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.

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.

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.

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.

Stability of Sexual Attractions Across Different Timescales: The Roles of Bisexuality and Gender.

We examined the stability of same-sex and other-sex attractions among 294 heterosexual, lesbian, gay, and bisexual men and women between the ages of 18 and 40 years. Participants used online daily diaries to report the intensity of each day's strongest same-sex and other-sex attraction, and they also reported on changes they recalled experiencing in their attractions since adolescence. We used multilevel dynamical systems models to examine individual differences in the stability of daily attractions (stability, in these models, denotes the tendency for attractions to "self-correct" toward a person-specific setpoint over time). Women's attractions showed less day-to-day stability than men's, consistent with the notion of female sexual fluidity (i.e., heightened erotic sensitivity to situational and contextual influences). Yet, women did not recollect larger post-adolescent changes in sexual attractions than did men, and larger recollected post-adolescent changes did not predict lower day-to-day stability in the sample as a whole. Bisexually attracted individuals recollected larger post-adolescent changes in their attractions, and they showed lower day-to-day stability in attractions to their "less-preferred" gender, compared to individuals with exclusive same-sex or exclusive other-sex attractions. Our results suggest that both gender and bisexuality have independent influences on sexual fluidity, but these influences vary across short versus long timescales, and they also differ for attractions to one's "more-preferred" versus "less-preferred" gender.

Three critical questions for future research on lesbian relationships.

In this article I discuss three questions that should be priorities for future research on lesbian love and relationships. The first question concerns the very definition of "lesbian relationship," given how many women may be engaged in same-sex relationships without identifying as lesbian. The second question concerns the potential influence of childhood neglect and abuse on adult women's same-sex relationships, a topic that has important implications for both psychological well-being and relationship functioning. The third question concerns the potential downsides of legal marriage for women's same-sex relationships, a topic that is particularly important in light of the newfound legal recognition of same-sex marriage in all 50 states. Although there are many understudied questions in the domain of women's same-sex relationships, research on these three questions has particularly strong potential to advance our understanding of lesbian love and relationships in important ways.

Female same-sex sexuality from a dynamical systems perspective: sexual desire, motivation, and behavior.

Fluidity in attractions and behaviors among same-sex attracted women has been well-documented, suggesting the appropriateness of dynamical systems modeling of these phenomena over time. As dynamical systems modeling offer an approach to explaining the patterns of complex phenomena, it may be apt for explaining variability in female same-sex sexuality. The present research is the first application of this analytical approach to such data. Dynamical systems modeling, and specifically generalized local linear approximation modeling, was used to fit daily diary data on same-sex attractions and behaviors over a 21 day period among a group of 33 sexual minority women characterized as lesbian, bisexual or "fluid" based on their identity histories. Daily measures of women's reported same-sex attractions were fit using a linear oscillator model and its parameters estimated the cyclicity in these attractions. Results supported the existence of a "core sexual orientation" for women in this sample, regardless of how they identified and despite a high degree of variability in daily same-sex attractions. Thus, modeling individual differences in the variability of attractions and behaviors of sexual minority women may be critical to furthering our understanding of female same-sex sexuality and human sexual orientation more broadly.

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.

The desire disorder in research on sexual orientation in women: contributions of dynamical systems theory.

Over the past decade, numerous studies have documented fundamental differences between the phenomenology of male and female sexual orientation, largely centering on women's capacity for fluidity in their sexual attractions. The past decade has also witnessed fundamental changes in clinical perspectives on "normal" versus "dysfunctional" patterns of female sexual desire, largely centering on women's greater capacity for responsive and context-dependent sexual desires. In both cases, traditional male-based models of sexuality have been found inadequate to describe women's experiences. I argue that this inadequacy stems from a failure of traditional models to appropriately account for the phenomenon of variability over time, which may constitute a fundamental feature of female sexual phenomenology. I maintain that dynamical systems theory provides a useful and generative approach for reconceptualizing female sexual orientation, because dynamical systems models focus specifically on describing and explaining complex patterns of change over time. I review the key properties of dynamical systems models and provide an illustrative model of how this approach might yield new perspectives on female sexual orientation.

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.

Sexual minority women's sexual motivation around the time of ovulation.

We investigated whether motivation for same-sex sexual contact was related to mid-cycle peaks in estrogen levels (typically associated with ovulation) among women with consistent versus inconsistent patterns of same-sex sexuality. Twenty women (M age = 30 years), all of whom have been providing data on their sexual behavior and identities since 1995, completed daily diaries assessing sexual motivation and provided 10 days of salivary estrogen samples. During the 3 consecutive days on which estrogen levels peaked, women who had consistently identified as lesbian since 1995 (n = 5) showed increased motivation for sexual contact with women. This change in same-sex motivation was significantly smaller among women who consistently identified as bisexual (n = 7) and women who had given up their lesbian or bisexual identities at some point since 1995 (n = 8). Women who ascribed a role for "choice" in their same-sex sexuality also showed smaller increases in same-sex motivation. The findings suggest that women with consistent versus inconsistent patterns of same-sex sexuality might be experiencing different types of same-sex desires influenced by different factors.

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.

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 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.

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.