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Showers in Raincoats

Earlier today we excerpted from With Pleasure: Thoughts on the Nature of Human Sexuality which argues that human sexuality cannot be understood if its significance is limited to reproduction alone.  Below is a second excerpt, which explores why having safe sex can be so difficult.

Probably the most influential reason that many people choose to forgo safe sex is that they believe it to be less pleasurable than the riskier alternatives. This is particularly true of condoms, the use of which has been unflatteringly compared to taking a shower in a raincoat. The primary complaint of men is that condoms decrease penile sensitivity, hence pleasure; some women also complain of a loss of sensation. (As one eighteenth-century rake brags, “I picked up a fresh agreeable girl called Alice Gibbs. We went down a lane to a snug place, and I took out my armor, but she begged that I might not put it on, as the sport was much pleasanter without it.”) Both men and women further dislike condoms for the related reason that they form an artificial barrier against intimate contact. Many people also believe that condoms decrease sexual spontaneity and therefore romance.

These are, for the most part, valid complaints. Condoms could certainly be made thinner to increase sensitivity and enjoyment. In 1995 a British company began marketing a thinner plastic condom, which it claimed is more comfortable and pleasurable than comparable latex condoms. And, as noted previously, the receptive partner’s pleasure could further be enhanced by thoughtfully designed condoms.

However, even if condoms were vastly improved, there would probably still be people who would refuse to use them. Some men claim to be unable to perform while wearing a condom. Others simply dislike them because they decrease sensitivity and pleasure; so much so that some men are willing to pay male or female prostitutes extra for unprotected sex. Although this practice increases the prostitute’s risk of becoming infected with HIV or some other STD, a skillful prostitute can slip a condom onto a customer -without him ever knowing it (or so we’ve been told). This trick requires the prostitute to hide a rolled-up condom in his or her cheek and then nimbly slip it onto the customer during oral sex, just prior to vaginal insertion. The fact that some men are unable to discern that they’ve been protected against their will suggests that whatever loss of sensitivity condom use entails cannot be that great. A slight loss of sensitivity might even be desirable in some instances because it helps stave off ejaculation, prolonging the pleasures of intercourse (some prostitutes dislike condoms for exactly this reason).

Inventing novel ways to put on condoms could also be a playful way for couples to eroticize condom usage. More generally, simply incorporating condoms into erotic foreplay can have measurably positive effects on how condom use is perceived and even on how much pleasure is experienced during protected intercourse. Furthermore, the power of sexual reward suggests that positive experiences with condoms should be self reinforcing. Perhaps, with enough practice, even couples that initially detested condoms could grow to love (or at least tolerate) them.

The adoption of behaviors, such as always using condoms, that reduce HIV risks is liable to be gradual at best. People must decide on a situation by- situation basis whether or not to take risks. Positive experiences with safer sex practices tend to reinforce protective behaviors, whereas negative experiences reduce the likelihood of these behaviors being repeated. But individuals do not make sexual decisions in a vacuum—it takes two to tango. Ideally, HIV-prevention decisions should be made jointly by the partners involved. In practice, however, the male half of a heterosexual couple often has the final say in whether or not condoms are used. (Not surprisingly, condoms are more likely to be utilized by couples who communicate freely about sexual issues.) This is especially true in traditional cultures. In parts of Africa, for example, some married women are at high risk of becoming infected with HIV as a result of having sex with their husbands, many of whom frequent prostitutes. Knowledge about HIV/ AIDS and specifically about the effectiveness of condoms in preventing HIV transmission is generally poor in Africa. Moreover, when women do attempt to protect themselves by suggesting that their husbands wear condoms, their suggestions are viewed with distrust, or worse, as a sign that the wife has been unfaithful. As a result, condoms are seldom used in marital relations, and millions of African women have become infected with a catastrophic, yet preventable, disease.

Social influences play an important role in shaping how safer sex practices are viewed. For example, some men refuse to wear condoms because they believe condoms are for boys, not for men. Others insist that “real men don’t wear condoms.” Furthermore, as a consequence of past “social hygiene” campaigns, condoms are inextricably linked with prostitution in many people’s minds.

However, the remarkable success of safer sex campaigns in the gay communities of large urban areas throughout the United States and Europe suggests that the social norms that regulate sexual behavior are at least somewhat malleable. By the early to mid-1990s the use of condoms had already been incorporated into socially accepted sexual scripts in many gay communities. Of course, gay sexual practice has always embraced a wide range of activities, many of which are completely safe. According to Donald Crimp, “We [gay men] were able to invent safe sex because we have always known that sex is not, in an epidemic or not, limited to penetrative sex.” Indeed, many gay men do not participate in anal intercourse at all, while others prefer only the relatively safer insertive role.

Despite the widespread (though sometimes grudging) acceptance of safer sex by many gay men, as therapies for treating HIV improved in the late 1990s, disturbing signs of complacency began to appear. As the twentieth century came to a close, incidence rates for many sexually transmitted diseases began to climb among some groups of men who have sex with men, and several studies of the behavior of these men documented increases in sexual risk taking, such as having unprotected anal sex. This apparent trend toward unsafe behaviors by some gay men reflects many factors, including “condom burn out” (dissatisfaction with the continued need for condoms more than a decade after the start of the epidemic) and a persistent desire for the pleasures of unprotected intercourse. It may also be related to the availability of effective therapies, which slow the progression of HIV disease in infected persons. These “combination therapies” consist of multiple antiretroviral drugs, which, when taken in large doses, can help keep the virus from proliferating, resulting in improved health and greater longevity for HIV patients. (These drugs do not work for everyone, however, and they are very toxic, causing myriad side effects that range from nausea to the development of anomalous fatty deposits, including so-called buffalo humps.) In short, the outlook for many—but not all—people living with HIV is much brighter than ever before…

As a result, having sex with a potentially infected partner is now perceived as being less risky than it was ten years ago, provided that the sex partner is receiving combination antiretroviral therapy…

A number of other factors can also influence “whether or not people decide to engage in particular sex acts and whether condoms are used in these activities. Adolescents, in particular, may have different reasons for having unprotected sex.

Recent Comments

  1. Apostle Shada Mishe


    THE IDEA that AMBUSH cures AIDS
    is being proven by the more than 400 individuals who have taken a dose of 60 ml three times daily for 21 days. The result is that AMBUSH ‘KILLS’ the virus by causing the protein envelope to rupture and the viral particles are discarded by the white blood cells. AMBUSH is able to ‘KILL’ the virus that are ‘hiding’ in the lymph system by its ‘natural radioactive’ properties. This process allows the body to ‘return to normal health’ with a corresponding immunity to that or those strains of the virus.

    What is AMBUSH ?
    AMBUSH is a radioactive isotope of uranium that is found in the ‘palm’ plant of which there are more than 3000 species. When ingested, AMBUSH causes the body temperature in the trunk area to rise to about 102 degrees when the individual is sleeping. The preparation takes four hours per batch, which is then given to the individuals for consumption 60 ml three times daily for 21 days. AMBUSH is a herbal preparation in this form but it contains an active ingredient which is a ‘NEW’ crystalline substance, a drug from the ‘palm plant’ similarly to ASPIRIN originating from the willow tree bark

    After 21 days on AMBUSH, ALL the individuals experienced a decrease in viral load to undetectable, an increase in cd4, increase in RBC, an improvement in general health such as more color to the face, decrease in Buffalo hump, an increase in gluteal muscles, a decrease to having no joint pains whereby individuals can bend to touch their toes, and walk up steps are but a few examples. There is also a dramatic increase in their sexual appetite beginning after the first week of therapy

    In any plant concoction such as percolated ‘tea’, there are 30-40,000 compounds, whi ch would take the scientific community twenty years to isolate one particular ingredient if they knew what they were looking for. The LORD GOD has given me seven steps to isolate the active ingredient, which is soft and metallic in nature and has a carbon- uranium-sulfur-(classified)-phentolamine configuration or structure. This is similar to Federick Kekule and the discovery of the benzene ring where he dreamt the structure.

    As an antiviral and ‘natural radioactivity’ producing agent, AMBUSH is also effective against leukemia, lupus and HPV. Here I am saying that I have ‘GIVEN’ AMBUSH in the same ‘strength’ and dosage to patients with leukemia, lupus and HPV. A 35 year old male with HIV found it difficult to impossible to urinate was put on ‘green tea’ and water while the doctors contemplated prostrate surgery. One of the doctors gave him my number , I sent him a supply of AMBUSH an d he has not been given any more ARV’s, since taking AMBUSH 18 months ago, is in ‘good’ health and has expressed a willingness to be examined by HIV investigators like many others who have taken AMBUSH.

    I have sent this ‘IDEA’ to most HIV research agencies, scientist of the field, universities, hospitals, clinics, politicians and news agencies to which it is REJECTED because the name of THE LORD GOD is mentioned. He has steered me scientifically through the processes such as which plant and how to produce the active ingredient. What are the odds of a Florida Pharmacist picking a plant would contain the CURE for HIV/AIDS ?
    I have never charged any of the people for their supply of AMBUSH but a life saving has been spent on the project with NO renumeration from any sources because AMBUSH falls outside the walls of modern medicine and research.


    My proposal is that I PROVE that AMBUSH CURES HIV/AIDS by giving it to a number of END-STAGE or DRUG-RESISTANT people and the scientific community watches their recovery. This proposal addresses the problem in that I have already outlaid the results to be obtained.

    This IDEA is unconventional in that the scientific community has rejected AMBUSH because I say it is GOD given. Secondly if I wrote it according to certain standards, then it might be peer reviewed. However, THE LORD GOD has also shown me that there are five enzyme systems associated with the virus, reverse transcriptase, protease, fusion and two more of which causes the virus to be AIRBOURNE. This means that without DIVINE intervention mankind and ALL warm- blooded mammals will be extinct in a number of years.

    The PROOF of what I am saying is found in scientific papers wherein it is found that when the protease cuts the viral strands, it cuts it at DIFFERENT lengths EVERY time, to which it should always be a valine at the end but is a different amino acid every time. This is why it is IMPOSSIBLE to produce a VACCINE.

    Since this is NOT a hypothesis but there are about 400 individuals who have taken AMBUSH, here lies a vast area in which to check, recheck and confirm that AMBUSH CURES AIDS. Let it be mentioned that during the HIV reproductive cycle, reverse transcriptase converts viral RNA into DNA compatible to human genetic materials. Thus the human DNA has been ‘hijacked’ and since each person has a DIFFERENT DNA, then the new viral copy is unique to that person which shows that each individual has a DIFFERENT STRAIN of the virus. Consider two HIV positive people swapping viral strains and increasing its complexity with multiple partners.
    It can also be proposed that they be revisited as proof that the strain or strains that they had were ‘killed’ at the time of taking AMBUSH considering that a person can catch as many different strains as there are people who are infected by HIV.
    I am also willing to work with the scientific community in identifying those individuals who took AMBUSH and wish to be identified with this process notwithstanding that some are stigmatized while others are jubilant,

    Once AMBUSH is verified as being able to accomplish that which is aforementioned then the next stage might be the natural and artificial synthesis of the substance.

    Finally, if this is accepted or not, believed or not, THE LORD GOD always wins and this is the heavenly truth to which AMBUSH was divinely given to mankind for the CURE of HIV/AIDS and it will be here forever. Apostle Shada Mishe.

    [email protected]

    Here is a video taped presentation that I gave at t he Martin Luther King library in Washington


  2. Toby Marotta

    In sub-Saharan Africa, where the spread of AIDS dwarfs that now taking place in the West, what we middle-class westerners call sexism makes condom use an unfeasible way of preventing STDs including HIV infections and AIDS. Among the desperately poor men and women who are most likely to get these sexually transmitted infections, interpersonal power dynamics preclude both parties from raising the subject of protection, much less insisting that their lovers use condoms.

    The most innovative study to examine an obvious alternative to this roadblock dwells on the potential of male genital hygiene to protect at-risk women. This study suggests that the best poor African women can do is to encourage their male lovers keep themselves from becoming infected with sexually transmitted diseases by making a habit of washing their penises after engaging in heterosexual intercourse.

    This groundbreaking study is the first American-funded research to examine the feasibility of post-sex hygiene to prevent HIV infections. Its results have been published in a seminal (sic) article about related attitudes and practices found in a sample of poor African men recruited and interviwed in the Kibera slum area of Nairobi, Kenya, between 2002 and 2004. Below I reproduce the published synopsis of this study’s results.

    Among other things, this study explains why poor Kenyan men tended to find engaging in the post-sex washing of genitals far more feasible than washing them before engaging intercourse, citing considerations equally apt to any use of condoms or microbicides, which have to be applied BEFORE intercourse takes place.

    In September of 2006 a report on a follow-up of study of a comparable population undertaken by leading members of this team (most notably King K. Holmes, M.D., Ph.D., widely considered the dean of STD studies in the U.S.A.)was published in the respected “Journal of AIDS.” This study is the first American research to statistically associate washing a penis after sexual intercourse with reduced risk of HIV infections. (Nigel O’Farrell,M.D., affiliated with the London School of Hygiene & Tropical Diseases, has published a handful of scientific studies that flesh out crucial details about the effectiveness of post-sex penile hygiene vis-a-vis HIV infections and AIDs inSex Transm Infect 2004;80:471-476
    © 2004 BMJ Publishing Group Ltd



    Male genital hygiene beliefs and practices in Nairobi, Kenya
    M S Steele1, E Bukusi2,3, C R Cohen4,*, B A Shell-Duncan5, K K Holmes6

    1 Program for Appropriate Technology and Health (PATH), Seattle, WA, USA
    2 Kenya Medical Research Institute, Nairobi, Kenya
    3 Department of Obstetrics and Gynecology, University of Nairobi, Nairobi, Kenya
    4 Department of Obstetrics and Gynecology, University of Washington, Seattle, WA, USA
    5 Department of Anthropology, University of Washington, Seattle, WA, USA
    6 Department of Medicine, University of Washington, Seattle, WA, USA

    Correspondence to:
    King K Holmes MD PhD
    University of Washington Center for AIDS and STDs, Harborview Medical Center, 325 Ninth Avenue, Seattle, WA 98104, USA; [email protected]

    Objectives: Attitudes and practices concerning genital hygiene may influence topical microbicide use by men. This study examines knowledge and behaviours related to hygiene, genital hygiene, circumcision and hygiene, and to genital hygiene before and after sex among men in Nairobi, Kenya.

    Methods: We conducted 463 interviews of men recruited by respondent driven sampling techniques and 10 focus group discussions with a subsample of 100 volunteers from this group. Men were asked individual quantitative survey and qualitative group discussion questions about general hygiene behaviours, genital hygiene, and the temporal relation of genital hygiene behaviours to sexual encounters.

    Results: Bathing once daily was associated with education, income, and inside tap water. Genital washing aside from regular bathing and washing before sex ever were negatively associated with bathroom crowding. Genital hygiene before the most recent sexual encounter was uncommon and negatively associated with HIV risk perception, bathroom crowding, and ethnicity. Men believed genital hygiene before sex would arouse suspicions of infidelity or cool sexual ardour. Genital hygiene after sex was associated with education, religion, and having inside tap water. Genital hygiene after the most recent sexual encounter was associated with age, income, and with men having at least one child.

    Conclusions: Genital hygiene behaviours were associated with resource access factors and group discussions suggest that they are modulated by interactions in sexual partnerships. Topical microbicides may improve hygiene before and after sex.


    Abbreviations: BV, bacterial vaginosis; FGD, focus group discussions; IDI, in-depth interviews; STI, sexually transmitted infections

    Keywords: genital hygiene; STI; microbicides; men

    samples of poor African populations.)

  3. Jim Pickett

    Thanks for this important article. As chair of the International Rectal Microbicide Advocates (IRMA), I am delighted to see Dr. Holmes bring up microbicides. Our network of over 600 advocates and researchers from around the globe are interested in all forms of new prevention technologies, recognizing that condoms will never be enough, no matter how good they are. We are particularly focused on the research and development of safe, effective and acceptable rectal microbicides for the millions of women and men who engage in anal intercourse – much of which is unprotected (and a very efficient means of HIV transmission.) I invite you all to check out our website and blog – http://www.rectalmicrobicides.org and consider joining our efforts to add more options to the prevention buffet.

  4. HealingMindN

    Actually, this article is an interesting comment on social mood rather than the incurred consequences of prophylaxis. This social mood or cultural enigma against condoms, from my experience, is handed around like so much candy to young men as they enter institutes of “higher learning.”

    The most sensitive sexual organ is the mind, therefore, the only blockade to pleasureable sex is the mind incurred by detrimental male social mood.

    BTW: Where do married men in poor parts of Africa find money to give to prostitutes? Where is their guilt when they go home to their wives and expect unprotected sex? How did their social mood become “Americanised?”

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