Using Condoms When You Have an IUD or Implant

man holding up condom to camera
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When people think about practicing safe sex, they have two basic concerns. The first concern is, at least in theory, universal. Everyone needs to consider protection against sexually transmitted diseases. The second concern is unique to heterosexual couples. That concern is protection against pregnancy. 

In terms of pregnancy protection, long-acting reversible contraception (LARC) is unquestionably the most efficient choice. There are several options for LARC, but the two main ones are IUDs and implants. IUDs are devices placed inside the uterine cavity. They may or may not contain hormones, and they can be left in place for up to 12 years. Implants are a small, matchstick-like device that is placed under the skin of the arm. This device then releases a low level of hormones for up to three years. 

The reason that LARCs are so effective is that women don't have to think about them. The IUD or implant is inserted, and that's it. A woman is protected from pregnancy for a long period of time. There is no need to buy supplies. There is no need to worry about seeing the doctor. Once in, LARCs are good until they expire. That's one of the reason that there has been a growing interest in using them to reduce teen pregnancy. They don't require teens to remember to take a pill or do anything else. Teens visit the doctor and they are almost fully protected from pregnancy for years at a time.

Failing to use a contraceptive correctly is one of the biggest problems for contraceptive efficacy. People forget to take their pills. They don't use spermicide with diaphragms. They forget to leave room at the tip of the condom. LARCs are great because they're pretty much impossible to use incorrectly. What they don't do is protect against STDs. 

Why Use Condoms If You're on LARC

The best thing about using a LARC is also one of it's biggest drawbacks. Women who use LARCs don't have to think about safe sex to prevent pregnancy. However, LARCs do nothing to prevent sexually transmitted diseases. They pose no barrier to infection. Therefore, anyone using a LARC outside of a mutually monogamous, long-term relationship where both partners have been tested should be counseled to use condoms as well. Unfortunately, this doesn't always happen.

Dual method use, using two contraceptive methods at once, is relatively uncommon. Few women use both condoms and LARCs. Even condom use combined with oral contraceptives is relatively uncommon. Generally, the theory is that women are primarily motivated by either pregnancy or disease prevention. They then choose the contraceptive that's most suitable for their budget and needs. Research also suggests that dual method users may be qualitatively different than single method users. For example, a 2014 study found that dual method users were more likely to have received the HPV vaccine. This suggests individuals who are somewhat more proactive about their sexual health.

However, even those who use dual methods may not be using them consistently correctly. A national sample of 18-44-year-olds found that 40% of reported episodes of intercourse included condom use. Twelve percent of those were dual method episodes. Unfortunately, on further examination, the investigators realized that dual method users were less likely to use condoms correctly. They often took the condom off early or put it on late. Additionally, relatively few dual method users used condoms consistently. Instead, they only used them for some episodes of sexual intercourse.

Teens Using LARC

Lack of dual method use may be particularly an issue for teen girls. Teen girls have some of the highest rates of STD acquisition. This means that it's important to consider STD prevention when counseling them about contraception. Preventing teen pregnancy is an important goal. However, there are some groups who are concerned that encouraging LARC use may increase STD risk. Such worries are well founded.

In 2016, research published in JAMA Pediatrics found that teens using LARCs were 60 percent less likely to use condoms than teens using oral contraceptives. Rates of condom use among LARC users were similar to those of girls using medium-term contraceptives such as Depo Provera, the patch, and the ring. This suggests that all the "set it and forget it" methods similarly decrease condom use. That's not really a surprise. Using a longer-term method means that sometimes the safe sex talk — and thought — can go on the back burner.

Some of this can hopefully be addressed through educational means. Teens and adults need to be reminded that pregnancy isn't the only risk of sex. Condoms provide protection against STDs. They also encourage additional communication between partners. That's something that can make for a sex life that's healthier both emotionally AND physically.

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