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.

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.

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.

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.

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.

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.

Social Support and Violence-prone Relationships as Predictors of Disclosure of HIV Status Among Newly Diagnosed HIV-positive South Africans.

Despite the salience of social support and violence as potential outcomes of disclosure, how pre-existing social support and relationship violence among people living with HIV shapes and influences HIV status disclosure has received limited attention. Following the Disclosure Process Model, this study investigated pre-disclosure support and violence-prone relationships as predictors of disclosure using data from a prospective study of 459 newly diagnosed South African women and men. Most (88%) disclosed their status to at least one person by their 8-month interview. Level of social support was unrelated to disclosure to a partner. However, those with higher levels of support had higher odds of disclosing to family and to others. Women in violence-prone relationships were more likely to report disclosure to a partner than were those not in such relationships, counter to expectations. The findings suggest that the same mechanisms may not explain processes of disclosure across all relationship types.

We Need to Talk: Disclosure of Sexual Problems Is Associated With Depression, Sexual Functioning, and Relationship Satisfaction in Women.

Women with sexual problems (e.g., difficulties with desire, arousal, lubrication, orgasm, and pain during sexual activity) experience more depressive symptoms, and poorer sexual functioning and relationship satisfaction compared with unaffected women. A robust literature highlights the importance of sexual communication, and sexual self-disclosures in particular, for the well-being of individuals in romantic relationships. However, little is known about the disclosure of sexual problems to romantic partners and its association with women's psychological, sexual, and relationship well-being. This study examined the proportion of women (N = 277) who disclose (vs. do not disclose) sexual problems to their partner, and the consequences of disclosure. Women (Mage = 29.79, SD = 6.54) completed online validated measures assessing sexual problems, relationship satisfaction, sexual functioning, and depressive symptoms. The majority (69.3%) reported disclosing sexual problems to their current romantic partner. Disclosers reported fewer depressive symptoms, and greater sexual functioning and relationship satisfaction compared to nondisclosers. Disclosing sexual problems may benefit women's well-being by enhancing intimacy or allowing couples to adapt sexual activities to accommodate sexual problems. Clinicians might use cognitive-behavioral strategies to assist women in disclosing sexual problems to partners to maximize the potential psychological, sexual, and relationship benefits.

Men's and Women's Use and Creation of Online Sexually Explicit Materials Including Fandom-Related Works.

The Internet and mobile computing have been highly influential in shaping the modern technological era and subsequently the production of and access to online sexually explicit materials (SEM). Fandom-the realm of fans sharing a common interest-has also adapted to the Internet, which has changed how fans access and distribute fanworks (i.e., material created by fans such as stories and art), many of which contain SEM. The current study examined gender differences in the use and creation of online SEM by surveying 468 men and 347 women (ages 18 or older; mean age = 33.8 years) residing in North America. Participants completed anonymous measures assessing demographic information, experiences using and creating online SEM, and measures of related sexual attitudes. Use of online SEM was widely reported by participants, with men (87.8 %) indicating more use than with women (67.4 %). As expected, few participants reported creating online SEM (3.6 % of men, 4.9 % of women). Men and women reported similar levels of preferred sexual explicitness in the online SEM that they used. There were no significant gender differences in the use of fanworks reported by men (14.3 %) and women (14.7 %) or in the creation of fanworks (1.5 % of men, 3.2 % of women). Fandom-related online SEM use was predicted only by more permissive sexual attitudes (one of eight predictors). Although there were many similarities between men's and women's use of online SEM, some gender differences were found in their motives for online SEM use. Findings are discussed in terms of the context in which men and women experience online SEM.

Time Out from Sex or Romance: Sexually Experienced Adolescents' Decisions to Purposefully Avoid Sexual Activity or Romantic Relationships.

Researchers have given significant attention to abstinence among adolescents, but far less is known about purposeful avoidance of sexual activity (and relationship involvement). Typically, it is assumed that, once adolescents have initiated sexual activity, they will thereafter engage in sexual activity if given the opportunity. However, it is unclear whether that is true as some research indicates that many adolescents engage in sexual activity intermittently. Sexually experienced adolescents may purposefully avoid engaging in sexual activity for a period of time and, if so, this has implications for understanding their sexual decision-making. We used a mixed methods approach to investigate sexually experienced adolescents' decisions to purposefully avoid further sexual activity and/or romantic relationships with a focus on how common these decisions are and factors influencing them. Participants were 411 (56 % female) adolescents (16-21 years old) who completed an on-line survey that assessed reasons for each type of avoidance, religiosity, sexual esteem, sexual distress, sexual coercion, and dysfunctional sexual beliefs. Overall, 27 % of participants had engaged in sexual avoidance and 47 % had engaged in romantic avoidance. Significantly more female than male adolescents reported sexual and romantic avoidance. Adolescents' reasons for sexual avoidance included: lack of sexual pleasure or enjoyment, relationship reasons, negative emotions, values, fear of negative outcomes, negative physical experience, and other priorities. Reasons for romantic avoidance included: effects of previous relationship, not interested in commitment, wrong time, other priorities, negative emotions, no one was good enough, and sexual concerns. Logistical regressions were used to assess associations between age, religiosity, sexual esteem, sexual distress, experience of sexual coercion, and dysfunctional sexual beliefs and having engaged in romantic and/or sexual avoidance. The female adolescents who had avoided sexual activity were more likely to have experienced sexual coercion. The male adolescents who had avoided sexual activity were more religious and likely to have experienced sexual coercion. The male adolescents who had avoided romantic relationships were more sexually distressed and likely to have experienced sexual coercion. No associations were found for romantic avoidance among female adolescents. These results reflect considerable agency in the decision-making of adolescents in intimate contexts. They are discussed in terms of their challenge to current discourses about rampant adolescent sexuality as well as their implications for education and prevention interventions that incorporate personal choice and decision-making into their protocols.

Access to and use of sexual health care services among young Canadians with and without a history of sexual coercion.

OBJECTIVE: To determine access to and use of sexual health care services among adolescents and young adults with and without a history of sexual coercion, and to examine whether a history of sexual coercion was a barrier to using sexual health care services. DESIGN: Online survey. SETTING: Canada. PARTICIPANTS: A total of 405 adolescents and young adults aged 16 to 21. MAIN OUTCOME MEASURES: Participants' sexual histories, sexual coercion histories, current psychological functioning, and perceptions and use of health care services. RESULTS: A history of sexual coercion was reported by 29.6% of participants; more female participants reported a history of sexual coercion than male participants did, and female participants reported more related distress than male participants did. Those with a history of sexual coercion reported more sexual health-related visits than those without a history of sexual coercion did. Among participants with and without sexual coercion histories, there were no differences in difficulty accessing care, perceived quality of care, or rates of unmet health needs. Among those who reported a history of sexual coercion, the odds of having a sexual health-related visit increased for those who had had a routine checkup in the previous year (odds ratio = 8.29) and those who believed it was not difficult to access care (odds ratio = 1.74). CONCLUSION: Having a history of sexual coercion was not a barrier to the use of health care services among adolescents and young adults. In fact, rates of health care service use were higher among those with a history of sexual coercion than those without such a history.

Prevalence and characteristics of sexual functioning among sexually experienced middle to late adolescents.

INTRODUCTION: Little is known about problems in sexual functioning among young people, despite the high rates found in adult samples. It is unclear which problems are most prevalent or how common sexual distress is for young people experiencing problems. AIMS: This study aims to assess the prevalence, range, and correlates of sexual problems and distress among a sample of adolescents (16-21 years). METHODS: Participants (mean age 19.2) were recruited from community and area high schools. Male adolescents (n = 114) completed online the International Index of Erectile Function (IIEF) and Premature Ejaculation Diagnostic Tool (PEDT). Female adolescents (n = 144) completed the Female Sexual Function Index (FSFI). Both completed the Female Sexual Distress Scale (FSDS) and the measures of background, relationship characteristics, and sexual histories. MAIN OUTCOMES MEASURES: Clinical cutoff scores on the IIEF, PEDT, FSFI, and FSDS were used to determine whether there was a significant sexual problem. RESULTS: Adolescents reported extensive sexual experience, most in relationship contexts. Half of the sample (51.1%) reported a sexual problem; 50.0% reported clinically significant levels of distress associated with it. Similar rates of problems and distress were found among male and female adolescents. For the most part, adolescent characteristics, backgrounds, and experience were not associated with adolescents' sexual problems. CONCLUSION: Sexual problems are clearly prevalent among adolescents, and distressing to many who experience them, emphasizing a strong need to develop programs to address this issue.

Linking online sexual activities to health outcomes among teens.

New digital technologies are highly responsive to many of the developmental needs of adolescents, including their need for intimate connection and social identity. This chapter explores adolescents' use of web-based sexual information, texting and "sexting," online dating sites, role-playing games, and sexually explicit media, and presents new data comparing the interpersonal and intrapersonal health outcomes among youth who engage in online sexual activities to those who do not. Despite the media-stoked concerns surrounding adolescents' participation in online sexual activities, the ubiquity of online activities and close overlap between online and offline activities indicate that this type of behavior should not be pathologized or used as a metric of problem behavior. The chapter concludes with implications for parents, educators, researchers, counselors, and health care providers, a call to challenge our deep discomfort around adolescent sexuality and to harness these technologies in ways that help promote growth and positive development.

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.

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.

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.

"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.

Gender differences in associations of sexual and romantic stimuli: do young men really prefer sex over romance?

Theory and research emphasize differences in men's and women's sexual and romantic attitudes, concluding that men have stronger preferences for sexual than romantic stimuli as compared to women. However, most of the research on gender differences have relied on self-reports, which are plagued by problems of social desirability bias. The current study assessed young men's and women's implicit attitudes toward sexual and romantic stimuli to test whether, in fact, men have a stronger preference for sexual over romantic stimuli compared to women. We also assessed associations between implicit and explicit attitudes, as well as sex role ideology and personality. College students (68 men and 114 women) completed an Implicit Association Test (IAT) that assessed strengths of associations of sexual and romantic stimuli to both pleasant and unpleasant conditions. Results revealed that both men and women more strongly associated romantic images to the pleasant condition than they associated the sexual images to the pleasant condition. However, as predicted, women had a stronger preference toward romantic versus sexual stimuli compared to men. Our study challenges a common assumption that men prefer sexual over romantic stimuli. The findings indicate that measures of implicit attitudes may tap preferences that are not apparent in studies relying on self-reported (explicit) attitudes.