About the pill and STDs

[SomethingOnce]

I've always wondered why teens and young women, or any women really, are encouraged to use the pill rather than condoms (not least because of questions over the wisdom of mass hormone treatment, but that's not for this thread).

Now the WHO is warning about untreatable gonorrhoea.

www.theguardian.com/society/2017/jul/07/untreatable-gonorrhoea-superbug-spreading-around-world-who-warns

AIBU to think it's madness not to encourage condom use as standard (with the pill for contraceptive back up if hormone treatment isn't a concern for the individual)?

They are encouraged to use the pill AND condoms. The standard is for condoms.

I have no idea how you could think otherwise.

Ok, I'm thoroughly out of touch with health education then.

I think otherwise because of what I hear people saying they do, I suppose.

I am on the receiving end of zero advice in this area, but maybe that's normal for late 30s, mothers of small children in LTRs.

The standard advice is definitely for condoms with hormonal contraception as back up unless you are confident that your sexual partner is totally free of stds - usually that means if you're in a long term monogamous relationship. Every time i'm prescribed hormonal contraception i'm reminded that it only prevents pregnancy. It's always been like that?

It's reassuring that the message is still the same, but I find it surprising how many young women seem to be ignoring it. Maybe it's less common than my sample, such as it is, suggests. I certainly hope so.

A lot of men and women ignore it. Its not just the young and not just women.

The advice i have always had has been condoms are a must if not in a monogamous relationship (if you then no one is going to tell you, you must) and hormonal contraception is a choice, but recommended.

But what made you assert that anyone is encouraging young women to use the pill INSTEAD of condoms? You seem to have just plucked it out of the air.

i wont sleep with anyone without an std test because I can never get the sodding condoms on without them splitting :|

Apologies, I should've phrased the AIBU better.

A lot of men and women ignore it. Its not just the young and not just women.

I wasn't suggesting that, but the conversations I've had that led me wonder about this have been with young women. And men don't have the option of the pill (yet).

Thanks for setting me straight, MN.

And men don't have the option of the pill (yet).

No, but they could just use a condom. Unlike women, they don't even have to get someone else to use a condom. They can just use one.

I'd recommend condoms for long term relationships, too. Lots of people cheat. Unless you demand an STD test every couple of months, you cannot know for sure.

Some of us know for sure.

i wont sleep with anyone without an std test because I can never get the sodding condoms on without them splitting :|

I've never experienced one splitting in my life, how's that even possible? Do your men have massive, fat dongs or are your fingers made of razor blades!?

Every time (over the last 20 years) I've been to a contraceptive clinic I've been offered the old faithful paper bag of condoms. And there are posters up all over the place aimed at the teens advertising free condom schemes. And the last few women I've known who have given birth were sent home from maternity with a bag of noddies as well - right when they were all swearing they'd never ever have sex again!

The Double Dutch method just makes sense if you're at a point in your life where an unwanted pregnancy would be a disaster. Or you both haven't had a clear STI check before sleeping together. Or you don't have an exclusive relationship. So of course Sexual Healthcare professionals are going to push it as the best option.

I worked on the national teen pregnancy and sexual health strategy for the department of health back in 2008-2010

At that time the focus was entirely on condom usage, and chlamydia testing, as this was the most rampant STI, and high St chemist 'pee in a pot' testing had been introduced (ie you don't have to have a swab up your vag or cock to get tested)

That strategy was a bit too successful as testing shot up, and the perception that a course of ABs would sort it, so condoms as STI prevention became less strong a message (and at this time the MAP was also now widely available)

So at this point the focus shifted beyond condoms to LARCs - as pill taking was notoriously unreliable, whereas a depo shot or Mirena was much more effective as perfect use rates were higher

When the Tories came in they slashed budgets and I moved jobs, but it was genuinely one of the most rewarding projects I've ever worked on

My proudest career moment was writing a ministerial submission to report the results of a pilot study where we'd actually significantly managed to move the needle on usage rates for condoms

The focus groups with teens talking about attitudes to sex and contraception were absolutely fascinating

Some of the things that I remember from my time working on this strategy

• the pill was widely refused because of fears of weight gain

• girls with tonnes of facial piercings would refuse the depot shot because they 'didn't like needles'

• statistically with perfect use the withdrawal method is actually incredibly reliable. The challenge of course is that the gap between typical and perfect use for the pull out method is massive. I have been shocked to learn just how many of my (educated, professional) friends successfully relied upon this method throughout their 20s. Apparently their boyfriends had their technique down to a fine art!!

Caveat - the double Dutch method was always, always advocated

But the rationale of the LARCs strategy was that at least with a LARC, the likelihood of pregnancy was less than with a pill that was invariably forgotten, if condoms weren't used. And because of the effect of the chlamydia testing scheme success, the drop in condom usage meant the LARCs push became more important to at least try and protect pregnancy rates (as STI rates were dropping, but this was because of more widespread testing and treatment)