After the Institutional Ethics Committee approval, a prospective cross-sectional survey was conducted amongst 500 commerce students of the K.P.B. Hinduja College of Commerce from December 2012 to March 2013 as per the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) guidelines. Assuming a prevalence rate of sex related knowledge to be 30%, and for a permissible error of 5% and 98% confidence levels, the calculated sample size was 445. Hence, we decided to collect 500 completed questionnaires for which we had to administer 538 questionnaires. The analysis of data was done from these 500 completed questionnaires. The study questionnaire was pilot tested amongst a cohort similar to the study participants and its reproducibility and precision were confirmed. It was a self administered paper questionnaire (Annexure I). Teachers and college authorities were not involved in administering the questionnaire. Members of the research team briefed the students about the purpose and significance of the study and that their responses would be confidential. The questionnaire collected information about participant characteristics and their sex related knowledge, attitudes and practices. In the ‘Knowledge’ section, the total number of correct answers to twelve questions were scored as per a pre-decided scale, with higher scores indicating better knowledge. Its internal consistency was found to be good with a Cronbachs alpha of 0.85.

The analysis was conducted in two parts using the SPSS 16.0 software (Chicago, IL: SPSS Inc.). First, descriptive statistical analysis was conducted to describe participant profiles, sex-related knowledge and attitudes. Next, variations observed in these parameters were tested using chi-square tests for categorical variables and t-tests for continuous variables at the significance level of p = 0.05.

The mean age was 18.6 ±1.6 y. Out of the total, 230 (46%) students were female and the rest males. Seven percent of the participants were born outside the city of Mumbai. None of the participants came from a divorced family and 5% of them reported that either one or both of their parents were deceased. 48% reported a less than satisfactory family life.

Sex Related Knowledge [Table/Fig-1]. Sex related Attitudes and perceptions [Table/Fig-2]. Premarital sex and high-risk sexual activities.

Premarital sexual activity was reported by 48% male and 18% female participants (p<0.001). Out of the participants who had premarital sexual activity:

The reasons given for not using contraceptives were, reliance on emergency contraceptive pills after a sexual encounter, standing while performing sexual acts to allow the fluid to flow out, no fear of pregnancy as ‘we had sex only once’, ‘only people with HIV should use condoms’, non availability of contraceptives in spur of the moment acts, problem with storage of contraceptives and feeling embarrassed to purchase them from the shops.

We found that the participants, i.e., commerce college students, showed less than satisfactory knowledge regarding various aspects of sex and, especially, contraception. A similar study conducted in Hong Kong demonstrated much higher knowledge about various aspects of sex, except contraception, for which, even their knowledge was poor [10]. Many other studies from India have also reported low knowledge about contraception [11–13]. A summary of the key findings of some similar studies conducted in and around Mumbai is presented in [Table/Fig-3] [3,4,14–16].

Females faced worse than males in the knowledge scores. Being well informed about contraception is one of the pre-requisites for successfully regulating fertlity, something that has been lacking in India. In our study, 40% of males versus 13% of females were of the opinion that contraception is the sole responsibility of the female partner. With the currently available and commonly used reversible and effective contraceptive measures being mostly female centric, poor contraception knowledge among them is indeed a matter of concern. Another study also showed low knowledge amongst women but the point to note is that their study was conducted among rural women unlike ours [13]. In our opinion, knowledge regarding contraception was poor because it is not a part of the conventional sex education programs due to the erroneous perception that knowledge about contraception will increase premarital sexual encounters. But most of our participants disagree with this notion. Only 7% of females felt that condoms should be available in vending machines in all public toilets while a significantly larger number (59%) of males felt so. Many a times, procurement related stigma may prevent youngsters from using condoms and this has been rightly pointed out in our study too. A study conducted in Ethiopia concluded that condom machines may be associated with more condom procurement among vulnerable female students and could be an important component of a comprehensive university health policy [17].

Our participants scored relatively better in the STDs and HIV knowledge section compared to contraception. With the HIV/AIDs epidemic looming large, adequate knowledge about its cause, transmission and prevention are extremely important.

When questions depicting attitudes and perceptions towards various aspects of sex where asked, it was found that majority of the women gave neutral answers. This again raises the question as to whether they are less knowledgeable or that they shy away from giving their opinion on issues related to sexuality.

Majority of our participants were open to the thought of premarital sex. They felt that virginity need not be preserved until marriage if the partners were engaged. Yet, almost half of them felt that men loose respect for women who have had premarital sex. In the author’s opinion, this ambiguity in the thoughts of our participants is a result of a more deeply rooted tug-of-war between modernization and conservatism. On one hand is the belief in gender equality and social progress, while on the other is, the reactionary desire to preserve tradition, including underlying sexist notions. About half of males and 20% of females confessed to having had premarital sex. Different studies have reported highly variable statistics about premarital sex due to many socio-cultural and educational differences among participants. But in all the studies, more males have reported to have had premarital sex than females [18,19]. Also, in our study, more males have reported to have had sex with more than one partner and also sex with casual partners, whereas none of the females reported either. The reported contraceptive use was found to be very low and this is not surprising given the low knowledge and misconceptions about contraception among our study participants. Given the above, it was surprising that none of the participants reported a premarital pregnancy. The reasons could be that they might not have revealed the truth due to fear of embarrassment or because of the popular use of the ‘morning after’ pills that have been recently made available ‘over-the-counter’.

One very serious finding was that about one fifth of both males and females reported to have been forced to have sex. With the rising incidences of sexual assault and related crimes, it is very important to make youngsters understand their right to firmly deny being part of an undesired sexual encounter and also that forcing someone to have sex is grave offence that will be dealt with in the strictest possible manner. For the later, an effective and stringent law and its strict implementation are indispensable.

More than 80% of the participants said that sex education in secondary schools will not lead to a rise in premarital intercourse. On the contrary, a study has shown that imparting sex education not only delays the time to first sexual intercourse but educated individuals are also more likely to use a contraceptive method [20,21].

In the authors opinion, most Indian parents find it difficult to talk to their children about sexual satisfaction and pleasure, masturbation, pornography, prostitution and safe sex practices. The reasons for this as reported by a study are, [1] a belief that conversations about sex and reproductive health services encourage sexual activity and promiscuity [2] a presumption that unmarried women are not sexually active and therefore do not require sexual and reproductive health services; and [3] a high value placed on virginity [22]. Thus, a formal sex education program is extremely important.

Some of the limitations of our study, which are true for any survey based research project, are as follows:

Sexuality education must be a continuous process and regular assessment of the student’s knowledge, attitudes and practices is necessary to understand where the emphasis has to be laid. The lack of sexuality education will only lead young people to seek information about their bodies and the sexual act from misinformed sources like peers, media, and pornography. It is important in order to develop an open and healthy approach towards sex and sexuality and assist them to make well-thought judgments.