Sexual Decision Making When Intoxicated: Women’s Reasons For and Against Having Sex in a Laboratory-Based Scenario

Abstract

Young adult women report high condom use intentions, but inconsistent condom use. Cognitive appraisals during sexual encounters are important determinants of condom use decisions, but a nuanced understanding of what cognitions emerge during women’s “hot states” (e.g., sexual arousal, alcohol intoxication) remains lacking. To address this gap, we examined women’s heat-of-the-moment cognitions in their own words using mixed methods. Young adult women (N=503; M_age=25.01, SD_age=2.66) were randomized to a beverage condition (alcohol or control), then read and responded to questions about an eroticized sexual scenario. The nature and strength of reasons for and against having sex were reported before and after learning no condom was available. Multilevel models revealed intoxicated participants were more likely to let the partner decide how far to go sexually than sober participants at both timepoints, but the strength of cognitive appraisals (reasons for, reasons against, and feeling conflicted) only differed between beverage conditions after knowledge of no condom. These results suggest alcohol myopia was evident in the presence of inhibition conflict. Content analysis of these reasons revealed multifaceted cognitions that changed upon learning there was no condom. Findings highlight cognitions to target through interventions and underscore the importance of both alcohol and situational context in decision-making.

Sexual debut (i.e., having consensual sex for the first time) is a normative part of the transition from adolescence to young adulthood. In the US, around two in four individuals report having sex during high school, and by the age of 20, the majority of young adults report a history of sexual intercourse (Ethier et al., 2018; Finer & Philbin, 2013; Martinez & Abma, 2020). Thus, young adulthood involves considerable exploration in identity, relationships, and sexual behavior (Halpern & Kaestle, 2014; Tolman & McClelland, 2011). During this period of increased exploration, sexual behavior can be rewarding, but also has risks. Adolescents and young adults make up a quarter of the sexually active population in the US, yet account for half of all newly diagnosed sexually transmitted infections (STIs) each year (Kreisel et al., 2021). Young adult women are disproportionally affected by STIs (Kreisel et al., 2021; Satterwhite et al., 2013) and report the highest rates of unintended pregnancies relative to other age groups (Finer & Zolna, 2014, 2016). Condoms are an important form of prevention given their potential to reduce both risk for unintended pregnancy and STIs, yet only 28% of sexually active college women report always using condoms during vaginal-penile sex (American College Health Association, 2022). Condom use is even less likely when sexual partners are under the influence of alcohol (Rehm et al., 2012), which is an important consideration given that drinking and sexual activity commonly co-occur among young adults (Garcia et al., 2019). Given the public health implications of women’s inconsistent condom use – especially in light of recent restrictions in reproductive rights, an accurate understanding of factors that contribute to sexual decision making is needed to inform and improve interventions.

The Role of Cognitive Appraisals in Sexual Decisions

Inconsistent condom use can be understood through several key frameworks. From the perspective of the Health Belief Model (Carpenter, 2010; Rosenstock et al., 1988), a person might be expected to use a condom if they believe they are susceptible to a negative health outcome (e.g., unintended pregnancy, STI), believe the condom will prevent that outcome, and perceive few barriers to condom use. Barriers can arise when a condom is not available or sexual partners have different perspectives on condoms. Within a consensual male-female sexual encounter, a woman can either negotiate condom use, decide to consent to sexual activity without a condom, or abdicate their decision about condomless sex to their partner. The Cognitive Mediation Model (Norris et al., 2004) provides a framework for understanding women’s sexual decision making in this context. Building on Cognitive-Motivational-Relational Theory (Lazarus, 1991) and supported by empirical work (Davis et al., 2010; Jacques-Tiura et al., 2015; Norris et al., 2009; Purdie et al., 2011; Zawacki et al., 2009), this framework highlights the importance of women’s primary and secondary cognitive appraisals in a given sexual situation. Primary appraisals are evaluations of how relevant and congruent the sexual situation is to the woman’s goals. Such goals may include sexual intimacy, safety, and/or developing a relationship, with the specific nature of the goals influenced by individual characteristics and prior experiences. Secondary appraisals involve evaluating coping options (e.g., negotiating), including beliefs about blame or credit (who is responsible), coping potential (capacity to effectively engage in the strategy), and expected future outcomes. Taken together, these attributions will determine whether and how women choose to engage in condom use negotiation, consent to sex without a condom, or abdicate the decision to their partner.

Hot States and Attentional Narrowing

As is also highlighted in the Cognitive Mediation Model (Norris et al., 2004), situational factors can affect appraisals. Visceral factors, which include drive states such as sexual arousal (as well as hunger, thirst, pain), can affect cognitive processes by focusing one’s attention on behaviors that would satisfy the drive in the moment (Loewenstein, 1996). Relative to “cold states,” which rely on slow logical reasoning, sexual arousal can also activate a “hot state” involving fast reflexive actions (Metcalfe & Mischel, 1999). As one example of the effect of sexual arousal on behavior, Ariely and Lowenstein (2006) found that sexually aroused men reported willingness to engage in a wider range of sexual behaviors than non-sexually aroused men.

In addition, sexual behavior often co-occurs with alcohol use (George, 2019), as alcohol is commonly used to reduce inhibitions and facilitate sexual encounters (Carey et al., 2019). In a manner similar to sexual arousal, alcohol intoxication can affect cognitive processing. Specifically, Alcohol Myopia Theory (Steele & Josephs, 1990) posits that acute intoxication can impair cognitive processing by narrowing one’s attention to salient and proximal cues of the situation. For instance, when intoxicated, instead of focusing on multiple situational cues, attention may narrow to cues that are most immediate (e.g., sexual desire and arousal) at the expense of distal, inhibiting cues (e.g., unknown STI status of sexual partner) and may lead to riskier decision making and behaviors (e.g., condom non-use). Indeed, alcohol has been linked to riskier sexual behavior, including sex with multiple partners, sex with casual partners, and inconsistent condom use (Patrick et al., 2012; Rehm et al., 2012). Thus, alcohol can contribute to the hot states that influence cognitions and decisions during sexual situations.

Prior Research on Arousal, Alcohol, and Sexual Decisions

Despite the influence of sexual arousal and alcohol intoxication on cognitive appraisals, not all research studies have activated these hot states when investigating sexual decision making. For example, interviews and focus groups have been conducted with young adults to gain insight into their condom use decisions. Although these methods have provided important information, revealing perceptions of pressure, a desire to be seen as normal, and the hope that casual sex may lead to a relationship (Cooper & Gordon, 2015; Fantasia et al., 2014), such cold-state reflections may not be representative of heat-of-the-moment cognitions (Loewenstein, 2005). Thus, it has long been recognized that sexual decision making is best studied during aroused hot states (Gold, 1993). In response, laboratory methods using eroticized sexual scenarios and alcohol administration have become instrumental to this field (George et al., 2021). Across these laboratory studies, findings indicate that greater intoxication is associated with greater intentions to engage in unprotected sex (Rehm et al., 2012; Scott-Sheldon et al., 2016). These findings also extend to sexual abdication (i.e., letting a sexual partner decide how far to go sexually), as intoxicated participants are more likely to report unprotected sex intentions, specifically through sexual abdication, compared to sober participants (Masters et al., 2014). Alcohol’s effect on sexual risk taking may be partially explained by increased positive affect and sexual desire (George et al., 2014; Scott-Sheldon et al., 2016), suggesting that intoxication may exacerbate other hot states.

Importantly, prior laboratory-based research has also highlighted the role of inhibitory and impelling cognitions in mediating the effects of alcohol intoxication on sexual decision making (Davis et al., 2007; Norris et al., 2009; Purdie et al., 2011), including appraisals regarding future relationship potential and the pros and cons of sex without a condom (Jacques-Tiura et al., 2015; Zawacki et al., 2009). Such appraisals are often assessed via ratings for a set of predetermined cognitions. Although the development of such scales was informed by focus groups (Norris, 2005), these groups were limited by retrospective recall during cold states. Thus, research conducted with preset response options may miss cognitive appraisals that emerge during hot states.

To allow for more open-ended responses of cognitive appraisals relevant to sexual decision making, several studies have used a thought-listing paradigm, which involves listing one’s current thoughts (Cacioppo et al., 1997) at specific points within eroticized scenarios (Ditto et al., 2006; MacDonald et al., 2000, 2016). This technique provides rich, nuanced information regarding appraisals made during hot states, but these data have remained underutilized, as responses have been most often coded into a priori categories (e.g., impelling vs. inhibiting, risk vs. attractiveness) and quantified to determine condition differences in the number of thoughts per category (Ditto et al., 2006; MacDonald et al., 2016). One study (MacDonald et al., 2000) evaluated thoughts expressed by college men who participated in an alcohol administration study and watched a video vignette in which the woman is taking an oral contraceptive, a condom is not available, and the woman abdicates the decision about sexual intercourse to the man. A total of 10 content codes for men’s thoughts were utilized, including cognitions about alternative thoughts for the situation, the woman’s willingness, risk, attractiveness, past experience, future expectations, arousal, intoxication, personal rules regarding conduct, and dating or religious reasons. Although this study provided some important information about men’s considerations in response to a standardized sexual situation while in hot states, women’s decision-making processes are likely to be different. Because women are not the ones wearing the condom, men are ultimately in control of whether or not a condom is worn. Therefore, women must instead decide whether and how to negotiate with a partner regarding condom use. Even when using hormonal contraceptives, pregnancy-related considerations may also factor into women’s decisions regarding condom use as added protection. Thus, a nuanced understanding of women’s heat-of-the-moment cognitive appraisals is important to understand sexual decision making, but remains lacking. With the present study, we sought to address this gap.

The Present Study

Sexual decision making is complex and often influenced by individual and contextual factors. Although young adult women report high condom use intentions, condoms are inconsistently used when in the heat of the moment (Roberts & Kennedy, 2006). Cognitive appraisals are important determinants of sexual decisions, but a nuanced understanding of the cognitive appraisals that might arise during women’s hot states remains lacking. In the present study, we examined women’s heat-of-the-moment cognitions – in their own words – through use of alcohol administration and an eroticized sexual scenario designed to activate relevant hot states of intoxication and sexual arousal. We used a mixed methods design that allowed participants to report and rate the strength of their reasons for and against having sex in a sexual scenario with a newer sexual partner in which they discover that no condom is available. Recognizing that appraisals are not static within an unfolding sexual situation, we examined how the nature and strength of appraisals changed when it became clear that there was no condom. Based on Alcohol Myopia Theory (Steele & Josephs, 1990), we expected that participants in the alcohol condition would report stronger reasons for having sex, weaker reasons against having sex, less conflict about their decision, and greater sexual abdication than those in the control condition. Also consistent with Alcohol Myopia Theory, we anticipated that alcohol intoxication would heighten one’s focus on the salient cue of sexual arousal relative to the longer-term health risks associated with condom non-use. Thus, we expected that the knowledge of no condom being available would be less impactful on decision making in the alcohol condition than the control condition. Content analysis was also used to explore the nature of cognitive appraisals regarding reasons for and against having sex at two timepoints – before participants had knowledge that there was no condom and after. This information clarifying women’s hot-state sexual decision making is expected to inform interventions designed to mitigate risk and promote sexual health.

Method

Participants and Procedures

Participants were drawn from a larger multi-method study on women’s alcohol use and sexual risk behaviors (Davis et al., 2019; Stappenbeck et al., 2023). In the larger study, participants completed three phases: (1) a baseline survey, (2) 32 days of daily diaries, and (3) an in-person alcohol administration session. Participants could earn up to $320 ($20 for baseline, $5 per daily diary survey with a $20 bonus for completing at least 75% of surveys, $15 per hour for the in-person session). Data for the present study came from the alcohol administration session. All procedures were approved by the University’s Institutional Review Board.

Participants were recruited via online ads and flyers from a large metropolitan city in the Northwestern US. Recruitment materials asked interested women to call and complete a screening over the phone by trained research staff. To be eligible, participants had to be cisgender women ages 21–30 who reported consensual condomless sex with a male partner in the past year and another sexual risk index based either on behavior (e.g., having a new male sexual partner, multiple sexual partners, or a previous STI diagnosis) or the characteristics of their male sexual partners (e.g., was sexually concurrent, had ever been incarcerated, used intravenous drugs, had sex with men, or had a previous STI diagnosis). Participants also had to report having sex as well as drinking alcohol at least two times per month and consuming at least three drinks per week in the past month. Lastly, consistent with NIAAA’s guidelines for alcohol administration (National Advisory Council on Alcohol Abuse and Alcoholism, 2005), we screened for factors that would otherwise contraindicate alcohol administration, such as medical conditions, medication use, history of problem drinking, and pregnancy.

Of the 2,560 screening calls completed during the recruitment window (July 2013 to July 2017), 646 (25%) women were eligible and sent a link to the baseline survey. A total of 600 women then completed the survey and went on to the daily diary phase of the study. Following the daily diary phase, 503 participants completed the alcohol administration session. At the start of the lab session, female research staff obtained informed consent and confirmed each participant’s breath alcohol concentration (BrAC) of .00% via breathalyzer (Alco-Sensor IV, Intoximeters, Inc.). Then, participants took a pregnancy test, were weighed, and completed a brief survey.

Following the survey, participants were randomized into a beverage condition (alcohol vs. control). In the alcohol condition, participants were given three beverages each containing 190 proof grain alcohol and cranberry juice to achieve a target BrAC of .08%. In the control condition, participants received the same amount of cranberry juice to control for other factors associated with participating in the experiment (e.g., consuming liquid, time spent on study procedures). Participants were asked to consume their drinks within 12 minutes and then were breathalyzed every four minutes until participants in the alcohol condition reached a target BrAC on the ascending limb. Control participants were yoked to an individual in the alcohol condition to account for varying time due to individual differences in absorption rates (Schacht et al., 2010). After beverage administration, participants read a sexual risk scenario and completed questions in between the story blocks. After the scenario, those who received alcohol were monitored and remained in the lab until they reached a BrAC of .03% or below.

Participants for the present study were 503 women ages 21 to 30 (M = 25.01, SD = 2.66). Regarding racial identity, 71.7% identified as White, 8.3% Asian, 4.9% Black/African American, 2.2% Native American/Alaskan Native, 10.7% multiracial, and 2.2% identified as another race. Regarding ethnicity, 9.2% were Hispanic/Latina. The majority of participants were single (90.2%), employed (74.5%), and college graduates (54.5%), whereas a minority of participants were students (38.1%).

Measures

Sexual Risk Scenario

Participants were presented with an eroticized sexual scenario involving a newer sexual partner named “Michael.” Participants were asked to “Imagine that you are the person being described in the scenario and try and put yourself in the situation.” So that participants could easily project themselves into the situation, the scenario was written in the second person (e.g., “You and Michael have been running into each other a lot lately.”) and designed to be highly detailed, descriptive, and arousing. Participants read the scenario and answered associated questions during an uninterrupted period of approximately 40 minutes. In the roughly 1,600-word story, the protagonist meets up with Michael, a sexually attractive man she had protected sex with once before. In the previous sexual encounter, the protagonist was taking oral contraceptives and a condom was used. In the current situation, the two go to dinner and then back to Michael’s apartment where they begin to kiss. In the alcohol condition, the protagonist drinks alcohol, but in the control condition, she drinks soda. Michael is drinking and consumes three beers regardless of study condition. The sexual encounter progresses until the two are ready to have consensual sex, but discover that no condom is available. The scenario ends with Michael saying, “I really want to make love to you, but I’ll do whatever you want. Do we have to stop now?” Although not examined in the current study, the scenario also includes a mood manipulation such that participants were randomized to be informed that they were either having a good day (e.g., excellent weather, light traffic, fun conversation with a friend, unexpectedly received money) or a bad day (e.g., raining, heavy traffic, talked with a friend who was recently fired, unexpected bill). As the situation unfolds (see Figure 1), the scenario is paused for participants to complete brief questionnaire blocks (5 timepoints in total) to assess sexual decision making and condomless sex intentions. Of particular interest to the current study are timepoints 4 and 5 where the protagonist and Michael are ready to have sex (T4) but find that no condom is available (T5).

Figure 1.

Scenario Timeline

Note. Summaries of scenario parts are provided. Italicized text refers to conditions that were manipulated within the scenario (control vs. alcohol refers to beverage condition; good vs. bad day refers to mood). Note that differences between good and bad day conditions were not examined in the current study.

This scenario was developed and refined with feedback from focus groups and pilot studies (Norris, 2005). Qualitative findings indicative of the realism of the scenario are available elsewhere (Andrasik et al., 2014). External validity of the scenario has also been supported, as participants’ reports of sexual risk behaviors in the scenario have been correlated with their past and projected future condom use (Kajumulo et al., 2009; Norris et al., 2010).

Reasons For and Against Having Sex.

At T4 and T5, participants were presented with two questions to assess their reasons for and against having sex with Michael. For each question, participants were provided with open-ended response fields where they could describe up to three reasons. To assess the strength of each set of reasons collectively, participants were then asked, “Overall, how strong are the reasons [for / against] having sex with Michael in this situation?” (response options: 1 = not at all strong to 7 = extremely strong). In addition, participants were asked how conflicted they felt about having sex with Michael at both timepoints (response options: 1 = not at all conflicted to 7 = extremely conflicted).

Sexual Abdication Intentions.

At T4 and T5, to assess intentions to let Michael make the decisions in the sexual situation, participants were presented with three separate questions. These items included “How likely are you to let Michael decide how far to go sexually?,” “How likely are you to do whatever Michael wants to do sexually?,” and “How likely are you to go along with what Michael wants sexually?” Response options for each item were 1 = not at all likely to 7 = extremely likely. A mean score of these items was calculated, with higher scores representing higher sexual abdication. The Cronbach’s alpha at T4 was α = .90 and at T5 was α = .96.

Data Analysis

First, quantitative ratings for the strength of reasons for, reasons against, conflict, and abdication were examined descriptively. Then, to examine how ratings changed from T4 to T5 as a function of alcohol condition, multilevel models were estimated in R v4.2.1 (R Core Team, 2022) via the glmmTMB package (Brooks et al., 2017). Specifically, timepoint (Level 1) was nested within participants (Level 2). Separate models were examined for each of the four ratings, but predictors were the same for all four models. Timepoint was included as a Level 1 (within-person) predictor and dummy coded such that 0 = T4 (before knowledge of no condom) and 1 = T5 (after knowledge of no condom). Randomly assigned beverage condition (0 = control, 1 = alcohol) was included as a Level 2 (between-person) predictor. A cross-level interaction of timepoint by condition was included to determine whether knowledge of no condom was associated with a greater change in the control condition or alcohol condition. Participants who had missing data for ratings at exactly one timepoint were retained in analyses via maximum likelihood estimation (n = 0 to 3 participants per model); four participants missing all ratings at both timepoints were excluded from the models. Interactions were probed with the emmeans (Lenth, 2022) and ggeffects (Lüdecke, 2018) packages.

Finally, to provide context about the nature of the reasons for and against having sex, directed content analysis (Hsieh & Shannon, 2005) was applied to the open-ended responses from the scenario at T4 and T5. The coding process began with the first and second author separately reviewing all responses at each timepoint to become familiar with the data. Next, the data were again separately reviewed by the first two authors to create a list of preliminary codes. The authors then met to discuss preliminary codes and an iterative process ensued to define, refine, and finalize codes together. The coding process was informed by salience, frequency, and extensiveness of the data (Creswell & Poth, 2016) and codes were not considered to be mutually exclusive. When discrepancies arose, these were resolved through discussion.

Results

Manipulation Check

Five questions, rated from 1 (not at all) to 7 (extremely), were used to determine the realism of the scenario, including whether Michael was a realistic character and the ability to project themselves into the scenario (α = .81). On average, realism was rated highly (M = 5.75, SD = 1.09). On the same 1 to 7 scale, participants were also asked: “Was the story sexually arousing?” (M = 5.17, SD = 1.53). Thus, it appeared that participants were able to relate well to the scenario, which was perceived as arousing, thereby activating hot states.

Immediately following completion of the scenario and related questions, participants in the alcohol condition had an average BrAC of .083% (SD = .014) and perceived intoxication (on a 1 to 7 scale) of 4.84 (SD = 1.31); all control participants had a BrAC of exactly 0 and perceived themselves to be at the lowest level of intoxication (1). Thus, the beverage conditions were significantly different in both objective and subjective intoxication levels (ps < .001).

Quantitative Findings

Descriptive Statistics

Before knowing there was no condom (T4), participants reported relatively strong reasons for having sex (M = 5.96, SD = 1.16), relatively weak reasons against having sex (M = 2.84, SD = 1.59), low conflict (M = 2.70, SD = 1.66), and a moderate degree of abdication (i.e., near the midpoint; M = 4.38, SD = 1.62). After knowing there was no condom (T5), participants reported lower, but still relatively strong reasons for having sex (M = 5.14, SD = 1.76), relatively higher reasons against having sex (M = 4.67, SD = 1.85), a moderate degree of conflict (M = 4.34, SD = 1.90), and a lower but still moderate degree of abdication (M = 3.54, SD = 1.93). To determine which changes in ratings were statistically significant, and for which conditions, we used a multilevel modeling approach.

Multilevel Models

Results of multilevel models predicting strength of reasons for, reasons against, conflict, and abdication as a function of time and alcohol condition are presented in Table 1 and Figure 2. Before knowledge of no condom (T4), simple effects revealed that abdication in the alcohol condition was significantly higher than control (p = .003), consistent with expectations. However, there was no difference between beverage conditions in reasons for (p = .739), reasons against (p = .051), or feeling conflicted (p = .348). There was a significant effect of timepoint (T5 vs. T4) among all conditions and for all outcomes (ps < .001). However, as revealed by significant interactions, the effect of timepoint was dampened among the alcohol condition in reasons for (p = .027), reasons against (p = .004), and feeling conflicted (p = .007), but not for abdication (p = .061). After learning there was no condom (T5), there were significant differences between conditions on all outcomes; relative to control, participants in the alcohol condition had stronger reasons for (p = .006), lower reasons against (p < .001), lower feelings of conflict (p = .008), and higher abdication (p < .001). Overall, the amount of variance accounted for by the fixed effects in each model (i.e., alcohol condition, timepoint, and the interaction) ranged from 7.8% (reasons for) to 24.5% (reasons against).

Table 1.

Multilevel Model Results

	Strength of Reasons For Sex (R2 = .078)		Strength of Reasons Against Sex (R2 = .245)		Feeling Conflicted (R2 = .181)		Sexual Decision Abdication (R2 = .080)
Predictor	b (SE)	p	b (SE)	p	b (SE)	p	b (SE)	p
Alcohol	0.04 (0.13)	.739	−0.30 (0.15)	.051	0.15 (0.16)	.348	0.47 (0.16)	.003
Timepoint	−0.98 (0.10)	<.001	2.09 (0.13)	<.001	1.93 (0.15)	<.001	−0.96 (0.09)	<.001
Alcohol × Timepoint	0.32 (0.15)	.027	−0.51 (0.18)	.004	−0.58 (0.22)	.007	0.24 (0.13)	.061

Note. Timepoint was coded such that 0 = T4 (before knowledge of no condom) and 1 = T5 (after knowledge of no condom). The analytic sample size for all multilevel models was n = 499. Marginal R² values are reported, reflecting the variance accounted for by the fixed effects in each model.

Figure 2.

Model-Predicted Estimates by Beverage Condition and Timepoint

Qualitative Findings

A summary of definitions for each theme and subtheme is shown in Table 2. Below, we provide descriptions and examples of each theme from reasons for and against having sex, as well as prominent subthemes that emerged both before (T4) and after (T5) it became known that no condom is available. Many brief responses were identical across multiple participants, so exemplar quotes are provided without participant demographics or condition. To ensure that the same participant was not overly represented in any given subtheme, only one text response per participant was considered (at random) when selecting quotes for each subtheme. Quotes were only adjusted to correct for errors in spacing and capitalization; where a single word was capitalized for emphasis, capitalization was retained.

Table 2.

Definitions for Themes and Subthemes

Reason For	Considering having sex because of…
Sexual desire	… interest in or wanting to, with a focus on cognitions and emotions
Coping motives	… a desire to regulate negative emotions
Sexual arousal	… physiological arousal in response to sex-related stimuli or anticipated sexual pleasure
Relationship	… past, current, or future experiences specifically with Michael
Past history with partner	… sexual precedence and history specific to Michael
Current experiences on the date	… experiences with Michael that night
Future relationship potential	… the potential that sex could facilitate growth in the relationship with Michael
Heat of the moment	… a focus on the here-and-now, including the proximal “hot state” of alcohol intoxication
Risk consideration	… a perception of low risk
Reason Against	Considering not having sex because concerned about…
Health risks	… potential health-related consequences
Condom	… condom (non-)availability
Sexually transmitted infection	… acquiring an STI or HIV
Birth control or pregnancy	… unintended pregnancy
Sexual history and communication	… lack of discussion around sexual history (including recent STI testing)
Not having a condom changed things	… Michael’s character after learning he did not have a condom
Relationship	… the context of the relationship with Michael
Current relationship	… not knowing Michael or where the relationship stands
Future relationship potential	… how sex would impact where the relationship goes from here
Alcohol	… drinking negatively influencing the sexual situation
Emotions	… emotions affecting decisions or emotional consequences
It can wait	… a lack of desire or practical considerations
Societal concerns	… stigma against women who have casual sex

Reasons For Having Sex

Table 3 includes the percentage of participants who provided an open-ended response with each coded reason for having sex, separated by timepoint and beverage condition.

Table 3.

Reasons For Having Sex, Separated by Beverage Condition and Timepoint

Reason For Sex	T4: Before Knowledge of No Condom		T5: After Knowledge of No Condom
	Control	Alcohol	Control	Alcohol
	n = 250	n = 253	n = 250	n = 253
Sexual desire	193 (77%)	208 (82%)	145 (58%)	171 (68%)
Coping motives	21 (8%)	48 (19%)	10 (4%)	12 (5%)
Sexual arousal	139 (56%)	133 (53%)	145 (58%)	152 (60%)
Relationship	158 (63%)	142 (56%)	90 (36%)	97 (38%)
Past history with partner	67 (27%)	52 (21%)	28 (11%)	22 (9%)
Current experiences on the date	111 (44%)	100 (40%)	73 (29%)	78 (31%)
Future relationship potential	12 (5%)	20 (8%)	6 (2%)	11 (4%)
Heat of the moment	35 (14%)	59 (23%)	50 (20%)	52 (21%)
Risk consideration	8 (3%)	6 (2%)	28 (11%)	24 (10%)

Note. Participants were given three text boxes in which to report reasons for having sex. Each response could receive multiple codes. Thus, some participants are represented across multiple codes; 5% of participants received no codes (e.g., provided responses such as “no answer,” “N/A,” or provided an answer that was inconsistent with or beyond the scenario).

Sexual Desire.

The most frequently reported theme (80% of participants at T4, 63% of participants at T5) was sexual desire, referring to cognitions and emotions reflecting the motivation or urge to engage in sexual activity. This theme included mention of attraction to and sexual chemistry with Michael specifically (e.g., “He is attractive,” “Mutual chemistry and attraction,” “He seems into me”), as well as liking sex generally (“I want to have sex,” “Sex is awesome, and I like having it”) and an expectation of fun (e.g., “It could be a really fun hookup”).

Within this theme, a subset of participants indicated their sexual desire was driven by coping motives (14% at T4, 4% at T5). As shown in Table 3, coping motives were highest at T4 in the alcohol condition (19%). Some responses also referenced the scenario mood condition, such that they were motivated to have sex either to feel better after a bad day (e.g., “It would redeem a shitty day,” “Will erase the horrible day”) or to have a good end to an already good day (e.g., “Perfect end to a perfect day,” “I had a good day and might as well make it better,” “The day is excellent and I don’t want it to take a turn”). Others acknowledged efforts to regulate their emotion through sex (e.g., “A release from your day and stress,” “To forget about everything for a little while”). A few clarified that being desired by Michael would help them to feel better (e.g., “He makes me feel wanted,” “He wants me badly so it gives me a feeling of control,” “He’s fulfilling my needs of feeling lonely and unattractive”) and that having sex would enhance their self-esteem (e.g., “I’ll feel better about myself afterwards,” “Ego boost,” “It would make you feel in charge and beautiful”). Still others reported that having sex would alleviate boredom (e.g., “Because I’m bored,” “Nothing else to do”) or satisfy their curiosity (e.g., “Because I’m feeling adventurous/curious,” “Curiosity”).

Amongst the participants who reported sexual desire as a reason for having sex, participants most focused on their own sexual desire (42% at T4, 54% at T5) or both the desire of Michael and themselves (54% at T4, 42% at T5). Notably, a minority of participants focused exclusively on the sexual desires of Michael (4% at T4, 4% at T5; e.g., “To make him happy,” “He really wants to have sex”).

Sexual Arousal.

The second most common theme (54% at T4, 59% at T5) was sexual arousal. Whereas sexual desire focused on cognitions and emotions, this theme focused on physiological arousal as a reason for having sex. For example, participants reported feeling turned on (e.g., “Extremely turned on,” “He seems to be turned on by me,” “We’re both horny”), with some responses focused on Michael’s physical signs of arousal (e.g., “He’s so hard it’s incredibly sexy,” “He is sustaining an erection and is ready to bang”). Others noted the anticipated sexual pleasure they would feel (e.g., “My own personal pleasure,” “Because it would feel good”). Participants also commonly highlighted reasons related to satisfying sexual needs (e.g., “To satisfy both our needs,” “Gratification”) and some focused on the potential to orgasm (e.g., “I think it would be great climax,” “orgasm,” “want to get off”). Most participants who endorsed this theme focused on their own sexual arousal (64% at T4, 59% at T5) or the arousal of both themselves and Michael (28% at T4, 36% at T5). However, a minority of participants focused exclusively on Michael’s arousal (8% at T4, 5% at T5; e.g., “Satisfy partner,” “To make him have an orgasm”).

Relationship.

Regarding the next most common theme (60% at T4, 37% at T5), participants reported the relationship with Michael was a reason for having sex. Specific subthemes emerged here regarding the nature of the considerations about the relationship. Past experiences with Michael were noted by 24% at T4 and 10% at T5 and included sexual precedence (e.g., “Already had sex and are comfortable with each other,” “I’ve had sex with him before (less awkwardness)”). This history of consensual, protected, and enjoyable sexual activity also increased confidence that sex would be enjoyable again (e.g., “I KNOW it will be good because it was last time,” “It was good last time so it will probably be even better this time”).

Current considerations regarding the relationship with Michael were reported by 42% at T4 and 30% at T5. This subtheme focused on Michael’s behavior that evening or the current status of their emerging relationship. For example, participants noted that the date was going well (e.g., “Enjoy spending time with him and had a great night out,” “Took me out to dinner! Listened to me,” “He asked me on a REAL date”), which may have contributed to perceptions of trust (e.g., “I trust him”) and favorable impressions of Michael’s character (e.g., “Seems like a nice guy, would be respectful,” “He was patient and nice”). Some participants described intimacy and connection (e.g., “Because I feel a connection to him,” “We like each other,” “I feel a fun, positive, intimate connection with him”) that could be enhanced through sex (e.g., “I would have sex with Michael in this situation to build a stronger connection between the two of us”). Others reflected on the mutual consent (e.g., “We are two consenting adults”) and lack of perceived pressure in the sexual situation as a reason for having sex (e.g., “He hasn’t forced himself on me in any way,” “He says he will do whatever I want,” “He sounds like an okay guy (he offered to stop)”). As one participant put it, “No red flags: the consent is there, good conversation all evening, respectful interactions so far” (T4). Responses highlighting the lack of pressure continued for a subset of participants at T5. For example, one stated: “He intentionally put the choice as to whether to use a condom or not on me, to the point of stopping/pausing the encounter. That’s respectful - and sexy - of him” (T5).

Reasons for having sex also included consideration of how sexual activity might affect the future potential of a relationship (6% at T4, 3% at T5). These responses reflected a hope that having sex would propel the relationship forward (e.g., “It would strengthen the relationship,” “It would be the next step in our relationship”) – either to make Michael a regular casual sexual partner (e.g., “securing a safe friend with benefits,” “so we could have sex in the future”) or to pursue a romantic relationship with Michael (e.g., “Maybe we would date afterwards,” “Potential boyfriend”). As one participant put it, having sex would “help make a decision about where your relationship is going.”

Heat of the Moment.

Approximately one-fifth of participants (19% at T4, 20% at T5) reported a reason for having sex was being in the heat of the moment. These participants described being focused on the here-and-now (e.g., “I’m caught in the moment,” “To live in the moment,” “Because I let my body take over and not doing much thinking”) and that sexual activity had already started (e.g., “Already naked might as well,” “Foreplay has already started,” “Because you’re basically already having sex,” “We’re already so close,” “You’ve gone pretty far at this point”) or would be difficult to stop (e.g., “Because it would be very difficult to stop what you are doing,” “Don’t want to stop,” “I have gotten to this point, and it would be hard to turn back,” “Not breaking the mood”). Some participants stated that they did not care about the aftermath (e.g., “Because I don’t care about the consequences,” “I can do what I want and deal with the consequences later!”) or that there would be downsides of interrupting the moment to get a condom (T5) (e.g., “No point in ruining the moment with running to a gas station to get a condom,” “To avoid the ‘let’s go get a condom’ pause”). Across timepoints, participants also indicated a lack of reasons against having sex was a reason to proceed (e.g., “At this point, there is no reason why not,” “No good reasons not to,” “Why the hell not?”). Another area that emerged within the heat-of-the-moment theme was that participants were motivated to have sex because alcohol was involved in some way (e.g., “Both of us have been drinking,” “He is drunk,” “If I did, I wouldn’t remember most of it”); this included participants in the alcohol condition (5% at T4, 2% at T5) and one participant in the control condition (<1% at both T4 and T5).

Within this theme emerged a small, but noteworthy subset of respondents (1% at T4, 2% at T5) who indicated that the heat of the moment was so strong that they were feeling pressured to continue sexual activity. These participants indicated they expected Michael would be unhappy if they stopped after agreeing to go this far (e.g., “He expects sex at this point,” “He might act weird/upset if I cut it off now,” “I don’t want to hurt his feelings/upset him by stopping”), which could lead to disappointment (e.g., “Avoiding the disappointment of having to stop,” “To not disappoint him”) and/or awkwardness (e.g., “To avoid awkwardness,” “Stopping now would make things awkward”).

Risk Considerations.

Finally, a small subset of participants (3% at T4, 10% at T5) indicated that they considered health and safety risks associated with having sex, and their perception of low risk contributed to their motivation to proceed. Most of these responses focused on low risk of pregnancy given other protective measures used before the sexual activity (e.g., “I wouldn’t get pregnant (I’m on birth control),” “Have Implanon – risk of pregnancy w/o condom is low,” “I am on the IUD and not worried about pregnancy”) or during/after the sexual encounter (e.g., “He can pull out and that’s better than nothing,” “I can get plan B if I’m not on birth control”). A few perceived low risk for STI (e.g., “He probably is clean,” “You are on the pill so as long as neither of you has a disease you can skip the condom”) and feeling otherwise safe, although what participants felt safe from was not specified (e.g., “I feel safe with Michael,” “It seems like a safe situation,” “We are being safe”).

Reasons Against Having Sex

Table 4 includes the percentage of participants who provided an open-ended response with each coded reason against having sex, separated by timepoint and beverage condition.

Table 4.

Reasons Against Having Sex, Separated by Beverage Condition and Timepoint

Reason Against Sex	T4: Before Knowledge of No Condom		T5: After Knowledge of No Condom
	Control	Alcohol	Control	Alcohol
	n = 250	n = 253	n = 250	n = 253
Health‎ risks	102 (41%)	100 (40%)	238 (95%)	231 (91%)
Condom	46 (18%)	33 (13%)	195 (78%)	188 (74%)
Sexually transmitted infection	59 (24%)	61 (24%)	114 (46%)	118 (47%)
Birth control or pregnancy	18 (7%)	25 (10%)	47 (19%)	49 (19%)
Sexual history and communication	32 (13%)	24 (10%)	37 (15%)	34 (13%)
Not having a condom changed things	--	-	24 (10%)	35 (14%)
Relationship	149 (60%)	156 (62%)	73 (29%)	94 (37%)
Current relationship	135 (54%)	141 (56%)	60 (24%)	86 (34%)
Future relationship potential	40 (16%)	41 (16%)	17 (7%)	12 (5%)
Alcohol	67 (27%)	45 (18%)	20 (8%)	9 (4%)
Emotions	34 (14%)	38 (15%)	18 (7%)	25 (10%)
It can wait	32 (13%)	39 (15%)	25 (10%)	21 (8%)
Societal concerns	16 (6%)	30 (12%)	12 (5%)	11 (4%)

Note. Participants were given three text boxes in which to report reasons against having sex. Each response could receive multiple codes. Thus, some participants are represented across multiple codes; 10% of participants received no codes (e.g., provided responses such as “no answer,” “N/A,” or provided an answer that was inconsistent with or beyond the scenario).

Health‎ Risks.

Participants commonly reported health risk concerns as a reason not to have sex (40% at T4), and this was a more prominent concern after becoming aware there was no condom (93% at T5). Several subthemes emerged within this theme, with discussion of condoms being most common. Whereas 16% reported concerns about the availability of a condom at T4 (e.g., “I don’t know if he has condoms,” “No one has put a condom on yet,” “Might not have protection”), 76% reported not having a condom as a reason not to have sex at T5 (e.g., “There is no condom,” “No protection”), with some indicating this was a shared responsibility (e.g., “Neither of us have a condom,” “You don’t have a condom”). At T5, many also expressed agitation about the lack of a condom (e.g., “Damnit! No condom!,” “DUDE! No condom! Not cool!,” “The lack of condom ugh,” “No FUCKING condom,” “No condommmmm”).

Nearly a quarter (24%) of participants at T4 and half (46%) at T5 reported concerns about STIs. These concerns most often focused on the possibility that the participant could contract an STI from Michael (94% at T4, 88% at T5). For example, participants highlighted that they were unaware of his STI status (e.g., “Because he is a partner whose STI status I cannot confirm,” “Don’t know if he is clean,” “He could have an STI,” “He might actually be a festering petri dish of exotic strains of VD”) and the potential to contract an STI (e.g., “Don’t want an STI,” “One time could land you with an STD,” “You don’t want to get an STD from this fool”). A smaller portion of participants who reported concerns about STIs (5% at T4, 4% at T5) focused exclusively on Michael’s risk of getting an STI because they have, or might have one (e.g., “I have an STI,” “If I had another partner before, for which I had not been tested for STD’s [so I would be unsure if I had any]”). Others reported concern for both themselves and Michael (2% at T4, 8% at T5; e.g., “Could pass STDs between each other,” “Neither of you can be sure either of you don’t have an STI or STD.”). Further, a minority of participants reported a specific concern about HIV/AIDS (1% at T4, 3% at T5).

The next most common health and safety concern raised was pregnancy (9% at T4, 19% at T5), even though the scenario said they were taking an oral contraceptive. Many of these reasons against having sex simply focused on the possibility of getting pregnant (e.g., “Pregnancy,” “Risk of getting pregnant”). Others expressed concern about effectiveness of contraceptives (e.g., “What if you missed your pill for that night,” “You can’t be sure if your birth control will work”) or other efforts toward preventing pregnancy (e.g., “You don’t know if you can trust him to pull out,” “There is still a risk for pregnancy even if he pulls out”), including interventions after sex (e.g., “Can I afford Plan B,” “I don’t want to get an abortion”). Still others highlighted concerns about how they would specifically navigate a pregnancy (e.g., “How would he respond if I became pregnant?,” “I am not okay with being a mom right now”).

Some participants noted the lack of conversation about sexual history or STI testing (11% at T4, 14% at T5). Many of these responses focused broadly on Michael’s sexual history (e.g., “I don’t know his previous sexual activity,” “Not sure how many partners he has had”), while a smaller number of participants described the need for open discussion with Michael about topics related to sexual health and safety (e.g., “We haven’t discussed sexual safety and expectations,” “As of right now, we probably haven’t discussed safety and whatnot”). Others focused on the lack of discussion about STI history (e.g., “Haven’t talked about STIs yet,” “No STD talk”). Beyond a conversation, some indicated an expectation of mutual exchange of STI testing proof (e.g., “No exchange of current STI testing paperwork,” “I haven’t seen his STI test results,” “No proof that he doesn’t have an STI”).

After participants learned there was no condom (T5), 12% commented that this information altered their perception of Michael. Some indicated that not carrying a condom suggested that Michael was irresponsible (e.g., “He is irresponsible for not having condoms on hand,” “Clearly he is irresponsible,” “He didn’t plan ahead,” “He is unprepared for having sex- this displays POOR JUDGMENT on his part, albeit in regards to a minor situation, it might reflect the quality of his judgment about his life decisions as a whole”). Others expressed concern Michael might be lying (e.g., “Was he lying about not having a condom because he doesn’t like it?,” “Risk that Michael does have a condom and is lying”) or was being manipulative (e.g., “Him not wanting to having sex without a condom makes him a shady dude that does this often”). Some indicated that Michael asking to have sex without a condom was a warning sign (e.g., “He thinks it might be ok to proceed without a condom,” “He seems like an asshole for even asking to have sex without a condom”). Others perceived Michael not having a condom as pressuring and, instead of seeing that pressure as a reason for having sex, stated this was a turnoff (e.g., “It seems like he is really pressuring me to have sex with no condoms – that is super lame,” “He wasn’t prepared - turn off”).

Relationship.

Participants also commonly reported relationship factors as a reason not to have sex (61% at T4, 33% at T5), including their current relationship with Michael (55% at T4, 29% at T5). Several subthemes emerged within this theme. Participants commonly indicated they did not know Michael well yet (37% at T4, 19% at T5; e.g., “Barely know him,” “Haven’t known him long,” “Don’t know each other that well”). Within this subtheme, a few participants insinuated that this lack of trust combined with the location of the encounter might pose additional risks (e.g., “Being at his house, not mine, makes me a tiny bit worried safety-wise,” “You’re at his place, not yours, which gives you slightly less control over the situation”).

Some participants also indicated that the parameters of the relationship with Michael were unclear (23% at T4, 10% at T5). For example, participants were unsure if he had another partner (e.g., “He could be having sex with someone else,” “Not sure if he has other partners,” “You don’t know who else he’s seeing”), what his intentions were (e.g., “He might be using me,” “Relationship will be too much based on sexual aspect,” “Stress over figuring out if it’s a relationship or just sex”), or whether the relationship with Michael was casual or in pursuit of a committed relationship (e.g., “Even though you’ve seen a lot of each other lately, the commitment level of the relationship is unclear,” “I have no idea if sex means commitment to him right now”). Not being in a committed relationship was another reason described for not having sex (e.g., “Not monogamous,” “We aren’t dating exclusively”).

Other participants stated it was too early in the relationship with Michael to have sex (11% at T4, 2% at T5; e.g., “It seems too early,” “Moving too fast,” “Want to take it slower in the relationship”). A few highlighted that the emotional connection was not yet as strong as they would like it to be to have sex (e.g., “I am not in love with him,” “We aren’t emotionally attached”).

Finally, some thought having sex might negatively impact the potential for a future relationship with Michael (16% at T4, 6% at T5). These concerns centered around worries that it might ruin the relationship (e.g., “It could mess up our relationship”) such that he would lose interest (e.g., “He will never talk to me again,” “Him not contacting me the next day”) or it would affect how he sees them (e.g., “Don’t want him to see me only as a sexual object,” “He may judge you for having sex so fast,” “He may think you’re ok with being a booty call,” “I want to be a girlfriend and not just a hookup”). Others expressed concerns that sex would lead Michael to be more emotionally invested than they were (e.g., “He would get clingy,” “Obligated to hang out again soon,” “I don’t want intimacy or a relationship right now”).

Alcohol.

Participants also reported reasons against having sex related to alcohol (22% at T4, 6% at T5), with concerns differing by beverage condition. In the control condition, participants commonly expressed worries about Michael being drunk while they were sober (14%; e.g., “He has been drinking and I have not,” “He is more intoxicated than I am”) and his level of intoxication (12%; e.g., “He might be too drunk,” “He’s been drinking,” “His level of intoxication”). One participant noted that this could lead to miscommunication (“He’s a little drunk and I’m completely sober so we might not be on the same page about what’s going on”), whereas others expressed concern about consent (“Michael has had three beers and I am sober. I should make sure he consents,” “He’s had more to drink than I have [which could have affected his consent]”). Another participant indicated his intoxication could pose a safety risk for them: “He might be drunk and try something I don’t want to do.” A couple of participants (1%) indicated that simply being sober was a reason not to have sex (“You are totally sober,” “Stone sober”).

Within the alcohol condition, participants said they were drunk (6%) or that both people were drunk (5%), with two participants focusing on Michael’s intoxication (1%). Several highlighted that alcohol could impair their own decision-making (e.g., “Am I too drunk to be making good decisions, right now?,” “Have had a good amount to drink – could be clouding my judgement”). Similar to the control condition, one participant in the alcohol condition also highlighted that Michael may not be able to consent due to intoxication (“I shouldn’t be taking advantage of him while he may/may not be intoxicated”). A few others expressed concerns about alcohol’s effects on his sexual functioning (“Maybe he is too drunk to keep it up”) or the sexual interaction generally (“Drunk sex is never the best sex”).

Emotions.

Reasons focused on motivations or consequences related to emotions were reported by 14% at T4 and 9% at T5. Regarding motivations, some participants recognized that emotions may be motivating their desire to have sex (e.g., “I had a bad day,” “Mood,” “I’m just trying to distract myself”) and indicated coping was not a good reason to have sex (e.g., “Using sex as a coping mechanism,” “I may be acting selfishly if I’ve had a bad day”). Others anticipated negative emotional consequences of having sex, such as regret (e.g., “I’ll regret it tomorrow”), anxiety (e.g., “Sex makes me feel nervous the next day”), and concern that negative feelings would outweigh the positive (e.g., “All these great feelings will end right after we’re done having sex”).

It Can Wait.

The fact that sex could wait, was not practical, or not desired was reported by 14% at T4 and 9% at T5. Most of these participants focused on simply not wanting to have sex (e.g., “I don’t want to,” “I feel uncertain,” “I’m honestly not completely into it,” “Not in the mood”). Some were disinterested in Michael (e.g., “Because he doesn’t value me,” “He seems kind of controlling”). Others indicated the sex could wait (e.g., “If he really likes me, he can wait,” “Preference to wait”) and highlighted that other sexual activity would not pose the same risk (e.g., “Non-intercourse stuff is still pretty fun,” “We can enjoy other physical things than sex,” “You could satisfy each other without having intercourse”). Some participants also indicated practical reasons to not have sex (e.g., “I’m on my period,” “My tummy kind of hurts,” “You might have things to do tomorrow and need to get home,” “Do I have to get up early?”).

Societal Concerns.

A notable minority of participants reported reasons against having sex related to societal considerations and social norms (9% at T4, 5% at T5). This theme included fear of stigma (e.g., “Don’t want to seem easy,” “Fear of what other people will think,” “Judged by others,” “Don’t want to be thought of as promiscuous,” “Because society says promiscuity is bad”) or harm to reputation (e.g., “I don’t sleep around and want to keep the reputation,” “Reputation will be lowered”). Consistent with the notion of women as sexual gatekeepers, some expressed a belief that denying him sex would make them seem “hard-to-get” and put them in a relative position of power (e.g., “Making him wait more will only make him want me more,” “You don’t want to give up that much control,” “May want to pull back, play harder to get,” “Don’t want to give him the upper hand”).

Discussion

The aim of this study was to examine the nature and strength of women’s cognitive appraisals regarding the decision to have sex in the context of an eroticized sexual scenario presented after consuming either alcoholic or non-alcoholic drinks. Participants generally found the scenario to be realistic and arousing, as reflected in both their average ratings and the degree of engagement expressed in the open-ended responses. Thus, the desired “hot states” of arousal and intoxication appear to have been activated, at least to some degree, for participants in this study, thereby providing an ideal context in which to examine the cognitive appraisals motivating women’s decisions regarding sex and condom use.

Quantitative ratings were first examined regarding timepoint and condition differences. Extending past work on the association between alcohol intoxication and sexual abdication (Masters et al., 2014), alcohol was associated with greater sexual abdication at both timepoints, regardless of information about condom (non-)availability. Further, for both conditions, learning there was no condom led to a weakening of reasons for having sex, a strengthening of reasons against having sex, and greater conflict. However, these changes were buffered by alcohol, such that intoxicated individuals were less affected by the knowledge of no condom relative to sober individuals. In turn, the strength of cognitive appraisals (reasons for, reasons against, and feeling conflicted) only differed between beverage conditions after there was knowledge of no condom. This is consistent with the role of inhibition conflict in alcohol myopia (Steele & Josephs, 1990), whereby the attention-narrowing effects of alcohol intoxication become most apparent when impelling cues (e.g., arousal, attraction) are accompanied by inhibiting cues (e.g., lack of condom availability). Although we expected earlier aspects of the scenario mentioning protective methods (birth control, condom use in the prior sexual encounter) to be reminders of sexual risk, thereby serving as potential inhibitory cues within the standardized situation, these were relatively subtle compared to the overt impelling cues of arousal in the scenario. Thus, it was not until the explicit discussion of condoms that inhibitory cues became salient enough to reveal myopic effects of alcohol on appraisals. Of note, alcohol and lack of condom availability explained more variability in the strength of reasons against having sex (24.5%) than reasons for having sex (7.8%), suggesting these impelling and inhibiting cues were particularly informative for participants’ thoughts about stopping the sexual encounter. However, a substantial amount of variability in all quantitative outcomes remained unexplained, suggesting additional factors may have contributed to participants’ ratings regarding their reasoning.

Coded open-ended responses regarding reasons for and against having sex at each timepoint revealed women’s complex decision-making process. Although theory was not used to inform or guide the content analysis, findings can be interpreted in light of the Cognitive Mediation Model (Norris et al., 2004). Primary appraisals of the situation in the context of individual goals were reflected in several themes. Sexual intimacy and satisfaction goals emerged as themes of sexual desire and arousal. Individual goals for either a casual or committed relationship were reflected in relationship-related reasons for and against sex. Goals to maintain physical and emotional safety were also reflected across several themes, as women considered whether the sexual situation might confer risk for STIs, unintended pregnancy, non-consensual sexual experiences, stigma, or feelings of regret. Beyond these primary appraisals, participants also engaged in secondary appraisals by weighing the risks and benefits, and reflecting on their capacity to cope with future potential outcomes, such as unintended pregnancy.

These cognitive processes underlying women’s sexual decision making were multifaceted, even when intoxicated. Although our quantitative findings revealed that the strength of these reasons differed by alcohol condition after knowledge of no condom, qualitative findings revealed that the nature of these reasons was similarly distributed across beverage conditions at both timepoints—with a few exceptions. Before knowledge of no condom, intoxicated participants more often mentioned being in the heat of the moment (23%) than sober participants (14%), consistent with our conceptualization of alcohol intoxication as a hot state. After knowledge of no condom, there were similar rates of heat-of-the-moment considerations between conditions (21% and 20%), but sexual desire emerged as a more salient consideration for those who had consumed alcohol (68%) instead of the control drink (58%), which may reflect the potential for alcohol myopia to increase one’s focus on sexual desire in the presence of inhibition conflict.

Further, there were alcohol-specific cognitions that emerged as both reasons for and against having sex in both beverage conditions. Interestingly, alcohol-related considerations were most frequently mentioned as a reason against having sex for sober participants before learning there was no condom (27%). One alcohol-related cognition that emerged was a concern that Michael may not be able to consent to sex while intoxicated. Although this concern was raised by a small number of participants in both conditions, it was more common among sober participants. It is possible that a partner’s capacity to consent may be a clearer concern amongst those whose cognition is not affected by alcohol use. On the other hand, it is also possible that a discrepancy in intoxication levels between sexual partners heightens concerns about consent.

In contrast to these more subtle and low-frequency distinctions between alcohol conditions in the nature of cognitions, there were notable differences between timepoints. Given that participants had limited space to report their reasoning (they could write up to three reasons for and three reasons against having sex), these timepoint differences likely reflect shifts in participants’ focus upon learning that there was no condom. Understandably, health risk considerations as a reason against having sex increased most dramatically, from 40% to 93%, such that nearly all participants reported some considerations related to the lack of condom, STI, or pregnancy. Even when reporting their reasons for having sex, risk considerations increased somewhat (3% to 10%), reflecting that participants were weighing risk relating to condom use. In turn, participants’ relative attention shifted away from other reasons against having sex, such that there was a decrease in focus on relationship considerations (61% to 33%), alcohol use (22% to 6%), emotions (14% to 9%), a belief that sex can simply wait (also 14% to 9%), and societal concerns (9% to 5%). Similarly, reasons for having sex also reduced with regard to relationship considerations (60% to 37%) and the cognitive and emotional aspects of sexual desire (80% to 63%). Endorsement of physiological arousal (54% to 59%) and being in the heat of the moment (19% to 20%) remained relatively unchanged. Further, one new code emerged, such that 12% indicated they now viewed Michael as irresponsible, untrustworthy, or manipulative specifically because he did not have a condom. Past work has highlighted young adults’ embarrassment and fears around purchasing and carrying condoms (Sheeran et al., 1999) as well as methods to cope with this embarrassment (Arndt & Ekebas-Turedi, 2017; Moore et al., 2006). However, young men and women both believe others think more negatively about carrying and purchasing condoms than they actually do (Dahl et al., 2005; Frankel & Curtis, 2008), and current findings suggest that having a condom available may even be expected by some women.

It is notable that only 40% of participants reported health risk concerns on their own, before condoms were made a focus of the scenario. Thus, it is unclear how many would have initiated a conversation about condoms if Michael had not done so as part of the scenario. Regarding specific health concerns, STIs were a more common consideration than pregnancy. Although participants were told in the scenario that they were taking an oral contraceptive, it is not known to what extent they recalled this detail when reporting their reasons. Those who mentioned pregnancy still expressed salient and strong concerns, including perceptions of high fertility, distrust of birth control methods, and concerns about how they would navigate or cope with a pregnancy. These salient pregnancy concerns even in the presence of birth control echoes past qualitative work highlighting young adult women’s overwhelming concern about pregnancy (Fantasia et al., 2014; Murphy et al., 2021). Although these data were collected in the US prior to the restriction of reproductive rights (Dobbs v. Jackson Women’s Health Organization, 2022), such pregnancy-related cognitions may be further heightened for women who now have uncertain or reduced access to health care. Notably, very few participants mentioned health-related concerns regarding HIV or AIDS specifically. Thus, although efforts to mitigate HIV risk have historically motivated large advances in sexual risk behavior research and intervention, HIV risk was not a salient concern among young adult women in the current study.

Strengths, Limitations, and Future Directions

Strengths of the current study include our use of a large community sample, adding to prior research that has often focused on college students’ experiences of alcohol and sexual behavior (Cooper, 2002; Griffin et al., 2010). Our use of laboratory-based methods to activate hot states of sexual arousal and alcohol intoxication also adds to prior interview- and survey-based methodologies that have been used to examine sexual decision-making while in cold states. Further, our use of both quantitative and qualitative analyses allowed for a rich understanding of how alcohol affected women’s reactions to learning there was no condom available while in the midst of an eroticized sexual scenario.

Nonetheless, findings should be interpreted in the context of several limitations, including the standardized scenario. Although we focused on two timepoints in the scenario to examine changes associated with learning there was no condom, appraisals may have been primed by questions in other parts of the study, and other aspects of the sexual encounter may have also led to important changes in cognitions. Future research could investigate other turning points that may shift the focus from impelling to inhibitory cues within a sexual encounter. The changes we did observe highlight alcohol’s effect on cognitive appraisals in sexual situations and the importance of situational context. As research designs employing ecological momentary assessments become increasingly popular to examine sexual risk (e.g., Blayney et al., 2022; Santa Maria et al., 2018; Yeater et al., 2022), our findings serve as an important reminder that appraisals can change quickly, such that within-person fluctuations can occur not only between days or events, but also within a given sexual encounter.

Second, in addition to being randomized to beverage condition, participants were randomized to a mood condition (good day vs. bad day) within the current scenario. Although affect may have important implications for cognitive appraisals, we expected that heightened affective intensity rather than valence would drive the attentional narrowing associated with hot states (Leite et al., 2012). Thus, we did not examine differences between positive and negative mood conditions in the current study. Nonetheless, mood-related considerations were mentioned in some participants’ reasons for and against having sex, suggesting the potential utility of examining the combined role of mood and alcohol use on sexual decision making in future work.

Finally, findings should be generalized with caution. Although the target BrAC of .08% for the alcohol condition is standard in laboratory research and consistent with the legal limit for intoxication, many young adults experience higher BrAC levels in natural drinking episodes (Grant et al., 2012; Jozkowski et al., 2023). In addition, the current sample was limited to young adult women who had recently engaged in consensual condomless sex with a male partner. Thus, it is unclear if the cognitions reported in this study would generalize to women who are more consistent condom users, women who do not have sex with men, men, or non-binary individuals. Although there was some overlap in the cognitive processes displayed among the women in this study and college men in a past study (MacDonald et al., 2000) – including consideration of health risks, past and future experiences, sexual arousal, and alcohol intoxication – more research is needed to directly examine gender differences and learn of each partner’s attributions in response to a standardized scenario. Although beyond the scope of the current study, considerations of gender and sexual identity of both partners will be crucial to understand in future research. Importantly, the standardized sexual scenario in this study may have appeared centered on the potential for vaginal-penile sex. In turn, participants tended to interpret questions about reasons for and against sex (broadly defined) with regard to vaginal-penile sex. It is therefore unclear how cognitions might differ for sexual encounters involving other forms of sex. Finally, most young adult women who participated in this study were White college graduates. Given that cultural context and social norms may have important implications for cognitive appraisals of sexual behavior and condom use, we encourage future research exploring appraisals in more diverse samples.

Clinical Implications

To mitigate risk, interventions often focus on ways to increase condom use (Noar, 2008) via psychoeducation, motivation building, and skills training (Crepaz et al., 2009; Fisher et al., 2003; Johnson et al., 2011). However, without a clear understanding of young adult women’s sexual decision making during hot states, intervention efforts may be hampered by providing guidance that is unlikely to be used in the heat of the moment. Indeed, within focus groups, multiethnic college women stated that the safer-sex education they received presumed they would maintain control during sexual encounters, but in reality, they experienced a feeling “as if they were being taken over” by “being in the moment” (Kennedy & Roberts, 2009). In addition to greater preparation for the effects of hot states on decision-making, interventions could be enhanced by including the scenario from this study, which could encourage reflection, risk awareness, and consideration of behavior change while hot states are activated (Andrasik et al., 2013). Interventions may also benefit from a clearer understanding of the factors that motivate heat-of-the-moment sexual decision making, as detailed in this study. That participants reported a wide variety of cognitive appraisals – both for and against having sex – highlights the need to develop more sex positive interventions. These interventions could be aimed at addressing women’s heat-of-the-moment cognitions by increasing positive outcomes of sex and decreasing negative outcomes, with a focus on skills that can be effectively translated from trainings to real-world, hot-state encounters.

Conclusion

The current study adds to prior literature by providing insight into the cognitive processes underlying young adult women’s sexual decision-making. By activating the hot states of sexual arousal and alcohol intoxication through the use of an eroticized sexual scenario and alcohol administration, we were able to investigate women’s cognitive appraisals regarding the decision to have condomless sex. Both quantitative and qualitative findings highlighted the influence of alcohol on women’s reasons for and against having sex, particularly after participants learned that there was no condom available. Highlighting the role of alcohol myopia in narrowing one’s attention to salient impelling cues (e.g., sexual arousal) in the presence of inhibiting cues (e.g., lack of a condom), intoxicated participants had stronger reasons for having sex, weaker reasons against having sex, and perceived less conflict in their decision than sober participants. Yet, a substantial amount of variability in ratings remained unaccounted for by alcohol intoxication and lack of condom availability, and open-ended responses provided more insight into participants’ rationale. The detailed and multifaceted cognitive appraisals women reported when hot states were activated reflected not only the sexual desire and arousal experienced in the present moment, but also considerations about individual health and well-being, the relationship, and broader societal concerns. These findings highlight the complexity of factors that contribute to women’s decisions to engage in consensual condomless sex with a male partner. Thus, to mitigate health risks associated with condomless sex, multifaceted heat-of-the-moment cognitions regarding both the risks and rewards of sex will be critical to address in interventions aimed at promoting women’s sexual health and well-being.