Views of a Sexually Active College-Age Couple

A candid interview details what two students learned about STDs, what they think about the behavior of fellow students, and what they suggest for physicians.

He: She's 18 and I'm 20. We're both Caucasians and in college. She's a freshman at a private, all girls' school and I go to a state school about an hour and a half's drive away.

She: I've known him for about three and a half years, and we've been seeing each other exclusively for six months.

He: She was a friend of my sister; she came over to stay overnight and I remember her as a quiet and subdued person; she was rather immature then and I didn't pay much attention to her. I went away then for a year of college. A year later, she had grown up a lot and wasn't all giggly and weird anymore. I realized she was intelligent, was more talkative; she was a woman!

She: I never really talked to him because he was sort of a recluse and read a lot and stayed in his room when I visited my girlfriend.

How have you learned about sexually transmitted diseases?

She: I've known about them in some form almost all my life. I learned a lot of that type of stuff then and all through school, and also I grew up with a doctor in my family. From elementary school on we covered AIDS and later (certainly by the 9th grade) STDs in detail.

I was tested for them because I was sexually abused as a tiny child, so I knew that they existed. I did a report on AIDS in about third grade, so basically I've always been sort of aware, even if not in detail. I've read books-my health book from high school had everything in it, a chart with all the STDs, cause and effect, signs and so on.

He: In primary school [about age 10], they had a company from outside the school come to teach human sexuality, and had us stick the body parts where they belong and watch videos. They taught us more about it in secondary school [ages 12-16], in home economics. That was in another country. Then when I came to the U.S. [11th grade], it never was mentioned in the classes of the high school I attended. When I got to college, it was talked about in my Courtship and Marriage (sociology class); also, my resident advisor had a meeting and had a person from the health department come; and in my Health Course which covers everything about sex and STDs.

What were some of the key things that stand out from what you learned?

He: We learned their names and the slang terms, like "clap". I remember that Hep B stays in the blood for eight days, and that you can get AIDS from breast milk.

She: We learned what kinds of condoms are best-latex is the best, and sheepskin condoms don't protect you. I learned you can get genital lice from sharing a towel or washing laundry together.

He: If you're allergic to latex, you can use the sheepskin with a latex or polyurethane condom over it.

Throughout your teen-age years, what was your contact with doctors?

He: I had regular contact with doctors for medical checkups-ingrown toenails, a bad stint of tonsillitis-seven times in one year, and later knee problems, which eventually resulted in surgery.

She: I lived with a doctor, had one for a neighbor, and several of my parents' friends were doctors. Also I went for annual checkups and 3-4 times a year for ear infections or other minor illnesses.

Did the doctors talk with you about your own sexual behaviors or practices?

He: Not until I went and asked to have an STD checkup. I went because my girlfriend wanted me to. She was concerned about the history of my other partners. I didn't know whether my previous girlfriends had told me the full truth about their lives, other relationships.

I went during my sophomore year in college. The doctor asked me why I wanted to be tested, questions about my sexual history, about body and ear piercing, and if I did drugs, had sex with men, and other questions in an anonymous questionnaire scantron form. She took some blood to test for syphilis, AIDS and Hep B. She put a small metal Q-tip down the shaft of my penis and wiggled it around to get tests for gonorrhea, chlamydia, and whatever else.

Basically, from when I started to have sexual contact around age 15 or 16, they never really asked me. They really didn't check anything in the sports checkups either.

She: Being a girl, anytime you go in for the flu or any stomach illness, one of the first questions asked is if you're sexually active, menstrual cycles, etc. I think I was first taught about breast exams when I was about 13; my doctor talked with me about sexuality at that time.

When I was 17, I went to get birth control pills because I was considering becoming sexually active in the near future; they did a pregnancy test even though I wasn't sexually active!

It was a standard procedure, along with a Pap smear. They talked to me about the importance of using a condom, especially during the first few months on the pill, and how antibiotics might interfere with the pills' effectiveness. They may have talked a little about STDs at that time, but not much.

Tell me about how you decided to become sexually active.

He: I was curious. It was an older woman, and I was curious what it would be like. I wasn't thinking about STDs.

She: I was in love, and I don't know, I guess I cared deeply about the person whom I had been dating for a year and a half at that point and felt ready. I was 18. My [former] boyfriend had been tested for STDs at my request, and I'm not real sure now whether he was tested far enough after the last time, because he cheated on me once during our relationship.

What considerations went into your decision to become active with one another?

She: We had talked about pregnancy, STDs, sexual history, emotional connections and intimacy, and abortion beliefs for about an hour or two that day, plus before. Also, we talked about what we would do if I got pregnant, if one of us got an STD and, most importantly, whether we were really ready. It was important for us to have compatible beliefs and ways of dealing with undesired consequences.

What do you observe about decisions by other college students to become sexually active?

He: Half of them don't think and don't care. My roommate has had 7 different women in his bed his first semester. And he's only washed his sheets once that whole time!

A lot of time it's unplanned. I think most college women should be on pills because they either choose to have sex at the last moment or they get drunk and go with the flow. Especially freshmen; my father has a name for them: "fresh meat."

I think it's rather sad; they just don't care. So many go downtown and get drunk, they have unprotected sex. The chance of getting STDs is really high.

She: I agree, because I think love is an important part of sex. For example, my roommate had a pregnancy scare this semester. It makes me sad, especially since she confided in me that if she got pregnant, her first thought of dealing with it would be suicide-because her parents had told her if she ever got pregnant to never set foot in their house again. And, she didn't feel her boyfriend would have believed it [the pregnancy] was his.

What do you observe about other students' knowledge of STDs?

Both: Most know about them, that they exist, but choose to ignore the consequences, or just don't think about it.

What about their behaviors related to this? And their experiences with physicians about STDs?

She: The two worst things I have heard of physicians doing is commenting, "How did a good girl like you end up with something like this?" or generally making somebody uncomfortable. Also, it annoys me when I go in for an unrelated thing like an ear infection and the first thing they ask me is "When was your last period?" or "Are you sexually active?" If it's not related, why ask?

He: None of them really talk about that. Most of them are familiar with the movie, The Hand that Rocks the Cradle, a movie about a gynecologist who abused his position; it would turn me off about going to see a doctor. It gives the impression that some doctors are perverts, and you never know which one it is.

If you could communicate something to help physicians be more attuned and effective in their work with teens and young adults about STDs and issues related to sexuality, what would you tell them?

She: Take time to treat the person-and a person, not a number. Take time to explain why you're asking and doing things.

He: There's not much they can really do. The parents are often the biggest problem-like the friend of my girlfriend's roommate. Parents are so judgmental! That makes it real hard. If you can't talk to your parents, who can you talk to?

She: Be very straightforward about telling the teen what will and won't show up on their parents' billing statements. If the teen thinks the parents will find out and the parents are judgmental or it will upset them, they won't go to the doctor.

He: Also, kids have problems with embarrassment to buy condoms at stores. I sometimes buy them for my sister. As for me, I'd rather be safe, no matter what anyone thinks.

GStoodt@dhs.ca.gov