CONDOMS AND PRE-MARITAL SEX

CONFLICTS RELATED TO YOUTH SEXUALITY

Many inter-related topics concerning youth sexuality are being hotly debated. The positions that people take are often influenced by their religious beliefs. Some "hot" topics are:

where human sexuality should be taught to young people
whether methods of prevention of pregnancy and/or STDs (sexually transmitted diseases) should be included in sex-ed classes
whether abstinence should be taught alone or in addition to disease and pregnancy prevention
whether condoms should be supplied to students in schools
whether homosexuality and bisexuality should be taught in class
what beliefs about minority sexual orientations should be taught

Conflicts mostly occur at the local school board level, where more heat is often generated than light. There is no magic solution that everyone will find acceptable. There is probably not even a compromise on the above items that will satisfy the majority.

CONSENSUS DOES EXIST IN SOME AREAS

Most people agree that:

Human sexuality is an important part of life.
Under optimal conditions, sexual activity is an overwhelmingly positive experience.
The best way for a child to learn about sexuality is in the home, from knowledgeable parents who can teach it in a relaxed manner.
Most parents give little information to their children; those who do often lack sufficient knowledge and/or feel awkward when talking about this subject.
Young people often go through a "superman/superwoman" phase when they feel immune from pregnancy, cancer and STDs.
A woman who engages in penile-vaginal intercourse without a condom with a variety of partners is in increased risk for cervical cancer. The risk is higher for women who became sexually active earlier.
Individuals who engage in anal, vaginal or oral sexual intercourse without a condom run the risk of contracting AIDS, chlamydia, gonorrhea, hepatitis B, herpes, human papillomavirus [genital warts], syphilis, trichomonas, and other STD's.
condoms (if used) reduce the chance of disease and pregnancy
A heterosexual couple engaged in penile-vaginal intercourse without contraception once per week will typically be pregnant within a few months.
The life expectancy of a person who is infected with AIDS is measured in years rather than decades.
The chance of transmission of AIDS from an infected partner ranges from perhaps 1 in 10 (for anal sex) to possibly 1 in many hundreds of thousands of encounters (for oral sex), depending upon the exact sexual act, the way in which it is performed, and whether a latex barrier was used.
Anal intercourse without a condom is the highest risk sexual activity.
Sexual activity is most enjoyable if it is done between an enthusiastically consenting, committed couple.
many young people are manipulated or pressured into sexual activity before they are ready. This causes a great deal of emotional pain.
most heterosexual young people become sexually active before marriage.
most heterosexual couples live together for an interval before marriage.

CONSENSUS APPEARS IMPOSSIBLE IN SOME AREAS

Some adults believe in the extreme importance of delaying sexual experience until marriage; others believe that it is acceptable (and even beneficial) if it is engaged in when the couple enters a committed relationship
Some adults want abstinence taught exclusively, without any mention of STD and pregnancy prevention; they often feel that to talk about chastity and condoms delivers a mixed and confusing message to youth. Others feel that abstinence should be promoted, but that disease and pregnancy prevention are important topics for the majority of youth who choose to become sexually active before marriage.
Some adults want homosexuality and bisexuality taught as degenerate lifestyles that are a personal choice and can be changed at any time. Others want them taught as alternate sexual orientations that are healthy, unchangeable and normal for the individuals concerned.

RESULTS OF SELECTED STUDIES

First Sexual Experience: Most surveys show that the average age at which a person becomes sexually active is about 16 years of age. One US survey revealed that 63% of youth aged 14 to 21 are sexually active. Another found that 70% of youth will become sexually active before graduation from high school. 40% of teen women will become pregnant; 20% of teen women will have a child.
Effectiveness of Chastity/Abstinence ONLY Education: Most Fundamentalist and other Evangelical Christian families place great stress on teaching the importance of abstinence to their children. A survey of their children shows that their first sexual experience is typically delayed 11 months when compared to non-Evangelical / Fundamentalist youth. This raises serious questions about the effectiveness of chastity education at school. A single school course on abstinence would be far less effective than many years of continual family education. An abstinence based sex-ed course might only delay the first sexual experience by a few months or less.
Comprehensive Sex-Ed Courses: This form of education promotes abstinence as the option of choice. It also teaches pregnancy and disease prevention for students who choose to be sexually active. Some surveys show that young people who are given thorough sex-ed instruction delay their first sexual experience. A few surveys show the opposite. The results appear to be related more to the beliefs of the group sponsoring the survey than to reality.
"Inclusive Sex-Ed Courses This type of course teaches four alternatives:
1. abstinence as the only absolutely effective way of preventing pregnancy and disease transmission
2. condoms as the most effective way of preventing complications for those students who choose to engage in penile/vagina intercourse
3. stroking, massage, mutual masturbation and petting for those students who want to enjoy sexual experiences without danger of pregnancy or disease
4. oral sex for those students who want to enjoy sexual experiences without danger of pregnancy and with reduced chance of disease,
The latter two alternatives appeals to some young people who do not want to use condoms, because of reduced feeling and/or lack of spontaneity. They would divert students away from high risk sexual activities, and also give them another option if no condom is available.
Unfortunately, this type of course has never been tried, to our knowledge. Some parents would probably "go ballistic" if one were taught.
Youth Suicide: A US federal government study into youth suicide has revealed that fully a third are done by young people who are unable to come to terms with their homosexual orientation. Many had been taught to hate homosexuality during their childhood. As teens, they realize that they are gay or lesbian, and are certain that they have no possibility of changing. Many terminate their lives rather than face a lifetime of homosexuality.
Condoms and HIV: Many conservative Christian and other sources have claimed that condoms are useless, and prevent neither pregnancy nor the transmission of the HIV virus. Fortunately, their claims contain little merit:
- Condoms on the shelf or in the back pocket, wallet or purse are totally ineffective. They have to be used correctly and every time that sexual intercourse is experienced. A report in the New England Journal of Medicine reported on a lengthy study (1) of 245 heterosexual couples in which one partner was infected with the HIV virus, and the other was initially HIV free. Half (123) of the couples consistently used condoms; none of the partners were infected. The other half (122) never used condoms or used them inconsistently; 12 partners became infected and will probably die within a decade.
- Some (usually conservative Christian) sources claim that condoms contain holes of up to 5 microns in diameter. This would allow free transmission of the HIV virus. There is an element of truth in these claims. A small percentage of condoms are made from natural membranes (sheep intestines). These do contain holes and are thus not recommended for protection against HIV. However, the vast majority of condoms are made from latex and are free of holes.
  Stories about holes in latex condoms are a hoax. Those who spread such stories are acting irresponsibly. They will convince many people that condoms are not reliable; this will cause some individuals to stop using them. Deaths due to HIV infection will result.
Condoms and Cervical Cancer: A consensus exists that cervical cancer is caused by the human papilloma virus (HPV) which is spread sexually. The cellular structure of an adolescent female's reproductive system is much more likely to encourage the development cervical cancer than the system of an older woman, All women are regarded at high risk except those who delayed sexual activity until adulthood, had only one or two sexual partners during their lifetime, and in which those partners only had one or two partners. Fortunately, condoms are effective in stopping the passage of the virus to women. Also, Pap smear tests are effective in detecting early indications of cervical cancer.

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REFERENCES

1. I. De Vincenzi "A longitudinal study of human immunodeficiency virus transmission by heterosexual partners". New England Journal of Medicine 1994;331:341-346.