The Journal of Sexual Medicine, Available online 17 February 2020
Debby Herbenick, Tsung-Chieh Fu, Paul Wright, Bryant Paul, Ronna Gradus, Jill Bauer, Rashida Jones
https://doi.org/10.1016/j.jsxm.2020.01.013
[Excerpts below Abstract. Note: this was published in a journal that is biased toward “sex positivity.”]
Abstract
Background
Convenience sample data indicate that substantial portions of adults have engaged in sexual behaviors sometimes described as rough; little is known about these behaviors at the population level.
Aim
To describe, in a U.S. probability sample of Americans aged 18 to 60 years, (i) the prevalence of diverse sexual behaviors, described here as dominant and target behaviors; (ii) the age at first pornography exposure as well as prevalence, range, and frequency of pornography use; (iii) the association between past year pornography use frequency and dominant/target sexual behaviors; and (iv) associations between lifetime range of pornography use and dominant/target sexual behaviors.
Methods
A confidential cross-sectional online survey was used in this study.
Outcomes
Lifetime engagement in dominant behaviors (eg, spanking, choking, name calling, performing aggressive fellatio, facial ejaculation, penile-anal penetration without first asking/discussing) and lifetime engagement in target behaviors (eg, being spanked, being choked, being called names during sex, having their face ejaculated on, receiving aggressive fellatio, or receiving penile-anal penetration without having discussed) were assessed; lifetime pornography use, age at first porn exposure, past-year frequency of porn viewing, and lifetime range of pornography were also assessed.
Results
Women as well as men who have sex with men were more likely to report target sexual behaviors: having been choked (21.4% women), having one’s face ejaculated on (32.3% women, 52.7% men who have sex with men), and aggressive fellatio (34.0% women). Lifetime pornography use was reported by most respondents. After adjusting for age, age at first porn exposure, and current relationship status, the associations between pornography use and sexual behaviors was statistically significant.
Clinical Implications
Clinicians need to be aware of recent potential shifts in sexual behaviors, particularly those such as choking that may lead to harm.
Strengths & Limitations
Strengths include U.S. probability sampling to provide population level estimates and the use of Internet-based data collection on sensitive topics. We were limited by a lack of detail and context related to understanding the diverse sexual behaviors assessed.
Conclusion
Clinicians, educators, and researchers have unique and important roles to play in continued understanding of these sexual behaviors in the contemporary United States.
Excerpts
More frequent past-year pornography use and a greater lifetime range of pornography accessed were significantly associated with engaging in [rough sex behaviors, characterized as spanking, choking, name calling, performing aggressive fellatio, facial ejaculation, penile-anal penetration without first asking/discussing].
We were struck that one-fifth of women with oral, vaginal, or anal sex experience reported having been choked as part of sex. As no previous population health studies have assessed the prevalence of choking as part of partnered sexual interactions, we cannot know to what extent this may represent a change in population-level sexual repertoire. However, our experiences teaching undergraduate students suggest that more people may be engaging in choking behaviors as part of sex than in previous decades. [Earlier research supports this conclusion.] … Choking/strangulation has been reported as part of college sexual assaults41 and in other cases has resulted in death.
In addition, 27% of women and 31% of men who had sex with men reported that a male partner had tried to have anal sex with them without first asking or discussing. This has implications for sexual assault and coercion as well as risk of sexually transmitted infections,
These findings are mostly consistent with findings from convenience samples that have found a relationship between porn use and either engagement in or appeal of dominant sexual behaviors.
We believe that some of these sexual behaviors (eg, choking, aggressive fellatio) may have increased in prevalence over at least the past 10 to 15 years. This is supported by data showing that the greatest lifetime prevalence for most of the behaviors associated with the pornographic sexual script is reported by adults between 18 and 29 years. [The mean age for the sample was 42.4 years (SD ¼ 11.9).]
Given the dangers of asphyxiation, it is clinically relevant to understand to what extent their patients—and especially their adolescent and young adult patients—may be exploring choking or strangulation as part of sex, behaviors that have been characterized by some individuals as scary (both in being choked and in being asked to choke a partner).
3 times as many women (compared with men) reported experiencing sexual pressure (36.9% vs 12.0%).
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