Assessment of Sexual Behavior

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Sexuality is essential to human life, experienced through individual thoughts and desires, behaviors, relationships, and cultures (Robinson et al, 2002; WHO, 2006). A responsible, safe, and fulfilling sexual life experience requires a positive approach to sexuality and an understanding of the social, economic, and political factors (e.g., gender inequality and poverty) that may lead to sexual ill-health (WHO, 2006). Sexual well-being involves positive sexual expression, coupled with the possibility of satisfying and safe sexual experiences. To promote sexual health, public policy experts, health educators, physicians, and clinicians, benefit from extensive knowledge and understanding of sexual behavior including sexual aspects of relationships (e.g., sexual arousal and functioning).

Since the 1980s, research in sexual health has escalated due to the sexual revolution, advent of the HIV pandemic, and the pharmacological treatment of sexual problems. Advances in data collection methods and the assessment of sexual behavior have furthered our understanding of sexual behavior patterns and functioning. Although biological markers (e.g., incidence of sexually transmitted diseases or pregnancy) provide useful information about an individual's

Center for Health and Behavior, Syracuse University, 430 Huntington Hall, Syracuse, NY 13244-2340, USA e-mail: [email protected]

behavior, these markers are incomplete because they convey little information about the frequency, number of sexual partners, and the co-occurrence of sexual behavior with other behaviors (e.g., alcohol or drug use). Because no objective indicators are available and sexual behavior cannot readily (or ethically) be measured through direct observation, researchers often rely on self-reports of sexual behavior. Obtaining detailed and accurate self-reports of sexual behavior are necessary to fully evaluate and further develop prevention programs, assess and treat sexual problems and trauma, and inform public policy and health care (Bogart et al, 2007; Catania et al, 1990; Cecil et al, 2005; Schroder et al, 2003b; Wincze and Carey, 2001).

Measurement of sexual behavior poses unique challenges to health researchers given (a) concerns about privacy, cultural taboos, and stigmatizing behaviors, (b) the nature of the behavior (i.e., dyadic rather than individual), and (c) motives for sexual behavior (Catania et al, 1990; Schroder et al, 2003a). Moreover, assessment of complex sexual behavior likely necessitates multiple types of assessment measures and methodology. In this chapter we address the importance of measuring sexual behaviors, measures and assessment methods, and challenges to sexual behavior measurement. We provide information about clinical interviewing and written assessments. Although we focus primarily on retrospective methods (e.g., questionnaires), we also present contemporaneous assessment methods (e.g., daily diary). We conclude by offering suggestions for improving sexual behavior assessments in future research.

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