A Spider Web Against Danger

STEVEN J. SAINSBURY

July 16, 1993|By STEVEN J. SAINSBURY

San Luis Obispo, California. -- My 15 year-old patient with pelvic pain lay quietly on the gurney, as I asked her the standard questions.

''Are you sexually active?''

''Yes.''

''Are you using any form of birth control?''

''No.''

''What about condoms?''

''No.''

Her answers didn't surprise me. Nor was it surprising that her pain was due to a rip-roaring gonorrheal infection, although it just as easily could have been due to some other venereal disease, a tubal pregnancy or even AIDS. As a specialist in emergency medicine, I treat teen-agers like this one every day. Most are sexually active. Condoms are used rarely and sporadically.

Yet in midst of the AIDS epidemic, I continue to hear condoms touted as the solution to HIV transmission. As part of a ''safe sex'' campaign, condoms are passed out in high schools, sold in college restroom dispensers and routinely discussed in movies and television -- a sure sign that the subject is politically correct.

The message? Condoms equal safe sex.

As a physician, I wish that this were true. Yet, to imply that the use of condoms will safeguard both sex partners from venereal disease, including AIDS, is not only a lie, it is a dangerous lie.

Consider the following two vital facts.

Fact No. 1: Condoms are not being used. Many studies confirm this, including one survey among college women -- a group we presume to be as well-informed as any on the risks of herpes, genital warts, cervical cancer and AIDS. In 1989, only 41 percent insisted on condom use during sexual intercourse! If educated women cannot or will not use condoms, how can we expect teen-agers or the uninformed to do so?

Fact No. 2: Condoms fail, and fail frequently. Due to improper storage, handling and usage by consumers, the condom breakage rate during vaginal intercourse is 14 percent. Other high-risk behaviors, particularly anal intercourse, increase this rate significantly. For the person who averages sex three times a week, a 14 percent breakage rate equates to a condom failure every two weeks.

AIDS is a killer disease, and any measures taken to prevent its transmission must be 100 percent effective. For condoms to be the answer to AIDS, they must be used every time and can never break or leak. Neither criterion is ever likely to be met. Condoms may mean ''safer'' sex, but is ''safer'' acceptable for this deadly epidemic?

Look at it this way.

Suppose that, for unknown reasons, automobiles suddenly began to explode every time someone turned the ignition. Motorists were getting blown up all over the country. Finally, the government comes out with a solution. Just put this additive in the fuel, they say, and the risk of explosion will go down 90 percent. Would you consider the problem solved? Would you still keep driving your car? I doubt it. Then why do we accept condoms as the solution for AIDS?

So, you say, if condoms aren't the answer, what is?

There is one recommendation, and only one, that is guaranteed to prevent the transmission of the AIDS virus and most other sexually transmitted diseases. A recommendation that lies buried in government reports but has always resided in common sense: that the only safe sex is no sex until one is ready to commit to a monogamous relationship with an uninfected person. The key words are abstinence and monogamy.

I can hear the moans already. Condom fans begin to reflexively murmur words like unrealistic, naive and old-fashioned.

Well, perhaps a return to a few old-fashioned concepts is what's needed to stem the surging tide of AIDS, unwanted pregnancies and venereal disease.

Just as we try to teach our children to be honest, kind and gentle, perhaps we can also teach them to be chaste. Why do we harbor such reluctance to teach abstinence and marital fidelity?

American families are bombarded by continual images of unprincipled sexual activity in movies, television and the printed media. Planned Parenthood found that there are roughly 20,000 sexual scenes every year on American television. Isn't it time to lend balance to the distorted and dangerous lifestyles portrayed as the norm for our society?

Madame de Sevigne, writing in 1671, described the condom as a ''spider web against danger.'' Three centuries later, little has changed. To quote Dr. Robert C. Noble, a University of Kentucky infectious disease expert, ''We should stop kidding ourselves. There is no safe sex. Condoms aren't going to make a dent in the sexual epidemics that we are facing. If the condom breaks, you may die.''

Steven J. Sainsbury, a physician, wrote this commentary for the Los Angeles Times.

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