Young people need advice on correct use of condoms
Two studies have recently highlighted the fact that young people do not always use condoms properly.
The first study was a large
cross-sectional survey of 1,373 young people in English educational establishments; a subsample of these completed sexual event diaries over
a six-month period.
Of the 375 survey respondents who reported having used a condom on the most recent occasion of vaginal sex, 6% reported applying the condom after penetration and 6% had continued penetration after condom removal. Of the 74 diary respondents, 31% admitted putting on the condom late and another 9% removed the condom early at least once over a six-month period.
Effective use of condoms was associated with overall consistency of condom use, confidence in correct condom use, non-use of other contraception, desire to use a condom and, oddly, positive reported relationship with mother.
Many primary care professionals may advise condom use to patients to avoid STIs/HIV infection and unplanned pregnancies, and some may offer condoms to those who request them. However, this does not appear to be enough.
This paper suggests that when giving advice about and offering condoms, we should ensure that men and women, and at the very least young people, are confident with using condoms consistently.
In the second study, 278 young men attending an urban clinic for treatment of STIs in the US completed an anonymous questionnaire. To reduce recall bias, only men who had used a condom for vaginal sex at least three times in the past three months were included.
Almost a third of the men reported recent breakage; the breakage rate was 15%. The attributes that were significantly associated with breakage were past history of STI (adjusted odds ratio (AOR) 2.08), men who reported condom slippage (AOR 2.72) and reduced self-efficacy for correct condom use (AOR 1.07). Furthermore, three condom-specific behaviours were associated with breakage: allowing condoms to contact sharp objects (AOR 2.6), problems with ‘fit or feel' (AOR 2.3) and not squeezing air from the receptacle tip (AOR 2.0).
This paper again illustrates the value of brief discussion on condom use with young men, but emphasises the point that the discussion needs to include how to use condoms correctly.
Although findings from a small sample of young men from the US might not be directly transferable to the UK, the message seems to be consistent with other UK-based studies on condom use.
Clearly there is more to sexual health promotion than just giving out condoms. One cannot assume that condoms given to people will be used reliably and effectively. We routinely check for medication adherence and correct use of devices such as inhalers, so perhaps we should extend this to condoms. I can see GPs and practice nurses nervously using condom demonstrators – this is not going to be easy!
Hatherall B, Ingham R, Stone N, et al. How, not just if, condoms are used: the timing of condom application and removal during vaginal sex among young people in England. Sex Transm Inf 2007;83(1);68-70
Crosby RA, Yarber WL, Sanders SA, et al. Men with broken condoms: who and why? Sex Transm Inf 2007;83(1):71-5Reviewer
Dr Richard Ma
GP principal, North London and staff grade in sexual and reproductive health, Margaret Pyke Centre, London