Whether or not you're really able to tell the difference between sex with a condom and sex without, many couples might end up ditching their happy hats (a phrase OnlineSlangDictionary.com tells me means "condom") at one point or another in their relationship. One common reason why is if a heterosexual couple is trying to conceive, but in other instances, it's an act of trust, lust, or maybe even just convenience. If two monogamous partners are using other forms of contraception and have tested negative for STIs, should they consider having sex sans latex? And, just as importantly, when?
Know your risks
"I should lay the groundwork and say that really the most reliable way to avoid STDs is abstinence," Dr. Jennifer Caudle, Family Physician and assistant professor at Rowan University School of Osteopathic Medicine, explained to Cosmopolitan.com. "There are things that reduce the risk of STDs that couples can do."
It's important for anyone who's sexually active to get regularly tested for STDs like gonorrhea, chlamydia, HIV, and syphilis, but even if you and a potential first time partner have recently tested negative, Dr. Caudle still recommends using condoms.
"And the reason for that is, let's just use HIV for example," she says. "HIV tests...are very accurate, but we don't have a test right now that can actually detect the virus immediately after infection."
Dr. Raegan McDonald-Mosley, Chief Medical Officer at Planned Parenthood Federation of America, agrees.
"Some of the commonly used tests for HIV do not detect risks from intercourse in the last three months," she explained. "If a person or their partner has had unprotected intercourse or intercourse with other partners in the last three months then they should continue to use condoms for another three months, and then have another HIV test."
While condoms are more geared towards sex with a penis, this step, and the following steps, apply to any partners looking to ditch any barrier method of contraception (such as dental dams) that both partners are ready to forgo. Whatever the relationship, regular testing is a must.
Define the relationship
Using condoms and regularly getting tested is especially important during that non-committal "what are we" period that often precedes relationships. But let's say you're (thankfully) past that and are taking the plunge into full-on monogamy. First, congrats, that's cool, if that's what you wanted! Second, make sure you and your partner have a mutual understanding of what that term means (AKA no surprise one-night stands that you never tell your partner about because "it meant nothing").
"So that means that you and your partner, you talk to each other," Dr. Caudle says. "You agree to be sexually active only with that person, you follow through with that agreement, that you also make sure that you get tested which of course we're assuming here, and that you get vaccines," which exist for things like HPV and HepC.
But, the decision to not use condoms is much bigger than a simple yes or no. If you're not intending on getting pregnant, make sure you have an alternate method of birth control, and allow enough time for it to go into effect. Something like the ParaGard IUD is effective immediately, but depending on the time of your last period, hormonal IUDs and certain birth control pills can take up to seven days. Talk to your gynecologist to determine which method is right for you. Then, it's time for you to talk to your partner.
Trust and tests
"You really have to ask yourself, how much you trust your partner and how much do you trust yourself?" Dr. Caudle continues. "This is where it goes beyond conversations about STDs but really conversations about who are you as people, how much you trust your partner, how dedicated are you and how dedicated and how comfortable, really, is your partner. Because you are taking a risk, it is a risk."
It's a risk because technically, it's possible that during the course of two negatively-tested monogamous couples having sex without condoms, STDs could still emerge. That's because there are types of STDs that aren't always routinely screened for when you ask for an STD test, like HPV.
While the CDC reports that HPV is the most common STD, it can be hard to nail down, especially considering that there's no approved HPV test for men. More often than not, HPV goes away on its own, sometimes without the patient ever knowing they had it. In fact, the HPV tests that screen for cervical cancer aren't recommended for women under 30 years old.
That being said, if the HPV doesn't go away on its own and is left untreated, Dr. Caudle warns that it can lead to "cervical cancers in women, penile cancers in men, and anal cancers in men and women. HPV can also cause cancer in the throat, tongue and tonsils (oropharyngeal cancer)."
If this is something you're worried about when making the decision to ditch condoms, it's important to let your provider know and ask for all the tests.
"Lots of people have HPV and herpes in their blood system, and that's not something that all providers routinely test for," Dr. McDonald-Mosley reiterates. "There's never a 0 risk situation."
If you do test positive, your doctor or gynecologist can help you with next steps. If detected early, STDs like gonorrhea, chlamydia, and syphilis are can be cured with antibiotics. Other STDs, like herpes, can be managed.
That being said, the tests are "very, very good," Dr. McDonald-Mosley continues. The risk of falsely testing negative is small, so "if someone has been negative, and they've been negative twice, they can be very reassured that they're negative."
Trust comes into play again in another way: It's also important that you and your partner have talked about drug use, as this can radically change what is and isn't necessary. "If the couple is monogamous but one person is an IV drug abuser, then risk is still very high," Dr. Caudle warns. "Drug use can provide an environment where those who use drugs may engage risky behaviors (unprotected sex, etc) that could provide an opportunity to acquire ANY STDs. But with IV drug abuse, we often worry particularly about blood borne infections such as HIV and Viral Hepatitis (Hep B and Hep C)."
That's why this question isn't just medical, but emotional. "It's really a decision about, 'How do I really feel about my partner?'" Dr. Caudle concludes. "'What path are we on? How serious are we with each other? What risks are we willing to allow, how much are we in love, or in like, or in lust, or whatever our criteria is?'"
This is not an in-the-moment decision. It's a decision that has to be discussed candidly with a partner you trust to give their honest input, and made in a relationship that you're invested enough in to regularly drop by a clinic. If not, keep those condoms right where you left them — in a little drawer labeled "TAX STUFF" so your roommate won't steal them.
Follow Kathryn on Twitter.