Involuntary Childlessness, Suffering, and Equality of Resources: An Argument for Expanding State-funded Fertility Treatment Provision.

Assessing what counts as infertility has practical implications: access to (state-funded) fertility treatment is usually premised on meeting the criteria that constitute the chosen definition of infertility. In this paper, I argue that we should adopt the expression "involuntary childlessness" to discuss the normative dimensions of people's inability to conceive. Once this conceptualization is adopted, it becomes clear that there exists a mismatch between those who experience involuntary childlessness and those that are currently able to access fertility treatment. My concern in this article is explaining why such a mismatch deserves attention and what reasons can be advanced to justify addressing it. My case rests on a three-part argument: that there are good reasons to address the suffering associated with involuntary childlessness; that people would decide to insure against it; and that involuntary childlessness is characterized by a prima facie exceptional kind of desire.

Marital Stress and Emotion Work in Same-Sex and Different-Sex Marriages: The Moderating Role of Childhood Adversity.

Adverse experiences in childhood may set the stage for future response to stress, emotion regulation, and interaction with partners in intimate relationships. Prior research suggests the influence of childhood adversity on stress response is gendered, yet we do not know much about how individuals with a history of significant childhood adversity respond to marital stress outside of a different-sex marriage context. This study examines the moderating role of childhood adversity on the association of daily marital stress with emotion work provision (intentional activities devoted to enhancing others' emotional well-being) and considers whether the association varies for men and women in same- and different-sex marriages. Specifically, I use ten days of dyadic diary data collected from 378 midlife same- and different-sex married couples (n=756 individuals) and conduct multilevel regression models. The results show marital stress is positively associated with emotion work provision, and that the association is stronger for respondents who report more adverse childhood experiences. For respondents with low childhood adversity, the association of marital stress with emotion work is greater for same-sex couples compared to different-sex couples; for those with high childhood adversity, the association is equally strong. Findings from this study suggest that both men and women in same- and different-sex relationships do more emotion work in response to increased daily marital stress. Furthermore, early experiences of adversity are linked to stress responses in adulthood, with differing implications for men and women in different-sex and same-sex unions.

The negative effects of internalized homonegativity on sexual satisfaction: dyadic effects and gender-based differences in Chile.

Heterosexism is not only expressed through sexual prejudice as an external stressor, but also as an internalized rejection toward one's own (and others') sexually diverse identity. That is, lesbian women and gay men themselves internalize negative societal attitudes toward their sexual orientation and identity-a phenomenon called internalized homonegativity. A wealth of research shows that internalized homonegativity negatively affects the health and social adjustment of gay and lesbian people. However, the literature has documented this trend from an individual (over a dyadic) perspective, and largely among gay (over lesbian) samples. To address this oversight, we analyzed data from 210 gay and lesbian couples in Chile to examine both actor and partner effects of internalized homonegativity on their sexual satisfaction. Results from moderation analyses from an actor-partner interdependence model (APIM) approach show that partners' internalized homonegativity negatively affects actor sexual satisfaction, a pattern significantly moderated by gender; that is, only observed among lesbian couples. Our results further demonstrated that these effects hold above and beyond the actor and partner effects of age and relationship satisfaction, as well as relationship length. These results are consistent with the broader literature, which discusses the specific features of internalized homonegativity in lesbian women, characterized-among other aspects-by restrictive social demands over their sexuality. Accordingly, our findings highlight the deleterious relational consequences of internalized homonegativity and offer a relevant empirical contribution to the understanding of specific minority stress dynamics among lesbian women.

Cohabitation and Marriage Among Same-Sex Couples in the 2019 ACS and CPS: A Research Note.

Since the 2015 U.S. Supreme Court ruling that marriages of same-sex couples are legal in all states in the union, federal surveys have adapted to the shifting legal climate and included new measures that more directly identify same-sex and different-sex cohabiting and married couples. In this research note comparing the largest and most recent federal surveys-the 2019 American Community Survey and Current Population Survey-we find consistent levels of cohabitation and marriage across surveys. While the vast majority (90%) of different-sex couples were married, we report a more even split in cohabitation and marriage among same-sex couples. Our evaluation of sociodemographic characteristics of married and cohabiting couples indicates that differences were less prominent among same-sex couples than among different-sex couples, suggesting weaker sociodemographic selection into marriage among the former. However, factors affecting same-sex and different-sex couples' decisions to live together and marry may differ because of legal and social climates that still present unique obstacles for same-sex couples. Researchers need to acknowledge these differences in assessments of the implications of marriage for health and well-being.

Academic Achievement of Children in Same- and Different-Sex-Parented Families: A Population-Level Analysis of Linked Administrative Data From the Netherlands.

Although numerous studies have examined how children raised in same-sex-parented families fare relative to children in different-sex-parented families, this body of work suffers from major methodological shortcomings. By leveraging linked administrative data from several population registers from the Netherlands covering the 2006-2018 period (n = 1,454,577), we overcome most methodological limitations affecting earlier research. The unique features of the data include complete population coverage, reliable identification of same-sex-parented families, a large number of children in same-sex-parented families (n = 3,006), multiple objective and verifiable educational outcomes, and detailed measures of family dynamics over children's entire life courses. The results indicate that children in same-sex-parented families outperform children in different-sex-parented families on multiple indicators of academic performance, including standardized tests scores, high school graduation rates, and college enrollment. Such advantages extend to both male and female children, and are more pronounced among children in female than male same-sex-parented families. These findings challenge deficit models of same-sex parenting.

Heteronormative Relationship Education for Same-Gender Couples.

In recent years, same-gender group-based relationship education has emerged as a viable intervention to prevent relationship distress among same-gender couples. However, many of these programs are conducted in metropolitan areas and lack the ability to reach rural populations. The current study sought to investigate whether two wide-reaching web-based heteronormative relationship education programs could positively impact same-gender relationships. In a sample of 49 same-gender couples, heteronormative relationship education had small (Cohen's d = 0.16-0.39) but reliably positive effects on key areas of relationship functioning and perceived stress relative to a waitlist control group. Additionally, when same-gender couples were matched with different-gender individuals with similar baseline characteristics, no reliable differences between the two groups emerged even though the program effects were sometimes half as large for same-gender couples. Finally, same-gender participants were as satisfied with the program as the matched different-gender individuals. Though the results of the present study indicate that heteronormative relationship education can be helpful for same-gender couples, additional tailoring should be undertaken to ensure that same-gender couples experience as much benefit as possible. Estimates from the current study could be used in future studies to detect what might be small-sized differences.

En los últimos años, la capacitación en relaciones grupal y del mismo sexo ha surgido como una intervención viable para prevenir el distrés relacional entre parejas del mismo género. Sin embargo, muchos de estos programas se realizan en áreas metropolitanas y no pueden llegar a las poblaciones rurales. El presente estudio tuvo como finalidad investigar si dos programas de capacitación heteronormativa en relaciones, por Internet y de amplio alcance podrían tener un efecto positivo en las relaciones del mismo género. En una muestra de 49 parejas del mismo género, la capacitación heteronormativa en relaciones tuvo efectos pequeños (d de Cohen = 0.16-0.39) pero fiablemente positivos en áreas clave del funcionamiento relacional y del estrés percibido respecto de un grupo control en lista de espera. Además, cuando las parejas del mismo género se igualaron con personas de diferente género con características iniciales similares, no surgieron diferencias fiables entre los dos grupos, aunque los efectos del programa fueron a veces de la mitad para las parejas del mismo género. Finalmente, los participantes del mismo género estuvieron tan satisfechos con el programa como las personas de diferente género con quienes se las igualó. Aunque los resultados del presente estudio indican que la capacitación heteronormativa en relaciones puede ser útil para parejas del mismo género, deberían realizarse más adaptaciones para garantizar que las parejas del mismo género tengan todos los beneficios posibles. En futuros estudios podrían usarse cálculos del presente estudio para detectar las posibles diferencias pequeñas.

Cumulative live birth rates following insemination with donor spermatozoa in single women, same-sex couples and heterosexual patients.

RESEARCH QUESTION: What is the cumulative live birth rate (LBR) following donor intrauterine insemination (IUI-D) treatment in a large, retrospective, single-centre cohort of single women, same-sex couples and heterosexual patients? DESIGN: Outcomes from 8922 treatments performed in 3333 consecutive women (45% single, 43% from same-sex and 12% from heterosexual couples) were analysed in a 13-year retrospective study from a private, HFEA-regulated UK centre between January 2004 and December 2016. RESULTS: A total of 795 live births resulted in an overall delivery rate of 8.9% per cycle, including 24 (3%) twins. Age-specific crude and expected cumulative LBR calculated in four age groups (<35, 35-37, 38-39 and 40-42 years) were 29, 23, 21, 12% and 66, 49, 54, 28%, respectively. A plateau was reached after six cycles, beyond which there were few additional live births. There was no significant difference in cumulative LBR between single women and same-sex couples. In a multivariate analysis, female age (adjusted odds ratio [aOR] 0.92; 95% confidence interval [CI] 0.90-0.93; P < 0.0001), previous live birth following IUI-D (aOR 2.15; 95% CI 1.69-2.73; P < 0.0001) and mild stimulation (aOR 1.27; 95% CI 1.09-1.48; P = 0.02) had a significant effect on outcome, but relationship status or cycle rank did not. CONCLUSIONS: These results indicate there is little benefit performing more than six cycles of IUI-D in all women up to 40 years old, including those from same-sex relationships, while only three attempts seem reasonable in those aged 40-42 years. These results do not reflect current clinical guidelines in the UK. The authors found that consecutive IUI cycles, especially with mild stimulation, were an efficient treatment in all indications.

A Dyadic Perspective on Sexual Agreements Among Same-Sex Male Couples in the United States.

Sexual agreements are an important HIV risk reduction strategy enacted by men in male-male partnerships. Greater levels of relationship quality have been associated with sexual agreement formation and adherence. However, current evidence supporting the associations between relationship quality and sexual agreements for male dyads is based primarily on the responses of just one partner. Understanding that relationship quality and decisions about sexual agreements are inherently influenced by both partners, the present analysis uses dyadic-level data to examine the sexual agreements among 199 HIV serodiscordant and seroconcordant male dyads (n = 398 individuals). Specifically, the analysis examines measures of love, trust, and conflict style as they relate to (1) the type of agreement established, (2) concordance in agreement reporting, (3) satisfaction with the agreement, and (4) broken agreements. A discrepancy in love between partners was associated with the type of agreement established, whether they reported the same agreement type, and whether one of the partners reported a broken agreement, but it was not associated with either partner's satisfaction with the agreement. A discrepancy in trust was associated with agreement concordance and agreement breaks, but it was not associated with the type of agreement established or satisfaction with the agreement. Lastly, a discrepancy in conflict style was associated with each of the agreement outcomes. Future research and intervention efforts should focus on understanding the behavioral and communication skills necessary for couples to make successful sexual agreements.

Same-Sex Couples' Shared Time in the United States.

This study examines and compares shared time for same-sex and different-sex coresident couples using large, nationally representative data from the 2003-2016 American Time Use Survey (ATUS). We compare the total time that same-sex couples and different-sex couples spend together; for parents, the time they spend together with children; and for both parents and nonparents, the time they spend together with no one else present and the time they spend with others (excluding children). After we control for demographic and socioeconomic characteristics of the couples, women in same-sex couples spend more time together, both alone and in total, than individuals in different-sex arrangements and men in same-sex couples, regardless of parenthood status. Women in same-sex relationships also spend a larger percentage of their total available time together than other couples, and the difference in time is not limited to any specific activity.

Legalizing Same-Sex Marriage Matters for the Subjective Well-being of Individuals in Same-Sex Unions.

We investigate whether the subjective well-being of individuals in same-sex unions improved following the legalization of same-sex marriage in England and Wales in March 2014. We employ repeated cross-sectional data from the 2011-2016 Annual Population Surveys on 476,411 persons, including 4,112 individuals in coresidential same-sex relationships. The analysis reveals increases in subjective well-being for individuals in same-sex relationships following legalization. Additional analysis documents higher subjective well-being for individuals in married same-sex couples compared with individuals who are in a civil partnership or an informal cohabiting same-sex union. However, the subjective well-being of individuals from same-sex couples increased after legalization among all subgroups considered, including those who cohabited informally. This result hints at a general reduction in structural stigma as an important mechanism behind the improved well-being of individuals in same-sex unions.

Same-Sex Parents and Children's School Progress: An Association That Disappeared Over Time.

Research is divided as to whether children living in same-sex parent families achieve different outcomes compared with their peers. In this article, we improve on earlier estimates of such differences and subsequently study whether and why the association between parental union sex composition and children's school progress changed over time. Data from the American Community Survey waves 2008-2015 (N = 1,952,490 including 7,792 children living with a same-sex couple) indicate that children living with same-sex couples were historically more likely to be behind in school but that this association disappeared over time. Changes in socioeconomic characteristics of same-sex couples played a minor role. In 2008, it was only in areas with unfavorable laws and attitudes toward same-sex couples that children living with same-sex couples were more likely to be behind in school. This was especially the case for adopted children. In more recent periods, no effect of parental union sex composition on school progress is observed within any area or among any group studied. Based on where and when these changes took place, it is suggested that changing attitudes toward same-sex couples might have played an important role in equalizing school progress across groups.

Biogenetic ties and parent-child relationships: The misplaced critique.

According to an almost axiomatic standard in bioethics, moral commitment should ground parents' relationship with their children, rather than biogenetic relatedness. This standard has been used lately to express skepticism about extending existing assisted reproductive treatments (ARTs) to same-sex couples and to research into novel fertility interventions for those couples, but this skepticism is misplaced on several grounds. As a matter of access and equity, same-sex couples seem presumptively entitled to genetic relatedness to their children as far as possible both in regard to existing ARTs and to novel ARTs under investigation. For those worried about the effects of trying to secure biogenetic relatedness for same-sex couples, it may be noted that same-sex couples will only ever be a fraction of the parents implicated in propping up "biologism," as the expectation of biogenetic relatedness it is sometimes called. The cultural force of biologism would survive almost intact even if no same-sex couples were ever to have genetically related children. It is therefore hard to see why same-sex couples should forfeit aspirations to biogenetic relationships with their children or enjoy less subsidy for ARTs than the subsidy given to different-sex couples. As matter of moral consistency, the full implications of the biologism critique have yet to be evaluated relative to different-sex couples.

An Examination of Gay Couples' Motivations to Use (or Forego) Pre-exposure Prophylaxis Expressed During Couples HIV Testing and Counseling (CHTC) Sessions.

While many gay couples perceive themselves to have little risk for HIV transmission, research estimates that 35-68% of new HIV infections are transmitted within main partnerships. Pre-exposure prophylaxis (PrEP) is recommended for those partnered gay and bisexual men (GBM) who engage in sex outside their primary relationship or who have an HIV-positive partner. There is reason to believe that couples' sero-status and sexual agreement will shape perceptions of PrEP's personal relevance among gay couples. The current study examined motivations for and ambivalence towards PrEP uptake reported in a sample of 67 gay couples during completion of a brief CDC-recommended prevention intervention: Couples HIV Testing and Counseling. Findings suggest that all types of couples identified some circumstances in which they would consider PrEP; however, PrEP messaging should be crafted to avoid undermining current prevention strategies or threatening the trust and legitimacy of the relationship.

Minority Stress and Same-Sex Relationship Satisfaction: The Role of Concealment Motivation.

Most lesbian, gay, and bisexual (LGB) people want a stable, satisfying romantic relationship. Although many of the predictors of relationship outcomes are similar to those of heterosexual couples, same-sex couples face some additional challenges associated with minority stress that also impact upon relationship quality. Here, we investigate the association between minority stressors and relationship quality in a sample of 363 adults (M age = 30.37, SD = 10.78) currently in a same-sex romantic relationship. Internalized homophobia and difficulties accepting one's LGB identity were each negatively associated with relationship satisfaction via heightened concealment motivation. We also examined the protective role of identity affirmation on relationship quality, finding a direct positive relationship between the two variables. Minority stressors were negatively associated with couple relationship satisfaction via heightened concealment motivation. The finding that identity affirmation directly predicted increased couple satisfaction also highlights the important role of protective factors in same-sex couple relationships.

La mayoría de las personas lesbianas, gais y bisexuales (LGB) desean una relación amorosa estable y satisfactoria. Aunque muchos de los predictores de las complicaciones en las relaciones son similares a los de las parejas heterosexuales, las parejas del mismo sexo enfrentan algunas otras dificultades asociadas con el estrés de las minorías que también repercuten en la calidad de la relación. Aquí investigamos la asociación entre los factores desencadenantes de estrés en las minorías y la calidad de la relación en una muestra de 363 adultos (edad promedio = 30.37, desviación estándar = 10.78) que están actualmente en una relación amorosa del mismo sexo. La homofobia internalizada y las dificultades para aceptar la identidad LGB propia estuvieron asociadas negativamente con la satisfacción en la relación mediante un incremento de la motivación por la ocultación. También analizamos el papel protector que desempeña la afirmación de la identidad en la calidad de la relación y encontramos una relación positiva directa entre las dos variables. Los factores desencadentantes de estrés en las minorías estuvieron asociados negativamente con la satisfacción en la relación de pareja mediante un incremento de la motivación por la ocultación. El hallazgo de que la afirmación de la identidad predijo directamente una mayor satisfacción en la pareja también destaca el papel importante que desempeñan los factores protectores de las relaciones de pareja del mismo sexo.

Relationship Status and Drinking-Related Outcomes in a Community Sample of Lesbian and Bisexual Women.

Although marriage tends to be protective against hazardous drinking among women in the general population, few studies have compared drinking rates, levels, or problems based on relationship status among sexual minority women (SMW; lesbian, bisexual). We examined associations between relationship status (committed relationship/cohabiting; committed/not cohabiting; single) and past-year drinking outcomes using data from a diverse sample of 696 SMW interviewed in wave 3 of the 17-year longitudinal Chicago Health and Life Experiences of Women study. The mean age of SMW in the sample was 40.01 (SD = 14.15; range 18-82). A little more than one-third (37%) of the sample was white, 36% was African American, and 23% Latina; 4% reported another or multi- race/ethnicity. Compared to SMW in committed cohabiting relationships, single SMW were significantly more likely to be heavy drinkers. SMW in committed non-cohabiting relationships were more likely to report alcohol-related problem consequences, and both single SMW and those in committed non-cohabiting relationships were more likely to report one or more symptoms of potential alcohol dependence. Findings underscore the importance of exploring relationship factors that may influence drinking and drinking-related problems among SMW.

Sexual orientation-related stigma and relationship functioning among female same-sex couples.

This article discusses how sexual orientation-based stigma serves to undermine functioning in female same-sex relationships. We particularly focus on the unique roles of interpersonal stigma (e.g., victimization, microaggressions) and structural stigma (e.g., institutional forms of discrimination), highlighting critical limitations and gaps in this literature and offering suggestions for future studies. We also discuss the need for future work on sexual orientation-related stigma and relationship functioning to consider the unique experiences of bisexual women, intersecting identities, and couple-level perspectives on stigma.

The effects of minority stressors in the workplace on same-sex relationships: A collective case study of female couples.

The purpose of this study is to explore the relational effects of minority stress processes experienced at work by female sexual minority employees. Lesbians, in particular, warrant attention in the work environment, as their experiences with homophobia may be exacerbated by sexist overtones. While scholars have linked hostility in the work environment to individual health and employment outcomes for LGBQ employees, less attention has been given to the cross-contextual effects from work to family life. This collective case study examines the experiences of three lesbian employees and their partners in various workplaces using minority stress border theory. Results show that, for these women, there are negative effects on their same-sex relationships; surprisingly though, several women also discussed positive changes in their relationship as a result of experiences with minority stress processes in the workplace. Implications for future research are discussed.

The Influence of Internalized Stigma on the Efficacy of an HIV Prevention and Relationship Education Program for Young Male Couples.

Young MSM are at increased risk for HIV, especially in the context of serious relationships, but there is a lack of couples-based HIV prevention for this population. The 2GETHER intervention-an HIV prevention and relationship education program for young male couples-demonstrated promising effects in a pilot trial. However, there is evidence that internalized stigma (IS) can influence treatment outcomes among MSM. The current study examined the influence of IS on the efficacy of the 2GETHER intervention among 57 young male couples. The intervention led to decreases in percentage of condomless anal sex partners and increases in subjective norms regarding HIV prevention for those with low/average IS, but not high IS. The intervention also led to increases in motivation to get tested with one's partner and decreases in alcohol consumption for those with high IS, but not low/average IS. In contrast, IS did not moderate intervention effects on other motivational constructs, dyadic adjustment, or alcohol problems. In sum, IS influences the extent to which young male couples benefit from HIV prevention and relationship education depending on the outcome. Research is needed to understand how IS influences treatment outcomes.

Should I Convince My Partner to Go on Pre-Exposure Prophylaxis (PrEP)? The Role of Personal and Relationship Factors on PrEP-Related Social Control among Gay and Bisexual Men.

An estimated 35-68% of new HIV infections among gay, bisexual, and other men who have sex with men (GBM) are transmitted through main partnerships. Pre-exposure prophylaxis (PrEP) is highly effective in reducing HIV seroconversion, yet PrEP uptake has been modest. PrEP-naïve GBM with HIV-negative, PrEP-naïve main partners enrolled in One Thousand Strong (n = 409), a U.S. national cohort of GBM, were asked about (1) the importance of partner PrEP use and (2) their willingness to convince their partner to initiate PrEP. On average, participants thought partner PrEP was only modestly important and were only moderately willing to try to convince their partner to initiate PrEP. Personal PrEP uptake willingness and intentions were the strongest indicators of partner PrEP outcomes. Being in a monogamish relationship arrangement (as compared to a monogamous arrangement) and the experience of intimate partner violence victimization were associated with increased willingness to persuade a partner to initiate PrEP.

Sexuality Within Female Same-Gender Couples: Definitions of Sex, Sexual Frequency Norms, and Factors Associated with Sexual Satisfaction.

Despite a growing number of female same-gender (FSG) relationships, couples-based research and interventions have focused primarily on mixed-gender couples. Consequently, research has applied a heteronormative lens to understanding some relationship factors, including sexuality. The current study sought to provide descriptive data regarding frequency and conceptualizations of sex across partners in FSG relationships, as well as to analyze how relationship factors are associated with sexual satisfaction in this population. Participants (N = 206) were 103 adult FSG couples who had been together for at least 2 months. Individuals provided self-report data on how they conceptualized sex, and actor-partner models were utilized to assess relationship factors associated with sexual satisfaction. Findings indicated that women in FSG relationships hold broad definitions of sex, with the majority of behaviors conceptualized as sex, including acts that involved partnered genital touching. In dyadic actor-partner models, sexual satisfaction was predicted by several factors including sexual frequency, emotional intimacy, and sexual intimacy. Unexpectedly, higher desired sexual frequency was associated with lower sexual satisfaction; however, this finding only emerged after controlling for actual sexual frequency, suggesting that discrepancies between desired and actual sex frequency may be important for FSG couples. Implications for clinical practice with FSG couples are explored, including a strength-based focus on broad conceptualizations of sex within this population and targeting relationship factors associated with sexual satisfaction.