Health and Sexual Outcomes of Women Who Have Experienced Forced or Coercive Sex

Previous research has linked women's history of experiencing sexual assault with negative health outcomes; however, much of this research is over a decade old. Furthermore, little research has examined the relationship between sexual assault and women's sexuality. In the current study the authors aimed to assess the relation of experiencing sexual assault to women's health and sexuality and the relation of repeat victimization by multiple different perpetrators to such outcomes. Data were collected from a convenience sample of 2,915 women using an online questionnaire. Nearly half (n = 1,394, 47.8%) indicated having experienced forced or coercive sex. Women who had experienced forced or coercive sex were more likely to report negative health outcomes (Adj. OR = 1.56; 95% CI: 1.35–1.82, p < .001) and some negative sexual outcomes compared to women without a history of forced or coercive sex. Similarly, women who experienced repeat victimizations by multiple different perpetrators were even more likely to report negative health outcomes (Adj. OR = 1.43; 95% CI: 1.28–1.59, p < .001) as well as some negative sexual outcomes. Healthcare providers should be aware of the relation of sexual assault to health and sexuality and continue to address health and sexuality issues associated with sexual assault for their patients.     

Sexual Violence and Reproductive Health

Sexual violence is a significant public health problem, and has been linked to adverse effects on women's physical and mental health. Although some advances in the research have been made, more scientific exploration is needed to understand the potential association between sexual violence and women's reproductive health, and to identify measures that could be implemented in reproductive health care settings to assist women who have experienced sexual violence. Three general areas needing further study include (1) expansion of the theoretical frameworks and analytic models used in future research, (2) the reproductive health care needs of women who have experienced sexual violence, (3) and intervention strategies that could be implemented most effectively in reproductive health care settings.     

Defining Sexual Health: A Descriptive Overview

This paper examines the historical events that have contributed to evolving definitions of sexual health. Through a review of the literature, eight definitions of sexual health were identified from the original 1975 World Health Organization (WHO) definition up until the most recent definition in 2002. Each of these definitions is reviewed for the context in which they were developed and the particular contributions they have played in the development of the understanding of sexual health. The more recent definitions have built upon the essential elements provided in the original WHO definition but have added concepts of mental health, responsibility, and sexual rights. Although similarities exist in the definitions, they are not all alike. The importance of defining sexual health in the discussion of promoting sexual health is illustrated. The concept and definition of sexual health will continue to evolve shaped by historical events.     

Sexual Coercion and Behavior Among a Sample of Sexual Minority Women

Sexual coercion may affect the sexual experiences of sexual minority women differently. Women (n = 445) aged 18 to 71 years (Mean = 30.38) answered an online survey on sexual orientation, lifetime coercion, and sexual history. Sexual minority women (45.8%, n = 204) were more likely to report having been coerced into unwanted sexual behavior (56.5%) than heterosexual women (44.8 %; p = 0.010). Coerced sexual minority women reported earlier ages of initiation into performing oral sex (p = 0.016), penile-vaginal (p = 0.024), and penile-anal (p = 0.027) intercourse. In multiple logistic regression models, currently being in a partnered relationship was the sole factor related to lifetime engagement in penile-vaginal intercourse and receiving oral sex from partners. Having at least a graduate degree was the only characteristic related to engagement in lifetime penile-anal intercourse. Sexual coercion was not related to any lifetime sexual behavior outcomes. The nature of sexual initiation and coercion should be explored further among sexual minority women, with the goal of incorporating their experiences into prevention and treatment initiatives.     

Sexual Violence Inside Prisons: Rates of Victimization

People in prison are exposed to and experience sexual violence inside prisons, further exposing them to communicable diseases and trauma. The consequences of sexual violence follow the individual into the community upon release. This paper estimates the prevalence of sexual victimization within a state prison system. A total of 6,964 men and 564 women participated in a survey administered using audio-CASI. Weighted estimates of prevalence were constructed by gender and facility size. Rates of sexual victimization varied significantly by gender, age, perpetrator, question wording, and facility. Rates of inmate-on-inmate sexual victimization in the previous 6 months were highest for female inmates (212 per 1,000), more than four times higher than male rates (43 per 1,000). Abusive sexual conduct was more likely between inmates and between staff and inmates than nonconsensual sexual acts. Sexual violence inside prison is an urgent public health issue needing targeted interventions to prevent and ameliorate its health and social consequences, which spatially concentrate in poor inner-city areas where these individuals ultimately return.Wolff, Blitz, and Shi are with the Center for Mental Health Services & Criminal Justice Research, Rutgers University, New Brunswick, NJ, USA; Bachman is with the Department of Sociology and Criminal Justice, University of Delaware, Newark, DE, USA; Siegel is with the Department of Criminal Justice, Rutgers University, Camden, NJ, USA.This study was supported by the Office of Justice Programs (Grant #0JP-2004-RP-BX-0012) and the National Institute of Mental Health (Grant #P20 MH66170).     

Sexual and Physical Health After Sex Reassignment Surgery

A long-term follow-up study of 55 transsexual patients (32 male-to-female and 23 female-to-male) post-sex reassignment surgery (SRS) was carried out to evaluate sexual and general health outcome. Relatively few and minor morbidities were observed in our group of patients, and they were mostly reversible with appropriate treatment. A trend toward more general health problems in male-to-females was seen, possibly explained by older age and smoking habits. Although all male-to-females, treated with estrogens continuously, had total testosterone levels within the normal female range because of estrogen effects on sex hormone binding globulin, only 32.1% reached normal free testosterone levels. After SRS, the transsexual person's expectations were met at an emotional and social level, but less so at the physical and sexual level even though a large number of transsexuals (80%) reported improvement of their sexuality. The female-to-males masturbated significantly more frequently than the male-to-females, and a trend to more sexual satisfaction, more sexual excitement, and more easily reaching orgasm was seen in the female-to-male group. The majority of participants reported a change in orgasmic feeling, toward more powerful and shorter for female-to-males and more intense, smoother, and longer in male-to-females. Over two-thirds of male-to-females reported the secretion of a vaginal fluid during sexual excitation, originating from the Cowper's glands, left in place during surgery. In female-to-males with erection prosthesis, sexual expectations were more realized (compared to those without), but pain during intercourse was more often reported.     

Understanding Sexual Coercion Among Young Adolescents: Communicative Clarity, Pressure, and Acceptance

Young people's understanding of sexual coercion was studied. Boys and girls (N = 191) were asked to rate scenarios depicting sexual situations according to their perceptions of communicative clarity, the extent of pressure being applied to one partner, and the acceptability of the behaviors. Judgments of communicative clarity were given more readily when there was consent rather than dissent to sex. Clear communication was readily inferred even when there were no cues that this was the case. Boundaries of behaviors that were defined as constituting pressure were influenced by the outcome, that is whether sex did or did not occur, as well as the behavior itself. Ratings of acceptability closely followed those of pressure, although the relationships between perceptions of pressure and acceptability were stronger for girls than for boys. In general, there were few gender differences in perceptions of pressure and communicative clarity. Of concern was the finding that, for some respondents, pressure and acceptability were unrelated to the use of either physical or emotional force.     

Sexual aggression and love styles: An exploratory study

The relationship between sexual aggression and theoretical love styles was studied. Based on self-reported sexual history, 63 college men were grouped as having either consensual sexual experience only (n =33) or having verbally coercive sexual experience (n =30). Analyses were conducted using six love style scales, likelihood to rape, likelihood to use sexual force, masculinity, and sociopathy to predict sexual coercive group membership. Logistic regression indicated that the Ludus love style, a manipulative, game-playing orientation towards intimate relationships, was the best predictor of sexual coercion among the six love styles. Additionally, logistic regression indicated that the Ludus love style was as effective in classifying men as coercive or noncoercive as other dispositions related to sexual aggression. These results suggest that the Ludus love style may serve as a unifying construct for dispositions related to sexual aggression. This study constitutes an initial attempt to link sexually coercive behaviors to a theoretical model of intimate relationships. Results are discussed in the context of a situational model of sexual coercion.     

Gender Attitudes,Sexual Risk,Intimate Partner Violence,and Coercive Sex Among Adolescent Gang Members

Purpose

Adolescent gang members are at greater risk of poor sexual health outcomes than nongang members. Gang members' beliefs about gender may explain variation in their sexual health outcomes. The purpose of this study was to examine how gangs' and gang members' beliefs about gender are associated with sexual health outcomes, including sexual risk-taking, intimate partner violence, and coercive sex.

To Be Seen and Not Heard: Femininity Ideology and Adolescent Girls’ Sexual Health

This study used a feminist developmental framework to test the hypothesis that internalizing conventional ideas about femininity in two domains—inauthenticity in relationships and body objectification—is associated with diminished sexual health among adolescent girls. In this study, sexual health was conceptualized as feelings of sexual self-efficacy (i.e., a girl's conviction that she can act upon her own sexual needs in a relationship) and protection behavior (i.e., from both STIs and unwanted pregnancy). A total of 116 girls (aged 16–19) completed measures of femininity ideology, sexual self-efficacy, sexual experiences, and protection behavior. Results revealed that inauthenticity in relationships and body objectification were associated with poorer sexual self-efficacy and sexual self-efficacy, in turn, predicted less sexual experience and less use of protection. Further, the two components of femininity ideology were associated with different forms of protection. The importance of a feminist developmental framework for identifying and understanding salient dimensions of sexual health for female adolescents is discussed.     

History of Sexual Abuse and Development of Sexual Risk Behavior in Low-Income,Urban African American Girls Seeking Mental Health Treatment

Objective: This study examined relationships between sexual abuse and patterns of sexual risk-taking among low-income, urban African American adolescent girls seeking mental health treatment. Method: Participants (N = 158) were 12- to 16-year-old African American girls recruited from outpatient mental health clinics serving urban, mostly low-socioeconomic status communities in Chicago, Illinois and followed for two years between 2003 and 2010. This study included self-reports of sexual abuse and four waves (T2–T5) of self-reported data on sexual experience and sexual risk-taking (number of partners, inconsistent condom use, and sex with a risky partner). Latent curve modeling was used to examine patterns of sexual behavior over the four time points with sexual abuse and mental health symptoms as covariates. Results: Sexual abuse was significantly associated with T2 sexual experience, T2–T4 number of partners, T3 inconsistent condom use, and T2–T3 having a risky partner. These relationships decreased when mental health symptoms were controlled. Conclusions: This longitudinal study revealed a complex relationship between sexual abuse and sexual risk that would be missed if sexual risk were assessed at a single time point. Findings supported early intervention to delay onset of sexual risk behavior among low-income African American girls with mental health concerns and histories of sexual abuse.     

Examining Sexual Health Discourses in a Racial/Ethnic Context

Sexual health is a complex, multidimensional construct. In analyzing race and ethnicity in sexual health, this article examines 2 domains of discourse: (1) preventive sexual health, a public health oriented domain of discourse concerned with the prevention of disease, and (2) eudaemonic sexual health, a domain of discourse concerned with attainment of sexual pleasure within a moral context. Research on the sexual health of ethnic minority populations is typically focused on preventive sexual health. There is an underemphasis on eudaemonic discourses when applied to ethnic minority persons, particularly in the examination of ethnic variations in sexual dysfunction. Medicalization of sexual dysfunction, control of minority sexualities, and ethnically oriented cultural scenarios are cited as reasons for this underemphasis. Exploring racial/ethnic aspects of eudaemonic sexual health can deepen understanding of sexual health in multiple domains and strengthen the ability to promote sexual health for all.