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Background Probability-based surveys of college students typically assess sexual behaviors such as oral, vaginal, and anal sex. Little is known about the broader range of sexual behaviors in which students engage. Aims In a random sample survey of undergraduate students, we aimed to: (1) describe how recently participants had engaged in solo and partnered sexual behaviors, (2) examine how frequently participants enacted certain rough sex sexual behaviors (e.g., light spanking, hard spanking, choking, slapping, and others), (3) assess participants’ frequency of experiencing certain rough sex behaviors, (4) describe participants’ frequency of threesome/group sex, (5) assess the characteristics of participants’ experiences with choking during sex; and (6) examine choking and face slapping in regard to consent. Methods A confidential, online cross-sectional survey of 4,989 randomly sampled undergraduate students at a large U.S. university. Outcomes Participants reported having engaged in a broad range of solo and partnered sexual activities, including rough sex behaviors. RESULTS The most prevalent general sexual behaviors were solo masturbation (88.6%), oral sex (79.4% received, 78.4% performed), penile-vaginal intercourse (73.5%), and partnered masturbation (71.1%). Anal intercourse was the least prevalent of these behaviors (16.8% received, 25.3% performed). Among those with any partnered sexual experience, 43.0% had choked a partner, 47.3% had been choked, 59.1% had been lightly spanked and 12.1% had been slapped on the face during sex. Clinical translation College health clinicians and educators need to be aware of the diverse and evolving range of solo and partnered sexual behaviors reported by students. In addition to counseling students about pregnancy and sexually transmitted infection risk, clinicians might assess patients’ engagement in diverse sexual behaviors, such as choking/strangulation during sex, given the risk for serious outcomes including death. Strengths and limitations Strengths of our research include the large sample size, use of random sampling, high response rate for college populations, broad range of behaviors assessed, and novel data on choking during sex. Among our limitations, we did not assess to what extent the experiences were wanted, pleasurable, or appealing to participants. Except for in relation to choking and slapping, we also did not assess issues of consent. CONCLUSION Participants reported engaging in diverse sexual behaviors, some of which have important clinical implications, are understudied, and warrant further research.

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Recent research indicates that some young people initially learn about sexual choking through Internet memes. Thus, a qualitative content analysis was performed on 316 visual and textual memes collected from various social media websites and online searches to assess salient categories related to choking during sex. We identified nine main categories: communication, gendered dynamics, choking as dangerous, choking as sexy, sexualization of the nonsexual, shame and worry, romance/rough sex juxtaposition, choking and religious references, instructional/informational. Given that memes, through their humor, can make difficult topics more palatable and minimize potential harm in the phenomenon they depict, more concerted, synergistic effort that integrates media literacy into sexuality education programming on the potential risks that may ensue for those engaging in sexual choking is warranted. Supplementary Information The online version contains supplementary material available at 10.1007/s10508-022-02502-5.

Introduction: Using data from the 2018 National Survey of Sexual Health and Behavior, we determined the prevalence and content of adolescents' and young adults' communication with healthcare providers about condom use.Methods: Adolescents (14-17 years-old; n = 283) and young adults (18-24 years-old, n = 225), who discussed sexual health with a healthcare provider in the past-year, reported if they had discussed condom use with a healthcare provider and among those who did, they also reported why healthcare providers recommended condoms, if they demonstrated correct condom use, and/or provided condoms. Data collection occurred in February and March 2018.Results: Most adolescents (71.0%) and young adults (66.7%) who discussed sexual health with a healthcare provider, reported discussing condom use. Condoms were most often recommended for both pregnancy and STD prevention. Fewer adolescents and young adults were shown how to use condoms (11.4% of adolescents; 5.7% of young adults) or provided condoms (14.9% of adolescents; 14.7% of young adults). Only 3.2% of adolescents and 1.3% of young adults had healthcare providers who discussed, demonstrated, and provided condoms.Conclusions: Sexual health conversations with healthcare providers are likely to include condoms. But few adolescents and young adults were shown how to use condoms or provide condoms.Policy Implications: Providing healthcare providers with resources and trainings about how to talk about condoms with patients may lead to more adolescents and young adults learning medically accurate information about condoms. Healthcare offices and clinics could also provide condom use resources outside of provider-patient interactions.

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