Although anal intercourse is known to be a risky behavior when it comes to transmission of HIV and other STDs, most messages given to teens about STDs and condom use focus on vaginal intercourse. This study examined the prevalence of anal intercourse and associated condom use rates in an effort to determine if different education strategies are necessary. The data was acquired as part of a greater longitudinal study of adolescent STD acquisition and cervical ectopy.
The participants were 350 adolescent females ages 12–18 from an urban environment; 96% were African American. All of them had engaged in sexual activity, were healthy, and were neither pregnant nor had been pregnant in the previous three months. Participants were asked about sexual activity with two different types of partners: a “main partner” and a “casual partner.”
The participants were given the following definition about the partner types: “A main partner is someone that you have vaginal sex with and that you are serious about. A casual partner is someone you have vaginal sex with but do not consider to be a main partner.” The casual partner could be someone the participant had had sex with once, or many times—as long as she did not consider him to be a main partner.
Participants were asked about their sexual activity with each type of partner in the last three months. Specifically, researchers asked about the: (a) occurrence and frequency of vaginal sex, (b) frequency of condom use in vaginal sex, (c) occurrence and frequency of anal sex, (d) frequency of condom use in anal sex, and (e) method of contraception use with partner (condom, withdrawal, anal sex, spermicide, etc.).
Avril Melissa Houston, M.D., M.P.H, et al., “More Than Just Vaginal Intercourse: Anal Intercourse and Condom Use Patterns in the Context of ‘Main’ and ‘Casual’ Sexual Relationships among Urban Minority Adolescent Females,” Journal of Pediatric Adolescent Gynecology 20 (2007): 299-304
Participants were more sexually active with main partners. While the frequency of either anal or vaginal sex was lower with casual partners, participants were much more likely to use contraception/condoms with casual partners during both anal and vaginal sex.
Furthermore, the rates of condom use during anal sex were significantly lower than during vaginal sex. This was reflected both in the median frequency for condom use and the lower percentage of participants who always used a condom for anal sex.
Type of Partner
- 302 (86.5%) participants had engaged in any sexual activity with a main partner.
- 142 (40.7%) participants had engaged in any sexual activity with a casual partner.
Frequency of Sex
- Of the participants who reported having had sex with a main partner, 272 (90.1%) had had vaginal intercourse and 47 (15.6%) had had anal intercourse. The median frequency of sex for each type of intercourse was once per week.
- Of the participants who reported having had sex with a casual partner, 118 (83.1%) had had vaginal intercourse and 17 (12%) had had anal intercourse. The median frequency of sex for each type of intercourse was few times per month.
Frequency of Condom Use
- With a main partner, the median frequency of condom use during vaginal sex was sometimes, while the median frequency of condom use during anal sex was few times in the last 3 months.
- With a casual partner, the median frequency of condom use during vaginal sex was always, while the median frequency of condom use during anal sex was few times in the last 3 months.
- With a main partner, 32.4% of participants always used a condom during vaginal sex, while only 21.3% of participants always used a condom during anal sex.
- With a casual partner, 61% of participants always used a condom during vaginal sex, while only 47.1% of participants always used a condom during anal sex.
Contraception Use during Last Vaginal Intercourse
- With a main partner, 48.2% used a condom, 18.4% used withdrawal, 6.6% used spermicide, and 15.1% used any other methods.
- With a casual partner, 70.3% used a condom, 29.7% used withdrawal, 13.6% used spermicide, and 38.1% used any other methods.
Anal Sex as Contraception
- 41.2% of the participants had used anal sex as a method of contraception with a casual partner, while only 8.5% had used anal sex for contraception with a main partner
This study has a number of very disturbing findings. First, that participants are not using condoms consistently for vaginal sex and second, that they are even less likely to use condoms when engaging in anal sex. These results show that the standard discussion of STDs and pregnancy in a vaginal sex paradigm is obviously insufficient in meeting the needs of today’s teens. Education about condoms must improve and take into account the reality of young people’s relationships and behaviors.
While the frequency of condom use was too low regardless of partner, it is interesting to note that young people were even less likely to use a condom with a main partner. It is unclear if the subjects were motivated by the belief that they are less likely to contract an STD or become pregnant with a main partner, by a greater desire for intimacy with that partner, or by some other factor. While further research on young people’s motivations could be useful, these findings suggest that young people need a better forum for learning about condom use and, perhaps, additional help in communicating about condom use with partners.
Another worrisome finding is the prevalence of unprotected anal sex. Anal sex is as risky in terms of STD transmission as vaginal sex, yet participants were more likely to forgo condoms. This raises questions about both their level of knowledge of STD risks and their reasons for using condoms. In particular it suggests (as previous studies have) that young people are more concerned with pregnancy than STDs. This seems to be confirmed by the number of participants who acknowledged using anal sex as a method of contraception. The idea that anal sex is somehow “safer” than vaginal sex (and therefore can be performed unprotected) is a dangerous misconception.
Young people need comprehensive sexuality education that discusses not only vaginal sex, condoms, and contraception, but also extends that discussion to other sexual practices, like anal sex.