Pleasure and risk: Adolescent females reporting high “sexual pleasure” Have significantly greater HIV/STD-associated sexual behaviors and higher STD incidence

Background: “Sexual pleasure” is a construct receiving increased attention in studies among adult women; however, there is little empirical data about “sexual pleasure” and its association with sexual behavior among adolescents. This study examined differences in HIV/STD-associated sexual behavior and STD incidence between adolescent females reporting high verses low “sexual pleasure”.

Methods: African American female adolescents (N=439), ages 15-21, participating in an HIV/STD prevention trial, completed ACASI baseline assessments measuring sociodemographic, psychosocial, and behaviors and provided vaginal swab specimens to assess the prevalence of STDs and a nondisease marker of unprotected sex (Y-chromosome in vaginal fluid). Adolescents indicating a lot of pleasure from sex where categorized as the “High Sexual Pleasure Group” (n = 267) while those reporting some to no pleasure were classified as the “Low Sexual Pleasure Group” (n = 170). Contingency tables analyses and t-tests evaluated group differences in STD incidence, presence of Y-chromosome, and HIV/STD-associated sexual behaviors.

Results: Adolescents reporting high sexual pleasure, relative to those reporting low sexual pleasure, had significantly higher STD incidence (33.3% vs 23.5%), were more likely to test positive for Y-chromosome (semen) in vaginal fluid (51% vs 40%), and had significantly more sexual episodes, more sexual episodes while high on alcohol/drugs, more unprotected vaginal sex episodes, and less condom use.

Conclusions: The findings demonstrate an association between sexual pleasure and HIV/STD-associated risk behaviors and STDs. Understanding the role of “sexual pleasure” and how best to address this construct in HIV/STD prevention interventions is critical for reducing adolescents' risk for HIV/STD acquisition.