Young women and limits to the normalisation of condom use: a qualitative study
Lisa M. Williamson*, Katie Buston and Helen Sweeting
MRC Social and Public Health Sciences Unit, Glasgow, UK
(Received 1 April 2008; final version received 25 June 2008)
Encouraging condom use among young women is a major focus of HIV/STI prevention efforts but the degree to
which they see themselves as being at risk limits their use of the method. In this paper, we examine the extent to
which condom use has become normalised among young women. In-depth interviews were conducted with 20
year old women from eastern Scotland (N?20). Purposive sampling was used to select a heterogeneous group
with different levels of sexual experience and from different social backgrounds. All of the interviewees had used
(male) condoms but only three reported consistent use. The rest had changed to other methods, most often the
pill, though they typically went back to using condoms occasionally. Condoms were talked about as the most
readily available contraceptive method, and were most often the first contraceptive method used. The young
women had ingrained expectations of use, but for most, these norms centred only on their new or casual partners,
with whom not using condoms was thought to be irresponsible. Many reported negative experiences with
condoms, and condom dislike and failure were common, lessening trust in the method. Although the sexually
transmitted infection (STI) prevention provided by condoms was important, this was seen as additional, and
secondary, to pregnancy prevention. As the perceived risks of STIs lessened in relationships with boyfriends, so
did condom use. The promotion of condoms for STI prevention alone fails to consider the wider influences of
partners and young women’s negative experiences of the method. Focusing on the development of condom
negotiation skills alone will not address these issues. Interventions to counter dislike, method failure, and the
limits of the normalisation of condom use should be included in STI prevention efforts.
Keywords: condoms; norms; young women; STI prevention; sexual behaviour
Recently, sexually transmitted infections (STIs), such
as Chlamydia trachomatis, have increased among
young women (The UK Collaborative Group for
HIV and STI Surveillance, 2006). Condoms offer
protection from these and their promotion is essential
to HIV and STI prevention in the UK Sexual Health
Strategies (Department of Health, 2001; Scottish
Executive, 2005). In the 2000 UK National Survey
of Sexual Attitudes and Lifestyles (Natsal, 2000) 80%
of 16?19 year olds and 76% of 20?24 year olds
reported condom use at first sexual intercourse
(Wellings et al., 2001). However, use appears to
decrease with age, and in the 2006/07 Office for
National Statistics Omnibus Survey only 39% of
20?24 year olds reported current condom use (Lader,
This paper describes condom use among a sample
of young women from eastern Scotland and explores
the factors they report are associated with use and
non-use of this method. We discuss how, although
condom use has, to some extent, been normalised,
this is limited by the young women’s risk perceptions
and actual experiences of use.
The findings in this paper come from a qualitative
study of young women’s patterns of contraceptive use
(Williamson, 2007). Interviewees were selected from
the SHARE (a randomised trial of a school-based sex
education intervention) sample. The intervention did
not improve condom use among those who received
SHARE sex education (Wight et al., 2002), and we
found no differences in the qualitative sample be-
tween those in the intervention and control arms of
the trial. Ethical approval was granted by the
Glasgow University Ethics Committee for Non-
Clinical Research Involving Human Subjects.
Purposive sampling was used to select a hetero-
geneous group of young women at age 20 with
different levels of sexual experience and from different
social backgrounds: based on father’s social class
(derived from occupation) and their own educational
attainment (both significantly associated with contra-
ceptive use in quantitative analyses of the SHARE
data), and area of residence (because of differences in
area) (Williamson, 2007). Demographic and sexual
experience characteristics of the 20 interviewees are
*Corresponding author. Email: Lisa@sphsu.mrc.ac.uk
Vol. 21, No. 5, May 2009, 561?566
ISSN 0954-0121 print/ISSN 1360-0451 online
# 2009 Taylor & Francis
shown in Table 1. The interviewees were evenly split
across the sampling frame groups. All but one of the
young women was white, reflecting the relatively
homogenous ethnic composition of the SHARE
sample. The interviewees reported a range of different
sexual experiences, but their contraceptive experience
was mainly limited to condoms and the pill.
The sample is over-representative of those poten-
tially exposed to greatest risk, given that 11 of the
interviewees (55%) had first had sex by age 16,
compared to 28% of 20?24 year old females in Natsal
2000 (Wellings et al., 2001). In the SHARE survey
data collected at age 18, the interviewees reported
comparable condom use at most recent sexual inter-
course to the rest of the sample (45 and 46%,
respectively), but considerably more pregnancy ex-
perience (30 and 16%). Also, three of the interviewees
(15%) reported motherhood before age 18 compared
with only 6% of 20?24 year olds in Natsal 2000
(Wellings et al., 2001).
Most of the interviews took place in the young
women’s own homes and were conducted in private
to ensure confidentiality. They were audio recorded,
averaged one hour in length, and covered their
sexual, relationship and contraceptive experiences.
The interviews were transcribed verbatim and the
young women were given pseudonyms.
All of the young women had used condoms but only
three reported always doing so. The rest had changed
to other methods, most often the pill, though they
typically went back to using condoms occasionally
(10 always used condoms with new or casual
partners). Most (17) had used a condom at first
sexual intercourse, but only five at most recent (two
with a new or casual partner and three with a
Factors encouraging condom use included social
norms and expectations of condom use and STI
prevention, and the accessibility of the method. Those
discouraging use were negative experiences of use and
expectations of stopping use with boyfriends. Each is
considered in turn.
Reasons for using condoms
Social norms and expectations of condom use and STI
Condoms were the first contraceptive method these
young women reported using. Most (15) reported
some expectation of condom use, particularly when
they first had sex or with new or casual partners. The
three with strongest expectations thought that it was
just what you should do. As a result, they always used
Table 1. Basic demographic and sexual experience char-
acteristics of the interviewees.
Sampling frame characteristics*
Two or more sexual partners by age 16
First sexual experience by age 16 (one
First sexual experience by age 18
Father’s social class
Educational attainment (at age 16)
Credit CSE grades$
General/foundation CSE grades
Area of residence
Rest of study area
Other demographic characteristics%
On own with (child/children)
In full-time education (college or
Age at first sexual intercourse (range)
Total number of sexual partners (range)
Casual sex partners
Coercive sexual experiences/abusive
Tested for STIs
Sexually transmitted infection
Experience of contraceptive use (ever use)%
Alternatives (e.g. injection)
Non-use (i.e. unprotected sex)
*As reported in survey data at age 16 or 18.
$CSE Grades are the exams at the end of statutory education, with
credit being the highest level.
%As reported at interview at age 20.
562L.M. Williamson et al.
‘‘I think it’s just kind of that’s what you just think
you’re gonnae do, there’s not kind of any objections
or anything. Cos it’s just what you should do ...’’
For this small group, condom use had become
normalised and they found it difficult to further
justify or explain their use.
Although the social norms of condom use were
intrinsically tied to the need for STI prevention, and
the condom is the only contraceptive that is also a
prophylactic; its contraceptive properties are still seen
as most important. The young women talked of being
more worried about pregnancy and the STIs they
worried about most were those that were easily
‘‘... HIV and AIDS is not something that I’ve ever,
I’ve never really considered that I could catch it. ...
when somebody says like, ‘but what if you catch
something?’, the first thing that pops into my mind is
like er, chlamydia or genital warts ...’’ (Kim).
For most of the young women, social norms of use
centred only on new or casual partners. There was
a sensethatnot using
partners was ‘‘not the most sensible thing to do’’.
Casual partners were perceived to pose a greater
STI risk because they and their sexual histories
were unknown. The need for STI prevention was
perceived to be limited to such partners, and the
influence of this factor was reduced in relationships
with boyfriends. Yet the distinction between casual
partners and boyfriends was often tenuous and
some said they would use condoms with casual
partners but not with partners classed as boy-
friends, even when they had relatively short rela-
tionships with them.
Condom use was reinforced by their accessibility.
Although sex education was identified as a source of
information on where to get condoms, it had little
bearing on use beyond this. Condoms were described
as the most obtainable contraceptive method and
availability was often cited as the reason for use at
‘‘... it’s like the most readily available, out of any
form of contraception, it’s condoms really. Em,
because you can just buy them anywhere really ...’’
It was also apparent from their accounts that
condoms were the only method that partners could
provide. Some young women relied on this, and
most (11) who used a condom at first sex said that
their partner had provided it. However, only four
went on to rely solely on their partners for
‘‘I never carry them, he always carried them. That
was his department to look after.’’ (Margaret).
For many, the decision to use condoms was reported
to be a joint one, but relying on partners to supply
condoms meant the young women could be subject to
pressure not to use them:
‘‘He was trying to be smart and said he only had one
condom and deliberately never put it on properly
and ... he’d says that it had come off and then I
stopped him. I knew, I wasnae that daft, I stopped
there and then.’’ (Fiona).
As they got older, most (16) of the young women
reported that they carried their own condoms:
‘‘I think because I always had one in my bag and
normally ... not that you’re drunk but I would
normally just kinda put it on the bed or throw it at
him or, like, well, ‘there you go’ kinda thing. And you
know, you see a few guys that are like ‘I’m not using
this’. It’s like ‘well, you either do or nothing’s gonnae
Others said they waited to see if their partner would
introduce the condom first, and then insisted on use if
this did not happen. None suggested that carrying
condoms was associated with having a negative
The accessibility of condoms combined with
ingrained expectations of use, meant that they were
most often the first contraceptive method the young
women used, yet most reported stopping use at some
Reasons for discontinuing condom use
Negative experiences of condom use
Fourteen of the young women reported their own,
personal dislike of the method, describing how
condoms interrupted sex and were ‘‘a moment killer’’.
Condoms also lessened their enjoyment of sex. Sex
did not feel as good with condoms because they
reduced the sensations:
‘‘I don’t know, they just don’t feel right. Just some-
thing weird about ... I don’t know, I think it’s cos I
know that they’re there sorta thing. It just doesn’t
feel right.’’ (Debbie).
For some, condom use even resulted in sex being
painful during or after the event. A minority also
reported finding condoms difficult and awkward to
AIDS Care 563
‘‘And then all the magazines that tell you they can
become a fun part of foreplay. Lies! Lies! They’re the
worst things. I’ve been having sex since I was 14 years
old and I still can’t put one on somebody properly.’’
This young woman also went on to talk about
how condoms were awkward to dispose of, parti-
cularly given that she stayed in shared student
It was not inevitable that condom dislike would
lead to non-use, and only three reported disliking
them so much that they would choose not to have sex
rather than to use them. However, the experience of
condom failure was more likely to lead to disconti-
nuation. Eight reported condoms breaking, bursting,
splitting, or slipping off:
‘‘... we just kept having like condom disasters. They
kept coming off and I was just, I think it happened, it
must have happened twice ...’’ (Tammy).
When this happened, condoms came to be seen as an
ineffective pregnancy prevention method. However,
none of the young women reported pregnancy or
STIs as a result of condom failure; all reported using
emergency contraception but only three had been
screened for STIs (and not as a result of the condom
Expectations of stopping condom use with boyfriends
Just over half (12) of the young women said they had
stopped using condoms within a boyfriend relation-
ship, often when they felt the relationship was well
enough established. There was no set timing for this,
with condoms being stopped after anything from a
few weeks to almost a year. Condom discontinuation
was seen as a demonstration of trust:
‘‘... at first we did use contraception [condom] but
then a couple of months into the relationship we were
like ‘nah, it’s alright now’, you know? [...] ... so
basically I had a wee discussion about that and said
we don’t need to use them any more, we’re quite safe
wi each other.’’ (Melanie).
However, only one young woman stopped using
condoms simply because she was in a relationship.
For the rest, this and negative experiences of use were
often combined. For example, Melanie, in addition to
trusting her boyfriend, particularly disliked the inter-
ruption of his stopping to put on a condom. This
pattern of condom discontinuation was frequently
repeated; if their relationship ended, the young
women would start using condoms with their next
partner, before again discontinuing use when trust
was established. Although they trusted that their
boyfriends did not pose an STI risk, they could not
always know for sure this was actually the case. Only
one young woman went for STI screening before she
stopped using condoms with her boyfriend.
Condom promotion is integral to STI prevention in
the UK and although many young women report use
at first intercourse, it generally decreases over time
(Darroch, Singh, Frost, & the Study Team, 2001;
Lader, 2007; Wellings et al., 2001). This pattern was
evident in the reports of the young women in this
study. Condom use was universal, but rarely con-
sistent, and whereas reasons for use were most
salient at first sexual intercourse and with new or
casual partners, reasons for non-use emerged with
The findings are from a small qualitative sample
within one particular geographical locality (eastern
Scotland) and caution should be taken generalising
beyond this population. Although this should be
considered when interpreting our results, our novel
finding that condom use has (to some extent) been
normalised at first sex and with casual partners, but
continued use is limited by negative experiences and
dislike of the method has important implications for
STI prevention. The following discussion concen-
trates on this finding (see Williamson, 2007 for
further contextualisation and discussion of all of the
young women’s experiences of condoms and other
For a few young women, consistent condom use
had become the perceived social norm. Belief in
positive social norms of condom use can encourage
use (Hatherall, Stone, Ingham, & McEachran, 2005;
HEA, 1999; Schaalma, Kok, & Peters, 1993), and
there are reports elsewhere of use becoming the norm
for some (Coleman, 2001; Lear, 1995; Maharaj &
Cleland, 2006). Although, for many it was the partner
who supplied condoms at first sex (Mitchell &
Wellings, 1998), most went on to carry their own
supply (without fear for their reputations) as they got
older and more sexually experienced. None suggested
this was associated with a negative reputation,
(Browne & Minichiello, 1994; HEA, 1999; Hillier,
Harrison, & Warr, 1998; Holland, Ramazanoglu,
Sharpe, & Thomson, 1998; Kirkman, Rosenthal, &
Smith, 1998; Lees, 1993; Stewart, 1999). Yet, for most
of the young women in this study the normalisation
of condom use was limited to new or casual partners.
Almost all reported using condoms with their casual
partners without question and it can only be surmised
that this is a result of the policy initiatives and health
the previous literature
564 L.M. Williamson et al.
promotion campaigns that have followed in the wake
of concern over HIV/AIDS and, more recently, STIs
in general (Department of Health, 2001; Scottish
Executive, 2005). However, most discontinued use
once in boyfriend relationships.
As pregnancy prevention was still required, the
young women changed to the contraceptive pill at
this stage (see Williamson, Buston, & Sweeting,
in press), and inability to maintain STI prevention
in relationships with boyfriends prevailed. Invulner-
ability to STIs, the greater salience of pregnancy
concerns, and discontinuation of condom use in
relationships with boyfriends (as a demonstration of
trust) have been widely reported (Abel & Brunton,
2005; Bauman & Berman, 2005; de Visser, 2005;
Hatherall et al., 2005; Hillier, 1998; Holland et al.,
1998; Lear, 1995). These remain important factors in
young women’s contraceptive decisions, but only one
young woman stopped using condoms simply because
she was in a relationship. For the rest, the (often
joint) decision to stop use was encouraged by
negative experiences of use.
Eight of the young women had experienced
condom failures; slightly higher than the 27?36%
failure rates reported in recent quantitative studies
(Crosby, Yarber, Sanders, & Graham, 2005; Crosby
et al., 2005; Hatherall et al., 2005; Sanders, Graham,
Yarber, & Crosby, 2003). Although frequency of
condom failure has been associated with greater risk
of STIs (Crosby et al., 2005), none of the young
women who experienced failure reported STIs. All
also appeared to have avoided pregnancy by using
emergency contraception. Higher condom failure
rates (40%) have been reported among young men
and women who report discomfort (including irrita-
tion, and loss of sensation and sexual pleasure)
during use (Crosby et al., 2005). Such discomfort
was a commonly reported reason for disliking con-
doms among the young women in this study, and it is
striking how many talked of this.
Female dislike of condoms is infrequently re-
ported in the literature (Crosby et al., 2005; Gavey,
McPhillips, & Doherty, 2001; Hammer, Fisher,
Fitzgerald, & Fisher, 1996; HEA, 1999). The focus
instead is generally in terms of male sexual pleasure
(Browne & Minichiello, 1994; Holland et al., 1998;
Measor, 2006). The descriptions of condom dislike
among those in this study were certainly similar to
those used by men, and centred on how condoms
reduced sensations, ruined the moment, and were
difficult to use (Flood, 2003), but the young women
were talking about their own sexual pleasure, and
their own enjoyment of sex.
Although condom discontinuation is pre-empted
by negative experiences of use, these were rarely
enough in themselves to lead to discontinuation
because they were countered by social norms of use
with new or casual partners. It is being in a relation-
ship with a boyfriend, and the trust implicit in this,
which allows the change to take place. Hence, the
normalisation of condom use is intrinsically limited.
Condom use is more likely when young people have
1999a; Coleman & Ingham, 1999b; Hatherall et al.,
2005; Sheeran, Abraham, & Orbell, 1999), and much
focus is given to the development of condom negotia-
tion skills in HIV/STI prevention. This alone may not
be enough to increase condom use and improve the
sexual health of young women (and young men)
because it fails to consider the wider influences of
their negative experiences. Imperfect use has been
associated with a lack of confidence in using condoms
(Hatherall, Ingham, Stone, & McEachran, 2007).
Greater promotion of condom use skills should
become a focus at distribution points. Interventions
to counter dislike, method failure, and the limits of the
normalisation of condom use should be included in
future HIV/STI prevention efforts.
Funded by the UK Medical Research Council as part of the
U.1300.00.005) at the Social and Public Health Sciences
Unit. We thank the 20 young women who took part in
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