Advancing Sexual and Reproductive Health and Rights
Perspectives on Sexual and Reproductive Health
Volume 35, Number 5, September/October 2003

Disease Risk Is Elevated Among People Who Feel Bad About Having Sex

Emotional experiences surrounding intercourse may be important predictors of high-risk teenagers' and young adults' likelihood of acquiring a sexually transmitted disease (STD).1 In a decision-tree analysis based on data from patients at an STD clinic, the majority of factors that distinguished those who had an STD diagnosed from those who tested negative for all STDs reflected patients' reasons for engaging in intercourse or emotional reactions to having sex. The strongest associations were found between STD diagnosis and patients' reports that they usually do not feel good about themselves after having intercourse or do not feel comfortable during sex. Traditional behavioral variables had little association with the odds of diagnosis.

The sample consisted of 188 patients attending a Virginia STD clinic during five months of 1997. Participants were, on average, 25 years old, and 54% were women. Fifty-six percent were white, 38% black and 6% members of other racial groups. The majority had had at least a high school education and had never been married. All participants underwent the clinic's standard examination and STD testing; 55% had no STD diagnosed. Eighteen percent had gone to the clinic to obtain an HIV test; all tested negative for the virus.

Responses to a self-administered questionnaire that participants completed during their clinic visit indicated that on average, these men and women had been about 16 years old the first time they had intercourse; they had had about 12 partners, including three during the six months preceding their clinic visit. Thirty-two percent of participants said they had never used condoms during intercourse in the past six months, and another 25% had used them less than half the time; only 11% reported always having used condoms.

In response to questionnaire items about emotional reactions to intercourse, 37% of participants reported feeling good about themselves no more than half the time they had sex, 22% said that sex feels comfortable no more than half the time and 19% said that sex feels good only half the time or less. Twenty-two percent reported feeling angry, and 35% reported feeling sad, at least some of the time they have sex. Twenty-one percent said that they are scared at least half the time they have sex. Other questions addressing the emotional context of sexual relations covered participants' reasons for having sex and experiences of coerced sex.

The researchers used decision-tree analysis to ascertain what variables distinguished respondents who had an STD diagnosed from those who did not. Of the 18 most important variables identified in this analysis, six reflected emotional responses to sex, seven pertained to reasons for having sex (e.g., to get back at someone, to express love or intimacy, or to relieve sexual tension) and five reflected risk-related behavior (e.g., using condoms inconsistently, initiating intercourse at an early age or having multiple partners).

In univariate analyses, only four of these 18 variables--three emotional factors and one behavioral factor--emerged as significant predictors of STD diagnosis. The likelihood of diagnosis was elevated among participants who reported feeling good about themselves no more than half the time after having sex (odds ratio from univariate analysis, 3.2) and those who said they were comfortable during sex only half the time or less (2.2). Participants who used condoms only half the time or less also had elevated odds of having an STD diagnosed (2.0). Decision-tree analysis showed that risk factors operate differently for different subgroups: Condom use was a protective factor only for participants who felt good about themselves more than half the time after having sex.

Results of logistic regression analysis confirmed the significance of variables measuring emotional reactions to intercourse; the addition of behavioral variables to the multivariate model did not improve its ability to predict STD diagnosis.

Given these results, the researchers suggest that questions about emotional reactions to sex could be used "to improve selective mass screening for all STDs" and "to further explore the psychological states or traits that contribute to behaviors that are more proximal risks for STD." Additionally, they conclude that the emotional aspects of sex should be taken into account in the design of programs geared to reducing sexual risk and models of healthy sexual decision-making.--D. Hollander


1. Whitten KL et al., The emotional experience of intercourse and sexually transmitted diseases, Sexually Transmitted Diseases, 2003, 30(4):348-356.