July 2015

Do we, as reproductive health care providers, follow our own informed counsel as we hope our patients do? Or do we suffer from similar human vulnerabilities, such as “heat of the moment” temptations or hopeful trust in statistical odds of avoiding consequences? A recent study we undertook gives insight into that question.

Little is known about reproductive health professionals’ sexual risk-taking behavior. When providing counseling about safe sex practices, reproductive healthcare providers generally wish their patients to adhere to US Selected Practice Recommendations for Contraceptive Use to prevent unintended pregnancy and sexually transmitted infections (STIs). We examined the prevalence of and circumstances surrounding unprotected intercourse among Society of Family Planning (SFP) fellows in the United States.

We conducted an online survey, inviting 477 SFP fellows via email to participate anonymously. The response rate was 70% (n=340). We asked whether respondents had ever and in the past year had unprotected vaginal intercourse when not intending a pregnancy, and if so, how many times, under what circumstances, and at what age the first time. We then asked about unprotected vaginal, anal, or oral intercourse ever and in the past year under three different scenarios relating to sexually transmitted infections (STIs): 1) partner not known to be STI-free, respondent STI-free; 2) partner known to be STI-free, respondent not known to be STI-free; 3) partner known to have an STI, respondent STI-free. Each scenario included questions about the number of times, applicable circumstances, and age at first time.

• 46% of respondents have ever had unprotected vaginal intercourse when not intending pregnancy; 35% more than 10 times and 7% in the past year.
• 60% have had unprotected vaginal, anal, or oral intercourse with a partner not known to be STI-free; 39% more than 10 times, and 12% within the past year.
• 8% have ever had unprotected intercourse with an STI-free partner when they themselves had an STI, and 4% with a partner known to have an STI.

Ever having taken a risk with respect to unintended pregnancy and STIs is common among our sample of reproductive health professionals and researchers. Having taken such risks in the past year is uncommon, but not non-existent. Most risk-taking behavior is concentrated at younger ages. Many more fellows reported having experienced unprotected intercourse carrying a risk of unintended pregnancy or a potential risk of STIs to themselves than reported having experienced unprotected intercourse carrying a potential risk of STIs to a partner or a known risk of STIs to themselves. Those who reported experiencing the former two types of unprotected intercourse tended to experience them at younger ages and under circumstances that did not involve conscious calculation of risk. Those who reported experiencing the latter two types appeared to have experienced them with higher frequency, at older ages, and for reasons that more often involved conscious choice rather than spontaneous risky behavior. These patterns suggest that engaging in unprotected intercourse conferring a potential risk of STIs to a partner or a known risk of STIs to self might more commonly occur within relationships where partners are aware of each other’s STI status and/or that most these events involved STIs where the risk of transmission is reduced at certain times (e.g. herpes simplex virus). It is also likely that having undergone STI testing and being aware of one’s own or a partner’s STI status is more common at older ages. The fact that taking the risk of potentially contracting STIs was so much more common than potentially putting a partner at risk of STIs might also suggest that fellows were much more likely to know their own STI status than to enquire about their partners’ status.

Our study was based upon a sample of reproductive healthcare providers and researchers from a single professional society in the US and thus may not be generalizable to reproductive healthcare professionals nationally or in other settings. Our study relied upon self-report of experiences regarding a personal and potentially sensitive topic and thus results may be affected by social desirability bias, recall bias, or other self-reporting biases.

Despite these limitations, the findings of our study represent a novel contribution to our knowledge of the behavioral patterns surrounding unprotected intercourse: healthcare professionals appear to be much more like their patients and study populations than might commonly be assumed. When counseling patients about safe sex or designing education programs to reduce unintended pregnancy and STIs, much might be gained if clinicians and researchers were to reflect upon their own experiences of unprotected sex, both recently and in the past. Drawing upon such experiences might help bridge the gap between what is ideally expected in guidelines and what tends to happen in real life, creating an avenue for understanding the behaviors of patients and study populations and opening up more meaningful conversations.

Reference

Aiken ARA, Trussell J. Do as we say, not as we do: experiences of unprotected intercourse reported by members of the Society of Family Planning. Contraception, (2015) 92(1): 71-76.

—Submitted by Abigail R.A. Aiken, MD, MPH, PhD and James Trussell, PhD; Office of Population Research, Princeton University; Princeton, NJ