Do phosphodiesterase type 5 inhibitors protect against condom-associated erection loss and condom slippage?

Some physicians prescribe phosphodiesterase type 5 inhibitors (PDE5i) for men who experience condom-associated erection difficulties with a view to increasing condom use and reducing risk of sexually transmitted infections.

To examine whether the prevalence of erection-related condom problems differs between men using and not using PDE5i at the last condom-protected penile-vaginal (PVI) or penile-anal intercourse.

Seven hundred-five men who had used a male condom during the past 3 months for PVI were selected from a sample recruited through advertisement to an electronic mailing list for a large, internet-based, sexual-enhancement product company. An internet-based questionnaire posted in 2006 assessed condom-use errors and problems.

Men who did and did not use PDE5i during the last time a condom was used were compared on: (i) erection loss while applying a condom; (ii) erection loss during sex while using a condom; (iii) condom slipped off during sex; (iv) delayed condom application (penetration of the vagina or anus prior to application of the male condom); (v) early condom removal (condom taken off and intercourse continued without it); (vi) "problem with the way the condom fit"; (vii) "problem with the way the condom felt"; and (viii) condom breakage.

Controlling for age, marital status (yes/no), and having children (yes/no), PDE5i users, compared with nonusers, were: (i) three times more likely to report erection loss during sex while using a condom (adjusted odds ratio [AOR] = 3.21, 95% confidence interval [CI] = 1.40-7.39, P = 0.006); (ii) almost five times more likely to report the condom slipped off during sex (AOR = 4.75, 95% CI = 1.68-13.44, P = 0.003); and (iii) more than twice as likely to remove condoms before sex was over (AOR = 2.46, 95% CI = 1.09-5.56, P = 0.03).

Physicians prescribing PDE5i may want to evaluate whether men are experiencing condom-associated erection difficulties and, if they are, consider titrating dosages and/or making referrals for psychosexual therapy and/or condom skills education.