Not a Big Deal? Examining Help-Seeking Behaviors of Sexually Victimized Women on the College Campus

Abstract

The sexual assault and coercion of women on university campuses continues to be an ongoing problem. It is estimated that more than 15% of women attending college experience some type of sexual assault or coercion each year. As universities and other social institutions begin to acknowledge the prevalence of sexual victimization, an increased emphasis has been placed on helping victims of sexual crimes. The current study uses results from 378 surveys completed by females at a midwestern university to examine the help-seeking behaviors of those who have been victimized. This study specifically focuses on formal and informal reporting, identifying help agents, and reasons for not reporting. Results reveal that 1% of women who were victimized reported their experience to a formal entity, whereas 45% told an informal agent, such as a friend or roommate. Reasons for not reporting included not identifying the experience as rape, wanting to keep the experience private, and feeling ashamed.

Keywords

sexual assault prevention adult victims support seeking

Sexual victimization on college campuses has been a topic of interest for more than half a century, with the earliest studies emerging in the late 1950s (Cantalupo, 2011; Kirkpatrick & Kanin, 1957). Studies reveal that women who attend college are at a higher risk of sexual victimization than their counterparts who choose not to attend college (Karjane, Fisher, & Cullen, 2005). These findings are not specific to public universities but are also similar on military campuses and private colleges (Brubaker, 2009; Koss, Gidycz, & Wisniewski, 1987). Not only do women who suffer sexual victimization experience emotional and psychological distress, but their academic progress and grade point average may also be affected, potentially influencing their entire college career (Jordan, Combs, & Smith, 2014).

Forbes and Adams-Curtis (2001) stress the importance of studying college students in conjunction with sexual victimization, noting that college students are likely to have experiences with dating aggression, and are then likely to use their dating history as a model for future dating patterns. College students are also in an environment where sexual coercion and sexually aggressive behaviors may be viewed as culturally acceptable, and are therefore prevalent (Forbes & Adams-Curtis, 2001; Schwartz & DeKeseredy, 1997). Nonconsensual sexual activity can occur in a number of ways, encompassing behaviors from verbally coercing an individual to engage in sexual activities they are uncomfortable with, to using excessive violence and physical force to garner sex against someone’s will.

Individuals who have been sexually victimized on or near a college campus may seek help from formal or informal help agents. Formal help comes through professional avenues, such as local law enforcement, university officials, or medical assistance. Informal help comes in the form of friends, dorm mates, or family members. Although colleges and universities have made efforts to make reporting easier and many campuses offer sexual assault victimization services in the form of counseling, formal reporting assistance, and medical resources, these services are often not utilized (DeMatteo, Galloway, Arnold, & Patel, 2015; Fisher, Cullen, & Turner, 2000). Studies have determined that fewer than half of all rapes are reported to the police, and that women in college are less likely than women of the same age who are not in college to report their victimization to the police (Greenfeld, 1997; Sinozich & Langton, 2014). Other studies have found that college women are reluctant to report instances of rape due to fear of retaliation, worry that their incident will not be kept confidential, and concerns about not being believed by authorities (Sable, Danis, Mauzy, & Gallagher, 2006). These trepidations may be amplified on a college campus as it is possible the perpetrator may be seen frequently on campus, and the public atmosphere of universities can augment apprehensions about reporting being kept private. Another researcher suggests that maybe college women do not report accounts of sexual assault on campus because it is considered to be a social norm, where college males assault women, and generally do not suffer consequences.

Thus, if too many men act like they can force sexual intercourse on a woman anytime they wish on college campuses and get away with it, it is because it is too often true. In fact, they can often act with impunity. (Schwartz & Leggett, 1999, pp. 266-267)

University-specific studies reveal an even lower reporting rate, with less than 5% of college-age women who were sexually victimized reporting their experience to law enforcement (Fisher et al., 2000). College women who do not report their victimization to professional law enforcement are likely to discuss it with their friends, but not their family or other members of their social group (Fisher et al., 2000). A study by Roberta Ogletree of sexually coerced college students from three universities found that less than 30% of women sought help after engaging in unwanted sex due to sexual coercion (Ogletree, 1993). Of the women who did seek help, the vast majority sought assistance from a friend, and did not go to a professional or school sponsored source. The remaining few who did not seek assistance from a friend obtained help from a variety of sources, including counselors, the police, family members, rape crises facilities, or medical personnel (Ogletree, 1993).

Due to the extremely personal nature of the act, it is likely that sex crimes are the most underreported of all violent crimes (Adams-Curtis & Forbes, 2004; Karjane et al., 2005). Often, these assaults go unreported because the perpetrator is someone who knows the victim (Karjane et al., 2005). The relationship between the victim and perpetrator can make reporting uncomfortable and humiliating, as well as leave the victim fearful of retaliation by the offender or acquaintances of the offender (Fisher, Daigle, & Cullen, 2010). Furthermore, research has found that students might be justified in their reporting fear, with one study determining that individuals who have disclosed their victimization and have experienced social reactions akin to blaming experienced an increased loss of self-esteem (Orchowski, Untied, & Gidycz, 2013). In addition, students who are assaulted may be fearful about maintaining discreetness throughout the reporting process. Although more than 80% of campuses guarantee confidentiality during and after the reporting process, less than half of universities offer students the opportunity to report sexual victimizations anonymously (Karjane et al., 2005).

Although the majority of campuses offer confidentiality in reporting a sex crime, and some offer anonymity, fear of others finding out about the coercion, assault, or rape prevents many victims from reporting the crime or seeking help (Fisher et al., 2010; Karjane et al., 2005). The availability of resources for sexual assault prevention, reporting, and treatment on college campuses does not mean that they are adequate or sufficient. Problems may arise when university therapists and counselors harbor gender biases, buy into rape myths, or are unprepared to be sympathetic and understanding to the trauma that sexual assault victims are experiencing. Studies have found that close to half of all rape victims and a third of all attempted rape victims refuse to report the crime because they do not want other people to know about their victimization, or they do not want their family to hear about the assault (Fisher et al., 2010). This lack of reporting contributes to the cloud of secrecy that surrounds sex crimes and prevents victims of these crimes from reaching out to available help options.

Although rape and assault are commonly underreported, sexual coercion may be the most underreported sex crime. Separating sexual coercion from sexual assault can be a difficult and arduous task. According to Fisher et al. (2010), determining the “type of contact,” “degree of coercion,” and “degree of action” are all necessary to decide whether or not the victimization was assault or coercion (p. 90). For this study, sexual coercion involves any event where verbal pressures, misuse of authority, continuous and unrelenting verbal advances, or threats to end a relationship were used. Sexual coercion can specifically be defined as “any situation in which one party uses verbal or physical means (including administering drugs or alcohol to the other party either with or without her consent) to obtain sexual activity against freely given consent” (Adams-Curtis & Forbes, 2004, p. 99). This includes threatening to end a relationship with an individual unless they engage in sexual activity, using a position of authority to solicit sex, making promises in exchange for sex, or consistently pestering and badgering a person to participate in sex after having been repeatedly told no. College women may be hesitant to seek help after being a victim of sexual coercion because sexual coercion is markedly different from the stereotypical rape story, which generally includes a stranger, late at night, who uses extreme and painful measures to molest their victim, leaving their victim with visible bruises, scratches, and marks (Ogletree, 1993). As sexual coercion experiences generally include a person the victim knows (as opposed to a stranger), and there is commonly no evidence of a physical struggle, the victim may be reluctant to acknowledge that they were sexually coerced, and even more reluctant to report the coercion to a formal help-providing body.

Many victims of sexual crimes attempt to minimize their traumatic experience as a coping mechanism. In the National Crime Against Women Sexual Victimization (NCWSV) study, Bonnie Fisher and associates found that 65% of their sample who had been raped and 76% of their sample who had experienced attempted rape chose not to divulge the rape to officials because they felt it was “not serious enough to report” (Fisher et al., 2010, p. 144). Victims may also second-guess the intentions of the offender after the assault, particularly in cases where alcohol and drugs were used by one or both parties. Forty-four percent of the women who were raped in the NCWSV study did not report the rape because they were unsure whether crime or harm was actually intended by the offender (Fisher et al., 2010).

A study investigating why individuals in college choose not to report their victimization found that women perceived shame, guilt, and embarrassment as their number one reporting barrier, followed by fear of retaliation from the perpetrator, apprehensions related to the confidentiality of the report, and fear of not being believed (Sable et al., 2006). Results of former studies reveal a need for further investigation into not only who victims report their assaults to, but also why they chose not to report (Fisher, Daigle, Cullen, & Turner, 2003). As Fisher and colleagues recommend, campus administrators need to be made aware that although formal reports of assault may not be made, several students roam the university with information about victimizations their friends have experienced (Fisher et al., 2003). Gathering information related to help-seeking behaviors can lead to campus policies in regard to encouraging victims to report their experiences and seek medical and emotional assistance, as well as aid in the development of prevention policies, educational programs, and bystander awareness (Sable et al., 2006). This study adds to the current literature investigating why women might not report incidents by examining whether circumstances of the event are related to their perceptions as to whether the incident was important enough to report, or had a significant effect on them.

Research Questions

This study examined the following research questions:

Research Question 1: How many women in college reported their victimization to formal agencies (e.g., police or university) and/or informally to friends, family, or other people?

Research Question 2: Of the women who did not formally report their victimization, what were the reasons for not reporting?

Research Question 3: Did women who felt the victimization was not serious enough to warrant formal reporting experience different circumstances in the victimization incident compared with women who believed the action was serious?

Method

The current study utilizes findings from a survey on sexual assault and coercion administered across a medium-sized college campus in the upper Midwest. In selecting the participants, first, a list of all classes at the university was obtained from the registrar’s office. Next, to make sure that classes from all colleges were represented, the classes were separated out into college. A random sample of classes was then selected from each college according to the proportion of students majoring in that college. The instructors of these classes were then contacted by the researcher to request that the survey be conducted during class time; the survey was estimated to take around 15 to 20 min to complete. If instructors did not respond after multiple contacts, or if they declined the invitation to participate, then the researchers randomly selected other classes. This continued until the end of the academic school year. Of the instructors of the selected classes, 43.75% (21 out of 48) allowed the researchers to conduct the study.

Paper questionnaires were administered to students in the selected classes. Surveys contained questions related to sexual victimization on the college campus, including rape, sexual assault, and sexual coercion.¹ As a result of the sensitivity of the questions and not wanting students to feel forced into answering the questionnaires, the instructors were asked to leave the classroom during survey administration. Students were informed that they could choose not to participate or could stop participating at any time without any repercussions. Those students who chose not to participate were asked to remain in the classroom and do class work while others took the survey. They were informed that all surveys were anonymous and that no information could be traced back to the respondents. Students were also requested to use the informed consent document to cover their responses. Overall, 873 surveys were completed, resulting in a 97% response rate for the students in those classes. Of those completed, 378 came from females. Only the female findings will be analyzed in this article.² Of the 378 women who participated in the survey, 22.2% (N = 83) reported they had been sexually coerced, sexually assaulted, or both. Of these, 73 women answered additional questions about the circumstances of the assault or coercive event and noted whether or not they reported it formally or informally.

This survey utilized the “incident report” method. If a student answered in the affirmative to questions regarding sexual victimization, they were asked to complete a separate “incident report,” providing additional details about their victimization experience, including location, victim–offender relationship, and formal and informal help seeking. Help-seeking behaviors are related to the reporting of sexual victimization to both formal and informal institutions or individuals. Therefore, participants in the current study were given a list of both official agents (local or campus law enforcement) and non-official agents (friends, roommates, family members), and were asked to identify who they contacted for help following their victimization.

To answer the first two research questions, those women who were identified as victims were asked whether they reported to a formal agency (coded as 1) or not (coded as 0) and whether they reported the incident informally (coded as 1) or not (coded as 0). Next, women who formally reported the incident were asked to whom they reported to, and those who had not reported were asked for the reason for not doing so. The potential reasons are listed in Table 1.

Table 1.

Help-Seeking Behaviors of Sexually Coerced and Assaulted Women.

Variable	n	%
Formal reporting
Yes	1	1.4
No	72	98.6
Informal reporting
Yes	33	45.8
No	39	54.2
Informal help agents^a
Friend	32	82.1
Family member	5	14.3
Medical worker	2	5.7
Resident assistant	0	0
Faculty or campus staff member	1	2.9
Counselor/therapist	3	8.6
Local rape crisis center	1	2.9
Other	1	1.2
Reasons for not reporting^b
Felt ashamed	16	23.9
Did not want to go through the court process	4	6.0
Did not think anyone would believe me	5	7.5
Wanted to keep it private	31	46.3
Thought the offenders’ friends might punish me	1	1.5
Did not think the offender would be held accountable	5	7.5
Did not know how to report	6	9.0
Did not identify it as rape	32	47.8
Did not want my parents to find out	10	14.9
Did not want the offender to get in trouble	13	19.4
Thought I might get in trouble	6	9.0
I was discouraged from reporting	2	3.0

Percentages may not equal 100 because women may have told more than one person about the incident.

Percentages may not equal 100 because women may have cited more than one reason for not telling anyone about the incident.

For the final research question, a new variable was created, which was called the “big deal” variable to determine whether the woman thought the incident was important. This variable was created based on the following information: (a) the woman’s only response why she opted not to report was “didn’t identify as rape,” or (b) the woman stated that she did not formally report, but listed no reasons, and (c) if she did not informally report the incident to anyone. By using these criteria, it is assumed that the woman did not believe the experience to be a “big deal.”³ There were a couple of cases that were exceptions to these criteria. The women in these cases told a friend, but explicitly stated in the comments that they did not feel the incident was important. Therefore, 24 women (approximately 33%) did not believe the incident was a big deal.

The women who thought the incident was important were compared with those who did not believe the incident was important by looking at who the perpetrator was (intimate = 1; other = 0), whether alcohol or drugs were taken by either the victim or perpetrator (yes = 1; no = 0, respectively), how well they knew the person (5 = extremely well, 4 = very well, 3 = moderately well, 2 = somewhat well, and 1 = not at all), whether the incident was coercive or assaultive (yes = 1, no = 0, respectively), and number of times they had stated they had been assaulted or coerced.

Findings

In response to the first research question, univariate findings were analyzed by looking at the percentage of victimized women who reported their victimization to formal or informal help-seeking agents. Furthermore, specific help-seeking agents were identified, as well as reasons why some women chose not to report their victimization.

Of these women, only one reported her victimization to a formal help-seeking agent (in this case, a law enforcement agency; see Table 1). More than half of the victims reported their coercion or assault to an informal help-seeking agent, mostly to friends and family members.

In response to the second research question, it was found that those who chose not to tell anyone about their victimization listed a variety of reasons for doing so (Table 1). Many women did not report because they did not specifically identify their victimization as rape. Others failed to report because they were worried about their privacy or public exposure. Forty-six percent of women who did not tell anyone cited wanting to keep the incident private as the reason for their silence. Nineteen percent were worried about their parents finding out, and 9% were concerned that they themselves might get in trouble. Three percent of women reported that they were discouraged from telling anyone about the incident; however, it is unknown who discouraged them. Almost 8% of women expressed reluctance to report out of fear that no one would believe them. With only one women reporting that she did not tell anyone because she thought the offenders’ friends might harass and punish her, it is likely that many women do not report out of fear of social repercussions (concerns about their reputation, having friends and family find out about the incident, etc.) as opposed to verbal and physical retaliation from the offender or his acquaintances.

Some women demonstrated a lack of confidence in the social justice system, with 6% reporting they did not want to go through the court process, and almost 8% asserting that they did not think the offender would be held accountable. One woman stated that she had prior experience with the system that kept her from reporting this incident, specifically that she had “reported things in high school; cops didn’t help.” Nine percent of those who did not report the incident indicated that they did not know how, perhaps signifying a greater need for simplifying and advertising the reporting process on and near college campuses.

When asked why they did not seek help, victims were able to choose from a variety of options, or write in their own response. Many of the women who wrote their own response seemed to feel that their experience was not worthy of a formal report. Three women reported they did not seek help because their experience “wasn’t a big deal.” One woman said she did not tell anyone about her victimization because “it was not a big enough deal to report it,” and another wrote that the situation “didn’t feel that important.” These patterns of undermining episodes of coercion or assault continued with other women reporting that it “was not a big event, I didn’t feel harmed,” and that they “did not view it as a reportable thing.”

In response to the final research question, those women who did not believe the assault or coercion was a big deal were compared with those women who did. The purpose behind this was to determine whether perceptions can change according to who was involved, whether alcohol or drug use was present, the type of coercive or assaultive behavior, and the number of assaults/coercive events. For all these bivariate tests using a chi-square, the results indicted no significant relationship between whether it was a big deal and any of the above variables.⁴

Whether a woman had experienced coercion or assault, coercion and assault, or multiple examples of each appeared to be irrelevant to likelihood of reporting to an informal agent.

Table 2 contains results from the bivariate analysis. Bivariate tests revealed no significant differences for those who had experienced one victimization, multiple victimizations, or multiple types of victimizations.

Table 2.

Bivariate Results for Big Deal and Report to Informal Agents and Situational Variables.

	Big deal			Report to informal agents
	No (n)	Yes (n)		No (n)	Yes (n)
Perpetrator intoxication			χ²(1) = 0.73; p = .69			χ²(1) = 2.35; p = .12
No	10	18		15	8
Yes	13	29		21	25
Victim intoxication			χ²(1) = 0.04; p = .84			χ²(1) = 2.52; p = .11
No	10	18		16	8
Yes	14	28		21	24
Perpetrator well known			χ²(1) = 0.05; p = .83			χ²(1) = 6.73; p = .01*
No	7	23		5	13
Yes	11	32		35	20
Number of coercive events (0-4)	$\bar{X}$ = 1.09	$\bar{X}$ = 1.26	t(73) = −0.75; p = .46	$\bar{X}$ = 1.09	$\bar{X}$ = 1.26	t(70) = −0.88; p = .38
Number of assaultive events (0-7)	$\bar{X}$ = .094	$\bar{X}$ = 1.23	t(73) = −0.86; p = .40	$\bar{X}$ = 1.09	$\bar{X}$ = 1.26	t(70) = 0.79; p = .44
Total number (0-11)	$\bar{X}$ = 2.03	$\bar{X}$ = 2.49	t(73) = −1.12; p = .27	$\bar{X}$ = 1.09	$\bar{X}$ = 1.26	t(70) = 0.19; p = .85

p ≤ .01.

Discussion

Despite the frequency of sexual victimization, it continues to be extremely underreported (Orchowski & Gidycz, 2012; Tjaden & Thoennes, 2000). Of the entire sample of victimized women, sadly, only one reported her victimization to a law enforcement agency. Almost half (45.8%) of those who were victimized revealed their abuse to an informal source, mainly friends or family. Although it is possible that some friends might encourage victims to make a formal report, studies have found that on occasion the “friend” might further reinforce victim-blaming and the idea that a formal report is unnecessary. An ethnographic observation study by Armstrong, Hamilton, and Sweeney (2006) described friends’ reactions to a woman who was sexually assaulted. Although the friends expressed concern and said that “no one deserves that,” they also noted that the assaulted woman “flaunts herself,” and mentioned that “she is a whore,” implying that perhaps the assault was to be expected (p. 493).

Other studies have determined that formal reporting rates for sexual assault victims vary between 0% and 13% (Sabina & Ho, 2014). A large meta-analysis by Sabina and Ho (2014) found that those who chose to report to the police were women who experienced severe physical assault (particularly with a weapon). Those who were victims of coercion or sexual violence perpetuated by an intimate partner or a date were less likely to discuss their victimization with law enforcement. Nationally, official reporting rates hover between 2% and 5%, with approximately 2% of college women reporting their assaults to city police, and 3% reporting to some type of campus official (campus police, school administrator, etc.; Fisher et al., 2003; Sabina & Ho, 2014).

When asked why women did not report their coercion and/or assault, several women claimed that they did not view what happened as rape. Other studies have revealed similar findings. In a study by Bondurant (2001) investigating a sample of women who had been raped, only 64% of them acknowledged that what happened to them actually was rape. A culmination of several sexual assault studies found that the overwhelming reason why females do not make official reports to the police is because they did not view their victimization as “serious enough” (Sabina & Ho, 2014, p. 16). Some women in the current study noted that they did not report their experience for fear of not being believed. This is a valid concern as studies have shown that on occasion police have overestimated the amount of false reports from women in sexual assault cases, despite little evidence that false reporting happens more in rape cases than any other criminal events (Rumney, 2003; Temkin, 2002).

Although it is possible that some women remain in denial after a sexual assault, or use refusal to acknowledge that this horrific event happened to them as a coping mechanism, it is more likely that many women are not reporting because they feel that their victimization is not severe enough, physical enough, or rare enough to warrant a formal report. This belief that their victimization is “not a big deal” was echoed in several qualitative statements made by victims. Because of the null findings relating whether women felt it was a “big deal” to the circumstances of the assault or coercive event, it is also, therefore, possible that the definitions are more fluid, meaning that individuals will interpret events differently, and may have even been surprised to see these incidents listed as assaultive.

At the same time, it might be that this “not a big deal” mentality begins not with the individual, but with the university, filtering down to those who are victimized and abused. This may especially be true among universities that receive large amounts of endowments and funding, or universities with popular sports teams (Giroux & Giroux, 2011). The “not a big deal” attitude is particularly evident in the extremely low number of campus sexual assault perpetrators who receive disciplinary action from universities (Krebs, Lindquist, Warner, Fisher, & Martin, 2009). By treating sexual victimization as petty or unimportant, colleges strive to protect their school name, and use their energy and resources to promote grandiose achievements and athletics instead of ensuring that students are supported and protected (Giroux & Giroux, 2011). Although certainly not the case with all universities, this pattern of behavior has been witnessed several times over the past decade.

Policy Implications

Despite measures taken by campus officials, it is obvious that university administrators have a long way to go before women feel safe, comfortable, and prepared to report their victimization. Researchers have suggested several areas that need to be implemented or improved to ensure that sexual victimization reporting is handled quickly, properly, and quietly. Among the suggestions for improvement is the need to make reporting available and easy, not only for the mainstream college female but also for diverse demographics. Reporting processes may be designed for White, heterosexual females, making reporting difficult or uncomfortable for non-English speaking students, males, or those who identify with the lesbian, bisexual, gay, transgender, queer/questioning (LBGTQ) community (Sabina & Ho, 2014).

Furthermore, college freshman, immediately out of high school, may not be aware of the reporting services or counseling that may be offered on the campus. These services need to be visible and advertised so students know they exist, and can easily access their location or contact information. These services should also emphasize that they are concerned about what happened to the victim, not whether or not the victim was intoxicated or under the influence of drugs at the time. Providing victims with immunity from university sanctions for underage drinking or illicit drug use will encourage women who are scared to report their victimization out of fear of being in trouble to seek help.

Service visibility can be achieved in a variety of ways, including signs and pamphlets located in areas frequented by students (campus gym, dormitories, dining centers, etc.), campus emails, tours during freshman orientation, and the campus website. Sexual assault prevention information, as well as opportunities to report sexual assault, should be available on the campus website. A study of university websites in Ohio during the 2010-2011 academic year found that many universities still have non-existent or inadequate sexual assault policies available on the Web. Of the 105 colleges included in the study, only 66% had information related to campus sexual victimization policies available online, and only 1% provided state or university definitions regarding exactly what constituted a sexual offense (Krivoshey, Adkins, Hayes, Nemeth, & Klein, 2013). Although Ohio may not be reflective of all colleges and universities across the United States, schools that do not already have a sexual assault reporting option available through their campus website should remedy that immediately. Living in an Internet-fueled age leaves many college students turning to the Web for assistance, support, and answers. Having an accessible and user-friendly website can allow victims to report their experience, browse various help options, and locate resources for campus counselors, law enforcement, and medical services, all within the comfort of their home.

By providing well-advertised contact information for campus help centers, not only will the victim know about available resources, but also those who the victim informally confides in can help direct them to a campus help source. These confidents (particularly female friends) can play a large part in determining the future help-seeking actions the victim takes (Orchowski & Gidycz, 2012). One study found that women who informally disclose their victimization were likely to do it within 2 days of their abuse (Orchowski & Gidycz, 2012). Friends, family members, resident assistants, and other informal sources that are knowledgeable about these campus resources can encourage the victim to seek formal help instantaneously. An active respondent who listens to the victim, believes the victim, and suggests help resources for the victim can make a large difference in the reporting and healing process.

Women who are left feeling like the pain, embarrassment, and fear that their sexual victimization created is “not a big deal” are likely to avoid seeking formal help-seeking agents, and experience stress, guilt, and other negative emotions. Changes to campus policies should happen systemically, beginning at the upper tiers of campus, passing down through student organizations, clubs, sports, and programs, and extending to every student until everyone on the campus is privy to the consistent message that sexual victimization is a big deal, it will not be tolerated, and comprehensive help programs are in place for those who have been victimized.

Footnotes

Appendix

Please refer to these definitions for the following questions. By sexual intercourse, we mean penetration of a woman’s vagina, no matter how slight, by a man’s penis. Ejaculation is not required. By oral sex, we mean that someone’s mouth or tongue making contact with your vagina or anus, or your mouth or tongue making contact with someone else’s genitals or anus. By anal sex, we mean putting a penis in your anus or rectum.

Declaration of Conflicting Interests

The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Funding

The author(s) received no financial support for the research, authorship, and/or publication of this article.

Notes

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