Consent & Condoms – Oh My!

Written by Austin Rusher, WHNP / Kalispell OB-GYN

{Original Article posted 406 Woman }

Being a girl is hard. Being a woman is also hard. Figuring out who we are, what we like, what we do not like, what our boundaries are etc. is an entire process that changes as we mature and grow as an individuals. To make matters worse, there are often no clear guidelines and the most influential and easily accessible outlets often do not have our best interests in mind. The media, for example, broadly implies that women are unworthy if their Body Mass Index (BMI) is too high. Society and the media assume women’s preferences, or that their decisions and/or lifestyles are “debatable” or “open to persuasion.” Historically women have been shamed, encouraged, or even groomed to believe this as well.

Today, we are going to tackle a few areas of confusion often encountered in medicine, or disclosed during a “doctor’s” visit, and hopefully shed some light on some grey areas. One topic, that I believe should be included in every young woman’s annual appointment, birth control counseling consultation, or period management visit is consent. By now, most readers are familiar with Larry Nassar (especially relevant as the 2024 Olympics just wrapped up in Paris) and the despicable abuse that he carried out on adolescent and young female athletes. Nassar abused his position of authority as a doctor, and as a trusted male adult, to sexually abuse these athletes for years, and arguably, right under the public eye. Those same brave, young, female athletes exposed him and he was held accountable for his crimes and is currently serving time in prison. These types of situations are unacceptable and women need to feel empowered and believed when, unfortunately not if, these events occur. 

Nowadays, I often have parents of young patients, past the age that a provider assesses for normal physical development BUT less than 21 years of age and young patients themselves, ask when they need their first breast or pelvic exams. Under 21 years of age, unless there is a symptom (such as abnormal bleeding, discharge, or pain), or the patient has a chosen method of contraception or period management that requires it, young women DO NOT need a pelvic exam OR a breast exam. Again, before the age of 21 years old, unless you as the patient have a concern and fully understand the indications for the exam, you should not be asked to take your top and/or pants off for a medical exam. After 21 years of age, the answer is a little more complicated as not all of the medical organizations agree. However, broadly speaking, if a symptom is present, an exam is usually warranted to which the patient may be asked to get undressed to properly address the issue. 

Another area of consent that concerns me deeply, is when a patient communicates during their appointment that it is difficult to “get” their partner to use a condom OR they are uncertain if their partner uses a condom. I believe that this is a reflection of their partner’s character. Often the partner is not fully considering the extent of the consequences of forgoing protection for expedited or perhaps a few brief moments of increased pleasure or worse, control. In not wearing a condom, they are putting their partner (and themselves) at risk for Sexually Transmitted Diseases (STDs) (potentially asymptomatic that may not be found for years with chronic health consequences including infertility), pregnancy, and CANCER. Penises (or penes in some medical literature) are excellent conduits of the Human Papilloma Virus (HPV) which causes over 99% of the cases of cervical cancer in women. 

Men often have no idea that they have been exposed, are most commonly asymptomatic, and it only takes one exposure to essentially be a “carrier.” Men also don’t get regular HPV testing or screening pap smears (a “pap” is when the pathologist receives cells from a sample, collected during a doctor’s appointment, and looks at them under a microscope to look for cellular changes consistent with HPV). Penes do a great job of pushing the HPV virus up to the female cervical tissue during intercourse, which HPV favors. Using a condom helps reduce this risk of exposure by acting as a barrier. And ladies, because men don’t receive regular HPV testing or paps (those are just for our pleasure – insert sarcasm) ensure you are visiting your provider annually and following guidelines from your provider if you test positive for HPV or have an abnormal pap. 

While condoms are only 75-87% effective at preventing pregnancy, they are an excellent barrier and help protect against STDs and are advisable in conjunction with other forms of birth control for that purpose! For example, if a person has an IUD for pregnancy prevention, they should also use condoms for the prevention of STDs. This also prevents whining from a male partner worried that they may get poked by the IUD strings (a rare occurrence that can be solved by using condoms or trimming the IUD strings).

I love saying “interestingly enough” but really, this is probably only interesting in my very narrow field of Women’s Health. However, here goes: “Interestingly enough,” the prevalence of oropharyngeal (mouth and throat) cancer in men has recently surpassed cervical cancer in HPV-related cancers. There are multiple factors at play here, one of them being that men have a higher rate of tobacco and alcohol use than women. This increased substance use is also likely hard on their mouth and throat tissue, allowing the HPV virus increased access with decreased healing. To be clear, substance usage does not cause HPV, the damage that it causes “promotes” infection. Men deserve the protection of condoms as well as women, and everyone should have regular dental care to assess for obvious lesions that could be related to HPV. Any lesions that do not heal should ALWAYS be evaluated. A good basic time frame for a minor but persistent unhealing lesion is 2-4 weeks. If it persists for that long, schedule an appointment with a medical provider for evaluation. 

On a final note, related to consent, if you cannot obviously tell that your partner is “into it” and excited to be there, DO NOT CONTINUE. If there is any question of consent, consent has not been obtained. Stop. Do not pass go! You will never regret this, but if someone feels pressured into moving forward when they are not ready, they may regret that for the rest of their lives. This regret can lead to the potential for emotional, physical, or even legal repercussions. 

Finally, one last friendly reminder to drive the point home, biological beings have biological problems, and viruses and bacteria really like mucous membranes. Mucus membranes include both our mouths and parts of our genitals. Therefore, you can get STDs in both areas (though they often favor the genitals) by taking precautions, using protection such as condoms, and getting regular care with screening if asymptomatic or testing if symptomatic is advisable. Everyone deserves a safe, respectful, and ideally enjoyable sex life. We as humans have the right to consent, we have the right to say NO, not right now, wrap it up or bye-bye without consequence. Remember, ask questions and if any uncertainty remains, consent has not been obtained. 

If you don’t have a provider or you have questions about consent, HPV, condoms or anything women’s health-related, we are here for you! Call our office to schedule an appointment: 406-752-5252.