1. Introduction
Sexuality is a fundamental aspect of everyone’s identity and life. Since the early stages of psychological science, authors like Sigmund Freud (1856–1939), Alfred Kinsey (1894–1959), William Master (1915–2001) and Johnson (1925–2013) have investigated human sexuality. What has been less investigated are diverse sexual behaviors and “rough sex” [
1]. In particular, concerning the Italian context, there are few data about different sexual behaviors, including the frequency of participants’ involvement in threesomes and group sex, as well as the frequency of rough sexual behaviors.
As Herbenick and colleagues [
1] highlight, “rough sex” is a term that has not been properly defined, which has implications in research and clinical practice. For this reason, the authors studied what people consider “rough sex” by conducting a survey on a sample of 4998 students [
1]. They found that rough sex appears to be a multidimensional construct that can be explained by two clusters. The first cluster includes behaviors that were found in prior research: “hair pulling, being pinned down, hard thrusting, spanking, throwing someone onto a bed, and tearing clothes off” [
1]. The second cluster includes behaviors that are considered more violent, such as choking, being pinned down, slapping, punching, making someone have sex and other behaviors that “appear to be increasingly part of sexual assault allegations” [
1]. In this way, rough sex may be defined as a set of several sexual behaviors that could have an impact on the psychophysical health of the person practicing these behaviors. For example, choking or sexual asphyxiation, is performed by restricting oxygen to the brain to improve sexual pleasure [
2]. Although this behavior may lead to greater sexual pleasure, the risk of death by asphyxiation remains. However, partnered sexual asphyxiation is considered less risky because asphyxiation tends to be induced by the hands and not by ropes, and the presence of a partner mitigates potential risks [
2]. The prevalence of this behavior cannot be estimated precisely, since all rough sexual behaviors have not been investigated on a large scale. However, in the study by Herbenick et al. [
2], 26.5% of women, 6.6% of men and 22.3% of transgender and non-binary (TGNB) participants reported having been choked. On the other hand, 5.7% of women, 24.8% of men and 25.9% of TGNB participants reported that they choked their partners [
2]. These findings indicate a gender-associated distinction: females experience asphyxiation, while males engage in choking behavior towards their partners. Moreover, in another study, Herbenick et al. [
3] found that most of the women participants did not ask to be choked and that they were often initially choked by their partner without prior content or communication. Thus, through this example, one could argue that rough sexual behaviors border on sexual aggression. However, as elucidated by Burch and Salmon [
4], rough sexual activity diverges from sexual aggression by necessitating participants’ explicit acknowledgment of consent and mutual involvement in the associated behaviors.
While some might contend that rough sex and BDSM are interchangeable, Vogels and O’Sullivan [
5] point out that while rough sex can include element of BDSM (like choking), it cannot be considered the exact opposite. In other words, while there may be an overlap, these two terms are not entirely interchangeable. Indeed, sexual activity is not always involved during BDSM sessions [
6], while rough sex implicates sexual activity [
5]. Moreover, as McKee [
7] suggests that even when rough sex does not consider BDSM rules (e.g., safe–sane–consensual, SSC; risk-aware consensual kink, RACK; personal responsibility-informed-consensual kink, PRICK) and does not incorporate the explicit consent of the partner, it can still be consensual, for example, though the use of non-verbal communication.
Also, whereas there is emerging literature regarding rough sex, too many issues remain. For example, Vogels and O’Sullivan [
5] highlighted that the meaning of consent and the interpretation of what constitutes rough sex may change between people. These differences may represent a difficulty in properly measuring these behaviors. Moreover, Burch and Salmon [
4] explain that there is a lack of tools for measuring consensual aggressive sexual behaviors, and the questions used to measure these behaviors may be affected by social desirability. However, what is important to consider is defining and studying these behaviors as objectively as possible without pathologizing them.
Thus, given the aforementioned potential risks of rough sexual behaviors, this research aims to replicate the study of Herbenick et al. [
8] in the Italian context in order to measure and assess (1) participants’ solo and partnered sexual behaviors, and how frequently participants are involved in threesomes and group sex; (2) the frequency of enacting rough sex behaviors such as slapping, spanking and choking; (3) the frequency of receiving rough sexual behaviors; (4) the characteristics of choking during rough sex; and (5) whether consent is present or not during rough sex.
3. Results
3.1. Participant Characteristics
A total of 4618 people participated in this study (mean age = 26.9, S.D. = 6.92, age range: 18–59). Of them, 50.10% (n = 2314) identified themselves as women, 49.03% (n = 2264) as men and 0.87% (n = 40) as transgender, non-binary, gender-fluid or other non-conforming gender identities (TGNB). This prevalence of TGNB individuals is consistent with a previous study where the prevalence rate of TGNB individuals was between 0.55% and 0.75% [
11]. However, given the small percentage of TGNB persons, caution is needed in the interpretation and generalization of the results. Regarding sexual orientation, 83.2% (n = 3845) of the sample identified as heterosexual. Additional demographic characteristics are visible in
Table 1.
3.2. Aim 1: Sexual Behaviors Reported over Time
As visible in
Table 2, the most frequently enacted sexual behaviors were masturbation only (98.4% overall), partner masturbation (97.8%) and performed oral sex (96.4%), while the least enacted behaviors were performed anal sex (73.9%) and received penile–anal sex (62.1%).
Looking at the results by gender, females were more involved in partner masturbation (98.3%) and received oral sex (97.5%), and males in solo masturbation (100%) and partner masturbation (96.8%), while in the TGNB population, the most frequent behaviors were solo masturbation (100%), followed by partner masturbation, received masturbation and performed oral sex (95%).
3.3. Aim 2: Frequency of Performed Rough Sex Practices
The frequencies of enacting rough sexual behaviors are reported in
Table 3. Overall, the most frequently enacted rough sexual behaviors were light spanking (76.1%), choking (60%) and hard spanking (55.5%).
The chi-square analyses showed a statistically significant difference with a strong effect size in the behaviors of ejaculation on a partner’s face (X2(6) = 2102.403, p < 0.001, Cramer’s V = 0.477) and aggressive fellatio (X2(6) = 2139.01, p < 0.001, Cramer’s V = 0.48) among the subgroups.
3.4. Aim 3: Frequency of Experiencing Rough Sex Behaviors
As visible in
Table 4, the most frequently experienced rough sexual behaviors were light spanking (73.2% overall) and ejaculation on a partner’s face (53.2%).
The chi-square analyses showed a statistically significant difference with a strong effect size in the behaviors of experienced light spanking (X2(6) = 1633.1, p < 0.001, Cramer’s V = 0.42), experienced facial ejaculation (X2(6) = 3074.60, p < 0.001, Cramer’s V = 0.58) and experienced aggressive fellatio (X2(6) = 1692.55, p < 0.001, Cramer’s V = 0.43).
3.5. Aim 4: Characteristics of Choking during Rough Sex
According to the results presented in
Table 5, the mean age of those who reported having been choked (n = 2734) during sexual intercourse is 21.7 years old (SD = 4.79; range 13–50). Among these participants, 59.03% were women, 39.80% were men and 1.17% were TGNB. However, 14.7% of the participants reported being choked before the age of 18.
A portion of the sample (54.9% overall) never asked someone to choke them, and never received a request to choke the partner (90.3%). Among those participants who asked to be choked, the main reasons were that the practice seemed exciting (25.7% of women, 11.3% of men, 37.5% of the TGNB population) and that the practice would arouse the partner (6.9% of women, 5.3% of men, 7.5% of TGNB population). In conclusion, of the participants who reported being choked during sexual intercourse, 0.4% (n = 11) of them fainted. Specifically, n = 10 of women, n = 0 of men and n = 1 of the TGNB population.
3.6. Aim 5: Presence of Consent during Choking and Slapping
Choking and Consent. As visible in
Table 6, n = 1024 (22.2%) participants reported that they were never asked for consent to be choked. By analyzing these data for gender, 23.3% of women, 21.2% of men and 10% of the TGNB population were never asked for consent. However, 21.0% of women and 55.0% of the TGNB population were always asked to be choked before their partner choked them.
Slapping and Consent. Similarly to choking, 22.6% of participants reported that they were never asked for consent to be slapped. Again, by analyzing these data for gender, 21.3% of women, 23.9% of men and 25% of the TGNB population were never asked for consent. However, 14.9% of women and 27.5% of the TGNB population were always asked to be slapped before their partner choked them.
4. Discussion
This study represents one of the first investigations in Italy into rough sexual behaviors. It is important to note that the nature of this study, as well as the work by Herbenick et al. [
8], is purely descriptive. The interpretation of the results identified three discussion points: (1) a description of the sexual behaviors enacted by the sample population, (2) gender differences in rough sexual behaviors and (3) the role of consent in choking or slapping.
First, this study involved 4618 participants with a mean age of 26.9 years (SD = 6.92) and an age range of 18 to 59. The gender distribution was 50.10% women, 49.03% men and 0.87% TGNB. In terms of sexual orientation, 83.2% identified as heterosexual. Regarding sexual behaviors, solo masturbation was the most common (88.8–98.5%) sexual behavior in the last month. Additionally, most participants reported masturbating their partner (75.0–82.5%) and received (70.0–72.1%) and performed oral sex (70.0–78.3%) in the previous month. Penile–vaginal intercourse was reported by 82.2% of women, 69.3% of men and 70.0% of TGNB participants in the last month. Regarding penile–anal sex, most of the sample (62.1%) never received it, but 54.6% of women and 52.5% of TGNB individuals reported receiving it. In contrast, 79.5% of men never received penile–anal sex, with the remaining 20.5% reporting receiving it, predominantly men who have sex with men (88.96%). It is interesting to note that the remaining 11.04% of heterosexual men received anal sex. Few studies underscore how perceptions regarding received anal sex performed by heterosexual men are gradually shifting in the Western world, also illuminating alterations in notions of masculinity. For instance, in the sample of the qualitative study conducted by Wignall and colleagues [
12], the 30 heterosexual undergraduate men interviewed challenged cultural narratives that equate anal receptivity with being gay. Furthermore, this research also suggests that young, heterosexual men are increasingly willing to engage in anal stimulation, either by being anally penetrated by a sex toy under the control of a woman or through personal exploration [
12].
Second, the statistical analyses demonstrated, with moderate effect sizes, significant differences in rough sexual behaviors (spanking, aggressive fellatio, choking, names calling, e.g., slut, whore or bitch) across gender groups, suggesting that gender influences the likelihood of engaging in these behaviors. For instance, while approximately 45.1% of women reported having asked a sexual partner to engage in choking, only 16.4% of men and 32.5% of the TGNB population reported being asked to enact the behavior. Similarly, significant differences are noticeable between reported behaviors such as choking and spanking. These findings are in line with previous studies [
3,
13], where men often demonstrate rough behaviors, whereas women are more prone to encountering such behaviors. While there is no full consensus in the literature, as highlighted by Herbenick [
8], the existing reflection—particularly among women and men—on the heteronormativity of violence and the manifestations of masculinity (as indicated, for example, by Ward [
14]) is noteworthy. This can also be seen in the context of how women are socialized into assuming submissive sexual roles (see McCreary and Rhodes [
15]). Possible explanations could include men not recognizing or acknowledging when their partners express certain desires, the potential underreporting of passive sexual behaviors by men or the potential overreporting of assertive sexual behaviors by women. Exploring these nuances in future studies could provide valuable insights into the complexities of sexual dynamics and communication within intimate relationships. Moreover, although these results show that the TGNB population has high levels of rough sexual behaviors, it is important to carefully interpret the data in relation to the low representation of this specific population (n = 40; 0.87% of the sample). However, the literature recently began to highlight how there is an intersection between LGBTQIA+ and kinky identities [
16], which could explain the apparent prevalence of choking in this specific population, as found by Herbenick and colleagues [
8]. Moreover, due to its physical implications (e.g., fainting) and the limited research on it [
3], the behavior of choking has been investigated in detail. As for the other rough sexual behaviors, the first point to emphasize is a gender difference, where women experienced this behavior more, while men and the TGNB population enacted it. The mean age at first experience of being choked during sex was 21.7 years old (SD = 4.79; range 13–50), while 14.7% of the participants reported being choked before the age of 18. With respect to the role of consent in choking, in our study, the largest portion of the sample never asked their partner to choke them. For the remaining portion of subjects, the main reasons why participants asked to be choked were that the practice seemed exciting and that the practice would arouse the partner. In contrast, of those who practiced choking, 13.2% of participants were asked to choke during intercourse, especially with the idea that this practice would arouse the sexual partner or that it seemed exciting. In addition, although it is a small percentage of participants, it is important to note that 0.4% of participants who had engaged in choking fainted during the practice. These results partially differ from the findings of Herbenick et al. [
8] in that the age of first experience of being choked was 18.4 years, and 58.7% of men and 54.8% of the TGNB population had choked someone during sexual intercourse, while 64.4% of women had been choked during a sexual interaction.
Finally, this study examined the prevalence of non-consensual acts such as anal sex, choking and slapping without consent. The findings indicated that a small percentage of women and TGNB individuals reported that they had experienced anal sex without consent at least one time. Moreover, 22.2% of participants reported that they were never asked for consent to be choked and 22.6% of participants reported they were never asked for consent to be slapped. These results, partially in line with those of Herbenick et al. [
8], highlight the importance of continuing to study the role of consent during sexual intercourse. However, if one considers kinky sexuality and, in particular, BDSM, consent to behaviors such as choking and slapping is not always explicitly expressed. This is because although consent appears to be central to BDSM [
17], several levels are present: superficial, of the scene and deep [
18]. In this sense, consent represents an ongoing interactive and dynamic process [
19], and the extent and complexity of negotiation varies with level of intimacy [
20] and depending on the context, and is influenced by mood [
21]. Thus, although these results indicate that a portion of the sample experienced sexual behavior without their explicit consent, the hypothesis is that the presence of this phenomenon is because consent was implicit within the sexual dynamic.
Since this study is a replication of Herbenick and colleagues’ work [
8], a comparison between the two studies could be interesting. While the sample size is roughly similar, the demographic variability (e.g., age) of our sample was larger due to the fact that the study was extended to the general population and not just undergraduate students.
Regarding sexual behaviors, solo masturbation was the most enacted behavior in both samples, while differences are present with respect to the other behaviors. In general, the main difference can be seen in the percentages of people who enacted the various behaviors at least once. In fact, our study shows that the Italian sample tends to enact the various behaviors (except for performed anal sex) more than the sample of Herbenick and colleagues’ study [
8]. For example, partner masturbation was overall enacted by 97.6 percent of the Italian sample and 71.1 percent by the sample of the previous study [
8].
Furthermore, although a comparison between the two samples was not conducted through statistical analysis, greater gender differences regarding rough sexual behaviors exist in the Italian sample. This could be attributed to the fact that gender-based biases and stereotypes are still deeply ingrained in the Italian population, along with a strong male hegemony [
22]. However, further investigations are necessary to avoid speculation or the pathologization of sexuality.
Given its relevance, future studies should focus on the role of consent within the dynamics of sexual relations to understand the degree of consent, awareness and knowledge of this construct. Future studies, therefore, should better understand how consent is also mediated by non-verbal behaviors and couple dynamics.
Moreover, more research is needed to fully understand the relationship between consent and watching pornography, especially for young people who begin to view sexually explicit content at age 14 [
23], when sexual exploration begins to take place. In addition, as argued by Herbenick et al. [
8], future studies should investigate the presence of sexual behaviors such as choking in adolescence. Moreover, future studies should investigate how consent is handled by adolescents, who tend to have lower levels of sexual assertiveness [
24]. Sexual assertiveness refers to the ability to communicate one’s thoughts, desires and boundaries in sexual relationships and is a central aspect in maintaining good sexual health and preventing unwanted sexual contact [
24], and is associated with lower levels of sexual dysfunction and coercion in relationships [
25]. Furthermore, with reference to the Italian context, it is necessary to implement and institutionalize paths of education on affectivity and sexuality with the aim of educating new generations on greater adherence to consent in sexual relations. As is the case in other European contexts (e.g., Norway, Denmark and Portugal), it would be appropriate to develop affectivity and sexuality education programs based on scientific evidence and the
Standards for Sex Education in Europe [
26].
In conclusion, this study has several strengths that contribute to its importance in this field of research. First, it addresses a topic that has been little investigated in Italy, thus helping to fill a significant gap in the existing literature. In addition, the sample used for the research is large and varied, which increases the generalizability of the results. Finally, the methodological approach adopted for this study is rigorous and well structured, which increases the reliability of the results. Despite its strengths, this study also has some limitations. The sample has low representation of TGNB individuals, which means that the results may not be reliable for this population. Finally, this study is based on self-reported data, which can be subject to biases such as the social desirability effect.