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Doing it for his sake

"Does love have responsibility and duty, and will it use those words? When you do something out of duty is there any love in it? In duty there is no love. The structure of duty in which the human being is caught is destroying him. So long as you are compelled to do something because it is your duty you don't love what you are doing. When there is love there is no duty. "

J. Khrisnamurti: Reflections on Love 1964

An academic paper

COPYRIGHT: University of Melbourne - Australia - Faculty of Medicine - Paper submitted by the webmaster for an exam in a Postgraduate Course in Women's Health - 2005/2006

SEXUAL COMPLIANCE: the ongoing experience of initiating or consenting to a sexual activity which is unwanted, within a consensual union.

Few research studies on sexual coercion specifically asked women how wanted a sexual experience with their partner was, however, whenever a direct question was asked or the wantedness scale used, extremely high rates of unwanted consensual sex were found in all settings ( sexual initiation, marriage, dating situations) and in both developed and developing countries.

Basile (1999) started shedding light on ‘sexual acquiescence’ as a lesser observed aspect of marital rape by interviewing 41 married American women who had all reported unwanted consensual sex. Of a national sample of 2,017 US women aged 15-24 who reported consensual premarital intercourse (Abma 1998), 25% of all respondents chose a very low degree on the wantedness scale (1-4 on a scale of 10).

If only the women choosing 10 out of 10 were counted as having a fully wanted first sexual experience, then the rate of complacency would be 76%, a percentage more in line with further studies. According to Muehlenland and Cook (in Impett and Peplau 2003) 61% of the women surveyed declared having had unwanted consensual activity with their partners out of feelings of obligation.

Impett and Peplau’s own study on sexual complacency (Impett and Peplau 2002) found that 65% of the American college women interviewed had complied sexually to unwanted intercourse.

Definitions restricted to intercourse will always produce lower rates than more inclusive one (Hamby and Koss 2003), in fact, in a recent US study where any unwanted sexual act was included and women were also asked about being unwilling initiators (Renea 2004), rates of sexual compliance skyrocketed to 91.9%.

The WHO multi-country study on domestic violence also explored the degree to which first intercourse was fully voluntary in developing countries such as Peru and Tanzania, and although data on sexual compliance has not yet been made public, the study reported that nearly 2 to 3 times as many women described their first sex as unwanted in comparison to non-voluntary or forced (WHO 2005).

A gendered issue

When disaggregating data and using a gender perspective on rates of sexual compliance, it clearly emerges how more women than men report engaging in unwanted sex. In Impett and Peplau (2002), 40% of men against 65% of women had consented to unwanted intercourse and similarly in Reneau’s study of 176 undergraduate students in the US, about 52% of men reported complying, compared to 91% of women (Reneau 2004).

Interestingly, a substantial number of males report unwanted sex and their compliance may be even easier to ignore as an issue in society due to their accepted roles as sexual predators, in fact, gender differences particularly emerged in the reasons given for complying, with much smaller numbers of men reporting complying out of ‘relationship duty’ and more reporting ‘peer pressure’ (Shotland and Hunter 1995; Impett and Peplau 2003; Reneau 2004).

Although compliance will be here analyzed as a woman’s issue, it may also be seen as a couple’s issue: a societal pressure on both parties to comply with their sexual roles.

Health effects of sexual compliance

Although the presence of consent in some relationships may overshadow concerns about the possible unsafety of unwanted sexual acts, it is clear that just as consensual sex is by no means synonymous with safe sex, unwanted consensual sex may not be any safer. Each sexual act women comply to has the potential of causing them an unplanned, unwanted pregnancy and/or an STI, including HIV/AIDS.

Although it may be impossible to directly infer the link between sexual compliance and such health effects, some clear correlates have been found:
in their literature review on the topic, Impett and Peplau (2003) report that a considerable number of women had reported forms of emotional and physical discomfort as well as relationship tension associated with the unwanted sexual activity, besides sexual compliance was also found to be associated with risky sexual practices, less effective birth control use and more unplanned pregnancies, especially when women were complying for ‘avoidance reasons’ such as fear of losing a partner.

Although a minority, in a study on verbal sexual coercion leading to unwanted sexual acts (Livingston et al. 2004) some women reported physical discomfort, soreness or contracted an STI as a result of the unwanted sex.

Although the term ‘physical discomfort’ in those studies was not specified, a possible link between sexual compliance and gyneacological conditions such as painful intercourse, vaginismus, chronic pelvic pain, UTI’s and other sexual ‘dysfunctions’ such as lack of libido, cannot be excluded and more research is needed, especially on sexual compliance among young women.

Young women: the risk group for sexual compliance

Girls globally report higher rates of sexual coercion and sexual abuse within consensual unions, especially within early and arranged marriages (Haberland and Chong 2005; Population Council 2004; WHO 2005; Blum 2004).

The association between early coerced sex and compromised sexual reproductive health is by now well established:
girls who experienced sexual coercion are far more likely to have a higher frequency of subsequent sexual activity and a greater number of partners (Abma 1998) and to experience subsequent higher incidences of non-consensual sex, consensual risk-taking behaviour and unintended pregnancy and STI’s (WHO 2005; Blum 2004).

What is also clear is that once a sexual act has been experienced under coercion the first time, many young girls feel obligated to keep consenting, whether they want the sexual experience to happen again or not (Livingston 2004; Wood 1998).

Young women with much older partners in particular were twice as likely to rate their first sexual experience as low on the wantedness scale, with a direct link between low wantedness of first intercourse and lower contraceptive use (Abma et al. 1998).

Especially in countries such as Pakistan, India, Nepal and Bangladesh which report some of the lowest rates of usage of modern contraceptive methods among young married adolescents (Haberland and Chong 2003), or areas such as Latin America with extremely high rates of unprotected marital sex (UNFPA 2005), the experience of sexual compliance will have serious physical consequences.

Young women in developing countries in fact bear the greatest burden of reproductive and sexual health problems. HIV and AIDS is the first cause of morbidity and the second leading cause of mortality for young women in developing countries, especially for those in sub-Saharan Africa (Blum 2004) Unsafe sex was estimated to be the second leading risk factor for HIV/AIDS globally in 2002 and the first one in Africa and it has been assigned the second highest rate of years of life lost to disability and premature mortality (10.2% Daly) for women in developing countries (WHO 2002).

Unwanted consensual sex is therefore a risk factor in increasing the global burden of disease of young women. As Hanson pointed out, one of the most serious bias of the GBD is that data for some gender-related factors contributing to ill-health for women is not existent due to conceptual issues (Hanson 1999).

The failure to clearly conceptualize sexual compliance as a serious form of coercion can be seen as one of these limitations of measuring disability for women and a reason why programs may fail to reduce girls’ exposure to this widespread risk factor.

Societal Sexual Coercion

The presence of consent in a relationship may make the experience of unwanted consensual sex look socially acceptable and even normalized.

In fact, a significant percentage of women in studies carried out in both developed and developing countries report thinking that consenting to sex was their ‘marital/relationship duty’ (Basile 1999;Wood 1998).

The WHO multi-country study found that from as few as 25% of women in Tanzania and Samoa to less than 50% in Peru agreed that a woman has a right to refuse sex if she does not want it (Who 2005 Table 4.8).

Although there is no statistical cluster of reasons for age or country, one emerging difference appears: young girl in developing countries seem sexually coerced by the construction of women as sexually passive and therefore submissive. Young girls in developed countries on the contrary, seem to be engaging in unwanted sexual acts under peer and social pressure to be sexually predatory (Souter F. 2006).

Such invisible but widespread social coercion may seem less violent than a marital rape, however, if up to 91% of women in developed countries admit consenting to sexual acts they do not want to have, such coercion is in fact just as violent and powerful and an integral yet hidden part of our society.

The problem with conceptualizing social sexual coercion is similar to that of acknowledging psychological coercion in sexual victimization: it is hard to measure. As Livingston’s study shows, verbal sexual coercion include subtle actions such as constant nagging, false promises or veiled threats to abandon (Livingston et at. 2004), all actions which may be hard to quantify but not less coercive for women and which can lead to sexual compliance.

Although only a woman can define what is acceptable sexual behaviour for herself, it seems nonetheless necessary to challenge myths such as men’s having an uncontrollable sex drive that must be released through sex (vs. self-pleasuring), women having a social, marital duty to satisfy it and men being entitled to it in a relationship.

Reasons for complying

When explaining their reasons for complying sexually, similar themes emerged throughout the literature in both developed and developing countries and a sense of obligation and duty was overwhelmingly reported as the main reason.

In Basile (1999), all 41 women shared the idea that sex was a wife’s responsibility. In the study by Muehlenland and Cook (in Impett 2003), 61% of the women surveyed declared complying out of feelings of obligation. Similarly, in Reneau (2004) the main reason quoted was ‘feelings of relationship duty/maintenance’.

Sexual precedence was found to be another common reason for complying: once a couple starts engaging in sex, subsequent sex then seems expected and therefore easily becomes an obligation (Shotland R. and Goodstein L. 1992).

In Livingston et al. (2004) sexual precedence was positively correlated to women being subject to more verbal sexual coercion (threats, nagging, physical persuasion) compared with women without sexual precedence.

In Shotland and Hunter 1995 (in Impett 2003), 40% of respondents had complied since they had already had sex with that partner. Fear of being betrayed, divorced or abandoned was another major motivators in most studies (Reneau 2004; Livingston et al. 2004; Impett 2003; Basile 2002).

Other reasons showed that sex was seen as a trade resource in some relationships, where women complied to have the favour reciprocated or in exchange for money spent on them.

These reasons make certain relationships look worringly similar to prostitution and in fact, the phenomenon of ‘sugar daddies’ clearly examplifies women’s feeling that when money or gifts are offered, they cannot refuse sex .

At the two extremes of this continuum of compliance, there are actions which could be categorized as ‘token rejections’ (saying no when meaning yes) and coping/defence mechanisms: the former may exist to fulfil traditional sexual scripts, while the latter is used to avoid violence or rape.

So far, researchers have coded reasons for sexual compliance in binary categories such as ‘positive and negative’ (Reneau 2004), ‘approaching and avoiding’ (Impett and Peplau 2003), ‘intrinsic and extrinsic’ (Livingston et al. 2004).

These arbitrary choices seem extremely biased by ingrained societal norms. For example, “avoiding relationship conflicts” or “satisfying the partners’ sexual needs” have been labelled by Reneau as positive types of sexual compliance due to their leading to positive outcomes.

The idea that choosing to satisfy a partner’s sexual needs when a woman does not want to is coded as ‘positive’ shows how even in developed societies, and by educated people, a woman is still seen responsible for the satisfaction of men’s sexual needs and judged positively for attending to them.


Over 100 million girls will be married before 18 in the next years globally (Haberland and Chong 2005).
It was beyond the scope of this paper to consider the dramatic issue and health consequences of marital rape and forced sexual initiation, however, it seems clear that when considering how to best prevent those issues, together with the spread of AIDS and unwanted pregnancies, programs should be more aware of the prevalence of sexual compliance.

Besides, the societal sexual coercion which subtly creates men’s feelings of entitlement to sex and young women’s sense of sexual duty in consensual intimate relationships, should be acknowledged and challenged.

Medically, sexual compliance should be considered a risk factor for unsafe sex, especially for young women in poor areas, and more research is needed to establish the health effects which ongoing compliance can lead to.

Scholars such as Yllo still asks the question: “What entitlement to sex does marriage confer?” and say that they do not yet have the answers (Yllo 1999, p. 1062).

Although the question may look for legal or scientific replies, it seems clear that in the light of such widespread unwanted compliant sex that so many women worldwide feel obliged to provide, the only human answer should be: NONE.


Abma J, Driscoll A, Moore K Young (1998) Women’s Degree of Control over First Intercourse: An Exploratory Analysis. Family Planning Perspectives 30 (1): 12-18

Basile C. K. (1999) Rape by Acquiescence: the ways in which women “give in” to unwanted sex with their husbands. Violence against Women 5 (9): 1036-1058

Basile K. (2002) Prevalence of wire rape and other intimate partner sexual coercion in a nationally representative sample of women. Violence and Victims 17 (5): 511-525)

Blum R. and Nelson-Mmari K. (2004) The health of young people in a global context. Journal of Adolescent Health 35 (5): pp. 402-418

Finkelhor, D. & Yllo, K. (1985). License to Rape: Sexual abuse of wives. New York: Holt, Rinehart, and Winston.

Haberland N, Chong E. (2005) Child marriage: a cause for global action. The Population Council Brief no. 14. Retreived March 2006 from www.popcouncil.org/pdfs/TABriefs/GFD_Brief-14_GLOBALACTION.pdf

Haberland N, Chong E. (2003) Married Adolescents: an overview. Paper prepared for the WHO/UNFPA/Population Council Technical Consultation on Married Adolescents. Geneva. Retreived March 2006 from www.popcouncil.org/pdfs/MA- Overview.pdf#

Heise L, Moore K, Toubia N. (1985) Sexual Coercion and Reproductive Health. A focus on research. (Population Council). Retreived April 2006 from www.popcouncil.org/pdfs/scoer.pdf#

Hamby S., Koss M. (2003). Shades of gray: a qualitative study of terms used in the measurement of sexual victimization. Psychology of Women Quarterly (27): pp. 243-255.

Hanson K. (1999) Measuring up: gender, burden of disease and priority setting techniques in the health sector. Harvard Centre for Population and Development Studies. Retrieved February 2006 from www.hsph.harvard.edu/Organizations/healthnet/HUpapers/gender/hanson.html

Livingston J, Buddie A., Testa M. et al. (2004). The role of sexual precedence in verbal sexual coercion. Psychology of Women Quarterly (28): pp. 287-297.

Impett E. and Peplau L. (2003) Sexual Compliance: Gender, Motivational and Relationship Perspective. The Journal of Sex Research 40 (1): 87-100

Impett E. and Peplau L. (2002) Why some women consent to unwanted sex with a dating partner. Insights from attachment theory. Psychology of Women Quarterly (26): pp. 360-370.

Plitcha S. (2004) Intimate Partner Violence and Physical Health Consequences. Policy and practice implications. Journal of Interpersonal Violence 19 (11): pp. 1296-1323

Population Council (2004) Forced Sexual Relations among married young women in developing countries. Retreived 10 April 2006 from www.popcouncil.org

Population Council (2004) The adverse health and social outcomes of sexual coercion: experiences of young women in developing countries. Retreived April 2006 from www.popcouncil.org/pdfs/popsyn/PopulationSynthesis3.pdf

Reneau S. (2004) (part of an unpublished PH.D. Dissertation) Unwanted Consensual Sexual Activity in Heterosexual Dating Relationships. Retrieved April 2006 from http://www.womensstudies.ku.edu/graduate_certificate_research/Unwanted%20Consensual%20Sexual%20Activity%20-%20Long.doc

Shotland R. and Goodstein L. (1992) Sexual Precedence reduces the perceived legitimacy of sexual refusal – an examination of attributions concerning date rape and consensual sex. Personality and Social Psychology Bullettin 18 (6): pp.756-764 (Abstract)

Souter Fenella (Feb 11, 2006) “Generation Sex” in The Age insert Good Weekend – Australia

UNFPA (2005) Child Marriage Fact Sheet. Factsheet State of World Population. Retrieved March 2006 from www.unfpa.org/swp/2005/presskit/factsheets/facts_child_marriage.htm

WHO (2005) Multi-country study on Women’s Health and Domestic Violence against women. Retrieved from www.who.int/gender/violence/who_multicountry_study/en

WHO (2002) Global Burden of Disease (GBD) 2002 Estimates Retreived May 2006 from www.who.int/healthinfo/bodestimates/en/index.html (Annex Table 12 and Table 14)

Wood K, Maforah F, Jewkes R. (1998) “He forced me to love him”: putting violence on adolescent sexual health agendas. Soc. Sci. Med. 47 (2): 233-242

Yillo K. (1999) Wife Rape: a social problem for the 21st Century. Violence against Women 5 (9): pp. 1059-1063

YouthNet (2004) Non-consensual sex among youth No. 10 in the Series YouthLens on Reproductive Health and HIV/AIDS. Retreived March 2006 from www.youthandhiv.org/bangkok/resources/media/YL_nonconsensual_sex.pdf

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