Beltzer N, Moreau C, Bajos N
ORS Île-de-France, 21-23, rue Miollis, 75015 Paris, France.
Rev Epidemiol Sante Publique. 2011 Feb;59(1):15-21. doi: 10.1016/j.respe.2010.10.006. Epub 2011 Jan 21.
Despite the expanded range of contraceptive options and the fact that the first acts of intercourse are well protected, abortion rates among young women in France have increased in the last 15 years. These contraceptive failures could result from the lower effectiveness of the condom compared with the pill, and/or the occurrence of contraceptive gaps when switching from the condom to the pill. Adding to the existing literature, this paper explores the conditions by which women and men discontinue using the condom.
The study sample was comprised of 1552 men and 1849 women under the age of 30, who participated in the National Survey on Sexual Health in France. Respondents answered questions on contraceptive use, duration of condom use, condom discontinuation and the switch to another method of contraception at the time of condom discontinuation in the context of their first and last sexual relationships.
Condoms, used by a large majority of respondents during the first acts of intercourse, were rapidly discontinued in favor of other methods, particular the pill, for continuing relationships. However, one in ten respondents (women and men alike) had unprotected intercourse after condom discontinuation, when condom use was discontinued in the first trimester of their relationship. Abortions were more frequent among respondents who reported they did not use a condom at the start of a relationship or among women who did not switch to another form of contraception after discontinuing condom use.
While condoms are widely used during the first acts of intercourse, the rising abortion rates among young people suggests frequent contraceptive failures, which partly result from unprotected intercourse following condom discontinuation. These results question the dichotomy between HIV campaigns based on condom use and campaigns to reduce unintended pregnancies, which promote use of other forms of contraception, such as the pill. To reduce the incidence of unprotected intercourse, it would be important to promote the use of condoms at sexual debut, both as a contraceptive and preventive method against STIs, and provide counseling about all available contraceptive options, including the use of emergency contraception as a backup option in case of errors of use of the condom.
尽管避孕选择范围有所扩大，且初次性行为得到了良好保护，但在过去15年中，法国年轻女性的堕胎率仍有所上升。这些避孕失败可能是由于与避孕药相比，避孕套的有效性较低，和/或从避孕套改用避孕药时出现避孕间隔。为补充现有文献，本文探讨了男性和女性停止使用避孕套的情况。
研究样本包括1552名年龄在30岁以下的男性和1849名年龄在30岁以下的女性，他们参与了法国全国性健康调查。受访者回答了关于避孕方法使用、避孕套使用时长、停止使用避孕套以及在首次和最后一次性关系中停止使用避孕套时改用其他避孕方法的问题。
在初次性行为中，绝大多数受访者使用避孕套，但在维持恋爱关系时，避孕套很快就被其他方法取代，尤其是避孕药。然而，十分之一的受访者（包括男性和女性）在停止使用避孕套后有过无保护性行为，这种情况发生在恋爱关系的前三个月停止使用避孕套时。在开始恋爱关系时未使用避孕套的受访者中，或在停止使用避孕套后未改用其他避孕方式的女性中，堕胎更为常见。
虽然避孕套在初次性行为中被广泛使用，但年轻人堕胎率上升表明避孕失败频繁，部分原因是停止使用避孕套后发生无保护性行为。这些结果对基于使用避孕套的艾滋病防治运动与旨在减少意外怀孕、推广使用其他避孕方式（如避孕药）的运动之间的二分法提出了质疑。为降低无保护性行为的发生率，重要的是在首次性行为时推广使用避孕套，将其作为一种避孕方法和预防性传播感染的手段，并提供关于所有可用避孕选择的咨询，包括在避孕套使用失误时将紧急避孕作为备用选择。
