between guilt about premarital sexual activity and contraceptive use among never-married female college students was shown by Keller and Sack (1982). The findings of these various investigations support the hypothesis that acceptance of one's own sexuality is positively related to the consistent use of a reliable form of contraception. Furthermore, the hypothesized relationship seems to hold regardless of whether a female or a male contraceptive method is used.

Focus groups designed to learn more about how adolescents feel about obtaining contraception at clinics confirm the importance of shame, embarrassment, and fear related to the medical examinations; embarrassment about being sexually active; and concern about confidentiality (Silverman and Singh, 1986). Pelvic examinations are often required before securing such prescription-based methods as oral contraceptives or diaphragms. In some clinics, such examinations are also required before nonprescription contraceptive methods are supplied. Consequently, among adolescents, in addition to the fear that their families will find out, another important factor in delaying a visit to a family planning clinic can be the fear of medical examination (Zabin and Clark, 1981). As noted in Chapter 5, this finding has led some groups to experiment with providing the first several cycles of oral contraceptives to adolescents without first requiring a pelvic exam.

Similarly, one of the major reasons given by men for not using condoms is because of embarrassment involved in obtaining them. Among a sample of adult males between the ages of 20 and 39 interviewed in 1991, 27 percent stated that it was embarrassing to buy condoms, and 20 percent stated that discarding condoms was embarrassing (Grady et al., 1993). The television comedian Jerry Seinfeld captured the essence of the embarrassment factor in a recent monologue (Seinfeld, 1993):

Which brings us to the condom. There's nothing wrong with the condom itself. The problem with condoms is still buying them. I think we should have like a secret signal with the druggist. You just walk into the drugstore, you go up to the counter, he looks at you and if you nod slowly, he puts them in the bag for you. That's it.

You show up there, you put your little shaving cream, you little toothpaste at the counter.

How are you today? (You nod.)

Not bad. Yourself? (He puts them in.)

Oh, pretty good.

And you've got them.

There is also a small but important body of data suggesting that fears of being infertile, as well as inaccurate assessments of the risk of pregnancy in a variety of circumstances, may limit the careful and consistent use of contraception.

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