Andrew Smiler, Ph.D.

America's leading expert on the masculine self

Condoms! Condoms everywhere!

Sexuality, Parenting, Social JusticeAndrew Smiler

The American Association of Pediatrics (AAP) recently released a policy statement recommending that adolescents use condoms whenever they have sex and that adults provide adolescents with accurate knowledge about condoms and make condoms readily available.

You probably didn’t hear about the statement when it was released a few weeks ago because American news media are hesitant to draw attention to the fact that most high school seniors have had sex at least once. Given that almost all of the news media are owned by companies that also produce TV shows and movies in which teens routinely have sex, this has always struck me as incredibly hypocritical. Who decided the media can talk incessantly about fictional teen sex but can barely mention the realities of teen sex?

The AAP started by making the case for adolescent condom use. It’s a case the organization has made before, as have countless individuals and a variety of other organizations. Some of the key points:

  • American adolescents have notably higher rates of unplanned pregnancy and sexually transmitted infections (STIs) than adolescents in any other “Western” nation. Our numbers were so out of line that despite historic drops in both of these numbers over the last few years, we’re still not in the same ballpark as our peer countries. We may have arrived in the parking lot, however.
  • Condoms are highly effective at preventing both pregnancy and disease. In the lab, latex condoms are about 98% effective. In reality, due to poor storage, incorrect use, and other forms of user error, the efficacy rate is in the 80 – 85% range.
  • Study after study, and review after review, shows that teaching adolescents to use condoms doesn’t cause them to have sex younger en masse. Almost half of programs that teach teens to use condoms do just the opposite: they delay and decrease sexual activity. Among virgins, comparisons between those who participated in the program and those who didn’t typically show an average delay of about 6 months for first sex. Among non-virgins, program participants often report fewer new partners 6 – 12 months after the program. The other half of programs do not seem to have any effect on average age of first sex or number of partners post-program.

Then the AAP did something they’ve never done before: they recommended that “restrictions and barriers to condom availability should be removed” and that “beyond retail distribution, sexually active adolescents should have ready access to condoms at free or low cost where possible.” They specifically mentioned pediatrician’s offices—it’s the American Academy of Pediatrics, after all—as well as schools. They also recommended that teens be explicitly taught how to use condoms.  To my knowledge, no American organization with this kind of stature has ever recommended giving out condoms in schools before. Planned Parenthood certainly has, but a substantial percentage of the population doesn’t trust them at all.

The AAP provided several reasons for greater condom education and availability.

  • Condom use isn’t quite as easy as it seems. Sure, the act of putting it on is straightforward after you’ve done it a few times, but you also need to know that if you put it on “backwards” and it doesn’t unroll, then some seminal fluid and sperm will get onto the condom, so flipping it over and putting it on carries greater risk than if you’d gotten it right the first time. Teens also need to know how to store condoms so they don’t break, dry out, or otherwise become unusable (just ask Kenickie from Grease) and that you can’t use the same condom twice.
  • Easier access to condoms increases condom carrying, condom acquisition, and ultimately condom use, and it also decreases the number of new STIs, as study after study has shown. Easier access to condoms does not lead to younger age of first sex.
  • Combining greater access to condoms with instruction on condom use is especially effective. After all, if you know how to use a condom but don’t have one, that knowledge isn’t very helpful. Ditto if you’ve got one but don’t know what to do with it.

There’s also an economic issue here that the AAP makes indirect reference to. Condoms aren’t exactly cheap, so if you’re living in or near the poverty line, there’s relatively little chance that you’d have the money to buy one. Given the choice between buying necessities like today’s only meal, buying new underwear, or buying condoms, I suspect condoms lose more often than not.

If you live in a world where the implication of “no condom” is no sex, then you’re not thinking realistically about teens. The average age of first sex among US adolescents is about 16 and a clear majority have sex before they graduate high school. We often think about teens as impulsive, risk-takers, and not considering consequences; although the reality isn’t as bad as many adults make it out to be, believing  adolescents will follow “no condom = no sex” in large numbers is folly.

The consequences can be disastrous. We know that teen girls who get pregnant – and especially those who give birth – prior to high school graduation are especially likely to not graduate, be unable to find gainful employment, and end up on public assistance. The same thing is true for the boys who father those children. Teen fathers are also unlikely to graduate high school and they’re substantially more likely to end up in jail or on public assistance; and whether its jail or welfare, the rest of us pay for it.

It gets worse. The child of those teen parents is likely to grow up in poverty, which means they’re at increased risk of doing the same thing their parents did: becoming a parent before they graduate high school. This is one manifestation of the cycle of poverty.

Bravo to the American Association of Pediatrics for publicly taking this stand. We should all follow this advice.


Photo: paulk / flickr