Adolescents that pair alcohol with their first sexual intercourse are more likely to engage in risky sexual behaviors and suffer from long-term negative physical and emotional effects, according to a new report.
Teenaged drinking can have numerous negative outcomes, but a new study reveals that it may also have lasting negative physical and psychosocial effects when paired with an adolescent’s first sexual experience.
“When an adolescent screens positive for drinking, pediatricians should also be talking to them about the sexual risks associated with drinking contexts,” says Jennifer A Livingston, PhD, senior research scientist at the Research Institute on Addictions at the University of Buffalo, in New York and lead author of the study. “There is a strong cultural expectation that drinking fuels and excuses casual sexual encounters. Many teenagers have gotten the messages about condom use, but they do not realize that hooking up with someone who is significantly older, not well known, or having sex with several different partners over time, increases their chances of encountering an aggressive or infected partner.”
In addition to the physical risks, alcohol use during early sexual encounters can also have lasting psychosocial effects.
“For young women, using alcohol at first sex actually decreases their sexual agency, that is, their control over their own bodies. This can have lasting effects on their sexual health,” says Livingston.
About half of all teenagers initiate intercourse before the end of high school. While researchers say that this behavior is both normal and a part of healthy development, adolescents are also at risk of many significant health issues as a result, ranging from unintended pregnancy to sexually transmitted diseases (STDs).
Identifying the conditions that transform normal and healthy sexual behavior to risky behavior may help lead to the development of better policies and practices to prevent negative outcomes and promote improved sexual well-being, according to the report.
The study examined nearly 300 young adults aged 18 to 20 years in New York via written surveys and personal interviews. Within that cohort, the median age at which alcohol was first consumed was 14.25 years, and first coitus was at 15.70 years. One quarter of those surveyed say alcohol was involved the first time they had sexual intercourse, with an average of 5 drinks consumed prior to having sex, according to the report.
Overall, the study found that the use of alcohol at first coitus was positively associated with age at first coitus, partner age, pressure to participate in sexual intercourse, and future risky sexual behaviors. In terms of the effect of alcohol on the first experience with intercourse alone, researchers found that alcohol negatively impacted the length of time a woman knew her sexual partner before engaging in coitus, and the extent to which the encounter was planned and desired.
Instances of alcohol consumption during the first coital experience also was more likely to occur outside of a romantic relationship, after a social gathering, or with a partner using substances, the report states. Additionally, 18% of the women studied who consumed alcohol at first coitus were more likely to report that the encounter occurred against their will or without their consent.
The risks associated with alcohol use related to sexual encounters are no secret-particularly sexual risks for women, increased risk of sexual assault, and STDs. Like adults, adolescents who use alcohol are more likely to engage in risky sexual behaviors, especially teenaged girls who are more likely to be indiscriminant in their choice of partners when alcohol is involved, the study notes. This may involve selecting a partner who is significantly older, someone they don’t know, or selecting multiple partners. The study reveals that adolescent girls who engage in intercourse with a partner at least 2 years older than themselves are less likely to discuss birth control options; are more likely to contract a sexually transmitted infections; and have a higher incidence of sexual assault and unintended pregnancy.
Cognitive and behavioral disinhibition brought on by alcohol can also increase risks, particularly for adolescents who drink in social settings and are susceptible to the influence of their peers.
The report also cites numerous research studies supporting the common perception that alcohol consumption leads to a loss of sexual inhibition and promiscuity. Many of these encounters occur in social settings, as well, which may also cause young women to feel additional pressure to engage in sexual activity-beyond the effects of the alcohol-whether they are prepared to do so or not, the study authors note.
There is a lot of pressure and significance surrounding a person’s first experience with sexual intercourse in US culture, and a negative first experience can shape the future of a person’s sexual behavior, according to the report. In studies about sexual initiation, most of the research has been based on age at the time of first intercourse. However, age related to peers at first coitus may have more impact that age alone.
“For example, adolescent females who initiated at an earlier age relative to peers were more likely to report that the encounter was unplanned and that they felt pressured by their partner to have sex,” the report states. “Among females, early first coitus has been linked to precocious puberty, delinquency, and risky sexual behavior, including having more sexual partners and having sex while under the influence of alcohol or drugs. This is likely to occur when early maturing girls affiliate with older adolescents, exposing them to developmentally advanced behaviors.”
Another argument is that context in which the first coitus occurs is the most significant in the development of future sexual behaviors.
“When first coitus occurred under conditions of coercion, child sexual abuse, or under the influence of alcohol or drugs, individuals experienced worse psychological and physical health outcomes over time than those whose first experiences occurred under consensual conditions, regardless of age of initiation,” according to the report. “These situations are characterized by a lack of control or violation of one's wishes. Having such an experience at a developmentally critical time point may result in the formation of maladaptive sexual scripts through mechanisms such as traumatic sexualization, perceived powerlessness, and depressed sexual assertiveness and self-efficacy.”
Study participants that used alcohol before their first coital experience also were less likely to know their partner, and were more likely to be pressured to participate in sex and later regret it.
The study also found that participants that used alcohol during their first sexual experience were also more likely to continue to engage in risky sexual behavior going forward. They were more likely than their peers who did not drink at the time of first coitus to regularly drink to the point of intoxication, and continued to practice risky sexual behaviors such as having sex with someone they had just met that day, and having sex after passing out from drinking.
Livingston says pediatricians should take note of the report’s findings, and work to counsel patients that are known to use alcohol on the long term risks when paired with sexual intercourse. Interventions aimed at delaying alcohol consumption are beneficial, and Livingston further suggests combining substance abuse and sexual behavior education efforts in middle school and high school students.
In counseling patients, however, Livingston says abstinence-only is not a realistic approach.
“Instead of simply lecturing teens on why they should not have sex (which does not work), provide opportunities for adolescents to reflect on the circumstances under which sexual contact would be positive and safe for them,” she says. “Having a plan and standards for themselves may lessen the allure of a drunken hook up.”
Adolescents benefit when healthcare providers share with them information, skills, and guidance to promote social competence and sexual health, she says. The Life Skills training approach, which empowers adolescent females to take charge of their sexual decisions, have been promising in previous studies, Livingston notes.