Bill Gates and Better Condoms: Error 404?

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condomsCondom compliance may be a matter of software, not hardware

Progress has stalled on teen condom use to ward off the spread of STIs. Bill Gates is convinced that better condoms will increase condom use by making sex more pleasurable. To this end, "His foundation will give a $100,000 grant to anyone with credible plans to make a condom that 'is felt to enhance pleasure.'" Apparently, after the initial $100k, each of 80 grantees can apply for a follow-up grant of up to $1,000,000. If there's a blueprint for a better condom in the ethers, this monster carrot will surely entice it into material form. However...

Is blunted friction the major impediment to condom use?

If it isn't, then enhancing condoms won't do much to increase condom compliance. It may seem odd to question whether friction is the issue given that sexual arousal is so often logically reduced to the formula of "More friction and erotica = better sex. Duh!"

Yet there are some ominous signals that this formula overlooks the key element of sluggish condom use: sexual pleasure's natural propensity for declining in the face of too much stimulation. Paradoxically, the effects of overstimulation show up in two ways:

  1. Increased rates of sexual performance trouble, and
  2. Sexual sensation-seeking, driving risky behavior.

Sexual performance trouble

Popular blogger Andrew Sullivan recently referred to an epidemic of "young men with floppy dicks." Unreliable erections deflate enthusiasm for condom use. What is more awkward then going limp when it's time for you, or your partner, to grace your manhood with a condom?

A 2002 study reported that 32% of young condom users had erection problems resulting in unsafe use. By 2006, the number was up to 37%.Given that tube sites (free, streaming porn videos) appear to have increased the number of guys reporting sexual performance problems, and tube sites only arose since 2006, one has to wonder what percentage of young condom users are having trouble now?

Less sensitivity to pleasure is a natural response of the brain to too much stimulation. Obviously, the decline in sensitivity is gradual, and not everyone is equally affected. Those who are, however, tend to grab (or long) for more intense stimulation to achieve climax. Said one guy,

My ex mentioned how I had appeared distant during sex. I explained it was not because I was not interested in her sexually but because I had been so over-stimulated [by Internet porn] that she would have needed to be juggling with her feet, sucking off a horse and rimming a [transwoman] for me to be stimulated during sex with her.

Consider this response to a 2012 poll of hundreds of porn users who were trying to quit. Notice how many were experiencing ED, disinterest in sex with gender of preference, or inability/difficulty orgasming during intercourse. A whopping 44 percent were experiencing decreased genital sensitivity or sexual pleasure. Is it realistic to expect such guys to welcome condoms of any kind? (Click to enlarge images)

survey results - changed sexual responsiveness

Incidentally, more than 60 percent reported that their tastes had grown increasingly "extreme" with continued use. Some were bothered, some were not (until it affected their sexual performance):

survey results - changed tastes

Sexual sensation-seeking

One common result of declining sensitivity to sexual pleasure is decreased feelings of satisfaction; the brain wants more and more. In fact, heightened stimulation feels so vital to brains that are responding lethargically to everyday sexual pleasure that some people naturally seek out daring sexual exploits. More extreme porn isn't enough.

Risk and novelty increase the release of exciting and euphoric neurochemicals in the brain's reward circuitry—often later followed by a further decline in sensitivity to pleasure and increased cravings, and another cycle of escalation.

Experts call the pursuit of stimulation "sexual sensation-seeking." Unsurprisingly a recent study found that those reporting the riskiest sexual behaviors also ranked highest in sexual sensation-seeking.

We found that sexual sensation seeking was consistently and significantly associated with the sexual behaviors of young people.... Other studies, specifically assessing STI related sexual behaviors in both young people and adult populations, have similarly found strong associations between these behaviors and sexual sensation seeking.

Which youthful sexual behaviors?

  • Adventurous Sex: (i) experience with threesomes; (ii) sex with a same sex partner; and (iii) real-life sex with a partner met online; 
  • Partner Experience: (i) age at first intercourse (in years); (ii) experience with one-night stands; and (iii) lifetime number of different sexual partners (1 = 1 partner; 7 = 20+ partners).
  • Transactional Sex: (i) ever been paid/paid for sex (in money or in kind).

Unfortunately, people caught up in sensation-seeking are looking for a stronger fix of stimulation than any condom can provide.

The recklessness that results from sexual sensation-seeking is well known in the gay community where "bare-backing" (unprotected sex) is common in spite of much higher infection risks. As the article about Gates cited above states, "Despite widespread HIV awareness campaigns and knowledge about condoms, 50 percent of gay men do not use them, and the HIV rate among gay men is on the rise because of it. ... According to the Center for Disease Control, in 2010, men who have sex with men accounted for 63 percent of HIV infections."

Sexual sensation-seeking is, of course, related to the "floppy dick epidemic"—and not just in the gay community. Said a man commenting on Sullivan's blog:

I can tell you from experience – as a 33-year-old gay man who’s been on Viagra for seven years, who was given my first tablet from a 30-year-old man who was dependent on them, who has a handful of straight and gay friends who “can’t stay hard with condoms”, who knows guys who fight ED in their early 20s, and knows guys who can only come if it’s on someone’s face – there’s something happening to young men these days.

Brains not genitals

A new condom could boost penile sensation, but the majority of today's safe-sex challenge may well lie in the software of the brain. Our experience of pleasure occurs between our ears, not between our legs. Overstimulation of our brain's delicate reward circuitry is behind both numbed pleasure and consequent sensation-seeking. Simply increasing the friction on our genitals won't be enough.

We may have to remind each other how to ratchet up our sensitivity to pleasure if we want to improve sexual safety. This turns out to be a fairly simple matter: Lay off the intense stimulation until normal sensitivity to pleasure bounces back. This can take months, but the good news is that brains are plastic. Said one young guy,

I thought I would miss jerking it to porn, and I used to think guys who didn’t were just weird or religious nutballs. Maybe I’m weird, but sex feels better and my erections are stronger. I can last as long/short as I want, and I even enjoy sex with a condom. I don’t have to make every session a rough banging, choking, smacking, f--k session.

Just as fruits and veggies are boring to a brain for which Lay's potato chips have become de rigueur, everyday sex is uninspiring while a brain is numbed to pleasure. For more, watch this TEDx talk by psychologist Douglas Lisle author of The Pleasure Trap.

Once you understand how the brain operates, it becomes evident that there are two ways to enhance sexual pleasure. Option One: You can ratchet up sexual sensation—and run the risk of recurring feelings of intense dissatisfaction (cravings). Option Two: You can protect the sensitivity of your brain to sexual pleasure by learning to live with a bit of horniness now and then. The advantage of this course is that everyday sexual activities continue to furnish enough sensation to register as pleasurable.

Over the long course of evolution, our environments have often pushed us toward Option Two. Scarcity of mates made it difficult to overconsume sexual stimulation. (For more, see this interview with the authors of Mean Genes by UCLA biology professor Jay Phelan and Terry Burnham PhD.)

Today, though, our environment shoves us toward Option One. It "feels" right in the short-term because our brains evolved under conditions of scarcity and they like sexual arousal and climax a lot. Yet the results of overstimulation are gradually leading to less sexual pleasure for many young guys, making condom use chancy.

However compelling the erotic nirvana of nonstop sexual sensation, it overlooks the natural tendency of the brain to numb its response to chronic overstimulation. In other words, the "more stimulation = more pleasure" formula unfortunately turns out to be overly optimistic as a matter of neuroscience. Bummer.

Gates's humanitarian objective is noble. Now, he needs to take the next step and get his buddy Warren Buffet to fund research that targets the long-term physiological effects of overconsumption of sexual stimuli. That investment would pay multiple dividends: More people would learn how to experience sustainable sexual pleasure. Condoms would once again present only minor impediments to sexual pleasure. And the "floppy dick epidemic" would soon be but a bad memory.

When I first became sexually active as a 19-year old, my gynecologist persuaded me to rely on a combination of spermicide (for me) and condoms (for him). When I asked him, "Will that be pleasurable for my boyfriend?" He said, "It will if you put it on for him." He was right.

Sexual pleasure doesn't have to be as hard to achieve as we're convincing ourselves it is. Think brains, not condoms.