To have sex or not to have sex? An online focus group study of sexual decision making among sexually experienced and inexperienced gay and bisexual adolescent men

Abstract

Adolescent gay and bisexual men (AGBM) are at disproportionately high risk for HIV and other sexually transmitted infections, yet healthy sexuality and HIV prevention programs grounded in experiences unique to AGBM (e.g., coming out) are lacking, as is the formative work necessary to inform such programs. A richer understanding of factors informing AGBM’s decisions to have or not have sex is needed. To fill this gap in the literature, we conducted qualitative and mixed methods analyses of data collected in online focus groups with 75 ethnically-diverse 14–18 year old AGBM across the United States. Findings suggest that many reasons why AGBM choose to have or abstain from sex mirror those noted in previous literature as influential for heterosexual adolescents (e.g., temptation, “horniness”). AGBM conveyed additional experiences/concerns that appeared unique to their sexual identity, particularly fears about pain during anal sex, and difficulties safely and accurately identifying same-sex partners. Both groups voiced reasons to wait or stop having sex. Sexually inexperienced youth said their motivations centered on wanting to avoid STIs and HIV, a desire to wait for the right partner, and the specialness of sex. On the other hand, sexually experienced AGBM said they stopped having sex if there was not an available partner they had interest in, or to improve their romantic relationship. Thus, while our findings suggest that there may be common factors across sexual identity that impact youth’s sexual decision making, healthy sexuality programs for AGBM also need to address issues specific to being gay and bisexual.

Sex and sexuality are integral aspects of adolescent development (e.g., Fortenberry, 2014; Halpern, 2010; Russell, 2005), yet our knowledge of how sexually experienced and inexperienced sexual minority youth navigate decisions about if and when to have sex remains relatively limited. While the decision making process is likely similar to heterosexual youth, factors unique to youth’s sexual identity likely play a role in making decisions about sex as adolescent gay and bisexual men (AGBM)¹ must navigate additional “cultural, structural, interpersonal, and intrapsychic factors” during their development (Diamond & Savin-Williams, 2005; Diamond, Savin Williams, & Dube, 1999). These factors can include attempting to come out, identifying potential same-sex partners, and forming and sustaining intimate same-sex relationships within the context of a heterosexist society (Garofalo & Harper, 2003; Harper, 2007; Harper & Riplinger, 2013). To date, most of the research on sexual activity and abstinence among adolescents–both heterosexual, and gay and bisexual–has been focused on determinants of behaviors that place them at risk for HIV and other STIs, or adolescent pregnancy (among heterosexual female youth). Less work has attempted to qualitatively understand how young people, particularly AGBM, describe their lived experiences regarding sexual initiation (e.g., Arrington-Sanders et al., 2015; Kubicek, Beyer, Weiss, Iverson, & Kipke, 2010). To address this gap, the present study conducted online focus groups to investigate the experiential factors influencing AGBM’s decision making about if and when they have sex.

Existing research on adolescent decision making about sex has focused primarily on sexually active heterosexual youth and young adults (O’Sullivan & Meyer-Bahlburg, 2003; Tolman, Spencer, Harmon, Rosen-Reynoso, & Striepe, 2004). The heterosexual youth in these studies report a variety of physical, emotional, and relationship-based reasons for having sex, including: feelings of horniness/desire; for physical pleasure; because the timing feels right; feeling decreased inhibition due to substance use; a desire to express love, devotion, intimacy, or commitment; and pressure from a partner or society (Cooper, Shapiro, & Powers, 1998; Dawson, Shih, de Moor, & Shrier, 2008; Eyre & Millstein, 1999; Ozer, Dolcini, & Harper, 2003; Voisin & Bird, 2012). While research has examined factors like sexual desire, attraction, and love among gay and bisexual adult men (e.g., Diamond, 2003), how these findings translate to adolescent gay and bisexual men who are still in their formative sexual development is not well understood.

Research on the sexual motivations of sexually inexperienced youth has been limited in comparison to sexually experienced youth. Existing studies primarily focus on heterosexual youth’s decisions to remain abstinent from sex (Abbott & Dalla, 2008; Loewenson, Ireland, & Resnick, 2004; Michels, Kropp, Eyre, & Halpern-Felsher, 2005; Ott, Pfeiffer, & Fortenberry, 2006; Paradise, Cote, Minsky, Lourenco, & Howland, 2001; Voisin & Bird, 2012). To our knowledge, there has been little research on abstinence motivations of AGBM. Among heterosexual youth, studies have identified a number of reasons to wait to have sex, including fear of negative consequences, youth’s personal moral or religious values, their parents’ beliefs and moral values, and/or their desire to wait until marriage (Abbott & Dalla, 2008; Loewenson et al., 2004; Michels et al., 2005; Ott et al., 2006; Paradise et al., 2001; Voisin & Bird, 2012). Additional reasons more germane to AGBM, such as questions and fears about anal sex, are less well explored in the literature.

While it is likely that the sexual motivations of heterosexual adolescents and AGBM overlap (e.g., desire to have sex to experience pleasure, desire to abstain from sex to prevent HIV), the social context and sexual scripts that guide their decisions about sexual interactions likely differ as a result of sexual identity (D’Augelli, 1994; Harper & Riplinger, 2013). For example, while concerns about pregnancy may motivate heterosexual adolescents to abstain from sex or use condoms, a lack of concern may contribute to non-condom use among AGBM (Mustanski, DuBois, Prescott, & Ybarra, 2014) or not influence their decision making about sex altogether. In contrast, decision making about sex among AGBM may be informed by issues with little meaning for heterosexual youth, such as coming out or safely identifying same-sex partners (Diamond & Savin-Williams, 2005; Diamond et al., 1999). Indeed, partner availability, while a challenge for all youth, may be a particular challenge for AGBM as there are typically fewer out and gay- or bisexual-identified young men in settings frequented by adolescent males (e.g., schools).

For example, one qualitative study of young gay men’s initial online dating experiences highlights the difficulties AGBM experience in identifying dating partners in person (Pingel, Bauermeister, Johns, Eisenberg, & Leslie-Santana, 2013). Respondents talked about how online dating sites helped them validate and accept their sexual identity and provided a relatively safe and anonymous way to explore same-sex dating without having to confirm a potential partner’s sexual orientation. Despite these benefits, they also voiced discomfort about the overtly sexual nature of online dating sites and uncertainty about handling sexual requests from other men. This is in contrast to heterosexual youth, who are often unable to voice how they learned about their sexual attractions and are less comfortable looking to the Internet for dating partners (Hillier, Mitchell, & Ybarra, 2012). A more nuanced understanding of sexual motivation and decision making about sex among AGBM, as well a sense of the social context in which their sexual decisions are made, is necessary to better understand adolescent sexual development in general as well as to better inform supportive programs and interventions tailored specifically for this population.

While there is relatively little qualitative research focused on AGBM who are not yet sexually active, one longitudinal study of sex and sexuality in young sexual minority men included retrospective discussions about their early sexual experiences and first sexual encounters (Kubicek et al., 2010). In these interviews, young men described learning through sexual experimentation, relying on the sexual experience of (often older) sexual partners, and engaging in high-risk sexual activities as a result of being ill-equipped with sexual health information. While heterosexual youth likely also have a sense of learning about sex by actually doing it, the lack of access to relevant sexual health information and relying on older partners to teach them how to have sex may both be unique factors that influence decision making about sex among AGBM. Another retrospective interview study revealed that prior to initiating their first same-sex sexual experience AGBM used sexually explicit videos to learn about the mechanics of sex, determine their readiness to initiate sex, and to learn more about same-sex sexual scripts and expectations (Arrington-Sanders et al., 2015). In addition, some participants reported modeling sexual risk behaviors (e.g., condomless sex) observed in these videos during their first sexual experiences. The use of sexually explicit material – which may portray unrealistic or inaccurate models of sex and sexuality – and “learning by doing” as a substitute for adequate sexual education for AGBM underscores the need to further investigate the experiences and factors that inform decision making among sexually inexperienced AGBM in particular. Such information would provide insights into gaps in AGBM’s knowledge about sexual health and how best to develop sexual health programs aimed at reducing high-risk and exploratory sexual activity. As first-time sexual behavior has been shown to impact the likelihood of safe sexual decisions in the future (O’Donnell, O’Donnell, & Stueve, 2001; Sneed, 2009), these early experiences provide a critical window for promoting healthy decision making through sexual education and intervention.

Taken together, although much is known about sexual motivations and decision making in heterosexual youth, and about the life experiences that distinguish sexual minority adolescents and adults from their heterosexual peers, the motivations to have or abstain from sex among sexually experienced and inexperienced AGBM are relatively understudied. This information is critical given that AGBM and other young men who have sex with men (YMSM) in the United States are disproportionately affected by HIV (CDC, 2013) and that they lack healthy sexuality and HIV prevention programs that consider their needs (Harper, 2007; Harper & Riplinger, 2013; Mustanski, Newcomb, Du Bois, Garcia, & Grov, 2011). To fill the noted gaps in the literature, we used qualitative and mixed-methods analyses to identify factors that inform AGBM’s decisions to have sex and to not have sex, and to examine whether these factors differed by sexual experience. To our knowledge, this is among the first studies to explore reasons that inform decisions about sex among an ethnically-diverse, nationally-recruited sample of sexually experienced and inexperienced AGBM.

METHODS

Participants

Eighty adolescent males were enrolled in online, asynchronous, bulletin-board style focus groups. Eligible participants were 14–18 years of age, self-identified as gay, bisexual, and/or queer, were assigned a male sex at birth, and lived in the United States (Mustanski et al., 2014).

Procedures

The Chesapeake Institutional Review Board (IRB) and the Northwestern University IRB approved all human subjects procedures prior to study initiation. All participants provided verbal informed assent and completed an assessment of decisional capacity during the telephone interview portion of the screening as part of this process (Moser et al., 2002; UCSD Task Force on Decisional Capacity, 2003). A waiver of parental permission was obtained to protect youth from unintentional disclosure of their sexual identity to their parents, which may have put them at increased risk for victimization within their families (Mustanski, 2011).

Two focus groups were conducted in November 2012, and another two conducted in January 2013. Participants were recruited nationally through online advertisements posted on Facebook and LGBT-focused organizations’ websites. Interested candidates completed an online screening form and then a telephone interview with a member of our research staff to confirm eligibility. Purposeful sampling (Patton, 2001) was used to enroll a diverse group of participants with respect to their age, geographic region, race, and ethnicity (Patton, 2001; Ybarra, Prescott, & Holtrop, 2014c).

Across the two recruitment efforts, 460 screeners were completed, of which 193 appeared eligible for participation. We successfully contacted 152 eligible candidates and enrolled 80 into the study. Of the 152 eligible and contacted, six candidates were no longer interested, for reasons including being too busy, mental health issues, and stress at school caused by peers. Two contacted candidates did not want to talk on the phone to complete the enrollment process, one phone number was invalid, one candidate did not pass capacity to assent, and four were contacted and responded; however, their enrollment “bin” was subsequently filled before they were enrolled. The remainder of contacted but not enrolled participants (n = 58) did not respond to contact attempts. Seventy-five participants logged in and participated fully (i.e., participated at least once per day) in the focus groups and thus comprise our analytic sample. Of the five participants who did not complete the focus groups, two participants withdrew because they were busy and had too much going on with other commitments (e.g., school).

Participants were stratified based on past sexual experience as this was posited to be a key feature predicting differences in decision making about sex (Ybarra, Bull, Prescott, & Birungi, 2014a; Ybarra et al., 2013). We assessed sexual experience by asking: “Have you ever had sex?” Response options included: “Yes, with a guy”, “Yes, with a girl”, or “No”. Participants who indicated that they had sex with either a male and/or a female partner were assigned to the sexually experienced group. All other participants were assigned to the sexually inexperienced group. As such, two focus groups were conducted with AGBM who had not had sex (sexually inexperienced; n=36), and two were conducted with AGBM who had sex with a male or female partner at least once in their lifetime (sexually experienced; n=39).

Data were collected on a password-protected bulletin board website asynchronously over three consecutive days. In other words, participants answered questions at their convenience, rather than participating in a simultaneous, dynamic discussion. Participants created a unique user name using a pseudonym in order to protect their privacy. All research team members had access to the online bulletin boards and were able to monitor the discussions. Two moderators from the research team facilitated the focus groups. Moderators posted questions to the group twice daily (one set of questions in the morning and another in the afternoon). Participants were instructed to visit the online bulletin board at least twice per day in order to type their responses to these questions and to respond to moderator comments that were posted to elicit further discussion or clarification. A moderator prompted participants who did not respond to each question. Participants received a $25 Amazon.com gift card for their complete participation.

Measures

Demographic characteristics

Demographic data, including participant age, race, ethnicity, geographic region, sex assigned at birth (i.e., “the sex you were assigned by the doctor at birth”), and sexual identity (gay, bisexual, and/or queer) were collected in both the online and phone screeners.

Focus group questions

Focus group guides covered a range of topics relevant to a larger study focused on the development of a text messaging-based HIV prevention program for AGBM, called Guy2Guy. This paper focuses on analyses of responses to topics specifically centered on decision making about sex and sexual experience. These topics include participant discussions of their reasons to have sex, reasons and benefits of not having sex, experiences with pressure to have sex, decision making about first time sex, and reasons to stop having sex. Both sexually experienced and sexually inexperienced groups were asked to discuss reasons why they or their peers might choose to have sex. Other questions were tailored specifically for the sexually experienced and inexperienced groups. For instance, sexually inexperienced participants were asked to discuss the benefits and drawbacks of not having sex, whereas the sexually experienced groups were asked about their first-ever sexual experiences and reasons they may have for stopping after having previously had sex.

In addition to answering questions by typing their responses in the online bulletin board, participants were able to indicate their agreement or disagreement with other group members by including a quotation from another participant within the context of their own response. Where agreement with another participant was communicated in this way, the excerpt was coded for endorsement of the relevant theme.

Data processing and analysis

The participants’ individual transcripts of their comments on the online bulletin board were directly imported into Dedoose (2012), a mixed-methods analysis program. Our analysis focused on individual-level transcripts, rather than the group narratives (Carey & Smith, 1994), in order to examine individual responses to our research questions and to conduct mixed-methods analyses across subgroups of sexually experienced and sexually inexperienced participants. We applied two rounds of constant comparison analysis to the data (Glaser & Strauss, 1967). First, transcripts were coded using the focus group guide questions and by identifying emerging themes (Carey & Smith, 1994; Glaser & Strauss, 1967; Ryan & Bernard, 2003). This resulted in 25 broad thematic codes, one of which was “sexual decision making.” This code subsequently was applied to 326 excerpts in which there was any reference to reasons to have sex, not to have sex, or to stop having sex. Second, two coders independently generated lists of axial codes pertaining to sexual decision making for comparison, discussion, and refinement. Disagreements were resolved through consensus, and these axial codes were retained and applied to an additional subset of excerpts while we read for additional emergent themes. This iterative process continued until all of the excerpts were reviewed and an initial list of 176 axial codes related to sexual decision making was generated. Constant comparison analysis was again used to reduce the data into 31 discrete axial codes. This technique can be beneficial when working with focus group data from multiple focus groups within a single study (Onwuegbuzie, Dickinson, Leech, & Zoran, 2009).

Then, we grouped the 31 axial codes into three overarching categories: 1) reasons to have sex, 2) reasons not to have sex, and 3) reasons to stop having sex. Axial codes that were applied to less than 5 excerpts (9 axial codes total) were removed. Analyses presented here include the 22 remaining axial codes related to sexual decision making (Table 1). A pooled Cohen’s Kappa of .75 was observed across coders, indicating a good (Dedoose, 2012; Landis & Koch, 1977) to excellent level of reliability (Fleiss, 1971).

Table 1.

Themes and axial codes associated with “Sexual Decision Making” code

Theme/Axial Codes	Description
Reasons to have sex*
Personal Reasons
Horny/temptation	Hormones, physical attraction or sexual tension
Physical pleasure	Sex as “good”, “fun”, “thrilling”, or physically pleasurable
Curiosity/Experience	Wanting and/or gaining experience or knowledge about sex
Interpersonal Reasons
To show love	Using sex to improve a bond, communicate love, or close a gap with a partner
Loneliness/make connection	Desire to make a connection, to feel close, or to resolve loneliness through sex
Feels “right/”right” guy	Having found the “right” guy, waited the “right” amount of time, or sex feels “right”
Sociocultural Reasons
Types of Pressure	Pressure to have sex from external sources including social group/peers, culture, media, and one’s partner
Reasons not to have sex**
Personal Reasons
Specialness	“Specialness” of relationships, the body, romance, virginity/sexual inexperience, and/or sex
Fear	Fear of physical or emotional pain or consequences
“I’m not ready”	Not feeling “ready” (e.g., too young, immature, inexperienced, wanting to wait)
Moral/Ethical	Waiting due to morals, ethics or values, or doing what’s “right”
Because it will be my “First Time”	Refers specifically to losing virginity or having sex for the “first time”
Interpersonal Reasons
Decreases disease risk	Benefits of waiting/abstaining to reduce risk for STDs/STIs and HIV
Waiting for the “right” guy	Not having sex until in a committed, serious relationship, and/or with the “right guy”
Waiting for love	Not having sex until they are in love
Relationship isn’t ready	Relationship not being “ready” (i.e., lack of communication or emotional connection)
Reasons to stop having sex among youth have had sex***
Personal Reasons
No interest	Loss of interest or desire in sex
For physical rest	Stopping because of need to physically take a break
Too busy/focusing on other things	Need to focus on school, self, sports, etc., or being busy with other things
Interpersonal Reasons
Scarcity of partners	Lack of availability or access to viable sexual partners
To improve relationship	Wanting more out of relationship; to test, rekindle, or revitalize the relationship
To stop having “unhealthy” sex	Feeling “used” for sex, “addicted” to sex, forced to have sex, or being in an unhealthy sexual relationship

Note.

^*Applied only when referring to reasons to have sex;

^**Applied only when referring to reasons to not have sex;

^***Applied only when referring to reasons to stop having sex among youth who have sex before. The first two categories include all youth, whereas the third is restricted to sexually active youth.

Mixed methods analyses (Axinn & Pearce, 2006) were conducted only in cases where similar questions were posted for both groups; this included questions pertaining to reasons to have sex. Analyses were modeled after our prior mixed-methods studies (DeHaan, Kuper, Magee, Bigelow, & Mustanski, 2013; Magee, Bigelow, Dehaan, & Mustanski, 2012; Mustanski, Lyons, & Garcia, 2011). Within the theme, reasons to have sex, we identified group differences through mixed-methods analyses and defined them as meaningful if: 1) they were noticed as a theme during qualitative analysis, 2) they were endorsed by a minimum of five participants, and 3) code application rates that differed by at least 20% between groups (Magee et al., 2012). Group differences are presented in terms of the percentages of excerpts that were associated with a particular code for each group. These percentages are normalized because of unequal numbers of individuals in each group (Dedoose, 2012).

Thematic analyses are presented regarding external types of pressures to have sex, reasons not to have sex, and reasons to stop having sex as our questions and probes were tailored by sexual experience in order to encourage discussion in areas most relevant to group members. This thematic analysis enabled us to identify unexpected themes and patterns that emerged during interactions between focus group participants as well as in individual responses to our research questions (Miles & Huberman, 1994). Given that the identical items were not asked of each group, presenting group differences in theme frequencies would be misleading and therefore are not provided. To facilitate readability, grammar and spelling have been corrected in quotations from focus group participants. Content and emphases are unchanged.

RESULTS

The focus group completion rate was 95%: 71 participants posted in both sessions daily (e.g., Monday morning, Monday afternoon). Eighty-five percent of participants (n=64) responded to at least one question in all 6 sessions; 8% (n=6) responded to 5 sessions; 5% (n=4) responded to 4 sessions; and 1% (n=1) responded to 3 sessions.

Participant characteristics are presented overall and by sexual experience in Table 2. Within our purposefully recruited sample, demographic characteristics were generally similar by sexual experience. Results are organized into three categories related to decision making about sex: 1) reasons to have sex, 2) reasons not to have sex, and 3) reasons to stop having sex among those who are sexually active. Table 3 provides the number and percent of participants who endorsed each theme, the number of total excerpts, and the mean number of such excerpts per participant (e.g., 2.0 indicates that on average, each participant had two excerpts with this theme).

Table 2.

Demographic characteristics across groups and by participants’ sexual experience

Variable	Combined % (n)	Sexually Experienced % (n)	Sexually Inexperienced % (n)
Age M (n)
14–16	M = 15.4 (46)	M = 15.4 (25)	M = 15.3 (21)
17–18	M = 17.5 (29)	M = 17.5 (14)	M = 17.4 (15)
Race
Caucasian	54.7% (41)	46.2% (18)	63.9% (23)
African American	5.3% (4)	5.1% (2)	5.6% (2)
Asian	5.3% (4)	5.1% (2)	5.6% (2)
Multiracial	18.7% (14)	25.6% (10)	11.1% (4)
Native American or Alaskan Native	1.3% (1)	2.6% (1)	0.0% (0)
Other	14.7% (11)	15.4% (6)	13.9% (5)
Hispanic ethnicity	25.3% (19)	33.3% (13)	16.7% (6)
Sexual orientationa
Gay	86.7% (65)	92.3%(36)	80.6% (29)
Bisexual	18.7% (14)	15.4% (6)	22.2% (8)
Queer	5.3% (4)	10.3% (4)	0.0% (0)
Urban-rural status
Urban	70.7% (53)	66.7% (26)	72.0% (27)
Rural	29.3% (22)	33.3% (13)	25.0% (9)

Note.

^aCategories are not mutually exclusive.

Table 3.

Themes and axial codes per participant for excerpts referencing sexual decision making

Theme	Participants % (n)	Excerpts (M excerpts per participant)
Reasons to have sex
Personal Reasons
Horny/temptation	61% (46)	49 (1.1)
Physical pleasure	28% (21)	23 (1.1)
Curiosity/Experience	28% (21)	25 (1.2)
Interpersonal Reasons
To show love	28% (21)	23 (1.1)
Loneliness/make connection	9% (7)	7 (1.1)
Feels “right”/”right” guy	8% (6)	6 (1.1)
Sociocultural Reasons
Types of Pressure	81% (61)	92 (1.5)
Reasons not to have sex
Personal Reasons
Specialness*	29% (22)	30 (1.4)
Fear of pain	31% (23)	30 (1.3)
“Not ready”*	19% (14)	17 (1.2)
Moral/Ethical	16% (12)	14 (1.2)
Because it will be my “First Time”*	13% (10)	12 (1.2)
Interpersonal Reasons
Decreases disease risk	55% (41)	44 (1.1)
Waiting for the “right” guy	32% (24)	35 (1.5)
Waiting for love*	15% (11)	15 (1.4)
Relationship isn’t ready	17% (13)	14 (1.1)
Reasons to stop having sex
Personal Reasons
No interest	17% (13)	13 (1.1)
For physical rest	7% (5)	5 (1.1)
Too busy/focusing on other things	7% (5)	5 (1.1)
Interpersonal Reasons
Scarcity of partners	11% (8)	8 (1.1)
To improve relationship	7% (5)	6 (1.2)
To stop having “unhealthy” sex	7% (5)	5 (1.0)

Note. For the number of participants, the number in parentheses is the percentage who endorsed a certain subtheme out of all participants. For the number of excerpts, the number in parentheses is the average number of excerpts provided per participant. Codes applied to ≤5 excerpts were removed from analysis. Only sexually experienced participants were asked about reasons to stop having sex.

^*Indicates responses only given by sexually inexperienced participants.

Reasons to have sex

Participants in both sexually experienced and sexually inexperienced groups described a number of reasons for having or wanting to have sex, including: 1) personal reasons, 2) interpersonal reasons and 3) external types of pressure to have sex. Quantitative group differences are presented for personal and interpersonal reasons, as both sexually experienced and inexperienced participants discussed these themes in response to our research questions. Qualitative thematic results include several types of external pressures to have sex that participants described during the focus groups.

Personal reasons to have sex

The most frequently-mentioned personal reason for sex was horny/temptation, which was in 49 excerpts. This included descriptions of feeling horny, physical attraction, sexual tension, and hormones. For example, participants talked about having sex because of having “raging” hormones, “the horniness in a locker room,” or feeling sexual tension “[because] the guy is sooo hot and seductive.” Mixed-methods analysis suggested that the theme horny/temptation was mentioned with similar frequency among sexually experienced (21 excerpts) and sexually inexperienced (28 excerpts) AGBM (see Figure 1). However, participants’ discussions about horniness and temptation tended to reflect how their sexual experiences informed their decision making about sex. For example, sexually experienced participants conveyed their physical desire to have sex: “We’re just damn horny” (14 yo sexually experienced participant). In contrast, sexually inexperienced participants talked about physical desire in the context of discussing the challenges they faced in adhering to their decision to wait or when describing the drawbacks of not having sex. Sexually inexperienced participants also referenced their hormones and their experience of sexual tension more specifically than their sexually experienced peers when conveying the difficulty of not having sex: “Sexual tension! For guys who can’t even find a boyfriend particularly” (17 yo sexually inexperienced participant).

Figure 1.

Reasons to have sex: Percentage of excerpts endorsing each theme by participant sexual experience. Numbers beside bars indicate raw number of excerpts.

Participants also described wanting to have sex simply out of curiosity, to experience it, or to gain knowledge about it. We applied the code curiosity/experience to these 25 excerpts. This theme was mentioned more frequently by sexually experienced compared to sexually inexperienced AGBM (19 vs. 6 excerpts). Moreover, this theme was discussed differently between the two groups: sexually inexperienced participants tended to emphasize the aspect of gaining experience, specifically describing the importance of having sexual experience in order to feel adequate at sex. For example, “…somebody might jump at it because they want to have the experience so that when they DO meet the person they love, they won’t be a useless sack of potatoes” (16 yo sexually inexperienced participant). In contrast, sexually experienced participants used the term “curiosity” when reflecting on their own personal reasons for having sex—for example, “Curiosity got the best of me. Caught up in the moment, went for it” (15 yo sexually experienced participant).

Participants also discussed having sex for physical pleasure (23 excerpts), that it is “thrilling”, “fun”, or “a good time”. Unlike horniness/temptation, sexually experienced youth referenced physical pleasure more frequently compared to their sexually inexperienced peers (18 vs. 5 excerpts).

Interpersonal reasons to have sex

Overall, interpersonal reasons to have sex were more frequently discussed among participants in the sexually experienced group compared to the sexually inexperienced group (28 vs. 8 excerpts; Figure 1). Within this category, to show love or to improve a bond with a partner was the most frequently described interpersonal reason for having or wanting to have sex, with more references to this theme occurring among sexually experienced participants than among sexually inexperienced participants (17 vs. 6 excerpts). Participants’ discussions of having sex as a way to show love or improve a bond with a partner were similar across groups. For example:

I feel I have sex for that intimate closeness when I am in a relationship, out of pure lust and/or hormones, or to close an emotional gap with my partner that is very apparent at the stage of the relationship. (16 yo sexually experienced participant)

An 18 year-old sexually inexperienced participant voiced a similar reason:

Well, I’m a very logical person, so when I heard some biological facts about how having sex with somebody you loved makes that relationship deeper and gives you a stronger connection, I knew I wanted to wait, because I don’t want to lose that feeling of connection.

Additional reasons participants described for having or wanting to have sex included wanting to resolve loneliness or the desire to make a connection with another guy, and because it felt “right” or they felt they had found the “right” guy. We applied the code loneliness/connection to 7 excerpts and the code feels ‘right’/’right’ guy to 6 excerpts in which these themes emerged. Sexually experienced participants talked more frequently about both loneliness/connection (6 of the 7 excerpts) and feels ‘right’/’right’ guy (5 of the 6 excerpts). One additional theme was infrequently voiced but worthy of mentioning because of its unique relevance to this population: having sex because of the scarcity of gay or bisexual male partners (4 excerpts). Instead of functioning as a factor that would reduce sexual activity, lack of partners was cited as a reason these AGBM had sex whenever they had the chance because of their concern that another opportunity might not occur.

External types of pressure to have sex

Participants reported a number of external pressures to have sex. The code for types of pressure was applied to 92 excerpts (45 sexually experienced and 47 sexually inexperienced) in which participants referred to three main types of pressure to have sex: 1) peer pressure, 2) partner pressure, and 3) sociocultural and media-based pressure.

Peer pressure

Pressure from friends and the sense that “everyone else is doing it” emerged as a theme among both sexually experienced and sexually inexperienced participants. Sexually inexperienced participants talked about feeling isolated because of their inexperience: “…At my school, EVERYONE is having sex. Being a virgin is almost like an endangered species” (16 yo sexually inexperienced participant). They also conveyed feelings of isolation related to being gay: “It is hard seeing many of your classmates talking about how they love having sex… it almost makes you a little jealous that, being gay, you can’t be that open about it with friends like straight people can” (17 yo sexually inexperienced participant). Sexually experienced participants also talked about pressures to have sex in order to fit in with their peers, even though they are sexually experienced, “Here I am at 18 and finally not a virgin. Friends are a big one [pressure]. I feel I have two sets of friends, those who have sex and those who are virgins…. I’m just amazed when they talk about how much fun having sex with this guy was and kind of makes me jealous” (18 yo sexually experienced participant).

Partner pressure

Both sexually experienced and sexually inexperienced participants talked about sexual pressure from partners. When discussed by sexually inexperienced participants, their references included pressure to have sex for the first time. Additionally, when discussing the drawbacks of not having sex, some sexually inexperienced participants expressed their worry about disappointing their partner. Some participants also indicated that they thought a good boyfriend would be one who would support their decision to wait: “Tempting boyfriends can be a problem. But the REAL boyfriends are ones who respect you and your decision to be abstinent” (18 yo sexually inexperienced participant).

Like their sexually inexperienced peers, sexually experienced participants also discussed having sex in order to please or keep their boyfriends: “I think that people have sex because they think they are ready, but most of all because they feel they need to hurry the process for their partner” (17 yo sexually experienced participant) and “…they wanna have sex and you wanna wait but you’re afraid that if you make them wait too long he might break up with you” (15 yo sexually experienced participant). A minority of sexually experienced participants made reference to unwanted sexual experiences: “We have sex for the fun of it and to fit in and in some cases because we were forced into it” (16 yo sexually experienced participant).

Cultural and media-based pressure

Media and cultural factors were discussed as major influences in the lives of both sexually experienced and sexually inexperienced participants: “I think that our sex driven culture is the biggest challenge. People are ridiculed for still being virgins” (16 yo sexually inexperienced participant). Similarly, another participant said, “Sex is constantly being thrown in our faces through TV, movies, videogames, books, music etc. and I suppose it could make you feel a bit left out” (16 yo sexually inexperienced participant).

Recent shifts in legislation pertaining to gay marriage in the United States may also play a role in the way these young men experience cultural pressures to have sex as illustrated by the following comment:

So much of the gay community is portrayed in media or that we see in real life is shown as nothing but people who sleep around… I feel we almost conform to these standards to be accepted in the gay community. Everyone also says wait until you get married but we can’t get married (depending on where you live) so what’s the point of waiting? (15 yo sexually experienced participant)

Reasons not to have sex

Our questions and probes were tailored by sexual experience in order to encourage discussion in areas most relevant to group members. As such, thematic analyses are presented but group differences are not.

Personal reasons for not having sex

Several personal reasons for not having sex were discussed exclusively by sexually inexperienced participants. Participants most frequently described their personal feelings about “specialness” (e.g., of sex, virginity or romance) as a reason for not having sex (Table 3). The code specialness was applied to excerpts that included these references or descriptions. For example, sexually inexperienced participants talked about waiting to have sex until they “find someone special,” how they hope it will be a “special moment,” and virginity as something “saved” not “thrown away.” Some sexually inexperienced participants also discussed waiting for marriage: “I should wait for the person I want to marry because it’ll be much more special and meaningful” (17 yo sexually inexperienced participant).

Another theme that emerged only in discussions among sexually inexperienced participants pertained to the concept of individual readiness as a reason not to have sex. Participants used the term “ready” to refer to their own sense that sex was something that they could handle. For example, one participant said, “I choose not to have sex because I have my own standards for sex and feel like I’m not quite ready to have sex” (17 yo sexually inexperienced participant).

The code first time was applied to excerpts where sexually inexperienced participants mentioned losing their virginity or having sex for the first time, for instance: “I want to wait… I want losing my virginity to mean something” (15 yo sexually inexperienced participant). As this quote illustrates, this theme of first time often overlapped with other themes (e.g., specialness) when discussed as a reason to wait for sex.

The remaining themes were discussed by both sexually inexperienced and sexually experienced participants. The fear code was applied to excerpts where participants explicitly raised fears about physical pain (e.g., during anal sex) or emotional discomfort (e.g., heartbreak, conflict with parents) as reasons to not have sex. The ways in which participants described their fears reflected their sexual experience. For instance, sexually inexperienced participants talked about fears of parents finding out and fears of pain based on what they had heard from their peers:

Well guys like us really don’t wanna have sex with a partner because they are scared if something does happen parents will flip…and I guess as well guys don’t wanna have sex because people say it hurts and stuff. (14 yo sexually inexperienced participant)

Participants in the sexually experienced group, in contrast, discussed fear as a reason not to have sex in context of their personal experiences having sex: “…fears though, may include the … worry of the inability to perform, premature ejaculation.” (18 yo sexually experienced participant) One sexually experienced participant also referenced a fear of emotional ties related to sex, “…some young men are afraid of having emotional ties and possibly the thought of sex disgusts them.” (18 yo sexually experienced participant)

Both sexually inexperienced and sexually experienced participants raised moral/ethical reasons for not having sex as illustrated with this quote from a bisexual participant:

I am waiting for both religious reasons and this “If I don’t marry this person, this will be someone else’s husband/wife. What if we met? How would I feel knowing that I had had sex with this guy’s husband/wife?” (17 yo sexually inexperienced participant)

Interpersonal reasons not to have sex

Four interpersonal themes emerged, one of which was mentioned exclusively by sexually inexperienced participants: waiting for love, which often intersected with comments about having sex for the first time. This code was applied to excerpts in which participants explicitly referenced the importance of love. For example, “For me and people like me, sex isn’t just a physical pleasure. It is emotionally significant. When I have my first time, I want it to be with a man whom I’m in love with.” (17 yo sexually inexperienced participant)

The remaining interpersonal themes were discussed by both groups. Avoiding the risk of contracting an STI or HIV was frequently mentioned. Comments made by sexually experienced participants generally listed this as a reason some young men may choose not to have sex, for example, “I think they want to avoid any situation with AIDS or STDs.” (15 yo sexually experienced participant). However, for sexually inexperienced participants, this was also talked about in the context of discussing the good things about waiting/not having sex, “Avoiding sex takes away any and all possibility of contracting an STD.” (17 yo sexually inexperienced participant)

The importance of waiting for the ‘right’ guy emerged during discussions among both sexually inexperienced and sexually experienced participants, though discussions were much more in depth among the sexually inexperienced participants. For example, although sexually experienced participants conveyed that they may be waiting for the right guy, “…really right now I’m just waiting for a certain person” (15 yo sexually experienced participant), their comments did not overlap with the theme of specialness and did not place emphasis on sex being a “big thing” as was the case among the sexually inexperienced group:

I think the main reason why we wait is because we want to find the right person. For me sex is a big thing, and I won’t be having it with any guy, they must be somebody I have a real connection with. (15 yo sexually inexperienced participant)

Lastly, choosing not to have sex because the relationship is not ready and wanting a solid relationship was a theme that emerged among both sexually inexperienced and sexually experienced participants, who described this theme in similar ways: “Well I AM ONE OF THOSE PEOPLE who wants to wait until I am a little older in a strong relationship... I do get tempted. A lot” (18 yo sexually inexperienced participant).

Reasons to temporarily stop having sex

Personal reasons to stop having sex

Three personal themes related to reasons to stop having sex were identified. Having no interest in sex or in having sex was the most frequently endorsed theme (13 excerpts). Some participants described a general lack of interest in sex: “I dunno. I just don’t feel like it most of the time. I am presented with opportunities, but I usually just don’t want to” (18 yo sexually experienced participant). Others’ responses reflected a lack of interest in sex due to negative experiences, such as finding sex to be boring or aversive.

The need for physical rest was referenced in five excerpts. For example, “I stop for a while to give my body a break” (17 yo sexually experienced participant). Being too busy or because they are focusing on other things was also referenced in five excerpts that mostly pertained to being busy with other activities. For example, “[stopping] when you need to be focused on something else like school or sports” (16 yo sexually experienced participant).

Interpersonal reasons to stop having sex

Three interpersonal reasons to stop having sex were identified. Scarcity of partners was discussed most frequently (8 excerpts), and could occur for a few reasons, according to our participants. The following quote describes a partner/boyfriend who is sexually unavailable or uninterested in having sex: “Mostly because the person I have it with is on and off about it. He wants to then doesn’t then wants to then doesn’t. Ugh” (14 yo sexually experienced participant). Others referred to a lack of potential partners: “Because I can’t find someone usually” (16 yo sexually experienced participant).

The code improve relationship was applied to 6 excerpts where participants described stopping having sex to revitalize the relationship: “Me and my boyfriend often decide to stop having sex for a while so that we connect on a deeper more emotional level rather than just date each other for sex” (15 yo sexually experienced participant). Others stopped in order to improve sex with their partner: “…Well if you don’t have sex long enough which is like a year maybe... when you do end up having sex it feels like the first time” (17 yo sexually experienced participant).

An important theme that emerged relatively infrequently (5 excerpts) referred to stopping sex because it was unhealthy. These excerpts included references to feeling used in addition to other aspects of sex that they identified as unhealthy for them. For example, “I sometimes feel like I’m being used so I avoid it a lot. Or if something gets me paranoid about being safe” (15 yo sexually experienced participant). Staying safe was also a concern for these young men:

There was also a time where this guy wouldn’t put on a condom because it didn’t feel good enough for him to do it, but I just told him to stop and that we could try it another time if he decided to put one on. I think it’s really important to be protected, no matter what. You never know what the other person may be doing when you’re not with them, and with whom. (16 yo sexually experienced participant)

Another participant described feeling used and isolated because he is gay:

Another reason I won’t have sex is because I feel used by the guys in my town who are “straight” to everyone else but want me to give up myself for only sex and unfortunately for a few years I gave in because that was the only experience I had with other gay people. (15 yo sexually experienced participant)

Finally, feeling an unhealthy addiction to sex was mentioned as a reason to stop: “There have been times when I have decided to stop having sex and masturbating both either for religious reasons or feeling as if I was almost ‘addicted’ to it” (18 yo sexually experienced participant).

DISCUSSION

Because decision making patterns, including those about sex, are being formed during adolescence (Ponton & Judice, 2004; Steinberg, 2008), understanding the factors that AGBM face in deciding when to first have sex, and then when to have sex or abstain once they are sexually active, are critical for both their current health and future behaviors. Similar to their heterosexual male peers (e.g., Cooper et al., 1998; Leigh, 1989; Meston & Buss, 2007), findings in this national, qualitative study suggest that AGBM’s primary motivators for sex were personal in nature. Both sexually experienced and inexperienced AGBM voiced physical reasons as a primary motivator for sex, but for sexually inexperienced participants, physical desire and sexual tension were discussed more frequently as a challenge or drawback they faced when abstaining from sex rather than as a motivator to have sex. Emotional and interpersonal reasons, including feelings of curiosity, a desire for sexual experience, wanting to show love to a partner, and having sex to improve a romantic bond were also particularly important to sexually inexperienced and sexually experienced AGBM.

Participants further described reasons to have sex that seemed unique to being sexual minority adolescent men. One was the scarcity of same-sex partners, which was described as a reason to have sex in the rare times when an interested male partner was available. Heterosexual adolescent men might voice a similar sentiment about interested female partners, but given the smaller pool of potential partners available to AGBM, this issue may be one that AGBM-tailored healthy sexuality programs could consider discussing explicitly. Reminiscent of participants in Pingel et al. (2013) who voiced concerns about safety, participants in the current study also conveyed an interest in learning how to meet other AGBM and how to safely identify or come out to other young men who may not be out themselves. These findings indicate that AGBM-focused healthy sexuality programs could provide youth with suggestions about ways that they could safely query another person’s sexual identity; and assure youth that even when it may not seem like it, they will likely meet many other GBM in the future.

Reasons not to have sex

Analyses uncovered several personal and interpersonal reasons why sexual minority adolescent men might decide not to have sex. Past sexual experience provided a context through which participants in both groups conveyed their reasons for not having sex. For participants in the sexually inexperienced group, their reasons included those focused on decision making criteria for the future, when they might decide they are ready to have sex. These reasons were often framed in ways that conveyed that waiting to have sex was a positive decision. This was reflected in their discussion about the specialness of sex and/or virginity and the importance of feeling ready to have sex, both of which overlapped with discussions where participants talked about having sex for the first time (e.g., to make the first time special).

Both sexually experienced and inexperienced AGBM described fear as a personal reason not to have sex. In addition to describing fears similar to those of heterosexual adolescents, such as heartbreak and embarrassment (Michels et al., 2005), feelings of regret (Abbott & Dalla, 2008), and conflict with their parents (Brady & Halpern-Felsher, 2008; Eyre & Millstein, 1999; Loewenson et al., 2004; Ott et al., 2006), participants in our focus groups also consistently conveyed a specific fear of physical pain during sex.

Consistent with other research on heterosexual adolescent men (Loewenson et al., 2004) and gay adult men (Leigh, 1989), the most common personal reason to stop having sex raised by sexually experienced AGBM was a general lack of interest in sex. Importantly, youth voiced purposeful, positive reasons to stop having sex as well, including a desire to improve the emotional aspects of a romantic relationship or to improve sex with their partner, or to take a break from unhealthy relationships. For example, one participant chose to stop having sex because he had felt used by multiple heterosexually-identified men who have sex with men who were living in his community. These findings contrast with prior studies that have reported largely negative reasons for stopping sex among gay and lesbian adults (e.g., fear of HIV/STIs, lack of opportunities; Leigh, 1989), heterosexual adolescents (e.g. fear of getting caught; Loewenson et al., 2004), and overlap with findings among young black women who chose to stop having sex to improve their situation after being mistreated or used (Bradley, Sales, Elifson, & DiClemente, 2012). Our findings emphasize that AGBM and other young people can also choose to engage in preventive behaviors for positive, affirming reasons that are prime for reinforcement in healthy sexuality programming. Moreover, AGBM’s reasons for not having sex highlight that this decision is not simply to reduce the risk of STIs or HIV, but also to improve relationships, sexual well-being, and overall quality of life.

Limitations

Results should be interpreted within the context of the study’s limitations. We utilized a mixed-methods approach that including quantifying the frequencies of themes that emerged from items that were asked of all participants and explicitly inquired about the theme. For themes that emerged from more open ended questions we did not quantify results. Within a purely qualitative framework, the use of numbers may implicitly suggest that some experiences are more noteworthy than others and/or presume comparisons between groups. Frequencies of themes must be interpreted in recognition that some participants may have had similar thoughts, feelings, and experiences but may not have chosen to describe them in the focus groups for a number of reasons.

Additionally, these findings are based on a sample of AGBM who used Facebook or were active with community-based LGBT organizations. Results may not generalize to other AGBM, particularly those who are not out online, those who are not on Facebook, or those who would not participate in LGBT-focused groups. That said, online recruitment resulted in a broader sample than traditional recruitment methods that focus on one specific region or city. Online focus groups may offer an additional benefit, as it has been suggested that individuals from stigmatized groups are more likely to participate in online rather than face-to-face forums given their anonymity (Fox, Morris, & Rumsey, 2007). In addition to successfully reducing participants’ sense of isolation as sexual minority youth, the majority of our participants reported that their focus group participation led to positive changes in their attitudes about sex and their plans to enact healthier changes in their sexual behavior in the future (Ybarra, DuBois, Parsons, Prescott, & Mustanski, 2014b). Sexually inexperienced participants in particular reported that the group made them feel supported in their decision to delay having sex, which itself reduces the likelihood of contracting HIV or other sexually transmitted infections (Ybarra et al., 2014b).

Moreover, we did not define the term “sex” in the screener to make the question more approachable to youth who may be uncomfortable with the topic. Although the definition was provided if youth asked for clarification during the phone interview, this resulted in many youth applying their own definition of sex. It is possible that some youth were not assigned to the correct sexual experience group. However, careful review of participants’ responses to the focus group questions suggests that this was not a discernable issue.

Implications and Future Directions

More comprehensive measures that tap into different dimensions of sexual attraction, behavior, and identity could allow for examination of differences in sexual motivations by identity. Future studies could also incorporate specific measures of minority stress and stigma. For example, participants’ concerns that their “parents will flip out” if they were to discover that they were gay and having sex speaks to the benefit of integrating scales pertaining to outness or victimization into future studies. These could then provide additional insights into specific environmental factors that inform decisions to have sex or to wait to have sex among AGBM.

Given the paucity of interventions tailored to AGBM, qualitatively identifying factors that affect their decision to either have or abstain from sex can help inform the development of interventions salient to their concerns about and experiences with sex. Our findings suggest that the reasons why sexually experienced and inexperienced youth choose to have or not have sex are in many ways similar to those noted for heterosexual youth (Abbott & Dalla, 2008; Dawson et al., 2008; Eyre & Millstein, 1999; Loewenson et al., 2004; Ott et al., 2006; Paradise et al., 2001; Voisin & Bird, 2012). However, findings also provide clues as to where and how content could be tailored to increase the relevance of healthy sexuality programs designed for AGBM. Such programs could consider contextualizing and modifying content so that it addresses the health risks and concerns of AGBM related to their sexual identity (e.g., heightened concern about HIV infection) but also that reflects their specific experiences as sexual minority youth. For example, programs could acknowledge youth’s fears about pain during anal sex and provide information about how to avoid it, educating AGBM about condom and lubricant use to both reduce the likelihood of condom breakage during anal sex and make sex more pleasurable and less painful. In addition, including information on topics such as the difficulties AGBM may face in finding gay or bisexually-identified partners, and validating any frustrations and challenges related wanting to wait until marriage (although gay marriage may not be recognized in their home state) would increase relevance of sexual education programs for AGBM.