Abstract
Condoms can help young adults protect themselves from sexually transmitted infections and unintended pregnancy. We examined young people’s attitudes about whether condoms reduced pleasure and how these attitudes shape condom practices. We used a nationally representative sample of 2328 heterosexually active, unmarried 15- to 24-year-old young adults to document multivariate associations with condom nonuse at the last sexual episode. For both young men and women, pleasure-related attitudes were more strongly associated with lack of condom use than all sociodemographic or sexual history factors. Research and interventions should consistently assess and address young people’s attitudes about how condoms affect pleasure.
Because of their unique ability to prevent both pregnancy and sexually transmitted infections (STIs), male condoms are a vital public health tool. For decades, researchers have worked to understand and promote young adults’ consistent condom use. Although 15- to 24-year-old young adults represent only 25% of the sexually experienced population in the United States, they account for 53% of all unintended pregnancies1 and nearly half of all new STI cases.2
Many studies document the sociodemographic and sexual history factors most associated with young adults’ condom use,3–5 including age, education, and number of sexual partners.6 Research also explores psychosocial factors such as self-esteem7,8 and condom self-efficacy,9 as well as gender inequality that may render condom use especially difficult for young women.10 Relatively little research explores young people’s attitudes about condoms and sexual pleasure.
Burgeoning research among samples of “older” adults11,12 and college students13,14 has suggested that attitudes about how condoms affected sexual pleasure might influence condom use practices, although this work has primarily focused on men.15,16 One exploratory mixed-gender study documented that both adult women and men who reported that condoms undermine arousal and enjoyment were least likely to use them.17 However, fewer studies have explored such pleasure attitudes among adolescents and young adults, especially among young women,18 and no nationally representative studies of this topic exist for any age group. We addressed these limitations using a nationally representative sample of young adult women and men to assess how attitudes about condoms and sexual pleasure might be related to condom practices.
METHODS
We worked with data from the 2006 to 2010 National Survey of Family Growth (NSFG), which collects information on sexual behavior and contraception (among other things) in a national probability sample of 15- to 44-year-old respondents.19 We limited our sample to nonsterile, unmarried 15- to 24-year-old respondents who had heterosexual sexual intercourse in the past month and were not pregnant or trying to get pregnant (1183 women, 1145 men).
Our outcome variable was condom nonuse at last sexual episode served. Our pleasure variable was captured by the following question: “What is the chance that if you/your partner used a condom during sex, you would feel less physical pleasure?” Response categories were no chance, a little chance, a 50–50 chance, a pretty good chance, and an almost certain chance. Control variables included age, education, race/ethnicity, public assistance in the last year, number of opposite-gender partners in the last year, pregnancy ambivalence, condom-related embarrassment, and appreciation of condom use.
We performed all analyses in STATA/MP version 13 (StataCorp, College Station, TX) and ran all analyses separately for women and men. All analyses used the svy command in STATA to adjust for the sampling and weighting scheme of the NSFG. For bivariate analyses, we used the χ2 test to gauge the strength of associations between all controls and condom nonuse at last sexual episode. For multivariate analyses, we used logistic regression to examine the association between all control variables and condom nonuse.
RESULTS
Fewer than one half (44%) of respondents reported no condom use at last penile vaginal intercourse in the last month (53% of young women, 34% of young men). In terms of condoms and pleasure, 22% of respondents reported there was no chance that condoms would reduce their pleasure (31% women, 12% men), 27% reported a little chance (32% women, 22% men), 23% reported a 50–50 chance (20% women, 25% men), 18% reported a pretty good chance (11% women, 25% men), and 11% reported an almost certain chance (7% women, 14% men).
Table 1 presents the variables’ associations with condom nonuse at the bivariate level. Sociodemographic and psychosocial associations followed expected directions: lack of condom use was more common among older respondents, those who had received public assistance in the last year, and those who would be pleased to learn their partner was pregnant. Among those who said there was a certain chance that condoms would reduce pleasure, 68% did not use condoms (80% women, 61% men), compared with 54% of those who said there was a pretty good chance (71% women, 46% men), 52% of those who said there was a 50–50 chance (63% women, 44% men), 36% of those who said there was a little chance (42% women, 28% men), and 29% of those who said there was no chance (34% women, 18% men).
TABLE 1—
Sociodemographic Characteristics, Pleasure Attitudes, and Psychosocial Characteristics of 15- to 24-Year-Old Women (n = 1183) and Men (n = 1090): United States, 2006–2010 National Survey of Family Growth
| No Use of Condom |
|||
| Variable | Women, P or No. (%) | Men, P or No. (%) | Total, P or No. (%) |
| Sociodemographic variables | |||
| Age, y | .001 | .001 | |
| 15–19 | 622 (48.7) | 619 (30.2) | 1241 (39.9) |
| 20–24 | 561 (50.3) | 471 (49.8) | 1032 (50.0) |
| Education | .01 | .05 | |
| No high school diploma or GED | 463 (50.5) | 507 (39.3) | 970 (44.4) |
| High school diploma or GED | 340 (58.7) | 294 (43.2) | 634 (51.5) |
| Any college or more | 380 (41.7) | 289 (38.8) | 669 (40.4) |
| Race/ethnicity | .05 | ||
| Non-Hispanic White | 611 (48.1) | 486 (40.9) | 1097 (44.7) |
| Non-Hispanic Black | 276 (43.1) | 286 (34.4) | 562 (38.5) |
| Non-Hispanic other | 64 (66.4) | 49 (27.5) | 113 (49.7) |
| Hispanic | 232 (55.3) | 269 (46.9) | 501 (50.8) |
| Received public assistance in last year | .01 | .001 | .001 |
| No | 669 (44.9) | 716 (37) | 1385 (40.8) |
| Yes | 514 (57.7) | 374 (47.2) | 888 (53.0) |
| No. of opposite-sex partners in last year | |||
| One | 762 (50.7) | 551 (42.5) | 1313 (47.1) |
| Two or more | 421 (47.3) | 539 (37.6) | 960 (41.9) |
| Pleasure attitudes | |||
| What is the chance that if you/your partner used a condom during sex, you’d feel less physical pleasure? | .001 | .001 | .001 |
| No chance | 371 (33.5) | 130 (17.5) | 501 (29.1) |
| A little chance | 353 (42.1) | 275 (27.8) | 628 (36.3) |
| 50–50 chance | 245 (63.0) | 261 (43.8) | 506 (52.4) |
| A pretty good chance | 135 (71.3) | 275 (46.3) | 410 (53.8) |
| An almost certain chance | 79 (80.1) | 149 (61.2) | 228 (67.8) |
| Psychosocial variables | |||
| If you got pregnant/got your partner pregnant now, how would you feel? | .001 | .01 | .001 |
| Upset | 838 (43.7) | 693 (35.2) | 1531 (39.8) |
| Pleased | 337 (65.8) | 381 (49.5) | 718 (56.7) |
| Wouldn’t care | 8 (46.0) | 16 (37.6) | 24 (39.2) |
| What is the chance that it would be embarrassing for you and a new partner to discuss using a condom? | .05 | ||
| No chance | 847 (48.4) | 703 (37.9) | 1550 (43.6) |
| A little chance | 168 (47.7) | 213 (36.9) | 381 (41.6) |
| 50–50 chance | 72 (61.4) | 80 (52.3) | 152 (56.6) |
| A pretty good chance | 60 (45.1) | 56 (52.4) | 116 (49.1) |
| An almost certain chance | 36 (68.6) | 38 (56.1) | 74 (62.3) |
| What is the chance that if a new partner used a condom, you would appreciate it? | .001 | .05 | .001 |
| An almost certain chance | 864 (43.1) | 488 (37.5) | 1352 (41.1) |
| No chance | 10 (76.3) | 13 (59.5) | 23 (66.2) |
| A little chance | 18 (91.7) | 35 (66.9) | 53 (73.0) |
| 50–50 chance | 35 (87.4) | 119 (51.2) | 154 (60.0) |
| A pretty good chance | 256 (62.6) | 435 (37.1) | 691 (46.1) |
Note. GED = general equivalency diploma. Percentages are weighted to account for survey design effects.
Attitudes about condoms and pleasure remained significantly associated with condom practices in multivariate models (Table 2). Pleasure-related attitudes had stronger associations with lack of condom use than all other variables. Among young women, compared with those who said condoms were unlikely to reduce pleasure, those who said condoms were almost certain to reduce pleasure were 8.7 times as likely to not use a condom (P < .001). Among young men only, the odds were 9.1 times as high (P < .001). Odds ratios for this association followed a positive, stepwise progression in that the greater the chance of pleasure reduction, the greater the odds of condom nonuse.
TABLE 2—
Multivariate Logistic Regression Models of Condom Nonuse by Gender: United States, 2006–2010 National Survey of Family Growth
| Variable | Women (n = 1183) OR (95% CI)a | Men (n = 1090) OR (95% CI)a |
| Sociodemographic variables | ||
| Age 20–24 y (Ref = 15–19) | 1.00 (0.70, 1.44) | 2.70*** (1.71, 4.26) |
| Education (Ref = no high school diploma or GED) | ||
| High school diploma or GED | 1.59* (1.07, 2.36) | 1.06 (0.67, 1.65) |
| Any college or more | 0.94 (0.57, 1.56) | 0.78 (0.43, 1.41) |
| Race/ethnicity (Ref = Non-Hispanic White) | ||
| Non-Hispanic Black | 0.57* (0.34, 0.95) | 0.62 (0.35, 1.10) |
| Non-Hispanic other | 1.70 (0.85, 3.39) | 0.51 (0.24, 1.09) |
| Hispanic | 0.98 (0.64, 1.51) | 0.95 (0.61, 1.49) |
| Received public assistance in last year, yes (Ref = no) | 1.66** (1.15, 2.41) | 1.77* (1.07, 2.90) |
| ≥ 2 opposite-sex partners in last year (Ref = 1) | 0.93 (0.65, 1.34) | 0.80 (0.55, 1.17) |
| Pleasure attitudes | ||
| Chance that if you/your partner used a condom during sex, you’d feel less physical pleasure (Ref = No chance) | ||
| A little chance | 1.44 (0.94, 2.19) | 1.97 (0.95, 4.09) |
| 50–50 chance | 3.28*** (1.87, 5.74) | 3.97*** (2.00, 7.88) |
| A pretty good chance | 4.14*** (2.10, 8.17) | 5.11*** (2.41, 10.82) |
| An almost certain chance | 8.66*** (4.35, 17.27) | 9.08*** (3.83, 21.53) |
| Psychosocial variables | ||
| If you got pregnant/got your partner pregnant now, how would you feel? (Ref = upset) | ||
| Pleased | 2.13*** (1.43, 3.17) | 1.85** (1.22, 2.80) |
| Wouldn’t care | 0.51 (0.12, 2.16) | 0.87 (0.20, 3.85) |
| Chance that it would be embarrassing for you and a new partner to discuss using a condom (Ref = no chance) | ||
| A little chance | 0.81 (0.50, 1.30) | 0.96 (0.59, 1.55) |
| 50–50 chance | 1.40 (0.70, 2.78) | 1.53 (0.65, 3.61) |
| A pretty good chance | 0.66 (0.28, 1.56) | 1.57 (0.71, 3.47) |
| An almost certain chance | 1.61 (0.45, 5.80) | 2.76 (0.74, 10.23) |
| Chance that if a new partner used a condom, you would appreciate it (Ref = an almost certain chance) | ||
| No chance | 1.98 (0.25, 15.90) | 3.10 (0.82, 11.67) |
| A little chance | 9.78** (2.18, 43.83) | 3.13* (1.27, 7.69) |
| 50–50 chance | 3.63* (1.34, 9.80) | 1.74 (0.89, 3.38) |
| A pretty good chance | 2.33*** (1.63, 3.33) | 0.90 (0.56, 1.46) |
Note. CI = confidence interval; GED = general equivalency diploma; OR = odds ratio.
All OR values are weighted to account for survey design effects.
*P < .05; **P < .01; ***P < .001.
DISCUSSION
In this nationally representative study of 15- to 24-year-old young adults, we found striking relationships between condom-related pleasure attitudes and lack of condom use at last sex in the last month. Perceptions about how condoms reduce sexual pleasure were more strongly associated with condom nonuse than all other sociodemographic, sexual history, or psychosocial factors. Although proportionately more men than women reported that condoms would reduce pleasure, the direction and magnitude of the relationship between pleasure attitudes and condom practices were virtually identical for both genders.
Future research and interventions should assess young adults’ beliefs about how condoms reduce pleasure. Failure to do so could mean overlooking the young adults least likely to use condoms. Sexual health professionals might also wish to share ideas on how to better integrate condoms into the sexual experience with both male and female clients. Young men might struggle with condoms’ fit and feel,20,21 whereas young women might struggle with texture or lubrication; such clients should be encouraged to try a variety of condom types, sizes, and lubricants. We believe these findings also underscore the value of affirmative models of sexual health. Attending to pleasure and sexual well-being for both young men and women could gain new insights compared with a disease model alone.
Acknowledgments
During analysis and article preparation, J. A. Higgins was supported by an NIH K12 award (K12HD055894) from the Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD). J. A. Higgins and Y. Wang also received support from an NICHD Population Research Infrastructure grant (P2C HD047873). An internal grant from the University of Wisconsin-Madison Graduate School also helped fund this analysis.
Note. The content is solely the responsibility of the authors and does not necessarily represent the official views of the funding organizations.
Human Participant Protection
Data for the analyses came from a de-identified, public use data set from the National Center for Health Statistics (Centers for Disease Control and Prevention).
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