Upsala J Med Sci 89: 171-177, 1984 Sexual and Contraceptive Experience among Teenagers in Uppsala Erik Weiner, Ines Johansson, Gisela Helmius and Viveca Odlind Department of Obstetrics and Gynaecology, University Hospital, Uppsala, Sweden ABSTRACT A questionnaire was offered t o 181 sixteen-year-old boys (n=88) and girls (n=93) in different schools in the city of Uppsala. The questionnaire was introduced to the students by a nurse midwife during a regular lesson and included over 100 questions dealing partly with sexual education, attitudes towards sex and own experience of sex and contraception. Of the girls, 47% and of the boys, 31% answered that they had had intercourse. Twenty-eight per cent of the girls and 21.5 % of the boys had had their first intercourse before the age of 15. Contraception was used a t the f i r s t intercourse by 59 % of the girls and by 70 % of the boys. A t the very f i r s t intercourse, the condom was the most commonly used contraceptive method. Increasing sexual experience changed the contraceptive pattern and a t their last intercourse 48 %j of the girls were on the pill and 33 % of the boys said that their girl friend was on the pill. INTRODUCTION In order to provide adequate counselling and education in matters of sexual- ity and contraception to teenagers it is important to know not only the habits but also the common attitudes towards these questions in the age group. Previous studies have reported a gradual decrease in the age of the f i r s t intercourse among girls and boys (1, 2 , 3 ) . Accordingly, society has increasingly provided clinics for teenagers, where not only contraception advice can be given but also a wider counselling can take place in matters that apply to adolescents. In collaboration with the Institute of Sociology a t the University of Uppsala and the School Gynaecologic Clinic in Uppsala, a study was performed in 171 1978 among high-school students. The aim of the s t u d y was to evaluate sexual experience and attitudes towards sexuality and contraception in a group of 16-year-old boys and girls. Parts of the results have previously been published ( 4 ) and this report deals mainly with sexual and contra- ceptive experience. The School Gynaecologic Clinic in Uppsala is p a r t of the local School Health Care programme and s t a r t e d in 1973. The main interest of the Clinic is to give contraceptive advice to both girls and boys b u t girls can also be exa- mined and treated for various gynaecologic disorders by a trained gynae- cologist who visits the Clinic twice weekly. The Clinic is mainly r u n by two nurse midwives, who always see the patients before they see the gynae- cologist. Usually, the midwives can give the patient all the advice and care she/he needs and supply contraceptives and very few of the patients have to see the gynaecologist. MATERIAL A N D METHODS The Students One hundred and eighty-one students participated in the present s t u d y , 88 boys and 93 girls. This sample was achieved by a cluster-sampling procedure in which all high schools in Uppsala participated and their classes were arranged in clusters of around 30 students each. Among the arranged 50 clusters, 7 from 5 different schools were sampled by use of a random number generator. The sample constituted 14% of the total number of first year high school students. The median age among the girls was 15.9 years (range 15 to 18) and among the boys 16.0 years (range 1 4 to 18). - The questionnaire The questionnaire included more than 100 questions on topics such a s family background, attitudes and plans for the the f u t u r e , hobbies, knowledge of and previous educat.ion in s e x , attitudes towards s e x , own sexual experience and experience of contraceptive methods. The questionnaire was distributed among the students during a biology lesson without the students having previously been informed about the s t u d y . Instead of their regular and expected teacher they were met by one of the nurse midwives from the School Gynaecologic Clinic, who carefully informed the students about the aim of the s t u d y , the questionnaire, the importance of serious answers and that they were to be guaranteed anonymity. The students had the oppor- tunity to ask questions and they all agreed to participate in the s t u d y . I72 RESULTS Most of the results a r e presented in the following tables. The head of the tables represents the question that the students were asked to answer. Of the girls 44 (47 %) and among the boys 27 (31 %) said that they had a t least had intercourse once. Table 1. How old were you a t the time of your first intercourse? 12 1 3 14 1 5 1 6 1 7 N G i r l s 1 3 22 13 4 1 44 Boys 0 3 5 11 8 0 27 Table 2 . How old was your partner a t your first intercourse? 12 13 14 1 5 1 6 1 7 18-22 N Girls 0 1 2 6 12 8 1 5 44 Boys 1 2 5 12 6 1 0 27 Table 3. For how long had you known your first coital partner? 1 day 1 week 1 month <+! year >$ year N Girls 3 4 11 11 1 5 44 Boys 6 4 5 2 10 27 Table 4. What kind of relationship did you have to your f i r s t coital partner? Going steady Good friend Casual friend N Girls 29 Boys 11 10 7 4 43 9 27 12-848572 173 To the question 'where did your first intercourse take place?' almost 90 % of the girls replied t h a t it had been in their own house or a t the home of their boyfriend or of a mutual friend. Among the boys, 45 % claimed that their f i r s t intercourse had taken place in a c a r , in a tent or otherwise outdoors. When asked about the degree of alcohol use a t the time of the first inter- course, 59 % of the girls answered that they were not a t all d r u n k , 29 % said t h a t they were a little drunk and 11 % answered that they had been very d r u n k . Among the boys, 37 % were not a t all d r u n k , 45 % were a little drunk and 18.5 % were very drunk a t the time of their f i r s t intercourse. The students were asked whether they now were going steady. Among the girls 64 (70 %) said that they were and among the boys 75 (85 %). The majority of the girls said that they had been going steady for up to half a y e a r , several close to two years. None of the boys had been going steady for more than six months. Table 5 . What type of contraceptive method did you use a t your first intercourse? None Condom Oral IUD Foam N Girls 18 23 2 0 1 44 % 40.9 52.3 4.5 0 2 . 3 Boys 8 13 4 2 0 27 % 26.9 48.1 1 4 . 8 7 . 4 0 Table 6. Which contraceptive method did you use during your last intercourse? None Condom Oral IUD Foam N Girls 9 14 21 0 0 44 % 20.5 31.8 47.7 0 0 Boys 7 11 9 0 0 27 % 25.9 40.7 33.3 0 0 174 The contraceptive method was provided to the girls either by the School Gynaecologic Clinic (42 %), a hospital clinic (23 %) or by a private doctor (11.5 7,). The boys had bought the condoms a t a shop (69 %) or got it from a friend ( 2 1 %). No boy had received contraceptives from the School Clinic although it is open to both boys and girls. A s many a s 84 % of the girls and 70 % of the boys had used the condom on some occasions. No girl in the study had ever used the diaphragm, nor an IUD. The students were also asked about their total number of partners with whom thay had had sexual intercourse. Thirty-six per cent of the sexually active girls had only had intercourse with one boy and another 24 % had had two boys. A minority of the girls claimed to have had coitus ,with three boys or more. Among the sexually active boys, 48 % had only been together with one girl and 17 % had had two girls. Thirty-five per cent of the boys had had inter- course with three or more girls. Table 7. How many times did you have intercourse during the last month? 0 1-3 4-6 7-9 >10 N Girls 23 4 7 1 9 44 Boys 18 6 0 1 2 27 Table 8. Are you satisfied with your present frequency of intercourse? Wants Satis- Wants Inexper. Inexper. more fied less Wants Does not want N Girls 10 31 2 25 2 90 Boys 15 15 0 35 20 85 175 COMMENT This study describes a random sample of 16-year-old students in a medium-sized Swedish city. The answers were judged to be serious (4) and therefore the results can be assumed to give a true picture of the sexual and contraceptive habits and experiences in this group of adolescents. The proportion of girls and boys who claimed t o have had intercourse is well in agreement with other recent reports ( 3 , 6 ) . In a study from Stockholm, 1978, the median age for the first intercourse was reported to be 15.8 years for girls and 17.4 years f o r boys (3). In the present study nearly 50 % of the 16-year-old girls and a third of the 16-year-old boys had had inter- course. In a recent study f r o m Uppsala, i t was reported that among 15-year-old students 71 % of the girls and 67 % of the boys had had inter- course, suggesting that the age a t the first intercourse has decreased further (5). In a study f r o m I978 on Finnish girls, the mean age a t the first intercourse was around 15 years (7). A majority of the girls said that they were going steady o r had known their first 'coital' partner for a t least one month, which is a fairly long time in the perspective of an adolescent (5). A less idyllic picture was given by the boys, who more often had had their f i r s t intercourse with a casual friend, more often were more or less drunk on the occasion and the intercourse had often taken place outside their homes. The girls often had had their f i r s t intercourse with a partner who was older whereas the boys chose partners of their own age. The use of contraceptives a t the f i r s t intercourse was relatively frequent as more than 60 % of the girls and 70 % of the boys claimed that contraception was used a t their very first sexual intercourse, the most common contra- ceptive a t that time being the condom. The results suggest a shift in the type of contraceptive method to a more safe and efficient one after the first intercourse a s the proportion of users of oral contraceptives increased with increasing sexual experience. Although almost 50 % of the girls were on the pill a t their last intercourse, a s large a proportion a s 20 % did not use any form of contraception, indicating the need of continued efforts to reach teenagers with education and information about contraceptive methods. When such advice is given i t has to be kept in mind that the sexual habits in this age group a r e very irregular (Table 7 ) , and the motivation among many teenagers with sporadic sexual contacts to use a highly efficient method may be weak. Therefore, good and repeated information also on barrier methods should be given to this age group. 176 ACKNOWLEDGEMENT This study was supported by the Swedish National Board of Health and Welfare, which is gratefully acknowledged. 1 . 2 . 3. 4. 5. 6 . 7. REFERENCES Crafoord, K . : Symptom eller ilderstypiskt beteende. Department of Psychology, University of Stockholm, 1972. (Swe. ) Karlsson, G . : Sexuella vanor och attityder bland folkhogskoleelever . Sociologisk Forskning 1 , 1964. (Swe. ) Klackenberg-Larsson, I . ti Bjorkman, K . : Tonsringars sexualdebut. Socialmed Tidskrift 55: 5-6, 1978. (Swe.) Lewin, B . : Sexual attitudes and sexual experiences among teenagers in a Swedish city. Department of Sociology, Uppsala University, 1980. Lewin, B . & Helmius, G. : Ungdom och Sexualitet. Department of Socio- logy, Uppsala University, 1983. (Swe . ) Rahm, V . A . : Flickorna t a r initiativet . Journalen 2 : 230-232, 1982. (Swe.) Ruusuvaara, L . R . : Teenage abortions. Dissertation a t the University of Helsinki, 1983. Address for reprints : Erik Weiner, M.D. Department of Obstetrics & Gynaecology University Hospital S-751 85 UPPSALA SWEDEN 177