UNIVERSIDAD DE GRANADA

FACULTAD DE PSICOLOGÍA

Departamento de Personalidad, Evaluación y Tratamiento Psicológico

TESIS DOCTORAL

ASERTIVIDAD SEXUAL: ANÁLISIS DE VARIABLES RELACIONADAS E

IMPLICACIONES CLÍNICAS

Doctorando:
PABLO SANTOS IGLESIAS
Departamento de Personalidad, Evaluación y Tratamiento Psicológico, Universidad
de Granada (España)

Director:
Dr. JUAN CARLOS SIERRA FREIRE
Departamento de Personalidad, Evaluación y Tratamiento Psicológico, Universidad
de Granada (España)

Granada, 2012
Editor: Editorial de la Universidad de Granada
Autor: Pablo Santos Iglesias
D.L.: GR 2308-2012
ISBN: 978-84-9028-138-3
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El Dr. Juan Carlos Sierra Freire, Profesor Titular de Universidad en el Departamento de
Personalidad, Evaluación y Tratamiento Psicológico de la Universidad de Granada (España)

INFORMA

Que la Tesis Doctoral titulada Asertividad sexual: análisis de variables relacionadas e

implicaciones clínicas, realizada por el doctorando D. Pablo Santos Iglesias, ha sido
realizada bajo la dirección del Dr. Juan Carlos Sierra Freire y que reúne las condiciones de
calidad, originalidad, rigor científico y académico necesarios para que se proceda a su
defensa pública de acuerdo con la legislación vigente.

Y para que conste, se expide en Granada el presente a día 17 de febrero de 2012

Fdo. Dr. Juan Carlos Sierra Freire

Fdo. D. Pablo Santos Iglesias

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Esta investigación ha sido realizada gracias a la beca del Programa Nacional de Formación de
Profesorado Universitario (FPU; referencia AP2007-03122) concedida a D. Pablo Santos
Iglesias. Parte de la investigación desarrollada ha sido realizada en el marco del proyecto de
investigación concedido por el Ministerio de Ciencia e Innovación al Dr. Juan Carlos Sierra
Freire (referencia SEJ2007-61824).

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A mis padres, por su apoyo

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 Agradecimientos

Quisiera dar las gracias a todas las personas que, de una forma u otra, han contribuido a la
realización de este trabajo:

A mi director de tesis, Dr. Juan Carlos Sierra Freire, por ofrecerme la oportunidad de trabajar
con él, por su ayuda y supervisión continua y por ser un ejemplo de constancia, tenacidad y
dedicación en el trabajo. Sin su apoyo el desarrollo de este trabajo habría sido imposible.

Al director de mi grupo de investigación, Dr. Gualberto Buela Casal, por enseñarme actitudes
que aún son necesarias.

A mis profesores durante mis estancias de investigación, Dra. Carmen Luciano Soriano, Dr.
Antonio Fuertes Martín y Dr. Pedro Nobre, por vuestra ayuda y colaboración. En especial a
la Dra. Sandra Byers, por enseñarme tantas y tan valiosas cosas en tan poco tiempo, por su
disponibilidad y por ser un ejemplo a seguir dentro del mundo de la investigación en
sexualidad humana.

A mi compañero y amigo, Dr. Ángel Castro Vázquez, por compartir experiencias,

aprendizajes y lecciones necesarias. Gracias por tu ayuda en todo momento y por tu
disponibilidad incondicional.

A mis compañeros del grupo de investigación, por vuestro apoyo, ánimos y colaboración.
Dra. Juana María Bretón, Dra. Olga Gutiérrez, Dra. Laura Navarro, Dra. Macarena de los
Santos y Dra. Inmaculada Teva, Carolina Díaz, Alejandro Guillén, Ottavia Gulgliemi, Nieves
Moyano, Raúl Quevedo, María del Mar Sánchez, Reina Granados y, en especial, a Pablo
Vallejo, por resolver y compartir dudas, problemas y conocimientos a lo largo de nuestro
trabajo.

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Al profesor, Dr. Hugo Carretero Dios, siempre dispuesto a resolver dudas y ser un gran
apoyo en mi trabajo. A mis compañeras, Dra. Inmaculada Valor e Isabel Benítez, por su
amistad y ayuda. A mis compañeros en las universidades de destino de mis estancias:
Franciso Ruiz, Isabel Vicario, Leah Levac, Krystelle Shaughnessy, Lyndsay Foster, Sarah
Thornton, Kerri Gibson, Susan Voyer, Kaitlyn Hill, Joana Carvalho, Manuela Peixoto, Vera
Leirós y Pedro Laja.

Por último, quiero agradecer todo el apoyo a mis padres, a mis hermanos, familiares y
amigos. A todas las personas que me han apoyado y ayudado en esta etapa de formación.

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 Índice

1. RESUMEN ................................................................................................................. 1
2. SUMMARY ............................................................................................................... 5
3. INTRODUCCIÓN ...................................................................................................... 9
4. ARTÍCULO 1: El papel de la asertividad sexual en la sexualidad humana: una
revisión sistemática ........................................................................................................ 15
5. ARTÍCULO 2: Hurlbert Index of Sexual Assertiveness: a study of psychometric
properties in a Spanish sample ....................................................................................... 47
6. ARTÍCULO 3: Equivalence and Standard Scores of the Hurlbert Index of Sexual
Assertiveness Across Spanish Men and Women ............................................................ 69
7. ARTÍCULO 4: Sexual Victimization Among Spanish College Women and Risk
Factors for Sexual Revictimization ................................................................................ 85
8. ARTÍCULO 5: Predictors of sexual assertiveness: The role of sexual desire,
arousal, attitudes, and partner abuse ............................................................................... 105
9. DISCUSIÓN ............................................................................................................... 127
10. CONCLUSIONES .................................................................................................... 135
11. CONCLUSIONS ...................................................................................................... 137
12. REFERENCIAS ....................................................................................................... 139
13. ANEXO .................................................................................................................... 145

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 Resumen

Resumen

El estudio de la asertividad cuenta con una larga tradición dentro de la investigación

en sexualidad humana, sin embargo los estudios que han analizado su papel no son muy
numerosos. En líneas generales, se puede sostener que los trabajos que han incluido la
asertividad sexual pueden agruparse en dos líneas, la primera y menos numerosa, ha tratado
de desarrollar instrumentos de evaluación de la asertividad sexual. La segunda ha analizado
el papel que juega la asertividad sexual en la sexualidad humana, concluyendo que es una
variable que facilita un buen funcionamiento sexual y que sirve como factor de protección
ante los episodios de victimización sexual y las conductas de riesgo para Infecciones de
Transmisión Sexual (ITS), VIH y embarazos no deseados. Para ampliar el estudio de esta
variable se ha llevado a cabo esta Tesis Doctoral, cuyos objetivos han sido 1) analizar las
propiedades psicométricas de la versión española del Hurlbert Index of Sexual Assertiveness
(HISA), 2) analizar el papel de la asertividad sexual en las experiencias de revictimización
sexual junto con otras variables como la experiencia sexual y el uso de sustancias, y 3)
analizar las variables predictoras de la asertividad sexual partiendo de un modelo
multidimensional previamente usado.
El primer objetivo se articula en torno a dos trabajos de naturaleza instrumental. En el
primero de ellos se analizaron las propiedades psicométricas (i.e., análisis de ítems, validez
de constructo, fiabilidad de consistencia interna y validez convergente) de la versión española
del HISA. Para ello se empleó una muestra compuesta por 400 hombres y 453 mujeres
heterosexuales con una relación de, al menos, seis meses de duración. Todos ellos
respondieron al HISA, la Escala de Ajuste Diádico, el Cuestionario de Aserción en la Pareja,
y la Escala de Habilidades Sociales. Los resultados mostraron una estructura factorial
compuesta por 19 ítems agrupados en dos factores: Inicio, o la habilidad para iniciar
contactos sexuales deseados y compartir deseos y fantasías sexuales con la pareja; y Ausencia
de Timidez/Rechazo, que hace referencia a la habilidad para rechazar contactos sexuales no
deseados y la capacidad para iniciar y mantener conversaciones sobre temas sexuales. Ambas
subescalas mostraron buenos índices de fiabilidad de consistencia interna, con valores omega
en torno a 0,80 y buenos indicadores de validez convergente, con correlaciones

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Asertividad sexual: análisis de variables relacionadas e implicaciones clínicas

estadísticamente significativas de signo positivo con las medidas de ajuste diádico, aserción
en la pareja y habilidades sociales.
El segundo estudio tenía como objetivo analizar la invarianza factorial y el
funcionamiento diferencial del ítem (DIF) de la versión española del HISA, previamente
validado, entre hombres y mujeres. La razón para llevar a cabo este estudio fue que en el
pasado se han encontrado diferencias en las estructuras factoriales cuando se han empleado
muestras de mujeres o muestras de hombres y mujeres. Y además, que la asertividad ha sido
un constructo típicamente comparado entre hombres y mujeres, por lo que es necesario
garantizar la equivalencia y ausencia de sesgo de la escala. Participaron en este estudio 1.600
mujeres y 1.598 hombres heterosexuales. Los resultados del análisis de invariaza mostraron
ausencia de invarianza fuerte en tres de sus ítems (2, 9, y 13), lo que implica que las
interceptas no son similares para hombres y mujeres e indica la posibilidad de
funcionamiento diferencial del ítem. El análisis del funcionamiento diferencial del ítem
mostró que de esos tres, sólo el ítem 2 (“Pienso que soy tímido/a en el ámbito sexual”)
mostró DIF moderado uniforme. Concretamente, las mujeres tienen una mayor tendencia a
responder “Siempre” a este ítem. Con estos resultados se plantea la necesidad de eliminar los
tres ítems, resultando en una versión final compuesta por 16 ítems agrupados en las dos
dimensiones: Inicio (8 ítems) y Ausencia de timidez/Rechazo (8 ítems). Los resultados de los
baremos para esta versión final muestran que la asertividad sexual aún sigue roles sexuales
tradicionales, ya que los hombres puntúan más alto en Inicio, mientras que las mujeres más
mayores muestran mayor timidez y menos habilidad para rechazar contactos sexuales.
Respecto al objetivo sobre victimización sexual, se puso a prueba qué variables
mediaban entre el abuso sexual en la infancia y la victimización sexual en la adolescencia y
edad adulta temprana. Para ello se emplearon cuatro variables que habían sido examinadas en
la literatura previa: número de parejas, edad de inicio de los contactos sexuales, asertividad
sexual y consumo de sustancias antes de los contactos sexuales. Además, se ofrecen datos
sobre las tasas de vicimización sexual en las participantes, así como los tipos de agresores
más frecuentes. Un total de 402 mujeres universitarias participaron en el estudio. Los
resultados mostraron que un 30,4% había sufrido algún contacto sexual no deseado, mientras
que un 3,4% habían sido violadas. Los agresores más frecuentes son parejas o exparejas,
conocidos o citas ocasionales, dependiendo del tipo de agresión. Sin embargo, es poco
frecuente que la agresión haya sido perpetrada por un extraño. Las variables que mediaron
entre el abuso sexual en la infancia y la victimización sexual adulta fueron el número de
parejas y la falta de asertividad sexual. Estos resultados ponen de manifiesto la elevada

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 Resumen

prevalencia de las agresiones sexuales en muestras de mujeres universitarias y apuntan al

número de parejas como un factor de riesgo importante para predecir la revictimización
sexual, tal y como se ha encontrado en estudios previos. Sin embargo, a diferencia de los
estudios llevados a cabo en Estados Unidos, la asertividad sexual también explica esa
revictimización, que puede explicarse por una mayor presencia de roles sexuales
tradicionales en mujeres universitarias estadounidenses.
Por último, se planteó la necesidad de estudiar las variables que predicen la
asertividad sexual, ya que sólo un estudio previo ha analizado este aspecto. Basándonos en el
modelo multifacético de riesgo para el VIH (MMOHR, por sus siglas en inglés) se plantea
que la asertividad sexual puede ser predicha a partir de variables interpersonales (abuso en la
pareja) y variables actitudinales (erotofilia y actitudes positivas hacia las fantasías sexuales).
Además, se plantea la necesidad de introducir componentes de la respuesta sexual humana
(deseo sexual y excitación), pues no se han puesto a prueba en modelos multidimensionales.
Participaron un total de 1.755 mujeres y 1.619 varones heterosexuales. Los resultados
mostraron que en el caso de los hombres la asertividad sexual fue predicha de forma positiva
por la excitación, deseo sexual diádico, erotofilia y actitudes positivas hacia las fantasías
sexuales, y de forma negativa por el abuso no físico por parte de la pareja. En el caso de las
mujeres, la asertividad sexual fue predicha de forma positiva por la excitación, deseo sexual
diádico, erotofilia y actitudes positivas hacia las fantasías sexuales y de forma negativa por el
abuso no físico y el deseo sexual solitario. Estos resultados ponen de manifiesto la naturaleza
multidimensional de la asertividad sexual y la necesidad de evaluar otras variables, como las
actitudes o la presencia de abuso en la pareja, cuando se trabaja con la asertividad sexual en
programas educativos o de intervención.
Para finalizar, es necesario concluir que los resultados de la presente Tesis Doctoral
nos dan una idea más clara acerca del papel que juega la asertividad sexual en la sexualidad
humana en el contexto español, pues ha sido una variable poco estudiada en España. Se
dispone, ahora, de una versión abreviada del HISA –que es uno de los instrumentos más
utilizados a la hora de evaluar la asertividad sexual- con adecuadas garantías psicométricas
sobre su funcionamiento y, además, equivalente entre hombres y mujeres. Son necesarios
más trabajos que ahonden en el papel de la asertividad en la victimización sexual, así como
evaluar más variables relevantes que puedan predecir la presencia de respuestas sexualmente
asertivas tanto en hombres como en mujeres.

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Asertividad sexual: análisis de variables relacionadas e implicaciones clínicas

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 Summary

Summary

The study of assertiveness has a long tradition in research on human sexuality, but
studies that have examined its role are scarce. Overall, it is arguable that the scope of work
included sexual assertiveness can be grouped into two lines, the first and less numerous, has
sought to develop instruments to assess sexual assertiveness. The second has analyzed the
role of sexual assertiveness in human sexuality, concluding that it is a variable that provides a
good sexual function and serves as a protective factor against sexual victimization episodes
and risk behaviors for sexually transmitted infections (STIs), HIV and unwanted pregnancies.
To extend the study of this variable this Doctoral Dissertation was carried out, whose main
objectives were: 1) to analyze the psychometric properties of the Spanish version of the
Hurlbert Index of Sexual Assertiveness (HISA); 2) to analyze the role of sexual assertiveness
in experiences of sexual revictimization along with other variables such as sexual experience
and substance use, and 3) to analyze the predictors of sexual assertiveness based on a
multidimensional model previously used.
The first objective is articulated around two instrumental studies. In the first study we
analyzed the psychometric properties (i.e., item analysis, construct validity, internal
consistency reliability, and convergent validity) of the Spanish version of HISA. For this
purpose we used a sample of 400 men and 453 heterosexual women involved in a
heterosexual relationship of at least six months. They responded to HISA, the Dyadic
Adjustment Scale, the Assertion Questionnaire in Couples, and the Social Skills Scale.
Results showed a factor structure composed of 19 items clustered into two factors: Initiation,
or the ability to initiate sexual contacts and the expression of sexual desires and fantasies to
one’s partner, and No Shyness/Refusal, which means the difficulty starting and mantaining
conversations on sexual issues and an inability to reject undesired sexual contacts. Both
subscales showed good internal consistency reliability, with omega values around .80, and
good indicators of convergent validity, with significant and positive correlations with
measures of dyadic adjustment, assertion in relationships and social skills.
The second study analyzed the factorial invariance and differential item functioning
(DIF) of the previously validated Spanish version of the HISA, across men and women. The
reason for conducting this study was that past research have found different factor structures

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Asertividad sexual: análisis de variables relacionadas e implicaciones clínicas

when samples of women or mixed samples (i.e., men and women) have been used.
Furthermore, sexual assertiveness is a construct that has been typically compared between
men and women, so it is necessary to ensure both the equivalence and lack of bias of this
scale. 1,600 heterosexual women and 1,598 heterosexual men participated in this study.
Results showed the lack of strong invariance on three items (2, 9, and 13), implying that the
intercepts are different for men and women on those three items, and indicating the
possibility of differential item functioning. Analysis of the differential item functioning
showed that among those three items, only the item 2 (“I feel that I am shy when it comes to
sex”) flagged moderate uniform DIF. More specifically, women are more likely to answer
"Always" to this item. These results suggests the need to eliminate those three items,
resulting in a final version composed by 16 items grouped into two dimensions: Initiation (8
items) and No Shyness/Refusal (8 items). Results of the standard scores for this final version
show that sexual assertiveness still follows traditional gender roles, as men scored higher on
Initiation, while older women showed more sexual shyness and less ability to refuse sexual
contact.
Regarding sexual victimization, we tested which variables would mediate between
childhood sexual abuse and sexual victimization in adolescence and early adulthood. For this
purpose we used four variables that were examined in previous literature: number of partners,
age at first sexual contact, sexual assertiveness, and substance use prior to sex. We also
offered data on sexual victimization rates and the types of most frequent sexual aggressors. A
total of 402 college women participated in the study. The results showed that 30.4% had had
an unwanted sexual contact, while 3.4% had been raped. The most frequent offenders were
partners or ex-partners, acquaintances, or casual dates, depending on the type of aggression.
However, it is rare that the attack was perpetrated by a stranger. The mediators between
childhood sexual abuse and adult sexual victimization were the number of sexual partners
and lack of sexual assertiveness. These results demonstrate the high prevalence of sexual
abuse in samples of college women and pointed to the number of partners as an important
risk factor for predicting sexual revictimization, as found in previous research. However,
unlike the studies conducted in the U.S., sexual assertiveness also explains revictimization,
which can be explained by an increased presence of traditional gender roles in American
college women.
Finally, we found it necessary to study the predictors of sexual assertiveness, since
only one previous study has analyzed this aspect. Based on the Multifaceted Model of HIV
Risk (MMOHR), it is stated that sexual assertiveness can be predicted from interpersonal

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 Summary

variables (e.g., partner abuse) and attitudinal variables (e.g., erotophilia and positive attitudes
towards sexual fantasies). It is also necessary to include components of the human sexual
response (sexual desire and arousal), which have not been tested in multidimensional models.
A total of 1,755 heterosexual women and 1,619 heterosexual men participated in the study.
Results showed that in the case of male, sexual assertiveness was positively predicted by
arousal, dyadic sexual desire, erotophilia, and positive attitudes toward sexual fantasies, and
negatively predicted by non-physical abuse by an intimate partner. For women, sexual
assertiveness was positively predicted by arousal, dyadic sexual desire, erotophilia, and
positive attitudes toward sexual fantasies, and negatively predicted by non-physical abuse
and solitary sexual desire. These results highlight the multidimensional nature of sexual
assertiveness. They also stress the need to evaluate variables such as sexual attitudes or the
presence of partner abuse when working with sexual assertiveness in educational programs or
intervention.
Finally, it is necessary to conclude that these results give us a clearer idea about the
role of sexual assertiveness in human sexuality in the Spanish context, because it has not
been studied frequently in Spain. An abbreviated version of the HISA, which is one of the
most widely used instruments to assess sexual assertiveness, is now available with adequate
psychometric guarantees and also equivalent between men and women. More work is needed
to further our understanding about the role of assertiveness in sexual victimization, as well as
to evaluate more relevant variables that can predict the presence of sexually assertive
responses in both men and women.

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Asertividad sexual: análisis de variables relacionadas e implicaciones clínicas

8
 Introducción

Introducción

En la actualidad existen diversas definiciones de la asertividad sexual. La mayoría de

ellas han realizado una aproximación conductual, delimitando el rango de conductas que
implica un comportamiento sexualmente asertivo. Entre estas definiciones, las más generales
sostienen que la asertividad sexual es la capacidad para llevar a cabo comportamientos
socialmente asertivos en un contexto sexual (Painter, 1997) o que implica el uso de una serie
de habilidades conductuales para obtener satisfacción sexual en las relaciones sexuales
(Dunn, Lloyd y Phelps, 1979). A pesar de realizar una aproximación de tipo conductual,
ninguna de estas dos definiciones deja claro cuáles son las conductas implícitas en un
comportamiento sexualmente asertivo, indicando únicamente la segunda de ellas que sería un
medio para obtener satisfacción sexual. Una definición más específica y completa, que
delimita cuáles son esos comportamientos y la finalidad de los mismos, fue aportada por
Morokoff et al. (1997). En ella se afirma que la asertividad sexual es la capacidad para iniciar
la actividad sexual, rechazar la actividad sexual no deseada, y emplear métodos
anticonceptivos y llevar a cabo comportamientos sexuales saludables.
Las anteriores definiciones derivan en un par de implicaciones. La primera es que
circunscriben la asertividad sexual a contextos exclusivamente sexuales frente a otras formas
de asertividad más generales o frente a otros contextos que no sean sexuales. En este sentido,
Livingston, Testa y VanZile-Tamsen (2007) señalaron que, cuando se quiere analizar el papel
que juega la asertividad en experiencias de victimización sexual, es necesario evaluar la
asertividad sexual frente a formas más generales de asertividad. La segunda implicación hace
referencia a la importancia de la asertividad sexual dentro del concepto de salud sexual, ya
que la asertividad sexual tiene como finalidad desarrollar comportamientos sexualmente
saludables (Morokoff et al., 1997). Además, es la herramienta que las personas usan para
ejercer su derecho a tomar decisiones sobre sus experiencias y conductas sexuales y su
sexualidad en general (Sierra, Santos, Gutiérrez-Quintanilla, Gómez y Maeso, 2008),
llevando a cabo conductas sexuales seguras, placenteras y actividades sexuales informadas y
consentidas, basadas en una visión positiva de la sexualidad y de respeto dentro de las
relaciones íntimas (Lottes, 2000).

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Asertividad sexual: análisis de variables relacionadas e implicaciones clínicas

Sin embargo, esta disparidad de definiciones y conceptualizaciones acerca de qué es

la asertividad tiene también sus problemas asociados. El primero, y principal, es la falta de
consenso sobre lo qué es y lo qué implica un comportamiento sexual asertivo, llegándose en
ocasiones a hablar de la asertividad sexual como una habilidad social o incluso como un
rasgo de personalidad. Esto ha supuesto que la asertividad sexual se haya operacionalizado de
formas muy diferentes haciendo difícil la comparación de distintos estudios. El segundo
problema afecta a la evaluación de la asertividad sexual. Esta disparidad de definiciones
genera, por un lado, una gran cantidad de instrumentos de evaluación para un mismo
constructo y, por otro, esos diferentes instrumentos evalúan conceptos distintos, componentes
diferentes e incluso correlatos mismos de la asertividad sexual, tal y como sucede con la
evaluación de otros constructos sexuales (e.g., satisfacción sexual; véase Lawrance y Byers,
1995, 1998). Como ejemplo, se pueden encontrar hasta 20 instrumentos diferentes empleados
en la evaluación de la asertividad sexual (eso sin mencionar que en muchos estudios se hayan
elaborado ítems ad hoc) que evalúan componentes como el inicio de la actividad sexual, el
rechazo de actividades sexuales no deseadas, o conceptos distintos –aunque relacionados-
como comunicación sexual o autorrevelación sexual. A estos problemas hay que añadir una
seria limitación de los instrumentos de evaluación de la asertividad sexual: la escasez de
estudios que avalen sus propiedades psicométricas. En este contexto sólo la Sexual
Assertiveness Scale (Morokoff et al., 1997) y –en menor medida- el Sexual Awareness
Questionnaire (Snell, Fisher y Miller, 1991) fueron desarrollados a partir de completos
estudios instrumentales. En el resto de los casos poca información se tiene sobre la fiabilidad
de sus puntuaciones o la validez de su uso. Además, es especialmente importante tener en
cuenta que estos instrumentos han sido empleados en varias ocasiones para realizar
comparaciones entre grupos (e.g., varones vs. mujeres), por lo que un examen pormenorizado
–aunque inexistente- sobre la equivalencia de las escalas y la ausencia de sesgo está más que
justificado (Dimitrov, 2010; Wu, Li y Zumbo, 2007). Es, por tanto, necesario llevar a cabo
estudios psicométricos con estos instrumentos de evaluación que nos aseguren la fiabilidad y
la validez de los resultados obtenidos con ellos.
Al margen de las definiciones y los problemas implícitos en la evaluación de la
asertividad sexual anteriormente citados, cabe mencionar los estudios que han analizado el
papel que juega la asertividad sexual en la sexualidad humana. A pesar de ser un constructo
que cuenta con cerca de 40 años (cfr., Jakubowski-Spector, 1973) no ha sido muy estudiado a
lo largo de su historia y, en muchas ocasiones, cuando en algunos estudios se habla de
asertividad sexual se está aludiendo a conceptos afines pero no a asertividad sexual de forma

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 Introducción

estricta (Santos-Iglesias y Sierra, 2010a). Es importante mencionar también que, salvo

algunas excepciones (véase Hurlbert, 1991; Morokoff et al., 1997), la asertividad sexual ha
sido usada en estos estudios a modo de variable independiente o bien como variable
mediadora, pero no como variable dependiente, por lo que no se tiene una idea clara de cuál
es la naturaleza de la misma o cuáles son los factores que determinan o facilitan la aparición
de comportamientos sexualmente asertivos. En este orden de cosas, tal y como se
mencionaba, no son muy numerosos los estudios que analizan qué función tiene la
asertividad sexual en la vida sexual de las personas. Estos estudios se han llevado a cabo de
forma generalizada en torno a tres áreas de la sexualidad humana: el funcionamiento sexual,
las agresiones sexuales y las conductas sexuales de riesgo para el VIH e ITSs (Santos Iglesias
y Castro Vázquez, 2011; Sierra et al., 2008) y permiten afirmar de forma consistente que la
asertividad sexual funciona como factor de protección ante conductas sexuales de riesgo y
agresiones sexuales y que favorece contactos sexuales positivos y una mayor salud sexual.
Por ejemplo, en el caso del funcionamiento sexual, diversos estudios han comprobado que la
asertividad sexual es un facilitador de la respuesta sexual humana, ya que se relaciona de
forma positiva con el deseo y activación sexual, la satisfacción sexual y el número de
orgasmos (Haavio-Mannila y Kontula, 1997; Hurlbert, 1991; Hurlbert, Apt y Rabehl, 1993;
Ménard y Offman, 2009; van Anders y Dunn, 2009). Sin embargo, estos estudios han tratado
el deseo y la satisfacción sexual al mismo nivel (véase Hurlbert, 1991), cuando el deseo
podría ser un determinante de comportamientos sexualmente asertivos, mientras que la
satisfacción sexual podría ser la consecuencia de los mismos. De la misma forma, también se
encuentra asociada con dimensiones positivas de la sexualidad como la erotofilia (Sierra et
al., 2008), un mayor comfort con el propio cuerpo y la imagen corporal (Weaver y Byers,
2006) y mayor autoestima sexual (Oattes y Offman, 2007). Sin embargo, la mayor parte de
estos estudios se han llevado a cabo mediante diseños correlacionales y la evidencia no
supera en muchos casos la de una correlación. Por este motivo, es difícil conocer cuál es la
dirección de esa relación; si el deseo sexual sucede antes del comportamiento asertivo, o si el
comportamiento asertivo es previo al deseo sexual, por ejemplo. De la misma forma es difícil
encontrar estudios que revelen cuál es la naturaleza de la asertividad sexual. Únicamente el
estudio de Morokoff et al. (1997) demostró que la asertividad sexual está determinada por
variables interpersonales (e.g., victimización sexual), actitudinales (e.g., autoeficacia para
llevar a cabo conductas para evitar ITSs) y conductuales (e.g., experiencia sexual), sin
embargo, no se tuvieron en cuenta componentes de la respuesta sexual humana como el deseo

11
Asertividad sexual: análisis de variables relacionadas e implicaciones clínicas

o la excitación, que pueden poner en marcha conductas para el inicio de la actividad sexual
(Matsuura, 2008).
En segundo lugar, los estudios sobre victimización y agresiones sexuales han
mostrado que la asertividad sexual funciona como un factor de protección ante las
experiencias de abuso sexual (Macy, Nurius y Norris, 2006), independientemente del tipo de
agresor (Apt y Hurlbert, 1993; Testa, VanZile-Tamsen y Livingston, 2007). No obstante, una
de las críticas más comunes ante este tipo de estudios es si la asertividad sexual es una
consecuencia o un predictor de las experiencias de abuso sexual. En este sentido, Livingston
et al. (2007) realizaron un estudio longitudinal en el que demostraron que la falta de
asertividad sexual es tanto una consecuencia del abuso sexual como un factor de riesgo para
sufrir abusos posteriores. De la misma manera, también se ha propuesto que la asertividad
sexual puede ser un factor mediador que explica la revictimización sexual (Greene y Navarro,
1998; Livingston et al., 2007; Muehlenhard, Highby, Lee, Bryan y Dodrill, 1998), es decir,
personas que han sufrido abusos sexuales tienen mayor probabilidad de volver a sufrir abusos
en el futuro. Sin embargo, aunque parece que la asertividad puede ser un factor mediador en
la revictimización cuando el abuso sucede en la adolescencia y/o edad adulta (Livingston et
al., 2007), no está tan claro que lo sea ante sucesos más distales en el tiempo como el abuso
sexual en la infancia. Además, la asertividad sexual tiene que competir con muchas otras
variables (e.g., experiencia sexual, uso de alcohol o sustancias) a la hora de explicar la
revictimización sexual (para una revisión, véase Muehlenhard et al., 1998), ya que son
muchas las hipótesis propuestas, pero la mayoría de ellas se han puesto a prueba de forma
aislada, nunca de forma conjunta. Por último, estudios más concluyentes se han presentado
acerca del papel de la asertividad sexual en la emisión de conductas sexuales de riesgo para el
contagio por ITSs, VIH o para embarazos no deseados. Así, no sólo estudios correlacionales
han mostrado que la falta de asertividad sexual se relaciona con una mayor emisión de
conductas sexuales de riesgo (Hardeman, Pierro y Mannetti, 1997; Morokoff et al., 2009;
Sikkema, Winett y Lombard, 1995), sino también programas de intervención destinados a
mejorar la asertividad sexual reducen el número de conductas sexuales de riesgo (St.
Lawrence et al., 1995; Weinhardt, Carey, Carey y Verdecias, 1998).
Todos los resultados presentados anteriormente ponen de manifiesto que, aunque
existe cierta evidencia sobre el papel que juega la asertividad sexual en la sexualidad humana,
aún es necesario investigar más sobre su naturaleza y el papel que juega en determinadas
áreas de la vida sexual de las personas. Además, es necesario realizar estudios sobre las
propiedades psicométricas de los instrumentos de evaluación de la asertividad sexual para

12
 Introducción

garantizar, no sólo su adecuada fiabilidad y validez, sino también la falta de sesgo a la hora
de utilizarlo en diferentes grupos. Por todo ello, se plantea la necesidad de esta Tesis
Doctoral, cuyo objetivo es triple. Por una parte, analizar las propiedades psicométricas de la
versión española de un instrumento de evaluación de la asertividad sexual (Hurlbert Index of
Sexual Assertiveness; HISA; Hurlbert, 1991) y, por otra, analizar el papel de la asertividad
sexual en las experiencias de revictimización sexual, y analizar cuáles son las variables que
favorecen la aparición de comportamientos sexuales asertivos. Así, el contenido de este
trabajo se articuló en torno a cinco estudios independientes.
El primer estudio tuvo como objetivo realizar una revisión sistemática de la literatura
relacionada con la asertividad sexual para obtener información sobre los resultados más
relevantes relacionados con este constructo, así como información sobre la metodología más
empleada en estos estudios, instrumentos de evaluación y muestras empleadas. Los resultados
sirvieron para actualizar el estado de la cuestión y desvelar con mayor profundidad qué es lo
que se sabe acerca de este constructo.
El segundo estudio se llevó a cabo con el objetivo de analizar las propiedades
psicométricas de la versión española de uno de los instrumentos más utilizados para evaluar
la asertividad sexual, el Hurlbert Index of Sexual Assertiveness (Hurlbert, 1991). Previa
traducción y adaptación lingüística del instrumento, se analizaron sus propiedades
psicométricas mediante un análisis de ítems, análisis factorial exploratorio y análisis factorial
confirmatorio mediate modelos de ecuaciones estructurales. Una vez que se obtuvo una
versión definitiva del instrumento y sus subescalas se ofrecieron evidencias de fiabilidad y
validez del instrumento.
El tercero fue un estudio sobre la equivalencia factorial de la versión española del
Hurlbert Index of Sexual Assertiveness (Hurlbert, 1991). Mediante un análisis de invarianza
factorial se puso a prueba la equivalencia factorial obtenida en el estudio previo entre
hombres y mujeres. En segundo lugar, se realizó un análisis del funcionamiento diferencial
de sus ítems para estudiar la existencia de posibles sesgos en el uso de esta escala en hombres
y mujeres. Por último, de cara a su posible utilidad clínica, se establecieronn baremos de las
puntuaciones de la escala en hombres y mujeres diferenciando tres grupos de edad.
Una vez analizadas las propiedades métricas de la escala en muestras españolas, el
cuarto estudio tuvo como objetivo analizar el papel de la asertividad sexual en las
experiencias de revictimización sexual. En este contexto se plantearon cuatro posibles
mediadores –derivados de la literatura previa- entre el abuso sexual en la infancia y la
victimización sexual en la adolescencia y edad adulta. Así, se puso a prueba cuál de los

13
Asertividad sexual: análisis de variables relacionadas e implicaciones clínicas

cuatro mediadores propuestos (i.e., número de parejas sexuales, edad de inicio en las
relaciones sexuales, uso de sustancias y baja asertividad sexual) explicaría mejor la
revictimización sexual. Además, se ofrecieron datos sobre las experiencias de victimización
sexual, así como el tipo de abusadores, en una muestra de mujeres estudiantes de la
Universidad de Granada.
El quinto, y último estudio, se realizó para analizar la naturaleza de la asertividad
sexual. En base al Multifaceted Model of HIV Risk (Harlow, Quina, Morokoff, Rose y
Grimley, 1993) se planteó que la asertividad sexual podría ser predicha por variables
interpersonales (abuso en la pareja), actitudinales (erotofilia y actitudes hacia las fantasías
sexuales) y sexuales (deseo sexual y excitación). Así, a partir de un modelo de ecuaciones
estructurales se analizó cuáles son las variables que favorecen una mayor asertividad sexual
en hombres y mujeres.

14
 El papel de la asertividad sexual en la sexualidad humana: una revisión sistemática

Artículo 1
El Papel de la Asertividad Sexual en la Sexualidad Humana: una Revisión
Sistemática

Santos-Iglesias, P. y Sierra, J.C. (2010). El papel de la asertividad sexual en la sexualidad

humana: una revisión sistemática. International Journal of Clinical and Health Psychology,
10, 553-577.

15
Asertividad sexual: análisis de variables relacionadas e implicaciones clínicas

16
 El papel de la asertividad sexual en la sexualidad humana: una revisión sistemática

El Papel de la Asertividad Sexual en la Sexualidad Sumana: una Revisión

Sistemática

Pablo Santos-Iglesias y Juan Carlos Sierra

(Universidad de Granada, España)

Resumen.— El estudio de la asertividad sexual ha generado resultados que demuestran su

importancia y su papel fundamental en la sexualidad humana. En este trabajo teórico se lleva
a cabo una revisión sistemática de los principales resultados obtenidos en estos estudios.
Después de una búsqueda en las principales bases de datos se obtienen un total de 76 trabajos
publicados entre 1980 y 2009, que demuestran que la asertividad sexual es un factor
determinante tanto de la respuesta sexual como del funcionamiento sexual humano. Además
se relaciona de forma directa con una visión positiva de la sexualidad humana y con algunas
variables sociodemográficas como el sexo, aunque esta relación no está clara. Otros estudios
ponen de manifiesto que es un factor de protección ante experiencias de abuso y victimización
sexual, así como ante conductas sexuales de riesgo. Se discuten los resultados y se plantea la
necesidad de incluir la asertividad sexual de forma específica, más que la asertividad general,
en los programas educativos y en intervenciones con poblaciones en situación de riesgo.

Palabras Clave.— Asertividad sexual. Respuesta sexual. Victimización. Conductas de riesgo.

Estudio teórico.

Abstract.— Study on sexual assertiveness has generated results which demonstrates its
relevance and fundamental role in human sexuality. In this theoretical study, a systematic
revision of the main results derived from these studies on sexual assertiveness was performed.
After searching in the main databases a total number of 76 works were retrieved, published
from 1980 to 2009. These works show that sexual assertiveness is a crucial factor determining
both human sexual response and human sexual functioning. Furthermore, sexual assertiveness
is directly related to a positive view of human sexuality and various sociodemographical
variables such as sex, although this relationship is not very clear. Other studies reveal that
sexual assertivenes works as a protective factor from sexual abuse and victimization

17
Asertividad sexual: análisis de variables relacionadas e implicaciones clínicas

experiences, as well as from engage in sexual risk behaviors. Results are discussed and it is
purposed to include sexual assertiveness, better than general assertiveness, in educational
programs and interventions with risky populations.

Keywords.— Sexual Assertiveness. Sexual response. Victimization. Risk behaviors.

Theoretical study.

La asertividad sexual ha sido definida de múltiples formas. Painter (1997) sostiene

que es la capacidad para llevar a cabo la asertividad social en un contexto sexual. Por su
parte, Dunn, Lloyd y Phelps (1979) defienden que es “la conciencia de uno mismo como ser
sexual y el uso, con poca ansiedad, de un conjunto de habilidades conductuales para obtener
satisfacción sexual de uno mismo y de su pareja” (p. 294). Pero, sin duda, una de las
definiciones más aceptadas sostiene que es la capacidad para iniciar la actividad sexual,
rechazar la actividad sexual no deseada, así como negociar las conductas sexuales deseadas,
el empleo de métodos anticonceptivos y los comportamientos sexuales más saludables
(Morokoff et al., 1997). Todas estas definiciones ponen de manifiesto la especificidad de la
asertividad sexual en situaciones sexuales. Asimismo, un gran número de estudios demuestra
que la asertividad sexual constituye un componente central de la sexualidad humana, pues se
relaciona con diversos aspectos de la respuesta sexual, como el deseo y la satisfacción sexual,
con menores niveles y frecuencia de victimización y coerción sexual (véanse Santos-Iglesias
y Sierra, 2009; Sierra, Santos, Gutiérrez-Quintanilla, Gómez y Maeso, 2008) y con la
ausencia de conductas sexuales de riesgo, hasta el punto de que los principales modelos
teóricos de prácticas sexuales de riesgo asumen la importancia que juega este constructo
(Fisher y Fisher, 1992).
A pesar de la importancia de la asertividad sexual en la sexualidad humana y a que su
estudio se remonta a la década de los años setenta (cfr., Jakubowski-Spector, 1973), no
existen hasta la fecha revisiones que sinteticen y agrupen la información disponible sobre la
misma, si bien es cierto que en alguna revisión de literatura es tratada de forma tangencial
(e.g., Stampley, Mallory y Gabrielson, 2005). Por esta razón se plantea el presente estudio
teórico (Montero y León, 2007) que, siguiendo las normas propuestas por Fernández-Ríos y
Buela-Casal (2009), tiene como objetivo realizar una revisión bibliográfica y sintetizar la
información disponible sobre el papel de la asertividad sexual en la sexualidad humana.

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 El papel de la asertividad sexual en la sexualidad humana: una revisión sistemática

Método
Revisión bibliográfica
La búsqueda de los trabajos se realizó en diferentes bases de datos, con el objetivo de
cubrir el mayor número de áreas temáticas, pues existen trabajos enfocados desde la
Psicología, la Sociología o la Medicina. Así, las bases de datos empleadas fueron PsycINFO,
EBSCOhost, ProQuest, Scopus, JSTOR, PubMed y Psicodoc. No se introdujo ninguna
restricción en los años de búsqueda, ni en el tipo de documento, pues se pretendía realizar
una búsqueda exhaustiva y obtener el mayor número de trabajos posibles. Los términos
empleados para la búsqueda fueron: “sexual assertiveness”, “sexual assertion”, “sexual
assertivity” y “sexual assert*” para obtener cualquier otra variante del término
“assertiveness”. En el caso de bases de datos en castellano, los términos empleados fueron
“asertividad sexual”, “aserción sexual” y “aser* sexual”. Los términos de búsqueda se
limitaron al título, resumen y palabras clave.

Criterios de inclusión
- Trabajos en los que se analizaba la asertividad sexual de forma específica y
claramente operacionalizada. Este criterio permitió descartar todos aquellos trabajos
que incluían asertividad general o social, comunicación sexual o habilidades de
comunicación y aquellos en los que la operacionalización no dejaba claro si se trataba
de asertividad sexual.
- Trabajos que empleaban la asertividad sexual como variable independiente o
dependiente, ya fuese mediante su manipulación en programas de prevención o en
experimentos, o su evaluación a través de cuestionarios estandarizados, preguntas
diseñadas ad hoc o mediante role playing.
- Trabajos que aportasen datos empíricos originales, descartando trabajos teóricos
previos en los que apareciese la asertividad sexual.

Procedimiento
La búsqueda se realizó entre febrero y noviembre de 2009. Una vez recuperados todos
los trabajos se procedió a su revisión con el objetivo de analizar cuáles cumplían los criterios
de inclusión, los cuales fueron revisados de forma exhaustiva con el objetivo de extraer la
información pertinente. Los datos obtenidos fueron codificados en una base de datos para su
posterior análisis y discusión.

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Asertividad sexual: análisis de variables relacionadas e implicaciones clínicas

Codificación de los resultados

De cada uno de los trabajos se extraía la siguiente información:
- Autor/es y año de publicación.
- Metodología del trabajo. Debido a que cada trabajo expone la metodología siguiendo
clasificaciones diferentes, se unificaron todas ellas aproximándolas a la clasificación
propuesta por Montero y León (2007).
- Muestra. De la que se extraía el número de participantes, sexo, y origen de la muestra
(estudiantes universitarios vs. muestra comunitaria; muestra clínica vs. muestra no
clínica).
- Evaluación/manipulación de la asertividad sexual. En el caso de tratarse de diseños
descriptivos, instrumentales, ex post facto o experimentales se analizaba el
instrumento empleado para la evaluación de la asertividad sexual, las posibles
modificaciones del mismo, así como su fiabilidad (si se informa de ella). En el caso
de estudios cuasi-experimentales y experimentales en los que se manipulaba la
asertividad sexual también se informaba del tipo de manipulación.
- Principales resultados. Haciendo énfasis en las relaciones y efectos observados por y
sobre la asertividad sexual.

Resultados
El procedimiento detallado dio lugar a un total de 76 documentos: 72 artículos de
investigación, tres Tesis Doctorales y un resumen de una comunicación oral publicado en el
Journal of Pediatric and Adolescent Gynecology. Todos estos trabajos se agrupan en tres
temáticas principales: 30 relacionados con la respuesta y funcionamiento sexual, 16
relacionados con experiencias de coerción y victimización sexual, y 37 relacionados con
conductas sexuales de riesgo. La suma de trabajos por temática alcanza el valor 83 debido a
que algunos (e.g., Morokoff et al., 1997) aportan resultados clasificables en más de una
temática. A pesar de que los trabajos de la primera temática incluyen, en su mayoría,
resultados relacionados con la respuesta y funcionamiento sexual, también se han incluido
entre éstos resultados referentes a variables sociodemográficas y actitudinales.
Respecto al diseño, 12 estudios (15,78%) son experimentales, 11 (14,47%) cuasi-
experimentales, 48 (63,16%) de tipo ex post facto y 5 (6,59%) instrumentales. El tipo de
muestra se ha organizado en base a tres categorías (sexo, procedencia y muestra clínica). En
función del sexo, 5 (6,59%) trabajos incluyen únicamente varones, 46 (60,52%) sólo mujeres

20
 El papel de la asertividad sexual en la sexualidad humana: una revisión sistemática

y 25 (32,89%) a varones y mujeres. En cuanto a la procedencia, en el 38,15% de los estudios

(n = 29) los participantes son universitarios y en el 61,85% (n = 47) de procedencia
comunitaria; cinco trabajos (6,59%) emplean muestras clínicas y otros cinco muestras mixtas
(clínica y no clínica), siendo la gran mayoría realizados con muestras no clínicas (n = 66;
86,82%). Para finalizar, de los veinte instrumentos que se emplearon para evaluar la
asertividad sexual, los más utilizados son por este orden: Hurlbert Index of Sexual
Assertiveness (Hurlbert, 1991; n = 18; 23,68%), Sexual Assertiveness Scale (Morokoff et al.,
1997; n = 17; 22,36%), evaluación mediante role playing (n = 8; 10,52%), instrumentos
desarrollados ad hoc (n = 7; 9,21%) y Sexual Awareness Questionnaire (Snell, Fisher y
Miller, 1991; n = 6; 7,89%).
Los resultados principales obtenidos en cada trabajo se pueden observar en la Tabla 1,
los cuales son descritos a continuación de forma general agrupados en las distintas temáticas.

TABLA 1. Principales resultados de los estudios de asertividad sexual (AS).

Autor Diseño Muestra Evaluación/manipulación AS Principales resultados

Respuesta y funcionamiento sexual

Apt, Hurlbert y Ex post facto 21 parejas HISA (Hurlbert, 1991). La diferencia entre la AS de
Powell (1993) comunitarias. los dos miembros de la
Los hombres pareja (AS mujer – AS
acudían a terapia por varón) es un predictor
deseo sexual significativo del deseo
hipoactivo. sexual del varón, pero no de
la mujer.
Gentry (1998) Experimental 254 estudiantes Janda, O’Grady y Barnhart Las mujeres más activas
(varones y mujeres) (1981). Factor Subordination (α sexualmente, también eran
universitarios. = 0,94). más asertivas sexualmente.

Greene y Faulkner Ex post facto 698 parejas HISA (Hurlbert, 1991). Versión Mayor AS-Inicio se
(2005) comunitarias. de 19 ítems. Tres factores: Inicio relaciona con menor doble
(α = 0,86), Rechazo (α = 0,81); moral sexual. Mayor AS se
Conversación sexual asertiva relaciona con mayor
(α = 0,79). satisfacción en la relación.
AS se relaciona de forma
positiva con la negociación
en la pareja, comunicación
sexual y discusión sexual.
Haavio-Mannila y Ex post facto Dos muestra No se informa del instrumento. Las mujeres muestran
Kontula (1997) comunitarias: 2.250 menos AS que los hombres.
varones y mujeres, y La satisfacción sexual se
2.188 varones y relaciona de forma positiva
mujeres. con la AS, tanto en
hombres como en mujeres.

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 Asertividad sexual: análisis de variables relacionadas e implicaciones clínicas

Hammond y Oei Experimental 29 mujeres Sexual Assertiveness Rating La combinación de

(1982) comunitarias. Form (11 ítems). entrenamiento en
Sexual Assertiveness Role- habilidades sociales
playing Test: compuesto por 16 (comunicación asertiva) y
escenarios, 8 de Inicio y 8 de reestructuración cognitiva
Rechazo. fue el tratamiento más
efectivo para incrementar la
asertividad sexual, seguido
por el entrenamiento en
habilidades sociales. Sin
embargo, estas
intervenciones no
mejoraron la asertividad
general.
Hurlbert (1991) Cuasi- 100 mujeres HISA (Hurlbert, 1991; α = Las mujeres sexualmente
experimental comunitarias. 0,91). asertivas informan de
mayor actividad sexual y
orgasmos, mayor deseo
sexual y mayor satisfacción
sexual y marital.
Hurlbert y Apt Ex post facto 68 mujeres HISA (Hurlbert, 1991). Las mujeres con
(1993) comunitarias. orientación heterosexual
mostraron mayor AS que
las mujeres con orientación
homosexual.
Hurlbert, Apt y Ex post facto 98 mujeres casadas HISA (Hurlbert, 1991). La AS se relaciona de
Rabehl (1993) comunitarias. forma positiva con la
erotofilia, la consistencia
experimentando orgasmos,
la cercanía en la relación, la
excitabilidad sexual y la
satisfacción sexual.
Además, es uno de los
mejores predictores de la
satisfacción sexual.
Hurlbert, Apt y Cuasi- 32 mujeres HISA (Hurlbert, 1991). Las mujeres borderline
White (1992) experimental borderline y 32 no mostraron mayor AS.
borderline.
Hurlbert et al. Ex post facto 66 mujeres con HISA (Hurlbert, 1991). La AS se relaciona de
(2005) deseo sexual forma positiva con el
hipoactivo. estatus socioeconómico, la
satisfacción marital,
compatibilidad sexual y
satisfacción sexual.
Hurlbert, White, Experimental 57 mujeres con HISA (Hurlbert, 1991). La AS mejoró debido a un
Powell y Apt (1993) trastorno por deseo entrenamiento en
sexual hipoactivo. consistencia del orgasmo en
el grupo en el que
participaban los dos
miembros de la pareja, pero
no cuando participaban sólo
las mujeres.

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 El papel de la asertividad sexual en la sexualidad humana: una revisión sistemática

Jacobs y Thomlison Ex post facto 572 mujeres SAS (Morokoff et al., 1997; α = La AS se relaciona con
(2009) comunitarias. 0,83). mayor autoestima y
búsqueda de sensaciones y
con menor supresión de
pensamientos o acciones
contrarios a los de la pareja
para evitar conflictos y
creencias negativas,
vergüenza y prejuicios
sociales hacia personas con
VIH.
Ménard y Offman Ex post facto 25 varones y 46 Sexual Assertiveness Scale La AS es un mediador
(2009) mujeres (Shafer, 1977). 28 ítems. parcial de la relación entre
comunitarios. la autoestima sexual sobre
la satisfacción sexual.
La relación de la AS sobre
la satisfacción sexual está
mediada parcialmente por
la autoestima sexual.
Morokoff et al. Instrumental Dos muestras de SAS (Morokoff et al., 1997). La AS se relaciona con una
(1997) mujeres mayor satisfacción en la
comunitarias: 503 y relación de pareja, buen
714. intercambio con la pareja y
mayor experiencia sexual.
Murphy, Coleman, Cuasi- 74 mujeres Entrenamiento en AS. Las mujeres que
Hoon y Scott (1980) experimental alcohólicas. completaron el programa
que incluía entrenamiento
en AS mejoraron en
satisfacción marital,
activación sexual y
educación sexual.
Oattes y Offman Ex post facto 27 varones y 47 Sexual Assertiveness Scale Existe una correlación
(2007) mujeres (Shafer, 1977). moderada entre la AS y la
comunitarios. comunicación sobre
cuestiones generales en la
pareja.
La autoestima sexual es
mejor predictor de la AS
que la autoestima general.
Onuoha y Munakata Ex post facto 101 adolescentes AIDS Social Assertiveness No hay diferencias
(1999) varones y mujeres. Scale (ASAS; α = 0,82) y AIDS estadísticamente
Self-Assertion Questionnaire significativas en AS entre
(ASAQ; α = 0,82). australianos y japoneses,
aunque los japoneses
muestran menor AS.
Pierce y Hurlbert Instrumental 54 participantes no HISA (Hurlbert, 1991). Los hombres mostraron
(1999) clínicos y 46 clínicos mayor AS que las mujeres,
(acudían a terapia de tanto en la muestra clínica
pareja). como en la no clínica.
Rickert, Neal, Ex post facto 904 mujeres 13 ítems que evaluaban Las mujeres con baja AS
Wiemann y comunitarias. asertividad sexual. creen que su pareja es
Berenson (2000) monógama, están casadas o
viven con su pareja y han
tenido menos de tres
parejas sexuales en su vida.

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 Asertividad sexual: análisis de variables relacionadas e implicaciones clínicas

Rickert, Sanghvi y Ex post facto 904 mujeres Cuestionario ad hoc. Uno de los La historia sexual y
Wiemann (2002) comunitarias. componentes era AS percibida. reproductiva y la historia de
abuso previo son los
mejores predictores de la
AS, concretamente el
número de parejas es el
mejor predictor.
Pertenecer a una minoría
étnica, menor edad, bajo
nivel escolar, inexperiencia
sexual y el uso
inconsistente de métodos
anticonceptivos se
relacionan con baja AS.
Schooler y Ward Ex post facto 184 varones HISA (Hurlbert, 1991; α = 0,92) La AS se relacionó de
(2006) universitarios. forma negativa con la
religiosidad y con ser de
origen asiático y de forma
positiva con el confort con
el propio cuerpo y con el
cuerpo de las mujeres.
Schooler, Ward, Ex post facto 199 mujeres HISA (Hurlbert, 1991; α = 0,92) Las mujeres con actitudes
Merriwether y universitarias. más favorables hacia la
Caruthers (2005) menstruación, mayor
confort con el propio
cuerpo y con más
experiencia sexual,
muestran más AS.
La AS ejerce un efecto
mediador entre el confort
con el propio cuerpo y la
experiencia sexual.
Sierra et al. (2008) Instrumental 530 mujeres. HISA (Hurlbert, 1991; α = 0,90) La AS correlacionó de
forma positiva con la
erotofilia y con la
autoestima.
Snell, Fisher y Instrumental 173 varones y SAQ (Snell et al., 1991). Los hombres informan de
Miller (1991) mujeres Subescala de AS (α = 0,81- mayor AS que las mujeres.
universitarios. 0,83). La AS correlacionó de
forma negativa con
culpabilidad sexual,
ansiedad sexual y ansiedad
para el contacto
heterosexual.
En mujeres correlacionó de
forma negativa con
depresión y locus de control
externo (creencia en la
suerte) y de forma positiva
con autoestima, erotofilia y
locus de control interno.
Snell y Wooldridge Ex post facto 253 varones y SAQ (Snell et al., 1991) Tanto en varones como en
(1998) mujeres Subescala AS. mujeres la AS se relaciona
universitarios. con mayor experiencia
sexual.

24
 El papel de la asertividad sexual en la sexualidad humana: una revisión sistemática

van Anders y Dunn Ex post facto 177 varones y HISA (Hurlbert, 1991). La AS no muestra relación
(2009) mujeres con los niveles de
comunitarios. testosterona y estradiol, ni
en hombres ni mujeres.
Los participantes con alta
AS informaron de mayor
número de orgasmos en la
pareja.
Walker (2006) Ex post facto 447 mujeres SAQ-W (Walker, 2006; α = La baja AS actúa como
universitarias. 0,74- 0,93). predictor de una identidad
sexual negativa y de la
conducta sexual no
motivada para la
sexualidad.
Weaver y Byers Ex post facto 214 mujeres HISA (Hurlbert, 1991; α = La AS baja se relaciona con
(2006) universitarias. 0,82). insatisfacción con el propio
cuerpo general y en
situaciones sexuales.
Yamayima, Cash y Ex post facto 384 mujeres SAQ (Snell et al., 1991 ; α = Las mujeres con mayor
Thompson (2006) universitarias. 0,84). preocupación por la imagen
corporal y por la apariencia
corporal en situaciones
sexuales muestran menor
AS.
Yoder, Perry y Saal Ex post facto 165 mujeres SAS (Morokoff et al., 1997 ; α = Las mujeres con
(2007) comunitarias. 0,76–0,86). puntuaciones elevadas en
aceptación pasiva
(sumisión) muestran
puntuaciones más bajas en
AS global, AS-Inicio y AS-
prevención embarazo/STD.
Victimización sexual
Apt y Hurlbert Cuasi- 120 mujeres: 60 HISA (Hurlbert, 1991; α = Las mujeres que sufrían
(1993) experimental sufrían abuso de 0,84). abuso de pareja mostraban
pareja y 60 no. menor AS.
Corbin, Bernat, Ex post facto 238 mujeres SAS (Morokoff et al., 1997). Las mujeres que han
Calhoun, McNair y universitarias. sufrido alguna experiencia
Seals (2001) de victimización sexual
muestran menor habilidad
para rechazar actos
sexuales no deseados
(menor AS-Rechazo).
Kiefer y Sánchez Experimental 48 varones Percepción de ser sexualmente La percepción de una
(2007) universitarios. asertivo (α = 0,73). mayor necesidad de ser
sexualmente asertivo se
relaciona con una menor
inhibición ante conceptos
relacionados con
dominancia sexual.
Livingston, Testa y Ex post facto 937 mujeres SAS-Rechazo (Morokoff et al., La victimización sexual
VanZile-Tamsen comunitarias. 1997; α = 0,77). predice de forma negativa
(2007) la AS-Rechazo, y ésta
predice de forma negativa
la subsecuente
victimización sexual.

25
 Asertividad sexual: análisis de variables relacionadas e implicaciones clínicas

Greene y Navarro Ex post facto 274 mujeres Asertividad sexual. Añadiendo La victimización sexual
(1998) universitarias. “con el sexo opuesto” a los correlacionó de forma
ítems del Inventory of negativa con la AS.
Interpersonal Problems La baja AS con el sexo
(Horowitz, Rosenberg, Baer, opuesto es uno de los
Ureno y Villasenor, 1988; factores principales (junto
fiabilidad dos mitades = 0,92– con la victimización previa)
0,94). en la predicción de la
victimización sexual.
Macy, Nurius y Ex post facto 202 mujeres 2 ítems del SAS (Harlow, La AS funciona como un
Norris (2006) universitarias. Quina, Morokoff, Rose y factor de protección que
Grimley, 1993). modula la respuesta de
escape y resistencia ante
una agresión sexual, pues
se relaciona de forma
negativa con las barreras
que favorecen una agresión.
Miner, Flitter y Ex post facto 230 mujeres 9 ítems dicotómicos (α = 0,73). No se encontraron
Robinson (2006) comunitarias. diferencias en AS en
función del tipo de
victimización (abuso sexual
en la infancia,
victimización adulta y
revictimización).
Morokoff et al. Instrumental Dos muestras de SAS (Morokoff et al., 1997). La AS se relaciona de
(1997) mujeres forma negativa con la
comunitarias: 503 y victimización, coerción y
714. asalto sexual y con historia
de abuso en la infancia.
Rickert et al. (2000) Ex post facto 904 mujeres 13 ítems que evaluaban Las mujeres con baja AS
comunitarias. asertividad sexual. informan de contactos
sexuales forzados en los
últimos 12 meses, pero
ausencia de abuso físico.
Sierra, Ortega, Instrumental 300 mujeres HISA (Hurlbert, 1991 ; α = La AS se relaciona de
Santos y Gutiérrez comunitarias. 0,89). forma negativa con las
(2007) experiencias de abuso físico
y no físico dentro de la
pareja.
Stoner et al. (2008) Experimental 161 mujeres SAS (Morokoff et al., 1997 ; α = Hay una relación negativa
comunitarias. 0,80). entre AS y agresión sexual
adulta y violencia de pareja.
Testa y Dermen Ex post facto 190 mujeres Health Protective Las mujeres que han
(1999) comunitarias. Communication Scale (Catania, sufrido coerción sexual
1998). Asertividad relacionada informan de menor AS. Sin
con VIH (α = 0,83). embargo, haber sufrido una
violación no influye en la
AS.
Testa, VanZile- Ex post facto 927 mujeres SAS-Rechazo (Morokoff et al., Bajos niveles de AS
Tamsen y comunitarias. 1997; α = 0,77) predicen la victimización
Livingston (2007) sexual por parte de la
pareja.

26
 El papel de la asertividad sexual en la sexualidad humana: una revisión sistemática

VanZile-Tamsen, Experimental 318 mujeres SAS-Rechazo (Morokoff et al., La victimización

Testa y Livingston comunitarias. 1997; α = 0,77). adolescente/adulta y el
(2005) CSA se relacionan de forma
negativa con AS-Rechazo y
ésta a su vez actúa como
mediador entre la
resistencia directa o la no
resistencia ante una
agresión.
Walker (2006) Ex post facto 447 mujeres SAQ-W (Walker, 2006; α = La AS mantiene una
universitarias. 0,74- 0,93) relación negativa con la
coerción sexual.
Yagil, Karnielli- Experimental 374 varones y Presentación de escenarios Las respuestas asertivas son
Miller, Eisikovits y mujeres asertivos vs. no-asertivos. más efectivas en la
Enosh (2006) universitarios. reducción de avances
sexuales no deseados.
Conductas de riesgo
Artz, Demand, Cuasi- 1.159 mujeres Entrevista cualitativa. Las mujeres que tienen
Pulley, Posner y experimental comunitarias. dificultades para introducir
Macaluso (2002) el condón femenino
muestran menores niveles
de AS que aquellas sin
dificultades.
Auslander, Perfect, Ex post facto 106 adolescentes SAS (Morokoff et al., 1997). Las adolescentes con
Succop y Rosenthal varones y mujeres. historia de embarazo previo
(2007) inician más frecuentemente
la conducta sexual.
Un mayor número de
parejas sexuales se asocia
con menor frecuencia de
conductas asertivas de
rechazo.
Una mayor experiencia
sexual previa, un mayor
número de parejas y un
mayor número de contactos
sexuales desprotegidos se
relacionan con un menor
número de conductas de
prevención de
embarazo/ITS.
Baele, Dusseldorp y Ex post facto 424 adolescentes Escala ad hoc (6 ítems; α = La AS se relaciona con la
Maes (2001) varones y mujeres: 0,76). intención y la consistencia
con experiencia en el uso del preservativo
sexual (n = 165) y en adolescentes con y sin
sin experiencia (n = experiencia sexual.
255).
Bay-Cheng y ZuckerEx post facto 430 mujeres Escala de Asertividad del SAQ No existen diferencias entre
(2007) universitarias. (Snell et al., 1991; α = 0,90). mujeres con ideología
feminista, igualitaria y no
feminista en su AS para el
uso del preservativo.
Bertens, Eiling, van Cuasi- 273 mujeres Sexual Self-Efficacy Scale La intervención para la
den Borne y experimental comunitarias (Rosenthal, Moore y Flynn, prevención de ITS/VIH
Schaalma (2009) 1991); RBD (Witte, Cameron, mejoró la AS de las
McKeon y Berkowitz, 1996). participantes.

27
 Asertividad sexual: análisis de variables relacionadas e implicaciones clínicas

Caruthers (2005) Ex post facto Dos muestras: 361 y HISA (Hurlbert, 1991; α = 0,92 Las mujeres en relaciones
171 mujeres y 0,93). con pareja ocasional
comunitarias. muestran menos AS que las
mujeres en relaciones
estables.
Correlación negativa entre
AS y edad de la menarquia
y religiosidad, y positiva
con la edad.
Crowell (2004) Cuasi- 40 pacientes VIH Intimate Relationships La AS se relaciona de
experimental positivo y 40 VIH Questionnaire (IRQ ; α = 0,90 – forma positiva con el uso
negativo. 0,91). del condón en sexo oral,
vaginal y anal, con la
frecuencia de comunicación
sobre sexo seguro y el
deseo de comunicación
sobre sexo seguro.
DiNoia y Schinke Cuasi- 204 mujeres Escala AS del SAQ (Snell et al., En el postest las mujeres
(2007) experimental adolescentes. 1991; α = 0,80). que pasaron por el
programa de prevención del
VIH (Keepin’ it Safe)
aumentaron su AS.
Dolcini y Catania Cuasi- 209 mujeres con Sexual Assertiveness Scale Las mujeres con pareja de
(2000) experimental pareja en riesgo (Kirby, 1998). 5 ítems (α = riesgo mostraron menos AS
sexual y 209 con 0,83). que las mujeres con pareja
pareja sin riesgo. sin riesgo.
Hardeman, Pierro y Ex post facto 274 estudiantes 5 ítems que evalúan asertividad Las mujeres muestran
Mannetti (1997) universitarios y de en las relaciones sexuales (α = mayor asertividad sexual
educación superior. 0,44). que los hombres.
La asertividad sexual es un
predictor fiable de la
intención para evitar
relaciones sexuales
casuales.
Jenkins (2008) Ex post facto 111 mujeres SAS (Morokoff et al., 1997 ; α = Las mujeres que no han
comunitarias. 0,71 – 0,83). tenido pareja manifiestan
menos AS-Rechazo que las
que han tenido una pareja.
Correlación positiva entre
las escalas Rechazo y
Prevención embarazo/STD.
Kelly, Lawrance, Experimental 104 varones AS role play. La intervención con un
Hood y Brasfield comunitarios componente de
(1989) (homosexuales). entrenamiento en AS redujo
el rechazo de actividades
sexuales de riesgo y
conductas de riesgo para el
VIH/sida
Kelly, Murphy y Experimental 197 mujeres AS role play. Las mujeres en el grupo
Washington (1994) comunitarias. experimental mejoraron sus
habilidades de
comunicación y
negociación sexual.
Los contactos sexuales
desprotegidos
disminuyeron y el uso del
preservativo aumentó de un
26 a un 56% en los
contactos sexuales.

28
 El papel de la asertividad sexual en la sexualidad humana: una revisión sistemática

Klein y Knäuper Ex post facto 71 mujeres 14 ítems del Intimate Las mujeres con baja AS
(2003) universitarias. Relationships Questionnaire tienden a evitar
(Yesmont, 1992). pensamientos relacionados
con las ITS.
Morokoff et al. Instrumental Dos muestras de SAS (Morokoff et al., 1997). La AS se relaciona con una
(1997) mujeres mayor autoeficacia en la
comunitarias: 503 y prevención del VIH.
714.
Morokoff et al. Ex post facto 473 varones y SAS-prevención embarazo/STD La AS correlaciona de
(2009) mujeres (Morokoff et al., 1997; α = forma positiva con el uso
comunitarios. 0,78). del condón, la fase de
cambio para el uso del
condón y la ratio de sexo
protegido.
Es un predictor
significativo del sexo
desprotegido y ejerce un
papel mediador entre éste y
la victimización sexual en
hombres y entre éste y la
depresión y victimización
sexual en mujeres.
Mosack, Weeks, Ex post facto 109 mujeres SAS-Prevención embarazo/STD La AS-prevención
Sylla y Abbott comunitarias. (Morokoff et al., 1997; α = embarazo/STD es un
(2005) 0,70). predictor de la intención de
uso de microbicidas en las
relaciones sexuales.
Noar, Morokoff y Ex post facto 471 varones y SAS-Prevención embarazo/STD La AS-prevención
Harlow (2002) mujeres (Morokoff et al., 1997). embarazo/STD se relaciona
universitarios. con diversas estrategias de
influencia para el uso del
preservativo (interrupción
del sexo, petición directa,
seducción, insistencia en la
importancia de la relación,
información sobre el
riesgo).
Noar, Morokoff y Ex post facto Tres muestras: 272 y SAS-Prevención embarazo/STD Existen diferencias en AS-
Redding (2002) 152 varones (Morokoff et al., 1997; α = 0,73- prevención embarazo/STD
universitarios; 62 0,78). en función de la etapa de
varones en riesgo cambio para el uso del
para el VIH. condón; mayor AS quienes
lo usan de forma más
consistente.
Los varones con mayor AS
tienen menor tendencia a
involucrarse en actividad
sexual desprotegida.
Onuoha y Munakata Ex post facto 1.957 varones y 7 ítems derivados del Becoming Tanto la AS como la
(2005) mujeres A Responsible Teen (BART; St. asertividad social son
universitarios. Lawrence, 1998). predictores de la evitación
del VIH, siendo mayor el
efecto de la AS.
Parks, Hsieh, Ex post facto 241 mujeres SAS (Morokoff et al., 1997 ; α = Niveles bajos de AS-
Collins, King y comunitarias. 0,66-086). Embarazo/STD se
Levonyan-Radloff relacionan con un menor
(2009) uso del condón tanto con
parejas estables como
ocasionales.

29
 Asertividad sexual: análisis de variables relacionadas e implicaciones clínicas

Quina, Harlow, Ex post facto 816 mujeres SAS-Inicio y SAS-Rechazo La comunicación sexual
Morokoff, comunitarias. (Morokoff et al., 1997; α = 0,77 asertiva sobre las
Burkholder y Deiter y 0,74, respectivamente). preferencias sexuales se
(2000) relaciona más con AS-
Inicio que con Rechazo.
La comunicación sexual
asertiva que busca
información en la pareja
sobre su riesgo para el VIH
se relaciona más con la AS-
Rechazo que con Inicio.
Rickert et al. (2000) Ex post facto 904 mujeres 13 ítems que evaluaban Las mujeres con baja AS
comunitarias. asertividad sexual. informan de un uso
inconsistente de
mecanismos de control de
embarazo.
Roberts y Kennedy Ex post facto 100 mujeres 11 ítems. Adaptación de La AS correlaciona de
(2006) universitarias. Wingood y DiClemente (1998b; forma positiva con el uso
α = 0,77). Evalúa la habilidad de del condón, mayor control
la mujer para sugerir usar el sexual y la intención del
condón a su pareja. uso del condón.
Sikkema, Winett y Experimental 43 mujeres Entrenamiento cognitivo- El entrenamiento en
Lombard (1995) universitarias. conductual de habilidades habilidades sociales mejoró
sociales para mejorar la AS. la asertividad sexual de los
AS role play. participantes y redujo el
número de conductas
sexuales de riesgo.
Snell y Wooldridge Ex post facto 253 varones y SAQ (Snell et al., 1991) Tanto en hombres como en
(1998) mujeres Subescala AS. mujeres la AS se relacionó
universitarios. con un mayor uso de
métodos contraceptivos.
Somlai et al. (1998) Cuasi- 114 varones y AS Role play. Los participantes con
experimental mujeres con menor AS mostraron menor
enfermedad mental porcentaje de uso del
severa. condón, mayor número de
actos sexuales
desprotegidos, parejas
sexuales diferentes y
ocasionales.
St. Lawrence et al. Experimental 246 varones y AS Role play. El programa de
(1995) mujeres intervención que incluye
adolescentes. entrenamiento en AS
disminuye los intercambios
sexuales desprotegidos y
aumenta el uso del
preservativo.
Stoner et al. (2008) Experimental 161 mujeres SAS (Morokoff et al., 1997 ; α = Las participantes con
comunitarias. 0,80). menor AS insistían menos
en el uso del condón,
independientemente del
grado de intoxicación
alcohólica.
Stulhofer, Graham, Ex post facto 1.093 hombres y 3 ítems dicotómicos (α = 0,52). Las mujeres muestran más
Bozievic, Kufrin y mujeres AS que los hombres.
Ajdukovic (2007) comunitarias. Sólo en el caso de las
mujeres, la AS predice de
forma negativa las
conductas sexuales de
riesgo.

30
 El papel de la asertividad sexual en la sexualidad humana: una revisión sistemática

Treffke, Tiggemann Ex post facto 83 hombres Condom Assertiveness Scale AS para el uso del condón
y Ross (1992) homosexuales y 128 (CAS) 26 ítems (α = 0,94). correlaciona de forma
heterosexuales positiva con las actitudes
comunitarios. positivas hacia el uso del
condón.
Weinhardt, Carey, Cuasi 20 mujeres con Escenarios de role play. Las mujeres que recibieron
Carey y Verdecias experimental trastornos Entrenamiento en AS (Kelly, el entrenamiento en AS
(1998) psiquiátricos. 1995). mejoraron su AS del pre al
post y en seguimiento.
Además mejoraron la
frecuencia de sexo
desprotegido.
Weinstein, Walsh y Ex post facto 347 varones y HISA (Hurlbert, 1991; α = La AS se relaciona de
Ward (2008) mujeres 0,92). forma positiva con mayor
universitarios. conocimiento sobre
contracepción, uso del
preservativo, ITS,
VIH/sida.
Wingood y Ex post facto 128 mujeres 7 ítems que evalúan su La AS se relaciona con un
DiClemente (1998a) comunitarias. capacidad de comunicarse uso consistente del condón
asertivamente con sus parejas en mujeres.
sexuales (α = 0,77).
Workman, Experimental 111 mujeres AS y habilidades de Las adolescentes
Robinson, Cotler y adolescentes. comunicación. afroamericanas mostraron
Harper (1997) Sexual Assertiveness Scale mayores niveles de AS que
(Kirby, 1984; α = 0,78). las hispanas.
Yesmont (1992) Ex post facto 253 varones y Intimate Relationships Las mujeres muestran más
mujeres Questionnaire (IRQ). respuestas asertivas que los
universitarios. varones.
La AS correlaciona con la
precaución, preguntas a la
pareja sobre conductas de
riesgo, y el uso del
preservativo.
Zamboni, Crawford Ex post facto 227 varones y SAQ (Snell et al., 1991). La AS es el principal
y Williams (2000) mujeres predictor de la frecuencia
universitarios. del uso del condón en sexo
vaginal.
Correlaciona con
asertividad general y
comunicación sexual.
La relación entre AS y uso
del condón está mediada
por las actitudes hacia el
preservativo; la relación es
positiva cuando las
actitudes hacia el condón
son positivas.

Respuesta y funcionamiento sexual

Los resultados muestran que la asertividad sexual se relaciona de forma positiva con
el deseo sexual (Hurlbert, 1991), tanto en varones como en mujeres. Una mayor asertividad
sexual en la mujer es un predictor del deseo sexual del varón (Apt et al., 1993). También se

31
Asertividad sexual: análisis de variables relacionadas e implicaciones clínicas

encuentra una relación positiva con la satisfacción sexual y marital (Greene y Faulkner, 2005;
Haavio-Mannila y Kontula, 1997; Hurlbert, 1991; Ménard y Offman, 2009), con el número
de orgasmos y, sobre todo, con la consistencia en alcanzarlo (Hurlbert, 1991; Hurlbert, Apt et
al., 1993; Hurlbert, White et al., 1993), y con la actividad y experiencia sexual (Gentry, 1998;
Morokoff et al., 1997; Rickert et al., 2000; Snell y Wooldridge, 1998). Sin embargo, no
parece existir una relación entre la asertividad sexual y los niveles hormonales, ni en hombres
ni en mujeres (van Anders y Dunn, 2009).
Al margen de la respuesta y funcionamiento sexual, se ha informado de mayor
asertividad sexual en varones (Haavio-Mannila y Kontula, 1997; Pierce y Hurlbert, 1999), en
mujeres heterosexuales frente a mujeres homosexuales (Hurlbert y Apt, 1993), en personas
de estatus socioeconómico elevado (Hurlbert et al., 2005), en mujeres con trastorno de
personalidad borderline (Hurlbert, Apt et al., 1992) y en personas poco religiosas (Schooler y
Ward, 2006). Por otra parte, diversas variables actitudinales relacionadas con la respuesta
sexual se encuentran asociadas con la asertividad sexual. Así, las personas con alta
asertividad muestran menor doble moral sexual, mayor autoestima global y sexual, menor
búsqueda de sensaciones y mayor erotofilia (Greene y Faulkner, 2005; Hurlbert, Apt et al.,
1993; Jacobs y Thomlison, 2009; Oattes y Offman, 2007; Sierra et al., 2008), tienen actitudes
más favorables hacia la menstruación, muestran menor culpabilidad sexual y menor sumisión
ante la pareja y manifiestan una identidad sexual más positiva, experimentando un mayor
confort con su propio cuerpo (Schooler y Ward, 2006; Schooler et al., 2005; Walker, 2006;
Weaver y Byers, 2006; Yamamiya, Cash y Thompson, 2006; Yoder et al., 2007).

Victimización y coerción sexual

En líneas generales, los estudios demuestran que la asertividad sexual funciona como
un factor de protección frente a la victimización y coerción sexual (Macy et al., 2006), ya que
es una estrategia eficaz en la reducción de avances sexuales no deseados (Corbin et al., 2001;
Yagil et al., 2006). Además, se ha demostrado una relación negativa con distintos tipos de
conductas de abuso, como abuso sexual en la infancia, coerción sexual, victimización
(Greene y Navarro, 1998; Morokoff et al., 1997; Rickert et al., 2000; Sierra et al., 2007;
Stoner et al., 2008; Testa y Dermen, 1999; Testa et al., 2007; VanZile-Tamsen et al., 2005;
Walker, 2006), sin que existan diferencias en asertividad sexual en función del tipo de abuso
(Miner et al., 2006), encontrándose también esa relación con distintos tipos de agresores, ya
sean personas desconocidas, citas ocasionales, relaciones de pareja estable o matrimonios
(Apt y Hurlbert, 1993; Testa et al., 2007). Se ha señalado además que la baja asertividad

32
 El papel de la asertividad sexual en la sexualidad humana: una revisión sistemática

sexual puede ser tanto una consecuencia de la victimización como un factor de riesgo para la
misma (Livingston et al., 2007).

Conductas sexuales de riesgo

De la misma forma que sucede con la victimización sexual, la asertividad funciona
como un factor de protección ante conductas sexuales de riesgo (Hardeman et al., 1997;
Kelly et al., 1989; Kelly et al., 1994; Sikkema et al., 1995). Los estudios demuestran que una
mayor asertividad sexual se relaciona no sólo con el uso del preservativo de forma
consistente (Baele et al., 2001; Bay-Cheng y Zucker, 2007; Crowell, 2004; Morokoff et al.,
2009; Wingood y DiClemente, 1998a), sino también con la intención de uso del mismo
(Baele et al., 2001; Roberts y Kennedy, 2006) independientemente de si se ha ingerido
alcohol (Stoner et al., 2008), las actitudes positivas hacia su uso (Treffke et al., 1992;
Zamboni et al., 2000), la intención para usar microbicidas (Mosack et al., 2005) y mejores
estrategias de influencia para el uso del preservativo (Noar et al., 2002). Además, puede
actuar como mediador en la relación que se establece entre la victimización sexual y las
conductas sexuales de riesgo (Morokoff et al., 2009). Por el contrario, la baja asertividad
sexual se relaciona con dificultades para usar el condón fenemino (Artz et al., 2002;
Lameiras-Fernández, Núñez-Mangana, Rodríguez-Castro, Bretón-López y Agudelo, 2007) y
con un uso inconsistente de mecanismos útiles para la prevención de embarazos (Rickert et
al., 2000; Snell y Wooldridge, 1998), razón por la cual se asocia con historia de embarazo
previo (Auslander et al., 2007).
También se ha señalado que las personas con baja asertividad sexual tienen un mayor
número de parejas sexuales (Auslander et al., 2007), suelen tener más parejas en riesgo para
el contagio por VIH (Dolcini y Catania, 2000), tienen mayor número de relaciones sexuales
casuales (Somlai et al., 1998) y evitan pensamientos acerca de las infecciones de transmisión
sexual (ITS; Klein y Knäuper, 2003). Además, la asertividad sexual es menor en mujeres que
tienen encuentros ocasionales que en aquellas con pareja estable (Caruthers, 2005). Por
último, también se ha puesto de manifiesto que intervenciones destinadas a prevenir el
contagio de ITS/VIH producen mejoras en la asertividad sexual (Bertens et al., 2009; Di Noia
y Schinke, 2007) y que programas destinados a mejorar la asertividad sexual reducen el
número de conductas de riesgo emitidas por una persona (Kelly et al., 1989; Kelly et al.,
1994; Sikkema et al., 1995; St. Lawrence et al., 1995; Weinhardt et al., 1998).

Discusión

33
Asertividad sexual: análisis de variables relacionadas e implicaciones clínicas

La importancia de la asertividad sexual dentro de la sexualidad humana constituye un

hecho relevante y constatado (Hammond y Oei, 1982); sin embargo, hasta la fecha no existen
estudios que agrupen y analicen la información obtenida acerca de este constructo. Los
resultados obtenidos en esta revisión de trabajos publicados hasta la fecha demuestran que la
asertividad sexual es un elemento fundamental en el funcionamiento y respuesta sexual, y
que es sumamente relevante como factor de protección ante conductas sexuales de riesgo y
experiencias de victimización y coerción sexual.
A nivel descriptivo encontramos que la mayoría de los estudios son de diseño ex post
facto, mientras que pocos son de tipo experimental o cuasi-experimental. Si bien es cierto que
los estudios experimentales son los que permiten establecer relaciones de causalidad
(Montero y León, 2007; Ramos-Alvarez, Moreno-Fernández, Valdés-Conroy y Catena, 2008)
y, por tanto, descubrir el auténtico papel de la asertividad sexual, también es verdad que en
determinadas áreas como en victimización sexual es difícil plantear estudios experimentales
dotados de la suficiente validez ecológica. Por otra parte, también es notorio que a pesar de la
cantidad de instrumentos encontrados para evaluar de una u otra forma la asertividad sexual,
los estudios instrumentales son muy escasos, es decir, que la mayoría de los instrumentos
empleados no han sido desarrollados siguiendo unos estándares mínimos que garanticen su
adecuado funcionamiento.
Respecto a las muestras empleadas destacan sobre todo los estudios realizados con
mujeres, echándose en falta estudios con varones, así como trabajos que analicen las
relaciones diádicas. También, al igual que sucede con otros constructos sexuales (e.g.,
satisfacción sexual) el empleo de muestras de homosexuales o de ancianos es prácticamente
inexistente (Delamater, Hyde y Fong, 2008; Henderson, Lehavot y Simoni, 2009). Por
último, también hay que destacar que algo más de un 45% de los estudios se realizan con los
mismos instrumentos: el SAS (Morokoff et al., 1997) y el HISA (Hurlbert, 1991), que son
justamente los que se han desarrollado a través de estudios instrumentales. Sin embargo, hay
que destacar la elevada utilización de instrumentos desarrollados ad hoc carentes, en la
mayoría de los casos, de las garantías psicométricas necesarias.
Los resultados del primer grupo de estudios ponen de manifiesto la asociación de la
asertividad sexual con las distintas fases de la respuesta sexual humana, como el deseo, el
orgasmo y la satisfacción (Haavio-Mannila y Kontula, 1997; Hurlbert, 1991; Hurlbert, Apt et
al., 1993; Hurlbert, White et al., 1993). Sin embargo, estos estudios han sido elaborados
mediante diseños ex post facto, lo que impide conocer los mecanismos o procesos por los
cuales se da esta asociación y mucho menos cuál es la dirección de la misma. Por ejemplo,

34
 El papel de la asertividad sexual en la sexualidad humana: una revisión sistemática

las personas que tienen mayor asertividad sexual, ¿se comunican más con la pareja
solicitando aquello que les resulta placentero y, por tanto, consiguen mayores niveles de
satisfacción o, por el contrario, la satisfacción sexual crea un mayor vínculo en la pareja y es
este vínculo el que favorece la asertividad sexual? Respecto al primer ejemplo algunos
estudios han demostrado que la autorrevelación sexual favorece la satisfacción (Byers y
MacNeil, 2008; MacNeil y Byers, 2005), pero no se han llevado a cabo estudios similares
con asertividad sexual. Respecto al segundo, sí se ha demostrado que un mayor vínculo y
compromiso en la pareja se asocia con la satisfacción sexual (Warehime y Bass, 2008), pero
no se sabe si esta relación esta mediada por la asertividad sexual. De la misma manera
también se echan en falta más estudios sobre el papel de los niveles hormonales y de la
excitación –medida a través de registros psicofisiológicos- en las respuestas asertivas.
Respecto a variables sociodemográficas, los resultados más interesantes tienen que
ver con el papel del sexo. Aquí se encuentran resultados contradictorios, pues mientras
algunos estudios sostienen una mayor asertividad sexual en varones (Haavio-Mannila y
Kontula, 1997; Pierce y Hurlbert, 1999) otros lo hacen en mujeres (Hardeman et al., 1997;
Stulhofer et al., 2007), si bien desde una perspectiva de género lo esperable es que las
mujeres muestren menos asertividad sexual, pues iniciar interacciones asertivas en
situaciones sexuales no es una habilidad que se haya enseñado con frecuencia a las mujeres
(Muehlenhard y McCoy, 1991). Además algunos estudios demuestran que las mujeres que
discuten sus deseos sexuales y toman decisiones basadas en sus propias necesidades corren el
riesgo de ser etiquetadas como “zorras” (sluts; Holland, Ramazanoglu, Scott, Sharpe y
Thompson, 1990). Por ello, sería necesario investigar cuál es el papel real que juega el sexo
en la asertividad sexual. Por el contrario, sí queda claro el papel de las actitudes sexuales y
otros factores que favorecen el funcionamiento sexual, como la autoestima, una imagen
corporal positiva o la búsqueda de sensaciones sexuales.
Los estudios relacionados con la victimización y la coerción sexual no dejan lugar a
dudas de que la asertividad sexual, en líneas generales, es un factor de protección frente a las
experiencias de abuso (Macy et al., 2006). Además, la principal ventaja es que estos
resultados se han encontrado en distintas modalidades de abuso, así como ante diferentes
tipos de agresores. Sin embargo, existe un aspecto discutido que es conveniente aclarar y
sobre el que se han realizado pocos estudios y es si la baja asertividad surge como
consecuencia de las experiencias de victimización o si la baja asertividad es la causa de las
mismas. En este sentido, en el estudio de Livingston et al. (2007) se encontró que la
asertividad es tanto causa como consecuencia de la victimización sexual, razón por la que son

35
Asertividad sexual: análisis de variables relacionadas e implicaciones clínicas

necesarios más estudios al respecto, que tal y como señalan dichas autoras, deben ser de tipo
longitudinal.
Por último, tal y como muestran los resultados relativos a la victimización, los
estudios sobre conductas sexuales de riesgo coinciden en señalar el papel preventivo de la
asertividad sexual ante dichas conductas (Hardeman et al., 1997; Kelly et al., 1989; Kelly et
al., 1994; Sikkema et al., 1995). A pesar de ello, estos estudios han sido en su mayoría
desarrollados con poblaciones heterosexuales, por lo que es necesario trabajar con
poblaciones homosexuales y bisexuales para comprobar si los resultados coinciden, siempre
teniendo en cuenta que es la asertividad sexual y no la general la que funciona como factor de
protección y, por tanto, los estudios y las estrategias de intervención –que también se han
mostrado efectivas- tienen que ser diseñadas sobre la asertividad sexual.
Para finalizar, es necesario volver a insistir en el papel fundamental de la asertividad
sexual humana, tal y como se desprende de los resultados obtenidos y revisados en el
presente trabajo. De esto se deriva también la necesidad de contemplar la inclusión de la
misma en programas de prevención e intervención (véase, por ejemplo, Carrera-Fernández,
Lameiras-Fernández, Foltz, Núñez-Mangana y Rodríguez-Castro, 2007), tal y como se ha
venido haciendo de forma generalizada con los entrenamientos en habilidades sociales que
incluían componentes de asertividad general. Sin duda, las conclusiones extraídas del
presente trabajo serían mucho más valiosas si se hubiese empleado una metodología meta-
analítica (Cooper y Rosenthal, 1980), pero la heterogeneidad de variables tratadas,
instrumentos y diseños empleados en un número tan reducido de trabajos, favorecieron la
realización de una revisión sistemática descartando la posibilidad de realizar un estudio meta-
analítico, que será más pertinente cuando se disponga un mayor número de trabajos (Botella
y Gambara, 2006; Cooper, 1998).

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 Hurlbert Index of Sexual Assertiveness: a study of psychometric properties in a Spanish sample

Artículo 2
Hurlbert Index of Sexual Assertiveness: a study of psychometric properties
in a Spanish sample

Santos-Iglesias, P., & Sierra, J.C. (2010). Hurlbert Index of Sexual Assertiveness: a study of
psychometric properties in a Spanish sample. Psychological Reports, 107, 39-57. doi:
10.2466/[Link].21.PR0.107.4.39-57

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Asertividad sexual: análisis de variables relacionadas e implicaciones clínicas

48
 Hurlbert Index of Sexual Assertiveness: a study of psychometric properties in a Spanish sample

Hurlbert Index of Sexual Assertiveness: A Study of Psychometric

Properties in a Spanish Sample

Pablo Santos-Iglesias and Juan Carlos Sierra

(University of Granada, Spain)

Abstract.— The study analyzed psychometric properties of a Spanish version of the Hurlbert
Index of Sexual Assertiveness in a Spanish sample of 400 men and 453 women who had had
a partner for the last 6 months or longer at the time of the study. Exploratory and confirmatory
factor analyses suggested a two-factor solution with the factors Initiation and No
shyness/Refusal. Internal consistency values for total scores were .87 and .83 for the factors,
respectively. Convergent validity tests were also satisfactory. It is therefore reasonable to
conclude that the Spanish version of the scale has appropriate psychometric properties.

Sexual assertiveness implies that people have the right to make independent decisions
about their own sexual experiences and activities (Morokoff et al., 1997). It reflects people’s
ability to initiate sexual activity, reject unwanted sexual activity, use contraceptive methods,
and develop healthy sexual behaviors (Morokoff et al., 1997). It also refers to awareness of
oneself as a sexual being and to the use of various behavioral skills to obtain and provide
satisfaction in sexual relations (Dunn, Lloyd, & Phelps, 1979). In short, sexual assertiveness
is an essential component of sexual health. It allows people to make decisions about their
own sexuality (Sierra, Santos, Gutiérrez-Quintanilla, Gómez, & Maeso, 2008) and to engage
in safe, pleasant, and informed sexual activity based on a positive view of sexuality with
mutual respect in intimate relationships (Lottes, 2000).
Sexual assertiveness is related to three key aspects of human sexuality: sexual
functioning, sexual coercion, and risky sexual behaviors. With regard to sexual functioning,
most treatment programs for sexual dysfunctions use components of sexual assertiveness
training (Ellis, 1975; Kerr, 1975; Sierra & Buela-Casal, 2001). Moreover, the results of

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Asertividad sexual: análisis de variables relacionadas e implicaciones clínicas

various studies have shown sexual assertiveness to be negatively related to guilt and sexual
anxiety (Snell, Fisher, & Miller, 1991) and positively related to the ability to give and receive
pleasure in sexual encounters (Dunn et al., 1979). More specifically, lack of sexual
assertiveness has been related to anorgasmy (Cotten-Houston & Wheeler, 1983; Hurlbert,
1991; Kuriansky, Sharpe, & O’Connor, 1982); high sexual assertiveness is associated with
greater activity, sexual desire, orgasms, and sexual and marital satisfaction (Greene &
Faulkner, 2005; Haavio-Mannila & Kontula, 1997; Hite, 1976; Hurlbert, 1991; Hurlbert et
al., 2005; Whitley & Poulsen, 1975;). Positive correlations have also been noted between
sexual assertiveness and body satisfaction and comfort (Schooler, Ward, Merriweather, &
Caruthers, 2005), which indirectly contribute to positive sexual experiences. As far as social
coercion is concerned, most researchers agree that sexual assertiveness is a protective factor
(Bohmer & Parrot, 1993; Parrot, 1990; Ullman, 1998; Fisher, Cullen, & Turner, 2000). In
fact, a negative association has been reported between sexual assertiveness and experiences
of abuse and sexual and verbal coercion (Livingston, Testa, & VanZile-Tamsen, 2007;
MacGreene & Navarro, 1998; Morokoff, et al., 1997; Rickert, Neal, Wiemann, & Berenson,
2000; Sierra, Ortega, Santos, & Gutiérrez, 2007; Stoner et al., 2008; ; Testa & Dermen,
1999), even in married couples (Apt & Hurlbert, 1993). Finally, lack of sexual assertiveness
is also a risk factor for HIV, sexually transmitted infections (STIs), and unwanted
pregnancies (Somlai et al., 1998). Likewise, sexual assertiveness is a significant predictor of
condom use in adolescent and young adult samples (Auslander, Perfect, Succop, &
Rosenthal, 2007; Catania et al., 1992; Crowell, 2004; Ehrhardt et al., 2002; Pulerwitz,
Amaro, De Jong, Gortmaker, & Rudd, 2002; Wingood & DiClemente, 1998), of intention to
use microbicides for HIV and STI prevention (Mosack, Weeks, Sylla, & Abbott, 2005), and
of the absence of sexual risk behaviors (Noar, Morokoff, & Redding, 2002; Rickert et al.,
2000; Thompson, Geher, Stevens, Stem, & Lintz, 2001; Zamboni, Crawford, & Williams,
2000).
Because sexual assertiveness is a very important component of human sexuality,
reliable and valid tests are necessary, given that the interpretations of studies and
interventions could be based on the scores (Padilla, Gómez, Hidalgo, & Muñiz, 2006, 2007).
In the Spanish context, the only test to measure sexual assertiveness with some psychometric
evidence is the Hurlbert Index of Sexual Assertiveness (Sierra et al., 2008), the measure of
sexual assertiveness most frequently used (Santos-Iglesias & Sierra, 2010).
The Hurlbert Index of Sexual Assertiveness (Hurlbert, 1991) has 25 items and
provides a unidimensional measure of sexual assertiveness in couples. Studies of the English

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 Hurlbert Index of Sexual Assertiveness: a study of psychometric properties in a Spanish sample

version have reported adequate psychometric properties, with internal consistency reliability
values ranging from .84 to .92 (Apt & Hurlbert, 1993; Hurlbert, 1991; Schooler et al., 2005)
and a test-retest reliability of .85 over a four week interval (Pierce & Hurlbert, 1999).
Nevertheless, none of these studies have replicated the unidimensional factor structure. With
regard to construct validity, a correlation of .82 was found with the Gambrill-Richey
Assertion Inventory (Hurlbert, 1991). A psychometric assessment of the Spanish version
(Sierra et al., 2008) showed a single factor with an internal consistency reliability estimate of
.90 and significant positive correlations with measures of erotophilia and self-esteem.
However, this study was only based on adult female participants, half of whom were
Salvadorian. Since there may be cultural as well as gender-based differences in sexual
assertiveness, the reliability and validity of the Spanish version need to be assessed with a
Spanish sample of men and women.
The present instrumental study (Montero & León, 2007) was carried out to analyze
the psychometric properties of the Hurlbert Index of Sexual Assertiveness in a
nonrepresentative Spanish sample. In conducting this study, the recommendations made by
Hambleton, Merenda, and Spielberger (2005) and Carretero-Dios and Pérez (2007) were
followed. The psychometric properties of the items in the scale were analyzed and the factor
structure of the scale was examined through exploratory factor analysis and later confirmed
through confirmatory factor analysis. After confirming the final structure of the scale in the
Spanish population, internal consistency reliability and convergent validity indicators were
analyzed. To assess convergent validity, correlations of scores on the Hurlbert Index of
Sexual Assertiveness with those on the Questionnaire on Assertion in Couples (Carrasco,
1998), the abbreviated Spanish version of the Dyadic Adjustment Scale (Santos-Iglesias,
Vallejo-Medina, & Sierra, 2009), and the Social Skills Scale (Gismero, 2002) were
calculated; all these tests measure different constructs (assertion in couples, dyadic
adjustment, and social skills) related to sexual assertiveness.
The following hypotheses about the relations between scores on the Hurlbert Index of
Sexual Assertiveness and the various measures were developed: (1) Since Apt and Hurlbert
(1993) argued that women who experience abuse and male dominance in their marriages
show lower assertiveness, scores on the Hurlbert Index of Sexual Assertiveness were
hypothesized to correlate positively with the Assertion subscale of the Questionnaire on
Assertion in Couples and negatively with the subscales Aggression, Submission, and Passive
aggression. (2) Sexual assertiveness was hypothesized to correlate positively with marital
satisfaction (Hurlbert, 1991), and marital adjustment was hypothesized to correlate with

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Asertividad sexual: análisis de variables relacionadas e implicaciones clínicas

assertive interactions in couples (Epstein, 1981; Smolen, Spiegel, Bakker-Rabdan, Bakker, &
Martin, 1985). A positive correlation was expected between scores on the Hurlbert Index of
Sexual Assertiveness and the abbreviated Spanish version of the Dyadic Adjustment Scale.
(3) Since sexual assertiveness is related to communication skills and other social skills that
are useful to negotiate safe sexual behaviors (Hammond & Oei, 1982; Quina, Harlow,
Morokoff, Burkholder, & Deiter, 2000; Salazar et al., 2004), Hurlbert Index of Sexual
Assertiveness scores were hypothesized to correlate positively with those of the Social Skills
Scale.

Method
Participants
The sample was recruited from the general population through a convenience
sampling procedure and consisted of 400 men and 453 women (N = 853) who had been
involved in stable sexually active heterosexual relationships for at least 6 months at the time
of the study. Ages of participants ranged from 18 to 71 years (M = 30.8; SD = 9.6); men’s
mean age was 32.1 years (SD = 10.0; range 18–71) and women’s mean age was 29.7 years
(SD = 9.0; range 18–65). A total of 65.7% of the participants had a university education
(64.4% men, 68.8% women), 24.7% had secondary school (27.2% men, 22.7% women), and
9.6% had primary school education (8.2% men, 7.2% women). Due to the sampling
procedure and participants’ distribution across different educational levels, the sample is not
representative of the Spanish population.
For the statistical analysis, the sample was randomly divided into two subsamples.
The first subsample consisted of 300 participants (137 men, 163 women) selected through a
random sampling procedure without replacement using SPSS software. This sample size is
considered “good” for an exploratory factor analysis (Tabachnick & Fidell, 2001). The other
subsample consisted of 490 participants (232 men, 258 women) and was used for the
confirmatory factor analysis. The data of 63 participants (7.38%) could not be used in the
factor analyses because their responses were incomplete. These 63 participants did not show
statistically significant differences in age (Mann-Whitney U = 20,461.5, p = .4), sex (U =
.008, p = .8), or education (U = .8, p = .2).

Instruments
Hurlbert Index of Sexual Assertiveness (Hurlbert, 1991). The version used was the
corrected Spanish translation by Sierra et al. (2008). This version, which was previously used

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 Hurlbert Index of Sexual Assertiveness: a study of psychometric properties in a Spanish sample

with Salvadoran women, was sent to four Spanish experts in human sexuality, who were
asked to analyze the meaning of the items in the Spanish context. After making the changes
suggested by the experts, the result was administered to 28 participants (13 university
students, 15 nonstudents) who assessed the meaning of the items again and suggested new
changes. The resulting version was used in the present study. The 25-item scale uses a 5-
point response format with anchors of 0 (never) and 4 (always), so scores could range from 0
to 100. High scores indicate high sexual assertiveness. The psychometric properties of the
scale have been described above.
Questionnaire on Assertion in Couples (Carrasco, 1998). This questionnaire is a 40-
item scale that uses a 5-point response format with anchors of 1 (very rarely) and 5 (very
often). Higher scores reflect higher assertion. The Questionnaire on Assertion in Couples
provides scores on four different subscales: Assertion, direct expression of feelings and
opinions without forcing others’ agreement by means of punishment or punishment threat;
Aggression, coercive expression of feelings and opinions using coercive tactics to obtain
others’ agreement; Submission, lack of direct expression of feelings and opinions or
automatic subjugation to others’ opinions and preferences; and Passive aggression, lack of
direct expression of preferences and opinions, while coercing indirectly by means of
punishment or punishment threat. The author of the questionnaire reported internal
consistency values between α = .75 and .90 (in the present study, McDonald’s omega values
ranged from .86 to .78) and adequate convergent validity, with statistically significant
positive correlations with scores on the Dyadic Adjustment Scale ranging from .33 to .46
(Carrasco, 1998).
Dyadic adjustment. The abbreviated version of the Dyadic Adjustment Scale
(Santos-Iglesias, Vallejo-Medina et al., 2009), which has 13 items that provide a global score
on dyadic adjustment as well as specific scores on three: subscales Consensus, Satisfaction,
and Cohesion. The scale also uses a Likert-type response format with six response options
(with anchors of 0: always disagree and 5: always agree) and five response options (with
anchors of 0: never and 4: every day). Higher scores indicate greater adjustment. The authors
reported adequate internal consistency reliability, with a value of .83 for the global scale, and
values of .73, .70, and .63 for the three subscales, as listed above, respectively (Santos-
Iglesias, Vallejo-Medina et al., 2009). In the present study, estimates of McDonald’s omega
were .92 for the global scale and .71, .72, and .62, respectively, for the three subscales.
Social Skills Scale (Gismero, 2002). This scale has 33 items and uses a 5-point Likert
response format with anchors of 1 (I don’t identify at all) and 5 (I strongly agree and would

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Asertividad sexual: análisis de variables relacionadas e implicaciones clínicas

feel or act this way in most cases). High scores indicate greater assertiveness and social skills.
Internal consistency reliability was α = .88; in the present study, McDonald’s omega was .91.
Convergent validity was indicated by significant correlations with scores on assertive self-
descriptions (from .48 to .50) and scores on neuroticism (−.40) and extraversion (.52;
Gismero, 2002).

Procedure
Participants were recruited through convenience sampling from the general
population. A quota convenience sampling method was used to obtain the same number of
men and women, distributed across different ages and education. The only requirement for
participating was involvement in a stable heterosexual relation with sexual activity for at least
6 months at the time of the study. This sampling method does not allow generalizing results
to the Spanish population.
Testing was conducted individually, except in university classrooms, where it was
performed collectively, by eight well-trained researchers who recruited participants in
different settings (university classrooms, public libraries, social centers, and public places).
The purpose of the study was explained briefly to all participants; after obtaining verbal
informed consent, each participant was given a booklet with the questionnaires in the same
order as described above and a response sheet. Anonymity and confidentiality were
guaranteed, as well as the exclusive use of the tests for research purposes. Since participants
were recruited from the general population, no institutional review board was required.

Results
Item Analysis and Exploratory Factor Analysis
The item analysis was carried out with SPSS Statistics, Version 17.0, software and
showed all response options were chosen for all of the items. In every case, the means
obtained were above the theoretical midpoint of the response scale (which was 2, with
anchors of 0: never and 4: always). Standard deviations were greater than 1.00 for all items
except 1, 2, 10, 11, 14, 19, 23, and 25, for which they were slightly below 1.00. Skewness
and kurtosis values ranged between -2.3 (Item 19) and -0.2 (Item 20) for skewness, and
between 0.03 (Item 18) and 5.1 (Item 19) for kurtosis, so there were no extreme problems
with skew and kurtosis (Kline, 2005). Corrected item-total correlations were above .30
(Nunnally & Bernstein, 1995), except for Items 15 (rit = .28), 20 (rit = .01), and 22 (rit = .27).
Eliminating some of these items increased internal consistency reliability for Items 20 and

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 Hurlbert Index of Sexual Assertiveness: a study of psychometric properties in a Spanish sample

22, although the increase was not statistically significant. The low item-total correlation of
Item 20 (“Pleasing my partner is more important than my pleasure”/“Dar placer a mi pareja
es más importante que mi propio placer”), the inconsistency of the content of Item 22 (“I
enjoy masturbating myself to orgasm”/“Disfruto masturbándome hasta llegar al orgasmo”)
with the construct of sexual assertiveness led to eliminating these two items from later
analyses.
The exploratory factor analysis was carried out with Factor 7.02 software (Lorenzo-
Seva & Ferrando, 2006) after eliminating Items 20 and 22. The coefficient of multivariate
normality showed the nonnormal distribution of the data (Z = 37.56, p < .001). Thus, an
unweighted least squares procedure was used to extract the factors. Promin, an oblique
rotation procedure (Lorenzo-Seva, 1999), was used, given that a correlation between the
possible factors was expected. The Kaiser-Meyer-Olkin measure of sampling adequacy
(KMO = .87) and Bartlett’s test of sphericity (χ2 = 1,971.90, p < .001) showed the adequacy
of the data for this type of analysis (Carretero-Dios & Pérez, 2007; Catena, Ramos, &
Trujillo, 2003).
The analysis yielded a two-factor structure, Initiation and No shyness/Refusal.
Initiation is related to the beginning of sexual contact and the expression of sexual desires
and fantasies to one’s partner, and No shyness/Refusal means the difficulty starting and
maintaining conversations on sexual issues and an inability to reject undesired sexual contact.
The correlation between both factors was .64 (p < .001). Except Items 8 and 15, all factors
loaded above .30 on either of the two factors (see Table 1). Items 8 and 15 were therefore
eliminated from the scale. Items 12 and 23 loaded on the factor No shyness/Refusal, although
their content was more typical of the factor Initiation. Moreover, the difference in the
loadings of these items on both factors was lower than .15. Thus, they were retained in the
analysis and tested in various models with confirmatory factor analysis.

TABLE 1. Factor loadings, communalities (h2), percent of variance, and eigenvalue of each factor.
Item English Spanish Translation Initiation No shyness/ h2
Refusal
1 I feel uncomfortable talking Me siento incómodo/a al hablar .30 .37 .38
(R) during sex durante mis relaciones sexuales
2 I feel that I am shy when it Creo que soy tímido en el ámbito .32 .36 .39
(R) comes to sex sexual
3 I approach my partner for sex Le propongo sexo a mi pareja .66 -.05 .39
when I desire it cuando lo deseo

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Asertividad sexual: análisis de variables relacionadas e implicaciones clínicas

4 I think I am open with my Creo que soy abierto/a con mi .59 .11 .45
partner about sexual needs pareja acerca de mis necesidades
sexuales
5 I enjoy sharing my sexual Disfruto compartiendo mis .55 -.13 .23
fantasies with my partner fantasías sexuales con mi pareja
6 I feel uncomfortable talking to Me siento incómodo/a hablando -.10 .56 .25
(R) my friends about sex de sexo con mis amigos/as
7 I communicate my sexual desires Le comunico mis deseos sexuales .59 .15 .49
to my partner a mi pareja
8 It is difficult for me to touch Me resulta difícil tocarme .23 .29 .22
(R) myself during sex durante mis relaciones sexuales
9 It is hard for me to say no even Me resulta difícil decir que no, -.10 .54 .23
(R) when I do not want sex incluso cuando no deseo tener
relaciones sexuales
10 I am reluctant to describe myself Soy reacio/a a describirme como .03 .55 .32
(R) as a sexual person una persona sexualmente activa
11 I feel uncomfortable telling my Me siento incómodo/a al decirle .08 .61 .44
(R) partner what feels good a mi pareja lo que me gusta
12 I speak up for my sexual feelings Expreso mis sensaciones .24 .37 .30
sexuales
13 I am reluctant to insist that my Soy reacio/a a insistirle a mi .001 .43 .19
(R) partner satisfy me pareja para que me satisfaga
sexualmente
14 I find myself having sex when I Suelo tener relaciones sexuales -.05 .47 .19
(R) do not really want it cuando realmente no quiero
15 When a technique does not feel Cuando no me gusta una práctica .06 .27 .10
good, I tell my partner sexual, se lo digo a mi pareja
16 I feel comfortable giving sexual Me siento cómodo/a diciendo .64 -.20 .28
praise to my partner piropos sexuales a mi pareja
17 It is easy for me to discuss sex Me resulta fácil hablar de sexo .45 .06 .24
with my partner con mi pareja
18 I feel comfortable in initiating Me siento cómodo/a tomando la .65 -.19 .29
sex with my partner iniciativa en las relaciones
sexuales con mi pareja
19 I find myself doing sexual things Tiendo a realizar actividades -.09 .52 .22
(R) that I do not like sexuales que no me gustan
21 I feel comfortable telling my Me siento cómodo/a indicándole .46 .01 .22
partner how to touch me a mi pareja cómo tocarme
23 If something feels good, I insist Si algo me gusta, insisto en .27 .30 .26
on doing it again volver a hacerlo
24 It is hard for me to be honest Me resulta difícil ser sincero/a .16 .39 .27
(R) about my sexual feelings acerca de mis sensaciones
sexuales
25 I try to avoid discussing the Trato de evitar hablar de sexo .06 .60 .41
(R) subject of sex
% variance 28.17 7.65
Eigenvalue 6.48 1.76
Note. (R): The socores of these items are reversed. Content coherence is indicated with
loadings in bold. The reversal of the scores of the factor No shyness/Refusal implies that higher
scores show an absence of sexual shyness, that is, greater sexual assertiveness.

Confirmatory Factor Analysis

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 Hurlbert Index of Sexual Assertiveness: a study of psychometric properties in a Spanish sample

AMOS 7.0 software was used to perform a confirmatory factor analysis. Three
different models were compared: (1) a one-factor model, justified by the high correlation
between both factors and the results obtained in earlier studies (Sierra et al., 2008); (2) a two-
factor model from the exploratory factor analysis; and (3) a two-factor model in which Items
12 and 23 were eliminated, since their content did not fit that of the factor No
shyness/Refusal and their loadings on the factor Initiation were lower than .30. These models
were compared using the generalized least squares procedure. To assess the fitness of the
proposed models, a joint assessment of a group of indexes was used (Kline, 2005; Tanaka,
1993). Given that the value of χ2 is highly influenced by sample size, the χ2/df ratio was
analyzed (Kline, 2005). Moreover, following the recommendations of Jöreskog and Sörbom
(1993), the Goodness of Fit Index and Adjusted Goodness of Fit Index were used as absolute
indicators of adjustment, since no comparison was made with the independence model
(Kline, 2005), and the Root Mean Square Error of Approximation as the best overall fit index
(Marsh, Balla, & Hau, 1996). Good fit is shown by values below 3 in the χ2/df ratio, above
.90 in the Goodness of Fit Index and Adjusted Goodness of Fit Index (Hu & Bentler, 1999;
Kline, 2005), and below .05 in the Root Mean Square Error of Approximation (Browne &
Cudeck, 1993). Table 2 shows the fit indexes of the three models compared. The two-factor
model in which Items 12 and 23 were eliminated showed the best fit, as its χ2/df ratio was
lowest and was the only one with values above .90 in the Adjusted Goodness of Fit Index and
below .05 in the Root Mean Square Error of Approximation (Browne & Cudeck, 1993).
Modification indexes suggested relations between Items 7 and 17, and 9 and 14. Such
relations were included in the model given their theoretical consistency (Batista Foguet &
Coenders, 2000). Thus, Items 7 and 17 correspond to the same factor (Initiation) and refer to
the beginning of sexual communication with one’s partner. Items 9 and 14 correspond to the
factor No shyness/Refusal and are both related to the inability to reject unwanted sexual
contact, as stated by Morokoff et al. (1997). Therefore, 19 items, which clustered into two
factors (see Figure 1), were included in the Spanish version of the Hurlbert Index of Sexual
Assertiveness.

TABLE 2. Fit indexes of the comfirmatory models compared.

Model χ2 df χ2/df GFI AGFI RMSEA
1 factor 488.9* 189 2.58 .905 .884 .057
2 factors of the exploratory factor 460.9* 188 2.45 .910 .890 .054
analysis
2 factors eliminating items 12 and 23 320.3* 149 2.14 .931 .912 .048

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Asertividad sexual: análisis de variables relacionadas e implicaciones clínicas

* p < .001.

FIGURE 1. Two-factor structure of the Hurlbert Index of Sexual Assertiveness.

Before analyzing the reliability and validity of the Spanish version of the Hurlbert
Index of Sexual Assertiveness (19 items clustered into two factors), it was considered that the
underlying structure might be showing a methodological artifact rather than the true structure
of the scale. As demonstrated in studies with other tests, such as the Hurlbert Index of Sexual
Fantasies or the Index of Sexual Satisfaction (Desvarieux, Salamanca, Ortega, & Sierra,
2005; Marsh, 1996; Santos-Iglesias et al., 2009), this artifact consists of separating the
positive and negative items of a unidimensional scale into two different factors (Carmines &
Zeller, 1979; Marsh, 1996; Morales, 2000). A hierarchical multiple regression analysis of the
various criteria (scores on the Social Skills Scale, the abbreviated version of the Dyadic
Adjustment Scale, and the subscales of the Questionnaire on Assertion in Couples) was
performed. It showed that when the second factor is introduced as a predictor in the model,
the change of prediction is significant, except in the Aggression subscale of the Questionnaire
on Assertion in Couples, as shown by the F change (see Table 3). This result implies that
both factors form different constructs.

58
 Hurlbert Index of Sexual Assertiveness: a study of psychometric properties in a Spanish sample

TABLE 3. Summary of hierarchical multiple regression models.

Criterion/Predictor R2 β Partial r Semipartial r R2 change F
ASPA Assertion
1. No .13 .25 .23 .21 .13 119.66*
shyness/Refusal
2 Initiation .17 .21 .19 .18 .04 31.66*
ASPA Aggression
1. No .09 -.27 -.23 -.23 .09 75.99*
shyness/Refusal
2 Initiation .09 -.05 -.04 -.04 .002 1.82
ASPA Submission
1. No .22 -.39 -.35 -.33 .22 219.74*
shyness/Refusal
2 Initiation .23 -.14 -.14 -.12 .001 15.42*
ASPA Passive
aggression
1. No .07 -.18 -.16 -.15 .07 61.38*
shyness/Refusal
2 Initiation .09 -.16 -.15 -.14 .02 17.81*
EAD-13
1. No .09 .20 .18 .17 .09 75.73*
shyness/Refusal
2 Initiation .11 .18 .17 .16 .02 21.95*
EHS
1. No .18 .31 .29 .29 .18 172.02*
shyness/Refusal
2 Initiation .22 .22 .21 .19 .04 35.15*
Note. ASPA: Questionaire on Assertion in Couples; EAD-13; Spanish abbreviated version of the
Dyadic Adjustment Scale; EHS: Social Skills Scale. * p < .001.

Internal Consistency Reliability and Convergent Validity

Internal consistency reliability (McDonald’s omega) of the global scale was .87,
whereas McDonald’s omega of both subscales was .83. Convergent validity indicators
confirmed the three hypotheses. Indeed, statistically significant positive correlations were
found with all the subscales of the Questionnaire on Assertion in Couples, the abbreviated
version of the Dyadic Adjustment Scale, and the Social Skills Scale, except with the
subscales Aggression, Submission, and Passive aggression of the Questionnaire on Assertion
in Couples, which showed negative correlations (see Table 4).

59
Asertividad sexual: análisis de variables relacionadas e implicaciones clínicas

TABLE 4. Pearson correlations between both factors of Hurlbert Index of Sexual Assertiveness and
subscales of teh Questionnaire on Assertion in Couples, Dyadic Adjustment Scale, and Social Skills
Scale.
Subscale Initiation No shyness/Refusal
Questionnaire on Assertion in Couples
Assertion .34* .36*
Aggression -.19* -.30*
Submission -.34* -.47*
Passive aggression -.26 -.27*
Dyadic Adjustment Scale
Consensus .22* .22*
Satisfaction .28* .33*
Cohesion .23* .18*
Social Skills Scale .39* .43*
* p < .001

Discussion
Sexual assertiveness, as an essential component of people’s sexual health (Sierra et
al., 2008), has many implications for human sexuality. Therefore, it is important to have
appropriate scales to assess this construct. Although there are many measures of sexual
assertiveness available in English, no psychometrically adequate scale is available in Spanish.
This study has been carried out to assess the internal consistency reliability and construct
validity of a Spanish version of the Hurlbert Index of Sexual Assertiveness, the most
frequently used sexual assertiveness test (Santos-Iglesias & Sierra, 2010).
First of all, it is important to note that sampling procedure and sample distribution
across education do not guarantee a representative sample, and therefore results cannot be
generalized to the Spanish population. Nevertheless, results show appropriate psychometric
properties of the items. Response means were above the theoretical midpoint of the scale,
probably due to the use of nonclinical instead of clinical samples, because the former show
higher scores on sexual assertiveness (Pierce & Hurlbert, 1999). In this item analysis, two
items (20 and 22) were eliminated from the scale due to problems with item-total correlations
and content coherence. It should be noted that these two items also showed the same
problems in earlier studies (Sierra et al., 2008).
Results of the exploratory and confirmatory factor analyses show a structure formed
by 19 items clustered into two correlated factors, after eliminating six items of the scale. The
factor Initiation refers to the ability to initiate sexual activity pointed out by Morokoff et al.

60
 Hurlbert Index of Sexual Assertiveness: a study of psychometric properties in a Spanish sample

(1997) and the use of behavioral skills to obtain and provide satisfaction in sexual relations
(Dunn et al., 1979). The factor No shyness/Refusal refers both to the difficulty starting and
maintaining conversations on sexual issues and the inability to reject undesired sexual contact
(Morokoff et al., 1997). This two-factor structure is not consistent with the proposal by Sierra
et al. (2008) or the original proposal by Hurlbert (1991). However, Hurlbert did not study the
dimensionality of the scale. In a later study, Greene and Faulkner (2005) found a structure
composed of three highly correlated factors (Initiation, Refusal, and Sexual assertive talk).
Although the exact distribution of the items is not known, since it was not a strictly
psychometric study, there might be correspondence between the factors Initiation (in Greene
and Faulkner and the present study) and between the factors Refusal and Sexual assertive
talk, found by Greene and Faulkner, and No shyness/Refusal in this study.
One of the problems raised by this factor structure is that the high correlation
observed between both factors may suggest overlap between them and therefore the existence
of one single factor. The two-factor structure has been maintained for several reasons. The
first one is theoretical, given that the contents included in both factors reflect different
components of sexual assertiveness such as the beginning of sexual activity, the rejection of
unwanted sexual contact (Morokoff et al., 1997), or the use of behavioral skills to obtain
satisfaction in sexual relations (Dunn et al., 1979), given that sexual satisfaction has often
been found to be related to the expression of sexual desires (Haavio-Mannila & Kontula,
1997; Hurlbert, 1991; Hurlbert, Apt, & Rabehl, 1993; Hurlbert et al., 2005; Ménard &
Offman, 2009). Secondly, the two-factor structure was found using an exploratory factor
analysis and confirmed through a confirmatory factor analysis, unlike the one-factor
structure, which provides evidence of better fit of the two-factor model to the data. Thirdly,
the results of the multiple hierarchical multiple regression model show that after introducing
one of the factors as a predictor over one criterion, the second factor is still able to
significantly contribute to the percentage of variance explained by the first factor. This
suggests the existence of two different factors.
Finally, previous studies performed with sexual assertiveness (Greene & Faulkner,
2005) and other constructs (e.g., social anxiety or gelotophobia) have shown that highly
correlated dimensions can form isolated factors (Carretero-Dios, Ruch, Agudelo, Platt, &
Proyer, 2010). Finally, results showed an internal consistency reliability of .87 in the global
scale. This is slightly lower than the reliability found in earlier studies (Hurlbert, 1991;
Schooler et al., 2005; Sierra et al., 2008). Yet, in the present study, the final version of the
Hurlbert Index of Sexual Assertiveness was formed by a lower number of items. The

61
Asertividad sexual: análisis de variables relacionadas e implicaciones clínicas

reliability of its two factors was .83, a very adequate value that guarantees that they can be
used separately. Likewise, the convergent validity tests confirmed the hypotheses, since
positive correlations were found with social skills (Hammond & Oei, 1982; Quina et al.,
2000; Salazar et al., 2004), marital adjustment (Epstein, 1981; Hurlbert, 1991; Smolen et al.,
1985), and assertion in couples, and negative correlations were found with the subscales
Aggression, Submission, and Passive aggression of the Questionnaire on Assertion in
Couples (Apt & Hurlbert, 1993).
In short, this 19-item abbreviated version of the Hurlbert Index of Sexual
Assertiveness shows a consistent internal structure with adequate indicators of internal
consistency reliability and convergent validity. However, this scale should be the subject of
further research to verify the stability of its factor structure and the possible invariance of the
scale between sexes. It is also highly important to analyze other forms of validity, such as
discriminant or predictive validity, and other forms of reliability, such as test-retest
reliability. Once again, it should be noted that these results must be interpreted with caution
because of the nonrepresentative sample and cannot be generalized to the Spanish population.

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Equivalence and standard scores of the Hurlbert Index of Sexual Assertiveness across Spanish men and women

Artículo 3
Equivalence and Standard Scores of the Hurlbert Index of Sexual
Assertiveness Across Spanish Men and Women

Santos-Iglesias, P., Vallejo-Medina, P. y Sierra, J.C. (2012). Equivalence and

standard scores of the Hurlbert Index of Sexual Assertiveness across Spanish men and
women. Manuscrito sometido a revisión.

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Asertividad sexual: análisis de variables relacionadas e implicaciones clínicas

70
 Equivalence and standard scores of the Hurlbert Index of Sexual Assertiveness across Spanish men and women

Equivalence and Standard Scores of the Hurlbert Index of Sexual

Assertiveness Across Spanish Men and Women

Pablo Santos-Iglesias, Pablo Vallejo-Medina, and Juan Carlos Sierra

(University of Granada, Spain)

Abstract.— The purpose of the present study was to analyze the measurement invariance and
differential item functioning of the Spanish version of the Hurlbert Index of Sexual
Assertiveness across gender. The sample was composed of 1,600 women and 1,598 men from
Spain, with ages ranging from 18 to 84 years old. The Hurlbert Index of Sexual Assertiveness
showed partial strong invariance for men and women, as items 2, 9, and 13 had different
intercept values between groups. The differential item functioning analysis showed that only
item 2 (“I feel that I am shy when it comes to sex”) flagged moderate uniform differential
item functioning. More specifically, women tended to respond “Always” to this item more
frequently than did men. Results strongly suggested eliminating those three items (2, 9, and
13), resulting in a final version with 16 items clustered into two dimensions. Standard scores
for both Initiation and No Shyness/Refusal reflected traditional sexual scripts for men and
women.

Keywords.— Sexual assertiveness. Hurlbert Index of Sexual Assertiveness. Measurement

invariance. Differential item functioning. Standard scores.

Sexual assertiveness has been defined in a variety of ways. Painter (1997) stated that
sexual assertiveness is the ability to develop assertive behaviors in a sexual context. Dunn,
Lloyd, and Phelps (1979) noted that it involves using “behavioral skills to obtain sexual
satisfaction for yourself and your partner” (p. 294). Morokoff et al. (1997) provided a clearer
picture of sexual assertiveness by stating that it embraces the ability to initiate desired sexual
contacts, refuse unwanted sexual contacts, and the ability to prevent pregnancy or STIs with a
regular partner. In line with this definition, several studies have explored the relevance of

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Asertividad sexual: análisis de variables relacionadas e implicaciones clínicas

sexual assertiveness for human sexual life (for a review, see Santos-Iglesias & Sierra, 2010a)
and concluded that it helps develop sexual healthy behaviors (e.g., use of condom) and obtain
greater sexual satisfaction. Finally, sexual assertiveness training programs help promote
positive sexual outcomes and behaviors (Kelly, St. Lawrence, Hood, & Brasfield, 1989;
Murphy, Coleman, Hoon, & Scott, 1980, St. Lawrence et al., 1995).
According to the sexual script theory (Simon & Gagnon, 1984, 1986, 2003), men are
typically initiators of sexual encounters, while women are supposed to be restrictors of such
contacts. Thus, men should score high on initiation sexual assertiveness (i.e., the ability to
initiate desired sexual contacts) while women should score high on refusal sexual
assertiveness (i.e., the ability to refuse undesired sexual contacts). This traditional sexual
script has generated some research to analyze whether men or women scored higher on
sexual assertiveness. In general, results have usually found that men scored higher than
women on sexual assertiveness (Haavio-Mannila & Kontula, 1997; Pierce & Hurlbert, 1999;
Snell, Fisher, & Miller, 1991), although results have been mixed (Stulhofer, Graham,
Bozicevic, Kufrin, & Ajdukovic, 2007). For example, Pierce and Hurlbert (1999) interviewed
54 non-clinical individuals and 46 clinical individuals attending sex therapy and showed that
men in both clinical and non-clinical samples scored higher on sexual assertiveness than
women. On the other hand, Sutlhofer et al. (2007) interviewed a nationally representative
sample of young men and women and found that women scored higher than men on sexual
assertiveness. These results can be explained by the fact that the studies by Hurlbert et al. and
Snell et al. were based on sexual assertiveness scores mostly composed of initiation items,
while Stulhofer et al. used refusal assertiveness items (A. Stulhofer, personal communication,
March 22, 2011). Moreover, a study by Sierra, Santos-Iglesias, and Vallejo-Medina (in press)
showed that, as age increased, initiation sexual assertiveness was higher in men compared to
women. These authors also found that refusal sexual assertiveness was higher in women than
men regardless of age. These results suggest that sexual assertiveness might follow traditional
sexual scripts. They also noted that men and women have usually been compared on the basis
of their sexual assertiveness. However, to our knowledge, there is no psychometric evidence,
such as measurement invariance or lack of differential item functioning, to allow researchers
to make such comparisons using those instruments.
Measurement invariance means that the probability of an observed score does not
depend on the person’s group membership (Meredith, 1993), that is: “respondents from
different groups, but with the same true score, will have the same observed score” (Wu, Li, &
Zumbo, 2007, p. 2). This concept implies that measuring constructs with the same instrument

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 Equivalence and standard scores of the Hurlbert Index of Sexual Assertiveness across Spanish men and women

will reflect differences based on the performance/attribute between groups, and not
differences based on confounding variables. Differential item functioning (DIF) is related to
the conditional probability of answering an item in two or more groups after matching on the
underlying ability (Hidalgo & Gómez, 2006; Zumbo, 1999). In the context of sexual
assertiveness, for example, measurements should be invariant and show lack of DIF for
comparisons between men and women to really reflect differences in sexual assertiveness and
not differences based on sexist items or item comprehension, for example. Both procedures
are strongly related (Dimitrov, 2010; Holland & Wainer, 1993) and are supposed to be tested
together as evidence of validity, especially when test scores are used to compare groups.
The Hurlbert Index of Sexual Assertiveness (HISA; Hurlbert, 1991) is one of the
instruments used most frequently to assess sexual assertiveness (Santos-Iglesias & Sierra,
2010a). In its original version, it was composed of 25 items providing an one-dimensional
measure of sexual assertiveness in couples. The Spanish adaptation was shortened to a 19-
item version clustered into two dimensions: (1) Initiation, which reflects the ability to begin
sexual contacts and to express sexual desires and fantasies; and (2) No Shyness/Refusal,
which means the difficulty starting and maintaining sexual conversations and the inability to
reject undesired sexual contacts (Santos-Iglesias & Sierra, 2010b). Although the HISA has
shown adequate psychometric properties (Santos-Iglesias & Sierra, 2010b; Sierra, Santos,
Gutiérrez-Quintanilla, Gómez, & Maeso, 2008) and has been used to compare men and
women (see Pierce & Hurlbert, 1999), no studies have tested whether its psychometric
properties are the same for men and women. Thus, the main aim of the present study was to
assess the measurement invariance and DIF of the Hurlbert Index of Sexual Assertiveness
across gender using a Spanish sample. Due to the lack of normative data and its potential
usefulness for clinical and epidemiological assessments, standard scores were developed for
both the Initiation and No Shyness/Refusal subscales for both men and women across three
different age groups (18-34, 35-49, and 50 years old or older).

Method
Participants
Participants were recruited from the general population in Spain. The final sample
was composed of 1,598 men and 1,600 women, all of them involved in a romantic
relationship that included sexual activity at the time of the study. The mean age of men was
39.47 years (SD = 13.38, range 18-81), while that of women was 36.98 years (SD = 13.41,

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range 18-84). Educational level, religion, and frequency of religious practice are reported in
Table 1.

TABLE 1. Educational level, religion, and religious practice of both men and women.
Variables Men Women
n % N %
Educational level
No education 25 1.6 20 1.3
Primary 274 17.1 267 16.8
Secondary 490 30.7 353 22.1
University 809 50.6 954 59.8
Religion
Christian 1,135 71.2 1,237 77.6
Islamic 2 0.1 2 0.1
Hindu 1 0.1 3 0.2
Buddhist 2 0.1 3 0.2
None 455 28.5 350 21.9
Religious practice
Daily 6 0.4 9 0.6
Once a week 67 4.2 119 7.4
Once a month 127 7.9 156 9.8
Once a year 754 47.2 841 52.6
Never 644 40.3 473 29.6

Measures
A background questionnaire was administered to obtain information about sex, age,
whether participants were involved on a romantic relationship, whether they had sexual
activity with their partners, educational level, religion, and frequency of religious practice.
Hurlbert Index of Sexual Assertiveness (HISA; Hurlbert, 1991). The Spanish
version by Santos-Iglesias and Sierra (2010b) was used. It includes 19 items clustered into
two factors: Initiation and No Shyness/Refusal. Participants responded using a 5-point Likert
scale from 0 (never) to 4 (always). Higher scores indicated greater initiation assertiveness
(Initiation subscale), and lack of shyness and greater refusal assertiveness (No
Shyness/Refusal subscale). Santos-Iglesias and Sierra reported an internal consistency of .83
for each factor and .87 for the global scale. It is correlated with the Spanish version of the
Sexual Assertiveness Scale (Sierra, Vallejo-Medina, & Santos-Iglesias, 2011) and the
Spanish abbreviated version of the Dyadic Adjustment Scale (Santos-Iglesias, Vallejo-
Medina, & Sierra, 2009).

Procedure

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 Equivalence and standard scores of the Hurlbert Index of Sexual Assertiveness across Spanish men and women

Participants were recruited from the Spanish general population. A quota convenience
sampling method was used to obtain the same number of men and women, distributed across
different groups according to age (18-34 years old, 35-49 years old, and 50 years old or
older), size of the town or city of residence (a population lesser than 50,000 and greater than
50,000), and geographical area (north and south of Spain). Participants were required to be
involved in a stable heterosexual relation with sexual activity for at least 6 months at the time
of the study. Testing was conducted individually in different settings by well-trained
researchers (public libraries, social centers, and public places). In university classrooms,
participants were tested collectively. The purpose of the study was briefly explained to all
participants. Verbal informed consent was obtained, and anonymity and confidentiality were
guaranteed, as well as the exclusive use of the tests for research purposes.

Data analysis
Measurement invariance was tested using LISREL 8.51 (Jöreskog & Sörbom, 2001)
following the procedure described by Wu et al. (2007) for multi-group confirmatory factor
analysis (MG-CFA). Four models were assessed: (1) configural invariance constrained the
number of factors and the pattern of free and fixed loadings across both groups; (2) weak
invariance tested equality of factor loadings across groups; (3) strong invariance tested
equality of intercepts for both groups; and (4) strict invariance assumed that residual
variances for all items were equal across groups. These four steps were estimated using
maximum likelihood. In order to avoid problems with sample size, three main indices were
used to assess adjustment: the Root Mean Square Error of Approximation (RMSEA), Non-
Normed Fit Index (NNFI), and Comparative Fit Index (CFI). In this context, NNFI and CFI
values above .85 and RMSEA values below .08 were used as indicators of good fit (Browne
& Cudeck, 1993). Additionally, to assess the fit of nested models –such as the MG-CFA–,
changes in the fit indices were examined (Cheung & Rensvold, 2002; Wu, et al., 2007).
Cheung and Rensvold (2002) recommended using ∆CFI and proposed ∆CFI ≤ -.01 as a good
indicator of measurement invariance.
Differential item functioning was tested using discriminant logistic analysis (Hidalgo
& Gómez, 2006; Hidalgo & Gómez-Benito, 2010) through SPSS 17.0. A 3-step hierarchical
procedure was followed. Step 1 tested the contribution of each subscale score (Initiation and
No shyness/Refusal). Step 2 tested whether item score significantly contributed to differences
between men and women (dependent variable), and Step 3 tested the interaction between

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Asertividad sexual: análisis de variables relacionadas e implicaciones clínicas

subscale score and item score. Significance of Step 2 - Step 1 (Step 2 itself) indicated
uniform DIF, while significance of Step 3 - Step 2 (Step 3 itself) was considered evidence of
non-uniform DIF. Effect size was tested through the increase in Nagelkerke’s R2, so that
values up to .035 indicated negligible DIF, values between .035 and .070 showed moderate
DIF, and values above .070 indicated large DIF (Jodoin & Gierl, 2001). A stepwise
purification procedure was performed for all the items showing DIF. Finally, to analyze the
response category in which the DIF did exist, a discriminant logistic analysis using a
cumulative probability model was performed on each item showing DIF (Mellenberg, 1995).

Results
Measurement invariance
Measurement invariance started by testing configural invariance. Results showed that
the model was the same for men and women (see Table 2). Although the χ2 value was
extremely high due to the large sample size, the NNFI, CFI, and RMSEA showed good fit.
Step 2 involved testing whether weak invariance, or factor loading equivalence, was
supported. The NNFI, CFI, and RMSEA showed good fit, and the increase in CFI was -.002,
indicating good fit for nested models between model 1 and model 2. Step 3 tested strong
invariance or equivalence of intercepts across groups. Results showed an increase in the
RMSEA and a decrease in the GFI, NNFI, and CFI. Furthermore, changes in the CFI reached
.023, which meant that this nested model did not fit the data and therefore that strong
invariance was not supported. At this point, the modification indices in the Tau-x matrix were
assessed and revealed that items 2, 9, and 13 had large modification values (110.19, 62.58,
and 57.39, respectively) and large expected change values too (.149; -.152; and -.149,
respectively). This suggested testing strong invariance again without restrictions for these
three items. Results showed good fit and a slight non-significant decrease in the CFI (ΔCFI =
-.01), which showed support for partial strong invariance (Byrne, Shavelson, & Muthén,
1989). At this point, strict invariance was tested without restrictions for intercepts on items 2,
9, and 13. As shown in Table 2, strict invariance without restrictions for intercepts on items
2, 9, and 13 showed good fit.

TABLE 2. Goodness-of-fit indices for measurement invariance models.

Model χ2 df NNFI CFI ΔCFI RMSEA
1. Configural invariance 2,006.75*** 305 .890 .902 .059
2. Weak invariance 2,063.30*** 322 .894 .900 -.002 .058
3. Strong invariance 2,482.13*** 341 .876 .877 -.023 .062

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 Equivalence and standard scores of the Hurlbert Index of Sexual Assertiveness across Spanish men and women

3a. Partial strong invariancea 2,231.16*** 338 .889 .890 -.01 .059
4. Strict invariancea 2,379.52*** 357 .885 .880 -.01 .059
a
Note. Without restrictions on intercepts in items 2, 9, and 13. *** p < .001.

Differential item functioning

As shown in Table 3, the only item flagging moderate uniform DIF across gender was
item 2 (ΔR2 = .059; “I feel that I am shy when it comes to sex”). The purification process
showed that, after deleting item 2 from the matching score, uniform DIF was still moderate
(χ2 = 144.55, p < .001, ΔR2 = .059). Results of the discriminant logistic analysis performed
on response scale categories revealed moderate uniform DIF in response category 4 (always)
for item 2 (χ2 = 158.56, p < .001, ΔR2 = .065), indicating that women chose this anchor more
frequently than men (OR = 0.37).

TABLE 3. Differential item functioning of the Initiation and No Shyness/Refusal subscales.

Scale Item Step 2 - Step 1 Step 3 - Step 2
χ2 p ΔR2 χ2 p ΔR2
Initiation 3 8.75 .003 .003 22.79 < .001 .009
4 2.53 .11 .001 15.14 < .001 .006
5 0.35 .55 .000 1.60 .20 .000
7 1.83 .17 .000 11.19 < .001 .005
16 7.87 .005 .003 1.20 .27 .000
17 35.54 < .001 .014 1.81 .17 .001
18 23.78 < .001 .009 29.81 < .001 .012
21 2.40 .12 .001 2.74 .10 .001
No Shyness/ Refusal 1 2.72 .09 .001 1.88 .17 .001
2 145.49 < .001 .059 5.29 .02 .002
6 1.12 .28 .001 1.16 .28 .000
9 57.65 < .001 .024 2.09 .14 .001
10 4.42 .03 .002 4.18 .04 .002
11 4.79 .02 .002 2.36 .12 .001
13 44.09 < .001 .018 12.88 < .001 .006
14 .02 .88 .000 3.55 .06 .002
19 .30 .58 .000 2.23 .13 .001
24 .56 .45 .000 6.97 .008 .003
25 .06 .80 .000 6.10 .013 .003

Standard scores
Standard scores for Initiation and No Shyness/Refusal were created from z score
transformations due to the violation of normality (see Table 4 and Table 5, respectively). It
must be noted that items 2, 9 and 13 were eliminated from the No Shyness/Refusal subscale
before calculating standard scores. Results showed that men scored slightly higher on

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Asertividad sexual: análisis de variables relacionadas e implicaciones clínicas

initiation assertiveness in the 18-34 year-old group, t (1307) = 4.64, p < .001, d = 0.07. This
effect was stronger in the middle-aged group (35-49 years old), t (1059) = 3.15, p = .002, d =
0.19, and especially stronger in participants 50 years old or older, t (818) = 9.41, p < .0001, d
= 0.65 (see Table 4). Regarding the No Shyness/Refusal subscale, young women scored
slightly higher than younger men, t (1307) = -2.28, p = .023, d = 0.12, but older men scored
higher than older women, t (818) = 5.87, p < .001, d = 0.40 (see Table 5). No significant
differences were found between men and women in the middle-aged group.

TABLE 4. Standard scores of the Initiation subscale.

Initiation Men Women
18-34 35-49 50- 18-34 35-49 50-
M 24.40 22.53 21.62 22.84 21.20 16.73
SD 5.68 6.25 6.96 6.35 7.35 7.86
Cent
99 32 32 32 32 32 32
95 32 32 32 32 32 30
85 30 29 29 30 30 25
75 29 27 27 28 28 23
65 28 26 25 26 25 21
55 26 24 23 24 23 18
50 25.50 23 23 24 22 16
45 25 22 22 23 20 15
35 23 21 19 21 18 13
25 21 18 17 19 16 10
15 18 16 14 16 13 8
5 13 11 9 10 7 4
1 8.06 6 4 6.08 5 0

TABLE 5. Standard scores of the No Shyness/Refusal subscale.

No Men Women
Shyness
18-34 35-49 50- 18-34 35-49 50-
M 27.28 26.53 25.97 27.80 26.38 23.76
SD 4.37 4.74 4.80 3.89 4.94 5.94
Cent
99 32 32 32 32 32 32
95 32 32 32 32 32 31
85 31 31 31 31 31 30
75 31 30 30 31 30 29
65 29.95 29 28 30 29 27
55 28 28 27 20 28 26
50 28 27.50 27 29 28 25
45 28 27 26 28 27 24
35 27 25 25 27 25 23
25 25 24 24 26 24 20
15 24 22 21 24 21 18

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 Equivalence and standard scores of the Hurlbert Index of Sexual Assertiveness across Spanish men and women

5 19 18 17 20 16 12.10
1 12 8.70 9.60 14 11 6

Discussion
When assessment instruments are used to compare groups (i.e., cultures, gender, etc.)
it is essential for such instruments to operate in the same way for each group (Dimitrov,
2010). The main purpose of the present study was to analyze the measurement invariance and
differential item functioning of the Spanish version of the Hurlbert Index of Sexual
Assertiveness (Santos-Iglesias & Sierra, 2010b), because it is a construct that has typically
been compared across men and women. Results show that, except for items 2, 9, and 13, this
scale can be used to compare men and women on the underlying constructs. Therefore, we
highly recommend deleting these items from the scale.
Regarding measurement invariance, results show that the model proposed by Santos-
Iglesias and Sierra (2010b) is the same for men and women, as proven by the configural
invariance test. Furthermore, not only is the structure the same but factor loadings are also
equivalent across gender. Strict invariance also showed good fit, so the regression residual
variances for all items were the same across groups. Nevertheless, when testing for strong
invariance, the present results did not support the same item intercepts for men and women.
More specifically, items 2, 9, and 13 showed different intercepts for men and women. Strong
invariance was tested again without restricting item 2, 9, and 13 intercept values to be the
same across groups. Results showed support for partial strong invariance, which, according to
Dimitrov (2010) and Wu et al. (2007) could be an indicator of differential item functioning in
such items.
Differential item functioning confirmed measurement invariance results. As
mentioned earlier, item 2 showed uniform differential item functioning, which means that
men and women have different probabilities of endorsing a response even if they belong to
the same attribute level. More specifically, women have a greater probability of responding
“Always” to item 2 (“I feel that I am shy when it comes to sex”) compared to men. These
results are related with traditional sexual scripts and gender-role stereotypes, in which women
are supposed to follow traditionally feminine attributes like being sympathetic or shy (Bem,
1974; Holt & Ellis, 1998) and are encouraged not to talk overtly about sex (Quina, Harlow,
Morokoff, Burkholder, & Deiter, 2000).

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Asertividad sexual: análisis de variables relacionadas e implicaciones clínicas

Finally, standard scores are provided. Results of mean scores reveal that assertiveness
still follows traditional sexual scripts and gender-role stereotypes, especially among older
participants. According to this, men assertively initiate sexual contacts more frequently than
women (Haavio-Mannila & Kontula, 1997; Pierce & Hurlbert, 1999; Snell, et al., 1991)
because they are supposed to initiate sexual contacts while women are supposed to act as
restrictors of such contacts (Simon & Gagnon, 1984, 1986, 2003). In addition, young women
scored slightly higher than young men on the No Shyness/Refusal subscale, which indicates
that young women are less shy and refuse sexual contacts more often than young men.
Regarding older men and women, results reveal that older women are shyer and less able to
refuse undesired sexual contacts than older men. These results, although contrary to
traditional sexual scripts, are consistent with some gender stereotypes, such as shyness in
women (Bem, 1974; Holt & Ellis, 1998) actually show that sexual assertive skills were not
traditionally taught to women (Muehlenhard & McCoy, 1991). This is particularly true in the
case of Spanish women, who were taught to be “good wives” and comply with their partners’
sexual desires in the past (Vázquez García & Moreno Mengíbar, 1997).
Some implications of these results must be noted. First, the factor structure found by
Santos-Iglesias and Sierra (2010b) has been replicated in a sample of Spanish men and
women, which is an indicator of construct validity of the scale. Second, some items (i.e., 2, 9,
and 13) are problematic when the purpose is to compare men and women’s factor scores. In
such cases, it is highly recommended to eliminate those items and use either the total score or
factor scores based on this abbreviated Spanish version, which is finally composed of 16
items clustered into two dimensions. It is also possible to use the Spanish version of the
Sexual Assertiveness Scale (Sierra, Vallejo-Medina, et al., 2011), whose equivalence across
gender has been proven. Third, standard scores provided here are useful tools for clinicians
and applied psychologists who want to assess individuals’ sexual assertiveness. Finally, some
limitations must be noted. For example, results are based on a non-representative sample with
a large proportion of participants with high educational level, which implies that these results
cannot be generalized to the entire Spanish population. Second, such results only apply to the
Spanish version of the HISA, so no inferences can be made about the original English
version.

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 Sexual victimization among Spanish college women and risk factors for sexual revictimization

Artículo 4
Sexual Victimization Among Spanish College Women and Risk Factors for
Sexual Revictimization

Santos-Iglesias, P., & Sierra, J. C. (in press). Sexual victimization among Spanish
college women and risk factors for sexual revictimization. Journal of Interpersonal Violence.

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Dear Mr. Santos-Iglesias:

It is a pleasure to accept your manuscript entitled "Sexual Victimization among

Spanish College Women and Risk Factors for Sexual Revictimization" in its current
form for publication in the Journal of Interpersonal Violence.

Thank you for your fine contribution. On behalf of the Editors of the Journal of
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 Sexual victimization among Spanish college women and risk factors for sexual revictimization

Sexual Victimization among Spanish College Women and Risk Factors for
Sexual Revictimization

Pablo Santos-Iglesias and Juan Carlos Sierra

(University of Granada, Spain)

Abstract.— Sexual revictimization is frequent among victims of child sexual abuse. Several
variables, such as sexual experience, substance abuse, and sexual assertiveness, have been
proposed to explain the link between child sexual abuse and adolescent and adult sexual
victimization, although they have typically been tested separately. The main objective of this
study was to analyze which of these variables better explains the revictimization phenomenon
using a multiple mediation analysis. The study also tested the frequency of sexual
victimization experiences in a Spanish sample of college women. Four hundred and two
women were interviewed. Results showed that 30.4% of them engaged in undesired sexual
contact while almost 4% were victims of rape. The most frequent perpetrators were partners
or ex-partners, acquaintances, or dating partners, but not strangers. Finally, the relationship
between child sexual abuse and adolescent and adult sexual victimization was mediated by
number of consensual sexual partners and sexual assertiveness. Results reflect some cultural
differences from previous research.

Keywords.— Sexual revictimization. Sexual experience. Sexual assertiveness. Substance use.

Multiple mediation.

Sexual victimization experiences encompass different “violent, coercive, and

developmentally inappropriate sexual experiences including incest, rape, and other forms of
sexual abuse such as fondling and sexual exposure; use of physical force, authority, or age
differentials to obtain sexual contact; and verbally coerced sexual contact” (Greene &
Navarro, 1998, p. 590). Previous studies have shown that the female college population is at
high risk for sexual victimization (Bureau of Justice Statistics, 2007; Christopher & Kisler,

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Asertividad sexual: análisis de variables relacionadas e implicaciones clínicas

2004; National Victim Center, 1992; Tjaden & Thoennes, 2000). For example, it has been
shown that 13% to 78% of college women have been victims of different forms of sexual
victimization that in some cases meet the legal definition of rape (Fisher, Cullen, & Turner,
2000; Kanin & Parcell, 1977; Kirkpatrick & Kanin, 1957; Koss, Gidycz, & Wisniewski,
1987; Koss & Oros, 1982; Muehlenhard & Linton, 1987). In Spain, only a few studies have
examined sexual victimization rates among the female college population. Sipsma,
Carrobles-Isabel, Montorio Cerrato, and Everaerd (2000) revealed that 33.2% of college
women had been victims of some form of sexual victimization and 3.2% had been raped.
Fuertes et al. noted that 30.9% and 42.7% of college women had been sexually coerced or
sexually victimized, respectively (Fuertes, Ramos, Martínez, López, & Tabernero, 2006;
Ramos, Fuertes, & De la Orden, 2006). Regarding perpetrators, research studies have
consistently found that partners and new acquaintances are more frequent perpetrators than
strangers (Koss, Dinero, Seibel, & Cox, 1988; Krahé, Scheinberger-Olwig, Waizenhöfer, and
Kolpin, 1999). In Spain, these issues have only been explored by Ramos et al. (2006), who
found that 24% were victimized by a friend, 17% were victimize by a partner, and 16% were
victimized by a new acquaintance.
Regarding risk factors, past research proposed child sexual abuse (CSA) as the main
risk factor for adolescent or adult sexual victimization (AASV) –known as the
revictimization hypothesis– (Messman & Long, 1996). For example, Barnes, Noll, Putnam,
and Trickett (2009) found that female victims of CSA were 1.99 times more likely than
females who had not experienced CSA to be sexually revictimized as adults. In a meta-
analytic review, Roodman and Clum (2001) found an overall effect size of .59 regarding
sexual revictimization. Many other studies have shown similar results (for a review, see
Arata, 2000; Classen, Palesh, & Aggarwal, 2005; Messman & Long, 1996; Muehlenhard,
Highby, Lee, Bryan, & Dodrill, 1998; Roodman & Clum, 2001). A number of variables have
been proposed to explain why women who have experienced CSA are at increased risk for
sexual victimization in adolescence and young adulthood. Muehlenhard et al. (1998)
suggested that the relationship between CSA and adolescent and adult sexual victimization
(AASV) might be mediated by third variables, such as sexual experience, sexual
assertiveness, and substance use prior to sex.
First, regarding sexual experience, it has been proposed that the number of consensual
sexual partners mediates the relationship between CSA and AASV. That is, women who have
experienced CSA have a larger number of consensual sexual partners, which in turn increases
the risk for AASV. This is because the higher the number of sexual partners, the greater the

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 Sexual victimization among Spanish college women and risk factors for sexual revictimization

probability of finding an aggressive one (Muehlenhard et al., 1998). This has been supported
by the results of several studies. For example, Arata (2000) discovered that consensual sexual
behavior mediated the relationship between CSA and sexual revictimization, and Krahé et al.
(1999) also found that both number of intercourse partners and number of non-intercourse
partners mediated between CSA and AASV. This effect has also been supported by studies
assessing the role of early consensual sexual activity as a mediator between CSA and AASV.
Fergusson, Horwood, and Lynskey (1997) found that CSA was associated with early
consensual sexual activity, and early sexual activity was related to adolescent sexual
victimization. Himelein, Vogel, and Wachowiak (1994) found that age of first consensual
experience was related to both CSA and AASV, although they did not strictly test mediation.
Sexual assertiveness has also been proposed as a mediator between CSA and AASV.
In this regard, Russell (1986) stated that child sexual abuse “socializes a child into the role of
a victim... [leaving her] less able to muster the confidence and assertiveness required to reject
unwanted sexual advances from others” (p. 169). Finkelhor (1984) also stressed the
significance of lack of sexual assertiveness and suggested that CSA victims “... also lack
assertiveness to short-circuit at an early stage encounters where they sense some risk” (p.
194). Although this hypothesis has existed for a long time and has a very intuitive appeal
(Livingston, Testa, & VanZile-Tamsen, 2007), to date we have only found two studies
examining the mediator role of sexual assertiveness (Greene & Navarro, 1998; Livingston et
al., 2007). Neither study found that sexual assertiveness mediated the relationship between
CSA and AASV, basically because CSA did not predict low sexual assertiveness. However,
this hypothesis was tested using the causal steps approach to assess mediation. Compared to
the differences in coefficients and the product of coefficients approach, this approach is
known to have less power to detect mediation effects (MacKinnon, Lockwood, Hoffman,
West, & Sheets, 2002).
Substance use may also mediate between CSA and AASV (Muehlenhard et al., 1998).
Various studies have shown that CSA is a risk factor for substance use (see Muehlenhard et
al., 1998) and substance use is a risk factor for AASV (Fisher & Cullen, 2006; Kilpatrick,
Acierno, Resnick, Saunders, & Best, 1997). Moreover, Kilpatrick et al. (1997) found that
revictimization in women was mediated by alcohol and substance consumption together. In
this context, it is also relevant to examine substance abuse prior to sex. For example, Testa et
al. (1999) demonstrated this effect with alcohol. They found that women who had been raped
or coerced into sex reported higher frequency of alcohol consumption in conjunction with
sexual activity. Furthermore, Livingston, Hequembourg, Testa, and VanZile-Tamsen (2009)

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Asertividad sexual: análisis de variables relacionadas e implicaciones clínicas

found that substance abuse prior to sex was a common risk factor for sexual victimization.
Thus, it would be interesting to explore whether substance use prior to sex can mediate the
relationship between CSA and AASV.
Most of these previous studies tested mediation effects individually (Fargo, 2009).
However, it is important to test all of these potential mediation effects together for several
reasons. First, the relationship between an independent variable and an outcome is usually
mediated by more than one single variable (Preacher & Hayes, 2008a). For example,
Livingston et al. (2007) recognized that sexual assertiveness “is not the only mechanism
through which sexual revictimization occurs” (p. 310) and added that other mechanisms
should be considered as well. Along the same lines, Ullman (2003) suggested the need to
simultaneously test the relevance of different mediators between child and adult sexual
assault. In fact, testing each mediator individually limits our understanding of the multiple
pathways by which CSA enhances women’s risk for AASV. In contrast, including all these
mediators in one model provides a test of the total indirect effect (all mediators taken
together) as well as specific indirect effects (the independent contribution of each mediator)
(Preacher & Hayes, 2008b). This also makes it possible to test differential effect sizes
between specific indirect effects and thus to analyze which variables or effects are most
plausible (Preacher & Hayes, 2008a).
As we mentioned, little is known about rates of sexual victimization experiences and
risk factors for sexual revictimization among Spanish college women. Moreover, most
studies on sexual revictimization have been performed in the United States, so the present
study has the potential to further our understanding about cultural differences regarding the
revictimization phenomenon. Thus, the main objective was to analyze which variables
mediate the relationship between CSA and AASV using a multiple mediation test (Preacher
& Hayes, 2008a) in a Spanish sample of college women. The study simultaneously assessed
the mediation effect of sexual experience (both number of consensual sexual partners and age
of onset of consensual sex), substance use before sexual intercourse, and sexual assertiveness,
following the model depicted in Figure 1. The second objective was to analyze rates of sexual
victimization experiences in a Spanish sample of college women. Specifically, the present
study analyzed rates of undesired sexual contacts, sexual coercion, attempted rape, and rape,
as well as the frequencies of each experience committed by different kinds of perpetrators
(i.e., stranger, acquaintance, occasional date, and partner or ex-partner).

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 Sexual victimization among Spanish college women and risk factors for sexual revictimization

FIGURE 1. Path diagram of the full multiple mediation model.

Method
Participants
The sample was composed of 402 women recruited in 13 different schools of a major
Spanish university. The age of participants ranged from 18 to 24 years old (M = 20.82; SD =
1.60). Among participants, 73.3% were Catholic (n = 293), 24.8% (n = 99) reported no
religious beliefs, and 2.2% (n = 8) reported other religions. A total of 62% of participants
were currently involved in a romantic relationship; 94.3% were heterosexual, 2% were
homosexual, and 3.7% were bisexual.

Materials
A socio-demographic background questionnaire assessed age, religion, and sexual
orientation of participants and whether they were currently involved in a romantic
relationship.
Sexual assertiveness. The study used the Refusal subscale of the Spanish validation
of Morokoff’s Sexual Assertiveness Scale (Sierra, Vallejo-Medina, & Santos-Iglesias, 2011).
The subscale is comprised of six items aimed at assessing the ability to refuse undesired
sexual contacts using a 5-point Likert scale from 0 (never) to 4 (almost always). Higher
scores indicate greater sexual assertiveness. Morokoff et al. (1997) reported internal
consistency values from .71 to .80. Sierra et al. reported an omega value of .76. Validity

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Asertividad sexual: análisis de variables relacionadas e implicaciones clínicas

evidence showed positive correlations with the No Shyness/Refusal subscale of the Spanish
Hurlbert Index of Sexual Assertiveness (Santos-Iglesias & Sierra, 2010b). In the present
study, Cronbach’s alpha reached .66.
Sexual experience. Two questions were used to assess sexual experience. The first
one assessed the age of onset of consensual sexual intercourse (anal or vaginal) (“At what age
did you have sexual intercourse for the first time?”). The second one assessed the number of
consensual sexual partners since that age of onset (“With how many different consensual
partners have you engaged in sexual intercourse?”).
Substance use prior to sex. Frequency of substance use prior to sex was assessed
through one question: “In general, when you engage in sexual intercourse (anal or vaginal)
how often do you use any kind of drug or substance before having sex?” Participants
responded using a 5-point Likert scale from 1 (never) to 5 (always).
Child sexual abuse (CSA). The Sexual victimization subscale of the Spanish
translation (Pereda, Gallardo-Pujol, & Forero, 2008) of the Juvenile Victimization
Questionnaire (JVQ; Hamby, Finkelhor, Ormrod, & Turner, 2005) was used. Given that
contact CSA has a stronger relationship with revictimization (Roodman & Clum, 2001), we
decided to include only 4 items assessing offenses involving sexual contact that occurred
during childhood. Participants responded using a 6-point Likert scale from 0 (never) to 5 (5
times or more). A total score was computed, with higher scores indicating higher frequency
of CSA. Finkelhor, Hamby, Ormrod, and Turner (2005) found moderated correlations with
trauma symptoms (anxiety, depression, and anger). They also reported good test-retest and
high internal consistency reliability. Following the Spanish penal code (Título VIII Cap. II.
De los abusos sexuales, art. 181/2), CSA was defined as sexual abuse experienced before the
age of 13 years.
Adolescent and adult sexual victimization (AASV). The Sexual Experiences Survey
(SES; Koss & Oros, 1982) was used. It is composed of ten items aimed at assessing sexual
victimization experienced after the age of 14 years , and considers four different subtypes of
victimization experiences: a) sexual contact, which means having engaged in sexual contact
(kissing, fondling, etc.) without penetration when the woman did not want it, using pressure,
drugs or alcohol and threatening or using force; b) sexual coercion, which involves having
had sexual intercourse without a woman wishing it, by means of verbal pressure or use of
authority; c) attempted rape, which involves having attempted to have coitus without a
woman wishing it, using alcohol or drugs and threatening with the use of force or using it;
and d) rape, which means having engaged in coitus when the woman did not want to, using

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 Sexual victimization among Spanish college women and risk factors for sexual revictimization

alcohol/drugs and threatening or using force. In the present study, participants were asked
about the frequency of experiencing each item using a Likert-type scale from 0 (never) to 5
(5 times or more) since the age of 14 years. A global score was computed by summing up
each item frequency, which indicates the number of times the participant was victimized.
Koss et al. reported an internal consistency index of .79 and good test-retest reliability after
one week. After each question, an extra item was added asking who perpetrated each
experience: a stranger (i.e., totally unknown person), an acquaintance (i.e., someone the
victim knows but does not have an intimate relationship with), an occasional date (i.e.,
someone the victim has recently met and is involved to some degree of intimacy with), or a
partner or ex-partner (i.e., a current partner or ex partner).

Procedure
Participants were recruited from various schools of the university. One lecturer from
each school was randomly selected from all possible departments at the university. The
lecturers were contacted by e-mail, given information about the study, and asked for
permission to attend one of their lectures to assess the female students. After obtaining
permission, the researchers attended the lectures and asked the male students to leave the
classroom. Once only female students were left in the classroom (the lecturer was not present
either), the aim of the study was briefly explained and female students were asked for their
anonymous and confidential collaboration. These students had the option to refuse (only three
students declined to participate) and no incentives were given to those who decided to
participate. Questionnaires did not include information that could identify participants, and
participants were asked to put them all together in a box once the questionnaires had been
completed. Finally, participants were debriefed and students were given the researchers’
contact details to ask any questions or share any concerns about the topic of the study.

Results
As can be seen in Table 1, the most frequent sexual victimization experiences were
sexual contact (30.4%), followed by sexual coercion (19.1%), attempted rape (3.9%), and
rape (3.4%). The most frequent perpetrators were ex/current partners in the case of sexual
contact and sexual coercion, acquaintances in attempted rape, and dating partners in rape.
Descriptive statistics in Table 2 show that the mean age of onset of sexual intercourse was
nearly 17 years old, while the mean number of partners was 3.57. Sexual assertiveness scores

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Asertividad sexual: análisis de variables relacionadas e implicaciones clínicas

were high, while those of child sexual abuse were very low. Most participants reported no
substance use prior to sex.

TABLE 1. Frequency and percentage of each sexual victimization experience and perpetrators.
Sexual victimization n % Perpetrator n %
Sexual contact Yes 125 30.4 Stranger 4 3.2
Acquaintance 27 21.6
Dating partner 30 24
Ex/Current partner 64 51.2
No 286 69.6
Attempted rape Yes 16 3.9 Stranger 2 15.4
Acquaintance 7 53.9
Dating partner 3 23
Ex/Current partner 1 7.7
No 397 96.1
Sexual coercion Yes 79 19.1 Stranger 1 1.5
Acquaintance 5 7.7
Dating partner 12 18.5
Ex/Current partner 47 72.3
No 334 80.9
Rape Yes 14 3.4 Acquaintance 5 35.7
Dating partner 6 42.8
Ex/Current partner 3 21.5
No 399 96.6

TABLE 2. Descriptive statistics for all variables in the study.

Variables Scale range Observed range M SD

min Max
Sexual experience Age of -- 7 21 16.85 1.67
onset
No. of -- 1 50 3.57 4.72
partners
Substance use 1-5 1 5 1a 0.53
Sexual assertiveness 0-24 2 24 17.18 4.40
Child sexual abuse 0-20 0 5 0.12 0.50
Note. a = Median

At the same time, a test was conducted to determine which variables mediated the
relationship between CSA and AASV. Table 3 shows a correlation among variables. Because
age of onset of consensual sexual intercourse was not related either to CSA or to AASV, it
was decided not to include this variable in subsequent analyses. A multiple mediation
analysis was run following the bootstrapping procedure described and recommended by

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 Sexual victimization among Spanish college women and risk factors for sexual revictimization

Preacher and Hayes (2008a) using SPSS 17.0. CSA was entered as a predictor variable.
Global score on the SES was used as an indicator of AASV (criterion). Number of partners,
substance use, and sexual assertiveness were introduced as mediators. Five thousand
bootstrap samples were extracted using the BCa procedure with a 95% confidence interval.
Results showed that higher frequency of CSA was associated with higher number of partners
(B = 2.57, t = 4.91, p < .001), more substance use prior to sex (B = .12, t = 2.09, p = .03), and
lower sexual assertiveness (B = -1.22, t = -2.49, p = .01). In addition, higher number of
partners (B = .06, t = 1.97, p = .05) and lower sexual assertiveness (B = -.08, t = -2.60, p =
.009) were associated with higher frequency of AASV. The total (c path) and direct (c’ path)
effects of CSA on sexual victimization were 1.33 (t = 4.67, p < .001) and 1.04 (t = 3.58, p =
.004), respectively. Thus, the total indirect effect of the four mediators was .28 (Z = 2.85, p =
.004), which led to the conclusion that these mediators taken as a whole mediated the
relationship between CSA and AASV. A closer examination of specific indirect effects
showed that number of partners (95% bootstrap CI: .002 - .589) and sexual assertiveness
(95% bootstrap CI: .016 - .285) individually mediated that relationship. This model (see
Figure 2) had a R2adj of .09, F (4, 344) = 9.23, p < .001.

TABLE 3. Pearson correlations among variables in the multiple mediation model.

1 2 3 4 5 6
1. CSA 1
2. Age of onset -.04 n.s. 1
3. Number of partners .21*** -.35*** 1
4. Sexual assertiveness -.13** .009 n.s. -.07 n.s. 1
5. Substance use .08 n.s. -.16** .24*** -.02 n.s. 1
6. AASV .30*** -.08 n.s. .18** -.17** .13** 1
Note. n.s. = non-significant, ** p < .01, *** p < .001

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Asertividad sexual: análisis de variables relacionadas e implicaciones clínicas

FIGURE 2. Path diagram of the multiple mediation model (The c’ path is shown between brackets. *
p < .05, ** p < .01, *** p < .001)

Discussion
The present study was performed to analyze a series of mediators between child
sexual abuse and adolescent and adult sexual victimization. It also explored the frequency of
sexual victimization experiences in a sample of Spanish college women. Results showed that
number of partners and sexual assertiveness mediate the relationship between CSA and
AASV, that is, victims of CSA have a higher number of partners and lower sexual
assertiveness, which in turn makes them more vulnerable to experiencing AASV. Results
also showed high rates of victimization experiences, particularly in the case of undesired
sexual contacts and sexual coercion.
The results obtained in this study show high rates of sexual victimization that are
similar to those found in previous studies in Spain (Ramos et al., 2006; Sipsma et al., 2000),
except for sexual coercion. In this case (i.e., sexual coercion) our results are more similar to
those found in the United States (see Testa, Livingston, & VanZile-Tamsen, 2005; Testa,
VanZile-Tamsen, Livingston, & Koss, 2004). It is also important to note the difference in
rates of rape and attempted rape between the United States and Spain, which call for
differences in traditional sexual scripts between the two cultures, that is, those different
expectations for men’s and women’s behavior and attitudes in sexual situations that make
men to be more oversexed, aggresive, instrumental and taught not to accept a “no” for an
answer in comparison to the unassertive and passive women, “who is trying to protect her
worth by restricting access to her sexuality while still appear interested in sex” (Byers, 1996,
p. 11). For example, it seems that the token refusal myth (i.e., belief that a women desires sex

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 Sexual victimization among Spanish college women and risk factors for sexual revictimization

even after saying “no”) is hardly accepted by Spanish students in comparison to American
students (Fuertes et al., 2005; Sipsma et al., 2000), which may lead to differences in
victimization, because American men would continue to pursue their sexual needs by using
strategies to overcome women’s initial reluctance. Although this may be due to a difference
in traditional sexual scripts endorsement, it could be due to a difference in reporting caused
by social desirability (Testa, et al., 2005) or perhaps some questions of the Spanish adaptation
of the SES have been interpreted in a different way with respect to the original scale (Fuertes
et al., 2005). Regarding perpetrators, as shown by previous studies in Spain, the United
States, and Europe, the present results show that strangers are less frequent perpetrators (Koss
et al., 1988; Krahé et al., 1999) while partners/ex-partners and acquaintances are more
frequent offenders (Koss et al., 1988; Krahé et al., 1999; Ramos et al., 2006). These results
dismiss the myth of the batterer as a male stranger (Arata, 2000; Koss et al., 1994).
A multiple mediation test was run to analyze which variables mediate between child
sexual abuse and adolescent and adult sexual victimization, as a way to explain the
revictimization hypothesis (see Muehlenhard et al., 1998). Results showed that higher
frequency of CSA, higher number of consensual sexual partners, and lower sexual
assertiveness were associated with higher frequency of AASV, as found in previous research
(Arata, 2000; Barnes et al., 2009; Greene & Navarro, 1998; Krahé et al., 1999; Livingston et
al., 2007; Messman & Long, 1996). This means that both child sexual abuse and number of
sexual partners are risk factors for AASV, while sexual assertiveness is a protective factor for
sexual victimization (see Santos-Iglesias & Sierra, 2010a). Child sexual abuse was found to
increase the risk for substance use prior to sex and the number of sexual partners (Krahé,
1998; Muehlenhard et al., 1998) and to decrease sexual assertiveness (Miner, Flitter, &
Robinson, 2006; Morokoff et al., 1997, VanZile-Tamsen, Testa, & Livingston, 2005). Thus,
according to the causal steps procedure to test mediation (see MacKinnon et al., 2002),
number of consensual sexual partners and sexual assertiveness were able to mediate between
CSA and AASV. Mediation results confirmed that number of consensual sexual partners
mediated between CSA and AASV, as found by previous research (Arata, 2000; Krahé et al.,
1999). Surprinsingly, sexual assertiveness also mediated between CSA and AASV. It should
be noted that previous research (Greene & Navarro, 1998; Livingston et al., 2007) did not
found this mediation effect and that such differences may be due to methodological and
cultural factors. First, studies by Greene and Navarro (1998) and Livingston et al. (2007)
assessed mediation with a causal steps approach, which is less powerful to find statistical
effects than the product of coefficients approach used in the present study (MacKinnon et al.,

97
Asertividad sexual: análisis de variables relacionadas e implicaciones clínicas

2002). Second, as mentioned above, American students have been found to endorse the
traditional sexual script more than Spanish ones. Therefore, lower sexual assertiveness is
only a risk factor for AASV, and then female American students may feel obliged to fulfil
their partners’ sexual needs (VanZile-Tamsen et al., 2005) instead of protect her worth and
restrict access to her sexuality (Byers, 1996). Lack of sexual assertiveness in American
students depends on traditional sexual scripts that make women less able to directly refuse
undesired sexual contact. In Spain, however, lower sexual assertiveness is associated with
higher frequency of CSA, it does not depend on the traditional sexual script as it does in the
United States, and therefore can – and actually does – mediate between CSA and AASV.
Substance use did not work as a mediator. CSA was found to predict higher substance
use, but substance use did not predict AASV. Similar results have been found when testing
for alcohol consumption as a mediator; Gidycz, Hanson, and Layman (1995) and Merrill et
al. (1999) found that alcohol consumption did not mediate the relation between CSA and
AASV.
Although these results are interesting, some limitations must be noted. First,
prospective designs rather than cross-sectional ones are preferred for testing the
revictimization hypothesis. Prospective designs are useful to analyze whether the predictor
has a truly adverse effect on criterion variables (Livingston et al., 2007), which means that
previous events have an adverse effect on later ones. However, although prospective designs
are preferred, CSA assessments are typically retrospective in this kind of studies. Second, the
sample only included college women. Previous research using these samples has been the
target of severe criticism (Muehlenhard et al., 1998), because the broader and more
representative samples are used, the fewer generalization problems emerge. Third, the
amount of variance of AASV accounted for by these variables is low, which suggests the
need to include more variables (e.g., alcohol abuse, rape-supportive attitudes) in future
research. These limitations suggest other directions for research. First, it would be interesting
to carry out a prospective study to assess multiple mediators. This would provide certainty
that both predictor and mediation effects are temporarily consistent. Second, more sexual
victimization assessments should be made. This would probably show, for example, that
sexual assertiveness mediates between more recent victimization events (Greene & Navarro,
1998; Livingston et al., 2007) over and above more distant ones. Finally, more representative
samples should be used in future research so that the results can be generalized to the general
population.

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 Sexual victimization among Spanish college women and risk factors for sexual revictimization

Finally, we wish to conclude that the present study contributes substantially to the
literature on revictimization, given that different mediators were simultaneously tested on the
same model. Moreover, the presence of a cultural component and the comparisons made
between Spain and the United States provide a different picture of the risk factors for sexual
revictimization in Spain and show that it may be useful to train and increase sexually
assertiveness skills in health promotion interventions.

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 Predictors of sexual assertiveness: the role of sexual desire, arousal, attitudes, and partner abuse

Artículo 5
Predictors of Sexual Assertiveness: The Role of Sexual Desire, Arousal,
Attitudes, and Partner Abuse

Santos-Iglesias, P., Sierra, J. C. y Vallejo-Medina, P. (in press). Predictors of sexual

assertiveness: The role of sexual desire, arousal, attitudes, and partner abuse. Archives of
Sexual Behavior.

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From: "Archives of Sexual Behavior (ASEB)" <ken_zucker@[Link]>
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To: "Pablo Santos-Iglesias" <psantos@[Link]>
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February 5, 2012

Pablo Santos-Iglesias, Ph.D.

Departamento de Personalidad, Evaluacion y Tratamiento Psicologico
Facultad de Psicologia
Campus de Cartuja s/n
18071 Granada,
SPAIN

Dear Dr. Santos-Iglesias,

RE: MS# ASEB-11-223R.2

I have now reviewed the second revision of your manuscript, "Predictors of Sexual
Assertiveness: The Role of Sexual Desire, Arousal, Attitudes, and Partner Abuse,"
and assess that you have adequately addressed reviewer and editor concerns,

The manuscript is now accepted for publication with the proviso that you attend to
the following grammatical/stylistic issues before submitting the final draft.
Please make changes/additions as requested.

Introduction

Page 3 - Line 7 - should be <communication about sexual issues>

Page 3 - Line 8 - should be <and form the construct of sexual assertiveness>
Page 3 - Line 9 - almost no correlations are perfect so you may want to say
<correlations among these components are not always high>
Page 3 - second paragraph - first sentence - edit as follows: A recent systematic
review has shown that the construct of sexual assertiveness is relevant to our
understanding of sexual behavior as it is related to better...>
Page 4 - second paragraph - second line - replace <amount> with <number>
Page 4 - second paragraph - second to last line - replace <STD> with <STI>
Page 5 - last paragraph - Delete <This required setting the following bases:> and

[Link] Página 1 de 2

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 Predictors of sexual assertiveness: the role of sexual desire, arousal, attitudes, and partner abuse

Predictors of Sexual Assertiveness: the Role of Sexual Desire, Arousal,

Attitudes, and Partner abuse

Pablo Santos-Iglesias, Juan Carlos Sierra, and Pablo Vallejo-Medina

(University of Granada, Spain)

Abstract.— This study was conducted to test interpersonal, attitudinal, and sexual predictors
of sexual assertiveness in a Spanish sample of 1,619 men and 1,755 women aged 18-87 years.
Participants completed measures of sexual assertiveness, dyadic and solitary sexual desire,
sexual arousal, erection, sexual attitudes, and frequency of partner abuse. In men, higher
sexual assertiveness was predicted by less non-physical abuse, more positive attitudes toward
sexual fantasies and erotophilia, higher dyadic desire, and higher sexual arousal. In women,
higher sexual assertiveness was predicted by less non-physical abuse, less solitary sexual
desire and higher dyadic sexual desire, arousal, erotophilia, and attitudes towards sexual
fantasies. Results are discussed in the light of prevention and educational programs that
include training in sexual assertiveness skills.

Keywords.— Sexual assertiveness. Sexual desire. Sexual arousal. Sexual attitudes. Partner
abuse.

Sexual assertiveness is a social skill that involves exhibiting assertive behaviors in

sexual situations (Painter, 1997). Morokoff et al. (1997) argue that it consists of three
different components: the ability to initiate desired sexual activity, refuse unwanted sexual
contact, and discuss the use of contraceptive methods to avoid unwanted pregnancies and
sexually transmitted infections. Other authors such as Hurlbert (1991, see also Santos-Iglesias
& Sierra, 2010b) include components related to initiation of sexual activity, refusal of
unwanted contact, and communication about sexual issues. These components are
interrelated and form the construct of sexual assertiveness. Yet, the fact that correlations

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Asertividad sexual: análisis de variables relacionadas e implicaciones clínicas

among these components are not always high (see Morokoff et al., 1997; Sierra, Vallejo-
Medina, & Santos-Iglesias, 2011) may suggest, for example, that an individual who is
assertive in initiation of contact may not be assertive in refusal of unwanted sexual activity.
A recent systematic review has shown that the construct of sexual assertiveness is
relevant to our understanding of sexual behavior as it is related to better sexual functioning,
fewer sexual victimization experiences, and less risky sexual behavior (see Santos-Iglesias &
Sierra, 2010a). Thus, sexual assertiveness facilitates the attainment of sexual goals, such as
sexual autonomy and satisfaction (Dunn, Lloyd, & Phelps, 1979), and protects individuals
from unsafe sexual practices. According to traditional sexual roles (Simon & Gagnon, 1984,
1986, 2003), men and women should differ in sexual assertiveness (i.e., men being more
sexually assertive) because sexual scripts tend to dictate that men initiate sexual contact and
women respond to these initiations. In a recent study, Santos-Iglesias, Vallejo-Medina, and
Sierra (2012) found that men reported greater ability to initiate sexual contacts than women
did. In contrast, only older women reported lower ability to reject undesired contacts and
more sexual shyness (i.e., talking overtly about sexual topics). These results imply that
women and individuals who are less sexually assertive will be less likely to express their
sexual interests and will experience more unwanted sex (Morokoff et al., 1997).

Predictors of Sexual Assertiveness

In most cases, predictors of sexual assertiveness have been studied in isolation. In
other words, there is evidence of a large number of constructs related to sexual assertiveness
explored separately but there have been few attempts to build a predictor model of sexual
assertiveness. Consequently, the present study aimed to overcome this limitation and include
the results of various studies in a single model. To the best of our knowledge, only Morokoff
et al. (1997) have attempted to design a comprehensive model to predict sexual assertiveness.
They did so using the Multifaceted Model of HIV Risk (Harlow, Quina, Morokoff, Rose, &
Grimley, 1993). According to this study (Morokoff et al., 1997), sexual assertiveness can be
explained using attitudinal, behavioral, and interpersonal variables. Their results indicated
that individuals who were more sexually assertive reported less sexual victimization, were
less likely to anticipate a negative partner response, and had more sexual experience and
higher self-efficacy for STI-preventive behaviors. However, this study was limited to a
female sample and did not explore sexual responses.
Previous studies partially support the findings of Morokoff et al. (1997). In general
terms, people with traditional sexual attitudes have shown lower levels of sexual

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 Predictors of sexual assertiveness: the role of sexual desire, arousal, attitudes, and partner abuse

assertiveness. More specifically, some studies have found that people who report higher
erotophilia show greater sexual assertiveness (Hurlbert, Apt, & Rabehl, 1993; Sierra, Santos,
Gutiérrez-Quintanilla, Gómez, & Maeso, 2008; Snell, Fisher, & Miller, 1991). Similar results
have been obtained with more specific sexual attitudes such as positive attitudes toward
condom use (Treffke, Tiggemann, & Ross, 1992) and attitudes toward menstruation
(Schooler, Ward, Merriwether, & Caruthers, 2005). All these results support the idea that
general sexual attitudes (i.e., erotophilia) as well as more specific ones (i.e., attitudes toward
condom use or attitudes toward menstruation) are relevant to sexual assertiveness. Therefore,
including both general and specific sexual attitudes may be useful to predict sexual
assertiveness.
Regarding interpersonal variables, studies have shown that women with a history of
partner abuse are less sexually assertive (Apt & Hurlbert, 1993; Sierra, Ortega, Santos, &
Gutiérrez, 2007; Stoner et al., 2008). For example, Apt and Hurlbert (1993) compared 60
women who experienced partner abuse and 60 who did not and found that women in abusive
marriages reported less sexual assertiveness.

Objectives of the Present Study

The main objective of the present study was to examine predictors of sexual
assertiveness in a sample of Spanish men and women while overcoming some of the
limitations of past research. First, we strove to develop a multivariate predictive model of
sexual assertiveness; second, we included a sample of both men and women; and lastly we
investigated aspects of the sexual response as possible predictors of sexual assertiveness. Our
results may help us understand the nature of sexual assertiveness and why some individuals
are at increased risk of unwanted sex and/or risky sexual behaviors.
Following the guidance of Morokoff et al. (1997), the present study proposed a series
of predictors clustered into three categories: sexual attitudes, interpersonal variables, and
components of the sexual response. Attitudinal variables included general sexual attitudes
(i.e., erotophilia) and specific attitudes such as attitudes toward sexual fantasies. Instruments
to assess sexual assertiveness have considered the sharing of sexual fantasies with one's
partner to be an example of sexual assertiveness (Hurlbert, 1991). In regard to interpersonal
variables, abuse in intimate relationships was included as a predictor variable, as per Hurlbert
et al. (1993). Finally, sexual desire and arousal – and erection in men – were included as
predictors, since high levels of desire and arousal can lead to sexually assertive behaviors to
satisfy such urges (Matsuura, 2008). In support of this contention, Hurlbert (1991) showed

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Asertividad sexual: análisis de variables relacionadas e implicaciones clínicas

that sexually assertive women in his sample reported greater sexual desire compared to
sexually nonassertive women. Regarding sexual arousal, Hurlbert et al. (1993) interviewed
98 married women and found that sexual assertiveness was positively correlated with sexual
excitability and Murphy et al. (1980) found that women increased their sexual arousability
after a sexual assertiveness training program.
Thus, based on previous research, we predicted that greater erotophilia and attitudes
toward sexual fantasies (i.e., attitudinal variables), greater sexual arousal, sexual desire and
erection in the case of men (i.e., sexual responses), and lower frequency of partner abuse
would be related to greater sexual assertiveness. The criterion variables used were Initiation
assertiveness and No shyness/refusal assertiveness included in the scale developed by
Hurlbert (1991; see also Santos-Iglesias & Sierra, 2010b).

Method
Participants
The sample consisted of 1,619 men and 1,755 women from the general Spanish
population. The mean age of men was 41.02 years (SD = 13.39; range 18-87) and that of
women was 38.09 years (SD = 13.84; range 18-79). All participants were involved in a
romantic relationship at the time of the study and had sexual activity with their current
partners. Approximately half of men and women (50.1% and 57.6%, respectively) reported
some university education. Thirty percent of men and 22% of women reported secondary
education, while around 18% of men and women reported elementary education. Only 2% of
men and women reported no formal education. Most participants (71.1% of men and 78.4%
of women) were Catholic, and 28.7% of men and 21% of women reported no religious
beliefs. Finally, about 50% (45.8% of men and 51.2 of women) practiced religion once a
year, and more men (40%) than women (29%) did not practice religion.

Measures
Background socio-demographic questionnaire. This questionnaire gathered
information on participants’ gender, age, relationship status, sexual activity with their partner,
educational level, religion, and frequency of religious practice.
Hurlbert Index of Sexual Assertiveness (Hurlbert, 1991). The Spanish version by
Santos-Iglesias, Vallejo-Medina, et al. (2012) was used. It is composed of 16 items clustered
into two factors: Initiation and No shyness/Refusal (Santos-Iglesias & Sierra, 2010b).
Initiation refers to the ability to begin sexual contact and to express sexual desires and

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 Predictors of sexual assertiveness: the role of sexual desire, arousal, attitudes, and partner abuse

fantasies to one’s partner (e.g., “I approach my partner for sex when I desire it”; “I enjoy
sharing my sexual fantasies with my partner”). No shyness/Refusal refers to the ability to
start and maintain conversations on sexual issues and reject undesired sexual contact (e.g., “I
feel that I am shy when it comes to sex”; “It is hard for me to say no even when I do not want
sex”). Participants responded using a 5-point Likert scale ranging from 0 (never) to 4
(always). Higher scores indicated greater sexual assertiveness. The original scale by Hurlbert
(1991) showed good internal consistency (from .84 to .92; Apt & Hurlbert, 1993; Hurlbert,
1991) and good test-retest reliability (.84; Pierce & Hurlbert, 1999). Regarding construct
validity, a correlation of .82 was found with the Gambrill-Richey Assertion Inventory
(Hurlbert, 1991). Santos-Iglesias and Sierra (2010b) reported an internal consistency of .83
for each factor and .87 for the global scale for the Spanish version. Both subscales were
positively correlated with the Spanish version of the Sexual Assertiveness Scale (Sierra,
Vallejo-Medina, & Santos-Iglesias, 2011) and the Spanish abbreviated version of the Dyadic
Adjustment Scale (Santos-Iglesias, Vallejo-Medina, & Sierra, 2009), supporting the validity
of the scale. In the present study, Cronbach’s alpha values were .78 for men and .83 for
women in the Initiation subscale, and .73 and .78 respectively in the No shyness/Refusal
subscale.
Sexual Desire Inventory (Spector, Carey, & Steinberg, 1996). The Spanish version
by Ortega, Zubeidat, and Sierra (2006) was used. It is composed of 13 items assessing two
dimensions: Dyadic desire (9 items), which means an interest in or a wish to engage in sexual
activity with another person, and Solitary desire (4 items), that is, an interest in sexual
activities that do not involve a partner. Higher scores indicate greater sexual desire. Ortega et
al. reported high internal consistency values above .87 for both subscales. In the current
study, internal consistency was .73 and .83 for men and women, respectively, on Dyadic
desire, and .90 and .92, respectively on Solitary desire.
Massachusetts General Hospital Sexual Functioning Questionnaire (Fava,
Rankin, Alpert, Nierenberg, & Worthington, 1998). The Spanish version (Bobes, Portilla,
Bascarán, Saiz, & Bousoño, 2002) was used. It is composed of five items assessing sexual
functioning in five areas: interest, arousal, orgasm, erection, and overall sexual satisfaction.
Only the items on arousal and on erection (only for men) were used in the present study.
Responses were given on a 5-point Likert scale ranging from 0 (totally absent) to 4 (normal),
with higher scores indicating better sexual functioning. This scale has shown good concurrent
validity with the Changes in Sexual Functioning Questionnaire (Labbate & Lare, 2001). In
this study, Cronbach’s alpha values were .88 for men and .92 for women.

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Asertividad sexual: análisis de variables relacionadas e implicaciones clínicas

Sexual Opinion Survey (Fisher, Byrne, White, & Kelley, 1988). The Spanish version
by Carpintero and Fuertes (1994) was used. This scale is composed of 21 items to assess
erotophilia (i.e., positive disposition and attitudes toward sexual topics and sexuality).
Participants responded using a 7-point Likert scale ranging from 1 (totally disagree) to 7
(totally agree). Higher scores indicate greater erotophilia. The Spanish validation showed
good reliability, with internal consistency values ranging from .80 to .86. Internal consistency
in the present study was .82 for men and .85 for women.
Hurlbert Index of Sexual Fantasy (Hurlbert & Apt, 1993). The Spanish validation
(Desvarieux, Salamanca, Ortega, & Sierra, 2005) is composed of 10 items assessing attitudes
towards sexual fantasies. Participants responded using a 5-point Likert scale from 0 (never)
to 4 (always). Higher scores indicate greater positive disposition toward sexual fantasies.
Cronbach’s alpha value was .85, and this scale was positively correlated with frequency in
sexual fantasies and sexual desire (Desvarieux et al., 2005). Cronbach’s alpha in the present
study was .89 for men and .91 for women.
Index of Spouse Abuse (Hudson & McIntosh, 1981). The Spanish validation was
used to assess frequency of experienced partner abuse in women (Sierra, Monge, Santos-
Iglesias, Bermúdez, & Salinas, 2011). This version is composed of 19 items clustered into
two dimensions assessing the frequency of experiences of Physical and Non-physical abuse.
For men, the 30-item-Spanish version was used (Santos-Iglesias, Sierra, & Vallejo-Medina,
2012) to assess Non-Physical and Physical abuse. In both cases, Non-physical abuse includes
items such as “My partner belittles me” or “My partner acts like I am his/her personal
servant.” Physical abuse include items such as “My partner punches me with his/her fists” or
“My partner beats me so badly that I must seek medical help.” Participants respond on a 5-
point Likert scale ranging from 0 (never) to 4 (always). Higher scores indicated more
frequent abuse. Internal consistency reliability was good in the female version, with
Cronbach’s alpha values of .89 and .93, for Physical and Non-physical abuse respectively. In
the male version, Cronbach’s alpha values were .81, and .80, respectively. In the present
study, internal consistency of the female version was .73 for Physical abuse and .87 for Non-
physical abuse. In the male version, values were .78 for Physical abuse, and .88 for Non-
physical abuse.

Procedure
Participants were recruited from the general Spanish population in 2009 and 2010. A
quota convenience sampling method was used to obtain the same number of men and women,

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 Predictors of sexual assertiveness: the role of sexual desire, arousal, attitudes, and partner abuse

distributed across three different groups according to age (18-34 years old, 35-49 years old,
and 50 years old or older), size of the town or city of residence (a population less than 50,000
and greater than 50,000), and geographical area (northern and southern Spain). Participants
were required to be involved in a sexually active, stable, heterosexual relationship of at least
6 months duration at the time of the study.
Ethical approval was obtained from the Ethics Board on Human Research of the
university. Testing was conducted individually in different settings (e.g., public libraries,
social centers, and public places) by well-trained researchers. Group testing occurred in
university classrooms. Participants were approached by researchers and were asked to
participate in the study. Researchers introduced themselves and briefly explained the purpose
of the study. Once anonymity and confidentiality as well as the exclusive use of test scores
for research purposes were guaranteed, verbal informed consent was obtained and then
participants completed the questionnaires on their own.

Data analysis
Descriptive statistics and gender differences were calculated for all variables included
in the study. Pearson correlations were computed between dependent variables (Initiation
sexual assertiveness and No shyness/Refusal sexual assertiveness) and predictor variables
(partner abuse, erotophilia, attitudes toward sexual fantasies, solitary and dyadic sexual
desire, arousal, and erection). Only significantly correlated variables were included in a
structural equation model that was run separately for men and women. All analyses were
performed using SPSS 17.0 and LISREL 8.51 (Jöreskog & Sörbom, 2001). Due to the large
sample size and violation of multivariate normality, a robust maximum likelihood estimation
was used. To assess the fit of the proposed models, a joint assessment of a group of indexes
was used (Tanaka, 1993). Values above .90 in the Comparative Fit Index (CFI) and Non-
Normed Fit Index (NNFI) and values below .05 in the Root Mean Square Error of
Approximation (RMSEA) were used as indicators of fit (Byrne, 2010).

Results
Descriptive Statistics and Gender Differences
Results of descriptive statistics revealed that both men and women in this study
showed high scores on initiation assertiveness, no shyness/refusal assertiveness, dyadic
desire, erotophilia, attitudes toward sexual fantasies, and arousal. On the other hand, scores
on all forms of abuse were low in both men and women. Men also showed high scores on

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 Asertividad sexual: análisis de variables relacionadas e implicaciones clínicas

erection and moderate scores on solitary sexual desire. Women had low scores on solitary
sexual desire (see Table 1).
Gender comparisons showed that men scored higher than women on initiation
assertiveness, t (3062) = 7.64, p < .001, Cohen’s d = 0.28; dyadic desire, t (3039) = 14.68, p
< .001, Cohen’s d = 0.53; solitary desire, t (3058) = 14.20, p < .001, Cohen’s d = 0.51;
erotophilia, t (2765) = 7.61, p < .001, Cohen’s d = 0.29; and positive attitudes toward sexual
fantasies, t (3093) = 12.70, p < .001, Cohen’s d = 0.46. No significant differences were found
in no shyness/refusal assertiveness, t (3101) = 1.62, p < .10, Cohen’s d = 0.06 (see
descriptives in Table 1). No comparisons could be made between non-physical and physical
abuse, because the number of items on each component for men and women were different.

TABLE 1. Means, standard deviations, and ranges for self-report measures for men and women.
Men Women
Range Observed Range Observed
range range
M SD Min Max Min Max M SD Min Max Min Max
Initiation 22.64 6.46 0 32 0 32 20.69 7.56 0 32 0 32
No 26.52 4.69 0 32 4 32 26.23 5.18 0 32 0 32
shyness/Refusal
Dyadic 49.96 8.94 0 70 0 70 44.70 11.39 0 70 0 68
Solitary 15.34 7.90 0 31 0 31 11.07 8.68 0 31 0 31
Erotophilia 109.30 18.68 7 147 33 147 103.54 21.01 7 147 22 145
Attitudes toward 30.24 7.41 0 40 0 40 26.48 8.90 0 40 0 40
fantasies
Arousal 3.55 0.88 0 4 0 4 3.29 1.15 0 4 0 4
Erection 3.69 0.75 0 4 0 4
Non-physical 6.30 7.20 0 68 0 62 3.07 4.99 0 48 0 41
Physical 0.50 1.55 0 28 0 22 0.71 1.87 0 28 0 26

The correlations in Table 2 showed that, in men, initiation assertiveness and no

shyness/refusal were positively correlated with dyadic desire, arousal, erection, erotophilia,
and attitudes toward sexual fantasies, and negatively correlated with non-physical and
physical abuse. In the case of women (see Table 3), greater initiation and no shyness/refusal
assertiveness were positively correlated with greater dyadic and solitary sexual desire,
arousal, erotophilia, and attitudes toward sexual fantasies; sexual assertiveness was
negatively correlated with physical and non-physical abuse. Physical abuse was removed
from subsequent analyses to avoid problems with multicollinearity, due to its high correlation
with non-physical abuse (Cohen, Cohen, West, & Aiken, 2003; Tabachnik & Fidell, 2007).
We decided to remove it rather than combine them into a single measure, because it has been

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 Predictors of sexual assertiveness: the role of sexual desire, arousal, attitudes, and partner abuse

demonstrated that non-physical abuse has greater impact than physical abuse on sexual
assertiveness (Testa & Dermen, 1999).

TABLE 2. Correlation matrix for men.

1 2 3 4 5 6 7 8 9 10
1. Initiation 1
2. No .45*** 1
shyness/
Refusal
3. Dyadic .35*** .33*** 1
4. Solitary .03 .01 .38*** 1
5. .28*** .34*** .43*** .47*** 1
Erotophilia
6. Attitudes .41*** .32*** .54*** .39*** .57*** 1
toward
fantasies
7. Arousal .28*** .23*** .38*** .13*** .20*** .28*** 1
8. Erection .25*** .22*** .35*** .15*** .26*** .29*** .59*** 1
9. Non- -.13*** -.16*** -.06* .07** -.06* -.06* -.06* -.10*** 1
physical
10. Physical -.05* -.10*** -.04 .06* -.07** -.04 -.04 -.10*** .53*** 1
* p < .05, ** p < .01, *** p < .001

TABLE 3. Correlation matrix for women.

1 2 3 4 5 6 7 8 9
1. Initiation 1
2. No .55*** 1
shyness/
Refusal
3. Dyadic .49*** .40*** 1
4. Solitary .14*** .08** .35*** 1
5. .41*** .43*** .48*** .49*** 1
Erotophilia
6. Attitudes .58*** .44*** .64*** .41*** .64*** 1
toward
fantasies
7. Arousal .32*** .32*** .53*** .13*** .20*** .36*** 1
8. Non- -.23*** -.24*** -.13*** .006 -.11*** -.13*** -.23*** 1
physical
9. Physical -.13*** -.21*** -.07** .04 -.08** -.09*** -.14*** .71*** 1
** p < .01, *** p < .001

In men, results of the structural equation model (see Figure 1) showed that greater
initiation assertiveness (R2 = .24) was associated with higher sexual arousal, dyadic sexual
desire, and attitudes towards sexual fantasies, and lower non-physical abuse. Greater no

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Asertividad sexual: análisis de variables relacionadas e implicaciones clínicas

shyness/refusal assertiveness (R2 = .21) was associated with greater sexual arousal, more
dyadic desire, more erotophilia, more positive attitudes towards sexual fantasies, and lower
frequency of partner non-physical abuse (χ2 = 0.92, p = .34, CFI = 1, NNFI = 1, RMSEA =
0).

FIGURE 1. Path diagram of sexual assertiveness in men.

In women, greater initiation (R2 = .41) and no shyness/refusal (R2 = .33) assertiveness
were associated with higher sexual arousal, dyadic desire, erotophilia, and attitudes towards
sexual fantasies, and lower solitary sexual desire and frequency of non-physical partner abuse
(see Figure 2). Fit was perfect because the model was saturated.

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 Predictors of sexual assertiveness: the role of sexual desire, arousal, attitudes, and partner abuse

FIGURE 2. Path diagram of sexual assertiveness in women.

Discussion
The goal of this study was to test a set of predictors of sexual assertiveness. The
present results demonstrate that greater sexual assertiveness is associated with lower
frequency of partner abuse and more positive sexual attitudes, and higher levels of sexual
arousal and desire. This supports the multidimensional nature of sexual assertiveness shown
previously (Morokoff et al., 1997) but also demonstrates the relevance of sexual response
components such as desire or arousal for sexual assertiveness. These results may help us
understand why some individuals are less sexually assertive and thus at increased risk for
undesired sex and risky sexual behaviors (Morokoff et al., 1997; Santos-Iglesias & Sierra,
2010a).
First, both men and women scored high on all variables, except for solitary desire and
abuse dimensions. However, these scores are similar to scores obtained on these measures
with Spanish samples. Previous research with Spanish samples has yielded similar scores on
sexual assertiveness, dyadic and solitary desire, arousal, erotophilia, positive attitudes toward
sexual fantasies, and physical and non-physical partner abuse (Ortega et al., 2006; Perla,
Sierra, Vallejo-Medina, & Gutiérrez-Quintanilla, 2009; Santos-Iglesias, Calvillo, & Sierra, in
press; Santos-Iglesias & Sierra, 2010b; Sierra, Vallejo-Medina, Santos-Iglesias, & Lameiras

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Asertividad sexual: análisis de variables relacionadas e implicaciones clínicas

Fernández, 2011; Torres, Navarro, García-Esteve, Tarragona, Ascaso, Herreras et al., 2010;
Zubeidat, Ortega, del Villar, & Sierra, 2003).
Gender comparisons showed similar patterns to those found in previous studies. For
example, in keeping with traditional sexual roles, men scored higher on initiation
assertiveness, which makes them more likely to express their sexual interest and to initiate
sexual activity (Byers & Heinlein, 1989; Morokoff et al., 1997; Stulhofer, Graham,
Bozicevic, Kufrin, & Ajdukovic, 2007). Similarly, Santos-Iglesias, Vallejo-Medina, et al.
(2012) found greater initiation assertiveness in men, while only women over 50 years old
reported less no shyness/refusal assertiveness. These results have major implications for men
and women. It has been noted that sexual assertiveness is a protective factor against sexual
aggression and risky sexual behaviors (Santos-Iglesias & Sierra, 2010a). Therefore,
individuals with less sexual assertiveness in general and women in particular are less likely to
escape or avoid those situations. It is also interesting to note that individuals who are more
sexually assertive are likely to be more sexually satisfied (Santos-Iglesias & Byers, 2011),
which suggests that less sexually assertive individuals have fewer chances of increasing their
sexual satisfaction (Dunn et al., 1979). Gender differences in the other constructs also support
past research. For example, it has consistently been shown that men report more sexual desire
than women (Regan & Atkins, 2006) and women also have greater erotophobic attitudes
(Carpintero & Fuertes, 1994; Sierra et al., 2008).
Results of structural equation modeling reveal that different variables have a different
impact on sexual assertiveness. While some variables increase the likelihood of sexual
assertiveness, others do not. For example, individuals who reported more non-physical abuse
tended to report lower initiation and no shyness/refusal sexual assertiveness. This supported
our hypothesis and demonstrates that, in keeping with previous research, victimization and
abuse experiences diminish the ability to assert oneself in sexual contexts (Apt & Hurlbert,
1993; Sierra et al., 2007; Testa, VanZile-Tamsen, & Livingston, 2007). The fact that non-
physical abuse instead of physical abuse was associated with sexual assertiveness is related to
results that have found that sexual coercion experiences but not rape –which involves using
physical force– are related to lower sexual assertiveness (Testa & Dermen, 1999). These
results imply that sexual coercion experiences may damage the belief that sexual
assertiveness can serve as a way to escape or avoid victimization.
Regarding attitudinal factors, results show that higher initiation assertiveness was
associated with a positive disposition towards sexual fantasies. On the other hand, higher no
shyness/refusal assertiveness was associated with both higher erotophilia and more positive

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 Predictors of sexual assertiveness: the role of sexual desire, arousal, attitudes, and partner abuse

attitudes towards sexual fantasies, although standardized coefficients were higher for
erotophilia. These results confirm that sexual attitudes are able to predict sexual assertiveness
(Hurlbert et al., 1993; Schooler et al., 2005; Sierra et al., 2008; Snell et al., 1991; Treffke et
al., 1992), but also indicate some specificity in these relationships. For example, initiation
assertiveness was predicted strongly by attitudes towards sexual fantasies, because the
initiation factor includes communication about fantasies and sexual desires. Hurlbert, Apt,
Hurlbert, and Pierce (2000) found that attitudes towards sexual fantasies were positively
related to sexual motivation. In the study by Hurlbert et al. (2000), sexual motivation was
assessed with items such as “I told my partner I wanted sex” or “I approach my partner for
sex,” which in some instances is the same as initiation assertiveness, so attitudes toward
sexual fantasies were related to initiation assertiveness. In contrast, no shyness/refusal was
more related to erotophilia than to positive attitudes toward sexual fantasies, supporting
previous research (Hurlbert et al., 1993; Sierra et al., 2008; Snell et al., 1991) and suggesting
that shyness about sexual topics or communication about sexual topics is a general trait that is
more determined by general attitudes, such as erotophilia, rather than more specific ones (i.e.,
attitudes toward sexual fantasies).
Finally, as predicted, we found that dyadic sexual desire positively predicted both
initiation and no shyness/refusal assertiveness in men and women, as found by Hurlbert
(1991). This suggests that people who experience greater sexual desire to engage in sexual
activities with another person are more likely to be sexually assertive, which means that
sexual assertiveness can serve to satisfy an initial desire for sexual contact (Matsuura, 2008).
The same pattern was found for arousal, so that people who feel more aroused are more likely
to initiate sexual contacts (Hurlbert et al., 1993). Finally, in women, solitary sexual desire
negatively predicted sexual assertiveness, although zero-order correlations were positive. In
this case, a negative suppression effect was found (Kline, 2011; Tabachnick & Fidell, 2007),
which means that after controlling for dyadic sexual desire, the relationship between solitary
sexual desire and sexual assertiveness was negative. This could be explained by arguing that
sexual guilt, which is more frequent in women (Ortega, Ojeda, Sutil, & Sierra, 2005; Sierra,
Perla, & Santos-Iglesias, 2011) and is negatively related to sexual assertiveness (Snell et al.,
1991), may mediate the relationship between dyadic solitary desire and sexual assertiveness.
Yet, this hypothesis needs to be tested in the future. The fact that solitary sexual desire
predicted sexual assertiveness in women may explain the difference between men and
women in the amount of variance accounted for.

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Asertividad sexual: análisis de variables relacionadas e implicaciones clínicas

In conclusion, it is important to note that sexual assertiveness is determined by

different variables. The present study shows, in line with previous research (Morokoff et al.,
1997), that both sexual attitudes and abuse have a strong impact on sexual assertiveness, but
also that sexual response components such as sexual desire and arousal predict sexual
assertiveness. These results have two main implications. First, sexual experiences are still
influenced by traditional sexual scripts (Vannier & O’Sullivan, 2010), which, as previously
stated, place women and less assertive individuals at greater risk for unwanted sexual
experiences. Second, education and prevention programs including sexual assertiveness
training need to consider sexual attitudes or history of partner abuse. Training sexual
assertiveness (Leiblum, 2007), which has proven to be effective for increasing condom use
and risky sexual behaviors (Crowell, 2004; Kelly et al., 1994; Sikkema, Winett, & Lombard,
1995; St. Lawrence et al., 1995; Stoner et al., 2008) and reducing unwanted sexual advances
(Yagil, Karnieli-Miller, Eisikovits, & Enosh, 2006) may be less effective in individuals who
do not have positive sexual attitudes. Finally, implications also exist for positive outcomes.
Given that sexual assertiveness is based on the right to choose what we want in our sexual
lives, feeling sexual desire or arousal may be followed by an assertion to engage in sexual
contact as a way to increase sexual satisfaction and sexual health (Lottes, 2000; Murphy et
al., 1980).
Despite the results, it is important to note that, although sample size was very large
and scores were similar to those that could be found in previous research, the sample was
recruited through a non-random procedure and, thus, generalization to the Spanish population
is limited. The sample was taken from a high educational environment, which should be
taken into account by future research. Another limitation is related to some of the instruments
used in this research, which are not frequently used and are quite dated. However, they had
been previously validated in Spain and there was evidence of their appropriate psychometric
properties for use on our sample. Also, more studies with individuals with sexual problems
would provide greater insight about factors that place individuals at risk for undesired sexual
activities, since our sample was based on functional individuals. The present research was
based on self-report data so future studies should include other forms of assessment. For
example, it would be useful to analyze how sexual arousal influences both initiation and
refusal of sexual contacts, while controlling for relevant variables (e.g., attitudes, patterns of
excitation/inhibition). Therefore, more research is needed to address the role of sexual
assertiveness in the human sexual response and its effectiveness to increase not only sexual
satisfaction but also sexual health.

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 Predictors of sexual assertiveness: the role of sexual desire, arousal, attitudes, and partner abuse

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Discusión

Con el objetivo de profundizar en el estudio de la asertividad sexual y su influencia en

la sexualidad humana se ha llevado a cabo esta Tesis Doctoral compuesta por cinco estudios.
Estos se agrupan en un primer estudio teórico que aporta una descripción de los principales
resultados obtenidos en estudios sobre asertividad sexual. A continuación se presentan dos
estudios psicométricos que suponen la adaptación española del Hurlbert Index of Sexual
Assertiveness (Hurlbert, 1991), uno de los instrumentos empleados con más frecuencia en el
estudio de la asertividad sexual (Santos-Iglesias y Sierra, 2010a). Los resultados de estos dos
estudios muestran una versión española final compuesta por 16 ítems que evalúa dos
componentes de la asertividad sexual: Inicio y Ausencia de timidez/Rechazo. Los dos últimos
trabajos analizan la influencia que la asertividad sexual tiene en distintos ámbitos de la
sexualidad humana. Así, el cuarto estudio centrado en los procesos de victimización sexual
muestra que, la relación entre el abuso sexual en la infacia y la victimización sexual en la
adolescencia y edad adulta temprana se explica a través del número de parejas sexuales y de
la falta de asertividad sexual. Por último, en el quinto estudio se propone un modelo
explicativo de la asertividad sexual basado en el Multifaceted Model of HIV Risk (MMOHR;
Harlow et al., 1993) y muestra que tanto variables interpersonales (i.e., abuso en la pareja),
actitudinales (i.e., actitudes sexuales y actitudes hacia las fantasías sexuales), como sexuales
(i.e., deseo sexual y excitación sexual) son relevantes a la hora de predecir respuestas
sexualmente asertivas. Por tanto, esta Tesis Doctoral ofrece una serie de resultados
interesantes acerca de la asertividad sexual, tanto desde el punto de vista de su evaluación,
como desde su naturaleza y papel en la sexualidad humana.
El primer trabajo pone de manifiesto la falta de estudios sobre asertividad sexual de
forma generalizada y, más concretamente, la escasa variabilidad de metodologías empleadas
en los mismos, pues casi el 64% de estos estudios son de naturaleza ex post facto (Montero &
León, 2007), mientras que sólo un 6,59% son instrumentales. Esto demuestra que de todos
los instrumentos empleados para la evaluación de la asertividad sexual (20 instrumentos
distintos), sólo dos de ellos han sido elaborados mediante un estudio psicométrico más o
menos riguroso: el Sexual Awareness Questionnaire (Snell et al., 1991) y la Sexual
Assertiveness Scale (Morokoff et al., 1997), subrayando las importantes carencias existentes

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en la evaluación de la asertividad sexual. Primero, la ausencia, en la mayoría de los casos, de

una conceptualización de base a la hora de desarrollar una batería de ítems para evaluar la
asertividad sexual, de lo que se deriva, tal y como se comentaba en la introducción, que los
diferentes instrumentos de evaluación que se han encontrado incluyen diferentes
componentes de la asertividad sexual (e.g., inicio de la actividad sexual, uso de preservativos)
o constructos asociados como la autorrevelación sexual o la timidez, más relacionados con un
componente global de comunicación que con la asertividad propiamente dicha. En segundo
lugar, encontramos también que muchos de estos instrumentos no informan sobre sus
propiedades psicométricas o simplemente dan un dato de fiabilidad de consistencia interna,
sin llegar a conocer datos sobre distintas formas de validez de los mismos. Por tanto, los
estudios realizados hasta la fecha demuestran que una de las grandes debilidades de la
asertividad sexual es la evaluación de la misma y, por tanto, uno de los aspectos en los que es
necesario trabajar.
En otro orden de cosas, la revisión teórica también muestra otras dos grandes
evidencias. La primera es que, a pesar de conocer que la asertividad sexual funciona como un
factor de protección ante experiencias de victimización sexual (Macy et al., 2006) y que
puede ser tanto una causa como una consecuencia de las mismas (Livingston et al., 2007), no
se sabe mucho acerca de su papel dentro del fenómeno de la revictimización sexual, a pesar
de que se ha planteado como un posible mecanismo explicativo (Muehlenhard et al., 1998).
Mucho menos se conoce acerca del papel que juega frente a otras hipótesis explicativas de la
revictimización que han sido contrastadas con mayor frecuencia, como la experiencia sexual
y el consumo de sustancias (Arata, 2000; Fergusson, Horwood y Lynskey, 1997; Kilpatrick,
Acierno, Resnick, Saunders y Best, 1997). En segundo lugar, es preciso señalar que la
mayoría de los estudios han usado la asertividad como variable predictora o mediadora, pero
en pocos casos ha sido estudiada como variable dependiente (e.g., Morokoff et al., 1997). Es
decir, se sabe muy poco sobre su naturaleza o sobre cuáles son las variables que favorecen la
aparición de respuestas sexualmente asertivas o no. Por tanto, esta revisión teórica, además
de dejar abiertos muchos frentes de investigación, confirma la necesidad de ahondar en tres
campos diferentes. Primero, la investigación instrumental sobre las características
psicométricas de los instrumentos de evaluación de la asertividad sexual, especialmente en
España, en donde no disponemos de adaptaciones de dichos instrumentos. Segundo, el papel
de la asertividad sexual en las experiencias de revictimización sexual. Tercero, el estudio
sobre la naturaleza y las variables predictoras de la asertividad sexual.

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En relación a la primera cuestión se desarrollan dos estudios psicométricos. El

primero de ellos constituye la validación española del Hurlbert Index of Sexual Assertiveness
(HISA; Hurlbert, 1991), que es el instrumento de evaluación de asertividad sexual más usado
(Santos-Iglesias y Sierra, 2010a). Este estudio parte de la versión anglosajona compuesta por
25 ítems, de la que no se tiene información sobre la elaboración de los ítems ni de su
estructura factorial. Únicamente se informa de su fiabilidad de consistencia interna y test-
retest. Un estudio posterior elaborado por Greene y Faulkner (2005) descubre tres factores
mediante análisis factorial exploratorio: Inicio, Rechazo y Conversación sexual asertiva. Sin
embargo, estos autores no proporcionan detalles sobre los ítems que componen dicha
estructura. Posteriormente, Sierra et al. (2008) en un estudio con mujeres hispanas encuentran
un sólo factor que explica cerca de un 32% de varianza. Ante la diversidad de resultados, la
validación española del HISA (Santos-Iglesias y Sierra, 2010b) parte de un análisis de ítems
para seguir con un análisis factorial exploratorio y confirmar posteriormente mediante
análisis factorial confirmatorio la estructura encontrada. Los resultados del análisis factorial
exploratorio y confirmatorio muestran una versión final compuesta por 19 ítems que se
agrupan en dos factores: Inicio y Ausencia de timidez/Rechazo. Ambos muestran buenos
índices de fiabilidad de consistencia interna y adecuada validez convergente con otras
medidas de asertividad en la pareja, ajuste diádico y habilidades sociales. Esta solución final
bien podría asemejarse a la encontrada por Greene y Faulkner (2005) con la equivalencia
entre las dimensiones Conversación sexual asertiva y Ausencia de timidez. Sin embargo, el
hecho de que no se disponga de los ítems que componen aquella dimensión en el estudio de
Greene y Faulkner hace que sea imposible su comprobación. Por otra parte, el resultado
obtenido dista mucho de la solución encontrada por Sierra et al., pero es necesario recordar
que en el estudio de Sierra et al. se emplearon únicamente mujeres de dos países distintos
(España y El Salvador), mientras que en el estudio de esta tesis se evalúan tanto hombres
como mujeres españoles. Esta diferencia entre los estudios llevados a cabo sólo con mujeres
(Hurlbert, 1991; Sierra et al., 2008) y los llevados a cabo con hombres y mujeres (Greene y
Faulkner, 2005; Santos-Iglesias y Sierra, 2010b), que demuestran una sola dimensión en el
primer caso y varias dimensiones en el segundo, despierta la sospecha de que puedan existir
diferencias en la estructura factorial entre hombres y mujeres y la posibilidad de que el
instrumento de evaluación esté sesgado en función del género. Con el propósito de desvelar
esta incógnita se lleva a cabo el segundo estudio psicométrico que analiza la equivalencia de
la estructura del HISA entre hombres y mujeres.

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Asertividad sexual: análisis de variables relacionadas e implicaciones clínicas

Debido al planteamiento anterior y a que la asertividad sexual es un constructo que

típicamente se ha comparado entre hombres y mujeres, se evalúa la equivalencia de la
estructura factorial de la versión española del HISA (Santos-Iglesias y Sierra, 2010b) y se
analiza la ausencia de sesgo en sus ítems entre hombres y mujeres, ya que es necesario que se
cumplan estos dos requisitos cuando las puntuaciones de un instrumento de evaluación van a
ser empleadas para comparar distintos grupos (Dimitrov, 2010). Lo primero que se desprende
de los resultados de este estudio es que la estructura encontrada por Santos-Iglesias y Sierra
(2010b) se confirma de nuevo, tanto en hombres como en mujeres españoles, en el nivel más
bajo de invarianza (invarianza configural). Por tanto, se obtiene una segunda evidencia
confirmatoria de la estructura de la versión española del HISA. Sin embargo, tres de los ítems
(2, 9 y 13) no cumplen la invarianza fuerte (i.e., muestran interceptas diferentes en hombres y
mujeres) indicando la posible presencia de funcionamiento diferencial del ítem (Dimitrov,
2010). Los resultados del análisis de funcionamiento diferencial del ítem muestran que de
esos tres ítems, sólo el ítem 2 (“Creo que soy tímido/a en el ámbito sexual”) muestra
funcionamiento diferencial y, por tanto, sesgo entre hombres y mujeres. Concretamente,
cuando se analizan las categorías de respuesta se encuentra que las mujeres tienen una mayor
tendendia a responder “siempre” a este ítem en comparación con los hombres. Así, hombres
y mujeres con el mismo nivel de timidez no responderían de la misma forma a este ítem, pues
debido a los roles tradicionales de género, las mujeres responderían “siempre” con más
frecuencia ya que se espera que sean más tímidas (Bem, 1974; Holt y Ellis, 1998), que
muestren menos sus preferencias y deseos sexuales y que conversen de forma menos abierta
sobre el sexo (Quina, Harlow, Morokoff, Burkholder y Deiter, 2000). Por esta razón, y en
base a los resultados obtenidos, se recomienda eliminar los ítems 2, 9 y 13 de la escala,
obteniendo una versión final compuesta por 16 ítems agrupados en las dimensiones Inicio (8
ítems) y Ausencia de timidez/Rechazo (8 ítems). Con esta versión definitiva y equiparable
por sexos se elaboran los baremos españoles del HISA diferenciando a hombres y mujeres en
tres grupos de edad. Los resultados de los baremos muestran que la asertividad sexual aún
sigue roles tradicionales de género, pues los hombres muestran mayor asertividad de inicio
(Simon y Gagnon, 1984, 1986, 2003), mientras que las mujeres mayores en comparación con
mujeres jóvenes, muestran comportamientos más estereotipados como timidez a la hora de
hablar sobre sexualidad (Bem, 1974; Holt y Ellis, 1998).
Los resultados de estos dos estudios suponen, en general, un avance en la evaluación
de la asertividad sexual mediante el uso del Hurlbert Index of Sexual Assertiveness (Hurlbert,
1991). En este sentido, partiendo de su estructura unidimensional inicial, la ausencia de una

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definición clara sobre el constructo evaluado por el instrumento y la escasez de evidencias

empíricas sobre su funcionamiento, propiedades psicométricas o la presencia de sesgo, se
llega finalmente a una versión española depurada más breve y formada por dos componentes
claramente definidos. El primero, Inicio, hace referencia al inicio de contactos sexuales y la
comunicación de deseos sexuales y fantasías a la pareja. El segundo de los componentes,
Ausencia de timidez/Rechazo, es la dificultad para iniciar y mantener conversaciones sobre
temas sexuales y la incapacidad para rechazar contactos sexuales no deseados. A este
respecto hay que señalar que, tal y como se ha comentado anteriormente, este segundo factor
incluiría un componente que no sería puramente asertividad sexual (i.e., ausencia de timidez),
sino un factor asociado a la misma y, así, se desaconseja el uso de este instrumento cuando lo
que se precisa es una evaluación pura de la asertividad sexual. Al margen de esto hay que
sumar que las propiedades psicométricas demostradas garantizan un adecuado
funcionamiento en muestras españolas y, aún más, garantizan la equivalencia de las
puntuaciones cuando dicha escala se emplea para comparar a hombres y mujeres.
Además del estudio sobre la evaluación de la asertividad sexual, se propone investigar
su papel en los procesos de victimización. La investigación previa ha demostrado que la
asertividad sexual es un factor de protección ante las experiencias de coerción y
victimización sexual (véase Santos-Iglesias y Sierra, 2010a). Los resultados obtenidos en esta
Tesis Doctoral muestran que la falta de asertividad sexual explica la relación entre el abuso
sexual en la infancia y la victimización sexual en la adolescencia y edad adulta temprana.
Este resultado no coincide con estudios previos llevados a cabo, principalmente, en Estados
Unidos, sin embargo la metodología de análisis de datos empleada en este estudio es más
potente a la hora de detectar efectos de mediación que la que se ha empleado en estudios
previos (véase, Greene y Navarro, 1998; Livingston et al., 2007). Otra posible explicación
tiene que ver con los roles tradicionales de género, pues estudios previos han encontrado que
las estudiantes estadounidenses muestran más roles tradicionales de género (e.g., satisfacer
las necesidades y deseos de la pareja, token-refusal; Fuertes, Ramos, de la Orden, del Campo
y Lázaro, 2005; Sipsma, Carrobles-Isabel, Montorio Cerrato y Everaerd, 2000, VanZile-
Tamsen, Testa y Livingston, 2005) que afectan directamente a la asertividad sexual, de forma
que esas creencias disminuyen la asertividad sexual en estudiantes estadounidenses, mientras
que en España la falta de habilidades asertivas está más asociada al abuso sexual en la
infancia. Esta puede ser la razón por la que se encuentran diferencias entre los estudios en
Estados Unidos y en España.

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Los resultados muestran, además, que el número de parejas sexuales explica también
la revictimización sexual, dando credibilidad a la hipótesis de la exposición y a la impotencia
dentro de las dinámicas traumatogénicas propuestas por Finkelhor y Browne (1985). No
obstante, a pesar de los resultados de este trabajo, aún queda por delante realizar una mejora
en este estudio. Una de las principales críticas a este tipo de trabajos es que, debido a su
naturaleza transversal, no es posible saber si la falta de asertividad sexual desencadena
experiencias de victimización sexual o si, por el contrario, sufrir experiencias de
victimización sexual disminuye la asertividad sexual. A este respecto, varios autores ponen
de manifiesto la necesidad de llevar a cabo estudios longitudinales con el objetivo de
dilucidar este problema (Greene y Navarro, 1998; Livingston et al., 2007). Así, el estudio que
aquí se presenta es una primera aproximación a la evaluación conjunta de una serie de
posibles mediadores de la revictimización, pero sería mucho más recomendable la realización
de este tipo de estudios mediante un diseño longitudinal que permita contrastar qué variables
preceden a otras y si existe dicha mediación.
Para finalizar con este trabajo, es necesario señalar las elevadas cifras de
victimización sexual encontradas en el mismo. Los resultados muestran que algo más de un
30% de las mujeres entrevistadas informaron haber sufrido algún contacto sexual no deseado
después de los 14 años de edad, un 19% habían sufrido un episodio de coerción sexual, y casi
un 4% habían sufrido un intento de violación y violación completa. Estos resultados ponen de
manifiesto, al igual que estudios previos realizados tanto en España (Ramos, Fuertes y de la
Orden, 2006; Sipsma et al., 2000) como en Estados Unidos (Testa, Livingston y VanZile-
Tamsen, 2005; Testa, VanZile-Tamsen, Livingston y Koss, 2004), las elevadas cifras de
prevalencia de las agresiones sexuales en mujeres universitarias, que son, precisamente, la
población con una mayor vulnerabilidad para este tipo de episodios (Bureau of Justice
Statistics, 2007; Tjaden y Thoennes, 2000). Además, se vuelve a encontrar falta de apoyo
para el mito del violador extraño, pues la mayoría de las agresiones son cometidas por
exparejas o parejas actuales, conocidos con los que no se tiene una relación romántica y/o
citas ocasionales (Koss et al., 1994; Muehlenhard, Goggins, Jones y Satterfield, 1991).
Por último, sólo resta analizar la naturaleza de la asertividad sexual. Como punto de
partida es necesario señalar la ausencia, a excepción de contados casos (Morokoff et al.,
1997), de trabajos que analicen los predictores de la asertividad sexual de forma
multidimensional como se ha realizado con otras variables sexuales (e.g., deseo sexual;
Santos-Iglesias, Calvillo y Sierra, en prensa). En este sentido, Morokoff et al. (1997)
aplicaron el Multifaceted Model of HIV Risk (MMOHR; Harlow et al., 1993) pero no

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 Discusión

incluyeron variables sexuales como el deseo o la excitación, que han mostrado estar
relacionadas con la asertividad sexual (Hurlbert, 1991; Hurlbert et al., 1993). No es de
extrañar si se piensa que personas con elevados niveles de deseo y de excitación tenderán a
iniciar más contactos sexuales con el objetivo de satisfacer ese deseo o excitación previos
(Matsuura, 2008). Por ello se pone a prueba un modelo multidimensional en hombres y
mujeres que pretende analizar los predictores de la asertividad sexual a partir de una serie de
variables interpersonales, actitudinales y sexuales.
Los resultados ponen de manifiesto la naturaleza multidimensional de la asertividad
sexual, tal y como fue demostrado en el estudio de Morokoff et al. (1997). Así, tanto en el
caso de los hombres como en el de las mujeres los tres grupos de variables son significativos
a la hora de predecir la asertividad sexual, aunque sí se encuentran algunas pequeñas
diferencias. Se encuentra que las variables sexuales son relevantes a la hora de predecir la
asertividad sexual, de forma que hombres y mujeres con elevados niveles de excitación y de
deseo sexual diádico muestran mayor asertividad sexual. Es importante señalar que aunque
uno de los componentes es la asertividad de rechazo y ausencia de timidez, el factor tiene una
gran carga de ítems que evalúan ausencia de timidez (que se definió como la capacidad para
expresar los deseos y fantasías sexuales). De esta forma es comprensible que personas que
con mayor deseo muestren también mayores puntuaciones en esta dimensión. Sin embargo,
es importante señalar que sólo en el caso de las mujeres el deseo sexual solitario predice de
forma negativa la asertividad sexual. La explicación sobre este resultado se podría encontrar
en la posible culpabilidad sexual asociada al deseo solitario en el caso de las mujeres, aunque
es una hipótesis que habría que comprobar. En segundo lugar, tanto actitudes sexuales
generales como la erotofilia, como actitudes más específicas, como las actitudes positivas
hacia las fantasías sexuales, muestran una relación positiva con la asertividad sexual tanto en
hombres como en mujeres, indicando que la especificidad de las actitudes es, a veces, más
importante a la hora de predecir el comportamiento que las actitudes más generales. Además,
debido al componente de comunicación de fantasías sexuales se entiende fácilmente la
relación entre las actitudes específicas y este componente. Por último, el abuso de la pareja
ejerce un efecto demoledor sobre la asertividad sexual, especialmente, en el caso del abuso
no físico. En este sentido, estudios previos han mostrado que la asertividad sexual es menor
en víctimas de agresiones sexuales que implican un componente verbal para ejercer presión,
pero no cuando existe una agresión física (Testa y Dermen, 1999), ya que en estos casos es
más dificil escapar mediante respuestas verbales asertivas. Por último, es necesario señalar
que de los tres grupos de variables añadidas en el modelo, las más importantes son las

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Asertividad sexual: análisis de variables relacionadas e implicaciones clínicas

actitudinales, de manera que sin la presencia de actitudes positivas el resto de variables no

van a ser tan relevantes a la hora de provocar respuestas sexualmente asertivas.
A modo de síntesis general, se puede concluir que los resultados hallados en esta
Tesis Doctoral ofrecen una herramienta útil para la evaluación de la asertividad sexual en el
contexto español. Respecto a la versión original anglosajona (Hurlbert, 1991), la adaptación
española supone una triple ventaja. En primer lugar, los ítems están agrupados en dos
dimensiones conceptualmente coherentes y que representan dos componentes de la
asertividad sexual. En segundo lugar, la adaptación española supone la eliminación de 9
ítems que no muestran un adecuado funcionamiento. Esto implica una versión más corta y de
más fácil aplicación, con suficientes garantías psicométricas sobre su adecuado
funcionamiento. Por último, los resultados implican que la adaptación española permite su
uso y la comparación de las puntuaciones entre hombres y mujeres debido a la obtención de
una versión no sesgada. Además, los baremos obtenidos a partir de esta última versión
ofrecen información relevante sobre las puntuaciones normativas para hombres y mujeres en
tres grupos de edad distintos. Sin embargo, los resultados de ambos estudios serían mucho
más valiosos en el caso de contar con muestras respresentativas de la población españolas, ya
que permitirían asegurar que los resultados obtenidos y la utilización de la versión española
del Hurlbert Index of Sexual Assertiveness, así como sus baremos, serían aplicables con total
garantía a la población española.
En segundo lugar, se ha encontrado también que la asertividad sexual sirve como
factor de protección frente a la victimización sexual en la adolescencia y edad adulta, además
de ser un mecanismo que sirve para explicar la revictimización sexual entre el abuso sexual
en la infacia y la victimización adulta. A pesar de la información que ofrecen estos resultados
es necesario poner a prueba estas hipótesis mediante el uso de diseños longitudinales (véase
Livingston et al., 2007) que permitan establecer un orden en la sucesión de los eventos y las
consecuencias de los mismos.
Por último, el estudio sobre la naturaleza de la asertividad sexual pone de manifiesto
la relevancia de variables interpersonales, actitudinales y sexuales, con especial relevancia de
las actitudinales. Por tanto, los programas de intervención que incluyan la mejora de la
asertividad sexual tendrían que trabajar siempre el plano actitudinal, mejorando la
disposición hacia la sexualidad tanto de forma general como específica. De esta forma,
podrían darse mayores cambios en la asertividad sexual de las personas y, por tanto,
desarrollar mecanismos que contribuyan a una mayor salud sexual.

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 Conclusiones

Conclusiones

1. La asertividad sexual es un elemento clave en la vida sexual de las personas, ya que

está relacionado con la respuesta sexual, las conductas sexuales de riesgo y las
experiencias de victimización sexual.
2. La asertividad sexual está al servicio de la salud sexual, ya que permite poner en
marcha conductas sexualmente saludables y defender los derechos sexuales de las
personas.
3. Existen muchos instrumentos para la evaluación de la asertividad sexual, aunque
pocos han sido elaborados siguiendo un procedimiento adecuado y muchos apenas
informan de sus propiedades psicométricas. En este contexto, la versión española del
Hurlbert Index of Sexual Assertiveness se postula como un instrumento breve para
la evaluación de la asertividad sexual, con adecuadas índices de fiabilidad y validez,
así como la ausencia de sesgo a la hora de comparar las puntuaciones de hombres y
mujeres.
4. El inicio y rechazo de las actividades sexuales sigue en la actualidad en España los
roles tradicionales de género. Así, se muestra que los varones tienden a iniciar más
los contactos sexuales, mientras que las mujeres jóvenes son más restrictoras del
contacto sexual y las mujeres mayores muestran mayor timidez sexual.
5. Las tasas de victimización sexual en España siguen siendo elevadas y muestran la
misma tendencia que estudios anteriores, con cifras que oscilan entre el 3,4% de
violaciones y un 30,4% de contactos sexuales no deseados.
6. La mayor parte de las experiencias de victimización sexual se llevan a cabo por
conocidos o parejas actuales, destruyendo el mito del violador/agresor desconocido.
7. La asertividad sexual es un factor de protección contra las agresiones sexuales en la
adolescencia y edad adulta, y funciona como mecanismo explicativo de la
revictimización sexual cuando la primera experiencia fue abuso sexual en la
infancia.
8. La asertividad sexual es de naturaleza multidimensional y está determinada por
factores interpersonales (como el abuso en la pareja), factores actitudinales y
componentes de la respuesta sexual humana (como el deseo y la excitación).

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Asertividad sexual: análisis de variables relacionadas e implicaciones clínicas

9. El abuso en la pareja, sobre todo de naturaleza no física, disminuye la capacidad de

respuesta sexualmente asertiva tanto en hombres como en mujeres.
10. Las actitudes sexuales generales y actitudes más específicas, como las actitudes
hacia las fantasías sexuales, son factores facilitadores de respuestas sexuales
asertivas tanto en hombres como en mujeres.
11. El deseo sexual y la excitación favorecen respuestas sexualmente asertivas tanto en
hombres como en mujeres. Sin embargo, en las mujeres el deseo sexual solitario
dificulta la asertividad sexual, posiblemente debido a la culpabilidad sexual que
aquel genera.

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 Conclusions

Conclusions

1. Sexual assertiveness is a key component in human sexual life, as it is related to

human sexual response, risky sexual behavior, and sexual victimization experiences.
2. Sexual assertiveness serves sexual health, since it empowers the ability to engage in
healthy sexual behaviors and defense human sexual rights.
3. There are many instruments to assess sexual assertiveness. However, only a few
have been developed following appropriate psychometric procedures and most of
them do not give information about their psychometric properties. In such a context,
the Spanish validation of the Hurlbert Index of Sexual Assertiveness is a short
instrument to assess sexual assertiveness. It has demonstrated good reliability and
validity properties and its validity and lack of bias when it is used to compare scores
between men and women.
4. Currently, initiation and refusal of sexual contacts follow traditional gender roles in
Spain. It has been showed that males typically are initiators of sexual contacts, while
young females are restrictors of such contacts and older females show greater sexual
shyness.
5. Sexual victimization rates in Spain are still high and show similar rates as previous
studies; rates range from 3,4% of rapes and 30,4% of undesired sexual contacts.
6. Most of the sexual victimization experiences are perpetrated by known people or
actual partners, ruling the stranger rapist myth out.
7. Sexual assertivness is a protective factor against sexual aggressions in adolescence
and young adulthood, and it does work as an explaining mechanism for sexual
revictimization when first offence was child sexual abuse.
8. Sexual assertiveness has a multidimensional nature and it is determined by
interpersonal factors, such as partner abuse, attitudinal factors and components of
the human sexual response (such as desire and arousal).
9. Partner abuse, specially non-physical abuse, lessens the ability to sexually assert in
men and women.
10. General sexual attitudes and specific sexual attitudes, such as attitudes towards
sexual fantasies, facilitate sexually assertive responses in men and women.

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Asertividad sexual: análisis de variables relacionadas e implicaciones clínicas

11. Sexual desire and arousal facilitate sexually assertive responses in men and women.
However, among women, solitary sexual desire difficults sexual assertiveness,
probably due to the sexual guilt caused by solitary sexual desire.

138
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*HK*E(O*"#+'*.2$cZ$\;925;b`$G*$#(K1$,6"7$2/"*(0/$$/$:$\;2:_b`$(".#EIO*"#+'*.4$C'$#(K1$G*
OI*.#E+$.*$,+$1EP+"(Y+G1$*"$N+.*$+$#E*.$0+#*P1ET+.$\.*H12$KE10*G*"0(+$/$OI*.#E+$0'T"(0+`4
C"$MI"0(U"$G*'$.*H12$:$\;2:_b`$#E+N+W1.$("0'I/*"$d"(0+O*"#*$F+E1"*.2$c;$\;62:Sb`$.U'1
OIW*E*.$/$S:$\9S2Z_b`$+$F+E1"*.$/$OIW*E*.4$C"$0I+"#1$+$'+$KE10*G*"0(+2$*"$*'$9Z25:b
G*$'1.$*.#IG(1.$\'$e$S_`$'1.$K+E#(0(K+"#*.$.1"$I"(F*E.(#+E(1.$/$*"$*'$;52Z:b$\'$e$cQ`$G*
KE10*G*"0(+$01OI"(#+E(+f$0("01$#E+N+W1.$\;2:_b`$*OK'*+"$OI*.#E+.$0'T"(0+.$/$1#E1.$0("01
OI*.#E+.$O(H#+.$\0'T"(0+$/$"1$0'T"(0+`2$.(*"G1$'+$PE+"$O+/1ET+$E*+'(Y+G1.$01"$OI*.#E+.
"1$0'T"(0+.$\'$e$;;f$Z;2ZSb`4$-+E+$M("+'(Y+E2$G*$'1.$F*("#*$(".#EIO*"#1.$[I*$.*$*OK'*+E1"
K+E+$*F+'I+E$'+$+.*E#(F(G+G$.*HI+'2$'1.$OX.$I#('(Y+G1.$.1"$K1E$*.#*$1EG*"R$8%&)9,&/":'-,6
$*";,6%()"122,&/.<,',22$\)IE'N*E#2$5__5`$\'$e$5Zf$S92;Zb`2";,6%()"122,&/.<,',22";0(),
\]1E1^1MM$ ,/" ()42$ 5__Q`$ \'$ e$ 5Qf$ SS29;b`2$ *F+'I+0(U"$ O*G(+"#*$ &$)," 7)(4.'5" \'$ e$ Zf
562:Sb`2$ (".#EIO*"#1.$ G*.+EE1''+G1.$ (-" =$0$ \'$ e$ Qf$ _2S5b`$ /$ ;,6%()" 1>(&,',22
?%,2/.$''(.&,$\<"*''2$g(.,*E$/$](''*E2$5__5`$\'$e$;f$Q2Z_b`4
B1.$ E*.I'#+G1.$ KE("0(K+'*.$ 1N#*"(G1.$ *"$ 0+G+$ #E+N+W1$ .*$ KI*G*"$ 1N.*EF+E$ *"$ '+
>+N'+$ 52$ '1.$ 0I+'*.$ .1"$ G*.0E(#1.$ +$ 01"#("I+0(U"$ G*$ M1EO+$ P*"*E+'$ +PEIK+G1.$ *"$ '+.
G(.#("#+.$ #*OX#(0+.4

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148
 TABLA 1. Principales resultados de los estudios de asertividad sexual (AS).

Autor Diseño Muestra Evaluación/manipulación AS Principales resultados

Respuesta y funcionamiento sexual
Apt, Hurlbert y Powell (1993) Ex post facto 21 parejas comunitarias. HISA (Hurlbert, 1991). La diferencia entre la AS de los dos
Los hombres acudían a terapia por miembros de la pareja (AS mujer – AS varón)
deseo sexual hipoactivo. es un predictor significativo del deseo sexual
del varón, pero no de la mujer.
Gentry (1998) Experimental 254 estudiantes (varones y Janda, O’Grady y Barnhart Las mujeres más activas sexualmente,
mujeres) universitarios. (1981). Factor Subordination (Į también eran más asertivas sexualmente.
= 0,94).
Greene y Faulkner (2005) Ex post facto 698 parejas comunitarias. HISA (Hurlbert, 1991). Versión Mayor AS-Inicio se relaciona con menor
de 19 ítems. Tres factores: Inicio doble moral sexual. Mayor AS se relaciona
(Į = 0,86), Rechazo (Į = 0,81); con mayor satisfacción en la relación. AS se
Conversación sexual asertiva (Į= relaciona de forma positiva con la
0,79). negociación en la pareja, comunicación
sexual y discusión sexual.
Haavio-Mannila y Kontula (1997) Ex post facto Dos muestra comunitarias: 2250 No se informa del instrumento. Las mujeres muestran menos AS que los
:;7<=:>!?@A:!;:$ /$ :!ABB;!" ;.*C#(D(E+E$ .*FG+'

varones y mujeres, y 2188 varones hombres.

y mujeres. La satisfacción sexual se relaciona de forma
positiva con la AS, tanto en hombres como en
mujeres.
Hammond y Oei (1982) Experimental 29 mujeres comunitarias. Sexual Assertiveness Rating Form La combinación de entrenamiento en
(11 ítems). habilidades sociales (comunicación asertiva)
Sexual Assertiveness Role-playing y reestructuración cognitiva fue el tratamiento
Test: compuesto por 16 más efectivo para incrementar la asertividad
escenarios, 8 de Inicio y 8 de sexual, seguido por el entrenamiento en
Rechazo. habilidades sociales. Sin embargo, estas
intervenciones no mejoraron la asertividad
general.
Hurlbert (1991) Cuasi-experimental 100 mujeres comunitarias. HISA (Hurlbert, 1991) (Į = 0,91) Las mujeres sexualmente asertivas informan
de mayor actividad sexual y orgasmos, mayor
deseo sexual y mayor satisfacción sexual y
marital.
HHI

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149
Anexo
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!"#$"% &'% -E("0(J+'*.$ E*.I'#+G1.$ G*$ '1.$ *.#IG(1.$ G*$ +.*E#(F(G+G$ .*HI+'$ K=<L4$ K&1"#4L4 ::;

Hurlbert y Apt (1993) 68 mujeres comunitarias HISA (Hurlbert, 1991) Las mujeres con orientación heterosexual

4
Ex post facto
mostraron mayor AS que las mujeres con
orientación homosexual.
Hurlbert, Apt y Rabehl (1993) Ex post facto 98 mujeres casadas comunitarias. HISA (Hurlbert, 1991) La AS se relaciona de forma positiva con la
erotofilia, la consistencia experimentando
orgasmos, la cercanía en la relación, la
excitabilidad sexual y la satisfacción sexual.
Además, es uno de los mejores predictores de
la satisfacción sexual.
Hurlbert, Apt y White (1992) Cuasi-experimental 32 mujeres borderline y 32 no HISA (Hurlbert, 1991) Las mujeres borderline mostraron mayor AS.
borderline.
Hurlbert et al. (2005) Ex post facto 66 mujeres con deseo sexual HISA (Hurlbert, 1991) La AS se relaciona de forma positiva con el

!"#$ %$ &'("$ )*+'#,$ -./0,1'2$ 31'4$ 564$ 78$ 9

hipoactivo. estatus socioeconómico, la satisfacción
marital, compatibilidad sexual y satisfacción
sexual.
Hurlbert, White, Powell y Apt Experimental 57 mujeres con trastorno por HISA (Hurlbert, 1991) La AS mejoró debido a un entrenamiento en
(1993) deseo sexual hipoactivo. consistencia del orgasmo en el grupo en el
que participaban los dos miembros de la
pareja, pero no cuando participaban sólo las
mujeres.
Jacobs y Thomlison (2009) Ex post facto 572 mujeres comunitarias. SAS (Morokoff et al., 1997) (Į = La AS se relaciona con mayor autoestima y
0,83) búsqueda de sensaciones y con menor
supresión de pensamientos o acciones
contrarios a los de la pareja para evitar
conflictos) y creencias negativas, vergüenza y
prejuicios sociales hacia personas con VIH.
Asertividad sexual: análisis de variables relacionadas e implicaciones clínicas

Ménard y Offman (2009) Ex post facto 25 varones y 46 mujeres Sexual Assertiveness Scale La AS es un mediador parcial de la relación
comunitarios. (Shafer, 1977). 28 ítems. entre la autoestima sexual sobre la
satisfacción sexual.
La relación de la AS sobre la satisfacción
sexual está mediada parcialmente por la
autoestima sexual.
Morokoff et al. (1997) Instrumental Dos muestras de mujeres SAS (Morokoff et al., 1997) La AS se relaciona con una mayor
comunitarias: 503 y 714. satisfacción en la relación de pareja, buen
intercambio con la pareja y mayor
experiencia sexual.
<=7>?<@!ABC<!=<$ /$ <!CDD=!" =.*E#(F(G+G$ .*HI+'
 !"#$"% &'% -C("0(J+'*.$ C*.G'#+E1.$ E*$ '1.$ *.#GE(1.$ E*$ +.*C#(D(E+E$ .*FG+'$ K;:L4$ K&1"#4L4

Murphy, Coleman, Hoon y Scott Cuasi-experimental 74 mujeres alcohólicas. Entrenamiento en AS. Las mujeres que completaron el programa
(1980) que incluía entrenamiento en AS mejoraron
en satisfacción marital, activación sexual y
educación sexual.
Oattes y Offman (2007) Ex post facto 27 varones y 47 mujeres Sexual Assertiveness Scale
#$%&'(")**$+,-.$/$**"#0'($ Existe una correlación moderada entre la AS
comunitarios. (Shafer, 1977). y la comunicación sobre cuestiones generales
en la pareja.
La autoestima sexual es mejor predictor de la
AS que la autoestima general.
Onuoha y Munakata (1999) Ex post facto 101 adolescentes varones y AIDS Social Assertiveness Scale No hay diferencias estadísticamente
mujeres. (ASAS) (Į = 0,82) y AIDS Self- significativas en AS entre australianos y
Assertion Questionnaire (ASAQ) japoneses, aunque los japoneses muestran
(Į = 0,82) menor AS.
Pierce y Hurlbert (1999) Instrumental 54 participantes no clínicos y 46 HISA (Hurlbert, 1991). Los hombres mostraron mayor AS que las
clínicos (acudían a terapia de mujeres, tanto en la muestra clínica como en
:;7<=:>!?@A:!;:$ /$ :!ABB;!" ;.*C#(D(E+E$ .*FG+'

pareja). la no clínica.
Rickert, Neal, Wiemann y Ex post facto 904 mujeres comunitarias. 13 ítems que evaluaban Las mujeres con baja AS creen que su pareja
Berenson (2000) asertividad sexual. es monógama, están casadas o viven con su
pareja y han tenido menos de tres parejas
sexuales en su vida.
Rickert, Sanghvi y Wiemann Ex post facto 904 mujeres comunitarias. Cuestionario ad hoc. Uno de los La historia sexual y reproductiva y la historia
(2002) componentes era AS percibida. de abuso previo son los mejores predictores
de la AS, concretamente el número de parejas
es el mejor predictor.
Pertenecer a una minoría étnica, menor edad,
bajo nivel escolar, inexperiencia sexual y el
uso inconsistente de métodos anticonceptivos
se relacionan con baja AS.
Schooler y Ward (2006) Ex post facto 184 varones universitarios. HISA (Hurlbert, 1991) (Į = 0,92) La AS se relacionó de forma negativa con la
religiosidad y con ser de origen asiático y de
forma positiva con el confort con el propio
cuerpo y con el cuerpo de las mujeres.
HHI

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!"#$"% &'% -E("0(J+'*.$ E*.I'#+G1.$ G*$ '1.$ *.#IG(1.$ G*$ +.*E#(F(G+G$ .*HI+'$ K=<L4$ K&1"#4L4 :;6

Schooler, Ward, Merriwether y Ex post facto 199 mujeres universitarias. HISA (Hurlbert, 1991) (Į = 0,92) Las mujeres con actitudes más favorables
Caruthers (2005) hacia la menstruación, mayor confort con el
propio cuerpo y con más experiencia sexual
muestran más AS.
La AS ejerce un efecto mediador entre el
confort con el propio cuerpo y la experiencia
sexual.
Sierra et al. (2008) Instrumental 530 mujeres. HISA (Hurlbert, 1991) (Į = 0,90) La AS correlacionó de forma positiva con la
erotofilia y con la autoestima.
Snell et al. (1991) Instrumental 173 varones y mujeres SAQ (Snell et al., 1991). Los hombres informan de mayor AS que las
universitarios. Subescala de AS (Į = 0,81-0,83) mujeres.
La AS correlacionó de forma negativa con

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culpabilidad sexual, ansiedad sexual y
ansiedad para el contacto heterosexual.
En mujeres correlacionó de forma negativa
con depresión y locus de control externo
(creencia en la suerte) y de forma positiva con
autoestima, erotofilia y locus de control
interno.
Snell y Wooldridge (1998) Ex post facto 253 varones y mujeres SAQ (Snell et al., 1991) Tanto en varones como en mujeres la AS se
universitarios. Subescala AS relaciona con mayor experiencia sexual.
Van Anders y Dunn (2009) Ex post facto 177 varones y mujeres HISA (Hurlbert, 1991) La AS no muestra relación con los niveles de
comunitarios. testosterona y estradiol, ni en hombres ni
mujeres.
Los participantes con alta AS informaron de
mayor número de orgasmos en la pareja.
Asertividad sexual: análisis de variables relacionadas e implicaciones clínicas

Walker (2006) Ex post facto 447 mujeres universitarias. SAQ-W (Walker, 2006) (Į = 0,74- La baja AS actúa como predictor de una
0,93) identidad sexual negativa y de la conducta
sexual no motivada para la sexualidad.
Weaver y Byers (2006) Ex post facto 214 mujeres universitarias. HISA (Hurlbert, 1991) (Į = 0,82) La AS baja se relaciona con insatisfacción
con el propio cuerpo general y en situaciones
sexuales.
Yamayima, Cash y Thompson Ex post facto 384 mujeres universitarias. SAQ (Snell et al., 1991) (Į = Las mujeres con mayor preocupación por la
(2006) 0,84) imagen corporal y por la apariencia corporal
en situaciones sexuales muestran menor AS.
<=7>?<@!ABC<!=<$ /$ <!CDD=!" =.*E#(F(G+G$ .*HI+'
 !"#$"% &'% -C("0(J+'*.$ C*.G'#+E1.$ E*$ '1.$ *.#GE(1.$ E*$ +.*C#(D(E+E$ .*FG+'$ K;:L4$ K&1"#4L4

Yoder, Perry y Saal (2007) Ex post facto 165 mujeres comunitarias. SAS (Morokoff et al., 1997) (Į = Las mujeres con puntuaciones elevadas en
0,76–0,86). aceptación pasiva (sumisión) muestran
puntuaciones más bajas en AS global, AS-
Inicio y AS-prevención embarazo/STD.
Victimización sexual
Apt y Hurlbert (1993) Cuasi-experimental 120 mujeres: 60 sufrían abuso de HISA (Hurlbert, 1991) (Į = 0,84) Las mujeres que sufrían abuso de pareja
pareja y 60 no. mostraban menor AS.
Corbin, Bernat, Calhoun, McNair Ex post facto 238 mujeres universitarias. SAS (Morokoff et al., 1997) Las mujeres que han sufrido alguna
y Seals (2001) experiencia de victimización sexual muestran
menor habilidad para rechazar actos sexuales
no deseados (menor AS-Rechazo).
Greene y Navarro (1998) Ex post facto 274 mujeres universitarias. Asertividad sexual. Añadiendo La victimización sexual correlacionó de
“con el sexo opuesto” a los ítems forma negativa con la AS.
del Inventory of Interpersonal La baja AS con el sexo opuesto es uno de los
Problems (Horowitz, Rosenberg, factores principales (junto con la
:;7<=:>!?@A:!;:$ /$ :!ABB;!" ;.*C#(D(E+E$ .*FG+'

Baer, Ureno y Villasenor, 1988). victimización previa) en la predicción de la

(Fiabilidad dos mitades = 0,92– victimización sexual.
0,94).
Kiefer y Sánchez (2007) Experimental 48 varones universitarios. Percepción de ser sexualmente La percepción de una mayor necesidad de ser
asertivo (Į = 0,73) sexualmente asertivo se relaciona con una
menor inhibición ante conceptos relacionados
con dominancia sexual.
Livingston, Testa y VanZile- Ex post facto 937 mujeres comunitarias. SAS-Rechazo (Morokoff et al., La victimización sexual predice de forma
Tamsen (2007) 1997) (Į = 0,77) negativa la AS-Rechazo, y ésta predice de
forma negativa la subsecuente victimización
sexual.
Macy, Nurius y Norris (2006) Ex post facto 202 mujeres universitarias. 2 ítems del SAS (Harlow, Quina, La AS funciona como un factor de protección
Morokoff, Rose y Grimley, 1993) que modula la respuesta de escape y
resistencia ante una agresión sexual, pues se
relaciona de forma negativa con las barreras
que favorecen una agresión.
Miner, Flitter y Robinson (2006) Ex post facto 230 mujeres comunitarias. 9 ítems dicotómicos (Į = 0,73) No se encontraron diferencias en AS en
función del tipo de victimización (abuso
sexual en la infancia, victimización adulta y
revictimización).
HI5

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!"#$"% &'% -F("0(K+'*.$ F*.J'#+H1.$ H*$ '1.$ *.#JH(1.$ H*$ +.*F#(G(H+H$ .*IJ+'$ L>=M4$ L&1"#4M4 :;<
Morokoff et al. (1997) Instrumental Dos muestras de mujeres SAS (Morokoff et al., 1997). La AS se relaciona de forma negativa con la
comunitarias: 503 y 714. victimización, coerción y asalto sexual y con
historia de abuso en la infancia.
Rickert et al. (2000) Ex post facto 904 mujeres comunitarias. 13 ítems que evaluaban Las mujeres con baja AS informan de
asertividad sexual. contactos sexuales forzados en los últimos 12
meses, pero ausencia de abuso físico.
Sierra, Ortega, Santos y Gutiérrez Instrumental 300 mujeres comunitarias. HISA (Hurlbert, 1991) (D = 0,89) La AS se relaciona de forma negativa con las
(2007) experiencias de abuso físico y no físico dentro
de la pareja.
Stoner et al. (2008) Experimental 161 mujeres comunitarias. SAS (Morokoff et al., 1997) (Į = Hay una relación negativa entre AS y
0,80). agresión sexual adulta y violencia de pareja.
Testa y Dermen (1999) Ex post facto 190 mujeres comunitarias. Health Protective Communication Las mujeres que han sufrido coerción sexual

!"#$ %$ &'("$ )*+'#,$ -./0,1'2$ 31'4$ 564$ 78$ 9

Scale (Catania, 1998). Asertividad informan de menor AS. Sin embargo, haber
relacionada con VIH (Į = 0,83). sufrido una violación no influye en la AS.
Testa, VanZile-Tamsen y Ex post facto 927 mujeres comunitarias. SAS-Rechazo (Morokoff et al., Bajos niveles de AS predicen la victimización
Livingston (2007) 1997) (Į = 0,77) sexual por parte de la pareja.
VanZile-Tamsen, Testa y Experimental 318 mujeres comunitarias. SAS-Rechazo (Morokoff et al., La victimización adolescente/adulta y el CSA
Livingston (2005) 1997) (Į = 0,77). se relacionan de forma negativa con AS-
Rechazo y ésta a su vez actúa como mediador
entre la resistencia directa o la no resistencia
ante una agresión.
Walker (2006) Ex post facto 447 mujeres universitarias. SAQ-W (Walker, 2006) (Į = 0,74- La AS mantiene una relación negativa con la
0,93) coerción sexual.
Yagil, Karnielli-Miller, Eisikovits Experimental 374 varones y mujeres Presentación de escenarios Las respuestas asertivas son más efectivas en
y Enosh (2006) universitarios. asertivos vs. no-asertivos. la reducción de avances sexuales no deseados.
Conductas de riesgo
Asertividad sexual: análisis de variables relacionadas e implicaciones clínicas

Artz, Demand, Pulley, Posner y Cuasi-experimental 1.159 mujeres comunitarias. Entrevista cualitativa. Las mujeres que tienen dificultades para
Macaluso (2002) introducir el condón femenino muestran
menores niveles de AS que aquellas sin
dificultades.
=>7?@=A!BCD=!>=$ /$ =!DEE>!" >.*F#(G(H+H$ .*IJ+'
 !"#$"% &'% -C("0(J+'*.$ C*.G'#+E1.$ E*$ '1.$ *.#GE(1.$ E*$ +.*C#(D(E+E$ .*FG+'$ K;:L4$ K&1"#4L4

Auslander, Perfect, Succop y Ex post facto 106 adolescentes varones y SAS (Morokoff et al., 1997). Las adolescentes con historia de embarazo
Rosenthal (2007) mujeres. previo inician más frecuentemente la
conducta sexual.
Un mayor número de parejas sexuales se
asocia con menor frecuencia de conductas
asertivas de rechazo.
Una mayor experiencia sexual previa, un
mayor número de parejas y un mayor número
de contactos sexuales desprotegidos se
relacionan con un menor número de
conductas de prevención de embarazo/ITS.
Baele, Dusseldorp y Maes (2001) Ex post facto 424 adolescentes varones y Escala ad hoc (6 ítems) (Į = 0,76).La AS se relaciona con la intención y la
mujeres: con experiencia sexual (n consistencia en el uso del preservativo en
= 165) y sin experiencia (n = 255). adolescentes con y sin experiencia sexual.
Bay-Cheng y Zucker (2007) Ex post facto 430 mujeres universitarias. Escala de Asertividad del SAQ No existen diferencias entre mujeres con
ideología feminista, igualitaria y no feminista
:;7<=:>!?@A:!;:$ /$ :!ABB;!" ;.*C#(D(E+E$ .*FG+'

(Snell et al., 1991) (Į = 0,90).

en su AS para el uso del preservativo.
Bertens, Eiling, Van den Borne y Cuasi-experimental 273 mujeres comunitarias Sexual Self-Efficacy Scale La intervención para la prevención de
Schaalma (2009) (Rosenthal, Moore y Flynn, 1991);ITS/VIH mejoró la AS de las participantes.
RBD (Witte, Cameron, McKeon y
Berkowitz, 1996).
Caruthers (2005) Ex post facto Dos muestras: 361 y 171 mujeres HISA (Hurlbert, 1991) (Į = 0,92 y Las mujeres en relaciones con pareja
comunitarias. 0,93). ocasional muestran menos AS que las
mujeres en relaciones estables.
Correlación negativa entre AS y edad de la
menarquia y religiosidad, y positiva con la
edad.
Crowell (2004) Cuasi-experimental 40 pacientes VIH positivo y 40 Intimate Relationships La AS se relaciona de forma positiva con el
VIH negativo. Questionnaire (IRQ) (Į = 0,90 – uso del condón en sexo oral, vaginal y anal,
0,91). con la frecuencia de comunicación sobre sexo
seguro y el deseo de comunicación sobre sexo
seguro.
DiNoia y Schinke (2007) Cuasi-experimental 204 mujeres adolescentes. Escala AS del SAQ (Snell et al., En el postest las mujeres que pasaron por el
1991) (Į = 0,80). programa de prevención del VIH (Keepin’ it
Safe) aumentaron su AS.
HI9

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155
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!"#$"% &'% -F("0(K+'*.$ F*.J'#+H1.$ H*$ '1.$ *.#JH(1.$ H*$ +.*F#(G(H+H$ .*IJ+'$ L>=M4$ L&1"#4M4 :;<

Dolcini y Catania (2000) Cuasi-experimental 209 mujeres con pareja en riesgo Sexual Assertiveness Scale (Kirby, Las mujeres con pareja de riesgo mostraron
sexual y 209 con pareja sin riesgo. 1998). 5 ítems (Į = 0,83). menos AS que las mujeres con pareja sin
riesgo.
Hardeman, Pierro y Mannetti Ex post facto 274 estudiantes universitarios y de 5 ítems que evalúan asertividad en Las mujeres muestran mayor asertividad
(1997) educación superior. las relaciones sexuales (Į = 0,44). sexual que los hombres.
La asertividad sexual es un predictor fiable de
la intención para evitar relaciones sexuales
casuales.
Jenkins (2008) Ex post facto 111 mujeres comunitarias. SAS (Morokoff et al., 1997) (Į = Las mujeres que no han tenido pareja
0,71 – 0,83). manifiestan menos AS-Rechazo que las que
han tenido una pareja.

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Correlación positiva entre las escalas Rechazo
y Prevención embarazo/STD.
Kelly, Lawrance, Hood y Experimental 104 varones comunitarios AS role play. La intervención con un componente de
Brasfield (1989) (homosexuales). entrenamiento en AS redujo el rechazo de
actividades sexuales de riesgo y conductas de
riesgo para el VIH/sida
Kelly, Murphy y Washington Experimental 197 mujeres comunitarias. AS role play. Las mujeres en el grupo experimental
(1994) mejoraron sus habilidades de comunicación y
negociación sexual.
Los contactos sexuales desprotegidos
disminuyeron y el uso del preservativo
aumentó de un 26 a un 56% en los contactos
sexuales.
Klein y Knäuper (2003) Ex post facto 71 mujeres universitarias. 14 ítems del Intimate Las mujeres con baja AS tienden a evitar
pensamientos relacionados con las ITS.
Asertividad sexual: análisis de variables relacionadas e implicaciones clínicas

Relationships Questionnaire
(Yesmont, 1992).
Morokoff et al. (1997) Instrumental Dos muestras de mujeres SAS (Morokoff et al., 1997). La AS se relaciona con una mayor
comunitarias: 503 y 714. autoeficacia en la prevención del VIH.
=>7?@=A!BCD=!>=$ /$ =!DEE>!" >.*F#(G(H+H$ .*IJ+'
 !"#$"% &'% -C("0(J+'*.$ C*.G'#+E1.$ E*$ '1.$ *.#GE(1.$ E*$ +.*C#(D(E+E$ .*FG+'$ K;:L4$ K&1"#4L4

Morokoff et al. (2009) Ex post facto 473 varones y mujeres SAS-prevención embarazo/STD La AS correlaciona de forma positiva con el
comunitarios. (Morokoff et al., 1997) (Į = 0,78) uso del condón, la fase de cambio para el uso
del condón y la ratio de sexo protegido.
Es un predictor significativo del sexo
desprotegido y ejerce un papel mediador entre
éste y la victimización sexual en hombres y
entre éste y la depresión y victimización
sexual en mujeres.
Mosack, Weeks, Sylla y Abbott Ex post facto 109 mujeres comunitarias. SAS-Prevención embarazo/STD La AS-prevención embarazo/STD es un
(2005) (Morokoff et al., 1997) (Į = 0,70) predictor de la intención de uso de
microbicidas en las relaciones sexuales.
Noar, Morokoff y Harlow (2002) Ex post facto 471 varones y mujeres SAS-Prevención embarazo/STD La AS-prevención embarazo/STD se
universitarios. (Morokoff et al., 1997) relaciona con diversas estrategias de
influencia para el uso del preservativo
(interrupción del sexo, petición directa,
:;7<=:>!?@A:!;:$ /$ :!ABB;!" ;.*C#(D(E+E$ .*FG+'

seducción, insistencia en la importancia de la

relación, información sobre el riesgo).
Noar, Morokoff y Redding (2002) Ex post facto Tres muestras: 272 y 152 varones SAS-Prevención embarazo/STD Existen diferencias en AS-prevención
universitarios; 62 varones en (Morokoff et al., 1997) (Į = 0,73- embarazo/STD en función de la etapa de
riesgo para el VIH. 0,78). cambio para el uso del condón; mayor AS
quienes lo usan de forma más consistente.
Los varones con mayor AS tienen menor
tendencia a involucrarse en actividad sexual
desprotegida.
Onuoha y Munakata (2005) Ex post facto 1.957 varones y mujeres 7 ítems derivados del Becoming A Tanto la AS como la asertividad social son
universitarios. Responsible Teen (BART; St. predictores de la evitación del VIH, siendo
Lawrence, 1998). mayor el efecto de la AS.
Parks, Hsieh, Collins, King y Ex post facto 241 mujeres comunitarias. SAS (Morokoff et al., 1997) (Į = Niveles bajos de AS-Embarazo/STD se
Levonyan-Radloff (2009) 0,66-086). relacionan con un menor uso del condón tanto
con parejas estables como ocasionales.
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157
Anexo
158
!"#$"% &'% -E("0(J+'*.$ E*.I'#+G1.$ G*$ '1.$ *.#IG(1.$ G*$ +.*E#(F(G+G$ .*HI+'$ K=<L4$ K&1"#4L4 :;;

Quina, Harlow, Morokoff, Ex post facto 816 mujeres comunitarias. SAS-Inicio y SAS-Rechazo La comunicación sexual asertiva sobre las
Burkholder y Deiter (2000) (Morokoff et al., 1997) (Į = 0,77 preferencias sexuales se relaciona más con
y 0,74, respectivamente). AS-Inicio que con Rechazo.
La comunicación sexual asertiva que busca
información en la pareja sobre su riesgo para
el VIH se relaciona más con la AS-Rechazo
que con Inicio.
Rickert et al. (2000) Ex post facto 904 mujeres comunitarias. 13 ítems que evaluaban Las mujeres con baja AS informan de un uso
asertividad sexual. inconsistente de mecanismos de control de
embarazo.
Roberts y Kennedy (2006) Ex post facto 100 mujeres universitarias. 11 ítems. Adaptación de Wingood La AS correlaciona de forma positiva con el

!"#$ %$ &'("$ )*+'#,$ -./0,1'2$ 31'4$ 564$ 78$ 9

y DiClemente (1998b) (Į = 0,77). uso del condón, mayor control sexual y la
Evalúa la habilidad de la mujer intención del uso del condón.
para sugerir usar el condón a su
pareja.
Sikkema, Winett y Lombard Experimental 43 mujeres universitarias. Entrenamiento cognitivo- El entrenamiento en habilidades sociales
(1995) conductual de habilidades sociales mejoró la asertividad sexual de los
para mejorar la AS. participantes y redujo el número de conductas
AS role play. sexuales de riesgo.
Snell y Wooldridge (1998) Ex post facto 253 varones y mujeres SAQ (Snell et al., 1991) Tanto en hombres como en mujeres la AS se
universitarios. Subescala AS. relacionó con un mayor uso de métodos
contraceptivos.
Somlai et al. (1998) Cuasi-experimental 114 varones y mujeres con AS Role play. Los participantes con menor AS mostraron
enfermedad mental severa. menor porcentaje de uso del condón, mayor
número de actos sexuales desprotegidos,
parejas sexuales diferentes y ocasionales.
Asertividad sexual: análisis de variables relacionadas e implicaciones clínicas

St. Lawrence et al. (1995) Experimental 246 varones y mujeres AS Role play. El programa de intervención que incluye
adolescentes. entrenamiento en AS disminuye los
intercambios sexuales desprotegidos y
aumenta el uso del preservativo.
Stoner et al. (2008) Experimental 161 mujeres comunitarias. SAS (Morokoff et al., 1997) (Į = Las participantes con menor AS insistían
0,80). menos en el uso del condón,
independientemente del grado de intoxicación
alcohólica.
<=7>?<@!ABC<!=<$ /$ <!CDD=!" =.*E#(F(G+G$ .*HI+'
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Stulhofer, Graham, Bozievic, Ex post facto 1.093 hombres y mujeres 3 ítems dicotómicos (Į = 0,52). Las mujeres muestran más AS que los
Kufrin y Ajdukovic (2007) comunitarias. hombres.
Sólo en el caso de las mujeres, la AS predice
de forma negativa las conductas sexuales de
riesgo.
Treffke, Tiggemann y Ross Ex post facto 83 hombres homosexuales y 128 Condom Assertiveness Scale AS para el uso del condón correlaciona de
(1992) heterosexuales comunitarios. (CAS) 26 ítems. (Į = 0,94). forma positiva con las actitudes positivas
hacia el uso del condón.
Weinhardt, Carey, Carey y Cuasi experimental 20 mujeres con trastornos Escenarios de role play Las mujeres que recibieron el entrenamiento
Verdecias (1998) psiquiátricos. Entrenamiento en AS (Kelly, en AS mejoraron su AS del pre al post y en
1995). seguimiento. Además mejoraron la frecuencia
de sexo desprotegido.
Weinstein, Walsh y Ward (2008) Ex post facto 347 varones y mujeres HISA (Hurlbert, 1991) (Į = 0,92). La AS se relaciona de forma positiva con
universitarios. mayor conocimiento sobre contracepción, uso
del preservativo, ITS, VIH/sida.
128 mujeres comunitarias. 7 ítems que evalúan su capacidad La AS se relaciona con un uso consistente del
:;7<=:>!?@A:!;:$ /$ :!ABB;!" ;.*C#(D(E+E$ .*FG+'

Wingood y DiClemente (1998a) Ex post facto

de comunicarse asertivamente con condón en mujeres.
sus parejas sexuales (Į = 0,77).
Workman, Robinson, Cotler y Experimental 111 mujeres adolescentes. AS y habilidades de Las adolescentes afroamericanas mostraron
Harper (1997) comunicación. mayores niveles de AS que las hispanas.
Sexual Assertiveness Scale (Kirby,
1984) (Į = 0,78).
Yesmont (1992) Ex post facto 253 varones y mujeres Intimate Relationships Las mujeres muestran más respuestas
universitarios. Questionnaire (IRQ). asertivas que los varones.
La AS correlaciona con la precaución,
preguntas a la pareja sobre conductas de
riesgo, y el uso del preservativo.
Zamboni, Crawford y Williams Ex post facto 227 varones y mujeres SAQ (Snell et al., 1991). La AS es el principal predictor de la
(2000) universitarios. frecuencia del uso del condón en sexo
vaginal.
Correlaciona con asertividad general y
comunicación sexual.
La relación entre AS y uso del condón está
mediada por las actitudes hacia el
preservativo; la relación es positiva cuando
las actitudes hacia el condón son positivas.
HIJ

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159
Anexo
Asertividad sexual: análisis de variables relacionadas e implicaciones clínicas

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160
 Anexo

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161
Asertividad sexual: análisis de variables relacionadas e implicaciones clínicas

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162
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163
Asertividad sexual: análisis de variables relacionadas e implicaciones clínicas

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173
Asertividad sexual: análisis de variables relacionadas e implicaciones clínicas

!"#$%&#'()*+&,(-.(/&,"0$(0//&#')1&*&// 23

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174
 Anexo

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175
Asertividad sexual: análisis de variables relacionadas e implicaciones clínicas

!"#$%&#'()*+&,(-.(/&,"0$(0//&#')1&*&// 23

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176
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