It's [NOT] All about Sex, Baby: Sexual Behaviors As Mediators of Sexual Wellbeing

Background: The majority of youth sexuality research is focused on the negative impact of engaging in sexual behaviors. Youth with histories of trauma are deemed particularly vulnerable to negative sexual outcomes. However, two bodies of research challenge these deficit-focused perspectives. First, youth researchers increasingly affirm sexuality as developmentally normative. In addition, studies of resilience challenge the assumption of inevitable negative outcomes for those with trauma histories. These strengths-based perspectives guided this study of sexual behaviors as a mediator of emerging adults’ sexual wellbeing in the context of adverse childhood events (ACEs).

Methods: A sample of 375 18-25 year olds were recruited through Amazon Mechanical Turk to complete an online survey about sexuality and relationships. Participants were, on average, 22 years old (SD = 2.13), split fairly evenly across genders (44.4% women, 55.6% men), and predominantly identified as white (66.8%). Baseline surveys included the ACE Questionnaire (childhood maltreatment), the Brief Resilient Coping Scale (resilience), and items about sexual experiences (i.e., performing/receiving oral sex). Follow-up surveys were administered at 6-months (n = 249), and included subscales of the Multidimensional Sexual Self-concept Questionnaire (sexual wellbeing).

Structural equation modeling in Mplus 7 was used for all analyses. Full information maximum likelihood with auxiliary variables to correct for missing data were used. Model 1 assessed the relation between resilience and sexual wellbeing as mediated by sexual behaviors. Models 2 and 3 probed this model to assess the moderating effects of ACEs and gender using multigroup models.

Results: Some form of maltreatment occurring before someone’s 18^th birthday was prevalent. Psychological abuse was most common (28.9%), followed by physical abuse (20.4%), and sexual abuse (11.4%). Participants reported having about nine sexual experiences (SD = 8.5; range 0 – 40).

SEM results indicated that number of sexual experiences mediated the relation of resilience to measures of sexual wellbeing (sexual consciousness, assertiveness, monitoring, esteem, motivation). The indirect path and the constituent paths were positive: increased resilience was associated with increased number of sexual experiences, which was in turn associated with increased sexual wellbeing. There were also positive direct effects of resilience on sexual consciousness, esteem, and motivation.

Probing the model by ACE scores (< 2 versus 2+ ACEs) highlighted that number of sexual experiences only mediated the relation between resilience and sexual wellbeing for individuals with low ACE scores. Probing the model by gender showed that number of sexual experiences mediated the relation between resilience and sexual wellbeing for women but not men. For both models, indirect effects of resilience were evident for sexual consciousness, assertiveness, monitoring, esteem, and motivation.

Implications: Results align with normative views of youth sexuality and indicate that sexual behaviors are not inherently problematic or endangering, even for some with trauma histories. In fact, they may promote sexual wellbeing within certain contexts. Findings indicate that social work practitioners, policymakers, and researchers must attend not only to youths’ sexual behaviors, but also to promoting individual and contextual factors that foster youth resilience.