Gay patients report anal irritation with spermicidal condoms, while female sex workers cannot tolerate the foul taste particularly during fellatio. Instead, couples choose from a repertoire which includes sexual abstinence, sexual practices other than anal or vaginal intercourse, withdrawal and intermittent condom use. It should not be ignored. These strategies have been shown to be effective. Concerns about contraceptive cover in the event of condom breakage or slippage can be addressed by counselling about the availability of morning after contraception.
Some women opt for the double contraception option of also using oral contraception or a diaphragm.
We also need to be persistent in our efforts to promote condoms and allow time for sexual cultures to change. Even the targeted programs among gay men and commercial sex workers took several years to take full effect. Conclusion Health education and research workers need to better recognise the varieties in sexual contexts and the complexities of condom use. Condoms probably only provide limited protection for STDs that readily involve other anatomical areas. Control of other STDs, in part attributable to successful condom promotion among core groups, has left the general population less vulnerable to HIV infection in most developing countries.