A Comparison of Sexual Health History and Practices among Monogamous and Consensually Nonmonogamous Sexual Partners

IntroductionAlthough consensually nonmonogamous (CNM) relationships are presumed to be far riskier for partners' sexual health compared with monogamous relationships, the disparity between them may be smaller than assumed. A growing body of research finds that many partners who have made monogamy agreements cheat, and when they do, they are less likely to practice safe sex than CNM partners.AimExtant comparisons of monogamous and CNM relationships are rare and have yet to establish whether rates of sexually transmitted infections (STIs) and STI testing differ between these groups. The present research compared self-reported STI history, lifetime number of sex partners, and condom use practices among monogamous and CNM partners.MethodsParticipants (N = 556) were recruited for an online survey of “attitudes toward sexual relationships.” Approximately two-thirds of the sample reported current involvement in a monogamous relationship, with the remainder indicating involvement in a CNM relationship.Main Outcome MeasuresAll participants completed a questionnaire that included measures of condom use practices with primary and extra-pair partners, as well as their STI history.ResultsCNM partners reported more lifetime sexual partners than individuals in monogamous relationships. In addition, compared with monogamous partners, CNM partners were more likely to (i) report using condoms during intercourse with their primary partner; (ii) report using condoms during intercourse with extradyadic partners; and (iii) report having been tested for STIs. Approximately one-quarter of monogamous partners reported sex outside of their primary relationship, most of whom indicated that their primary partner did not know about their infidelity. The percentage of participants reporting previous STI diagnoses did not differ across relationship type.ConclusionsCNM partners reported taking more precautions than those in monogamous relationships in terms of greater condom use during intercourse with all partners and a higher likelihood of STI testing. Thus, although persons in CNM relationships had more sexual partners, the precautions they took did not appear to elevate their rate of STIs above an imperfect implementation of monogamy. Lehmiller JJ. A comparison of sexual health history and practices among monogamous and consensually nonmonogamous sexual partners.     

Safer sex as the bolder choice: testosterone is positively correlated with safer sex behaviorally relevant attitudes in young men

IntroductionHigher testosterone (T) is tied to risk‐taking, especially in financial domains but also in health domains relevant to acquiring sexually transmitted infections (STIs). However, safer sex constructs could themselves carry the possibility of “social risk” due to sexual stigma or embarrassment, or could involve boldness or confidence because they could represent status displays of frequent sexual activity.AimTo determine how T and behaviorally relevant attitudes about sexual risk‐taking are linked, to better understand biopsychosocial aspects of sexual health related to STIs.MethodsIn 78 first‐year male college students, we examined correlations between salivary T and behaviorally relevant safer sex attitudes assessed via questionnaires.Main Outcome MeasuresT, via saliva; safer sex attitudes, via a composite and the University of California, Los Angeles Multidimensional Condom Attitudes Scale (MCAS).ResultsHigher T was significantly correlated with higher scores on the following: safer sex likelihood composite, r(73) = 0.33, P = 0.003; the MCAS safer sex resilience, r(32) = 0.36, P = 0.037; and the MCAS condom purchase comfort, r(32) = 0.37, P = 0.031. Associations between T and safer sex likelihood and resilience were still robust after controlling for potential confounds, though the association between T and purchase comfort diminished to a trend.ConclusionsHigher T was positively linked with safer sex attitudes, especially those most closely tied to STI risk avoidance. Thus, future research and interventions for STI prevention should address the possibility that safer sex may be paradoxically perceived as a “bold” or “risky” choice even as it decreases STI risk. van Anders SM, Goldey KL, Conley TD, Snipes DJ, and Patel DA. Safer sex as the bolder choice: Testosterone is positively correlated with safer sex behaviorally relevant attitudes in young men. J Sex Med 2012;9:727–734.     

Meeting Sexual Partners Online and Associations With Sexual Risk Behaviors in the Swedish Population

BackgroundOnline arenas may facilitate sexual encounters. However, to what extent finding sexual partners online is associated with sexual risk behavior and sexual health outcomes is still not fully explored.MethodsA stratified randomized population based study on sexual and reproductive health and rights of 50,000 Swedes was conducted in 2017. The final sample consisted of 14,537 women and men aged 16–84 years. We identified sexual health factors associated with finding sexual partners online and estimated prevalences thereof.ResultsHaving used the internet to meet sexual partners was reported by 11% (95% confidence interval: 10.1–12.3) of men and 7% (95% confidence interval: 6.0–7.4) of women and was most common among men aged 30–44 years (13.7%). After adjustment, those reporting a non-heterosexual identity were most likely to meet sexual partners online. Meeting sexual partners online was also associated with reporting several sexual risk behaviors: condomless sex with temporary partner during the past 12 months, adjusted odds ratio (AOR): 5.1 (3.8–6.8) for women and AOR: 6.0 (4.5–7.9) for men, and having had a test for sexually transmitted infections (STIs) generated a 4-fold AOR for both sexes, STI diagnosis showed a 2-fold AOR, ever having paid or given other compensation for sex AOR: 4.8 (2.7–8.8) for women and AOR: 4.2 (2.9–6.1) for men as well as ever having received money or other compensation for sex AOR: 4.0 (1.3–11.9) for women and AOR: 6.0 (2.4–15.1) for men.Clinical translationMeeting sexual partners online was associated with sexual risk behaviors, which is of importance in tailoring sexual health interventions and STI/HIV-control activities.Strengths and limitationsFew studies of online sexual behaviors are based on population-based surveys of the general population with results stratified by sexual identity. However, the use of lifetime prevalence of ever having used the internet, smartphone, or app to meet sexual partners has limitations.ConclusionMeeting sexual partners online was associated with sexual risk behaviors in a randomized sample of the Swedish population, which is of importance to tailoring sexual health interventions.Deogan C, Jacobsson E, Mannheimer L, et al. Meeting Sexual Partners Online and Associations With Sexual Risk Behaviors in the Swedish Population. J Sex Med 2020;17:2141–2147.     

Female Youth Who Sexually Coerce: Prevalence,Risk, and Protective Factors in Two National High School Surveys

IntroductionSexual coercion is recognized as a serious societal problem. Correlates and risk factors of sexually abusive behavior in females are not well known.AimEtiological theory and empirical study of female perpetrators of sexual coercion are usually based on small or highly selected samples. Specifically, population‐based data are needed to elucidate risk/protective factors.Main Outcome MeasuresMain outcome measures include a self‐report questionnaire containing 65 items tapping socio‐demographic and health conditions, social relations, sexual victimization, conduct problems and a set of normative and deviant sexual cognitions, attitudes, and behaviors.MethodsWe used a 2003–2004 survey of sexual attitudes and experiences among high school students in Norway and Sweden to identify risk factors and correlates to sexually coercive behavior (response rate 80%); 4,363 females participated (Mean = 18.1 years).ResultsThirty‐seven women (0.8%) reported sexual coercion (ever talked someone into, used pressure, or forced somebody to have sex). Sexually coercive compared with non‐coercive women were similar on socio‐demographic variables, but reported less parental care and more parental overprotection, aggression, depressive symptoms, and substance misuse. Also, sexually coercive females reported more sexual lust, sex partners, penetrative sexual victimization, rape myths, use of violent porn, and friends more likely to use porn. When using the Swedish subsample to differentiate risk factors specific for sexual coercion from those for antisocial behavior in general, we found less cannabis use, but more sexual preoccupation, pro‐rape attitudes, and friends using violent porn in sexually coercive compared with non‐sex conduct problem females.ConclusionsSexually coercive behavior in high school women was associated with general risk/needs factors for antisocial behavior, but also with specific sexuality‐related risk factors. This differential effect has previously been overlooked, agrees with similar findings in men, and should have substantial etiological importance. Kjellgren C, Priebe G, Svedin CG, Mossige S, and Långström N. Female youth who sexually coerce: Prevalence, risk, and protective factors in two national high school surveys. J Sex Med **;**:**–**.     

More than just vaginal intercourse: anal intercourse and condom use patterns in the context of "main" and "casual" sexual relationships among urban minority adolescent females

PURPOSE: Receptive anal intercourse has long been recognized as a risk factor for the transmission of HIV and STIs. Most HIV/STI prevention messages continue to emphasize penile-vaginal transmission, so many teens do not recognize anal intercourse as risky sexual behavior. This purpose of this study was to determine the prevalence of anal intercourse, and to describe the relationship between types of sexual relationships (main vs. casual), types of sexual behaviors (vaginal vs. anal sex), and types of contraception used among inner-city sexually experienced adolescents. METHODS: Reproductive health histories were obtained from 350 sexually experienced adolescent females aged 12-18 years participating in a 5-year STI acquisition study at an urban health center. Baseline sexual behavior data was analyzed and described using frequencies, percentages and chi-square tests. RESULTS: 41% of teens and 86.5% of teens reported engaging in sexual activity with casual and main partners respectively. Sixteen percent of teens with main partners and 12% of those with casual partners engaged in receptive anal intercourse (P = 0.31). Condom use is more prevalent for both vaginal (61% vs. 32.4%, P < or = 0.0001) and anal (47.1% vs. 21.3%, P = 0.0428) intercourse in the context of casual as compared to main sexual relationships. Teens involved in a casual relationship were more likely to use anal intercourse as a form of contraception (41.2% vs. 8.5%, P = 0.0022). CONCLUSION: It is imperative that health care providers recognize that adolescents engage in anal sex, specifically inquire about their types of sexual behavior and types of sexual relationships so that anticipatory guidance regarding HIV/STI transmission risk reduction education can be tailored to meet their needs.     

Community-level intimate partner violence and the circumstances of first sex among young women from five African countries

Background  

Gender-based violence is an important risk factor for adverse reproductive health (RH). Community-level violence may inhibit young women's ability to engage in safer sexual behaviors due to a lack of control over sexual encounters. Few studies examine violence as a contextual risk factor.     

Racial/Ethnic Differences in Patterns of Sexual Behavior and STI Risk among Sexually Experienced Adolescent Girls

Study ObjectiveRacial/ethnic differences in prevalence and patterns of oral and anal sex were analyzed among girls participating in a microbicide acceptability study.DesignCross-sectional analysisSettingRecruitment to participate in a 6-month study examining microbicide acceptability was conducted at a school-based health clinic and local colleges in Galveston, Texas and through snowball sampling.ParticipantsSexually experienced girls (n = 202) ages 14 to 21 years of age.Main Outcome MeasuresGirls reported on their demographic and sexual history at the intake interview.Results and ConclusionsTheir mean age was 18.2 years; 26% were white, 43% African-American, and 31% Hispanic. African-American girls were significantly less likely than whites and Hispanics to have had oral sex; no differences were found for anal sex. African-American girls were significantly older than whites and Hispanics when they initiated oral sex. African-American girls had a greater difference between ages of vaginal and oral sex initiation than whites and Hispanics. Oral sex history was associated with a 6-factor increase and anal sex history was associated with a 3-factor increase in the likelihood of a history of sexually transmitted infection. Future studies should explore these differences in greater depth in order to develop culturally specific STI prevention efforts.     

Transmission of nonviral sexually transmitted infections and oral sex

IntroductionOral sex is usually considered a lower‐risk sexual activity when compared with sex, but it is frequently the cause of sexually transmitted infections (STI). In particular, STI transferred through oral sex might have no visible symptoms, depending on the type of infection.AimsThe aim of this study is to review the literature about the role of oral sex in the transmission of nonviral STI.Main Outcome MeasuresState‐of‐the‐art information in the area of STI in relation to sexual function and self–care, this last important for development of STI prevention products such as vaginal microbicides. Sexual behaviors assessed focusing on receiving oral sex and giving oral sex.MethodsA search of the main electronic databases including registers of clinical controlled trials was performed in addition to a hand search of the most relevant Journals. The following electronic databases were searched: PubMed, Embase, Google Scholar, literature review of research articles, and public health department Internet Web sites, for the period of 1945–2011. In addition to searching the Clinical Trials Registry at the US National Institutes of Health, we also used the meta Register of Controlled Trials and the Cochrane Central Register of Controlled Trials.ResultsSTI affect the mucous membranes both directly and indirectly producing characteristic diagnostic signs and lesions. Daily dental clinical activity needs an appropriate knowledge of any kind of oral lesions‐related STI. The reader is offered a practical approach with clinically relevant recommendations that may prove useful in his/her daily practice when dealing with STI.Conclusions.These data provide a foundation for understanding diverse STI. We advise physicians to be receptive to discuss sexuality issues and provide patients with adequate therapy. Ballini A, Cantore S, Fatone L, Montenegro V, De Vito D, Pettini F, Crincoli V, Antelmi A, Romita P, Rapone B, Miniello G, Perillo L, Grassi FR, and Foti C. Transmission of nonviral sexually transmitted infections and oral sex. J Sex Med 2012;9:372–384.     

The Relationship Between Self-Reported Sexually Explicit Media Consumption and Sexual Risk Behaviors Among Men Who Have Sex With Men in China

IntroductionPrevious studies have indicated that viewing sexually explicit media (SEM) might be associated with sexual risk behaviors in men who have sex with men (MSM). However, most prior research has not explored this association cross-culturally or the potential influence that important covariates might have on the association.AimTo explore the association between self-reports of viewing SEM depicting various sexual risk behaviors and engagement in sexual risk behaviors after controlling for relevant covariates in MSM in China.MethodsThree hundred fourteen Chinese MSM participated in a web-based survey.Main Outcome MeasuresSEM consumption, sexual risk behavior, and measurements of covariates.ResultsSEM consumption was frequent in MSM in China. Viewing a larger proportion of SEM depicting sexual risk behaviors was associated with a larger number of regular partners with whom MSM reported engaging in sexual risk behaviors, but not with the number of casual partners, after controlling for covariates. HIV-related knowledge and seeking male sex partners were associated with the number of regular partners with whom MSM had engaged in sexual risk behaviors. Seeking sexual sensation, HIV-related knowledge, and seeking male sex partners were associated with the number of casual partners with whom MSM had engaged in sexual risk behaviors.ConclusionFuture research exploring the relation between SEM use and sexual health risk behaviors should consider theoretically important psychological and behavioral covariates.Xu Y, Zheng Y, Rahman Q. The Relationship Between Self-Reported Sexually Explicit Media Consumption and Sexual Risk Behaviors Among Men Who Have Sex With Men in China. J Sex Med 2017;14:357–365.     

Perceived Effects of Sexually Explicit Media among Men Who Have Sex with Men and Psychometric Properties of the Pornography Consumption Effects Scale (PCES)

IntroductionResearchers have proposed that consumption of Sexually Explicit Media (SEM) may not only adversely influence sexual attitudes and behaviors of Men Who Have Sex with Men (MSM) but (also) play a positive role in the development and sexual education of MSM, be a major source of sexual information for MSM, and provide validation, understanding, and confirmation of MSM's sexual orientation. However, such claims are in urgent need of empirical validation as is the development of psychometrically sound and easily implemented instruments able to reliably assist such validations.AimsTo investigate how MSM who consume SEM self-perceive the impact of SEM on their sexually-transmitted-infections-related sexual risk behaviors (i.e., anal intercourse), sexual knowledge, enjoyment of sex, interest in sex, attitudes toward sex, and understanding of their sexual orientation. Further, to provide a thorough psychometric validation of a reduced and reworked version of the Pornography Consumption Effects Scale (PCES).Main Outcome MeasureA revised version of the PCES by Hald and Malamuth.MethodsOnline cross-sectional survey study of 1,333 US adult Men Who Have Sex with Men.ResultsThis study found that 97% of MSM reported positive effects of SEM consumption on their sexual knowledge, enjoyment of and interest in sex, attitudes toward sex, and understanding of their sexual orientation. Only 3% reported any negative effects of their SEM consumption. SEM consumption was found to significantly increase consumers' interest in having protected anal intercourse while not significantly influencing their interests in having unprotected anal intercourse. The revised version of the PCES showed excellent psychometric performance.ConclusionThe study found that MSM generally report positive effects of their consumption of sexually explicit materials in areas related to their sexual knowledge, attitudes, behaviors, and orientation. This finding could have important implications for the sexual health and well-being of MSM by suggesting that SEM-based education and intervention might hold considerable overall health potential for MSM. Hald GM, Smolenski D, and Rosser BRS. Perceived effects of sexually explicit media among men who have sex with men and psychometric properties of the Pornography Consumption Effects Scale (PCES). J Sex Med 2013;10:757–767.     

Opportunities and challenges of sexual health services among young people: a study in Nepal

IntroductionIt has been well documented that young people are more likely to engage in high-risk sexual activity. Appropriate understanding of safe sex, sexual practices, and related behaviors must recognize the importance of socioeconomic and cultural factors in prevention efforts related to HIV and other sexual transmitted infections (STIs).AimTo examine and summarize the opportunities and challenges of sexual health services among young people in Nepal.Main Outcome MeasuresReview of literature—assessing knowledge, attitudes, and understanding of sex, sexual health, and related sexual risk behaviors, among young people (15–24), in line with the current sociocultural and health service practices.MethodsMedline, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Science, Cochrane database, and Google were searched. Similarly, documents published at the WHO, United Nations Population Fund, United Nations Development Program, and at national/local level—Ministry of Health, National Center for AIDS, and STD Control were also assessed to access the relevant reports and articles. Published and gray articles were also reviewed.ResultsThis study contends growing expansion of communication and transportation networks, urbanization, and urban in-migration is creating a different sociocultural environment, which is conducive to more social interactions between young girls and boys in Nepal. Rising age at marriage opens a window of opportunity for premarital and unsafe sexual activity among young people and this creates risks of unwanted pregnancy, STIs/HIV and AIDS. Socioeconomic, demographic, and cultural factors have been identified as encouraging factors for risk-taking behaviors among young people.ConclusionsUnderstanding safer sex and responsible sexual/reproductive behavior is important. Effective and appropriate interventions on sexual and reproductive health education directed at young people and the whole family, including fathers, could have significant effect on reducing risk and related risk practices in the context of Nepal. Regmi K. Opportunities and challenges of sexual health services among young people: A study in Nepal. J Sex Med 2009;6:352–361.     

Sense of Mission and Sexual Health Outcomes Among Young Adult Women

Study ObjectiveTo examine the association between self-reported sense of mission and sexual health behaviors in a geographically diverse cohort of U.S. young adult females in the Growing Up Today Study (GUTS).DesignWe conducted a cross-sectional analysis of the 2007 wave of GUTS data from self-reported online or mailed surveys. Outcomes were early sex initiation and history of sexually transmitted infection (STI), which were analyzed as a binary outcome using logit link, and number of sex partners, which was analyzed as a continuous outcome. Models for number of sex partners and history of STIs were adjusted for age.ParticipantsThere were 5,624 young women aged 20 to 25 years who participate in GUTS and who answered the question on “sense of mission.”Main Outcome MeasuresAge at sexual initiation, history of STIs, and number of lifetime partners.ResultsWhen asked whether they had a sense of mission in their life, 28.1% of women strongly agreed, 54.9% agreed, and 17% disagreed. Women with a low sense of mission had higher odds of reporting a history of STI (odds ratio 1.35, 95% confidence interval 1.08 to 1.70), and more lifetime sexual partners (β = .83, P < .001).ConclusionsHaving a high sense of mission is associated with lower sexual risk in young women. Interventions to increase sense of mission among young women may improve sexual health outcomes.     

Primary Contraceptive Method use and Sexually Transmitted Infections in a Nationally Representative Sample of Young Women

Study objectiveRates of sexually transmitted infections (STIs) in the United States have increased for the sixth consecutive year. Young people ages 15-24 account for over half of all new infections despite comprising only a quarter of the sexually active population. A potential explanation for this is the increased use of long-acting reversible contraceptives, (LARCs) which could result in lower condom use and/or increased sexual risk-taking due to higher pregnancy prevention efficacy.DesignThis paper uses the National Survey of Family Growth to examine the relationship between primary contraceptive method use among young women ages 15-24 and STI treatment in the past year, as well as the extent to which this association is mediated by relationship status and frequency of condom use.ResultsFindings did not show differences in STI treatment in the past year by primary contraceptive method, indicating that LARC use among young women does not equate to increased STI risk. Findings did show that young women who had been in casual-only relationships or a mix of relationship types in the past year were more likely to have been treated for an STI than young women in serious or dating-only relationships, regardless of the primary method used. Additionally, young women who used condoms “some” of the time were more likely to have been treated for an STI compared with women who used condoms “all” or “most” of the time. This association was mediated by relationship status (P = .05).ConclusionFindings suggest that efforts to address the growing STI burden should be directed at providing comprehensive, gender-equitable sexual health education that enables young people to engage in healthy relationships and consistent condom use.     

Sexually compulsive/addictive behaviors in women: a women's healthcare issue

Sexually compulsive/addictive behavior is a pattern of sexual behaviors that cause distress and/or impairment of social functioning. It is marked by obsessive thoughts, compulsive behaviors, and the individual's inability to stop the behaviors despite negative consequences. Women experiencing sexually compulsive/addictive behavior are preoccupied with sex not as a response to desire but rather as a behavior that serves the purpose of anxiety reduction. Sexually compulsive/addictive behavior is associated with a number of health consequences, including sexually transmitted infections, unwanted pregnancies, abortions, and violence. It is important for providers to have an understanding of the addiction process, assessment, diagnosis, and interventions for these women.     

Posting Sexually Explicit Images or Videos of Oneself Online Is Associated With Impulsivity and Hypersexuality but Not Measures of Psychopathology in a Sample of US Veterans

IntroductionSending sexually explicit text messages (“sexting”) is prevalent among US adults; however, the mental health correlates of this behavior among adults have not been studied adequately. Furthermore, there are few studies examining the related but distinct behavior of posting sexually explicit photos or videos of oneself online (posting sexual images [PSI]) and the mental health correlates of this behavior.AimTo examine associations between sexting, PSI, impulsivity, hypersexuality, and measures of psychopathology.MethodsUsing a national convenience sample of 283 US post-deployment, post-9/11 military veterans, we evaluated the prevalence of 2 behaviors: sexting and PSI and the associations of these behaviors with psychopathology, suicidal ideation, sexual behaviors, hypersexuality, sexually transmitted infections, trauma history, and measures of impulsivity.Main Outcome MeasureMeasures of psychopathology including depression, anxiety, post-traumatic stress disorder, insomnia, substance dependence, hypersexuality, and suicidal ideation, as well as measures of impulsivity, sexual behavior, and trauma.ResultsSexting was found to be common among post-9/11 veterans (68.9%). A smaller number of veterans engaged in PSI (16.3%). PSI veterans were more likely to be younger, male, less educated, and unemployed. After adjusting for covariates, no associations were detected between PSI or sexting and the examined measures of psychopathology. However, PSI was associated with higher levels of impulsivity and hypersexuality, whereas sexting was not associated with these measures.Clinical ImplicationsResults from this study suggest that not all digital sexual behaviors are associated with psychopathology. However, PSI was associated with hypersexuality and impulsivity. Those who engage with PSI may benefit from guidance on how to manage their impulsivity to prevent ego-dystonic sexual behaviors.Strengths & LimitationsThe strengths of this study include differentiating PSI from sexting broadly, highlighting that digital sexual behaviors are heterogeneous. Limitations include the study's cross-sectional design, which limits causal interpretations. More research is also needed in civilian populations.ConclusionPSI was less prevalent than sexting in our sample. This behavior was associated with impulsivity and hypersexuality but not with elevated levels of psychopathology. Sexting was not associated with any of these measures.Turban JL, Shirk SD, Potenza MN, et al. Posting Sexually Explicit Images or Videos of Oneself Online Is Associated with Impulsivity and Hypersexuality but Not Measures of Psychopathology in a Sample of US Veterans. J Sex Med 2020;17:163–167.     

Effect of Previous Adverse Reproductive Health Outcomes on Young Women's Engagement in a Health Coaching Intervention to Improve Contraceptive Continuation

Study ObjectiveNonadherence in sexual risk reduction interventions might be common among adolescents. We compared intervention completion rates among adolescent and young adult women with and without a previous pregnancy or sexually transmitted infection (STI) participating in a program to improve contraceptive continuation.DesignSecondary data analysis from a feasibility study of a health-coaching intervention to improve contraceptive continuation.SettingThree urban pediatric clinics in Philadelphia.ParticipantsWomen ages 14-22 years who were English-speaking, sexually active in the past year, not desiring pregnancy in the next year, and starting a new contraceptive method.InterventionsAt baseline, participants completed a sociodemographic questionnaire and semistructured interview, followed by 5 monthly coaching sessions. Interviews and coaching sessions were audio-recorded, transcribed, and coded for thematic content.Main Outcome MeasuresIntervention completion was defined as the number of completed coaching sessions. Secondary outcomes were qualitatively explored group differences in reproductive knowledge, attitudes, and risk perception.ResultsParticipants with a previous adverse outcome (a previous STI and/or a previous pregnancy) completed fewer coaching sessions than those without such history (median: 2 vs 4; P = .03). Both groups had low HIV/STI knowledge, negative attitudes toward pregnancy, and low HIV/STI risk perception. Those with a previous adverse reproductive outcome held more negative attitudes toward condoms.ConclusionDespite similar reproductive knowledge, attitudes, and risk perception, young women who have experienced an adverse reproductive outcome might be less likely to fully engage in sexual risk reduction interventions. Future studies should confirm these findings and consider strategies to optimize the intervention's reach for vulnerable youth.     

Prevalence Rates of Sexual Behaviors,Condom Use,and Contraception Among Australian Heterosexual Adolescents

BackgroundThe development of effective health promotion practices and education programs to reduce rates of sexually transmitted infections and unintended pregnancy requires accurate, up-to-date information about young people's sexual behaviors.AimsTo provide prevalence rates on sexual behaviors and condom and contraceptive use for Australian year 10–12 heterosexual students in a nationally representative sample.MethodsA nationally representative sample of 2,301 male and 2,055 female year 10 through 12 heterosexual students were recruited to an online survey about their lifetime sexual behaviors and condom and contraceptive use. Means and 95% confidence intervals of weighted data, based on the national census, were reported.OutcomesThe main outcomes of this study were prevalence of sexual behaviors by gender (excluding trans and gender diverse) and prevalence of contraception and condom use among sexually active students by gender.ResultsThe most common sexual behavior was masturbation (96.3% of male students, 78.9% of female students), and the least common behavior was anal or vaginal sex (43.7% of male students, 48.5% of female students). Of the sexually active students, condoms were used by 78.1% of male students and 77.5% of female students at first sexual experience and by 65.1% of male students and 56.8% of female students at their most recent sexual experience, whereas 91.6% of male students and 92.3% of female students used some form of contraception at most recent sexual experience.Clinical TranslationResults provide up-to-date information on the practices clinicians who are likely to encounter with heterosexual cisgender adolescent populations in Australia.Strengths & LimitaitonsThe study represents the largest representative cohort of adolescents in Australia to date. However, comparisons with previous representative studies were limited owing to differing samples by age and culture.ConclusionsCompared with earlier Australian studies, young heterosexual cisgender people today engage in slightly less oral and penetrative sexual behaviors, with the exception of more women receiving oral sex, and are generally consistent in condom and contraceptive use.Fisher CM, Kauer S, Mikolajczak G, et al. Prevalence Rates of Sexual Behaviors, Condom Use, and Contraception Among Australian Heterosexual Adolescents. J Sex Med 2020;17:2313–2321.     

Racial/Ethnic Disparities in Female Sexual Health from Adolescence to Young Adulthood: How Adolescent Characteristics Matter?

Study ObjectiveTo describe sexual initiation patterns in female adolescents and examine their association with adolescent characteristics and racial disparities in adverse sexual health across adolescence into early adulthood.DesignA prospective, longitudinal, observational study from adolescence to adulthood.SettingNationally representative, the National Longitudinal Study of Adolescent to Adult Health data, in the range of 24-32 years old at final assessment.ParticipantsData from 43,577 US women from 1994 to 2008.Interventions and Main Outcome MeasuresAdolescent sex-related characteristics at the individual-, family-, and school peer-level were assessed, and multiple sex partners, sexually transmitted infections (STIs)/HIV, and intimate partner violence (IPV) were longitudinally tracked. The sexual initiation pattern and its longitudinal association with sexual health were analyzed using latent class analysis and mixed effects Poisson regression models.ResultsOf the 43,577 subjects, the sexual initiation patterns were determined as normative (n = 28,712, 65.9%), late (n = 10,799, 24.8%), and early but unempowered (n = 4,066, 9.3%). The highest rate of the early-unempowered group was shown in Hispanic individuals (1,054/7,307 = 14.4%); they were more likely to be depressed, unsatisfied with their bodies, receiving welfare, and have less educated/permissive parents to their sexual initiation than others. The late group had a higher body mass index and greater satisfaction with their bodies. The highest number of STIs/HIV and IPV victimization was shown in non-Hispanic Black (NHB) and Hispanic individuals, respectively. However, NHB females’ higher number of STIs/HIV was shown in the late/normative groups, not in the early-unempowered group. Among Hispanic females, adolescent sexual initiation patterns were not directly associated with their frequent IPV victimization.ConclusionNHB females' higher STI/HIV in late/normative groups and Hispanic females’ frequent IPV victimization regardless of their sexual initiation patterns might indicate that racial/ethnic disparities in female sexual health was not directly determined by adolescent risk behaviors.