ORIGINAL RESEARCH & REVIEWS
BEHAVIOR
Diverse Sexual Behaviors and Pornography Use: Findings From a
Nationally Representative Probability Survey of Americans Aged 18
to 60 Years
Debby Herbenick, PhD, MPH,1
Tsung-Chieh Fu, PhD,1
Paul Wright, PhD,2
Bryant Paul, PhD,2
Ronna Gradus,3
Jill Bauer,4
and Rashida Jones5
ABSTRACT
Background: Convenience sample data indicate that substantial portions of adults have engaged in sexual
behaviors sometimes described as rough; little is known about these behaviors at the population level.
Aim: To describe, in a U.S. probability sample of Americans aged 18 to 60 years, (i) the prevalence of diverse
sexual behaviors, described here as dominant and target behaviors; (ii) the age at first pornography exposure as
well as prevalence, range, and frequency of pornography use; (iii) the association between past year pornography
use frequency and dominant/target sexual behaviors; and (iv) associations between lifetime range of pornography
use and dominant/target sexual behaviors.
Methods: A confidential cross-sectional online survey was used in this study.
Outcomes: Lifetime engagement in dominant behaviors (eg, spanking, choking, name calling, performing
aggressive fellatio, facial ejaculation, penile-anal penetration without first asking/discussing) and lifetime
engagement in target behaviors (eg, being spanked, being choked, being called names during sex, having their
face ejaculated on, receiving aggressive fellatio, or receiving penile-anal penetration without having discussed)
were assessed; lifetime pornography use, age at first porn exposure, past-year frequency of porn viewing, and
lifetime range of pornography were also assessed.
Results: Women as well as men who have sex with men were more likely to report target sexual behaviors:
having been choked (21.4% women), having one's face ejaculated on (32.3% women, 52.7% men who have sex
with men), and aggressive fellatio (34.0% women). Lifetime pornography use was reported by most respondents.
After adjusting for age, age at first porn exposure, and current relationship status, the associations between
pornography use and sexual behaviors was statistically significant.
Clinical Implications: Clinicians need to be aware of recent potential shifts in sexual behaviors, particularly
those such as choking that may lead to harm.
Strengths & Limitations: Strengths include U.S. probability sampling to provide population level estimates
and the use of Internet-based data collection on sensitive topics. We were limited by a lack of detail and context
related to understanding the diverse sexual behaviors assessed.
Conclusion: Clinicians, educators, and researchers have unique and important roles to play in continued understanding
of these sexual behaviors in the contemporary United States. Herbenick D, Fu T-C, Wright P,
et al. Diverse Sexual Behaviors and Pornography Use: Findings From a Nationally Representative Probability
Survey of Americans Aged 14 to 60 Years. J Sex Med 2020;17:623e633.
Copyright Ó 2020, International Society for Sexual Medicine. Published by Elsevier Inc. All rights reserved.
Key Words: Sexual Behavior; Population Health; Anal Sex; Pornography
Received August 29, 2019. Accepted January 17, 2020.
1
Center for Sexual Health Promotion, Indiana University School of Public
Health-Bloomington, Indiana University, Bloomington, IN, USA;
2
Media School, Indiana University, IN, USA;
3
Brooklyn, NY, USA;
4
Miami Beach, FL, USA;
5
Los Angeles, CA, USA
Copyright ª 2020, International Society for Sexual Medicine. Published by
Elsevier Inc. All rights reserved.
https://doi.org/10.1016/j.jsxm.2020.01.013
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BACKGROUND
Recent research has described declines in sexual frequency in
the United States (U.S.) and in other industrialized countries.1e3
Less is understood about changes to sexual repertoire. In 2009,
the first wave of the decade-long National Survey of Sexual
Health and Behavior (NSSHB) was conducted.4
Findings suggested
that few sexual behaviors had changed in the nearly
2 decades since the National Health and Social Life Survey
(NHSLS).5
Compared with the NHSLS, nearly twice as many
Americans in the NSSHB reported lifetime anal sex.4
In addition,
a 2008 U.S. nationally representative probability survey
found that about half of respondents had used vibrators,6,7
a
substantial increase from the 2% of NHSLS respondents who
indicated past-year vibrator/dildo purchase.5
However, all
research is limited to the questions it asks, and these surveys
focused largely on behaviors associated with sexually transmitted
infection and/or pregnancy risk (eg, oral sex, vaginal sex, anal sex,
and sex toy use).
A subsequent U.S. nationally representative probability survey,
the 2015 Sexual Exploration in America Study (SEAS),
improved our understanding of diverse sexual behaviors by
asking 2,021 women and men aged 18 to 91 years about their
engagement in more than 30 sexual behaviors.8
The SEAS was
conducted a few years after the release of the book Fifty Shades of
Grey, which was associated with increased sales of sex toys and
with greater interest in bondage, domination, submission, and
masochism (BDSM).9e11
Among the SEAS findings were indications
that >70% of respondents had viewed sexually explicit
videos or DVDs, 57% had read erotic stories, one-third reported
lifetime spanking, and about one-fifth had tied a partner up or
been tied up.8
Given the lack of earlier benchmarks, it is unclear
to what extent these behaviors may reflect population-level
behavior changes.
Sexual Behaviors and the Pornographic Sexual
Script
Both the NSSHB and SEAS were administered following
shifts in the volume of porn produced, the accessibility of porn,
and its content. Porn producers and actors have described a
greater emphasis on anal sex and rough sex behaviors in films
produced between the 1990s and 2000s.12e14
However, research
indicates that sexual behaviors differ between porn genres. For
example, a content analysis found that women in the “Asian
women” category of one porn website were treated less aggressively
than women in other categories.15
Another study found
that physical aggression was significantly more often depicted in
the queer feminist porn films sampled, as compared with porn
categorized as “For Women.”16
Researchers and journalists have considered whether and how
pornographic content and other erotic media may influence
people's interest in or engagement in certain sexual behaviors.
These behaviors are sometimes described as reflecting
“pornographic sexual scripts” owing to their prevalent depiction
in mainstream pornography.17
Such behaviors include hair
pulling, slapping, spanking, facial ejaculation, anal sex, and
choking, among others. Recent research indicates that sizable
numbers of young adults report having engaged in some of these
behaviors.8,17e19
2 studies that asked about enacting and/or
receiving these behaviors—grouped as “dominant” and “submissive”
in these studies—were conducted among German individuals
and used convenience sampling.18,19
Another study
used survey data from 1,880 Americans, grouping such behaviors
as “aggressor behaviors,” “target behaviors,” and “degrading/uncommon
sexual behaviors” and used a convenience sample.17
The present study adds to the existing literature by assessing
the prevalence of such behaviors in a U.S. nationally representative
probability sample.
Sexual Scripts and Acquisition, Activation,
Application Model
To the extent that population-level sexual behaviors may have
changed, sexual scripts offer a means of considering such changes
and their influences. Sexual scripts are socially constructed ideas
or guidelines for sexual behavior; they address how sex unfolds
and with what consequences.20
The sexual script acquisition,
activation, application model (3AM) of sexual media socializ-
ation21
proposes that greater exposure to pornography could lead
to a greater likelihood of certain sexual behaviors, including those
associated with risk.22,23
The model has been used in research
demonstrating how such risks may be mitigated by other factors.
For example, in a recent study, it was found that adolescents’
pornography use was related to condomless sex only when parents
engaged in little to no sexual health communication with
their children.24
Because people's sexual scripts can influence their sexual attitudes,
beliefs, and ideas about how to behave in partnered sex,
the 3AM hypothesizes that sexual media consumption can result
in people learning new sexual scripts (sexual script acquisition),
the priming of sexual scripts they have previously acquired
(sexual script activation), and the utilization of sexual scripts that
may then direct their sexual practices or how they feel about
others’ sexual practices (sexual script application).21
In convenience
samples, greater pornography use has been associated with
a range of sexual behaviors associated with pornographic sexual
scripts.17e19
Aims
The purpose of the present study was to describe, in a U.S.
nationally representative probability sample of Americans aged
18 to 60 years, (i) the self-reported prevalence of diverse sexual
behaviors, focusing on those associated with pornographic sexual
scripts and grouped here as dominant and target behaviors; (ii)
the age at first exposure to pornography as well as the prevalence,
range, and frequency of pornography use; (iii) the extent to
which past year pornography use frequency is related to
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engagement in dominant and target sexual behaviors; and (iv) the
extent to which lifetime range of pornography use is related to
engagement in dominant and target sexual behaviors.
METHOD
Data are from the 2016 National Survey of Pornography Use,
Relationships, and Sexual Socialization (NSPRSS), a populationbased
probability survey of 18- to 60-year-old individuals living
in the United States and whose methods have been detailed
elsewhere.25
Study protocols were reviewed and approved by the
institutional review board at the first author's university. Data
collection occurred in fall 2016 and was conducted by Ipsos
(formerly GfK Research) using KnowledgePanel, a probabilitybased
online panel constructed using address-based sampling
and is thus designed to be nationally representative of noninstitutionalized
individuals living in the United States. KnowledgePanel
samples have been used for numerous U.S. nationally
representative probability surveys on diverse topics including
sexual health and behavior.4,6e8,26e29
KnowledgePanel members
are first identified using address-based sampling methodologies
and the U.S. Postal Service's Delivery Sequence File. Mailings
with follow-up phone calls were used to invite households to
participate in the panel. Households without Internet access have
been offered Internet access to facilitate participation. A panel
base weight, which was created taking the sampling frame into
account, was used in a probability proportional to the size selection
method to draw specific study samples from the panel.
We aimed to recruit a probability sample of 18- to 60-year-old
adults from the KnowledgePanel. They received an email invitation
for the study, with reminders sent to nonresponders for up
to 6 days of the data collection period. KnowledgePanel members
earn points for online survey participation. These points can
accumulate and then be exchanged for merchandise or payment.
In all, 6,535 individuals were recruited; 3,622 (55.4%) clicked
on the survey link and viewed the study information sheet; and
2,533 (44.9% of those invited) agreed to participate and proceeded
to complete the confidential online survey. We suggested
that individuals take the survey in a private space. Survey
completion times were a median of 15 minutes. Ipsos prepared
poststratification statistical weights to adjust for nonresponse or
under/over-coverage. Weighted data were used for quantitative
analyses.
Measures
Demographics
Demographic data (eg, age, gender, race/ethnicity, education,
annual household income) are collected by Ipsos when individuals
join the panel and periodically throughout retention
and then included in the deidentified data set provided to the
researchers. In addition, we asked respondents their sexual
orientation (heterosexual or straight/gay or lesbian/bisexual/
asexual/something else) and relationship status (single, not dating
or hooking up with anyone/dating or hooking up with one
person/dating or hooking up with more than one person/in a
relationship with one person/in a relationship with more than
one person/engaged/married/widowed/something else).
Recency of Sexual Behaviors
Using items modified from the NSSHB and SEAS,4,8
we
asked respondents how recently they had kissed someone
romantically, masturbated by themselves, performed oral sex,
received oral sex, had penile-vaginal intercourse, received anal sex
(“someone put their penis in your anus/butthole”), had someone
put a sex toy or similar object in their anus, and (for men)
performed anal sex (“you put your penis in someone's anus/
butthole). Response options were as follows: done in past 30 days
(past month), done in past year, done more than a year ago, and
never done this.
Dominant Sexual Behaviors
Respondents who reported having ever engaged in oral,
vaginal, or anal sex behaviors were asked how many times they
had ever spanked a partner's behind (butt) as part of sex play;
choked someone as part of sex play; called someone names like
“slut” or “whore” or “bitch” as part of sex play; and pressured
someone into doing something sexual that they did not want to
do. Men were also asked how often they had slipped their penis
in a partner's anus without first asking or talking about it;
ejaculated (cum) on someone's face; and aggressively thrust their
penis in and out of someone's mouth (sometimes called “facefucking”).
Response options were as follows: never, 1 or 2 times,
3e5 times, 6e10 times, and more than 10 times. The Cronbach's
alpha for these 7 dominant sexual behaviors was 0.74.
Target Sexual Behaviors
Respondents were asked to indicate how many times they had
ever been spanked by a partner as part of sex play; been called
names like “slut,” “whore,” or “bitch” as part of sex play; been
choked as part of sex play; someone pressured you into doing
something sexual that you did not want to do. Those who reported
having ever had male partners were also asked how many times
someone had ejaculated (“cum”) on their face; aggressively thrust
their penis in and out of their mouth (sometimes called “facefucking”);
or slipped their penis in their anus without first asking
(tried anal sex without asking). Response options were never, 1 or 2
times, 3e5 times, 6e10 times, and more than 10 times. The
Cronbach's alpha for these 7 target sexual behaviors was 0.79.
Bondage, Domination, Submission, and Masochism
We also asked participants how many times they had engaged
in “BDSM (eg, things such as bondage or whipping) as part of
sex” with the same response options as mentioned previously,
ranging from never to more than 10 times. Owing to the broad
range of behaviors associated with BDSM play, we did not code
these as either dominant or target behaviors and instead present
results separately.
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Pornography Use
At the beginning of a section about porn use, we wrote that
“Many people have seen porn e sometimes just by accident and
sometimes on purpose.” We indicated that, for the purposes of
this survey, “pornography or porn refers to sexually explicit
pictures, videos, or livestreams showing clearly exposes genitals
OR in which people are clearly shown having sex, such as oral
sex, vaginal sex, or anal sex.” This definition is consistent with
others in the literature.30,31
Lifetime prevalence of porn use. Respondents were asked,
“Have you ever seen any kind of pornography (“porn”) e even if
just one time, and whether on purpose or by accident?” (yes/no).
Age at first porn exposure. Those who reported ever seeing
porn were then asked “How old were you (in years) when you
first saw any type of pornography (‘porn’)?” Responses of 4 years
and under were set to missing, resulting in a total of 1.5% of
missing responses for this item.
Past-year frequency of viewing porn. Participants were
asked, “Thinking about the last year, how often would you say
you have used each of the following to see pornography?” Sources
listed were as follows: Free porn websites (eg, Pornhub, PornTube,
Xvideos), pay porn websites (where you have to pay a fee
to access content), social media apps or websites (Tumblr,
Reddit, Twitter, Snapchat, and so on), print (eg, magazines or
books), smartphone, or tablet, laptop, or desktop computer. For
each, response options were never, once or twice per year, once
or twice per month, once or twice per week, every day, or nearly
every day. A score representing the frequency of past-year
pornography use was created by summing all the responses and
then subtracting by the number of items answered.
Lifetime range of pornography viewed. Participants were
asked, “Which of the following types of pornography (‘porn’) have
you EVER seen e even if just once or twice? (yes/no)” The categories
shown were described as follows: amateur porn (featuring
regular people who are not professional models or actors); porn
showing facials (male ejaculating on a person's face); porn showing
gang bangs (gang bangs show multiple different people having sex
with one person one after another); porn showing double penetration
(showing 2 or more penises or objects in one person's vagina
and/or anus at the same time); porn showing rough oral sex (where
a man forces or aggressively thrusts his penis in and out of a person's
mouth; sometimes called ‘face fucking’); porn showing bondage/
domination (BDSM); porn where someone seems to physically or
verbally persuade or force another person to do something that
they either did not want to do or were unsure about doing; porn
showing simulated rape. The different types of pornography ever
seen were summed to represent the lifetime range of pornography
ever accessed byeach individual (range: 0e8); 5.9% didnot answer
these questions and were not included in this part of the analysis.
Statistical Analysis
All statistical analyses were conducted using Stata, version
15. We included individuals who reported ever having had
oral, vaginal, or anal sex during their lifetime in our analysis.
As most of the measured behaviors were uncommon, we
recoded each sexual behavior to a dichotomous yes/no variable.
A score was created from the sum of the dichotomously
coded variables, separately for dominant vs target behaviors,
and then divided by the number of items that the participant
had answered. The resulting percentage of sexual behaviors
engaged in during the lifetime is the dependent variable of
interest.
We assessed the effect of pornography use frequency and
range of pornography accessed on dominant vs target sexual
Table 1. Weighted demographic characteristics
Characteristics
Men Women
% (n) % (n)
Total n ¼ 1,075 n ¼ 1,152
Age
18e24 8.1 (87) 6.6 (76)
25e29 16.2 (174) 19.2 (221)
30e39 23.7 (254) 23.3 (268)
40e49 23.5 (253) 23.2 (267)
50e60 28.6 (307) 27.7 (319)
Race/ethnicity
White, non-Hispanic 61.8 (664) 62.3 (717)
Black, non-Hispanic 11.4 (122) 13.1 (151)
Other, non-Hispanic 7.3 (78) 6.4 (74)
Hispanic 18.4 (197) 17.0 (196)
Multiple races/ethnicities 1.3 (14) 1.3 (14)
Adult/parent education
Less than high school 10.1 (109) 11.2 (128)
High school 27.6 (297) 27.2 (314)
Some college 29.7 (320) 28.1 (323)
Bachelor's degree or higher 32.5 (350) 33.5 (386)
Adult/parent household income
<$25,000 11.2 (121) 12.7 (146)
$25,000e$49,999 19.3 (207) 18.4 (211)
50,000e$74,999 17.0 (183) 18.6 (214)
$75,000 52.5 (565) 50.4 (580)
Sexual orientation
Heterosexual/straight 91.5 (984) 93.2 (1,072)
Gay or lesbian 6.3 (67) 1.3 (15)
Bisexual 2.0 (21) 4.9 (57)
Asexual/other 0.3 (3) 0.5 (6)
Current relationship status
Single, not dating 16.7 (180) 12.1 (139)
Dating or in a relationship 26.1 (281) 25.2 (290)
Married 56.2 (604) 61.2 (705)
Other 0.9 (10) 1.6 (18)
The total sample presented here is of respondents who reported having
engaged in oral, vaginal, or anal sex at least once in their lifetime.
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behaviors, respectively, using fractional logit regression. Our
dependent variable of interest is the percentage of dominant/
target sexual behaviors reported among a list of such sexual
behaviors. We chose to dichotomize our behavior items and
model our dependent variable as a percentage because of the fact
that not all behavior items were given to all respondents; certain
behavior items, such as a partner ejaculated on your face, a
partner face-fucked you, and a partner tried anal sex without
asking, were asked only to respondents who reported at least one
male partner during their lifetime. Analyses were conducted
separately for men and women because of the fact that some of
the sexual behaviors measured pertains only to men (eg, tried
anal sex without asking, face-fucked someone, ejaculated on
someone's face). Adjusted regression models accounted for potential
confounding because of age (in years), age of first access
to pornography (in years), and current relationship status (single/
dating or in a relationship/married/other). Missing data were
rare (<1%) for most survey items (with the exception of age at
first porn exposure and lifetime range of porn accessed; missing
data described in the Measures section); therefore, complete case
analysis was used.
RESULTS
A weighted total of 2,227 individuals aged 18e60 years who
reported oral, vaginal, or anal sex during their lifetime were
included in the present analysis. The mean age for the sample
was 42.4 years (SD ¼ 11.9). Additional demographic characteristics
are presented in Table 1.
Lifetime Prevalence of Dominant and Target Sexual
Behaviors
Women were consistently more likely to report target sexual
behaviors than dominant sexual behaviors, whereas men were
generally more likely to report dominant sexual behaviors rather
than target sexual behaviors, with the exception of target sexual
behaviors where the denominator was men who have had sex
with men (ie, a partner tried anal sex without asking, a partner
face-fucked you, and a partner ejaculated on your face) (Table 2).
Among the target behaviors were having been choked (21.4% of
women), having one's face ejaculated on (32.3% of women,
52.7% of men who have sex with men), and aggressive fellatio
(34.0% of women).
Dominant and target spanking was the most commonly reported
behavior among women (more than half of women).
Although spanking was also commonly reported among men,
dominant spanking (77% of men) was more common than target
spanking (46% of men). Other common behaviors included
ejaculating on someone's face (reported by 48% of men) and
being pressured into doing something sexual that they did not
want to do. 3 times as many women (compared with men) reported
experiencing sexual pressure (36.9% vs 12.0%).
Pornography Use
Lifetime pornography use was reported by 94% of men and
87% of women, with the mean age of first porn exposure at 13.8
and 17.8, respectively (Table 3). Pornography was most often
accessed through free porn websites and by using smartphones,
Table 2. Lifetime dominant and target sexual behaviors
Behaviors
Men Women
P value% (n) % (n)
Called someone names such as “slut” or “whore” or “bitch” 23.3 (249) 12.0 (138) <.001
A partner called you names such as “slut”, “whore”, or “bitch” 13.6 (146) 26.1 (299) <.001
Choked someone during sex 19.6 (209) 12.2 (140) <.001
A partner choked you during sex 11.0 (118) 21.4 (245) <.001
Spanked a partner's behind 76.6 (819) 54.3 (621) <.001
A partner spanked your behind 45.5 (488) 66.2 (756) <.001
Pressured someone into doing something sexual that they did not want to do 15.2 (163) 5.0 (57) <.001
Someone pressured you into doing something sexual that you did not want to do 12.0 (128) 36.9 (423) <.001
Tried anal sex without asking 21.9 (234) – –
A partner tried anal sex without asking* 31.0 (39) 26.8 (303) .318
Face-fucked someone 35.7 (381) – –
A partner face-fucked you* 54.2 (68) 34.0 (385) <.001
Ejaculated on someone's face 47.7 (509) – –
A partner ejaculated on your face* 52.7 (66) 32.3 (365) <.001
Engaged in BDSM†
19.7 (210) 20.3 (233) .752
M (SD) M (SD)
Number of dominant sexual behaviors 2.4 (2.0) 0.8 (0.9) <.001
Number of target sexual behaviors 1.0 (1.4) 2.4 (2.0) <.001
BDSM ¼ bondage, domination, submission, and masochism.
*Among those who have ever had sex with men (126 adult men, 1,138 adult women, 1 adolescent boy, 57 adolescent girls).
†
Not included in dominant or target sexual behaviors.
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websites/apps, or a tablet/laptop/desktop computer. Frequency
of pornography use through any source was lower among women
than among men. Participants reported seeing a wide range of
pornography throughout their lifetime, with amateur porn being
the most commonly reported type and porn showing simulated
rape being the least commonly viewed. Of the 8 types of porn
assessed, men reported seeing an average of 4 types compared
with 3 for women.
Pornography Use in Relation to Dominant and
Target Sexual Behaviors
In unadjusted models, we observed that more frequent pastyear
pornography use and a greater lifetime range of pornography
accessed were significantly associated with engaging in
both dominant and target sexual behaviors among all participants
(Table 4). After adjusting for age, age at first porn exposure, and
current relationship status, the associations between pornography
use and sexual behaviors, although attenuated, remain statistically
significant (Table 5).
DISCUSSION
Using data from a U.S. nationally representative probability
survey of 18- to 60-year-olds, the present study describes the
prevalence of diverse sexual behaviors, including those associated
with what has been called “pornographic sexual scripts.”17
Significantly more men than women reported having engaged
in at least one dominant sexual behavior such as choking, name
Table 4. Associations between past-year pornography use
frequency and dominant vs target sexual behaviors
Men Women
OR (95% CI) OR (95% CI)
Dominant sexual
behaviors
Past-year
pornography use
frequency
1.09 (1.07e1.11)** 1.15 (1.11e1.19)**
Lifetime range of
pornography
accessed
1.17 (1.13e1.21)** 1.20 (1.16e1.25)**
Target sexual behaviors
Past-year
pornography use
frequency
1.13 (1.10e1.15)** 1.19 (1.14e1.23)**
Lifetime range of
pornography
accessed
1.17 (1.12e1.22)** 1.28 (1.24e1.32)**
**P < .001.
OR ¼ odds ratio.
Table 3. Lifetime and past year pornography use
Men Women
P value% (n) % (n)
Lifetime porn use 94.1 (1,007) 86.9 (990) <.001
Age of first porn exposure, M (SD) 13.8 (3.7) 17.5 (5.7) <.001
Past-year porn use frequency*
Free porn websites, M (SD) 2.7 (1.4) 1.6 (0.9)
Pay porn websites, M (SD) 1.1 (0.5) 1.0 (0.2)
Social media apps or websites, M (SD) 1.6 (1.2) 1.2 (0.6)
Print, M (SD) 1.4 (0.7) 1.1 (0.4)
Smartphone, M (SD) 2.1 (1.4) 1.5 (0.9)
Tablet, laptop, or desktop computer, M (SD) 2.4 (1.4) 1.4 (0.8)
Sum score of aforementioned porn sources, M (SD) 5.3 (4.6) 1.8 (2.8) <.001
Range of porn seen during lifetime
Amateur porn 82.8 (794) 63.0 (579) <.001
Porn showing facials 71.9 (689) 45.6 (419) <.001
Porn showing gang bangs 61.7 (592) 39.6 (364) <.001
Porn showing double penetration 64.2 (616) 46.4 (426) <.001
Porn showing face-fucking 60.2 (577) 38.7 (256) <.001
Porn showing BDSM 44.9 (431) 32.6 (300) <.001
Porn where someone pressures another person to do
something that they did not want to do
35.2 (337) 21.7 (200) <.001
Porn showing simulated rape 20.5 (197) 11.4 (105) <.001
Types of aforementioned porn seen, M (SD) 4.4 (2.7) 3.0 (2.4) <.001
Lifetime porn use assessed for the total sample; all other variables restricted to those who reported lifetime porn use.
*Porn use frequency for each source coded 1 (never) to 5 (every day or nearly every day). The sum score was calculated by summing all sources of porn
subtracted by the number of items answered (max: 24).
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calling, spanking, and pressuring someone sexually. In addition,
significantly more women than men reported experiencing at
least one target behavior, such as having been choked, spanked,
sexually pressured, or name-calling.
Women were significantly more likely than men to be called
a name during sex such as “bitch,” “slut,” or “whore” (26.1%
women vs 13.6% men). While the examples of names we gave
are gendered and thus may have influenced responses, our team
made efforts to identify comparable words more often applied
to men but were unable to do so (and indeed, these terms are
sometimes applied to men, as our findings demonstrate). Prior
research indicates that name-calling is prevalent in porn and
that commonly used words are “bitch,” “slut,” and “whore.”32
This same research shows that female targets of these terms are
generally depicted as responding positively, which—as the 3AM
would predict—may potentially influence viewers to incorporate
name-calling into their sexual scripts. Although some
people (especially women) use terms such as “slut” and “whore”
to refer to themselves or close friends in an effort to reclaim
these words,33,34
verbal harassment related to sexual behavior
(eg, referring to someone as loose, promiscuous, a slut, and so
on) is more commonly applied by men to female targets.35
Such harassment or name-calling tends to be viewed as harmful
or insulting to women when occurring in schools or social
settings.35,36
Little is understood about how people experience
name-calling as part of partnered sexual experiences.
We were struck that one-fifth of women with oral, vaginal, or
anal sex experience reported having been choked as part of sex. As
no previous population health studies have assessed the prevalence
of choking as part of partnered sexual interactions, we cannot
know to what extent this may represent a change in populationlevel
sexual repertoire. However, our experiences teaching undergraduate
students suggest that more people may be engaging in
choking behaviors as part of sex than in previous decades. Beyond
anecdotal experience is earlier research that found that college
students’ examples of playful sexual aggression or force were
wrestling, restraining, “lightly hitting,” “ripping off clothes,”
“pulling hair,” and other assorted behaviors, but choking was not
among the dozens of text responses presented.37
Another survey of
734 college students, with data collected between 2006 and 2015,
found that only 36% considered choking to be a rough sexual
behavior (similar in prevalence to those who considered punching
as a rough sex behavior), whereas most considered hair pulling,
being pinned down, biting, being tied up, and slapping as rough
sexual behaviors.38
Moreover, choking/strangulation was reported
as occurring infrequently to participants—far less often than
spanking, scratching, being tied up, or being thrown around and
only slightly more often than being physically forced to have sex,
being forced to do humiliating or degrading things, or having a
partner throw, hit, kick, or smash things. We acknowledge that
choking and other forms of asphyxiation are not new, have been
previously documented in the literature, and have been previously
Table 5. Associations between lifetime range of pornography accessed and dominant vs target sexual behaviors
Men Women
aOR (95% CI) aOR (95% CI)
Dominant sexual behaviors
Past-year pornography use frequency 1.05 (1.03e1.07)** 1.08 (1.04e1.12)**
Lifetime range of pornography accessed 1.10 (1.06e1.15)** 1.12 (1.07e1.17)**
Age 1.01 (1.00e1.01) 0.99 (0.98e1.00)*
Age at first porn exposure 0.96 (0.93e0.98)* 0.99 (0.97e1.00)
Current relationship status
Single 1.00 1.00
Dating or in a relationship 1.80 (1.37e2.37)** 1.25 (0.86e1.83)
Married 1.25 (0.97e1.61) 1.53 (1.08e2.16)*
Other 2.21 (0.79e6.17) 0.91 (0.33e2.52)
Target sexual behaviors
Past-year pornography use frequency 1.10 (1.07e1.13)** 1.05 (1.01e1.09)*
Lifetime range of pornography accessed 1.07 (1.02e1.12)* 1.20 (1.16e1.25)**
Age 1.00 (0.99e1.01) 0.99 (0.98e1.00)*
Age at first porn exposure 0.97 (0.94e1.00) 0.98 (0.97e1.00)
Current relationship status
Single 1.00 1.00
Dating or in a relationship 1.85 (1.31e2.60)** 0.90 (0.66e1.21)
Married 1.19 (0.86e1.64) 0.79 (0.61e1.03)
Other 1.59 (0.48e5.26) 3.08 (1.35e7.03)*
*P < .05; **P < .001.
aOR ¼ adjusted odds ratio.
J Sex Med 2020;17:623e633
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connected to learning from sexually explicit materials.39,40
However,
we also note that temporary choking/strangulation has been
reported as part of college sexual assaults41
and in other cases has
resulted in death.42
In addition, 27% of women and 31% of men who had sex
with men reported that a male partner had tried to have anal sex
with them without first asking or discussing. This has implications
for sexual assault and coercion as well as risk of sexually
transmitted infections, since one cannot negotiate condom use if
one has not first been given an opportunity to consent to or
express interest in a sexual behavior. Although anal sex has
become increasingly prevalent,4
it remains an infrequent
behavior in male-female dyads and one for which condoms are
less often used as compared with vaginal intercourse.43,44
Consistent with prior research, we found that most respondents
reported having seen porn and that the mean age of
first exposure to porn was in early adolescence for men but in
later adolescence for women. Most respondents watched porn on
free sites and via a smartphone; print and paid porn sites were
uncommon. These findings underscore the value of contemporary
content analyses of porn available through free websites.15,16
Among respondents who reported having seen porn, more men
than women reported having seen each of the porn types assessed
(eg, porn showing facials, gang bangs, double penetration, face
fucking, simulated rape, among others). More than half of male
viewers had seen 5 of the 8 genres queried. While it was least
common to have seen porn showing simulated rape, even that
was not rare as one-fifth of men reported having seen it as did
more than 11% of women.
In regard to the relationship of porn use and dominant/target
sexual behaviors, we found relationships with both past-year frequency
of porn use and lifetime range of porn use and participants’
reporting of dominant and target sexual behaviors. These findings
are mostly consistent with findings from convenience samples that
have found a relationship between porn use and either engagement
in or appeal of dominant sexual behaviors. One difference is
that we found a significant relationship between women's
engagement in both dominant and target behaviors, whereas an
earlier study of heterosexual German women found that greater
exposure to pornography was significantly associated with their
desire for, or engagement in, submissive but not dominant sexual
behaviors. That said, similar to the German study, the
pornography-target point estimates for women were larger than
the pornography-dominant point estimates. Subsequent research
is needed to further investigate the extent of the effect of porn use
on engagement in aggressive/rough sexual behaviors.
Strengths and Limitations
Our research has several strengths and limitations. A significant
strength is that data were collected from a U.S. nationally
representative probability sample and provide population level
estimates of a diverse range of sexual behaviors and their associations
with porn use. The use of internet-based data collection
is also a strength of our study, facilitating participants’ ability to
complete the study in a private setting of their choice and easing
data collection on sensitive topics. Subsequent research might
explore whether certain behaviors are more common with othergender
partners or with same-gender partners. In addition, like
most U.S. probability sampling, our survey was limited to
noninstitutionalized individuals who had an address and who
were able to read and respond to questions in the English language.
Our survey was cross-sectional, and thus, findings may be
influenced by memory recall (particularly for long-ago
events such as age at first pornography use) as well as participants’
current feelings about their sexual lives or use of
pornography.
Another limitation pertains to the subjective experiences of
viewing pornography and the subjective experiences of engaging
in sexual behaviors. Subsequent research might examine each in a
more nuanced way. For example, it would be useful to understand
what proportion of respondents’ experiences with any
given sexual behavior (eg, vaginal intercourse, spanking, aggressive
oral sex, and so on) are consensual, wanted, or pleasurable.
How do people feel about the sex that they are having?
Furthermore, we acknowledge that our assessment of porn
use—while consistent with the literature—could be more
detailed. As with partnered sexual behaviors, how much of respondents’
porn use was of their own volition? How do they feel
when they watch porn? What have they learned from porn that
has been helpful and what have they learned that has contributed
to challenges in partnered sex? We felt limited by how to even
describe certain sexual behaviors as terms such as “rough” and
“aggressive” lack the nuance that these diverse behaviors likely
reflect. We felt that “dominant” and “target” were the closest fits,
but even these terms felt somehow insufficient. In addition, we
wish to emphasize that the phrase “pornographic sexual script”
makes some sense in that certain behaviors such as aggressive
fellatio and anal sex are common in pornography43,45
; yet, we are
acutely aware that there are differences between porn genres and
categories, as described earlier,15,16
and thus, there is no single
pornographic sexual script. We also did not collect data on respondents’
medical antecedents, including psychiatric ones,
which may be related to some of the other variables in the study.
Although we lack historical benchmarks to compare many of
these sexual behaviors at the population level, we believe that
some of these sexual behaviors (eg, choking, aggressive fellatio)
may have increased in prevalence over at least the past 10 to
15 years. This is supported by data showing that the greatest
lifetime prevalence for most of the behaviors associated with the
pornographic sexual script is reported by adults between 18 and
29 years (data not shown). Regardless of whether our data reflect
increasing prevalence, they clearly indicate that a substantial
percentage of Americans report having engaged in behaviors
often perceived as rough, aggressive, and/or associated with
sexual harassment or violence (eg, anal sex without first asking or
discussing).
J Sex Med 2020;17:623e633
630 Herbenick et al
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In light of our findings, clinicians might consider how to
expand conversations with their patients so as to assess diverse
sexual behaviors beyond oral, vaginal, and anal sex. Given the
dangers of asphyxiation, it is clinically relevant to understand to
what extent their patients—and especially their adolescent and
young adult patients—may be exploring choking or strangulation
as part of sex, behaviors that have been characterized by
some individuals as scary (both in being choked and in being
asked to choke a partner).25
Clinicians and educators are encouraged to consider the varied
ways in which people experience their sexuality. We need to be
careful not to stigmatize sexual behaviors or the people who
engage in them as the sexual behaviors assessed in this study can
be and often are engaged in safely, by mutual consent, and with
pleasure. That said, we would be wise not to ignore the prevalence
of these sexual behaviors and the ways in which partnered
sex in the United States may be shifting. To the extent that our
data reflect changes in population-level sexual repertoires, we
should ask ourselves what changes are required from us all. If
adolescents and young adults are learning sexual behaviors from
sexually explicit media such as porn (and perhaps erotic stories),
then perhaps this reflects that young people (like older people)
simply want to learn how to have pleasurable, exciting sex. How
can we support their interests with helpful, engaging, and
developmentally appropriate information?
School-based sexuality educators and the policy makers who
shape sexuality education—whether in middle school, high
school, or college—should consider the ways that young people
are exploring their sexuality and the information they seek out.
Some have called for the integration of “porn literacy” into
sexuality education curricula, teaching adolescents to think critically
about the media they consume. People may benefit from a
more visible kink community and related workshops, books,
classes, and/or forums. Parents may need to engage more deeply
in sexuality conversations with their preteen and adolescent
children, sharing values and helping them think through what
they want from their relationships and sexual interactions. In
addition, clinicians and educators may need to expand their
advice on safer sex practices to move beyond condoms, lubricants,
and consent, to include more information about minimizing
risk of injury and preventing death (as with choking
behaviors). Researchers might study more diverse sexual behaviors
and how they are experienced and shaped, whether through
porn, erotica, conversations with friends, or experiences with
partners.
In conclusion, findings from this U.S. nationally representative
probability survey provide population-level data about
diverse sexual behaviors. We found that both dominant and
target sexual behaviors were prevalent and that women were
more often targets of the behaviors we assessed. Finally, we found
associations between the frequency and range of pornography
viewed and the dominant and target behaviors. Clinicians, educators,
and researchers have unique and important roles to play
in continued understanding of these sexual behaviors in the
contemporary United States.
Corresponding Author: Debby Herbenick, PhD, MPH,
Department of Applied Health Science, Indiana University
School of Public Health, PH 116, Bloomington, IN 47405,
USA. Tel: 812-855-7011; E-mail: debby@indiana.edu
Conflict of Interest: The authors report no conflicts of interest.
Funding: The authors are grateful to the following for their
generous support of our research: Julie Parker Benello, Abigail E.
Disney, Natasha and David Dolby, Embrey Family Foundation,
The Fledgling Fund, Ruth Ann Harnisch and The Harnisch
Foundation, Chandra Jessee, Suzanne Lerner, Cristina Ljungberg,
Ann Lovell, Nion McEvoy, Regina K. Scully, Artemis
Rising Foundation, and Lindsey Taylor Wood and Jacki Zehner.
STATEMENT OF AUTHORSHIP
Category 1
(a) Conception and Design
Debby Herbenick; Tsung-chieh Fu; Paul Wright; Bryant Paul;
Ronna Gradus; Jill Bauer; Rashida Jones
(b) Acquisition of Data
Debby Herbenick; Bryant Paul; Ronna Gradus; Jill Bauer;
Rashida Jones
(c) Analysis and Interpretation of Data
Tsung-chieh Fu; Debby Herbenick; Bryant Paul; Ronna Gradus;
Jill Bauer; Rashida Jones
Category 2
(a) Drafting the Article
Debby Herbenick; Tsung-chieh Fu
(b) Revising It for Intellectual Content
Debby Herbenick; Tsung-chieh Fu; Paul Wright; Bryant Paul;
Ronna Gradus; Jill Bauer; Rashida Jones
Category 3
(a) Final Approval of the Completed Article
Debby Herbenick; Bryant Paul
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