Women who have sex with women: a comprehensive review of the literature and conceptual model of sexual function

Stigma and Sexual Dissatisfaction in Middle-Aged and Older Sexual Minorities

High sexual quality and activity predict psychological well-being in heterosexual middle-aged and older adults; however, these associations have not been documented in sexual minorities, who have faced lifelong stigma concerning their sexuality. This paper presents data from two secondary studies that explored the benefits of being sexually active and satisfied and the role of internalized homonegativity in a sample of middle-aged and older sexual minorities. Study 1 was a cross-sectional survey collected on 91 sexually active sexual minorities (ages 40-80) in same-sex relationships. Study 2 was a cross-sectional survey collected on 235 single and partnered sexual minorities (ages 40-90), which included sexually active (N = 101) and inactive (N = 134) participants. In Study 1, sexual satisfaction was associated with higher psychological well-being and dissatisfaction was more prominently associated with lower psychological well-being. In Study 2, we found that the sexually active participants had higher levels of psychological well-being, in addition to corroborating the Study 1 findings. Additionally, we also determined that sexual dissatisfaction was a mediator between internalized homonegativity and psychological well-being. These findings accentuate the benefits of retaining high sexual quality and activity for middle-aged and older sexual minorities. Although there are apparent advantages of being sexually satisfied, the relationship to psychological well-being is stronger and more of a concern for those who are dissatisfied, which is rooted in internalized homonegativity. These results can guide practitioners working with middle-aged and older sexual minorities to help them achieve successful aging trajectories by reducing their internalized homonegativity and promoting higher sexual quality.

The Biopsychosocial Puzzle of Painful Sex

Genital pain associated with sex is a prevalent and distressing problem with a complex research and clinical profile. This article reviews the historical context of the "sexual pain disorders" and the circuitous trajectory that has led from the first mention of painful sex in ancient documents to the latest diagnostic category of genito-pelvic pain penetration disorder in the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders as well as in other existing and proposed nomenclatures. Prominent etiologic research and emergent theoretical models are critically assessed, as is the latest treatment outcome research of note. Finally, the review points to a number of extant needs in the research and clinical effort, including an integrated biopsychosocial and multidisciplinary approach, randomized clinical trials, targeting of treatment barriers, and expansion of the entire enterprise to include populations that have not been considered. Expected final online publication date for the Annual Review of Clinical Psychology, Volume 18 is May 2022. Please see http://www.annualreviews.org/page/journal/pubdates for revised estimates.

Debunking Lesbian Bed Death: Using Coarsened Exact Matching to Compare Sexual Practices and Satisfaction of Lesbian and Heterosexual Women

The current study examined the prevalence and correlates of over 50 sexual practices in a national survey of heterosexual and lesbian women in relationships. Coarsened exact matching was used to create comparable samples of heterosexual (n = 2510) and lesbian (n = 283) women on six demographic factors, including relationship length. Heterosexual and lesbian women were equally likely to be sexually satisfied (66% heterosexual women vs. 68% lesbian women). Compared to heterosexuals, lesbians were more likely to report having sex 0-1 times per month (11% vs. 23%) and were less likely to report having sex greater than once per month (89% vs. 77%). Among women who had been in relationships for longer than 5 years, heterosexual women were less likely than lesbian women to report having sex 0-1 times per month (15%; 42%). This steeper drop in sexual frequency among lesbian women than heterosexual women has pejoratively been labeled lesbian bed death. Rather than accept the label "lesbian bed death" as characterizing these sexual relationships, we turn our attention to what we call lesbian bed intimacies: the myriad ways that lesbian women incorporate behaviors promoting emotional connection, romance, and mood setting, as well as relying on a wide variety of specific sexual acts (e.g., use of sex toys) and sexual communication. Compared to heterosexual women, lesbian women were more likely to usually to always receive oral sex during sex in the past month (28%; 47%) and to use sex toys in the past year (40%; 62%). In their last sexual encounter, lesbian women were more likely to say "I love you" (67%; 80%), have sex longer than 30 min (48%; 72%), and engage in gentle kissing (80%; 92%). These intimacies likely help explain why sexual satisfaction was similar in these groups despite notable differences in sexual frequency.

Sexual Wellness in Cisgender Lesbian, Gay, and Bisexual People

Cisgender sexual minority persons have sexual wellness needs that go well beyond disease prevention. Despite historical asymmetries in research and clinical attention to sexual wellness in cisgender lesbian, gay, and bisexual persons, a growing body of evidence exists on how to optimally care for these populations. Additional research and development is warranted.

A Structural Equation Model of Sexual Satisfaction and Relationship Functioning Among Sexual and Gender Minority Individuals Assigned Female at Birth in Diverse Relationships

While there is a sizeable literature on sexual satisfaction among male-female mixed-sex couples, research examining other types of relationships (e.g., same-sex) is limited. The current study aimed to broaden our understanding of sexual satisfaction across the diverse relationships of sexual and gender minority individuals assigned female at birth (SGM-AFAB) and inform models of sexual satisfaction for this population. We examined: (1) differences in sexual satisfaction and characteristics of sexual activity (frequency of sex, frequency of orgasm, duration of sex) by relationship type (same-sex, mixed-sex, gender-diverse) among SGM-AFAB; (2) a model of sexual satisfaction and its correlates; and (3) differences in this model by relationship type. Results indicated cisgender women in relationships with cisgender women (same-sex) reported higher duration of sex, frequency of orgasm, and sexual satisfaction compared to cisgender women in relationships with cisgender men (mixed-sex). There were few differences in characteristics of sexual activity between SGM-AFAB in gender-diverse relationships (involving one or more gender minority partners) and those in same- or mixed-sex relationships. Results indicated similarities across relationship types in a model of sexual satisfaction and its correlates. For all relationship types, more frequent and longer duration of sexual activity predicted higher orgasm frequency, more frequent orgasm predicted higher sexual satisfaction, and higher sexual satisfaction predicted better relationship functioning. Only the association between orgasm frequency and sexual satisfaction varied by relationship type. As one of the first studies examining sexual satisfaction among SGM-AFAB in mixed-sex and gender-diverse relationships, findings substantially further our understanding of sexual satisfaction in this population.

The Relational and Bodily Experiences Theory of Sexual Desire in Women

We review the theory and research on women's sexual desire and present a theory that incorporates internalized representations of relational and bodily experiences into our understanding of the full range of desire in women. To this end, we move away from the current tendency to focus on low sexual desire in women and instead consider desire on a spectrum or continuum from absent or diminished to high desire across multiple sexual orientations, including heterosexual, bisexual, and lesbian. We review definitions of sexual desire, as well as the epidemiology and etiology of hypoactive sexual desire, the most prevalent sexual complaint in women, including the biological, psychological, and relationship correlates of inhibited sexual desire. Subsequently, we examine the research on highly sexual women, who tend to experience high levels of sexual desire, sexual agency, and sexual esteem, and distinguish between high sexual desire and hypersexuality. We introduce two important constructs that are integrated into the Relational and Bodily Experiences Theory (RBET) of sexual desire in women: attachment and sexual body self-representations, suggesting that women's internalized representations of self and other that stem from childhood and their capacity to embody their sexual bodies are integral to our understanding of the phenomenology of sexual desire in women. RBET calls for further research into the links between attachment, sexual body self-representations, and desire, and suggests that clinical interventions for sexual desire difficulties in women should emphasize internalized working models of relationships (i.e., attachment) and integrate bodily based approaches.

Are Women's Orgasms Hindered by Phallocentric Imperatives?

Women who have sex with women (WSW) are more likely to report experiencing an orgasm during partnered sex, compared to women who have sex with men (WSM). We investigated whether this difference can be partially accounted for by phallocentric imperatives-gendered sexual scripts that prioritize men's sexual experience. For example, these imperatives emphasize vaginal-penile intercourse (i.e., the coital imperative) and men's physical pleasure (i.e., the male orgasm imperative). We reasoned that a larger variety of sexual behaviors indicates less adherence to the coital imperative and that more self-oriented orgasm goals for women indicate less adherence to the male orgasm imperative. Consistent with previous work, we expected WSW to report higher rates of orgasm than WSM when taking frequency of sex into account. We also hypothesized that this difference in orgasm rates would dissipate when controlling for variety of sexual behavior and women's self-oriented orgasm goals. In a sample of 1988 WSM and 308 WSW, we found that WSW were 1.33 times (p < .001) more likely to report experiencing an orgasm than WSM, controlling for frequency of sex. This incidence rate ratio was reduced to 1.16 (p < .001) after taking into account variety of sexual behavior and self-oriented orgasm goals. Our findings indicate that certain sexual scripts (e.g., phallocentric imperatives) help explain the orgasm discrepancy between WSW and WSM. We discuss masturbation as another male-centered practice that may be relevant to this gap, as well as implications for intervention and future research.

Psychometric properties of the Sexual Excitation/Sexual Inhibition Inventory for Women and Men (SESII-W/M) and the Sexual Excitation Scales/Sexual Inhibition Scales short form (SIS/SES-SF) in a population-based sample in Germany

The Sexual Excitation Sexual/Inhibition Inventory for Women and Men (SESII-W/M) and the Sexual Excitation Scales/Sexual Inhibition Scales short form (SIS/SES-SF) are two self-report questionnaires for assessing sexual excitation (SE) and sexual inhibition (SI). According to the dual control model of sexual response, SE and SI differ between individuals and influence the occurrence of sexual arousal in given situations. Extreme levels of SE and SI are postulated to be associated with sexual difficulties or risky sexual behaviors. The present study was designed to assess the psychometric properties of the German versions of both questionnaires utilizing a large population-based sample of 2,708 participants (Mage = 51.19, SD = 14.03). Overall, psychometric evaluation of the two instruments yielded good convergent and discriminant validity and mediocre to good internal consistency. The original 30-item version of the SESII-W/M did not show a sufficient model fit. For a 24-item version of the SESII-W/M partial strong measurement invariance across gender, and strong measurement invariance across relationship status, age, and educational levels were established. The original structure (14 items, 3 factors) of the SIS/SES-SF was not replicated. However, a 4-factor model including 13 items showed a good model fit and strong measurement invariance across the before-mentioned participant groups. For both questionnaires, partial strong measurement invariance with the original American versions of the scales was found. As some factors showed unsatisfactory internal consistency and the factor structure of the original scales could not be replicated, scores on several SE- and SI-factors should be interpreted with caution. However, most analyses indicated sufficient psychometric quality of the German SESII-W/M and SIS/SES-SF and their use can be recommended in German-speaking samples. More research with diverse samples (i.e., different sexual orientations, individuals with sexual difficulties) is needed to ensure the replicability of the factor solutions presented in this study.

The Year's Best: Interpersonal Elements of Bisexual Women's Most Satisfying Sexual Experiences in the Past Year

Sexual satisfaction is commonly defined and discussed in physiological terms of arousal and orgasm. Yet this narrow discourse does not accommodate the complex, multidimensional, and interpersonal aspects of sexual experience. To broaden and deepen our understanding of sexual satisfaction, we employed McClelland's (2014) holistic four-factor framework of sexual satisfaction in a theoretical thematic analysis of 39 behaviorally bisexual women's descriptions of their "best" partnered sexual experiences from the past year. We found women's accounts mapped on to four elements: emotional attunement, emotional gratification, partner gratification, and sensory gratification. Relational and emotional dynamics, including emotional security, quality of interpersonal interaction during and after a sexual encounter, mutuality, intimacy, partner skill, novelty, and communication, were key to participants' best sex experiences. Our findings support a multifaceted model of women's sexual satisfaction that accounts for emotional, relational, and embodied experiences and the diverse relationships and behaviors these might involve.

Validation of the Interpersonal Exchange Model of Sexual Satisfaction With Women in a Same-Sex Relationship

We examined the validity of the interpersonal exchange model of sexual satisfaction for sexual-minority women (SMW) with a range of sexual identities (lesbian, bisexual, queer, unlabeled, questioning). Participants, 898 (192 who were dating, 439 who were cohabitating) SMW in a romantic relationship of at least 3 months, completed an online survey that included the Interpersonal Exchange Model of Sexual Satisfaction Questionnaire. The results provide support for the validity of the model for SMW in that all the model components (relationship satisfaction, balance of sexual rewards and costs, balance of relative sexual rewards and costs, equality of rewards, equality of costs) were significantly associated with sexual satisfaction. All of the components, except equality of sexual costs, contributed uniquely to the prediction of sexual satisfaction. Neither relationship stage (dating vs. cohabiting) nor sexual identity (lesbian vs. other sexual-minority identity) moderated these associations. Women daters reported a significantly higher level of sexual rewards, sexual costs, and sexual satisfaction than did women cohabiters. The interpersonal exchange model may be used by clinicians as a framework for exploring experiences of low sexual satisfaction with a couple. The results also add to an emerging positive picture of the sexual relationships of SMW at both stages; this information can be used to counter negative stereotypes. Online supplemental files are available at http://journals.sagepub.com/doi/suppl/10.1177/0361684316679655 .

Women's motivations to have sex in casual and committed relationships with male and female partners

Women report a wide variety of reasons to have sex (e.g., Meston & Buss, 2010), and while it is reasonable to assume that those reasons may vary based on the context of the relationship, this assumption has not yet been tested. The purpose of this study was to explore how relationship type, sexual attraction, and the gender of one's partner interact and affect the sexual motivations of women. A total of 510 women (361 who reported exclusively other-sex attraction and 149 who reported same-sex/bisexual attraction) completed the YSEX? questionnaire. Participants rated their sexual motivations for casual sex and sex in a committed relationship with male and/or female partners, depending on reported sexual attraction. Results showed that relationship type affected reported motivation for sex: physical motivations were more strongly endorsed for casual sex, whereas emotional motivations were more strongly endorsed for sex in committed relationships. No significant differences in motivation were reported between women who reported same-sex attraction and those who did not. Women who reported bisexual attraction and identified as being lesbian, bisexual, or another sexual minority reported no significant differences in motivation for sex with male or female partners. The results of this study highlight the importance of relationship context when discussing sexual motivation and suggest a high degree of similarity in motivation for women, regardless of sexual orientation or gender of partner.

Variation in orgasm occurrence by sexual orientation in a sample of U.S. singles

INTRODUCTION

Despite recent advances in understanding orgasm variation, little is known about ways in which sexual orientation is associated with men's and women's orgasm occurrence.

AIM

To assess orgasm occurrence during sexual activity across sexual orientation categories.

METHODS

Data were collected by Internet questionnaire from 6,151 men and women (ages 21-65+ years) as part of a nationally representative sample of single individuals in the United States. Analyses were restricted to a subsample of 2,850 singles (1,497 men, 1,353 women) who had experienced sexual activity in the past 12 months.

MAIN OUTCOME MEASURES

Participants reported their sex/gender, self-identified sexual orientation (heterosexual, gay/lesbian, bisexual), and what percentage of the time they experience orgasm when having sex with a familiar partner.

RESULTS

Mean occurrence rate for experiencing orgasm during sexual activity with a familiar partner was 62.9% among single women and 85.1% among single men, which was significantly different (F1,2848  = 370.6, P < 0.001, η(2)  = 0.12). For men, mean occurrence rate of orgasm did not vary by sexual orientation: heterosexual men 85.5%, gay men 84.7%, bisexual men 77.6% (F2,1494  = 2.67, P = 0.07, η(2)  = 0.004). For women, however, mean occurrence rate of orgasm varied significantly by sexual orientation: heterosexual women 61.6%, lesbian women 74.7%, bisexual women 58.0% (F2,1350  = 10.95, P < 0.001, η(2)  = 0.02). Lesbian women had a significantly higher probability of orgasm than did either heterosexual or bisexual women (P < 0.05).

CONCLUSIONS

Findings from this large dataset of U.S. singles suggest that women, regardless of sexual orientation, have less predictable, more varied orgasm experiences than do men and that for women, but not men, the likelihood of orgasm varies with sexual orientation. These findings demonstrate the need for further investigations into the comparative sexual experiences and sexual health outcomes of sexual minorities.

Differential Associations of Communication and Love in Heterosexual, Lesbian, and Bisexual Women's Perceptions and Experiences of Chronic Vulvar and Pelvic Pain

The literature on genital and pelvic pain has largely focused on heterosexual women. An online study examined characteristics of vulvar pain in 839 lesbian, bisexual, and heterosexual women 18-45 years of age and investigated associations between relationship qualities such as love and communication with participants' perceptions of pain's influence on relationships. Characteristics of vulvar pain were similar across groups. Groups differed in how they perceived pain to impact their relationships, such that better communication for same-sex couples and more love for mixed-sex couples was associated with the perception of their pain as having less of an effect on their relationship functioning.

Why have sex? Reasons for having sex among lesbian, bisexual, queer, and questioning women in romantic relationships

Research has traditionally cited pleasure and reproduction as the primary reasons to engage in sex. However, recent research suggests that there are many psychosocial reasons that women engage in sex and that relational factors such as relationship duration may also influence why women engage in sex. Few studies have examined reasons for sex among sexual minority women, although research has suggested that reasons may be similar to and different from those of heterosexual women. Using the YSEX? survey measure, the current study examined reasons for having sex among 229 lesbian, bisexual, queer and questioning women, aged 18–59 currently in a romantic relationship. The most frequent reasons women reported for engaging in sex were reasons related to pleasure and love/commitment. Contrary to theories of love and attachment, women in the current study did not report significantly different reasons for engaging in sex depending upon the duration of the relationship. Women in earlier stages of their relationship were just as likely to report engaging in sex to feel close to their partner, as were women in later stages of their relationship. In addition, women in later stages of their relationship were just as likely to report engaging in sex out of a physical desire for their partner as were women in earlier stages of their relationship. The strengths and limitations of the study, along with implications of the results are discussed.

Can less be more? Comparing duration vs. frequency of sexual encounters in same-sex and mixed-sex relationships

A commonly measured indicator of a romantic couple's sexual well-being and satisfaction has been the frequency with which they engage in sexual activity, or more specifically, sexual intercourse. Although some have acknowledged that frequency of sexual intercourse is not an appropriate measure for all types of romantic relationships (e.g. same-sex couples), the measurement of sexual frequency, of one type or another, has remained fairly constant throughout sex and relationships research. While precise estimates of sexual frequency among different types of couples (male/female same-sex vs. mixed-sex) have varied, the general pattern of findings has often indicated that female same-sex couples report lower sexual frequencies than other couples. The current study sought to examine an alternate dimension of sexuality by asking individuals in same-sex and mixed-sex relationships to report the length of their last sexual encounter as well as the length of their average sexual encounter. A sample of 822 participants reported both length of sexual encounters and frequency of sexual activity. While the sexual frequency data replicated past findings, with female same-sex couples reporting the lowest sexual frequencies, sexual duration data painted a very different picture, with female same-sex couples reporting significantly longer durations spent on individual sexual encounters than men and women in mixed-sex or male same-sex relationships. Consequently, it is argued that to better understand the nature of a specific couple's sexual relationship, it is important to examine not just sexual frequency, but also the amount of time spent on individual sexual encounters.