Condoms can be uncomfortable, they can reduce the sensation during sex, and can often interrupt your fun when you have to find a condom, open the packet, find the lubricant and put it on. Nobody is saying that condoms are perfect, or that sex will be just as good if you use them. But, frankly, they are the best things we have now to cut down on HIV transmission during sex.

A lot of blame has been placed on men’s reluctance to use condoms. This ignores the fact that many women also prefer condomless sex, and, as indicated by the Simoni study above (Simoni 2000), there may be deep psychological reasons to do with the demonstration of trust and closeness that explains why both sexes may find them difficult to use consistently.

It also does not explain the deeper reasons for specifically male reluctance. One clue was given by a recent study of 78 HIV-positive gay men (Cove 2004) in London. It found that while 38 per cent of the men reported some degree of erectile dysfunction. But this went up to 51 per cent in the context of trying to use condoms – in other worlds, more than half of the men experienced difficulty in getting or sustaining an erection when trying to put a condom on. Furthermore 90 per cent of the 37 men whose erectile dysfunction was associated with condom use reported inconsistent condom use during insertive sex, compared with 28 per cent of those who did not report condom-related erectile dysfunction.

If other groups of men have anything in common with gay men, we may be underestimating performance anxiety and the terror of impotence (often disguised with bravado) as a driver of men’s reluctance to use condoms.