An Event Level Analysis of the Situational Factors Associated with Incomplete Condom Use

Background: When used correctly, condoms are highly effective tools for reducing the risk of STI and pregnancy. However, condoms are sometimes used incompletely, applied after intercourse begins or removed before intercourse ends.

Methods: To understand incomplete condom use, data were collected from 1,875 men during a prospective daily diary study of sexual behavior and condom use. Incomplete condom use was assessed during vaginal intercourse, considering situational, relational, intrapersonal and behavioral predictors. Analyses were performed using generalized estimating equation multinomial logistic regression with effects significant at p <.05.

Results: Of 29,714 diary reports, 30% (8,876) included vaginal intercourse. Analyses were conducted on 83.2% of these intercourse events (6,325) during which condoms were used and for which participants provided complete data. Incomplete condom use included penetration before applying condoms during 12% of events (749), removing condoms before intercourse ended during 3.1% (198) and both types of incomplete use during 2% (129). Erection quality (less than typical erect penile length and circumference, less rigidity, and difficulty maintaining erection) was associated with greater odds of incomplete use, as was a participant's history of other recent incomplete use. Perceptions of condom comfort and recent previous complete use were protective factors against incomplete use.

Conclusions: Incomplete condom use is associated with an individual's typical condom use patterns and also with men's physiological characteristics and their perceptions of condoms during sexual intercourse. Event-level analyses such as these help to understand why incomplete condom use occurs among individuals who are incorporating condoms into their sexual activities.