A College Student's Guide to Sexual Health

For many, college is a time of burgeoning sexual self-actualization, exploration, and experimentation. A recent report from the National College Health Association found that more than half of college students report having sex in the 12 months preceding the survey.1 Most students are keenly aware of this going into college, which can add a lot of pressure on students regardless of their experience level. And that pressure can lead to poor judgment and a cascade of unpleasant consequences.

Knowing all you can about collegiate sexual activity, expectations, and best practices to maximize your safety without dampening that pioneering spirit can ensure that your memories are the only things from college that follow you for life.

This guide will give you useful information to keep you safe and let you have experiences that can positively shape your time in college.

Questions of normalcy abound in sexual health both on and off college campuses. But for students who may have minimal or no experience with sex, it's hard to know how your activity compares to the average.

We want to stress that there is no "normal" when it comes to sex and that you shouldn't compare your experiences to another's in a way that diminishes either party. That said, there are statistical realities about recurrent behaviors among college students that may give you some comfort if you're worried that you don't measure up.

According to a CDC report from 2017, the mean age people are having sex for the first time is a little over 17.2 That gives them less than a year's sexual experience before they reach a college campus.

Here are the most prevalent sexual behaviors among college students:3

• Solo masturbation: 88.6%
• Oral sex (received): 79.4%
• Oral sex (performed): 78.4%
• Penile-vaginal intercourse: 73.5%
• Partnered masturbation: 71.1%
• Anal intercourse (received): 16.8%
• Anal intercourse: (performed): 25.3%
• Choking (received): 43.0%
• Choking (performed): 47.3%
• Spanking (received): 59.1%
• Facial slapping (received): 12.1%

The prevalence of choking4 may surprise some, but it's backed up by additional studies that come to similar conclusions.

Alcohol and sex in college

According to the NIH, at least 53% of college students drink alcohol at least once monthly, with 33% binge drinking.5 The real numbers are likely higher since these are self-reported survey statistics. So, there's not much point in proclaiming the dangers of alcohol abuse, however valid those proclamations are. College students are more likely to drink than not.

We encourage you not to engage in sex when intoxicated — especially with new partners. You might neglect to use protection or effectively communicate consent. You might even miss signs of active STDs like genital warts that might send you running in the other direction if you were sober.

None of this is to shame anyone for mistakes made at college under the influence of drugs or alcohol. Frankly, shame is unhealthy and unhelpful in this context.6 The above only serves to illustrate undeniable risks.

But if you or a fellow student are among the 20% of college students who meet the criteria for alcohol use disorder, there are some excellent resources for you, including:

• Alcohol Rehab Guide
• Alcohol Rehab Help
• College Drinking Prevention
• Rehab Spot

One of the biggest risks you take engaging in sex on a college campus is contracting a sexually transmitted disease. In fact, one in four college students has an active STI,7 meaning there's a 25% chance that someone you sleep with in college could potentially transmit something to you. And by age 25, one in two people will have had an STI at some point.

This is despite data that illustrate a slowdown in sexual behaviors among college students — a so-called sexual recession.8

The most common STDs on college campuses greatly resemble the most common STDs in the general populace. The big difference is that those aged 15-24 consistently make up the majority of new cases. And with the CDC reporting a yearly uptick in STDs, the concentration of infected students only stands to grow.

Here are the most prevalent STDs on college campuses:9

• Herpes (HSV-I): 60%
• EBV: 56%
• HPV: >43%
• Chlamydia: 3%
• Gonorrhea:10 2.1%
• Trichomoniasis: 2.3%
• Herpes (HSV-II): 1.6%
• HIV:11 0.5%
• Syphilis: 0.03%

STDs vs. STIs

You'll often hear the terms STD and STI bandied about somewhat loosely, but the difference is simple. STI stands for sexually transmitted infection, and it applies to anyone who contracts enough viral or bacterial cells from a partner to become infected. The medical community doesn't consider an STI to be an STD until a patient presents symptoms.12

This may seem like splitting hairs, but it serves a medical purpose in maintaining clarity in a diagnosis. For a college student, either term is acceptable, and you want to avoid encounters with both.

There are several ways you can protect yourself from STDs. Each has their own success rate, and it's ultimately up to you how much of a risk you're willing to take with your health. But from physical discomfort to mortal peril, there is a wide range of reasons to avoid STIs.

Here are the best ways to protect yourself from infection:

There are various signs that you may have been infected with an STI. What's more worrisome is that just about every STD can be asymptomatic for its lifespan. That means you could unknowingly spread a potentially deadly disease or experience late-term symptoms years down the line.

Here's a look at some common symptoms to watch out for, as well as whether a given infection may be asymptomatic.

Testing is one of the essential tools for identifying STIs and limiting their spread. It might seem scary, but the methods used today are a lot less invasive than those used in the past, so there's little to worry about in terms of the testing experience.

Knowing when to get tested can be confusing, especially if you're not that active and don't show any STI symptoms.

• Get tested immediately if you show signs or experience symptoms of an STI.
• Get tested at least every 3-6 months if you're sexually active but not in a monogamous relationship.
• Get tested at least once per year if you're sexually active and in a monogamous relationship.
• Get tested within an appropriate window period if you know you've been exposed to a particular STD. Refrain from intercourse until your results come in.
• Get tested quickly after having unprotected sex. You may want to take more than one test to cover various window periods. Refrain from intercourse until you get your results.

What are window periods?

Not all STIs are detectable within the same amount of time from exposure. A window period is the amount of time between exposure and detectable infection. For example, you could have unprotected sex with someone infected with gonorrhea and want to take a test immediately after finding out they're infected.

It could take between five days and two weeks for a test to be positive, even if you are infected. That means you should wait two weeks from the exposure to take a test. It also means you'll have to refrain from sex until those results come back, including sex with the infected partner. You may not have contracted it the first time, and there's no reason to increase the odds that you will.

Here are the different window periods for common STIs:

• HPV: 2-3 months
• Chlamydia: Five days to two weeks
• Gonorrhea: Five days to two weeks
• Syphilis: 1-3 months
• Herpes (HSV-I): 4-6 weeks
• Herpes(HSV-II): 4-6 weeks
• Trichomoniasis: 3-7 days
• HIV: 23-90 weeks

College campuses generally take their STD rates seriously and invest heavily in their on-campus health clinics. You can get tested for most STIs and receive treatment through on-campus clinics at most colleges.

Some non-secular colleges and universities may have restrictions regarding sexual health and safety,16 preferring instead to push abstinence. If you attend such a school and still need help, there are likely local resources that can help. Tools like the National Association of Free and Charitable Clinics' clinic finder can help you find resources within a reasonable distance.

You should take any potential exposure seriously, even if the infection is bacterial and especially if you're asymptomatic after exposure. Left untreated, many STDs can result in infertility or worse. Here's a look at some potential long-term side effects of untreated STDs:

Depending on where you go to school, access to birth control may be as simple as walking over to your campus clinic or so complicated that you're tempted to give up the search. As with STD resources, the best place to start is at your campus clinic. If that fails, Planned Parenthood has local clinics and resources to help you access birth control.

Planned Parenthood also offers advice and resources for obtaining emergency contraception after unprotected sex. Telemedicine has made it exceedingly simple to acquire a prescription for and free delivery of birth control pills. You can also use a helpful clinic finder and appointment tool from Options for Sexual Health.

Some online services will ship birth control to you in discreet packaging, which is especially useful if you live in a contraceptive desert. These companies include Favor (previously Pill Club), Simple Health, and Nurx. Different organizations may also carry other sexual health goods that are hard to come by like emergency contraception (Plan B or Ella), internal condoms, and herpes medication.

There may be nothing more important in a sexual relationship than consent. This is as true off-campus as it is on-campus. There shouldn't be any gray area here, either. That doesn't mean that you need to get written permission from each other to have sex, but it does mean that verbal consent is the gold standard.

If you have any reason to suspect your partner isn't enthusiastically on board with the direction your interaction is taking, you should simply ask. If you're worried it will ruin the mood, it won't. If it does, then that's not someone with whom you want to have a sexual relationship.

Of course, explicit consent becomes even more critical when you consider the rates of drug and alcohol use among college students. According to a National Institutes of Health report from 2019, nearly 55% of survey respondents 18-22 admitted to consuming alcohol within the past month.17 These are self-reported statistics; the real percentage may be higher.

Whether cold sober, slightly buzzed, or blackout drunk, sexual consent is an absolute must. The problem here is that alcohol commonly reduces inhibitions and impairs judgment.

Here are some signs18 to look for that might indicate your potential partner is not in a sober enough position to give consent:

• Slurred speech
• Trouble walking
• Poor coordination
• Heavy eyes
• Confusion
• Sweating
• Vomiting
• Slow reaction time

There are many more indications that someone may be too intoxicated for consent. There are also instances in which someone is too intoxicated for consent but otherwise seems normal. This is why clear consent is so important. Never assume that your partner is equally enthusiastic, especially when drugs or alcohol are present.

Unfortunately, consent is not something everyone holds dear. There are far more sexual acts performed without consent — or with a crystal clear refusal of consent — than most people would assume. Women on college campuses have three times the risk of sexual assault as women in general. And a shocking 13% of college students experience rape or sexual assault (including assault during periods of incapacitation).19

It's not just women who face the threat of sexual violence, either. Male-identifying college students are 78% more likely to endure rape or sexual assault than their peers outside of college.

Here are some other important RAINN (Rape, Abuse, and Incest National Network) statistics to consider:

• Nearly a quarter of trans, genderqueer, and nonconforming students have been sexually assaulted.
• Nearly 6% of students experience stalking during their time at college.
• Only one out of five female survivors have had assistance through a victims services agency.
• Only about 20% of female survivors file a report of sexual assault with law enforcement.

Part of getting survivors the assistance they need — including access to justice — is expanding the knowledge of available resources. If you've endured any form of sexual violence, there are various resources at your disposal. Some provide physical and psychological support, while others can help you file charges against assailants within criminal and collegiate justice systems.

RAINN

RAINN's National Sexual Assault Hotline offers support for survivors of sexual assault anywhere in the nation — on college campuses and beyond.

RAINN's contact resources include:

• Phone support: 800-656-HOPE (4673)
• Online chat (English)
• Online chat (Español)

RAINN also has a local service provider tool to help you find help centers in your immediate vicinity.

1in6

The name 1in6 is a direct reference to the portion of men who experience sexual assault. The organization offers various resources for men, not least of which involves busting myths and resolving the stigma around male victimhood.

1in6's resources include:

• One-on-one online chat
• Anonymous, counselor-facilitates group sessions
• Myths and facts about male abuse and assault
• Book and film recommendations
• Resources for family and friends of male victims

National Sexual Violence Resource Center

This invaluable resource provides a wide range of information on sexual assault for victims, family members, and more. They also host advocacy and education events around the country.

Some of their most important resources include:

• Directory of organizations
• Mental health resources for black, indigenous, and people of color (BIPOC) survivors
• Trauma exploration blog
• Guide for family and friends of survivors

There are many new things to learn when you get to college, not least of all what your classes have to teach you: a new landscape, new friends and neighbors, and new responsibilities for starters. We've put together this set of best practices you can follow to make the safe sex side of the equation a bit easier to take in. The list is by no means exhaustive, but it's a great place to start. Hopefully, it contains some valuable information you didn't have before

Learn your limits

You'll try a lot of new things when you get to college, and learning where your personal limits lie is critical. What might you be willing to do drunk that you wouldn't do sober? If you consume alcohol, how quickly do you become drunk? If you do drugs, how do they affect you? You can put all of this information together to help you realize when you're about to make a decision that's not in line with your sober thinking. It can also keep you from overindulging in any substance that could impair your judgment beyond safety.

If you're having a hard time keeping within your limits, you may want to speak to someone about your alcohol and drug use. The College Alcohol Intervention Matrix has a handful of excellent resources that can help you identify issues and provide you with treatment.

Get tested often

Testing is the best way to ensure that you and your fellow campus-mates are safe. Knowing you have a clean bill of health will also keep you from getting to the point where you're ready to enjoy the company of a classmate, only for them to ask you about your sexual health status and derail the whole relationship. And since so many potentially deadly STDs can exist inside you asymptomatically, knowing you have an infection could save your life.

Everyone wins when you test regularly.

Talk to your partners

It's not easy to stop in the middle of foreplay and ask a potential partner if they've been tested lately, but that's no reason not to do it. Talking to your partners before and after sex ensures that you're always on the same page about sexual health and consent.

Planned Parenthood offers some great advice on talking to your partner about sexual health.

Investigate your campus's resources

Most college campuses has a litany of resources dedicated to safe sex and sexual security. You may learn about these during your orientation, and your college's website likely has a section devoted to them. If you're sexually active on your campus or thinking of increasing your sexual activity, you should familiarize yourself with these resources as much as possible.

Use the right condoms, and use them correctly

The condom industry largely takes a one-size-fits-all approach to its products, resulting in unintentional misuse and even embarrassment. Some companies offer custom-sized condoms through online interfaces, which can help if you land in a size between specialty small, standard, and magnum sizes.

And please use your condoms correctly. That doesn't just mean putting them on correctly, either. It means storing them correctly.

Where not to store your condoms:

• Back pockets
• Wallet
• Car (glovebox, center console, etc.)
• Fridge or freezer
• Outdoors

Where to safely store your condoms:

• Uncluttered drawers (ideally bedside)
• Empty tin
• Toiletry or cosmetic bag (without sharp objects in it)
• Front pocket for no more than a few hours

Use the right lube in for the situation at hand

Lubrication can make an incredibly positive difference in the bedroom, but it can also cause some unintended complications. Certain lubes will fail under specific circumstances, and some can even make sex less safe.

Here are the main types of lubricants and their best uses:

There are also hybrid lubricants available, many of which combine water-based and silicone-based materials.

If you use toys, keep them clean

For many people expanding their sexual repertoire, sex toys will enter the picture at some point. If you're new to using sex toys, you may fail to clean them properly. That can result in a handful of unpleasant consequences, including dangerous infections. Fortunately, there are plenty of reputable sex toy cleaners on the market. Invest in one and use it regularly.