Virginity pledge did not prevent sexually transmitted infections.

This study [1], published in April 2005, surveyed more than 11,000 U.S. adolescents when they were young adults (ages 18-24), and found that adolescent virginity pledges were not associated with lower rates of several sexually transmitted infection--even though they were associated with several behavior changes that would have seemed to be protective. Although this survey did not ask about HIV, we thought it might interest our readers because it illustrates how an "abstinence only" intervention can fail to reduce illness, and look like it is working when it is not.

In this large, long-term study, adolescents who consistently' pledged virginity (about 7% of the 11,000, or 777 individuals) did have more behaviors that would be expected to be protective--fewer partners, fewer risky partners, and delayed age of first sexual experience, with 25% of men and 21% of women being virgins at age 25 (compared to 7% and 6% for non-pledgers). The reason for the lack of health benefit, according to an editorial summary of the study [2], seems to be that pledgers were less likely to use condoms when they did become sexually active, were more likely to have anal or oral sex (almost always without a condom), and were less likely to seek and receive medical care if they did get a sexually. transmitted infection. As one of the researchers told The Washington Post (2005-03-19), "The sad story is that kids who are trying to preserve their technical virginity' are, in some cases, engaging in much riskier behavior."

The adolescents studied included only those who were in school, an acknowledged limitation of the study. The new report is from their third 5-year followup. About 80% of those studied never reported taking a virginity pledge, 13% said they had pledged but in a later 5-year followup said they had not (they were counted as inconsistent pledgers in the study), leaving only 7% of "consistent pledgers," who reported at least once that they had pledged and never said otherwise. [We suspect that the 13% were not lying or forgetful; rather the wording of the questionnaire did not allow them to report the real situation, that they had taken a pledge but abandoned it. Probably most of those in this position felt that the most truthful answer available to the question of whether they had ever taken a pledge was No, since otherwise they would be counted as abstinent when they were not--suggesting that the real number of consistent pledgers may be less than 7%, since some who were no longer abstinent would have decided that the best of the poor choice of answers was Yes.]

Most of those who pledged virginity did have sex before marriage (and before the date of the study interview). Sixty-one percent of consistent pledgers, 79% of inconsistent pledgers, and 90% of all non-pledgers said on the questionnaire that they did have sex before marriage.

Among consistent pledgers, 13% reported having only oral sex with one or more partners but no vaginal sex--compared with only 2% of non-pledgers. This is the source of the news reports that pledgers were six times as likely to have oral sex. Condoms were very seldom used in these relationships.

The editorial [2] also notes that the debate over abstinence-only has not changed much since a century ago. "One camp advocates comprehensive education and skills. The other focuses only on eliminating adolescent sexual activity." The editorial also noted that abstinence is indeed 100% effective, as a personal choice--but not as a public-health program used at a population level, which will always have a failure rate.

For us, the take-home message is that virginity pledges were not associated with reduction of sexually transmitted infections (again, HIV was not measured here) in this large and fairly representative U.S. study--even though behavior changes that would seem to be protective were associated with the pledges. The reason for this paradox may have been that most of those who took the pledges did not stay with them, and then skipped precautions because they were reluctant to be seen as breaking their public pledge. This does not imply that other abstinence or behavior-change programs will also fail. The problem is not abstinence, but the ideological banning of all other prevention education when many, probably most, in the target audience are not going to stay abstinent.

References

[1.] H Bruckner and P Bearman. Alter the Promise: the STD consequences of adolescent virginity pledges. Journal of Adolescent Health. April 2005: volume 36, pages 271-278.

[2.] JD Fortenberry. The limits of abstinence-only in preventing sexually transmitted infections. Journal of Adolescent Health. April 2005; volume 36, pages 269-270.