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People today are less likely to report using condoms than they were in the past. Among teens, for example, the number who reported using a condom in their most recent sexual encounter dropped from 59 percent to 54 percent between 2013 and 2017, with similar declines for boys and girls. Condom use also declined among adult men who have sex with men over the same period, but the decline was steeper for this group.

So what's behind this trend? Why do condoms seem old-fashioned to so many people?

As with most sexual behavior changes, the answer is complex. We can point to more than one factor or explanation. However, here are some possible factors:

Part of the decline may be due to a growing number of women opting for long-acting, reversible methods of birth control, such as iuds and hormone implants. In fact, the decline in condom use coincided with an increase of several percent in other methods. Given that these methods are more than 99 percent effective in preventing pregnancy, it is likely that some people are now giving up using condoms because they have successfully alleviated their worries about unwanted pregnancies.

Part of the decline in condom use among men who have sex with men may be due to the increase in PrEP. PrEP is a drug that, if taken regularly, can significantly reduce the risk of HIV infection (studies I've seen show it to be between 90-99% effective). Several recent studies have found that when men start taking precautions, they are less likely to use condoms regularly. This may be because they think the threat of the most deadly sexually transmitted infections is neutralised.

When you consider the effectiveness of PrEP in preventing HIV, and the increase in the HPV vaccine, which protects against HPV-related cancers and genital warts, it may be that -- more broadly -- people just don't think sex is quite as dangerous as they used to be. Most of the other common sexually transmitted infection can be cured at present such as syphilis, gonorrhea and chlamydia, and cannot be cured can usually by drug treatment (for example, people with oral or genital herpes can take antiviral drugs in order to prevent the outbreak of a day, or at least reduce the severity and duration of the outbreak of). All of which may be because sex isn't as scary as it used to be.

The increase in condomless sex among adolescents coincides with the decline in sexual activity among adolescents. So while there may be more sex without condoms among teens, there are fewer sexually active teens. To me, this suggests that perhaps the teens who are most cautious about sex (and therefore most likely to use condoms when having sex) are the ones who have never had sex. So if the most cautious people wait longer to have sex, this could lead to a significant expansion in the rate of condomless sex because these people are no longer reflected in the sexual activity data.

Of course, another possible reason is poor sex education and high levels of sexual anxiety. We're not particularly good at teaching teens sexual communication skills, and the topic of condoms and safe sex makes many feel awkward and uncomfortable. As a result, the topic of condoms may not come up as often as it should, simply because too many people don't know how to have these conversations. Of course, there's also the fact that some people are embarrassed to buy condoms in the first place because they're afraid of being judged or humiliated. This obviously reduces the likelihood that people will be prepared to use condoms when having sex.

However, another explanation is that condoms make it difficult for some men to maintain an erection. More and more young men are having trouble getting erections these days -- and no, it's not because of porn, but because of sexual shame and anxiety, as well as factors like drugs and drug use. So if you ask men who already have some arousal problems to add something that reduces their feelings and sensitivity (even to a small degree), condoms will be seen as a barrier to pleasure, which may make men more reluctant to use them.

There may be other factors at work that I haven't mentioned yet; However, all of this suggests that more research is needed to understand why people are using condoms less now than in the past, and what we can do to promote safe sex.