Sexual and romantic spectrums: Mostly straights and mostly gays/lesbians.

Sexual and romantic orientations and identities exist along a spectrum with varying degrees of compliance to traditional concepts of sex and romance. Recent investigations have focused on individuals who are not exclusive in their sexual and romantic lives-mostly straights and mostly gays/lesbians. Multi-disciplinary research reveals the diversity of individuals' internal and external sexual and romantic feelings and expressions. One corrective strategy is to scrap categorically based assessment tools and replace them with continuum measures that capture the multiplicity of individuals' sexual and romantic lives. Here I suggest several new measures that are more responsive to a spectrum approach.

Gender Nonconformity of Bisexual Men and Women.

The degree to which bisexual-identified individuals are distinct from either heterosexual or homosexual individuals in their sexual orientation is an ongoing debate. We examined potential differences between these groups with respect to a strong correlate of sexual orientation, gender nonconformity (femininity in males, masculinity in females). Across pooled data, we compared self-reports of childhood gender nonconformity (n = 919) and adulthood gender nonconformity (n = 1265) and observer ratings of adulthood gender nonconformity (n = 915) between sexual orientations. Most analyses suggested a steady increase in gender nonconformity from exclusively heterosexual to exclusively homosexual. However, in some analyses, bisexual men were closer to homosexual men than to heterosexual men in their gender nonconformity. The intermediate status of bisexual people in gender nonconformity was not due to the sample having a mixture of very gender-conforming and very gender-nonconforming individuals. In total, men and women with bisexual orientations appeared neither like heterosexual nor homosexual individuals, at least with respect to their gender-related traits.

Robust evidence for bisexual orientation among men.

The question whether some men have a bisexual orientation-that is, whether they are substantially sexually aroused and attracted to both sexes-has remained controversial among both scientists and laypersons. Skeptics believe that male sexual orientation can only be homosexual or heterosexual, and that bisexual identification reflects nonsexual concerns, such as a desire to deemphasize homosexuality. Although most bisexual-identified men report that they are attracted to both men and women, self-report data cannot refute these claims. Patterns of physiological (genital) arousal to male and female erotic stimuli can provide compelling evidence for male sexual orientation. (In contrast, most women provide similar physiological responses to male and female stimuli.) We investigated whether men who self-report bisexual feelings tend to produce bisexual arousal patterns. Prior studies of this issue have been small, used potentially invalid statistical tests, and produced inconsistent findings. We combined nearly all previously published data (from eight previous studies in the United States, United Kingdom, and Canada), yielding a sample of 474 to 588 men (depending on analysis). All participants were cisgender males. Highly robust results showed that bisexual-identified men's genital and subjective arousal patterns were more bisexual than were those who identified as exclusively heterosexual or homosexual. These findings support the view that male sexual orientation contains a range, from heterosexuality, to bisexuality, to homosexuality.

Pupil Dilation to Explicit and Non-Explicit Sexual Stimuli.

Pupil dilation to explicit sexual stimuli (footage of naked and aroused men or women) can elicit sex and sexual orientation differences in sexual response. If similar patterns were replicated with non-explicit sexual stimuli (footage of dressed men and women), then pupil dilation could be indicative of automatic sexual response in fully noninvasive designs. We examined this in 325 men and women with varied sexual orientations to determine whether dilation patterns to non-explicit sexual stimuli resembled those to explicit sexual stimuli depicting the same sex or other sex. Sexual orientation differences in pupil dilation to non-explicit sexual stimuli mirrored those to explicit sexual stimuli. However, the relationship of dilation to non-explicit sexual stimuli with dilation to corresponding explicit sexual stimuli was modest, and effect magnitudes were smaller with non-explicit sexual stimuli than explicit sexual stimuli. The prediction that sexual orientation differences in pupil dilation are larger in men than in women was confirmed with explicit sexual stimuli but not with non-explicit sexual stimuli.

More Judicious Use of Expectant Management for Localized Prostate Cancer during the Last 2 Decades.

PURPOSE: Urologists have been criticized for overtreating men with low risk prostate cancer and for passively observing older men with higher risk disease. Proponents of active surveillance for low risk disease and critics of watchful waiting for higher risk disease have advocated for more judicious use of observation. Thus, we compared 2 population based cohorts to determine how expectant management has evolved during the last 2 decades. MATERIALS AND METHODS: A total of 5,871 men with localized prostate cancer were enrolled in the PCOS (Prostate Cancer Outcomes Study) or the CEASAR (Comparative Effectiveness Analysis of Surgery and Radiation) study. We compared the use of definitive treatment vs expectant management (watchful waiting or active surveillance) across cohorts, focusing on the influence of disease risk, age and comorbidities. RESULTS: Use of watchful waiting or active surveillance was similar in PCOS and CEASAR (14% in each). Compared to the PCOS, more men in the CEASAR study with low risk disease selected watchful waiting or active surveillance (25% vs 15%, respectively), whereas fewer men with intermediate (7% vs 14%) and high risk (3% vs 10%) disease chose watchful waiting or active surveillance (p <0.001 for each). The association of disease risk with watchful waiting or active surveillance was significantly larger in CEASAR than in PCOS (OR 7.3, 95% CI 3.4 to 15.7). Older age was associated with watchful waiting or active surveillance in both cohorts but there was no association between comorbidity and watchful waiting or active surveillance in the CEASAR study. CONCLUSIONS: Use of watchful waiting or active surveillance was more aligned with disease risk in CEASAR compared to PCOS, suggesting there has been a pivot from watchful waiting to active surveillance. While older men were more likely to be observed, comorbidity had little, if any, influence.

Gay, Mostly Gay, or Bisexual Leaning Gay? An Exploratory Study Distinguishing Gay Sexual Orientations Among Young Men.

This exploratory study assessed physiological, behavioral, and self-report measures of sexual and romantic indicators of sexual orientation identities among young men (mean age = 21.9 years) with predominant same-sex sexual and romantic interests: those who described themselves as bisexual leaning gay (n = 11), mostly gay (n = 17), and gay (n = 47). Although they were not significantly distinguishable based on physiological (pupil dilation) responses to nude stimuli, on behavioral and self-report measures a descending linear trend toward the less preferred sex (female) was significant regarding sexual attraction, fantasy, genital contact, infatuation, romantic relationship, sex appeal, and gazing time to the porn stimuli. Results supported a continuum of sexuality with distinct subgroups only for the self-report measure of sexual attraction. The other behavioral and self-report measures followed the same trend but did not significantly differ between the bisexual leaning gay and mostly gay groups, likely the result of small sample size. Results suggest that romantic indicators are as good as sexual measures in assessing sexual orientation and that a succession of logically following groups from bisexual leaning gay, mostly gay, to gay. Whether these three groups are discrete or overlapping needs further research.

Sexual Orientation: Categories or Continuum? Commentary on Bailey et al. (2016).

Bailey et al. (2016) have provided an excellent, state-of-the-art overview that is a major contribution to our understanding of sexual orientation. However, whereas Bailey and his coauthors have examined the physiological, behavioral, and self-report data of sexual orientation and see categories, I see a sexual and romantic continuum. After noting several objections concerning the limitations of the review and methodological shortcomings characteristic of sexual-orientation research in general, I present evidence from research investigating in-between sexualities to support an alternative, continuum-based perspective regarding the nature of sexual orientation for both women and men. A continuum conceptualization has potential implications for investigating the prevalence of nonheterosexuals, sexual-orientation differences in gender nonconformity, causes of sexual orientation, and political issues.

Sexual arousal and masculinity-femininity of women.

Studies with volunteers in sexual arousal experiments suggest that women are, on average, physiologically sexually aroused to both male and female sexual stimuli. Lesbians are the exception because they tend to be more aroused to their preferred sex than the other sex, a pattern typically seen in men. A separate research line suggests that lesbians are, on average, more masculine than straight women in their nonsexual behaviors and characteristics. Hence, a common influence could affect the expression of male-typical sexual and nonsexual traits in some women. By integrating these research programs, we tested the hypothesis that male-typical sexual arousal of lesbians relates to their nonsexual masculinity. Moreover, the most masculine-behaving lesbians, in particular, could show the most male-typical sexual responses. Across combined data, Study 1 examined these patterns in women's genital arousal and self-reports of masculine and feminine behaviors. Study 2 examined these patterns with another measure of sexual arousal, pupil dilation to sexual stimuli, and with observer-rated masculinity-femininity in addition to self-reported masculinity-femininity. Although both studies confirmed that lesbians were more male-typical in their sexual arousal and nonsexual characteristics, on average, there were no indications that these 2 patterns were in any way connected. Thus, women's sexual responses and nonsexual traits might be masculinized by independent factors. (PsycINFO Database Record

Developmental trajectories and milestones of lesbian, gay, and bisexual young people.

Lesbian, gay, and bisexual (LGB) young people experience a variety of developmental trajectories that consist of milestones, the sequence and timing of which differ across individuals. They include early feelings of being different from peers, the onset of same-sex attraction, questioning one's sexuality, first same-sex sexual experience, recognition and self-labelling, disclosure to others, first romantic relationship, and self-acceptance. The invention of 'gay youth' during the 1970s and 1980s is briefly reviewed with an emphasis on the ways in which the portrait created by early research fails to capture the developmental trajectories of millennial young people. Although some young people struggle with mental health problems as they navigate these milestones, research documents the complexity, variety, and normative nature of the vast majority of LGB young people. A growing chorus of developmental, behavioural, and social scientists now emphasize that many contemporary young people forego sexual confusion, recognize the sex or gender to which they are attracted to and love, and believe they are as mentally healthy as heterosexual young people.

Sexual arousal: the correspondence of eyes and genitals.

Men's, more than women's, sexual responses may include a coordination of several physiological indices in order to build their sexual arousal to relevant targets. Here, for the first time, genital arousal and pupil dilation to sexual stimuli were simultaneously assessed. These measures corresponded more strongly with each other, subjective sexual arousal, and self-reported sexual orientation in men than women. Bisexual arousal is more prevalent in women than men. We therefore predicted that if bisexual-identified men show bisexual arousal, the correspondence of their arousal indices would be more female-typical, thus weaker, than for other men. Homosexual women show more male-typical arousal than other women; hence, their correspondence of arousal indices should be stronger than for other women. Findings, albeit weak in effect, supported these predictions. Thus, if sex-specific patterns are reversed within one sex, they might affect more than one aspect of sexual arousal. Because pupillary responses reflected sexual orientation similar to genital responses, they offer a less invasive alternative for the measurement of sexual arousal.

Psychological and physical health of mostly heterosexuals: a systematic review.

We reviewed whether mostly heterosexuals, a sexual orientation group characterized by a small amount of same-sex sexuality, differ from heterosexuals and bisexuals on a variety of mental and physical health outcomes (e.g., internalizing problems, body dissatisfaction and disordered eating, obesity, sexual/reproductive health, physical health), health risk behaviors (e.g., substance use, sexual risk taking), and risk and protective factors (e.g., victimization, stressful/risky environment, socioeconomic status, personal and social relationships, gender nonconformity). A narrative and quantitative literature review was conducted of 60 papers covering 22 samples from five Western countries. Individual, mean, and median effect sizes (Cohen ds) were calculated whenever possible. Mostly heterosexuals reported higher levels of risk in most reviewed outcomes compared to heterosexuals (unweighted mean effect sizes ranged from 0.20 to 0.50) but typically somewhat lower than bisexuals (unweighted mean effect sizes ranged from -0.10 to -0.30). Various risk factors frequently reduced, but rarely eliminated, health disparities between mostly heterosexuals and heterosexuals. Findings are discussed through the lens of three potential explanations of elevated health risks among nonheterosexuals: minority stress, nonheterosexual lifestyles, and common causes. Because data on many outcomes were scarce or missing, particularly for men and in comparison with bisexuals, further research is needed.

An exploratory study of the categorical versus spectrum nature of sexual orientation.

This exploratory study investigated the nature of sexual orientation (categorical or spectrum) by assessing the relative ability of sexual and romantic indicators to be predicted by sexual orientation labels. Young adults from a variety of community and college venues (N =292) reported their sexual orientation label on a 9-point scale; from a 10-item list, their sexual identity; and the percentage of their sexual attraction, fantasy, genital contact, infatuation, and romantic relationship directed to males and females. Although the five indicators were significantly intercorrelated and sexual orientation labels predicted each indicator, discrepancies existed across indicators in relationship to sexual orientation (highest for attraction, lowest for romantic relationship). Sexual identity and sexual orientation label were strongly related at the ends of the sexual spectrum, less so in the middle. Men were nearly as nonexclusive as women. Study results supported the perspective that sexual orientation is a continuously distributed individual characteristic.

The dubious assessment of gay, lesbian, and bisexual adolescents of add health.

In this essay, we argue that researchers who base their investigations of nonheterosexuality derived from reports of romantic attractions of adolescent participants from Wave 1 of Add Health must account for their disappearance in future waves of data collection. The high prevalence of Wave 1 youth with either both-sex or same-sex romantic attractions was initially striking and unexpected. Subsequent data from Add Health indicated that this prevalence sharply declined over time such that over 70 % of these Wave 1 adolescents identified as exclusively heterosexual as Wave 4 young adults. Three explanations are proposed to account for the high prevalence rate and the temporal inconsistency: (1) gay adolescents going into the closet during their young adult years; (2) confusion regarding the use and meaning of romantic attraction as a proxy for sexual orientation; and (3) the existence of mischievous adolescents who played a "jokester" role by reporting same-sex attraction when none was present. Relying on Add Health data, we dismissed the first explanation as highly unlikely and found support for the other two. Importantly, these "dubious" gay, lesbian, and bisexual adolescents may have led researchers to erroneously conclude from the data that sexual-minority youth are more problematic than heterosexual youth in terms of physical, mental, and social health.

Male bisexual arousal: a matter of curiosity?

Conflicting evidence exists regarding whether bisexual-identified men are sexually aroused to both men and women. We hypothesized that a distinct characteristic, level of curiosity about sexually diverse acts, distinguishes bisexual-identified men with and without bisexual arousal. Study 1 assessed men's (n=277) sexual arousal via pupil dilation to male and female sexual stimuli. Bisexual men were, on average, higher in their sexual curiosity than other men. Despite this general difference, only bisexual-identified men with elevated sexual curiosity showed bisexual arousal. Those lower in curiosity had responses resembling those of homosexual men. Study 2 assessed men's (n=72) sexual arousal via genital responses and replicated findings of Study 1. Study 3 provided information on the validity on our measure of sexual curiosity by relating it to general curiosity and sexual sensation seeking (n=83). Based on their sexual arousal and personality, at least two groups of men identify as bisexual.

The eyes have it: sex and sexual orientation differences in pupil dilation patterns.

Recent research suggests profound sex and sexual orientation differences in sexual response. These results, however, are based on measures of genital arousal, which have potential limitations such as volunteer bias and differential measures for the sexes. The present study introduces a measure less affected by these limitations. We assessed the pupil dilation of 325 men and women of various sexual orientations to male and female erotic stimuli. Results supported hypotheses. In general, self-reported sexual orientation corresponded with pupil dilation to men and women. Among men, substantial dilation to both sexes was most common in bisexual-identified men. In contrast, among women, substantial dilation to both sexes was most common in heterosexual-identified women. Possible reasons for these differences are discussed. Because the measure of pupil dilation is less invasive than previous measures of sexual response, it allows for studying diverse age and cultural populations, usually not included in sexuality research.

Prevalence and stability of self-reported sexual orientation identity during young adulthood.

Based on date from Wave 3 and Wave 4 from National Longitudinal Survey of Adolescent Health (N=12,287), known as Add Health, the majority of young adults identified their sexual orientation as 100% heterosexual. The second largest identity group,''mostly heterosexual,''was larger than all other nonheterosexual identities combined. Comparing distributions across waves, which were approximately 6 years apart, stability of sexual orientation identity wasmore common than change. Stability was greatest among men and those identifying as heterosexual. Individuals who identified as 100% homosexual reported nearly the same level of stability as 100% heterosexuals. The bisexual categorywas themost unstable, with one quarter maintaining that status at Wave 4. Bisexual men who changed their identity distributed themselves among all other categories; among bisexual women, themost common shiftwas toward mostly heterosexual. Reflecting changes in identity, the proportion of heterosexuals decreased between the two waves.

Mostly heterosexual and mostly gay/lesbian: evidence for new sexual orientation identities.

A sample of 1,784 individuals responded to an online survey advertised on the Facebook social networking website. We explored the sexual orientation continuum by focusing on three components: self-reported sexual orientation identity, sexual attraction, and sexual partners. Results supported a 5-category classification of identity (heterosexual, mostly heterosexual, bisexual, mostly gay/lesbian, gay/lesbian) in that two added identity labels (mostly heterosexual and mostly gay/lesbian) were frequently chosen by participants and/or showed unique patterns of attraction and partners, distinct from their adjacent identities (heterosexual and bisexual, and bisexual and gay/lesbian, respectively). Those who reported an exclusive label (heterosexual, gay/lesbian) were not necessarily exclusive in other components; a significant minority of heterosexuals and the majority of gays/lesbians reported some attraction and/or partners toward their nonpreferred sex. The five identity groups differed in attraction and partners in a manner consistent with a continuous, rather than a categorical, distribution of sexual orientation. Findings also supported a sexual orientation continuum as consisting of two, rather than one, distinct dimensions (same- and other-sex sexuality). Having more same-sex sexuality did not necessarily imply having less other-sex sexuality, and vice versa. More men than women were at the exclusive ends of the continuum; however, men were not bimodally distributed in that a significant minority reported nonexclusivity in their sexuality.