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OP45 ‘Sexual competence’ at first heterosexual intercourse: examining the prevalence and correlates of a context-based measure of first intercourse in a population-based sample of british 16–24 year olds
  1. MJ Palmer1,
  2. L Clarke2,
  3. K Wellings1
  1. 1Social and Environmental Health Research, London School of Hygiene and Tropical Medicine, London, UK
  2. 2Department of Population Health, London School of Hygiene and Tropical Medicine, London, UK

Abstract

Background The timing of first sexual intercourse has long been of public health concern and is most commonly defined in terms of chronological age, with ‘early’ sex typically described as that occurring before the legal age of consent. The concept of ‘sexual competence’ at first intercourse attempts to provide a more nuanced assessment of timing, focusing on the contextual attributes of the event, rather than simply age at occurrence. This study examines the prevalence of ‘sexual competence’ at first intercourse, and its correlates, among young people in Britain.

Methods The third National Survey of Sexual Attitudes and Lifestyles (Natsal-3) is a stratified probability sample survey of 16–74 year olds resident in Britain. Participants were interviewed in 2010–2012 using face-to-face, computer-assisted personal- and self-interviews. Participants were classified as ‘sexually competent’ at first heterosexual intercourse if the event met the following self-reported criteria: use of a reliable contraceptive method, autonomy of decision (not due to external influences), consensuality (both partners ‘equally willing’), and occurrence at the perceived ‘right time’. We examined the prevalence of ‘sexual competence’ by age at first intercourse, among 16–24 year olds. Using multivariable logistic regression, we explored associations between sexual competence and several potential explanatory factors; age at first intercourse, socio-economic position, source of sex education, discussion of sexual matters with parents, and characteristics of first sexual partner/relationship.

Results 22.4% (95% CI:17.4–28.4) of women and 36.2% (29.7–43.3) of men who reported first intercourse at age 13–14 were categorised as ‘sexually competent’, rising to 63.7% and 60.4% among those aged ≥18 at first intercourse. In adjusted analyses, lack of sexual competence was independently associated with: first intercourse before 16 (AOR: 1.91 (95% CI: 1.38–2.65) men, 3.00 (2.25–4.00) women), greater area-level deprivation, lower educational level, non-’steady’ relationship at first sex, being unsure of first partner’s virginity status, and among women only: reporting ‘friends’ as main source of sex education, and not discussing sexual matters with parents.

Conclusion A substantial proportion of young people in Britain lack ‘sexual competence’ at first intercourse. Though correlated, age at first intercourse does not explain all of the variability in sexual competence, suggesting that chronological age is an overly simplistic indicator of the nature of first intercourse – and supporting the future use of this measure in sexual health/behaviour research. This study also finds that inequalities in sexual health are reflected in the context of first intercourse, indicating that greater efforts are required to reduce the disparities that exist from the onset of sexual activity.

  • sexual health
  • young people
  • first intercourse

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