Shame is part of the experience of seeking STD-related care, but stigma may be a more powerful barrier to obtaining such care.

Four studies were conducted to develop and validate the Sexual Assertiveness Scale (SAS), a measure of sexual assertiveness in women that consists of factors measuring initiation, refusal, and pregnancysexually transmitted disease prevention assertiveness. A total of 1,613 women from both university and community populations were studied. Confirmatory factor analyses demonstrated that the 3 factors remained stable across samples of university and community women. A structural model was tested in 2 samples, indicating that sexual experience, anticipated negative partner response, and self-efficacy are consistent predictors of sexual assertiveness. Sexual assertiveness was found to be somewhat related to relationship satisfaction, power, and length. The community sample was retested after 6 months and 1 year to establish test-retest reliability. The SAS provides a reliable instrument for assessing and understanding women's sexual assertiveness. Sexual assertiveness is important for attainment of sexual goals and self-protection from unwanted or unsafe sexual activity. However, traditional gender roles include expectations for men to initiate sexual activity and for women to respond to men's attempts to initiate sexual behavior (Morokoff, 1990; Muehlenhard & McCoy, 1991). Specific problems are associated with women's compliance with gender-based norms for sexual behavior. One problem is that by adopting a sexually passive role, women do not have the opportunity to assert their own sexual interests by initiating sexual activity. Research has shown that although men may often be the first to directly express sexual interest, women indicate sexual interest indirectly, for example by smiling, touching, or gazing into a partner's eyes (Perper & Weis, 1987). Evidence