A Question of Love and Trust? The Role of Relationship Factors in Adolescent Sexual Decision Making

Abstract

Objective While representing only 25% of the sexually active population, 50% of all new STI infections occur among young people, mostly due to inconsistent condom use. Critically, the majority of adolescent sexual activity takes place in the context of romantic relationships, thus it is important to understand how relationship factors may influence decision-making about the use, or not, of protection. Method We utilized a mixed method approach to investigate the extent to which relationship length, degree of trust or love in the relationship, and frequency of intercourse influence both perceptions of the probability of condom use and self-reported condom use in the context of relationships among a diverse sample of high risk adolescents (ages 12–19). Results Participants were least likely to use condoms if they were in relationships with high trust/love and high frequency of intercourse. Importantly, sexual experience status was a strong moderator of primary effects. Conclusion The perspective of motivated cognition provides a useful theoretical framework to better understand adolescent decision-making about condom use, particularly for sexually experienced youth.

Sexual risk-taking and subcortical brain volume in adolescence

“…Ultimately, these findings are particularly intriguing in light of behavioral studies showing different patterns of sexual decision-making by gender (62). The sample presented with gender differences in pubertal development.…”

Developmental Cognitive Neuroscience of Adolescent Sexual Risk and Alcohol Use

“…In other words, based on emerging empirical work in this area [55], gender differences may exist within mesocorticolimbic reward and emotion regulation pathways (VTA, insula/ACC, striatum/NAcc, limbic systems), although the scope, size, and direction of these relationships has yet to be established. These developmental gender differences would be in line with the broader behavioral sexual decision-making literature, which suggests that adolescent girls are more likely than boys to have sex to bolster or advance emotional aspects of relationship development (to foster intimacy, love, and trust) [3]. While empirical studies in this area are needed, we posit that there may be neurocognitive and behavioral differences in adolescent male sexual decision-making across the dimension of reward, particularly in the early years of sexual activity.…”

“…The impact of this shift is that neural organization underlying sexual decision-making may manifest differently for adolescent females versus males. For example, the human behavioral literature indicates that adolescent females seek sexual interactions to foster relationship factors (getting and/or keeping a partner), rather than for physical reward (as is the case for adolescent males) [3]. Studies with adult humans have also shown gender differences in willingness to engage in sexual encounters, differences in sexual arousal and the sexual double standard [54].…”

“…One critical issue within adolescent examinations of risk behavior generally and sexual risk in particular revolves around ethics; in other words, there are greater advances in animal models of sexual risk and substance use behavior, and far fewer studies with human adolescents because many of these questions are ethically tricky to examine or manipulate. For example, we cannot randomize youth to sexual intercourse or not [3] nor to alcohol use or not [57], nor can we conduct the important laboratory-based work that directly examines the effect of alcohol intoxication on sexual risk decision-making [68]. Relatedly, the most commonly used stimuli to evaluate sexual decision making within MRI/fMRI studies with adults is erotica [26, 69], which is clearly not ethical for this age group.…”

“…Just under half of those youth (41 %) use condoms, and almost a quarter (22 %) report substance use—most commonly alcohol—before having sex. While initiation of “adult” behaviors including sex and drinking is common and normative for this developmental stage [2, 3], unsafe engagement in these behaviors (i.e., unprotected sex) increases the chance of unintended, serious, and sustained health consequences, including unplanned pregnancy, sexually transmitted infections (STIs) and the human immunodeficiency virus (HIV) [4]. These risks are exacerbated when alcohol use is part of the equation [5].…”