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“First, I… then, we…”: exploring the sequence of sexual acts and safety strategies reported during a sexual encounter using a modified timeline followback method
  1. Vanessa R Schick1,
  2. Aleta Baldwin2,
  3. Laina Y Bay-Cheng3,
  4. Brian Dodge4,
  5. Barbara Van Der Pol5,
  6. J Dennis Fortenberry6
  1. 1Department of Management, Policy, and Community Health, University of Texas Health Science Center at Houston, Houston, Texas, USA
  2. 2California State University Stanislaus, Turlock, California, USA
  3. 3University at Buffalo, School of Social Work, Buffalo, New York, USA
  4. 4Indiana University—Bloomington, Center for Sexual Health Promotion, Bloomington, Indiana, USA
  5. 5Division of Infectious Diseases, University of Alabama at Birmingham, Birmingham, Alabama, USA
  6. 6Division of Adolescent Medicine, Indiana University School of Medicine, Indianapolis, Indiana, USA
  1. Correspondence to Dr Vanessa R Schick, School of Public Health, The University of Texas Health Science Center at Houston, 1200 Pressler Street, Rm E-917, Houston, TX 77030, USA; Vanessa.Schick{at}


Objectives Assessments of sexual safety often rely on questions about the occurrence of condom use within a designated timeline, assuming that penile–vaginal intercourse (PVI) occurred once at the conclusion of the event. An investigation of all sexual acts and safety strategies that occur during a single event may present a more nuanced picture of sexual risk.

Methods Behaviourally, bisexual women (N=45) were recruited due to the potential diversity of their sexual behaviour and safety strategies. A modified timeline follow-back method, the SEQUENCE Calendar, was designed to capture information about the participants’ most recent sexual event with a male partner, including the order of each sexual act during the sexual event. Interviews took between 1 and 3 h. These acts were compiled into narratives and the behavioural sequences were reviewed and coded.

Results Participants reported an average of 7.9 (SD=4.3) sexual acts. Over a third (35.9%, N=14) of the participants who reported PVI indicated engaging in genital contact after PVI and over 15% (N=6) of these participants reporting PVI at two different time points, separated by sexual behaviour. Additional potential for infection outside of condom use and PVI was also identified.

Conclusions Sexual interactions are comprised of multiple acts that occur in a variety of permutations. Understanding the complexity of people's sexual encounters has potential to inform the ways we measure condom use and consider sexual safety.


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