Use of phosphodiesterase type 5 inhibitors (PDE5-Is) and duration of intercourse may increase the likelihood of condom breakage.

A sample of 440 men was recruited via newspaper advertisements and the website of a condom company.

The men were instructed to fill in a questionnaire posted on the website of the Kinsey Institute. The inclusion criteria for the study were: male gender, age over 18, condom usage for vaginal intercourse in the past three months and English literacy. The questionnaire related to the last time a condom was used for vaginal sex and asked: whether the condom broke, if PDE5-Is were used, the length of time the penis was in the vagina and if any alcohol was drunk.

In all, 5.9% of the men reported breakage and 9.5% of men said they had used PDE5-Is during the last episode of vaginal sex using a condom. Men using PDE5-Is were twice as likely to have had condom breakage on the last occasion a condom was used compared with those not using the drugs (11.9% compared with 5.3%).

When adjustment was made for age; ethnic minority status; marital status; duration of intercourse and alcohol use men using PDE5-Is were four times more likely to report condom breakage. Adjusted odds ratio (AOR) 4.02 (95% CI 1.20-13.48, p=0.04).

Duration of intercourse was also found to be independently associated with breakage, AOR 1.36 (95% CI 1.02-1.83, p=0.04).

PDE5-Is are widely used for the treatment of erectile dysfunction. However, these drugs are also associated with recreational use, increased rates of high-risk sexual behaviour and HIV transmission in some men.

The authors conclude that PDE5-Is may potentially be a risk factor for condom breakage.

Counselling to reduce breakages might be helpful when prescribing these drugs. In the past, I have mentioned it is good practice to discuss STI testing for men prescribed PDE5-Is - this will give more weight to this practice.