OnlyFans, porn, and the fall in teen condom use

Could the influence of pornography, OnlyFans and so-called "natural family planning" techniques explain the drop in teenagers' use of condoms?

YMCA sexual health educator Sarah Peart said some boys were not willing to use them "because they're not seeing that in pornography".

She said young girls were often "targeted on social media" by those endorsing hormone-free, period-tracking apps to avoid unwanted pregnancies.

Young people have also said that controversial OnlyFans adult content creators set poor examples, who made headlines after bragging of having sex with several young men in a day.

Footage also emerged of one OnlyFans creator saying she had not used condoms during oral sex, putting her at risk of HIV.

"We've had multiple young people say "natural family planning" is their main form of contraception," said Ms Peart, adding that the lack of positive role models and influencers was a challenge for those providing sex education.

The YMCA sessions at schools, colleges and youth services attempt to inform, bust myths, discuss healthy relationships, but also hammer home the message that pregnancy is not the only risk.

"It's such a difficult barrier convincing young people that birth control isn't enough, and that you do need to protect yourself from STIs (sexually transmitted infections)."

She added they would also explain that "natural family planning" was not always reliable, "especially at that age when maybe periods aren't regular and young people don't tend to be the most strict with keeping notes".

"Our sessions also cover pornography and OnlyFans does sometimes come up as a strand of that.

"We try to educate young people to make their own healthy choices - and hopefully that includes not opening an OnlyFans account, but we can only provide the education."

The sessions delivered by YMCA for young people include information on the C-Card scheme, which is a supported service across the UK, providing training on sexual health awareness, as well as free condoms, lubrication and dental dams.

"Condoms are really expensive, so it's a fantastic service to make them accessible, but also acceptable, and not some weird, dark hidden corner of the pub toilets," said Ms Peart.

She is aware of fears the scheme could be seen as encouraging under-age sex but said research suggested more information at a younger age was likely to delay that.

"We try and persuade them to wait until they're at least 16. But if they are going to, then we can make sure they can do it in a safe way."

The World Health Organization recently reported that 56% of 15-year-old girls in Wales, and 49% of boys, had not used a condom the last time they had sex.

It comes amid a rise in STIs in the past year: 22% in chlamydia, 127% in gonorrhoea, and 14% in syphilis.

Ellie Whelan and Megan Grimley, both 21, from Cardiff, said the move away from condoms surprised them given more of their peers had turned away from the pill or coil as forms of contraception.

Use of long-acting, reversible contraception - such as an intra-uterine device (IUD) or hormonal implant - has fallen 22% in the last five years, with terminations up by a third.

"I think it's a lot to do with false information or bad experiences - or people are too scared to get information and talk about it," said Megan.

Testing is the best way to find out if you have a sexually transmitted infection.

The Sexual Health Wales service offers a free test kit for over-16s which can be sent and returned by post or collected from community venues.

Sexual health clinics across Wales also provide testing and support.

Infections can take several weeks after contact to show up in a test.

HIV takes seven weeks to be detected, hepatitis C and B can take 12 weeks or more, and chlamydia and gonorrhoea can show up within a fortnight.

But it is not solely an issue for young adults. Ms Peart said the YMCA sessions explain the range of contraception available, but at the back of most classrooms is a teacher also taking notes, as the gap in STI knowledge in particular is on "a national, societal level".

It is also reflected in the rise in sexually transmitted infections in the over-40s, according to Public Health Wales's Zoe Couzens, as people enter new relationships after divorce or bereavement.

"And I'm not putting an upper age on that – we've had a 72-year-old with chlamydia," she said.

"It's about ensuring the message goes out across all age groups.

"But the issue for the women especially is that pregnancy is not the concern they have any more, so they're not going to take the precautions. So that's another group that needs to be educated."

Arguably the rise in cases is a result of increased testing, as the free "test and post" service by Public Health Wales has made that far more accessible.

"Chlamydia is the most common [STI] in Wales, followed by gonorrhoea - and while it's all treatable with antibiotics, gonorrhoea is a nasty little bug that is developing resistance to antibiotics.

"Twenty years ago we had two cases of syphilis in Wales - last year it was 507.

"It tends to be a silent infection, but it can develop into neuro syphilis and cause cardiac problems."

Given other STIs can cause infertility, pain and pelvic inflammatory disease, the notion they are easily remedied is one many professionals wish to tackle.

Chlamydia: often described as a silent infection as most people do not have obvious signs. Symptoms can include pain when urinating, unusual discharge from the vagina, penis or rectum. Women may get pain in the tummy, bleeding during or after sex and in between periods, while men can have pain and swelling in the testicles.

Gonorrhoea: some people have no symptoms, but those who do may have a yellow or green discharge; a burning sensation when they wee and pain or tenderness in the stomach.

Syphilis: many people won't have symptoms. But for those that do, it will start with a small, painless ulcer in the mouth or genitals, followed by a rash. If left untreated, the infection can result in visual impairment, dementia and death. In pregnancy it can also lead to miscarriages, still births and infant mortality.

Herpes: again, some people have no symptoms, but they can include small blisters that burst to leave red, open sores around the genitals, rectum, thighs and buttocks. Blisters and ulcers can also be on the cervix; it can cause vaginal discharge, pain when having a wee, as well as general flu-like symptoms.

Genital warts: in women they start as small, gritty-feeling lumps that become larger. In men the warts will feel firm and raised, with a rough surface. They can be single warts or grow in clusters.