Satisfaction at Sexual Debut and Sexual Risk Among Young Black Men Who Have Sex With Men

PURPOSE: Sexual satisfaction is a key determinant of sexual health and well-being. Little work has examined how satisfaction during first sexual experiences influences later sexual risk. We sought to understand how experiences of physical and emotional satisfaction during first penetrative same-sex sexual experiences impacts future condom use and sexual risk among young Black men who have sex with men (YBMSM). METHODS: 152 YBMSM, aged 15-24, completed an Internet survey to assess how young men initiate early same-sex sexual relationships and sexual trajectories. Respondents rated emotional and physical satisfaction during first penetrative sexual experience with another man, and also their current condom use. Current sexual risk included scoring ≥3 across six questions regarding new and/or concurrent sex partners, history of sexually transmitted infection, ≥2 sex partners in the past three months, and no or inconsistent condom use. To examine the association between physical and emotional satisfaction during the first penetrative same-sex experience and both condomless sex in the past three months and sexual risk, multivariate logistic regression analysis was used. RESULTS: Mean age at sexual debut was 15.59 (SD=2.88) years, and moderate to high levels of emotional (50%) and physical (66.45%) satisfaction were common. YBMSM who described high levels of emotional or physical satisfaction, defined as very or extremely satisfied, at sexual debut were no more likely to engage in condomless sex or have high sexual risk compared to individuals who described low levels of satisfaction, controlling for age, condom use, and sexual arousal at sexual debut. Instead, younger age, condomless sex, and the presence of sexual arousal at sexual debut were significantly associated with increased sexual risk. CONCLUSIONS: Arousal at sexual debut, rather than satisfaction, may be key to understanding future sexual risk among YBMSM. These findings highlight the need for future longitudinal work to consider the role sexual arousal plays in determining sexual trajectories in adolescents. Future prevention strategies targeted to YBMSM must be delivered both prior to sexual debut and throughout adolescence, and include strategies regarding the negotiation of safer sex when sexually aroused. THESIS READERS: Susan G. Sherman, PhD, MPH and Danielle German, PhD, MP