Health associations for male survivors of unwanted and non-consensual sex

Abstract

Literature has established that men with non-consensual sexual experiences exhibit a higher likelihood of engaging in high-risk sexual behaviors; however, previous research does not explore men with unwanted sexual experiences, nor their sexual and general health outcomes. Weighted data from the 2011–2017 National Survey of Family Growth included men aged 18–49 years who ever experienced oral, vaginal, or anal sex by partners of any gender (N = 10,763). The Pearson χ² test compared the sociodemographic of men with or without a history of unwanted or non-consensual sex. Logistic regressions were used to examine the association of this history to sexual health and general health outcomes, while controlling for age, race/ethnicity, and education level. Approximately 1 in 10 (10.3%) American men reported experiencing unwanted or non-consensual sex in their lifetime. Men with these experiences were more likely to rate their health as fair or poor (aOR = 1.5, 95% CI = [1.1, 2.0]) and have difficulty concentrating, remembering, or making decisions due to a physical, mental, or emotional condition (aOR = 2.1, 95% CI = [1.7, 2.7]). Men with forced sex experiences reported higher odds of gonorrhea (aOR = 5.4; 95% CI = [3.0, 10.0]) or chlamydia diagnoses (aOR = 2.5; 95% CI = [1.5, 4.4]) in the past year, and a diagnosis of genital herpes (aOR = 2.7; 95% CI = [1.6, 4.6]), genital warts (aOR = 1.7; 95% CI = [1.0, 5.6]), and syphilis (aOR = 2.4; 95% CI = [1.0, 5.6]) in their lifetime than men who did not report these experiences. The association of sexually transmitted infections and general health outcomes to unwanted and non-consensual sex validates the demand for clinicians to integrate trauma-informed care into their practice with male patients.

Keywords

sexual assault male victims adult victims adolescent victims

Introduction

Social media movements that erupted in response to high-profile sexual assault allegations, such as #MeToo and #Cuéntalo, revealed the prevalence of sexual violence domestically and internationally. However, with the exception of Terry Crews, most of these cases described the routine victimization of women, leaving the stories of male sexual assault survivors largely untold and unheard. The Centers for Disease Control and Prevention (CDC) estimated that 1 in 6 men experience sexual abuse before the age of 18, and 1 in 21 men have been forced to penetrate someone else during their lifetime (Dube et al., 2005; Black et al., 2011). Likewise, 6% of men have experienced sexual coercion in their lifetime and 11.7% have experienced unwanted sexual touching (Black et al., 2011). Ultimately, each sexual assault translates to a cost of $124,631 per male victim, including the costs to productivity, medical care, and the criminal justice system (Peterson et al., 2017). For male and female victims alike, this equates to an economic cost of nearly $3.1 trillion—a third of which is financed by the government—over the course of their lifetimes (Peterson et al., 2017).

As unwantedness hardens into coercion and aggression, the proportion of men that lay claim to these experiences becomes disparate across nations. Of men in Hungary, a study estimated 5.4% reported experiencing sexual coercion; whereas an estimated 27.1% reported so in Germany (Costa et al., 2015). Equally troubling, an estimated 48.8% of men in Portugal reported experiencing psychological aggression from their partners, ranging to 71.8% in Greece (Costa et al., 2015). Other nations have begun to quantify unwanted sexual experiences. For example, 15.4% of university male students in Norway reported experiencing unwanted touching, hugging, or kissing (Sivertsen et al., 2019). Evidence that unwanted sexual encounters may be a universal experience among men, the gaping silence of the United States begins to raise questions.

Literature that focuses on men who experience victimization scrutinize their behaviors. Men with a history of sexual victimization by a female perpetrator were three times more likely to engage in sexual risk-taking behaviors, with odds more than doubling for men that were previously victimized by a male perpetrator (Smith & Ford, 2010). Men with a history of victimization by a female perpetrator had a higher likelihood of averaging more lifetime sexual partners, receiving treatment for a sexually transmitted infection (STI) the year previous, and reporting more substance use than men without similar histories (Cook et al., 2016). A history of forced sex is four times as prevalent among men who have sex with men (MSM), for whom sexual victimization was associated with a higher likelihood of sex with an intravenous drug user and sex in exchange for money or sex (Nasrullah et al., 2015).

Several studies have examined the sexual victimization of men, the perpetrators, and perpetrator tactics, but most focused on niche populations (Smith & Ford, 2010; Nasrullah et al., 2015), or only one perpetrator gender (Cook et al., 2016). To our knowledge, no recent study reports on the prevalence of American male sexual victimization, nor the sociodemographic, STIs, or general health outcomes of these men. Therefore, the purpose of this study is to assess the prevalence of unwanted and non-consensual sexual experiences in men; and the associations of unwanted and non-consensual experiences with STIs and general health outcomes in men.

Design and Methods

Data Source and Study Population

Conducted by the CDC, the National Survey of Family Growth (NSFG) is a cross-sectional, nationally representative survey of civilian men and women ages 15–49 years. The NSFG collects information on family life, marriage, divorce, pregnancy, infertility, and contraceptive use (CDC, 2019). Three datasets are publicly available that of men, women, and the pregnancies recorded by the female respondents (U.S. Department of Health and Human Services [U.S. DHHS], 2018). Surveys were conducted in-person; however, the questions regarding sensitive topics (including non-voluntary intercourse) were asked with Audio Computer-Assisted Self-Interviewing (Audio CASI) (U.S. DHHS, 2018).

Ultimately, we analyzed data on 11,294 male respondents from the 2011–2017 cycles, with male response rates that range from 63.6% to 72.1% (U.S. DHHS, 2018). We excluded men without a history of oral, vaginal, or anal intercourse (by any gender) and respondents younger than 18 at the time of survey completion, who were not asked about a history of non-consensual sex.

Study Variables

Forced sex and wantedness. Men responded to three questions, “At any time in your life, have you ever been forced by a male to have oral or anal sex against your will?”, “At any time in your life, have you ever been forced by a female to have vaginal intercourse against your will?” and “Think back to the very first time you had vaginal intercourse with a female. Which would you say comes closest to describing how much you wanted that first vaginal intercourse to happen?” Men could respond dichotomously (yes/no) to the first two questions, and respond to the third by choosing either, “I really didn’t want it to happen at the time,” “I had mixed feelings—part of me wanted it to happen at the time and part of me didn’t,” and “I really wanted it to happen at the time.” We coded men as having experienced unwanted or non-consensual sex if they responded yes to either of the first two questions, or if they responded “I really didn’t want to” to the third question.

Extensive research distinguishes wantedness from consent (Peterson & Muehlenhard, 2007; Jozkowski & Peterson, 2013) and in men, consenting to unwanted sex has been associated with unwanted memories, avoidance, numbing responses (Flack et al., 2007), and symptoms of depression (Larimer et al., 1999). Likewise, another study determined that although individuals would not label unwanted, consensual sex as rape, participants still rated the event equally distressing as those considered rape (Hills et al., 2020). Therefore, to identify men that experienced unwanted, consensual sex, we used two variables to include men with female perpetrators. The third variable, non-consensual sex with a man, does not have an equivalent question to make the same comparison. As the wantedness of a man’s first vaginal intercourse and a lifetime experience of forced vaginal intercourse are not mutually exclusive, these items were used to determine a presence or absence of experiential sexual violence over their lifetime (Brookmeyer et al., 2017; Nasrullah et al., 2015).

Measures. The National Survey for Health Statistics commissioned a study of how to ask the questions on nonvoluntary sex for the NSFG (Groves et al., 2005; Hamby, 1998). Focus groups supplied with the Cycle 5 questions concluded that unwanted, non-voluntary, and forced were not interchangeable terms; furthermore, supplying that ‘forced’ encapsulated some ambiguity to the degree of coercion (Hamby, 1998; Hamby & Koss, 2003). The NSFG incorporated the study recommendations and focus group feedback by including contextual questions about the forced intercourse (were alcohol/drugs given, verbal pressure, etc.) and the questions on forced intercourse were asked to male participants, which focus group participants felt would help redistribute the responsibility of sharing a history of victimization and promote fairness (Hamby & Koss, 2003). Although the inclusion of the same questions in the female questionnaire as the male questionnaire promotes equality, the questions inequitably deny women the opportunity to recount unwanted or nonconsensual experiences with female partners. Male and female respondents share the inability to report unwanted encounters beyond their first vaginal intercourse. This narrow focus of vaginal/penile intercourse remains as a vestigial limb of the origins of the NSFG as a survey on female fertility.

STIs and general health outcomes. Sexual health outcomes included a diagnosis of gonorrhea or chlamydia in the past 12 months (yes or no), a diagnosis of genital herpes, genital warts, or syphilis in their lifetime (yes or no), STI test (gonorrhea, chlamydia, herpes, or syphilis) in the past 12 months (yes or no), or HIV test in their lifetime (yes or no). We selected and included general health outcomes that have been associated with unwanted sex in previous literature: self-reported health (fair or poor vs good, very good, or excellent), obesity (defined as body mass index ≥ 30), illicit drug use (defined as self-reported use of cocaine, crack, methamphetamine, or injectable drugs in the past 12 months), and binge drinking (defined as consuming ≥ 5 alcoholic beverages on average on more than one occasion in the past month) (Cook et al., 2016; Hawks et al., 2019). The NSFG asks respondents if they have difficulty running errands or difficulty with their memory due to a physical, mental, or emotional condition. In line with previous literature (Hawks et al., 2019), these items were used as a proximate measure for the respondent’s mental health.

Sociodemographic variables. Descriptive covariates included the respondent’s categorical age at first sexual encounter (≤10, 11–14, 15–17, ≥18 ), race/ethnicity (white, Black/African American, Hispanic, other), federal poverty level (0–99%, 100–199%, 200–299%, 300–399%, 400–499%, 500% of poverty level or greater), sexual attraction (only females, mostly females, equally, mostly males, only males, not sure), highest level of education (less than high school, high school or equivalent, some college, college or beyond), history of foster care (yes or no, with a distinction between an intact and nonintact family formation), and history of receiving public assistance (yes or no).

Statistical Analysis

Statistical analysis was performed on a weighted study sample using SAS version 9.4 survey procedures. We compared the sociodemographic of men with or without a history of experiencing unwanted and non-consensual sex with the Pearson X² test. We used multivariate logistic regression models to assess the association between health outcomes and reporting unwanted and non-consensual sex. In adjusted models, multivariate regressions included variables with a p value ≤ .05 and found theoretically relevant in previous literature. Therefore, we controlled for age, race/ethnicity, and education level (Cook et al., 2016; Hawks et al., 2019). Unadjusted and adjusted odds ratios and 95% confidence intervals are reported.

Results

Bivariate analyses suggest significant differences among men that experienced unwanted or non-consensual sex compared to men that have not (Table 1). Black (23.8%, N = 373) and Hispanic (17.6%, N = 222) men reported experiencing unwanted and non-consensual sex at a significantly greater proportion compared to their white counterparts, χ² (3, N = 10,756) = 130.94, p < .0001. Compared to men that only experienced wanted and consensual intercourse, men with forced and unwanted sexual experiences were more likely to receive public assistance, χ² (1, N = 10,464) = 71.72, p <.0001, and live within the lowest poverty level χ² (5, N = 10,763) = 128.10, p < .0001. Likewise, men that reported unwanted or non-consensual sex were less likely to obtain a college degree (27.2% vs 35.0%) and more likely to have less than a high school education (18.1% vs 10.6%), χ² (3, N = 10,759) = 32.28, p <.0001.

Table 1.

Forced and Voluntary Sex by Demographic Variables (Weighted %).

Characteristic	Sample Population N = 10,763	Forced Sex, % N = 1,307	Voluntary Sex, % N = 9,456	p value
Percentage (95% CI)		10.33 (9.52–11.15)	89.67 (88.85–90.48)
Age, mean (95% CI)	31.23 (30.95–31.50)	31.64 (30.96–32.31)	31.18 (30.88–31.48)
Age at first sexual encounter (n = 10,000)
≤10	17.38	14.62	17.65	<.0001
11–14	16.83	27.52	15.78
15–17	42.11	37.07	42.60
≥18	23.68	20.79	23.96
Race/Ethnicity (n = 10,756)
White	41.27	27.82	42.82	<.0001
Black or African American	15.10	23.83	14.09
Hispanic	13.70	17.63	13.25
Other race groups	29.93	30.73	29.84
Born outside the USA (n = 10,760)
Yes	17.99	23.87	17.32	.0003
No	82.01	76.13	82.68	.0003
Public assistance (n = 10,464)
Yes	6.74	11.32	6.20	<.0001
No	93.26	88.68	93.80	<.0001
Family formation (n = 10,763)
Yes foster	0.18	0.14	0.19	<.0001
No foster, not intact	39.20	48.34	38.15
No foster, intact	60.62	51.51	61.67
Highest level of education (n = 10,759)
Less than high school	11.37	18.12	10.60	<.0001
High school or equivalent	24.92	27.23	24.65
Some college	29.56	27.48	29.80
College or beyond	34.15	27.18	34.95
Federal poverty level (n = 10,763)
0–99%	17.25	28.58	15.95	<.0001
100–199%	20.40	20.57	20.38
200–299%	16.72	16.37	16.76
300–399%	14.27	11.93	14.54
400–499%	9.62	6.55	9.97
500% or above	21.75	16.00	22.41
Sexual attraction (n = 10,716)
Only females	92.46	83.76	93.46	<.0001
Mostly females	3.66	6.48	3.33
Equally	0.81	2.47	0.62
Mostly males	0.90	1.92	0.78
Only males	1.58	3.11	1.41
Not sure	0.60	2.26	0.40
Past 12 months, jailed (n = 10,763)
Yes	5.94	8.78	5.61	<.0001
No	94.06	91.22	94.39	<.0001

General Health Outcomes

In models adjusting for age, race, and education-level, men that reported an unwanted or non-consensual sexual experience were more likely to have difficulty running errands alone (aOR = 2.8, 95% CI = [1.9, 4.1]) and serious difficulty concentrating, remembering, or making decisions (aOR = 2.1, 95% CI = [1.7, 2.7]) due to a physical, mental, or emotional condition (Table 2). The adjusted model strengthened the association with reporting illicit drug use, from OR = 1.61, 95% CI = (1.23, 2.11) to aOR = 1.75, 95% CI = (1.33, 2.30). Men that experienced unwanted or non-consensual intercourse were also more likely to rate their health as fair or poor (aOR = 1.5, 95% CI = [1.1, 2.0]) rather than excellent, very good, or fair. Men that reported an unwanted or non-consensual experience were no more likely to binge drink (aOR = 1.0, 95% CI [= 0.8, 1.2]) nor have a BMI greater than or equal to 30 (aOR = 1.1, 95% CI = [0.9, 1.3]).

Table 2.

Logistic Regression Models Predicting Health Outcomes by Unwanted or Non-consensual Sex

	Lifetime Experience		Odds Ratio
	Unwanted or Non-consensual, %	Voluntary (%)	Unadjusted (95% CI)	Adjusted (95% CI)
General Health Outcomes
Difficulty running errands (ref: no difficulty)	5.97	2.10	2.958 (1.995–4.385)	2.759 (1.875–4.060)
Difficulty concentrating (ref: no difficulty)	17.16	8.66	2.184 (1.761–2.707)	2.116 (1.686–2.655)
Illicit drug use (ref: no drug use)	9.18	5.91	1.609 (1.226–2.112)	1.747 (1.330–2.295)
Fair or poor health (ref: excellent, very good, or good health)	9.54	5.77	1.722 (1.293 – 2.294)	1.477 (1.098–1.987)
BMI ≥ 30 (ref: BMI ≤ 29)	32.85	29.58	1.165 (0.980–1.384)	1.110 (0.928–1.328)
Binge drinking (ref: no binge drinking)	20.87	21.76	0.948 (0.782–1.150)	0.979 (0.802–1.195)
Sexually Transmitted Infections
Never tested for HIV (ref: yes, tested)	35.84	48.79	0.586 (0.488–0.705)	0.610 (0.506–0.735)
No STI test in the past year (ref: yes, tested)	73.98	84.09	0.538 (0.444–0.652)	0.570 (0.465–0.700)
Genital Herpes (ref: no genital herpes diagnosis)	3.46	1.33	2.660 (1.607–4.405)	2.680 (1.576–4.558)
Genital Warts (ref: no genital warts diagnosis)	3.74	2.52	1.503 (0.937–2.413)	1.669 (1.036–2.688)
Syphilis (ref: no syphilis diagnosis)	1.49	0.53	2.832 (1.325–6.055)	2.404 (1.039–5.562)
Gonorrhea (ref: no gonorrhea diagnosis)	2.29	0.40	5.809 (3.300–10.224)	5.449 (2.978–9.969)
Chlamydia (ref: no chlamydia diagnosis)	2.03	0.74	2.763 (1.622–4.704)	2.525 (1.458–4.370)

Note. Bold indicates significance at p < .05.

Adjusted odds ratios control for age, race/ethnicity, and education level.

Sexually Transmitted Infections

The data suggest that unwanted or non-consensual sex was associated with an increased odds of a gonorrhea diagnosis (aOR = 5.4; 95% CI = [3.0, 10.0]) and chlamydia diagnosis (aOR = 2.5; 95% CI = [1.5, 4.4]) in the previous 12 months. Men that experienced unwanted or non-consensual sex also have increased odds for a diagnosis of genital herpes (aOR = 2.7; 95% CI = [1.6, 4.6]), genital warts (aOR = 1.7; 95% CI = [1.0, 5.6]), and syphilis (aOR = 2.4; 95% CI = [1.0, 5.6]) in their lifetime compared to men who did not experience unwanted or non-consensual sex. The odds of a genital warts diagnosis did not become significant until the introduction of the adjusted model (OR = 1.05, 95% CI = [0.94, 2.41] vs. aOR = 1.67, 95% CI = [1.04, 2.69]), and the model strengthened the relationship to a genital herpes diagnosis (OR = 2.66, 95% CI = [1.61, 4.41] vs. aOR = 2.68, 95% CI = 1.58, 4.56]). Men were more likely to receive a STI test in the past year (OR = 0.54, 95% CI = [0.44, 0.65]) and to receive an HIV test in their lifetime (OR = 0.59, 95% CI = [0.49, 0.71]) if they had experienced unwanted or non-consensual sex; however, the effect of this association weakened with the adjusted model (aOR = 0.6; 95% CI = [0.5, 0.7] and aOR = 0.6; 95% CI = [0.5, 0.7], respectively).

Discussion

This study explores the prevalence of unwanted and non-consensual sexual experiences in men and investigates associations with STI and general health outcomes. Approximately 1 in 10 sexually active men reported experiencing unwanted or non-consensual sex in their lifetime (10.3%), the weighted equivalent of 5,357,197 American men. Findings demonstrate men from all socioeconomic backgrounds, racial and ethnic groups, and education levels experience unwanted or non-consensual sexual encounters, with some groups carrying a higher burden of this risk than others. Likewise, the increased odds of STIs in men that experience sexual violence suggests the necessity of preparing clinicians to handle all STIs—in men or women—with a trauma-informed lens. Additionally, the data illustrate men that experienced unwanted or non-consensual sex have an elevated risk for fair or poor health, and difficulties with day-to-day activities due to a physical, mental, or emotional condition.

This study provides a wider scope of insight by analyzing a large, nationally representative sample, and by expanding the archaic model of rape to include all its forms—unwanted, coerced, and non-consensual. The prevalence of sexual violence produced by a study depend on the language of the questions and instruments selected by researchers. In a sample of 1,480 Los Angeles men, 7% acknowledged that they had been pressured or forced to have sexual contact after the age of 16 (Sorenson et al., 1987). Likewise, 3.8% of a national sample of 469 men reported that, since the age of 18, they had sexual contact with someone because they were threatened or physically forced (Elliot et al., 2004), and another California sample of 7,970 men reported that 16% of the sample experienced childhood sexual abuse before the age of 18 (Dube et al., 2015). As researchers impose restrictions on the experiences of respondents—age, method of coercion, degree of force—the prevalence of sexual violence respectively varies. With the undeniable mounting evidence of the existence of male survivors, not adapting clinical practices endorses rape myths and threatens to re-traumatize patients.

The elevated odds of receiving an STI diagnosis compliments other studies with the NSFG that demonstrated an increased likelihood of high-risk sexual behaviors. Non-consensual sex, for men, has been associated with STI-related risk behaviors, including a higher number of sexual partners over their lifetime (Cook et al., 2016; Nasrullah et al., 2015; Smith & Ford, 2010), sex with a person that has used intravenous drugs (Nasrullah et al., 2015; Smith & Ford, 2010), and with trading sex for money (Nasrullah et al., 2015; Smith & Ford, 2010). The culmination of these findings and the overall prevalence of non-consensual sex suggest the necessity of equipping physicians with clinical tools to converse with men about a potential history of trauma and their sexual health. The Substance Abuse and Mental Health Services Administration (SAMHSA) acknowledges the relationship between a person’s history of trauma and their engagement and comfort with primary care services (Huang et al., 2020). Trauma-informed care is one innovative strategy to maximizing the use of primary care services by realizing the universal prevalence of trauma and responding with actionable change. For example, implementing sexual trauma screenings in routine care with male patients provides male survivors an opportunity to be heard and to use their primary care provider as a segue to specialized treatment (Cook & Ellis, 2020; Polite et al., 2019; SAMHSA’S Trauma and Justice Strategic Initiative, 2014). Many guidelines and recommendations for sexual violence screening target women; however, the American Medical Association (AMA) states that all patients may be at risk for interpersonal violence and abuse (AMA, 2016). The AMA Code of Ethics states that physicians should “routinely inquire about physical, sexual and psychological abuse as part of the medical history” broadly, with all patients (AMA, 2016). Given that men who report previous victimization are more likely to experience both perpetration and victimization, primary care clinicians may be in a unique position to intervene and reduce violence on a larger scale (Walsh et al., 2020).

In this analysis, 513 men, a weighted frequency of 2,162,666 American males, agreed with the statement “I really didn’t want [my first vaginal intercourse] to happen at the time” but also stated they were never forced by a woman to have vaginal intercourse. Qualitative research revealed that men engage in unwanted sex to satisfy gendered sexual scripts—performing expectations of how they should act and what they should want (Ford, 2018). While we conceptually approach an understanding of why men may consent to unwanted sex, we still do not know the depths to which consenting to unwanted sex can affect men. Further qualitative research suggested men minimize their experiences of unwanted sex by enveloping themselves with the protection that hegemonic masculinity can afford: diminishing the woman’s power as an aggressor, employing humor to downplay the experience for themselves or for the sake of their masculinity, and insinuating that they maintained control (Ford & Maggio, 2020). However, men still acknowledged unwanted sex as negatively impactful, especially for younger or sexually inexperienced men, and men who were incapacitated, who perceived being manipulated, and who recognized power structures that disadvantaged them (Ford & Maggio, 2020). Our findings compliment this evidence that unwanted sex is associated with negative health outcomes; however, future research should investigate the relationship between wantedness, consent, and masculinity.

A study on the 1995 iteration of the NSFG, an iteration that asked women to rate the wantedness of their first intercourse on a 10-point scale, determined that a quarter of respondents who described their first intercourse as voluntary additionally rated that experience as unwanted (Abma et al., 1998). These findings validate that men similarly exhibit these decision-making intricacies. Although the inclusion of the same question in the female questionnaire as the male questionnaire promotes equality, the questions inequitably deny respondents with the opportunity to share unwanted experiences outside vaginal/penile intercourse, and unwanted vaginal/penile intercourse beyond their first encounter. Heteronormative questions remain as a vestigial limb of the NSFG origins as a survey on female fertility. While a three-point wantedness scale and a dichotomous variable describing forced sex is insufficient to capture the complexity of traumatic sexual experiences (Abma et al., 1998), this research furthers the evidence that we must include both unwanted and non-consensual experiences in analyses in order to capture the full spectrum of sexual trauma. Although the need for further research on this topic is clear, the release of the 2017–2019 NSFG iteration features no questions on non-consensual sex in either of the gendered data sets; with the summary of questionnaire changes since the 2015–2017 cycle bereft of the whereabouts of the two missing subsections (CDC, 2020). The lack of specificity in a question about sexual violence, and now the cavity of their absence, does not dispel the interaction of trauma and sexual health indicators. Rather, these associations between sexual violence and a person’s sexual and reproductive life course continue beneath the data, unspoken and silenced. Given this recent change, nationally representative data is critical to assess and monitor trends in the data reported here.

Limitations

A lack of information on the context of each unwanted and non-consensual encounter represents a limitation that directly affects clinicians and preventionists. For example, we did not analyze the sex of the perpetrator, the age of the perpetrator, the age of the respondent at the time of victimization, nor the potential for multiple instances of victimization over their lifetime. We additionally did not analyze the role of masculinity as it relates to unwanted and non-consensual experiences; future studies should qualitatively explore the effects of masculinity and the lived experiences of men who have had unwanted or non-consensual sexual contact.

Additionally, using secondary data limited the items available for analysis. For example, the NSFG only asks about the wantedness of a man’s first vaginal experience, which denies these men the opportunity to describe unwanted male experiences and unwanted female experiences beyond their first vaginal penetration. As mentioned in the discussion, the creation of the NSFG as a tool to collect information on female fertility has broadened to include male and female reproductive health. However, the interests of the nation in the citizen’s reproductive health does not equate to a vested interest in the nation’s sexual health. This not only suffers our body of literature on unwanted and forced sexual experiences, but the influence of negative sexual experiences roams unaccounted for as an undercurrent in the data. Moreover, in lieu of validated mental health measures, we relied on proximate measures of mental health that were included in the NSFG. These measures add some insight, but may not reflect the true relationship between negative sexual experiences and mental health outcomes.

Additionally, these data are cross-sectional and therefore we are unable to determine any temporality of the associations we noted. Survey collection data is subject to social desirability responses, give that NSFG data are collected via an in-person interviewer. However, many of the items analyzed in this study were completed via ACASI, which has been shown to improve the accuracy of the information collected (Villarroel et al., 2008; Metzger et al., 2000).

Conclusion

More men may experience sexual trauma than captured in previous studies when we consider the intersectionality of sexual consent and wantedness. These findings demand that clinicians consider the potential for a history of sexual victimization in their male patients and how this contributes to not only their risk of sexual infections, but how it threatens their well-being. Ultimately, this study lends witness to the prevalence of unwanted and non-consensual sex in men and provides justification to foster more research on their experiences out of nascency.

Footnotes

Author’s Note

Julia Aiken is now affiliated as an Epidemiologist at Colorado Department of Public Health and Environment, Colorado, United States.

Declaration of Conflicting Interests

Ethics Approval

Ethical approval was obtained from the North Texas Institutional Review Board.

Funding

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

ORCID iD

Stacey B. Griner

Authors Biographies

Julia Aiken, MPH, CPH, is an Epidemiologist for the Colorado Department of Public Health and Environment. Her research engages in the sexual and reproductive health of Fort Worth and analyzes national discussions of rape and consent in social media. She uses epidemiological approaches in a community-based setting to strengthen the local public health infrastructure.

Stacey B. Griner, PhD, MPH, CPH, is an assistant professor in the School of Public Health at the University of North Texas Health Science Center. Her research focuses on sexually transmitted infection prevention, particularly among sexual and gender minority populations. She uses implementation science and patient-centered approaches to translate public health research into clinical practice.

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