Despite growing scholarly attention to the importance of sexual health in older adults, little is known about the ways in which early sexual experiences shape sexual behavior and well-being in later life. This dissertation identifies acquiescence – or participation in sex without concomitant desire – at sexual debut as one such factor that may contribute to sexual dysfunction in older adulthood. Utilizing survey data from the National Social Life, Health, and Aging Project (NSHAP), the dissertation examines the relationship between acquiesced first sex and three measures of sexual function: sexual quality, including both physical pleasure and emotional satisfaction (n=1780), sexual problems (n=1678), and prevalence of masturbation in the past year (n=2105). Regression models and tests of predicted probabilities were used to analyze both the main effect of first-sex acquiescence and potential interaction effects with gender. The dissertation finds that acquiesced first sex is associated with lower levels of both physical pleasure (OR = 0.67, p < 0.01) and emotional satisfaction (OR = 0.66, p < 0.01) with sex. Additionally, acquiesced sexual debut is associated with a higher likelihood of experiencing several sexual problems, including experiencing pain during sex (OR = 1.55, p < 0.05), not finding sex pleasurable (OR = 1.75, p > 0.05), and lacking interest in sex (OR = 1.33, p < 0.05). There was no significant relationship between acquiesced first sex and likelihood of reporting masturbating within the past year. Regarding the effects of gender, significant interaction effects were only found with levels of physical pleasure, with the deleterious effect of acquiesced first sex being stronger on female respondents than on males. These results bring attention to the importance of a complete sexual history in physicians’ understandings of sexual dysfunction and long-term sexual well-being. Additionally, findings suggest that educating adolescents on sexual consent and healthy sexual boundaries to prevent experiences of acquiesced first sex may be a point of intervention for improving sexual wellness throughout the life course.
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