The Sexual Behavior of Men In the United States. (Articles).(Statistical Data Included)

(Family Planning Perspectives, 25:52-60, 1993)

A nationally representative study of the sexual behavior of men aged 20-39 in the United States shows that the prevalence and frequency of sexual acts (vaginal, anal and oral) and sexual orientation vary by social and demographic characteristics. Analysis of data from 3,321 respondents to the 1991 National Survey of Men reveals that 95% of men have had vaginal intercourse; among them, 23% have had 20 or more vaginal sex partners in their lifetime. About one-fifth of never-married and formerly married men had had four or more partners over a recent 18-month period. However, 41% of never-married men and 32% of formerly married men did not have coitus during the four weeks preceding the interview. Only 20% of men have ever engaged in anal intercourse. Among these, 51% had not done so during the previous 18 months, and 90% had not done so during the previous four weeks. Seventy-five percent of men have performed oral sex and 79% have received oral sex, although 53% of men who ever performed oral sex had not done so during the four weeks prior to interview, and only 11% had done so six or more times. The frequency of receiving oral sex is similar. Only 2% of sexually active men aged 20-39 have had any same-gender sexual activity during the last 10 years, and only 1% reported being exclusively homosexual during this interval.

In this era of AIDS and other sexually transmitted diseases (STDs), knowledge of the sexual behavior of the U.S. population is essential to prevent the spread of infection. Sexual orientation (heterosexual or homosexual), type of sexual contact (vaginal, anal or oral), number of sex partners and frequency of sex have all been cited as risk factors for the transmission of these diseases.

As for sexual orientation, the risk of infecting or being infected by a partner with AIDS is higher among men who have sex with men because infection with the human immunodeficiency virus (HIV) is more prevalent among this group. (1) However, the incidence of heterosexually transmitted AIDS has increased in the United States. (2) The Centers for Disease Control and Prevention estimates that 4% of all AIDS cases reported by April 1991 can be attributed to heterosexual contact with a partner who is known to be infected or at high risk of infection; 30% of these cases occurred among men and 70% among women. (3) Although this gender difference may exist because more men than women are HIV-positive and can infect female partners, recent evidence suggests that male-to-female transmission of HIV may be at least 20 times as efficient as female-to-male transmission. (4)

With respect to types of sexual contact, female infection through vaginal intercourse with an infected partner has been confirmed by most studies. (5) Although its incidence is less documented, female-to-male infection can also occur through vaginal intercourse. (6) HIV transmission through receptive anal intercourse is generally believed to be more efficient than transmission through vaginal intercourse. (7) Even though the virus has been isolated in saliva, research suggests that the risk of becoming infected with HIV by receiving or performing oral sex is minimal. (8) There are, however, documented cases in which a heterosexual man and a homosexual man appear to have become infected by engaging in oral sex with an infected partner. (9)

The number of sex partners is the most frequently cited risk factor for AIDS and other STDs. (10) As Stuart Seidman and colleagues note, having multiple partners" reflects the increased likelihood of encountering a sexually transmitted pathogen through having multiple potential exposures, and... may reflect an increased probability of choosing a partner with an infection through a riskier pattern of partner recruitment." (11) Although the evidence is mixed, a few studies report that the risk of HIV transmission increases with the frequency of sexual contact with an infected partner. (12)

Although some information about the sexual practices of Americans is available, much of our knowledge about sexual behavior has come from nonprobability samples, clinical studies and other small specialty samples; from select groups, such as college students; or from localized samples. The National Academy of Sciences has called for "a more detailed, representative, and contemporary evaluation of sexual behavior analogous to the Kinsey Report." (13) Forty years after its publication, research by Alfred Kinsey and colleagues still represents the most comprehensive study of adult sexual behavior, particularly the sexual practices of men. (14)