‘Sexual Competence’ at first intercourse: a critical assessment of a public health concept

Background: The timing of first sexual intercourse has long been of public health concern and a predominant focus of research into the sexual behaviour of young people. The onset of sexual activity has most commonly been defined in terms of chronological age – with particular attention to ‘early’ sex. Arguments for a more nuanced concept of timing have been made on the grounds that age fails capture individual differences and the context of the encounter. The concept of ‘sexual competence’ was most notably first operationalised by Wellings et al. (2001) using self-reports of four variables. Participants were classified as ‘sexually competent’ at first heterosexual intercourse if they reported the following four conditions: contraceptive protection, autonomy of decision (not due to external influences such as alcohol or peer pressure), consensuality (equal willingness of both partners), and acceptable timing (that it occurred at the ‘right time’). Methods: Using data from the Third National Survey of Sexual Attitudes and Lifestyles (Natsal-3), this study used a range of methods (confirmatory factor analysis, latent class analysis, and multivariable logistic regression) to conduct a quantitative examination of the properties of, and factors associated with, the measure of sexual competence at first intercourse. Supplementary analyses using two other datasets (Avon Longitudinal Study of Parents and Children, and Dunedin Multidisciplinary Health and Development Study) were also carried out in order to examine specific research questions that emerged. Finally, in-depth interviews were conducted with a subsample of Natsal-3 respondents to explore how they formulated their answers to the survey questions used to construct the measure of sexual competence. Findings: Statistical analyses found evidence that the four components of the sexual competence measure tap into a single underlying construct, and that the measure is associated with a range factors in the directions expected. For example, sexual non-competence at first intercourse was associated with several adverse sexual health outcomes, including sexually transmitted infections, unplanned pregnancy, and low sexual function. The qualitative component of this research found that responses to the four survey questions were formulated with reference to characteristics of the self, the partner, and the relationship, as well as what happened after the event of first intercourse. Conclusions: For a rather simply constructed operationalisation of a complex concept, the measure of sexual competence at first intercourse performs well empirically. The findings presented support the concept’s further integration into public health research and practice, and add to the evidence base supporting emphasis on enabling young people to protect the physical, social, and emotional aspects of their sexual health, from the onset of sexual activity.