The rates of sexually transmitted infections (STIs) and unintended pregnancy remain unacceptably high among teenagers and young adults, particularly underrepresented minorities.1,2 Studies have found that sexual behaviors such as discussion and use of condoms and hormonal contraception, which contribute to these STI and unintended pregnancy rates, differ by relationship type3–8; however, the research in this area has many methodological challenges and has predominately focused on the behavior of women.9 Thus, it is important to examine those behaviors and how they may differ by relationship type in men.
We examined in a cohort of young men the frequency of different relationship types and their association with sexual and reproductive health behaviors and communication.
As part of a study assessing attitudes regarding advanced provision of emergency contraception and health care, male participants (n = 327) aged 16 to 36 years reported on a specific relationship within the 12 months before the study. Inclusion criteria for the main study included having had sex with a woman or planning to do so within 12 months and being able to read English or Spanish. The questionnaire was self-completed; therefore, data are occasionally missing but never amounting to more than 10% of the entire questionnaire.
In a question that asked men to describe their relationship with the last woman with whom they had sex, the 8 choices given were as follows: girlfriend (GF), mother of my child (MOC), friend with benefits (FWB), someone that I have sex with, ex-GF, someone who I might want to have a romantic relationship with, a one-night stand, and someone I paid to have sex with.10 The investigators developed these choices based on previous work with female participants. For purposes of the present study, the men interpreted the terms on their own. Sexual history questions included the following: number of female partners in the last 12 months, whether they had ever had an STI, and frequency of condom use on a 5-point scale, which was collapsed into a 3-point scale during analyses. They also were asked whether the last woman with whom they had sex used a hormonal method of contraception, with response choices: no, yes, do not know. Also with regard to their last female partner, men were asked about their discussions of condom and contraception use and, for each, given the following choices: never discussed it, discussed before vaginal sex, or discussed after vaginal sex.
For the purpose of analysis, the relationship types were collapsed into 5 classifications as follows: (1) GF, (2) ex-GF and MOC (ex/MOC), (3) FWB (4) sex partner, and (5) “someone I might have a romantic relationship with,” one-night stand, and “someone I pay to have sex with” (not ongoing relationship, or NOR). GFs implied a committed relationship. Ex-GF and MOC were collapsed because in both, it was presumed that there had been a past emotional connection, and analyses suggested no differences on the outcome measures between them. Friends with benefits indicated a connection/friendship with the addition of sex and the assumption that the friendship would continue even if the sexual relationship did not. Sex partner reflected an ongoing sexual relationship and the assumption that the relationship would not continue if the sex stopped. The NOR category contained very different relationship types; however, they were similar in that they represented relationships that were not ongoing. In addition, it was assumed that if a relationship was established (i.e., it was ongoing), then it would have been described as a GF or some other category. Finally, the cell sizes for each type were too small to analyze independently.
Data were analyzed by comparing the 5 collapsed relationship categories with the variables of interest using a χ 2 test.
The 327 men were recruited from a New York City Young Men’s Clinic (n = 163), Baltimore City Health Department STI clinics (n = 140), and a Baltimore university-based adolescent clinic (n = 24). The men were primarily African American (n = 166; 51%) and Hispanic (n = 134; 41%), followed by other (n = 15; 5%) and white (n = 11; 3%). They had a mean (SD) age of 24.7 (5.1) years. Most African American men were from the Baltimore sites, and most Hispanic men were from New York City. This was a high-risk group, with more than 50% of the sample reporting having had an STI history.
Men reported all 8 types of relationships, with the most common being GF (n = 144; 44%) and the least common being “someone I pay to have sex with” (n = 3; 0.9%). The specific breakdown is presented in Table 1.
The significant results are presented in Table 2. Nonsignificant results included age and timing of condom use discussion. With regard to sexual history, there were significant differences for number of partners in the past 12 months (χ 2 = 36.1, P < 0.01), STI history (χ 2 = 9.58, P < 0.05), and condom use frequency (χ 2 = 22.8, P < 0.01). Those men whose last partner was a GF had fewer partners, and men who reported their last partner as a FWB or a NOR had more partners in the last 12 months. Those with an ex/MOC were more likely to have an STI history than those with GFs. Condom use was reported with lower frequency (rarely/never) in men with GFs as opposed to those with an ex/MOC and those with sex partners.
Specific to their most recent female partner, knowledge of partner’s hormonal birth control use (χ 2 = 25.2 P < 0.01), and the timing of conversations about birth control were significantly different (χ 2 = 17.1, P < 0.03). Men with FWBs and NORs were less likely to know if their partners were using contraception. Men with GFs were more likely to report that their GFs were not using hormonal methods. Men with NORs were also more likely to never speak to partners about contraception in contrast to men with GFs.
These results add to our understanding of men’s relationship types and their sexual behaviors. All 8 types were endorsed by at least a few men, and meaningful differences in sexual behavior were found when collapsed into 5 types. The results of this study support that although GFs were the most commonly reported relationship type, there were many types of “casual” relationships. These casual relationship types may have consistent but different profiles and are associated with both differences and similarities in communication and behavior in the current relationship. For example, men with FWBs and ex/MOC had high rates of STI histories, and many of them were inconsistent condom users. Understanding how men view these relationships differently from those that are not ongoing, which were also associated with risk, may help provide appropriate counseling for all relationship types. For example, the barriers for using condoms may be different with a woman with whom one has a past or current connection (e.g., with FWBs and ex/MOC) from those with a woman with one-night stand.
The current results are limited by the small sample size in some of the cells and the use of data that was collected for another purpose. In addition, the researchers used previously developed relationship categories and did not solicit the voice of men as to how they would describe and differentiate their relationships.10 Thus, when types were combined, it was done based on the researchers’ assumptions. Despite these limitations, these results provide an initial step in describing the relationship types and associated sexual risk among a group of primarily minority young men, an understudied but important factor in the high rates of STIs and unintended pregnancy in the United States.
1. Centers for Disease Control and Prevention. Sexually Transmitted Disease Surveillance. Atlanta, GA: U.S. Department of Health and Human Services, September 2011. 2010.
2. Finer LB, Zolna MR. Unintended pregnancy in the united states: Incidence and disparities, 2006. Contraception 2011; 84: 478–485.
3. Ellen JM, Cahn S, Eyre SL, et al. Types of adolescent sexual relationships and associated perceptions about condom use. J Adolesc Health 1996; 18: 417–421.
4. Fielder RL, Care MP. Prevalence and characteristics of sexual hookups among first-semester female college students. J Sex Marital Ther 2010; 36: 346–359.
5. Noar SM, Webb E, Van Stee S, et al. Sexual partnerships, risk behaviors and condom use among low-income heterosexual AfricanAmericans: A qualitative study. Arch Sex Behav 2012; 41: 959–970.
6. Lehmiller JJ, VanderDrift LE, Kelly JR. Sex differences in approaching friends with benefits relationships. J Sex Res 2011; 48 (2–3): 275–284.
7. Ellen JM, Adler N, Gurvey JE, et al. Improving predictions of condom behavioral intentions with partner-specific measures of risk perception. J Appl Soc Psychol 2002; 32: 648–663.
8. Manlove J, Ryan S, Franzetta K. Contraceptive use patterns across teens’ sexual relationships: The role of relationships, partners, and sexual histories. Demography 2007; 44: 603–621.
9. Short MB, Catallozzi M, Breitkopf CR, et al. Adolescent intimate heterosexual relationships: Measurement issues. J Pediatr Adolesc Gynecol 2013; 26: 3–6.
10. Rosenthal SL, Short MB, Loza M, et al. Classification of the Complexity of Adolescent Relationships. Atlanta, GA: Presented at: CDC National STD Prevention Conference, 2010.