J. Dennis Fortenberry

Sexual Behavior in the United States: Results from a National Probability Sample of Men and Women Ages 14–94

INTRODUCTION Despite a demonstrated relationship between sexual behaviors and health, including clinical risks, little is known about contemporary sexual behavior. AIMS To assess the rates of sexual behavior among adolescents and adults in the United States. METHODS We report the recent (past month, past year) and lifetime prevalence of sexual behaviors in a nationally representative probability sample of 5,865 men and women ages 14 to 94 in the United States (2,936 men, 2,929 women). MAIN OUTCOME MEASURES Behaviors assessed included solo masturbation, partnered masturbation, giving and receiving oral sex, vaginal intercourse, and anal intercourse. RESULTS Masturbation was common throughout the lifespan and more common than partnered sexual activities during adolescence and older age (70+). Although uncommon among 14- to 15-year olds, in the past year 18.3% of 16- to 17-year-old males and 22.4% of 16- to 17-year-old females performed oral sex with an other-sex partner. Also in the past year, more than half of women and men ages 18 to 49 engaged in oral sex. The proportion of adults who reported vaginal sex in the past year was highest among men ages 25-39 and for women ages 20-29, then progressively declined among older age groups. More than 20% of men ages 25-49 and women ages 20-39 reported anal sex in the past year. Same-sex sexual behaviors occurring in the past year were uncommonly reported. CONCLUSIONS Men and women engage in a diverse range of solo and partnered sexual behaviors throughout the life course. The rates of contemporary sexual behavior provided in this report will be valuable to those who develop, implement, and evaluate programs that seek to improve societal knowledge related to the prevalence of sexual behaviors and to sexual health clinicians whose work to improve sexual health among the population often requires such rates of behavior.

Condom Use Rates in a National Probability Sample of Males and Females Ages 14 to 94 in the United States

INTRODUCTION Given the efficacy of latex condoms for preventing pregnancy, HIV, and most STI, their promotion remains central to global sexual health efforts. To inform the development of accurate and appropriately-targeted interventions, there is a need for contemporary condom use rates among specific populations. AIMS The purpose of this study was to establish rates of condom use among sexually active individuals in the U.S. population. METHODS Data were collected via a national probability sample of 5,865 U.S. adolescents and adults aged 14 to 94 years. MAIN OUTCOME MEASURES Condom use was assessed during the most recent partnered vaginal or anal sexual event and over the past 10 vaginal and anal intercourse events. RESULTS Condom use by men during past 10 vaginal intercourse events was slightly higher (21.5%) than that reported by women (18.4%), and consistent with rates of condom use reported during most recent vaginal intercourse by men (24.7%) and women (21.8%). Adolescent men reported condom use during 79.1% of the past 10 vaginal intercourse events, adolescent women reported use during 58.1% of the same. Condom use during past 10 anal intercourse events was higher among men (25.8%) than women (13.2%); the same was observed for most recent anal intercourse event (26.5% for insertive men, 44.1% for receptive men, and 10.8% for receptive women). Generally, condom use was highest among unmarried adults, higher among adolescents than adults, and higher among black and Hispanic individuals when compared with other racial groups. CONCLUSION These data indicate clear trends in condom use across age, gender, relationship status, and race/ethnicity. These contemporary rates of condom use will be helpful to those who lead efforts to increase condom use among individuals who may be at risk for sexually transmitted infections or who desire to prevent pregnancy.

Sexual Behaviors, Condom Use, and Sexual Health of Americans Over 50: Implications for Sexual Health Promotion for Older Adults

INTRODUCTION In the contemporary U.S., men and women are living longer and healthier lives. As such, many people spend greater portions of their lives as sexually active individuals. Yet, little is known about the myriad of ways that older adults experience their sexual lives. AIM This study sought to assess the context and frequency of sexual behaviors, condom use, sexual pleasure, and sexual experience of men and women over age 50. METHODS Information regarding the sexual experiences of a nationally representative sample of men and women over age 50 within the past year was examined. MAIN OUTCOME MEASURES Sexual behavior over the past year was assessed in relation to several situational and contextual characteristics (e.g., event location, type of partner, health status, condom use). Participants were also asked about their experience (i.e., pleasure, arousal, pain, lubrication/erectile difficulties, and orgasm) during their most recent partnered sexual event. Bivariate or ordinal logistic regression models were used to investigate the relationship of age, health and partner status to sexual frequency and experience. RESULTS Although sizable proportions (20-30%) of both men and women remained sexually active well into their 80s age was related to a lower likelihood of solo and most partnered sexual behaviors. When controlling for age, relationship status, and health remained significant predictors of select sexual behaviors. The participants evaluation of their most recent sexual experience in terms of arousal, erectile difficulty, and orgasm all declined with age. Health status was related to mens evaluation of the experience. Relationship status was the most consistent predictor of womens evaluation of the experience. Condom use rates remained low for participants across age groups. CONCLUSION Many older adults continue be sexually active well into advanced age (80+). Thus, providers need to be attentive to the diverse sexual health needs of older adults.

Sexual Behaviors, Relationships, and Perceived Health Among Adult Men in the United States: Results from a National Probability Sample

INTRODUCTION To provide a foundation for those who provide sexual health services and programs to men in the United States, the need for population-based data that describes mens sexual behaviors and their correlates remains. AIMS The purpose of this study was to, in a national probability survey of men ages 18-94 years, assess the occurrence and frequency of sexual behaviors and their associations with relationship status and health status. METHODS A national probability sample of 2,522 men aged 18 to 94 completed a cross-sectional survey about their sexual behaviors, relationship status, and health. MAIN OUTCOME MEASURES Relationship status; health status; experience of solo masturbation, partnered masturbation, giving oral sex, receiving oral sex, vaginal intercourse and anal intercourse, in the past 90 days; frequency of solo masturbation, vaginal intercourse and anal intercourse in the past year. RESULTS Masturbation, oral intercourse, and vaginal intercourse are prevalent among men throughout most of their adult life, with both occurrence and frequency varying with age and as functions of relationship type and physical health status. Masturbation is prevalent and frequent across various stages of life and for both those with and without a relational partner, with fewer men with fair to poor health reporting recent masturbation. Patterns of giving oral sex to a female partner were similar to those for receiving oral sex. Vaginal intercourse in the past 90 days was more prevalent among men in their late 20s and 30s than in the other age groups, although being reported by approximately 50% of men in the sixth and seventh decades of life. Anal intercourse and sexual interactions with other men were less common than all other sexual behaviors. CONCLUSION Contemporary men in the United States engage in diverse solo and partnered sexual activities; however, sexual behavior is less common and more infrequent among older age cohorts.

The Female Genital Self‐Image Scale (FGSIS): Results from a Nationally Representative Probability Sample of Women in the United States

INTRODUCTION Over the past two decades, an expanding body of research has examined womens and mens genital self-image. Support for the reliability and validity of the 7-item Female Genital Self-Image Scale (FGSIS) has been found in a convenience sample of women. AIMS The purpose of this study was to assess the reliability and validity of the FGSIS, its model of fit, and its association with womens scores on the Female Sexual Function Index (FSFI) in a nationally representative probability sample of women in the United States ages 18 to 60. A second purpose was to assess the temporal stability of the scale in a subset of this sample. METHODS A nationally representative sample of 3,800 women ages 18 to 60 were invited to participate in a cross-sectional Internet-based survey; 2,056 (54.1%) participated. MAIN OUTCOME MEASURES Demographic items (e.g., age, race/ethnicity, marital status, sexual orientation, geographic region), having had a gynecological examination in the past year, having performed a genital self-examination in the past month, frequency of masturbation in the past month, vibrator use in the past month, the FGSIS, and the FSFI. RESULTS An abbreviated 4-item version of the scale, the FGSIS-4, was a better fit to the data than the original 7-item scale. Womens scores on the FGSIS-4 were significantly related to vibrator use, frequency of masturbation, having had a gynecological exam in the past year, having performed genital self examination in the past month, and all FSFI subscales. CONCLUSION Most of the participants felt generally positively about their genitals and female genital self-image was significantly related to female sexual function, womens sexual behavior and their sexual and genital healthcare behaviors. In addition, the FGSIS-4 has evidence of reliability, validity, and temporal stability in a nationally representative probability sample of women in the United States.

Women's vibrator use in sexual partnerships: results from a nationally representative survey in the United States.

Little is known about womens use of vibrators within sexual partnerships. Data were collected from a population-based, cross-sectional survey of 2056 women aged 18–60 years in the United States. Partnered vibrator use was common among heterosexual-, lesbian-, and bisexual-identified women. Most vibrator users indicated comfort using them with a partner and vibrator use was related to positive sexual function as measured by the Female Sexual Function Index (FSFI). In addition, partner knowledge and perceived liking of vibrator use was a significant predictor of sexual satisfaction for heterosexual women (p < .01). Clinical and research implications are discussed.

Perspectives on Decision Making About Human Papillomavirus Vaccination Among 11- to 12-Year-Old Girls and Their Mothers

Introduction. The aims of this qualitative study were to explore (a) the factors influencing mothers’ decisions to vaccinate 11- to 12-year-old daughters against human papillomavirus (HPV) and (b) the mothers’ and daughters’ perspectives about HPV vaccine–related decision making. Methods. Participants were girls (N = 33) who had received an HPV vaccine and their mothers (N = 32), recruited from suburban and urban pediatric practices. Semistructured interviews were conducted with girls and mothers separately, and data were analyzed using framework analysis. Results. The primary factors influencing mothers’ decisions to vaccinate daughters against HPV were (a) mother’s beliefs and experiences; (b) interactions with clinicians, friends, and family members; and (c) exposure to media reports/marketing. Most daughters believed the decision to be vaccinated was a mutual one, although most mothers believed the decision was theirs. Conclusions. This study provides novel insights into perspectives on decision making about HPV vaccination among mothers and 11- to12-year-old daughters, which can be used in interventions to improve vaccination rates.

A Psychometric Comparison of Three Scales and a Single-Item Measure to Assess Sexual Satisfaction

This study was designed to systematically compare and contrast the psychometric properties of three scales developed to measure sexual satisfaction and a single-item measure of sexual satisfaction. The Index of Sexual Satisfaction (ISS), Global Measure of Sexual Satisfaction (GMSEX), and the New Sexual Satisfaction Scale–Short (NSSS-S) were compared to one another and to a single-item measure of sexual satisfaction. Conceptualization of the constructs, distribution of scores, internal consistency, convergent validity, test-retest reliability, and factor structure were compared between the measures. A total of 211 men and 214 women completed the scales and a measure of relationship satisfaction, with 33% (n = 139) of the sample reassessed two months later. All scales demonstrated appropriate distribution of scores and adequate internal consistency. The GMSEX, NSSS-S, and the single-item measure demonstrated convergent validity. Test-retest reliability was demonstrated by the ISS, GMSEX, and NSSS-S, but not the single-item measure. Taken together, the GMSEX received the strongest psychometric support in this sample for a unidimensional measure of sexual satisfaction and the NSSS-S received the strongest psychometric support in this sample for a bidimensional measure of sexual satisfaction.

Sexual health and life experiences: voices from behaviourally bisexual Latino men in the Midwestern USA

Research on behaviourally bisexual Latino men in the USA has not yet examined sexual health issues among men living in diverse areas of the nation, including the Midwest. A community-based participatory research approach was used to engage a diverse sample of 75 behaviourally bisexual men (25 White, 25 Black and 25 Latino). Semi-structured interviews were conducted and standard qualitative analysis procedures were used to explore data from the 25 Latino participants. Men described their unique migration experiences as behaviourally bisexual men in this area of the USA, as well as related sexual risk behaviours and health concerns. Lack of culturally congruent public health and community resources for behaviourally bisexual men in the Midwestern USA were identified as significant barriers. As in other studies, familial and community relationships were significant for the participants, especially in terms of the decision to disclose or not disclose their bisexuality. Additionally, alcohol and other drugs were often used while engaging in sexual behaviours particularly with male and transgender, as well as female, partners. Behaviourally bisexual Latino men may benefit from receiving positive and affirmative individual- and structural-level support in regards to their unique experiences in this and other settings.

Vaginal Microbiota of Adolescent Girls Prior to the Onset of Menarche Resemble Those of Reproductive-Age Women

ABSTRACT Puberty is an important developmental stage wherein hormonal shifts mediate the physical and physiological changes that lead to menarche, but until now, the bacterial composition of vaginal microbiota during this period has been poorly characterized. We performed a prospective longitudinal study of perimenarcheal girls to gain insight into the timing and sequence of changes that occur in the vaginal and vulvar microbiota during puberty. The study enrolled 31 healthy, premenarcheal girls between the ages of 10 and 12 years and collected vaginal and vulvar swabs quarterly for up to 3 years. Bacterial composition was characterized by Roche 454 pyrosequencing and classification of regions V1 to V3 of 16S rRNA genes. Contrary to expectations, lactic acid bacteria, primarily Lactobacillus spp., were dominant in the microbiota of most girls well before the onset of menarche in the early to middle stages of puberty. Gardnerella vaginalis was detected at appreciable levels in approximately one-third of subjects, a notable finding considering that this organism is commonly associated with bacterial vaginosis in adults. Vulvar microbiota closely resembled vaginal microbiota but often exhibited additional taxa typically associated with skin microbiota. Our findings suggest that the vaginal microbiota of girls begin to resemble those of adults well before the onset of menarche. IMPORTANCE This study addresses longitudinal changes in vaginal and vulvar microbial communities prior to and immediately following menarche. The research is significant because microbial ecology of the vagina is an integral aspect of health, including resistance to infections. The physiologic changes of puberty and initiation of cyclic menstruation are likely to have profound effects on vaginal microbiota, but almost nothing is known about changes that normally occur during this time. Our understanding has been especially hampered by the lack of thorough characterization of microbial communities using techniques that do not rely on the cultivation of fastidious bacteria, as well as a dearth of studies on girls in the early to middle stages of puberty. This study improves our understanding of the normal development of vaginal microbiota during puberty and onset of menarche and may better inform clinical approaches to vulvovaginal care of adolescent girls. This study addresses longitudinal changes in vaginal and vulvar microbial communities prior to and immediately following menarche. The research is significant because microbial ecology of the vagina is an integral aspect of health, including resistance to infections. The physiologic changes of puberty and initiation of cyclic menstruation are likely to have profound effects on vaginal microbiota, but almost nothing is known about changes that normally occur during this time. Our understanding has been especially hampered by the lack of thorough characterization of microbial communities using techniques that do not rely on the cultivation of fastidious bacteria, as well as a dearth of studies on girls in the early to middle stages of puberty. This study improves our understanding of the normal development of vaginal microbiota during puberty and onset of menarche and may better inform clinical approaches to vulvovaginal care of adolescent girls.