Erection loss in association with condom use among young men attending a public STI clinic: Potential correlates and implications for risk behaviour

Background: To assess prevalence of condom-associated erection loss and to identify correlates of erection loss among men attending a sexually transmissible infections (STI) clinic. Methods: Men (n=278) attending an STI clinic responded to an anonymous questionnaire aided by a CD recording of the questions. The sample was screened to include only men who had used a condom during penile-vaginal sex at least three times in the past 3 months. Erection loss was assessed for 'the last three times a condom was used'. Results: The mean age of the participants was 23.7 years (s.d.=4.1); 37.1% of the men reported condom-associated erection loss on at least one occasion. Men who had reported condom-associated erection loss were also reported having more frequent unprotected vaginal sex (P=0.04) and were less likely to use condoms consistently (P=0.014) than men without erection loss. Men with erection loss were also more likely to remove condoms before sex was over (P=0.001). Age and race/ethnicity were not associated with erection loss. In multivariate analysis, three significant statistical predictors were identified: low self-efficacy to use condoms (P=0.001); problems with 'fit or feel' of condoms (P=0.005); and having more than three sex partners during the previous 3 months (P=0.02). Conclusions: Condom-associated erection loss may be common among men at risk for STIs. This problem may lead to incomplete or inconsistent condom use. Men may be more likely to experience condom-associated erection loss if they lack confidence to use condoms correctly, if they experience problems with the way condoms fit or feel, and if they have sex with multiple partners.