In-depth interviews conducted by researchers at the Johns Hopkins University School of Medicine of 20 young women attending an urban sexually transmitted disease clinic have documented a variety of unexpected, unintended sexual encounters linked to their alcohol use before sex occurs.

Links between alcohol use and risky or deleterious sexual encounters are not necessarily new, say investigators, but this small study identifies very specifically the disconnect between what young women have in mind when they drink and have sex and what really happens.

"The idea behind our study was to first unveil what women expect to happen, and then uncover what consequences really occur so that we can challenge unrealistic expectations and develop better interventions that lead to safer experiences," says Geetanjali Chander, M.D., M.P.H, associate professor of medicine at the Johns Hopkins University School of Medicine.

The interviews and results, described online in the July 27 edition of Women's Health Issues, are a follow-up to a previous study that reported the sexual expectations related to alcohol use held by the same group of women.

In this study, Chander and her colleagues conducted in-depth interviews between December 2009 and August 2010 with 20 African-American women attending a Baltimore clinic that treats sexually transmitted diseases. All study participants reported binge drinking in the past six months or engaging in intercourse while under the influence of alcohol.

According to the findings, five major unexpected sexual events happened with substantial frequency as revealed by the participants: sex with new partners; alternative sexual activities, including anal sex and "rough" sex; unprotected sex; blacked-out sex or sex occurring during alcohol-related amnesia; and rape.

In addition, several themes emerged among the interview subjects when describing their encounters, primarily a sense of sexual victimization. The women's discussions included words such as "predator," "opportunist" and "vulture."

In contrast to such descriptions, literature to date has shown that women tend to think alcohol will improve their sex drive, minimize their sexual inhibition or make the sexual experience better. "Ensuring that women understand this disconnect may help them focus on the consequences more than the positive expectation," says Dinah Lewis, a medical student at Johns Hopkins University School of Medicine.

"Experiences like those documented in our study happen everywhere -- on college campuses, in cities and small towns," says clinical psychologist Heidi Hutton, Ph.D., associate professor of psychiatry and behavioral sciences at the Johns Hopkins University School of Medicine. "The more important task for us is to develop interventions that empower women and men to make decisions that keep them safe."

When asked how they might be safer when drinking in public, Hutton says, a common suggestion from the interview subjects was to watch out for each other. "Women feel safer when they travel in packs, and one way participants suggested staying safe is to never let anyone get separated from the pack," she says.

Chander says they hope to conduct further studies to better document and understand men's expectations for drinking and sex and the outcomes they experience.

"Even though this particular study is small in size, it has led us to further explore needed interventions that may help women stay safer and healthier," says Chander.