Get Real! The Luck (or Not) of the Draw


lisasucks asks:

I’m 19
and my boyfriend is 28. We’ve been having sex for a year now and we
have not been very careful at all. We never use condoms! It’s weird
though cause I have not gotten pregnant. He usually doesn’t ejaculate
in me LOL but still. . . . I always joke and tell him he’s sterile but
now I’m really thinking he is. Since I haven’t gotten pregnant does
this mean there is something wrong with my boyfriend or me? Or does it
just mean I’m lucky?

Heather replies:

If
you are not looking to become pregnant, then chances are good you have
just been very lucky so far. Generally, in one year of sex without any
method of birth control, around 80 – 90% of young women will become
pregnant. So, for now, it seems you’ve been that 10 – 20% of women who
haven’t…so far.

However, it doesn’t sound like you haven’t actually been using NO
method at all, you’ve been using withdrawal, just not consistently.
According to sound sources like Contraceptive Technology and
Planned Parenthood, used perfectly, withdrawal is around 96% effective,
but in typical use (the way most people use methods), it’s one of the
two least effective methods there are: it’s only around 73% effective
with typical use.

You also may or may not have gotten lucky when it comes to sexually
transmitted infections, which you are just as much at risk of as you
are of pregnancy, and which withdrawal doesn’t offer you protection
from. I say you may or may not have because I don’t know if you (or he)
have gotten screened for sexually transmitted infections during your
relationship. Most often, STIs are asymptomatic: in other words, a
person who has one, will not see or find obvious symptoms on their own
without a healthcare professional and tests. If neither of you haven
gotten tested, you may be sitting with an infection you don’t even know
you have while you’re reading this.

Personally, I don’t really think STIs or unwanted pregnancies are LOL. I’m more inclined to file them in the OMFG department.

Most people’s experiences with them are that they’re not funny at
all, but instead, that they are anything from very unamusing to
seriously devastating. I have to say, I also don’t think gambling with
things that could have a pretty huge impact on your life and health —
and for you, most of those risks are far higher and more serious than
they are for him — are funny. I don’t find male partners who are
cavalier about putting female partners at risk of unwanted pregnancy
(and for your information, older male partners often are found to do
this more often than same-age partners are) at all amusing or cute or
funny. On a good day, I find them intensely irritating. On a bad day, I
can only find myself fuming incoherently or come up with words for them
I try not to use here at Scarleteen.

One never wants to just presume a partner to be free of STIs or
infertile, or find out if they are by experimenting with your own body,
especially if you don’t want or are not ready to discover that they are
neither of those things the hard way. The sound way to find out if a
person is infertile or not is through testing, not by risking a
consequence you or they don’t want or are not ready to deal with. As
well, know that male infertility is less common than female
infertility. It also stands to mention that with female infertility,
pelvic inflammatory disease (PID)
is one of the leading causes of infertility, and PID usually results
from an untreated sexually transmitted infection. So, if you care about
your own fertility, as well as your own general health, gambling with
STIs isn’t wise.

Here’s what I would ask you to ask of yourself: do you want to become pregnant right now? Additionally, do you want a sexually transmitted infection?

If not, then it’s time to seriously change your habits with sex,
pronto. What that means if you want protection from both is absolutely
using condoms for any oral, vaginal or anal sex, every single time you
do any of those things, from start to finish. That also means both of
you getting tested for all STIs regularly, and treated if either of you
has any STIs. Obviously, that also means choosing to be with a partner
(and being this kind of partner yourself) who takes and treats these
risks seriously. If you use female condoms, you don’t have to have a
partner’s cooperation with condom use: if you use male ones, you
obviously do. After six months of safer sex practices and tests which
show both of you clear of infections, and you’re both staying only with
each other as partners, if you both want to go without condoms then —
if you still want to prevent pregnancy — you can use another method of
birth control, such as oral contraceptives (the pill), cervical
barriers, an IUD, whatever you prefer. You also have the option of
using BOTH condoms and another method from here on out to up your
protection, or if you want to stay with this guy, but he just refuses
to use a condom. Suffice it to say, you also have the option of
choosing partners who take the risks of sex a lot more seriously.

My personal advice is also that no matter what type of barriers you
use or want to use, you choose partners who are on-board with safer sex
and with having a strong investment in the health of both of you, both
for your psychical health as well as to help have sexual relationships
of real quality. Obviously, partners who won’t cooperate with safer sex
and reliable birth control — or who enable their partners who are also
resistant to being safe — present health risks, and also risks of just
winding up in a spot we don’t want to be in when it comes to a
pregnancy or an STI. But partners who won’t cooperate with these
practices also can often tend to be partners who aren’t such great
partners in other respects, either. And a partner who can’t deal with
the responsibilities sex requires is probably not going to do so well
dealing with the far more complex and demanding responsibilities being
a parent requires.

I don’t think it’s a stretch to say that dismissing our health and
well-being with this stuff tends to often show up a dynamic we might
have in other areas of a relationship. A partner who won’t be a
supportive partner in contraception may also not be a supportive
partner when it comes to our life goals, to having a sex life that
involves real mutuality, to working through conflicts together like
grownups, to being responsible in other areas.

My personal rule for myself when it comes to sexual partners who
won’t practice safer sex or who are strongly resistant to managing
safer sex or contraception is to throw that fish back. I don’t know
about you, but I know that for myself, while sex is certainly fun, I
can’t have a whole lot of fun with someone, sexually or otherwise, who
doesn’t take things that could really mess me up very seriously. I feel
like that behaviour both shows me that person isn’t really ready to be
the kind of sexual partner I want and am likely to have a great sex
life with, and also indicates they’re probably going to be
less-than-fabulous in other areas, too.

I don’t know anything else about your relationship, so only you can
determine if this is a relationship you think is worth keeping around,
and where you are going to be able to draw a line on this and be gladly
respected. If it is an otherwise good relationship for you, then my
suggestion is to come to your boyfriend and make clear that from here
on out, you need the both of you to be more responsible and adult about
sex and reducing your risks; that you need to start on that path with
both of you having a round of STI tests and using condoms for ALL sex,
always, for at least the next six months.

I’d expect someone who earnestly cared for you to have no problem
with that whatsoever, and consider that someone who makes a big stink
about that or tries to argue against it may not care enough to be safe
as a partner for you or anyone else. I’d also figure that someone who
didn’t realize that you — not he, as he gets to be lucky in this no
matter what — becoming pregnant when you don’t want to isn’t any kind
of joke isn’t someone who can take your life seriously enough to be a
safe partner, as well as the kind of partner who supports you taking
your OWN life seriously. Sometimes, if we think little of ourselves or
our own lives, we can wind up drawing people to us who can see that and
seek to exploit it. Sometimes, our habits around sexual health and
contraception can also tell us a lot about how much or how little we
value ourselves, not just what value a partner has for us.

If you think or know that from the get-go, he’s not going to be
cooperative, and you don’t feel like a pregnancy or getting an STI is
worth whatever benefits you’re getting from not protecting yourself,
then my suggestion is to nix this relationship and hold out for a
partner with more maturity and care for the both of you. I know he’s
older than you, but age alone does not always mean someone is mature or
more mature.

If you feel like no matter what partner you’re with, and you have a
hard time being responsible for yourself in this way, I think it’s
helpful to sit down and take a look at what you really want with your
life. A pregnancy or a kid before you’re ready or when you don’t want
one can make life a lot more challenging, and can either derail some
things you might want, or just make getting them a lot tougher. An STI
— especially the ones that aren’t easily treated or which we don’t
have a cure for — can do a real number on your quality of life. Both
pregnancy and infections pose short and long-term risks to your health
and well-being. For that matter, a partner who doesn’t take your life
or theirs seriously can also really keep you from a life well-lived.

You might want to sit down with a piece of paper and look at where
you want to go: with school, work, with your own dreams and
aspirations, with your health, with how you feel in your body and mind,
and with your interpersonal relationships. What do you want? What do
you need to do — and also ideally avoid — to get what you want? What
does your best life look like, and how are your current partner and
your current habits in alignment (or not) with that ideal? In doing
that, you not only will probably see why being more responsible about
sex is more important, you might also discover if this relationship is
a good one for you, full-stop. That’s good information to have to
assure you make the best choices you can for yourself, with sex and
with everything else.

Here is some additional information you can use to consider all of this, and to have on hand when you talk to your boyfriend:

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  • http://www.condomologist.com invalid-0

    While it’s understandable that you’re concerned about what appears to be a somewhat cavalier attitude on the part of the young woman who wrote, your own personal biases seem to cloud your feedback, providing a surprisingly judgmental and negative response — especially coming from someone of your stature and credentials. We as sexuality educators certainly have a responsibility to discuss values and decision-making skills and to explore all the possibile outcomes of unprotected sex, but we also have a duty to espouse risk reduction in a manner that’s accepting of those who choose withdrawal or hormonal BC alone or — and especially in this case — mutual monogamy. There’s too much here in your response to take on, but looking at the question and then your fear-based, gloomy response, what I take away is something found in your general response to the withdrawal debate — that men can’t be trusted, that they could care less about female partners’ health, that they think this is a big joke. You note that you know little about this couple’s relationship, but then imply — and it’s pretty clear to me here — that you don’t think much of this guy you don’t know about, that he’s an older dude taking advantage of a young woman, and that she’d be better off without him. You don’t say it, but that’s the implication. And OMFG? Really, that’s how we’re speaking to 19 year-olds today? And your refusal to use the updated numbers about withdrawal? You gloss over it at the beginning — and I assume that’s why you chose this question to publish widely — but never again mention it, when the point of the withdrawal brouhaha was less about exact numbers and more about the reality that people are using it often and it’s fairly effective. But the establishment is too scared to promote that idea, even though they’ll happily talk spermicides, with comparable effectiveness numbers. Instead, we get here the same old talk: You MUST use condoms for the next 6 months for oral, anal and vaginal sex. I get that we want to be safe, but now you’ve not only made this young woman feel bad about her general behaviour and her choice of partners, misinformed her about the truth around withdrawal, but on top of that now she’ll feel bad if, say, she decides to engage in oral sex without a condom before he gets tested for HIV — when we all know there’s a miniscule (if any) chance of contracting it that way — and really, who’s using condoms for oral sex? We have a tough enough time getting people to use condoms for vaginal sex, which really is the bigger question here — we need a discussion of what may be preventing a couple from using them and how they incorporate condoms into pleasureable sex — but scaring teenagers into better behaviour, witholding important info on how they can avoid STDs and pregnancy when they don’t use them, and continuing on with this men-are-thoughtless nonsense is not helpful to our mutual goals or the general discussion.

  • heather-corinna

    Jonathan: there’s a lot here, but let me just touch on a few things.

     

    As a sexuality educator (and one who has primarily worked with teens and young adults over the last 11 years: a population which does differ from older adults in many ways), when I am talking about STIs, I’m not just talking about HIV.  Yes, HIV transmitted orally is unlikely: but other STIs transmitted orally is much more common. I suggest the "same old" safer sex practices because they are the ones which we know, from sound world health organizations, that those are the practices which work to prevent infection.  Who’s using condoms for oral sex?  People who want to avoid sexually transmitted infections by mouth.  And as someone who has counseled some folks over the years through STIs transmitted by mouth when barriers and testing were not used before, I can assure you that many of those people changed their practices afterwards.  I don’t think the attitude that no one uses barriers for protection that way helped those people in any way: I think it has done harm. I also think it does harm to only talk abut HIV when talking STIs, particularly given populations where other STIs are much more common, and also often go untreated because of a lack of sexual healthcare.

     

    I was not misinforming this poster in any way I know of, nor trying to scare her: the risks I talked about are real, and the risk of STIs and pregnancy for someone her age (and know unintended pregnancy in women her age and younger is often linked to older partners statistically) are high.  I was doing the best I could to explain what her risks are, especially since it seemed clear to me she and her partner have not been taking them seriously, and she did not express wanting those outcomes.  And theway I addressed this relationship is based on years of seeing and working with young people with these kinds of dynamics: they are very common.

     

    I also have no idea if this couple is mutually monogamous: she didn’t say anything about their status in that regard.

     

    Lastly, I’m not using the "updated numbers" about withdrawal because, to my knowledge, we do not HAVE any updated numbers (which is perhaps why Contraceptive Technology and PP aren’t showing any, either).  Rather, what we have recently had is one commentary piece (not a study: it is stated as commentary) in one journal which suggests withdrawal may be more effective in typical use than previously thought based on one broad census, not a specific study of withdrawal.  We did immediately update our page on withdrawal — a page listed and done in the same way on our site as we do all other methods — to make note of and link to the piece, but my suggestion, which I think is the right call, is to go by the existing numbers we have had until there is some specific study. One hopes that commentary will promote that further study: if it does, and sound study finds it to be more effective, you can be assured I will update our information to reflect that, as we do with any efficacy changes with any method.

  • invalid-0

    I appreciate your response. I’ll just say a few things.

    I should’ve been more clear about the oral sex risks. The reason I brought up HIV was because you had talked about waiting 6 months, and I took that to mean you were referring to the window period for HIV testing. Certainly chlamydia, gonnorhea, syphilis, herpes — they’re all risks. That said, most straight folks won’t get a syphilis test, nor a herpes test if they aren’t showing symptoms, and chlamydia and gonorrhea tests are almost always urine-based. It’s not to say they shouldn’t get tested, but I still think we need to clarify why we’re saying what we say. And as for using condoms for oral sex, I don’t dispute there are people here and there who use them, but it’s very rare and if that’s the case, then we need to talk about it outside of just condom use. And that’s true of withdrawal as well. Forget the debate about exact numbers, my point was more generally that if we’re to be honest about risk reduction, then we can’t be afraid to say that pulling out is fairly/highly effective, for both STD/HIV and pregnancy prevention — especially if, for whatever reason, condoms don’t work for that couple. And as for the question of mutual monogamy, she didn’t say they were, but she did say it was her boyfriend; and while he could very well be messing around, your response seemed to hint that it was likely he was and I feel like your harping on that took away from answering her actual question and focused too much on the negative aspects of her sexual relationship. The question was why she wasn’t getting pregnant, and that seems to call for a detailed look at withdrawal, menstrual cycles and times of ovulation, and the possibility of infertility — little of which was explored. It’s fair to mention briefly the other stuff, but it’s also very possible they’ve both been tested and just want to know how to have a pregnancy-free sex life, and that it’s an open, honest, relationship where the older man isn’t insisting on not using condoms or adversely pressuring her in any way. All that said, I greatly respect how much you care about these issues and take the time to respond in-depth to your readers.

  • heather-corinna

    For sure. Thanks for some of your comments as well. 

     

    A couple things, though: it sounds like you’re saying withdrawal is an effective practice for preventing STIs, which we know it is not.  maybe I am misunderstanding?  I said 6 months because 6 months of safer sex practices (and bookending them with testing) is still what orgs like the CDC suggest for prevention for all STIs, not just HIV.

     

    I’m not a hinter: really, I don’t hint at things.  If I didn’t say it — especially given how verbose I am! — there’s no sense in thinking I meant it.  When young women say "boyfriend" that may or may not have anything to do with monogamy, especially given the velocity of teen relationships: a second-date often gets someone to boyfriend status, and that boyfriend could have had another partner even days before.  With couples who haven’t ever been tested — and many straight men in particular have not — it’s not sound to assume even if there has been monogamy for a while that there are no STI risks.  Monogamy doesn’t undo existing infections, after all.

     

    Personally, I have had a lot of success working with teens and helping many move into using safer sex practices pretty gladly.  And, perhaps because they are new to their sex lives, plenty often seem to take up safer sex practices, including condoms for oral sex, with less reticence than older adults (who often are trying to change long-term patterns or habits).

     

    It also doesn’t make sense to me to talk in more depth than I did here to young people about infertility, as that so rarely is an issue, and in this case, since she does not seem to want to become pregnant, not very relevant.  And in linking the user to things like our Birth Control Bingo, she can certainly look into charting if she had interest in that.Same goes for looking more deeply into withdrawal.  Because we have all that information clearly on our site is why I tend to outlink to things like that rather than reiterate in an answer.

     

    Yes, I agree that what you posit per their relationship is possible, however, in my experience doing the work I do with this population for as long as I have, that’s less likely than what I did suggest.  And if what I suggested was NOT going on and he is supportive and serious about all this, all she needs do is dismiss that information.  But if it is NOT a supportive dynamic and I left it out that’d be really problematic in my book.

     

    Lastly, our users at Scarleteen are generally very good at following up when they’re not satisfied with what we’ve given them, and if an answer isn’t what they wanted or doesn’t answer their question, they do tend to let us know. In those cases, I will tend to go back and edit and adjust my answer: if I had any notion this hadn’t worked for her, or wouldn’t work for a lot of our readers, it’d read differently.

  • invalid-0

    And as for using condoms for oral sex, I don’t dispute there are people here and there who use them, but it’s very rare

    Really? Do you have a source for it being “very rare”?

    Also I’ve been monogamous with every boyfriend I’ve had and I still got HPV. I don’t think anyone cheated on me (none did that I’m aware), but it’s symptomless so probably someone already had it before me. Monogamy does not solve everything.

    Also, just because she said “boyfriend” says NOTHING about monogamy.

  • invalid-0

    KatWa, my experience doing testing and counseling, both on a hotline, in person regularly testing for HIV, and doing hundreds of safer sex programs — they all tell me it’s very rare. And while the research is lacking in this department, I’d point you to a few studies that all say it’s very rare.

    http://www.guttmacher.org/pubs/psrh/full/3800606.pdf
    http://www.ncbi.nlm.nih.gov/pubmed/12081363
    http://www.ncbi.nlm.nih.gov/pubmed/12730281
    http://www.childtrends.org/files/SexualActivityRB.pdf

    My general point in this discussion is that we have to meet teens where they are, that the idea of telling them, Condoms, condoms, condoms! often misses the point. And when we do that, we lose them and we lose credibility and appear out-of-touch when everything is so fear-based.

    I’m not saying monogamy prevents infection — and certainly with HPV, it’s so prevalent and since men don’t get tested, huge numbers of women contract it through no fault of either party, sometimes leading to potentially serious abnormalities and cancer, thus the need for regular pap smears; and condoms can reduce the risk, but not eliminate it — but I think it important not to demonize men, nor to make women feel constantly at risk or irresponsible if they don’t practice 100% safe sex or get tested regularly when with boyfriends. And sure, boyfriend often doesn’t mean monogamy, but we shouldn’t be constantly hinting at the fact that one’s boyfriend might be cheating.

    It’s not wrong for professionals to convey the consequences of sex to youth, but we also owe it to them to answer their questions directly, not get on our high horse and preach worst-case scenarios all the time. In this case, I don’t think an in-depth explanation of infertility is necessary, but I do think staying on topic is important. If I got such a response, I’d come away thinking, Gee, that was pretty harsh — and I’m not sure I’d respond for further inquiry. I’d feel attacked for being irresponsible and not likely to feel embraced when reaching out for help. Getting tested is great, and so is using protection. So is postponing sex, abstinence, and encouraging better communication amongst partners. But there’s a time and place for everything, and there’s also a need to give young and men all their options to reduce their risk — and this case, it would be the perfect time to explore withdrawal as a means to reduce pregnancy.