Development and Initial Validation of the Attitudes Towards Older Adult Sexuality in Long-term Care Scale (AOASLC).

In long-term care facilities where older adults may reside, negative attitudes about later life sexuality can result in restrictive facility policies and staff behaviors that suppress residents' rights to sexual expression. No assessment instrument specifically focuses on the sexual behaviors of long-term care residents and existing measures of attitudes toward older adult sexuality do not include sexual expression in long term care, nor do they assess a full range of sexual behaviors. We developed the Attitudes toward Older Adult Sexuality in Long-term Care Scale (AOASLC). A large, diverse sample of 295 community-dwelling adults in the United States completed an online survey through Amazon Mechanical Turk. The survey included the AOASLC and self-report measures of related constructs. Two-hundred-and-ninety-five participants completed the survey (Mage = 49.16, SD = 14.69, range = 18- 84 years). Of the sample, 50.2% identified as female, 49.5% identified as male, and one person identified as transgender male. An exploratory factor analysis indicated a two-factor structure. Factor 1 represented general attitudes toward sexual behaviors, and Factor 2 represented acceptability of various sexual behaviors. The instrument evidenced good reliability and validity. While further validation research is necessary, the AOASLC is a promising new measure.

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.

A Validation Study of the Global Measure of Sexual Satisfaction in Sexually Active Adolescents.

Positive views of adolescents' sexuality have only begun to garner interest in the last two decades. Despite great strides in this emerging area, progress is limited by the paucity of valid and reliable measures among this population. The goal of this study was to validate the widely used adult five-item Global Measure of Sexual Satisfaction (GMSEX) in a large sample of sexually active adolescents. A total of 1,036 adolescents (516 girls, 49.8%) aged between 14 and 17 years (Mage = 14.62; SD = 0.66) were recruited to investigate the reliability and validity of the GMSEX. The GMSEX yielded strong psychometric properties in adolescents, including factor structure, measurement invariance, and reliability. Results showed that the scale works similarly for boys and girls as well as for heterosexual, cisgender, and sexual minority adolescents. The GMSEX is a short, reliable, and valid measure of sexual satisfaction that can be used in future studies focusing on adolescents' sexuality and relationships.

Toward an Integrative Model of Intimacy, Sexual Satisfaction, and Relationship Satisfaction: A Prospective Study in Long-Term Couples.

Sexual and relationship well-being are strongly intertwined in couple relationships. However, relationship quality is generally examined through relationship satisfaction only, neglecting the importance of sexual satisfaction as an aspect of relationship quality for many couples. Moreover, considering the role of interpersonal processes, such as intimacy, in relationship quality seems essential to better understand couples' optimal functioning. Although the Vulnerability-Stress-Adaptation Model posits bidirectional associations between interpersonal processes and relationship quality, few studies have tested such models. This dyadic study examined the longitudinal associations between the process of intimacy and sexual and relationship satisfaction in 145 long-term mixed-gender/sex couples. Participants completed online questionnaires three times over 13 months. A cross-lagged panel model revealed bidirectional associations between intimacy behaviors and both sexual and relationship satisfaction. Findings suggest that intimacy behaviors could foster both sexual and relationship satisfaction in couples, and that higher sexual and relationship satisfaction could also promote intimacy behaviors over time. These results highlight that satisfaction may not only be an outcome of positive interpersonal processes, but also a facilitator of these interpersonal processes over time. This study underscores the need to consider the complex interplay of interpersonal processes and satisfaction to foster relationship quality in long-term couples over time.

Body Image and Sexual Well-Being: A Qualitative Study of Women's Perceptions of Partner and Relationship Influences.

Women with poorer body image tend to report lower sexual well-being; yet, minimal research has examined interpersonal factors affecting women's body image in the context of sexual activity. We examined women's perceptions of the influence of relationship and partner factors on their body image during sexual activity with their male partner. Semi-structured interviews with 16 young adult women (ages 19-29) revealed that relationship factors (relationship quality and stage) and partner factors (partner's judgment or objectification, compliments from partner, partner's attractiveness, partner's body image, and partner initiation of sexual activity) were perceived as influencing body image in sexual situations.

Perceived barriers and rewards to sexual consent communication: A qualitative analysis.

Increasingly, affirmative consent - direct, unambiguous and voluntary agreement to engage in sexual activity (Craig & McKinley, 2015) - is the standard being adopted by educational institutions in North America (Bennett, 2016). Yet, studies show that most individuals continue to communicate consent through nonresistance (Jozkowski et al., 2014a). Given this discrepancy, it is critical to understand what factors prevent individuals from engaging in affirmative consent. Furthermore, a better understanding of the perceived rewards of consent communication could incentivize the adoption of affirmative consent. To understand the range of perceived barriers and rewards, we conducted an online, qualitative study where 231 participants answered two open-ended questions. We used inductive content analysis to categorize participants' perceptions of sexual consent barriers and rewards into four general content areas: (1) Communication Quality, (2) Relational and Emotional Experiences, (3) Sexual Quality and (4) Safety and Coercion. These perceived rewards and barriers were examined through the lens of the Information-Motivation-Behavioural Skills Model. Participants viewed consent communication not only as a means of ensuring safety but also as a way to enhance relational and sexual quality. However, they also perceived barriers in all three of these domains as well as barriers to ensuring that sexual consent communication is fluid and easily understood. These findings provide important avenues for future research investigating how individuals reconcile perceived rewards and costs of affirmative consent communication. We also suggest ways to enhance sexual education by discussing potential rewards and validating the normative nature of fears and anxieties around affirmative consent.

Individual and Relationship Predictors of Trajectories of Sexual Function across Adolescent and Young Adult Relationships.

Many young adults report poor sexual function, but research typically fails to consider relationship context and how problems might evolve over time. Research is needed to provide insights into how sexual problems are experienced across relationships, as well as the types of sexual function problems associated with various trajectories. We investigated retrospective trajectories of sexual problems across the multiple relationships of 688 young adults (18-24 years) as well as the individual and relationship factors associated with these trajectories. Both persistent suboptimal and optimal trajectories emerged for men and women. However, persistent and variable problematic function trajectories also emerged for women (and not men). Across all individual and relationship factors analyzed, multivariate multinomial regression analysis indicated that higher sexual esteem and more traditional gender beliefs best predicted membership in trajectories capturing better sexual function. Implications are discussed in terms of the need to provide substantive information regarding sexual function to young people as they transition to adulthood.

Beyond the Label: Asexual Identity Among Individuals on the High-Functioning Autism Spectrum.

Researchers have suggested that asexuality, which has been conceptualized traditionally as a persistent lack of sexual attraction to others, may be more common among individuals with autism spectrum disorder than in the neurotypical population. However, no studies to date have considered how these individuals understand and conceptualize their sexual identity. The aim of this study was to provide a more nuanced understanding of asexuality among individuals with high-functioning autism spectrum disorder (HF-ASD) than has been done in the past. Individuals with ASD, 21-72 years old (M = 34.04 years, SD = 10.53), were recruited from online communities that serve adults with ASD and Amazon's Mechanical Turk to complete an online survey of sexual and gender identity. Overall, 17 (5.1%) participants who met study criteria (N = 332) self-identified as asexual. However, 9 of the 17 people identifying as asexual expressed at least some sexual attraction to others. In addition, based on open-ended responses, some participants linked their asexual identity more with a lack of desire or perceived skill to engage in interpersonal relations than a lack of sexual attraction. Results suggest that researchers should be cautious in attributing higher rates of asexuality among individuals with ASD than in the general population to a narrow explanation and that both researchers and professionals working with individuals with ASD should consider multiple questions or approaches to accurately assess sexual identity.

Young Adults' Qualitative Self-Reports of Their Outcomes of Online Sexual Activities.

Online sexual activities (OSA) refer to Internet-based activities, behaviours, and materials that are sexual in nature. Many young adults engage in OSA, but report doing so infrequently. Most OSA outcome research has focused on negative effects of only some types of OSA (e.g., viewing pornography online). The goal of this study was to enhance knowledge on the range of OSA outcomes by qualitatively exploring young adults' self-reported negative and positive outcomes from OSA experiences generally. University/College students from Canada (n = 246), Germany (n = 411), Sweden (n = 299), and the USA (n = 123) completed an online survey that included open-ended questions about "one of the most positive/negative effects that engaging in online sexual activities has had on your life". More participants provided positive outcome responses than negative outcome responses. Qualitative analysis of the responses suggested a wide range of positive and negative outcome content that fit into seven bi-polar, higher-order themes: No Outcomes, Relationship Outcomes, Sexual Experience, Emotional Outcomes, Knowledge, Personal Outcomes, and Security. We found no variations in themes or their respective codes across the four countries. The findings suggests that researchers, educators, health care and psychology providers need to include multiple dimensions of positive and negative, personal and interpersonal, sexual and non-sexual OSA outcomes in their work.

An Experimental Investigation of Variations in Judgments of Hypothetical Males and Females Initiating Mixed-Gender Threesomes: An Application of Sexual Script Theory.

Although many young adults are interested in mixed-gender threesomes (MGTs), little research has assessed attitudes toward them. Yet, MGTs offer a rare context to investigate how consensually nonmonogamous sexual encounters and involvement with same-sex others influence attitudes. Thus, by adopting sexual script theory as a framework, the current study compared three dimensions of character judgments (cognitive abilities, morality, partner quality) and assumptions about the sexual history of hypothetical males and females who initiated a MGT (two females and one male; two males and one female) or mixed-sex dyadic sexual activity with a casual or committed partner. To do so, a between-subject design was adopted in which 690 U.S. adults (405 women, 285 men) evaluated a hypothetical initiator described in one of 12 vignettes. On average, participants made neutral judgments about the initiator, yet those initiating dyadic sexual behavior were judged more favorably and as having a less extensive sexual history than MGT initiators. Male initiators were judged more favorably than female initiators, particularly by men. Those initiating in the context of a committed relationship were judged as more moral and as higher-quality partners than those initiating within a casual relationship; female (but not male) initiators in the committed context were judged as having a less extensive sexual history than female initiators in the casual context. These results confirm the presence of mononormativity biases and the sexual double standard and have implications for educators and practitioners related to stigma reduction and the promotion of inclusive sexual education.

A Mixed-Method Analysis of Women's Attributions about Their Partner's Pornography Use.

We used a mixed-method design to examine the attributions women in mixed-gender/sex relationships make for their partner's perceived pornography use and whether such attributions covary with women's relationship and sexual satisfaction. A final sample of 199 women completed measures of relationship satisfaction, sexual satisfaction, and their perceptions of partner's pornography use. Participants also completed three open-ended questions assessing their attributions of their partner's perceived pornography use. Qualitative analyses revealed 11 themes in women's attributions of their partner's perceived pornography use; some of the themes reflected on women themselves (e.g., being open-minded and accepting), whereas other themes reflected on the partner (e.g., partner is sexually bored) or the relationship (e.g., strong and trusting relationship). Furthermore, the women made positive, negative, and neutral attributions. Quantitative analyses showed that positive attributions were significantly more frequent than neutral or negative attributions and the latter two categories did not differ significantly from each other. Also, greater frequency of positive and neutral attributions and lower frequency of negative attributions were associated with higher relationship satisfaction and sexual satisfaction. Our results suggest that women make a range of attributions about their partner's pornography use and that this variation relates meaningfully to indices of relationship functioning.

A Dyadic Longitudinal Study of Child Maltreatment and Sexual Well-Being in Adult Couples: The Buffering Effect of a Satisfying Relationship.

This study examined the contribution of child maltreatment (CM) to trajectories of couples' sexual well-being, and whether relationship satisfaction moderates these associations. Using a sample of 269 mixed-sex couples followed over one year, dyadic latent growth curve models showed both actor and partner effects. In terms of actor effects, women's emotional neglect was associated with lower initial levels of sexual satisfaction, and most types of women's CM were related to a sharper decrease over time in sexual satisfaction. Men and women's emotional abuse and neglect, and women's sexual abuse, were associated with lower initial levels of sexual function. Men and women's emotional neglect and women's emotional abuse were related to higher initial levels of sexual distress. Women's sexual abuse was associated with a steeper increase in sexual distress. In terms of partner effects, women's emotional neglect was associated with lower initial levels of partner sexual satisfaction, and women's emotional abuse and neglect, with lower initial levels of partner sexual function. Greater relationship satisfaction buffered some of these negative effects. Given that sexual well-being requires a context in which the individual feels safe, all forms of CM may affect sexual well-being, although a satisfying relationship may buffer some of these effects.

Young adolescents' responsiveness to sexual communication with their mother: Distinguishing diverse intentions.

INTRODUCTION: It is unlikely that parents can have effective sexuality discussions with their adolescent if the adolescent is not responsive to their efforts. We evaluated young adolescents' intentions of being responsive to sexual communication with their mother and whether youths who were likely, ambivalent, or unlikely to be responsive differed on their characteristics, features of previous sexual communication, and features of the mother-adolescent relationship. METHODS: Participants were 259 Canadian adolescents (12-14 years; 53% girls) who received and returned a survey by mail. They completed measures of responsiveness intentions, expected outcomes of sexual communication, extent of past sexual communication, the frequency with which mothers encouraged questions and provided information about sexuality topics, open communication, and mothers' provision of warmth, structure, and autonomy support. RESULTS: We found that 37% of adolescents were likely to be responsive to sexual communication with their mother, 34% were ambivalent, and 29% were unlikely to be responsive. Youths' responsiveness intentions were general rather than topic-specific. A discriminant analysis showed that only features of previous sexual communication separated all three groups whereas specific mother-adolescent relationship features (open communication and structure) and one adolescent characteristic (expected outcomes) separated the unlikely group from the other groups. CONCLUSIONS: Young adolescents' intentions of being responsive to sexual communication from their mother are diverse yet general in nature. Mothers' engagement in sexual communication appears essential for youths' openness to these discussions. Enhancing specific mother-adolescent relationship features and youths' outcome expectations may shift adolescents who are resistant to sexuality discussions to being more sure.

Sexual health-related training of Canadian midwives and its association with practice outcome.

BACKGROUND: Although promoting sexual health should be an integral part of midwifery practice, little is known about midwives' preparation to address their clients' sexual health concerns. AIMS: To assess the formal and self-directed training on sexual health topics relevant to midwifery practice of Canadian midwives as well as the association between training and various practice outcomes. METHODS: Forty midwives registered in the Province of Ontario, Canada completed an online survey assessing their formal and self-directed sexual health training, knowledge, comfort, and practice related to 10 sexual health issues. FINDINGS: In terms of formal training, three of the 10 topics were coved in-depth and seven were covered in general terms only or not at all. Participants had received an average of 26.0 hours of formal training related to sexual health. Almost all (90%) participants had engaged in self-directed learning on at least one topic. Participants had asked at least one client about only 5 of the 10 topics and been asked by at least one client about 4.5 of them. Participants who reported more extensive formal training had been asked about more sexual health topics by their clients. More self-directed learning was associated with more positive attitudes toward midwives' role in addressing sexual health concerns, feeling more knowledgeable, and being asked about and asking about more sexual health topics. CONCLUSION: The midwives in this sample had limited training in some important sexual health issues relevant to midwifery practice. Likely as a result, they often did not address these issues in practice.

Figuring It Out: How Late Adolescent and Young Adult Men and Women Perceive and Address Problems in Sexual Functioning.

Although there are high rates of sexual problems and sexual dysfunction in adulthood (Mitchell et al., 2013), little is known about the circumstances under which problems are first experienced. A growing body of research addresses prevalence of problems in sexual functioning among adolescents and young adults, yet little is known about the meanings that young people give to these experiences or how they deal with them. We used content analysis of qualitative interviews with 53 heterosexual, sexually active Canadian adolescents (ages 18 to 21) to explore their perceptions of the sexual problems in functioning they had experienced and the strategies (if any) they used to address them over time. Problems among most young people originated early in their partnered sexual life. Figuring it out emerged as an intentional process directed toward improving sexual experiences, although certainly not all young people were successful. Strategies for figuring it out included informational or material help seeking, experimentation to inform future actions, mutual sharing and problem solving, and building emotional connection to improve sexual functioning. Implications for understanding the development of sexual dysfunctions in adulthood are discussed.

Sexual Portrait of Couples Seeking Relationship Therapy.

This study sought to provide information about the sexual well-being of 298 mixed-sex couples seeking relationship therapy and determined the extent to which problems with sexual functioning and dyadic adjustment of both partners are associated with sexual satisfaction. Partners completed measures of dyadic adjustment, sexual satisfaction, and sexual functioning. Thirty percent of couples reported a clinically significant sexual problem. Compared to their male partners, the women were more likely to report a sexual problem as well as lower dyadic adjustment, sexual satisfaction, and overall sexual functioning. Path analysis indicated that relationship adjustment uniquely predicted individuals' own sexual satisfaction; problems in sexual functioning uniquely predicted own and partner sexual satisfaction. Findings underscore the need to address sexual problems in relationship therapy.

A Dyadic Approach to Understanding the Link Between Sexual Functioning and Sexual Satisfaction in Heterosexual Couples.

Researchers have demonstrated that several dimensions of sexual functioning (e.g., sexual desire, arousal, orgasm) are associated with the sexual satisfaction of individuals in a committed mixed-sex (male-female) relationship. We extended this research by comparing a dyadic model that included both own (i.e., actor effect) and partner (i.e., partner effect) domains of sexual functioning to an individual model that included only actor effects. Participants were 124 mixed-sex couples who completed online measures of sexual functioning and sexual satisfaction. Data analysis using the actor-partner interdependence model (APIM) and structural equation modeling (SEM) indicated that the dyadic model had a better fit than the individual model. Women's sexual desire and orgasm and men's erectile functioning were significant positive predictors of both own and partner's sexual satisfaction. These results are discussed in terms of the importance of taking a dyadic approach to research and clinical work related to sexual satisfaction.

Heterosexual Young Adults' Interest, Attitudes, and Experiences Related to Mixed-Gender, Multi-Person Sex.

There has been little research on threesomes, a form of multi-person sex that involves sexual activity with two other people simultaneously. Therefore, we examined young adults' attitudes toward, interest in, and experiences with one form of threesome, mixed-gender threesomes (MGTs), defined as sexual activity involving three people where at least one member of each gender is present. Participants were 274 (202 women, 72 men) heterosexual young adults who completed an online survey. Overall, 13 % of participants (24 % of men and 8 % of women) reported experience and 64 % reported some interest in engaging in an MGT. However, the overall level of interest was quite low and varied according to contextual variables (i.e., what other persons were involved). Men's interest remained unaffected by third person status as long as the MGT involved familiar others (friends and acquaintances) rather than strangers, whereas women preferred familiar others only for MGTs with which they were the third person, not for those involving a romantic partner. Participants also reported fairly neutral attitudes toward MGTs. Compared to the women, the men reported significantly more positive attitudes and greater interest, and were more likely to report MGT experience. In addition, attitudes, interest, and experience were all positively associated with each other. Taken together, these results suggest that young people are not judgmental about others engaging in MGTs but are not highly motivated to do so themselves. Implications for researchers and sexual health educators are discussed.

Online Sexual Activity Experiences Among College Students: A Four-Country Comparison.

The purpose of this study was to compare male and female college students in four countries (Canada, Germany, Sweden, and the U.S.) on their lifetime experiences (prevalence) and frequency of recent experiences with six types of online sexual activities (OSA): sexual information, sexual entertainment, sexual contacts, sexual minority communities, sexual products, and sex work. Participants (N = 2690; M age, 24.65 years; 53.4 % women, 46.6 % men) were recruited from a university in each of the countries to complete an online survey that included background and demographic questions, and questions about OSA. Most participants reported experience with accessing sexual information (89.8 %) and sexual entertainment (76.5 %) online. Almost half (48.5 %) reported browsing for sexual products, and a substantial minority reported having engaged in cybersex (30.8 %). Very few participants (1.1 %) paid for online sexual services or received payment (0.5 %). In general, participants showed relatively infrequent experience with all types of OSA within the last 3 months. Men showed both higher prevalence and frequency of use of sexually stimulating material online than did women. However, this gender gap was smaller than in previous studies. Country and gender by country effects were (with one exception) either very small or non-existent, suggesting that, overall, students in the four countries were similar in their OSA experiences. Results are discussed in light of an emerging global net generation and globalized sexual culture.