“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.     

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.     

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.     

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.     

The Impact of Pre-Exposure Prophylaxis (PrEP) Use on Sexual Anxiety,Satisfaction, and Esteem Among Gay and Bisexual Men

Gay and bisexual men (GBM) with heightened fears of human immunodeficiency virus (HIV) acquisition have reported high levels of sexual anxiety and low sexual self-esteem. Similarly, sexual satisfaction has been reported to be lower among some GBM who rely solely on condom use as HIV prevention. We sought to explore whether pre-exposure prophylaxis (PrEP) had an impact on the sexual satisfaction, anxiety, and esteem of GBM. As part of a longitudinal cohort study of 1,071 GBM, participants reported at three time points on PrEP use and completed the Multidimensional Sexual Self-Concept Questionnaire (MSSCQ). A total of 137 GBM began taking PrEP in the 24 months following baseline. Comparing their responses during times before initiating PrEP and after, within adjusted multilevel models, there was a significant decrease in sexual anxiety (B = ?0.27, p = 0.03) but no significant changes in sexual esteem or satisfaction. Our findings indicate important psychological improvements resulting from PrEP initiation. Further research should explore the potential for other psychological benefits of PrEP use among GBM.     

Intrapersonal and Interpersonal Sexual Behaviors of Chinese University Students: Gender Differences in Prevalence and Correlates

The main aim of the present study was to investigate gender differences among university students in contemporary China regarding (1) the prevalence of various types of intrapersonal and interpersonal sexual behaviors and (2) their sociodemographic and psychosocial predictors. A total of 1,397 university students (M_age = 20.3 years) completed related questionnaires. Intrapersonal behaviors (i.e., sexual fantasizing, solitary masturbation, and viewing pornography) were generally reported more frequently than interpersonal behaviors (i.e., petting, oral sex, and intercourse). Gender differences were most evident for intrapersonal sexual behaviors, all of which were reported more frequently by men. Men reported significantly more heterosexual intercourse than women but not petting or oral sex. Several correlates (i.e., age, educational aspiration, family income, urbanity, relationship experience, and Internet use) were significant predictors of various intrapersonal and interpersonal sexual behaviors. Gender significantly moderated these correlations in three cases: Family income was a stronger negative predictor of intercourse for women, romantic relationship history was a stronger positive predictor of intercourse for men, and Internet use was a stronger positive predictor of sexual fantasizing for men. We discuss the implications of these findings for sexuality education and sexual health policies and practices in contemporary China.     

Associations between Young Adults' Use of Sexually Explicit Materials and Their Sexual Preferences,Behaviors, and Satisfaction

This study examined how levels of sexually explicit material (SEM) use during adolescence and young adulthood were associated with sexual preferences, sexual behaviors, and sexual and relationship satisfaction. Participants included 782 heterosexual college students (326 men and 456 women; M_age = 19.9) who completed a questionnaire online. Results revealed high frequencies and multiple types and contexts of SEM use, with men's usage rates systematically higher than women's. Regression analyses revealed that both the frequency of SEM use and number of SEM types viewed were uniquely associated with more sexual experience (a higher number of overall and casual sexual intercourse partners, as well as a lower age at first intercourse). Higher frequencies of SEM use were associated with less sexual and relationship satisfaction. The frequency of SEM use and number of SEM types viewed were both associated with higher sexual preferences for the types of sexual practices typically presented in SEM. These findings suggest that SEM use can play a significant role in a variety of aspects of young adults’ sexual development processes.     

A Dyadic Perspective on Childhood Maltreatment for Women With Provoked Vestibulodynia and Their Partners: Associations With Pain and Sexual and Psychosocial Functioning

Childhood maltreatment is robustly associated with adult-onset vulvodynia, a common form of female genito-pelvic pain/penetration disorder. However, little is known about the impact of childhood maltreatment on current sexual, psychological, and relationship adaptation for couples with provoked vestibulodynia (PVD). This study examined the associations between childhood maltreatment and sexual and psychosocial functioning and pain in women with PVD, the most common subtype of vulvodynia, and their partners. A total of 49 couples (M_age women = 27.80, SD = 6.05; M_age men = 30.04; SD = 6.48) with PVD completed the Childhood Trauma Questionnaire (CTQ), as well as measures of sexual functioning, couple satisfaction, and anxiety. Women also reported on their pain during intercourse. Analyses were guided by the actor–partner interdependence model. Women’s higher reports of childhood maltreatment were associated with their lower sexual functioning and higher anxiety. Partners’ higher reports of childhood maltreatment were associated with their lower sexual functioning, lower couple satisfaction, and higher anxiety, as well as women’s lower couple satisfaction and higher anxiety. Both women’s and partners’ higher reports of childhood maltreatment were associated with higher affective pain for women. Findings suggest childhood maltreatment experienced by women with PVD and their partners should be considered as part of treatment planning.     

What is Sexual Satisfaction? Thematic Analysis of Lay People's Definitions

Sexual satisfaction is an important indicator of sexual health and is strongly associated with relationship satisfaction. However, research exploring lay definitions of sexual satisfaction has been scarce. We present thematic analysis of written responses of 449 women and 311 men to the question “How would you define sexual satisfaction?” The participants were heterosexual individuals with a mean age of 36.05 years (SD = 8.34) involved in a committed exclusive relationship. In this exploratory study, two main themes were identified: personal sexual well-being and dyadic processes. The first theme focuses on the positive aspects of individual sexual experience, such as pleasure, positive feelings, arousal, sexual openness, and orgasm. The second theme emphasizes relational dimensions, such as mutuality, romance, expression of feelings, creativity, acting out desires, and frequency of sexual activity. Our results highlight that mutual pleasure is a crucial component of sexual satisfaction and that sexual satisfaction derives from positive sexual experiences and not from the absence of conflict or dysfunction. The findings support definitions and models of sexual satisfaction that focus on positive sexual outcomes and the use of measures that incorporate items linked to personal and dyadic sexual rewards for both men and women.     

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.     

Sexual Satisfaction Among Couples: The Role of Attachment Orientation and Sexual Motives

The mediating effect of sexual motives between attachment orientation and sexual satisfaction and functioning was investigated among 128 couples (N = 256) using the actor-partner interdependence model (Campbell & Kashy, 2002). Actor effects between attachment orientation and sexual satisfaction and functioning, mediated by sexual motives, were found regarding men’s sexual satisfaction, sexual intimacy, and orgasmic responsivity. Partner effect revealed two significant paths in which the greater the women’s attachment avoidance, the lower the partners’ intimacy motivation, which in turn was linked with lower partners’ sexual satisfaction and increased lack of sexual intimacy. The analyses did not reveal significant mediation paths affecting women’s sexual satisfaction and functioning. These findings emphasize the importance of implementing a dyadic perspective on sexuality within practice. Recommendations for further research and additional clinical implications are discussed.     

Sexual Well-Being in Older Women: The Relevance of Sexual Excitation and Sexual Inhibition

The aim of this study was to use the dual control model of sexual response (DCM) to investigate variation in sexual well-being among women 50 years of age and older. Data from 185 women 50 years of age and older (M = 59.46, SD = 6.96) were used to examine the relationships between sexual excitation (SE) and sexual inhibition (SI) and their lower-order factors to indicators of sexual well-being (i.e., sexual functioning, satisfaction, distress, frequency of sexual activity, and breadth of sexual behavior). Possible moderating factors were also explored. Independently, SE and SI were associated with the majority of the indicators of sexual well-being, and the directions of associations were consistent with the tenets of the DCM. SE and SI lower-order factors were significant predictors of sexual function, satisfaction, and frequency of sexual activity. Sexual distress was predicted more strongly by SI factors and breadth of sexual behavior by one SE lower-order factor (arousability). Partner physical and mental health and participant’s own mental health were identified as moderating variables of these associations. Findings of this study are discussed considering the contribution of the DCM to understanding the role of diversity in older women’s sexual well-being.     

Hypersexual Behavior and HIV Sex Risk among Young Gay and Bisexual Men

Hypersexual behavior has been identified as a sexual risk correlate among gay and bisexual men (GBM). The Hypersexual Behavior Inventory (HBI) has been shown to be a reliable and valid measure of hypersexual behavior in clinical populations, yet it has not been used to assess hypersexual behavior in nonclinical samples. We examined the psychometric properties of the HBI with survey data recorded between December 2009 and March 2010 in a sample of young men (N = 366, M = 21.46 years old, SD = 1.95) who self-identified as gay (89%) or bisexual (11%) and assessed its association with unprotected receptive anal intercourse (URAI) partners and occasions. Using cross-sectional data of single, sexually active young GBM (YGBM), we used confirmatory factor analyses to test the HBI's three-factor structure. Using negative binomial regressions, we then tested the association between the HBI subscales and sexual risk. After accounting for covariates, we found that sexual control was a risk factor for URAI partners and occasions, and coping was found to be a protective factor for URAI occasions. In light of our findings, we discuss the importance of reexamining the theoretical assumptions of hypersexual behavior and propose HIV prevention strategies that may reduce young GBM's vulnerability to HIV infection.     

Individual Differences in the Effects of Mood on Sexuality: The Revised Mood and Sexuality Questionnaire (MSQ-R)

Previous research using the Mood and Sexuality Questionnaire (MSQ) has revealed substantial variability in how negative mood impacts sexual response and behavior. However, the MSQ does not address differences between desire for solo or partnered sexual activity, examine the effects of sexual activity on mood, or assess the effects of positive mood. This article presents the development and factor structure of the Revised Mood and Sexuality Questionnaire (MSQ-R). An exploratory factor analysis in a sample of heterosexual men, homosexual men, and heterosexual women (N = 1,983) produced eight factors. Considerable variability was found in how moods influence sexual desire and arousal, in the effects of mood on sexual behavior, and in the reciprocal effects of sexual activity on mood. Among other findings, heterosexual women were less likely than heterosexual men and homosexual men to experience increased sexual desire and arousal when anxious or stressed, whereas homosexual men and heterosexual women were less likely than heterosexual men to experience increased desire when sad or depressed. Heterosexual men and heterosexual women were more likely than homosexual men to report increased desire when in a positive mood. Intercorrelations and correlations with various sexual behaviors varied by group. Limitations and implications of the findings are discussed.     

Heterosexual Women’s and Men’s Labeling of Anal Behaviors as Having “Had Sex”

This study explored labeling of penile–anal intercourse (PAI), manual–anal (MA), and oral–anal (OA) behaviors as having “had sex” among heterosexual men and women with such experience residing in the United States (n = 3,218). Adult men and women completed an online questionnaire assessing sexual behaviors and whether each counted as having had sex. With the exception of anal intercourse, there was high variation in whether a behavior was labeled having had sex. There was not consensus on which anal sexual behaviors constituted having had sex, with attitudes varying across age, gender, and behavioral experience. Those who were older, male, and had the specific behavioral experience were more likely to label it as having had sex. Behaviorally specific assessments of the various anal behaviors as part of the sexual repertoire is critical to more accurate evaluation of sexual histories and assessment of risks to sexual health.     

Men's Sexual and Relational Adaptations to Erectile Dysfunction After Prostate Cancer Treatment

This study investigated how men adapt to erectile dysfunction and other sexual side-effects of prostate cancer treatment. The study recruited nonheterosexual and heterosexual men using an anonymous, international, online survey (N = 558). This article focuses on a qualitative analysis of answers (n = 348) to one open-ended question on sexual practices after treatment. Five themes emerged: (a) recovery of erectile function; (b) reframing sexual practices; (c) the importance of partners; (d) exploring anal sex; (e) the use of masturbation. The findings suggest that men should explore varied sexual options. Partners are also important in the overall recovery of men's sexual lives.     

Male Clients of Male Escorts: Satisfaction,Sexual Behavior,and Demographic Characteristics

Few studies have examined male clients who pay for sex with male escorts. In 2012, clients (n = 495) completed an online survey about their most recent hire. Most clients were White/Caucasian (87.7%), HIV negative (89.5%), employed full time (71.1%), single (58.6%), with a mean age of 54. Three-quarters of clients were gay identified, 18% bisexual, and 4% heterosexual. The median rate paid to escorts was $250 per hour with a modal appointment time of 1 to 2 hours (41.6%). Oral sex was common (80% gave, 69% received), 30% reported anal insertive sex, and 34% reported anal receptive sex. In total, few (12%) reported unprotected anal sex. Satisfaction with encounters was high. Receptive unprotected anal intercourse was associated with greater satisfaction in bivariate analyses but not in multivariable analyses. In a multivariable model, having receptive anal sex (whether protected or not) and rating the financial cost of the encounter as “worth it” were significantly associated with greater satisfaction. This study contributes to a scarce literature regarding clients of male sex workers and, in particular, provides information on the characteristics of men hiring men for sexual services, behavioral event-level data about their encounters, and analysis of factors directly associated with client satisfaction.     

Heterosexual Anal Intercourse among Men in Long Beach,California

Anal intercourse poses a greater risk for human immunodeficiency virus (HIV) transmission than vaginal intercourse, and in recent years there has been a growing understanding that heterosexual anal intercourse (HAI) is not uncommon. However, the majority of the anal intercourse literature has focused on men who have sex with men. The little research on HAI has mostly looked at women, with limited work among men. This analysis examined the association between HAI and high-risk behaviors (N = 1,622) and sexual sensation seeking (N = 239) in a sample of men recruited from 2001 to 2012 in Long Beach, California. Almost half of the sample was non-Hispanic Black. The median age was 42 years, 42% were homeless, and 20% reported recent HAI. Men who reported HAI were likely to be Hispanic, were likely to be homeless, had a male partner, engaged in sex exchange, and used cocaine or amphetamines during sex. Men who reported HAI scored higher on the Sexual Sensation Seeking scale. This research supports other work showing the relationship between HAI and high-risk behaviors. More important, it contributes new knowledge by demonstrating the association between HAI and sexual sensation seeking. This research highlights the importance of personality traits when trying to understand sexual behavior and when developing HIV prevention interventions.     

Automatic Sex-Liking and Sex-Failure Associations in Men With Sexual Dysfunction

Current models of sexual functioning imply an important role for both automatic and controlled appraisals. Accordingly, it can be hypothesized that erectile dysfunction may be due to the automatic activation of negative appraisals at the prospect of sexual intercourse. However, previous research showed that men with sexual dysfunction exhibited relatively strong automatic sex-positive instead of sex-negative associations. This study tested the robustness of this unexpected finding and, additionally, examined the hypothesis that perhaps more specific sex-failure versus sex-success associations are relevant in explaining sexual dysfunction and distress. Male urological patients (N = 70), varying in level of sexual functioning and distress, performed two Single-Target Implicit Association Tests (ST-IATs) to assess automatic associations of visual erotic stimuli with attributes representing affective valence (“liking”; positive versus negative) and sexual success versus sexual failure. Consistent with the earlier findings, the lower the scores on sexual functioning, the stronger the automatic sex-positive associations. This association was independent of explicit associations and most prominent in the younger age group. Automatic sex-positive and sex-failure associations showed independent relationships with sexual distress. The relationship between sexual distress and sex-failure associations is consistent with the view that automatic associations with failure may contribute to sexual distress.     

Only Bad for Believers? Religion,Pornography Use,and Sexual Satisfaction Among American Men

Research has often demonstrated a negative association between pornography use and various intrapersonal and relationship outcomes, particularly for men. Several recent studies, however, have suggested that the negative association between pornography use and these indicators is stronger among more religious Americans, suggesting that moral incongruence (engaging in an activity that violates one’s sacred values) and the attendant shame or cognitive dissonance, rather than pornography use per se, may be the primary factor at work. The current study tested and extended this theory by examining how religion potentially moderates the link between pornography use and sexual satisfaction in a national random sample of American adults (N = 1,501). Analyses demonstrated that while pornography use was negatively associated with sexual satisfaction for American men (not women), among men who rarely attended religious services or held a low opinion of the Bible this negative association essentially disappeared. Conversely, the negative association between frequency of pornography consumption and sexual satisfaction was more pronounced for men with stronger ties to conventional religion. These findings suggest that the connection between pornography use and sexual satisfaction, especially for men, depends largely on what viewing pornography means to consumers and their moral community and less so on the practice itself.