The association of sexual interest and sexual behaviors among adolescent women: a daily diary perspective

Sexual Concurrency Among Adolescent Women With Multiple Partners: A Daily Diary Study

PURPOSE

Sexual partnerships that overlap in some period of time (i.e., concurrent) are a key factor in sexually transmitted infection (STI) transmission. Research examining concurrency among adolescents typically uses person-level, cross-sectional, and/or retrospective data, obscuring factors that manifest on any given occasion of concurrency. We used sexual diaries to examine: (1) daily prevalence of vaginal sex concurrency when two partners are reported by adolescent women; and (2) individual, relational, and behavioral attributes that impact the likelihood of sex with neither partner, with one partner or the other, or with both partners on any given day.

METHODS

Daily diaries were drawn from a large longitudinal cohort study examining sexual relationships, behaviors, and STIs among adolescent women. Participants contributed 280,844 partner-associated diary entries, of which (27.9%; n = 78,356) indicated multiple partners. All two-partner diary entries were retained for analysis (N = 323; Mage = 17.55; 90% African American). Random intercept mixed-effects multinomial logistic regression was used to evaluate the impact of predictor variables on odds of having sex with one or the other, both, or neither partner.

RESULTS

Most two-partner days (93.5%) involved no sex with either partner. Few reports (.2%) indicated same-day sexual concurrency. Older age, greater partner support, and higher sexual interest increased the likelihood of sex with both partners on the same day.

CONCLUSIONS

Individual, relational, and behavioral factors predict concurrency in ways that challenge assumptions that secondary partnerships constitute negligible relationships. Programs targeting partner concurrency in adolescents may find success tailoring messaging around these findings.

Developing Valid and Feasible Measures of Sexual Consent for Experience Sampling Methodology

Preliminary evidence indicates that people's sexual consent (i.e., their willingness to engage in sexual activity and communication of that willingness) varies across time and context. Study designs that assess sexual consent at multiple time points (e.g., experience sampling methodology [ESM]) are needed to better understand the within-person variability of sexual consent. However, extant validated measures of sexual consent are not appropriate for ESM studies, which require shorter assessments due to the increased burden this methodology has on participants. As such, the goal of the present study was to develop ESM measures of sexual consent based on items that have previously been validated for use in cross-sectional surveys. We selected items that balanced face validity as evidenced by cognitive interviews (n = 10) and content validity as evidenced by experts' ratings (n = 6). To assess the construct validity and feasibility of these items, we administered the selected ESM measures of sexual consent in a seven-day pilot study (n = 12). The results suggested that the ESM measures developed in the present study were a valid and feasible assessment of people's experience-specific internal consent feelings and external consent communication. We conclude with recommendations for sex researchers interested in ESM.

Daily diary study of adult men's and women's event-level sexual motivations and sexual behaviour

Background Understanding people's sexual motivations has long been of public health and health promotion interest. We used daily diaries to examine how adult men's and women's event-specific affective sexual motivations were linked to the types and combinations of sexual behaviours chosen in a given sexual event.

METHODS

Adult men (n=156) and women (n=192) completed thrice-daily electronic diaries assessing individual- and partner-specific attributes and non-coital or coital sexual behaviours. Sexual motivations were: interest in sex, feeling in love with partner, wanted to have sex and partner wanted to have sex. The outcome variable was: sexual behaviour type (no sex, one vaginal sex event, one vaginal sex event+any other sex types, multiple vaginal sex events, any other sex types). Mixed-effect multinomial logistic regression modelled the influence of each sexual motivation on sexual behaviour type (Stata; all p<0.05). 'No sex' was the referent in all models; all models controlled for gender.

RESULTS

Participants contributed 14856 total partner-associated diary entries. Most (54%; women: 56.5%, men: 51.2%) were associated with no sex; when sex occurred, the most common behaviour type was one vaginal sex event (13.1%) for women and other sex types (16.4%) for men. Wanting to have sex or perceiving a partner wanted to have sex were the strongest predictors of sexual behaviour type, and were associated with a greater number of reported sexual behaviours.

CONCLUSIONS

Event-specific sexual motivations are associated with the choice to have sex, and with variation in the chosen sexual behaviours.

The Potential of Hormonal Contraception to Influence Female Sexuality

The association between female sexual function and hormonal contraception is controversial. Recognition and management of sexual side effects in women using hormonal contraceptives are challenging. An unsatisfactory number of studies report the influence of the available contraceptives on female sexuality. This article provides an updated narrative review regarding the effect and the magnitude of the impact that hormonal contraceptives play in female sexual function.

The Mediating Role of Sexual Behavior in Event-Level Associations Between Sexual Difficulties and Sexual Satisfaction in Newlywed Mixed-Sex Couples

INTRODUCTION

Many sexual difficulties encountered by couples in their day-to-day lives, although of insufficient intensity and persistence to warrant a clinical diagnosis of sexual disorder, are nevertheless frequent and a source of individual and relational distress.

AIM

The aim of this study was to assess the event-level associations between couples' everyday, subclinical sexual difficulties (specifically, low subjective sexual arousal, low physiological sexual arousal, and genito-pelvic pain), the range of sexual behaviors that these couples engage in, and their sexual satisfaction.

METHODS

70 Newlywed participants (35 couples, average age = 25.6 years, SD = 3.2 years; average duration of relationship = 5.4 years, SD = 3.4 years) individually completed daily diaries about sexual difficulties, range of activities performed during sex, and sexual satisfaction over the course of 5 weeks. Analyses were guided by the actor-partner interdependence model.

MAIN OUTCOME MEASURE

The main outcome was sexual satisfaction, measured at the event-level on a 5-point Likert scale using a single-item question.

RESULTS

On days of sexual activity, men and women's difficulties with subjective sexual arousal were associated with lower sexual satisfaction in both partners (actor and partner effects). This association was mediated by the range of couples' sexual behaviors, such that lower subjective arousal was associated with a more restricted range of sexual activities, which in turn was associated with lower sexual satisfaction. Men's and women's difficulties with physiological sexual arousal, and women's genito-pelvic pain, were each associated with their own lower sexual satisfaction. No partner effects were observed for these sexual difficulties, nor were they mediated by the range of couples' sexual activities.

CLINICAL IMPLICATIONS

The study's results highlight how couples' sexual difficulties can interfere with same-day sexual satisfaction, and how for subjective sexual arousal, this interference is reflected by a more restricted range of sexual behaviors.

STRENGTH & LIMITATIONS

Strengths of the study include the daily diary methodology, which allowed a focus on event-level sexual activities with minimal retrospective bias. Further, the dyadic analyses allowed both intra-individual and inter-individual effects to be assessed. Limitations include the lack of a more general measure of sexual desire and of a more diverse sample, in terms of age, race, and sexual orientation.

CONCLUSION

These findings underscore the importance of treatments that include both partners, and that target the types as well as range of sexual activities in which couples engage. Jodouin J-F, Bergeron S, Janssen E. The Mediating Role of Sexual Behavior in Event-Level Associations Between Sexual Difficulties and Sexual Satisfaction in Newlywed Mixed-Sex Couples. J Sex Med 2018;15:1384-1392.

Hormonal contraceptive affects heterosexual but not homosexual behavior in free-ranging female Japanese macaques over 17 mating seasons

We assessed the effect of a progestin-based contraceptive treatment (chlormadinone acetate) on female heterosexual and homosexual behaviors in a free-ranging group of Japanese macaques (Macaca fuscata) living at Arashiyama-Kyoto, Central Japan. The data included estimated intensity of fertility cues, sexual solicitations and mounting behaviors collected daily during 17 consecutive mating seasons (1995-2012) from 159 females. Females that were on contraception: (1) exhibited less intense cues of putative fertility and for shorter periods; (2) were solicited by fewer males, and those males that did solicit them did so less often (i.e., lower heterosexual attractivity); (3) solicited fewer males and when they did perform sexual solicitations they did so less often (i.e., lower heterosexual proceptivity); (4) engaged in shorter heterosexual consortships with fewer male partners (i.e., lower heterosexual receptivity), compared with females that were not on contraception. In contrast, contraceptive treatment had no significant effect on the prevalence, occurrence, frequency, or duration of female homosexual behaviors. Even though heterosexual and homosexual behaviors can both be considered sexual in character and under hormonal control, our results suggested they are, to some extent, dissociable. Because females engaging in homosexual interactions showed less intense cues of putative fertility than those engaging in heterosexual interactions, regardless of contraceptive treatment, we argued that the hormonal threshold required for the expression of heterosexual behavior by females was associated with elevated sex hormones levels compared to homosexual behavior. We discussed the hormonal correlates of sexual behavior and partner preferences in Japanese macaques.

Etonogestrel contraceptive implant-associated secondary anorgasmia

The etonogestrel contraceptive implant is a 4-cm radio-opaque subdermal rod, inserted in the nondominant arm, providing up to 3 years of continuous contraception. We describe a 21-year-old nulligravid, nondepressed female who experienced new-onset secondary anorgasmia 1 month after etonogestrel insertion. Off-label, oral use of bupropion and sildenafil did not restore orgasmic ability. Finally, 1 week after implant removal (4½ months after insertion), spontaneous return of orgasmic ability occurred. Anorgasmia after etonogestrel implant use is a rare adverse event; nonetheless, clinicians should be alert to its possibility.

IMPLICATION STATEMENT

This report documents secondary anorgasmia in a nondepressed female temporally associated with etonogestrel implant insertion. Clinicians should be aware that this rare event can occur but is quickly reversible with implant removal.

The Sexual Acceptability of Contraception: Reviewing the Literature and Building a New Concept

How contraceptives affect women's sexual well-being is critically understudied. Fortunately, a growing literature focuses on sexual aspects of contraception, especially hormonal contraception's associations with libido. However, a more holistic approach to contraceptive sexual acceptability is needed to capture the full range of women's sexual experiences. We conducted a narrative literature review of this topic, working with an original sample of 3,001 citations published from 2005 to 2015. In Part 1, we draw from a subset of this literature (264 citations) to build a new conceptual model of sexual acceptability. Aspects include macro factors (gender, social inequality, culture, and structure), relationship factors (dyadic influences and partner preferences), and individual factors (sexual functioning, sexual preferences, such as dis/inhibition, spontaneity, pleasure, the sexual aspects of side effects, such as bleeding, mood changes, sexual identity and sexual minority status, and pregnancy intentions). In Part 2, we review the empirical literature on the sexual acceptability of individual methods (103 citations), applying the model as much as possible. Results suggest contraceptives can affect women's sexuality in a wide variety of positive and negative ways that extend beyond sexual functioning alone. More attention to sexual acceptability could promote both women's sexual well-being and more widespread, user-friendly contraceptive practices.

Sex in Its Daily Relational Context

INTRODUCTION

The present study measured the daily correlates of sexual behavior in an ecologically valid context by relying on a daily diary approach.

AIM

Examining the dyadic and multicomponent nature of sexual behavior is essential to create valid models of sexual responding that are better aligned with the day-to-day context of having sex in a relationship.

METHODS AND MAIN OUTCOME MEASURES

During 3 weeks, heterosexual couples completed, two times a day, an electronic diary to report on mood, own and perceived partner behavior, relational feelings (in the evening), sexual activity, physical intimacy, and masturbation (in the morning). This design allowed testing bidirectional temporal associations between daily context and different types of sexual behavior.

RESULTS

Positive mood, displays of positive partner behavior, perceived positive partner behavior, and positive relational feelings predicted more sexual activity and intimacy in men, which then further increased their positive mood, perceived positive partner behavior, and positive feelings about the relationship on the following day. Women showed a similar pattern of predictors regarding sexual activity as men, though the effect of sexual behavior on next-day feelings and behavior was more relationship-oriented rather than affecting personal mood. Intimacy was related to almost all daily variables in women, but related only to own and perceived positive partner behavior and positive relational feelings the next day. Several partner effects also reached significance, and these were more influential in predicting male than female intimacy. Solitary sexual activity showed a different pattern of results than dyadic sexual activity, with men experiencing masturbation as negatively in the context of their relationship.

CONCLUSION

These results confirm the regulatory function of sex and intimacy in maintaining a positive relational climate and indicate that the quality of the everyday relational context is important to get partners in the mood to act in a sexual way.

The intimate link: a systematic review of highly effective reversible contraception and women's sexual experience

Contraception is expressly designed for nonprocreative sexual activity, but we know little about how methods shape women's sexual experience. To systematically review the literature on highly effective reversible contraception (HERC) and sexual experiences. MEDLINE, SCOPUS, and Google Scholar were searched for relevant literature. Eleven studies met the inclusion criteria; all were conducted outside of the United States. All studies reviewed found either improvements or no change in sexual experience and function outcomes with HERC use. A need exists for more prospective studies with a wider range of measures to assess HERC methods' impact on women's sexual experiences.

Adolescent women's daily academic behaviors, sexual behaviors, and sexually related emotions

PURPOSE

Emerging literature suggests that the emotional and behavioral experience in young women's romantic/sexual relationships may link to their academic success. However, existing studies' reliance on retrospective and/or global measures prevents detailed understanding of how and when specific academic experiences link to specific relationship experiences and whether these associations could vary over different school days.

METHODS

Adolescent women (N = 387; 14-17 years at enrollment) were recruited from primary care adolescent clinics for a longitudinal cohort study of sexual relationships and sexual behavior. Participants provided daily diary information on academic behaviors, sexual emotions, and sexual behaviors. Chi-square and generalized estimating equation ordinal logistic or linear regression, respectively, assessed prevalence of sexual behaviors or differences in sexual emotions when academic behaviors did and did not occur.

RESULTS

Young women's weekday reports of skipping school or failing a test were significantly linked to more frequent vaginal sex, less frequent condom use, and different levels of sexual emotions, on that same day.

CONCLUSIONS

Our findings provide evidence that the emotional and behavioral experiences in young women's romantic/sexual relationships may impact young women's reaction to academic events.

Impact of an implantable steroid contraceptive (etonogestrel-releasing implant) on quality of life and sexual function: a preliminary study

The aim of the study was to determine the impact of etonogestrel (ENG)-implant used for contraceptive purpose on Quality of life (QoL) and on sexual function (FSF) of healthy Italian women. The Female Sexual Function Index (FSFI) questionnaire and the Short Form-36 (SF-36) validated questionnaire were administered at baseline, 3 and 6 months after insertion of Nexplanon. The implant seems to have a positive impact on QoL after the first three months of therapy. Users showed an improved general health status and physical role status. The implant did not show negative effects on libido and on sexual function. In the first three months of treatment, users experienced a temporary reduction of vitality, mental health, social functioning and emotional role functioning, which seem to disappear after six months of therapy.

Puberty and adolescent sexuality

This article is part of a Special Issue "Puberty and Adolescence". Sexuality emerges as a major developmental element of puberty and the adolescent years that follow. However, connecting the sexuality that emerges with puberty and elements of adult sexuality is difficult because much adolescent sexuality research addresses the transition to partnered sexual behaviors (primarily coitus) and consequences such as unplanned pregnancy and sexually transmitted infections. This review proposes a framework of an expanded understanding of puberty and adolescent sexuality from the perspective of four hallmarks of adult sexuality: sexual desire; sexual arousal; sexual behaviors; and, sexual function. This approach thus addresses important gaps in understanding of the ontogeny of sex and the continuum of sexuality development from adolescence through the adult lifespan.

Associations between affect, context, and sexual desire in depressed young women

We investigated associations of sexual desire with time of day, physical and social context, and positive and negative affect using momentary sampling in 44 depressed young women (mean age = 18). Analyses revealed that depressed young women experienced sexual desire when with their boyfriends and later in the evening. Sexual desire was also positively associated with positive affect. Sexual desire was not associated with negative affect or physical context. This research suggests that sexual desire is experienced by depressed young women in normative developmental social contexts. Our findings may help clinicians and sexual health educators in correcting the myth that depressed women do not have sexual desire.