Abstract
Study Objective
Our objective was to describe sexual behavior and contraceptive use among assigned
female cisgender and gender minority college students (ie, those whose gender identity
does not match their sex assigned at birth).
Design
Cross-sectional surveys administered as part of the fall 2015 through spring 2018
administrations of the National College Health Assessment.
Setting
Colleges across the United States.
Participants
A total of 185,289 cisgender and gender minority assigned females aged 18-25 years.
Main Outcome Measures
Recent vaginal intercourse; number and gender of sexual partners; use of contraception;
use of protective barriers during vaginal intercourse.
Results
Both gender minority and cisgender students often reported having male sexual partners,
but gender minority students were more likely to report having partners of another
gender identity (eg, women, trans women). Gender minorities were less likely than
cisgender students to report having vaginal intercourse (adjusted odds ratio [AOR]:
0.86; 95% confidence interval [95% CI]: 0.80, 0.93). Gender minorities were less likely
than cisgender students to report using any contraceptive methods (AOR: 0.86; 95%
CI: 0.73, 1.03), and were less likely to consistently use barrier methods (AOR: 0.72;
95% CI: 0.64, 0.81) or emergency contraception (AOR: 0.56; 95% CI: 0.48, 0.65). However,
gender minorities were more likely to use Tier 1 and Tier 3 contraceptive methods
than cisgender women.
Conclusions
Providers must be trained to meet the contraceptive counseling needs of cisgender
and gender minority patients. Providers should explicitly ask all patients about the
sex/gender of the patients’ sexual partners and the sexual behaviors in which they
engage, to assess sexual risk and healthcare needs.
Key Words
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Article info
Publication history
Published online: April 07, 2021
Accepted:
March 26,
2021
Received in revised form:
February 12,
2021
Received:
December 9,
2020
Footnotes
The authors have no conflicts of interest to report.
Dr. Charlton was supported by Grant MRSG CPHPS 130006 from the American Cancer Society.
Findings were presented at the American Public Health Association Annual Meeting and Exposition, November 2019, Philadelphia, Pennsylvania.
Identification
Copyright
© 2021 North American Society for Pediatric and Adolescent Gynecology. Published by Elsevier Inc. All rights reserved.
