‘Nice girls don’t’: women and the condom conundrum

Abstract

This study aims to highlight the tensions between the 'risks' of condom negotiation to feminine identity and safer sex health education messages of individual choice and responsibility. Effective education incorporates nurses' recognition that deterrents to women practising safer sex may increase subsequent to a diagnosis of a viral sexually transmitted infection. Health educational messages and clinicians' teaching emphasise rational decision-making with regard to condom use with a focus on the acquisition of technical information and ready access to condoms. These messages do not take into account the social complexities for women in negotiating condom use with men that deter condom use. A qualitative, feminist post-structuralist research design was used. In-depth email interviews were conducted with 12 clinicians with expertise in the sexual health field and 26 women with a diagnosis of either herpes simplex virus or human papilloma virus. A thematic analysis approach was used to analyse the semi-structured and interactive interviews. Few women in the study had received any direct safer sex education from clinicians and wanted them to initiate this discussion. Most women found the topic of safer sex became more difficult once diagnosed with a viral sexually transmitted infection. Women's dilemmas were whether to disclose the diagnosis as part of insisting on condom use, whether condom use mitigated the obligation to disclose or whether any talk or condom use was avoided as too 'risky' to feminine identity. Paradoxically, it may be harder for women to negotiate safer sex and ask for condoms to be used, once diagnosed with a viral sexually transmitted infection. Women want clinicians to give advice about the dissonance between 'rational' safer sex messages and social expectations of appropriate femininity. Relevance to clinical practice. Nurses have a key role in engaging with women in considering safer sex practices. Nurses need to be able to demonstrate to women that they understand the complexities of the 'real-life' barriers to acting on sexual health education messages, including an awareness of power in gender relations.