Sex isn’t always safe at Yale

Sex isn't always
safe at Yale.

Exploring the numbers behind sexual health on campus.

Published on January 23, 2015

In one of the first activities that all Yalies share in their college years, freshmen are taught to put a condom on a wooden, phallus-shaped object. Be safe — that is the message the exercise is supposed to convey.

But that message may not be taking root in students’ minds.

In a News survey on sexual health practices, completed by 241 students, 175 respondents said they were sexually active. Of these students, many reported engaging in sex without a condom and using methods of contraception that are widely considered to be ineffective. Public health experts at Yale and physicians who specialize in student health said that rates of unprotected sex on campus are worrisome.

EDITOR'S NOTE:

On Jan. 13, the News sent a 31-question survey to 757 randomly-selected undergraduates from every residential college and class year. Each respondent was guaranteed anonymity, in an attempt to ensure the sincerity of the survey’s results, which are reported here.
 
*Name has been altered to protect the identity of the student source, who spoke on the condition of anonymity due to the sensitive nature of the interviews conducted.

CONDOMS AND HEALTH

Not enough Yalies are using condoms to prevent STI infection. 

Of 139 sexually active survey respondents, almost one quarter said they rarely or never use condoms to prevent STIs. Thirty percent said they use condoms only some or most of the time, and 47 percent of students said they always use condoms. 

Interviewees’ experiences reflect these statistics. Johnny*, a freshman, said that he has had multiple, one-night stands with partners who were happy to engage in intercourse without a condom.

“I was shocked,” he said. 

But Director of Yale Health Paul Genecin and Chief of Student Health and Athletic Medicine at Yale Health Andrew Gotlin were not. Gotlin said he was unsurprised by the survey numbers showing the percentage of students who do not use condoms during sex, as they matched what he sees clinically. 

Genecin said that since the majority of sexually active respondents were monogamous, putting them at a lower risk of contracting STIs, Yalies with multiple sexual partners may produce very different results if surveyed. 

“It seems like very few people had more than one sexual partner,” he said, adding that the number of students who reported having more than one regular sexual partner is the demographic that worries him most. 

Of those who have reported not using a condom at some point, personal or partner preference for unprotected sex was the most common reason for foregoing condoms. 

Annabelle*, who never uses condoms with her boyfriend, is one of those students. 

“It just feels better,” she said. 

Not having a condom readily available was also an issue for some. In fact, a quarter of the sexually active students surveyed said they do not keep protection immediately accessible. 

“I just feel that the risks [of unprotected sex] completely outweigh the benefits of 20 minutes of slightly increased pleasure.”

—Jordan*

Jordan*, a freshman who in the past has gotten most of his condoms from the plastic bag in his entryway, said that, at times, condoms ran out. In contrast to the 30 percent of sexually active students surveyed who have opted to have sex despite the unavailability of condoms, Jordan decided to abstain on those occasions. 

“I just feel that the risks [of unprotected sex] completely outweigh the benefits of 20 minutes of slightly increased pleasure,” he said.

STIs: (NOT) PASSING THE TEST?

Even with a low-risk sample population — students who are typically having sex with just one partner — around 4 percent of Yalies surveyed admitted to having had an STI at some point.

Of those surveyed who have had penetrative or oral sex, there were 22 reported cases of an individual having a specific STI. Two percent of the 175 students surveyed said they had chlamydia, 2 percent reported having HPV and three students reported being HIV-positive.

Carl* has been diagnosed with chlamydia twice during his college years. 

Before those diagnoses, he did not take his sexual health seriously — there were times when, during anal sex, he did not use a condom with his partners, he said. Only after being diagnosed for the second time did he begin to research STIs and safe sex practices.  

Four percent may seem like a low prevalence for STIs, but 29 percent of sexually active  students surveyed said they did not know their STI status — they had never been tested, meaning that it is possible that the rates of infection are higher. In addition, 39 percent of students have not been tested in the past six months. 

The reasons that sexually active  students provided for not getting tested varied, but some fell within the following categories: they were too busy, Yale Health is too far away or they had never enaged in unprotected sex. Most, though, said they had not gotten tested because it simply was not common within their social groups. 

“I think people need to have a group of friends who think it’s a normal thing to do,” Sam Dealey ’15 said. “That will affect whether you [get tested].” 

Genecin said that while most Yale students will get tested at least once during their four years at Yale, some students are less open about it than others.

“Often people say they are coming in for something else, and then ask for STI testing [when they get there],” Genecin said. Some students simply feel more comfortable asking a clinician in person than telling the receptionist, he added.

STI tests are free to all Yale students — even those who have waived the Yale Health Hospitalization-Specialty Coverage — and, according to Carl, the test itself is easy. Schedule an appointment, urinate in a cup and wait for the results, he said, adding that he only waited four days for his.

He thinks that to increase testing rates, Yale Health should set up a yearly or semesterly clinic in an open part of campus, like Woolsey Hall or Commons, similar to the way it administers flu shots. Right now, he said, Yale Health is not doing enough to inform students of what it offers.

While Gotlin acknowledged the important role of health care providers in STI prevention and treatment, he said that students need to be proactive and ask about their partners’ sexual health histories before intercourse.

Twenty-two percent of sexually active  students surveyed have never asked about their partners’ sexual histories or STI statuses.

Annabelle, who cited the cultural stigma around talking about STIs, said she has felt uncomfortable asking a person about their sexual health history.

“I guess I don’t always [ask] because sometimes it’s awkward to bring it up in that time frame,” one male student added.

He added that he does not ask about sexual health history when he is receiving oral sex, but typically asks when he is giving.

Acknowledging that asking can be awkward, Gotlin offered strategies. When a student newly diagnosed with herpes asked Gotlin how to discuss STI status with future partners, Gotlin responded that it is best to ask openly and regularly.

“I suggested saying, ‘I do this as a matter of rote. I ask this of everybody so this isn’t a personal question,’” Gotlin said.

PREGNANCY AT THE FORE

For many women, though, STIs are not the primary concern. Pregnancy is. Indeed, while 76.71 percent of sexually active female students surveyed are on birth control, only 55.97 percent regularly use condoms. 

The discrepancy in numbers does not come as a surprise to Jill Carrera ’17, who uses the pill but not condoms. 

“I would definitely say that people on campus are just more concerned about pregnancy than STIs,” she said.

Such sentiments were echoed by all nine women interviewed.

“Undergrads are very young and are unlikely to reach a situation where it’s realistic and pragmatic to have a child and go forward with life plans,” said Genecin, in response to suggestions that pregnancy is less desirable than an STI infection.

Thirty-four percent of sexually active  female students surveyed said they had experienced a pregnancy scare at some point in their lives. Students interviewed attributed their worries to condom breakage, missed periods and having sex while drunk.  Twenty-seven percent of students surveyed said a broken condom was the cause of a legitimate pregnancy scare.  

During one of her first sexual experiences with her current boyfriend, Lila* discovered that the condom had broken. Though she worried that she might have gotten pregnant, she was too scared to admit the possibility to herself and ended up not using emergency contraception. 

“I would definitely say that people on campus are just more concerned about pregnancy than STIs”

—Jill Carrera '17

“I probably should have [taken the morning after pill],” she said. “It’s interesting what inertia and uncertainty will lead you not to do.” 

While Annabelle did not think twice before using Plan B after a condom had broken, she worries that other women misuse it and take it as an alternative to preventive contraception. 

Fifteen percent of sexually active  female students surveyed had used Plan B at least once, averaging 2.4 uses per person. The highest usage for one person was 11 times. 

Gotlin said he is concerned about what he identifies as a misconception that condoms are for pregnancy and not STIs. 

“The implication is that if people are not worried about pregnancy [because they are on birth control, for instance], people won’t use condoms,” he said. 

Genecin suggested that because today’s college generation did not experience the AIDS epidemic, instead living through a preoccupation with teen pregnancy, they struggle to internalize the dangers of unprotected sex. 

“People these days think HIV is a risk from an older generation,” he said, adding that there is a lack of concern about STIs across age groups.

NOT TAKING NECESSARY PRECAUTIONS

Students may be worried about pregnancy, but some are not taking the recommended precautions — for either pregnancy or STIs. Fourteen percent of respondents rarely or never use any form of contraception, 7 percent use contraception only sometimes and 23 percent use contraception during most but not all of their sexual encounters. 

For those who are not using the recommended forms of contraception — the ones widely considered to be effective — the rhythm and withdrawal methods are the main alternatives. Thirty-five percent of sexually active  students surveyed, who did not always use protection from condoms, said they had used either the rhythm or withdrawal method at some point.

Abdi* said those numbers were not particularly baffling — most members of his senior society confessed to having used one of those methods before. 

“I’m not at all surprised, but I would not at all use [them] myself because I’m not a dumbass,” he said. 

“If I was in the jungle and didn’t have a condom, sure,” said Dwayne*, a sophomore. “But since we have technology it’s best not to use what people in Ancient Rome used when they didn’t want kids,” he said. 

As a Community Health Educator, Carolyn Collado ’16 said she never recommends using the withdrawal method to avoid pregnancy. 

According to a study from the Office of Population Research at Princeton University, after using the withdrawal method for one year, 22 in 100 women will become pregnant. After using it for 10 years, 92 in 100 women will become pregnant. 

Marah* is one of those students who uses the rhythm and withdrawal methods. She tracks her cycle with a cell phone application, and said she knows when it is safe for her to have sex without risking getting pregnant.

The main reason Marah has not opted to take a birth control pill or have an IUD inserted is because she does not want to overload her body with “unnecessary hormones,” she said. 

Her decisions about her sexual practices do not sit well with her friends, who urge her to use condoms. But Marah said that she finds their admonishments hypocritical — most of them, she said, do not use condoms, even though they are having sex with multiple partners with whom they have not had conversations about STI status. 

But friends are not the only ones opposed to the rhythm method. According to Gotlin, stresses that exist in academic environments can make predicting ovulation particularly difficult.

“It’s neither accurate nor reliable,” he said. “I would not bet my pregnancy prevention method on the rhythm method.”

IS YALE’S SEX ED SUFFICIENT?

While sex education at Yale levels the playing field for students coming from places all across the country and world, it does not continue the conversation, students interviewed said.

“I don’t think sex education at Yale is entirely great,” said one student. “I just realized in this interview that I don’t know about STIs that could be passed through oral sex.”

Another student, Joshua McGilvray ’18, said he had no education about the mechanics of sex while at an American boarding school for two years. He said he worries about students’ range of sexual knowledge.

“Schools are so deregulated [in America]. You can’t count on good sex education happening in high school,” he said. “It seems worthwhile to continue with consent education and teach people about contraception.”

Rachel*, who grew up in rural Mississippi, is one of those students about whom McGilvray is concerned. She only received abstinence-only education at her public high school. Her STI education, she said, consisted of the teacher saying the students would be “hurting everyone around them by having sex.” He proceeded to show the students “horrible and graphic” images of STI infections, she said.

Gotlin noted that education about safe sex should not consist of dissuading people from having intercourse.

“Abstinence is a yucky option — who wants to do that?” Gotlin said.

Eduardo*, a senior who grew up in Miami, falls on the opposite side of the spectrum. The city, he said, is a “hotbed for venereal disease,” so he had a comprehensive sex education that included lessons about protection, the effects of STIs and the importance of always wearing a condom.

One of the obstacles students recalled facing in their middle school sex education is the gender divide in who learns what. Alexandra* said that, in middle school, she was brought into a separate room from the boys and taught her own anatomy and reproductive cycle. Meanwhile, the boys sat in the other room learning about theirs.

She said this division makes communication between heterosexual partners difficult. They are simply less aware of how each other’s anatomy works.

“I don’t think sex education at Yale is entirely great. I just realized in this interview that I don’t know about STIs that could be passed through oral sex.”

Eduardo, whose sex education was relatively comprehensive, said he was unaware of the different birth control options women have until recent conversations with female friends.

Steven*, a biology major, did not know that contraception is necessary at all points during a woman’s menstrual cycle. He asked if it was possible for a woman to get pregnant during her period. It is.

While Collado said she feels the CHE program is important to level the knowledge playing field for all freshmen, Sexual Literacy Forum co-director Jez Marston said it is important to have continued conversations about how to communicate and ask difficult questions during sexual encounters. He said he did not know much about female birth control until he began participating in SeLF his junior year.

“We can see it’s reasonable to enhance our sex education [at Yale],” Gotlin said, talking about the survey results.

According to Rachel, that sex education needs to touch on more than medical aspects of sexual health.

“Safer sex also goes into taking care of your partner during the act. [It] involves communication,” she said. “[It] doesn’t end with STDs and pregnancy.”

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