Sexual diversity in the United States: Results from a nationally representative probability sample of adult women and men

Anorectal Sexual Function Index: Development and Validation of a Health-related Quality of Life Measure

OBJECTIVE

To assess the reliability and validity of measuring receptive anal intercourse (RAI) sensation and associated satisfaction and bother.

METHODS

Between July 2022 and January 2023, we conducted a survey on sensations during RAI among people with prostates (ie, cisgender men and transgender women). The survey content was developed based on our previous qualitative study. We assessed internal reliability and consistency through time. Sensations experienced during RAI were correlated with health-related quality-of-life measures to ensure construct validity.

RESULTS

The final index contained four scales: pleasure (four items), pain (seven items), urinary (four items), and bowel (four items). Overall, 1084 individuals filled out the questionnaire. The internal consistency for all subscales was at or above 0.79. Scores tended to be stable across time with all test-retest coefficients at or above 0.72. Pleasure scores were inversely correlated with pain scores (r = -0.46). Pleasure was positively correlated with erections (r = 0.36) and orgasms (r = 0.44) during RAI, and sexual satisfaction (r = 0.39). Notable positive correlations for pain scores were with bowel scores (r = 0.49), internalized homophobia (r = 0.35), and prostatitis symptoms (r = 0.37). Urinary scores were moderately associated with IPSS scores (r = 0.22). Bowel scores were positively correlated with GI symptoms (r = 0.24), mental health symptoms (r = 0.28), and chronic prostatitis symptoms (r = 0.29).

CONCLUSION

The results of the current study provide evidence that the Anorectal Sexual Function Index is both reliable and valid. The Anorectal Sexual Function Index may be a particularly useful health-related quality-of-life measure to assess outcomes regarding a host of urologic issues that may affect RAI.

Vaginal Squirting: Experiences, Discoveries, and Strategies in a U.S. Probability Sample of Women Ages 18-93

Vaginal squirting is a phenomenon in which women expel fluid during the sexual response process, but it remains poorly understood in the extant literature. The study purpose was to use nationally representative data to investigate adult women's experiences with vaginal squirting. We assessed the prevalence of women who have ever squirted in their lifetime, the level of pleasure and concurrency of orgasm women reported during squirting, the ways in which women discovered squirting, and the challenges and/or concerns women experience with squirting. Forty percent of U.S. adult women (M = 47.6 years, SD = 16.8; Md = 24 years) had ever squirted in their lifetime (Md frequency = three to five times). Two thirds of women reported unintentional discovery of squirting, and most (75%) used specific techniques to promote build up and release of squirting versus squirting spontaneously. About 60% of participants reported squirting to be very or somewhat pleasurable, but only 20% "always" experienced squirting and orgasm together. Women reported different challenges with squirting, such as the time required to reach squirting or the experience being too emotionally intense. Our findings contribute to the growth of much needed, detailed literature on the ways in which women discover and enjoy squirting as part of their sexual lives. Knowledge of these techniques can enable women to better identify their own preferences, communicate about them with their partners, and advocate for their sexual pleasure.

Research in brief: How prevalent is rough sex? Results from a national online sample of adults in Germany

BACKGROUND

Rough sex refers to consensual sexual activities that incorporate playful aggression, such as hair pulling, spanking, or choking. It is relevant in the context of sexual health as it can enhance sexual arousal, pleasure, and intimacy among consenting partners. However, it can also be associated with consent violations, discomfort, and injuries ranging from mild to severe or even fatal. The prevalence of rough sex in Germany is widely unknown. Our study aims to establish, for the first time, the overall age-related and gender-related prevalence rates of active and passive rough sex involvement among adults in Germany.

METHODS

A national online sample of 1101 adults from Germany, aged 18-69 years (50% men, 49% women, 1% gender-diverse individuals) gave informed consent and reported on their lifetime engagement in rough sex in active and passive roles. We recruited participants through a professional panel provider for a multi-themed sexual health survey. Data analysis was conducted using R, with 95% confidence intervals of prevalence rates computed to answer the research questions.

RESULTS

Lifetime prevalence of rough sex involvement was 29%. Adults below the age of 40 reported higher rates of involvement (up to 43%) than people over 40 (up to 26%). Men reported predominantly active role involvement and women reported primarily passive role involvement.

DISCUSSION

Results show that rough sex is common. Sexual health professionals, educators, and researchers should be prepared to guide current and aspiring practitioners of rough sex, helping them understand potential benefits, risks, and age- and gender-related differences.

A Preliminary Exploratory Factor Analysis of the BDSM Counselor Competency Scale

BDSM practitioners represent a large sexual minority group often overlooked, misunderstood, and unnecessarily pathologized by mental health clinicians. Although developing cultural competence for diverse and marginalized populations is widely understood to be a core component of delivering efficacious therapeutic services that can counteract these stigmatizing mental healthcare experiences, no measures currently exist that assess clinicians' self-reported competence to work with BDSM practitioners. Previous measurement work has been done to establish self-report competency scales for clinicians working with other sexual and gender minority groups, but no such scales exist for working with BDSM practitioners. In the current study, we adapted a version of the Sexual Orientation Counselor Competency Scale (SOCCS) to measure clinicians' self-reported competence to work with BDSM practitioners and did a preliminary exploratory factor analysis of the new scale (n = 124). After an initial 24-item administration, principal axis factoring of our final 17-item solution revealed two latent factors (attitudes and skills/knowledge) consistent with the 2013 SOCCS and the theoretical constructs of cultural competency. The BDSM Counselor Competency Scale (BDSM-CCS) can help clinicians, practices, agencies, and training programs track self-reported cultural competence with the BDSM population. Future research directions for scale development and clinical and training applications are discussed.

Asexual or not sure: Findings from a probability sample of undergraduate students

OBJECTIVE

Present study aims to: 1) examine demographic correlates of LGB, asexual, or not sure participants 2) describe the prevalence of diverse sexual behaviors, 3) assess the prevalence of event-level sexual behaviors and 4) examine predictors of sexual pleasure.

PARTICIPANTS

761 non-heterosexual undergraduates at a large, public U.S. university.

METHODS

Randomly sampled undergraduate students completed a confidential, cross-sectional online survey.

RESULTS

Of 761 non-heterosexual respondents; 567 identified as LGB, 47 asexual, and 147 not sure. Asexual students, those not sure were less likely to report having engaged in solo and partnered sexual activities and report sexual activities being less pleasurable at most recent sexual event, compared with LGB students. This difference (relative to LGB) became nonsignificant when accounting for reported sexual activities.

CONCLUSIONS

Our findings inform how college students define and experience their sexual identities and assist college health professionals in training on sexuality and prevention of risk factors.

"It's Their Consent You Have to Wait For": Intimate Partner Violence and BDSM Among Gender and Sexual Minority Youth

Gender and sexual minoritized (GSM) youth are more likely than their cisgender heterosexual peers to experience intimate partner violence (IPV) and practice bondage and discipline, domination and submission, sadism, and masochism (BDSM). Although IPV and BDSM are vastly different phenomena, superficial similarities (e.g., violent behaviors) can lead to misidentification in both practice and research. This study explores how GSM youth (a) experience and understand the differences between IPV and BDSM and (b) report consensual violent and controlling behaviors when answering items on IPV measures. Nine demographically diverse GSM youth (mean age 21.2) were drawn from a GSM youth-serving organization in the Northeast United States. Participants were interviewed about their experiences with IPV, BDSM, and consent. Participants also were asked to describe the process of completing two standardized measures of IPV. Interviews were coded using conventional and directed content analysis. Eight of nine participants reported IPV victimization, and seven reported BDSM interest or experiences. Four themes emerged: (a) GSM youth experience a spectrum of IPV victimization, often related to their gender and sexual identity; (b) interest in BDSM does not imply an acceptance of IPV; (c) GSM youth have a nuanced understanding of consent and strategies to communicate consent with their partners; and (d) Consent is the organizing framework by which GSM youth distinguish IPV from BDSM. Participants reported various degrees of certainty that they would include BDSM behaviors when answering questions about violent behaviors. Findings underscore the importance of conceptually and operationally differentiating IPV and BDSM. Programs that serve GSM youth should address IPV victimization, offer sex-positive education regarding healthy relationships and BDSM, and assist GSM youth in differentiating abusive behaviors from consensual BDSM. Standardized measures that do not conflate BDSM with IPV are crucial for studying IPV among GSM youth.

Sexual Behaviors among Individuals Aged 20-49 in Japan: Initial Findings from a Quasi-Representative National Survey, 2022

Nationally representative data on sexual health and behaviors in Japan are scarce. We conducted an online survey, including questions about a range of topics related to sexual behaviors and outcomes. The sample, including 8000 men and women aged 20-49 years in Japan, was stratified by sex and weighted with respect to age, marital status, and region of residence to reflect the population of Japan. Of the women, 82.9% and 10.0% reported that they were heterosexual and asexual, respectively; corresponding proportions for men were 87.4% and 6.9%. 15.3% of women and 19.8% of men reported never having had any partners with whom they engaged in vaginal, anal, or oral sex. 45.3% of women and 44.5% of men reported not having had any sexual partners during the past year; this proportion was highest among women aged 40-49 years (51.7%) and men aged 20-29 years (55.1%). The proportion of those reporting satisfaction with their sex life was 27.8% for women and 23.1% for men; 17.6% of women and 27.1% of men reported dissatisfaction. Pornography use of ≥3 times per week was most common among those aged 20-29 years (6.5% of women; 34.8% of men), and the frequency of pornography use decreased slightly with age. 4.0% of women and 48.3% of men reported ever having used commercial sex worker services in their lifetime. This survey-based study provides data on sexual behaviors and health outcomes in Japan. Compared to other high-income countries, levels of sexual inexperience and inactivity seem to be high in Japan.

An International Survey of BDSM Practitioner Demographics: The Evolution of Purpose for, Participation in, and Engagement with, Kink Activities

While general proclivities for BDSM participation have been investigated in various countries, few large-scale studies have been conducted specifically with BDSM practitioners, which would allow for more in-depth analyses of participation. Through an online survey of 810 BDSM practitioners, the predictability of demographics and BDSM-related traits on the who, what, when, where, why, and how of BDSM participation were examined. Descriptive and regression analyses led to six findings. First, BDSM is practiced globally by a heterogeneous group. Second, learning about to participating in BDSM is a stepwise progression occurring over years. Third, pathways into BDSM vary with self-introduction, often as a form of sexual exploration, more common for adolescents, and friends/partners, and as a form of self-growth, more common for those introduced later in life. Fourth, historically viewed as sex-driven, few demographics predicted purpose for BDSM participation, while enjoyment/fun was the most common motivation. Fifth, practitioners participate in BDSM with multiple others beyond intimate partners, suggesting a communal element. Sixth, as a person gains more BDSM experience, their purpose/motivation evolves and the frequency and "risk" (i.e. edge-play) of activities participated in increases. Implications for further research into BDSM sub-culture are discussed, relating to the role of BDSM in sexual practice, sexual orientation, and leisure (hobby) activity identity formation, the impact of geographic, racial, and generational differences on participation, differing experiences of sexual and gender minorities (e.g. transgender, pansexual), and the importance of BDSM-specific measures, such as years of experience and occupying multiple BDSM-related roles, in analyses.

Inadequate Coping Strategies of Men who Have Committed Sexual Aggression Against Women: A Study of Their Developmental Antecedents

Several researchers have found that men who have committed sexual aggression have inadequate coping strategies (e.g., paraphilic sexual fantasies, substance abuse). However, very few researchers have empirically examined the factors potentially associated with the development of these strategies. In 2011, Maniglio hypothesized that the inadequate coping strategies of men who have committed sexual aggression are the result of childhood victimization, mediated by internalized psychological problems. The present study therefore empirically tested this hypothesis in a Canadian sample of 205 men who had committed sexual aggression against women, of whom 37 committed sexual murder. Structural equation modeling (SEM) resulted in the identification of several direct and indirect trajectories leading from childhood victimization (psychological, physical, sexual) to the development of inadequate coping strategies (paraphilic sexual fantasies, alcohol and drug use) mediated by internalized psychological problems (e.g., anxiety, depression, social isolation). The theoretical and clinical implications of these developmental trajectories are discussed.

Sexual pleasure during college students' most recent partnered sexual experiences

ObjectiveWe explored college students' sexual pleasure using a new self-report measure, the Body, Emotions, Sensations, Touch/Trust (B.E.S.T.) Scale of Sexual Pleasure. Participants: Data were from 3997 randomly sampled students with a partnered sexual experience. Methods: Students completed an online survey about their most recent partnered sexual experience. Data was collected in January 2020. Results: Students find the nonphysical aspects of partnered sex (e.g., emotions, trust, connection with partners) as pleasurable as physical aspects (e.g., behaviors engaged and received, bodily sensations). Self-reported arousal, wantedness, and emotional intimacy were the strongest correlates of male, female, and transgender/gender non-binary students' sexual pleasure. Few sexual behaviors were associated with sexual pleasure and only one - cuddling for women - was associated with greater sexual pleasure. Conclusions: Students find their partnered sexual experiences pleasurable. Students' sex may be more pleasurable when they feel ready for sex, desire sex, and feel close to their partners.

Orogenital Human Papillomavirus Infection and Vaccines: A Survey of High- and Low-Risk Genotypes Not Included in Vaccines

Knowledge of human papillomavirus transmission from the genital tract to the oral mucosa remains unsatisfactory, with poor and often inconsistent literature results. The increase in HPV-associated oral malignancies prompts further analysis of the simultaneous detection of the virus in the two anatomical areas and on the identification of genotypes to be included in future vaccines. Therefore, in this retrospective study, we evaluated orogenital HPV concurrence, hrHPV, lrHPV and type-concordance in 337 samples, as well as the prevalence of the most common genotypes not included in HPV vaccines. Concurrence was found in 12.5% (31/248) of cases, hr-concordance in 61.3% (19/31) and lr-concordance in 12.9% (4/31). Finally, type-concordance was found in 32.3% (10/31) of concurrent infections. Regarding the identification of non-vaccine genotypes, the significantly prevalent genotypes in the anogenital area were HPV66 (12.6%, p < 0.0001), HPV53 (11.1%, p < 0.0001), HPV51 (8.7%, p < 0.0001), HPV42 (8.2%, p < 0.0001) and HPV68 (5.6%, p = 0.0034) in women and HPV66 (14.6%, p = 0.0058), HPV42 (12.2%, p = 0.0428), HPV51 (12.2%, p = 0.0428), HPV53 (12.2%, p = 0.0428), HPV70 (12.2%, p = 0.0428) and HPV73 (12.2%, p = 0.0428) in men. Considering the results of our study, we recommend including the high-risk genotypes HPV51, HPV68, HPV53 and HPV66 in future HPV vaccine formulations.

"Oh! How Modern! And... Are You Ok with That?": Consensually Non-Monogamous People's Experiences When Accessing Sexual Health Care

The current research explored consensually non-monogamous peoples' experiences accessing sexual healthcare. Using a mixed method approach, a sample of 67 consensually non-monogamous individuals (48% Polyamorous; 42% Relationship Anarchy/Solo polyamory; 6% Swingers; 4% Uncategorized) reported having significantly lower rates of trust in healthcare professionals compared to standardized scores. Sixty-three percent of participants reported disclosing their relationship status to a clinician when accessing sexual health services, whereas 37% sometimes or never disclosed. Qualitative responses identified that some participants reported a willingness to be open about their relationships, but many chose to "pass" as monogamous to both simplify and streamline their interactions as well as to avoid potential stigma. Participants reported a wide range of experiences with clinicians from those who were accepting and professional, to some who displayed prejudice and withheld treatment. This research outlines some of the experiences and challenges presented to consensual non-monogamists when accessing sexual healthcare as well as providing suggestions for clinicians to help remove some of the barriers to appropriate patient care.

Pleasure despite pain: Associations between experiences of vulvar pleasure, vulvar pain, and sexual function in patients with chronic vulvar pain conditions

Background

Chronic pain can occur in the vulva, one of the primary pleasure centers of the body; however, the associations between pleasurable vulvar experiences and chronic vulvar pain have not yet been explored.

Aim

The aim of this study was to investigate associations between vulvar pleasure and pain experiences in patients with chronic vulvar pain.

Methods

This was a prospective cross-sectional study of 547 patients (aged ≥17 years) presenting over 10 months to 2 urban outpatient gynecology clinics specializing in vulvar pain. Prior to the initial evaluation, patients completed online validated questionnaires of pain-related anxiety, pain catastrophizing, and sexual functioning, as well as a researcher-developed questionnaire evaluating vulvar pleasure. Patients were divided into groups based on their pleasure and pain experiences. Between-group analyses consisting of t-tests, analyses of variance, and multivariate analyses of variance were conducted.

Outcomes

Outcomes consisted of total and subscale scores on the Pain Anxiety Symptoms Scale-20, Pain Catastrophizing Scale, Female Sexual Function Index, and a researcher-developed vulvar pleasure questionnaire.

Results

More than 70% of patients with chronic vulvar pain had experienced vulvar pleasure since the onset of their vulvar pain, with the clitoris as the most common source of pleasure. Average vulvar pleasure intensity was rated 7 (0, no pleasure; 10, extremely pleasurable). Masturbation ranked higher in pleasurable activities than vulvar stimulation by a partner or penetrative intercourse and was the most likely activity to lead to orgasm. When compared with patients who had not experienced vulvar pleasure since the onset of their vulvar pain, patients experiencing both pain and pleasure scored lower on the Pain Anxiety Symptoms Scale-20 total (P = .026) and fear subscale (P = .016), lower on the Pain Catastrophizing Scale total (P = .002) and all subscales (P = .008-.018), and higher on the Female Sexual Function Index total and all subscales (all P ≤ .001).

Clinical Implications

Incorporating strategies for cultivating vulvar pleasure in patients with chronic vulvar pain may be useful in comprehensive management approaches.

Strengths and Limitations

Strengths of this study include the novel examination of vulvar pleasure in a population with chronic vulvar pain and a large sample size. Limitations include the lack of a nonclinical comparator group and reliance on patient self-report.

Conclusion

Results suggest that greater vulvar pleasure is associated with lower pain-related anxiety, lower pain catastrophizing, and higher sexual functioning in patients with chronic vulvar pain conditions.

Clinical Guidelines for Working with Clients Involved in Kink

People involved in kink (BDSM or fetish) subcultures often encounter stigma and bias in healthcare settings or when seeking psychotherapy. Such individuals typically encounter well-meaning clinicians who are not prepared to provide culturally competent care or who have not recognized their own biases. Over a two-year period, a team of 20 experienced clinicians and researchers created clinical practice guidelines for working with people involved with kink, incorporating an extensive literature review and documentation of clinical expertise. This article summarizes the guidelines and discusses relevant issues facing clinicians and their clients, as well as implications for clinical practice, research and training.

Is everyone a mix of straight and gay? A social pressure theory of sexual orientation, with supporting data from a large global sample

Sigmund Freud, Alfred Kinsey, E.O. Wilson, and others have suggested that social pressure suppresses natural tendencies for humans to express bisexuality, the apparent norm for one of our two closest genetic relatives, the bonobo. An analysis of data obtained from a new online sample of 1,150,938 people in 215 countries and territories (63.9% from the United States, United Kingdom, and Canada) who completed the English version of a validated questionnaire of sexual orientation lends support to this idea. A histogram of scores from 0 (exclusive opposite-sex inclinations) to 18 (exclusive same-sex inclinations) forms a near-normal distribution. Although this distribution was likely caused to some extent by sampling bias, it may also reflect the unusual honesty people show when taking online tests anonymously, as an increasing body of evidence demonstrates. We present a formal mathematical expression of a social pressure theory of sexual orientation, along with empirical evidence and computational explorations that support the theory. We also present an analysis of the new data set. Among other findings: sexual orientation labels corresponded to broad, skewed, overlapping distributions of scores. Self-labeled gays/lesbians and, to a greater extent, self-labeled straights, reported that the larger the mismatch between their sexual orientation label and their actual sexual inclinations, the more distress they felt regarding their sexual orientation, a finding that is predictable from cognitive dissonance theory. Educating the public about the true nature of sexual orientation might quell the often rancorous public debates on this topic, as well as give comfort to a large number of mislabeled people.

Psychological and Developmental Correlates of Paraphilic and Normophilic Sexual Interests

The classification of sexual fantasies and behaviors (here referred to as 'sexual interests') has historically been divided into 'paraphilic' and 'normophilic'. However, studies on paraphilic interests are often limited to clinical or forensic samples and normophilic interests are rarely assessed in tandem. Previous research has found mixed results for psychological and other correlates of sexual interests, potentially due to inconsistency in operationalism and measurement of fantasies and behaviors. The aim of the current study was to quantify correlates of sexual interests via the Sexual Fantasies and Behaviors Inventory, containing factors related to general fantasies/behaviors, normophilia, power dynamics, sadomasochism, and courtship paraphilias, using a large (N = 4280) non-clinical sample. Psychological, developmental, sexual, and demographic correlates were investigated via bivariate correlations, mean difference testing, and multiple regression. Sexual interest domains were largely unrelated to psychopathology and developmental factors. Sociosexuality and more accepting attitudes towards sadomasochism was generally related to more arousal to/engagement in normophilic and paraphilic domains. More autism spectrum disorder traits were related to decreased normophilic interests. Psychopathic traits, sexual sensation seeking, and sexual compulsivity were related to paraphilia dimensions, especially courtship paraphilias and domination/sadism; the former was also associated with negative attitudes about establishing consent. Men, non-monogamous, and non-heterosexual participants indicated greater sexual fantasies and behaviors compared to women (except in the case of submission and masochism), monogamous, and heterosexual participants, respectively.

The Prevalence of BDSM in Finland and the Association between BDSM Interest and Personality Traits

According to previous research, interest in BDSM (Bondage-Discipline, Dominance-Submission and Sadomasochism) activities is high in several European countries and various BDSM practices are not uncommon. There is a limited amount of research on the personalities of BDSM practitioners, but in previous research practitioners have been found to have better overall well-being and to be more educated than the general population. The current study explored the prevalence of BDSM interest and practice in a Finnish sample (n = 8,137, age range 18-60, M = 30.14, SD = 8.08) and investigated the association between BDSM interest and personality measured with the six-factor personality measure HEXACO. A total of 38% of the sample was interested in BDSM sex and non-heterosexual individuals displayed almost twice as much interest and at most 83% more participation in BDSM than heterosexual individuals. Younger participants (18-28 years old) displayed almost three times as much interest than older participants. There were some associations between BDSM interest and personality factors, but the effect sizes of these associations were modest. The study shows that BDSM interest is quite common among the Finnish population.

Sexual diversity on college campuses: using a BDSM framework to discuss consent

Sexual assault in higher education is a continuing concern. At the same time, college students are engaging in a range of consensual sexual behaviors that could appear to be sexual violence. Sexuality education on college campuses should address the spectrum of sexual behaviors and college health professionals and administrators need to be able to distinguish consensual rough sex from sexual violence. Common consent negotiations in BDSM (bondage and discipline, dominance and submission, sadism and masochism) contexts may serve as an appropriate model for acquiring consent. This viewpoint article aims to (1) review the increased participation of college students in diverse sexual behaviors, and (2) introduce the consent process of BDSM as a framework for college health professionals to discuss consent for other sexual behaviors.

An Agent-Based Model of Sex and Sexual Orientation Differences in Short-Term Mating Behaviors as a Result of Mating Preferences

Sex differences in short-term mating behaviors are well-documented in human sexuality research. Existing studies usually explain sex differences in sexual behaviors through differences in mating preferences, which is theoretically problematic. Using an agent-based model, we investigated the circumstances under which males' and females' differential preferences for short-term mating would result in sex differences in short-term mating behaviors. The model showed that when all individuals in a closed heterosexual population were considered, males and females had the same average number of short-term mating experiences and short-term mates even when males had stronger preferences for short-term mating. Males (vs. females) had a higher average number of both experiences and mates when analyses were limited to only heterosexual males and females who successfully participated in the mating pool (i.e., those with a non-zero number of short-term mating experiences). Moreover, when males (vs. females) had stronger preferences for short-term mating, gay males had a higher average number of experiences and mates compared to both lesbian females and heterosexual males. These results suggest that even when sex differences in mating preferences exist, the sex differences in short-term mating behaviors only occur among particular populations, or when males' preferences for short-term mating are not constrained by those of females. Suggestions for future research in human mating psychology and behaviors were provided.

Atlas of the receptive anal sex experience among people with prostates

BACKGROUND

Receptive anal intercourse (RAI) is commonly practiced among individuals of all sexual orientations. However, negative stigmatization by society and health care professionals leads to the underreporting or this practice.

AIM

We sought to assess and describe the subjective role of the prostate as a pleasure center in participants with diverse RAI experiences. The secondary aim was to describe nonprostatic areas within the anorectal region that produce erotic sensation and/or pain.

METHODS

The exploratory sequential multimethod study design included focus groups and semistructured interviews with 30 individuals with prostates who had engaged in RAI. We used graphic elicitation of natal male anatomy to enhance visualization and assess participant perspectives.

OUTCOMES

The main outcome of interest was the identification of anatomic locations of erogenous sensation and pain during RAI.

RESULTS

Among the participants (median age 38, range 24-77 years), most participants (90%) identified as cisgender male. Three major themes emerged within the motivations for RAI, including (1) deriving intrinsic pleasure, (2) providing both pleasure for a partner and a way to improve intimacy/connection, and (3) an inability to be the insertive partner due to physical or mental challenges. The data suggest that the anorectal region produces a variety of erogenous sensations which participants find pleasurable. Overall, 2 major areas of erogenous sensation occur along the anterior rectal wall and within the anus. Within the context of RAI, 2 distinct categories of pain emerged, including pain with insertion and pain at other times.

CLINICAL IMPLICATIONS

Understanding where erogenous sensation originates for each individual may predict sexual functioning after various surgical interventions. Timing and location of pain may aid in further characterizing anodyspareunia.

STRENGTHS AND LIMITATIONS

Our study utilized a sequential design (from focus groups to interviews) with diverse RAI experiences, especially regarding age, geographic location, and prostate pathology. We included individuals of diverse gender identities, but too few to evaluate these groups independently from cisgender men.

CONCLUSION

People with prostates experience pleasure in multiple areas during RAI. Contrary to some lay literature, the prostate region is not the subjective pleasure center for all individuals. Timing and location of pain during RAI may inform areas for intervention. Providing a language for pleasure and pain during RAI may improve communication between not only sexual partners but also clinicians and patients.

Current biopsychosocial science on understanding kink

The field of kink (or BDSM) studies has grown significantly in recent years, with several areas of study being initiated. This paper summarizes the current state of kink research, including prevalence rates; marginalization and stigma; key biological, psychological, and social research findings; clinical issues; and recommendations for further research. Theoretical frameworks, such as minority stress, serious leisure, sexual orientation, personal growth, and sensation-seeking theories appear to be useful frameworks outside of approaches that assume psychopathology as an etiological factor. Studies find the following results: higher levels of sensation-seeking; kink activities generating states of flow and transient hypofrontality; notable levels of gender, sexual orientation, and relationship style diversity in kink samples; and higher levels of minority stress-related suicidality.

Sexual Violence and Nonconsensual Experiences Among Alt-Sex Communities' Members

BACKGROUND

As behaviors, alternative sexual (alt-sex) (i.e., kink, bondage, discipline, dominance, submission, sadism, and masochism , consensual non-monogamy, swinging, leather, and fetish practices) practitioners often emphasize that consent and boundaries are key elements of alt-sex activities. Despite these emphases, individuals experience consent violations and sexual assault both prior to engaging and during their involvement in alt-sex activities.

PURPOSE

This study examines alt-sex practitioners' sexual assault and nonconsensual experiences in order to highlight potential means of intervention and prevention, as well as inform clinical and legal professionals.

METHODS

In collaboration with the National Coalition for Sexual Freedom, this study uses an international survey of adults in alt-sex communities (N = 2996) to examine sexual assault and nonconsensual experiences both within and outside of alt-sex contexts.

RESULTS

We found a lower rate of consent violations in the alt-sex community (26%) compared to sexual assault as an adult outside of alt-sex contexts (34%) and sexual assault as a minor (40%). We found significant differences by groups in sexual assault as a minor (gender, sexual orientation, age, and live in the US or not), sexual assault outside of alt-sex contexts (gender, sexual orientation, and age), nonconsensual experiences in alt-sex contexts (gender, sexual orientation, age, and race), receiving nonconsensual touch in alt-sex contexts (gender, sexual orientation, and age), giving nonconsensual touch in alt-sex contexts (sexual orientation, age, living in the US or not, and race), and being falsely accused of nonconsensual touching in alt-sex contexts (gender, age, and living in the US or not). Within the most recent consent violation, the most common behaviors were non-kink related, except for lack of aftercare. Nearly 40% of participants reported the reasons for their most recent consent violation in alt-sex contexts were being selfish or caught up in the moment.

IMPLICATIONS

Focused interventions are needed to address how different populations are experiencing assault and violations in alt-sex contexts.

What do we know about consensual non-monogamy?

Recent years have seen considerable interest in consensual non-monogamy from both public and academic perspectives. At least 5% of the North American population is currently in a consensually non-monogamous relationship of some form and there is little difference in measures of relationship quality compared to monogamous relationships. Despite increasing levels of understanding and engagement many practitioners of consensual non-monogamy still experience stigma (and minority stress) which is exacerbated by context (e.g. parenting, healthcare settings), type of consensual non-monogamy (e.g. polyamory vs swinging) and intersects with other identities (e.g. race, sexuality). This review outlines what is currently understood about consensual non-monogamy and argues that relationship diversity has a place alongside gender and sexuality when studying sexual behaviours, romantic relationships, and well-being.

Solo and Partnered Sexual Behavior Among an International Sample of Adults With Spina Bifida

BACKGROUND

Spina bifida (SB) may differentially impact adults' participation in solo and partnered sexual behaviors, but little research investigates this topic.

AIM

Describe solo and partnered sexual behaviors among an international sample of adult men and women with SB.

MAIN OUTCOME MEASURES

Ever participated (no/yes) and recent participation (>1 year ago/within last year) in solo masturbation, cuddled with a partner, held hands with a partner, kissed a partner, touched a partner's genital, had genitals touched by a partner, gave a partner oral sex, received oral sex from a partner, vaginal sex, anal sex, and sex toy use.

METHODS

Data were drawn from a larger cross-sectional, internet-based survey assessing the sexual behaviors of an international sample of men and women with SB. We used logistic regression to examine the impact of background (gender, age, independent living, and relationship status) and health (shunt status, ambulation, and genital sensation) factors on each outcome.

RESULTS

The sample consisted of 345 respondents aged 18-73 years from 26 nations. Very few (<3%) had no lifetime experience with any solo or partnered behaviors; 25.0% reported participating in all behaviors at some point in their lives. The median number of past year sexual behaviors (of 16 total) was 7. Lifetime and recent participation were associated with demographic and health factors.

CLINICAL IMPLICATIONS

Despite impairment, adults with spina bifida do participate in solo and partnered sexual behaviors. Medical personnel who work with this population should include discussions about sexuality as part of routine care.

STRENGTHS & LIMITATIONS

Although this research measured solo and partnered sexual behavior in large international sample of adults with spina bifida, it is limited by its cross-sectional retrospective design and non-clinical convenience sample.

CONCLUSION

Despite disability, many adults with SB participate in solo and partnered sexual behavior. Medical and psychosocial supports are needed to help adults in this population enjoy sexuality in a healthy and safe manner. Hensel DJ, Misseri R, Wiener JS, et al. Solo and Partnered Sexual Behavior Among an International Sample of Adults With Spina Bifida. J Sex Med 2022;19:1766-1777.

Sexual Subjectivity in Solo and Partnered Masturbation Experiences Among Emerging Adult Women

This qualitative study aimed to examine the experiences and attitudes toward masturbation among emerging adult women. The study was the first to compare women's solo and partnered masturbation experiences, focusing on how feelings of pleasure, sexual desire, and a sense of empowerment-important markers of women's sexual subjectivity-varied across the two contexts. The sample consisted of 40 women between the ages of 18 and 22 years. The majority of participants identified as Latina (33%) or Black (30%) and were enrolled in community college. Semi-structured interviews about women's masturbation experiences were analyzed using thematic analysis. Women described a multitude of feelings, including pleasure but also awkwardness and guilt. Although women did not describe their masturbation practices as morally wrong, they often alluded to disliking masturbation and preferring it less to partnered sex. Whereas some attitudes and feelings (e.g., awkwardness) arose in the context of both solo and partnered masturbation encounters, others were prevalent only in one (e.g., guilt in the solo encounters). Feelings of pleasure, sexual desire, and empowerment manifested differently in the two contexts. There was more focus on self-knowledge, control, and physical pleasure in the solo encounters and more enjoyment of a partner's desire and intimacy in the partnered encounters. We examine the findings through a feminist lens and consider how race/ethnicity, sexual scripts, and contemporary societal contexts shape women's sexual lives.

Subcultural Identification, Penetration Practices, Masculinity, and Gender Labels within a Nationally Representative Sample of Three Cohorts of American Black, White, and Latina/o LGBQ People

Most quantitative research about lesbian, gay, bisexual, and queer (LGBQ) people's sexual subcultures and sexual practices has used non-probability samples due to data limitations. This paper used the Generations study, a national probability sample of LGBQ Americans in three age cohorts, 18-25 (n = 510), 34-41 (n = 294), and 52-59 (n = 425), who also identified as Black, white, or Latina/o. This paper analyzed men (n = 590) and women (n = 639) to answer the following sets of research questions: (1) What is the prevalence of subcultural identification as bear, leather/kink, twink, and jock among men, and how does it differ by cohort, race/ethnicity, and sexual identity? (2) What is the prevalence of men who describe themselves as a top, versatile top, versatile, versatile bottom, and bottom? What is the relationship between penetration practices and masculinity? (3) What is the prevalence of gender labels among women as femme, androgynous, and butch? How does the prevalence differ by cohort, race/ethnicity, and sexual identity? (4) What is the relationship between women's gender labels and masculinity? Penetration practices were fairly evenly distributed among men, and there were few differences in masculinity based on penetration practices after controlling for demographics and subcultural identification. Most women did not use gender labels, but butch identities were more common among lesbians and femme labels were more common among Black women and Latinas.

Sexual Consent Across Diverse Behaviors and Contexts: Gender Differences and Nonconsensual Sexual Experiences

Sexual consent refers to people's internal willingness to engage in sexual activity with another person-as well as their external communication of that willingness. Internal and external sexual consent can vary by type of sexual behavior; however, previous research on sexual consent has primarily only assessed "typical" sexual behaviors such as genital touching, oral sex, and vaginal-penile sex without providing further context or acknowledging people's sexual diversity. Therefore, we provided an initial account of people's sexual consent-and lack thereof-for a broader array of sexual behaviors and contexts in which they occur. Using an online cross-sectional survey of participants in the United Kingdom and the United States (N = 658, 50.5% women), we examined event-level internal and external sexual consent for 20 sexual behaviors or contexts. Women reported significantly lower levels of sexual consent feelings than men for 12 of the 20 sexual behaviors and lower levels of active consent communication for 7 of them. Almost a third of participants (31.0%) had experienced at least one of the listed sexual behaviors against their will. Of those, participants on average reported nonconsensual experiences with 3.1 of the 20 types of sexual behavior listed, ranging from 1 to 11. More women reported at least one nonconsensual experience with one of the sexual behaviors assessed compared with men (47.9% versus 22.3%, respectively). We discussed several behavior-specific findings regarding sexual consent and the lack thereof. We also made recommendations for initiatives aimed at promoting healthy sexual consent practices: embrace sexual diversity, emphasize sexual agency, and encourage active consent communication.

Ownership, Enjoyment, Arousal Troubles, and Robust Education: Pleasure in LGBTQ+ Alt-Sex Members’ Responses to Consent Violations

Background: Alt-sex practitioners are a diverse group with diverse unconventional sexual behaviors including consensual non-monogamy (CNM), kink, fetishism, and bondage/discipline dominance/submission, sadomasochism (BDSM). Perhaps because of their openness to non-normative sexuality, these communities often comprise a large proportion of lesbian, gay, bisexual, trans, queer, among others (LGBTQ+) individuals. LGBTQ+ individuals experience higher rates of sexual violence and consent violation than their cisgender, heterosexual peers both inside and outside of formalized alt-sex communities. Pleasure, including but not limited to sexual pleasure, is often a motivator for engaging in sexual and alt-sex activities. This study examines how consent violations influence pleasure among LGBTQ+ alt-sex members. Methods: We conducted an electronic one-time survey of LGBTQ+ alt-sex practitioners (N = 1354). In this study, we analyze open-ended responses for ways pleasure was described in response to questions about consent violations. We use thematic analyses in Dedoose online software. Results: Two subthemes emerged related to the violation itself, (a) pleasure as a motivator for violating consent and (b) pleasure in spite of consent violation. As the second theme that emerged, pleasure was a component of the aftereffects of the violation in two ways: (1) pleasure was reduced or inhibited by consent violations; (2) pleasure was a motivator for healing and advocacy. Conclusions: We discuss practical and research implications based on the complex relationships between violations and pleasure reported by participants.

Openness to Using an External Penile Prosthesis for Maintaining Sexual Intimacy by Individuals with Erectile Dysfunction: A Cross-Sectional Study

Introduction

Erectile dysfunction (ED) can lead to reduced sexual intimacy in men. The external penile prosthesis (EPP) is a device to help them participate in penetrative sex.

Aim

We investigate factors that may affect the willingness of individuals with ED to try an EPP and explore how the EPP could be presented most effectively to such patients to enhance their willingness to try an EPP.

Methods

Recruitment for this cross-sectional study occurred in-person and online. 147 participants (60.0 ± 14.3 years old; all experiencing self-reported ED) completed a survey containing both validated measures and questions specific to this study. The survey was open to English-speakers over the age of 18 who self-reported experiencing ED.

Main Outcome Measure

The primary outcome was participants’ willingness to try an EPP based on their level of knowledge about using the EPP. Secondary outcomes included the influence of the sexual function, sexual distress, ED history, age, relationship duration, sexual flexibility on willingness to try an EPP. We also collected feedback from participants’ on how and where they would like to be introduced to the EPP option.

Results

Most participants indicated a preference for being introduced to the EPP after trying some ED treatments (51.0%). Participants did not have strong preference regarding the setting where they were informed about the EPP. The majority however preferred having a sexual health therapist/counsellor (28.6%) or physician (25.9%) as the person introducing the EPP to them. Participants’ willingness to try the EPP increased with more information about the EPP presented to them (P < .001). Personalization of the EPP to match one's own penis was preferred by 38.7% of participants. Referring to this aid as an ‘external penile prosthesis’ was significantly more preferred over alternative labels, such as a “belted prosthetic phallus” or “strap-on dildo” (Ps < .001 for both). Multiple regression analyses showed that only sexual script flexibility was associated with the initial willingness to try an EPP (P < .01).

Clinical Implications

Clinicians should consider presenting the EPP to men with ED, who desire maintaining penetrative sexual intercourse with their partners.

Strength and Limitations

This is the first study to explore factors influencing the willingness to try an EPP. Further research is needed to establish the efficacy of EPPs for maintaining sexual activity and satisfaction in the real-life setting.

Conclusion

This study informs clinicians about effective ways to introduce the EPP to patients with ED who wish to maintain insertive/receptive sex.

Fu F, Duthie CJ, Wibowo E, et al. Openness to Using an External Penile Prosthesis for Maintaining Sexual Intimacy by Individuals with Erectile Dysfunction: A Cross-Sectional Study. Sex Med 2022;10:100559.

Dark personalities and general masochistic tendencies: Their relationships to giving and receiving sexualized pain

Recent research has shown that a tendency to harm others goes hand in hand with a tendency to harm oneself. The present two studies further supported the notion that the joy of harming others and oneself has a common core by showing positive relationships between dark personality traits (particularly psychopathy) and sexual masochistic preferences and between general masochistic tendencies and sexual sadistic preferences. Despite the overlap between dark personality traits and general masochistic tendencies, they independently predicted the engagement in sexual sadomasochism. These relationships statistically held when controlling for the impact of basic personality (Study 1). Study 2 found that self-enhancement, openness to change, and low conservation values serve as motivators for a person's attraction to sexual sadomasochism and shed some light on the differences between sexual sadomasochism and the Dark Tetrad. Overall, people who score relatively high on dark personalities and masochism are particularly predisposed to engage in sexual sadomasochism, in both the dominant and the submissive roles.

Women’s techniques for pleasure from anal touch: Results from a U.S. probability sample of women ages 18–93

The study purpose was to assess, in a U.S. probability sample of women, the specific ways women have discovered to experience pleasure from anal touch. Through qualitative pilot research with women that informed the development of the survey instrument used in this study, we identified three previously unnamed, but distinct, anal touch techniques that many women find pleasurable and that expand the anal sexual repertoire beyond the more commonly studied anal intercourse behaviors: Anal Surfacing, Anal Shallowing, and Anal Pairing. This study defines each technique and describes its prevalence among U.S. adult women. Weighted frequencies were drawn from the Second OMGYES Pleasure Report—a cross-sectional, online, national probability survey of 3017 American women’s (age 18–93) sexual experiences and discoveries. Participants were recruited via the Ipsos KnowledgePanel^®. Data suggest that 40% of women find ‘Anal Surfacing’ pleasurable: sexual touch by a finger, penis, or sex toy on and around the anus. Approximately 35% of women have experienced pleasure using ‘Anal Shallowing’: penetrative touch by a finger, penis, or sex toy just inside the anal opening, no deeper than a fingertip/knuckle. Finally, 40% of women make other forms of sexual touch more pleasurable using ‘Anal Pairing’: touch on or inside the anus that happens at the same time as other kinds of sexual touch such as vaginal penetration or clitoral touching. These data provide techniques that women can and do use to explore the anus as a pleasurable region for touch—which can enable women to better identify their own preferences, communicate about them and advocate for their sexual pleasure.

Perceptions of and stigma toward BDSM practitioners

Despite a recent increase in academic attention, little is known about how the general population perceives BDSM practitioners. Though the gay/lesbian community has undergone de-medicalization and de-stigmatization over time, the same process for BDSM practitioners is in its infancy. Past research suggests that BDSM practitioners do expect to be stigmatized by others, especially in the healthcare system; however, little is known about how the general population currently perceives and stigmatizes the BDSM community. In the current study, we found that the general population (N = 257) does stigmatize BDSM practitioners more than the gay/lesbian population, and both are stigmatized more than a low-stigma comparison group (people in romantic relationships), F(2, 253) = 21.70, p < .001,η 2 = 0.15. These findings help to inform mental healthcare providers and the general population about BDSM practitioners, with the goal of inspiring additional research and activism aimed at combating misinformation and reducing stigma toward this population.

The relationship between college students' campus sexual health resource utilization and self-reported STI testing: Findings from an undergraduate probability survey

ObjectiveTo examine the prevalence of student utilization of campus sexual health resources and their association with sexually transmitted infection (STI) testing. Participants: Undergraduate students (n = 7020) at a large Midwestern university completed a confidential online survey in 2015. Methods: A probability-based sample of undergraduate students completed a cross-sectional online survey. Results: Commonly accessed sexual health resources were student orientation activities about sexual assault or rape, sexuality/gender classes, gender and sexual orientation panels, class panels on sexual assault, birth control and STI presentations, and having joined a sexuality-related student organization. Campus sexual health resource utilization was significantly associated with greater STI testing since college. Gender, race, class level, enrollment status, sexual orientation, timing of last sexual event, and perceived STI risk were significantly associated with STI testing in college. Conclusions: Campus sexual health resources play an important role in student sexual health promotion.

Changes in Penile-Vaginal Intercourse Frequency and Sexual Repertoire from 2009 to 2018: Findings from the National Survey of Sexual Health and Behavior

Solo and partnered sexual behaviors are relevant to health, well-being, and relationships. Recent research shows that sexual frequency has declined in the U.S. and in other countries; however, measurement has been imprecise. We used data from 14- to 49-year-old participants in the 2009 and 2018 waves of the National Survey of Sexual Health and Behavior (NSSHB), a confidential U.S. nationally representative survey that is conducted online. We aimed to: (1) assess changes in frequency of past-year penile-vaginal intercourse and (2) examine combinations of past-year sexual behaviors for each of the two waves. We hypothesized that we would observe lower frequency of penile-vaginal intercourse (PVI) from 2009 to 2018 and that we would observe greater engagement in sexual repertoires involving non-coital partnered behaviors (e.g., partnered masturbation, oral sex) in 2018 as compared to 2009. Participants were 4155 individuals from the 2009 NSSHB (Adolescents: 406 females, 414 males; Adults: 1591 women, 1744 men) and 4547 individuals from the 2018 NSSHB (Adolescents: 416 females, 411 males; Adults: 2007 women, 1713 men). Compared to adult participants in the 2009 NSSHB, adults in the 2018 NSSHB were significantly more likely to report no PVI in the prior year (28% in 2018 vs. 24% in 2009). A similar difference in proportions reporting no PVI in the prior year was observed among 14-17-year-old adolescents (89% in 2018 vs. 79% in 2009). Additionally, for both adolescents and adults, we observed decreases in all modes of partnered sex queried and, for adolescents, decreases in solo masturbation.

Masturbation in the Animal Kingdom

Masturbation is one of the most common sexual behaviors in humans. It is also a phylogenetically widespread trait of various other mammalian and some non-mammalian species. Several hypotheses have been proposed aiming to explain the function of masturbation in primates and other species. These were mainly based on observations of nonhuman primates such as rhesus macaques or bonobos and rodents such as African ground squirrels. Based on these observations various scholars suggested that masturbation improves ejaculate quality, decreases the risk of contracting sexually transmitted infections or is merely a by-product of sexual arousal and thus an alternate outlet to copulation. While these theories may explain some facets of masturbation in some species, they do not explain why masturbation is so widespread and has developed in various species as well as our hominid ancestors. Moreover, the research on which these theories are based is scarce and heavily focused on male masturbation, while female masturbation remains largely unexplored. This sex difference may be responsible for the one-sided theorizing that attributes a specific biological benefit to masturbation. We propose that the widespread prevalence of masturbation in the animal kingdom may be better explained by viewing masturbation as a primarily self-reinforcing behavior that promotes pleasure both in human and in nonhuman species.

Impact of the COVID-19 pandemic on student' sleep patterns, sexual activity, screen use, and food intake: A global survey

Background

The education sector experienced substantial impacts during the COVID-19 pandemic resulting from worldwide restrictions.

Purpose

To examine differences in the sleep patterns, sexual activity, screen use, and food intake of students and non-students during the COVID-19 pandemic.

Methods

This was a global cross-sectional study conducted in the second half of 2020 using multiple social media platforms to recruit study participants globally. A close-ended questionnaire was administered anonymously in English, French, Spanish, Portuguese, and Arabic to adults ages 18 and older. The outcome variables considered in analyses were changes in sleep pattern, sexual activity, screen use, and food intake. The explanatory variable was student status categorized as students vs. non-student. T-test, chi-square, and Mann Whitney U tests were used to assess differences between student and non-student populations. One logistic regression model was built for each outcome variable. Country of residence and country income level were included in the adjusted models.

Results

There were 17,008 participants of which 3,793 (22.3%) were students. Of the total sample, 4,889 (28.7%) reported changes in sleep, 4,642 (31.8%) reported increases in sexual activity, 10,278 (70.7%) reported increases in screen use, and 5,662 (40.2%) reported increases in food intake during the pandemic. Compared to non-students, students had significantly higher odds of reporting changes in sleep (AOR = 1.52), increases in sexual activity (AOR = 1.79), and increases in screen use (AOR = 1.36) but lower odds of reporting increase in food intake (AOR = 0.87).

Conclusion

Students displayed higher risk of experiencing changes in sleep, sexual behavior, and screen use during the COVID-19 pandemic. This has the potential to lead to broader adverse effects on students’ overall wellbeing. The findings and implications raise further obligations on the education sector to put extra-curricular support systems in place that address COVID-19 related behavior changes that have the potential to adversely impact students’ wellbeing.

Sexual Variety in Norwegian Men and Women of Different Sexual Orientations and Ages

The purpose of this study was to examine Norwegians' reports of seven varied sexual acts. Data were obtained from a questionnaire survey of a probability-based web sample of 2,181 men and 1,967 women aged 18-89 years. Among seven acts of sexual variety, the most common sexual experiences were trying to watch pornography with a partner, engaging in sex in unusual places, and using sex toys. Older age was negatively associated with all sexual behaviors. Regarding more unorthodox acts of sexual variety, heterosexual men's sexual preferences involved having and desiring group sex, whereas heterosexual women's sexual experiences and desires involved having sex in unusual places. Lesbian, gay, bisexual (LGB) individuals generally showed greater curiosity or experience of having group sex and engaging in BDSM (bondage, discipline, dominance and submission, and sadomasochism) activities than heterosexual adults. However, while LGB men had a high preference for group sex activities, LGB women had more positive attitudes toward BDSM activity. Individuals appear to accumulate more acts of sexual variety over time, thus making the incorporation of sexual variety a function of age. This study supports the idea that sexual variety has expanded among those born from 1960 onwards.

Sexual-risk and STI-testing behaviors of a national sample of non-students, two-year, and four-year college students

OBJECTIVE

To determine whether sexual-risk and STI-testing behaviors differ by college student status.

PARTICIPANTS

Sexually experienced 17- to 25-year-olds from a 2013 nationally representative panel survey that evaluated the "Get Yourself Tested" campaign. Non-students (n = 628), 2-yr (n = 319), and 4-yr college students (n = 587) were surveyed.

METHODS

Bivariate analyses and multiple logistic regression were used.

RESULTS

Students were less likely than non-students to have had an early sexual debut and to have not used condoms in their most recent relationship. 4-yr students were less likely than non-students to have had multiple sexual partners. 2-yr students were less likely than non-students to have not used contraception in their most recent relationship.

CONCLUSIONS

2-yr and 4-yr college students were less likely than non-students to engage in sexual-risk behaviors. Given potentially greater risk for STI acquisition among non-students, identification and implementation of strategies to increase sexual health education and services among this population is needed.

"I Would Report It Even If They Have Not Committed Anything": Social Service Students' Attitudes Toward Minor-Attracted People

This study explores future mental health providers' assumptions about minor-attracted people, using data from a survey of 200 students preparing for entry into social service professions at a public university in the state of Utah. Survey results show that more than half of the students believe clients who identify themselves as pedophiles must be automatically reported to the police, which has implications for providers' understandings about the term "pedophile," as well as their knowledge of guidelines for when clinicians may break client confidentiality. This belief was not significantly affected by taking ethics courses, nor courses that discussed mandated reporting guidelines. Despite this finding, 91% of students did not believe that they would need to report a client who had attractions to children, but who had never committed a sexual offense against a child. The majority of students indicated a willingness to work with minor-attracted clients, and commonly indicated in comments that they wanted more information about MAPs and when to break client confidentiality in their programs of study. Study results indicate a need for education among social service students about these issues.

Porn Sex versus Real Sex: Sexual Behaviors Reported by a U.S. Probability Survey Compared to Depictions of Sex in Mainstream Internet-Based Male-Female Pornography

Using data from a 2014 U.S. nationally representative probability survey and a 2014 content analysis of 2562 male-female videos from two popular pornographic websites, this study aimed to: (1) compare the prevalence of survey respondents' event-level sexual behaviors with those depicted in mainstream pornography online videos; (2) compare event-level condom use with condom use prevalence in pornographic videos; (3) compare event-level orgasm with prevalence of orgasms in pornographic videos; and (4) assess whether respondents' partnered use of pornography was associated with the sexual behaviors in which they report engaging. We found that kissing, male orgasm, female orgasm, and condom use were significantly less prevalent in the pornographic videos than in survey respondents' most recent sexual experiences. Conversely, penile-anal intercourse and fellatio were significantly more prevalent in the pornographic videos than in participants' reports of their most recent sexual experience. There were no significant differences between the prevalence of cunnilingus or sex toy use represented in the videos as compared to survey respondents' reports. Finally, we found that individuals who reported partnered pornography use during their most recent sexual experience were more likely to report having engaged in oral sex, penile-anal intercourse, and sex toy use and were also more likely to report female orgasm during their most recent sexual experience.

Meanings of Rough Sex across Gender, Sexual Identity, and Political Ideology: A Conditional Covariance Approach

The purpose of this study was to investigate how various subgroups based on gender, sexual identity, and political ideology conceptualize rough sex. We used available data from a 2020 survey of randomly sampled undergraduate students at a large public university in the Midwestern U.S. (n = 4,989). The dichotomous responses to 13 items on the rough sex meaning scale were analyzed using a conditional covariance approach to better understand which behaviors commonly described as rough sex behaviors were prevalent. Our results showed that rough sex was conceptualized largely as a two-dimensional construct for vast majority of subgroups. Across all subgroups, nine of the 13 behaviors clustered along two dimensions in the same way. Specifically, four behaviors related to hair pulling, being pinned down, hard thrusting, and throwing someone onto a bed clustered together as one dimension (spanking and tearing clothes off being present along this dimension for vast majority of the subgroups). Being tied up, slapping, choking, punching, and making someone have sex behaviors formed a separate dimension of rough sex across all studied groups (with biting and scratching being associated with this dimension for vast majority of subgroups).

Sexual Health in Spanish People with Intellectual Disability: the Impact of the Lockdown due to COVID-19

INTRODUCTION

The lockdown due to COVID-19 affected the sexual health of the people with intellectual disabilities by differentially modifying the frequency and characteristics of people's sexual activity depending on whether or not they lived with a partner during this period. The aim of this study was to analyze the extent to which the sexual behavior of people with intellectual disabilities (with and without a partner) was affected during the lockdown.

METHODS

The sample consisted of 73 people with intellectual disabilities between 21 and 63 years old (M = 39.63; SD = 10.11). The variables analyzed were the physical, social, and technological environment during the lockdown, sexual appetite, sexual behavior, online sexual activity, and sexual abuse. The data were collected between the months of May and June of 2020.

RESULTS

The lockdown increased the sexual appetite of a third of the sample (38%), especially the youngest participants. Sexual activity focused on autoeroticism and online behavior, particularly sending nude images of oneself (88%) and viewing pornography (83.6%). Rates of sexual abuse during this period were relatively high (6.8%).

CONCLUSIONS

The sexual activity of people with ID was important during the lockdown, and they had to adapt to the circumstances of isolation in a similar way to the general population. Technological improvements in terms of devices and connection quality at home allowed their sexual behavior to be reoriented, opening the door to new risks for the sexual health of people with ID.

POLICY IMPLICATIONS

Cybersex and the increase in sexual abuse due to confinement are aspects that should be included in programs to improve the sexual health of this group.

"You Feel Like Normal Sex is not Enough Anymore": Women's Experiences of Coercive and Unwanted Anal Sex with Men

In this article, we explore the gendered dynamics of coercion described by 18 women we interviewed about their experiences of unwanted and nonconsensual heterosexual anal sex. Several women referred to what they believed to be the normative status of heterosexual anal sex. In many cases, the socially coercive effects of perceived norms intertwined with threads of interpersonal coercion, leaving women feeling pressured to agree to, or little room to refuse, anal sex they did not want. We discuss the ways that new sexual norms can translate into new pressures for women within the gendered framework of heterosexual relationships.

The effects of sex and handedness on masturbation laterality and other lateralized motor behaviours

Masturbation is a common human behaviour. Compared to other unimanual behaviours it has unique properties, including increased sexual and emotional arousal, and privacy. Self-reported hand preference for masturbation was examined in 104 left-handed and 103 right-handed women, and 100 left-handed and 99 right-handed men. Handedness (modified Edinburgh Handedness Inventory, EHI), footedness, eyedness, and cheek kissing preferences were also measured. Seventy nine percent used their dominant hand (always/usually) for masturbation, but left-handers (71.5%) were less consistently lateralized to use their dominant hand than right-handers (86.5%). Hand preference for masturbation correlated more strongly with handedness (EHI), than with footedness, eyedness, or cheek preference. There was no difference in masturbation frequency between left- and right-handers, but men masturbated more frequently than women, and more women (75%) than men (33%) masturbated with sex aids. For kissing the preferred cheek of an emotionally close person from the viewer's perspective, left-handers showed a left-cheek preference, and right-handers a weaker right-cheek preference. The results suggest that hemispheric asymmetries in emotion do not influence hand preference for masturbation but may promote a leftward shift in cheek kissing. In all, masturbation is lateralized in a similar way to other manual motor behaviours in left-handed and right-handed men and women.

Frequency of Pornography Use and Sexual Health Outcomes in Sweden: Analysis of a National Probability Survey

BACKGROUND

Little is known about pornography use and its relationship with sexual health outcomes in the general population.

AIM

To assess frequency of pornography use and the association of sexual health outcomes with frequent pornography use in Sweden.

METHODS

Cross-sectional analysis of 14,135 participants (6,169 men and 7,966 women) aged 16-84 years in a Swedish nationally representative survey from 2017. We used logistic regression to assess the association of sexual health outcomes with use of pornography ≥3 times/wk.

OUTCOMES

Frequency of pornography use (never; less than once/mo to 3 times/mo; 1-2 times/wk; 3-5 times/wk; and daily or almost daily) and sexual health outcomes (eg, sexual satisfaction and sexual health problems).

RESULTS

In total, 68.7% of men and 27.0% of women used pornography. Among men aged 16-24 years, 17.2% used pornography daily or almost daily, 24.7% used pornography 3-5 d/wk and 23.7% used pornography 1-2 d/wk. Among women aged 16-24 years, the proportions were 1.2% for daily or almost daily, 3.1% for 3-5 times/wk, and 8.6% for 1-2 times/wk. Frequency of pornography use decreased with age among both men and women. While 22.6% of all men and 15.4% of all women reported that their or a sex partner's pornography use predominantly had positive effects on their sex life, 4.7% of men and 4.0% of women reported that the effects were predominantly negative. Variables indicating sexual dissatisfaction and sexual health problems were associated with use of pornography ≥3 times/wk: for example, dissatisfaction with sex life (age-adjusted odds ratio [aOR]: men 2.90 [95% CI 2.40-3.51]; women 1.85 [95% CI 1.09-3.16]), not having sex in the preferred way (aOR: men 2.48 [95% CI 1.92-3.20]; women 3.59 [95% CI 2.00-6.42]) and erection problems (aOR: men 2.18 [95% CI 1.73-2.76]).

CLINICAL IMPLICATIONS

While frequent pornography use is common, potential effects on sexual health outcomes are likely to differ between individuals.

STRENGTH & LIMITATIONS

We used a large and recent nationally representative survey with detailed information regarding frequency of pornography use. The temporality of associations of sexual health variables with frequency of pornography use could not be assessed.

CONCLUSION

In this analysis of a nationally representative survey in Sweden, we found that frequent pornography use was common among young men; that reporting predominantly positive effects of pornography use on the sex life was more common than reporting predominantly negative effects; and that sexual dissatisfaction and sexual health problems were associated with using pornography ≥3 times/wk. Malki K, Rahm C, Öberg KG, et al. Frequency of Pornography Use and Sexual Health Outcomes in Sweden: Analysis of a National Probability Survey. J Sex Med 2021;18:1735-1751.

Virgins at age 26: who are they?

Background Studies on virgins remain scarce. This study explores the characteristics of virgin young adults, the reasons for remaining virgin, and its potential social and health implications.

METHODS

Data were drawn from the 2017 Swiss study on sexual health and behaviour among young adults. A total of 5175 participants (mean age 26 years ± 0.01) were divided into virgins and non-virgins. Virginity was defined as never having had a sexual partner, defined as a person with whom the participant has had sexual contact with or without penetration.

RESULTS

A total of 275 (5.3% (95% CI: 4.7-6.0), 58% males) were virgins. Virgins had higher odds of being male (aOR: 2.27 (95% CI: 1.62-3.17)) and reporting poorer health (1.43 (1.07-1.92)). They had lower odds of living on their own (0.24 (0.18-0.32)), being satisfied with their social life (0.78 (0.72-0.85)), having experimented with substances (e.g. drunkenness, 0.27 (0.19-0.67)) and having used online dating (0.52 (0.26-1.12)) or pornography (0.67 (0.42-0.94)). The main reason for remaining virgin was 'I have not found the right person' for females, and 'I have not had the occasion' for males.

CONCLUSIONS

Among young adults, 1 in 20 is a virgin. Virgins do not seem to have gone through the usual experimentations of adolescence, are less socially driven and reported more health challenges. The main reason for remaining a virgin reveals gender-stereotyped responses. Sexual inactivity among young adults should be considered by health professionals to ensure the absence of distress and open discussion for potential questions.

How safe is BDSM? A literature review on fatal outcome in BDSM play

A noteworthy number of people are interested in BDSM (bondage and discipline, dominance and submission, sadism, and masochism). Fatal outcomes while participating in BDSM activities occur. The aim of this literature review is to give a better insight into potential dangerous BDSM play by summarizing published data on BDSM fatalities. A literature search was conducted. It was searched for non-natural death related to BDSM activity. Seventeen cases were found. The age of the deceased ranged between 23 and 49 years (mean age 34.9 years). Strangulation in the course of erotic asphyxiation was the most common cause of death (88.2%). In 13 cases, a toxicology report for the deceased was mentioned, of which in eight cases (61.5%) toxicology analysis was positive. In four of these cases, the BDSM partner was also tested positive with the same substance. Drugs or alcohol was involved in 64.3% of fatal BDSM play. In nine cases, the level of experience in BDMS activity of the deceased and the partner was described, and in all of them, the deceased and the partner were not new to BDSM play. Fatal outcomes of BDSM plays are rarer than autoerotic fatalities and natural deaths related to sexual activities. Safeguards and education on medical aspects exist in the BDSM communities. If they are followed by the practitioners, the risks of BDMS play can be reduced. Cases of non-natural death connected to BDSM are rare incidents and can be prevented.

Age, sex, and other demographic trends in sexual behavior in the United States: Initial findings of the sexual behaviors, internet use, and psychological adjustment survey

It remains unclear how the seemingly ubiquitous use of the internet impacts user's offline personal relationships, particularly those that are romantic or sexual. Therefore, we conducted a national online survey to better understand the associations among internet use, sexual behavior, and adjustment called the Sexual Behaviors, Internet Use, and Psychological Adjustment Survey (SIPS). Here, we report patterns of sexual behavior in a sample of adults (N = 1987; ages 18-70) in the United States to establish its representativeness and consistency with similar recent surveys. We found age- and sex-related trends in oral, vaginal, and anal sex in terms of prevalence, frequency, number of partners, and age of initiation consistent with prior studies. We also detected differences in sexual behaviors based on relationship status and sexual orientation, but small and relatively few significant differences across racial and ethnic groups. The results confirm and expand upon trends identified in prior national surveys of sexual behavior, establishing the representativeness of the SIPS sample for use in future research examining the links among sexual behaviors and romantic relationships, internet use, and adjustment.