Sexual Discounting: A Systematic Review of Discounting Processes and Sexual Behavior

Behavioral processes underlying sexual behavior are important for understanding normal human functioning and risk behavior leading to sexually transmitted infections (STIs). This systematic reviewexamines delay and probability discounting in human sexual behavior through synthesis of 50 peerreviewed,original research articles. Sixteen studies focusing exclusively on monetary delay discountingfound small effect size positive correlations with sexual risk behaviors. Eleven studies examined delayor probability discounting of sexual behavior itself using tasks that varied duration, frequency, or qualityof sex to determine value. Results show delay and uncertainty of sex causes systematic decreases invalue. These studies also show consistent medium effect size relationships between sexual discountingmeasures and sexual health and substance use, supporting utility above and beyond monetary discounting.Twenty-three studies have modeled clinically relevant decision-making, examining effects of delayuntil condom availability and STI contraction probability on condom use. Observational and experimentaldesigns found condom-use discounting is elevated in high-risk substance use populations, is sensitiveto context (e.g., partner desirability), and is more robustly related to sexual risk compared with monetarydiscounting or condom use decisions when no delay/uncertainty was involved. Administering cocaine,alcohol, and, for some participants, methamphetamine increased condom-use discounting with minimaleffect on monetary discounting or condom use when no delay/uncertainty was involved. Reviewedstudies robustly support that sexual behavior is highly dependent on delay and probability discounting,and that these processes strongly contribute to sexual risk.