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Teenagers and group sex: a cause for concern?

December 21st, 2011

Dr Petra

Last week saw the publication of a paper Multi-person Sex among a Sample of Adolescent Female Urban Health Clinic Patients in the Journal of Urban Health (sadly not open access). This tackled the issue of young people having Multiple Sexual Partners (MSPs) and in particular raised concerns over coercive sexual practices.

Predictably the media reported on this story with scary headlines like:
Teen girls who engage in group sex are often coerced, study says – NY Daily
Group sex is the latest ‘trend’ for teenage girls, disturbing report reveals – Daily Mail (The research excited upset the Mail so much they ran coverage of it twice)
Teens as young as 14 engaging in group sex, study finds – ABC News
‘Sexting’ is related to teen group sex trend, says study – New Jersey News Room (the study doesn’t say this at all, in fact recent research suggests the phenomena of teen ‘sexting’ is over exaggerated).

While we sadly are used to the mainstream media sensationalising sex research (particularly on young people), other sex blogs and medical news outlets covering this study have been equally remiss at reading the original research and critiquing it. Which is depressing.

So let’s do the job the mainstream media should have done. Let’s critically appraise the research and see if we do need to worry about MSPs and young people.

First, a quick disclaimer. Researching young people’s sexual experiences is important. Such work should focus on their needs, report faithfully any adverse issues they may be at risk from, and take their mental and physical wellbeing seriously. Research on teens should always involve young people at all levels and avoid being a top-down process where adults define teenagers’ experiences. In critiquing this research I am not suggesting young people are not experiencing problems within their relationships. I am also not saying the researchers were anything other than well intentioned.

Strengths of the research
The paper’s plus points are that it tackles a topical issue. While group sex among young people is (as this paper acknowledges) pretty unusual, it is something that has gained media interest over the past few years. So trying to collect any data about this phenomenon is important to reassure and also to direct sex education and public health programmes. The researchers seem to have developed the study over time, basing the survey they used on a series of in-depth qualitative interviews. The paper does acknowledge early on that multiple sexual partner experiences may be consensual and non consensual (more on this in a bit).

Sampling and sample size
Participants were recruited from a youth sexual health clinic. This is not unreasonable at all. It’s an excellent place to find out about young people’s sexual health. But it does mean those going there may be in need of help or support so might not be representative of teens generally.

The authors acknowledge this but I suspect that fact will pass a lot of journalists by when they report this. Media focus, I imagine, will be on all teens, rather than a subset of teens.

The paper tells us researchers were aware of 1224 female clients at the youth clinics, with 747 identified suitable for the study. Why the other clients attending the clinic weren’t suitable for the study is not explained. That, I think, is a problem. Information about participants who were unsuitable for the study, or who refused to participate (and why) should have been clarified just to help us interpret this data. I’m surprised reviewers didn’t ask for it to be included in the demographics table as is standard practice. Of the 747 clients identified, 495 (65%) agreed to take part. A 65% response rate on a sensitive topic is not a problem, but it does reduce the number of people responding further, which in turn affects how representative the sample is.

It is not declared whether the participants were Cis or Trans Women. This would have been helpful to disclose.

Table 1 in the paper provides details of 328 participants. I’m unsure if these were the final sample that was used in the study/analysis. Regardless of all this we learn right at the end of the paper only 24 of those who completed the survey had had a Multiple Sexual Partner experience. And of those, their analysis indicates, 35% said the experience was consensual.

Does this represent a major new trend in youth behaviour?

No. The paper reports of the patients attending the youth clinic very few of them had experienced non consensual group sex. It does not mean we should not be very concerned about these young people or others like them. But it does mean journalists covering this story should put this into context. The study is not showing a major trend in teen girls being forced to have group sex. It is saying non consensual group sexual activity among teens does not seem to happen often, but when it does it is highly distressing and increases the risk of psychological and physical ill health.

My worry is the media coverage of this will not read the original paper and will suggest there is an outbreak of teen sex parties happening regularly, that young girls are forced to participate in. The study did not find this and nor has it identified a major public health problem. But I doubt that will be made clear. This in turn will worry parents, mislead teachers and healthcare professionals, and probably lead to slut shaming of young women (as this kind of coverage invariably does). All the while ignoring the role of boys at best, or presenting them as gang rapists at worst. None of which is directly helpful to the needs of young people.

Problems with phrasing and terminology

The paper seems to use terms like ‘sex parties’, ‘multiple sexual partners’ and ‘gang rape’ interchangeably in places. This is confusing for the reader but I imagine also for participants in the study. This is recognised as a limitation later in the paper where the authors talk about participants who’ve experienced gang rape not necessarily seeing what they experienced as a multiple sexual partner act.

The focus of the study appears to be on heterosexual teens, although this is not really clarified.

The age range of 14-20 is important as this is a wide age range in terms of young people. While some 14 year olds may be mature and some 20 year olds immature, in general the needs and experiences of those who are in the younger age group in this study will be very different from older participants. Any of these participants could be exploited, abuse has no age barrier. However, older teens/young adults may well be better able to consensually engage in sexual behaviours younger teens cannot. This was not explored in enough detail in this paper.

The main drawback with the study, to me, is the question used to identify if participants had engaged in Multiple Partner Sex. It asked:
“Have you ever had sex (vaginal, oral, or anal) with more than one person at the same time or with more than one person at the same place? (This might be called group sex, a threesome, an orgy, or pulling a train).”

The paper doesn’t clearly explain how participants were invited to answer this question, although does suggest it was via a yes/no response (or similar). Imagine I said ‘yes’ to this question. What am I saying ‘yes’ to? That I had vaginal, oral or anal sex? The wording of this question means there’s no way of differentiating between participants who had all of these experiences and those who had one of them.

There is also no way of identifying how often participants had engaged in these various activities and whether they experienced them positively or negatively. It could be completely possible for a participant to have experienced oral sex positively but vaginal sex negatively (or vice versa). But the question phrasing does not allow for this to be explored. It also doesn’t allow participants to indicate if they were giving or receiving these sexual activities (or both).

Once you get past this confusion participants are still being asked about these sexual activities AND whether they’ve done them with more than one person. How do you answer if you’ve engaged in said activities but with only one person? The question doesn’t allow for this.

Participants could also easily be confused by a question that doesn’t make clear if the mention of ‘sex’ here refers to penetrative sex (and if so is it via a penis, finger or sex toy) or oral sex. That is important as we know from sex research unless you are very specific about what you’re asking about you’ve no real idea what participants are reporting.

The question is also confusing a group sex act (i.e. having sex with more than one person at a time) with multiple partner sex over a period of time (i.e. sleeping with more than one person in a day, evening etc). In fact this becomes more confusing as these behaviours are asked as if they’re the same thing but with no time period specified. Most of us who’ve had more than one partner could easily answer ‘yes’ to the question, assuming you have been intimate with different partners on different occasions in your home.

Deconstructing this question may seem like nit picking but in fact is very important when we are designing surveys. Unless our questions are meticulously phrased we have no real idea what participants are responding to. This in turn makes a difference to the conclusions and recommendations we can make.

Elsewhere in the paper the researchers conflate group sex and an orgy (which usually involves several people) with a threesome. They also don’t clarify who might be participating in these activities. The assumption seems to be that it’s a girl and all boys. But it could well be all girls or a mix of girls and boys.

Does ‘pornography’ and ‘sexually explicit’ mean the same thing?

Participants were also asked
“Many people come into contact with pornographic, x rated, or other sexually explicit material. How many times in the past 30 days have you viewed pornographic, x rated, or other sexually explicit material?”

This is an interesting but again problematic question. What do the researchers mean by ‘pornographic’ or ‘sexually explicit material’? Are they the same thing? Are they including explicit mainstream media such as music videos or magazine articles talking about sexual positions? That could be considered sexually explicit but not necessarily pornographic. Is this a particularly accessible question to ask a young person? Asking how often they’ve viewed such material also isn’t clear. Do they mean how often someone has watched pornography/sexually explicit material and masturbated? Simply seen it in passing? Or perhaps laughed at it with friends (as is very common among teens)? Was it watched alone or with a partner? What did it feature?

This information IS important because the researchers did find an association with multiple sexual partners and reported porn use, but it isn’t clear what relationship the young women in the study really had with porn. In order to better educate women about issues around porn we need to know more about what they are watching and how they feel about it. It is worth noting if participants said anything other than ‘no times’ they classed this as having viewed porn. So that means someone might have seen porn once in passing and be categorised in the same way as someone who viewed porn regularly and was aroused by it and someone who was forced to watch porn occasionally but against their will.

Another question asked
“Has anyone ever insisted (without using force or threats) that you do sexual things they saw in pornographic or x-rated magazines, websites, or movies when you did not want to?”

This is not an unreasonable question, but it is not necessarily something that’s easy for a teen woman to answer. For example they may well have been coerced to do something they did not want to do, but unless they asked the person coercing them if they had seen this in porn they would not necessarily know for sure this was the case. They may have a good instinct they were being asked to perform something inspired by pornography, but they wouldn’t know for sure – and would not be in any position to ask if they felt threatened.

Given the age of participants it may be someone did coerce them to do something they didn’t like but had not got the idea for this from porn. They may have got the idea from a sex tips feature in mainstream magazines like Cosmopolitan or Men’s Health, or from their peers, or from a TV show. Much of the mainstream media talks about anal sex, threesomes, oral sex etc so this could have just as easily informed the coercive behaviour.

I would have liked to see more focus on the nature of the coercive behaviour, why participants felt this was linked to porn, and if it wasn’t linked to porn where they felt the driving force behind the coercion came from. I say this not to dispute porn may play a part, but to identify exactly what is driving coercive behaviour as if it’s features in mainstream magazines or peer pressure we need to tackle this just as urgently as any perceived threat from porn.

The focus here seems to present young women’s relationship with porn as something that is done to them by young men. Young men are presented as the consumers of porn and use it to get ideas to coerce young women into doing things they don’t want. This does not explore where young women may like or dislike porn, or young men having a critical view of porn. It does not include young people who have little or no exposure to porn. It presents young women as passive, as victims. And as heterosexual. This is often taken up by the media who use debates on sexualisation or pornification to demonise or ignore young men and victimise and slut shame young women. In both cases we find it becomes a situation where adults (either academics, medics or journalists) speak for young people.

Multiple Sexual Partners – a problem in itself?
In their reporting of the results the authors say:
“While there may be a subset of girls who initiate or make self-actualized decisions about MPS participation during adolescence, it is important to consider whether social norms that encourage hypersexuality may contribute to expectations about sexual activity that make it very challenging for adolescents to resist engaging in MPS, even though they would not perceive their MPS participation as nonconsensual. The strong association between exposure to pornography, having been forced to do things that their sex partner saw in pornography, and MPS suggests that pornography may have influenced directly the sexual experiences of the girls in this sample, as has been found elsewhere. Importantly, even if participation in MPS is voluntary for some adolescents, it is crucial to know how this early experience shapes their sexual behavior trajectory and affects their lifetime risk for negative sexual, reproductive, and other health risk behaviors”.

This statement concerned me for three reasons. Firstly it suggests a kind of false consciousness idea that no young woman could ever really consent to a MSP experience. This is disingenuous to the participants in this study who stated they had willingly enjoyed a MSP. I suspect it betrays more of the researchers own values about MSPs.

Secondly it implies that even if a young woman does consent to a MSP this will be because pornography has informed her choice. Yet we know from the way they asked about porn they don’t really have strong enough data to make this conclusion. It would have been interesting to explore if mainstream media might have influenced their choice as well, but not to have decided for participants that they didn’t really know their own minds.

Thirdly there is the implication that having a MSP as a young person will inevitably lead to problems in future relationships. That seems like a leap beyond the data and also I suspect unfair to those who consensually, as adults, explore non monogamous relationships. Moreover we know many people who never have MSPs as young people (or adults) have problems in their relationships as adults. So to make this claim really requires more than a small sample of 24 participants who were asked some confusing questions. The researchers do say this ought to be followed up in future research and I don’t disagree there, but I hope they would be less judgemental and aware of sexual diversity in doing so.

Where are the experiences of young men?
There is no focus on young men in this paper and I think any study that is tackling coercion in heterosexual youth (as this paper appears to be doing) really needs to also study young men. The assumption is they are coercing young women, but are young men also feeling coerced in relationships? Is the pressure of masculinity leading to risky sexual behaviours or are they acting respectfully with their partners? Are the experiences of young gay or bi men different from their heterosexual peers? How do young men feel about being portrayed as sexually coercive? Are there issues around communication and consent we need to focus on with young men and women – and how should we be addressing this issue?

I worry media coverage will report this as though young men have been included or present young men as predators, when again the number of participants reporting negative experiences from forced group sex or pornography was low.

Should this paper have been published?
I critically appraised this paper, but does not mean I think it should be ignored. Had I been asked to review it for publication I would have asked for major revisions (based on the comments above). I find many Public Health studies on youth sexual behaviour (and sexual behaviour in adults) are well intentioned but often problematic due to heteronormative approaches. In this case this can be seen with the focus on heterosexual activity and underlying subtext that group sexual activity is never truly consensual and non monogamous relationships are not presented positively. This can alienate or pathologize many people inadvertently, while trying to help another group of people. A better awareness of thinking around diverse sexualities would help ensure generalisations about group sex among consenting adults are not pathologised while trying to tackle gang rape of teens.

I hope coverage of this will be responsible but fear it will not. I suspect it will be further used to demonise young people and worry the public. In turn ignoring the fact most young people are not engaging in group sex or coercive behaviour. In fact that most aren’t having sex at all. They may well have questions and worries about sex, but these may not be addressed while we focus on more sensational topics.

Creating a moral panic in which we shout a lot about the behaviour of young people but do very little to actually help them. And in cases where research is poor or ambiguous it may direct our efforts to help young people in the wrong direction.

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