Mother hen here: Barrier Methods

This week in clinic I found myself having a very “mother hen: Barrier methods” conversation with a few clients.

Not in a condescending way. More in a: “I care about you, your body, your microbiome, and the effort you are going to here” kind of way.

Because if someone is spending time, money, energy, supplements, pathology, appointments, nervous-system capacity, the whole circus, trying to restore their vaginal microbiome, then we need to talk about what may be destabilising it.

The conversation was about safe sex and barrier methods.

One thing I’ve noticed clinically is that many people in the 15–30 age bracket are not consistently using barrier methods, more than other age brackets I work with. As an Gen X/elder millennial (ahem, 46 ) I find this both surprising and I am genuinely curious as to why. Not because I’m prudish. I truly do not care whether someone has multiple partners, casual partners, long-term partners, or enjoys different types of sex. In fact I am happy if someone experiences pleasure in their lives.

I care because I wan’t you to consider your microbiome.

The vaginal microbiome is not fragile. It has resilience. It is designed to respond, adapt, recover and protect, and one of it’s interactions is sex. But the people sitting in front of me are often not in a stable place. They are in a cycle of recurrence. Recurrent thrush, recurrent BV, irritation, odour, discharge, post-sex flares, and they are desperate to break that loop.

So if we are trying to rebuild stability, we need to reduce the number of variables coming into that ecosystem.

And that often includes sex.

Australian data backs up what we are seeing in the Intimate Ecology clinic. La Trobe University’s national survey of secondary students found that less than half of sexually active students reported using a condom at their most recent sexual encounter. UNSW’s National Debrief Survey found that 75% of Australians aged 15–29 who had sex in the previous year had sex without a condom at least once.

That matters because condoms are not just about pregnancy prevention. Long-acting contraception like implants and IUDs are excellent for preventing pregnancy, but they do not protect against STIs and they do not stop microbial exchange between partners.

Chlamydia is common in young Australians, often asymptomatic, and can directly affect reproductive and pelvic health. The Kirby Institute reported more than 101,000 chlamydia diagnoses in Australia in 2024, with around half occurring in people aged 20–29. So when we are talking about vaginal ecosystem recovery, STI screening and address is needed. We know that post infections like Chlamydia, the vaginal microbiome is challenged and may take some time to recover.

It is not only STIs that we wan’t barrier method usage increased for…

We need to consider partner microbe transfer. Bacterial Vaginosis (BV) is not classified in the same way as chlamydia or gonorrhoea, but research supports the role of sexual exchange of BV-associated organisms. A 2025 Australian trial published in the New England Journal of Medicine found that treating male partners alongside women significantly reduced BV recurrence. That is a big deal. It tells us that recurrence is not always about what the vagina is doing. Sometimes the ecosystem is being re-seeded, re-exposed and challenged.

So here is my clear, non-shaming, microbiome-loving message:

If your vaginal microbiome is unstable, recurrent, inflamed, reactive or in recovery, use barrier methods.

Condoms. Dams. Gloves were relevant. Especially with new partners, multiple partners, casual partners, same sex or different sex partners or partners whose STI and microbiome status you do not know. Essentially everyone until you have stability. Any regular partner should be on board with you using a condom or barrier. This might be the hard part, how to consistently enforce a barrier?

And while we’re here, let’s talk about self-advocacy.

Because I know there are real barriers to having these conversations, I too was once young…

Many people worry about being judged. They worry about “ruining the mood”. They worry a partner will think they don’t trust them. They have trouble finding their voice. They worry they’ll be rejected, laughed at, pressured, or made to feel difficult. And if we’re being honest, this burden often falls disproportionately on women and AFAB people. They are frequently expected to carry the responsibility for contraception, STI prevention, pregnancy prevention, sexual health screening and, somehow, maintaining the emotional comfort of everyone involved (patriarchal much?).

Advocating for your health is not being difficult.

It is being responsible.

One of the most practical things you can do is have a plan before you need one.

• Keep condoms in your bedside drawer.
• Keep them in your handbag.
• Keep them in the car.

If barrier methods are part of your recovery plan, make them accessible. Because when decisions are being made in the heat of the moment, convenience tends to win.

The best health decision is often the one that has already been made before the situation arises.

And I think we need to normalise the idea that carrying condoms is not an indication of anything other than being responsible.

It is an indication that someone is prepared.

• We carry sunscreen because we know we’ll eventually see the sun.
• We carry water because we know we’ll eventually get thirsty.
• Having condoms available is no different. It is simply planning ahead for something that may happen.

I would love to see more young (and older) people approaching sexual health with the same mindset they bring to other aspects of wellbeing. We meal prep. We book gym sessions. We take supplements. We track sleep. We plan holidays.

Yet somehow we still expect sexual health decisions to be made spontaneously in the dark with no preparation.

Your microbiome deserves better project management than that.

This is not forever. It is also not anti-sex.

Once your microbiome is stable, once symptoms have settled, once testing is clear, once you are in a mutually monogamous or lower-risk relationship, and once you and your partner/s have had the grown-up conversations, then yes, many people can return to unprotected sex without issue.

But during recovery? Give the microbiome fewer fires to put out.

The goal is not abstinence. The goal is informed, pleasurable, safer sex that does not keep dragging your vaginal ecosystem back into disorder.

Mother hen out 🙂

 

Dr Moira Bradfield Strydom

PhD.,  M.Acu., B.Nat

Intimate Ecology Naturopath

 

Need support. Book with an Intimate Ecology Naturopath HERE

References

Fisher, C. M., Waling, A., Kerr, L., Bellamy, R., Ezer, P., Mikolajczak, G., Brown, G., Lucke, J., & Fairley, C. K. (2022). The 7th National Survey of Australian Secondary Students and Sexual Health 2021. Australian Research Centre in Sex, Health and Society, La Trobe University. https://doi.org/10.26181/21761522.v1

Kirby Institute. (2025). HIV, viral hepatitis and sexually transmissible infections in Australia: Annual surveillance report 2025. UNSW Sydney. https://www.kirby.unsw.edu.au/research/reports/asr2025

Lim, M. S. C., Temple-Smith, M., & Hellard, M. E. (2019, May 2). UNSW survey finds most young Australians are not using condoms. UNSW Sydney Newsroom. https://www.unsw.edu.au/newsroom/news/2019/05/unsw-survey-finds-most-young-australians-are-not-using-condoms

Vodstrcil, L. A., Twin, J., Fairley, C. K., McClelland, R. S., Hocking, J. S., Law, M. G., Walker, S. M., Chow, E. P. F., Tachedjian, G., & Bradshaw, C. S. (2025). Partner treatment for bacterial vaginosis. New England Journal of Medicine, 392(10), 947–957. https://doi.org/10.1056/NEJMoa2405404