Mostly Heterosexual and Lesbian/Gay Young Adults: Differences in Mental Health and Substance Use and the Role of Minority Stress

Individuals mostly attracted to other-sex but also to same-sex partners are a distinct and common sexual orientation group with possibly increased levels of health problems. The current study examined whether mostly heterosexual individuals differed in mental health and substance use from lesbian/gay individuals and whether sexual minority risk and protective factors offer an explanation in a sample of 528 Dutch young adults (16 to 25 years old, M = 21.2 years). Mostly heterosexual participants reported higher levels of psychological distress, suicidality, drug use, and smoking than lesbian/gay participants and equal levels of binge drinking. They also reported higher levels of internalized negativity to same-sex attractions, less openness to family members and others, less community involvement, and lower numbers of lesbian/gay/bisexual friends. However, bootstrapped mediation analysis showed that the differences in minority stress risk and protective factors did not mediate most of the differences in mental health and substance use with one exception: higher levels of psychological distress were mediated by the higher levels of internalized negativity to same-sex attractions. The limited explanatory power of the minority stress factors combined with the elevated level of problems of mostly heterosexual individuals call for future studies examining other risk and protective factors.     

“I Want to Feel Like a Full Man”: Conceptualizing Gay,Bisexual, and Heterosexual Men’s Sexual Difficulties

Current understandings of sexual difficulties originate from a model that is based on the study of heterosexual men and women. Most research has focused on sexual difficulties experienced by heterosexual men incapable of engaging in vaginal penetration. To better understand men’s perceptions and experiences of sexual difficulties, seven focus groups and 29 individual interviews were conducted with gay (n = 22), bisexual (n = 5), and heterosexual (n = 25) men. In addition, the extent to which difficulties reported by gay and bisexual men differ from heterosexual men was explored. Data were analyzed using thematic analysis applying an inductive approach. Two intercorrelated conceptualizations were identified: penis function (themes: medicalization, masculine identity, psychological consequences, coping mechanisms) and pain (themes: penile pain, pain during receptive anal sex). For the most part, gay, bisexual, and heterosexual men reported similar sexual difficulties; differences were evident regarding alternative masculinity, penis size competition, and pain during receptive anal sex. The results of this study demonstrate the complexity of men’s sexual difficulties and the important role of sociocultural, interpersonal, and psychological factors. Limitations and suggested directions for future research are outlined.     

Examining the Psychometric Properties of the Sexual Excitation/Sexual Inhibition Inventory for Women (SESII-W) in a Sample of Lesbian and Bisexual Women

The Sexual Excitation/Sexual Inhibition Inventory for Women (SESII-W) assesses propensities for sexual excitation (SE) and inhibition (SI). Previous research utilizing the SESII-W included samples comprised exclusively or almost entirely of heterosexual women. The purpose of this study was to examine the psychometric properties of the SESII-W and assess its relation to aspects of sexual function within a sample of lesbian and bisexual women. The sample included 974 self-identified bisexual (n = 733) or lesbian/homosexual (n = 241) women who completed an online survey including items assessing women’s sexual behaviors, feelings, and functioning, sociodemographics, and the SESII-W. The sample was split; exploratory factor analyses were conducted on the first half, yielding eight lower-order factors with two higher-order factors. Confirmatory factor analysis was conducted on the second half and suggested reasonable model fit. SI was positively correlated with sexual problems and negatively correlated with sexual pleasure; the correlations were significant but small. Hierarchical regression analyses were conducted to examine the relationships between SESII-W scores and sexual problems/sexual pleasure, controlling for age, relationship duration, and relationship status. Four lower-order factors predicted reports of sexual problems. Findings indicated the SESII-W has similar psychometric properties among sexual minority women as it does among heterosexual women.     

Mental health and substance use of sexual minority college athletes

ABSTRACT

Objective: Assess the mental health and substance use of sexual minority collegiate student-athletes in the United States, as compared with heterosexual college students and heterosexual student-athletes. Participants: Undergraduate students (N = 196,872) who completed the American College Health Association's National College Health Assessment (Fall 2008–Fall 2012 administrations). Methods: Written cross-sectional survey. Results: Sexual minority student-athletes had a higher risk of experiencing mental health difficulties than their heterosexual athlete peers. There were no significant differences in mental health between sexual minority male athletes and nonathletes. Sexual minority female athletes appeared to fare better than nonathlete peers. Substance use was greater among sexual minority students (athlete and nonathlete) and was mediated by mental health. Conclusions: Participation in athletics does not appear to be associated with an elevated risk of negative mental health outcomes for sexual minority participants; however, there are disparities in mental health outcomes by sexual orientation regardless of athletics participation.     

Associations of Bisexual-Specific Minority Stress and Health Among Cisgender and Transgender Adults with Bisexual Orientation

Among sexual minorities, bisexuals are at the greatest risk for poor health due in part to prejudice and stigma. This research examined associations of bisexual-specific minority stress and health among cisgender (non-transgender) and transgender adults with bisexual orientation. Participants were 488 adults (378 cisgender women, 49 cisgender men, 61 transgender individuals), age 18 to 66 years, with bisexual orientation based on identity and/or attractions to multiple genders. Participants completed an online survey. Hierarchical linear regression analyses were conducted with sexual minority stress and bisexual-specific minority stress as the predictors and physical health, measured by the 36-Item Short Form Survey (SF-36), as the outcome. Models controlled for demographic variables. Moderation analyses were conducted to test for gender differences. Greater bisexual-specific minority stress significantly predicted poorer overall physical health (β = ?0.16), greater pain (β = ?0.16), and poorer general health (β = ?0.25) above and beyond the effects of sexual minority stress. Gender moderated the association between bisexual-specific minority stress and health, such that bisexual-specific minority stress predicted overall physical health and role limitations for transgender individuals but not for cisgender women. Addressing bisexual-specific minority stress is necessary to improve the health and well-being of bisexual individuals.     

Differences in Sexual Orientation Diversity and Sexual Fluidity in Attractions Among Gender Minority Adults in Massachusetts

This study characterized sexual orientation identities and sexual fluidity in attractions in a community-based sample of self-identified transgender and gender-nonconforming adults in Massachusetts. Participants were recruited in 2013 using bimodel methods (online and in person) to complete a one-time, Web-based quantitative survey that included questions about sexual orientation identity and sexual fluidity. Multivariable logistic regression models estimated adjusted risk ratios (aRRs) and 95% confidence intervals (95% CIs) to examine the correlates of self-reported changes in attractions ever in lifetime among the whole sample (n = 452) and after transition among those who reported social gender transition (n = 205). The sample endorsed diverse sexual orientation identities: 42.7% queer, 19.0% other nonbinary, 15.7% bisexual, 12.2% straight, and 10.4% gay/lesbian. Overall, 58.2% reported having experienced changes in sexual attractions in their lifetime. In adjusted models, trans masculine individuals were more likely than trans feminine individuals to report sexual fluidity in their lifetime (aRR = 1.69; 95% CI = 1.34, 2.12). Among those who transitioned, 64.6% reported a change in attractions posttransition, and trans masculine individuals were less likely than trans feminine individuals to report sexual fluidity (aRR = 0.44; 95% CI = 0.28, 0.69). Heterogeneity of sexual orientation identities and sexual fluidity in attractions are the norm rather than the exception among gender minority people.     

Sexual Minority and Heterosexual Former Foster Youth: A Comparison of Abuse Experiences and Trauma-Related Beliefs

The current study compared the abuse experiences of 108 sexual minority and heterosexual former foster youth who received scholarships through the Orphan Foundation of America. Participants used an anonymous online survey to answer questions regarding their history of physical and sexual abuse. All participants who reported a history of sexual abuse also completed the Trauma Related Beliefs questionnaire (TRB; Hazzard, 1993). Differences across sexual orientation were observed in sexual, but not physical, abuse rates and in the Self-Blame/Stigmatization subscale of the TRB. Specifically, sexual minority participants reported more incidents of sexual abuse, as well as higher scores on the TRB subscale, than did heterosexual participants. These results suggest that sexual orientation is relevant to the experience of abuse among children in the child welfare system.     

Processes of Sexual Orientation Questioning among Heterosexual Women

Because very little is known about heterosexual identity development, this study assesses and describes sexual orientation questioning processes of heterosexual-identified women and offers a comparison of these processes with those employed by their sexual-minority counterparts. Participants included 333 female college students (ages 18–23; M = 19.2): 228 participants primarily identified as “exclusively straight/heterosexual,” and 105 participants indicated a sexual-minority identity. Sixty-seven percent of exclusively heterosexual respondents (n = 154) indicated having thought about or questioned their sexual orientation. The processes by which heterosexual participants described questioning their sexual orientation were coded for the presence of five emergent categories using an inductive thematic coding methodology. These five categories included unelaborated questioning (19%), other-sex experiences (16%), exposure to sexual minorities (26%), assessment of same-sex attraction (48%), and evaluations of same-sex behavior (26%). Several unifying and differentiating themes emerged between sexual orientation groups. Results from this study suggest that contemporary young women's heterosexuality is not necessarily an unexamined identity; indeed, the large majority of young women in this sample were deliberately identifying as heterosexual after contemplating alternative possibilities.     

Psychosocial Factors Associated with Male Sexual Difficulties

The role of medical conditions, childhood experiences, and psychological and relationship factors in the development and maintenance of male sexual difficulties is not well understood. Using self-report questionnaires, the current study examined how these factors are associated with male sexual difficulties overall, as well as for each of four separate problems (low sexual desire, erectile difficulties, premature ejaculation, delayed ejaculation). The participants for the study were 331 Australian men from the general population, all of whom were in cohabiting heterosexual relationships and had experienced one or more of the aforementioned sexual problems. Data were collected via an online survey between January 2010 and April 2011. The results demonstrated that medical factors as well as current psychological factors (e.g., performance anxiety) were most likely associated with each male sexual difficulty. These findings are in contrast to those obtained with women, where relationship factors are strongly related to female sexual problems. They would suggest that the targets for sex therapy may be different for men and women, with medical problems and performance anxiety being the primary targets for men.     

Intimate partner violence,health, sexuality,and academic performance among a national sample of undergraduates

ABSTRACT

Objective: To determine the association between intimate partner violence (IPV) and academic performance among heterosexual and sexual minority undergraduates, including whether health mediates this relationship. Participants: A national sample of undergraduate students aged 18–24 years old who completed the 2011–2014 National College Health Assessment IIb (N = 85,071). Methods: We used structural equation modeling to create a latent variable of IPV victimization (stalking, physical, sexual, and emotional violence) in order to test its relationship with health (physical and mental) and two indicators of academic performance (GPA and perceived academic difficulties), according to participants’ sexual identity (heterosexual, lesbian, gay, bisexual, and unsure). Results: Regardless of sexual identity, undergraduates who reported IPV were more likely to have lower GPA and increased academic difficulties. Health mediates this relationship, such that IPV reduces health, which negatively affects performance. Conclusions: IPV poses a serious threat to undergraduates’ health and educational success. Findings warrant universal prevention and intervention.     

Brief Report: Sexual Wellbeing in Heterosexual,Mostly Heterosexual,and Bisexually Attracted Men and Women

Abstract

Objective: To assess differences in sexual wellbeing among men and women with exclusively heterosexual, mostly heterosexual, and bisexual attractions. Method: An anonymous online survey in a convenience sample of 597 young adults (394 women, 203 men; average age = 20.04) assessed patterns of sexual attraction, desire, sexual functioning, and sexual satisfaction using validated questionnaires. Results: Individuals with mostly heterosexual attractions reported significantly higher solitary sexual desire than exclusively heterosexual individuals (women: d?=?0.64; men: d?=?0.68). Partnered sexual desire did not differ between groups. Women with exclusively heterosexual attractions reported significantly higher sexual functioning and satisfaction than either mostly heterosexual or bisexually attracted women (functioning: d?=?0.29; satisfaction: d?=?0.47). Men with mostly heterosexual attractions reported significantly lower sexual functioning than either exclusively heterosexual or bisexually attracted men (d?=?0.40). Conclusions: There were significant differences between exclusively vs. mostly heterosexual individuals in several aspects of sexual wellbeing, supporting the assertion that mostly heterosexual may constitute a distinct orientation. Taken together with prior research showing higher rates of sexual dysfunction in bisexual women, these findings highlight sexual health disparities among nonmonosexual women. Efforts to support the sexual wellbeing of sexual minority individuals should include consideration of mostly heterosexual individuals, as this population may have unique sexual health needs.     

Bullying victimization in non-heterosexual university students

In this study the prevalence, impact on mental health, and coping of bullying victimization in university students identifying as non-heterosexual was compared with their heterosexual peers. University students were surveyed on bullying experiences within the past 12 months, their mental health, and use of coping strategies. Demographic information identified gender, age, and sexual orientation. Results indicated that 14.3% of students reported victimization, and that students ages 24 to 35, and those who identified as non-heterosexual, reported higher rates of victimization. No gender differences were found. Bullied students scored significantly higher on depression, anxiety, and stress scores than non-bullied students. Comparisons of mental health scores and coping strategies of non-heterosexual and heterosexual bullied students found no significant differences, indicating both groups are equally impacted, and equally utilize adaptive and maladaptive strategies to manage the victimization. Implications for tertiary institutions include identification of effective coping resources for diverse university student populations. Limitations and recommendations for future research are considered.     

Self-Perceptions of Sexual Attractiveness: Satisfaction With Physical Appearance is Not of Primary Importance Across Gender and Sexual Orientation

Research on self-perceived sexual attractiveness has predominantly focused on the importance of physical appearance, overlooking nonphysical traits that may contribute to these self-perceptions. The present study examined and compared the importance of a variety of traits for self-perceived sexual attractiveness. Self-identified heterosexual, gay, and bisexual men (N = 1,801) and heterosexual, lesbian, and bisexual women (N = 1,092) completed an online questionnaire examining self-perceived sexual attractiveness, body esteem, sexual esteem, adherence to gender norms, and sexual experience. Body esteem and sexual esteem were significant predictors of self-perceived sexual attractiveness, regardless of gender and sexual orientation. Adhering to a masculine gender norm was a significant predictor among all groups (to varying extents) but heterosexual women. Adhering to a feminine gender norm was a significant predictor among heterosexual men and bisexual women. Finally, sexual experience was a significant predictor for all men and bisexual women. Furthermore, while body esteem was a predictor across all groups, for most individuals it did not appear to be of primary importance, with either sexual esteem or masculinity proving to be of greater importance. These findings suggest the need to consider traits related to both physical and nonphysical factors for improving an individual's self-perceived sexual attractiveness.     

Bisexual Stigma,Sexual Violence,and Sexual Health Among Bisexual and Other Plurisexual Women: A Cross-Sectional Survey Study

Bisexual women experience higher rates of sexual victimization relative to heterosexual and lesbian women, and worse sexual health outcomes. Though these health disparities are well documented in the literature, few empirical data have been published on what factors are driving these disparities. Further, research documenting sexual victimization and health of plurisexual (i.e., attracted to more than one gender) women group all participants as bisexual. We do not know whether these experiences are similar across subgroups of plurisexual women. The current study reports on data from a cross-sectional survey, analyzing the relationships between bisexual-specific stigma and sexual violence, as well as other sexual health outcomes, across a sexually diverse group of plurisexual participants. Findings indicate that bisexual stigma is a significant predictor of lifetime sexual violence (odds ratio [OR] = 1.99, p = .015) and verbal coercion (OR = 2.60, p = .004), but not other outcomes. There are differences across sexual identity categories, with bisexual participants being less likely to report sexual violence and verbal coercion, and less likely to access sexually transmitted infection/human immunodeficiency syndrome testing, compared to other plurisexual groups. Our findings support that bisexual stigma is an important factor to consider in understanding sexual violence disparities experienced by bisexual and other plurisexual women.     

Heterosexual,Homosexual, and Bisexual Men’s Pupillary Responses to Persons at Different Stages of Sexual Development

This study investigated whether pupil size during the viewing of images of adults and children reflects the sexual orientation of heterosexual, homosexual, and bisexual men (n = 100, M_age = 22). More specifically, we explored whether this measure corresponds with sexual age preferences for adults over children in nonpedophilic men. In general, results across three experiments, in which observers freely viewed or rated the sexual appeal of person images, suggest that pupil dilation to sexual stimuli is an indicator of sexual orientation toward adults. Heterosexual men’s pupils dilated most strongly to adults of the other sex, homosexual men dilated most strongly to adults of the same sex, and bisexual men showed an intermediate pattern. Dilation to adults was substantially stronger than dilation to younger age groups. Sexual appeal ratings for images of adults and children also correlated with pupil responses, suggesting a direct link between pupil dilation and sexual interest. These findings provide support for pupil dilation as a measure of sex- and age-specific sexual preferences.     

Differences in Adolescent Experiences of Polyvictimization and Suicide Risk by Sexual Minority Status

Sexual minority adolescents (SMA) report more suicide risk behaviors than heterosexual adolescents. Polyvictimization (co‐occurrence of multiple types of victimization) may be an important, underresearched correlate of this disparity. With the 2017 national Youth Risk Behavior Survey (N = 13,179), national estimates of polyvictimization and suicide risk were assessed among high school students by sexual minority status (SM vs. heterosexual), and multivariate relationships between sexual minority status, polyvictimization, and suicide risk were tested. Additionally, risk profiles of those who experienced polyvictimization (2 + types of victimization; n = 1,932) were compared across sexual minority status. Results confirm that SMA are more likely to experience polyvictimization than heterosexual adolescents (31.8% v. 12.9%, respectively); however, also indicate that polyvictimization does not fully explain elevated suicide risk among SMA.     

Sexual Orientation Moderates the Effect of Gender on Body Satisfaction: Results From a National Probability Sample

Body image concerns typically affect women more so than men, but there is reason to believe that this pattern may depend on sexual orientation. The present study examined differences in levels of body satisfaction among men and women who identified as heterosexual, plurisexual (bisexual and pansexual), gay, and lesbian, using data from a large-scale national probability sample from New Zealand (N = 17,005). As expected, heterosexual men reported higher body satisfaction than heterosexual women. Gay and plurisexual men reported lower body satisfaction than heterosexual men. Gay men also reported lower body satisfaction than lesbian women, and did not differ significantly from heterosexual and plurisexual women. Ratings of heterosexual, plurisexual, and lesbian women’s body satisfaction did not differ significantly. Results held when adjusting for a range of demographic covariates (including age and BMI), and highlight the importance of examining the psychological and health outcomes associated with poor body image among gay men. These findings emphasize the relevance of sexual orientation in understanding men’s body image-related issues.     

Gender-Specificity of Women's and Men's Self-Reported Attention to Sexual Stimuli

Men's sexual arousal is largely dependent on the actor's gender in a sexual stimulus (gender-specific), whereas for women, particularly androphilic women, arousal is less dependent on gender (gender-nonspecific). According to information-processing models of sexual response, sexual arousal requires that attention be directed toward sexual cues. We evaluated whether men's and women's self-reported attention to sexual stimuli of men or women were consistent with genital responses and self-reported arousal. We presented gynephilic men (n = 21) and women (n = 22) and androphilic men (n = 16) and women (n = 33) with audiovisual stimuli depicting men or women engaged in sexual activities. Genital responses were continuously recorded and, following each stimulus, participants reported the amount of attention paid to the video and feelings of sexual arousal. Self-reported attention was gender-specific for men and gender-nonspecific for women, and generally mirrored genital responses and self-reported arousal. Gender-specificity of genital responses significantly predicted gender-specificity of self-reported arousal; however, for men only, this effect was significantly mediated by gender-specificity of self-reported attention. Gender differences in gender-specificity of sexual arousal may be partially accounted for by differences in gender-specificity of self-reported attention, although attention may play a greater role in men's sexual arousal than women's.     

Age Cohort Differences in Sexual Behaviors Among Black Men Who Have Sex With Men and Women

Little attention has focused on generational or age-related differences in human immunodeficiency virus/sexually transmitted infection (HIV/STI) risk behaviors among Black men who have sex with men and women (BMSMW). We examined sexual risk behaviors between BMSMW ages 40 and under compared to over age 40. Analysis was conducted using Centers for Disease Control and Prevention (CDC)–sponsored intervention data among BMSMW in Los Angeles, Chicago, and Philadelphia (n = 546). Pearson’s chi-square tests were conducted to evaluate associations between age groups and behavioral outcomes. Logistic regression was used to evaluate the odds of behavioral outcomes by age group, adjusting for sexual orientation and study location, within strata of HIV status. HIV-positive BMSMW over age 40 had 62% reduced odds of having a nonmain female partner of HIV-negative or unknown status compared to those ages 40 and under (adjusted odds ratio [AOR] 0.38, 95% confidence interval [CI] = 0.15, 0.95). Among HIV-negative BMSMW, the older cohort was associated with greater odds of having condomless insertive anal intercourse (IAI) with most recent main male partner (AOR 2.44, 95% CI = 1.12, 5.32) and having a concurrent partnership while with their recent main female partner (AOR = 2.6, 95% CI = 1.10, 4.67). For both groups, odds of engaging in certain risk behaviors increased with increasing age. Prevention efforts should consider generational differences and age in HIV risks among BMSMW.