Preserving Abstinence and Preventing Rape: How Sex Education Textbooks Contribute to Rape Culture

Recent academic and popular conversations regarding #MeToo, sexual violence and harassment, and rape culture have begun to focus on K-12 educational spaces in the U.S., but they rarely examine how educational curricula actually foster or combat these dynamics. In this article, we present a qualitative content analysis of health education textbooks, which explores the following question: What implicit and explicit messages do youth receive about sexual violence, and specifically, sexual violence prevention in health education textbooks? As we explored this question, we analyzed the roles that sex education curricula may play in shaping (e.g., contributing to, intervening upon) rape culture. We found the following messages across textbooks: abstinence is the only way to preserve one's safety; lack of abstinence increases risks, including the risk of being raped; and girls/women must assume personal responsibility and enact strategies that preserve one's abstinence and prevent them from being raped. This article concludes by teasing out how curricula can shape interactions, relationships, and culture, and by offering recommendations for improving sex education curricula.

Sexual Abstinence and Associated Factors Among Young and Middle-Aged Men: A Systematic Review

INTRODUCTION

Sexual activity is an essential human need and an important predictor of other aspects of human life. A literature review was conducted to investigate whether sexual abstinence in young and middle-aged men is generally considered a deliberate, healthy behavior and whether it has other causes and consequences.

AIM

To review the prevalence and factors associated with sexual abstinence in young (10-24 years) and middle-aged (25-59 years) men.

METHODS

Studies were retrieved from Science Direct, PubMed, and EBSCOhost published from 2008 to 2019. The selection criteria were original population- or community-based articles, published in the English language, on sexual abstinence, and in young and middle-aged men.

MAIN OUTCOME MEASURE

This article reviewed the literature on the proportions of and factors associated with sexual abstinence in young and middle-aged men.

RESULTS

A total of 13,154 studies were retrieved, from which data were extracted for 37 population- or community-based studies. The prevalence of sexual abstinence varied from 0% to 83.6% in men younger than 60 years. The prevalence of primary sexual abstinence was 3.4%-83.3% for young men and 12.5%-15.5% for middle-aged men. The prevalence of secondary abstinence for young men ranged from 1.3% to 83.6%, while for middle-aged men, it was from 1.2% to 67.7%. The prevalence of sexual abstinence decreased with increasing age in young men but increased with increasing age in middle-aged men. The significant factors reported were age, single status, poor relationships, low socioeconomic status, sex education, religious practices, caring and monitoring parents, and not using alcohol, cigarettes, or drugs. Although the variations in findings from different studies can be explained by different regions and cultures, the information cannot be generalized worldwide because of a lack of studies in Asian and Australian populations.

CLINICAL IMPLICATIONS

The studies on sexual abstinence in the future should use a consistent and standard definition, cover all sexual behaviors, and investigate all related factors.

STRENGTH & LIMITATIONS

The restricted timeframe (2008-2019), English language, availability of full text, and variability in definition and time duration may be the sources of bias.

CONCLUSION

Young men had higher proportions of sexual abstinence than middle-aged men, and age, unavailability of a partner, lower educational levels, low socioeconomic status, conservative and religious conditions, and no or less knowledge about sexually transmitted infections were common predictors of sexual abstinence in most of the men. Although determinants of sexual abstinence were identified, further investigation of biological factors in men younger than 60 years is needed. Irfan M, Hussain NHN, Noor NM, et al. Sexual Abstinence and Associated Factors Among Young and Middle-Aged Men: A Systematic Review. J Sex Med 2020;17:412-430.

Prevalence and types of sexual inactivity in Britain: analyses of national cross-sectional probability survey data

OBJECTIVES

To examine how prevalence and context of sexual inactivity varies across the life-course, assess dissatisfaction with sex life among those who are sexually inactive and identify associations with factors that may represent reasons for sexual inactivity.

DESIGN

Analysis of cross-sectional probability sample survey data.

SETTING

British general population.

PARTICIPANTS

14 623 participants (n men: 6045 unweighted, 7245 weighted), aged 16-74 years, of the third National Survey of Sexual Attitudes and Lifestyles (Natsal-3), undertaken in 2010-2012.

MAIN OUTCOME MEASURES

Sexual inactivity, defined as not reporting oral, vaginal or anal intercourse in the past year and further categorised into those who were sexually inexperienced (had never had sex), single or in a relationship.

RESULTS

Overall, 15.9% (weighted n 1155/7245) of men and 22.2% (1646/7410) of women were sexually inactive (p<0.001). The proportion of sexually inactive individuals who were sexually inexperienced was larger among men than women (26.3% (304/1155) vs 16.3% (268/1646)), while the proportion who were singles was larger among women (49.8% (820/1646) vs 40.4% (467/1155)). Sexual inexperience was the most common type of sexual inactivity in early adulthood, with this declining with age. A minority of those who had sexual experience but were sexually inactive-34.8% (293/842) of men and 23.6% (319/1349) of women-reported being dissatisfied with their sex lives. Associations with sexual inactivity was observed for a range of sociodemographics and sexual behaviours/attitudes, for example, religion, ethnicity, Body mass index, height, employment status and index of multiple deprivation; these associations varied by type of sexual inactivity and gender.

CONCLUSIONS

While sex is important for well-being, a non-negligible proportion of the population at all ages are sexually inactive, yet many are not dissatisfied with their situation, with implications for sex and relationship counselling.

Associations Between Patterns of Sexual Initiation, Sexual Partnering, and Sexual Health Outcomes from Adolescence to Early Adulthood

The goal of this study was to examine, in a nationally representative sample, relationships between various sexual initiation patterns, subsequent sexual partnerships, and related health outcomes from adolescence through early adulthood. Data were from a subset of 6587 respondents from the National Longitudinal Study of Adolescent to Adult Health. Bivariate analyses and adjusted logistic and ordinary least squares regression models were used to determine associations between membership in three sexual initiation classes, lifetime sexual partner counts, and multiple health outcomes, including lifetime sexually transmitted infection or disease (STI/STD) diagnosis, lifetime unintended pregnancy, and romantic relationship quality. Broadly, having fewer lifetime sexual partners was associated with lower odds of STI/STD diagnosis and unintended pregnancy, and better relationship quality; however, findings also indicated both within and between sexual initiation class differences in the relationship between lifetime sexual partners and all three health outcomes. In particular, results showed little variation in health outcomes by sexual partnering among those who postponed sexual activity, but members of the class characterized by early and atypical sexual initiation patterns who had fewer lifetime partners exhibited better health outcomes than most other initiation groups. These results show that while both sexual initiation and partnering patterns add important information for understanding sexual health from adolescence to early adulthood, partnering may be more relevant to these sexual health outcomes. Findings indicate a need for more comprehensive sexuality education focused on sexual risk reduction and promotion of relationship skills among adolescents and adults.

Technology-Based Interventions to Reduce Sexually Transmitted Infections and Unintended Pregnancy Among Youth

PURPOSE

Technology-based interventions to promote sexual health have proliferated in recent years, yet their efficacy among youth has not been meta-analyzed. This study synthesizes the literature on technology-based sexual health interventions among youth.

METHODS

Studies were included if they (1) sampled youth ages 13-24; (2) utilized technology-based platforms; (3) measured condom use or abstinence as outcomes; (4) evaluated program effects with experimental or quasi-experimental designs; and (5) were published in English.

RESULTS

Sixteen studies with 11,525 youth were synthesized. There was a significant weighted mean effect of technology-based interventions on condom use (d = .23, 95% confidence interval [CI] [.12, .34], p < .001) and abstinence (d = .21, 95% CI [.02, .40], p = .027). Effects did not differ by age, gender, country, intervention dose, interactivity, or program tailoring. However, effects were stronger when assessed with short-term (1-5 months) than with longer term (greater than 6 months) follow-ups. Compared with control programs, technology-based interventions were also more effective in increasing sexual health knowledge (d = .40, p < .001) and safer sex norms (d = .15, p = .022) and attitudes (d = .12, p= .016).

CONCLUSIONS

After 15 years of research on youth-focused technology-based interventions, this meta-analysis demonstrates their promise to improve safer sex behavior and cognitions. Future work should adapt interventions to extend their protective effects over time.

Abstinence-Only-Until-Marriage: An Updated Review of U.S. Policies and Programs and Their Impact

Adolescence is marked by the emergence of human sexuality, sexual identity, and the initiation of intimate relations; within this context, abstinence from sexual intercourse can be a healthy choice. However, programs that promote abstinence-only-until-marriage (AOUM) or sexual risk avoidance are scientifically and ethically problematic and-as such-have been widely rejected by medical and public health professionals. Although abstinence is theoretically effective, in actual practice, intentions to abstain from sexual activity often fail. Given a rising age at first marriage around the world, a rapidly declining percentage of young people remain abstinent until marriage. Promotion of AOUM policies by the U.S. government has undermined sexuality education in the United States and in U.S. foreign aid programs; funding for AOUM continues in the United States. The weight of scientific evidence finds that AOUM programs are not effective in delaying initiation of sexual intercourse or changing other sexual risk behaviors. AOUM programs, as defined by U.S. federal funding requirements, inherently withhold information about human sexuality and may provide medically inaccurate and stigmatizing information. Thus, AOUM programs threaten fundamental human rights to health, information, and life. Young people need access to accurate and comprehensive sexual health information to protect their health and lives.

The Effects of State-Mandated Abstinence-Based Sex Education on Teen Health Outcomes

In 2011, the USA had the second highest teen birth rate of any developed nation, according to the World Bank, . In an effort to lower teen pregnancy rates, several states have enacted policies requiring abstinence-based sex education. In this study, we utilize a difference-in-differences research design to analyze the causal effects of state-level sex education policies from 2000-2011 on various teen sexual health outcomes. We find that state-level abstinence education mandates have no effect on teen birth rates or abortion rates, although we find that state-level policies may affect teen sexually transmitted disease rates in some states. Copyright © 2016 John Wiley & Sons, Ltd.

Commitment to Celibacy in German Catholic Priests: Its Relation to Religious Practices, Psychosomatic Health and Psychosocial Resources

We aimed to investigate Catholic priests' commitment to celibacy and its relation to their religious practices, life and work satisfaction, and psychosomatic health. Results of our cross-sectional study of 2549 priests show that the majority finds living in celibacy helpful to minister more effectively. Nevertheless, a large proportion see it as a burden and would not choose celibate life again. Commitment to celibacy was predicted best by the frequency of religious practices (liturgy), work engagement and personal relation with God, explaining 39 % of variance. These resources are predictors for maintaining a celibate lifestyle and facilitate priests' satisfaction with life and commitment to their ministry.

Implementation and assessment of a prevention with positives intervention among people living with HIV at five hospitals in Thailand

BACKGROUND

We implemented a hospital-based prevention with positives (PwP) intervention among people living with HIV (PLHIV) that included HIV transmission risk screening, short HIV prevention messages, family planning, HIV disclosure counseling, and partner HIV testing at five hospitals in Thailand. We assessed changes in sexual risk behaviors among PLHIV who received the PwP services at the hospitals.

METHODS

From January 2008-March 2009, we systematically selected a subset of PLHIV receiving care at the five hospitals to offer participation in the PwP intervention. We collected demographic, risk behavior, and laboratory data using a standardized questionnaire. We analyzed data from PLHIV who completed at least four visits, using generalized estimating equations to identify baseline participant characteristics that were associated with adopting sexual practices less likely to be associated with HIV transmission during follow-up.

RESULTS

A total of 830 PLHIV were interviewed and 756 (91.1%) completed four visits. The median age of these 756 participants was 37 years, 400 (52.9%) were women, and 475 (62.8%) had a steady partner. At baseline, 353 (74.3%) of the steady partners had been tested for HIV and 132 (37.4%) had tested negative. Among the 756 PLHIV, 427 (56.5%) reported having sex in the 3 months before enrollment and 413 (54.6%) in the 3 months before the fourth visit. The proportion reporting having vaginal or anal sex without a condom decreased from 20.8% at baseline to 5.1% at the fourth visit (p<0.001). Factors associated (p<0.05) with abstinence or 100% condom use at follow-up visits included: completing ≥ two visits, being diagnosed with HIV for longer than 3 months, and receiving HIV prevention messages from a doctor (versus a nurse or counselor).

CONCLUSION

Safe sex behaviors increased among PLHIV receiving PwP services, suggesting that expansion of hospital-based PwP services may reduce the number of new HIV infections in Thailand.

What Does Asexuality Teach Us About Sexual Disinterest? Recommendations for Health Professionals Based on a Qualitative Study With Asexually Identified People

This article draws on qualitative in-depth interviews with 30 asexually identified individuals living in the United States in order to contribute to our understanding of when low sexual desire should be treated as a medical or mental health issue and when it should be treated as a benign sexual variation. The article discusses five findings of relevance to health professionals: (1) the line between a desire disorder and asexuality is not clear-cut; (2) asexually identified individuals may experience distress, so distress alone does not separate a desire disorder from asexuality; (3) asexually identified individuals may face sexual pressure from a partner or may have difficulty negotiating sexual activity with a partner; (4) asexuality does not need to be distressing, rather it can be experienced as a fulfilling form of sexuality; and (5) many asexually identified individuals believe in the usefulness of low sexual desire as a diagnostic category and support medical and mental health professionals in their efforts to develop treatments for sexual desire disorders. Based on these five findings, this article offers four concrete suggestions for health professionals working with clients with low sexual desire, whether or not those clients identify as asexual.

Factors Associated With Intentions to Engage in Vaginal Intercourse Among Sexually Abstinent Missouri High School Freshmen

BACKGROUND

We examine personal characteristics, alcohol consumption, normative beliefs, household factors, and extracurricular engagement associated with intentions to have intercourse before marriage among abstinent students.

METHODS

Data were analyzed from 245 freshmen enrolled in a school-based abstinence-only-until-marriage program. Two binary logistic regression analyses identified factors associated with intentions to engage in intercourse before marriage and within the next year.

RESULTS

Approximately 21% and 14% of participants reported intentions to have intercourse. Respondents participated in 2.2 (standard deviation [SD] = 1.2) extracurricular activities. Freshmen who were male, perceived their friends to approve of premarital sex, and consumed alcohol were more likely to report intentions to have intercourse. For every additional extracurricular activity in which freshmen participated, they were less likely to report intentions to have intercourse within the next year (odds ratio [OR] = 0.56).

CONCLUSIONS

Factors such as extracurricular activities provide youth with opportunities to build supportive relationships, connect with peers and role models, and positively engage in schools and communities. Extracurricular activities typically already exist, have funding, and are generally well-supported. School-based strategies can increase teenagers' autonomy by providing a variety of activities to participate in and reduce unsupervised time. This, in turn, has the potential to decrease sexual risk taking behaviors.

Self-Regulation and Sexual Restraint: Dispositionally and Temporarily Poor Self-Regulatory Abilities Contribute to Failures at Restraining Sexual Behavior

Nonsexual deficiencies in self-control may contribute to inappropriate or objectionable sexual behaviors, as shown by survey questionnaires, autobiographical narratives, and experimental manipulations. People with low overall trait self-control and/or whose self-control strength had been depleted by recent, nonsexual acts were less likely than other people to stifle inappropriate sexual thoughts and to resist the temptation to engage in sexual activities with someone other than their primary relationship partner. They also engaged in more extensive sexual activity in the laboratory with their dating partner and they reported more undercontrolled or impulsive sexual behavior generally. Furthermore, there was some evidence that the effects of diminished self-control were strongest among those with the strongest sexual desires (men and sexually unrestricted individuals) and among couples with less sexual experience.

Unintended pregnancy risk and contraceptive use among women 45-50 years old: Massachusetts, 2006, 2008, and 2010

BACKGROUND

Little is known about unintended pregnancy risk and current contraceptive use among women ≥45 years old in the United States.

OBJECTIVES

The purpose of this study was to describe the prevalence of women ages 45-50 years old at risk for unintended pregnancy and their current contraceptive use, and to compare these findings to those of women in younger age groups.

STUDY DESIGN

We analyzed 2006, 2008, and 2010 Massachusetts Behavioral Risk Factor Surveillance System data, the only state in the United States to collect contraceptive data routinely from women >44 years old. Women 18-50 years old (n = 4930) were considered to be at risk for unintended pregnancy unless they reported current pregnancy, hysterectomy, not being sexually active in the past year, having a same-sex partner, or wanting to become pregnant. Among women who were considered to be at risk (n = 3605), we estimated the prevalence of current contraceptive use by age group. Among women who were considered to be at risk and who were 45-50 years old (n = 940), we examined characteristics that were associated with current method use. Analyses were conducted on weighted data using SAS-callable SUDAAN (RTI International, Research Triangle Park, NC).

RESULTS

Among women who were 45-50 years old, 77.6% were at risk for unintended pregnancy, which was similar to other age groups. As age increased, hormonal contraceptive use (shots, pills, patch, or ring) decreased, and permanent contraception (tubal ligation or vasectomy) increased as did non-use of contraception. Of women who were 45-50 years old and at risk for unintended pregnancy, 66.9% reported using some contraceptive method; permanent contraception was the leading method reported by 44.0% and contraceptive non-use was reported by 16.8%.

CONCLUSION

A substantial proportion of women who were 45-50 years old were considered to be at risk for unintended pregnancy. Permanent contraception was most commonly used by women in this age group. Compared with other age groups, more women who were 45-50 years old were not using any contraception. Population-based surveillance efforts are needed to follow trends among this age group and better meet their family planning needs. Although expanding surveillance systems to include women through 50 years old requires additional resources, fertility trends that show increasingly delayed childbearing, uncertain end of fecundity, and potential adverse consequences of unplanned pregnancy in older age may justify these expenditures.

Semen says: assessing the accuracy of adolescents' self-reported sexual abstinence using a semen Y-chromosome biomarker

OBJECTIVE

Researchers often assess condom use only among participants who report recent sexual behaviour, excluding participants who report no recent vaginal sex or who did not answer questions about their sexual behaviour, but self-reported sexual behaviour may be inaccurate. This study uses a semen Y-chromosome biomarker to assess semen exposure among participants who reported sexual abstinence or did not report their sexual behaviour.

METHODS

This prospective cohort study uses data from 715 sexually active African-American female adolescents in Atlanta, surveyed at baseline, 6 months and 12 months. Participants completed a 40 min interview and were tested for semen Y-chromosome with PCR from a self-administered vaginal swab. We predicted Y-chromosome test results from self-reported sexual behaviour using within-subject panel regression.

RESULTS

Among the participants who reported abstinence from vaginal sex in the past 14 days, 9.4% tested positive for semen Y-chromosome. Among item non-respondents, 6.3% tested positive for semen Y-chromosome. Women who reported abstinence and engaged in item non-response regarding their sexual behaviour had respectively 62% and 78% lower odds of testing positive for Y-chromosome (OR 0.38 (0.21 to 0.67), OR 0.22 (0.12 to 0.40)), controlling for smoking, survey wave and non-coital sexual behaviours reported during abstinence.

CONCLUSIONS

Adolescents who report sexual abstinence under-report semen exposure. Research should validate self-reported sexual behaviour with biomarkers. Adolescents who engage in item non-response regarding vaginal sex test positive for semen Y-chromosome at similar rates, which supports the practice of grouping non-respondents with adolescents reporting abstinence in statistical analysis.

TRIAL REGISTRATION NUMBER

NCT00633906.

Virgin College Students' Reasons for and Reactions to Their Abstinence From Sex: Results From a 23-Year Study at a Midwestern U.S. University

Sexual activity is normative in college. Thus, college students who are virgins are a minority; they are also an understudied group. This study extended a prior investigation (Sprecher & Regan, 1996 ) that focused on U.S. college virgins' reported reasons for and reactions to virginity. Data were collected from the same university over an additional 18 years and from more than 700 additional virgin students. We found differences between male and female virgins that showed that men are more reluctant virgins. For example, the only reason for being a virgin that male virgins endorsed to a greater degree than did female virgins was "my partner was not willing." Men also had more negative affective reactions to being a virgin than did women. We also found some variation in reasons for and reactions to virginity based on sociodemographic variables such as religiosity and ethnicity. A temporal analysis revealed that reasons for being a virgin that referred to a fear (e.g., fear of AIDS and other sexually transmitted infections) became less important over the 23-year period. We discuss our findings in the frameworks of evolutionary and social exchange theories.

Community-based abstinence education project: program outcomes

PROBLEM

Middle school and adolescent populations demonstrate high rates of unintended pregnancies and sexually transmitted infections, with young people in inner cities in the United States especially vulnerable. Teen births remain high, and youth are affected physically, mentally, socially, and economically.

METHODS

The Sex After Marriage primary prevention program, a federally funded, community-based abstinence education (CBAE) initiative, was implemented for 3 years in Philadelphia neighborhoods with vulnerable youth 12 to 18 years of age, supporting adults, healthcare professionals, and the general public. The three-tiered program offered a middle school curriculum, Sex Can Wait, at 16 different sites. The CBAE program delivered by the university's nursing center attempted to support vulnerable youths' decisions to postpone sexual activity by matching the interests of young people through an established curriculum, by holding workshops for supporting adults, and by creating a multimedia approach to supplement abstinence education initiatives including public service announcements and a website. Youth and college ambassadors and community colleagues were trained in the curriculum with a focus on healthy lifestyles. Youth and parents in experimental and control groups completed self-report surveys before and after program implementation.

FINDINGS

The project achieved most of its objectives on program evaluation. Youth (n = 1,428) 12 to 18 years of age received services, with most completing ≥75% of the program. Parents (n = 338) and other participating adults (n = 486) also received education or services.

CONCLUSIONS

The need for risk reduction programs persists for youth in light of pregnancy, birth, and sexually transmitted disease statistics. Bailey Wolf.

Factors influencing abstinence, anticipation, and delay of sex among adolescent boys in high-sexually transmitted infection prevalence communities

PURPOSE

Abstinence is a core pregnancy and sexually transmitted infection (STI) prevention strategy. We explore the attitudinal, behavioral, and family contexts relating to abstinence and the decision to delay sex among adolescent boys.

METHODS

Adolescent boys ages 14-17 years were recruited from community sites using a venue-based sampling method. All eligible boys at venues were invited to participate in an electronic survey. Question items included sexual behaviors, attitudes related to sex, relationships, masculine values, and family contextual items.

RESULTS

We enrolled 667 participants, mean age 15.7 years, of diverse ethnicity. A total of 252 were abstinent (38%). Abstinent participants were younger and less likely to report non-coital behaviors, and reported lower conventional masculine values. Among abstinent participants, 62% planned to delay sex, whereas 38% anticipated sex in the next year. Participants with lower conventional masculine values and more religious or moral motivations for abstinence were more likely to plan to delay sex.

CONCLUSIONS

Abstinence among boys is common, even in high-STI risk communities. For these boys, abstinence appears to be a complex behavioral decision influenced by demographic, behavioral, attitudinal, and contextual factors such as age, race, non-coital sexual behaviors, and masculine values. Understanding the attitudes and contexts of abstinence, including plans to delay sex, can inform the development of public health programs for early fatherhood and STI prevention.

The association between sexual orientation identity and behavior across race/ethnicity, sex, and age in a probability sample of high school students

OBJECTIVES

We examined the prevalence and associations between behavioral and identity dimensions of sexual orientation among adolescents in the United States, with consideration of differences associated with race/ethnicity, sex, and age.

METHODS

We used pooled data from 2005 and 2007 Youth Risk Behavior Surveys to estimate prevalence of sexual orientation variables within demographic sub-groups. We used multilevel logistic regression models to test differences in the association between sexual orientation identity and sexual behavior across groups.

RESULTS

There was substantial incongruence between behavioral and identity dimensions of sexual orientation, which varied across sex and race/ethnicity. Whereas girls were more likely to identify as bisexual, boys showed a stronger association between same-sex behavior and a bisexual identity. The pattern of association of age with sexual orientation differed between boys and girls.

CONCLUSIONS

Our results highlight demographic differences between 2 sexual orientation dimensions, and their congruence, among 13- to 18-year-old adolescents. Future research is needed to better understand the implications of such differences, particularly in the realm of health and health disparities.

Prevalence and predictors of sexual inexperience in adulthood

The emergence of partnered sexual behavior represents an important developmental transition. However, little is known about individuals who remain sexually inexperienced well into adulthood. We used data from 2,857 individuals who participated in Waves I-IV of the National Longitudinal Study of Adolescent Health (Add Health) and reported no sexual activity (i.e., oral-genital, vaginal, or anal sex) by age 18 to identify, using discrete-time survival models, adolescent sociodemographic, biosocial, and behavioral characteristics that predicted adult sexual inexperience. The mean age of participants at Wave IV was 28.5 years (SD = 1.92). Over one out of eight participants who did not initiate sexual activity during adolescence remained abstinent as young adults. Sexual non-attraction significantly predicted sexual inexperience among both males (aOR = 0.5) and females (aOR = 0.6). Males also had lower odds of initiating sexual activity after age 18 if they were non-Hispanic Asian, reported later than average pubertal development, or were rated as physically unattractive (aORs = 0.6-0.7). Females who were overweight, had lower cognitive performance, or reported frequent religious attendance had lower odds of sexual experience (aORs = 0.7-0.8) while those who were rated by the interviewers as very attractive or whose parents had lower educational attainment had higher odds of sexual experience (aORs = 1.4-1.8). Our findings underscore the heterogeneity of this unique population and suggest that there are a number of different pathways that may lead to either voluntary or involuntary adult sexual inexperience. Understanding the meaning of sexual inexperience in young adulthood may have important implications for the study of sexuality development across the life course.

Factors that influence utilisation of HIV/AIDS prevention methods among university students residing at a selected university campus

Various studies have reported that university students, who are mostly young people, rarely use existing HIV/AIDS preventive methods. Although studies have shown that young university students have a high degree of knowledge about HIV/AIDS and HIV modes of transmission, they are still not utilising the existing HIV prevention methods and still engage in risky sexual practices favourable to HIV. Some variables, such as awareness of existing HIV/AIDS prevention methods, have been associated with utilisation of such methods. The study aimed to explore factors that influence use of existing HIV/AIDS prevention methods among university students residing in a selected campus, using the Health Belief Model (HBM) as a theoretical framework. A quantitative research approach and an exploratory-descriptive design were used to describe perceived factors that influence utilisation by university students of HIV/AIDS prevention methods. A total of 335 students completed online and manual questionnaires. Study findings showed that the factors which influenced utilisation of HIV/AIDS prevention methods were mainly determined by awareness of the existing university-based HIV/AIDS prevention strategies. Most utilised prevention methods were voluntary counselling and testing services and free condoms. Perceived susceptibility and perceived threat of HIV/AIDS score was also found to correlate with HIV risk index score. Perceived susceptibility and perceived threat of HIV/AIDS showed correlation with self-efficacy on condoms and their utilisation. Most HBM variables were not predictors of utilisation of HIV/AIDS prevention methods among students. Intervention aiming to improve the utilisation of HIV/AIDS prevention methods among students at the selected university should focus on removing identified barriers, promoting HIV/AIDS prevention services and providing appropriate resources to implement such programmes.

Bringing your baggage to bed: associations of previous relationship experiences with sexual risk

Delaying sexual intercourse after initiating a relationship (i.e., increasing the presexual period) and delaying unprotected sex can reduce HIV/STI risk. Past relationship and risk experiences may influence sexual decisions in a current relationship. We examined how past relationship and risk experiences of both members of 296 young pregnant couples influenced length of presexual period and time to unprotected sex. Forty-six percent of couples had sex within the first month of seeing each other and had unprotected sex within 1 month of having sex. Length of presexual period and time to unprotected sex were significantly shorter in their current relationship than their previous relationship for both men and women (all p < 0.05). Female past relationship and risk factors were more strongly associated with length of presexual relationship than male past relationship and risk factors. Both male and female past relationship and risk factors were associated with time to unprotected sex.

High risk sexual behaviors for HIV among the in-school youth in Swaziland: a structural equation modeling approach

Background

Global efforts in response to the increased prevalence of the human immunodeficiency virus (HIV) are mainly aimed at reducing high risk sexual behaviors among young people. However, knowledge regarding intentions of young people to engage in protective sexual behaviors is still lacking in many countries around the world, especially in Sub-Saharan Africa where prevalence of human immunodeficiency virus is the highest. The objective of this study was to test the theory of planned behavior (TPB) for predicting factors associated with protective sexual behaviors, including sexual abstinence and condom use, among in-school youths aged between 15 and 19 years in Swaziland.

Methods

This cross-sectional survey was conducted using a anonymous questionnaire. A two-stage stratified and cluster random sampling method was used. Approximately one hundred pupils from each of four schools agreed to participate in the study, providing a total sample size of 403 pupils of which 369 were ultimately included for data analysis. The response rate was 98%. Structural equation modeling was used to analyse hypothesized paths.

Results

The TPB model used in this study was effective in predicting protective sexual behavior among Swazi in-school youths, as shown by model fit indices. All hypothesized constructs significantly predicted intentions for abstinence and condom use, except perceived abstinence controls. Subjective norms were the strongest predictors of intention for premarital sexual abstinence; however, perceived controls for condom use were the strongest predictors of intention for condom use.

Conclusions

Our findings support application of the model in predicting determinants of condom use and abstinence intentions among Swazi in-school youths.

Randomized controlled trial on the effectiveness of counseling messages for avoiding unprotected sexual intercourse during sexually transmitted infection and reproductive tract infection treatment among female sexually transmitted infection clinic patients

BACKGROUND

The effectiveness of counseling messages to avoid unprotected sex during short-term treatment for curable sexually transmitted infections is unknown.

METHODS

We randomized 300 female STI clinic patients 18 years or older with cervicitis and/or vaginal discharge in Kingston, Jamaica, in 2010 to 2011, to 1 of 2 counseling messages for their course of syndromic treatment: abstinence only or abstinence backed up by condom use. At a follow-up visit 6 days afterward, we collected vaginal swabs to test for prostate-specific antigen (PSA), a biological marker of recent semen exposure, and administered a questionnaire assessing sexual behavior.

RESULTS

No differences were found in the proportions of women testing positive for PSA at follow-up in the abstinence-plus-condom group (11.9%) and abstinence-only group (8.4%) (risk difference, 3.5; 95% confidence interval, -3.5 to 10.5). There also was no significant difference in reporting of unprotected sex between groups. Reporting a history of condom use before enrollment significantly modified the effect of counseling arm on PSA positivity (P = 0.03). Among those reporting recent condom use, 10.3% in the abstinence-only arm and 4.8% in the abstinence-plus-condom arm tested positive for PSA. Conversely, among those not reporting recent condom use, 6.5% in the abstinence-only arm and 17.3% in the abstinence-plus-condom arm had PSA detected.

CONCLUSIONS

We found no evidence to support the superiority of either counseling message. Post hoc analyses suggest that women with recent condom experience may benefit significantly more from abstinence-plus-condom messages, whereas women without such experience may benefit significantly more from abstinence-only messages. Providers should weigh individual condom use history when determining the most appropriate counseling message.

Exploring discordance between biologic and self-reported measures of semen exposure: a qualitative study among female patients attending an STI clinic in Jamaica

We explored the use of qualitative interviews to discuss discrepancies between two sources of information on unprotected sex: biomarker results and self-reported survey data. The study context was a randomized trial in Kingston, Jamaica examining the effect of STI counseling messages on recent sexual behavior using prostate-specific antigen (PSA) as the primary study outcome. Twenty women were interviewed. Eleven participants were selected because they tested positive for PSA indicating recent semen exposure, yet reported no unprotected sex in a quantitative survey ("discordant"): 5 reported abstinence and 6 reported condom use. Nine participants who also tested positive for PSA but reported unprotected sex in the survey were interviewed for comparison ("concordant"). Qualitative interviews with 6 of the 11 discordant participants provided possible explanations for their PSA test results, and 5 of those were prompted by direct discussion of those results. Rapid PSA testing combined with qualitative interviews provides a novel tool for investigating and complementing self-reported sexual behavior.

Associations between patterns of emerging sexual behavior and young adult reproductive health

CONTEXT

Identifying young adult outcomes associated with adolescent sexual behavior, including patterns of first oral, vaginal and anal sex, is critical to promoting healthy sexual development.

METHODS

Associations between patterns of emerging sexual behavior, defined using latent class analysis, and young adult sexual and reproductive health were examined among 9,441 respondents to Waves 1 (1994-1995), 3 (2001-2002) and 4 (2008) of the National Longitudinal Study of Adolescent Health. Logistic regression analyses examined associations between class membership and young adult outcomes, and tested for interactions by race and ethnicity.

RESULTS

Compared with respondents who initiated vaginal sex first and reported other sexual behaviors within two years, those who initiated oral and vaginal sex during the same year had similar odds of having had an STD diagnosis ever or in the last year, of having had concurrent sexual partnerships in the last year and of having exchanged sex for money. However, respondents who postponed sexual activity had reduced odds of each outcome (odds ratios, 0.2-0.4); those who initiated vaginal sex and reported only one type of sexual behavior had reduced odds of reporting STD diagnoses and concurrent partnerships (0.4-0.6). Respondents who reported early initiation of sexual activity combined with anal sex experience during adolescence had elevated odds of having had concurrent partnerships (1.6). The data suggest racial and ethnic disparities even when patterns of emerging sexual behavior were the same.

CONCLUSIONS

Patterns of early sexual behavior considered high-risk may not predict poor sexual and reproductive health in young adulthood.

Abstinence-only education and teen pregnancy rates: why we need comprehensive sex education in the U.S

The United States ranks first among developed nations in rates of both teenage pregnancy and sexually transmitted diseases. In an effort to reduce these rates, the U.S. government has funded abstinence-only sex education programs for more than a decade. However, a public controversy remains over whether this investment has been successful and whether these programs should be continued. Using the most recent national data (2005) from all U.S. states with information on sex education laws or policies (N = 48), we show that increasing emphasis on abstinence education is positively correlated with teenage pregnancy and birth rates. This trend remains significant after accounting for socioeconomic status, teen educational attainment, ethnic composition of the teen population, and availability of Medicaid waivers for family planning services in each state. These data show clearly that abstinence-only education as a state policy is ineffective in preventing teenage pregnancy and may actually be contributing to the high teenage pregnancy rates in the U.S. In alignment with the new evidence-based Teen Pregnancy Prevention Initiative and the Precaution Adoption Process Model advocated by the National Institutes of Health, we propose the integration of comprehensive sex and STD education into the biology curriculum in middle and high school science classes and a parallel social studies curriculum that addresses risk-aversion behaviors and planning for the future.

Making sense of abstinence: social representations in young Africans' HIV-related narratives from six countries

Despite the prominence of abstinence promotion in HIV prevention for young Africans, there is little documentation concerning its reception and interpretation. With the purpose of informing programmatic practice, we examined how young Africans from six countries with contrasting HIV prevalence rates make sense of abstinence. 'Scenarios from Africa' scriptwriting contests invite young people to contribute ideas for short films about HIV. Using thematic narrative-based approaches, we analyzed a stratified random sample of these narratives written in 2005 by young women and men aged 10-24 years from Senegal, Burkina Faso, South-East Nigeria, Kenya, Namibia and Swaziland. Abstinence was considerably more prominent as a theme in the samples from SE Nigeria, Kenya and Swaziland. It was articulated in relation to conservative Christian sexual morality and in opposition to condom use with particular intensity in SE Nigeria, with stigmatising implications for non-abstainers. However, cross-national commonalities were more striking than differences. Examples of non-stigmatising pro-abstinence messaging highlighted the appeal of discourses of romantic love and future plans across countries and demographic characteristics. The analysis yielded contextual understanding, youth-driven ideas and recommendations to inform comprehensive HIV-prevention efforts.

Students' experiences and perceived benefits of a sex education curriculum: a qualitative analysis

A qualitative evaluation explored the experiences and perceived benefits of students who participated in an abstinence-plus sex education program at enrollment and conclusion. The sample included 1130 inner-city high school students, 73.7% of whom were Hispanic. Thematic analysis was used to identify main themes in responses made by students to 3 open-ended questions. The most common preparticipation request was for information about sexually transmitted infections. At program conclusion, the most common response theme involved the quality of course delivery. Students indicated that they appreciated the facilitators who allowed open conversations. The implications of these findings to sex education programs are discussed.

Postpartum abstinence and risk of HIV among young mothers in the Kassena-Nankana District of Northern Ghana

This study explored the role and shaping of postpartum abstinence on young mothers' sexual conduct and vulnerability to HIV infection in a rural setting of Northern Ghana. Young mothers in their mid-twenties to early-thirties and men married to young mothers were purposively selected for repeated semi-structured interviews. The interviews were tape-recorded, transcribed and Nvivo software was used to organize and manage the data for analysis. In this setting, postpartum abstinence was perceived as a risk period for STIs due to increased male infidelity during this period. Yet, women's urge to take action to mitigate the risk of STIs is compromised by childbearing obligations. More assertive women, however, employ crafty and nifty protective strategies including the masturbation of their male partner when they perceive themselves at risk. We conclude that the advent of HIV and AIDS, coupled with improved access to sexual and reproductive health information and modern contraception, has eroded the logic of observance of postpartum abstinence in the Kassena-Nankana District of Northern Ghana. Efforts should be made to facilitate easy access to modern contraceptives and HIV protection by rural women.

Beyond monogamy: opportunities to further reduce risk for HIV infection among married Zimbabwean women with only one lifetime partner

The main objective of this paper was to identify HIV risk factors at the individual, partner, and partnership levels among married, lifetime monogamous women in a nationally representative sample of Zimbabweans aged 15-29 years. Cross-sectional data were collected through individual survey interviews among 1,286 women who provided blood for HIV testing. The HIV prevalence among these women was high (21.8%). HIV risk increased with female age, within-couple age difference of more than 5 years, the husband having children with other women, and the respondent being 'extremely likely' to discuss monogamy in the next 3 months with her husband. The latter suggests that women were attempting to communicate their concerns while unaware that they were already HIV positive. HIV risk largely appears related to the partner's past and present sexual behavior, resulting in limited ability for married women to protect themselves from infection. Overall, lifetime monogamy offers insufficient protection for women.

Efficacy of a theory-based abstinence-only intervention over 24 months: a randomized controlled trial with young adolescents

OBJECTIVE

To evaluate the efficacy of an abstinence-only intervention in preventing sexual involvement in young adolescents.

DESIGN

Randomized controlled trial.

SETTING

Urban public schools.

PARTICIPANTS

A total of 662 African American students in grades 6 and 7.

INTERVENTIONS

An 8-hour abstinence-only intervention targeted reduced sexual intercourse; an 8-hour safer sex-only intervention targeted increased condom use; 8-hour and 12-hour comprehensive interventions targeted sexual intercourse and condom use; and an 8-hour health-promotion control intervention targeted health issues unrelated to sexual behavior. Participants also were randomized to receive or not receive an intervention maintenance program to extend intervention efficacy.

OUTCOME MEASURES

The primary outcome was self-report of ever having sexual intercourse by the 24-month follow-up. Secondary outcomes were other sexual behaviors.

RESULTS

The participants' mean age was 12.2 years; 53.5% were girls; and 84.4% were still enrolled at 24 months. Abstinence-only intervention reduced sexual initiation (risk ratio [RR], 0.67; 95% confidence interval [CI], 0.48-0.96). The model-estimated probability of ever having sexual intercourse by the 24-month follow-up was 33.5% in the abstinence-only intervention and 48.5% in the control group. Fewer abstinence-only intervention participants (20.6%) than control participants (29.0%) reported having coitus in the previous 3 months during the follow-up period (RR, 0.94; 95% CI, 0.90-0.99). Abstinence-only intervention did not affect condom use. The 8-hour (RR, 0.96; 95% CI, 0.92-1.00) and 12-hour comprehensive (RR, 0.95; 95% CI, 0.91-0.99) interventions reduced reports of having multiple partners compared with the control group. No other differences between interventions and controls were significant.

CONCLUSION

Theory-based abstinence-only interventions may have an important role in preventing adolescent sexual involvement.

TRIAL REGISTRATION

clinicaltrials.gov Identifier: NCT00640653.

Targeting HIV interventions for adolescent girls and young women in Southern Africa: use of the PLACE methodology in Hwange District, Zimbabwe

This paper addresses the issue of how to target interventions to girls 15-19 and young women 20-24 in a resource poor setting of Hwange District, Zimbabwe. The Priorities for Local AIDS Control efforts methodology was used to understand where these young people socialize and also to understand whether age disparate relationships were a common occurrence. Findings indicated prevention efforts for those 15-19 would need to focus on "everyday" sites as these are the places where the majority of girls socialized. However, the girls 15-19 with the riskiest sexual behaviors were found at venues affiliated with alcohol. Prevention efforts for those 20-24 would also need to largely focus on venues affiliated with alcohol. Women at such sites generally reported more risky behaviors than women in other types of venues. Reporting of a partner 5 or more years older was common across age groups and across venues. Tackling HIV in Zimbabwe will take a multifaceted approach targeted towards the places girls 15-19 and young women 20-24 are meeting new partners.

Evaluation of "big decisions": an abstinence-plus sexuality curriculum

This study examines the effectiveness of Big Decisions, a sexuality curriculum developed to promote abstinence, as well as condom and contraceptive use, while overcoming school districts' concern about controversy surrounding sex education. The authors used a pre- and post-test survey design to measure changes in attitudes, self-efficacy, and behavioral intentions regarding sex, pregnancy, sexually transmitted diseases, and condom use. The sample for this analysis included 788 inner-city 9th-grade students, the majority of which (78.4%) were Hispanic. Pre- to posttest data comparisons demonstrated improvement in mean scores for each item, with statistically significant changes for 11 of the 12 items measured. The male participants' pretest responses reflected higher risk status than did those of female participants. A large majority (87.8%) of students rated the program as "great" or "good". The results suggest that Big Decisions provides a promising approach to reaching minority students with both abstinence and risk-reduction messages.

Intentional abstinence among homeless and unstably housed persons living with HIV/AIDS

Some persons living with HIV/AIDS (PLWHA) engage in periods of sexual abstinence. Baseline data from a larger study of homeless/unstably housed PLWHA indicated that 20% (125/644) intentionally abstained from sex in the past 90 days. Reasons included: (1) 'not interested' (n = 78); (2) did not want to infect someone (n = 46); and (3) did not have a partner (n = 37). Abstinence was less likely among all who had a main partner. Among men who have sex with men (MSM), abstinence was less likely among those with a detectable viral load. It was more likely among heterosexual men who were experiencing current housing problems and who had at least a high school education. Among women, abstinence was less likely among African Americans and those whose social networks were more aware of their HIV status. Better understanding of motivations to abstain may improve how programs serving PLWHA address this issue.

[HIV infection prophylaxis in Uganda]

Uganda is one of the few countries where rates of HIV infection decreased, from about 18 percent in the early 1990s to about five percent in 2001. Although at the end of 2005, UNAIDS estimated that 6.7 percent of adults were HIV-infected, in recent years the number of infections has started to rise again. Uganda receives funds from the Unites States President's Emergency Plan for AIDS Relief (PEPFAR), which promotes the ABC approach focusing on sexual abstinence. Many experts argue that by emphasizing abstinence over condom use, the approach leaves women at risk of infection, because currently in Uganda marital sex continues to pose a particular risk for women.

Observance of the laws of family purity in modern-orthodox Judaism

This research is a follow-up to a previous study measuring the observance of the ritually unclean period (Niddah) among Modern-Orthodox Jews. A total of 267 participants completed an online questionnaire comprised of a list of 16 "strict" and "lenient" forbidden behaviors. Participants reported whether they had engaged in these behaviors during Week 1 (the actual menstrual period) and during Week 2 (the "clean days" following the cessation of bleeding). Results showed that laws were being violated, with more transgressions during the second week than the first week. Additionally, more "lenient" laws were being broken than "strict" ones. Level of religious observance was significantly negatively correlated to the number of transgressions. However, there was no significant correlation between the number of transgressions and the age at marriage, sex, or how long one had been married.

Validation set correlates of anogenital injury after sexual assault

OBJECTIVES

Forensic investigators remain unsure exactly why some sexual assault victims display acute injury while others do not. This investigation explores potential reasons for these differential findings among female victims.

METHODS

This cross-sectional analysis examined data from consecutive female sexual assault victims, at least 12 years old, who agreed to a forensic exam between November 1, 2002, and November 30, 2006. Exams utilized colposcopy, anoscopy, macrodigital imaging, and toluidine blue dye to delineate anogenital injury (AGI), which was defined as the presence of recorded anogenital abrasions, tears, or ecchymosis. Demographic variables of the victim, including sexual experience and reproductive parity, and assault characteristics were recorded in the database for bivariate and multivariate analysis with AGI.

RESULTS

Forty-nine percent of the initial 3,356 patients displayed AGI. Of this total, 2,879 cases included complete data for all variables and were included in the multivariate logistic regression model. A statistically significant increased risk for AGI was noted with: educational status (odds ratio [OR] 1.53, 95% CI = 1.25 to 1.87); vaginal or attempted penetration using penis (OR 2.29, 95% CI = 1.74 to 3.01), finger (OR 1.61, 95% CI = 1.88 to 1.94), or object (OR 3.19, 95% CI = 1.52 to 6.68); anal-penile penetration (OR 2.00, 95% CI = 1.57 to 2.54); alcohol involvement (OR 1.25, 95% CI = 1.04 to 1.50); and virgin status of victim (OR 1.38, 95% CI = 1.11 to 1.71). Victims were less likely to display AGI with a longer postcoital interval (OR 0.50, 95% CI = 0.39 to 0.65) and increased parity (OR 0.76, 95% CI = 0.57 to 0.99).

CONCLUSIONS

Approximately half the patients displayed AGI. This rate is higher than earlier studies, but consistent with current investigations utilizing similar injury detection methods. The correlates of injury found reinforce the findings of prior studies, while prompting questions for future study.

Variations in coital and noncoital sexual repertoire among adolescent women

PURPOSE

Little is known about factors associated with the day-to-day selection and orchestration of sexual repertoire among adolescent women. Analyzing differences in adolescent women's sexual activity may augment both the clinical and behavioral understanding of sexuality development and sexual decision making, and may yield important points to enhance existing programs for prevention of sexually transmitted infection or pregnancy.

METHODS

Adolescent women (N = 387, aged 14-17 years at enrollment) were recruited from primary care adolescent clinics serving primarily lower- and middle-income patients. Data were taken from daily sexual diaries. A four-category outcome variable, using generalized estimating equation multinomial logistic regression assessed the likelihood of specific sexual behaviors on a given day: none (abstinence), non-coital-only, coital-only, and dual noncoital/coitus. Separate models were analyzed for fellatio, cunnilingus, and anal sex. Predictor variables included age, menstrual bleeding, alcohol or marijuana use, positive or negative mood, recent coitus, recent noncoital sexual activity, partner support or negativity, sexual interest, feeling in love, time of the week, and same-day noncoital behaviors. Coital-only sexual behavior was used as the reference category.

RESULTS

Among adolescent women, abstinence is prevalent on the majority of days. When sexual activity does occur, coital-only activity is most common; however, noncoital behaviors alone and/or in tandem with coitus are not rare.

CONCLUSIONS

Differing associations of intrapersonal, partner and situational variables with specific types of day-to-day sexual activity underscores a complex sexual repertoire which may be insufficiently examined with a simple focus on coital risk.

Traditional values of virginity and sexual behaviour in rural Ethiopian youth: results from a cross-sectional study

BACKGROUND

Delaying sexual initiation has been promoted as one of the methods of decreasing risks of HIV among young people. In traditional countries, such as Ethiopia, retaining virginity until marriage is the norm. However, no one has examined the impact of this traditional norm on sexual behaviour and risk of HIV in marriage. This study examined the effect of virginity norm on having sex before marriage and sexual behaviour after marriage among rural Ethiopian youth.

METHODS

We did a cross-sectional survey in 9 rural and 1 urban area using a probabilistic sample of 3,743 youth, 15-24 years of age. Univariate analysis was used to assess associations between virginity norm and gender stratified by area, and between sexual behaviour and marital status. We applied Kaplan-Meier and Cox regression analysis to estimate age at sexual debut and assessed the predictors of premarital sex among the never-married using SPSS.

RESULTS

We found that maintaining virginity is still a way of securing marriage for girls, especially in rural areas; the odds of belief and intention to marry a virgin among boys was 3-4 times higher among rural young males. As age increased, the likelihood of remaining a virgin decreased. There was no significant difference between married and unmarried young people in terms of number of partners and visiting commercial sex workers. Married men were twice more likely to have multiple sexual partners than their female counterparts. A Cox regression show that those who did not believe in traditional values of preserving virginity (adjusted hazard ratio [AHR] = 2.91 [1.92-4.40]), alcohol drinkers (AHR = 2.91 [1.97-4.29]), Khat chewers (AHR = 2.36 [1.45-3.85]), literates (AHR = 18.01 [4.34-74.42]), and the older age group (AHR = 1.85 [1.19-2.91]) were more likely to have premarital sex than their counterparts.

CONCLUSION

Although virginity norms help delay age at sexual debut among rural Ethiopian youth, and thus reduces vulnerability to sexually transmitted infections and HIV infection, vulnerability among females may increase after marriage due to unprotected multiple risky sexual behaviours by spouses. The use of preventive services, such as VCT before marriage and condom use in marriage should be part of the HIV/AIDS prevention and control strategies.

Impacts of abstinence education on teen sexual activity, risk of pregnancy, and risk of sexually transmitted diseases

This paper examines the impacts of four abstinence-only education programs on adolescent sexual activity and risks of pregnancy and sexually transmitted diseases (STDs). Based on an experimental design, the impact analysis uses survey data collected in 2005 and early 2006 from more than 2,000 teens who had been randomly assigned to either a program group that was eligible to participate in one of the four programs or a control group that was not. The findings show no significant impact on teen sexual activity, no differences in rates of unprotected sex, and some impacts on knowledge of STDs and perceived effectiveness of condoms and birth control pills

Sexual satisfaction in the seventh decade of life

This research presents data on the sexuality of men and women in their mid-sixties. The data are from the Wisconsin Longitudinal Study 2003 mail survey; analyses include 2156 men and 1955 women. Respondents reported having sex 1.7 times per month. Regression analyses were used to identify variables associated with sexual behavior and satisfaction. Included were measures of physical health, sexual functioning, psychological distress, and satisfaction with the relationship. Frequency of sexual activity was significantly predicted by reports that partner lost interest in sex. Satisfaction with the sexual relationship was predicted by marital/ relationship satisfaction and frequency of sexual activity. Sexual expression remains a significant aspect of intimate relationships in the seventh decade of life.

The unconsummated marriage: its frequency and clinical characteristics in a sexual dysfunction clinic

The object of this study was to investigate frequency of the unconsummated marriages and its clinical characteristics among the subjects who referred to a sexual dysfunction clinic in Turkey. Four hundred and forty-nine unconsummated marriage cases were evaluated among 1880 subjects referred to Acibadem Sexual Health Clinic, Istanbul, between December 2000 and December 2004. Unconsummated marriage rose from the female partner in 67% of the cases, 7% males, and 26% both. Vaginismus was the most prominent cause in 81% of the cases, erectile dysfunction in 10.5%, premature ejaculation in 5%. Previous reports from Eastern societies including Turkey indicate higher incidences of premature ejaculation and vaginismus than the Western world which underline a strong cultural influence in the background of these disorders. These also appeared to be the most important precursors of unconsummated marriage in our study.

Factors associated with sexual abstinence among adolescents in four sub-Saharan African countries

Drawing on nationally representative data collected from Burkinabé, Ghanaian, Malawian, and Ugandan adolescents, this study examines differences among four groups of never married, 15-19 year olds: primary abstainers (sexually inexperienced), secondary abstainers (last sex more than 12 months prior to the survey), recent abstainers (sexually active in last year but not in the last 3 months), and sexually active (had sexual intercourse in the last 3 months). The percentage of primary abstinent adolescents ranged from 42% (Malawian males) to 85% (Ghanaian males). In general, a greater proportion of females than males were primary abstainers. Primary abstainers were younger than sexually experienced adolescents. Current involvement in a romantic relationship was a significant predictor of sexual status with primary abstainers being the least likely to be romantically involved. Overall, findings suggest that adolescents' gender, prior sexual experiences and contextual circumstances, such as romantic partnerships, should be considered when designing abstinence promotion programs.

Sex and the single (older) guy: sexual lives of older unmarried Thai men during the AIDS era

In Thailand and elsewhere, some older persons remain sexually active well into late middle and old age. Very little research, program, or advocacy effort has targeted this group with respect to HIV and their susceptibility to it. We explore these issues using qualitative data from two sets of semi-structured, in-depth interviews of unmarried older Thai men, most of whom were in their 50's. Opportunities exist for several of the men we interviewed to engage in a fairly wide range of sexual relationships. Some do, but others choose celibacy because of declining interest; a wish to avoid financial hardships thought to be inextricably linked with sexual relationships; a wish to avoid social sanctions; and desires to pursue interests thought to be more appropriate for their age group.

Association of sexual abstinence in adolescence with mental health in adulthood

We examined whether adolescent sexual abstinence predicts better adult mental health. 1,917 adolescents, recruited from middle schools at age 13, were surveyed at ages 13, 18, 23, and 29. In bivariate analyses, adolescent sexual abstinence was associated with better mental health at age 29 for females, but not males; three adolescent factors, educational prospects, family bonding, and unconventionality were investigated as explanatory variables of this relationship. The abstinence-mental health relationship was nonsignificant when educational prospects was included in multivariate models, and marginally significant when family bonding and unconventionality were included; all three explanatory factors accounted for significant proportions of the variance in adult mental health. Girls who are uninvolved in school, have weak family backgrounds, and exhibit unconventionality may have poor adult mental health, whether or not they abstain from sex in adolescence. Interventions that strengthen adolescents' connections to families and schools may reduce risk for long-term mental health problems.