Decisions, decisions — condoms, sex, etc.

Dear Not Too Sure,

Condoms are very effective for pregnancy prevention if they're used correctly and consistently each time you have sex. Unlike other contraceptives (the pill, the patch, etc), condoms can prevent both unwanted pregnancies and sexually transmitted infections (STIs). If you are worried about the durability of different types of condoms, you can set your fears aside; studies have shown that thinner or ultra-sensitive condoms are as strong as standard condoms.

While it was once thought that using condoms together with spermicide increased contraceptive effectiveness, many condom manufacturers have stopped producing condoms with spermicide due to the controversy surrounding the spermicidal agent nonoxynol-9. Nonoxynol-9 is a detergent that can be abrasive to delicate vaginal and anal tissues. The micro-abrasions caused by spermicide may allow viruses and bacteria that cause STIs to more easily enter the bloodstream. Thus, nonoxynol-9 could actually increase risk of STI infection by damaging epithelial tissue (layers of skin cells) of the vagina and anus. In accordance with this finding the World Health Organization stated, "There is no evidence that condoms lubricated with nonoxynol-9 are any more effective in preventing pregnancy or infection than condoms lubricated with silicone, and such condoms should no longer be promoted."

If you're going to continue to have sex, your girlfriend might make an appointment with her gynecologist or nurse practitioner to have an annual exam and discuss contraceptive options. In the meantime, directions come with the condoms, and it may do you and your girlfriend well to read them together and practice putting them on. Try practicing both in the light and in the dark, sitting and standing up. The more practice you have, the easier it will be to put on uninterrupted when you're aroused.

It's also wise to look at an issue you mentioned in passing, that you had sex due to "outside pressure." Before you decide to have sex again, consider thinking about some of these questions: Do you and your girlfriend want to have intercourse at this point? Why or why not? Are you both comfortable with your decision?

If you've had sex once, it does not mean that you have to continue having intercourse. There are many other kinds of loving ways to express tenderness and caring for each other, and still experiment with your sexuality: touching, massage, caressing — with or without clothes, poetry, candlelight dinners, mutual masturbation, etc.

Here's some ideas to help guide you in your sexual decision-making:

• Be comfortable with your sexual feelings. Trust yourself. If you're not comfortable, or  if you feel confused, guilty, or ashamed — it's ok to wait.
• Think about your expectations for a relationship. Do you need to be in love to have sex? Is casual sex okay? Are you hoping to be monogamous? What do you think about romance? It's a good idea to clarify these issues for yourself before beginning a sexual relationship with someone else.
• Make sure that the sexual relationship is mutually desired. Sexual activity that occurs against a person's will is illegal and wrong.
• Not interested in sex again (at this time)? Consider making that a topic of conversation with your partner.

If you do both decide that you want to have sex, keep in mind that sex is something that is awkward at first for many people. Although folks tend to believe that sexual skills are innate, they're actually learned. Think about how awkward you felt the first time you rode a bicycle, tried to dance with a partner, or had to live with a roommate. Over time, with practice and comfort with your partner(s), sex becomes more natural. Good luck, and be safe!