Sir: In the literature, there is a general consensus that alcohol and/or drug use heighten the probability of sexual impulsivity. In this regard, there are findings in the areas of homosexuality and/or infection with human immunodeficiency virus. Beyond this literature, there are also alcohol studies that have examined specific variables related to sexual impulsivity, predominantly in nonclinical populations. For example, among college students, researchers have confirmed relationships between alcohol use and a lower likelihood of inquiring if new partners had sexually transmitted diseases,1 unwanted sexual intercourse,2 high-risk sexual behaviors,3 unplanned and unprotected sex,4 and a lower likelihood of condom use.5 Studies have also examined community samples and confirmed relationships between alcohol use and multiple partners, premarital sex, and transactional sex (i.e., sex for money) in China6; forced sex, transactional sex, and greater condom use in South Africa7; unprotected sex, multiple sexual partners, and transactional sex in Botswana8; and a greater likelihood of herpes infection.9 These types of relationships have been examined in clinical samples as well. For example, among women beginning alcohol treatment, Mckay10 found no patterns with condom use or nonuse. In contrast, Breen and colleagues11 found among ecstasy users that comorbid alcohol use was related to sex with a greater number of partners as well as a lesser likelihood of practicing safe sex. In addition, Stein and colleagues12 found among intravenous drug users with alcohol problems that alcohol use predicted risk-taking behaviors with regard to sex.
Enhanced sexual impulsivity has been reported with drugs other than alcohol as well. For example, Simbayi and colleagues13 found among a South African community sample that methamphetamine use was associated with unprotected intercourse and relations with multiple partners. Raj and colleagues14 found among detoxification patients that cocaine use was associated with being sexually active as well as transactional sex. Finally, Kingree and Betz15 found among African American males in juvenile detention that marijuana use was associated with no prior discussion of sexual risks as well as nonuse of condoms.
In this study, we examined relationships between self-reported alcohol and drug problems, and 13 variables related to sexuality in a sample of female internal medicine outpatients.
Method
Participants were female outpatients, aged 18 years or older, who presented for routine medical care at an ambulatory center in which residents in the Department of Internal Medicine function as the primary providers. The sample was one of convenience. Exclusion criteria, which were determined by recruiters, were cognitive, psychiatric, or medical impairment that would preclude the successful completion of a survey.
Participants (N = 76) ranged in age from 18 to 75 (mean = 42.64, SD = 15.16) years. Most (85.5%, N = 65) were white, with 11.8% (N = 9) being African American, 1.3% (N = 1) Native American, and 1.3% (N = 1) Asian. The majority had attained a high school diploma (68.4%, N = 52); 11.8% (N = 9) reported a bachelor's degree and 6.6% (N = 5) a graduate degree. While most participants (71.6%, 53/74) had been married, only 24.3% (18/74) of the sample was currently married; 5.4% (4/74) were separated, 29.7% (22/74) were divorced, and 12.2% (9/74) were widowed.
Each participant completed a 4-page survey. The cover page of the survey contained the various elements of informed consent, and completion of the survey was assumed to function as informed consent. The booklet explored (1) demographic information (i.e., age, race, marital status, and highest level of completed education), (2) alcohol and drug history (i.e., “Have you ever had a problem with alcohol?” and “Have you ever had a problem with drugs?” with yes/no response options), and (3) the sexual history (i.e., age of menarche; age of first intercourse; number of pregnancies, live births, births outside of marriage, miscarriages, and abortions; number of different lifetime sexual partners; number of treatments for a sexually transmitted disease; homosexual experiences; and history of rape by a stranger, date, or partner). This study was approved by the institutional review boards of both the community hospital that sponsors the internal medicine residency and the university and was conducted from July 2005 to June 2006.
Results
Nine participants (11.8%) reported having had a problem with alcohol and 8 (10.5%) with drugs. The simple correlations between alcohol or substance abuse and the sexuality variables are presented in Table 1.
Table 1.
Correlations Between Self-Reported Alcohol or Drug Abuse Problem and the Sexuality-Related Variables in a Sample of Female Internal Medicine Outpatients (N = 76)
Discussion
For participants endorsing a history of alcohol problems, there were statistically significant positive correlations with a later age at menarche, being raped by a stranger, and having had same-sex experiences. Likewise, for participants endorsing a history of drug problems, there were statistically significant positive correlations with the total number of births outside of marriage, the total number of different sexual partners, and having had same-sex experiences. Clearly, these data confirm relationships between alcohol and/or drug use and specific sexuality-related behaviors, reflecting the general theme in the literature.
In comparison with previous studies in this area, our sexuality variables for examination were broad and somewhat different. The majority of previous studies have examined high-risk sexual behaviors, including the lack of use of condoms, unsafe sex, multiple partners, and transactional sex. In this study, we focused more on sexual impulsivity and its possible aftermaths (e.g., pregnancies). Despite the differing sexuality variables under study, the general theme of impulsivity appears consistent both in our study and in the studies of others.
There are a number of potential limitations to this study including the self-report nature of the data, global queries about alcohol and drug problems, small sample size, and use of a female sample. However, this is one of the few studies to examine a number of sexuality variables in relationship to alcohol and substance abuse as well as to use a primary care sample for study. Future studies might clarify these data, explore temporal relationships between alcohol/drug usage and sexual impulsivity, and examine the role of personality dysfunction as a moderating variable. In addition, the role of same-sex experiences warrants further investigation. Regardless, we can conclude that alcohol and drugs may have a potentially detrimental effect on sexual regulation in many individuals.
Acknowledgments
The authors report no financial affiliation or other relationship relevant to the subject of this letter.
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