Dual method use at last sexual encounter: An episode-level analysis from a nationally representative survey of US men and women

Context & Background: Using condoms in conjunction with other contraceptives can increase protection against pregnancy and STIs. However, few analyses have 1) examined dual method use at the level of the sexual episode or 2) included men or explored gendered patterns in reporting. Methods: We analyzed dual use patterns using a nationally representative dataset of 18-44 year-olds in the US (N=662 men, 600 women). Respondents indicated which, if any, contraceptive methods they used at last vaginal intercourse. Results: Preliminary findings reveal that eight (7.8%) percent of respondents used a male condom plus a hormonal method at last vaginal intercourse, a figure that did not differ significantly by gender. However, only 60% of dual users reported condom use during the entire intercourse episode; 34% initiated intercourse without a condom, and 6% removed the condom during intercourse. Men were significantly more likely to report these condom errors. Moreover, not all respondents who used dual methods at last sexual episode had done so consistently: only 22% of dual users reported condom use in 10 out of the last 10 intercourse episodes, compared to 78% of condom-only users. Discussion: Many people classified as "dual users" in previous studies may not be using dual methods appropriately or regularly. Researchers and practitioners should inquire how and how often condoms are used when assessing and addressing dual method use. Furthermore, though men have rarely been surveyed about dual use, they may provide more accurate reports of condom practices such as late application or early removal.