Feeling Scared During Sex: Findings From a U.S. Probability Sample of Women and Men Ages 14 to 60

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.

Association of Frequent Sexual Choking/Strangulation With Neurophysiological Responses: A Pilot Resting-State fMRI Study

Being choked or strangled during partnered sex is an emerging sexual behavior, prevalent among young adult women. The goal of this study was to test whether, and to what extent, frequently being choked or strangled during sex is associated with cortical surface functioning and functional connectivity. This case-control study consisted of two groups (choking vs. choking-naïve). Women who were choked 4 or more times during sex in the past 30 days were enrolled into the choking group, whereas those without were assigned to the choking-naïve group. We collected structural and resting-state functional magnetic resonance imaging (fMRI) data and analyzed the data for amplitude of low-frequency fluctuation (ALFF) and regional homogeneity (ReHo) using cortical surface-based resting-state fMRI analysis, followed by static and dynamic resting-state fMRI connectivity analysis. Forty-one participants (choking n = 20; choking-n-aïve n = 21) contributed to the analysis. An inter-hemispheric imbalance in neuronal activation pattern was observed in the choking group. Specifically, we observed significantly lower ALFF and ReHo in the left cortical regions (e.g., angular gyrus, orbitofrontal gyrus) and higher ALFF and ReHo in the right cortical regions (e.g., pre-central/post-central gyri) in the choking group compared with the choking-naïve group. A significant group difference was found in static functional connectivity between the bilateral angular gyrus and the whole brain, in which the choking group's angular gyrus showed hyperconnectivity with, for example, the post-central gyrus, pre-central gyrus, and Rolandic operculum, relative to the choking-naïve group. The dynamic analysis revealed hyperconnectivity between the left angular gyrus and the bilateral postcentral gyrus in the choking group compared with the choking-naïve group. Taken together, our data show that multiple experiences of sexual choking/strangulation are associated with an inter-hemispheric imbalance in neural activation pattern and hyperconnectivity between the angular gyrus and brain regions related to motor control, consciousness, and emotion. A longitudinal study using multi-modal neurological assessments is needed to clarify the acute and chronic consequences of sexual choking/strangulation.

Pornography, Sexual Insecurity, and Orgasm Difficulty

While recent meta-analyses have provided answers to a number of historically contentious debates about correlates of pornography use, several questions remain unanswered. Whether pornography is associated with sexual functioning is one such question. Informed by theorizing on sexual scripting, social comparisons, and sexual objectification, the present study examined the possibility that pornography is related to orgasm difficulty through sexual insecurity (i.e., insecurity about one's sexual performance and sexual attractiveness). Data were from the National Survey of Porn Use, Relationships, and Sexual Socialization (NSPRSS), a U.S. population-based probability study. There was an indirect effect of pornography consumption frequency on orgasm difficulty through sexual insecurity. Participants who used pornography more frequently reported higher levels of sexual insecurity, and higher levels of sexual insecurity predicted orgasm difficulty. There was also an indirect effect of partner pressure to view pornography on orgasm difficulty. Higher levels of partner pressure to view pornography were associated with higher levels of sexual insecurity, which in turn predicted orgasm difficulty. Results were indistinguishable by gender and maintained after controlling for a number of potential confounds. These findings suggest that some men and women's personal and (pressured) partnered pornography consumption have the potential to increase orgasm difficulty through bodily and performance insecurity.

Examining the Psychometric Properties of the Sexual Initiation Strategies Scale (SISS): A New Self-Report Measure of Sexual Aggression Perpetration History

Psychometrically-sound measures of sexual aggression are essential for identifying risk factors for perpetration and examining the behavioral impact of prevention interventions. This project reports on the psychometric evaluation of a new measure of sexual perpetration-the Sexual Initiation Strategies Scale (SISS)-which was designed to correct for weaknesses in prior measures. In Study 1, scores on the SISS demonstrated reasonable convergent and divergent validity and test-rest reliability among a sample of mixed gender college students (N = 575). Participants were more likely to endorse having engaged in sexually aggressive behavior on the SISS than on two other measures of sexual aggression. In Study 2, rates of endorsement on the SISS also were higher than on the most commonly-used measure of perpetration in a community sample of men and women (N = 551) in which gay, lesbian, and bisexual participants were oversampled. In general, the SISS seemed to perform well as a measure of sexual aggression perpetration in both men and women and in those reporting both same- and other-gender sexual aggression. Advantages and disadvantages of the SISS as compared to other measures are discussed.

Sexual Repertoire, Duration of Partnered Sex, Sexual Pleasure, and Orgasm: Findings from a US Nationally Representative Survey of Adults

In a confidential U.S. nationally representative survey of 2,525 adults (1300 women, 1225 men), we examined participants' event-level sexual behaviors, predictors of pleasure and orgasm, and perceived actual and ideal duration of sex, by gender and age. Event-level kissing, cuddling, vaginal intercourse, and oral sex were prevalent. Sexual choking was more prevalent among adults under 40. While women and men reported a similar actual duration of sex, men reported a longer ideal duration. Participants with same-sex partners reported a longer ideal duration than those with other-sex partners. Finally, findings show that gendered sexual inequities related to pleasure and orgasm persist.

Doula Support Challenges and Coping Strategies during the COVID-19 Pandemic: Implications for Maternal Health Inequities

The COVID-19 pandemic has made birthing more stressful and isolating, which has raised particular concern for populations of birthing people affected by maternal health inequities. Doulas have been proposed as one means of improving health outcomes by providing emotional, physical, and informational support to patients and their families before, during, or after labor. However, the social and economic conditions of the COVID-19 pandemic have posed new challenges for doula care. We conducted thematic analysis on 25 semi-structured interviews with practicing doulas in the United States to explore changes to doula care during the pandemic. Although doulas have faced many challenges in providing virtual and socially-distanced support during the pandemic, the rising use of telehealth among doulas has revealed new coping strategies and opportunities for virtual communication with the doula community. Our findings indicate that doula experiences during the pandemic can inform future doula care practices, particularly for birthing people of color and low-income birthing people.

Frequency, Method, Intensity, and Health Sequelae of Sexual Choking Among U.S. Undergraduate and Graduate Students

Although sexual choking is now prevalent, little is known about how people engage in choking in terms of frequency, intensity, method, or potential health sequelae. In a campus-representative survey of undergraduate and graduate students, we aimed to: (1) describe the prevalence of ever having choked/been choked as part of sex; (2) examine the characteristics of choking one's sexual partners (e.g., age at first experience, number of partners, frequency, intensity, method); (3) examine the characteristics of having been choked during sex; and (4) assess immediate responses of having been choked including the extent to which frequency and method (e.g., hand, ligature, limb) of having been choked predicts the range of responses endorsed by participants. A total of 4254 randomly sampled students (2668 undergraduate, 1576 graduate) completed a confidential online survey during Spring 2021. The mean age of first choking/being choked was about 19, with more undergraduates than graduate students reporting first choking/being choked in adolescence. Women and transgender/gender non-binary participants were significantly more likely to have been choked than men. Participants more often reported the use of hands compared to limbs or ligature. Common responses to being choked were pleasurable sensations/euphoria (81.7%), a head rush (43.8%), feeling like they could not breathe (43.0%), difficulty swallowing (38.9%), unable to speak (37.6%), and watery eyes (37.2%). About 15% had noticed neck bruising and 3% had lost consciousness from being choked. Greater frequency and intensity of being choked was associated with reports of more physical responses as was use of limb (arm, leg) or ligature.

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.

Frequent and Recent Non-fatal Strangulation/Choking During Sex and Its Association With fMRI Activation During Working Memory Tasks

Being strangled, or “choked,” by a sexual partner has emerged as a prevalent, often wanted and consensual sexual behavior among adolescent and young adult women, yet the neurological consequences of repeated exposure to this behavior are unknown. The objective of the study was to examine the association between a history of repeated, recent choking/strangling episodes during sex and fMRI activation during working memory tasks in young adult women. This case-control study involved young adult women (18–30 years old) at a large, public university, and consisted of two study groups: a choking group consisting of participants who were recently and frequently choked/strangled during sex by a partner (≥4 times in the past 30 days) and a choking-naïve (control) group who had never been choked/strangled during sex. Participants completed two variations of the N-back (0-back, 1-back, and 2-back) working memory task during functional magnetic resonance imaging (fMRI): verbal and visual N-back tasks. Data from 20 participants per group were available for analysis. Between-group differences for accuracy and reaction time were not significant for either variation of the N-back task. Significant differences in fMRI activation patterns were detected between the choking and the choking-naïve groups for the three contrasts of interest (1-back > 0-back, 2-back > 0-back, and 2-back > 1-back). The choking group exhibited increased activation in multiple clusters relative to the choking-naïve group for the contrasts between the 1-back and 2-back conditions compared to the 0-back conditions (e.g., superior frontal gyrus, corpus callosum). However, the choking-naïve group exhibited increased activation relative to the choking group in several clusters for the 2-back > 1 back contrast (e.g., splenium, middle frontal gyrus). These data indicate that recent, frequent exposure to partnered sexual strangulation is associated with different neural activation patterns during verbal and visual working memory tasks compared to controls, suggesting that being choked/strangled during sex may modify the allocation of neural resources at increasing levels of cognitive load. Further investigation into the neurologic effects of this sexual behavior is warranted, given the prevalence of sexual choking among adolescent and young adult women.

Approach considerations for the management of strangulation in the emergency department

Patients with a history of strangulation present to the emergency department with a variety of different circumstances and injury patterns. We review the terminology, pathophysiology, evaluation, management, and special considerations for strangulation injuries, including an overview of forensic considerations and legal framework for strangulation events.

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.

"It Was Scary, But Then It Was Kind of Exciting": Young Women's Experiences with Choking During Sex

Choking/strangulation during sex is prevalent among young adults, with one study finding that 58% of women college students had ever been choked during sex. However, no qualitative study has examined women's experiences with choking/strangulation during sex outside of intimate partner violence. The purpose of our qualitative interview study was to investigate women's experiences with choking and/or being choked during partnered sex. Through in-depth interviews with 24 undergraduate and graduate women students ages 18 to 33, we sought to understand how women communicate about choking, their learning about and initiation into choking, their feelings about being choked and choking others, as well as consent and safety practices used in relation to choking. We found that women had first learned about choking through diverse sources including pornography, erotic stories, magazines, social media, friends, and partners. While all 24 women had been choked during sex, only 13 of 24 had ever choked a partner. They described having engaged in choking with men as well as women and with committed as well as more casual partner types. Participants described consensual and non-consensual choking experiences. While many women enjoyed choking, others did it largely to please their sexual partner. Women described different methods and intensities of having been choked. Although very few had ever sought out information on safety practices or risk reduction, and only some had established safe words or safe gestures with partners, participants consistently expressed a belief that the ways in which they and their partner(s) engaged in choking were safe.

Non-Fatal Strangulation/Choking During Sex and Its Associations with Mental Health: Findings from an Undergraduate Probability Survey

Choking/strangulation during sex is prevalent among young adults in the United States. We examined associations between having ever been choked and participants' current mental health symptoms (e.g., feeling depressed, anxious, sad, lonely) in the prior 30 days and in the prior year. Participants were 4352 randomly sampled undergraduates who completed a confidential online survey and reported lifetime partnered sexual activity. 33.6% of women and 6.0% of men reported having been choked more than five times. After adjusting for demographic characteristics, having been choked remained significantly associated with all four mental health outcomes, except for overwhelming anxiety among men.

The Heteronormativity Theory of Low Sexual Desire in Women Partnered with Men

Low sexual desire in women partnered with men is typically presumed to be a problem-one that exists in women and encourages a research agenda on causation and treatment targeting women. In this paper, we present a distinct way forward for research on low sexual desire in women partnered with men that attends to a more structural explanation: heteronormativity. A heteronormative worldview assumes that relationships and structures are heterosexual, gender (usually conflated with sex) is binary and complementary, and gender roles fit within narrow bounds including nurturant labor for women. We propose the heteronormativity theory of low sexual desire in women partnered with men, arguing that heteronormative gender inequities are contributing factors. We outline four hypotheses and their predictions related to: inequitable divisions of household labor, blurring of partner and mother roles, objectification of women, and gender norms surrounding sexual initiation. We discuss some mechanisms-social, physiological, and otherwise-for the heteronormativity theory, especially related to stress, objectification, and nurturance. We close by noting some limitations of our paper and the ways that the heteronormativity theory of low sexual desire in women partnered with men provides a rigorous, generative, and empirical way forward.

"If Their Face Starts Turning Purple, You Are Probably Doing Something Wrong": Young Men's Experiences with Choking During Sex

Choking/strangulation during sex has become prevalent in the United States. Yet, no qualitative research has addressed men's choking experiences. Through interviews with 21 young adult men, we examined the language men use to refer to choking, how they first learned about it, their experiences with choking, and consent and safety practices. Men learned about choking during adolescence from pornography, partners, friends, and mainstream media. They engaged in choking to be kinky, adventurous, and to please partners. While many enjoyed or felt neutral about choking, others were reluctant to choke or be choked. Safety and verbal/non-verbal consent practices varied widely.

"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.

In Pursuit of Pleasure: A Biopsychosocial Perspective on Sexual Pleasure and Gender

Objective: Various sources of evidence suggest that men and women differ in their experience of sexual pleasure. Such gender differences have been attributed to men's higher innate sex drive, supported by evolutionary psychology perspectives and gender differences in reproductive strategies. Method: This paper presents biopsychosocial evidence for gender similarities in the capacity to experience pleasure, and for substantial gender differences in opportunities for sexual pleasure. Results: We conclude that sexual activity, in most cultures, is less pleasurable and associated with greater cost for heterosexual women than for heterosexual men, even though they do not differ in the capacity for sexual pleasure. Conclusion: Since gender differences in experienced sexual pleasure are not a biological given, a more critical discourse of sexual pleasure might create awareness of current inequalities, help lift restrictions for women's opportunities for pleasure, and could reduce gender differences in the cost of sex. That would truly serve sexual justice around the globe.

Trauma-Informed Sex Positive Approaches to Sexual Pleasure

This paper develops a trauma-informed sex-positive framework as a public health, clinical, and research approach to sexual experience over the life course. The framework centers trauma-informed sex positivity as the linkage for sexual pleasure (along with sexual wellbeing and sexual health) to the social, cultural, and legal concepts of sexual justice. By providing a conceptual distinction of sexual pleasure from sexual wellbeing and sexual health, the framework improves clarity about how these constructs are related as well as provides possibilities for detailed operationalization in public health surveillance and in the new research.

Pornography, impersonal sex, and sexual aggression: A test of the confluence model in a national probability sample of men in the U.S

This paper reports findings on men's exposure to extreme pornography, impersonal sexuality, and sexual aggression from the National Survey of Porn Use, Relationships, and Sexual Socialization, a U.S. population-based probability study. Despite Malamuth's confluence model (CM) of sexual aggression positing that an impersonal approach to sex interacts with exposure to pornography to predict the likelihood of committing sexual assault, only a few studies have actually tested this prediction. Additionally, the data from the only previous nationally representative study were gathered more than 30 years ago. Results of the present study generally supported the CM. Extreme pornography exposure and impersonal sexuality were both associated with a higher probability of sexual aggression. Although impersonal sex was a robust predictor in and of itself, men who were more exposed to pornography and impersonal in their approach to sex were more likely to be sexually aggressive than men who were impersonal in their approach to sex but less exposed to pornography. Results maintained when indicators of sex drive were included in analyses. The only finding inconsistent with the CM was that the association between pornography exposure and sexual aggression was stronger among men lower rather than higher in impersonal sex.

Diverse Sexual Behaviors in Undergraduate Students: Findings From a Campus Probability Survey

BACKGROUND

Probability-based surveys of college students typically assess sexual behaviors such as oral, vaginal, and anal sex. Little is known about the broader range of sexual behaviors in which students engage.

AIMS

In a random sample survey of undergraduate students, we aimed to: (1) describe how recently participants had engaged in solo and partnered sexual behaviors, (2) examine how frequently participants enacted certain rough sex sexual behaviors (e.g., light spanking, hard spanking, choking, slapping, and others), (3) assess participants' frequency of experiencing certain rough sex behaviors, (4) describe participants' frequency of threesome/group sex, (5) assess the characteristics of participants' experiences with choking during sex; and (6) examine choking and face slapping in regard to consent.

METHODS

A confidential, online cross-sectional survey of 4,989 randomly sampled undergraduate students at a large U.S. university.

OUTCOMES

Participants reported having engaged in a broad range of solo and partnered sexual activities, including rough sex behaviors.

RESULTS

The most prevalent general sexual behaviors were solo masturbation (88.6%), oral sex (79.4% received, 78.4% performed), penile-vaginal intercourse (73.5%), and partnered masturbation (71.1%). Anal intercourse was the least prevalent of these behaviors (16.8% received, 25.3% performed). Among those with any partnered sexual experience, 43.0% had choked a partner, 47.3% had been choked, 59.1% had been lightly spanked and 12.1% had been slapped on the face during sex.

CLINICAL TRANSLATION

College health clinicians and educators need to be aware of the diverse and evolving range of solo and partnered sexual behaviors reported by students. In addition to counseling students about pregnancy and sexually transmitted infection risk, clinicians might assess patients' engagement in diverse sexual behaviors, such as choking/strangulation during sex, given the risk for serious outcomes including death.

STRENGTHS AND LIMITATIONS

Strengths of our research include the large sample size, use of random sampling, high response rate for college populations, broad range of behaviors assessed, and novel data on choking during sex. Among our limitations, we did not assess to what extent the experiences were wanted, pleasurable, or appealing to participants. Except for in relation to choking and slapping, we also did not assess issues of consent.

CONCLUSION

Participants reported engaging in diverse sexual behaviors, some of which have important clinical implications, are understudied, and warrant further research. Herbenick D, Patterson C, Beckmeyer J, et al. Diverse Sexual Behaviors in Undergraduate Students: Findings From a Campus Probability Survey. J Sex Med 2021;18:1024-1041.

Women's techniques for making vaginal penetration more pleasurable: Results from a nationally representative study of adult women in the United States

The study purpose was to assess, in a U.S. probability sample of women, the specific ways women have discovered to make vaginal penetration more pleasurable. Through qualitative pilot research with women that informed the development of the survey instrument used in this study, we identified four previously unnamed, but distinct, techniques women use to make vaginal penetration more pleasurable: Angling, Rocking, Shallowing and 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 87.5% of women make vaginal penetration more pleasurable using ‘Angling’: rotating, raising, or lowering the pelvis/hips during penetration to adjust where inside the vagina the toy or penis rubs and what it feels like. Approximately 76% of women make vaginal penetration more pleasurable using ‘Rocking’: the base of a penis or sex toy rubbing against the clitoris constantly during penetration, by staying all the way inside the vagina rather than thrusting in and out. About 84% of women make vaginal penetration more pleasurable using ‘Shallowing’: penetrative touch just inside of the entrance of the vagina—not on the outside, but also not deep inside—with a fingertip, sex toy, penis tip, tongue, or lips. Finally, 69.7% of women orgasm more often or make vaginal penetration more pleasurable using ‘Pairing’: when a woman herself (Solo Pairing) or her partner (Partner Pairing) reaches down to stimulate her clitoris with a finger or sex toy at the same time as her vagina is being penetrated. These data provide techniques that are at women’s disposal to make penetration more pleasurable—which can enable women to better identify their own preferences, communicate about them and advocate for their sexual pleasure.

What Is Rough Sex, Who Does It, and Who Likes It? Findings from a Probability Sample of U.S. Undergraduate Students

Using data from an undergraduate probability sample, we aimed to: (1) describe the prevalence and demographic characteristics of students who reported having engaged in rough sex with their current partner; (2) assess which sexual behaviors students consider to be rough sex; (3) describe the frequency with which participants report engaging in rough sex as well as their reports of initiating and liking rough sex, in relation to gender and sexual identity; and (4) examine predictors of rough sex frequency. Participants were 4998 students randomly sampled from a large Midwestern university who completed a confidential Internet-based survey (2453 women, 2445 men, 41 gender non-binary, 36 transgender or other gender non-conforming identities). Within these, 1795 individuals who reported a romantic/sexual partner of at least 3 months responded to questions about engaging, liking, and initiating rough sex. The most common behaviors participants considered to be rough sex were choking, hair pulling, and spanking. Transgender and gender non-binary students more often endorsed behaviors as rough sex. Also, rough sex was conceptualized as multidimensional, with one cluster being more consistent with earlier conceptualizations of rough sex (e.g., hair pulling, spanking) and the second cluster including behaviors such as choking, slapping, punching, and making someone have sex. About 80% of those with a current sexual or romantic partner engaged in rough sex with them and most who engaged it liked it. Bisexual women reported greater rough sex frequency and enjoyment (54.1% indicated enjoying it "very much"). Implications for sexuality research and education are discussed.

Exploratory Findings on U.S. Adolescents' Pornography Use, Dominant Behavior, and Sexual Satisfaction

Objectives: Sexual satisfaction is an important component of sexual health and wellbeing across the life course, including adolescence. While research on pornography use and sexual satisfaction has become increasingly common, the vast majority of studies have focused on adults. An additional limitation of studies to date is a lack of assessment of mediating mechanisms. Methods: To help address these gaps in the literature, this study used data from a population-based probability survey of U.S. adolescents to assess whether an increased likelihood of engaging in dominant sexual behaviors such as choking, spanking, and name calling was a possible mediator. Results: Path analytic results supported a conceptual model whereby youth with greater exposure to pornography are more likely to engage in sexually dominant behaviors, distancing them from their partners, and reducing their sense of sexual satisfaction. Conclusion: These results, while preliminary due to a small analytical sample and cross-sectional design, should serve as a springboard for larger-scale efforts in this important area of human sexuality.

Parental Hesitancy About Routine Childhood and Influenza Vaccinations: A National Survey

BACKGROUND AND OBJECTIVES

The World Health Organization has designated vaccine hesitancy as 1 of the 10 leading threats to global health, yet there is limited current national data on prevalence of hesitancy among US parents. Among a nationally representative sample of US parents, we aimed to (1) assess and compare prevalence of hesitancy and factors driving hesitancy for routine childhood and influenza vaccination and (2) examine associations between sociodemographic characteristics and hesitancy for routine childhood or influenza vaccination.

METHODS

In February 2019, we surveyed families with children using the largest online panel generating representative US samples. After weighting, we assessed hesitancy using a modified 5-point Vaccine Hesitancy Scale and labeled parents as hesitant if they scored >3.

RESULTS

A total of 2176 of 4445 parents sampled completed the survey (response rate 49%). Hesitancy prevalence was 6.1% for routine childhood and 25.8% for influenza vaccines; 12% strongly and 27% somewhat agreed they had concerns about serious side effects of both routine childhood and influenza vaccines. A total of 70% strongly agreed that routine childhood vaccines are effective versus 26% for influenza vaccine (P < .001). In multivariable models, an educational level lower than a bachelor's degree and household income <400% of the federal poverty level predicted hesitancy about both routine childhood and influenza vaccines.

CONCLUSIONS

Almost 1 in 15 US parents are hesitant about routine childhood vaccines, whereas >1 in 4 are hesitant about influenza vaccine. Furthermore, 1 in 8 parents are concerned about vaccine safety for both routine childhood and influenza vaccines, and only 1 in 4 believe influenza vaccine is effective. Vaccine hesitancy, particularly for influenza vaccine, is prevalent in the United States.

Trends in Frequency of Sexual Activity and Number of Sexual Partners Among Adults Aged 18 to 44 Years in the US, 2000-2018

IMPORTANCE

Sexual relationships are important for well-being and health. Recent trends in sexual activity among US adults are unknown.

OBJECTIVES

To examine trends in reported frequency of sexual activity and number of sexual partners by sex and age and the association between measures of sexual activity and sociodemographic variables.

DESIGN, SETTING, AND PARTICIPANTS

In this survey study, repeat, cross-sectional analyses of participants aged 18 to 44 years from 10 rounds of the General Social Survey (2000-2018), a US nationally representative survey, were performed for men and women separately.

MAIN OUTCOMES AND MEASURES

Sexual frequency in the past year (sexual inactivity, once or twice per year, 1-3 times per month, or weekly or more) and number of sexual partners in the past year (0, 1, 2, or ≥3 partners). The association between measures of sexual activity and sociodemographic variables were assessed using logistic regression.

RESULTS

The study population included 4291 men and 5213 women in the analysis of sexual frequency and 4372 men and 5377 women in the analysis of number of sexual partners (mean [SD] age, 31.4 [7.6] years; survey response rate, 59.5%-71.4%). Between 2000-2002 and 2016-2018, the proportion of 18- to 24-year-old individuals who reported having had no sexual activity in the past year increased among men (18.9% vs 30.9%; age-adjusted odds ratio [aOR] for trend across survey periods, 1.20; 95% CI, 1.04-1.39) but not among women (15.1% vs 19.1%; aOR for trend, 1.03; 95% CI, 0.89-1.18). Smaller absolute increases in sexual inactivity were observed among those aged 25 to 34 years for both men (7.0% vs 14.1%; aOR for trend, 1.23; 95% CI, 1.07-1.42) and women (7.0% vs 12.6%; aOR for trend, 1.17; 95% CI, 1.01-1.35) but not among those aged 35 to 44 years. The increase in sexual inactivity coincided with decreases in the proportion reporting weekly or more sexual frequency (men aged 18-24 years: 51.8% vs. 37.4%; aOR for trend, 0.88 [95% CI, 0.79-0.99]; men aged 25-34 years: 65.3% vs 50.3%; aOR for trend, 0.87 [95% CI, 0.81-0.94]; women aged 25-34 years: 66.4% vs. 54.2%; aOR for trend, 0.90 [95% CI, 0.84-0.96]) or 1 sexual partner (men aged 18-24 years: 44.2% vs. 30.0%; aOR for trend, 0.88 [95% CI, 0.80-0.98]; women aged 25-34 years: 79.6% vs 72.7%; aOR for trend, 0.91 [95% CI, 0.84-0.99]) and occurred mainly among unmarried men (unmarried men aged 18-44 years: 16.2% vs 24.4%; aOR for trend, 1.14 [95% CI, 1.04-1.25]). Among married men and women, weekly or more sexual frequency decreased (men: 71.1 % vs 57.7%; aOR for trend, 0.86 [95% CI, 0.79-0.93]; women: 69.1% vs 60.9%; aOR for trend, 0.92 [95% CI, 0.86-0.99]). Men with lower income (aOR for men with an annual income of ≥$50 000 vs $0-$9999, 0.37 [95% CI, 0.15-0.90]) and with part-time (aOR vs full-time employment, 2.08; 95% CI, 1.48-2.93) and no employment (aOR vs full-time employment, 2.08; 95% CI, 1.48-2.93) were more likely to be sexually inactive, as were men (aOR vs full-time employment, 2.94; 95% CI, 2.06-4.21) and women (aOR vs full-time employment, 2.37; 95% CI, 1.68-3.35) who were students.

CONCLUSIONS AND RELEVANCE

This survey study found that from 2000 to 2018, sexual inactivity increased among US men such that approximately 1 in 3 men aged 18 to 24 years reported no sexual activity in the past year. Sexual inactivity also increased among men and women aged 25 to 34 years. These findings may have implications for public health.

Diverse Sexual Behaviors and Pornography Use: Findings From a Nationally Representative Probability Survey of Americans Aged 18 to 60 Years

BACKGROUND

Convenience sample data indicate that substantial portions of adults have engaged in sexual behaviors sometimes described as rough; little is known about these behaviors at the population level.

AIM

To describe, in a U.S. probability sample of Americans aged 18 to 60 years, (i) the prevalence of diverse sexual behaviors, described here as dominant and target behaviors; (ii) the age at first pornography exposure as well as prevalence, range, and frequency of pornography use; (iii) the association between past year pornography use frequency and dominant/target sexual behaviors; and (iv) associations between lifetime range of pornography use and dominant/target sexual behaviors.

METHODS

A confidential cross-sectional online survey was used in this study.

OUTCOMES

Lifetime engagement in dominant behaviors (eg, spanking, choking, name calling, performing aggressive fellatio, facial ejaculation, penile-anal penetration without first asking/discussing) and lifetime engagement in target behaviors (eg, being spanked, being choked, being called names during sex, having their face ejaculated on, receiving aggressive fellatio, or receiving penile-anal penetration without having discussed) were assessed; lifetime pornography use, age at first porn exposure, past-year frequency of porn viewing, and lifetime range of pornography were also assessed.

RESULTS

Women as well as men who have sex with men were more likely to report target sexual behaviors: having been choked (21.4% women), having one's face ejaculated on (32.3% women, 52.7% men who have sex with men), and aggressive fellatio (34.0% women). Lifetime pornography use was reported by most respondents. After adjusting for age, age at first porn exposure, and current relationship status, the associations between pornography use and sexual behaviors was statistically significant.

CLINICAL IMPLICATIONS

Clinicians need to be aware of recent potential shifts in sexual behaviors, particularly those such as choking that may lead to harm.

STRENGTHS & LIMITATIONS

Strengths include U.S. probability sampling to provide population level estimates and the use of Internet-based data collection on sensitive topics. We were limited by a lack of detail and context related to understanding the diverse sexual behaviors assessed.

CONCLUSION

Clinicians, educators, and researchers have unique and important roles to play in continued understanding of these sexual behaviors in the contemporary United States. Herbenick D, Fu T-C, Wright P, et al. Diverse Sexual Behaviors and Pornography Use: Findings From a Nationally Representative Probability Survey of Americans Aged 14 to 60 Years. J Sex Med 2020;17:623-633.