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塞尔维亚贝尔格莱德异性恋男性不使用避孕套的原因。

Reasons for not Using Condoms among Heterosexual Men in Belgrade, Serbia.

作者信息

Bjekić Milan, Sipetić-Grujičić Sandra, Vlajinac Hristina, Nikolić Aleksandra

机构信息

Milan Bjekić, MD, City Institute for Skin and Venereal Diseases , Džordža Vašingtona 17, 11000 Belgrade, Serbia;

出版信息

Acta Dermatovenerol Croat. 2018 Apr;26(1):58-60.

Abstract

Dear Editor, Proper and consistent use of male condoms can be a highly effective method of preventing the transmission of sexually transmitted infections (STIs) and HIV (1), but this method relies on men's willingness and ability to use condoms. In the United States of America, about 20% overall and less than 50% of adults with multiple partners used a condom at last intercourse (2). In Serbia in 2013 (3), 50.0% of women and 62.5% of men aged 15-49 who had more than one partner in the past year used a condom during their last intercourse. Heterosexual men often use condoms to prevent pregnancy rather than the transmission of venereal diseases (4). For better public promotion of condom use, it is necessary to know the reasons for its inconsistent or incorrect use. With this in mind, we asked 200 consecutive chlamydia-positive heterosexual men admitted to the City Institute for Skin and Venereal Diseases in Belgrade to complete an anonymous questionnaire, taken from a Danish study (5), about their attitudes to/or experience with condoms. Patients were divided into two groups; Group I consisted of 109 (54.5%) men who reported that they had never or sometimes used condoms during intercourse and Group II consisted of 91 (45.5%) men who had used a condom often or always. The majority of participants (68.5%) were ≤30 years old, while the rest were older. The analysis of differences between these two groups was performed using a chi-square test. Attitudes concerning use of condoms are presented in Table 1. The majority of our participants (43.5%) did not use a condom because they had sexual intercourse with regular partners. This may be explained by trust and misperception of risk of contracting STIs during sex with a regular partner or lack of discussion with the partner about condom use. The results of another study about condom use with a steady partner (6) have shown that 31% of participants reported using condoms consistently with steady partners. The second most frequent reason for not using a condom in our participants was the statement that condom decreased sexual pleasure. Several studies (7,8) have reported that this is one of the main reasons for not using a condom. In Randolph et al. (9), both women and men rated unprotected vaginal intercourse as more pleasurable than protected vaginal sex. In particular, men believe that condoms reduce sexual pleasure and they are less likely to use them in practice. Condom-associated erection problems or problems with condom fit were reported by 42% of our participants (items 1, 14, 15 in Table 1). Several studies have shown that men experiencing condom-associated erection problems practiced unprotected vaginal intercourse significantly more frequently than men who did not experience this problem (10,11). Although alcohol use has been found to be an independent and important risk factor for unprotected sex (5,12), only 5.5% of our participants reported that alcohol intake was the main reason for not using a condom. In the present study, participants who had never or sometimes used condoms reported significantly more frequently that they forgot to bring or even use a condom when it was available, which illustrates their risky behavior and unwillingness to use a condom. Patients who had often used a condom reported condom failure significantly more frequently because of their partners refusing to use it. Since men believe more frequently than women that condoms reduce sexual pleasure, the question is whether they could not persuade their partners or find a good excuse not to use it. In summary, the results of the present study indicate the main factors that should be considered when promoting condom use. Such promotion should include advice about using condoms, a demonstration of correct use, and provision of condoms to the patient.

摘要

尊敬的编辑

正确且持续使用男用避孕套是预防性传播感染(STIs)和艾滋病毒(HIV)传播的一种高效方法(1),但该方法依赖于男性使用避孕套的意愿和能力。在美国,总体上约20%的成年人以及不到50%的有多个性伴侣的成年人在最近一次性交时使用了避孕套(2)。2013年在塞尔维亚(3),过去一年有多个性伴侣的15 - 49岁女性中,50.0%的人在最近一次性交时使用了避孕套,而男性为62.5%。异性恋男性经常使用避孕套来预防怀孕,而非预防性病传播(4)。为了更好地向公众推广避孕套的使用,有必要了解其使用不一致或不正确的原因。考虑到这一点,我们让连续200名被贝尔格莱德市皮肤性病研究所收治的衣原体阳性异性恋男性填写一份源自丹麦一项研究(5)的关于他们对避孕套的态度或使用经历的匿名问卷。患者被分为两组;第一组由109名(54.5%)男性组成,他们报告在性交时从未或有时使用避孕套,第二组由91名(45.5%)男性组成,他们经常或总是使用避孕套。大多数参与者(68.5%)年龄≤30岁,其余年龄较大。使用卡方检验对这两组之间的差异进行分析。关于避孕套使用的态度见表1。我们的大多数参与者(43.5%)不使用避孕套是因为他们与固定性伴侣发生性行为。这可能是由于信任以及对与固定性伴侣发生性行为时感染性传播感染风险的误解,或者是与伴侣缺乏关于使用避孕套的讨论。另一项关于与固定伴侣使用避孕套的研究(6)结果表明,31%的参与者报告与固定伴侣始终使用避孕套。我们的参与者中不使用避孕套的第二常见原因是称避孕套会降低性快感。多项研究(7,8)报告这是不使用避孕套的主要原因之一。在伦道夫等人(9)的研究中,男性和女性都认为无保护的阴道性交比有保护的阴道性交更愉悦。特别是,男性认为避孕套会降低性快感,并且在实际中他们使用避孕套的可能性更小。42%的参与者报告了与避孕套相关的勃起问题或避孕套尺寸不合适的问题(表1中的第1、14、15项)。多项研究表明,有与避孕套相关勃起问题的男性进行无保护阴道性交的频率显著高于没有此问题的男性(10,11)。尽管已发现饮酒是无保护性行为的一个独立且重要的风险因素(5,12),但我们的参与者中只有5.5%报告饮酒是不使用避孕套的主要原因。在本研究中,从未或有时使用避孕套的参与者更频繁地报告他们在有避孕套时忘记携带甚至使用,这说明了他们的危险行为以及不愿意使用避孕套。经常使用避孕套的患者更频繁地报告避孕套失败是因为他们的伴侣拒绝使用。由于男性比女性更频繁地认为避孕套会降低性快感,问题在于他们是否无法说服伴侣或找到不使用的合适借口。总之,本研究结果表明了在推广避孕套使用时应考虑的主要因素。这种推广应包括关于使用避孕套的建议、正确使用的示范以及向患者提供避孕套。

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