharmacist can help you find a brand that suits you.

It may hurt to use condoms because you're allergic to them. Find out more about being allergic to condoms.

'I don't need a condom – I'm sterile/I had a vasectomy'

Whether a man is sterile or not, he can still get and pass on STIs by having unprotected sex. Only a small number of men under 30 are sterile, so if someone tells you that they are, they may not be telling the truth. Always use a condom to protect yourself and your partner(s) from STIs.

'I've got no change for the condom machine'

Keep condoms at home and always carry them with you when you go out so you're always prepared. This way if your partner hasn't got money to buy them, you'll have some with you.

You can get condoms free from:

• community contraception clinics
• sexual health clinics
• some genitourinary medicine (GUM) clinics, GPs and nurses
• some young people's clinics

You can buy condoms from a pharmacy, from vending machines, supermarkets, some petrol stations and other shops. If you're well-prepared, you can also get condoms by mail order or buy them online.

Always buy condoms that have the CE mark on the packet. This means that they've been tested to the high safety standards required in Europe. Condoms that don't have the CE mark won't meet these standards, so don't use them.

'I don't need a condom – we've been seeing each other for a while'

Many STIs, such as chlamydia, don't have any noticeable symptoms and can lie undetected for a long time. Even though you may have been with your partner for a while, you still may not be risk free.

Discuss your sexual history with your partner and get checked at a sexual health (GUM) clinic before you stop using condoms.

'I can't wear a condom – I'm allergic to them'

Only a very small number of people are allergic to condoms, so don't always trust someone who tells you that they are. An allergy isn't a good excuse to have unprotected sex, as there are condoms that don't cause allergies.

People who are allergic to condoms may react to:

• the latex condoms are made from
• the chemicals used to manufacture condoms
• the spermicide added to most condoms to increase their effectiveness as a contraceptive – the spermicide is usually on the outside of the condom, so the person who reacts is not the person wearing it, but their partner

If you or your partner are allergic to condoms, you could try:

• non-latex condoms made from polyurethane or polyisoprene, which don't cause allergic reactions
• using condoms that have no added spermicide

Remember: use a condom every time you have sex to protect against STIs. To protect against unintended pregnancy, you can use another form of contraception as well, such as long-acting reversible contraceptive methods:

• the contraceptive implant
• the contraceptive injection
• the intrauterine system (IUS)
• the intrauterine device (IUD)

Further information about condoms

For more information on sexual health, including HIV, you can call our Sexual Health Line on 0800 22 44 88, or phone your local NHS sexual health clinic.

Most antibiotics don't affect contraception. It's now thought that the only types of antibiotic that interact with hormonal contraception and make it less effective are rifampicin-like antibiotics.

These can be used to treat or prevent diseases, including tuberculosis and meningitis. They include:

• rifampicin
• rifabutin

These types of antibiotics can increase the enzymes in your body. This is known as being "enzyme-inducing", and can affect hormonal contraception.

If you are taking enzyme-inducing antibiotics while using hormonal contraception, to avoid getting pregnant you'll need to use additional contraception, such as condoms, change to a different method of contraception, or take your contraception in a different way.

Apart from those mentioned above, all other antibiotics are not enzyme-inducing. However, the patient information leaflet that comes with other types of antibiotics may say they could affect your contraception. This information may be different from evidence-based guidelines used by health professionals.

Additional contraception when taking antibiotics

If you're going to take rifampicin or rifabutin for more than two months, you may want to consider starting, or changing to, a contraception method that's not affected by these medicines.

You should consider doing this if you're currently using:

• the combined pill 
• the progestogen-only pill
• an implant
• a patch
• a vaginal ring

Contraception methods that aren't affected by rifampicin or rifabutin include:

• the progestogen-only injection
• an intrauterine device (IUD)
• an intrauterine system (IUS)

If you're taking rifampicin or rifabutin for less than two months and want to continue using the same hormonal contraception, you must discuss this with your doctor. You may be asked to take this contraception in a different way from usual and use condoms as well. You will need to continue this for 28 days after finishing the antibiotics.

One option for women who have a contraceptive implant and need to take a short dose of rifampicin (for preventing meningitis, for example) is a single dose of the progestogen injection. The implant can stay in place while you're covered by the injection. 

You don't normally need to use additional contraception if you're taking antibiotics other than rifampicin and rifabutin.

However, if the antibiotics or the illness they are treating cause diarrhoea or vomiting, absorption of the contraceptive pill may be affected.