A Review of Factors Associated with Unprotected Sex among Adult Women in the United States


  • The authors report no conflict of interest or relevant financial relationships.


Mary T. Paterno, MSN, CNM, RN, Johns Hopkins University, School of Nursing, 525 N. Wolfe St., Baltimore, MD 21205. mpatern3@son.jhmi.edu



To provide an updated review of research since 2005 on factors associated with unprotected sex among women in the United States.

Data Sources

PubMed, CINAHL, and PsychINFO were searched from January 2006 through April 2011 using the terms unsafe sex, sexual risk taking, contraception, contraception behavior, birth control, condoms, and condom utilization.

Study Selection

Inclusion criteria included studies written in English on adult women in the United States age ≥ 18. Forty-five publications met inclusion criteria.

Data Extraction

All factors associated with engagement in unprotected sex are presented.

Data Synthesis

Unprotected sex has been associated with increasing age, being married, establishment of trust, recent experience of intimate partner violence, contraceptive side effects, infrequent sexual intercourse, and decreased arousal and pleasure due to contraceptive use. Religion, depression, history of abortion, number of children, having children, and number of pregnancies have not been associated with unprotected sex in recent studies. Several other variables have been studied with mixed results, possibly due to differences in research methods and sample characteristics.


More research is needed to elucidate the impact of cultural factors, relationship factors, attitude to pregnancy and motherhood, and reproductive coercion on prevention of pregnancy and sexually transmitted infections. Nurses can lead research on these topics and implement evidence-based practice based on study findings.