Early adversity and sexual diversity: the importance of self-reported and neurobiological sexual reward sensitivity.

Work shows that sexually-diverse individuals face high rates of early life adversity and in turn increased engagement in behavioral outcomes traditionally associated with adversity, such as sexual risk taking. Recent theoretical work suggests that these associations may be attributable to heightened sexual reward sensitivity among adversity-exposed women. We aimed to test these claims using a combination of self-report and EEG measures to test the relationship between early adversity, sexual reward sensitivity (both self-reported and EEG measured) and sexual risk taking in a sexually diverse sample of cis-gender women (N = 208) (Mage = 27.17, SD = 6.36). Results showed that childhood SES predicted self-reported sexual reward sensitivity which in turn predicted numbers of male and female sexual partners. In contrast we found that perceived childhood unpredictability predicted neurobiological sexual reward sensitivity as measured by EEG which in turn predicted male sexual partner number. The results presented here provide support for the notion that heightened sexual reward sensitivity may be a pathway through which early life adversity augments future sexual behavior, and underscores the importance of including greater attention to the dynamics of pleasure and reward in sexual health promotion.

Associations Between Childhood Victimization, Adult Victimization, and Physical Health Among Sexually Diverse Adults at Different Stages of Life.

Purpose: Research examining health disparities in sexually diverse populations is quite variable. The purpose of the present article was to shed light on the conflicting findings pertaining to minority stress and health by examining the potential impact of age, childhood victimization, and different measurements of health. Methods: The present research used data from the Generations Study, a questionnaire study of sexually diverse adults (ages 18-60) surveyed between 2016 and 2019. We modeled direct and indirect links among (1) childhood exposure to physical or sexual abuse, (2) adult exposure to victimization or harassment, and (3) adult physical health status, assessed both subjectively and objectively. Participants were 1398 sexually diverse adults (e.g., lesbian, gay, bisexual); the present work only utilizes wave one of the data collected in 2016. Results: We found that both childhood abuse and adult harassment/victimization predicted sexually diverse adults' health status, but these associations only manifested as diagnosable disease outcomes among adults over 50. Associations between childhood abuse and adult health were partly attributable to the fact that abuse-exposed children were disproportionately exposed to harassment and victimization as adults. Conclusion: Our research makes a novel contribution to our understanding of the health effects of stigma by pinpointing the multiple, cascading pathways through which adversity relates to health.

Rethinking minority stress: A social safety perspective on the health effects of stigma in sexually-diverse and gender-diverse populations.

For over two decades, the minority stress model has guided research on the health of sexually-diverse individuals (those who are not exclusively heterosexual) and gender-diverse individuals (those whose gender identity/expression differs from their birth-assigned sex/gender). According to this model, the cumulative stress caused by stigma and social marginalization fosters stress-related health problems. Yet studies linking minority stress to physical health outcomes have yielded mixed results, suggesting that something is missing from our understanding of stigma and health. Social safety may be the missing piece. Social safety refers to reliable social connection, inclusion, and protection, which are core human needs that are imperiled by stigma. The absence of social safety is just as health-consequential for stigmatized individuals as the presence of minority stress, because the chronic threat-vigilance fostered by insufficient safety has negative long-term effects on cognitive, emotional, and immunological functioning, even when exposure to minority stress is low. We argue that insufficient social safety is a primary cause of stigma-related health disparities and a key target for intervention.

Menstrual Cycle Changes in Daily Sexual Motivation and Behavior Among Sexually Diverse Cisgender Women.

We used a one-month daily diary assessment to measure menstrual cycle-related changes in same-gender and other-gender sexual motivation and behavior in 148 cisgender women (32% lesbian-identified, 35% bisexually identified, and 33% heterosexual-identified). Women with exclusive same-gender orientations reported increased motivation for same-gender sexual contact during the higher-fertility phase of the cycle, but women with exclusive other-gender orientations did not show a parallel increase in other-gender sexual motivation during the higher-fertility phase. Bisexually attracted women showed no phase-related changes in same-gender or other-gender sexual motivation, regardless of whether they generally preferred one gender versus the other. Rates of partnered sexual contact did not increase during the higher-fertility phase. During the 14 midcycle days during which we assayed salivary estrogen and testosterone, we found no significant associations between daily hormones and sexual motivation. However, daily estrogen levels were positively related to sexual behavior among women currently partnered with women, and negatively related to sexual behavior among women currently partnered with men. Our results suggest that traditional evolutionary models of menstrual cycle-related changes in sexual motivation do not adequately reflect the full range of cycle-related changes observed among sexually diverse women.

Understanding the Link Between Adolescent Same-Gender Contact and Unintended Pregnancy: The Role of Early Adversity and Sexual Risk Behavior.

Past research suggests an apparent paradox: Women who engage in same-gender sexual behavior show higher rates of unintended pregnancy than women with exclusive other-gender sexual behavior. Such women also have disproportionate rates of early adversity (both harshness, such as abuse or neglect, and unpredictability, such as father absence). We used the Add Health data (N = 5,617 cisgender women) to examine the relative contributions of early adversity, adolescent same-gender sexual behavior, and general sexual risk behavior to women's risks for adult unintended pregnancy. Women who engaged in adolescent same-gender sexual behavior were more likely to report childhood adversity, and both childhood adversity and adolescent same-gender behavior made independent contributions to subsequent rates of unintended pregnancy. The association between adolescent same-gender sexual behavior and adult unintended pregnancy was partially attributable to the fact that women with adolescent same-gender sexual behavior engaged in greater sexual risk behavior more broadly. These findings suggest that same-gender sexual behavior in adolescence may relate to a broader set of sexual risk behaviors that augment future risk for unintended pregnancy, independent of sexual identity. We draw on life history theory to explain this pattern of results and suggest directions for future research.

Systemic inflammation as a driver of health disparities among sexually-diverse and gender-diverse individuals.

Sexually-diverse individuals (those who seek sexual or romantic relationships with the same and/or multiple genders) and gender-diverse individuals (those whose gender identity and/or expression differs from their birth-assigned sex/gender) have disproportionately high physical health problems, but the underlying biological causes for these health disparities remain unclear. Building on the minority stress model linking social stigmatization to health outcomes, we argue that systemic inflammation (the body's primary response to both physical and psychological threats, indicated by inflammatory markers such as C-reactive protein and proinflammatory cytokines) is a primary biobehavioral pathway linking sexual and gender stigma to physical health outcomes. Expectations and experiences of social threat (i.e., rejection, shame, and isolation) are widespread and chronic among sexually-diverse and gender-diverse individuals, and social threats are particularly potent drivers of inflammation. We review research suggesting that framing "minority stress" in terms of social safety versus threat, and attending specifically to the inflammatory consequences of these experiences, can advance our understanding of the biobehavioral consequences of sexual and gender stigma and can promote the development of health promoting interventions for this population.

The New Genetic Evidence on Same-Gender Sexuality: Implications for Sexual Fluidity and Multiple Forms of Sexual Diversity.

In September of 2019, the largest-ever (N = 477,522) genome-wide-association study of same-gender sexuality was published in Science. The primary finding was that multiple genes are significantly associated with ever engaging in same-gender sexual behavior, accounting for between 8-25% of variance in this outcome. Yet an additional finding of this study, which received less attention, has more potential to transform our current understanding of same-gender sexuality: Specifically, the genes associated with ever engaging in same-gender sexual behavior differed from the genes associated with one's relative proportion of same-gender to other-gender behavior. I review recent research on sexual orientation and sexual fluidity to illustrate how these findings speak to longstanding questions regarding distinctions among subtypes of same-gender sexuality (such as mostly-heterosexuality, bisexuality, and exclusive same-gender experience). I conclude by outlining directions for future research on the multiple causes and correlates of same-gender expression.

The Health Benefits of Sexual Expression.

Objective: Sexual activity is a fundamental human function with short-term and long-term emotional, social, and physical benefits. Yet within healthcare, sexuality has been marginalized and many HCPs are unaware of its beneficial implications for immediate and long-term health. Methods: To challenge this assumption we combined the data that already had been collected by the authors with an extensive search of articles on the various health benefits of sexual activity. The results of this process are displayed according to short-term, intermediate-term, and long-term benefits with some explanation about potential causal relationships. Results: For the time being, it cannot yet be proved that "good sex promotes good health" since good health also favors good sex. Conclusions: Despite lacking such convincing evidence, the article concludes with recommendations for the relevant professions. The balance of research supports that sexuality anyhow deserves greater attention among HCPs and that sexuality research needs better integration within health research.

Women's Cortisol Stress Responsivity, Sexual Arousability, and Sexual History.

Life history theory and the adaptive calibration model state that characteristics of one's early environment influence individual differences in both neuroendocrine reactivity to stress and sexual risk-taking behavior. However, few studies have directly examined the relationship between neuroendocrine reactivity to stress and risky sexual behavior. This study used multilevel modeling to test whether cortisol reactivity and recovery in response to laboratory stress were associated with women's history of sexual behavior and their sexual arousability in response to laboratory sexual stimuli. Participants were 65 women (35% heterosexual, 44% bisexual, and 21% lesbian) who completed two laboratory sessions, two weeks apart. Women's self-reported sexual arousability to sexual stimuli interacted with their sexual abuse history to predict their trajectories of cortisol stress reactivity and recovery. Cortisol reactivity and recovery were not associated with women's sexual risk taking, such as the age of sexual debut, sociosexuality, or lifetime number of sexual partners.

Racial/Ethnic Differences in Unwanted Pregnancy: Moderation by Sexual Orientation.

OBJECTIVE: To explore sexual orientation disparities in unwanted pregnancy by race/ethnicity. BACKGROUND: Previous research has documented that sexual-minority women (SMW) are more likely to report unplanned pregnancy than heterosexual women, and that Black and Latina women are more likely to report unplanned pregnancy than White women. No research has examined how pregnancy intention varies at the intersection of these two identities. METHOD: Data come from the pregnancy roster data in Waves IV and Wave V subsample in the National Longitudinal Study of Adolescent to Adult Health. We used pregnancy as the unit of analysis (n=10,845) and multilevel logistic regression models to account for clustering of pregnancies within women. Per pregnancy, women were asked if they "wanted" to be pregnant at the time of pregnancy. We conducted models stratified by race/ethnicity, as well as models stratified by sexual identity. RESULTS: Among White women, sexual-minority women were more likely to describe their pregnancy as unwanted than were their heterosexual counterparts. Conversely, among Black and Latina women, sexual-minority women were less likely to describe their pregnancy as unwanted than were their heterosexual counterparts. Results stratified by sexual identity underscore these contrasting patterns: Among heterosexual women, White women were less likely to describe their pregnancies as unwanted compared to Black and Latina women; among sexual-minority women, White women were more likely to describe their pregnancy as unwanted than were Black and Latina women. CONCLUSION: Traditional race/ethnicity trends in pregnancy intention (i.e., greater unwanted pregnancy among Black/Latina than White women) are reversed among sexual-minority women.

Who Counts as Sexually Fluid? Comparing Four Different Types of Sexual Fluidity in Women.

Previous research has examined the phenomenon of "sexual fluidity," but there is no current consensus on the specific meaning and operationalization of this construct. The present study used a sample of 76 women with diverse sexual orientations to compare four different types of sexual fluidity: (1) fluidity as overall erotic responsiveness to one's less-preferred gender, (2) fluidity as situational variability in erotic responsiveness to one's less-preferred gender, (3) fluidity as discrepancy between the gender patterning of sexual attractions and the gender patterning of sexual partnering, and (4) fluidity as instability in day-to-day attractions over time. We examined how these four types of fluidity relate to one another and to other features of women's sexual profiles (bisexual vs. exclusive patterns of attraction, sex drive, interest in uncommitted sex, age of sexual debut, and lifetime number of sexual partners). The four types of fluidity were not correlated with one another (with the exception of the first and fourth), and each showed a unique pattern of association with other features of women's sexual profiles. The only type of fluidity associated with bisexuality was overall erotic responsiveness to the less-preferred gender. The findings demonstrate that future research on sexual fluidity should distinguish between its different forms.

Corrigendum: Subjective and Oxytocinergic Responses to Mindfulness Are Associated With Subjective and Oxytocinergic Responses to Sexual Arousal.

[This corrects the article DOI: 10.3389/fpsyg.2019.01101.].

Subjective and Oxytocinergic Responses to Mindfulness Are Associated With Subjective and Oxytocinergic Responses to Sexual Arousal.

Mindfulness - the ability to pay attention, on purpose, without judgment, and in the present moment - has consistently been shown to enhance women's sexual arousal. As a first step toward understanding potential neuroendocrine underpinnings of mindfulness and sexual arousal, we examined whether individual differences in subjective and neuroendocrine (i.e., oxytocin) responses to mindful breathing were associated with individual differences in subjective and neuroendocrine responses to sexual arousal. To achieve this aim, 61 lesbian, bisexual, and heterosexual women completed a questionnaire assessing dispositional mindfulness, underwent an arousal task while continuously rating their sexual arousal and a mindful breathing task, after which participants reported on their ability to detect attentional shifts, and provided salivary samples after each assessment. Results indicated that women who were quicker to detect attentional shifts and women who reported greater sexual arousability reported larger changes (decreases) in oxytocin in response to mindful breathing and were the only women to report increases in oxytocin in response to the sexual arousal induction. Results further indicated that individuals who report greater subjective responsiveness to mindfulness and sexual arousal appear to have an oxytocinergic system that is also more responsive to both arousal and to mindfulness. These results make a significant contribution to our understanding of the role of attentional processes in sexual arousal, and warrant future examination of oxytocin as a potential neuroendocrine mechanism underlying the link between mindfulness and sexual arousal.

Associations between oxytocin and cortisol reactivity and recovery in response to psychological stress and sexual arousal.

Previous research suggests a dynamic regulatory relationship between oxytocin and cortisol, but the specific nature of this relationship and its context-specificity have not been fully specified. In the present study, we repeatedly assessed both salivary oxytocin and salivary cortisol during two experimental sessions (one inducing sexual arousal and one inducing psychological stress), conducted two weeks apart with the same group of 63 female participants. Baseline cortisol and baseline oxytocin were significantly correlated in both sessions. Cortisol levels showed significantly different patterns of change during the stress assessment than during the sexual arousal assessment, but oxytocin showed similar patterns of change across both assessments. Greater cortisol stress reactivity predicted higher oxytocin levels immediately after the stressor, but a different pattern emerged during the arousal assessment: Greater oxytocin arousal reactivity predicted attenuated post-arousal reductions in cortisol. For both cortisol and oxytocin, individual differences in women's reactivity to sexual arousal did not predict their reactivity to psychological stress. These findings contribute new insights regarding associations between cortisol and oxytocin reactivity and recovery in different psychological contexts.

Physical separation in adult attachment relationships.

Attachment theory suggests that at all stages of life, regular contact with attachment figures fosters a fundamental sense of safety and security. Yet an increasing number of romantic couples undergo prolonged physical separations from one another, rangingfrom several weeks to several years, and involving widely varying opportunities for communication and contact. This article reviews contemporary research on the implications of such separations for attachment-related dynamics, including relationship satisfaction and psychobiological attunement between partners. Recent technological innovations in computer-mediated contact (such as video calls and electronic messaging) and their capacity to `stand in' for direct physical contact are also discussed, along with directions for future research in the diverse psychobiological mechanisms underlying attachment formation and functioning at different stages of life and in different contexts.

Incorporating epigenetic mechanisms to advance fetal programming theories.

Decades of fetal programming research indicates that we may be able to map the origins of many physical, psychological, and medical variations and morbidities before the birth of the child. While great strides have been made in identifying associations between prenatal insults, such as undernutrition or psychosocial stress, and negative developmental outcomes, far less is known about how adaptive responses to adversity regulate the developing phenotype to match stressful conditions. As the application of epigenetic methods to human behavior has exploded in the last decade, research has begun to shed light on the role of epigenetic mechanisms in explaining how prenatal conditions shape later susceptibilities to mental and physical health problems. In this review, we describe and attempt to integrate two dominant fetal programming models: the cumulative stress model (a disease-focused approach) and the match-mismatch model (an evolutionary-developmental approach). In conjunction with biological sensitivity to context theory, we employ these two models to generate new hypotheses regarding epigenetic mechanisms through which prenatal and postnatal experiences program child stress reactivity and, in turn, promote development of adaptive versus maladaptive phenotypic outcomes. We conclude by outlining priority questions and future directions for the fetal programming field.

Heterogeneity in Gender/Sex Sexualities: An Exploration of Gendered Physical and Psychological Traits in Attractions to Women and Men.

Sexuality research has generally privileged attractions based on partners' sexed physical bodies over attractions based on other features, including gender expression and personality traits. Gender may actually be quite central to sexual attractions. However, its role has received little empirical attention. To explore how gendered and sexed features, among others, are related to sexual attractions, the current study assessed how sexually diverse individuals described their attractions to feminine, masculine, and gender-nonspecific features of women and men. A sample of 280 individuals responded to the open-ended questions: "What do you find attractive in a man?" and "What do you find attractive in a woman?" We coded responses as pertaining to physical and/or psychological features, and as being gendered masculine, feminine, or gender-nonspecific. Our analyses showed that participants named gender-nonspecific features most frequently in responses to both questions, feminine features more than masculine features in attractions to women, and masculine features more than feminine features in attractions to men. Additionally, participants named feminine physical features more than masculine physical features, and masculine psychological features more than feminine psychological features, both in their attractions to women and overall. These results highlight the importance of considering attractions based on gender, rather than sex alone.