How Does Sexual Subjectivity Vary on the Basis of Gender and Sexual Orientation? Validation of the Short Sexual Subjectivity Inventory (SSSI-11) in Cisgender, Heterosexual and Sexual and Gender Minority Adolescents

Through sexual exploration, adolescents learn that they are sexual beings with choices, desires, and are deserving of pleasure, which corresponds to sexual subjectivity. However, the two measures of this construct (i.e., Female Sexual Subjectivity Inventory and Male Sexual Subjectivity Inventory) have not been validated with younger adolescents and have different items for boys and girls (with no scale available for gender diverse individuals), limiting gender comparisons. This study examined (1) the factor structure of the adapted Short Sexual Subjectivity Inventory-11 items (SSSI-11) in a large sample of young cisgender, heterosexual and sexual and gender minority adolescents, (2) measurement invariance across language (English and French), gender, and sexual orientation, (3) validity with sexuality-related outcomes, and (4) one-year temporal stability. Results of a confirmatory factor analysis among 2001 adolescents (Mage = 15.5 years, SD = 0.60) revealed a multidimensional factor structure. The SSSI-11, in both English and French, showed adequate reliability and one-year temporal stability, and was invariant across genders, sexual orientations, and languages. Girls had lower scores on the entitlement to self-pleasure and self-efficacy in achieving pleasure factors, and higher scores on the entitlement to pleasure from a partner factor. No significant differences were observed on the basis of language or between heterosexual and sexual minority adolescents. The SSSI-11 correlated positively with sexuality-related variables. Findings support the strong psychometric properties of the SSSI-11, rendering it of considerable use in clinical, education, and research applications.

"I Was Worshiped and in Control": Sugar Arrangements Involving Transactional Sex from the Perspective of Both Sugar Babies and Sugar Benefactors

Sugar dating arrangements involve an older partner ("sugar daddy/mommy") who provides financial support to a younger partner ("sugar baby") in exchange for intimacy. The current study recruited a U.S. and Canadian sample of sugar babies (n = 45) and sugar benefactors (n = 32) through social media sources to survey them about perceived power in their sugar arrangement, gender roles, and stigma. Sugar benefactors did not differ in perceived power from sugar babies, nor in endorsement of traditional gender roles or stigma. Directed content analysis analyzing open-ended responses about associated outcomes indicated that both partners placed strong emphasis on companionship despite the importance of sex within arrangements. Sugar babies reported that money drives participation, although arrangements fulfill other needs, such as pleasure. Other benefits include having an arrangement with clear boundaries and expectations. Disadvantages include concerns for safety, that being physical safety for babies, and reputation and being used for money for daddies. Notably, both groups perceived sugar babies as having equal or more power than sugar benefactors, although this was often attributed to sugar babies' attractiveness and youth. Findings include insights from both babies and benefactors, and support perspectives that sugar dating is distinct from traditional sex work.

Romanticizing the Stolen Kiss: Men's and Women's Reports of Nonconsensual Kisses and Perceptions of Impact on the Targets of Those Kisses

Stolen kisses are often portrayed as resulting from uncontrollable passion and a need to connect intimately with another. This study examined stolen kisses, defined as kissing someone for the first time when the kisser perceived the kiss recipient was not expecting it, and had not provided consent for the kiss. These kisses were examined from the perspective of the individual initiating the kiss. Participants (N = 130; Mage = 32.27; 67% identified as male) completed an anonymous online survey assessing kissing experiences of having stolen a kiss and their open-ended responses were analyzed here. Men were more likely than women to report having stolen a kiss in line with traditional heterosexual scripts. Three scenarios emerged through content analysis: mutual attraction leading to a new relationship; no known mutual attraction but a positive outcome; and no known mutual attraction and a negative outcome. Stealing a kiss from someone for whom there was mutual attraction often led to the onset of an intimate relationship; thus, the kiss constituted a relationship catalyst. When there was no known shared attraction, some interactions ended positively, but others resulted in an end to cordial relations and often strong negative reactions. Findings are discussed in terms of the limited literature on kissing generally and the nonconsensual nature of these events.

Anxiety Sensitivity in the Sexual Context: Links between Sexual Anxiety Sensitivity and Sexual Well-Being

Anxiety sensitivity, the fear of physiological arousal sensations, has been linked to lower sexual frequency, poorer sexual function, and greater sexual anxiety. The current study assessed whether anxiety sensitivity specific to the sexual context, termed sexual anxiety sensitivity, was linked to a wide range of indicators of sexual well-being over and above associations accounted for by general anxiety sensitivity. As a first step, we developed the Sexual Anxiety Sensitivity Inventory (SASI). Participants were 484 adults aged 19 to 60 years old who completed an on-line survey. To develop the SASI, we constructed parallel items to those on the Anxiety Sensitivity Scale-3 (ASI-3; Taylor et al., 2007). The SASI demonstrated the same three-factor structure as the ASI-3 and showed high internal consistency providing evidence for its reliability. As predicted, sexual anxiety sensitivity was significantly associated with all ten of the markers of the behavioral, cognitive-affective, and functional domains of sexual well-being assessed and six of these associations remained significant after controlling for general anxiety sensitivity. The results provide evidence that sexual anxiety sensitivity is an important construct for understanding individuals' sexual well-being and provide initial evidence that the specificity of the SASI has value as a reliable and valid measure for assessing sex-related anxiety sensitivity. Implications for clinicians and researchers are discussed.

Individual and Relationship Predictors of Trajectories of Sexual Function across Adolescent and Young Adult Relationships

Many young adults report poor sexual function, but research typically fails to consider relationship context and how problems might evolve over time. Research is needed to provide insights into how sexual problems are experienced across relationships, as well as the types of sexual function problems associated with various trajectories. We investigated retrospective trajectories of sexual problems across the multiple relationships of 688 young adults (18-24 years) as well as the individual and relationship factors associated with these trajectories. Both persistent suboptimal and optimal trajectories emerged for men and women. However, persistent and variable problematic function trajectories also emerged for women (and not men). Across all individual and relationship factors analyzed, multivariate multinomial regression analysis indicated that higher sexual esteem and more traditional gender beliefs best predicted membership in trajectories capturing better sexual function. Implications are discussed in terms of the need to provide substantive information regarding sexual function to young people as they transition to adulthood.

Perhaps It Was Too Soon: College Students' Reflections on the Timing of Their Sexual Debut

Early sexual debut has been a focus of social scientific research due to its association with adverse circumstances and negative outcomes. However, there has been a recent shift to considering not only chronological age, but also the degree to which the event is viewed to be optimally timed (i.e., the perception that it occurred at the "right time" versus too soon). The purpose of this study was to assess how individual/family background variables and contextual aspects of the experience (including partner and relationship aspects) are associated with both the actual age at sexual debut and the perceived acceptability of the timing of the event. Using data collected from students at a U.S. university between 1990 and 2019 (N = 6,430), several factors (in addition to chronological age) were associated with the perceived acceptability of the timing of sexual debut. Strong gender differences were found - women perceived their timing to be less acceptable, even though they did not differ from men in actual age at sexual debut. Other robust predictors of perceived acceptability included (lower) religious involvement and recalling desire (for the experience), pleasure, and lower guilt at the time. Only slight changes occurred over the 30-year period in age at sexual debut and perceived acceptability of the timing. Suggestions for future research are provided and implications for sex education/sexual health interventions are discussed.

What is sexual wellbeing and why does it matter for public health?

Sexual health has provided a guiding framework for addressing sexuality in public health for several decades. Although the WHO definition of sexual health is revolutionary in acknowledging positive sexuality, public health approaches remain focused on risk and adverse outcomes. The long-standing conflation of sexual health and sexual wellbeing has affected our ability to address everyday sexual issues. This Viewpoint provides a way forward to resolve this impasse. We propose sexual wellbeing as a distinct and revolutionary concept that can be operationalised as a seven-domain model. We situate sexual wellbeing alongside sexual health, sexual justice, and sexual pleasure as one of four pillars of public health enquiry. We argue that sexual wellbeing is imperative to public health as a marker of health equity, a meaningful population indicator of wellbeing, a means to capture population trends distinct from sexual health, and an opportunity to refocus the ethics, form, and practices of public health.

Once a Poacher Always a Poacher? Mate Poaching History and its Association with Relationship Quality

Successful mate poaching is a form of infidelity that occurs when one partner knowingly attracts the mate of another with the intention of starting a sexual and/or romantic relationship with this individual. Relationships formed from poaching tend to be of lower quality than their non-poached counterparts. A history of poaching might reflect a sociosexuality that propels seeking new partnerships without regard for exclusivity. It is unknown whether serial poaching for relationship formation is linked to more permissive sociosexual orientation. Adults (N = 653; aged 25-40; 57% women) in a romantic relationship completed online surveys assessing mate poaching, poaching history, sociosexuality, and relationship quality (commitment, satisfaction, trust, jealousy). Those in a poached relationship at the time of the study had a more extensive history of poached relationships and a more permissive sociosexuality. Participants who reported a more extensive history of mate poaching reported poorer quality relationships. The link between poaching history and relationship quality was partially accounted for by sociosexuality. This research adds to our understanding of difficulties that may be associated with the relationships of individuals who use poaching as a relationship initiation strategy, and the challenges that permissive sociosexuality may present for maintaining long-term relationships.

Walk the Line: How Successful Are Efforts to Maintain Monogamy in Intimate Relationships?

Monogamy, typically defined as sexual and romantic exclusivity to one partner, is a near-universal expectation in committed intimate relationships in Western societies. Attractive alternative partners are a common threat to monogamous relationships. However, little is known about how individuals strive to protect their relationships from tempting alternatives, particularly those embedded in one's social network. The current exploratory study was guided by the Investment Model, which states that satisfaction, investments, and perceived alternatives to a relationship predict commitment, which in turn predicts relationship longevity. The study aimed to identify relationship and extradyadic attraction characteristics associated with monogamy maintenance efforts, specifically relationship commitment, as predicted by the Investment Model. The efficacy of monogamy maintenance efforts was assessed via sexual and emotional infidelity measures at a 2-month follow-up. U.S. adults in heterosexual intimate relationships (N = 287; 50.2% male; M age = 34.5 years; M relationship length = 87 months) were recruited online to complete the survey study. Through structural equation modelling, the Investment Model structure was replicated, and relationship commitment predicted use of relationship-enhancing efforts as well as self-monitoring/derogation efforts. Individuals who experienced reciprocated attraction used significantly more avoidance and self-monitoring/derogation efforts than did those who experienced unreciprocated attraction. Ultimately, monogamy maintenance efforts did not significantly predict success in maintaining monogamy at follow-up. These findings have important research, educational, and clinical implications relating to relationship longevity.

From Promoting Healthy Sexual Functioning to Managing Biomedical Sexual Dysfunction: Health Professional Views of Youth Sexual Health

A body of work emerging in the last few years has expanded the focus of youth sexual health to include problems in sexual functioning. Recent surveys show that rates of youth sexual functioning problems are similar to those of adults. Physicians' lack of awareness about problems of sexual functioning has been identified as a major obstacle in treatment. Yet little is known about health-care provider (HCP) perspectives on youth sexual functioning. We conducted a descriptive qualitative study with HCPs to learn about their perceptions of adolescent sexual problems and HCP roles in managing these issues including sexual functioning. Nineteen HCPs: Family physicians, nurse practitioners, and public health nurses working primarily with youth in universities, schools, or sexual health clinics were recruited to draw on their expert knowledge and experience. All completed in-depth individual interviews. Data were analyzed using directed qualitative content analysis. Our findings illuminate inconsistent views. Some HCPs, particularly those in youth-focused services, adopt a holistic role in promoting healthy sexual functioning, and others, commonly those in general practice, attend only to biomedical issues related to sexual dysfunction. All HCPs in our study were challenged by a paucity of sexual health preparation in their formal education. HCP interest in youth sexual health affected their efforts to acquire new information and training and, along with the structure of their practice setting, influenced whether they framed their role in youth sexual health holistically within a context of social determination or constrained their role to a medical model. These findings draw attention to the need for new approaches for strengthening knowledge, training, and resources to foster HCP promotion of healthy sexual functioning and prevention of lifelong sexual health problems.

Figuring It Out: How Late Adolescent and Young Adult Men and Women Perceive and Address Problems in Sexual Functioning

Although there are high rates of sexual problems and sexual dysfunction in adulthood (Mitchell et al., 2013), little is known about the circumstances under which problems are first experienced. A growing body of research addresses prevalence of problems in sexual functioning among adolescents and young adults, yet little is known about the meanings that young people give to these experiences or how they deal with them. We used content analysis of qualitative interviews with 53 heterosexual, sexually active Canadian adolescents (ages 18 to 21) to explore their perceptions of the sexual problems in functioning they had experienced and the strategies (if any) they used to address them over time. Problems among most young people originated early in their partnered sexual life. Figuring it out emerged as an intentional process directed toward improving sexual experiences, although certainly not all young people were successful. Strategies for figuring it out included informational or material help seeking, experimentation to inform future actions, mutual sharing and problem solving, and building emotional connection to improve sexual functioning. Implications for understanding the development of sexual dysfunctions in adulthood are discussed.

Plenty of Fish in the Ocean: How do Traits Reflecting Resiliency Moderate Adjustment After Experiencing a Romantic Breakup in Emerging Adulthood?

Breakups are common but often one of the most distressing experiences that young people can have. Poor adjustment to relationship loss is linked to depressive symptoms and rumination. This study assessed traits that reflect resiliency and that might comprise protective factors that ameliorate depressive symptoms and rumination. Online survey participants included 866 male and female late adolescents (18-22 years; Mean age = 20.7; 62% female; 82% White/Caucasian; 7% Asian/Southeast Asian; 6% Black/African American) who recently had experienced the breakup of a romantic relationship. Analyses assessed whether optimism, grit, and self-esteem moderated the breakup-adjustment relationship. After controlling for gender and current relationship status, higher optimism, self-esteem, and grit were expected to be associated with lower levels of depressive symptoms and rumination for those who had experienced a breakup in the three months prior to the study, and for the most part, these predictions were confirmed. These findings can be reinforced in education and counseling programs to better support individuals suffering the aftermath of a breakup. The findings add to the literature on adolescents' development of interpersonal functioning and skills required in intimate relationships.

The Relationship Among Online Sexually Explicit Material Exposure to, Desire for, and Participation in Rough Sex

The broad accessibility of online sexually explicit material (SEM) exposes viewers to a wide scope of sexual behaviors. Social concern tends to be heightened over SEM that incorporates highly graphic, "rough" sex. This study assessed the associations among exposure to rough sex in SEM, desire for rough sex, and participation in rough sex while accounting for gender, sexual orientation, and perceived realism of SEM. Young adults (N = 327; ages 19-30; 50.8% men) were recruited through a crowdsourcing website. They completed an anonymous online survey that assessed viewing frequency for a range of sexual behaviors in SEM, the perceived realism of SEM, desire to participate in the behaviors viewed, and if they had ever participated in those behaviors. Hair pulling, spanking, scratching, biting, bondage, fisting, and double penetration were used to create the variable of rough sex. Rough sex desire and participation were common among individuals who have been exposed to rough sex in SEM, with 91.4% desiring to engage in 1 + behaviors at least to a small degree and 81.7% having engaged in 1 + behaviors. Exposure to rough sex in SEM was positively associated with desire for and participation in rough sex, emphasizing the need to ensure that individuals can distinguish between consensual rough sex and sexual violence. This study did not parse out causal effects or directionality, but did provide some insights into the interrelatedness of viewing, desiring, and participating in rough sex.

Cognitive processing in the aftermath of relationship dissolution: Associations with concurrent and prospective distress and posttraumatic growth

Non-marital romantic relationship dissolution is amongst the most stressful life events experienced by young adults. Yet, some individuals experience posttraumatic growth following relationship dissolution. Little is known about the specific and differential contribution of trait-like and event-specific cognitive processing styles to each of these outcomes. A longitudinal design was employed in which trait-like (brooding and reflection) and dissolution-specific (intrusive and deliberate) cognitive processing was examined as predictors of growth (Posttraumatic Growth Inventory) and distress (Breakup Distress Scale) following a recent relationship dissolution. Initially, 148 participants completed measures of trait-like and dissolution-specific cognitive processing, growth, and distress (T1). A subsample completed a seven-month follow-up (T2). Higher frequency of relationship-dissolution intrusive thoughts predicted concurrent distress after accounting for brooding and relationship characteristics. Further, higher brooding and lower reflection predicted higher distress prospectively. Concurrent growth was predicted by both higher brooding and more deliberate relationship-dissolution thoughts. Prospectively, T1 dissolution intrusive thoughts predicted higher T2 deliberate thoughts, and the interaction between these two constructs predicted higher T2 growth. Therefore, deliberately thinking of the dissolution was related to positive psychological outcomes. In contrast, intrusive dissolution cognitions and a tendency for brooding had a mixed (paradoxical) association with psychological adjustment.

We Need to Talk: Disclosure of Sexual Problems Is Associated With Depression, Sexual Functioning, and Relationship Satisfaction in Women

Women with sexual problems (e.g., difficulties with desire, arousal, lubrication, orgasm, and pain during sexual activity) experience more depressive symptoms, and poorer sexual functioning and relationship satisfaction compared with unaffected women. A robust literature highlights the importance of sexual communication, and sexual self-disclosures in particular, for the well-being of individuals in romantic relationships. However, little is known about the disclosure of sexual problems to romantic partners and its association with women's psychological, sexual, and relationship well-being. This study examined the proportion of women (N = 277) who disclose (vs. do not disclose) sexual problems to their partner, and the consequences of disclosure. Women (M_age = 29.79, SD = 6.54) completed online validated measures assessing sexual problems, relationship satisfaction, sexual functioning, and depressive symptoms. The majority (69.3%) reported disclosing sexual problems to their current romantic partner. Disclosers reported fewer depressive symptoms, and greater sexual functioning and relationship satisfaction compared to nondisclosers. Disclosing sexual problems may benefit women's well-being by enhancing intimacy or allowing couples to adapt sexual activities to accommodate sexual problems. Clinicians might use cognitive-behavioral strategies to assist women in disclosing sexual problems to partners to maximize the potential psychological, sexual, and relationship benefits.

Men's and Women's Use and Creation of Online Sexually Explicit Materials Including Fandom-Related Works

The Internet and mobile computing have been highly influential in shaping the modern technological era and subsequently the production of and access to online sexually explicit materials (SEM). Fandom-the realm of fans sharing a common interest-has also adapted to the Internet, which has changed how fans access and distribute fanworks (i.e., material created by fans such as stories and art), many of which contain SEM. The current study examined gender differences in the use and creation of online SEM by surveying 468 men and 347 women (ages 18 or older; mean age = 33.8 years) residing in North America. Participants completed anonymous measures assessing demographic information, experiences using and creating online SEM, and measures of related sexual attitudes. Use of online SEM was widely reported by participants, with men (87.8 %) indicating more use than with women (67.4 %). As expected, few participants reported creating online SEM (3.6 % of men, 4.9 % of women). Men and women reported similar levels of preferred sexual explicitness in the online SEM that they used. There were no significant gender differences in the use of fanworks reported by men (14.3 %) and women (14.7 %) or in the creation of fanworks (1.5 % of men, 3.2 % of women). Fandom-related online SEM use was predicted only by more permissive sexual attitudes (one of eight predictors). Although there were many similarities between men's and women's use of online SEM, some gender differences were found in their motives for online SEM use. Findings are discussed in terms of the context in which men and women experience online SEM.

Love thy neighbour: Personality traits, relationship quality, and attraction to others as predictors of infidelity among young adults

Infidelity is defined as the violation of a couple's assumed or stated agreement concerning emotional and/or sexual exclusivity. The current study examined the utility of personality traits (i.e., the Big Five and SIS/SES - an individual's sexual response to sexual desires, arousal, and behaviours are based on the balance between sexual excitation and sexual inhibition; Bancroft & Janssen, 2000) relative to relationship quality and attraction to others in predicting reports of infidelity among a sample of young adults (ages 18–26 years). A total of 131 men and 164 women from the US who reported being in a romantic relationship were recruited using MTurk®, an online crowdsourcing survey tool. Participants completed a series of measures assessing demographics, relationship quality and investment, sexual experience, sexual attitudes, attraction to others, and personality traits, including the Big Five and SIS/SES. A notable minority (16.6%) of participants reported at least one occasion of past infidelity during their current romantic relationship (yes/no reports); however, reports of infidelity increased significantly when individuals reported actual sexual, romantic, and online infidelity activities (78.6%). Personality traits within the Big Five and SIS/SES models were not significant predictors of infidelity. With each occurrence of emotional attraction to a person other than their current partner, the odds of reporting infidelity increased by 51.6%. The findings are discussed in terms of implications for counselling and education regarding infidelity, as well as continued research on risk factors for infidelity among young adults.

Drawing the Line: The Development of a Comprehensive Assessment of Infidelity Judgments

Infidelity is a leading cause of relationship discord and dissolution, and couples generally report expectations to maintain monogamy. However, a majority of men and women report engaging in some form of infidelity at least once in their lives. Research assessing judgments of the behaviors that constitute infidelity is lacking. The three studies reported here advanced the literature by developing and validating the Definitions of Infidelity Questionnaire (DIQ), a comprehensive measure examining infidelity judgments. Exploratory and confirmatory factor analyses indicated four factors to the scale: sexual/explicit behaviors, technology/online behaviors, emotional/affectionate behaviors, and solitary behaviors. Investigation of the psychometric properties demonstrated the DIQ to be reliable and valid. Participants agreed that sexual/explicit behaviors comprised infidelity to the largest extent, whereas other types of behaviors (technology/online behaviors, emotional/affectionate behaviors, and solitary behaviors) were judged as comprising infidelity to a lesser extent. Men reported more permissive judgments than did women. This study provides insights regarding operationalizing infidelity and identifying areas of ambiguity and consensus. Implications of the findings for educators and practitioners working with individuals in intimate relationships are discussed.

A Longitudinal Study of Problems in Sexual Functioning and Related Sexual Distress Among Middle to Late Adolescents

PURPOSE

Rates of sexual dysfunctions are high among adults, but little is known about problems in sexual functioning among adolescents. We completed a comprehensive assessment of problems in sexual functioning and related distress over a 2-year period among adolescents (16-21 years).

METHODS

A sample of 405 adolescents completed five online surveys over 2 years. The main outcome measures were clinical cutoff scores on the International Index of Erectile Function and Premature Ejaculation Diagnostic Tool for male adolescents and the Female Sexual Function Index for female adolescents. A secondary outcome was clinical levels of distress.

RESULTS

The majority of sexually active adolescents (78.6% of the male and 84.4% of the female) reported a sexual problem over the course; rates did not differ significantly by gender. Common problems for males were low sexual satisfaction (47.9%), low desire (46.2%), and problems in erectile function (45.3%). Common problems for females were inability to reach orgasm (59.2%), low satisfaction (48.3%), and pain (46.9%). Models predicting problems over time showed increased odds among those not in a sexual relationship. Odds of reporting a distressing sexual problem decreased over time for female but not male adolescents.

CONCLUSIONS

Problems in sexual functioning emerge early in individuals' sexual lives, are often distressing, and appear not to fluctuate over time. Additional efforts to identify key factors linked to onset will help elucidate possible mechanisms.

The Development of the Sexual Self-Concept Inventory for Early Adolescent Girls

The Sexual Self-Concept Inventory (SSCI) was developed to assess sexual self-concept in an ethnically diverse sample of urban early adolescent girls. Three scales (Sexual Arousability, Sexual Agency, and Negative Sexual Affect) were shown to be distinct and reliable dimensions of girls' sexual self-concepts. Validity was established through comparisons with established instruments. Sexual Arousability and Sexual Agency were associated with positive sexual self-esteem, positive future orientation toward sex, intentions to engage in intercourse, and lower levels of sexual experience. Negative Sexual Affect was associated with stronger abstinence attitudes and lack of intentions or orientation toward sex in the near future. The results indicate that the SSCI constitutes a valid means of assessing early adolescent girls' views of their sexuality and sexual behavior and may be of use in studies of health and risk-related decision making.

A Comparison of Male and Female College Students' Experiences of Sexual Coercion

Research comparing men's and women's experiences of sexual coercion has typically assessed differences in prevalence rates and risk. We extended this line of research by comparing the contexts of sexual coercion and reactions to sexually coercive experiences in an attempt to understand the meanings that men and women attribute to these events. Participants were 433 randomly selected college students who responded to an anonymous survey. In line with past research, more men than women reported being sexually coercive, and more women than men reported being sexually coerced in the preceding year. There was a great degree of correspondence between men's and women's reports of the contexts within which sexual coercion occurred. According to their reports, sexual coercion occurred primarily within the heterosexual dating context. Compared to men, however, women reported more negative reactions and stronger resistance to the use of sexual coercion. These findings emphasize how comparisons of prevalence rates alone may obscure important differences in the phenomenology of sexually coercive incidents for men and women. Findings are discussed in terms of implications for the development of education and prevention programs and the need to reevaluate current approaches to interpreting prevalence reports.

Linking online sexual activities to health outcomes among teens

New digital technologies are highly responsive to many of the developmental needs of adolescents, including their need for intimate connection and social identity. This chapter explores adolescents' use of web-based sexual information, texting and "sexting," online dating sites, role-playing games, and sexually explicit media, and presents new data comparing the interpersonal and intrapersonal health outcomes among youth who engage in online sexual activities to those who do not. Despite the media-stoked concerns surrounding adolescents' participation in online sexual activities, the ubiquity of online activities and close overlap between online and offline activities indicate that this type of behavior should not be pathologized or used as a metric of problem behavior. The chapter concludes with implications for parents, educators, researchers, counselors, and health care providers, a call to challenge our deep discomfort around adolescent sexuality and to harness these technologies in ways that help promote growth and positive development.

The ex-factor: Characteristics of online and offline post-relationship contact and tracking among Canadian emerging adults

The breakup of an intimate relationship is a highly distressing event among emerging adults (Cutler, Glaeser, Norberg, 2001) and can often be accompanied by difficulty adjusting to the loss and “letting go” (Mearns, 1991). Research on stalking and cyberstalking behaviours address criminal activities that incite fear in a target (e.g., Spitzberg & Cupach, 2007). Little is known about more general post-relationship contact and tracking (PRCT), that is, efforts to maintain or re-establish contact with an ex-partner or to track their whereabouts, new partnerships or activities. To understand both the use and experience of PRCT, we examined reports from 271 Canadian emerging adults (aged 18–25) regarding their most recent breakup within the prior year. Results indicated that online and offline forms of post-relationship contact and tracking were common, characterizing 87.8% of all recent breakups, and were typically used in conjunction. In fact, online forms rarely occurred in isolation. Attempts to keep in contact were most commonly reported by users and targets of behaviours, whereas extreme and threatening behaviours that might comprise stalking or cyberstalking were rare. No gender differences were found in the use of PRCT behaviours, although women reported experiencing more offline forms.

Prevalence and characteristics of sexual functioning among sexually experienced middle to late adolescents

INTRODUCTION

Little is known about problems in sexual functioning among young people, despite the high rates found in adult samples. It is unclear which problems are most prevalent or how common sexual distress is for young people experiencing problems.

AIMS

This study aims to assess the prevalence, range, and correlates of sexual problems and distress among a sample of adolescents (16-21 years).

METHODS

Participants (mean age 19.2) were recruited from community and area high schools. Male adolescents (n = 114) completed online the International Index of Erectile Function (IIEF) and Premature Ejaculation Diagnostic Tool (PEDT). Female adolescents (n = 144) completed the Female Sexual Function Index (FSFI). Both completed the Female Sexual Distress Scale (FSDS) and the measures of background, relationship characteristics, and sexual histories.

MAIN OUTCOMES MEASURES

Clinical cutoff scores on the IIEF, PEDT, FSFI, and FSDS were used to determine whether there was a significant sexual problem.

RESULTS

Adolescents reported extensive sexual experience, most in relationship contexts. Half of the sample (51.1%) reported a sexual problem; 50.0% reported clinically significant levels of distress associated with it. Similar rates of problems and distress were found among male and female adolescents. For the most part, adolescent characteristics, backgrounds, and experience were not associated with adolescents' sexual problems.

CONCLUSION

Sexual problems are clearly prevalent among adolescents, and distressing to many who experience them, emphasizing a strong need to develop programs to address this issue.

Schoolgirls and soccer moms: a content analysis of free "teen" and "MILF" online pornography

Viewing free online pornographic videos has increasingly become a common behavior among young people, although little is known about the content of these videos. The current study analyzed the content of two popular female-age-based types of free, online pornography (teen and MILF) and examined nuances in the portrayal of gender and access to power in relation to the age of the female actor. A total of 100 videos were selected from 10 popular Web sites, and their content was coded using independent raters. Vaginal intercourse and fellatio were the most frequently depicted sexual acts. The use of sex toys, paraphilias, cuddling, and condom use were rare, as were depictions of coercion. Control of the pace and direction of sexual activity was typically shared by the male and female actors. Moreover, there were no gender differences in initiation of sexual activity, use of persuasion, portrayals of sexual experience, or in professional status. However, female actors in MILF videos were portrayed as more agentic and were more likely to initiate sexual activity, control the pace of sexual activity, and have a higher professional status. Implications regarding the role of pornography in generating or reinforcing sexual norms or scripts are discussed.

Gender differences in associations of sexual and romantic stimuli: do young men really prefer sex over romance?

Theory and research emphasize differences in men's and women's sexual and romantic attitudes, concluding that men have stronger preferences for sexual than romantic stimuli as compared to women. However, most of the research on gender differences have relied on self-reports, which are plagued by problems of social desirability bias. The current study assessed young men's and women's implicit attitudes toward sexual and romantic stimuli to test whether, in fact, men have a stronger preference for sexual over romantic stimuli compared to women. We also assessed associations between implicit and explicit attitudes, as well as sex role ideology and personality. College students (68 men and 114 women) completed an Implicit Association Test (IAT) that assessed strengths of associations of sexual and romantic stimuli to both pleasant and unpleasant conditions. Results revealed that both men and women more strongly associated romantic images to the pleasant condition than they associated the sexual images to the pleasant condition. However, as predicted, women had a stronger preference toward romantic versus sexual stimuli compared to men. Our study challenges a common assumption that men prefer sexual over romantic stimuli. The findings indicate that measures of implicit attitudes may tap preferences that are not apparent in studies relying on self-reported (explicit) attitudes.

Who gives and who gets: why, when, and with whom young people engage in oral sex

Surprisingly little is known about oral sex experiences among emerging adults, including the motives behind their participation in this sexual activity. The current study examined the characteristics of emerging adults' most recent oral sex experience. A total of 431 young people (M age = 21.7 years; 71.7% female) completed an on-line survey assessing their sexual history, context (partner type, co-occurring sexual behaviors), and motives (physical, emotional, goal attainment, and insecurity) for engaging in their most recent heterosexual oral sex interaction. The majority of oral sex encounters occurred within the context of a committed relationship and during an interaction that also included intercourse. Cunnilingus was rare unless reciprocated with fellatio. Overall, both males' and females' reports indicate that they were motivated to engage in oral sex by sexual desire and attraction to their partner, or to enhance an emotional connection with their partner. Insecurity and goal attainment motives were uncommon. Males reported more physical motives than did females, and females reported more emotional and insecurity motives than did males. The findings provide insights into youths' oral sex experiences, and make clear how essential it is to understand the broader sexual and partnership context in which a given sexual activity occurs. These findings have implications for policies aimed at the development of effective sexual health education programs.

Communicating interest in sex: verbal and nonverbal initiation of sexual activity in young adults' romantic dating relationships

Relatively little is known about the day-to-day initiation of sexual activity between young adults in committed relationships, notably the ways in which young people communicate interest in sexual activity. Sexual script theory (Simon and Gagnon, Society 22:53-60, 1984) posits that men are traditionally the initiators and women the restrictors of sexual activity early in relationships. However, research suggests that these patterns may be different for individuals in committed relationships. The current study used a diary method to examine verbal/nonverbal and indirect/direct initiation strategies, responses to initiations, and patterns between initiations and responses. Participants included 31 men and 32 women between the ages of 18 and 24 years who were involved in committed heterosexual relationships. Men initiated more frequently than did women and most initiations were nonverbal initiation (91%) rather than verbal (65%). Responses to initiations tended to match the initiators' choice of strategies, suggesting that synchrony plays an important role in initiation patterns. The findings have implications for understanding sexual communication as well as relationship and sexual satisfaction among young adults.

A longitudinal analysis of predictors of male and female adolescents' transitions to intimate sexual behavior

PURPOSE

Determining predictors of sexual transitions is essential for developing health interventions.

METHODS

Adolescents (13-16 years) completed baseline and 6-month surveys assessing psychosocial factors and sexual behavior.

RESULTS AND CONCLUSIONS

Lower self-esteem for boys and higher lifetime alcohol use for girls predicted transitions to more intimate sex. These differential profiles may warrant tailored health initiatives.

Challenges of providing confidential care to adolescents in urban primary care: clinician perspectives

PURPOSE

Clinician time alone with an adolescent has a major impact on disclosure of risk behavior. This study sought to describe primary care clinicians' patterns of delivering time alone, decision making about introducing time alone to adolescents and their parents, and experiences delivering confidential services.

METHODS

We undertook qualitative interviews with 18 primary care clinicians in urban health centers staffed by specialists in pediatrics, family medicine, and adolescent medicine.

RESULTS

The annual preventive care visit is the primary context for provision of time alone with adolescents; clinicians consider the parent-child dynamic and the nature of the chief complaint for including time alone during visits for other than preventive care. Time constraints are a major barrier to offering time alone more frequently. Clinicians perceive that parental discomfort with time alone is rare. Many clinicians wrestle with internal conflict about providing confidential services to adolescents with serious health threats and regard their role as facilitating adolescent-parent communication. Health systems factors can interfere with delivery of confidential services, such as inconsistent procedures for determining whether unaccompanied youth would be seen.

CONCLUSION

Despite competing time demands, clinicians report commitment to offering time alone during preventive care visits and infrequently offer it at other times. Experienced clinicians can gain skills in the art of managing complex relationships between adolescents and their parents. Office systems should be developed that enhance the consistency of delivery of confidential services.

Delivery of confidential care to adolescent males

PURPOSE

Primary care providers' (PCPs') provision of time alone with an adolescent without the parents present (henceforth referred to as "confidential care") has a significant impact on adolescents' disclosure of risk behavior. To inform the development of interventions to improve PCPs' delivery of confidential care, we obtained the perspectives of adolescent males and their mothers about the health care concerns of adolescent males and the provision of confidential care.

METHODS

This focus-group study (5 groups: 2 with adolescent males and 2 with mothers) used standard qualitative methods for analysis. We recruited mother/son dyads who had been seen at urban primary care practices.

RESULTS

Adolescents' health concerns focused on pregnancy and sexually transmitted infections; mothers took a broader view. Many adolescents felt that PCPs often delivered safe sex counseling in a superficial, impersonal manner that did not add much value to what they already knew, and that their PCP's principal role was limited to performing sexually transmitted infection testing. Though adolescents cited a number of advantages of confidential care and disclosure, they expressed some general mistrust in PCPs and concerns about limits of confidentiality. Rapport and relationship building with their PCP are key elements to adolescents' comfort and increased disclosure. Overall, mothers viewed confidential care positively, especially in the context of continuity of care, but many felt excluded.

CONCLUSIONS

To increase adolescents' perception of the relevance of primary care and to foster disclosure during health encounters, our participants described the critical nature of a strong doctor-patient relationship and positive physician demeanor and personalized messages, especially in the context of a continuity relationship. Regular, routine inclusion of confidential care time starting early in adolescence, as well as discussion of the purpose and limitations of confidentiality with parents and adolescents, could lead to greater parental comfort with confidential care and increased disclosure by the adolescent.

The developmental association of sexual self-concept with sexual behavior among adolescent women

Developing a sexual self-concept is an important developmental task of adolescence; however, little empirical evidence describes this development, nor how these changes are related to development in sexual behavior. Using longitudinal cohort data from adolescent women, we invoked latent growth curve analysis to: (1) examine reciprocal development in sexual self-concept (sexual openness, sexual esteem and sexual anxiety) over a four year time frame; (2) describe the relationship of these trajectories with changes in sexual behavior. We found significant transactional effects between these dimensions and behavior: sexual self-concept evolved during adolescence in a manner consistent with less reserve, less anxiety and greater personal comfort with sexuality and sexual behavior. Moreover, we found that sexual self-concept results from sexual behavior, as well as regulates future behavior.

A cognitive analysis of college students' explanations for engaging in unprotected sexual intercourse

Young adults, including college students, engage in high levels of unprotected sexual activity despite relatively high rates of HIV/STI and pregnancy-related knowledge. Little is known about the cognitive strategies that young people use to explain this inconsistency. The current study examined young people's explanations for engaging in unprotected sexual activity in their committed relationships. A total of 63 young adults (32 women and 31 men) completed daily diaries over a 3-week period, providing a total of 1,284 daily reports tracking their condom use and non-use during intercourse. Diary collection was followed by in-depth interviews designed to explore participants' decision-making regarding their participation in sexual intercourse unprotected against infection or unwanted pregnancy. Less than a quarter of the sample used condoms or oral contraceptives consistently. Participants primarily viewed condoms as a means of preventing pregnancy; few described disease prevention as a main motivation for their use. Analysis of the cognitions underlying explanations for condom and contraception non-use were classified as (1) general biased risk evaluation, (2) biased evidence evaluation, (3) endorsement of poor alternatives, (4) focus on spurious justifications, (5) dismissing risk, and (6) ignoring risk. Prevention interventions should incorporate methods to challenge young people to acknowledge personal risk and commit themselves to taking steps to reduce this risk.

In the absence of marriage: long-term concurrent partnerships, pregnancy, and HIV risk dynamics among South African young adults

In KwaZulu/Natal, South Africa, where HIV prevalence is among the world's highest, a longitudinal qualitative study of partnership dynamics and HIV preventive behaviors was conducted. 47 young adults aged 18-24 participated in in-depth interviews, and 29 were re-interviewed 2 years later. Five analytical domains emerged: primary partnerships, love and romance; secondary partnerships; pregnancy/parenthood; condom use/prevention; and contextual influences, including schooling and future aspirations. Primary relationships were long-lasting, with most men and women in the same relationship at 2-year follow-up. Secondary, casual partnerships were common for men and women, although these were shorter and changed frequently. Love and marriage aspirations were not viewed as incompatible with secondary partners. Condom use increased over time in some primary relationships, but decreased in others, and was nearly universal with non-primary partners. Pregnancy, school drop-out, and economic need strongly influence young people's lifecourse. These findings suggest the need to focus prevention efforts on the partnership context, including partner reduction, and structural factors that impede or enhance prevention success.

Sex without desire: characteristics of occasions of sexual compliance in young adults' committed relationships

Sexual compliance (i.e., willingly engaging in sexual activity that one does not desire) is a common behavior among young people. Little is known about the characteristics of occasions of sexual compliance in the context of a committed relationship. This study used both a diary method and in-depth interviews to assess occasions of sexual compliance, as well as types of sexual activity, condom use, pleasure, and feelings of pressure and control. Participants included 63 young adults (18-24 years old) in committed, heterosexual relationships. Seventeen percent of all sexual activity was rated as sexually compliant. Occasions of sexual compliance were rated as less enjoyable and more unexpected. In-depth interviews revealed four key themes including endorsement of an implicit contract between partners, partner awareness of low desire, past experience of pressure, and justification for reporting low desire. Future research should evaluate the long-term impact of sexual compliance on a relationship.

Does HIV VCT reduce risk behaviors? An observational study in Guatemala City

OBJECTIVE

We examined the impact of HIV voluntary counseling and testing on self-reported behavioral risks three months after HIV testing.

DESIGN

Cohort study comparing self-reported risk behaviors prior to and three months after HIV testing.

SETTING

Clinica Familiar Luis Angel Garcia, an HIV specialty clinic located in a Guatemalan National Hospital.

SUBJECTS, PARTICIPANTS

144 people undergoing HIV testing were enrolled. 44 were HIV positive. 41 HIV positive and 49 HIV negative subjects returned for follow-up interviews.

INTERVENTION

All subjects were tested and received voluntary counseling regarding HIV infection, transmission, prevention, and interpretation of HIV test results.

MAIN OUTCOME MEASURE

The primary study outcome measure was change in self-reported risk behaviors three months after voluntary counseling and testing.

RESULTS

Men were more likely than women to report a history of sexually transmitted diseases, more than 2 sexual partners, using alcohol with sex, and receiving money for sex; they were less likely to have a regular partner. 26% of men reported non-heterosexual orientation; no woman did. Alcohol was the primary drug of abuse in both men and women. At three month follow-up HIV positive subjects showed decreases in the average number of sexual partners, use of alcohol with sex, and episodes of unprotected sex.

CONCLUSIONS

Voluntary counseling and testing resulted in changes in some self-reported risk behaviors, but only among HIV positive subjects. On nearly all measures men report riskier behavior than women. Alcohol is the most commonly used drug in this population and is often used with sex.

Can a clinical prediction tool guide HIV-testing decisions? Experience at a national hospital in Guatemala

The USA and international recommendations no longer emphasize using risk factors to target groups for HIV-testing. Using a Guatemalan database of HIV tests, we developed a clinical prediction rule to guide decisions on HIV-testing. Prior to HIV-testing, data were collected on demographics, risk factors and prior testing. Based on a theoretical construct incorporating demographics, known HIV risk factors and symptoms, we developed a logistic regression model to predict HIV seropositivity. Between 2000 and 2005, 16,471 tests were performed, of which 19.8% were positive. The algorithm successfully predicted 1883 of 2489 HIV-positive tests (sensitivity 76%, likelihood ratio [LR]-positive 2.45) and 6282 of 9086 HIV-negative tests (specificity 69%, LR-negative 0.35). Although the model indices are robust, applying the model in a clinical setting would have little impact on improving selective testing practices. Our findings support current recommendations for universal HIV-testing, not selective testing based on risk factors. Before these recommendations can be adopted widely in Guatemala, treatment access needs to be assured and protections put in place for people diagnosed with HIV infection.

Such a tease: intentional sexual provocation within heterosexual interactions

Sexual teasing is a form of provocation characterized by the promise of sexual contact followed by withdrawal. The intention is to frustrate or cause tension in the target and incorporates some use of power of one person over another. To date, this form of interaction between individuals has received little research attention. A total of 742 undergraduate university students (143 men, 599 women) provided reports regarding whether they had ever engaged in sexual teasing and, for those who had, the motives behind this behavior, the type of relationship and sexual history with the target, and the reactions and outcomes associated with these interactions. Sexual teasing was relatively common among both women and men, although women were significantly more likely to report having engaged in sexual teasing at least once in the past. The outcomes associated with their interactions were perceived to be more positive for participants (elicitors) than for their targets, although relatively few participants reported more adverse outcomes from the use of sexual teasing. Discussion focused on the need to better characterize forms of communication regarding sexual intentions and consent. The findings may have implications for efforts to improve models of communication and negotiation in sexual interactions.

I wanna hold your hand: the progression of social, romantic and sexual events in adolescent relationships

CONTEXT

Despite the vast amount of existing research on adolescent sexual behavior, little is known about the trajectory of social, romantic and sexual events within an adolescent's relationship.

METHODS

A subsample of participants in Wave 2 of the National Longitudinal Study of Adolescent Health (8,438 respondents aged 12-21) provided data on the sequence of 15 social, romantic and sexual events that occurred in a recent romantic relationship. Proportions reporting each event and average relative rankings were assessed for all respondents, for different racial and ethnic groups, and for respondents who belonged to the same racial or ethnic group as their partner. Logistic regression was used to compare proportions; ordinary least square regression was used to analyze the mean sequential ranking of each event.

RESULTS

Social and romantic events, such as spending time with one's partner in a group and holding hands, were far more common than sexual events, such as touching one's partner without clothing, and typically preceded sexual events in the trajectory of relationship events. Romantic events were the most common across three of the four major U.S. racial and ethnic groups. Asian and Hispanic respondents tended to have low proportions reporting sexual events compared with white respondents. Black adolescents were the only group for whom talking about prevention of pregnancy and STDs preceded sexual events. Reports from male and female adolescents were similar.

CONCLUSION

Recognition of the diversity of relationship experiences may prompt the development of more effective interventions for adolescents who engage in risky sexual behavior.

Awareness and attitudes regarding microbicides and Nonoxynol-9 use in a probability sample of gay men

A household probability sample of 879 adult gay and other men who have sex with men in San Francisco underwent phone interviews. Approximately, half reported recent unprotected anal intercourse (UAI). Yet, lubricant use was high, a behavior that may facilitate future adoption of topical microbicide delivered by a lubricant gel. Despite warnings against Nonoxynol-9 (N-9), 26% of respondents reported still using it. Microbicide awareness was higher among men reporting UAI than among consistent condom users. Scenarios presenting microbicides "as effective as condoms," "nearly as effective," or "less effective but better than nothing" produced wide variability in willingness to use them, which may have implications for microbicide acceptability. HIV-infected men and those who reported UAI showed greater microbicide acceptance.

Perspectives on confidential care for adolescent girls

PURPOSE

We wanted to obtain perspectives of mothers and daughters on facilitators of and barriers to with adolescent girls' timely access to risk-appropriate reproductive care.

METHODS

We conducted 5 separate focus groups with Latina and black mothers and their adolescent daughters. All participants resided in impoverished neighborhoods of New York City. Participants addressed mothers' roles in helping girls initiate gynecologic care, perceived role of physicians in daughters' sexual health, including the provision of confidential care, and perceived need for girls' gynecologic care. Data were analyzed using qualitative data analysis methods.

RESULTS

Mothers see themselves as their daughters' primary protectors against daughters' poor reproductive outcomes. Many believe that confidential care promotes risky behavior and undermines mothers' efforts to protect girls. Mothers endorse facilitating gynecologic care and entering alliances with physicians but see the need for care as arising only after girls' sexual debut. Unfortunately, maternal awareness of sexual activity is low. Adolescent girls express considerable discomfort around reproductive health care and negotiating maternal involvement, and they fear breaches in confidentiality.

CONCLUSIONS

A lack of trust in health care clinicians and the mother's gatekeeper role are key barriers to girls' transition to reproductive care. Consistently including a confidential component to health care visits in early adolescence, with preparation for both mothers and daughters, may reduce the distrust and discomfort.