Protected Intercourse Research Articles

Emergency contraception: society of family planning clinical recommendation (2023)

Emergency contraception (EC) refers to several contraceptive options that can be used within a few days after unprotected or under protected intercourse or sexual assault to reduce the risk of pregnancy. Current EC options available in the United States include the copper intrauterine device (IUD), levonorgestrel (LNG) 52 mg IUD, oral LNG, and oral ulipristal acetate (UPА).
 These clinical recommendations review the indications, effectiveness, safety, and side effects of emergency contraceptive methods; considerations for the use of EC by specific patient populations and in specific clinical circumstances and current barriers to emergency contraceptive access. Further research is needed to evaluate the effectiveness of LNG IUDs for emergency contraceptive use; address the effects of repeated use of UPА at different times in the same menstrual cycle; assess the impact on ovulation of initiating or reinitiating different regimens of regular hormonal contraception following UPА use; and elucidate effective emergency contraceptive pill options by body mass indices or weight.

Sexual compulsivity, anxiety, depression, and sexual risk behavior among treatment-seeking men in São Paulo, Brazil.

Objective:There is a lack of studies on negative mood states and sexual risk behavior in men of all sexual orientations who seek treatment for excessive sexual behavior (ESB). We aim to examine sexual compulsivity (SC), anxiety, depression, and sexual risk behavior in a treatment-seeking sample of men and controls.Methods:We enrolled 88 (37 [42%] gay or bisexual and 51 [58%] heterosexual) ESB outpatients and 64 controls. Assessments included the Sexual Compulsivity Scale (SCS), the Beck Anxiety Inventory (BAI), the Beck Depression Inventory (BDI), and sexual risk behaviors.Results:Compared to controls, ESB outpatients showed increased SC, anxiety, and depression, which were correlated. Regarding sex with casual partners, ESB outpatients reported more sexual intercourse, a greater number of partners, more anal intercourse, and unprotected anal intercourse. Anxiety, depression, and SC were associated with protected vaginal intercourse with a main partner, whereas they were associated with unprotected anal intercourse with a casual partner. Depression was associated with unprotected vaginal intercourse with a casual partner. Condomless anal intercourse was predicted by SC and was also reported by the heterosexual ESB outpatients (36%).Conclusion:The data contribute to the field by providing information on men of all sexual orientations who are searching for mental healthcare. The connections among these psychopathological factors and sexual risk behavior have implications for public health, clinicians, and research.

Daily associations between alcohol and sexual behavior in young adults.

We tested within-person effects of alcohol on sexual behavior among young adults in a longitudinal burst design (N = 213, 6,487 days) using data collected from a previously published parent study. We differentiated effects of alcohol on likelihood of sexual activity versus use of protection against sexually transmitted diseases (STDs) or pregnancy on intercourse occasions by testing a multilevel multinomial model with 4 outcomes (no sex, oral sex without intercourse, protected intercourse, and unprotected intercourse). At the within-person level, effects of alcohol were hypothesized to be conditional upon level of intoxication (i.e., curvilinear effect). We also tested effects of four between-person moderators: gender, typical length of relationship with sexual partners, and two facets of self-control (effortful control and reactivity). Consistent with our hypothesis, low-level intoxication was associated with increased likelihood of engaging in oral sex or protected intercourse (relative to no sex) but was not related to likelihood of unprotected intercourse. The effect of intoxication on unprotected versus protected intercourse was an accelerating curve, significantly increasing likelihood of unprotected intercourse at high levels of intoxication. Between-person factors moderated associations between intoxication and sexual behavior. Effects of intoxication on both protected and unprotected intercourse were diminished for individuals with more familiar sexual partners. Effortful control exhibited a protective effect, reducing the effects of intoxication on likelihood of unprotected intercourse. Hypothesized effects of reactivity were not supported. Intoxication was a stronger predictor of oral sex and protected intercourse (but not unprotected intercourse) for women relative to men. Results highlight the inherent complexities of the alcohol-sexual behavior nexus. (PsycINFO Database Record

Perfect-use and typical-use Pearl Index of a contraceptive mobile app

ObjectivesThe Natural Cycles application is a fertility awareness-based contraceptive method that uses dates of menstruation and basal body temperature to inform couples whether protected intercourse is needed to prevent pregnancies. Our purpose with this study is to investigate the contraceptive efficacy of the mobile application by evaluating the perfect- and typical-use Pearl Index. Study designIn this prospective observational study, 22,785 users of the application logged a total of 18,548 woman-years of data into the application. We used these data to calculate typical- and perfect-use Pearl Indexes, as well as 13-cycle pregnancy rates using life-table analysis. ResultsWe found a typical-use Pearl Index of 6.9 pregnancies per 100 woman-years [95% confidence interval (CI): 6.5–7.2], corrected to 6.8 (95% CI: 6.4–7.2) when truncating users after 12months. We estimated a 13-cycle typical-use failure rate of 8.3% (95% CI: 7.8–8.9). We found that the perfect-use Pearl Index was 1.0 pregnancy per 100 woman-years (95% CI: 0.5–1.5). Finally, we estimated that the rate of pregnancies from cycles where the application erroneously flagged a fertile day as infertile was 0.5 (95% CI: 0.4–0.7) per 100 woman-years. We estimated a discontinuation rate over 12months of 54%. ConclusionsThis study shows that the efficacy of a contraceptive mobile application is higher than usually reported for traditional fertility awareness-based methods. The application may contribute to reducing the unmet need for contraception. ImplicationsThe measured typical- and perfect-use efficacies of the mobile application Natural Cycles are important parameters for women considering their contraceptive options as well as for the clinicians advising them. The large available data set in this paper allows for future studies on acceptability, for example, by studying the efficacy for different cohorts and geographic regions.

Daily co-occurrence of alcohol use and high-risk sexual behavior among heterosexual, heavy drinking emergency department patients

BackgroundGlobal association and experimental studies suggest that alcohol use may increase sexual behavior that poses risk for exposure to sexually transmitted infections (STI) among heterosexual men and women. However, results from longitudinal and daily recall studies exploring the co-occurrence of alcohol use with various sexual risk outcomes in more naturalistic contexts have been mixed, and the bulk of this research has focused on college students. MethodsThe current study enrolled heavy-drinking emergency department (ED) patients and used a cross-sectional, 30-day Timeline Followback (TLFB) method to examine the daily co-occurrence between alcohol use and three sexual behavior outcomes: Any sex, unprotected intercourse (UI), and UI with casual partners (versus protected intercourse [PI] with casual partners, or UI/PI with steady partners). ResultsResults indicated that increasing levels of alcohol use on a given day increased the odds of engaging in any sexual activity and that heavy drinking (but not very heavy drinking) on a given day was associated with an increased odds of engaging in UI with either steady or casual partners. However, day-level alcohol use was not associated with an increased odds of UI with casual partners. ConclusionsThese findings suggest that alcohol may play an important role in increasing risk for HIV/STIs among heterosexuals, and support the continued need to target heavy drinking in sex risk reduction interventions. However, our results also suggest that alcohol may not universally result in unprotected sex with casual partners, a behavior posing perhaps the highest risk for HIV/STI transmission.

68. Predictors of Condom and Contraceptive Use Differ Between Younger and Older Adolescents

Adolescence is a period of rapid physical, emotional, and social development. Factors influencing whether sexually active teens engage in protected intercourse may change as they mature. We explored whether predictors of any contraceptive use at last sex (condoms, hormonal contraception or both) differed by age among a sample of African-American adolescents.

"Bareback" pornography consumption and safe-sex intentions of men having sex with men.

Men having sex with men (MSM) commonly consume "bareback" pornography, which includes scenes of unprotected anal intercourse. Prior research on human imitative behavior suggests that these media might counteract efforts to promote safe-sex behaviors. To date, no studies have demonstrated a causal link between bareback pornography consumption and reduced safe-sex intentions. Study 1 utilized a correlational design conducted as an online survey. Study 2 was set in an actual MSM sex club, using a 2 × 2 mixed-factorial design to compare type of pornography (unprotected vs. protected anal intercourse) and age of actors (younger vs. older). As the main dependent variable in both studies, participants self-reported their inclinations toward unprotected versus protected intercourse, using a 100-point sliding scale (1 = unprotected, 100 = protected). In Study 1, more attention to unprotected sex acts on actual DVD film covers predicted lower safe-sex intentions, as compared to other elements of the film cover. In Study 2, safe-sex intentions after viewing unprotected-sex films were lower than after viewing protected-sex films. The results provide novel and ecologically valid evidence that "bareback" pornography consumption impacts viewer's inclinations toward sexual risk-taking by lowering their intentions to use protected sex measures. Suggestions are given as to how these findings can be utilized for purposes of intervention and prevention of STI and HIV infections.

The epidemiology of bacterial vaginosis in relation to sexual behaviour

BackgroundBacterial vaginosis (BV) has been most consistently linked to sexual behaviour, and the epidemiological profile of BV mirrors that of established sexually transmitted infections (STIs). It remains a matter of debate however whether BV pathogenesis does actually involve sexual transmission of pathogenic micro-organisms from men to women. We therefore made a critical appraisal of the literature on BV in relation to sexual behaviour.DiscussionG. vaginalis carriage and BV occurs rarely with children, but has been observed among adolescent, even sexually non-experienced girls, contradicting that sexual transmission is a necessary prerequisite to disease acquisition. G. vaginalis carriage is enhanced by penetrative sexual contact but also by non-penetrative digito-genital contact and oral sex, again indicating that sex per se, but not necessarily coital transmission is involved. Several observations also point at female-to-male rather than at male-to-female transmission of G. vaginalis, presumably explaining the high concordance rates of G. vaginalis carriage among couples. Male antibiotic treatment has not been found to protect against BV, condom use is slightly protective, whereas male circumcision might protect against BV. BV is also common among women-who-have-sex-with-women and this relates at least in part to non-coital sexual behaviours. Though male-to-female transmission cannot be ruled out, overall there is little evidence that BV acts as an STD. Rather, we suggest BV may be considered a sexually enhanced disease (SED), with frequency of intercourse being a critical factor. This may relate to two distinct pathogenetic mechanisms: (1) in case of unprotected intercourse alkalinisation of the vaginal niche enhances a shift from lactobacilli-dominated microflora to a BV-like type of microflora and (2) in case of unprotected and protected intercourse mechanical transfer of perineal enteric bacteria is enhanced by coitus. A similar mechanism of mechanical transfer may explain the consistent link between non-coital sexual acts and BV. Similar observations supporting the SED pathogenetic model have been made for vaginal candidiasis and for urinary tract infection.SummaryThough male-to-female transmission cannot be ruled out, overall there is incomplete evidence that BV acts as an STI. We believe however that BV may be considered a sexually enhanced disease, with frequency of intercourse being a critical factor.

An Evaluation of HIV Partner Counseling and Referral Services Using New Disposition Codes

New Centers for Disease Control recommendations suggest that all persons with newly diagnosed HIV receive partner counseling and referral services (PCRS). We evaluated the King County, WA, PCRS program using a new set of disposition codes that disaggregate the components of PCRS (notification, testing, and test results), distinguish verified and unverified outcomes, and differentiate outcomes that occur before and after cases receive PCRS. Between 2005 and 2007, 427 (65%) of 659 persons with newly diagnosed HIV received PCRS. The number of cases staff needed to interview to identify 1 new case of HIV varied from 12.2 to 47.4 depending on whether number needed to interview was defined to include both verified and unverified outcomes and whether it excluded partners diagnosed with HIV before cases' receipt of PCRS. Age <25, testing HIV negative within the last year, receipt of PCRS within 58 days of HIV diagnoses, and participation in a program to link persons with HIV to medical care were significantly associated notifying more partners. PCRS evaluations may overestimate success because of limitations inherent in Centers for Disease Control PCRS disposition codes. Efforts to promote frequent HIV testing, assure timely provision of PCRS, and integrate PCRS with programs that link patients to care may improve PCRS outcomes.

Sexual Pleasure and Condom Use

The purpose of the present study was to determine whether sexually-experienced individuals' pleasure ratings for protected and unprotected vaginal intercourse would be related to actual condom use. College participants (80 women and 35 men, M age = 22.29 years) who reported engaging in vaginal intercourse in the past 3 months completed a questionnaire that assessed their perceptions of the pleasurability of unprotected and condom-protected vaginal intercourse and their own sexual behaviors. Both women and men rated unprotected vaginal intercourse as more pleasurable than protected vaginal intercourse. However, men's pleasure ratings for unprotected vaginal intercourse were higher than women's. Furthermore, men and women's pleasure ratings for condom-protected intercourse were correlated with their actual condom use behaviors. Men's "pleasure decrement" scores indicated a significantly greater reduction in pleasure ratings between unprotected and protected intercourse than women's scores. Men who perceived a larger decrease in pleasure between unprotected and protected intercourse were less likely to have used condoms in the past 3 months than those who perceived a smaller decrease in pleasure. The results provide evidence that many people believe that condoms reduce sexual pleasure and that men, in particular, who believe that condoms decrease pleasure are less likely to use them. Condom promotion campaigns should work to emphasize the pleasure-enhancing aspects of condom use.

Unprotected intercourse for extra money among commercial sex workers in Kinshasa, Democratic Republic of Congo

This study assessed the extent and correlates of the practice of engaging in unprotected intercourse for extra money among commercial sex workers (CSWs) in Kinshasa, Democratic Republic of the Congo. We conducted a cross-sectional survey using a structured, interviewer-administered questionnaire among a convenience sample of 136 CSWs. More than one-quarter of CSWs (26.5%) engaged in unprotected intercourse for extra money. These CSWs charged about 3.5 times more for unprotected intercourse than for protected intercourse. Multivariate logistic regression showed that CSWs who engaged in unprotected intercourse for extra money were significantly more likely to live or work in non-downtown (lower socioeconomic) areas of Kinshasa (odds ratio [OR] = 3.07), to have at least one child less than six years of age (OR = 2.95), and to know other CSWs who engaged in the same practice (OR = 9.38). We hypothesize that desperate socioeconomic conditions combined with peer/social norms drive the practice of engaging in unprotected intercourse for extra money. Additional circumstances under which Kinshasa CSWs engaged in unprotected intercourse included intercourse with clients who tore their condoms to increase sexual pleasure (58.8% of CSWs), episodes of condom failure (56.8% of CSWs), and unprotected intercourse with regular noncommercial partners (only 5.3% of CSWs with noncommercial partners always used condoms with these partners).

Efficacy of an HIV Prevention Program Among Female Adolescents Experiencing Gender-Based Violence

We examined the efficacy of an HIV prevention intervention among African American female adolescents reporting a history of gender-based violence. In this analysis of a subgroup of participants involved in a randomized controlled trial, consistent condom use, psychosocial mediators associated with HIV-preventive behaviors, and presence of sexually transmitted diseases were assessed at 6- and 12-month follow-ups. The intervention emphasized ethnic and gender pride, HIV knowledge, condom attitudes, healthy relationships, communication, and condom use skills. Relative to the comparison condition, participants randomized to the intervention reported using condoms more consistently, had fewer episodes of unprotected vaginal sex, engaged in a greater proportion of protected intercourse acts, were more likely to have used a condom during their most recent intercourse, were less likely to have a new sexual partner, were less likely to have a sexually transmitted disease, and demonstrated more proficient condom skills. Given the substantial prevalence of gender-based violence among female adolescents and the associations observed between gender-based violence, HIV risk, and HIV infection, it is essential that HIV interventions involving young women address partner violence.

Hierarchical Models for the Probabilities of Conception

In the last thirty years, there has been considerable interest in finding better models to fit data for probabilities of conception. An important early model was proposed by Barrett and Marshall (1969) and extended by Schwartz, MacDonald and Heuchel (1980). Recently, researchers have further extended these models by adding covariates. However, the increasingly complicated models are challenging to analyze with frequentist methods such as the EM algorithm. Bayesian models are more feasible, and the computation can be done via Markov chain Monte Carlo (MCMC). We consider a Bayesian model with an effect for protected intercourse to analyze data from the California Women's Reproductive Health Study and assess the effects of water contaminants and hormones. There are two main contributions in the paper. (1) For protected intercourse, we propose modeling the ratios of daily conception probabilities with protected intercourse to corresponding daily conception probabilities with unprotected intercourse. Due to the small sample size of our data set, we assume the ratios are the same for each day but unknown. (2) We consider Bayesian analysis under a unimodality assumption where the probabilities of conception increase before ovulation and decrease after ovulation. Gibbs sampling is used for finding the Bayesian estimates. There is some evidence that the two covariates affect fecundability.

Management of Male Infertility.

While 85% of couples are able to conceive after one year of protected intercourse, approximately 15% of couples are unable to initiate a pregnancy without some form of assistance or therapy. These patients are said to be primarily infertile. In approximately one-third of these couples, a male factor appears to be singularly responsible, and in an additional 20% both a male and a female factor can be identified. Therefore, a male factor is at least partly responsible for difficulties in conception in roughly 50% of these couples. It has been shown that the longer a couple remains subfertile, the worse their chance for an effective cure. In addition, many couples experience significant apprehension and anxiety after only a few months of failure to conceive. For these reasons, unduly prolonged unprotected intercourse should not be advocated before workup of the male is instituted. Although it has often been recommended that clinical evaluation be delayed until 12 months of unprotected intercourse has passed, we believe that the initial screening of the male should be considered whenever the patient presents with the chief complaint of infertility. This initial evaluation, however, should be rapid, noninvasive, and cost-effective. The most important part of the management of male infertility is the correct diagnosis. The use of standard techniques for evaluating medical problems in general, such as complete history, physical examination, and laboratory tests is essential for this purpose.

Condom Use, Condom Refusal, and Substituted Sexual Behaviors Among Youth at Higher and Lower Risk for HIV Infection

ABSTRACT The purpose of this study was to describe sexual behaviors that youth substitute for protected intercourse when a partner refuses to use a condom or a condom is not used. Participants included: (a) 120 adolescents (mean age 17.2 years) undergoing substance abuse treatment and (b) 171 university students (mean age 21.3 years). The treatment sample reported significantly higher levels of discrete risk factors for HIV exposure. While only a small proportion of each sample experienced outright refusals by partners to use condoms, the majority of participants in each sample used condoms inconsistently with main partners. The university sample reported more substituted behaviors (lower risk and total) when partners did not want to use condoms. Yet, substantial proportions of participants in each sample engaged in unprotected intercourse. Implications for social work and health promotion efforts directed toward youth at risk for HIV/STD exposures are discussed.

HIV transmission risk behaviours among HIV-positive persons in serodiscordant relationships.

As many as one in three persons living with HIV-AIDS continue to practise unprotected sexual intercourse and these practices often occur with HIV-negative or unknown HIV serostatus (serodiscordant) partners. The current study examined the rates of HIV transmission risk behaviours in non-regular (e.g. casual) and regular (e.g. steady) serodiscordant relationships. HIV positive men (n = 269) and women (n = 114) responded to measures of demographic characteristics, health and mental health status, and sexual behaviours assessed in partner-by-partner interviews. 257 (67%) participants were sexually active in the preceding three months and 182 (71%) of the sexually active persons had engaged in vaginal or anal intercourse with serodiscordant partners. Comparisons of persons with non-regular (n = 97) and regular (n = 85) serodiscordant partners showed that overall rates of unprotected and protected intercourse were greater with regular partners than non-regular partners. Disclosure of HIV status to regular and non-regular serodiscordant partners did not appear to influence the pattern of results. Mathematical modelling showed that HIV transmission estimates over a one-year horizon were significantly greater for male regular partners of HIV-positive men than non-regular partners and there was a trend toward greater HIV transmission rates from HIV-positive men to their regular serodiscordant female partners compared to non-regular partners. Results suggest an urgent need for HIV transmission risk reduction interventions for HIV serodiscordant couples, particularly for couples in established, regular relationships.

Consistency of Recall of Sexual and Drug-Using Behaviors for Homeless Persons with Dual Diagnosis

In this paper we present data from a study of the consistency of recall of several sexual and drug-using behaviors gathered from face-to-face interviews with homeless persons who have dual diagnosis (severe mental illness plus a substance use disorder). Factors associated with inconsistent reporting are also examined. One hundred and thirty-three individuals participating in a longitudinal study of HIV risk behaviors were recruited for a retrospective recall study. Participants were completing monthly interviews that included assessments of sexual behaviors and drug use. Participants completed an additional interview using the same instruments and were randomly assigned to a 3- or 6-month recall condition; the data from the additional interview were correlated with the regular, monthly interviews. Results indicated that reports of sexual and substance-using behaviors were generally reported consistently for both 3- and 6-month recall periods; however, coefficients for the 3-month interval were generally better than those for the 6-month interval. One exception was that protected intercourse was generally not reported consistently. Inconsistent reporting of sexual and drug-using behaviors was associated with the severity of substance abuse; inconsistent reporting of sexual behaviors was also associated with African-American race. Our data suggest that a 3-month recall interval is generally superior to a 6-month interval for persons with severe mental illness.

Self-efficacy to Negotiate Partner Condom Use Among High-risk Adolescent Girls

Background Sexually active adolescent girls whose partners do not use condoms are at significant risk for sexually transmitted disease (SID). Low self-efficacy to negotiate partner condom use has been shown to be a major determinant of high-risk sexual behavior among adult women, but the factors that influence adolescent girls’ ability to engage in protected intercourse have not been fully explored. This study was undertaken to determine the association between self-efficacy to negotiate condom use and self-reported condom use. Methods 21 nonpregnant adolescent girls with cervicitis or pelvic inflammatory disease were enrolled over a 4-month period. Participants were interviewed to collect demographic infonnation, then completed a self-administered questionnaire, which included a 6-item condom use negotiation scale (Cronbach's alpha =.80), a 16-item SID prevention knowledge scale (Cronbach's alpha =.79), and questions on frequency of condom use, condom use at last sexual intercourse, and other sexual risk behaviors. Results Mean age was 17.3 years (range 14–22). 57% were black and 14% were Hispanic. Mean age at first sexual intercourse was 14.4 years; mean number of lifetime sexual partners was 6.2 (range 1–25) and 62% had I partner in the past 3 months. Over 80% reported high frequency partner condom use (“all of the time” or “most of the time”), but only 38% reported partner condom use at last intercourse. All participants whose partner used a condom at last intercourse also reported high frequency condom use. Mean knowledge score was 14.3 (± 2.4) (possible score 0–16). Knowledge score was not associated with condom use or negotiation score. Mean negotiation score was 26.1 (± 5.0) (possible score 6–30). Participants whose partner used a condom at last intercourse had higher negotiation scores than those whose partner did not (Wilcoxon Rank Sum test, p = 0.03). Participants who reported high frequency condom use had higher negotiation scores than those who reported low frequency condom use, but this difference was not significant. Conclusions High self-efficacy to negotiate condom use is associated with self-reported partner condom use at last sexual intercourse among high-risk adolescent girls. Further investigation into the influence of self-efficacy to negotiate condom use in adolescent girls is warranted and may have significant implications for development of STD risk reduction interventions.

Natural family planning with and without barrier method use in the fertile phase: efficacy in relation to sexual behavior: a German prospective long-term study.

A large prospective long-term study with users of natural family planning (NFP) methods has been conducted to analyze the relation between unintended pregnancy rates and sexual behavior with special reference to barrier method use in the fertile phase. Seven hundred and fifty eight NFP beginners, 19-45 years of age, 14870 cycles, 28 unintended pregnancies were studied. Of the couples, 54.2% use NFP only or predominantly and 45.9% use mixed methods (additional barrier method use in the fertile phase in 55.7% of the cycles). The overall pregnancy rate after 12 cycles of exposure is 2.2% according to the actuarial method. There is no significant difference between NFP users and mixed methods users and also no significant effect of duration of use in the first 5 years of exposure. During "perfect use" the pregnancy rate at 12 months is 0.63%. When only protected intercourse takes place in the fertile phase the pregnancy rate is 0.45%. The symptothermal method of NFP is most unforgiving for imperfect use (unprotected intercourse in the fertile phase). However, it is extremely effective when either abstinence or protected intercourse is used in the fertile phase.

Retention in methadone maintenance is associated with reductions in different HIV risk behaviors for women and men.

Using AIDS Initial Assessment questionnaire (AIA) data from 353 injection drug users (IDUs) newly admitted to methadone maintenance (MM), three dimensions of injection risk behavior ("sharing with sexual partner," "sharing with others," and "new needle use") were identified. Among IDUs who continued to inject drugs at 1 year, men retained in treatment obtained lower scores on the "sharing with others" scale than men not retained, even when controlling for initial scale scores and injection frequency. Associations between retention in MM and changes in sexual risk were examined using two AIA measures of sexual risk behavior ("number of IDU sexual partners" and "relative frequency of protected vaginal intercourse"). Controlling for injection frequency, prior sexual risk, and age, there was no difference in sexual risk for men retained in treatment versus those not retained. Among women, those who stayed in MM for 1 year reported significantly fewer IDU partners.