The impact of sexual arousal on sexual risk-taking: a qualitative study.

Until recently, the main emphasis in the literature on interventions to reduce sexual risk-taking has been on rational decision-making based on good information. It is being increasingly recognized, however, that sexual behavior is uniquely different from other types of risk-associated behavior because of the impact of sexual arousal: making decisions "in the heat of the moment" (Gerrard, Gibbons, & Bushman, 1996; Gold & Skinner, 1997; Kelly & Kalichman, 1995). Canin, Dolcini, and Adler (1999) commented that sexual arousal and desire for sexual satisfaction impose a sense of urgency that can distort judgment.

So far, attempts to study this fundamental aspect of sexual risk-taking, and how it might account for some people being more resistant than others to behavioral change, have been surprisingly few. Emmons et al. (1986), in a study of gay men, reported that "difficulties with sexual impulse control" were associated with less "avoidance of anonymous sexual partners"; however, "sexual impulse control" was not defined. In one of the few studies that has looked directly at the impact of sexual arousal on risk-taking, Boldero, Moore, and Rosenthal (1992) assessed heterosexual men's intent to use condoms in the future and then asked them to complete a further questionnaire immediately after a subsequent encounter, indicating their intention to use condoms immediately before the encounter, the extent to which they were sexually aroused, and whether they actually used condoms. The degree of sexual arousal during the sexual encounter was negatively associated with condom use. The authors commented, "the fact that the majority of those changing their intention shifted from intending to use condoms to having no thoughts of using condoms at the time of the encounter is suggestive of the influence of arousal" (p.1,392). Gold and Skinner (1997) looked at self-justifications that gay men use to explain unprotected anal intercourse (UAI). They concluded that in many cases, the decision to withdraw before ejaculating is most often taken "in the heat of the moment" rather than as a premeditated plan. In a later commentary, Gold (2000) proposed that such "heat of the moment" self-justifications could be explained as a consequence of the sexual arousal, tipping the balance towards UAI.

Our theoretical approach to studying the impact of sexual arousal on sexual risk-taking is based on the assumption that inhibition of sexual arousal, across species, is an adaptive mechanism that reduces the likelihood that sexual activity occurs in situations where such activity is likely to be disadvantageous (Bancroft, 1999). Our model postulates individual variability in this propensity for inhibition of sexual arousal. Using a psychometrically validated instrument to measure such individual variability (SIS/SES; Janssen, Vorst, Finn, & Bancroft, 2002), we have found close to normal distributions in the scores for sexual excitation proneness (SES) and sexual inhibition proneness (SIS1 and SIS2) in the several thousand men so far tested. The model postulates that for the majority of individuals, the propensity for inhibition (i.e., in the mid-range of the distribution) is adaptive, helping them avoid risk, but that a minority of individuals with low propensity for such inhibition become or remain sexually aroused in spite of the risk and are, as a consequence, more likely to engage in high-risk sexual behavior (Bancroft, 2000). We found support for this hypothesis in our studies of sexual risk-taking in both gay men (Bancroft et al., 2003a) and heterosexual men (Bancroft et al., 2004). In both studies, those with low scores on our measure of inhibition due to the threat of performance consequences (SIS2) were more likely to engage in unprotected penetrative sex.

This is of potential importance in developing effective intervention strategies, as it implies that different types of intervention will be required for different types of individuals. Put simply, the individual who, because of adaptive inhibitory response patterns, is less likely to take sexual risks, needs to be well-informed about what is and what is not risky behavior. The individual who becomes and remains sexually aroused in high-risk situations, in addition to being well-informed about risk, needs to understand this aspect of his personality and how such arousal can impair his risk management, resulting in the need to learn appropriate ways to plan ahead. This theoretical model, as postulated, invokes inhibitory mechanisms which are no more consciously intended or deliberate than are arousal mechanisms, a conceptualization compatible with the items which make up the SIS1 and SIS2 scales of the SIS/SES (e.g., one item of the 11 item SIS2 scale is "If I realize there is a risk of catching a sexually transmitted disease, I am unlikely to stay sexually aroused."). In order to make best use of this theoretical model for improving interventions, we need a better understanding of how these different patterns of response are experienced at the time. To what extent are individuals aware of the effect that sexual arousal is having on their perception of risk, and vice versa? The purpose of this article is to use a qualitative approach to explore such experiences. Because we found some potentially important differences in the impact of arousability on risk-taking between straight and gay men in our quantitative studies (Bancroft et al., 2003a; 2004), we have presented our findings from the present study separately for straight and gay men.

METHOD

Participants

In a questionnaire study of high-risk sexual behavior involving 744 homosexual and 1,282 heterosexual men (Bancroft et al., 2003a; 2004), all subjects were asked whether they would be willing to participate in an interview study. Recruitment of homosexual men was from the campus GLBT office, gay bars, other gay organizations or STI clinics; of the heterosexual men, 61% were recruited through student venues, and the remainder from various sites, including STI clinics and the internet. From those indicating willingness, subsamples were selected to provide a range of risk-taking behaviors, and we contacted them to invite them to participate. Interviews were carried out at the Kinsey Institute, STI clinics, or the participants' homes. This interview was also intended to explore the impact of mood on risk management. These results have been reported elsewhere (Bancroft et al., 2003b; Bancroft, Janssen, Strong, & Vukadinovic, 2003). In all, we interviewed 111 men; of these, 85 commented on the relevance of sexual arousal to risk management, and were thus suitable for systematic content analysis for this paper. Thirty-four (40%) were gay men and 51 (60%) were heterosexual men. See Table 1 for participant demographics.

Subjects were paid $30 for their participation. The Indiana University Bloomington Human Subjects Committee approved this study.

Interview Method

The interviews were conducted using qualitative interviewing techniques. The interviewers were intensively trained in both the research topic and the interviewing procedures. The format of the interviews was based on active interviewing techniques described by Holstein and Gubrium (1995). Traditional interviewing techniques in both standardized and qualitative interviewing assume the interviewer is a neutral interrogator and that the subject provides the information requested either in standardized or free-form answers. By comparison, the active interview attempts to "provide an environment conducive to the production of the range and complexity of meanings that address relevant issues, and not be confined by predetermined agendas" (Holstein & Gubrium; p. 17). Using active interviewing procedures, the interviewer and the subject actively create deeper understandings of the meanings of the events they describe.

Each interview, which typically lasted 45 to 60 minutes, was divided into three parts; first, the interviewee answered questions about his current relationship status and current satisfaction with his sexual life. In the second part, the respondent was asked to recall a sexual episode, preferably during the last 1 to 2 years, which he regretted, either at the time or subsequently. It was explained that regret could take various forms, such as regret about not using a condom, going further than he would want to, or simply regretting that the whole episode had occurred. Once an episode had been identified, a detailed narrative account of that episode was obtained, in the course of which the interviewer asked the subject to comment on the relevance of three aspects: sexual arousal, mood, and interpersonal control.

After the narrative was completed, the third part of the interview involved a series of open-ended questions about the general relevance of sexual arousal and control to the interviewee's risk-taking behavior; for example, "Do you find that generally when you're in a highly sexually aroused state it is more difficult to make sensible decisions?" The interviewer encouraged the subject to discuss these issues in his own terms. Each interview was audio-recorded and transcribed, and the transcript was content analyzed by two researchers. Disagreements or differences between coders were negotiated.

RESULTS

Results are presented separately for the gay and heterosexual men. In each case, responses to the general questions are reported first, followed by relevant content from the narrative accounts. Then illustrative quotes from either stage of the interview are presented. Each respondent is identified at the end of a quote by a capital letter.

Gay Men

All 34 gay/bisexual men commented on how, in general, sexual arousal affected sexual risk-taking. Twelve (35%) indicated that when sexually aroused, they were either definitely or probably more likely to take higher risks or engage in behavior they would later regret, whereas 8 men (24%) said they would take more risks, but would still use a condom. Four men (12%) said they would not take more risks, but they admitted it was hard to make the right decisions, whereas 10 men (29%) said they were not at all more likely to take risks because of being sexually aroused.

Of the 34 gay men interviewed, 20 provided a narrative account of a specific episode of risky or regretted sexual behavior in which the impact of sexual arousal was discussed in sufficient detail for the assessment of its relevance. Twelve of the 20 subjects (60%) clearly saw sexual arousal playing a role in their participation in this regretted or risky episode, and two different patterns emerged from their accounts. Eight men (40%) said that while they remained aware of the risk, they became aroused to a point where the risk seemed less relevant, while 2 men (10%) said they were so aroused they did not think about the potential risk at all. Two other men (10%) simply indicated that arousal increased the likelihood of their involvement in the regretted or risky encounter. Eight men (40%) did not feel that arousal was relevant to their risk management.

A typical example of how arousal affects risk-taking was given by an African-American college student. His risky and regretted episode occurred on an out-of-town trip where he cheated on his boyfriend, in an encounter that included him being penetrated in UAI with a relative stranger. He commented,

   Things progressed and you reach that point of no return where
   you realize that he's not going to use a condom.... It felt good
   and it was really weird because it felt like my mind and body were
   divided, because my body felt really good, but my mind was saying
   this is wrong, this is wrong, this needs to stop.... But I felt it
   was out of my hands ... I wasn't in control of the situation
   anymore. (Subject A)

In this episode, the other man was the instigator, both in terms of initiating the encounter and deciding that no condom would be used. So when the subject talked about not being in control, part of this indicates a loss of interpersonal control to his partner, but he is also clear that sexual arousal played a central role in his decision-making process. An important point is that despite being highly aroused, feeling a loss of control, and being intoxicated (something he says is not typical for him), the risks of this encounter, both in terms of HIV/STDs and the fact he was cheating on a supposedly exclusive partner, never completely left his mind. This sentiment was shared by several of our gay respondents; for them it is not that potential risks just "go out the window," but rather that they seem less important in the context of high sexual arousal.

This point was echoed by a Caucasian gay man in his 40s. When asked about whether it gets harder to make decisions when highly aroused, he said,

   It's a lot more difficult. I'd say that my defenses go down by at
   least 50%. It's not that I'm not aware of it but it just becomes
   a lot harder for me to make that decision. (B)

Similar feelings were expressed by a Caucasian gay man in his late 20s, who has, for several years, engaged frequently in casual sexual encounters:

   I remember being in the situation and thinking 'Gosh,
   I could get AIDS from this,' but it didn't slow me down in
   any way. (C)

When asked whether or not an awareness of the risks were still in his mind, he answered,

   It's still there, but the pleasure you're receiving overrides it
   and you just kind of give into that. (C).

Being aware of the risks but choosing to ignore them in the context of high sexual arousal was not the only pattern described. Some respondents reported being "swept away" and completely forgetting about any kind of risk. This is illustrated in the following episode, in which a gay man in his 20s was picked up by a stranger in a bar, and within an hour they were at a hotel where the subject was the "bottom" in an episode of UAI:

   The exhilaration of it all [being singled out and picked up by a
   partner he found very attractive] and the whirlwind effect, I
   wasn't sure what to expect and things were happening faster
   than I could react to them, and so in the heat of the action of
   course you're not going to think 'Hey, stop, wait a minute.' So we
   actually got to the physical parts of it before I had any thought
   of maybe we should use a condom. It just didn't come up. I can't
   really say why. (D).

This subject reported being very nervous in the time leading up to this encounter, and considered backing out of it several times, but once the actual physical interaction began, he never thought about using a condom.

Some gay men reported that sometimes they forget about the risk completely, but at other times, it just seems less important than sexual enjoyment. The following comments by a Hispanic college student are typical:

   The more aroused I am, the less I'll think about safe sex.... It
   doesn't seem as risky to me when I'm really aroused....
   Sometimes they [potential risks] can completely go away and
   then other times you're still aware of them, but at that point
   you're having such a good time it doesn't seem to matter. (E)

One of the most telling results to emerge from our use of subject narrative accounts of a risky or regretted episode was asking respondents how they felt once they had ejaculated and sexual arousal declined. In discussing a specific episode where he had oral sex with someone sooner than he wanted to, the Hispanic college student quoted above said,

   Pre-orgasm, I was all for it and afterwards it was like 'Wow.
   Should I have done that or not?' I started questioning after, not
   before. Not before at all.... [After ejaculating] when my heart
   rate starts to go down I start to think. I'm like, 'Oh
   gosh.' (E)

The following Caucasian gay man in his 20s had a sexual encounter with an acquaintance he had been attracted to for some time, and even though they did not engage in physically risky behavior (there was no anal intercourse or even oral sex), the subject, in retrospect, wished it had not happened, and this realization came soon after ejaculating.

   [I was] disappointed that I kind of let it happen. I mean, it was
   fine, but there's nothing worse than the silence after sex where
   you just know that you're both thinking about how much you
   shouldn't have had sex, and we were so in that space. (F)

Another man commented,

   When it was all over with I just wanted him out of there. I just
   wanted him out of my face. I didn't want to look at the guy, you
   know. I had to take him home, which was bad enough. (G)

Some gay men were clear that arousal did not interfere with their intention to use safe sex. The following man described how not using a condom would be threatening. This raises the possibility that maintaining sexual arousal is easier if appropriate precautions are taken.

   It's a little bit harder. I usually make myself ... it would
   scare me to do anything without it, so I usually make myself.
   I want to go ahead, but I know I have to stop and put on a
   condom. (H)

Another factor that influences the impact of arousal is the type of relationship between partners in a risky episode. Several respondents indicated that arousal was easier to manage in a casual encounter than in the context of a romantic relationship or situation. One subject, a white college student, captured this difference in his account. He said that with an established, romantic partner,

   [You] don't want to stop to say, 'Hey, we need to do this [put on
   a condom],' you're so into it you don't want to do anything to
   break that. (I)

However, he does not find arousal impacting his ability to decide to use a condom during a more casual encounter.

   For me personally, I can break that arousal or that intimacy with
   no problem and get back into it with no problem. I mean, for me
   it doesn't do anything to break the mood. It just doesn't. (I)

The following two quotes are also representative:

   I took the risk [having UAI with a short-term boyfriend he cared
   about] because I wanted to be involved with that person.... That's
   the time I will take bigger risks because I want to be committed
   to somebody or connected and want to share in those very intimate
   things that you can do. (J)

   It goes beyond arousal for me. With my boyfriend ... it's like I
   would feel even more connected to him, if we were able to have
   anal intercourse without a condom, and that is very desirable to
   me. (K)

These accounts from gay men illustrate the variable impact of sexual arousal on risk management. In some, the arousal seems to lessen the perceived risk, but in others, the risk goes "out of mind" once they are sufficiently aroused. Both effects may be more powerful in an established relationship compared to casual encounters. Other gay men say that sexual arousal does not influence their risk management.

Heterosexual Men

All 51 straight men commented on how sexual arousal affected sexual risk-taking. One half (26) said they were either definitely or probably more likely to take higher risks or engage in behavior they would later regret when sexually aroused. Twenty (39%) said while it might be more difficult, they would still use a condom or avoid risks, and 9 (17%) said sexual arousal did not affect their likelihood of taking risks.

Of the 51 straight men, 34 gave narrative accounts of a specific regretted or risky sexual episode that included comments on the relevance of sexual arousal. Only 4 of these 34 men (12%) said that sexual arousal had not affected their management of risk on that occasion. Of the remaining 30, 18 (53%) indicated that when sexually aroused, risk seemed less important, 8 (24%) said that when aroused they did not even think about risk, and 4 (12%) said arousal was relevant to risk for other reasons. The following quote is typical of those who are more likely to take risks when sexually aroused:

   ... definitely a lot more difficult just because it seems like once
   you get that on your mind ... the rational voice kind of gets
   hidden a little bit in your head. (L)

A Caucasian college student who engages in relatively frequent casual sex, despite having a steady girlfriend, said,

   It's, you know, working towards like a sexual frenzy type
   mentality here.... I usually won't start anything with a
   girl anymore, but if the girl starts kissing my neck or my
   ear or something, it's just, I'm lost. It's over. I don't
   have enough control. (M)

He is clear that he's not talking about losing interpersonal control to his partner, but rather, losing self-control once aroused. This account suggests a tendency to lose self-control in unexpected situations.

As with our gay respondents, several heterosexual men commented on the impact of the sudden loss of arousal that follows ejaculation: not only the confrontation with the risk that had been taken, but also other types of regret. A White college student who has had several sexual encounters he later regretted, when asked if his regret occurred immediately post-ejaculation, responded,

   That seems to happen quite a lot. I mean, it's kind of like,
   it just seems worthless after that. I mean, there's so much
   excitement and anxiety building up to that, and once you
   ejaculate it's like, 'Oh, no big deal.' I just want to
   leave. I want to get out of this weird situation. (N)

Another subject said,

   Its okay as long as you're having sex, but 30 seconds after you
   cum you're like 'No. Why did I do this?' (O)

The decline of sexual arousal following ejaculation may shift attention from the pleasure of the moment to other implications of the situation. As one man put it,

'Now what?' sort of thing. I was wondering if she was going to cling on and expect like a relationship, ... or if it was going to be like, 'Okay, we just did this and its over'.... I was really worried what she was going to expect from me after ... that was the main thing going through my head. (P)

Several straight men talked about how hard it was to make the decision to use a condom at the time one is highly aroused, so they had learnt to plan ahead deliberately to have a condom available, and also to be clear in their intention to use it. The following two comments are representative:

   I don't think I normally would have done that [engage in an
   encounter which included unprotected intercourse] if I wasn't so
   worked up.... It definitely does change the way you think. The
   hormones get going and once you get that worked up you're just
   concentrating on sex and you can't really think as well as you
   normally do.... I always think if there's going to be sex I
   already have to have the condoms purchased, because I know if I
   have to go out and actually buy the condoms then it's gonna
   make it a whole lot more difficult. (Q)

   I think you pretty much get tunnel vision ... its like when you're
   hungry, and it's just a lot worse than that. It sounds like a
   really great idea and you're just like 'Oh, the chances of
   something bad happening are so small, it'll be just this one time
   and then the next time I'll have something on me.' (U)

This subject went on to describe how he now plans ahead:

   I make the decisions ahead of time and I just don't do it anymore
   [have sex without a condom]. (U)

In the intervention literature, the principal emphasis is on using condoms or not having sex. Exactly what is meant by "having sex" is less often considered (Sanders & Reinisch, 1999). The following subject pointed out that there are alternatives to vaginal (or anal) sex if no condom is available:

   I honestly have the mindset that if sexual intercourse is an option
   and there isn't a condom there, it's not an option--there are other
   things that you can do that will take care of your sexual arousal
   with a person. It doesn't always have to be intercourse and it
   seems to me that the consequences that are there are just too
   ridiculously high to not think about that for one second. (V)

Although there has been growing attention to the impact of the condom itself on the sexual experience and how negative effects could discourage condom use by both straight and gay men, subjects in this study were not asked systematically about such effects. Some did comment, however:

   I enjoy it a lot more [without a condom]. The concept of being
   natural and not having a boundary; we're touching each other,
   that's good and that's the way it's supposed to be. The condom
   does bother me. (Q)

Only one subject described how the condom interfered with his sexual responsiveness. He described how he started the encounter with a condom on, and took it off halfway through: "the obvious reason is it feels better without a condom." He went on to describe how he would start a relationship using a condom: "for like two weeks and then after that we stopped and I just got used to having sex without condoms on." When asked whether wearing a condom makes a difference, he replied, "Yeah, it does. When I use a condom I usually don't ejaculate." (W)

Like our gay respondents, some straight men distinguished between sex within the context of a romantic, committed relationship and more casual encounters, saying that it is harder to make decisions in the context of a more romantic setting. A Caucasian college student's comments are representative:

   When you're in the 'making love' state, you've got the passion. The
   passion's really firing in there and that's getting your adrenaline
   going ... it's getting your brain to turn on the emotion and turn
   off the rationale. But when you're just 'having sex,' you're like,
   all right now, some emotion, but not as much and you've got more
   'rationale' going on in your head. You can think a little bit
   more. (X)

The interviews with straight men produced results similar to those from the gay men, with a clear variability across individuals. Some took risks when they were aroused, some recognized this difficulty and disciplined themselves to plan ahead, and others did not appear to find that arousal influenced their judgment. Some respondents actually found it more difficult to stay aroused if they had not taken appropriate precautions. Clearly, there are differences in the nature of risks involved between straight and gay men, with pregnancy as well as STDs being relevant to straight men, and STDs, particularly HIV, as well as possible legal consequences and other effects of social stigma being relevant to gay men. In both groups, risks to one's current relationship may apply. The impact of sexual arousal on risk management is likely to be relevant to most types of risk.

DISCUSSION

These qualitative data from both straight and gay men support the impression from our quantitative studies: that sexual arousal is an important factor in risk-taking, but individuals vary considerably in the extent to which sexual arousal impairs their risk management. The use of a narrative account, which requires the respondent to focus on a specific episode and describe it in detail, has methodological advantages; the answers to the more general questions that follow are likely to be better informed as a result (e.g., "this is what typically happens to me" or "I deal with this better now"). The limitations of this qualitative study should, however, be kept in mind. As with any self-report method of inquiry, answers may be influenced by post-hoc justifications or reflect the folk theories that prevail in the individual's subculture. In addition, this study was carried out in parallel with the large-scale quantitative study. If we had completed the qualitative study first, our questions in the main survey would have been improved, with some important additions derived from the qualitative data. If we had completed the quantitative study first, we would have selected participants to represent contrasting groups on our SIS/SES measures. As it turned out, we recruited a sample for the interview study in which those with high risk propensities related to sexual arousal were over-represented. In further qualitative research of this kind, more focus should be placed on those who do not find that sexual arousal undermines their risk management, so that a clearer picture of the mediating mechanisms in such cases may result.

With these limitations in mind, we can recognize three patterns evident in this study: (a) individuals whose risk management is impaired by sexual arousal on some if not all occasions; (b) those who have recognized the problem and have learned to plan ahead; and (c) those who do not find that arousal impairs risk management. Obviously, we do not know the prevalence of such patterns, and there may be others not apparent in this study, such as a tendency to be more sexually aroused because of the risk involved. However, they are useful in generating researchable questions about the mediating mechanisms involved. Other factors that emerged of potential relevance to mediation included (a) the impact of the relationship, with risk management being more difficult in a loving relationship than in a casual encounter; (b) experience of the post-ejaculatory period; and (c) negative effect of condom use. Let us then consider some possible explanatory mechanisms.

Neurophysiological Inhibition

Our theoretical model postulates a process by which appraisal of a situation as dangerous results in increased inhibition of sexual arousal. What this model, and the research derived from it, has not yet addressed is how this inhibitory response is mediated; in particular, how actively does the individual need to be thinking about the risk in order for the inhibition to result? Or, to use current terminology, to what extent is the inhibitory mechanism dependent on implicit or automatic, rather than explicit or controlled, information processing? It is possible that those who report not finding that arousal impairs their risk management may experience inhibition of arousal without having to think explicitly about the associated risk. This may underlie the third of our three observed patterns, whereas individuals without this established inhibitory response to recognizing risk could find themselves with either the first or second of the patterns. A crucial difference between the first and second pattern--whether or not the individual plans ahead, thus minimizing the impact of the sexual arousal--could depend on other aspects of the individual's personality. These possibilities should be studied in further research with large enough samples to allow exploration of personality mediators.

The issue of implicit appraisal of risk may be relevant to the impact of the relationship with the sexual partner, or the distinction between "making love" and "having sex." There is a growing literature addressing this issue (Elford, Bolding, Maguire, & Sherr, 2001; Flowers, Smith, Sheeran, & Beanil, 1997), although it is unusual for the interaction between intimacy and arousal to be considered. Is it that an implicit

appraisal of the intimacy and exclusiveness of the relationship lowers the perception of threat or risk and, hence, lessens the inhibitory component, even though the possibility of risk is considered? Or is it simply that such situations are more arousing, with excitation overwhelming inhibition? Is it a combination of both, or are there other relevant mechanisms not dependent on excitation and inhibition, such as the motivation to demonstrate one's commitment by taking the risk? This important aspect of sexual risk-taking deserves closer study.

Self-Regulation

Our theoretical model postulates a specific inhibitory mechanism relevant to sex. It could be argued, however, that sexual arousal is similar to the effects of alcohol or fatigue in impairing the monitoring and transcendence that is necessary for effective self-regulation (Baumeister & Heatherton, 1996). The relevance of such general mechanisms to "out of control" sexual behavior has been discussed in another article (Bancroft & Vukadinovic, 2004). The effects of alcohol have been formulated as the alcohol myopia theory (Steele & Josephs, 1990), which postulates that alcohol, by causing a restriction in attentional capacity, shifts the emphasis from inhibiting cues (those that emphasize the risks) to impelling cues (those that emphasize the benefits).

MacDonald, MacDonald, Zanna, and Fong (2000), in a series of experimental studies with male undergraduates, manipulated alcohol level and assessed subjective ratings of sexual arousal while watching a film of a sexual interaction between a man and a woman. This was followed by assessment of intentions, thoughts, and attitudes about engaging in unprotected sexual intercourse with the woman in the film. When participants were sober or taking placebo, their self-reports of sexual arousal were not related to these indices of sexual risk. When intoxicated, participants were more likely to report more favorable attitudes, thoughts, and intentions toward having unprotected sex than those who did not feel sexual aroused. They concluded that sexual arousal is a powerful internal cue that interacts with alcohol to increase the likelihood of sexual risk-taking. This illustrates how experimental methods can be used to explore these issues, but leaves us uncertain whether sexual arousal, which would be relatively modest in this experimental context, is acting in a similar way to alcohol or contributing to the process in a more specific way.

Some individuals commented on the striking contrast in how they feel between sexual arousal and the immediate post-ejaculatory phase when their sexual arousal has markedly declined. This aspect of sexual response and behavior has not received much attention in the literature, yet it is an excellent window into the impact of sexual arousal which could be used to get individuals to manage their sexuality. For example, "On the basis of previous experience, how will you expect to feel immediately after ejaculating? Will it be a feeling of calm and closeness to your partner? Or a feeling of satisfaction that you have achieved another sexual conquest? Or an immediate feeling of regret or alarm about the possible consequences?"

Although further research into the factors presented in this paper is needed, we can already make some suggestions relevant to individually-oriented interventions to reduce high-risk sexual behavior. Clearly, some men deal with the arousal problem by planning ahead in a determined fashion. This strategy can be discussed, particularly with those men whose arousability appears to be unimpeded by risk. Pointing out such individual differences may serve to motivate the individual to see this not as just common-sense advice, but of particular relevance to him. Encouraging the self-discipline of contemplating the likely post-ejaculatory reaction early in an encounter has already been mentioned, and can be added to the interventionist's agenda as one way of increasing the salience of inhibitory cues. On the other hand, the contrast between the romantic, or committed, and nonromantic, uncommitted situation is likely to be manifested in the subjective reaction immediately following ejaculation--the anticipated feeling of closeness and intimacy in the first compared with the regret, alarm about possible consequences, or a need to escape from the situation in the second. This emphasizes the importance of developing alternative intervention strategies to deal with potential risk in committed relationships. The impact of the relationship on risk management is a major factor for both straight and gay men and deserves careful research scrutiny in its own right.

Note. This study was made possible by NIMH Grant R01-MH60519-02.

Manuscript accepted August 11, 2004

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David A. Strong

The Kinsey Institute for Research in Sex, Gender and Reproduction and IUPUI

John Bancroft, Lori A. Carnes, and Leah A. Davis

The Kinsey Institute for Research in Sex, Gender and Reproduction

John Kennedy

Institute for Social Research, Indiana University

Address correspondence to John Bancroft, M.D., 4 Blenheim Road, Horspath, Oxfordshire, OX33 IRY, United Kingdom; e-mail: [e-mail].

Table 1. Demographic Characteristics of Participants (n = 85)

                                    Gay (n = 34)    Straight (n = 51)

Mean age                            28.9 (18-48)      21.2 (18-37)

Ethnicity
  Caucasian                             88%                76%
  Hispanic                               6%                 4%
  African American                       2%                14%
  Asian                                  2%                 2%
  Other                                  --                 4%
Socioeconomic status
  Upper-middle income                   12%                18%
  Middle income                         18%                23%
  Lower-middle income                   23%                20%
  Lower income                          35%                25%
  Poverty level                         12%                14%
Relationship status
  Exclusive                             18%                39%
  Non-exclusive                         32%                31%
  No current relationship               50%                29%
Mean # of partners in
 past year                          7.25 (0-50)        4.3 (0-30)
Lifetime number of one-night
 stands                             19.6 (0-200)       3.8 (0-50)
HIV status
  HIV-negative                          100%               96%
  Unknown                                --                 4%