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

Journal of Sex Research, August, 2005 by David A. Strong, John Bancroft, Lori A. Carnes, Leah A. Davis, John Kennedy

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.