title: Do phosphodiesterase type 5 inhibitors protect against condom-associated erection loss and condom slippage?
abstract: BACKGROUND
  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.
  
  
  OBJECTIVE
  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.
  
  
  METHODS
  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.
  
  
  METHODS
  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.
  
  
  RESULTS
  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).
  
  
  CONCLUSIONS
  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.
authors.affiliation: The Kinsey Institute for Research in Sex, Gender, and Reproduction, Indiana University, Bloomington, IN, USA.
authors.forename: Stephanie A
authors.initials: SA
authors.lastname: Sanders
authors.forename: Robin R
authors.initials: RR
authors.lastname: Milhausen
authors.forename: Richard A
authors.initials: RA
authors.lastname: Crosby
authors.forename: Cynthia A
authors.initials: CA
authors.lastname: Graham
authors.forename: William L
authors.initials: WL
authors.lastname: Yarber
mesh_terms: D000328:Adult; D003075:Coitus; D017280:Condoms; D005260:Female; D006801:Humans; D018783:Impotence, Vasculogenic / Q000188:drug therapy*; D008297:Male; D008875:Middle Aged; D010410:Penile Erection / Q000187:drug effects*; D010726:Phosphodiesterase Inhibitors / Q000494:pharmacology*; D012747:Sexual Partners; D011795:Surveys and Questionnaires
chemical_list: D010726:Phosphodiesterase Inhibitors