© 2013 Springer Publishing Company

Hispanic Health Care International, Vol. 11, No. 3, 2013

http://dx.doi.org/10.1891/1540-4153.11.3.101

Sexual Communication Among Young Adult Heterosexual Latinos: A Qualitative Descriptive Study Carmen Paula Alvarez, PhD, CNP George Washington University Antonia Villarruel, PhD, FAAN University of Michigan School of Nursing Sexual communication between sexual partners is an important component in prevention efforts against unintended consequences of sex. The purpose of this study was to describe sexual communication among young adult Latinos. Four semistructured, sex-segregated focus groups were used for this study. Participants (N 5 20) were 18–30 years old self-identified Latinos who were in heterosexual and sexually active relationships (more than 3 months). Participants revealed that initial sexual communication with their partners was avoided related to a lack of interest in a partner’s sexual history, feeling embarrassed about the topic, or concern for offending one’s partner or partner’s family. As a result of these beliefs and attitudes, initial sexual communication was nonverbal and focused on sexual pleasure. After the initiation of sexual activity, verbal sexual communication expanded to include sexual history. These findings highlight the importance of attitudes and subjective norms toward verbal sexual communication. Attitudes and subjective norms toward sexual communication in the context of a romantic relationship and how it may impact sexual behavior in the relationship should be further explored. La comunicación sexual entre parejas es un componente importante en la prevención de situaciones no deseadas relacionadas con el sexo. El objetivo de este estudio es describir la comunicación sexual entre jóvenes latinos. Cuatro grupos focales fueron realizados con 20 jóvenes latinos entre 18 a 30 años de edad y en una relación sexual con alguien del sexo opuesto. Los participantes expresaron que al inicio de la relación la comunicación sexual con sus parejas fue evitada por: falta de interés en la historia sexual de su pareja, sentir vergüenza al hablar sobre el tema, o por miedo de ofender su pareja o su familia. Como resultado de estas creencias y actitudes, la comunicación sexual al inicio era no verbal y enfocada en la satisfacción sexual. Luego la comunicación se expandió a incluir a la historia sexual de la pareja. Los resultados de este estudio reflejan la importancia de las actitudes y normas subjetivas relacionadas con la comunicación sexual verbal. Las actitudes y normas subjetivas relacionadas con la comunicación sexual en el contexto de una relación romántica y como esto impacta la conducta sexual en la relación de pareja necesita ser investigada. Keywords: sexual communication; Latinos; young adults; facilitators; barriers

I

n the United States, young adult Latinos continue to be disproportionately affected by unintended consequences of sex, particularly sexually transmitted infections (STIs) and HIV/AIDS. In 2010, the prevalence rate for chlamydia and gonorrhea among Latinos was two and three times higher than prevalence rates among

Whites (Centers for Disease Control and Prevention [CDC], 2011c). Regarding HIV/AIDS, in 2009, Latinos represented 16% of the U.S. population but represented 20% of all new HIV infections (CDC, 2011b). Among Latinos, the 13–29 years age group (for both sexes) has the highest prevalence of persons newly infected with 101

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HIV, and Latino gay and bisexual men accounted for 45% of new infections (CDC, 2011a). In recent years, public health researchers have considered bisexual men or men who have sex with both men and women as a potential “bridge population” (Siegel, Schrimshaw, Lekas, & Parsons, 2008). Men who have unprotected sex with an infected male partner and then have sex with women may contribute to the transfer of HIV to women. This bridge population further highlights the importance of attention to sexual communication within heterosexual relationships. Sexual communication between sexual partners is an important strategy for prevention of unintended pregnancies and STIs. Sexual communication between sexual partners has been found to be positively associated with safer sex practices, particularly condom use (Rojas-Guyler, Ellis, & Sanders, 2005; Widman, Welsh, McNulty, & Little, 2006). Few studies have explored sexual communication among young adult Latinos, and those studies that have examined the influence of sexual communication on condom use among Latinos have shown equivocal results. Some studies demonstrate a positive relationship between sexual communication and condom use (Ibañez, Van Oss Marin, Villareal, & Gomez, 2005; Rickman et al., 1994; Rojas-Guyler et al., 2005), whereas other studies found no relationship (Harvey & Henderson, 2006; Moore, Harrison, Kay, Deren, & Doll, 1995). Understanding sexual communication between couples is an important prerequisite for the development of effective sexual health promotion and risk-reduction interventions and is relevant for nursing practice. An awareness of how young adult Latinos communicate about sex can help nurses adopt health protective behaviors that take into account the context of their sexual relationships. Studies that have explored sexual communication among Latinos have primarily focused on issues such as sexual history, including disclosure of past STIs and/ or HIV status, and condom use negotiation (Crepaz & Marks, 2003; Ibañez et al., 2005; van der Straten, Catania, & Pollack, 1998). This health-focused perspective on sexual communication has several limitations. First, evaluating sexual communication from this health perspective assumes that individuals want to know their partner’s sexual history. Second, exploring sexual communication from such a narrow perspective does not reveal the other mechanisms individuals may employ to influence their sexual behavior. To understand how sexual communication (verbal and/or nonverbal) may influence sexual behavior, it is essential to learn from the perspective of young adult Latinos the context and content of sexual communication. Among Latino populations, traditional cultural beliefs and perceptions of gender roles are purported to be the main barriers to successful sexual communication between sexual partners. For example, the sexual gender roles of marianismo and machismo support the notion that women should be sexually naïve and

faithful, whereas men should demonstrate their masculinity by behaviors, which include greater sexual freedoms and the power to make decisions about sex between the couple (Davila, 2000; Ortiz-Torres, Serrano-García, & Torres-Burgos, 2000). These beliefs promote the practice of “sexual silence” (the avoidance of verbal communication about sex)—a practice cultivated from childhood that perpetuates discomfort and shame about sexual communication (Carillo, 2002). Although sexual silence has been explored with qualitative methods, there is a paucity of findings about the relationships between sexual gender roles, sexual silence, and sexual behaviors among Latinos. Qualitative studies that have explored gender roles and sexual communication among Latinos revealed that men either discussed sex explicitly to impress their peers (Marston, 2004) or avoided discussing sex with their female partner because it was uncomfortable and disrespectful (Noland, 2008). On the other hand, women reported limiting their discussions about sex to avoid appearing too knowledgeable or experienced about sex (Marston, 2004; Noland, 2006). These findings suggest that men and women felt the need to live up to certain social expectations that in turn stifle sexual communication. Although these qualitative studies emphasized how “culture” and machismo impede sexual communication between partners, there is little clarification on the perception and meaning of machismo and little insight on what aspect of machismo makes communication difficult. The premise that culture and machismo are barriers to sexual communication limits opportunity for learning about the verbal and nonverbal ways in which sexual partners make their needs known to each other. Only one study explored sexual communication based on the contrary perspective that power dynamics within a relationship is often fluid and not male-dominated. Pulerwitz and Dworkin (2006) conducted a qualitative study with heterosexual couples, most of whom were Latinos, to explore power dynamics in sexual relationships and its effects on safe sex negotiation. Although participants believed that sex should be based on early, firm, and nonthreatening requests, condoms were not always used in their relationships. Men reported willingness to use condoms if their partner insisted; however, some women did not insist on condoms because condoms were thought to decrease sexual pleasure. Overall, research on sexual communication among young adult Latinos is sparse and conflicting. The narrow perspective with which sexual communication has been measured suggests that a more exploratory and descriptive approach should be considered. As part of a larger descriptive study, a small preliminary qualitative study was conducted to pilot questionnaires and to explore what sexual communication entails for young adult heterosexual Latinos and the context in which such communication does or does not occur. 102

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Methods

population. Regarding preparation as a moderator, the PI developed the semistructured interview and piloted the ­interview prior to conducting the focus groups. The focus groups were conducted in a conference room in a community health clinic, library, or student multicultural center. Sessions were 2–2 1/2 hr. Participants were compensated $20, and food was provided. At the beginning of each session, eligibility was evaluated for individuals who had not been previously screened, and informed consent was obtained. Participants were then provided with an explanation of the purpose of the ¡Háblame! project and the focus groups. Each session started with participants completing a questionnaire, collecting demographic information and including two sexual communication measures—the Health Protective Sexual Communication Scale (HPSC; van der Straten et al., 1998) and the Dyadic Sexual Communication Scale (Catania, 1998). The sexual communication measures were being piloted for their use in a related study. The first part of the focus group discussions focused on issues of clarity, meaning, and reaction to questionnaires. The initial focus on the questionnaires helped to frame subsequent discussions and to increase comfort in openly discussing a sensitive topic (Wellings, Branigan, & Mitchell, 2000).

The perspective of the young adults was obtained through focus group methodology. Focus groups were chosen to (a) obtain a breadth of perspectives about sexual communication across several groups, (b) uncover the terminology about sexual communication used by the target population, and (c) gain better understanding of the nuances of sexual communication within a relationship. Focus groups were also chosen because of the sensitivity of the topic; researchers (Morgan, 1998; Sandelowski, 2000) have suggested that more discussion about sensitive issues can be generated in a group setting compared to individual interviews. A purposive sample of 20 Latinos, who were currently in heterosexual relationships, sexually active, and between the ages of 18 and 30 years, participated in the focus groups. Four sex- and language-segregated groups, consisting of five same-sex participants in each group, were held. Two of the groups were conducted in Spanish and two in English. To obtain a variety of opinions about sexual communication (Morrison-Beedy, Côté-Arsenault, & Feinstein, 2001), the authors decided a priori to conduct four focus groups representing the four main categories of Latinos—English-dominant men and women and Spanish-dominant men and women. Participants were recruited from a health clinic and surrounding urban areas in the Midwest. The university and the community clinic institutional review boards approved this qualitative descriptive study named ¡Háblame! Potential participants were recruited via fliers posted at the health clinic and in selected communities and also through e-mails advertising the study, a project website on Facebook, word of mouth, or being individually approached at the clinic by the primary investigator (PI). Participants who contacted the PI were screened for eligibility and invited to participate in the focus group discussions held at the clinic. Once eligibility was determined, participants were asked if they preferred to speak English or Spanish and were given the date and place of the focus group to be held in their preferred language. If the potential participants reported that they were comfortable speaking either language, they were asked to attend the group which at that time had less participants. All participants were informed that they could invite their sexual partner to participate separately in sex-segregated focus groups and were also asked to invite other eligible participants. No couples were represented in these focus groups. From October through November, 2010, the PI and a research assistant conducted the focus groups. Morrison-Beedy and others (2001) suggest that the moderator be well prepared to conduct the sessions and be a match with focus groups. The PI had several characteristics and experiences consistent with recommendations about personal characteristics and preparation for focus group moderators (­Morrison-Beedy et al., 2001). The PI is a bicultural and ­bilingual clinician who had several years of experience working with the target

Sample Table 1 describes the sample characteristics. The only significant gender difference was that compared to men, women had been with their partners for more years. Women represented various backgrounds. Six women had children. Except for one homemaker, all women were employed and represented various occupations including medical assistant, factory worker, community worker, ­office clerk, and registered nurse. Five women participated in an English-speaking focus group and five in a Spanishspeaking focus group. Male participants also represented various backgrounds. One male had a child. All men, except one, were employed in occupations including cook, teacher, supervisor (unspecified area), and custodial work. Five men participated in the English-speaking focus group and five in the Spanish-speaking focus group. One participant did not report his relationship living status or his level of education.

Data Collection and Recording An interview guide was used to facilitate discussion (Corbin & Strauss, 2008). The purpose of the focus groups was to obtain perspectives from young adult Latinos about what sexual communication entails, how one informs his or her partner (verbal vs. nonverbal methods), what influences the sexual communication, and the consequences of the communication. The focus group discussion guide addressed topics including sentiments 103

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TABLE 1.  Demographic Characteristics of Sample Women (N 5 10) M (SD) Range

Men (N 5 10) M (SD) Range

Age

24.2 (3.9) 19–29

23.9 (3.9) 19–30

Age of partner

27.6 (6.1) 20–40

21.0 (2.7) 17–25

Relationship duration (years)

5.3 (3.4) 0.66–11.0

2.1 (2.5) 0.5–8.0

Time in United States (years)

16.5 (6.9) 7–25

14.0 (10.5) 1–30

Characteristics

n

n

Birth place   United States   Mexico   El Salvador

5 4 1

6 4

Relationship statusa   Married   Cohabitating   Living apart

4 2 4

1 1 7

Level of educationb   High school   High school graduate   Some college   College graduate

2 2 5 1

3 0 4 2

Employment status   Employed   Unemployed

9 1

9 1

Characteristics

aOne

bOne

participant did not report his relationship status. participant did not report his level of education.

about general communication with one’s partner, trust, and issues regarding communicating with a partner about sex. The interview guide started with general questions and progressed to specific questions about verbal and nonverbal ways of sharing sexual information with one’s partner. The questions were open-ended to obtain unanticipated thoughts and opinions as well as foster group discussion; for example, (a) “Thinking about communicating with a boyfriend, girlfriend, or spouse, what are things that are shared?” (b) “What information about sex is shared between couples?” and (c) “How does a person communicate to his or her partner what he or she wants in a relationship?” All sessions were audio-recorded, and both the moderator and research assistant took notes during each session. Notes were taken on key themes that emerged for each question, quotes that illustrated relevant points, and ideas that emerged from the PI and moderator during their debriefing reflections after the focus group. The audio recordings were transcribed verbatim by the PI and reviewed for accuracy by both the moderator and research assistant.

Data Analysis Data analysis started after completion of the first focus group session and was conducted separately by the PI and research assistant. The QSR NVivo 8 software, a qualitative data analysis software program, was used to assist with data coding, code comparisons, categorizing codes, and linking themes. Qualitative analysis consisted of open coding (Level I) of the transcribed interviews using in vivo terms derived from the data to create the selected codes. Continuous review and comparison of the codes revealed domains (Level II) into which the codes were sorted. These domains were used to create a codebook that guided the coding of all interviews (Corbin & Strauss, 2008). Common patterns noted among these domains generated several categories within each domain (Level III). Upon development of these categories and themes, the PI and research assistant debriefed to compare results and arrive at consensus about codes and categories. This process involved combining similar codes, identifying those that were distinct, and examining how the categories and codes 104

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learning too much about a person, particularly in the beginning of a relationship, has the potential to “shatter” whatever positive image you have of the person. Unlike the men, most women were willing to learn about how many sexual partners their current partner had, but no other detail was desired. Learning the details about past sexual partners was not only considered “unhelpful” but also, similarly to the men, considered the information somewhat threatening. One woman said,

related to one another. The transcripts were then recoded using the joint codebook (Lofland & Lofland, 1995). Interview modifications were concurrent with data collection, which contributed to validity of the data (Boeije, 2002). After the first focus group session, data analysis revealed challenges with some interview questions that informed adjustments for subsequent focus groups. For example, one of the interview questions was, “For a lot of people, sex is also part of a relationship. What is your definition of sex?” Participants’ prolonged silence with this question suggested a need for clarification. The question was then changed to “Some people consider sex to be the penis in the vagina. What do you think about this? What do you consider to be sex?”

I guess because I’m self-conscious about myself, I didn’t want to know specifics because if I ever ran into the person in the street, I didn’t know if I would be like—that’s her! [said in a surprised tone] . . . I didn’t want to compare myself to other women that he’s been with. (Female, English-speaking group)

Results

Other reason for not wanting to know about a partner’s past sexual history was that for some, it was considered irrelevant. As one man said, “If I want to be with her, I want to be with her; I couldn’t care less who she’s been with.” Several participants also remarked, “It’s none of your business who I’ve been with.” In which case, not only were they not willing to inquire about their partner’s sexual past but these participants were also not willing to readily talk about their own sexual history. Indirectness. Men in particular discussed using indirect means of learning information about a partner and also being able to “just tell” about someone’s past. A  man shared that he had never asked his girlfriend about past drug abuse because when looking for a partner, he does not “ . . . look for someone that looks like they’re too crazy, like they use drugs . . . . ” Some male participants also discussed among themselves how one can tell through mannerisms if a girl has “been around.” Regarding indirectness, most male participants agreed that “ . . . you don’t have to touch the subject to really know what’s going on.” Participants believed that through spending time with one’s partner, you start to figure things about him or her and therefore never need to directly ask about the matter. For instance, one participant shared that he knows his wife has never had a sexual experience with another female because they had talked about homosexuality and it probably would have been mentioned at that time. Feeling Embarrassed. Embarrassment in talking about sex arose in discussions with the Spanish-speaking groups. Participants shared that particularly in the beginning of their relationships, discussions about sex were avoided because of la vergüenza—feelings of embarrassment or shame. The embarrassment stemmed from participants’ upbringing. One woman offered, “ . . . our parents did not instill this [the open practice of discussing issues regarding sex] in us from our childhood; on the contrary, if we ever wanted to know anything about sex as children we were punished.” She went on to describe how the fear of being chastised with attempts

Analysis of the focus group discussions revealed the following domains: (a) barriers to verbal communication, (b) facilitators of communication, (c) sex and condom use, (d) contexts for verbal sexual communication, and (e) nonverbal sexual communication. Data from the focus group participants revealed the progression and complexity of sexual communication within a relationship. All participants agreed that open communication is critical to a successful relationship; however, communication regarding sex remained a challenging topic to broach.

Barriers to Verbal Communication In the beginning of a relationship, participants shared how topics regarding sex were avoided. Barriers and reasons for avoiding certain discussions about sex were categorized as “not wanting to know,” “indirectness,” “feeling embarrassed,” “perceived negative reaction,” and “machismo.” These reasons were voiced by both men and women. Not Wanting to Know. Male and female participants indicated that there is some information, for several reasons, that they simply do not want to know about their partner. A few men felt as though knowing some information, such as how many people their current partner has had sex with, could potentially “threaten their ego.” As a couple of men described, . . . how do I say this, men have a certain ego, so to know how many people [your partner has had sex with] it like . . . it would raise the issue of who was better—was he [the previous partner] better or am I better? So it’s preferable not to [ask]. (Male, Spanish-speaking group).

Another said, If I ask her how many partners she has been with, I’m always going to wonder where I rank compared to other men . . . it’s best not to ask about information that you can’t handle. (Male, English-speaking group)”

Similar to not being able to “handle” certain information, another male participant shared how sometimes 105

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to talk about sex continued into adulthood and created the feeling of embarrassment even in talking with their sexual partner about sex. Perceived Negative Reaction. Another challenge to verbal communication about sex was the anticipation of a negative reaction from one’s partner. This perception was, in part, influenced by past experiences. One male participant shared,

through tradition, through religion, through every aspect of the culture.” Given these characteristics, participants shared that machismo often hinders verbal sexual communication between partners. Women described machista men as being so intimidating to their partners that their female partners would never initiate discussions about sex. Machista men were also described as so egotistical they would not initiate discussions about sex because only their needs are important. One male participant summed up how machismo affects communication, “Machismo means . . . what a woman says isn’t valued in a relationship. When a man is machista, what a woman says and her opinion isn’t worth anything.” Although machismo was considered a common and pervasive issue in relationships, none of the participants described themselves as machistas or being with machista partners.

I remember one time I was talking to this one girl and ummm and I don’t recall exactly how I met her, but she came over for a date, and she had like a weird growth on her lips and that’s an indication of having ummm what is it . . . STDs? So I was, you know, we were talking, and I couldn’t help but notice it, you know? So I straight up asked her, “Have you ever been tested for STDs?” And she’s like, “Oh no! It’s not what you think, it’s a cold sore, blah blah blah . . . make a long story short, she was very offended and embarrassed by my question and I, I mean, we kind of stood friendly for a while, but it never really progressed from there. (Male, English-speaking group)

Facilitators of Communication Despite the multiple barriers to sexual communication, young adult participants also described several factors that facilitate sexual communication. Facilitators of communication included (a) perceived openness, (b) length of time in the relationship, (c) initial sexual activity, and (d) technology. Perceived Openness. Both male and female Englishspeaking groups talked about how they were more likely to discuss sex with their partner if they had the sense that their partner would be open to the discussion. When asked about ways in which one would “know” if the person were open to talking about sex, men in particular described how one can always tell from a woman’s mannerisms. One participant elaborated further, “ . . . honestly, it’s more about her mannerisms, in my opinion. I was with this one girl one time and she like [said], ‘Hey, can I get on top?’ She was audacious enough to ask so that told me a lot about her . . . you know . . . being open sexually.” Another participant shared how she had established the openness with her partner. Initiating discussions from the very beginning she said, “Set the stage for the rest of the relationship,” where she and her partner were able to talk openly about sex. Length of Time in the Relationship. Almost all participants discussed length of time in the relationship as a positive influence on sexual communication with their partner. The more time one spent with his or her partner, feelings of trust and comfort increased, thus allowing for more discussion on sexual issues without the concern of a negative reaction. For example, one woman shared,

In this situation, not only did he offend his potential partner but the question also hindered the relationship from becoming anything more than a friendship. Despite potentially anticipating a negative reaction, men remained opened to discussing sex with their partner. However, given their uncertainty about how a woman may respond, and knowing that as men they would always be open to the discussion, they felt it safer to let women bring up the topic. One male participant said, I wouldn’t jump into the subject, I think I would leave it up to her; me as a man, I would leave it up to her, if she wants to bring it up. I think women are more sensitive, some . . . depends on who it is, but a lot of women are more touchy about the subject. (Male, English-speaking group)

Regarding the female participants, they also avoided initiating conversations about sex out of concern for creating negative impressions about themselves or upsetting their partners. Machismo. Machismo was described as “pride of your manliness,” aversion of any “feminism” or “homosexuality,” and a belief and practice of male domination over female partners. According to several female participants, male domination included the expectation that women maintain and remain in the home, take care of the children, and do whatever their partner requested. These behaviors were considered to be cultivated in men throughout life starting from the home. As one woman said, “Macho men are made not born,” and explained how mothers often create double standards; for example, having a daughter serve her brother food or iron his clothing. In addition to nurturing machismo in the home, one man shared that machismo is in fact encouraged in all aspects of life and “ . . . that’s very induced in Mexican males through songs, through music, through theatre,

. . . it’s with time that my trust grows, I see that he also trusts me and that’s why I tell him everything. It’s not like how it was in the beginning; with more time, there is more trust. I share everything, nothing bad happens. (Female, Spanishspeaking group) 106

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In addition to actual length of time in the relationship, participants suggested that the progression from a casual relationship to marriage facilitated discussion about sex. One woman shared,

One participant shared that she had an open relationship with her partner, where she allowed him to have other sexual partners to decrease his temptation to be unfaithful. She considered sex and making love “two different things” so that just having sex with another woman was not significant. Other women in the group did not endorse this idea of an open relationship. Condom Use. Condom use was discussed differently among the female and male participants. Almost all women suggested that they did not use condoms in their relationship. A couple of women explained their rationale:

I think for me at the beginning, I mean, I protected myself with condoms or whatever but I didn’t care who he had been with or how many people he had been with, it was . . . we were just dating and it was just kind of fun but then once you’re living together and you guys are married, well then, now details become more important. (Female, English-speaking group)

Participant #1: I’m a control freak so I would never want to rely on a man to wear a condom, so I’d rather use birth control and mess up my hormones. (Female, Englishspeaking group)

Similarly, other participants shared that there is an appropriate time to talk about sex. For example, during the discussions, a male participant from the Spanish-speaking group remarked that “it takes a long time to talk about all that [sex] . . . . ” When asked what is considered a long time, he responded, “No . . . well . . . first you’re dating, then afterwards you get married; in the event that you do get married, and then maybe then . . . [you can talk about sex].” Initial Sexual Activity. Some participants described the first time having sex with someone as “breaking a barrier,” where sharing of information between the couple flows more easily. This sentiment came about, in part, because for some participants, having sex with someone signified a committed relationship. Along with the sense of a committed relationship came sentiments of more openness in the relationship and consequently more communication. Technology. Both groups of men discussed the usefulness of using text messaging for facilitating communication about sex. Sensitive questions or questions that would cause embarrassment were sent as text messages. For instance, one male gave the example of asking a girlfriend “jokingly” through a text message if she had ever kissed a girl or thought about kissing a girl. Using text messages also helped eased the pressure of having to respond immediately to a comment. As some men said, it is the “cowardly” way of communicating, but it was viewed as easy and helpful.

Participant #2: Yeah, I’m sort of like you, in that we never use condoms really, and I’m more in control, like, I have the birth control. (Female, English-speaking group)

Although women primarily equated condoms to birth control only, men, on the other hand, discussed using condoms for both prevention of pregnancy and STIs. Prevention of pregnancy and STIs was so important for some participants that when they are dating, condom use is obligatory and not discussed at all with their partner. However, some men suggested that there were occasions in which one “forgets” or no condom is available, and unprotected sex occurs. Men also shared how condom use changed over the course of a relationship. Men from the Spanish-speaking group explained that during the dating phase, both sex in general and condom use was not discussed but condom use was obligatory. Once trust has been established, the desire to continue with condom use is discussed. In the case of one participant, condom use was never a discussion because he never wanted to have children and therefore always used a condom. For others, the decision was up to their partners whether to continue with condoms or not.

Contexts for Verbal Sexual Communication Sex and Condom Use

Although participants overall avoided discussions about one’s sexual history, they did talk about sexual satisfaction. According to most participants, maintaining a sexually satisfying relationship involved sharing with one’s partner sexual likes and dislikes. These discussions occurred either before, after, or during sex. For example, one woman shared,

Sex. There was little variation among the groups on what the act of sex entailed. Sex was considered to be penetration described as the “penis in the vagina.” Oral sex was not considered sex but “foreplay.” Sex could be merely for pleasure between two random people, but most participants, men and women alike, described it to be an act of love and something that is shared with someone that one trusts and loves.

. . . but during the act, I ask him if he feels comfortable, if he likes it, or if he wants . . . we talk during the actual moment a lot. I need to know if he’s satisfied . . . or he likes the position that we’re in . . . he also asks me if I feel comfortable or if he’s hurting me, or whatever. So we talk while we’re having sex. (Female, Spanish-speaking group)

. . . to me sex is an act of love, there’s [sic] different things you can do when you love someone, and sex is categorized over here, and then there’s like getting them things, and then there’s like complimenting them . . . and I feel it’s [sex] like . . . an off thing that you do with someone that you love. (Female, English-speaking group)

Another participant recounted how noticing that his partner was not enjoying sex and talking to her about it 107

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­ articipants, initial sexual communication with their p partners focused primarily on sexual satisfaction; issues regarding one’s health and sexual past were avoided or not discussed because of lack of interest. In a few cases, as the relationship progressed and there was a sense of comfort and trust with one’s partner, matters regarding sexual history were sometimes discussed. Data from this study both support and challenge findings from other studies, and there is paucity in the literature about how young adult Latinos share sexual information with their sexual partners. Previous studies have maintained that Latino men and women do not communicate with each other about sex (Marston, 2004; Noland, 2006, 2008), particularly because of stereotypical gender norms. However, participants from this study revealed the rationale behind avoiding discussions about certain aspects of sex. Some participants felt that with time, one could eventually figure out pertinent information about his or her partner. In addition, many participants lacked interest in their partner’s sexual history. Not discussing one’s sexual past because of lack of interest is an important perspective that has often been omitted in the literature. Given that sexual communication is positively associated with sexually protective behavior, learning that some individuals may not have an interest in such discussions creates opportunity for researchers to further explore other aspects of communication that could potentially promote safer sex behavior. Sexual satisfaction communication is one such aspect. Among this sample of young adults, sexual satisfaction was important, and nonverbal sexual communication was often sufficient for conveying what one wanted to his or her partner. They described how body language and actions, such as heavy petting, were sufficient to communicate to a partner when sex was desired and what felt pleasurable during sex. When verbal communication did occur, the communication continued to pertain to sexual satisfaction in the relationship. For some participants, as time progressed in the relationship, sexual communication included discussion about one’s past sexual history, whereas for others, their partner’s sexual history remained irrelevant. These findings suggest that sexual communication in relationships is contextual; discussing one’s sexual history with a partner after a period of being sexually active with him or her may have a different meaning and consequence compared to sharing this information prior to sexual activity or at the beginning of a relationship. Some findings from this study are similar to the previous research on sexual communication among Latinos. Perceived negative reactions from one’s partner, feeling embarrassed, and machismo were barriers to communication also noted in other studies (Noland, 2006, 2008). In this study, avoidance of verbal sexual communication was influenced by feelings of embarrassment and concern about offending one’s partner. Regarding machismo, although considered a common barrier to sexual

helped both of them realize other options to ensure her sexual satisfaction. Aside from sexual satisfaction, some participants did address sexual history with their partners. Some women did ask their partners about the number of past sexual partners. Finding out about the number of past sexual partners helped them to know whether or not their partner was safe (unlikely to have STIs) to be with. One woman shared, I asked how many partners he had, I didn’t want to know names, I didn’t want to know where. I just wanted to know how many. I wanted to know if I was with a man, whore, or with a calm person, that’s what I wanted to know. (Female, English-speaking group)

For women with children, sexual communication included planning with their partners on when to have sex and how best to prepare for it. A woman with children from the Spanish-speaking group talked about how sex was not a spontaneous activity for her. Having sex involved prior discussions with her spouse on when to schedule sex so that she could plan. She gave the example of having to make sure the children were asleep by the scheduled time.

Nonverbal Sexual Communication Sexual communication also included physical actions to communicate sexual desires. A couple of women reported that telling their partners what they liked sexually was often unnecessary because their body language affirmed for their partners what they liked. One woman shared, “I don’t tell him what I like, he just kind of knows.” Similarly, men shared how they tried to use a woman’s body language to recognize what pleased her. Participant #1: . . . it’s like this, there comes a time when you have to find her point; you learn how to know a woman, a man also has to . . . how should I say this? You learn how to find out. . . . (Male, Spanish-speaking group) Participant #2: . . . a woman’s weaknesses. (Male, Spanishspeaking group) Moderator: What things help you find this out? Participant #3: . . . like when you touch a nerve [sensitive area] . . . that’s where you focus your attention. (Male, Spanish-speaking group)

Playful touching and/or heavy petting were methods used to let one’s partner know of interest in sexual activity. According to both men and women, the absence of any objection to these physical sexual advances was considered consent for sexual activity to continue.

Discussion The goal of this research study was to describe the context and content of sexual communication for young adult Latinos in heterosexual relationships. For most 108

Sexual Communication Among Young Adult Heterosexual Latinos

communication, our focus group participants emphasized not experiencing machismo in their relationships. Their comments about machismo stemmed from experiences of seeing others in their surroundings contend with the behavior. The fact that the participants did not personally experience machismo in their relationships offers a different perspective to the common stereotype that machismo is a typical behavior among Latinos with which Latina women often struggle. The suggestion that machismo was not a factor in their relationships may also be a matter of social desirability. The negative connotation associated with machismo may have influenced denial of machista behaviors in one’s relationship. Unique to this study are the comments on factors that facilitate sexual communication within their relationship. For some participants, greater length of time with their partners allowed for more comfortable and open communication about one’s sexual past. Time was not so much a factor for other participants, as was initial sexual activity. These participants shared how once they had sex with their partner that there was nothing left to hide, and communication about one’s past and issues regarding sexual satisfaction were now open for discussion. This phenomenon of verbal sexual communication after sexual activity presents challenges to the realization of sexual health benefits of sexual communication. If, indeed, young adult Latinos are engaging in unprotected sex prior to discussing sexual history with one’s partner, there is a missed opportunity to learn about one’s potential need for protection. Another facilitator of sexual communication was text messaging. Text messaging was also revealed as a way of sharing feelings of anger as well as inquiring about a partner’s sexual past. The extent to which young adult Latinos use text messages for sexual communication should be further evaluated. Findings from such a study could reveal unconventional and useful ways to promote health-related sexual communication among young adults, particularly prior to sexual activity. A subtle contributor to the sexual communication and behavior described in this study is the importance of affective attachment (emotional feelings toward someone). The emotional feelings and attachment some participants had for their partner superseded concerns for past sexual behavior, which diminished the need for discussions about sexual history and potentially heightened the importance of sexual satisfaction. Regarding sexual behavior, the lack of condom use (particularly among women) supports the notion that sex is a part of love. Pulerwitz and Dworkin (2006) also described this relationship between affective attachment and condom use in their study with couples. The critical factor of affective attachment warrants further attention when exploring sexual behavior and its predictors. Several limitations with this study need to be noted. This study presents data from focus group discussions,

which provided a broad overview of sexual communication among young adult Latinos. Individual interviews and interviews with couples may be useful to better illustrate the progression of sexual communication throughout a relationship as well as the variation of sexual communication between couples in different types of relationships. Another limitation of this study is the use of a convenience sample. Although it is never the intention to generalize findings from focus group discussions given the nature of the topic, the data presented most likely represents perspectives of young adult Latinos open enough to share their thoughts about sexual communication with one’s partner. As experts in health promotion and risk reduction, nurses and advanced practice nurses have the unique opportunity to support healthy sexual behavior among the sexually active young adult clientele. Among sexually active adults, evaluation of one’s sexual risk behavior is a recommended part of a provider’s routine annual health assessment. Findings from this study validate the problem of young adult Latinos continuing to engage in sexual risk behavior, primarily unprotected sex among young adult Latina women. In efforts to address this problem, providers should address matters of sexual communication with one’s partner and sexual satisfaction instead of succumbing to the stereotype that Latinos do not communicate about sex. Given the importance of sexual satisfaction in this clientele, providers may want to have a dialogue about preventative measures in the context of sexual satisfaction. Such discussions with a provider may support more positive attitudes toward sexual health communication with their partners and consequently more sexual health communication. In summary, this study highlights the relevance of relationship context to sexual communication among young adult Latinos and their sexual partners. Within the context of a romantic relationship, sexual communication encompasses nonverbal actions, prioritizes sexual satisfaction, and starts with what the couple is comfortable discussing. Given this complexity of sexual communication, future research about sexual communication should consider factors unique to the couple/dyad as opposed to continuing to explore the perspective of individuals. Findings from such a study will inform the development of interventions to support relevant and effective sexual communication between couples.

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