Original Article

Pornography and Sexual Experiences Among High School Students in Sweden Magdalena Mattebo, RNM, MSc,*† Tanja Tydén, PhD,‡ Elisabet Häggström-Nordin, PhD,*§ Kent W. Nilsson, PhD,† Margareta Larsson, PhD* ABSTRACT: Objectives: The study investigated the differences between high school boys and girls in: (1) the use of pornography, (2) sexual experiences, (3) experience of sexual abuse, and (4) perceptions of sexuality and pornography. It also examined the possible predictors of experiencing sexual activities, such as sex, sociodemographic factors (high school program, household, and ethnic background), pornography consumption, experience of sexual abuse, perception of sexuality, and perception of pornography. Method: A population-based classroom survey of 16-year-old boys (n 5 477) and girls (n 5 400) from 53 randomly selected high school classes in 2 towns in mid-Sweden. Results: Almost all boys (96%, n 5 453) and 54% of the girls (n 5 213) had watched pornography. Regardless of sex, pornography consumers had a positive perception of pornography. There were no differences between pornography-consuming boys and girls regarding fantasies, and they had attempted sexual acts inspired by pornography. A higher proportion of girls (15%) than boys (6%) had experienced sexual abuse. Predictors for being sexually experienced (oral sex, intercourse, and anal sex) included: being a girl, attending a vocational high school program, living with separated parents, having experience of sexual abuse, stating that boys and girls are equally interested in sex, and having a positive perception of pornography (Adj. R2 = 0.166). Conclusion: Boys had more experience of and a more positive perception of pornography, but there were only a few differences between boys and girls in the pornography-consumer group. Girls were more sexually experienced than boys. A positive perception of pornography predicted being sexually experienced. (J Dev Behav Pediatr 35:179–188, 2014) Index terms: adolescents, pornography, sexuality, sexual experiences.

T

here is ongoing debate as to whether the impact of pornography on sexual behavior is a cause for concern, especially in relation to adolescents, because their developmental immaturity and vulnerability may put them particularly at risk. The perceived consequences of extensive exposure to pornography include: risky sexual behavior, multiple partners, experimentation with sexuality, unrealistic expectations of sex, sexual coercion, sexual violence, and sexual fashion trends, such as highly sexualized images of women that blur the lines between pornography and messages in magazines, marketing, and

From the *Department of Women’s and Children’s Health, Uppsala University, Uppsala, Sweden; †Center of Clinical Science, Uppsala University, County Hospital, Västerås, Sweden; ‡Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden; §School of Health, Care and Social Welfare, Mälardalen University, Västerås, Sweden. Received August 2013; accepted December 2013. Supported by the European Society of Contraception and Reproductive Health, Uppsala-Örebro Regional Research Council, and Uppsala University. Disclosure: The authors declare no conflict of interest. Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions this article on the journal’s Web site (www.jdbp.org). Address for reprints: Magdalena Mattebo, RNM, MSc, Center of Clinical Science, Central Hospital, Uppsala University, Entr 29, Västerås 721 89, Sweden; e-mail: [email protected]. Copyright Ó 2014 Lippincott Williams & Wilkins

Vol. 35, No. 3, April 2014

advertising. The messages convey that young girls should look sexy, and that bodily perfection is exemplified by sexualized ideals of young, thin, and beautiful models. The underlying message for boys is to be sexually dominant and to objectify the female body.1 Pornographic messages have also been interpreted as instigating pressure regarding physical appearance and sexual techniques, conveying a distorted reality.2 A review of studies performed over the last 10 years that focused explicitly on Internet pornography showed both negative (relationship and interpersonal distress) and positive effects (increase in sexual knowledge) of pornography consumption3; however, because the studies had used different methodologies and measurements, it was difficult to establish the levels of Internet pornography use and related problematic behaviors. There are different gender patterns regarding the use of, and attitudes toward, pornography. Boys watch pornography more regularly,4–7 have more positive attitudes toward pornography, and believe that they learn more about sex from pornography than girls do.5,7,8 Men report more positive effects than women on: sexual knowledge, attitudes toward sex, attitudes toward and perception of the opposite sex, sex life, and general quality of life.9 There are varying explanations regarding the cause of sex differences in human sexuality.10 Some researchers www.jdbp.org | 179

claim that these differences are biologically determined and that men and women, although their brains are very similar, are different in characteristics related to sexuality.11 However, the symbolic interaction perspective postulates that sexuality is not only biologically determined but also created in meetings with others and in social interaction between the individual and society.12 Research regarding the environmental and genetic origins of masculine and feminine personality attributes suggests that genetic influences explain 20–48% of the variation, with the remaining 52–80% of the variation being explained by environmental influences.13,14 Some researchers argue that the role of testosterone is crucial for producing sex drive and the active initiation of sexual activity, and that estrogen is responsible for the passive acceptance of sexual activity.15 However, Connell16 argues against the assumption that reproductive differences, such as bodily characteristics (men are stronger and faster), sexual desire (men have more powerful urges), and character (men are aggressive and women are nurturing), directly reflect differences between men and women. Gender is usually seen as a social construct within which individuals and groups act. It is multidimensional and affects identity, work, power, and sexuality. The perception of bodies as male or female arises from the social processes of society; social behaviors create reproductive differences in a so-called “reproductive arena,” and may continue to reshape the perceptions. It is possible for social practices to move gender order in different directions. Gender involves much more than one-to-one relationships between bodies; it involves a vast and complicated institutional and cultural order. It is this whole order that defines bodies and gives them gender meanings.16 National surveys from different countries indicate that sexual behavior in adolescents has changed over time and that the average age for the first sexual intercourse has declined over the recent years.8,17–19 Girls in Sweden were found to be younger (16.4 years) than boys (16.9 years) at the time of their first sexual intercourse18; and among 16-year-old Swedish adolescents, almost half of them reported having experienced oral sex (given and received) and just over 1 in 10 reported having experienced anal sex.20 Among adolescents, oral sex has been described as common and is an accepted sexual activity, whereas anal sex has been less common.21,22 Experiences of casual sexual relationships, such as friends-withbenefits relationships23 and one-night stands, have increased, as has the number of sexual partners.8,17–19 In a Swedish study, approximately half of the 18-year-old male adolescents reported experiencing friends-withbenefits relationships.4 Not all sexual experiences are voluntary; a Dutch study found that sexually abused boys and girls reported more emotional problems, behavioral problems, suicidal thoughts, and suicide attempts than nonabused adolescents.24 Sexual abuse is associated with poorer mental and physical health, and with risk-taking 180 Pornography and Sexuality Among Adolescents

behavior, such as sexual risk and the use of alcohol and drugs.25,26 Our aims in this study were to investigate the differences between high school boys and girls in their: (1) use of pornography, (2) sexual experiences, (3) experience of sexual abuse, and (4) perceptions of sexuality and pornography. It also aimed to examine the following possible predictors for experiencing sexual activities: sex, sociodemographic factors (high school program, household, and ethnic background), pornography consumption, experience of sexual abuse, perception of sexuality, and perception of pornography.

METHODS Population and Sample Data collection was performed in spring, 2011 from 16-year-old first-year high school students from 53 high school classes in a medium-sized and a small town in mid-Sweden. According to the Swedish Act governing the Ethical Review of Research Involving Humans, individuals elder than 15 years are allowed to decide whether to participate in scientific surveys without parental consent.27 The total population of the first-year high school students was 2562 students (1254 boys and 1308 girls). A power analysis was calculated based on previously reported psychosomatic symptoms, defined by the World Health Organization, among adolescents in the county where data collection was performed. The power analysis resulted in a random sample of 1134 students (613 boys and 521 girls). The sample size was determined to be sufficient to detect differences in psychosomatic symptoms between frequent and infrequent users of pornography,4,5 with a p value of .05 and a power of 80%.28 At the time of data collection, 78% (N 5 888) of the students were present in the classrooms. A total of 477 boys and 400 girls agreed to participate.

Instrument The questionnaire consisted of 64 multiple-choice questions on demographics, use of pornography, sexual experiences, physical and psychological health, perceptions of sexuality and pornography, and perceptions of gender equality, previously described.28 Some questions regarding sexuality and perceptions of gender equality were created specifically for this study with the aim of discovering possible differences between boys and girls. The alternative “not relevant to me” was available for those who lacked experience of the subject in question. A pilot test with a test-retest of the questionnaire was performed in a group (n 5 35) similar to the study group in another town. Correlations using Cohen’s Kappa (nominal data) and Spearman’s rank order correlations test (ordinal data) were used on the questions created specifically for this study, and an acceptable degree of correlation was found between the 2 tests (mean values .812 and .608, respectively). As Journal of Developmental & Behavioral Pediatrics

sexuality is probably shaped by biological and social aspects, this article offers a combination of models that may explain why there are differences between boys and girls. Sex is used to refer to biological sex, and gender is used to refer to social sex. This article reports the differences between boys and girls on their use of pornography, sexual experiences, experience of sexual abuse, and perceptions of sexuality and pornography, as well as predictors for being sexually experienced.

Measures Sex of the participants was coded as Boy (0) or Girl (1).

Sociodemographics The participants stated the high school program they were attending (university preparation program or vocational program), family members with whom they lived (2 parents, 1 parent, social parents, siblings, with other adults, foster care, or alone), and ethnic background (born in Sweden, Europe, or outside Europe). The variable household was created, Living with 2 parents (0) and Other (1) and used as an independent variable in general linear models. The variable ethnic background was created, Born in Sweden (0) and Born outside Sweden (1) and used as an independent variable in general linear models.

Sexual Experiences The participants were asked to respond to 7 statements about sexual experiences and 1 question about sexual orientation. Four statements, Experience of having given oral sex, Experience of having received oral sex, Experience of intercourse, and Experience of anal sex had response alternatives of No (0) and Yes (1). Three statements, Experience of one-night stand, Experience of friends-with-benefits relationships, and Experience of group sex had response alternatives of No (0), Once (1), 2–5 times (2), 6–10 times (3), and More than 10 times (4). What do you consider your sexual orientation? had response alternatives of: Heterosexual (1), Homosexual (2), Bisexual (3), and Don’t know/uncertain (4).

Sexual Abuse The participants were asked to respond to 5 statements about the experience of sexual abuse. The statements were preceded by the header “Sometimes, people are persuaded, pressured, or forced to perform sexual acts against their will” to indicate that information about involuntary sexual acts was being requested. The statements were: masturbated to someone, involuntary intercourse, oral sex (given, received), and anal sex. Response alternatives were: No (0), Once (1), 2–5 times (2), 6–10 times (3), and More than 10 times (4). A summation index of sexual abuse was created to dichotomize responses for having experienced sexual abuse into No (0) and Yes (1). A range of 0–20 points was calculated and used as an independent variable in the Vol. 35, No. 3, April 2014

general linear models. There was high internal consistency (Cronbach’s alpha) between the items (.772) (boys and girls, .836 and .730, respectively).

Perceptions of Sexuality The participants were asked to respond to 7 statements about their perceptions of sexuality (Table 1). These statements were designed to elicit information on possible associations with sexual experience and use of pornography. Two statements, Girls having many different partners and Boys having many different partners each had a 5-point Likert scale with response alternatives as follows: Very positive (1), Positive to some extent (2), Neither positive nor negative (3), Negative to some extent (4), and Very negative (5). One statement, You should agree to have sex when your partner wants it within a relationship had a 5-point Likert scale with alternatives as follows: Strongly agree (1), Agree to some extent (2), Unsure (3), Disagree to some extent (4), and Strongly disagree (5). Two statements, Boys and girls are equally interested in sex and Boys and girls are equally interested in pornography had 3 nominal alternatives as follows: Yes (1), Boys are more interested (2), and Girls are more interested (3). Two statements, Boys and girls have an equal need for sex and Boys and girls have an equal need for tenderness had 3 nominal alternatives as follows: Yes (1), Boys have a greater need (2), and Girls have a greater need (3).

Perceptions of Pornography The participants were asked to consider 14 statements about perceptions of pornography (Table 2). A 5-point Likert scale was used with response alternatives as follows: Strongly agree (1), Agree to some extent (2), Unsure (3), Disagree to some extent (4), and Strongly disagree (5). The use of this measurement has previously been reported.4 Based on factor analysis, 2 indexes were created and used as independent variables: positive and negative perceptions of pornography. The positive perception of pornography index comprised 6 items: Pornography can be very arousing, Pornography can teach you about sex, Pornography is good for masturbating, I get a kick by watching pornography, Pornography is part of adolescents’ everyday life, and It is natural to watch pornography. There was high internal consistency (Cronbach’s alpha) between the items (.950) (boys and girls, .911 and .946, respectively). The negative perception of pornography index comprised 8 items: Pornography may give a false view of sexuality, Pornography is degrading for women, Pornography is degrading for men, Pornography is a turnoff, Pornography may contribute to performance anxiety, Pornography is disgusting, Pornography can be addictive, and Pornography conveys traditional gender roles for men and women. There was high © 2014 Lippincott Williams & Wilkins

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Table 1. Perceptions of Pornography Among 16-year-old Boys and Girls Items

Total, N (%)

Boys, n (%)

Girls, n (%)

n 5 540

n 5 323

n 5 217

Agree

464 (86)

262 (81)

202 (93)

Disagree

76 (14)

61 (19)

15 (7)

Pornography may give a false view of sexuality

Pornography can be very arousing Agree Disagree Pornography is degrading for women

n 5 526

n 5 378

n 5 148

473 (90)

356 (94)

117 (79)

53 (10)

22 (6)

31 (21)

n 5 387

n 5 255

n 5 132

Agree

170 (44)

89 (35)

81 (62)

Disagree

217 (56)

166 (65)

51 (38)

n 5 392

n 5 265

n 5 127

62 (16)

34 (13)

28 (22)

Pornography is degrading for men Agree Disagree

330 (84)

231 (87)

99 (78)

n 5 428

n 5 270

n 5 158

Agree

271 (63)

196 (73)

75 (47)

Disagree

157 (37)

74 (27)

83 (53)

n 5 490

n 5 358

n 5 132

426 (87)

330 (92)

96 (72)

Pornography can teach you about sex

Pornography is good for masturbating Agree Disagree Pornography is a turnoff

64 (13)

28 (8)

36 (28)

n 5 444

n 5 305

n 5 139

Agree

103 (23)

29 (10)

74 (53)

Disagree

341 (77)

276 (90)

65 (47)

n 5 380

n 5 255

n 5 125

Agree

202 (53)

148 (58)

54 (43)

Disagree

178 (47)

107 (42)

71 (57)

You get a kick by watching pornography

Pornography may contribute to performance anxiety Agree Disagree Pornography is disgusting

n 5 381

n 5 237

n 5 144

255 (67)

153 (65)

102 (70)

126 (33)

84 (35)

42 (30)

n 5 490

n 5 320

n 5 170

Agree

147 (30)

42 (13)

105 (61)

Disagree

343 (70)

278 (78)

65 (39)

Pornography is part of adolescents’ everyday life Agree Disagree

n 5 509

n 5 333

n 5 176

474 (93)

314 (95)

159 (90)

35 (7)

18 (5)

17 (10)

n 5 385

n 5 247

n 5 138

Agree

280 (73)

169 (69)

111 (80)

Disagree

105 (27)

78 (31)

27 (20)

Pornography can be addictive

It is natural to watch pornography Agree Disagree Pornography conveys traditional gender roles of men and women Agree Disagree aChi-square

n 5 471

n 5 326

n 5 145

413 (88)

299 (92)

114 (79)

58 (12)

27 (8)

31 (21)

n 5 340

n 5 224

n 5 116

203 (60)

146 (66)

57 (49)

137 (40)

78 (34)

59 (51)

pa ,.001

,.001

,.001

.022

,.001

,.001

,.001

.005

NS

,.001

NS

.018

,.001

.003

test; significance level: p , .05. NS, nonsignificant.

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Table 2. Sociodemographic Background of Boys (n 5 477) and Girls (n 5 400) Items

Total, N 5 877 (%)

Boys, n 5 477 (%)

Girls, n 5 400 (%)

pa .044

Study program Academic

489 (56)

281 (59)

208 (52)

Vocational

387 (44)

196 (41)

191 (48)

Living with 2 parents

546 (63)

310 (65)

236 (59)

NS

Living with 1 parent

270 (31)

140 (30)

130 (33)

NS

Living alone

28 (3)

12 (3)

16 (4)

NS

Other

25 (3)

10 (2)

15 (4)

NS

790 (90)

431 (90)

359 (90)

NS

86 (10)

46 (10)

40 (10)

NS

776 (89)

421 (89)

355 (88)

NS

96 (11)

51 (11)

45 (11)

NS

Mother’s occupation (working/studying) Mother unemployed/sick leave Father’s occupation (working/studying) Father unemployed/sick leave aChi-square

test; significance level: p , .05. NS, nonsignificant.

internal consistency (Cronbach’s alpha) between the items (.929) (boys and girls, .855 and .945, respectively). Two sexual experience indexes were created as dependent variables and used in general linear models: sexual practices and casual sex. The sexual practices index was based on experiences of oral sex, intercourse, and anal sex. It had high internal consistency (Cronbach’s alpha) between the items (.847) (boys and girls, .828 and .861, respectively). The casual sex index was based on experiences of one-night stands, friends-with-benefits relationships, and group sex. It had acceptable internal consistency (Cronbach’s alpha) between the items (.672) (boys and girls, .740 and .560, respectively). The correlation between the items in each index was tested. Oral sex and intercourse had higher correlations with each other than each did with anal sex. One-night stands and friends-with-benefits relationships had higher correlations with each other than each did with group sex. The correlation tests were performed separately for boys and girls (see Tables, Supplemental Digital Content 1, http://links.lww.com/JDBP/A56).

Procedure Permission was obtained from the Director of the High Schools at the Department of the County Council. Two schools declined participation and were replaced with other schools. A letter explaining the aim of the study was sent to the teachers, and they were followed up by telephone calls when necessary. One of the authors and 2 specifically trained study assistants visited all the classes and provided information about the study. The participants were asked to write their names on the questionnaires because a follow-up study had been planned for the same participants in 2-year period, but this was voluntary and participating anonymously was possible. Seven percent (n 5 48) of participants chose to remain anonymous. The questionnaires were then coded and the identification page was kept separately in a locked cupboard accessible to the researchers only. Vol. 35, No. 3, April 2014

Statistical Analysis Differences between girls and boys regarding their use of pornography, sexual experiences, experience of sexual abuse, and perceptions of sexuality and pornography were analyzed with the x2 test for nominal scaled variables, Mann-Whitney U test for ordinal-scaled variables, and Student’s t test for interval-scaled variables. A p value , .05 was considered statistically significant. A factor analysis, Varimax Kaiser normalization with orthogonal rotation, was performed to demonstrate different perceptions of pornography. Factors with Eigenvalue .1 were kept, and 2 factors emerged. Components loading . .4 were included in each factor. The 2 indexes based on sexual activities were created (sexual practices and casual sex) and used as dependent variables in general linear models to investigate the predictors for having experienced sexual practices and/ or casual sex. Initially, univariate general linear models were calculated (p , .05) to identify associations between predictors and sexual experiences according to the indexes described. Predictors with significant associations were entered into the general linear models. Finally, the interaction of each factor with sex was tested. All data were transferred and analyzed in IBM Statistical Packages of Social Sciences, SPSS 20, IBM Corp, Armonk, NY.

Ethics The regional ethical review board in Uppsala, Sweden, approved the study (Dnr 2010/369).

RESULTS At the time of the data collection, 78% (N 5 888) of the students were present in their classrooms. Of these, 11 students (8 boys and 3 girls) declined participation. Consequently, the external nonresponse rate was 22%, and the internal nonresponse rate was 1%. The questionnaires were completed by 477 boys and 400 girls. © 2014 Lippincott Williams & Wilkins

183

Background Data The mean age of the participants was 16.6 years (median, 16.0 years; range, 16–23). There were no differences in sociodemographic background between boys and girls except for the study program (p 5 .044) (Table 2).

Experience and Perceptions of Pornography A higher proportion of boys than girls had watched pornography (96% [n 5 453] vs 54% [n 5 213], p , .001). The mean age of actively searching for pornography was lower among boys than girls (mean, 12.3 years; median, 13.0 years; range, 5–18 vs mean, 13.8 years; median, 14.0 years; range, 6–18; p , .001). Ninety percent (n 5 419) of boys consumed pornography compared with 30% (n 5 124) of girls. In this group of pornography consumers, a higher proportion of boys than girls fantasized at least once a week (22% [n 5 92] vs 9% [n 5 11], p , .001) about trying sexual acts inspired by pornography. The most common fantasy was vaginal intercourse (43% [n 5 182] vs 35% [n 5 41]) followed by oral sex (19% [n 5 78] vs 14% [n 5 16]), group sex (12% [n 5 51] vs 15% [n 5 18]), and anal sex (9% [n 5 38] vs 6% [n 5 7]), with no differences between boys and girls. Around one third of pornography-consuming boys and girls had attempted sexual activities inspired by pornography (28% [n 5 118] vs 35% [n 5 41]; nonsignificant [NS]). The most common sexual act inspired by pornography was vaginal intercourse (23% [n 5 95] vs 28% [n 5 33]), followed by oral sex (13% [n 5 56] vs 14% [n 5 16]), anal sex (6% [n 5 23] vs 5% [n 5 6]), and group sex (3% [n 5 11] vs 3% [n 5 3]), with no differences between boys and girls. A higher proportion of boys than girls stated that they watched pornography more than they actually wanted (7% [n 5 29] vs 2% [n 5 2], p , .033), whereas a higher proportion of girls stated that they watched pornography less than they actually wanted (6% [n 5 24] vs 12% [n 5 14], p 5 .019). An equal proportion of boys and girls

stated that pornography affected their own sexual behavior to a high extent (10% [n 5 43] vs 5% [n 5 6]; NS), and a higher proportion of girls stated that pornography affected others’ sexual behavior to a high extent (20% [n 5 84] vs 35% [n 5 41], p , .001). A factor analysis was performed to examine patterns in the perceptions of pornography among boys and girls. Two factors with Eigenvalues .1 emerged (factor loadings .48–.90 and .42–.84, respectively), which explains 74% of the variance in the data. Factor 1 described a positive and personal perception of pornography with statements such as: Pornography can be very arousing, you can learn a lot about sex by watching pornography, and pornography is a natural part of adolescent life. Factor 2 described a negative and rejecting attitude toward pornography with statements such as: Pornography is disgusting, pornography is a turnoff, and pornography can be addictive. Perceptions of pornography were generally more positive among boys than girls, and were more negative among girls than boys (p , .001) (Table 2). However, perceptions of pornography were generally more positive among consumers than nonconsumers, regardless of sex (p , .001).

Sexual Orientation and Experience Almost all boys (96%) and most girls (90%) defined themselves as heterosexual. For other orientations, see Table 3. Overall, girls were more sexually experienced than boys (Table 3). A higher proportion of girls than boys had experienced sexual abuse, with the exception of receiving involuntary oral sex (Table 4). In the total sample, a quarter of boys and 1 of 7 girls reported a positive attitude toward boys having sex with many different partners (24%, n 5 115 vs 14%, n 5 56; p , .001), whereas the proportions of those who reported a positive attitude toward girls having sex with many different partners were much lower (7%, n 5 36 vs 5%, n 5 20; NS) (see Table, Supplemental Digital Content 2, http://links.lww.com/JDBP/A57).

Table 3. Sexual Orientation and Sexual Experience Among Boys (n 5 477) and Girls (n 5 400) Total, N 5 877 (%)

Boys, n 5 477 (%)

Girls, n 5 400 (%)

pa

Heterosexual

801 (94)

448 (96)

353 (90)

,.001

Homosexual

6 (1)

3 (1)

3 (1)

NS

Items

Bisexual

20 (2)

5 (1)

15 (4)

.011

Don’t know/uncertain

29 (3)

9 (2)

20 (5)

.003

Oral sex (received)

457 (53)

225 (48)

232 (58)

.001

Oral sex (performed)

429 (49)

202 (43)

227 (57)

,.001

Intercourse

530 (61)

268 (57)

262 (66)

.004

Anal sex

127 (15)

50 (11)

77 (19)

.001

One-night stand

266 (31)

147 (31)

119 (30)

NS

Friends-with-benefits relationships

227 (26)

122 (26)

105 (26)

NS

48 (5)

32 (6)

16 (4)

NS

Group sex aChi-square

test, Fisher’s exact test; significance level: p , .05. NS, nonsignificant.

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Table 4. Experience of Sexual Abuse Among Boys (n 5 477) and Girls (n 5 400) Items Masturbated for someone

Total, N 5 877 (%)

Boys, n 5 477 (%)

Girls, n 5 400 (%)

pa

56 (7)

15 (3)

41 (10)

,.001

Involuntary intercourse

87 (10)

27 (6)

60 (15)

,.001

Involuntary oral sex (performed)

52 (6)

14 (3)

38 (10)

,.001

Involuntary oral sex (received)

45 (5)

19 (4)

26 (7)

NS

Involuntary anal sex

22 (3)

6 (1)

16 (4)

.01

254 (29)

84 (18)

170 (43)

Knows friend/friends who have been abused aChi-square

,.001

test; significance level: p , .05. NS, non-significant.

The general linear models were performed in a backward stepwise manner, omitting the nonsignificant variables according to p value order. Predictors were investigated in relation to (1) sexual practices (oral sex, intercourse, and anal sex) and (2) casual sex (one-night stands, friends-with-benefits relationships, and group sex). In model A, we found that being a girl (f 5 34.3, p , .001), attending a vocational high school program (f 5 8.08, p 5 .005), living with separated parents (f 5 6.25, p 5 .013), having experienced sexual abuse (f 5 51.1, p 5 .001), stating that boys and girls are equally interested in sex (f 5 8.88, p 5 .003), and having a positive perception of pornography (f 5 56.20, p , .001) were predictors for having experienced sexual practices (Adj. R2 = 0.166). In model B, we found that being a girl (f 5 6.56, p 5 .011), attending a vocational high school program (f 5 9.13, p 5 .003), living with separated parents (f 5 6.86, p 5 .009), having experienced sexual abuse (f 5 38.62, p , .001), stating that boys and girls are equally interested in sex (f 5 7.01, p 5 .008), frequent use of pornography (daily consumption) (f 5 7.15, p 5 .008), having a positive perception of boys having sex with many different partners (f 5 15.92, p , .001), having a positive attitude toward agreeing to sex when a partner wants it within a relationship (f 5 12.20, p 5 .001), and having a positive perception of pornography (f 5 8.73, p 5 .003) were predictors for having experienced casual sex (Adj. R2 = 0.145).

DISCUSSION Three interesting findings emerged. First, among the participants who consumed pornography, there were no differences between boys and girls in the kind of sexual acts they fantasized about, although boys fantasized more often. Second, among the participants who consumed pornography, there were no differences between boys and girls regarding the sexual acts inspired by pornography that they attempted. Third, among the participants who consumed pornography, there were no differences between the proportion of boys and girls who stated that pornography affects one’s own sexual behavior to a large extent. Furthermore, when perceptions of pornography were compared, boys were generally more positive than girls, but regardless of sex, consumers had a more positive perception of pornography than nonconsumers. Vol. 35, No. 3, April 2014

This may indicate that boys and girls who watch pornography have similar thoughts about pornography, and are affected by it to the same extent.

Use and Perception of Pornography and Sexuality Several factors may explain why girls are generally less positive toward pornography than boys. In this study, just over half of the girls reported having watched pornography. Nevertheless, 57–70% responded to the different statements about pornography although “I don’t watch pornography” was provided as a response alternative. This could mean that many of the girls had either watched pornography but did not want to report that or that many statements were based on preconceptions rather than their own experiences. Other explanations may be that pornography is often produced by men for men,29 meaning that the way pornography is produced may attract men more than women. However, a study that exposed a group of women to a femaleinitiated and female-centered erotic film made by a woman and to a man-made erotic film found that genital arousal did not differ, although genital response to both films was substantial.30 Subjective experience of sexual arousal was significantly higher during the woman-made film, and the man-made film evoked more feelings of shame, guilt, and aversion.30 It is interesting to think that bodily reactions may be different from learned social codes and patterns and provoke paradoxical feelings. Sexual acts in pornography may be a reality that some girls experience although they do not wish to, and are not inspired by it. For other girls, it could be far from the reality they recognize, which may partly explain why girls consume pornography much less than boys do. Boys, however, are also aware that pornography represents fiction and not the reality in sexual relationships.2,4,6,7 Sexual acts and messages in pornography may also differ from what boys recognize and experience, which could be one of the reasons why some of the boys in this study had chosen not to consume pornography. Men are perceived as competing with each other for status, to have more interest in no-strings sex with anonymous partners, and to consume prostitution and visual pornography; whereas women are considered to experience basic emotions more intensely and have © 2014 Lippincott Williams & Wilkins

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more intimate relationships,11 aspects that are not portrayed in pornography. It is possible that the differences between boys and girls in pornography consumption reflect sex-typical behavior13,14 and biological differences based on hormones.15 However, a higher proportion of girls than boys reported that they watched pornography less than they wanted, and a higher proportion of boys stated that they watched pornography more than they wanted. It may not be as socially acceptable for girls to watch pornography; such norms could prevent girls from being open about their interest in it and create views that female adolescents should reject pornography and consider it as negative. At the same time, enjoying watching pornography and being openly positive toward pornography may not be socially acceptable either, and could create feelings of guilt and shame among frequent users, which may be one of the reasons why one third of frequent male consumers reported more pornography consumption than they wanted.28 A majority of the participants claimed that boys were more interested in sex. It is possible that these results merely reflect socially expected norms because expressions of male desire and sexuality are still more accepted than expressions of female desire and sexuality.10

Sexual Experiences In a general linear model, one predictor for having experienced casual sex was reporting that boys and girls were equally as interested in sex, which suggests that adolescents with a gender-equal attitude toward sexual interest are sexually experienced to a higher extent than their peers. Connell16 indicates that differences in sexuality are often explained by factors such as body, sexual desire, and character, and that gender is a multidimensional social structure combining identity, work, power, and sexuality. Gender involves much more than one-toone relationships between bodies; it involves a vast and complicated institutional and cultural order. Connell16 claims that there is no obvious biological foundation for explaining gender differences, and that reproductive differences are created by social behavior in an arena where our bodies are used in social processes.16 However, masculinity and femininity have been found to be both genetically and environmentally dependent, which may affect how boys and girls express and shape their sexuality.13,14 It is most likely that biology, environment, and culture shape our sexuality even though it may be difficult to establish how each part contributes to and controls the possibilities and opportunities to practice sex without prejudice. A higher proportion of girls than boys had experienced the sexual activities of oral sex, intercourse, and anal sex, which is in line with previous research.4,18,20 One explanation may be a natural reflection of the biological differences between boys and girls, because testosterone inhibits the myelination of the male brain. This makes boys approximately 2 years younger in maturity than girls of the same age31 and may be one reason 186 Pornography and Sexuality Among Adolescents

why boys are older at their sexual debut. Twice the proportion of girls had experienced anal sex compared with boys; however, there were no differences regarding experiences of friends-with-benefits relationships,23 onenight stands, or group sex. This may indicate that these 16-year-old girls and boys experienced sexual practices such as oral sex, intercourse, and anal sex with partners other than same-aged peers. It is possible that these girls practiced sex with older boys, which could confirm the biological differences.31 It is also interesting that casual sex such as friends-with-benefits relationships,23 onenight stands, and group sex were equally uncommon between boys and girls. This may indicate that these 16-year-old boys and girls mainly have sex within steady relationships. Another explanation could be that, among peers, the attitude toward girls having sex with many partners was mainly negative, which may contribute to a reluctance to report experiences of casual sex.

Sexual Abuse Fourteen percent of the girls and 6% of the boys reported having experienced sexual abuse, which is somewhat higher than other studies.24,25 It is alarming that many girls at the age of 16 had already been exposed to sexual abuse25,26 in a country like Sweden that protects the individual’s rights and freedom of choice.32 Sexual abuse among adolescents can be considered a public health problem and is associated with poor health, risk-taking behaviors, and self-harm behaviors.24–26 Children should be taught at an early age about self-esteem, empowerment, and setting limits in relation to their own and others’ bodies. It is likely that personnel working with young people in different settings will meet adolescents who have experienced sexual abuse. It is of great importance that personnel have the right knowledge, tools, and methods to handle issues about sexual abuse among adolescents. During pregnancy in Sweden, questions are asked about abuse and, if necessary, the pregnant woman is offered help by staff educated in handling these issues. Adolescents would also probably benefit from meeting staff who are professionally equipped to work with these issues. Laws in Sweden regarding sexual abuse are gradually being refined to determine what should be punishable, and there are national recommendations to include questions about violence and abuse in every consultation with heath care providers.33 We did not ask anything about the perpetrators of sexual abuse in our study; it is therefore impossible to determine whether they were peers, adults, or relatives. It may be important to start discussions in schools and in other environments with adolescents about the different social norms for boys and girls to express sexuality, and what opportunities and problems these differences may cause. Adolescents need to be aware of the messages that the media and pornography convey regarding sexuality and how they may affect their own sexuality. It is also important to acknowledge the dramatic hormonal change affecting the adolescent body Journal of Developmental & Behavioral Pediatrics

and brain,34 which has a major impact on behavior such as striving to find a partner.11 How this biological force is expressed is probably mostly moderated by societal, social, and cultural norms and attitudes.35 Helping boys and girls to become aware of this interplay will enhance their opportunities to make decisions based on individual choices rather than on external expectations. Personnel working with adolescents’ norms and values also need to reflect on personal norms and values of their own36 and on the norms and values of adolescents,2 as well as on social12,16 and biological11,13–15 sex differences. Gender-related issues regarding sexuality, both social and biological, should be embedded in the school curriculum.

details for the researchers, in case anybody wanted to ask questions afterward.

Strengths and Limitations

1. Papadopoulus L. Sexualisation of young people review. 2010. Available at: http://webarchive.nationalarchives.gov.uk/ 20100418065544/http://homeoffice.gov.uk/documents/ Sexualisation-of-young-people2835.pdf?view5Binary. Accessed July 15, 2013. 2. Mattebo M, Larsson M, Tydén T, et al. Hercules and Barbie? Reflections on the influence of pornography and its spread in the media and society in groups of adolescents in Sweden. Eur J Contracept Reprod Health Care. 2012;17:40–49. 3. Short MB, Black L, Smith AH, et al. A review of Internet pornography use research: methodology and content from the past 10 years. Cyberpsychol Behav Soc Netw. 2012;15:13–23. 4. Häggström-Nordin E, Hanson U, Tydén T. Associations between pornography consumption and sexual practices among adolescents in Sweden. Int J STD AIDS. 2005;16:102–107. 5. Häggström-Nordin E, Tydén T, Hanson U, et al. Experiences of and attitudes towards pornography among a group of Swedish high school students. Eur J Contracept Reprod Health Care. 2009;14: 277–284. 6. Romito P, Beltramini L. Watching pornography: gender differences, violence and victimization. An exploratory study in Italy. Violence Against Women. 2011;17:1313–1326. 7. Svedin CG, Åkerman I, Priebe G. Frequent users of pornography. A population based epidemiological study of Swedish male adolescents. J Adolesc. 2011;34:779–788. 8. Tydén T, Rogala C. Sexual behaviour among boys in Sweden and the impact of pornography. Int J STD AIDS. 2004;15:590–593. 9. Hald GM, Malamuth NM. Self-perceived effects of pornography consumption. Arch Sex Behav. 2008;37:614–625. 10. Baumeister RF. Gender differences in erotic plasticity: the female sex drive as socially flexible and responsive. Psychol Bull. 2000; 126:347–374. 11. Pinker S. The Blank Slate. The Modern Denial of Human Nature. London, UK: Penguin Books Ltd; 2002. 12. Gagnon JH, Simon W. Sexual Conduct: The Social Sources of Human Sexuality. 2nd ed. Somerset, NJ: Aldine Transaction; 2002. 13. Mitchell JE, Baker LA, Jacklin CN. Masculinity and femininity in twin children: genetic and environmental factors. Child Dev. 1989; 60:1475–1485. 14. Cleveland H, Udry J, Chantala K. Environmental and genetic influences on sex-typed behaviors and attitudes of male and female adolescents. Pers Soc Psychol Bull. 2001;27:1587–1598. 15. Baumeister RF, Catanese KR, Vohs KD. Is there a gender difference in strength of sex drive? Theoretical views, conceptual distinctions, and a review of relevant evidence. Pers Soc Psychol Rev. 2001;5: 242–273. 16. Connell RW. Gender. Malden, MA: Blackwell Publishing Ltd; 2002. 17. Teitler J. Trends in youth sexual initiation and fertility in developed countries: 1960–1995. Ann Am Acad Pol Soc Sci. 2002;580:134–152. 18. Tikkanen RH, Abelsson J, Forsberg M. UngKab 09. The 2009 Youth and Sexuality Survey in Sweden. [Kunskaper, attityder, och sexuella handlingar bland unga]. Stockholm, Sweden: The Swedish Institute for Communicable Disease Control; 2011.

Data were collected from a randomly selected group of high school students in mid-Sweden. The internal nonresponse rate was low (1%), indicating an interest in questions regarding sexuality among adolescents. A pilot study with a test-retest design was conducted before the data collection to strengthen the validity of the instrument. However, when using a self-report questionnaire, the reliability of the answers should always be considered. At the end of the questionnaire, most of the respondents stated that they had filled out the questionnaire truthfully. Many of the questions were specifically created for this study. Although the questionnaire was tested and retested, there are limited opportunities for comparing some of our results with other findings, thereby making it difficult to know whether these results can be generalized to other adolescent populations and settings. Additional research is needed to enable comparison. No school staff members were present at data collection. This was to indicate that the schools were not involved in the investigation and to assure the participants that no staff had the opportunity to oversee any of the answers. The desks were separated to maintain privacy when the students filled out the questionnaire, although the participants could still have felt peer pressure. Questions about sexuality are often sensitive and some students may have reported more or less experience than they actually had. The participants marked their questionnaire with their names to enable a follow-up study. Although we guaranteed that their names would be removed from the questionnaire before analysis, some respondents may have exaggerated certain experiences or been reluctant to reveal them. The first author distributed the questionnaires in all the classes, which enabled the participants to ask directly any questions related to the research project. All school nurses and the local youth clinic were informed about the study in case any of the participants had questions related to the investigation. Information about the local youth clinic was given to all participants in case questions or thoughts arose. All participants received written information about the study, including contact Vol. 35, No. 3, April 2014

CONCLUSION Boys had more experience of and a more positive perception of pornography, but there were only a few differences between boys and girls in the group of pornography-consumers. Girls were more sexually experienced than boys were. A positive perception of pornography predicted being sexually experienced. REFERENCES

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19. Tydén T, Palmqvist M, Larsson M. A repeated survey of sexual behavior among female university students in Sweden. Acta Obstet Gynecol Scand. 2012;91:215–219. 20. Häggström-Nordin E, Borneskog C, Eriksson M, et al. Sexual behaviour and contraceptive use among Swedish high school students in two cities: comparisons between genders, study programs, and over time. Eur J Contracept Reprod Health Care. 2011;16:36–46. 21. Malacad BL, Hess GC. Oral sex: behaviours and feelings of Canadian young women and implications for sex education. Eur J Contracept Reprod Health Care. 2010;15:177–185. 22. Hensel D, Fortenberry D, Orr D. Variations in coital and noncoital sexual repertoire among adolescent women. J Adolesc Health. 2008;42:170–176. 23. Owen J, Fincham FD, Manthos M. Friendship after a friends with benefits relationship: deception, psychological functioning, and social connectedness. Arch Sex Behav. 2013;42:1443–1449. 24. Garnefski N, Arends E. Sexual abuse and adolescent maladjustment: differences between male and female victims. J Adolesc. 1998;21:99–107. 25. Annerbäck EM, Sahlqvist L, Svedin CG, et al. Child physical abuse and concurrence of other types of child abuse in Sweden— Associations with health and risk behaviors. Child Abuse Negl. 2012;36:585–595. 26. Svensson F, Fredlund C, Svedin CG, et al. Adolescents selling sex: exposure to abuse, mental health, self-harm behaviour and the need for help and support-a study of a Swedish national sample. Nord J Psychiatry. 2013;67:81–88. 27. Swedish Research Council. [Codex rules for guidelines and research Web site]. 2013. Available at: http://www.codex.vr.se/en/ index.shtml. Accessed Oct 25, 2013.

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28. Mattebo M, Tydén T, Häggström-Nordin E, et al. Pornography consumption, sexual experiences, lifestyles and self-rated health among male adolescents in Sweden. J Dev Behav Pediatr. 2013;34: 460–468. 29. Kort J. A review of “Getting off: pornography and the end of masculinity”. J Sex Marital Ther. 2010;36:383–385. 30. Laan E, Everaerd W, van Bellen G, et al. Women’s sexual and emotional responses to male- and female-produced erotica. Arch Sex Behav. 1994;23:153–169. 31. Lenroot RK, Gogtay N, Greenstein DK, et al. Sexual dimorphism of brain developmental trajectories during childhood and adolescence. Neuroimage. 2007;36:1065–1073. 32. Government Offices of Sweden. Discrimination Act. SFS 2008:567. Available at: http://www.regeringen.se/content/1/c6/11/59/03/ b463d1e1.pdf. Accessed June 10, 2013. 33. The National Center for Knowledge on Men’s Violence against Women (NCK). Att fråga om våldsutsatthet som en del av anamnesen (To Inquire About Exposure to Violence as Part of Anamnesis). NCK Report 2010. Uppsala, Sweden: Edita Västra Aros; 2011. 34. Scherf KS, Smyth JM, Delgado MR. The amygdala: an agent of change in adolescent neural networks. Horm Behav. 2013;64:298– 313. 35. Sudhinaraset M, Mmari K, Go V, et al. Sexual attitudes, behaviours and acculturation among young migrants in Shanghai. Cult Health Sex. 2012;14:1081–1094. 36. Mattebo M, Larsson M, Tydén T, et al. Professionals’ perceptions of the effect of pornography on Swedish adolescents. Public Health Nurs. 2013;[Epub ahead of print].

Journal of Developmental & Behavioral Pediatrics

Pornography and sexual experiences among high school students in Sweden.

The study investigated the differences between high school boys and girls in: (1) the use of pornography, (2) sexual experiences, (3) experience of se...
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