Rough Sex: A Conceptual and Empirical Review

Sexual practices commonly known as "rough sex" have become prevalent among adolescents and people in the first few decades of adulthood. Some (e.g. sexual "choking" and smothering) pose serious health risks. The increased prevalence of rough sex has presented new challenges to sexuality educators who now often field questions from young people about these sexual practices - sometimes to the shock and upset of parents and community members. Clinicians, too, have observed more marks and bruises on their patients, which have often been attributed to rough sex. Young people report having first learned, as adolescents, about rough sex from pornography, social media, and mainstream media, urging conversations about media and policy. How might social, behavioral, and public health research inform education, intervention, and policy related to these sexual practices? In this article, we first describe the conceptual challenges of defining "rough sex" and "consensual rough sex" and then use data from multiple countries to describe the prevalence and demographic correlates of rough sex generally as well as for specific practices that fall under this umbrella term. Then, we review research on the health consequences of certain rough sex practices, how people report having learned about rough sex, their reasons for engaging in it, their lived experiences with rough sex, and the relationship between rough sex and partner violence. Finally, we discuss implications for health and safety, sexuality education, clinical care, violence prevention, and policy; identify limitations of the existing research on rough sex; and suggest priorities for subsequent research and interventions.