Under Pressure: Men's and Women's Sexual Performance Anxiety in the Sexual Interactions of Adult Couples.

Most research on sexual performance anxiety has focused on men's experiences and links to erectile functioning and premature ejaculation, with little research attention given to women's experiences or to relationship dynamics. At times, sexual performance anxiety has been examined in the context of dysfunction, but rarely as a focus in its own right. Study 1 asked 51 participants reporting sexual performance anxiety to describe the cognitive and affective components of their experiences, coping strategies, and perceived impact on their relationship using open-ended responses from online surveys. Through directed content analysis, Study 1 revealed that men and women experience a range of cognitive and affective processes with predominant feelings of inadequacy, and overall promoting more approach coping strategies. Study 2 used quantitative surveys to examine whether sexual performance anxiety was associated with higher sexual distress and lower sexual and relationship satisfaction in a sample of 228 community-based couples. Guided by the Actor-Partner Interdependence Model, multilevel modeling analyses indicated that higher sexual performance anxiety was linked to higher sexual distress and lower sexual and relationship satisfaction in both individuals and their partners. This work advances knowledge of sexual performance anxiety to women's experiences, not just men's, and to couples' experiences. Effective treatment for those suffering from this anxiety may incorporate education around sexual beliefs and expectations.

It's Just a Little Crush: Attraction to an Alternative and Romantic Relationship Quality, Breakups and Infidelity.

Over the course of an intimate relationship, individuals will frequently encounter potential alternative partners and may in fact develop romantic or sexual attraction to them. It is unclear when a more distal attraction to a potential alternative (a "crush") is associated with impaired relationship quality to one's primary relationship. A growing body of work indicates that crushes are common among those in established, ostensibly monogamous relationships. Yet such attractions likely constitute a starting point for establishing new relationships, including through infidelity. This study was designed to help clarify whether and how extradyadic attraction is linked to compromised relationship quality for a primary relationship, infidelity, and breakup. Participants were 542 adults (22-35 years) in exclusive intimate relationships of at least three months' duration who reported an attraction toward a potential alternative. They were recruited online from crowdsourcing websites and social media to complete two surveys, four months apart. Path analyses indicated that greater attraction intensity was linked to lower relationship quality in one's primary relationship. Overall, few participants became romantically or sexually involved with their crush over the course of the study. However, lower relationship quality was linked to desire to engage in infidelity and primary relationship breakup four months later. Findings are discussed in terms of implications for other researchers examining maintenance of intimate relationships, educators who teach about attraction processes, as well as counselors supporting couples in distress.

How Does Sexual Subjectivity Vary on the Basis of Gender and Sexual Orientation? Validation of the Short Sexual Subjectivity Inventory (SSSI-11) in Cisgender, Heterosexual and Sexual and Gender Minority Adolescents.

Through sexual exploration, adolescents learn that they are sexual beings with choices, desires, and are deserving of pleasure, which corresponds to sexual subjectivity. However, the two measures of this construct (i.e., Female Sexual Subjectivity Inventory and Male Sexual Subjectivity Inventory) have not been validated with younger adolescents and have different items for boys and girls (with no scale available for gender diverse individuals), limiting gender comparisons. This study examined (1) the factor structure of the adapted Short Sexual Subjectivity Inventory-11 items (SSSI-11) in a large sample of young cisgender, heterosexual and sexual and gender minority adolescents, (2) measurement invariance across language (English and French), gender, and sexual orientation, (3) validity with sexuality-related outcomes, and (4) one-year temporal stability. Results of a confirmatory factor analysis among 2001 adolescents (Mage = 15.5 years, SD = 0.60) revealed a multidimensional factor structure. The SSSI-11, in both English and French, showed adequate reliability and one-year temporal stability, and was invariant across genders, sexual orientations, and languages. Girls had lower scores on the entitlement to self-pleasure and self-efficacy in achieving pleasure factors, and higher scores on the entitlement to pleasure from a partner factor. No significant differences were observed on the basis of language or between heterosexual and sexual minority adolescents. The SSSI-11 correlated positively with sexuality-related variables. Findings support the strong psychometric properties of the SSSI-11, rendering it of considerable use in clinical, education, and research applications.

"I Was Worshiped and in Control": Sugar Arrangements Involving Transactional Sex from the Perspective of Both Sugar Babies and Sugar Benefactors.

Sugar dating arrangements involve an older partner ("sugar daddy/mommy") who provides financial support to a younger partner ("sugar baby") in exchange for intimacy. The current study recruited a U.S. and Canadian sample of sugar babies (n = 45) and sugar benefactors (n = 32) through social media sources to survey them about perceived power in their sugar arrangement, gender roles, and stigma. Sugar benefactors did not differ in perceived power from sugar babies, nor in endorsement of traditional gender roles or stigma. Directed content analysis analyzing open-ended responses about associated outcomes indicated that both partners placed strong emphasis on companionship despite the importance of sex within arrangements. Sugar babies reported that money drives participation, although arrangements fulfill other needs, such as pleasure. Other benefits include having an arrangement with clear boundaries and expectations. Disadvantages include concerns for safety, that being physical safety for babies, and reputation and being used for money for daddies. Notably, both groups perceived sugar babies as having equal or more power than sugar benefactors, although this was often attributed to sugar babies' attractiveness and youth. Findings include insights from both babies and benefactors, and support perspectives that sugar dating is distinct from traditional sex work.

Anxiety Sensitivity in the Sexual Context: Links between Sexual Anxiety Sensitivity and Sexual Well-Being.

Anxiety sensitivity, the fear of physiological arousal sensations, has been linked to lower sexual frequency, poorer sexual function, and greater sexual anxiety. The current study assessed whether anxiety sensitivity specific to the sexual context, termed sexual anxiety sensitivity, was linked to a wide range of indicators of sexual well-being over and above associations accounted for by general anxiety sensitivity. As a first step, we developed the Sexual Anxiety Sensitivity Inventory (SASI). Participants were 484 adults aged 19 to 60 years old who completed an on-line survey. To develop the SASI, we constructed parallel items to those on the Anxiety Sensitivity Scale-3 (ASI-3; Taylor et al., 2007). The SASI demonstrated the same three-factor structure as the ASI-3 and showed high internal consistency providing evidence for its reliability. As predicted, sexual anxiety sensitivity was significantly associated with all ten of the markers of the behavioral, cognitive-affective, and functional domains of sexual well-being assessed and six of these associations remained significant after controlling for general anxiety sensitivity. The results provide evidence that sexual anxiety sensitivity is an important construct for understanding individuals' sexual well-being and provide initial evidence that the specificity of the SASI has value as a reliable and valid measure for assessing sex-related anxiety sensitivity. Implications for clinicians and researchers are discussed.

Romanticizing the Stolen Kiss: Men's and Women's Reports of Nonconsensual Kisses and Perceptions of Impact on the Targets of Those Kisses.

Stolen kisses are often portrayed as resulting from uncontrollable passion and a need to connect intimately with another. This study examined stolen kisses, defined as kissing someone for the first time when the kisser perceived the kiss recipient was not expecting it, and had not provided consent for the kiss. These kisses were examined from the perspective of the individual initiating the kiss. Participants (N = 130; Mage = 32.27; 67% identified as male) completed an anonymous online survey assessing kissing experiences of having stolen a kiss and their open-ended responses were analyzed here. Men were more likely than women to report having stolen a kiss in line with traditional heterosexual scripts. Three scenarios emerged through content analysis: mutual attraction leading to a new relationship; no known mutual attraction but a positive outcome; and no known mutual attraction and a negative outcome. Stealing a kiss from someone for whom there was mutual attraction often led to the onset of an intimate relationship; thus, the kiss constituted a relationship catalyst. When there was no known shared attraction, some interactions ended positively, but others resulted in an end to cordial relations and often strong negative reactions. Findings are discussed in terms of the limited literature on kissing generally and the nonconsensual nature of these events.

Sexual Concurrency Among Adolescent Women With Multiple Partners: A Daily Diary Study.

PURPOSE: Sexual partnerships that overlap in some period of time (i.e., concurrent) are a key factor in sexually transmitted infection (STI) transmission. Research examining concurrency among adolescents typically uses person-level, cross-sectional, and/or retrospective data, obscuring factors that manifest on any given occasion of concurrency. We used sexual diaries to examine: (1) daily prevalence of vaginal sex concurrency when two partners are reported by adolescent women; and (2) individual, relational, and behavioral attributes that impact the likelihood of sex with neither partner, with one partner or the other, or with both partners on any given day. METHODS: Daily diaries were drawn from a large longitudinal cohort study examining sexual relationships, behaviors, and STIs among adolescent women. Participants contributed 280,844 partner-associated diary entries, of which (27.9%; n = 78,356) indicated multiple partners. All two-partner diary entries were retained for analysis (N = 323; Mage = 17.55; 90% African American). Random intercept mixed-effects multinomial logistic regression was used to evaluate the impact of predictor variables on odds of having sex with one or the other, both, or neither partner. RESULTS: Most two-partner days (93.5%) involved no sex with either partner. Few reports (.2%) indicated same-day sexual concurrency. Older age, greater partner support, and higher sexual interest increased the likelihood of sex with both partners on the same day. CONCLUSIONS: Individual, relational, and behavioral factors predict concurrency in ways that challenge assumptions that secondary partnerships constitute negligible relationships. Programs targeting partner concurrency in adolescents may find success tailoring messaging around these findings.

Individual and Relationship Predictors of Trajectories of Sexual Function across Adolescent and Young Adult Relationships.

Many young adults report poor sexual function, but research typically fails to consider relationship context and how problems might evolve over time. Research is needed to provide insights into how sexual problems are experienced across relationships, as well as the types of sexual function problems associated with various trajectories. We investigated retrospective trajectories of sexual problems across the multiple relationships of 688 young adults (18-24 years) as well as the individual and relationship factors associated with these trajectories. Both persistent suboptimal and optimal trajectories emerged for men and women. However, persistent and variable problematic function trajectories also emerged for women (and not men). Across all individual and relationship factors analyzed, multivariate multinomial regression analysis indicated that higher sexual esteem and more traditional gender beliefs best predicted membership in trajectories capturing better sexual function. Implications are discussed in terms of the need to provide substantive information regarding sexual function to young people as they transition to adulthood.

Perhaps It Was Too Soon: College Students' Reflections on the Timing of Their Sexual Debut.

Early sexual debut has been a focus of social scientific research due to its association with adverse circumstances and negative outcomes. However, there has been a recent shift to considering not only chronological age, but also the degree to which the event is viewed to be optimally timed (i.e., the perception that it occurred at the "right time" versus too soon). The purpose of this study was to assess how individual/family background variables and contextual aspects of the experience (including partner and relationship aspects) are associated with both the actual age at sexual debut and the perceived acceptability of the timing of the event. Using data collected from students at a U.S. university between 1990 and 2019 (N = 6,430), several factors (in addition to chronological age) were associated with the perceived acceptability of the timing of sexual debut. Strong gender differences were found - women perceived their timing to be less acceptable, even though they did not differ from men in actual age at sexual debut. Other robust predictors of perceived acceptability included (lower) religious involvement and recalling desire (for the experience), pleasure, and lower guilt at the time. Only slight changes occurred over the 30-year period in age at sexual debut and perceived acceptability of the timing. Suggestions for future research are provided and implications for sex education/sexual health interventions are discussed.

Bullying Victimization and Sexual Wellbeing in Sexually Active Heterosexual, Cisgender and Sexual/Gender Minority Adolescents: The Mediating Role of Emotion Regulation.

Bullying victimization is prevalent in adolescence and associated with adverse consequences on physical and psychological wellbeing, paricularly in sexual and gender minority youth. However, little is known about its associations with sexual wellbeing and the underlying mechanisms that could explain this association. The present study assessed the associations between bullying victimization and sexual wellbeing (sexual satisfaction, sexual desire/arousal and orgasmic function difficulties, sexual distress) via the mediating role of emotion regulation difficulties, considering potential sexual/gender minority status-based differences. Self-report online surveys were completed by 1036 sexually active (49.7% were girls) high school students (Mage = 14.6 years, SDage = 0.6). Bullying victimization was directly and negatively associated with sexual desire/arousal difficulties and positively with sexual distress. Higher emotion regulation difficulties mediated the associations between higher bullying victimization and higher orgasmic function difficulties, as well as higher bullying victimization and higher sexual distress. No significant association was observed between bullying victimization and sexual satisfaction. No significant differences were observed between heterosexual, cisgender and sexual and gender minority youth in any of the associations. The findings suggest that bullying victimization is associated with adolescents' sexual wellbeing. The cross-sectional design and small effect sizes support the need for further prospective cohort studies.

What is sexual wellbeing and why does it matter for public health?

Sexual health has provided a guiding framework for addressing sexuality in public health for several decades. Although the WHO definition of sexual health is revolutionary in acknowledging positive sexuality, public health approaches remain focused on risk and adverse outcomes. The long-standing conflation of sexual health and sexual wellbeing has affected our ability to address everyday sexual issues. This Viewpoint provides a way forward to resolve this impasse. We propose sexual wellbeing as a distinct and revolutionary concept that can be operationalised as a seven-domain model. We situate sexual wellbeing alongside sexual health, sexual justice, and sexual pleasure as one of four pillars of public health enquiry. We argue that sexual wellbeing is imperative to public health as a marker of health equity, a meaningful population indicator of wellbeing, a means to capture population trends distinct from sexual health, and an opportunity to refocus the ethics, form, and practices of public health.

Predictors of antiretroviral therapy initiation in eThekwini (Durban), South Africa: Findings from a prospective cohort study.

Despite expanded antiretroviral therapy (ART) eligibility in South Africa, many people diagnosed with HIV do not initiate ART promptly, yet understanding of the reasons is limited. Using data from an 8-month prospective cohort interview study of women and men newly-diagnosed with HIV in three public-sector primary care clinics in the eThekwini (Durban) region, South Africa, 2010-2014, we examined if theoretically-relevant social-structural, social-cognitive, psychosocial, and health status indicators were associated with time to ART initiation. Of 459 diagnosed, 350 returned to the clinic for their CD4+ test results (linkage); 153 (33.3%) were ART-eligible according to treatment criteria at the time; 115 (75.2% of those eligible) initiated ART (median = 12.86 weeks [95% CI: 9.75, 15.97] after linkage). In adjusted Cox proportional hazard models, internalized stigma was associated with a 65% decrease in the rate of ART initiation (Adjusted hazard ratio [AHR] 0.35, 95% CI: 0.19-0.80) during the period less than four weeks after linkage to care, but not four or more weeks after linkage to care, suggesting that stigma-reduction interventions implemented shortly after diagnosis may accelerate ART uptake. As reported by others, older age was associated with more rapid ART initiation (AHR for 1-year age increase: 1.04, 95% CI: 1.01-1.07) and higher CD4+ cell count (≥300µL vs. <150µL) was associated with a lower rate of initiation (AHR 0.38, 95% CI: 0.19-0.80). Several other factors that were assessed prior to diagnosis, including stronger belief in traditional medicine, higher endorsement of stigma toward people living with HIV, food insecurity, and higher psychological distress, were found to be in the expected direction of association with ART initiation, but confidence intervals were wide and could not exclude a null finding.

Linkage to Care Following an HIV Diagnosis in Three Public Sector Clinics in eThekwini (Durban), South Africa: Findings from a Prospective Cohort Study.

Linkage to care following an HIV diagnosis remains an important HIV care continuum milestone, even in the era of universal ART eligibility. In an 8-month prospective cohort study among 459 (309 women, 150 men) newly-diagnosed HIV-positive individuals in three public-sector clinics in Durban metropolitan region, South Africa, from 2010 to 2013, median time to return to clinic for CD4+ results (linkage) was 10.71 weeks (95% CI 8.52-12.91), with 54.1% 3-month cumulative incidence of linkage. At study completion (9.23 months median follow-up), 26.2% had not linked. Holding more positive outcome-beliefs about enrolling in care was associated with more rapid linkage [adjusted hazard ratio (AHR)each additional belief 1.31; 95% CI 1.05-1.64] and lower odds of never linking [adjusted odds ratio (AOR) 0.50; 95% CI 0.33-0.75]. Holding positive ARV beliefs was strongly protective against never linking to care. Age over 30 years (AHR 1.59; 95% CI 1.29-1.97) and disclosing one's HIV-positive status within 30 days of diagnosis (AHR 1.52; 95% CI 1.10-2.10) were associated with higher linkage rates and lower odds of never linking. Gender was not associated with linkage and did not alter the effect of other predictors. Although expanded access to ART has reduced some linkage barriers, these findings demonstrate that people's beliefs and social relations also matter. In addition to structural interventions, consistent ART education and disclosure support, and targeting younger individuals for linkage are high priorities.

Once a Poacher Always a Poacher? Mate Poaching History and its Association with Relationship Quality.

Successful mate poaching is a form of infidelity that occurs when one partner knowingly attracts the mate of another with the intention of starting a sexual and/or romantic relationship with this individual. Relationships formed from poaching tend to be of lower quality than their non-poached counterparts. A history of poaching might reflect a sociosexuality that propels seeking new partnerships without regard for exclusivity. It is unknown whether serial poaching for relationship formation is linked to more permissive sociosexual orientation. Adults (N = 653; aged 25-40; 57% women) in a romantic relationship completed online surveys assessing mate poaching, poaching history, sociosexuality, and relationship quality (commitment, satisfaction, trust, jealousy). Those in a poached relationship at the time of the study had a more extensive history of poached relationships and a more permissive sociosexuality. Participants who reported a more extensive history of mate poaching reported poorer quality relationships. The link between poaching history and relationship quality was partially accounted for by sociosexuality. This research adds to our understanding of difficulties that may be associated with the relationships of individuals who use poaching as a relationship initiation strategy, and the challenges that permissive sociosexuality may present for maintaining long-term relationships.

Walk the Line: How Successful Are Efforts to Maintain Monogamy in Intimate Relationships?

Monogamy, typically defined as sexual and romantic exclusivity to one partner, is a near-universal expectation in committed intimate relationships in Western societies. Attractive alternative partners are a common threat to monogamous relationships. However, little is known about how individuals strive to protect their relationships from tempting alternatives, particularly those embedded in one's social network. The current exploratory study was guided by the Investment Model, which states that satisfaction, investments, and perceived alternatives to a relationship predict commitment, which in turn predicts relationship longevity. The study aimed to identify relationship and extradyadic attraction characteristics associated with monogamy maintenance efforts, specifically relationship commitment, as predicted by the Investment Model. The efficacy of monogamy maintenance efforts was assessed via sexual and emotional infidelity measures at a 2-month follow-up. U.S. adults in heterosexual intimate relationships (N = 287; 50.2% male; M age = 34.5 years; M relationship length = 87 months) were recruited online to complete the survey study. Through structural equation modelling, the Investment Model structure was replicated, and relationship commitment predicted use of relationship-enhancing efforts as well as self-monitoring/derogation efforts. Individuals who experienced reciprocated attraction used significantly more avoidance and self-monitoring/derogation efforts than did those who experienced unreciprocated attraction. Ultimately, monogamy maintenance efforts did not significantly predict success in maintaining monogamy at follow-up. These findings have important research, educational, and clinical implications relating to relationship longevity.

Plenty of Fish in the Ocean: How do Traits Reflecting Resiliency Moderate Adjustment After Experiencing a Romantic Breakup in Emerging Adulthood?

Breakups are common but often one of the most distressing experiences that young people can have. Poor adjustment to relationship loss is linked to depressive symptoms and rumination. This study assessed traits that reflect resiliency and that might comprise protective factors that ameliorate depressive symptoms and rumination. Online survey participants included 866 male and female late adolescents (18-22 years; Mean age = 20.7; 62% female; 82% White/Caucasian; 7% Asian/Southeast Asian; 6% Black/African American) who recently had experienced the breakup of a romantic relationship. Analyses assessed whether optimism, grit, and self-esteem moderated the breakup-adjustment relationship. After controlling for gender and current relationship status, higher optimism, self-esteem, and grit were expected to be associated with lower levels of depressive symptoms and rumination for those who had experienced a breakup in the three months prior to the study, and for the most part, these predictions were confirmed. These findings can be reinforced in education and counseling programs to better support individuals suffering the aftermath of a breakup. The findings add to the literature on adolescents' development of interpersonal functioning and skills required in intimate relationships.

From Promoting Healthy Sexual Functioning to Managing Biomedical Sexual Dysfunction: Health Professional Views of Youth Sexual Health.

A body of work emerging in the last few years has expanded the focus of youth sexual health to include problems in sexual functioning. Recent surveys show that rates of youth sexual functioning problems are similar to those of adults. Physicians' lack of awareness about problems of sexual functioning has been identified as a major obstacle in treatment. Yet little is known about health-care provider (HCP) perspectives on youth sexual functioning. We conducted a descriptive qualitative study with HCPs to learn about their perceptions of adolescent sexual problems and HCP roles in managing these issues including sexual functioning. Nineteen HCPs: Family physicians, nurse practitioners, and public health nurses working primarily with youth in universities, schools, or sexual health clinics were recruited to draw on their expert knowledge and experience. All completed in-depth individual interviews. Data were analyzed using directed qualitative content analysis. Our findings illuminate inconsistent views. Some HCPs, particularly those in youth-focused services, adopt a holistic role in promoting healthy sexual functioning, and others, commonly those in general practice, attend only to biomedical issues related to sexual dysfunction. All HCPs in our study were challenged by a paucity of sexual health preparation in their formal education. HCP interest in youth sexual health affected their efforts to acquire new information and training and, along with the structure of their practice setting, influenced whether they framed their role in youth sexual health holistically within a context of social determination or constrained their role to a medical model. These findings draw attention to the need for new approaches for strengthening knowledge, training, and resources to foster HCP promotion of healthy sexual functioning and prevention of lifelong sexual health problems.

Figuring It Out: How Late Adolescent and Young Adult Men and Women Perceive and Address Problems in Sexual Functioning.

Although there are high rates of sexual problems and sexual dysfunction in adulthood (Mitchell et al., 2013), little is known about the circumstances under which problems are first experienced. A growing body of research addresses prevalence of problems in sexual functioning among adolescents and young adults, yet little is known about the meanings that young people give to these experiences or how they deal with them. We used content analysis of qualitative interviews with 53 heterosexual, sexually active Canadian adolescents (ages 18 to 21) to explore their perceptions of the sexual problems in functioning they had experienced and the strategies (if any) they used to address them over time. Problems among most young people originated early in their partnered sexual life. Figuring it out emerged as an intentional process directed toward improving sexual experiences, although certainly not all young people were successful. Strategies for figuring it out included informational or material help seeking, experimentation to inform future actions, mutual sharing and problem solving, and building emotional connection to improve sexual functioning. Implications for understanding the development of sexual dysfunctions in adulthood are discussed.

The Relationship Among Online Sexually Explicit Material Exposure to, Desire for, and Participation in Rough Sex.

The broad accessibility of online sexually explicit material (SEM) exposes viewers to a wide scope of sexual behaviors. Social concern tends to be heightened over SEM that incorporates highly graphic, "rough" sex. This study assessed the associations among exposure to rough sex in SEM, desire for rough sex, and participation in rough sex while accounting for gender, sexual orientation, and perceived realism of SEM. Young adults (N = 327; ages 19-30; 50.8% men) were recruited through a crowdsourcing website. They completed an anonymous online survey that assessed viewing frequency for a range of sexual behaviors in SEM, the perceived realism of SEM, desire to participate in the behaviors viewed, and if they had ever participated in those behaviors. Hair pulling, spanking, scratching, biting, bondage, fisting, and double penetration were used to create the variable of rough sex. Rough sex desire and participation were common among individuals who have been exposed to rough sex in SEM, with 91.4% desiring to engage in 1 + behaviors at least to a small degree and 81.7% having engaged in 1 + behaviors. Exposure to rough sex in SEM was positively associated with desire for and participation in rough sex, emphasizing the need to ensure that individuals can distinguish between consensual rough sex and sexual violence. This study did not parse out causal effects or directionality, but did provide some insights into the interrelatedness of viewing, desiring, and participating in rough sex.