The Roles of Sexual Relationship Power and Sexual Assertiveness for Condom Use in the Association Between Sexual Victimization History and Condom Use Frequency

Abstract

Women who have experienced childhood sexual abuse (CSA) or adolescent/adult sexual assault (ASA) are at a heightened risk of acquiring sexually transmitted infections (STIs) and demonstrate lower rates of condom use than women who have not had these victimization experiences. Two understudied factors that may help explain these associations are sexual relationship power and sexual assertiveness for condom use. In this secondary data analysis study, we evaluated whether CSA and ASA severity were related to less frequent condom use through experiences of lower power in sexual relationships with men and lower sexual assertiveness for condom use. Women (N = 770) who reported STI risk factors and moderate social drinking were recruited from an urban community. Participants presented to a laboratory and completed a questionnaire battery on a computer as part of the larger study. Path analyses revealed that CSA and ASA were indirectly associated with a lower frequency of condom use through lower sexual relationship power and lower sexual assertiveness for condom use. Findings suggest that women's condom use frequency may be increased through interventions that prioritize decreasing power imbalances in sexual relationships and enhancing women's abilities to assertively request condom use, particularly among those with CSA and/or ASA histories. We conclude that trauma-informed interventions that enhance women's assertiveness and agency, address relational power imbalances, and involve male partners, alongside broader public health and policy efforts to promote women's social and economic power, are crucial for advancing shared responsibility for women's sexual health.