Sex Research Update
McKay, Alexander, The Canadian Journal of Human Sexuality
This instalment of Sex Research Update summarizes recent research on: the impact of advance provision of emergency contraception on adolescent women's sexual and contraceptive behaviour; adolescent oral sex; the effectiveness of consistent condom use in preventing STI; the impact of infertility on couple relationships and sexuality; the association between ejaculation and prostate cancer risk; the sexual functioning of women with ovarian cancer; and news media coverage of HPV.
Gold, M.A., Wolford, J.E., Kym, A., Smith, B.S., & Parker, A.M. (2004). The effects of advance provision of emergency contraception on adolescent women's sexual and contraceptive behaviors. Journal of Pediatric and Adolescent Gynecology, 17, 87-96.
It is estimated that 85% of pregnancies among adolescents are unintended. Emergency contraception (EC) can substantially reduce the risk of unintended pregnancy after unprotected intercourse or contraceptive method failure (e.g., condom slippage or breakage). Although EC can be effective if it is taken up to 120 hours after intercourse, it is more effective the sooner it is taken. For example, a delay in taking EC by 12 hours increases the odds of pregnancy by up to 50%. Thus, in their introductory discussion, Gold et al. ask, "Given that EC is safe and significantly more effective the sooner it is used, why not prescribe EC in advance to every female adolescent?" (p. 87-88). The author's note that some observers have been concerned that providing EC to adolescents in advance may result in increased unprotected sex and less frequent use of reliable contraception.
In order to assess the impact of providing EC in advance to adolescents, Gold et al. conducted a prospective randomized study of young women aged 15 to 20 who received either EC education plus advance EC (AEC group) or just EC education (control group). The final sample consisted of 301 sexually active young women (150 intervention, 151 control) attending a hospital-based adolescent medicine clinic in Pennsylvania. Women using Norplant or Depo-Provera were excluded from the study. After completing an enrolment survey, both groups received information on EC and how to access it from the clinic. The AEC group members also received one complete course of EC (two pills taken 12 hours apart) and were told that they could obtain two additional courses during the six-month study period. "For AEC group participants, obtaining subsequent EC courses was not contingent on experiencing an episode of unprotected intercourse, whereas control group participants could only access EC following an episode of unprotected intercourse and were not given EC in advance" (p. 89). The participants completed monthly follow-up questionnaires for six months after enrolment that assessed episodes of unprotected intercourse, contraceptive use in the previous month and at last intercourse, and EC use.
At the one-month follow-up, there were no significant differences between the two groups in unprotected intercourse in the past month or at last intercourse. For example, in the previous month, 28% of the AEC group and 32% of the control group reported that they had had unprotected sex. There were also no significant differences in pill of condom use. At the six-month follow-up, 26% of both the intervention and control groups reported that they had experienced unprotected intercourse but the AEC group was significantly more likely than the control group to report using condoms in the past month (77% vs. 62% respectively). During the course of the study, 26 participants in the AEC group reported using EC a total of 38 times compared to 20 control group participants who used EC 24 times. The AEC group participants who used EC after unprotected intercourse did so significantly sooner than those in the control group (11.4 hours vs. 21.8 hours). During the study, there were 13 pregnancies reported in the AEC group compared to 18 in the control group. …