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Theo G.M. Sandfort, PhD, Mark Orr, PhD, Jennifer S. Hirsch, PhD and John Santelli, MD, MPH

Theo G. M. Sandfort is with the HIV Center for Clinical and Behavioral Studies, New York State Psychiatric Institute and Columbia University, New York, NY. At the time of the study, Mark Orr was with the HIV Center for Clinical and Behavioral Studies, New York. Jennifer S. Hirsch is with the Department of Sociomedical Sciences, Columbia University, New York. John Santelli is with the Heilbrunn Department of Population and Family Health, Columbia University, New York.

Correspondence: Requests for reprints should be sent to Theo G. M. Sandfort, PhD, HIV Center for Clinical and Behavioral Studies, 1051 Riverside Dr, Unit 15, New York, NY 10032 (e-mail: tgs2001{at}columbia.edu).

Objectives. We explored long-term health consequences of age at sexual initiation and of abstinence until marriage to evaluate empirical support for the claim that postponing sexual initiation has beneficial health effects.

Methods. We analyzed data from the 1996 National Sexual Health Survey, a cross-sectional study of the US adult population. We compared sexual health outcomes among individuals who had initiated sexual activity at an early or late age versus a normative age. We also compared individuals whose first sexual intercourse had occurred before versus after marriage.

Results. Early initiation of sexual intercourse was associated with various sexual risk factors, including increased numbers of sexual partners and recent sexual intercourse under the influence of alcohol, whereas late initiation was associated with fewer risk factors. However, both early and late initiation were associated with sexual problems such as problems with arousal and orgasm, primarily among men. Relationship solidity and sexual relationship satisfaction were not associated with early or late initiation.

Conclusions. Early sexual debut is associated with certain long-term negative sexual health outcomes, including increased sexual risk behaviors and problems in sexual functioning. Late initiation was also associated with sexual problems, especially among men. Further research is needed to understand how sexual initiation patterns affect later health outcomes.