Is 'sexual competence' at first heterosexual intercourse associated with subsequent sexual health?

Melissa J. Palmer, London School of Hygiene and Tropical Medicine (LSHTM)
Lynda Clarke, London School of Hygiene and Tropical Medicine (LSHTM)
Kaye Wellings, London School of Hygiene and Tropical Medicine (LSHTM)

The timing of first sexual intercourse has long been a dominant focus of research on the sexual behaviour of young people. This is most commonly defined in terms of chronological age at the event. Some have argued for a more nuanced concept of readiness and appropriateness of first sexual intercourse, one that takes account of individual differences. This study explores whether the construct ‘sexual competence’ at sexual debut is associated with aspects of subsequent sexual health status in a population-based sample of British 16-24 year olds. Data from the third National Study of Sexual Attitudes and Lifestyles (Natsal-3) were analysed using multivariate logistic regression. Respondents were classified as having been ‘sexually competent’ at sexual debut if their first sex was characterised by the following four criteria: contraceptive protection (use of condom and/or pill at the time), autonomy of decision (not due to external influences), consensuality (both partners ‘equally willing’) and acceptable timing (that it happened at the ‘right time’). Indicators of sexual health included reported STI diagnosis, HPV urine test, unplanned pregnancy, low sexual function, and experience of non-volitional sex. Lack of sexual competence at first sexual intercourse was found to be associated with each of these sexual health indicators independently of age at sexual debut and other potential confounding factors among females. These findings provide an empirical basis for a shift in the focus of research and intervention concerned with young people’s sexual behaviour, from the current preoccupation with chronological age to greater emphasis on the circumstances and experience of transitioning into sexual activity.