JOURNAL OF SEX & MARITAL THERAPY, 41(4), 413–426, 2015 C Taylor & Francis Group, LLC Copyright ISSN: 0092-623X print / 1521-0715 online DOI: 10.1080/0092623X.2014.918065
Female Sexual Subjectivity and Verbal Consent to Receiving Oral Sex Sonya Satinsky Department of Health, Sport, and Exercise Sciences, University of Kansas, Lawrence, Kansas, USA
Kristen N. Jozkowski Department of Health, Human Performance & Recreation, University of Arkansas, Fayetteville, Arkansas, USA
Women are less likely than men are to report receiving oral sex from their partners. Elements of sexual subjectivity may have implications for women’s communication of consent to specific sexual acts. Sexually active women (n = 237) between 18 and 71 years of age (M = 28.85 years) completed an online survey measuring sociodemographic variables, entitlement to pleasure from partner, selfefficacy in achieving sexual pleasure, and consent communication at last receptive oral sex event. Participants were predominantly White (84.8%, n = 201) and in exclusive or monogamous sexual relationships (54.9%, n = 130). The authors used a 4-step test of mediation to determine whether self-efficacy in achieving sexual pleasure mediated the relation between entitlement to pleasure from partner and verbal consent communication. Self-efficacy emerged as a significant predictor of verbal consent communication (p < .01) in the fourth step, while entitlement to pleasure dropped out of the model (p > .05), indicating full mediation. Therefore, entitlement to pleasure predicted verbal consent to oral sex as a function of self-efficacy in achieving sexual pleasure. Sex-positive educational interventions may improve disparities between men and women in receiving oral sex from their partners. Results of this study offer insight into the ways in which culture-level forces affect interpersonal and intraindividual sexual health behaviors.
Traditional sexual scripts that support women sublimating their pleasure to male sexual partners remain prevalent in heterosexual encounters (Sanchez, Crocker, & Boike, 2005; Sanchez, Fetterolf, & Rudman, 2012). Existing cultural inequities between men and women in sexual initiation and power in sexual situations may infringe on women’s ability to feel entitled to sexual pleasure (Sanchez et al., 2012), an important component of fully formed sexual subjectivity. Cunnilingus may be a particularly fraught sexual behavior with regards to power dynamics and sexual pleasure, given the social construction of women’s genitals as being dangerous or disgusting (Braun & Wilkinson, 2001). Therefore, how women communicate consent to receiving oral sex from a male partner may be a unique correlate of sexual subjectivity in women. Address correspondence to Sonya Satinsky, Department of Health, Sport, and Exercise Sciences, Robinson Center, Room 161F, 1301 Sunnyside Avenue, University of Kansas, Lawrence, KS 66045, USA. E-mail: [email protected]
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Sexual subjectivity is conceptualized as becoming “the subject rather than the object of desire” (Burch 1998, as cited in Horne & Zimmer-Gembeck, 2006, p. 349), which entails feeling entitled to sexual pleasure, the ability to make sexual decisions, and having a critical consciousness about those social structures standing in opposition to girls’ and women’s fully becoming sexual subjects (Horne & Zimmer-Gembeck, 2006; Tolman, 2002). According to Tolman (2002), developing a sense of oneself as a sexual subject is necessary for an individual to make active sexual choices that meet one’s needs for both sexual pleasure and sexual safety. Although theorists of female sexual development posit that women should feel entitled to sexual pleasure and a fully formed sexual subjectivity beginning in adolescence when their sexual selfconcept trajectory begins forming (Fine, 1998; Tolman, 2002), this development is complicated, and young women are subjected to contradictory messages about their ability to be sexual and feel desire (Lamb, 2010; Lamb & Peterson, 2012; Tolman, 2012). Images of girls and young women are often highly sexualized with the implicit message that women should strive to appear sexy and attractive (American Psychological Association Task Force on the Sexualization of Girls, 2010). At the same time girls and young women in particular are bombarded with messages that they should fear repercussions of sex such as pregnancy, sexually transmitted infections and rape (Harris, 2008; Millar, 2008). Such conflicting messages surrounding women’s sexuality may lead adolescent girls and young women to feel confused rather than empowered (Gill, 2008; Tolman, 2012). The Female Sexual Subjectivity Inventory aimed to operationalize the construct of female sexual subjectivity (Horne & Zimmer-Gembeck, 2006). The inventory assesses the following elements of female sexual subjectivity among adolescent and emerging adult women: sexual body esteem; sense of entitlement to sexual pleasure from self; sense of entitlement to sexual pleasure from partner; self-efficacy in achieving sexual pleasure; and sexual self-reflection. In their prospective study of sexual subjectivity among young women, Zimmer-Gembeck, Ducat, and Boislard-Pepin (2011) found that sexual subjectivity increased with time, with greater experience of diverse sexual behaviors, and in the context of a romantic dyad, suggesting that factors associated with development and partners may play a role in girls’ and young women’s sexual subjectivity. Although the Female Sexual Subjectivity Inventory was conceptualized as a measure of the developmental trajectory among young women, intraindividual construction of sexual subjectivity does not halt at a specified age. It is likely that women will experience more diverse sexual behaviors, for example, even after adolescence (Fortenberry et al., 2005; Hearn, O’Sullivan, & Dudely, 2003; Herbenick et al., 2010), and shifts in the context of romantic relationships will continue through adolescence and adulthood. Therefore, the inventory may be an appropriate tool to use with a more age-diverse sample. Women’s Sexual Subjectivity in the Heterosexual Context Sexism and traditional sexual scripts can affect the equity of pleasure in dyadic relationships (Sanchez et al., 2012). In heterosexual sexual contexts, women often act as sexual and romantic caretakers, where their partner’s pleasure is prioritized above their own (Kim et al., 2007), which can lead to women’s sexual desires and needs becoming secondary to men’s (Sanchez et al., 2005). Looking at this phenomenon through the lens of sexual subjectivity, two factors of the Female Sexual Subjectivity Inventory that may be particularly relevant to measure in regard to sexual behavior outcomes are (a) entitlement to pleasure from partner and (b) self-efficacy
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in achieving sexual pleasure. These two constructs measure expectations and communication tactics to increase pleasure in partnered sexual situations; therefore, they may be particularly important to look at in terms of consent. These subjectivity constructs may potentially relate to women’s communication, in particular their consent to engaging in pleasure-focused sexual behaviors. Importance of Explicit Consent Sexual consent has been defined as the freely given verbal or nonverbal communication of feelings of willingness to engage in sexual activity (Hickman & Muehlenhard, 1999). Individuals have described using both verbal and nonverbal cues to communicate consent to sex (Beres, Herold, & Maitland, 2003; Jozkowski, Peterson, Sanders, Dennis, & Reece, 2013). Clear, explicit consent communicated through verbal cues remains a recommended standard for avoiding confusion and potentially preventing unwanted or nonconsensual sexual encounters (Beres, 2007; Donat & White, 2000; Jozkowski et al., 2013; Moore & Reynolds, 2004). Individuals’ explicit, verbal communication of consent may also assist in helping individuals get their sexual needs satisfied. For example, the more explicit that individuals can be in terms of communicating consent, the more likely they may be to explicitly communicate their sexual wants and desires. Previous research suggests that when consent is expressed in more explicit terms (i.e., verbal cues), individuals are more likely to experience a higher quality sexual encounter (Jozkowski, 2013). Thus, women who explicitly communicate consent may be better positioned to enjoy sex more because their needs are being stated. However, gendered expectations in sexual encounters and adherence to traditional sexual scripts may inhibit the giving of explicit consent. Women may believe that there is stigma associated with being upfront and explicit in their communication of their sexual wants and desires, as being explicit is in contrast to the traditional heterosexual script (Edgar & Fitzpatrick, 1993; Kim et al., 2007). Therefore, higher levels of sexual subjectivity in the form of feeling more entitlement to pleasure from partners and self-efficacy in achieving pleasure may be predictive of explicit verbal consent communication in sexual situations. Oral Sex as a Unique Behavior Research that has examined sexual behaviors between women and men in a heterosexual context has primarily focused on vaginal-penile sexual intercourse, with less exploration of oral sex behaviors, although most adults engage in a variety of sexual behaviors including giving and receiving oral sex (Herbenick et al., 2010). Oral sex is a uniquely different behavior from sexual intercourse, in part because of the ability to distinguish between giving and receiving forms of oral sex, leading to potential differences in frequency between giving and receiving oral stimulation from a partner. Although the sexual partner who is giving oral sex may experience enjoyment from giving pleasure to his or her receptive partner, the focus of physical pleasure is generally the recipient of oral stimulation. Given that women tend to perceive their sexual pleasure and needs as secondary to their male partners’ (Sanchez et al., 2005), they may be less likely to engage in or specifically ask to receive oral sex. Perceiving one’s own sexual pleasure as secondary may be why there is often a discrepancy between men and women in terms of giving and receiving
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oral sex (Brewster & Tilman, 2007; Chambers, 2007; Jozkowski & Peterson, 2013; Jozkowski & Satinsky, 2013), with men receiving oral sex more frequently than women. Women are often self-conscious about their bodies during engagement in sexual behavior (Cash, Maikkula, & Yamamiya, 2004). Self-consciousness may be particularly relevant with regard to oral-genital sex as cultural norms surrounding cunnilingus can imply that women’s genitals are somewhat unappealing (Braun, 2005; Braun & Tiefer, 2010; Schick, Calabrese, Rima, & Zucker, 2010), that they should be approached with caution (Wiederman, 2005) or that men may not like engaging in cunnilingus (e.g., Jozkowski & Peterson, 2013). There is conflicting evidence as to whether these cultural norms directly influence rates of oral sex between men and women. Some researchers have found that higher numbers of men report receiving oral sex than women and that more women report engaging in fellatio than do men report engaging in cunnilingus (Chambers, 2007; Jozkowski & Satinsky, 2013; Remez, 2000). A nationally representative study of U.S. adults found that roughly 77% of men ages 20–39 years report receiving oral sex from a female partner in the past year, and between 68% and 74% report giving oral sex to a female partner; between 58% and 71% of women ages 20–39 years in this same study report receiving oral sex from male partners in the previous year, and between 59% and 76% report giving oral sex to male partners (Herbenick et al., 2010). In addition, several researchers have noted that women’s experiences of genital concerns or insecurities related to genital appearance, taste, or smell have influenced their engagement in sexual activity in general (Braun, 2005; Braun & Kitzinger, 2001; Kerner, 2004). Specifically, Herbenick (2009) noted that having a more positive view toward women’s genitals may result in being more receptive to receiving cunnilingus for women and performing cunnilingus for men. Thus, consent to cunnilingus may be influenced by cultural norms about women’s bodies and individual attitudes toward women’s genitals. Women’s willingness to ask for and potentially receive oral sex from a male partner may be related to certain aspects of sexual subjectivity, specifically entitlement to pleasure and selfefficacy in achieving pleasure. If women feel entitled to receive pleasure from their partner and report high self-efficacy in achieving pleasure, they may be more likely to ask for and be willing to receive cunnilingus from their sexual partner despite cultural norms and stigmas that may otherwise inhibit women from being willing to receive oral sex. Verbal communication regarding engagement in certain sexual behaviors may also vary as a function of these elements of sexual subjectivity. As such, we are interested in better understanding how women’s entitlement to pleasure from their partner and women’s self-efficacy in achieving sexual pleasure may be related to their direct, verbal communication of consent to engage in receptive oral sex. In other words, we were interested in understanding how women’s perception of their own sense of pleasure influenced their communication of consent to a behavior that specifically focuses on providing them pleasure. The Present Study There seem to be conceptual links between women’s communication of desires for specific sexual behaviors and aspects of sexual subjectivity, specifically entitlement to pleasure from partner and self-efficacy in achieving sexual pleasure. We are therefore interested in examining the extent to which the sexual desire and pleasure element of sexual subjectivity may predict explicit verbal communication among women who have received oral sex during their most recent sexual encounter. Specifically, we hypothesize that self-efficacy may mediate the relation
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between consent and entitlement to pleasure from partner. The construct of self-efficacy in achieving sexual pleasure measures a woman’s ability to communicate her sexual desires to a partner; this is predicated on the idea that a woman is aware and knows what type of sexual stimulation and attention she would need from a partner. Sense of entitlement to pleasure from a partner measures the emotional outcomes a woman may feel if her sexual needs and desires are not met or attended to. Therefore, having a higher level of self-efficacy may indicate selfawareness of sexual needs and wants, which could directly influence ability to tell a partner what sexual stimulation she expects. Ability to communicate what kind of sexual stimulation may begin with communicating sexual consent (Jozkowski, 2013). Results may help researchers better understand the relationship between sexual subjectivity and consent, especially for those sexual behaviors such as oral sex that have distinctive roles in terms of pleasure giving and receiving, as taking on the role of giver or receiver may have different motivations and correlates. METHOD Procedure During fall of 2012, recruitment scripts for an online study on “Body Image and Sexual Communication” were disseminated via e-mail listservs related to sexuality and women’s health, as well as through social media networks such as Facebook. The study was described as “an online survey about body image and sexual communication strategies during a recent sexual encounter” and was open to women older than 18 years of age. Participants were provided with the study link, which offered information on the study, an informed consent statement, and the option to participate. No incentives for participation were offered to potential participants, and participants were informed the study would take between 15 and 25 min to complete. The study was approved by the institutional review board at both authors’ institutions. Participants We narrowed our study sample to 237 participants from 643 individuals who began the online survey. Those who were removed from the study sample did not meet eligibility requirements (18 and older [n = 2]; women [n = 22]), did not report having a male partner at last sexual encounter (n = 152), or did not report engaging in receptive oral sex at last sexual encounter (n = 134). The age range for the sample was 18–71 years (M = 28.85 years, SD = 10.25 years). Participants were predominantly White (84.8%, n = 201), and slightly more than half (54.9%, n = 130) were in exclusive or monogamous sexual relationships (see Table 1 for a full accounting of participant demographics). Measures Demographics and Sexual Behavior Participants completed measures of age, race, or ethnicity (open-ended response, coded into grouped categories), sexual orientation (open-ended response, coded into grouped categories),
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TABLE 1 Participant Characteristics (N = 237)
Age (years) 18–24 25–29 30–39 40–49 50 and older Ethnicity African American/Black Asian/Asian Pacific Islander Biracial/mixed race Caucasian/White Hispanic/Latina Other Sexual orientation Straight or heterosexual Bisexual or bi-curious Other Queer Sexual relationship status Exclusive/monogamous Not in defined sexual relationship Active relationships with more than one person Education High school/GED Some college Two-year college degree Four-year college degree Master’s degree Doctoral degree Professional degree (JD, MD)
n
%
110 44 50 17 15
46.4 18.6 21.1 7.2 6.3
4 4 8 201 11 7
1.7 1.7 3.4 84.8 4.6 3
189 31 9 8
79.7 13.1 3.8 3.4
130 70 37
54.9 29.5 15.6
8 85 15 62 40 18 2
3.4 35.9 6.3 26.2 16.9 7.6 0.8
sexual relationship status (in an exclusive or monogamous sexual relationship; in active sexual relationships with more than one person; not currently in a defined sexual relationship), highest education completed (high school/GED; some college; 2-year college degree; 4-year college degree; master’s degree; doctoral degree; professional degree such as a JD or MD), the gender of their sexual partner at last sexual encounter (male, female), if they engaged in oral sex at the last encounter (yes/no) and if they received oral sex (yes/no) or gave oral sex (yes/no) at their last encounter. External Consent Scale Participants also completed the External Consent Scale (Jozkowski, Sanders, Peterson, Dennis, & Reece, 2014) modified to be specific to oral sex behavior (receiving and giving). The External Consent Scale is a five-factor, 18-item scale (α = .84) measuring the “behavioral or verbal
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indicators that externally express one’s willingness to engage in sexual activity” (Jozkowski et al., 2014, p. 483). To assess external consent, participants were asked to indicate whether they engaged in a variety of consent cues to communicate their consent. For the present study, we used a modified version of the communication and initiator behaviors factor (ESC-V; three items) exclusively to assess the extent to which women used mainly direct/verbal indicators to communicate consent. According to Jozkowski and colleagues (2013), there were no statistically significant differences in cues used to assess consent to oral sex and vaginal-penile sex; thus, a modified version of this measure for oral could be considered appropriate. Jozkowski and colleagues (2014) estimated the reliability of this measure among college students to be α = .79. The following are two sample items from the ESC-V: “I used verbal cues such as communicating my interest in sexual behavior or asking my partner if he/she wanted to have sex with me” and “I initiated sexual behavior verbally and checked to see if my partner reciprocated.” Female Sexual Subjectivity Inventory The Female Sexual Subjectivity Inventory is a three-element, five-factor, 20-item measure assessing women’s overall sexual self-perceptions and feelings about sex (Horne & ZimmerGembeck, 2006). Element 2 measures sexual desire and pleasure, whereas elements 1 and 3 deal with aspects of sexuality tangential to pleasure (sexual body-esteem and sexual self-reflection, respectively). Thus, we examined consent in relation to only element 2, which comprises three factors: (element 2a) sense of entitlement to sexual pleasure from self (EPS); (element 2b) sense of entitlement to sexual pleasure from partner (EPP); and (element 2c) self-efficacy in achieving sexual pleasure (SESP). In the present study, we used elements 2b and 2c because they specifically addressed partnered sex and pleasure. EPS was excluded from analyses because it measures attitudes toward self-masturbation, for which consent is not a relevant correlate. Horne and Zimmer-Gembeck (2006) reported a reliability estimate of α = .83 in their sample of adolescent and emerging adult women for entitlement to sexual pleasure from partner (four items; EPP); the reliability estimate for EPP in our sample was α = 81. Self-efficacy in achieving sexual pleasure (three items; SESP) had a reliability estimate of α = .75 in the same sample (Horne & Zimmer-Gembeck, 2006); the reliability estimate for SESP in our sample was α = 83. Sample items from the EPP include the following: “If a partner were to ignore my sexual needs and desires, I’d feel hurt,” and “I would expect a sexual partner to be responsive to my sexual needs and feelings.” Sample items from the SESP include the following: “I would not hesitate to ask for what I want sexually from a romantic partner” and “I am able to ask a partner to provide the sexual stimulation I need.” Data Analyses We conducted descriptive analyses of participant characteristics. Given our wide range of participant ages, we also ran t tests to determine whether women older than 39 years of age were significantly different with regards to Female Sexual Subjectivity Inventory subscales than their younger counterparts. Subscale scores were not significantly different between the two groups, and therefore, participants were not excluded on the basis of age criteria. We conducted bivariate analyses, including one-way analyses of variance, to determine whether there were differences in ECS-V, EPP, or SESP by age and sexual relationship status. Means for ECS-V, EPP, and SESP
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TABLE 2 Means, Standard Deviations, and Correlations Among Measures (N = 237) Measure
M
SD
Range
1
2
3
1. Age 2. EPP 3. SESP 4. ESC-V
28.85 4.41 3.99 0.39
10.25 0.60 0.79 0.35
18–71 1.75–5.00 1.67–5.00 0.00–1.00
.073 .145∗ −.087
.391∗∗ .186∗∗
.315∗∗
Note. EPP (element 2b of the Female Sexual Subjectivity Inventory) refers to the sense of entitlement to sexual pleasure from partner, and SESP (element 2c of the inventory) refers to self-efficacy in achieving sexual pleasure. ESC-V refers to the modified version of the communication and initiator behaviors factor of the External Consent Scale. ∗ p ≤ .05. ∗∗ p ≤ .01.
were not significantly different across sexual relationship statuses. Intercorrelations between continuous variables are depicted in Table 2. Because correlations between EPP, SESP, and ESC-V were all significant, Baron and Kenny’s (1986) four-step test of mediation was used to determine whether self-efficacy in achieving sexual pleasure (SESP) mediated the relation between entitlement to pleasure from partner (EPP) and verbal consent communication (ECS-V) beyond the contribution of age. Also, we used Sobel’s test to test for partial mediation.
RESULTS Means, standard deviations and ranges of responses for all variables in the regression model are depicted in Table 2. EPP, SESP, and ESC-V were all significantly positively correlated (p < .001), and age was significantly positively correlated with SESP (p < .05). All correlations were weak to moderate, indicating that these constructs were related, but distinct. Because of the significant correlation between age and SESP, we controlled for participant age in our models. We conducted a series of analyses of variance to determine whether there were differences in EPP and SESP based on race, sexual orientation, and sexual relationship status. Results indicated there were no significant differences in EPP and SESP based on these demographic characteristics (p >.05). Therefore, these variables were not included in multivariate analyses. Because there were significant bivariate correlations among EPP, SESP, and ESC-V, we entered SESP into the linear regression model as a potential mediator, using Baron and Kenny’s (1986) four-step test of mediation. Given that age was significantly correlated with SESP, it was included as a control variable in the regression model. Baron and Kenny’s (1986) first three criteria were met by assessing regression coefficients among EPP, SESP, and ESC-V (see Figure 1). When SESP was entered into the model, Sobel’s test indicated that the relation from EPP to ESC-V was significantly reduced (p < .001), indicating at least partial mediation. When SESP was entered into the regression model, it emerged as a significant predictor of ESC-V (p = .001), while EPP dropped out of the model (p = .191), indicating full mediation (see Figure 1 for a depiction of these relations).
SEXUAL SUBJECTIVITY AND CONSENT TO ORAL SEX
0.391**
Entlement to Sexual Pleasure from Partner
Self-Efficacy in Achieving Sexual Pleasure
0.186*
421
0.315**
Explicit Verbal Consent to Receiving Oral Sex
FIGURE 1 Mediation model. ∗ p < .005. ∗∗ p
Female Sexual Subjectivity and Verbal Consent to Receiving Oral Sex Sonya Satinsky Department of Health, Sport, and Exercise Sciences, University of Kansas, Lawrence, Kansas, USA
Kristen N. Jozkowski Department of Health, Human Performance & Recreation, University of Arkansas, Fayetteville, Arkansas, USA
Women are less likely than men are to report receiving oral sex from their partners. Elements of sexual subjectivity may have implications for women’s communication of consent to specific sexual acts. Sexually active women (n = 237) between 18 and 71 years of age (M = 28.85 years) completed an online survey measuring sociodemographic variables, entitlement to pleasure from partner, selfefficacy in achieving sexual pleasure, and consent communication at last receptive oral sex event. Participants were predominantly White (84.8%, n = 201) and in exclusive or monogamous sexual relationships (54.9%, n = 130). The authors used a 4-step test of mediation to determine whether self-efficacy in achieving sexual pleasure mediated the relation between entitlement to pleasure from partner and verbal consent communication. Self-efficacy emerged as a significant predictor of verbal consent communication (p < .01) in the fourth step, while entitlement to pleasure dropped out of the model (p > .05), indicating full mediation. Therefore, entitlement to pleasure predicted verbal consent to oral sex as a function of self-efficacy in achieving sexual pleasure. Sex-positive educational interventions may improve disparities between men and women in receiving oral sex from their partners. Results of this study offer insight into the ways in which culture-level forces affect interpersonal and intraindividual sexual health behaviors.
Traditional sexual scripts that support women sublimating their pleasure to male sexual partners remain prevalent in heterosexual encounters (Sanchez, Crocker, & Boike, 2005; Sanchez, Fetterolf, & Rudman, 2012). Existing cultural inequities between men and women in sexual initiation and power in sexual situations may infringe on women’s ability to feel entitled to sexual pleasure (Sanchez et al., 2012), an important component of fully formed sexual subjectivity. Cunnilingus may be a particularly fraught sexual behavior with regards to power dynamics and sexual pleasure, given the social construction of women’s genitals as being dangerous or disgusting (Braun & Wilkinson, 2001). Therefore, how women communicate consent to receiving oral sex from a male partner may be a unique correlate of sexual subjectivity in women. Address correspondence to Sonya Satinsky, Department of Health, Sport, and Exercise Sciences, Robinson Center, Room 161F, 1301 Sunnyside Avenue, University of Kansas, Lawrence, KS 66045, USA. E-mail: [email protected]
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Sexual subjectivity is conceptualized as becoming “the subject rather than the object of desire” (Burch 1998, as cited in Horne & Zimmer-Gembeck, 2006, p. 349), which entails feeling entitled to sexual pleasure, the ability to make sexual decisions, and having a critical consciousness about those social structures standing in opposition to girls’ and women’s fully becoming sexual subjects (Horne & Zimmer-Gembeck, 2006; Tolman, 2002). According to Tolman (2002), developing a sense of oneself as a sexual subject is necessary for an individual to make active sexual choices that meet one’s needs for both sexual pleasure and sexual safety. Although theorists of female sexual development posit that women should feel entitled to sexual pleasure and a fully formed sexual subjectivity beginning in adolescence when their sexual selfconcept trajectory begins forming (Fine, 1998; Tolman, 2002), this development is complicated, and young women are subjected to contradictory messages about their ability to be sexual and feel desire (Lamb, 2010; Lamb & Peterson, 2012; Tolman, 2012). Images of girls and young women are often highly sexualized with the implicit message that women should strive to appear sexy and attractive (American Psychological Association Task Force on the Sexualization of Girls, 2010). At the same time girls and young women in particular are bombarded with messages that they should fear repercussions of sex such as pregnancy, sexually transmitted infections and rape (Harris, 2008; Millar, 2008). Such conflicting messages surrounding women’s sexuality may lead adolescent girls and young women to feel confused rather than empowered (Gill, 2008; Tolman, 2012). The Female Sexual Subjectivity Inventory aimed to operationalize the construct of female sexual subjectivity (Horne & Zimmer-Gembeck, 2006). The inventory assesses the following elements of female sexual subjectivity among adolescent and emerging adult women: sexual body esteem; sense of entitlement to sexual pleasure from self; sense of entitlement to sexual pleasure from partner; self-efficacy in achieving sexual pleasure; and sexual self-reflection. In their prospective study of sexual subjectivity among young women, Zimmer-Gembeck, Ducat, and Boislard-Pepin (2011) found that sexual subjectivity increased with time, with greater experience of diverse sexual behaviors, and in the context of a romantic dyad, suggesting that factors associated with development and partners may play a role in girls’ and young women’s sexual subjectivity. Although the Female Sexual Subjectivity Inventory was conceptualized as a measure of the developmental trajectory among young women, intraindividual construction of sexual subjectivity does not halt at a specified age. It is likely that women will experience more diverse sexual behaviors, for example, even after adolescence (Fortenberry et al., 2005; Hearn, O’Sullivan, & Dudely, 2003; Herbenick et al., 2010), and shifts in the context of romantic relationships will continue through adolescence and adulthood. Therefore, the inventory may be an appropriate tool to use with a more age-diverse sample. Women’s Sexual Subjectivity in the Heterosexual Context Sexism and traditional sexual scripts can affect the equity of pleasure in dyadic relationships (Sanchez et al., 2012). In heterosexual sexual contexts, women often act as sexual and romantic caretakers, where their partner’s pleasure is prioritized above their own (Kim et al., 2007), which can lead to women’s sexual desires and needs becoming secondary to men’s (Sanchez et al., 2005). Looking at this phenomenon through the lens of sexual subjectivity, two factors of the Female Sexual Subjectivity Inventory that may be particularly relevant to measure in regard to sexual behavior outcomes are (a) entitlement to pleasure from partner and (b) self-efficacy
SEXUAL SUBJECTIVITY AND CONSENT TO ORAL SEX
415
in achieving sexual pleasure. These two constructs measure expectations and communication tactics to increase pleasure in partnered sexual situations; therefore, they may be particularly important to look at in terms of consent. These subjectivity constructs may potentially relate to women’s communication, in particular their consent to engaging in pleasure-focused sexual behaviors. Importance of Explicit Consent Sexual consent has been defined as the freely given verbal or nonverbal communication of feelings of willingness to engage in sexual activity (Hickman & Muehlenhard, 1999). Individuals have described using both verbal and nonverbal cues to communicate consent to sex (Beres, Herold, & Maitland, 2003; Jozkowski, Peterson, Sanders, Dennis, & Reece, 2013). Clear, explicit consent communicated through verbal cues remains a recommended standard for avoiding confusion and potentially preventing unwanted or nonconsensual sexual encounters (Beres, 2007; Donat & White, 2000; Jozkowski et al., 2013; Moore & Reynolds, 2004). Individuals’ explicit, verbal communication of consent may also assist in helping individuals get their sexual needs satisfied. For example, the more explicit that individuals can be in terms of communicating consent, the more likely they may be to explicitly communicate their sexual wants and desires. Previous research suggests that when consent is expressed in more explicit terms (i.e., verbal cues), individuals are more likely to experience a higher quality sexual encounter (Jozkowski, 2013). Thus, women who explicitly communicate consent may be better positioned to enjoy sex more because their needs are being stated. However, gendered expectations in sexual encounters and adherence to traditional sexual scripts may inhibit the giving of explicit consent. Women may believe that there is stigma associated with being upfront and explicit in their communication of their sexual wants and desires, as being explicit is in contrast to the traditional heterosexual script (Edgar & Fitzpatrick, 1993; Kim et al., 2007). Therefore, higher levels of sexual subjectivity in the form of feeling more entitlement to pleasure from partners and self-efficacy in achieving pleasure may be predictive of explicit verbal consent communication in sexual situations. Oral Sex as a Unique Behavior Research that has examined sexual behaviors between women and men in a heterosexual context has primarily focused on vaginal-penile sexual intercourse, with less exploration of oral sex behaviors, although most adults engage in a variety of sexual behaviors including giving and receiving oral sex (Herbenick et al., 2010). Oral sex is a uniquely different behavior from sexual intercourse, in part because of the ability to distinguish between giving and receiving forms of oral sex, leading to potential differences in frequency between giving and receiving oral stimulation from a partner. Although the sexual partner who is giving oral sex may experience enjoyment from giving pleasure to his or her receptive partner, the focus of physical pleasure is generally the recipient of oral stimulation. Given that women tend to perceive their sexual pleasure and needs as secondary to their male partners’ (Sanchez et al., 2005), they may be less likely to engage in or specifically ask to receive oral sex. Perceiving one’s own sexual pleasure as secondary may be why there is often a discrepancy between men and women in terms of giving and receiving
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oral sex (Brewster & Tilman, 2007; Chambers, 2007; Jozkowski & Peterson, 2013; Jozkowski & Satinsky, 2013), with men receiving oral sex more frequently than women. Women are often self-conscious about their bodies during engagement in sexual behavior (Cash, Maikkula, & Yamamiya, 2004). Self-consciousness may be particularly relevant with regard to oral-genital sex as cultural norms surrounding cunnilingus can imply that women’s genitals are somewhat unappealing (Braun, 2005; Braun & Tiefer, 2010; Schick, Calabrese, Rima, & Zucker, 2010), that they should be approached with caution (Wiederman, 2005) or that men may not like engaging in cunnilingus (e.g., Jozkowski & Peterson, 2013). There is conflicting evidence as to whether these cultural norms directly influence rates of oral sex between men and women. Some researchers have found that higher numbers of men report receiving oral sex than women and that more women report engaging in fellatio than do men report engaging in cunnilingus (Chambers, 2007; Jozkowski & Satinsky, 2013; Remez, 2000). A nationally representative study of U.S. adults found that roughly 77% of men ages 20–39 years report receiving oral sex from a female partner in the past year, and between 68% and 74% report giving oral sex to a female partner; between 58% and 71% of women ages 20–39 years in this same study report receiving oral sex from male partners in the previous year, and between 59% and 76% report giving oral sex to male partners (Herbenick et al., 2010). In addition, several researchers have noted that women’s experiences of genital concerns or insecurities related to genital appearance, taste, or smell have influenced their engagement in sexual activity in general (Braun, 2005; Braun & Kitzinger, 2001; Kerner, 2004). Specifically, Herbenick (2009) noted that having a more positive view toward women’s genitals may result in being more receptive to receiving cunnilingus for women and performing cunnilingus for men. Thus, consent to cunnilingus may be influenced by cultural norms about women’s bodies and individual attitudes toward women’s genitals. Women’s willingness to ask for and potentially receive oral sex from a male partner may be related to certain aspects of sexual subjectivity, specifically entitlement to pleasure and selfefficacy in achieving pleasure. If women feel entitled to receive pleasure from their partner and report high self-efficacy in achieving pleasure, they may be more likely to ask for and be willing to receive cunnilingus from their sexual partner despite cultural norms and stigmas that may otherwise inhibit women from being willing to receive oral sex. Verbal communication regarding engagement in certain sexual behaviors may also vary as a function of these elements of sexual subjectivity. As such, we are interested in better understanding how women’s entitlement to pleasure from their partner and women’s self-efficacy in achieving sexual pleasure may be related to their direct, verbal communication of consent to engage in receptive oral sex. In other words, we were interested in understanding how women’s perception of their own sense of pleasure influenced their communication of consent to a behavior that specifically focuses on providing them pleasure. The Present Study There seem to be conceptual links between women’s communication of desires for specific sexual behaviors and aspects of sexual subjectivity, specifically entitlement to pleasure from partner and self-efficacy in achieving sexual pleasure. We are therefore interested in examining the extent to which the sexual desire and pleasure element of sexual subjectivity may predict explicit verbal communication among women who have received oral sex during their most recent sexual encounter. Specifically, we hypothesize that self-efficacy may mediate the relation
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between consent and entitlement to pleasure from partner. The construct of self-efficacy in achieving sexual pleasure measures a woman’s ability to communicate her sexual desires to a partner; this is predicated on the idea that a woman is aware and knows what type of sexual stimulation and attention she would need from a partner. Sense of entitlement to pleasure from a partner measures the emotional outcomes a woman may feel if her sexual needs and desires are not met or attended to. Therefore, having a higher level of self-efficacy may indicate selfawareness of sexual needs and wants, which could directly influence ability to tell a partner what sexual stimulation she expects. Ability to communicate what kind of sexual stimulation may begin with communicating sexual consent (Jozkowski, 2013). Results may help researchers better understand the relationship between sexual subjectivity and consent, especially for those sexual behaviors such as oral sex that have distinctive roles in terms of pleasure giving and receiving, as taking on the role of giver or receiver may have different motivations and correlates. METHOD Procedure During fall of 2012, recruitment scripts for an online study on “Body Image and Sexual Communication” were disseminated via e-mail listservs related to sexuality and women’s health, as well as through social media networks such as Facebook. The study was described as “an online survey about body image and sexual communication strategies during a recent sexual encounter” and was open to women older than 18 years of age. Participants were provided with the study link, which offered information on the study, an informed consent statement, and the option to participate. No incentives for participation were offered to potential participants, and participants were informed the study would take between 15 and 25 min to complete. The study was approved by the institutional review board at both authors’ institutions. Participants We narrowed our study sample to 237 participants from 643 individuals who began the online survey. Those who were removed from the study sample did not meet eligibility requirements (18 and older [n = 2]; women [n = 22]), did not report having a male partner at last sexual encounter (n = 152), or did not report engaging in receptive oral sex at last sexual encounter (n = 134). The age range for the sample was 18–71 years (M = 28.85 years, SD = 10.25 years). Participants were predominantly White (84.8%, n = 201), and slightly more than half (54.9%, n = 130) were in exclusive or monogamous sexual relationships (see Table 1 for a full accounting of participant demographics). Measures Demographics and Sexual Behavior Participants completed measures of age, race, or ethnicity (open-ended response, coded into grouped categories), sexual orientation (open-ended response, coded into grouped categories),
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TABLE 1 Participant Characteristics (N = 237)
Age (years) 18–24 25–29 30–39 40–49 50 and older Ethnicity African American/Black Asian/Asian Pacific Islander Biracial/mixed race Caucasian/White Hispanic/Latina Other Sexual orientation Straight or heterosexual Bisexual or bi-curious Other Queer Sexual relationship status Exclusive/monogamous Not in defined sexual relationship Active relationships with more than one person Education High school/GED Some college Two-year college degree Four-year college degree Master’s degree Doctoral degree Professional degree (JD, MD)
n
%
110 44 50 17 15
46.4 18.6 21.1 7.2 6.3
4 4 8 201 11 7
1.7 1.7 3.4 84.8 4.6 3
189 31 9 8
79.7 13.1 3.8 3.4
130 70 37
54.9 29.5 15.6
8 85 15 62 40 18 2
3.4 35.9 6.3 26.2 16.9 7.6 0.8
sexual relationship status (in an exclusive or monogamous sexual relationship; in active sexual relationships with more than one person; not currently in a defined sexual relationship), highest education completed (high school/GED; some college; 2-year college degree; 4-year college degree; master’s degree; doctoral degree; professional degree such as a JD or MD), the gender of their sexual partner at last sexual encounter (male, female), if they engaged in oral sex at the last encounter (yes/no) and if they received oral sex (yes/no) or gave oral sex (yes/no) at their last encounter. External Consent Scale Participants also completed the External Consent Scale (Jozkowski, Sanders, Peterson, Dennis, & Reece, 2014) modified to be specific to oral sex behavior (receiving and giving). The External Consent Scale is a five-factor, 18-item scale (α = .84) measuring the “behavioral or verbal
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indicators that externally express one’s willingness to engage in sexual activity” (Jozkowski et al., 2014, p. 483). To assess external consent, participants were asked to indicate whether they engaged in a variety of consent cues to communicate their consent. For the present study, we used a modified version of the communication and initiator behaviors factor (ESC-V; three items) exclusively to assess the extent to which women used mainly direct/verbal indicators to communicate consent. According to Jozkowski and colleagues (2013), there were no statistically significant differences in cues used to assess consent to oral sex and vaginal-penile sex; thus, a modified version of this measure for oral could be considered appropriate. Jozkowski and colleagues (2014) estimated the reliability of this measure among college students to be α = .79. The following are two sample items from the ESC-V: “I used verbal cues such as communicating my interest in sexual behavior or asking my partner if he/she wanted to have sex with me” and “I initiated sexual behavior verbally and checked to see if my partner reciprocated.” Female Sexual Subjectivity Inventory The Female Sexual Subjectivity Inventory is a three-element, five-factor, 20-item measure assessing women’s overall sexual self-perceptions and feelings about sex (Horne & ZimmerGembeck, 2006). Element 2 measures sexual desire and pleasure, whereas elements 1 and 3 deal with aspects of sexuality tangential to pleasure (sexual body-esteem and sexual self-reflection, respectively). Thus, we examined consent in relation to only element 2, which comprises three factors: (element 2a) sense of entitlement to sexual pleasure from self (EPS); (element 2b) sense of entitlement to sexual pleasure from partner (EPP); and (element 2c) self-efficacy in achieving sexual pleasure (SESP). In the present study, we used elements 2b and 2c because they specifically addressed partnered sex and pleasure. EPS was excluded from analyses because it measures attitudes toward self-masturbation, for which consent is not a relevant correlate. Horne and Zimmer-Gembeck (2006) reported a reliability estimate of α = .83 in their sample of adolescent and emerging adult women for entitlement to sexual pleasure from partner (four items; EPP); the reliability estimate for EPP in our sample was α = 81. Self-efficacy in achieving sexual pleasure (three items; SESP) had a reliability estimate of α = .75 in the same sample (Horne & Zimmer-Gembeck, 2006); the reliability estimate for SESP in our sample was α = 83. Sample items from the EPP include the following: “If a partner were to ignore my sexual needs and desires, I’d feel hurt,” and “I would expect a sexual partner to be responsive to my sexual needs and feelings.” Sample items from the SESP include the following: “I would not hesitate to ask for what I want sexually from a romantic partner” and “I am able to ask a partner to provide the sexual stimulation I need.” Data Analyses We conducted descriptive analyses of participant characteristics. Given our wide range of participant ages, we also ran t tests to determine whether women older than 39 years of age were significantly different with regards to Female Sexual Subjectivity Inventory subscales than their younger counterparts. Subscale scores were not significantly different between the two groups, and therefore, participants were not excluded on the basis of age criteria. We conducted bivariate analyses, including one-way analyses of variance, to determine whether there were differences in ECS-V, EPP, or SESP by age and sexual relationship status. Means for ECS-V, EPP, and SESP
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TABLE 2 Means, Standard Deviations, and Correlations Among Measures (N = 237) Measure
M
SD
Range
1
2
3
1. Age 2. EPP 3. SESP 4. ESC-V
28.85 4.41 3.99 0.39
10.25 0.60 0.79 0.35
18–71 1.75–5.00 1.67–5.00 0.00–1.00
.073 .145∗ −.087
.391∗∗ .186∗∗
.315∗∗
Note. EPP (element 2b of the Female Sexual Subjectivity Inventory) refers to the sense of entitlement to sexual pleasure from partner, and SESP (element 2c of the inventory) refers to self-efficacy in achieving sexual pleasure. ESC-V refers to the modified version of the communication and initiator behaviors factor of the External Consent Scale. ∗ p ≤ .05. ∗∗ p ≤ .01.
were not significantly different across sexual relationship statuses. Intercorrelations between continuous variables are depicted in Table 2. Because correlations between EPP, SESP, and ESC-V were all significant, Baron and Kenny’s (1986) four-step test of mediation was used to determine whether self-efficacy in achieving sexual pleasure (SESP) mediated the relation between entitlement to pleasure from partner (EPP) and verbal consent communication (ECS-V) beyond the contribution of age. Also, we used Sobel’s test to test for partial mediation.
RESULTS Means, standard deviations and ranges of responses for all variables in the regression model are depicted in Table 2. EPP, SESP, and ESC-V were all significantly positively correlated (p < .001), and age was significantly positively correlated with SESP (p < .05). All correlations were weak to moderate, indicating that these constructs were related, but distinct. Because of the significant correlation between age and SESP, we controlled for participant age in our models. We conducted a series of analyses of variance to determine whether there were differences in EPP and SESP based on race, sexual orientation, and sexual relationship status. Results indicated there were no significant differences in EPP and SESP based on these demographic characteristics (p >.05). Therefore, these variables were not included in multivariate analyses. Because there were significant bivariate correlations among EPP, SESP, and ESC-V, we entered SESP into the linear regression model as a potential mediator, using Baron and Kenny’s (1986) four-step test of mediation. Given that age was significantly correlated with SESP, it was included as a control variable in the regression model. Baron and Kenny’s (1986) first three criteria were met by assessing regression coefficients among EPP, SESP, and ESC-V (see Figure 1). When SESP was entered into the model, Sobel’s test indicated that the relation from EPP to ESC-V was significantly reduced (p < .001), indicating at least partial mediation. When SESP was entered into the regression model, it emerged as a significant predictor of ESC-V (p = .001), while EPP dropped out of the model (p = .191), indicating full mediation (see Figure 1 for a depiction of these relations).
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0.391**
Entlement to Sexual Pleasure from Partner
Self-Efficacy in Achieving Sexual Pleasure
0.186*
421
0.315**
Explicit Verbal Consent to Receiving Oral Sex
FIGURE 1 Mediation model. ∗ p < .005. ∗∗ p
