Analysis Sexual Health

Study Finds High Rates of Condom Use Among College Women Having Intercourse Irrespective of Alchohol Use

Martha Kempner

When it comes to condom use, a new study finds that expectations of what alcohol might do and partner type have much more to do with women’s decisions than whether they were drinking or even how much they drank.

This article was updated at 11:46 am, Sunday, December 22nd, 2013 to correct several editorial errors.

Use of alcohol is often cited as a major factor in sexual risk-taking and sexual intercourse especially among college students. A new study, however, turns this assumption on its head, finding high rates of protected sex using condoms among college-age women. The type of sexual partner and young women’s expectations of how alcohol affects their decisions have much more to do with their decision about about condom use than whether they were drinking or even how much they drank.

These researchers chose only to study women because they wanted to look beyond gender differences and do a systematic analysis of what affects young women’s sexual decisions. It’s worth noting that the study does not suggest that women are on their own in the choice to either get drunk or use condoms. Obviously young men were involved in each of the acts of intercourse reported in the study, and they too were (or should have been) part of the decision-making process. It goes without saying that all efforts to increase condom use—irrespective of whether the participants are drunk or sober—should be aimed at both men and women.

Now, back to the study at hand. The year-long research project followed some 500 young women in their first year at a university in the Northeast. Researchers asked them about a variety of health behaviors, including substance use, diet, exercise, sleep, and sexual behavior, as well as psychosocial adjustment. Researchers focused on students who had had sexual intercourse at least once during their first year in school. In monthly surveys, students were asked about their most recent experience of vaginal or anal intercourse, including what their relationship with the partner was like, how long they’d been in the relationship, how much alcohol, if any, they had consumed before having sex, if they’d smoked marijuana beforehand, and if they used a condom or any other birth control method. Participants were also asked how often they consumed more than four drinks at a time (categorized as heavy episodic drinking) and how often they smoked marijuana. Finally, researchers used a variety of scales to measure participants’ expectations relating to alcohol and sexual risk, and their level of impulsive behavior.

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The results are based on responses from 297 women and 1,856 reports of intercourse. (Since women were only asked about the two most recent events in a given month, each participant could report on no more than 24 events total.) Despite all of the focus on binge drinking on college campuses, only 20 percent of the events involved any drinking, only 13 involved heavy episodic drinking, and only six percent involved marijuana use. While this study looked to analyze these events in much more detail, I think it’s important for us to take a moment to note that most sex among these first year students happened largely without the influence of alcohol or pot.

Use of substances preceding or during intercourse was much higher with new partners than established partners. In particular, alcohol use was more common with relatively unknown casual partners (acquaintances and strangers) than with friends, and more common with friends than with ex-boyfriends. Marijuana use, however, did not differ across casual partner types.

The participants used condoms in 61 percent of act of intercourse reported. Condom use was less common when intercourse involved romantic partners (58 percent) than with casual partners (72 percent). Specifically, women were least likely to use condoms with established romantic partners (55 percent) and most likely to use them with friends (74 percent) and acquaintances (79 percent). This is not surprising, as many women switch from condoms to other long-term methods of contraception as relationships become more serious.

What may be surprising, however, is that drinking in and of itself did not affect condom use. In fact, when researchers looked only at the relationship between alcohol and condoms, they found that events involving alcohol were more likely to involve condoms. Condoms were used in 70 percent of events involving drinking and 59 percent of events that did not involve alcohol. This does not mean, however, that tipsy girls are more likely to reach for the rubber. It goes back to relationship type—both condoms and alcohol are more likely to be used with casual partners.

There are two prevailing theories about how alcohol affects sexual decision making. The first is called “alcohol myopia theory.” (Yes, researchers have basically turned “beer goggles” into a legitimate topic of academic study.) As the authors explain it, this theory suggests that alcohol changes the way we process information. We can still process cues such as arousal that make us want to have sex, but we can’t adequately think through those more complex ideas such as the possibility of sexually-transmitted infections or the fear of future rejection that might make us more cautious. Under this theory, women would be less likely to use condoms if they were drinking alcohol. The recent study, however, found otherwise:

After controlling for partner type, we found no associations between drinking and condom use, contrary to what might be predicted by alcohol myopia theory. Even in situations involving heavy drinking (four or more drinks), during which we might expect disinhibition to lead to decreases in safe-sex behavior, we found no evidence of decreased condom use across this sample of women.

The researchers did find, however, that in events during which women did use alcohol, condom use decreased as the number of drinks increased. They concluded that only extremely high levels of drinking reduce the probability of condom use.

There is a second theory about alcohol and sex that the findings of this study support. Expectancy theory says that the behavior of individuals after drinking is driven by their beliefs about alcohol’s effects on behavior. Essentially, how you behave while drunk is a self-fulfilling prophecy—if you think you are going to take more sexual risks because of alcohol, you probably will. Researchers used a six-point scale to measure women’s expectations and found that those women who believed alcohol use increased sexual risk-taking were somewhat less likely to use condoms in events involving alcohol. This suggests we need to address expectations with women before they drink.

In my peer sex educator days, I wrote a workshop called Bedspins, which explored sex and alcohol. The basic premise was: We’re not going to tell you not to drink, we’re not going to tell you not to have sex, and we’re not even going to tell you not to drink and have sex at the same time, but you do have to think about it, preferably before you get blitzed. In one of the activities, I handed out index cards with either an S (sober) or D (drunk) on the back and had participants finish this sentence based on their assigned sobriety or lack thereof: “On Friday night I went to this party and met this really cute guy/girl. We started talking, and ____.”  Not surprisingly, people were more likely to end the story with sex if they thought they were drunk at the time. I always liked to sneak in one card about mind-blowing sober sex just to buck expectations. This was 20 years ago, but clearly we still need to challenge the same assumptions because whether it is serving as a motivator of risky behavior or an after-the-fact excuse for it, expectations set the stage for actions.

That said, the researchers noted that in their sample of college-age women, “strong alcohol-sexual risk expectancy beliefs were relatively uncommon.” Only 13 percent of women in the study scored above a three on the six-point scale.

I think there’s a lot of good news in this study. For the most part sex was happening without alcohol and with a condom. Condoms were also more likely with new or casual partners, which seems to suggest that when women do forgo them it is part of a conscious decision based on the state of their relationship and possibly other birth control methods. Given the high rates of serial monogamy in college, however, I might suggest even more condom use, but in general I think this study gives us a view of young women making responsible sexual decision and I hope we all give them credit for it.

Commentary Sexuality

There Really Isn’t Any Bad News for People Who Like to Masturbate

Martha Kempner

A recent Maxim article warned readers that masturbation may be harmful in the long run if they do it too often or the wrong way. Thankfully, the article is based on pseudoscience and misunderstandings—there is no reason to stop the activity.

Masturbation is such an under-appreciated form of sexual activity. It has been blamed in urban legends for everything from hairy palms to lack of productivity, and has a reputation of being reserved for those who can’t find anyone else to have sex with them. But that’s just not true. Most people masturbate. It feels good. It carries no risk of pregnancy or disease. It can take as much or as little time as you have. And it’s relaxing. So why have media outlets warned readers that they might be doing it too much or the wrong way?

Recently, in a December 15 article titled “We’ve Got Bad News for People Who Love Masturbating,” Maxim’s Ali Drucker tells readers: “If you or someone you love frequently enjoys doing the five-finger shuffle, there’s a study that suggests they might face negative effects over time.” The article actually points to three pieces of “research” that seem to suggest masturbation isn’t as good as other forms of sexual behavior, that one can become addicted to it, and that the “grip of death” can make men incapable of experiencing pleasure any other way.

Well, Rewire has good news—these conclusions are largely based on junk science and misunderstandings.

The first study Drucker cites, originally published in Biological Psychology, is called, “The post-orgasmic prolactin increase following intercourse is greater than following masturbation and suggests greater satiety.” Prolactin is a hormone that is released by the pituitary gland. Its main function is to stimulate milk production when a woman is lactating, but it also plays a role in the sexual response cycle. According to the study, which was first published about ten years ago, prolactin is released after orgasm as a way to counteract the dopamine released during arousal. Some scientists believe that the more satisfying the experience is, the more prolactin levels will go up afterward.

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For this study, Stuart Brody and his colleagues compared data showing prolactin levels after penile-vaginal sex to those after masturbation and found that levels after intercourse were 400 percent higher than after masturbation. They interpreted this to mean that intercourse is more physiologically satisfying than masturbation.

On the surface, this conclusion isn’t surprising. Many people don’t view masturbation as the same as a shared experience with a partner. It doesn’t tend to produce the same physical or psychological feelings. But that doesn’t mean it’s not a fun and satisfying way to spend a few minutes (or hours, if you’re ambitious or bored).

When I read the study, I did not interpret it to say that intercourse was better than masturbation, just that our biological reactions to different sexual behaviors were different. I had never read anything by Professor Brody before and reached out to him, assuming that people were overstating his results and that he did not mean to discourage masturbation. I thought, what sex researcher would ever want to discourage masturbation?

However, he replied, “Instead of any fresh quotes, I attach my review paper on the evidence regarding health differences between different sexual behaviors.” He sent me a different article, a literature review in which he says in no uncertain terms that penile-vaginal intercourse (PVI) is the best kind of sex and that “sexual medicine, sex education, sex therapy, and sex research should disseminate details of the health benefits of specifically PVI.”

As a sex educator, I can’t imagine telling anyone that penile-vaginal sex is inherently better. For one thing, not everyone is in a couple, and not all couples have a penis and a vagina between them. And even for cisgender heterosexual couples, PVI is only one of countless potentially pleasurable behaviors. Moreover, many women find it less satisfying and less likely to end in orgasm than behaviors that incorporate clitoral stimulation.

But Brody not only thinks it’s the best form of sex—he thinks we sometimes do it wrong. He writes that “PVI might have been modified from its pure form, such as condom use or clitoral masturbation during PVI.” He also explains that Czech women who were vaginally orgasmic were more likely than their peers who didn’t have orgasms through PVI to have been taught during childhood that the vagina is “an important zone for inducing female orgasm,” concluding that “sex education should begin to be honest” about sexual behaviors.

I thought we’d moved on from the idea that we should all be having heterosexual, penile-vaginal sex in its “pure form” (missionary position?) and that women who couldn’t orgasm this way were both bad at sex and shit out of luck.

Colleagues in the field told me that many of them ignore Brody’s studies because he makes wild inferences based on soft science and, as implied by his research, is wedded to the idea that for sex to have the most benefits it needs to include PVI.

Nicole Prause, a researcher who has written critiques of Brody’s work, told me via email that, “His work almost exclusively uses data from other researchers, not his own, meaning the design is never really appropriate for the claim he is actually trying to make.” She went on to say that Brody’s studies on orgasm are often based on self-report, which is notoriously unreliable. Although the study Maxim cites was based on blood tests, “He has never once verified the presence of orgasm using a simple physiological measure designed for that purpose: anal EMG. Many women are thought not to be able to reliably distinguish their orgasm, so his purely self-report research is strongly suspect. If this is his area of focus, he should be studying it better than everyone else,” she concluded.

But Brody’s research on prolactin isn’t the only questionable science that Maxim relies on for its cautionary tale on masturbation. The article goes on to discuss the role of oxytocin and dopamine and points out that there’s less oxytocin released during masturbation. This is probably true—oxytocin is known as a bonding hormone and is triggered by contact with other people, so it’s not surprising that it’s not released when you’re orgasming alone. The Maxim article, however, argues that if the brain is flooded with dopamine (a neurochemical) during masturbation without the “warm, complacent, satisfied feeling from oxytocin,” you can build up a dopamine tolerance, or even an addiction, and get into “a vicious cycle of more masturbation.”

David Ley, PhD, a clinical psychologist and sexuality expert, explained in an email that many people describe dopamine as the “brain’s cocaine,” but this is an overly simplistic way of looking at it. It doesn’t mean we’re at risk of desensitizing our brain or getting addicted to jerking off. Ley wrote:

It appears that there are many people whose brains demonstrate lower sensitivity to dopamine and other such neurochemicals. These people tend to be “high sensation-seekers” who are jumping out of airplanes, doing extreme sports, or even engaging in lots of sex or lots of kinky sex. These behaviors aren’t caused by a development of tolerance or desensitizing, but in fact, the other way around—these behavior patterns are a symptom of the way these peoples’ brains work, and were made.

OK, dopamine isn’t cocaine and neither is masturbation: We’re not going to get addicted if we do it “too” much.

But, wait, Maxim throws one more warning at us—beware the “death grip.”

Though the article describes this as “the idea that whacking off too much will damage your dick,” the term, which was coined by sex advice columnist Dan Savage, is more about getting too accustomed to one kind of stimulation and being unable to reach orgasm without it. There is some truth to this—if you always get off using the same method, you can train your body to react to that kind of stimulation and it can be harder (though rarely impossible) to react to others. There are two solutions, neither of which involve giving up on masturbation: Retrain your body by taking some time off from that one behavior and trying some others, either by yourself or with a partner, or incorporate that behavior into whatever else you’re doing to orgasm (like clitoral masturbation during intercourse).

In fairness, the Maxim article ends by acknowledging that masturbation can have benefits, but I still think it did its readers a disservice by reviewing any of this pseudoscience in the first place. As Ley said in his email, “This article, targeted towards men (because we masturbate more), is still clearly pushing an assumption that there is a ‘right kind of sex/orgasm’ and that masturbation is just a cheap (and potentially dangerous) substitute … That’s a very sexist, heteronormative, and outdated belief based on a view of sex as procreative only.”

So for a different take on it all: Sure, there might be more prolactin and oxytocin produced during intercourse than masturbation, but that does not mean that masturbation isn’t enjoyable or worthwhile. You won’t become addicted to it, but you might want to mix up how you get to orgasm or just incorporate your preferred stroke into all other sexual activity.

What you shouldn’t do is view the Maxim article—or any of the research it cites—as reasons not to stick your hands down your own pants.

Commentary Abortion

Looking at the Racial Disparity in Abortion Rates Completely Misses the Point

Kate Castle

A recent Wall Street Journal article accuses the American left of being hypocritical by advocating for Black Lives Matter while failing to address racial inequities in U.S. abortion rates. This claim is a deliberate attempt to justify the deterioration of reproductive rights for women in the United States under the guise of racial justice.

In his Wall Street Journal article titled “Let’s Talk About the Racial Disparity in Abortions,” Jason Riley, a conservative Black journalist, accuses the left of being hypocritical by advocating for Black Lives Matter while failing to address racial inequities in U.S. abortion rates. He calls on the left to develop a critique of racial disparity in abortion rates:

A popular explanation for the racial divide is that abortion rates are a function of poverty. Low-income women are more likely to terminate a pregnancy, and black women are more likely to be low-income. Yet there are limits to this argument. Hispanic households are comparable to black ones in finances, sexual activity and use of birth control. Yet Hispanic women choose to abort at a rate much closer to that of white women than black women. Even when controlling for income, according to the pro-choice Guttmacher Institute, black women still have significantly higher rates of abortion.

The sad truth is that many black women are not acting irrationally when they decide to terminate an unwanted pregnancy. They are playing the odds. Out-of-wedlock Hispanic birthrates are above average, but Hispanic marriage rates are comparable to those of whites, which is not the case among blacks. Most Hispanic children are raised by two parents, while most black children are not. Many black women may be choosing to abort because they don’t believe the father will stick around to help raise the child. 

The left plays down the discomfiting incentives and unintended consequence that have resulted from Roe v. Wade. But if liberal activist and their media allies are going to lecture America about the value of black lives, the staggering disparity in abortion rates ought to be part of the discussion. [Emphasis added.]

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Riley’s argument is narrow-minded at best and extremely dangerous to the reproductive rights movement at worst.

I would like to address a few points of his piece here and argue that his focus on racial disparities in abortion rates is a deliberate attempt to justify the deterioration of reproductive rights for women in the United States under the guise of racial justice.

Riley’s argument is nothing novel. It echoes sentiments of the Black genocide campaigns. We’ve all seen the billboards that shame Black women with headlines like “The most dangerous place for an African American is in the womb.” What stands out about Riley’s argument is the way he frames his “concern.” Instead of accusing Black women of committing murder, Riley blames their partners. He says, “Many black women may be choosing to abort because they don’t believe the father will stick around to help raise the child.”

His claim about the root cause of why Black women have higher rates of abortion is both racist and sexist. By shifting the focus from systematic factors to Black women’s partners, presumably Black men, and an “unconventional” family structure among Black people (lower marriage rates and cohabitation), Riley is downplaying the importance of structural racism and blaming individuals for being “irresponsible.” He is attempting to depoliticize poverty by focusing on a very narrow and conservative view of morality.

Further, by inserting “the father” into the conversation, Riley is stripping Black women of their agency. In Riley’s world, Black women are merely subjects reacting to conditions they have no control over. This depiction of Black women as puppets disregards the complexities they grapple with and the strength they embody when making decisions about their reproduction and their lives. Black women, according to Riley, are not actors in their own lives.

However, as Monica Simpson of SisterSong explains in an article at Rewire, Black women “are making decisions every day to plan and care for ourselves and for our children.” Simpson adds:

We deal with attacks on our ability to access reproductive health care and obstacles to raising our children—the need for better education, difficulty affording child care, a broken criminal justice system that perpetuates mass incarceration and police violence, continued health disparities, and a lack of access to high quality health services. We are struggling, but we are also striving to get by in a world that far too often wants to push us down.

….

There is a real health crisis for Black women in this country that is only exacerbated by an organized attempt to strip us of our rights and our bodily autonomy. People should not be forced to be pregnant when they are not ready, and we will not be told that we cannot be parents or that we should have to endure having our children grow up in a climate of fear or without a safe and healthy place to call home.

Riley’s logic—that higher rates of abortion among Black women are linked to lower marriage rates among Black couples—can be traced back to the theory of social disorganization. Sociologists at the University of Chicago described social disorganization theory as an explanation for why individuals undergoing major social changes (such as migration) were unable to conform to certain social “norms” such as a nuclear family unit. High crime rates, sexually promiscuous behavior, desertion, and delinquency were considered by the theorists as attributes of social disorganization.

During and after World War II there was an influx of Black Americans into northern industrial cities from the South. Many cities did not have the infrastructure to accommodate the rapidly growing population. This, in turn, led to overcrowding and housing deterioration in Black neighborhoods. Black housing reformers, in search of an explanation for the housing crisis in Chicago, adopted the social disorganization theory.

In Racial Democracy and the Black Metropolis: Housing Policy in Post-War Chicago, political scientist Preston H. Smith II explains:

The idea of social disorganization appealed to black civic leaders for a number of reasons. Since all African Americans were subject to racial segregation, for these black elites, social disorganization helped to explain why some succeeded in escaping poverty while others failed. Not only was it a convenient concept to explain class differences in the black community but it also paid racial democratic dividends. Black policy elites could single out low-income blacks as the bearers of personal and family disorganization, and thus contest whites who generalized pathology to blacks of all economic strata. [Emphasis added.]

In other words, Black elites were able to draw a class distinction in order to separate themselves from low-income Black individuals. They did so by embracing white middle-class values and using “self-help” rhetoric (preaching these values to working-class Blacks). The fact that Chicago school theorists depicted social disorganization as a process allowed for an understanding that it could be disrupted. Smith goes on:

Black civic leaders could attack social disorganization in two ways: by confronting racial segregation that produced slum conditions, and/or by correcting the values and behavior of working-class blacks in the segregated institutions that they managed. Black elites became invested in inculcating middle-class values into their poorer brethren.

This is a historical account of how Black elites took on a managerial role toward low-income Black individuals in the post-war era. “Self-help” rhetoric became popularized with the rise of neoliberalism in the 1980s. As Preston H. Smith explains in “Self-Help,” Black Conservatives, and the Reemergence of Black Privatism:

The term “self-help” was used by political commentators, politicians, and ministers during the Reagan-Bush era to indicate a shift in black politics. Often invoked, self-help was associated with phrases such as “self-reliance” and “individual responsibility” to indicate that the source of black social problems came, and certainly alleviation should come, from within the black community.

Once understood to be a product of structural forces, with the help of self-help rhetoric, poverty is reduced to a character flaw. This focus on the individual depoliticizes poverty and perpetuates the idea that there is a Black underclass that needs to be “managed.” Riley’s use of self-help rhetoric to inflict shame on Black men, accusing them of being irresponsible, is a perfect example of how this logic is very much prevalent in Black politics today. Riley’s claim that Black men are not around to help raise their children reinforces this idea that poverty is a function of values and character. As a Black professional, he is attempting to take on the role of racial manager to tell low-income Black men how to be “responsible fathers.”

Riley’s accusation that Black men are not there to help Black women raise their children not only ignores structural factors that reproduce racial and economic inequality, such as mass incarceration and the lack of access to adequate health care and education, but it is also simply not true. Centers for Disease Control and Prevention data shows that Black dads are just as involved with their children as white and Latino dads in similar living situations. While Black dads are less likely to live with their children, they are more likely to see them at least once a month compared to their white and Latino counterparts.

While I would like to go more in depth into how neoliberal self-help rhetoric functions to depoliticize poverty, I want to get back to Riley’s central claim. Riley would like his readers to understand higher rates of abortion among Black women as a moral atrocity. He uses language like “babies” in the place of fetus intentionally to distract from the real issue at hand: controlling Black women’s reproduction and lives.

Reasons U.S. Women have Abortions, a study conducted by the Guttmacher Institute, found that 73 percent of women cited not being able to afford a baby right now as a reason for having an abortion. Over 60 percent of women having abortions already had children and 48 percent of women cited they were having relationship problems or did not want to be a single parent.

Of all the reasons women give for having abortions, not being able to afford to have another child is one of the most common. So yes, Mr. Riley, this is about economics.

Riley is correct that relationships play a role in women’s reproductive decisions. It is true that 48 percent of women cited relationship problems or avoiding single motherhood as a reason for having an abortion. But this doesn’t mean what Riley thinks it does. He blames higher abortion rates among Black women on allegedly irresponsible partners and dysfunctional family structure. He seems to want to say that it’s not poverty that matters, it’s “good” values, like personal responsibility. The reality is that relationships have an economic component. As the social safety net deteriorates, it’s low-income people who are hit the hardest. The desire to have a partner (and two incomes) to help raise a child is a matter of economic survival.

When I look at the disparity in abortion rates, I see women making difficult decisions based on their life circumstances. It is an undeniable truth that the evaluation of material conditions and relationships plays an important role in making reproductive decisions on an individual level. Of course they do. What is happening in our lives always influences the decisions that we make. But to attribute higher abortion rates to one factor (Black men’s “failure to father”) is ignorant at best. First, as I’ve already established, dominant stereotypes about Black fatherhood are simply wrong; the data says so. Secondly, according to the Guttmacher Institute, 89 percent of women selected at least two reasons they were choosing to have an abortion, and 72 percent selected three or more. What this tells us is that reasons for abortion are not clear-cut; they are multifaceted, just like the women who have them. There is no singular narrative to abortion and to suggest so minimizes the strength and compassion women exert in deciding to end a pregnancy.

This is only part of a much larger discussion our society needs to have surrounding abortion rights. We need to focus on women and the reality of their lives, including the structures that shape them, because that is what reproductive rights and justice is really about.

Riley may have fooled some by appealing to sentiments of racial unity. But I’ve attempted to unmask his motivations and highlight that this attack on Black women’s partners not “sticking around” as the primary reason why they have abortions at a higher rate than white women is part of a larger attempt to depoliticize poverty and blame individuals for their own systematic oppression. Riley’s accusation that the left is being hypocritical by mobilizing for Black Lives Matter without critiquing racial disparity in abortion rates completely misses the point. While Black Lives Matter activists target systems of oppression, specifically the prison industrial complex and police brutality, Riley is stuck on analyzing a symptom of the system. His accusation that Black men need to be better fathers and use of self-help rhetoric only act to further distract from the root of the problem: racial oppression and economic exploitation. It is insulting for Riley to suggest he cares about Black lives when he doesn’t respect Black women enough to value their lives and moral agency. If Riley was honestly concerned with Black lives, he would spend his time writing about racism in the justice system, the school-to-prison pipeline, job creation, the campaign for a living wage, comprehensive health care (including access to affordable birth control options), and public education (including comprehensive sex ed programs).

Editor’s note: The author’s affiliation is included for informational purposes only; this work was not conducted under the auspices of the Guttmacher Institute. The views expressed herein are those of the author’s and do not necessarily reflect the views of the Guttmacher Institute.