People use condoms for two main reasons—as a form of birth control and to prevent the transmission of sexually transmitted infections (STIs). While, for the most part, condoms are effective at doing both, they’re certainly not completely fail-safe.
Let’s look at the birth control use case first. When used perfectly every single time, condoms are 97% effective in preventing sperm from meeting an egg. Let’s put that in a way that’s easier to imagine. If one hundred people used condoms perfectly every single time for a year, three of them, or their sexual partners, could be pregnant by the end of that year. However, condoms are not used perfectly every time, which brings their effectiveness down to around 86%. How are we getting it wrong?
Sometimes, people put condoms on after intercourse has already begun or remove them before intercourse is over. People unroll them before putting them on, don’t leave space at the tip, fail to roll them down all the way, or put them on inside out before flipping them around. Many people fail to use an adequate amount of lubricant or a type of lubricant that will quickly compromise the integrity of the condom. Others will store condoms incorrectly, use expired condoms, or expose them to teeth and other sharp objects when removing them from the wrapper. Some have even used the same condom multiple times, and sometimes, they simply slip off during sex—even if they’re being used responsibly.
A 2012 meta-analysis found that a remarkable portion of people surveyed reported having made each of these mistakes at some point.
In any event, If we ran the same study mentioned above but wisely factored human error in, around 14 of those 100 people and their sexual partners would be pregnant by year’s end.
With STIs, things get a little more nuanced. That’s chiefly because condoms are better at protecting against the transmission of some STIs than others. Some STIs like genital herpes (HSV2) and human papillomavirus (HPV) are transmitted via parts of the genitals and surrounding area that condoms don’t fully cover. Consequently, condoms offer just 10-50% protection for HSV-2 and HPV.
That said, they offer greater than 90% against human immunodeficiency virus (HIV) and gonorrhea, and up to 90% protection against chlamydia when used perfectly every single time—which, as we’ve already learned, they’re not.
Incorrect condom use can increase the chance of a condom breaking, leaking, or slipping off, but all these things can—and do—happen regardless of how textbook our condom use is. So, it’s safe to say that in the absence of another method of birth control and comprehensive STI testing, sex involves a degree of risk.
For most people, it’s a risk worth taking. For others, the fear of an unplanned pregnancy or giving or getting an STI can become all-consuming and negatively impact their lives in several ways. Some of those people may be dealing with one of a couple mental health conditions that cause intense anxiety, which can interfere greatly in their sex lives and other areas of life.
Could my worry be caused by Generalized Anxiety Disorder (GAD)?
“There are several anxiety disorders, but by far the most common is Generalized Anxiety Disorder (GAD),” explains Dr.Nicholas Farrell, licensed clinical psychologist and a Regional Clinical Director at NOCD.
GAD is a chronic mental health condition characterized by excessive, uncontrollable worry about various aspects of life, usually disproportionate to the actual threat. It’s one of the most common anxiety disorders, affecting around 6.8% of adults in the United States. While it tends to run in families, high-stress environments and traumatic experiences can also contribute to its onset.
For those with GAD, everyday tasks can evoke overwhelming apprehension, leading to physical symptoms like restlessness, muscle tension, and difficulty concentrating. Persistent worries about hypothetical scenarios or perceived dangers can disrupt daily functioning, impairing relationships, work, and overall quality of life. GAD often co-occurs with other mental health disorders like depression.
“People with GAD worry about anything that could go wrong in any circumstance,” says Dr. Farrell. “To some degree, I think that a broken condom is a reasonable thing to worry about for anyone, but someone with GAD will often catastrophize the situation, imagining the worst possible outcomes if a condom were to break. This could lead to them not enjoying sex or avoiding sex altogether, which may have serious ramifications for their happiness and that of their partner.”
Could my worries be caused by Obsessive-Compulsive Disorder (OCD)?
Another condition that could underpin an all-encompassing fear of a condom breaking during sex is Obsessive-Compulsive Disorder (OCD). Often thought of as a relatively benign quirk related to cleanliness and order, OCD is a serious mental illness characterized by a cycle of obsessions and compulsions that significantly interfere with a person’s daily life. It can increase the chances of sufferers developing other mental health disorders and dramatically elevate their risk of suicide.
Here’s a breakdown of the terms that give OCD its name:
Obsessions: Obsessions are persistent, intrusive, and unwanted thoughts, images, feelings, sensations, or urges that cause distress or anxiety. These fears can be about causing harm to oneself or others, the stability of a romantic relationship, inappropriate and illegal sexual contact, and whether their behavior is ethical or aligned with their religious views—in addition to more widely-known themes like contamination, symmetry, and order.
Compulsions: Compulsions are repetitive behaviors or mental acts that a person feels driven to perform in response to an obsession, often in an attempt to neutralize the resulting distress or prevent a feared event. Compulsions can include actions like avoidance, excessive researching, reassurance-seeking, repetitive checking, or mental rituals like counting or praying.
If someone is experiencing anxiety caused by obsessions about a condom breaking during sex, their compulsions could include things like:
- Adapting their sexual practices or avoiding having sex altogether.
- Interrupting sex multiple times to check and recheck if the condom is safe.
- Meticulously checking and re-checking each new condom for signs that it could break.
- Spending hours on the internet researching the likelihood of a condom breaking.
- Asking their partner or close confidants whether they’ve ever experienced a condom breaking during sex.
- Praying that a condom doesn’t break while having sex.
While these compulsions will bring temporary relief, they inadvertently reinforce the sequence of obsessions, anxiety, compulsions, and relief known as the OCD cycle. Being trapped in this cycle is what can ultimately cause one’s OCD symptoms to get worse and worse over time.
“Having obsessions about a condom breaking could be related to a few different OCD subtypes,” explains Dr. Farrell. “Harm OCD focuses on fears of harming yourself or someone else, so getting or giving an STI could fit into that category—as well as causing an unwanted pregnancy. Religiosity or scrupulosity OCD could be at play if someone’s fear is focused on having a child out of wedlock. Responsibility OCD centers around fear of doing something wrong or causing harm, often driven by a strong desire to be morally upright or avoid any form of wrongdoing. This also could underpin this particular fear.”
Dr. Farrell adds that this fear could also be a facet of real-event OCD, also known as false memory OCD. This subtype is characterized by persistent and distressing obsessions related to past events and one’s memory of them, often involving fears about causing harm, behaving inappropriately, or misremembering important details.
With real event OCD, someone would not question that they had sex with a particular partner three months ago, but may become extremely anxious due to retroactive doubts about whether the condom functioned properly. Their obsession could be centered on the uncertainty of whether they could have contracted an STI unwittingly, or cause their partner to become pregnant.
“Of course, there’s a real but low-likelihood possibility of a condom breaking or slipping, and that’s certainly something to be mindful of,” explains Dr. Farrell. “But GAD and OCD are characterized by excessive worry about potential scenarios in the absence of any clear and present danger. That’s the difference between a reasonable concern and an indicator that a person may have an anxiety disorder. After all, there’s a certain probability of us getting into a serious auto accident every time we get behind the wheel. Still, most people who don’t have a disorder like GAD or OCD can accept that risk and still drive to work, because it’s relatively low and doesn’t cause distress every time they pull out of the driveway.”
GAD and OCD: how are they treated?
GAD is typically treated through a combination of therapy, lifestyle changes, and sometimes medication. Cognitive Behavioral Therapy (CBT) is a common and effective approach, helping people identify and challenge irrational thought patterns contributing to their anxiety, and Exposure and Response Prevention (ERP) Therapy is a highly effective form of CBT for GAD..
Lifestyle adjustments, such as regular exercise, a balanced diet, and sufficient sleep, reduce anxiety levels. Medications like selective serotonin reuptake inhibitors (SSRIs) or serotonin-norepinephrine reuptake inhibitors (SNRIs) may be prescribed to regulate neurotransmitter levels and reduce anxiety. It’s important to note that the most effective treatment plan for GAD varies from person to person, and a tailored approach in consultation with a mental health professional is recommended for optimal results.
While SSRIs and SNRIs can also be used to reduce OCD symptoms in many cases, standard CBT on its own is unlikely to help people with OCD, and could actually make their symptoms worse. Instead or in addition, Exposure and Response Prevention (ERP)—a particular treatment that is often used for GAD as well—is considered the most effective form of psychotherapy for OCD. It involves gradually exposing you to your obsessional triggers while you are guided in resisting the urge to engage in compulsive behaviors, helping you develop healthier coping mechanisms.
ERP is highly effective in helping people regain control of their lives from OCD, regardless of the subtype or the nature of their obsessions. Around two thirds of people who commit to this specialized approach see a significant reduction in their symptoms and are able to break free from the OCD cycle, often in a few months.
Begin your recovery journey today.
All of our therapists specialize in OCD and receive ERP-specific training. If you think you might have OCD and want to learn how it’s treated with exposure-based therapy, schedule a free 15-minute call with the NOCD Care team to learn more about how we can help you get your life back on track.