Debby Herbenick

Indiana University Bloomington | IUB · Department of Applied Health Science

This chapter outlines the current state of the literature on adolescents’ pornography use and sexual socialization (e.g., beliefs, attitudes, behaviors). Most adolescents have seen pornography, with over half reporting first viewing pornography prior to age 14, whether intentionally or not. In general, adolescents’ use of pornography has been assoc...

Background Pubic hair removal (PHR) is common among women in the United States, and understanding current practices is important for public health efforts. The most recent national study focusing on U.S. women’s PHR habits and their correlates was conducted over a decade ago. Objectives The current study aims to provide an updated understanding of...

Perimenopausal symptoms adversely impacting women’s sexual health are often unacknowledged or even dismissed by healthcare professionals (HCP). Using semi-structured interviews with 23 women experiencing perimenopause, we aimed to understand how HCPs address women’s sexual health needs and concerns during this transition. Thematic data analysis was...

Understanding current pubic hair removal (PHR) practices is vital for public health, given the prevalence among U.S. adults. This study updates the understanding of PHR practices, motivations, and correlates in a nationally representative sample of adult men. In April 2023, through a probability-based internet panel survey (Ipsos KnowledgePanel®),...

Introduction Consensual sexual choking has become prevalent among young United States (US) adults. In sex between women and men, women are overwhelmingly the ones choked, perhaps reproducing traditional heteronormative power dynamics. No research has examined the relationship between being choked during consensual sex and the use of external condom...

Methodologists from a variety of social and behavioral sciences have called attention to misunderstandings, misclassifications, and misapplications of third variable "controls" in observational research. We are unaware, however, of a comprehensive discussion of these issues in the sexological literature. In this article, we attempt to detail severa...

Introduction Sexual choking is a form of strangulation that involves using one’s hands, limb, or ligature to press or squeeze the neck, thus reducing blood and/or air flow, and has become prevalent among young adults in the United States. Yet, little is known about how sexual communication and consent occur in the context of choking, especially as...

Background In May 2023, the Food and Drug Administration (FDA) released final guidance for blood donor eligibility that recommended the elimination of 3‐month deferral for men who have sex with men (MSM) and the related deferral for women who have sex with MSM. In its place, FDA introduced an individual risk assessment policy of asking all presenti...

Using national probability data from the 2022 National Survey of Sexual Health and Behavior, the present study evaluated whether moderators of the association between frequency of pornography exposure and condomless sex are consistent with the sexual script acquisition, activation, application model’s (3AM) suppositions about the facilitating effec...

Background There has been a great deal of public speculation regarding a surge in erectile dysfunction (ED) in younger men despite data consistently indicating that the ED prevalence rates increase with age. Aim In this study we sought to assess the prevalence and risk of experiencing ED in a nationally representative sample of men in the United S...

Purpose of Review Sexual choking/strangulation—usually done as part of consensual sex—has increased in prevalence among U.S. adolescents and young adults. Thus, it is critical for sexual health professionals to become aware of this emerging sexual behavior, how people engage in it, as well as short-term and potential long-term health consequences....

Introduction Being choked/strangled during partnered sex is an emerging sexual behavior, particularly prevalent among young adult women. Using a multiparameter morphometric imaging approach, we aimed to characterize neuroanatomical differences between young adult women (18–30 years old) who were exposed to frequent sexual choking and their choking...

Abstract Historically, Black sexuality has been depicted through a risk-based lens rather than a sex-positive lens. This study analyzed data from a subset of 540 Black heterosexual adolescents and adults who participated in the 2018 National Survey of Sexual Health and Behavior. Masturbation, penile-vaginal intercourse, and oral sex were the most p...

Awareness of and discussions with a healthcare provider (HCP) around pre-exposure prophylaxis (PrEP), an effective HIV prevention method, are associated with PrEP uptake, yet few studies utilize representative samples or report on these outcomes using distinct behavioral risk subgroups. This cross-sectional study utilized responses given by men on...

Despite well-documented individual, relational, and health benefits, masturbation has been stigmatized and is understudied compared to partnered sex. In a US nationally representative survey of adults, we aimed to: (1) assess the prevalence and frequency of participants’ prior-year masturbation, (2) describe reasons people give for not masturbating...

Being choked or strangled during partnered sex is an emerging sexual behavior, prevalent among young adult women. The goal of this study was to test whether, and to what extent, frequently being choked or strangled during sex is associated with cortical surface functioning and functional connectivity. This case-control study consisted of two groups...

Recent research indicates that some young people initially learn about sexual choking through Internet memes. Thus, a qualitative content analysis was performed on 316 visual and textual memes collected from various social media websites and online searches to assess salient categories related to choking during sex. We identified nine main categori...

To understand how household context factors impacted self-reported changes in solo and sexual behaviors in U.S. adults during early stages of the COVID- 19 pandemic, we conducted an online, nationally representative, cross-sectional survey of U.S. adults (N = 1010; aged 18–94 years; 62% response rate) from April 10–20, 2020. We used weighted descri...

Research on parental knowledge and positive adolescent adjustment suggests that more accurate levels of the former increase the likelihood of the latter. Despite a significant body of literature correlating adolescent pornography use with negative adolescent adjustment, however, only a handful of studies have compared parents’ beliefs about their c...

Objectives: To examine changes over time in event-level condom/contraceptive use and the association between past year penile-vaginal intercourse frequency and event-level condom/contraceptive use. Methods: Data were from the 2009 and 2018 National Survey of Sexual Health and Behavior, an online probability survey of U.S. adolescents and adults....

In a confidential U.S. nationally representative survey of 2,525 adults (1300 women, 1225 men), we examined participants’ event-level sexual behaviors, predictors of pleasure and orgasm, and perceived actual and ideal duration of sex, by gender and age. Event-level kissing, cuddling, vaginal intercourse, and oral sex were prevalent. Sexual choking...

Recent meta-analytic and other large-scale multi-sample studies have established that pornography use is generally associated with lower relational satisfaction. Nevertheless, much remains unknown about the potential boundary conditions of this relationship. Using data from a campus-representative probability sample of more than 750 graduate studen...

Although sexual choking is now prevalent, little is known about how people engage in choking in terms of frequency, intensity, method, or potential health sequelae. In a campus-representative survey of undergraduate and graduate students, we aimed to: (1) describe the prevalence of ever having choked/been choked as part of sex; (2) examine the char...

Background: A growing body of research focuses on the quality of sexual experiences, such as the importance of sexual pleasure, comfort, and intimacy for overall health. Building upon this work, this study aims to develop a deeper understanding of the dimensions of sexual experiences using data from 2897 adult participants from the 2018 National S...

Vulvar inflammatory dermatoses (VID; e.g., lichen sclerosus, lichen planus, vulvar dermatitis) can significantly impact sexual function. Both vulvar and non-vulvar inflammatory dermatoses (NVID; i.e., skin conditions not impacting vulvar skin, such as non-genital psoriasis and eczema/dermatitis) have yet to be fully characterized with regard to imp...

Being strangled, or “choked,” by a sexual partner has emerged as a prevalent, often wanted and consensual sexual behavior among adolescent and young adult women, yet the neurological consequences of repeated exposure to this behavior are unknown. The objective of the study was to examine the association between a history of repeated, recent choking...

IntroductionUsing data from the 2018 National Survey of Sexual Health and Behavior, we determined the prevalence and content of adolescents’ and young adults’ communication with healthcare providers about condom use.Methods Adolescents (14–17 years old; n = 283) and young adults (18–24 years old, n = 225), who discussed sexual health with a healthc...

Sexual choking, which is a form of strangulation, can lead to various health consequences, including death. Recent surveys suggest that sexual choking is prevalent among young U.S. adults, a demographic also likely to view pornography. Pornography professionals, social commentators, and scholars have noted that mixed-gender choking is normative in...

The ills of modeling variables substantively involved in a causal process as “controls” have been discussed extensively by social scientists who do not study media. Until recently, Slater was one of the few communication scientists to suggest that media effects scholars engage in overcontrol. Bushman and Anderson have now echoed this concern in the...

Solo and partnered sexual behaviors are relevant to health, well-being, and relationships. Recent research shows that sexual frequency has declined in the U.S. and in other countries; however, measurement has been imprecise. We used data from 14- to 49-year-old participants in the 2009 and 2018 waves of the National Survey of Sexual Health and Beha...

One of the most consistent findings in content analyses of popular, commonly consumed pornography is the near absence of condoms. A recent meta-analysis found that pornography use is associated with an increased likelihood of condomless sex, but the studies available for analysis rarely included measures of potential cognitive mediators underlying...

Using data from 2069 romantically involved, randomly sampled, college students (53.8% female; mean age = 20.29; 74.6% White non-Hispanic; 83.0% heterosexual) we examined the prevalence of sexting and sexting interest with current romantic partners. Most students sexted with their current partners (55.3%), 8.9% did not sext but wanted to, 1.9% did n...

Objective: Present study aims to: 1) examine demographic correlates of LGB, asexual, or not sure participants 2) describe the prevalence of diverse sexual behaviors, 3) assess the prevalence of event-level sexual behaviors and 4) examine predictors of sexual pleasure. Participants: 761 non-heterosexual undergraduates at a large, public U.S. univ...

Using data from a 2014 U.S. nationally representative probability survey and a 2014 content analysis of 2562 male–female videos from two popular pornographic websites, this study aimed to: (1) compare the prevalence of survey respondents’ event-level sexual behaviors with those depicted in mainstream pornography online videos; (2) compare event-lev...

The purpose of this study was to investigate how various subgroups based on gender, sexual identity, and political ideology conceptualize rough sex. We used available data from a 2020 survey of randomly sampled undergraduate students at a large public university in the Midwestern U.S. (n = 4,989). The dichotomous responses to 13 items on the rough...

In the wake of the COVID-19 pandemic, most U.S. colleges closed their campuses—including residence halls—causing significant disruption to students’ lives. Two waves of data were collected from undergraduate students enrolled at a large U.S. Midwestern university: Wave 1 was a confidential online survey of 4989 randomly sampled undergraduate studen...

Objective: The purpose of this study was to investigate challenges women face before inflammatory vulvar dermatosis diagnosis to guide interventions for improving time to diagnosis and health care experiences. Materials and methods: The present analysis was part of a larger study exploring sexual health and quality of life of women with vulvar a...

Choking/strangulation during sex has become prevalent in the United States. Yet, no qualitative research has addressed men’s choking experiences. Through interviews with 21 young adult men, we examined the language men use to refer to choking, how they first learned about it, their experiences with choking, and consent and safety practices. Men lea...

Choking/strangulation during sex is prevalent among young adults, with one study finding that 58% of women college students had ever been choked during sex. However, no qualitative study has examined women’s experiences with choking/strangulation during sex outside of intimate partner violence. The purpose of our qualitative interview study was to...

Being choked/strangled during a partnered sex is an emerging sexual behavior, particularly prevalent among adolescent and young adult women, but the neurobiological impact of choking remains unknown. This case-control study aimed to test whether frequent choking during sex influences neurological health in young adult women, as assessed by serum le...

Many researchers interested In the socializing effects of pornography have found heuristic utility in the sexual script acquisition, activation, application model (3AM) of mediated sexual socialization. Studies have emphasized overall pornography/sexual behavior associations, however, rather than mediating sexual beliefs that a 3AM perspective sugg...

Little is known about skin tone and skin color representation within sexuality education materials. A content analysis was performed to assess skin tone and skin color diversity among anatomical images (n = 182) within eight contemporary, college-level human sexuality textbooks. Of these images, 1.1% represented dark skin tones while 83.5% represen...

This study examined U.S. adolescents’ pornography consumption, pornography dependency, and belief in a variety of notions contradicted by basic sexological science. Data were from 595 youth aged 14–18 who participated in a population-based probability survey. Consistent with the sexual script acquisition, activation, application model (3AM) of sexu...

Objective: We explored college students' sexual pleasure using a new self-report measure, the Body, Emotions, Sensations, Touch/Trust (B.E.S.T.) Scale of Sexual Pleasure. Participants: Data were from 3997 randomly sampled students with a partnered sexual experience. Methods: Students completed an online survey about their most recent partnered sex...

HIV service providers are the primary implementers of HIV care services, but rural HIV service providers are under researched. We used an interpretative phenomenological analysis to explore rural HIV service providers' lived experiences of working in HIV care, who work in a rural region of a Midwestern state in the United States. From July to Augus...

Choking/strangulation during sex is prevalent among young adults in the United States. We examined associations between having ever been choked and participants’ current mental health symptoms (e.g., feeling depressed, anxious, sad, lonely) in the prior 30 days and in the prior year. Participants were 4352 randomly sampled undergraduates who comple...

Objective To determine the prevalence of long-distance relationships (LDRs) among college students and explore how relationship dynamics differed between LDRs and geographically close relationships (GCRs). Participants Data were from romantically involved students (N = 2075) who participated in the 2020 College Sexual Health Survey. Methods Stude...

Sexual pleasure is best attained through facilitating access to the highest standard of health. Today global data show a persistent high burden of sexual health issues. Yet, pleasure remains a sensitive, stigmatized, and unspoken topic in healthcare services. This article examines how to incorporate a value for pleasure into healthcare services, gr...

Low sexual desire in women partnered with men is typically presumed to be a problem—one that exists in women and encourages a research agenda on causation and treatment targeting women. In this paper, we present a distinct way forward for research on low sexual desire in women partnered with men that attends to a more structural explanation: hetero...

Compared to studies on sexually transmitted infections and pregnancy prevention, sexual pleasure has received limited attention in the adolescent sexual development literature. In the present study, we used data from 157 adolescents (66 females; 14 to 17 years old), with a partnered sexual experience in the past 12 months to explore adolescents’ se...

Background Compulsive sexual behavior (CSB) is a clinical syndrome that causes significant distress and impairment for many individuals in the United States. Gay men are thought to have a higher prevalence of CSB, and it is associated with many relevant health outcomes including HIV risk behavior. Aim To estimate the prevalence and examine demogra...

Prior research has described women’s experiences with exercise-induced orgasm (EIO). However, little is known about men’s experiences with EIO, the population prevalence of EIO, or the association of EIO with other kinds of orgasm. Using U.S. probability survey data, the objectives of the present research were to: (1) describe the lifetime prevalen...

Background: Unintended pregnancy and safe abortion access in India remain critical public health concerns. The health of sexual- and gender-minoritized females (SGMF; those assigned female at birth and identify as other than heterosexual and/or as other than cisgender women) in India is understudied. Aim: We examined experiences of unintended pr...

While recent meta-analyses have provided answers to a number of historically contentious debates about correlates of pornography use, several questions remain unanswered. Whether pornography is associated with sexual functioning is one such question. Informed by theorizing on sexual scripting, social comparisons, and sexual objectification, the pre...

Objective: In a random sample of undergraduate students, we aimed to: (1) establish the prevalence of choking and being choked; (2) examine demographic and situational predictors of being choked, and (3) examine demographic and situational predictors of choking someone. Participants: 4168 randomly sampled undergraduates at a large public U.S. univ...

Purpose To estimate the prevalence of depression and loneliness during the US COVID-19 response, and examine their associations with frequency of social and sexual connections. Methods We conducted an online cross-sectional survey of a nationally representative sample of American adults (n = 1010), aged 18–94, running from April 10–20, 2020. We as...

Sexual health and intimacy take on a new meaning for men after sustaining a spinal cord injury (SCI), biologically and psychologically. Yet, the majority of sexual health information provided during the rehabilitation process focuses on loss of muscle movement, erectile response, and orgasm with little therapeutic interventions focusing on intimacy...

This paper reports findings on men's exposure to extreme pornography, impersonal sexuality, and sexual aggression from the National Survey of Porn Use, Relationships, and Sexual Socialization, a U.S. population-based probability study. Despite Malamuth's confluence model (CM) of sexual aggression positing that an impersonal approach to sex interact...

Background Probability-based surveys of college students typically assess sexual behaviors such as oral, vaginal, and anal sex. Little is known about the broader range of sexual behaviors in which students engage. Aims In a random sample survey of undergraduate students, we aimed to: (1) describe how recently participants had engaged in solo and p...

Pornography consumption is becoming more prevalent and may be a source of sexual learning for some users. Because popular male-female pornography rarely includes condoms, communication researchers have hypothesized that pornography use increases the likelihood of condomless sex in mixed sex encounters. A recent meta-analysis supported this predicti...

This community-based study explored the lived experiences of being in and going through the rural HIV care continuum among 15 gay and bisexual men (GBM) with HIV who live in a rural area of a Midwestern state. Our analysis adapted a six-step interpretative phenomenological analysis. Five themes emerged that reflected the five continuum stages: 1) D...

Research finding that pornography use is associated with lower sexual satisfaction is common; evaluation of the mechanisms hypothesized as underlying the association is not. Informed by multiple theoretical perspectives, the present study tested a conceptual model positing that (a) regularly consuming pornography conditions the user’s arousal templ...

Background Many women who inject drugs are aware of the associated risks, however social influences play a part in their behavioral decisions. Incorporation of others in drug use behaviors may be common practice among women who use drugs. The aim of this study was to gain an in-depth understanding of women’s injection drug use experiences with a fo...

Using data from an undergraduate probability sample, we aimed to: (1) describe the prevalence and demographic characteristics of students who reported having engaged in rough sex with their current partner; (2) assess which sexual behaviors students consider to be rough sex; (3) describe the frequency with which participants report engaging in roug...

Objectives: Sexual satisfaction is an important component of sexual health and wellbeing across the life course, including adolescence. While research on pornography use and sexual satisfaction has become increasingly common, the vast majority of studies have focused on adults. An additional limitation of studies to date is a lack of assessment of...

Sexual aggression is now widely recognized as a public health crisis. Using the sexual script acquisition, activation, application model (3AM) as a guide, this paper reports findings on U.S. teenagers' exposure to pornography, motivation for viewing pornography, perceptions of pornography's realism, identification with pornographic actors, and sexu...

The purpose of this study was to estimate the prevalence of sexual behaviors and experiences of Black women's partnered behaviors at their most recent sexual event. Data were from a subset of 980 Black women ages 18 to 92 who participated in the 2018 National Survey of Sexual Health and Behavior. Findings provide a sex-positive view of Black women...

We analyzed cross-sectional data collected from a U.S. nationally representative survey of individuals ages 14–24 years old on what sources of information from the past year they considered to be the most helpful about how to have sex (n = 600 adolescents ages 14–17 years old, and n = 666 young adults ages 18–24 years old). Among the 324 adolescent...

Objectives To describe long-acting reversible contraceptive (LARC) users’ knowledge, patient-provider interactions, and condom use associated with LARC use. Methods: Data are from the 2018 National Survey of Sexual Health and Behavior, a probability survey of Americans aged 14–49. Results: Of 1,451 sexually active women, 11.2% used intrauterine dev...

Research dedicated to understanding the sexual experiences of Black women has historically been framed around adverse outcomes. There are limited data that can be used to understand the lived experiences of Black women related to sexual health care. Twenty-five Black women aged 18- 35 from across nine US states were interviewed to gain insight into...

We explored the associations of gender expression with childhood gender expression, sexual identity, and demographic characteristics in a representative sample of the U.S. population aged 18 to 65 years (N = 1277), using data from the 2015 National Survey of Sexual Health and Behavior. As expected, gay men were less gender conforming than heterosex...

In early 2020, the novel coronavirus 2019 (COVID-19) spread across the United States and mitigation measures drastically affected the daily lives of Americans. In this study, we assessed the association between COVID-related relationship conflict and changes in intimate and sexual behaviors and experiences. Using data from an online nationally repr...

Purpose National practice guidelines encourage providers address sexual and reproductive health (SRH) as part of all clinical encounters with adolescents. Yet, no studies provide nationally representative estimates of how frequently adolescents are screened. Methods Data were adolescent participants (aged 14–17 years; N = 826) in the 2018 National...

Purpose The purpose of this study was to describe whether adolescent and young adult patients truthfully disclose sexual activity to providers during a sexual history and explore associations between disclosure and receipt of recommended services. Methods Data from the 2018 National Survey of Sexual Health and Behavior were used to describe self-r...