Fate, Desire, and the Centrality of the Relationship to Adolescent Condom Use
Article Outline
See Related Article p. 254
W.B. Yeats—in the wonderful poem “Leda and the Swan”—describes the tragic consequences of an unprotected copulation:
So it is with each copulation. Repeated hundreds of times in a life, each sexual act summarizes the life’s experience of two beings as individuals and as that mystifying unit we most neutrally call “a sexual dyad.” Each sexually transmitted infection, every pregnancy (intended or not), is engendered in the physical context of copulation. In contrast to the helpless fates of our mythical ancients, our divine fate is choice where within the few minutes of sequenced words, gestures, touches, and stereotyped mating movements we call “sex,” a latex condom may neutralize the adverse sequelae of a given copulation.
I have repetitively used the word “copulation” to emphasize the physical details of adolescents’ sex which include desire, arousal, erection, lubrication, ejaculation, orgasm, a place to stand or lie, a few minutes of time, and communication—the communication in sexual dyads that expresses sexual interest and accepts it from the other. These words and gestures guide the copulation and express its pains and pleasures. Perhaps most importantly, the communication in sexual dyads reflects our human capacity to conceive the desires of the other, and to match (or oppose) those desires with our own behavior.
The article by Tschann et al [1] makes an important empirical contribution to a large literature on condom use in adolescence by showing the central importance of the perception of the other’s desires about condom use. Tschann et al found that the perception of one’s partner’s desire for condom use was directly related to condom use without regard to the strategies employed to use condoms or resist their use. Condom use tended to be quite high (near 100% of exposures) when partners were perceived to desire condom use. However, specific strategies employed for condom use were associated with increased condom use when perceived partner’s desire for condom use was low. All forms of an explicit interchange about condoms—discussion of the risk of infection or pregnancy, direct expression of a desire to use condoms, insistence on condom use—were associated with higher levels of condom use, even when the partner’s desire for condom use was perceived to be low. Insistence on condom use in the face of low desire for condom use in the partner was particularly important for young women. However, high desire for condom use in the partner was not resistant to condom avoidance strategies, if employed at a high level.
The perception of the other’s desire for condom use is not named such by Tschann et al but is consistent with the concept of empathy. Empathy can be defined as “…any process where the attended perception of the object’s state generates a state in the subject that is more applicable to the object’s state or situation than to the subject’s previous state or situation” [2]. The experience of empathy—which has elements of both understanding the other and feeling understood by them—is an integral part of more successful, stable, and lasting relationships [3].
The concept of empathy leads inevitably to the role of the adolescent dyads’ relationship—romantic, sexual, and otherwise—in condom use. In fact, likelihood that a given person will perceive the condom use desires of their partner precisely depends on the quality of their relationship. This point is apropos of the findings of Tschann et al. because their participants were mostly in long-term relationships (almost 21 months, on average). Relationships of this duration also have other characteristics—co-residence, integration into family and social networks, pregnancies, and children—that may also influence the accurate perception of a partner’s condom use desires [4]. Because these are all dynamic aspects of relationships, such perceptions are likely to undergo substantial revision over time. Tschann et al noted that a substantial number of participants reported instances of wishing to use a condom with a given partner at one time, and not wishing to a use a condom (with the same partner) at another.
The ultimate centrality of adolescents’ romantic or sexual relationships to a relatively simple behavior such as condom use suggests the need for renewed research and prevention efforts in this area. Adolescent prevention research has been slow to incorporate the emerging understanding of adolescents’ romantic or sexual behaviors although progress in these areas during the past 15 years has been remarkable [5]. One challenge of renewed efforts to better incorporate lessons from psychological and sociologic studies of adolescent relationships into clinical and public health approaches to pregnancy and disease prevention is the need to focus on the sexual qualities of the relationships. The connection of sexual satisfaction to stability and exclusivity in a relationship is documented in at least a few studies [6], [7].
Two additional points support the importance of shifting clinical and public health attention to condom use within relationships rather than maintain a focus on condom use per se. First, condom use among U.S. adolescents is already quite high, with rates of condom use at last intercourse of 65% among 12th-grade males [8]. From my perspective, this represents a rather remarkable outcome of years of risk-focused condom promotion efforts, since comparable rates were 21% in 1979 [9]. Second, condom use declines rapidly in established relationships, often within 3–4 weeks [10]. From the epidemiologic risk-perspective on which most condom education and promotion is based, such decisions make little sense. However, from a relationship perspective, risk quickly loses its relevance, and use of condoms to prevent an irrelevant risk becomes relationally illogical.
The use of condoms within relationships requires one additional adjustment that continues to be very difficult: the attention to the quality of the sex itself within relationships. Interference with sexual pleasure is often cited (by both men and women) as a reason for condom non-use. Even young men who have never had sexual intercourse discuss interference with pleasure as a reason for condom non-use [11]. This is despite substantial advances in condom design and manufacturing techniques that have substantially reduced interference with sexual pleasure. However, an empirical discussion of sexual pleasure among adolescents is nearly impossible because we continue to lack the courage to explore the physical and emotional subjectivities of adolescents’ sexual experiences.
Personally, I believe this is our society’s deliberate decision. The idea of promoting sexual pleasure as a positive aspect of adolescents’ relationships, and promotion of STI and pregnancy prevention as a corollary of sexual pleasure, seems unthinkable. We seem content with our anguish about the unchangeable fates of a single, unprotected copulation. The findings of Tschann et al begin to point to some directions we might go, unless we choose to continue to squeamishly look away.
References
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- . Adolescent romantic relationships. Annu Rev Psychol. 2009;60:631–652
- . Sexual Satisfaction and Sexual Expression as Predictors of Relationship Satisfaction and Stability. In: Harvey JH, Wenzel A, Sprecher S editor. The Handbook of Sexuality in Close Relationships. Mahwah, NJ: Lawrence Erlbaum Associates; 2004;p. 235–256
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PII: S1054-139X(10)00317-4
doi:10.1016/j.jadohealth.2010.07.001
© 2010 Society for Adolescent Health and Medicine. Published by Elsevier Inc. All rights reserved.
Refers to article:
- Condom Negotiation Strategies and Actual Condom Use Among Latino Youth , 12 April 2010
