This study investigated whether characteristics of childhood and adolescent sexual abuse (i.e., force and type of sexual activity) were related to adult sexual risk behavior, and whether these associations differed by gender. This research benefited from several methodologic strengths. For example, we sampled a large group of both men and women who reported sexual abuse; this large and diverse sample allowed exploration of two sexual abuse characteristics and gender differences. We also used psychometrically sound measures and a computer-administered survey, known to result in higher, and presumably more candid, rates of socially stigmatized and sensitive behaviors (Schroder et al., 2003
). These strengths increase confidence in the validity and generalizability of the results.
A key set of findings was that (1) sexual abuse with penetration as well as (2) sexual abuse with force and penetration were both related to higher rates of adult sexual behavior compared to (3) sexual abuse without force and without penetration and (4) no sexual abuse. This pattern of findings corroborates results from research investigating the mental health sequelae of sexual abuse, which indicate that force (e.g., Bulik, Prescott, & Kendler, 2001
; Rind et al., 1998
; Rodriguez, Ryan, Kemp, & Foy, 1997
) and penetration (e.g., Briere & Elliott, 2003
; Bulik et al., 2001
) are associated with worse psychological outcomes; the current research also adds to the limited body of research suggesting a relation between force and penetration, and later sexual behavior (e.g., Cinq-Mars et al., 2003
; Fergusson et al., 1997
). The effect sizes for the association between sexual abuse and later sexual behavior were small to medium, indicating that other variables besides sexual abuse account for a large portion of the variance in adult sexual behavior. The latter finding is consistent with the idea that adult sexual behavior is influenced by multiple environmental as well as individual factors (Smith & Subramanian, 2006
Penetration by itself (i.e., without force) and penetration in combination with force were associated with increased sexual risk behavior relative to those who were abused without force and without penetration, and those who were not abused. The sole difference between the penetration only and the penetration plus force groups involved sex trading, where those who experienced sexual abuse with force and penetration reported engaging in a greater frequency of sex trading, relative to those who experienced sexual abuse with penetration and no force. However, this finding was qualified by a significant gender-by-abuse interaction. Because only a very small number of participants reported sexual abuse with force but without penetration (i.e., forced kissing or fondling), we were unable to investigate the impact of force only.
A somewhat unexpected finding was that the group that reported sexual abuse without force and without penetration did not differ significantly from the nonabused group on any of the sexual behavior outcomes. Future investigation of the relation between sexual abuse and adult sexual behavior might find it fruitful to conduct more fine-grained assessments of the sexual experiences that involve only large age differentials to determine how these experiences are perceived by both men and women, and whether such experiences influence subsequent sexual behavior.
It may seem counter-intuitive that individuals who experienced more severe sexual abuse (i.e., sexual abuse with force or penetration) would engage in more sexual experiences than those who experienced less severe sexual abuse; that is, one might expect individuals who experienced severe sexual abuse to avoid sex because of the negative consequences. However, relative to individuals who experienced less severe sexual abuse, individuals who experienced more severe sexual abuse may use different strategies to cope with their sexual abuse experience(s). Thus, for both men and women, those who experienced more severe forms of sexual abuse may use alcohol or drugs to cope with the sexual abuse, which, in turn, may lead to the exchange of sex for money or drugs, and/or to a greater number of sexual partners and episodes of unprotected sex. In addition, alcohol and other drug use may lead to a greater number of sexual partners and episodes of unprotected sex due to decreased ability to attend to distal concerns, such as acquiring an STD when intoxicated or high (cf. alcohol myopia; Steele & Josephs, 1990
). Indeed, we have reported previously that substance use is an important mediator of the relation between sexual abuse and risky sexual behavior (Senn, Carey, Vanable, Coury-Doniger, & Urban, 2006
); future research should explore whether substance use and other potential mediators operate differently for those who experienced different severity levels of sexual abuse.
An alternative explanation for the association between more severe sexual abuse and greater adult sexual risk behavior is Finkelhor and Browne’s (1985) traumagenic dynamics model. This model proposes that one consequence of sexual abuse is traumatic sexualization, in which a child develops maladaptive scripts for sexual behavior, when rewarded for sexual behavior by affection. More severe sexual abuse, such as sexual abuse involving force or penetration, may lead to greater traumatic sexualization. As adults, those who experienced traumatic sexualization may believe sex is necessary to obtain affection from others. Thus, traumatic sexualization may lead to, for example, earlier consensual sex or a greater number of sexual partners (e.g., Cinq-Mars et al., 2003
; Fergusson et al., 1997
Another consequence of sexual abuse, according to Finkelhor and Browne (1985
), is powerlessness, in which a child learns that his or her needs or requests are ignored by others; the child thus fails to develop self-efficacy to stop unwanted sexual advances. More severe sexual abuse, particularly sexual abuse involving force or penetration, may lead to greater feelings of powerlessness. Perhaps because they lack the interpersonal skills or the self-efficacy to stop unwanted sexual advances, these individuals may be less likely to refuse intercourse with aggressive partners, resulting in more sexual partners. Powerlessness could help explain findings linking more severe sexual abuse to more adult sexual risk behavior (e.g., Cinq-Mars et al., 2003
; Fergussion et al., 1997
). In this regard, Kallstrom-Fuqua, Weston, and Marshall (2004
) found that sexual abuse severity had an indirect effect on maladaptive relationships, mediated through powerlessness; thus, having many sexual partners could be a consequence of difficulty forming close relationships. Further research is needed to examine whether the sexual abuse characteristics investigated in this study are associated with Finkelhor and Browne’s (1985) traumagenic dynamics.
Another finding yielded by this study is that abuse characteristics were associated with different outcomes for men and women. For men, only abuse with both force and penetration was associated with a greater frequency of sex trading, whereas for women, abuse with penetration, regardless of whether or not force was involved, was associated with more sex trading. In the current cultural context, young males may view sex with an older woman as masculine and mature, rather than abusive. Males, therefore, may tend to view only experiences involving force or coercion as abusive. Women, on the other hand, may be more likely to view intercourse with an older individual as abusive, regardless of whether or not force was involved. This idea is supported by meta-analytic findings that boys’ reactions to sexual abuse were less negative than were girls’ reactions (Rind et al., 1998
). Different perceptions of whether or not the experience was abusive may lead to the use of different coping strategies.
These results should be interpreted mindful of the limitations of the study. One limitation involved the brevity of the sexual abuse assessment. Use of a brief survey allowed us to obtain a large and diverse sample, but limited the richness of the data collected. The survey did not assess other aspects of sexual abuse, such as duration, frequency, and relationship to the perpetrator, which may be important correlates of later outcomes (e.g., Banyard & Williams, 1996
; Briere & Elliott, 2003
). In addition, these brief questions did not allow for assessment of reactions to the sexual experience; many participants, especially those who did not report force or coercion, may not have considered themselves sexually abused, but may have viewed these sexual experiences as inconsequential or even consensual. Future research, involving mixed qualitative and quantitative methods, might help to elucidate the empirical relations observed in the current sample.
A second limitation involves the correlational nature of the data. Clearly, such data limit causal inferences, although given the temporal sequence of childhood/adolescent sexual abuse and adult sexual behavior, the limits may be less concerning in this context. Nonetheless, we acknowledge that unexplored variables that are related to both sexual abuse and greater sexual risk behavior (e.g., more adverse childhood experiences; Dong, Anda, Dube, Giles, & Felitti, 2003
) should be included in future investigations of the sexual abuse–risky sex relation.
It is important to recognize that participants in this study were recruited from a sexually transmitted disease clinic, and were included because they were currently engaging in sexual behavior that conferred risk for contracting an STD. The rates of sexual abuse reported in this sample were considerably higher than rates (i.e., 15% for men and 30% for women) reported in national samples (Briere & Elliott, 2003
; Finkelhor, Hotaling, Lewis, & Smith, 1990
; Vogeltanz et al., 1999
). In addition to engaging in sexual risk behavior, patients attending STD clinics may differ from the general population in other important ways as well; for example, patients attending STD clinics often report extremely high rates of alcohol and drug use (Cook et al.
). Due to the nature of the sample, these results of the present study may not generalize to other populations.
These results have implications for both practice and research. Regarding public health and clinical practice, they suggest that a thorough sexual health assessment should include inquiry about the nature of the sexual abuse, particularly whether force was involved and what type of sexual act occurred. Given the likely impact of sexual abuse on sexual risk behavior (as well as other health outcomes), we recommend a more comprehensive approach to sexual health assessment, education, counseling, and/or therapy. Indeed, these findings highlight the need to develop interventions tailored to the unique needs of persons with a history of sexual abuse to promote (and restore) sexual health and reduce sexual risk. With respect to research, these findings raise many questions about the conditions under which sexual abuse impairs healthy sexual development and expression, and about the mechanisms by which sexual abuse influences sexual development, behavior, and adjustment. This work will require sophisticated methods and analyses to overcome the limitations of what is inherently retrospective and correlational research.