Motives between the Sheets: Understanding Obligation for Sex at Midlife and Associations with Sexual and Relationship Satisfaction.

Reasons for sex are associated with sexual and relational outcomes. This study investigated reasons for sex at last sex, with a focus on obligation (an avoidance motivation) and doing something nice for a partner (an approach motivation), and their associations with sexual and relationship satisfaction, while controlling for marital duration, age, and sexual desire. We investigated these reasons among married, midlife Canadian women (n = 324), men (n = 275), and 25 non-binary/gender queer participants 40 to 59 years of age. Participants were recruited from a Qualtrics analytics panel and completed an online questionnaire. Obligation was reported as a reason for having sex by 12.4% of women and 1.8% of men; "doing something nice" was reported by 10.2% of women and 9.5% of men. In regression analyses, women who reported having sex for obligation had significantly lower relationship satisfaction and sexual satisfaction than women who did not report this reason. In contrast, having sex to do something nice for one's partner was associated with higher sexual satisfaction among women. Findings indicate that having sex when feeling obligated may be associated with negative sexual and relational outcomes among midlife women.

An exploratory test of a couples-based condom-use intervention designed to promote pleasurable and safer penile-vaginal sex among university students.

Objective: Dual use of male condoms and female contraceptives is widely advocated for unplanned pregnancy prevention, yet college students often neglect condoms. This feasibility and acceptability study assessed the efficacy of a self-guided home-based condom-promotion intervention among college students in heterosexual relationships. Participants: Fifty-nine couples who had been together at least 30 days and had penile-vaginal sex at least twice weekly. Methods: Assessments were done at baseline and 6 months later. Outcomes were frequency of condom-unprotected penile-vaginal sex and four psychosocial mediators of condom use. Results: Frequency of unprotected penile-vaginal sex decreased over time. Several corresponding psychosocial mediators showed change, particularly among women. Using actor-partner interdependence modeling, men's increase in condom use was associated with an increase in women's sexual pleasure. Conclusion: Findings support implementation of a brief, self-guided, home-based condom-use intervention that could lower incidence of unplanned pregnancy and STIs among heterosexually active college students.

Motivations for Engaging in Consensually Non-Monogamous Relationships.

Sexual, romantic, and intimate relationships provide opportunities for individual and interpersonal fulfillment and the enhancement of well-being. Though research has identified that consensual non-monogamy (CNM) offers unique relational benefits, little work has examined why individuals pursue CNM relationships. Both self-determination theory and self-expansion theory provide frameworks for understanding the range of intra- and interpersonal motives for choosing or negotiating a multipartnered relationship. We explored the reasons for which people engage in CNM and discuss how motivations for CNM might be linked to well-being and need fulfillment. Our study used a qualitative approach to examine the motivations individuals report for engaging in CNM relationships. As part of a larger online survey, participants completed open-ended questions examining motivations for, and experiences of, CNM relationships. Data from participants who indicated that they were currently in a CNM partnership was selected for the analyses (n = 540). Data were analyzed using thematic analysis, within a critical realist framework. Motivations were organized into six interconnected themes: reasons related to autonomy, beliefs and value systems, relationality, sexuality, growth and expansion, and pragmatism. Individuals reported diverse reasons for engaging in CNM relationships; reasons addressed both individual and relational needs and well-being. Findings contrast with stereotypic views of CNM relationships as unstable/unfulfilling or that individuals engage in CNM because of relationship problems. The findings may facilitate therapeutic interventions for counselors working with individuals who are in the process of negotiating or re-negotiating relationship boundaries.

A dyadic examination of self-determined sexual motives, need fulfillment, and relational outcomes among consensually non-monogamous partners.

Intimate and sexual relationships provide opportunity for emotional and sexual fulfillment. In consensually non-monogamous (CNM) relationships, needs are dispersed among multiple partners. Using Self-Determination Theory (SDT) and dyadic data from 56 CNM partnerships (112 individuals), we tested how sexual motives and need fulfillment were linked to relational outcomes. We drew from models of need fulfillment to explore how sexual motives with a second partner were associated with satisfaction in the primary relationship. In a cross-sectional and daily experience study we demonstrated that self-determined reasons for sex were positively associated with sexual satisfaction and indirectly linked through sexual need fulfillment. Self-determined reasons for sex predicted need fulfillment for both partners at a three-month follow up. The association between sexual motives and need fulfillment was stronger on days when participants engaged in sex with an additional partner, though this was not related to satisfaction in the primary relationship. Implications for need fulfillment are discussed.

A home-practice intervention for increasing condom use among university undergraduates.

The consistently high rate of sexually transmitted infections among people 18-24 years old warrants novel strategies promoting condom use among large segments of this population. Ample opportunity exits to employ such strategies in university settings. This study evaluated a sex-positive, home-practice intervention designed to promote condom use among university undergraduates engaging in penile-vaginal intercourse (PVI). A sample of 29 opposite-sex undergraduate couples, engaging in PVI, was recruited from a large university. After teaching couples about condom use, a health educator helped couples select condoms/lubricants from options comprising various sizes, fits, shapes, textures, and other features. A 30-day 'homework assignment' was made to use these products while reducing condom use errors/problems and enhancing sexual pleasure. A repeated measures design, with a six-month observation period, was used to evaluate the program. Over the six-month period, the mean frequency of condomless PVI decreased from 26.4 to 3.9 times (P < .001). Significant and favorable changes were also found relative to attitudes toward condom use (P = .027) and in condom use self-efficacy (P < .001). Most students completing the follow-up assessment indicated the intervention would favorably impact their future condom use. Findings suggest this intervention program may be important to promoting condom use among university couples engaging in PVI.

High Emotional and Sexual Satisfaction Among Partnered Midlife Canadians: Associations with Relationship Characteristics, Sexual Activity and Communication, and Health.

Despite midlife adults accounting for a substantial and growing segment of the population, few large-scale studies have investigated factors which distinguish highly satisfying relationships from less satisfying ones in midlife. In a subsample of partnered 40-59-year-old Canadians (705 men, 743 women), relationship characteristics, sexual activity and communication, and health were investigated individually and simultaneously as predictors of high emotional and sexual satisfaction. Though the vast majority of participants reported being at least somewhat satisfied in their current relationship, less than half reported high satisfaction. For men and women, high emotional and sexual satisfactions were strongly linked. Logistic regressions indicated that longer relationships, dating relationships, and greater subjective overall health predicted high emotional satisfaction for men, whereas older age, married or cohabiting relationships, and frequent sexual communication predicted high emotional satisfaction for women. All types of sexual activities (minus penile-anal intercourse) were bivariately related to high emotional and sexual satisfaction. More frequent partnered sexual activity predicted high emotional and sexual satisfaction for men and women in regression analyses. More frequent sexual communication predicted high emotional satisfaction for women and high sexual satisfaction for both men and women. Newer relationships were more sexually satisfying for men. Postmenopausal women were less likely to be highly sexually satisfied. Findings suggest that physical health conditions are not generally related to high levels of satisfaction in midlife couples and that frequently discussing sex and engaging in (any) sexual activity with a partner are key components of highly satisfying relationships.

Corrigendum to: Decision making over condom use during menses to avert sexually transmissible infections.

Background:The aim of this study was to test the hypothesis that receptive partners in penile-vaginal intercourse (PVI) who exercise independent decision making over condom use during menses do so to avert sexually transmissible infection (STI) transmission or acquisition. Methods: Data were collected through a partnership with Clue, the industry-leading female health app. A brief web-based questionnaire was developed, translated into 10 languages, and made accessible via a URL link sent to Clue users and posted on social media. Inclusion criteria were: age ≥14 years, not being currently pregnant and engaging in PVI and condom use during menses in the past 3 months. The analytical subsample comprised 12889 respondents residing in 146 countries. Results: Twenty per cent indicated independent decision making about condom use during menses. Independent decision making was associated with lower odds of reporting that condoms were used for contraception (adjusted odds ratio (aOR) 0.65; 99% confidence interval (CI) 0.57-0.73) and higher odds that they were used for the prevention of STIs (aOR 1.44; 99% CI 1.28-1.61). A third significant finding pertained to always using condoms during menses; this was less likely among those indicating independent (female only) decision making (aOR 0.69; 99% CI 0.62-0.78). Non-significant associations with another two outcomes were found: protecting the partner against menstrual blood and protecting themselves against semen. Conclusions: Findings from people in 146 countries strongly support the hypothesis that those exercising independent decision making over condom use during menses do so to avert STI transmission or acquisition. That only one-fifth of this global sample reported this type of independent decision making suggests that empowerment-oriented (structural-level) interventions may be advantageous for individuals who are the receptive partner in PVI that occurs during menses.

Genital Self-Image: Associations with Other Domains of Body Image and Sexual Response.

Genital self-image is an emerging aspect of body image relevant to sexual functioning and sexual satisfaction. The aims of the present study were to (1) examine the association between body image and genital self-image with a broad range of sexuality-related outcomes; (2) explore whether genital self-image is a more salient influence on sexual satisfaction and functioning than body image and (3) determine whether this would hold true for both men and women. The analytic sample (6,228 cis-gendered, heterosexual men and women between the ages of 18 and 40) was recruited from reddit.com online communities. Participants completed a survey that assessed genital self-image, body image, sexual satisfaction, and sexual functioning. Among women and men, positive genital self-image was associated with positive feelings about one's body overall and reduced body-related concerns specific to sexual encounters (e.g., sexual performance). In female respondents, as genital self-image increased, so did sexual satisfaction. Although genital self-image did not significantly predict sexual satisfaction among men, exploratory analysis indicated a mediating relationship with body image concerns. Findings from the current study may inform interventions to facilitate the development of a healthy sexual self-concept as well as a more positive outlook on genital appearance among men and women.

Decision making over condom use during menses to avert sexually transmissible infections.

Background The aim of this study was to test the hypothesis that receptive partners in penile-vaginal intercourse (PVI) who exercise independent decision making over condom use during menses do so to avert sexually transmissible infection (STI) transmission or acquisition. METHODS: Data were collected through a partnership with Clue, the industry-leading female health app. A brief web-based questionnaire was developed, translated into 10 languages, and made accessible via a URL link sent to Clue users and posted on social media. Inclusion criteria were: age ≥14 years, not being currently pregnant and engaging in PVI and condom use during menses in the past 3 months. The analytical subsample comprised 12889 respondents residing in 146 countries. RESULTS: Twenty per cent indicated independent decision making about condom use during menses. Independent decision making was associated with lower odds of reporting that condoms were used for contraception (adjusted odds ratio (aOR) 0.65; 99% confidence interval (CI) 0.57-0.73) and higher odds that they were used for the prevention of STIs (aOR 1.44; 99% CI 1.28-1.61). A third significant finding pertained to always using condoms during menses; this was less likely among those indicating independent (female only) decision making (aOR 0.69; 99% CI 0.62-0.78). Non-significant associations with another two outcomes were found: protecting the partner against menstrual blood and protecting themselves against semen. CONCLUSIONS: Findings from people in 146 countries strongly support the hypothesis that those exercising independent decision making over condom use during menses do so to avert STI transmission or acquisition. That only one-fifth of this global sample reported this type of independent decision making suggests that empowerment-oriented (structural-level) interventions may be advantageous for individuals who are the receptive partner in PVI that occurs during menses.

The Relationship Between Body Image and Sexual Functioning Among Gay and Bisexual Men.

Gay and bisexual men report high body dissatisfaction compared to heterosexual counterparts, but no studies to date have examined how this may impact their sexual functioning. The present study investigated body image domains as predictors of sexual functioning problems (inhibited desire, erectile dysfunction, and premature ejaculation) among an online community sample of 185 gay and bisexual men, ages 18-40. Participants reported moderate to high body image satisfaction and sexual functioning consistent with previous literature with nonclinical male samples. Overall, the total variance accounted for by regression models was low. Body image variables were not predictive of sexual desire. However, increased drive for muscularity and lower affective body esteem were predictive of erectile difficulties. Additionally, negative behavioral body image in sexual situations and evaluative body dissatisfaction were associated with premature ejaculation. Understanding this relationship may have implications for gay and bisexual men's health and wellbeing. Future research directions are discussed.

The Protective Value of Discussing Condom Use: A Study of Young Black Men Attending STI Clinics in the Southern United States.

Young Black men (YBM) experience disparities in both HIV incidence and incidence of bacterial sexually transmitted infections (STIs); thus, developing efficacious behavioral interventions is an especially critical goal. One potential avenue for intervention involves improving sexual health communications among YBM and their partners, before sex occurs. Such discussions may serve several purposes, including improving condom use and facilitating the negotiation of correct and consistent condom use. The aim of the current study was to determine the STI-protective effects of discussing condom use with sex partners, among medically underserved YBM. A total of 702 YBM were recruited from three STI clinics in the Southern United States. YBM completed a self-interview at baseline and again 6 months later. At 12 months postenrollment, a chart review determined incidents of STIs. The majority of YBM participants (61.1%) had recently discussed condom use with partners before sex. Of the 12 assessed outcomes, 7 were significantly associated with this measure. In each case, a protective effect was observed. In controlled analyses, the 12-month incidence of STIs was significantly ( p = .05) greater among YBM not discussing condoms with sex partners. The results of the current study suggest that, among YBM attending clinics, discussing condom use with sex partners may promote safer sex practices. This behavior was also predictive of lower STI incidence in the ensuing 12 months, suggesting that it may be an ideal intervention target for programs designed to protect YBM against STI acquisition, including HIV.

Prevalence and Predictors of Sexual Problems Among Midlife Canadian Adults: Results from a National Survey.

BACKGROUND: Sexual problems are common among midlife men and women, and studies have identified a range of demographic, health, and relational correlates. Research on prevalence of these sexual problems within Canada is sparse and is warranted given the unique context related to provision of health care services in contrast to other countries. AIM: We investigated sexual problems (women's low desire, orgasm difficulties, and vaginal pain, as well as men's low desire, erection difficulties, and ejaculation difficulties) and their correlates among a large sample of Canadian men and women aged 40-59 years. METHODS: A national sample of Canadians was recruited (N = 2,400). Prevalence statistics for the sexual problems, and odds ratios for correlates were computed using logistic regression to identify demographic, health, and behavioral correlates of men' and women's sexual problems. OUTCOMES: Self-reported experiences in the last 6-months of low desire, vaginal dryness, vaginal pain, and orgasm difficulties for women, and low desire, erectile difficulties, and ejaculation problems for men. RESULTS: Sexual problems were relatively common; low desire was the most common sexual problem, particularly for women, with 40% reporting low sexual desire in the last 6 months. Women who were post-menopausal were much more likely to report low desire, vaginal pain, and vaginal dryness. Low desire and erectile difficulties for men, and low desire and orgasm difficulties for women were significant predictors of overall happiness with sexual life. CLINICAL TRANSLATION: Given the prevalence and impact of sexual problems indicated in our study, physicians are encouraged to routinely assess for and treat these concerns. CONCLUSIONS: Strengths include a national sample of an understudied demographic category, midlife adults, and items consistent with other national studies of sexual problems. Causal or directional associations cannot be determined with these cross-sectional data. Results are largely consistent with previous national samples in the United States and the United Kingdom. Sexual problems are common among Canadian men and women, with many being associated with self-reported sexual happiness. Quinn-Nilas C, Milhausen RR, McKay A, et al. Prevalence and Predictors of Sexual Problems Among Midlife Canadian Adults: Results from a National Survey. J Sex Med 2018;15:873-879.

A pilot test of a self-guided, home-based intervention to improve condom-related sexual experiences, attitudes, and behaviors among young women.

OBJECTIVE: To conduct a pilot test of a brief, self-guided, home-based program designed to improve male condom use attitudes and behaviors among young women. PARTICIPANTS: Women aged 18-24 years from a large Midwestern University reporting having had penile-vaginal sex with two or more partners in the past 3 months. Sixty-seven enrolled; 91.0% completed the study. METHODS: A repeated measures design was used, with assessments occurring at baseline, immediately  post intervention (T2), and 30 days subsequent (T3). RESULTS: Condom use errors and problems decreased, condom-related attitudes and self-efficacy improved, and experiences of condom-protected sex were rated more positively when comparing baseline with T2 and T3 scores. Further, the proportion of condom-protected episodes more than doubled between T1 and T3 for those in the lowest quartile for condom use at baseline. CONCLUSION: This low-resource, home-based program improved condom-related attitudes and promoted the correct and consistent use of condoms.

Do Associations Between Pleasure Ratings and Condom Use During Penile-Vaginal Intercourse Vary by Relationship Type?: A Study of Canadian University Students.

Research suggests the relationship between pleasure and condom use during penile-vaginal intercourse (PVI) is associated with relationship status. This online study examined pleasure ratings and condom use at last PVI, stratifying by partner type, among a national sample of Canadian university students. Participants were 715 undergraduates (60.7% women, 39.3% men) who reported on their most recent sexual experience. Condom use decreased with level of relationship commitment, whereas ratings of pleasure increased. Overall, participants were more likely to rate their most recent PVI as Very pleasurable when condoms were not used compared to when condoms were used. However, when stratified by partner type, these differences largely disappeared. For women, with one exception, there were no differences in pleasure between PVI with and without condoms across most partner-type categories. Women in committed dating relationships were more likely to report their last PVI as very pleasurable if condoms were not used than women in these same relationships who had used condoms. Across relationship categories, men who did and did not use condoms did not differ in terms of their pleasure ratings. The results of this study suggest relationship context should be taken into account when assessing condom use experiences.

Women's willingness to experiment with condoms and lubricants: A study of women residing in a high HIV seroprevalence area.

The objective of this study was to investigate women's willingness to experiment with new condoms and lubricants, in order to inform condom promotion in a city with high rates of poverty and HIV. One hundred and seventy-three women (85.9% Black) sexually transmitted infection clinic attendees in Jackson, Mississippi, United States completed a questionnaire assessing willingness to experiment with condoms and lubricants and sexual pleasure and lubrication in relation to last condom use. Most women were willing to: (1) experiment with new types of condoms and lubricants to increase their sexual pleasure, (2) touch/handle these products in the absence of a partner, and (3) suggest experimenting with new condoms and lubricants to a sex partner. Previous positive sexual experiences with lubricant during condom use predicted willingness. The role women may play in male condom use should not be underestimated. Clinicians may benefit women by encouraging them to try new types of condoms and lubricants to find products consistent with sexual pleasure.

Evaluation of the Condom Barriers Scale for Young Black Men Who Have Sex With Men: Reliability and Validity of 3 Subscales.

BACKGROUND: Reliable and valid scale measures of barriers to condom use are not available for young black men who have sex with men (YBMSM). The purpose of this study was to evaluate the Condom Barriers Scales for application with YBMSM. METHODS: A clinic-based sample of 600 YBMSM completed a computer-assisted self-interview. The primary measure was a 14-item abbreviated version of the Condom Barriers Scale. Reliability and criterion validity were assessed. RESULTS: All 3 subscales were reliable: partner-related barriers (Cronbach α=0.73), sensation-related barriers (α=0.70), and motivation-related barriers (α =0.81). A complete absence of barriers was common: 47.0% (partner-related), 30.7% (sensation-related), and 46.5% (motivation-related). Dichotomized subscales were significantly associated with reporting any condomless insertive anal sex (all Ps < 0.001) and any condomless receptive anal sex (all Ps < 0.001). The subscales were significantly associated with these measures of condomless sex preserved at a continuous level (all Ps <0.001, except for sensation barriers associated with condomless receptive anal sex = 0.03). Further, the subscales were significantly associated with reporting any condom use problems (all Ps <0.001) and a measure of condomless oral sex (all Ps <0.001, except for partner-related barriers=0.31). Finally, the sensation-related barriers subscale was significantly associated with testing positive for Chlamydia and/or gonorrhea (P=0.049). CONCLUSIONS: The 3 identified subscales yielded adequate reliability and strong evidence of validity, thereby suggesting the utility of these brief measures for use in observational and experimental research with YBMSM.

"Hedge Your Bets": Technology's Role in Young Gay Men's Relationship Challenges.

Technology is playing an increasingly pervasive role among young gay men in the process of meeting potential romantic or sexual partners. We investigated challenges posed by technology related to young gay men's relationships. Focus groups (n = 9) of young gay men aged 18-24 (n = 43) were transcribed verbatim, and thematic analysis was used to identify two major themes regarding challenges to relationship development and maintenance. Subthemes include unrealistic expectations of relationships, inauthentic self-presentation online, sexual primacy over romance, increased opportunities for infidelity, and jealousy. The implications of this study for sexual education and sexual health promotion are discussed.

Sexual Motives in Heterosexual Women With and Without Sexual Difficulties.

Previous research indicates that women with sexual problems may have different reasons for engaging in sex than women who are not experiencing sexual problems. The current study investigated whether reasons for sex differed by women reporting high versus low overall sexual functioning, as assessed by the Female Sexual Function Index (FSFI) (Rosen et al., 2000). As low desire and inability to achieve orgasm are the two most commonly reported sexual problems for women, the study also investigated whether women with and without problems specifically related to sexual desire or orgasm cited different reasons for sex. The sample consisted of 446 heterosexual women between the ages of 18 and 61 who completed an online questionnaire assessing reasons for sex and sexual functioning. Women with low sexual functioning overall were more likely to endorse insecurity reasons for sex, while women with high sexual functioning overall were more likely to endorse physical reasons for sex. Women experiencing low desire specifically were less likely to endorse emotional and physical reasons for sex than women without desire difficulties. Women experiencing orgasm difficulties specifically were more likely to endorse insecurity reasons for sex than women without orgasm difficulties. The variance accounted for was low in all cases. This research offers insights into the important but limited role sexual functioning may play in the broader context of women's sexual motivations.

A Qualitative Exploration of Factors That Affect Sexual Desire Among Men Aged 30 to 65 in Long-Term Relationships.

Few empirical studies have explored men's experiences of sexual desire, particularly in the context of long-term relationships. The objective of the current study was to investigate the factors that elicit and inhibit men's sexual desire. Semistructured interviews were conducted with 30 men between the ages of 30 and 65 (average age 42.83 years) currently in long-term heterosexual relationships (average duration 13 years 4 months). Analysis was conducted using grounded theory methodology from the interpretivist perspective. A total of 14 themes and 23 subthemes were identified to capture men's descriptions of eliciting and inhibiting factors of their sexual desire. The six most integral themes are presented in the current article, all of which reflect the perspectives of the majority of participants, regardless of age or relationship duration, specifically (a) feeling desired, (b) exciting and unexpected sexual encounters, (c) intimate communication, (d) rejection, (e) physical ailments and negative health characteristics, and (f) lack of emotional connection with partner. The findings suggest that men's sexual desire may be more complex and relational than previous research suggests. Implications for researchers and therapists are discussed.

The Relationship Between Body Image and Domains of Sexual Functioning Among Heterosexual, Emerging Adult Women.

INTRODUCTION: Research suggests that body image affects sexual functioning, but the relationship between specific types of body image (evaluative, affective, and behavioral) and domains of sexual functioning (desire, arousal, and orgasm) has not been investigated. AIM: To determine whether, and to what degree, body image concerns (evaluative, affective, and behavioral) influence aspects of women's sexual functioning (desire, arousal, and orgasm). METHODS: Eighty-eight sexually active women in heterosexual romantic relationships completed surveys assessing evaluative, affective, and behavioral body image and sexual functioning. Body composition data also were collected using dual energy x-ray absorptiometry. MAIN OUTCOME MEASURES: Sexual functioning was assessed using the desire, arousal, and orgasm subscales of the Female Sexual Functioning Index. RESULTS: Hierarchical multiple regression analysis indicated that poor evaluative, affective, and behavioral body image were detrimental to women's sexual functioning. Specifically, dissatisfaction with one's body predicted decrements in desire (ß = -0.31, P < .05) and arousal (ß = -0.35, P < .01). Similarly, feeling that others evaluate one's body negatively predicted decrements in desire (ß = 0.22, P < .05) and arousal (ß = 0.35, P < .01). Feeling negatively about one's appearance predicted decrements in arousal (ß = 0.26, P < .05). Negative thoughts and feelings about one's body during a sexual encounter (body image self-consciousness) predicted decrements in arousal (ß = -0.37, P < .01) and orgasm (ß = -0.25, P < .05). CONCLUSION: Findings from this study suggest important linkages between body image and sexual functioning constructs and indicates that interventions to improve body image could have concomitant benefits related to sexual experience.