[Question #7275] Condom use question for HIV prevention

6 months ago
Hi,

Just wondering if using the same condom for getting blowjob first and then vaginal sex is safe and preventing HIV transmission?

Of course that if I notice any damage or holes in condom after blowjob before vaginal sex I will put a new condom before vaginal sex.

My questions are :

1.  From your experience/previous cases, 
     is it common that when using the same condom for blowjob and then for vaginal sex, 
     the condom tend to break more easily during vaginal sex?
     The condom may break more easily during vaginal sex 
     because of the mouth pressure and teeth grinding on condom which happened by blowjob before.

2.  Can unseen/tiny holes in condom during vaginal sex(may have caused by teeth grinding during blowjob before) 
     cause HIV infection/increase HIV infection risk during the vaginal sex with the same condom used for blolwjob before?

The case was that I visited commercial sex worker, 
we used the same condom for blowjob first and then for vaginal sex.
I could feel her teeth rubbing the condom during blowjob.
After blowjob, before vaginal sex, the condom looked ok with no damage and no holes, 
I asked the sex worker to change the condom before vaginal sex, 
but she did not want to change it(she told me the condom is intact), 
and we used the same condom for vaginal sex.
The condom looked intact also in the end of vaginal sex.

3.  For future events when using condom for both blowjob first and then vaginal sex.
     If after blowjob before vaginal sex the condom looks ok with no damage and no holes, 
     is it safe\no HIV concern to use the same condom for vaginal sex?
     Or next time for for better HIV prevention, 
     I should insist on putting another new condom after blowjob before vaginal sex?

I think that most sexual partners will think it is not necessary to chnage condom between protected blowjob and
then protected vaginal sex, and they will cause you feel unpleasant when you request to change the condom.
So I just want to know if it is necessary and  when it is necessary to change condom between
protected blowjob and then protected vaginal sex?

Thank you in advance for your advice.
      
H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
6 months ago
Welcome and thanks for your question. I'm happy to help.

The short answer is no, there is no risk from this sort of exposure. As you know, standard advice is to use a fresh condom for each exposure, even with the same partner. However, the chance of HIV (or other STDs) from not doing so is near zero -- probably truly zero. On top of which, in the US and other industrialized countries, the large majority of female sex workers don't have HIV -- on average, probably under 1 in a thousand. To your specific quesitons:

1) I don't know if condoms are more likely to break with vaginal exposure following oral. If so, it's a trivial increased risk. And from your description, it obviously didn't happen, so what does it matter?

2) One of the most enduring  urban myths about HIV transmission is that condoms contain microscopic pores that allow HIV/STD transmission; or that such defects can develop during condom use. In fact, it doesn't happen. Even if suc h microscopic defects existed, scientific reasons (e.g. hydrostatic pressure) would make them more or less impervious to enough infectious particles to allow transmission. A consequence in the myth is continuing advice about such nonsense as a "water test" on a used condom to detect such leaks. If a condom doesn't break wide open, protection is complete. And you would have noticed if that had happened.

3) As I said above, it's not a bad idea to use ifferent condom for each exposure, no matter what order it occurs in. Condoms are cheap -- if you sex worker partner(s) don't have them handy, have your own. But it you go quickly from one exposure to the other and changing condoms isn't practical, I wouldn't worry or lose any sleep over it. 

I hope these comments are helpful. Let me know if anything isn't clear.

HHH, MD
---
6 months ago
Hi Doctor,

Thank you very much for your answer and advices.
I read what you wrote and understood it.

Just about your answer to question number 3, I quote  your answer: 

"But it you go quickly from one exposure to the other and changing condoms isn't practical, 
I wouldn't worry or lose any sleep over it. "

I believe you were you mentioning to say  :  "But if you go quickly from one exposure to the other...."  ?

I have just one more question about this issue for a possible future situation:

1.  If the blowjob feels very rough on condom and penis,
      and you feel serious teeth grinding on condom and penis.
      Even though the blowjob was rough,  
      in the end of blowjob the condom still looks intact with no damage and no holes on the condom. 
     Is it also safe\no HIV concern using 
     the same condom for the vagial sex in such sitauation?

     Or in such situation, because the blowjob was rough 
     and there was serious stress on condom during blowjob, 
     it would be better using a new condom for vaginal sex to prevent condom breaking and prevent HIV?

According to your answer to question 3 I understand that if the protected blowjob 
feels gentle on penis/condom, and no stress/minimal stress applied on condom, 
I see no HIV concern for using the same condom for the vaginal sex afterwars.

My question is with rough protected blowjob as mentioned above,
would it be more impotant to insist on changing the condom before vaginal sex in such situation?
Or this is also no HIV concern not to change the condom in described situation?

Thank you for all the help.

H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
6 months ago
You correctly interpreted me, if not it. Sorry for the typo.

I suppose it's possible such vigorous contact could weaken a condom and raise the risk of rupture during subsequent vaginal or anal penetration. But that's only an educated guess, with no data; your judgment is as good as mine. I've already advised changing condoms between the oral and vaginal/anal event, regardless of the vigor of the first event. Maybe a vigorous first exposure makes that even more wise. But my expertise is in STDs and their prevention, not in the biomechanics of condoms and how they are used
---
---
6 months ago
Hi, 

Thank you for the reply and advice.

Last question is about the answer you initially gave me for question number 2 about the microscopic pores in condoms , 
I quote your answer:

"2) One of the most enduring  urban myths about HIV transmission is that condoms contain microscopic pores that allow HIV/STD transmission; or that such defects can develop during condom use. In fact, it doesn't happen. Even if such microscopic defects existed, scientific reasons (e.g. hydrostatic pressure) would make them more or less impervious to enough infectious particles to allow transmission. A consequence in the myth is continuing advice about such nonsense as a "water test" on a used condom to detect such leaks. If a condom doesn't break wide open, protection is complete. And you would have noticed if that had happened."

I did not really understand the way you phrased the bolded sentence : 
Even if such microscopic defects existed, scientific reasons (e.g. hydrostatic pressure) would make them more or less impervious to enough infectious particles to allow transmission

What you mean by this is that even with existance of microcscopic holes in condom during vaginal sex
(like those may have caused on condom during blowjob from teeth grinding),
these tiny holes in condom would scientificly allow passage through them of only very little amount of infectious particles 
which will not be enough to allow HIV transmission during the vaginal sex.

I would appreciate your last clarification for this. 

Thank you for all help and professional explanations.


H. Hunter Handsfield, MD
H. Hunter Handsfield, MD
6 months ago
Your second statement ("What you mean by this...") indicates you correctly understand. Stated less scientifically, the physics of fluids passing through smalle channels means that it takes high pressures to force water through microscopic passages -- far higher (maybe hundreds of times) that the pressure generated on a condom membrane during sex. In other words, even if HIV-infected genital fluids were pressed hard against a membrane with micfoscopic pores, not enough would go throut to allow infection. And anyway, such pores don't exist in most condoms anyway.

That completes the two follow-up exchanges included with each question, and so ends this thread. I hope the discussion has been helpful.
---