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People today are less likely to report using condoms than they were in the past. Among teens, for example, the number who reported using a condom in their last sexual encounter declined from 59 percent to 54 percent between 2013 and 2017, and the decline was similar for both male and female teens. Condom use also declined among adult men who have sex with men over the same period, but the decline was steeper in this group.

So what's behind this trend? Why do condoms seem out of date for so many people?

As with most sexual behavior changes, the answer is complicated. We can point to more than one factor or explanation. However, here are some possible contributors:

Part of the decline may be due to a growing number of women opting for long-acting, reversible methods of birth control, such as iuds and hormone implants. In fact, during the same period that condom use has declined, the use of other methods has increased by several percent. Given that these methods are more than 99 percent effective in preventing pregnancy, it is likely that some people are now giving up using condoms because they have succeeded in alleviating fears of unwanted pregnancy.

Some of the decline in condom use among men who have sex with men may be due to the increase in PrEP. PrEP is a drug that, if taken regularly, can significantly reduce the risk of HIV infection (studies I've seen show it to be between 90-99% effective).

Several recent studies have found that men are less likely to use condoms regularly when they start taking precautions, possibly because the perceived threat of the deadliest STIs is neutralized (learn more about this study here).

When you consider the effectiveness of PrEP in preventing HIV, and the increase in the HPV vaccine, which protects against HPV-related cancers and genital warts, it could be that -- more broadly -- people just don't think sex is quite as dangerous as they used to be. Most of the other common sexually transmitted infection can be cured at present such as syphilis, gonorrhea and chlamydia, those can usually cannot be cured by drugs (for example, people with oral or genital herpes can take antiviral drugs every day, to prevent outbreaks, or at least reduce the severity and duration of outbreaks). All of which may be because sex isn't as scary as it used to be.

The increase in condom free sex among teens has coincided with a decrease in the number of teens having sex. So while sex without condoms may be increasing among teens, fewer teens are sexually active. To me, this suggests that perhaps the teens who are most sexually cautious (and therefore most likely to use condoms when having sex) are the ones who are not having sex. So if the most cautious people wait longer to have sex, this could lead to a noticeable inflation in the rate of condomless sex, as these people are no longer reflected in the sexually active data.

Of course, another possible reason is poor sex education and high levels of sexual anxiety. We don't do a particularly good job of teaching teens sexual communication skills, and bringing up the subject of condoms and safe sex makes many feel awkward and uncomfortable. As a result, the topic of condoms may not come up as often as it should, simply because too many people don't know how to have these conversations. Of course, there's also the fact that some people are embarrassed to buy condoms in the first place because they're afraid of being judged or humiliated. This obviously reduces the likelihood that people will be prepared to use condoms when they enter sex.

However, another explanation is that condoms make it difficult for some men to maintain an erection. More and more young men are having trouble getting erections these days -- and no, it's not because of pornography, but because of sexual shame and anxiety, as well as factors like drugs and substance use. So if you put in men who already have some problems with sexual arousal with something that reduces sensation and sensitivity (even if only to a small degree), condoms will be seen as a barrier to pleasure, which may make men less willing to use them.

There may be other factors at work that I haven't mentioned yet;

However, all of this suggests that more research is needed to understand why people use condoms less today than they did in the past, and what we can do to promote safer sex.

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