Incorrect Condom Use Prevalent Among Teens

SOUTHAMPTON, England, Aug. 10 -- Teens appear to have problems using condoms properly, found investigators here.

Up to a third of surveyed British teens had used a condom improperly, putting it on too late or removing it too soon, according to a study published online in Sexually Transmitted Infections.

"If we are to see a reduction in [sexually transmitted infection] prevalence, it is essential that young people understand the importance of using condoms consistently and correctly, and are also equipped with the skills and knowledge to do so," wrote psychologist Nicole Stone, Ph.D., of the Centre for Sexual Health Research at the University of Southampton.

Other Australian and American studies have found that 38% to 51% of teens reported applying a condom after initial penetration on at least one recent occasion and 14% to 15% reported removing it early.

"We should not simply assume that adolescents know how to do this," said David S. Rosen, M.D., M.P.H., of the University of Michigan in Ann Arbor, who commented on the British study. "When physicians talk with sexually active male patients it's probably not enough to encourage them to use a condom but to be very specific in how to use condoms."

The British study surveyed 1,373 young people at 21 schools and colleges across England about their condom use at the most recent occasion of vaginal sex. Most participants were 16 to 18 years old. Of these, 108 were selected to participate in a second phase of the study in which they kept a diary for six months.

A little less than half of the surveyed teens reported having ever engaged in vaginal sex. A little more than 60% of these sexually active teens had used a condom on the most recent occasion.

Of those 375 survey participants who reported using a condom, 12% had used it incorrectly. Six percent applied the condom after penetration and another 6% continued engaging in sex after condom removal.

About 55% of the diary entries indicated condom use during sex. However, 7% of all condoms used during the diary phase were applied late and 2% were removed early. The most common responses for applying a condom late were intimacy, better sensation, use of another contraception method, and that they got carried away.

Only one diary entry indicated that the teen applied the condom although penetration had already occurred in order to prevent sexually transmitted diseases. Others replied that they used it in this circumstance to avoid pregnancy, to avoid making a mess, and to make sex last longer.

Overall, 31% of diary respondents applied a condom late and 9% removed it early at least once during the six-month diary phase of the study.

Teens who reported consistent condom use, confidence in correct condom use, not using another contraception method, and desire to use a condom were significantly less likely to use condoms incorrectly (P<0.05).

Survey respondents who reported having an unavailable mother or a poor relationship with her during their early teen years were 2.66 times more likely to improperly use condoms (P<0.05). Interestingly, this correlation was highly significant for men only (P<0.0001).

The reason may be that good early family relationships give teens an advantage in communication skills, less motivation to begin sexual relations at an early age, and different gender attitudes in general, the authors suggested.

Other studies have shown that age, primary partner, lack of partner support, multiple partners, and using condoms for contraceptive purposes only (rather than for protection against sexually transmitted diseases as well) increase the odds of delayed condom application.

The American Academy of Pediatrics recommends that physicians encourage abstinence in adolescent patients as well as correct and consistent use of reliable contraception and condoms when teens are contemplating or already sexually active.