Sexual health education often focuses on prevention of sexually transmitted infections and unintended pregnancies, but the decision to engage in sexual activity is equally important. This cross-sectional study examined the decisions of college students (n = 422) to engage in oral sex, vaginal sex, and other sexual behaviors. Regression analyses revealed physical gratification as the most consistent predictor of a decision to engage in sexual activity, whereas concern for risk was a predictor for only one decision. Differences were identified for males and females. As sexual health programs are often co-educational and do not address pleasure, these findings are critical considerations for educators. (Contains 4 tables.)