Presented at the 31 st Annual Meeting of the Society for Sex Therapy and Research .

1. THE EFFECT OF FIRST INTERCOURSE ON SEXUAL SELF EFFICACY, SEXUAL AVERSION AND CURRENT SEXUAL FUNCTION IN YOUNG ADULTS Presented at the 31st Annual Meeting of the Society for Sex Therapy and Research. Elke D. Reissing, Ph.D.

2. First time…but not the last time! (?) Vaginismus “I didn’t know I had a problem until we tried to have sex for the first time – it was awful; it took us months before we tried again … over the past 3 years we have tried to have intercourse maybe 2 times.” First intercourse is a remarkable experience in peoples’ lives - a rite of passage, a pivotal moment, a ready memory to recall at any time. What role does the first intercourse experience play in subsequent sexual adjustment?

3. Young adults’ sexuality High prevalence of sexual dysfunction in young adults (e.g., Lauman et al., 1999). During the decade of 20 – 30 years of age, every 2nd woman and every 3rd man reported at least one sexual problem (Ernst et al., 1993). Younger people tend to experience more distress about sexual problems (e.g., Barlow et al., 2003).

4. Factors related to sexual satisfactionin young adults Preponderance of studies on teenage pregnancy and risk of contracting a SDI. Limited information on sexual experiences of young adults and what factors may be related to positive sexual adjustment (e.g., Reissing, Laliberté, & Davis, 2005)

5. First Intercourse Experience In general: lack of empirical information Some information on the qualitative experience of girls and young women. Limited but more recent information on comparative studies of young men and women. Surprising paucity of information on the experience of young men. NO information on how positive or negative first experiences may set in place reinforcement contingencies for future sexual experiences.

6. 1st Intercourse ♀ / ♂ Different social meaning: - Loss of virginity vs. loss of inexperience and becoming a man - Losing the “gift” of virginity vs. the “social stigma” of being a virgin. (Carpenter, 2002; Holland, 2000)

7. 1st Intercourse ♀ / ♂ Different social meaning: Loss of virginity vs. loss of inexperience and becoming a man Losing the “gift” of virginity vs. the “social stigma” of being a virgin (Carpenter, 2002; Holland, 2000) Different expectations: Pain vs. Orgasm (Weis, 1983;Tsio & Nicoladis, 2004)

8. 1st Intercourse ♀ / ♂ Different social meaning: Loss of virginity vs. loss of inexperience and becoming a man Losing the “gift” of virginity vs. the “social stigma” of being a virgin (Carpenter, 2002; Holland, 2000) Different expectations: Pain vs. Orgasm (Weis, 1983; Tsio & Nicoladis, 2004) Different affective response: ♀ experienced fewer positive and more negative emotions, more anxiety and guilt, and less pleasure and satisfaction. ♂experienced more pleasure + satisfaction and less guilt, but also experience anxiety. (Darling et al., 1992; Guggino & Ponzetti, 1997; Sprecher et al., 1995; Weiss, 1983)

9. Affective reactions to 1st intercourse A large number of variables seem to affect whether or not a first experience is considered as subjectively pleasurable (♂+♀). Later age at 1st intercourse (>16; ♀) close, long-term relationship experience of orgasm contraception use first experience took place at home minimal to moderate pain experience (vs. strong pain) (♀) having expected pain (♀) no age discrepancy b/w partners no alcohol and drug use more “rehearsal” (prior non-coital activities including masturbation) (e.g., Guggino & Ponzetti, 1997; Schwartz, 1993; Sprecher et al., 1995; Tsui & Nicoladis, 2004; Weis, 1983)

10. 1st Intercourse affecting subsequent sexual adjustment Surprisingly lack of research Indirect evidence from clinical studies with reports of negative or disappointing 1st intercourse experiences. (Allen et al., 2003; Lamont et al., 2001; McCarthy, 2002) A focus on the interpersonal closeness with 1st-time partner is related to better sexual satisfaction for both men and women.  Study only looked at relationships wherein the first experience took place (Cate et al., 1993)

11. Purpose of study Currentsexual function 1st Intercourse

12. Sexual Self-Efficacy + Currentsexual function + 1st Intercourse

13. Sexual Self-Efficacy + + Currentsexual function + 1st Intercourse

14. Sexual Self-Efficacy + + Currentsexual function + 1st Intercourse - Sexual Aversion

15. Sexual Self-Efficacy + + Currentsexual function + 1st Intercourse - + Sexual Aversion

16. Sexual Self-Efficacy + + Currentsexual function + 1st Intercourse - - Sexual Aversion

17. A word about the directionality of our model: We impose directionality between the constructs consistent with our assumption that successful behavioural outcomes increase one’s expectations of personal mastery. Subsequent behaviours are guided by strong self-efficacy beliefs further predicting successful behaviour. Following a negative behavioural outcome, lack of exposure to sexual activity (aversion to and avoidance of sexual behaviour) further contributes ↓ efficacy beliefs because of a lack of “disconfirming opportunities”.

18. Method Recruitment: University Sample (Integrated System of Participation in Research, Introduction to Psychology, U of O)

19. Method Measures: Demographics Form First Coital Affective Reaction Scale (Schwartz, 1993) Sexual Self-Efficacy Scale—Female Functioning (Bailes, Creti, Fichten, Libman, Brender, & Amsel, 1998) Sexual Self-Efficacy Scale—Erectile Functioning (Libman, Rothenburg, Fichten, & Amsel, 1985) The Sexual Aversion Scale (Katz, Gipson, Kearl, & Kriskovich, 1989) The Sexual History Form (Nowinski & Lopiccolo, 1979)

20. Method Procedure: Chose study from a list of available studies online Register for participation by signing up for a time slot online Come to lab, welcome and brief description of study Retreat to private testing area and complete questionnaires Questionnaires place in envelope and dropped in a box

21. Method Sample: 536 participants 475 were included in analyses ♀322 ♂153 Main reasons for exclusion: Missing Data Sexual Orientation (other than hetero) No experience with sexual intercourse

22. Participant characteristics Men (N=153) Women (N=322) Age M: 20.6 yrs M: 19.6 yrs SD: 2.4 SD: 2.0 yrs Range: 18-29 Range : 18-29 Age at 1st intercourse M: 17.0 M: 16.7 Age of partner M: 16.8 M: 17.7 Orgasm at 1st intercourse Yes: 62.1% Yes : 6.3 % Use of drugs/alcohol Yes: 29.4% Yes : 19.3 %

23. Overall scores and gender differences aMen demonstrated more positive emotional reactions to first intercourse, t(473) = -5.32, p < .001. b Men demonstrated higher sexual self-efficacy than women, t(473) = 5.66, p < .001. cMen demonstrated better sexual function than women, t(473) = -11.15, p < .001.

24. Do you think your 1st intercourse experience changed the way you think or feel about sexuality? Men (N=153) Women (N=322) Negative (very to somewhat): 14% 16% No effect: 41% 36% Positively (very to somewhat): 45% 49% Note: ns χ2 , p=.639.

25. Correlations b/w reaction to 1st intercourse, sexual self-efficacy, sexual aversion, and current sexual function in ♂a an = 153 for all correlations. **p < .01. *p < .05

26. Correlations b/w reaction to 1st intercourse, sexual self-efficacy, sexual aversion, and current sexual function in ♀a an = 322 for all correlations. **p <.01.

27. Mediating effects of sexual self-efficacy and sexual aversion on reaction to 1st intercourse and current sexual function in ♂ Mediators Note. The β values are the correlations after controlling for mediator effects. *p < .05.

28. Mediating effects of sexual self-efficacy and sexual aversion on reaction to 1st intercourse and current sexual function in ♀ Mediators Note. The β values are the correlations after controlling for mediator effects. *p < .05.

29. Mediation model – ♂Direct correlation (r) .19* Currentsexual function 1st Intercourse

30. Mediation model – ♂ Direct correlations (r) Predictor and Mediators Sexual Self-Efficacy - .40** - .22** Currentsexual function 1st Intercourse Sexual Avoidance .25** .29**

31. Mediation model – ♂Indirect correlations (r) Sexual Self-Efficacy - .40** - .22** .11 NS Currentsexual function 1st Intercourse .12 NS Sexual Avoidance .25** .29**

32. Mediation model – ♀Direct correlation (r) .20* Currentsexual function 1st Intercourse

33. Mediation model – ♀ Direct correlations (r) Predictor and Mediators Sexual Self-Efficacy - .56** - .23** Currentsexual function 1st Intercourse Sexual Avoidance .33** .36**

34. Mediation model – ♀Indirect correlations (r) Sexual Self-Efficacy - .56** - .23** .07 NS Currentsexual function 1st Intercourse .08 NS Sexual Avoidance .33** .36**

35. Summary The affective reaction to the first intercourse experience appears to affect subsequent sexual adjustment via: increasing or decreasing the belief of the young man or woman to be a competent lover and, by increasing or decreasing sexual avoidance and aversion.

36. Limitations Relatively low N for men Self selected university sample Self report based on recall of the event (other circumstantial factors) Relationships are correlational, hence causation can not be assumed. Sexual Aversion Scale not optimal measure of sexual avoidance Direction of our model is theoretical / heuristic model to help exploration of the relationship b/w 1st intercourse and sexual adjustment.

37. Implications The first, consensual, heterosexual intercourse may be more important to subsequent sexual development than previously assumed. An assessment of the “first time” and the efficacy beliefs and aversive/avoidant beliefs and behaviours that may have resulted from a negative experience may need to be taken into account when conducting a thorough clinical assessment for sexual problems. This study indirectly supports the importance “C” in CBT for sexual problems, but it also highlights the importance of the “B”.

38. Implications Potential vicious cycle: Negative sexual self schema may predispose a young person to sexual dysfunctions via a negative 1st intercourse experience reinforcing negative expectancies and behavioural avoidance. Sex education and early intervention may help break the cycle – or prevent it from spinning into dysfunction. Recruitment of a community sample Closer examination of gender differences As well as confirming gender similarities.

39. Vaginismus …? Low sexual self efficacy and distorted beliefs about herself being able to engage in penile-vaginal intercourse. Significant aversion to and avoidance of intercourse following very negative first experience. Important not to discount first experience even if not consummated. Assess… Intervention preventing avoidance of “disconfirming opportunities”, and increasing sexual self efficacy by eliminating distorted beliefs is typically part of the treatment for vaginismus. BUT: Highlights the importance of engaging in BEHAVIOUR to disconfirm beliefs.