Factors Surrounding Lack of Condom Use at First Intercourse Among College-Age Men

Background: Condom use at first coitus is associated with greater lifetime condom use. Little is known, however, about factors which influence non-use of condoms at first coitus.

Methods: Data were analyzed from a cross-sectional study on condom use behaviors among 98 heterosexual male students attending two Georgia universities. Men were asked to recall condom use during first and subsequent coitus. Multivariable logistic regression was conducted to evaluate non-use of condoms at first coitus and how this influenced future condom intentions and use.

Results: Participant averaged 22.4 years of age and 16.8 years at first intercourse(range:13-23).Overall, 47(48%) reported not using condoms at first coitus;use was not initiated until 13 acts after sexual debut(med=5;range:1-100). Reasons for eventual condom initiation included infection/pregnancy concern(53%), partner insistence(32%), and being prepared for intercourse(15%). Compared with men who used condoms at first intercourse, men initiating use afterwards were significantly more likely to report their first condom experience was “negative” (62% vs.35%, aOR=3.2, 95% CI=1.3,7.8) and less inclined to use condoms subsequently(32% vs 10%, aOR=5.3 95% CI=1.62,1.5). While condom use during most recent coitus did not differ, men initiating use after first coitus were more likely than their counterparts to report putting on condoms after starting intercourse (68% vs. 45%, aOR=2.6, 95% CI=1.1,6.4).

Conclusions: Public health efforts should emphasize the importance of condom use starting at first intercourse. Counseling should be provided to help prepare men for a positive first experience with condoms, given that this experience could affect short-term, though not long term use, and how correctly condoms are used.