Alcohol Use and Sexual Behavior

2015

Generally, when disinhibitionas a consequence of alcohol use is discussed major interest is in the disinhibition of behavior rather than feelings. Alcohol could directly disinhibit behavior through its physiological and expectancy effects or alcohol could heighten sexual feelings which in turn could lead to changes in sexual behavior.

A global relationship between overall frequency or quantity of alcohol use and overall frequency of sexual behavior in women does exist. Women who drink more heavily may evidence more nontraditionalsexual behaviors, including premarital intercourse, masturbation to orgasm, and admitted homosexual feelings.

It is commonly believed that young women, particularly those in new or casual relationships, are more likely to engage in sexual behavior after they consume alcohol. However, whereas the literature clearly suggests that alcohol use, at least in moderate amount, increases feelings of sexual arousal and desire and decreases feelings of inhibition for some groups of women, much less evidence supports its disinhibition of womens sexual behavior. Feelings about sex — sexual desires and urges — that may be enhanced through alcohol use are not necessarily reflected in behavior. In fact, in a daily diary study, alcohol consumption by women was inversely related to female-initiated sexual activity. Only 22% of respondents in the national sample of womens drinking reported ever becoming more sexually forwardwhen drinking and only 8% stated they became less particular in choice of sexual partners. Other studies indicate that relative equal percentages of women think alcohol consumption has positive and negative effects on sexual performance, and still others find no differences in sexual activity between alcoholic and nonalcoholic women.

Alcohol Use and Risky Sexual Behavior

Women now constitute the fastest growing group likely to contract AIDS and the proportion of adolescent girls who have become infected is worryingly high. Moreover, minority women have been disproportionally affected by the AIDS epidemic; the number of reported AIDS cases associated with heterosexual transmission has been steadily increasing, and these cases occur more frequently in women than men. Two major risky sexual behaviors are nonuse of condoms and vaginal or anal intercourse with multiple partners. Although use of condoms has increased among US women since 1985, most investigators concur that the majority of adolescents and young adults at risk do not use condoms regularly during intercourse.

The literature supports a relationship between overall alcohol use and engaging in risky sexual behaviors. Persons who drink more heavily have more sexual partners and less frequently use condoms. While few studies focus specifically on women, a recent investigation provides indirect evidence that alcohol use is associated with risky sexual behavior in women. This representative survey of 968 households in the San Francisco Bay area in 1988–89 strongly supports problem drinking as a risk factor for STDs. Female problem drinkers were approximately 4.5 times more likely to have had an STD even when all other potential risk factors (e.g., age, drug use) were controlled. Problem drinking heightened risk of sexually transmitted diseases more than did a history of multiple sexual partners. It is noteworthy that among women, two drinking variables — frequent bar going and high-volume drinking — were important contributors to a history of a high number of sexual partners when other factors were controlled. Thus, these two variables indirectly contribute to risk of HIV and other STDs.

When the relationship between risky sexual behaviors and the use of alcohol immediately preceding or at the time of sexual contract is retrospectively reported for a specific time period, the trend is for alcohol consumption and risky sex to be associated. In many cases, this association may be attributable to uncontrolled third variables. For instance, in a survey of the San Francisco Bay area, a strong relationship was found for women, and men as well, between frequency of alcohol consumption in conjunction with sexual activity and the frequency of sexual risk-taking, but the relationship disappeared when total amount of sexual activity was taken into account.

When women are asked about alcohol use associated with discrete sexual events, results are mixed, with most studies showing no differences in unprotected sex between drinking and nondrinking sexual encounters. In one study of adolescents, however, drinking prior to specific instances of intercourse (first intercourse with most recent partner and first instance of intercourse) increased the likelihood of risky sex. These effects remained significant after controlling for age, race, and pattern of alcohol use and were similar for girls and boys. In contrast, the only two studies that have used a daily diary method to examine the relationship between alcohol use and sexual behavior on the individual incident level did not support a positive association between alcohol use and risky sexual practices. Harvey and Beckman reported no relationship between coitus-dependent contraceptive use and alcohol consumption, whereas Leigh found that for sex with new partners there was a trend toward more safe sex when drinking occurred.

 

Selections from the book: “Recent Developments in Alcoholism. Volume 12: Alcoholism and Women.” Edited by Marc Galanter. An Official Publication of the American Medical Society on Alcoholism, the Research Society on Alcoholism, and the National Council on Alcoholism. 1995.