Sexuality Research & Social Policy

Journal of NSRC http://nsrc.sfsu.edu

March 2009 Vol. 6, No. 1

Sexual Satisfaction in Committed Relationships

Pepper Schwartz, Linda Young

Abstract: This article provides an overview of the recent interdisciplinary research on the connection
between sexual satisfaction and overall relationship happiness for couples. The authors discuss the
literature on same- and opposite-sex couples and, cognizant of gender, race, and class differences,
state a case for how specific aspects of sexuality, such as frequency of sex, emotion, and orgasm, affect
individual and couple satisfaction.

Key words: sexuality; couples; commitment; intimacy; relationship happiness

This article seeks to explain how sexual satisfaction assessment model. Following these traditions—and be-
is created in committed relationships and how sexual sat- cause we are reviewing previous research rather than
isfaction or dissatisfaction affects relationship happiness doing our own—we will look at sexual and relationship
and durability. Defining the terms is an important part satisfaction as subjective assessments. In a few cases we
of this endeavor; however, the ability to do so is some- will consider negative subjective assessments (e.g., de-
what limited. For example, the word satisfaction can be pression or sadness), but for the most part we are inter-
defined in various ways and satisfaction may mean dif- ested in the correlations between sexual behavior, other
ferent things to different people. Nonetheless, because relationship behavior, and partners’ feelings about their
of a presumption that everyone knows what it means to sexual life and relationship as a couple.
say that someone is satisfied or dissatisfied, much of the
Why Is Sexual Satisfaction
literature on sexual satisfaction and relationship satis-
Important to Relationships?
faction never really defines the word. In most instances,
the measure of satisfaction is merely a question: How Without referring to the nonsexual satisfaction and
satisfied are you with your sex life together? Or, in ref- happiness literatures, people intuitively know what re-
erence to another assumed understanding, researchers searchers have discovered: Satisfaction and happiness
might ask, How happy would you say you are with your are correlated with mental and physical health. Further-
relationship right now? (McNulty & Fisher, 2008). more, research (Blumstein & Schwartz, 1983; Henderson-
The idea here is that a subjective assessment using King & Veroff, 1994; Kurdek, 1991; Lawrence & Byers,
open-ended questions is a better indicator of satisfaction 1995) has shown a general correlation between sexual
than a set of closed-ended questions, such as those that satisfaction and relationship satisfaction in both same-
might be used in a clinical test for depression (e.g., Do and opposite-sex couples. However, just as researchers
you wake up in the morning ready and willing to face the are not exactly sure which aspects of daily life produce
day?; Do you think your life is worse, average, or better personal happiness, they remain a bit hazy—though not
than that of the people you know?). These latter kinds of clueless—on exactly what contributes to people’s sexual
assessments are more or less unknown in the sexual sat- satisfaction. Research has indicated, for example, that
isfaction literature. Indeed, large-scale studies on general sexual dissatisfaction is correlated with extramarital
happiness (e.g., Yang, 2008) also follow the subjective sexuality (Bringle & Buunk, 1991) and that extramarital

Address correspondence concerning this article to Pepper Schwartz, Department of Sociology, University of Washington,
Box 353340, Seattle, WA 98195. E-mail: [email protected]; Linda Young, Campus Office Park, 1601 116th Avenue
NE, Suite 102, Bellevue, WA 98004. E-mail: [email protected]

Sexuality Research & Social Policy: Journal of NSRC, Vol. 6, Issue 1, pp. 1–17, electronic ISSN 1553-6610. © 2009 by the
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sexuality places both same-sex and opposite-sex couples 1994), has increased individual expectations about sexu-
at higher risk for dissolution (Blumstein & Schwartz). ality and has provided a comparative framework for as-
Mutual monogamy is a cultural mandate in the sessing one’s partner’s abilities as a lover. At the same
United States, Canada, most of Europe, and many other time that sexual satisfaction is being touted as a right, it
parts of the world. Mandated monogamy for women is being glamorized in various media outlets. The result:
is almost universal. Research conducted in the United Individuals’ own basis of comparison has likely given
States (Laumann, Gagnon, Michael, & Michaels, 1994) way to even higher standards for the quality of sexuality
has indicated that more than 85% of both men and in their relationships. These expectations may be dashed
women believe that any committed relationship—but if certain aspects of sex, such as frequency of intercourse
especially marriage—requires monogamy. The findings or amount of affectionate behavior, are perceived as de-
that nonmonogamy is stigmatized and creates risk of ficient. By examining existing research, we seek to deter-
crisis in relationships, plus the fact that the chances for mine what troubles or supports sexual satisfaction and
nonmonogamy are higher when couples are dissatisfied how those factors affect couples’ short- and long-term
with their sexual relationship, are powerful reasons to happiness, as well as their continuing commitment to
pursue more information about what produces sexual each other.
satisfaction within relationships. To that end, this article takes a closer look at the
Furthermore, we believe that sexuality has become a elements of personal expectations, sexual performance,
much more important factor in people’s self-assessment identity, gender, desire, and values that affect sexual
of personal happiness. Although not applicable to all satisfaction for individuals and couples. We also review
parts of the world, in advanced capitalist societies such literature indicating what outside forces might make
as the United States, Japan, Australia, and Europe, meeting sexual expectations harder or easier, as well as
sex—as marketing people so often say—sells. The aver- research examining other aspects of couples’ lives that
age citizen is barraged with ads that link products with affect sexual satisfaction.
sexual success and even with sexual adequacy. This
The Beginning: Sexual Expectations
message can be subtle—or not: P. Diddy, a popular per-
former and musician, advertised his new line of clothes Sexuality is one of the defining properties of a ro-
on the May 18, 2008, edition of CBS Morning News as mantic relationship. Of course, sex can be defined in a
fashion Viagra (Spoil The Ending, 2008). The market- number of ways, but most committed couples will have
ing of most products as sexual aids (e.g., a 2008 Cadillac had sexual intercourse or engaged in genital stimulation
commercial tag line: When you turn your car on, does it at some time in their relationship. The expectation of hav-
return the favor?) means that even morally conservative ing sex is almost at the core of the meaning of marriage
people cannot avoid media messaging that links sexual- and is one of a few criteria that separate marriage from
ity with the so-called good life. a friendship or a roommate relationship. The wedding
Leonore Tiefer’s (2001) analysis of this situation night may no longer be the first time most couples make
went even deeper: She wrote that sexuality is now de- love in Western societies, but it is certainly expected that
fined as the core of people’s identity and has been made sex will occur on that night and on succeeding others
synonymous with competent enactment of masculinity (McNulty & Fisher, 2008). Even under conditions of ex-
and femininity. In other words, given the emphasis on treme departure from the original marital contract—for
sexuality as part of social success, cultural capital, self- example, when one partner has Alzheimer’s disease—the
worth, and gender normality, it is hard to imagine that expectation of continued sex between married partners
sexual satisfaction could be anything but important to might be sustained (Wright, 1993).
personal and relationship happiness. In fact, to go a bit Committed couples (heterosexual, lesbian, and gay,
further, we believe that good sex—and, perhaps, great whether married or cohabiting) have more sex than di-
sex—has become one of adult men’s and women’s expec- vorced or single people (Blumstein & Schwartz, 1983;
tations in life. This expectation becomes especially poi- Laumann et al., 1994; Wellings et al., 2006). This higher
gnant in long-term committed relationships. rate may be due to the proximity of the sexual partner or,
Finally, we also believe that the surfeit of sexual in- perhaps, because commitment itself increases desire in
formation provided via movies, books, and Internet sites, some people. Another possibility is that living together
as well as the almost universal experience of premarital certifies seriousness of intent and, in the case of mar-
sexual experience by the age of 21 in the United States riage, invokes expectations of regular sexual access that
and other industrialized countries, (Laumann et al., make partners more likely to surrender to the sexual

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obligations of the relationship. Research has shown that that women in committed relationships find sexual fre-
couples become unhappy when sexual access declines: quency unimportant. For example, some researchers
Cohabiters are particularly unhappy if genital sexuality (Fassinger & Morrow, 1995; Loulan, 1988) have argued
decreases in frequency or disappears altogether (Blum- that genital sexuality is not as important for women’s
stein & Schwartz). One explanation of their greater sensi- sexual or relationship satisfaction as it is for men’s. A
tivity to the regularity of sexual contact is that cohabiters national study of 398 Black lesbian couples (Peplau, Co-
might represent the least committed of the four kinds of chran, & Mays, 1997) reported that 11% had sex three
committed relationships (married, cohabiting, lesbian, times a week, 47% one to three times per week, and 41%
and gay). Thus, a decrease in sexual interaction for co- less than once a week. Using a different unit of calcula-
habiters might indicate that one or both partners are tion, Blumstein and Schwartz (1983) reported that 76%
withdrawing from the union. For couples with the great- of lesbian couples that had been together up to 2 years
est security (i.e., those who have taken explicit vows or had sex one to three times a week, 37% of those together
would take such vows if that were possible), perhaps sex- 2 to 10 years had sex that often, and 27% of lesbian
ual frequency can be more irregular or less predictable couples together 10 years or more maintained that rate
than for cohabiting couples. It is important to note that of sexual connection. Lever (1995) also found steep de-
many cohabiting gay and lesbian couples are as commit- clines in sexual frequency in lesbian couples over time.
ted as married couples but are unable to legally marry. Are these rates of decline more acceptable for women
than they are for men? Further investigating whether
The Importance of Sexual Frequency to the
sexual frequency is important for men and less so for
Well-Being of the Relationship
women, as well as if it is important for gay men but not
Whereas cohabiters may be particularly sensitive for lesbians, requires looking more closely at the litera-
regarding sexual frequency, the fact is that all couples ture on sexual frequency.
expect to have a reasonable amount of sex in their rela-
Factors Affecting Sexual Frequency
tionship. Although those expectations may not be voiced
at the beginning of a relationship, some couples become Unarguably, one of the most studied aspects of
less satisfied with their sex life when frequency dimin- couples’ sexual behavior is coital frequency. Although
ishes over time (Bozon, 2001). However, the correlation not necessarily the most important aspect of couples’
between sexual frequency and satisfaction is more com- sexual pleasure, coital frequency is the easiest fact to re-
plex than immediate observation might suggest. For all call (at least in the short term) and is simpler to measure
couples, the frequency of genital sexual contact will de- than other, less noticeable elements of couples’ sexual-
crease over time. For example, in the American Couples ity (Bozon, 2001). The findings, remarkably consistent
Study, Blumstein and Schwartz (1983) found that in the across studies, have shown a strong correlation between
first 2 years of a relationship, 67% of gay male couples, sexual satisfaction and sexual frequency (Blumstein &
45% of heterosexual married couples, and 33% of lesbian Schwartz, 1983; Laumann et al., 1994; Peplau, Finger-
couples had sex three times a week or more. With time, hut, & Beals, 2004). This result makes sense because it is
however, came a big drop-off: After a decade, only 11% of unlikely that most couples would continue to have a lot
the partnered gay men, 18% of the married couples, and of sex if it were unsatisfactory; however, another expla-
1% of the lesbian couples had sex that often. Although the nation may be that frequency of sex itself raises the level
figures for gay men are a bit deceptive—a large majority of of receptivity, desire, and ease of reaching orgasm. A
those men in a coupled relationship in 1983 and a signifi- number of studies (Blumstein & Schwartz; Peplau et al.,
cant number more recently (Wagner, Remien, & Carballo- 2004; Richters, Grulich, Visser, Smith, & Rissel, 2003)
Dieguez, 2000) supplemented their sex lives with outside all found this association of satisfaction and frequency
partners—the fact that a majority of the married, cohab- among heterosexual married and cohabiting couples,
iting heterosexual, and lesbian couples remained intact gay men, and lesbians.
even with much-diminished monogamous sexual lives
Does Gender Make a Difference?
could indicate that frequency was not so important for
overall sexual or relationship satisfaction. As we suggested previously, quite a bit of research
Is sexual frequency, then, not important for rela- has indicated that gender makes a difference when it
tionships in the long run? Are there other indicators that comes to sexual satisfaction and frequency. In the Rich-
a moderate to high frequency of sexual contact is unim- ters et al. (2003) study, men’s ideal frequencies were
portant in long-term relationships? Evidence suggests significantly higher than women’s (83% of men versus

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69% of women wanted sex between two times a week not only had more sexual activity than lesbians but also
and once a day). Whereas nearly a quarter of the men rated genital sexuality as being more important in their
wanted to have sex on a daily basis, only 8% of women relationship. The authors hypothesized that the pres-
desired sex that often. In addition, men were more likely ence of a male partner changed both the practice and
than women to have had sex four times a week in the the meaning of sexuality for women; the context of the
previous month. In another study (McNulty & Fisher, relationship and the gender of a partner affected female
2008), changes in sexual frequency predicted changes in sexual desire and practice. Like the men in the study,
sexual satisfaction for newlywed husbands, but not for women also showed continuities across couple type, but
their wives. These findings, as well as those of the other couple type definitely had an impact on women’s actions
aforementioned studies, seem to support the idea that and attitudes regarding sexual frequency.
men value the quantity of sexual engagement more than
Does Age Make a Difference?
women do.
Still, some factors need to be considered. For exam- Age certainly affects the amount of sex that people
ple, McNulty and Fisher (2008) found that a majority of have. Sexual frequency sometimes is used as a surrogate
both male and female respondents in their study wanted variable for assessing older people’s health, biological
more sex than they were getting. In this sample, ideal functioning, and energy levels (DeLamater & Sill, 2005).
frequency was closer to actual frequency for women than However, after taking such factors into account, age
for men, but women still had some unmet needs. Does continues to have a strong independent negative impact
this association of gender and sexual frequency bespeak on sexual frequency (Call et al., 1995). Looking at long-
a biological difference? This question is currently unan- term married couples, Call and colleagues found that de-
swerable, but sociological and psychological data (see creases in sexual intercourse occurred most dramatically
Gagnon & Simon, 1973; Giddens, 1992; Tiefer, 2004) in those ages 56–70. For men, the decrease in sexual ac-
might suggest that some of the male-female differences tivities was significantly related to a decrease in libido
in demand for sex could stem from relationship issues and erectile function. However, the incidence of low li-
and female socialization. Later on in this article, we will bido in the men over age 75 (17%) was less than half that
examine some of the variables that might lend weight to of the group of postmenopausal wives. For these women,
a nonbiological interpretation of these findings. In the the onset of menopause (rather than age alone) appeared
next section, we will discuss another possible cultural to have the greatest impact. Postmenopausal women
and social explanation: whether the kind of relationship who were not on hormone replacement therapy (HRT)
people are in affects sexual frequency. had a much higher incidence of low libido, vaginal dis-
comfort or pain (dyspareunia), and vaginal dryness than
Does Couple Type Make a Difference?
younger women. (When women were on HRT, the dif-
Using the National Survey of Families and House- ference between older and younger women was negligi-
holds, Call, Sprecher, and Schwartz (1995) examined the ble). The results of a large study of Singaporean men and
coital frequency of married and cohabiting couples and women (Goh, Tain, Tong, Mok, & Ng, 2004) support the
found that married couples had sex at a mean frequency fact that menopause without estrogen replacement may
of 6.3 times per month whereas cohabiters had sex at be operating as an additional inhibiting factor of sexual
a mean frequency of 11–13 times per month. Blumstein frequency in older women. This study found that women
and Schwartz (1983) also found significant differences between the ages of 33 and 55 had sexual intercourse an
between married and cohabiting heterosexual couples, average of five or six times a month, but subjects over the
as well as between gay couples and lesbian couples. Part- age of 55 had sex only three times a month.
nered gay men started out with the highest sexual fre- In the study by Call and colleagues (1995), couples
quencies and lesbian couples started out with the lowest, under the age of 24 had a mean frequency of 11.7 coital
which became even lower over time. acts per month, and this frequency reduced for each
Although gender continuity regarding sexual fre- ensuing age group. Couples in the oldest age group (75
quency was apparent in Blumstein and Schwartz’s (1983) and older) reported having sex less than once a month.
study—compared with the women, the men in the study However, considering only those in this age category
wanted a higher sexual frequency and believed that fre- who were sexually active, the figures improved: Sexual
quency was more important for sexual satisfaction— frequency increased to about three times a month. These
findings also showed differences between women based findings are similar to those of several other studies (Ca-
on couple type. Women in heterosexual relationships lamidas, 1997; Clements, 1996; Laumann et al., 1994;

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Richard, 2001). A 1998 National Council on the Aging effects also have been shown to reduce sexual frequency
study with a random sample of 1,292 men and women in in gay male couples and lesbian couples (Blumstein &
their 60s, 70s, and 80s found that almost half of the re- Schwartz, 1983).
spondents, whether partnered or not, engaged in sexual
What Is the Impact of Relationship
activities of some kind at least once a month.
Factors, Children, and Work?
Because increasing age does seem to be indepen-
dent of the duration of a relationship as a factor for a Common sense says that elements of people’s day-
less frequent sex life (Blumstein & Schwartz, 1983; Call to-day lives are likely to affect sexual frequency. Although
et al., 1995), one might expect to find more sexual dissat- no studies have systematically compared how a variety
isfaction in older couples regardless of the length of re- of exogenous factors affect a couple’s sexual frequency, it
lationship. However, such dissatisfaction does not seem is clear that the entry of a child into a couple’s life almost
to be inevitable. There is a honeymoon effect—a time always affects their sexual life. Once they have a child,
when the newness of a relationship promotes desire—on couples have less opportunity for spontaneous sexual
couples of any age (Call et al.), and new sexual aids (e.g., encounters, and even their planned time together may
HRTs and erectile dysfunction drugs—see George, 2004; be disrupted by a child’s needs. Hyde, Delamater, Plant,
Kingsberg, 2005; Wyllie, 2003a, 2003b) may make a big and Byrd’s (1996) longitudinal study of 570 pregnant
difference in terms of how older couples feel about their women found that the presence of children negatively
sexual relationship (Althof et al., 2006). Masters and affected coital frequency. In this study, couples had sex
Johnson (1966) stated that many of the older couples an average of four to five times per month during preg-
they studied enjoyed sex and had no problems having nancy, but in the month postpartum, most couples had
sex as long as they had never stopped having it. The Na- little or no sex. This finding was most likely related to the
tional Council on the Aging (1998) study found that 70% physical impact of birth on a woman’s body. However,
of older adults who were sexually active rated their sex other factors also must have contributed: Sexual fre-
lives as very satisfying. Still, factors associated with ag- quency remained reduced when couples resumed sexual
ing do decrease sexual frequency and may cause issues intercourse at about 2 months postpartum. After having
for some relationships. a child, the frequency of sexual intercourse remained di-
minished indefinitely for most couples.
Does Habituation Take Its Toll on
These findings are consistent with a cross-national
Sexual Frequency?
study from a sample of Swedish first-time parents
The length of time that people have been together 6 months after delivery (Ahlborg, Dahlof, & Hallberg,
has its own independent effect on sexual frequency, an 2005). In this study, 820 parents (768 couples) in their
outcome that shows up almost immediately. The flipside early 30s reported on their sexual lives. Of the respon-
of the honeymoon period early in a relationship, when dents, 91% of the fathers and 10% of the mothers worked
newness fuels desire and couples take the time to inter- outside of the home, with fathers averaging a 40-hour
act sexually three or more times a week, is a dramatic di- week and mothers working an average of about 15 hours
minishment of response and behavior after about 1 year. per week. Based on the Dyadic Adjustment Scale, which
Call et al. (1995) found that married couples had a sig- was used to describe the quality of their intimate re-
nificantly higher sexual frequency during their 1st year lationship, the majority of the new parents were very
together than at any time thereafter. This finding did happy with their relationship. Fathers were more satis-
not apply to young couples, but even for young people, fied than mothers, but more fathers (33%) than moth-
sexual intercourse became much less frequent after a ers (13%) also reported being stressed. Both fathers and
couple’s 2nd year together. Apparently, the duration of a mothers reported that “being too tired for sexual activ-
relationship is quite a powerful variable: This finding of ity” (Ahlborg et al., p. 171) was a problem, although more
less frequent sex after 1 or 2 years is not limited to mar- mothers (47%) than fathers (38%) reported fatigue. Cou-
ried couples. A Canadian study (Gossman, Mathieu, Ju- ples remained affectionate, with the majority of parents
lien, & Chartrand, 2003) of 101 Caucasian married and reporting daily kisses and caresses. However, fathers
cohabiting heterosexual couples indicated that sexual were less satisfied than mothers with the frequency of
frequency for cohabiters also declined after their initial intimate contact.
years of living together. Shorter durations of cohabita- In the Ahlborg et al. (2005) study, sexual activity
tion were related to higher sexual initiation, sexual ac- resumed about 3 months postpartum, but couples re-
tivity, and sexual satisfaction (Gossman et al.). Duration ported that sex occurred less often than desired. Sexual

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frequency averaged once to twice per month; both men the time and energy expended for work, as well as work-
and women stated that they were discontented or only related stress (Hochschild & Machung, 1990). Not too
partly content with the sexual situation. Predictably, many studies have systematically examined the direct
more fathers (46%) were discontented than mothers relationship of work on sexual frequency and behavior.
(36%)—probably because fathers reported feeling sexual Two studies, however, called into question the supposi-
desire once a day to twice a week, whereas mothers re- tion that work and the intensity of work-related issues
ported desiring sex once a week to once a month. Once inevitably affect sexual frequency. Hyde, DeLamater, and
again, although sexual frequency increased 3 months Hewitt (1998), in a study of 570 racially diverse women
postpartum, it did not return to its prebirth level. Per- and their husbands before pregnancy, during pregnancy,
haps even more telling is the fact that some studies and 1 year postpartum, found no significant differences
(DeJudicibus & McCabe, 2002; Elliott & Watson, 1985; in sexual frequency between homemakers and women
Kumar, Brant, & Robson, 1981) have found great changes who were employed part time (20 hours or fewer per
in women’s sexual satisfaction after pregnancy: A signifi- week), full time (40 hours a week), and high full time
cant percentage of women in these studies said that they (more than 40 hours a week). In this study, dual-career
enjoyed intercourse less after having a child. Few studies couples had no less of a sex life than full-time homemak-
comment on men’s sexual satisfaction after the birth of ers and their husbands. Interestingly, for both men and
their child. women, the perceived quality of their work experience
These findings make clear that the early months post- was a better predictor of sexual satisfaction than the
partum require a personal transition that has an impact number of hours worked (Hyde et al.).
on a couple’s relationship. Although relationship satisfac- According to the work of Call et al. (1995), fatigue
tion is often high after the birth of a child, fatigue and var- (whether produced by hours of work, dissatisfaction
ious kinds of lifestyle adjustments affect couples’ sexual with work, or work-related stress) was also statistically
desire and sexual opportunity. Without some planning, correlated with less satisfaction and sexual frequency
effort, and commitment to having a good sex life, sexual about equally for both employed women and homemak-
frequency can decline precipitously after the birth of a ers. However, the connection between work-related is-
child. As the months pass and sexual frequency does not sues and coital frequency is not entirely clear: Some
rise to previous levels, some men and women undoubt- large, well-researched data sets (e.g., Jasso, 1985; White
edly become frustrated and angry. Cowan and colleagues & Keith, 1990) have shown that issues related to work do
(1985) discovered that new parents were more likely to suppress a couple’s sex life. Perhaps much of this appar-
report increased conflict and less likely to see themselves ent contradiction can be explained by the fact that Hyde
as lovers in their relationship than couples of the same et al.’s study did not investigate what specific elements
age who did not have children. Meyerowitz and Feldman of work, or feelings about work, might be antagonistic to
(1966) found that postpartum, couples reported more sexual frequency and satisfaction. One important factor
complaints of sexual and emotional incompatibility. to add into this equation, for example, is how much ac-
As part of pregnancy counseling, physicians or tual work-related stress partners are experiencing. Con-
other health care professionals should encourage cou- tinuing job stress has been found to have a strong impact
ples to discuss possible changes to their sexual life with on couples’ lives (Perry-Jenkins, Repetti, & Crouter,
the birth of the child. Without some understanding and 2000) and lifestyle stress in general has been shown
resolution of frustrations, differences in desire and avail- to affect sexual frequency (Goh et al., 2004; Otis, Ros-
ability for sexual intercourse can become a continuing tosky, Riggle, & Hamrin, 2006). In the Goh et al. study,
issue in a couple’s life (Haugen, Schmutzer, & Wenzel, approximately 26% of the men and 56% of the women
2004). An abundance of research has indicated that the wanted more frequent sex but reported that increased
presence of children in the home negatively affects both stress inhibited ideal levels of sexual frequency.
sexual frequency and satisfaction. For example, a study
How Much of a Couple’s Lower
of African American marriages (Henderson-King & Ver-
Sexual Frequency Is Due to Health,
off, 1994) found that couples with children had less co-
Mental Health, and Biological Issues?
ital frequency and a lower evaluation of their sex life.
Although having a child is a particularly demanding Completing this overview on variables that affect
transition for couples, sexual frequency obviously also is sexual frequency requires looking at issues that are re-
affected by the challenging exigencies of everyday life. lated not to status variables (e.g., age, duration, hours
The most common and constant issue for most couples is worked) but rather to issues that concern the health

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or biological makeup of one or both partners in a cou- women (e.g., vaginal dryness, hot flashes) make coitus
ple. Social science has a tendency to ignore biologi- less appealing until those conditions are ameliorated.
cal variables, but more than a little evidence indicates Gallicchio et al. (2007) measured the estrogen and an-
that health issues can inhibit the number of coital acts. drogen levels of 45- to 54-year-old women transitioning
For example, an article by Laumann, Paik, and Rosen into menopause and found that low sexual satisfaction
(1999) on sexual dysfunction indicated a number of was unrelated to hormone levels but positively cor-
medical complications that can affect sexual frequency. related with poor (self-reported) health and depres-
Problems that increase with age but may also be pres- sive symptoms. In any case, personal health, medical
ent among younger individuals—such as diabetes, high interventions, and individual psychological reactions
blood pressure, cancer, and heart-health issues—often to these conditions are important predictors of sexual
require medicines that blunt or extinguish sexual desire frequency.
or even ability. No good information is available on how
How Do Other Aspects of Sexual
much coital frequency is diminished by health issues,
Functioning Affect Couples’
but studies on the interaction of these conditions and
Sexual and Relationship Satisfaction?
sexual functioning (Avis, Crawford, & Johannes, 2002;
Jensen & Soren, 1986; Laumann & Michael, 2001) have Many studies (Blumstein & Schwartz, 1983; By-
indicated that frequency is affected. ers, 2005; Costa & Brody, 2007; Deenen, Gijs, & Van
Drinking alcohol, smoking, and using drugs are Naerseen, 1994; Gossman et al., 2003; Kurdek, 1991;
other factors that, over time, will negatively affect sexual Peplau et al., 1997; Sprecher, 2002; Yeh, Lorenz, Wick-
desire and sexual frequency (Kolodny, Masters, & John- rama, Conger, & Elder, 2006) have shown a strong cor-
son, 1979; Maurice, 1999). Certainly stress is implicated relation between relationship happiness, sexual activity,
in lower sexual desire for many people. Bancroft (2002) and sexual satisfaction for both same- and opposite-sex
argued that inhibited sexual desire is often a reasonable, couples. Specifically, we have considered sexual fre-
adaptive response to stress, fatigue, or even threatening quency as a surrogate for sexual activity because it is
behavior from a partner. In a nationally representative well researched—although we know that other measure-
study of 987 women ages 20 to 65, Bancroft, Loftus, and ments might be even more illustrative. The bottom line
Long (2003) found that one quarter of the women in is, sexually active heterosexual and gay and lesbian cou-
their sample clearly had been distressed about their re- ples are happier than couples who are not sexually active
lationship or their own sexuality in the previous month. (Deenen et al.; Kurdek, 1991, 1998).
Bancroft et al. concluded that problematic physiological
functioning in women, such as lack of arousal, lubrica- Specific Issues That Affect Couples’
tion, or orgasm, was mostly correlated with relational Satisfaction and Relationship
causes.
Orgasm
Still, many scholars (e.g., Caporael & Brewer, 1991;
Laumann, Paik, & Rosen, 1999; Milsten & Slowinski, In addition to sexual activity itself, the outcome of
1999) think that biology—for example, genetic program- sexual activity has an impact on couples’ satisfaction.
ming or hormones—can be the culprit in reduced sexual Using a multiple regression analysis of 417 heterosexual
desire and behavior. Researchers often look to endocrine females and 179 heterosexual males in long-term rela-
causes for female sexual inhibition (e.g., Kronenberg, tionships, Haning and co-researchers (2007) found that
1994). So far, however, attempts to find a biochemical having an orgasm best predicted sexual satisfaction. Fre-
answer to sexual desire problems in women have been quency of a person’s own orgasm and frequency of the
inconclusive (see Davis, Davison, Donath, & Bell, 2005; partner’s orgasm were also predictors of sexual and rela-
Kaplan et al., 1999). Nonetheless, hormones are seen tionship satisfaction in a large, diverse study of 797 mar-
as an important aspect of sexual drive for both men ried women and men ages 20–60 living in the United
and women. The role of hormones has been especially States (Young, Denny, Luquis, & Young, 1998).
prevalent in discussions about sexuality and menopause
Body Image and Sexual Confidence
(less so in the few discussions of andropause, the male
counterpart of menopause). Studies on menopause (e.g., Body image has been shown to be related to sexual
Love, 2003) are contradictory about whether hormonal desire and sexual satisfaction. In a Canadian study on
changes cause less interest and less sexual frequency for cohabiting couples (Gossman et al., 2003), people’s as-
women or if issues associated with menopause in some sessment of their own sex appeal was one of the main

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variables that affected levels of sexual activity and sat-

Matched Sexual Desire and
isfaction. Koch, Mansfield, Thurau, and Carey (2005)
Compatibility of Emotional Needs
investigated the association between sex appeal, sexual
frequency, desire, and satisfaction in their study of 307 Available data clearly indicate that severely disparate
midlife women (ages 39–56). Participants were pre- desire patterns have a negative impact on sexual and rela-
dominately White and well-educated; the majority were tionship satisfaction. A study by Davies, Katz, and Jackson
married or had a live-in partner. Although 72% of the (1999) showed that scores indicating discrepancy of part-
women were physically and emotionally satisfied with ners’ desire early in a marriage definitely affected future
their sexual relationships, the less attractive a woman marital happiness. In their study of young women in re-
perceived herself to be, the more likely she was to re- lationships averaging 2 years in length, scores indicating
port a decline in sexual response or activity (measured differences in desire were both negatively correlated with
by less frequent sex, less enjoyment of sex, and less de- sexual and relationship satisfaction. On the other hand,
sire for sex). For men this connection is less clear, but couples’ desire-discrepancy score was not significantly re-
the literature on gay men (e.g., Levesque & Vichesky, lated to men’s relationship and sexual satisfaction. Still,
2006) has emphasized the importance of looks, as well men who recognized sexual discrepancies between them-
as penis size, on body image. One could hypothesize selves and their partners had lower levels of relationship
that some of these standards might create feelings of satisfaction. In addition, women with less desire than
insecurity or unworthiness that could undermine men’s their partners had significantly lower levels of sexual and
sexual pleasure or sexual functioning even in a commit- relationship satisfaction that women who had similar or
ted relationship. more sexual desire than their partners. For both men and
women, the effects of unequal sexual desire on relation-
Duration of Sexual Contact
ship satisfaction was fully mediated by levels of sexual
In the Call et al. (1995) study, duration of sexual satisfaction, suggesting that discrepancies in sexual desire
contact had no impact on sexual satisfaction. Miller and affect relationship satisfaction only to the extent that such
Byers (2004), however, found that actual and desired discrepancies specifically affect sexual satisfaction.
duration of foreplay and intercourse affected couples’ A study of 54 married women with low sexual desire
sexual satisfaction. In a study of 152 primarily White (Hurlburt, Apt, Hurlburt, & Pierce, 2000) examined the
heterosexual couples (ages 21–76) in long-term rela- relationship between sexual compatibility and women’s
tionships, the authors asked participants how long they daily ratings of sexual desire and motivation. Not sur-
would like foreplay and intercourse to last and how long prisingly, sexual desire and motivation for sexual con-
they thought their partner wanted foreplay and inter- tact were strongly linked to sexual compatibility. More
course to last. Partners were also asked to rate their satis- interesting is that sexual compatibility was related more
faction with their sex life as a couple. Men’s and women’s to desire and motivation for sex than to marital satis-
estimates of actual duration of intercourse were similar, faction or depression. Apt, Hurlbert, Pierce, and White
and both men and women felt that actual foreplay and (1996) found that women in sexually compatible mar-
duration of intercourse were significantly shorter than riages anticipate that the sexual encounter will be sat-
their ideal level of sexual interaction. Interestingly—and isfying and therefore are more highly motivated to have
counterintuitively—the discrepancy between ideal and sex than women in sexually incompatible marriages.
real duration of foreplay and intercourse was not corre- In same-sex relationships, much of the same logic re-
lated with either people’s own or their partner’s sexual garding sexual compatibility applies. Kurdek (1991) found
satisfaction. This finding indicates that although qual- that sexual satisfaction was related to unified views on
ity of sexual interaction must be important, duration is fidelity, willingness to try new techniques and behaviors,
not necessarily important for perception of high quality. and the belief that one had sexually satisfied one’s partner.
Miller and Byers hypothesized that differences in actual Lever’s 1995 study of lesbians found that 91% of the women
and desired duration of foreplay and intercourse might said they loved kissing, caressing, and cuddling, with 82%
be a problem if sexual engagement were significantly putting French kissing into this category. In addition, 74%
shorter or longer than the average 12 minutes of foreplay said they loved holding hands. The core of this argument is
and 7 minutes of intercourse reported in this study. The that coital sexuality was not the main behavior that made
authors did not indicate whether extremes of duration these couples’ sexual relationship satisfying.
might have a different impact on each individual’s as- For heterosexual couples, however, coital sexuality
sessment of sexual satisfaction. may be much more important for relationship satisfaction

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than noncoital activities. Costa and Brody (2007) as- attention to men’s sexual complaints. In addition to the
sessed the correlation between the frequency of vari- work of Blumstein and Schwartz, other research (Pep-
ous sexual behaviors and relationship quality among 30 lau et al., 1997; Peplau et al., 2004) also found this same
Portuguese women and found that penile-vaginal inter- gender continuity in gay male and lesbian couples’ rela-
course was significantly correlated with intimacy, trust, tive ranking of the importance of a good sex life to their
passion, love, and global relationship quality, whereas relationship.
noncoital behaviors were not. Although scholars debate On the other hand, although women do not think
the direction of causality, there is some agreement that of sex as being quite so central to relationship quality as
coital sexuality and relationship quality interact closely men do, many researchers (e.g., Feeney & Noller, 2004;
with one another. For example, Henderson-King and Metz & Epstein, 2002) have found that for women to en-
Veroff (1994) argued persuasively for a feedback loop joy sex at all, they must perceive the relationship to be
between the two that mutually reinforces both. Lau- in good shape.
mann et al. (1994) found comparable results using a Men’s sexual pleasure, however, is not so linked to
random sample generated by the National Health and whether they think the relationship is going well (Law-
Social Life Survey. Looking for both the causes and the rence & Byers, 1995). This comparison is only relative,
prevalence of sexual satisfaction, they found that 88% of however: Like women, men also identify emotional inti-
the married individuals in their sample were either ex- macy as an important element of sexual satisfaction. In
tremely or very satisfied with their physical relationship fact, research on gay men and heterosexual men over age
and reported feelings of love after a variety of sexual be- 50 (Cove & Boyle, 2002; Schiavi, 1999) has suggested
haviors. In addition, married couples in Laumann et al.’s that relationship factors are a key element of men’s sex-
study reported higher levels of sexual satisfaction than ual enjoyment. In a study of gay male couples, Kurdek
cohabiting and dating couples. (1991) also found that sexual satisfaction was positively
Whatever the elements of sexual behavior that sat- correlated with what the author called global relation-
isfy individuals and couples, a strong reciprocal valence ship satisfaction.
clearly exists between the state of a relationship and the Thus, the data solidly support the importance of
state of sexuality within a relationship. This link between sexual satisfaction in the maintenance and durability of
sexual and relationship satisfaction holds true even for marriage and most long-term relationships. Yeh and col-
couples before marriage. In a longitudinal set of stud- leagues (2006) studied rural White couples between the
ies spanning 1988 to 1992, Sprecher (2002) investigated ages of 40 and 50 who had been married an average of
the extent to which sexual satisfaction was associated 30 years. Higher reported levels of sexual satisfaction at
with overall satisfaction, love, commitment, and stabil- one point in time predicted better marital quality at the
ity in 101 heterosexual premarital couples. She found subsequent point in time—although earlier marital qual-
that sexual satisfaction was positively associated with ity did not predict greater sexual satisfaction at a later
relationship satisfaction, love, and commitment for both time. Furthermore, higher reported levels of sexual sat-
men and women. In addition, changes in sexual satis- isfaction at one point in time led to decreases in marital
faction between the first-time assessment and the first instability at the next point in time, but earlier marital
follow-up 1 year later predicted changes in relationship instability did not predict lower levels of sexual satis-
satisfaction, love, and commitment. faction at a later time. In general, this study found that
Sprecher (2002) also found an association between those who were sexually content were also happy with
sexual satisfaction and relationship stability. Overall, sex- their marriages and had reduced marital instability.
ual satisfaction was related more strongly to relationship
Fidelity and Monogamy in the Relationship
quality for men than for women, a result that under-
scores a continuing theme of this article. Almost every Most cultures consider having sexual contact out-
related study reviewed in this article has indicated that side of a committed relationship to be a major trespass
sexual quality affects men’s feelings about the happiness and a moral taboo. In some countries, this behavior is
or unhappiness of the relationship more than it affects informally allowed to men, but in no country is it per-
women’s feelings. Blumstein and Schwartz (1983) dis- mitted and expected that women will have lovers other
covered this result for both married and cohabiting cou- than their husband or committed partner (Wellings et
ples; they hypothesized that heterosexual women do not al., 2006). A partner’s response to a violation of mo-
realize that sexual issues destabilize a relationship more nogamous expectations can vary from emotional dis-
for men than for women and thus do not pay enough tress to homicide. Almost all people in couples who are

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still interested in each other feel territorial about their agreements were broken if the couple discussed what had
partners. Two exceptions to this rule are a relatively high happened. These findings suggest that sexual monogamy
percentage of gay male couples who feel that the need for may not be a required component of a satisfactory sexual
sexual variety is inherent in male sexuality and some ex- relationship for committed gay male couples.
perimental couples (lesbian or heterosexual, married or However, monogamy does seem to be required for
cohabiting) who may open up their relationship to oth- relationship satisfaction in most heterosexual couples.
ers under rules and expectations that the primary part- Studies (Atkins, Baucom, & Jacobson, 2001; Banfield &
ners have mutually agreed upon (Blumstein & Schwartz, McCabe, 2001) have found a strong correlation between
1983; Parkinson, 1991; Schwartz & Rutter, 1998). relationship satisfaction and monogamy in married cou-
Gay men are most likely to have a consensually ples. Subjects who reported that they were not too happy
nonmonogamous relationship and are also most likely with their marriages were almost four times as likely to
to be able to conduct a nonmonogamous relationship report extramarital sex as those who said they were very
without undermining their commitment to one another. happy. In addition, subjects who reported being pretty
LaSala (2004) compared 121 gay male couples in com- happy were twice as likely to report extramarital sex as
mitted relationships, some of whom were monogamous those who said they were very happy. These data suggest
and some of whom were not. The couples were cat- that the correlation between relationship satisfaction
egorized as strictly monogamous, monogamous with and infidelity exists on a continuum: People in unhappy
outside sex (partners had violated the couple’s monoga- marriages are not the only ones who report engaging in
mous agreement), and open (partners with some rules extramarital sex.
that allowed nonmonogamy). All subjects filled out the Furthermore, there is a definite gender difference
Dyadic Adjustment Scale, which measures expressed in responses to the discovery of an act that is coded as
affection, dyadic consensus, and dyadic satisfaction, as infidelity. Studies (e.g., Cann, Mangum, & Wells, 2001)
well as overall dyadic adjustment. Regarding frequency have shown that women find emotional infidelity most
of extra-relationship sex, 73 couples (60%) reported that distressing, whereas men are more likely to be seriously
their relationship agreement was monogamous and 48 upset about sexual infidelity. Still, evidence (Abrams-
(40%) reported being in a sexually open, nonmonoga- Spring, 1997; Staheli, 1998) supports the idea that het-
mous relationship. Of the 73 couples who reported they erosexual couples can resuscitate a relationship that
were monogamous, 33 (45%) had engaged in sex out- has staggered under the discovery of nonmonogamy if
side of the relationship since the beginning of the rela- good therapeutic intervention is involved. Heterosexual
tionship (a median of 5 events) and 17 (23%) had been swingers and heterosexuals who embrace polyamory
nonmonogamous in the past year (a mean of 2 events). (a philosophy espousing that people can love and inte-
Frequency of outside sex for couples in open relation- grate more than one person into a committed relation-
ships ranged from 0 to 350 times in the past year, with a ship) believe that nonmonogamy can be consensual and
median of 8 events. need not destabilize a marriage or cause emotional dis-
LaSala (2004) found no differences in dyadic adjust- tress in committed unions. Studies on these groups are
ment, affectional expression, dyadic consensus, or dyadic rare and most often are done by proponents; still, some
cohesion between the monogamous and the nonmo- good qualitative evidence (e.g., Buunk, 1981) suggests
nogamous gay couples. Monogamous couples did score that some heterosexual, bisexual, and lesbian couples—
slightly lower on dyadic satisfaction than open couples, like gay male couples—also can thrive under nonmo-
but when monogamous couples with broken agreements nogamous agreements. However, given that this type of
were taken out of the analysis, the difference between agreement seems to work for some people, it is not at all
monogamous couples and open couples was no longer clear why some couples can tolerate or even enjoy non-
statistically significant. The gay male couples in this study monogamy while others are destroyed by it.
who had betrayed their own agreements did have lower
Prevalence
dyadic adjustment, cohesion, and satisfaction; other re-
searchers (e.g., Blumstein & Schwartz, 1983) have found In most cases, couples begin with a monogamous
similar results for other types of couples. The interest- agreement and do not admit to nonmonogamous expe-
ing fact, however, is that gay male couples can have riences. Therefore, the true prevalence of nonmonoga-
unaffected dyadic adjustment and satisfaction if they mous sex is hard to ascertain. According to Wiederman
have a consensual agreement to be nonmonogamous. (1997), approximately 23% of men and 12% of women
Couples also remained intact and capable of repair when have engaged in extramarital sex at least once in their

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lifetime. Other well-known studies, such as the National John, 2002), 92% of the lesbian couples and 83% of the
Health and Social Life Survey (Laumann, Gagnon, Mi- men indicated that their relationship was monogamous.
chael, & Michaels, 1992), found that 25% of married men Although these findings seem to indicate that institution-
and 15% of married women have had extramarital sex alization of gay relationships may increase monogamy in
(Billy, Tanfer, Grady, & Klepinger, 1993; Laumann et al., same-sex couples, these people are early adopters; cou-
1994). Although overall rates for lifetime incidence of ples who register or marry later on may or may not em-
extramarital sex differ by gender, these differences more brace heterosexual traditions of monogamous marriage.
or less disappear in the under-40 age group. Across all Many gay and lesbian commentators (e.g., Pollitt, 2008)
age groups, men’s lifetime rates of extramarital sex in- have spoken against exactly this kind of mirroring of het-
crease with age (except in the oldest cohort), whereas erosexual values and lifestyles in same-sex unions.
rates of extramarital sex during the past year remain
Which Relationship Qualities Are
stable (Laumann et al., 1994). For women, a curvilinear
Most Important for Promoting Sexual
relationship exists: The main incidence of lifetime extra-
Satisfaction in a Relationship?
marital sex takes place between the ages of 30 and 50
(Laumann et al., 1992; Wiederman). The most elusive aspect of understanding the cor-
Using data from the 1991–1996 General Social Sur- relation of sexual satisfaction to relationship satisfaction
vey, Atkins et al. (2001) found that men between the may be trying to isolate which nonsexual characteristics
ages of 55 and 76 were most likely to report infidelity, of a relationship promote intimacy and support a couple’s
whereas men who were older or younger were less likely sexual life. A number of scholars (Gossman et al., 2003;
to report it. This study also found a curvilinear pattern Renaud, Byers, & Pan, 1997; Richters et al., 2003) have
for women. The authors concluded that several distinct found that couples with a greater frequency of affectionate
vulnerability factors affected the incidence of extramari- and sexual behavior do, in general, experience increased
tal sex, including a lack of personal maturity (partners sexual and emotional satisfaction, fewer sexual concerns
who had been married at age 16 or younger were four and problems, and greater relationship satisfaction. Goss-
times more likely to have had extramarital sex than those man and colleagues found that certain scores on the Dy-
who first married at age 23 or older). Another factor was adic Adjustment Scale (on consensus, affection, cohesion,
religiousness; regular attendance at a religious institu- and satisfaction) correlated highly with positive sexual
tion was positively correlated with less extramarital sex. outcomes. Couples who indicated zest, communication
Similarly, the study by Atkins et al. found that people intimacy, and overall dyadic satisfaction reported more
who never attended religious services were 2.5 times frequent and satisfying sexual experiences (Baumeister,
more likely to have had extramarital sex than those who 2000; Kaschak & Tiefer, 2001; Tiefer, 2004).
attended services more than once a week. Furthermore, Young and colleagues (1998) found
Although a significant number of husbands and that nonsexual aspects of a couple’s relationship, such
wives have had extramarital sex, a much larger number as overall satisfaction with the marriage, were critical for
of cohabiters and same-sex couples have been nonmo- sexual satisfaction. In this study, nonsexual aspects of
nogamous (Blumstein & Schwartz, 1983; Laumann et the couples’ lives together, such as shared goals, respect,
al., 1994). Perhaps marital vows, or the institutional tra- and recreational companionship, were also correlated
ditions of legal marriage, make sex outside of marriage with sexual satisfaction. Similarly, Waite and Joyner
less likely. Another possible explanation is that married (2001) found that the single most predictive variable as-
people simply have more traditional values and behav- sociated with physical pleasure in both cohabiting and
iors than other couples. Some research (e.g., Kurdek, married couples was perception of emotional invest-
1991) has suggested that this difference in behavior ment. Men or women who said that one of the reasons
when vows are taken also may hold true for same-sex they last had sex was to express love for their partner
couples. In fact, now that same-sex couples can become had substantially higher ratings of sexual pleasure than
domestic partners, enter civil unions, or marry (pres- those who gave other reasons.
ently legislated in Massachusetts), it will be interesting These emotional aspects of relationship quality seem
to see whether entering into some kind of legal institu- to be particularly important for women’s sexual pleasure.
tional framework will make nonmonogamy less likely for Influential work by Basson et al. (2003) has convinced
the couples. many scholars that the relational aspects of women’s sex-
In a study of 160 lesbians and 115 men who obtained ual response have been undervalued and understudied.
civil unions in Vermont (Campbell, Aleks, Stevens, & St. Basson (2000) wrote about the special case of women in

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relationships of longer duration. She believes that wom- couples) to report that psychologically intimate commu-
en’s sexual motivation in these relationships may have as nication characterized their communication patterns.
much to do with the experience of male tenderness and Byers (2005) investigated this association between
the absence of men’s anger as with physiological triggers relationship satisfaction, sexual satisfaction, and com-
of desire. In other words, Basson concluded that women munication over time. She asked a sample of 87 married
are more likely to respond to positive relationship quali- people who had been with their partners from 1 to 35
ties and affectionate stroking by a trusted partner than years to complete measures of sexual and relationship
abstract drives or hunger for sexual fulfillment. satisfaction at the beginning and the end of an 18-month
Findings from a study by Bridges, Lease, and El- period. Byers found that participants with a higher qual-
lison (2004) support the direction of Basson’s (2000) ity of intimate communication (verbal and nonverbal)
work. Using a nationally representative sample of 2,632 reported higher relationship and sexual satisfaction.
racially and ethnically diverse women ages 19–70, Bridges Communication seems to be particularly important
et al. found that the relational context of these women’s during disrupted or difficult relationship periods. Ahlborg
lives was more important to their sexual satisfaction and colleagues (2005) studied communication among
than the sheer physical aspect of being sexually satisfied new parents and found that couples with good commu-
(measured as number of orgasms). In this study, being nication had greater intimacy in their relationship. When
connected to someone (some of which was measured partners listened and laughed together as part of good
by satisfaction with communication) was the most im- communication and cohesion, dyadic sensuality (i.e., hug-
portant predictor of women’s sexual satisfaction. Other ging and caressing) increased. This affectionate behavior
studies have found that respect and fair treatment are seemed to compensate for the temporarily lower levels of
the most important variables. In a study by Brezsnyak sexual satisfaction during this period of the couples’ lives.
and Whisman (2004), as well as in the American Cou- Gossman’s research team (2003) also explored the
ples Study (Blumstein & Schwartz, 1983), more egali- effects of communication on the frequency of intimate
tarian decision making in couples was correlated with and affectionate behaviors, such as sexual initiation and
elevated levels of sexual desire in women. The 1983 reported sexual satisfaction. They found that large dif-
study also found that women who believed they were in ferences in levels of communication between partners,
egalitarian relationships were more likely to participate such as a partner’s ability to communicate feelings, pre-
in a wider array of sexual positions during lovemaking. dicted lower sexual initiation, activity, and satisfaction.
Furthermore, in a study of egalitarian and nonegalitar- In addition, a lack of intimate communication skills in-
ian heterosexual couples, Schwartz (1994) found that hibited frequency of sexual activity and sexual satisfac-
egalitarianism correlated with relationship satisfaction tion specifically when the spouses showed differences in
and sexual satisfaction for both men and women. the importance that they assigned to communication.
Great differences between partners regarding the im-
Communication Skills and Sexual Satisfaction
portance of intimate communication predicted a greater
Studies on nonsexual contributions to sexual satis- likelihood of low sexual desire for both partners.
faction often mention communication as a key factor (e.g., Other researchers (MacNeil & Byers, 1997) have
Purnine & Carey, 1997). Mackey, Diemer, and O’Brien found that clear communication about sexual prefer-
(2000, 2004) examined the importance of communica- ences helps both the sexual relationship and the overall
tion to relationship quality, stability, and physical affec- relationship. In their study of sexual difficulties in cou-
tion in 216 racially diverse long-term committed couples ples, the authors found that more women (68%) than
(partners who had been married or in a committed same- men (59%) voiced their concerns, but more men (59%)
sex relationship for about 30 years). The authors found than women (38%) had one or more sexual complaints
that 85% of all respondents reported being satisfied with about their partner. Few men or women sought any
their relationships. Good communication contributed professional help for their concerns; for many couples,
to psychological intimacy, which, along with minimal sexual issues were exacerbated because they neither dis-
conflict, helped create relationship satisfaction. A sense cussed them between themselves nor with someone who
of equality in the relationship and mutual expression of could help them solve these problems.
physical affection enhanced what the authors called psy- Kelly, Strassberg, and Turner (2004) found similar
chologically intimate communication (and vice versa). outcomes in a study of communication among hetero-
Women in same-sex relationships were more likely than sexual couples who had been in a steady, sexually ac-
other couples in the study (heterosexual and gay male tive relationship for an average of 4 years. Comparing

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couples with a female partner who was nonorgasmic, their parents’ home, a move that certainly would affect
couples with no sexual issues that had one partner with a their sexual choices. People now meet online and thus
chronic illness, and couples that had no physical or sex- may be more likely to date someone who is from another
ual problems, the researchers found that couples with a culture, race, or religion. Interracial marriage is increas-
nonorgasmic female partner had more trouble commu- ing, and spouses of different religious backgrounds and
nicating about sex than both of the other two groups of beliefs about sex are becoming more common. So much
couples. Communication about direct clitoral stimula- of the research on couples is contextually vague: What
tion (such as cunnilingus and manual stimulation) was really can be known about a couple’s sexual life without
especially difficult both for women with orgasmic diffi- examining the environment they inhabit and the lifestyle
culties and for their male partners. Even though effective they embrace?
sexual stimulation might improve nonorgasmic women’s Finally, researchers simply do not know enough
sexual responsiveness, inhibited communication made about gender differences. Yes, many studies do com-
achieving a higher degree of satisfaction problematic. pare male and female differences, but there is a lack of
Artless or absent communication about sex cre- qualitative data that would explain more about how men
ates problems whether communication is difficult for and women experience sexuality. For example, it would
one partner or for both. Male partners of nonorgasmic be interesting to know how various kinds of contracep-
women in Kelly et al.’s (2004) study were much less accu- tion affect couples’ sexual pleasure and how men and
rate in estimating their partner’s sexual preferences than women experience issues of choosing and using various
male partners in the control groups. In fact, partners in contraceptives in committed relationships. Also needed
the couples with nonorgasmic women tended to see their is richer description, beyond the statistics: What hap-
sexual problems as rather narrowly caused by the wom- pens in bed between two people that makes sex special?
an’s inhibitions. The women in these couples reported the How do partners in a couple learn to make love to each
lowest levels of pleasure and were dissatisfied with sexual other in a satisfying way? How does the sex life of com-
frequency. Interestingly, their male partners were also mitted couples change over time (other than becoming
dissatisfied with frequency but not with pleasure received. less frequent)?
In this study, couples’ satisfaction or dissatisfaction with Current research does show that sex needs to be
communication was highly related to the partners’ satis- part of most relationships if a long-term committed re-
faction or dissatisfaction with their sexual life. lationship is to be happy. Sexual satisfaction is about
more than frequency, however: qualities of the partner,
Conclusion
of behaviors, of emotion, of trust, and of effective tech-
Covering all factors that describe sexuality in com- nique all contribute to couples’ overall satisfaction. The
mitted couples is impossible—all the more so given the research makes clear that sex is important and that very
large gaps in the literature on how sexual and nonsexual few couples think it is not. Women and men may have
aspects of a given relationship affect its future happiness significant differences in desire and in some values, but
and durability. Clearly, more life cycle data on couples most partners in couples resemble each other in wanting
are needed. Although research has shown that age mat- intimacy, affection, love, and sexual satisfaction. Sex and
ters and that critical events (such as pregnancy or child happiness, sex and commitment, and sex and relation-
rearing) have an enormous impact on couples’ sexual ship satisfaction are tightly intertwined.
satisfaction and relationship satisfaction, many inter-
Acknowledgments
esting questions remain to be examined. A number of
important factors that may affect sexual function and The authors would like to thank Becca Cubbage for
satisfaction have not been well studied, including geo- her research contributions to this article.
graphical transitions, job failures or successes, children
References
leaving home, the challenges of middle age (see Edwards
& Booth, 1994), age-related changes in body image or Abrahms-Spring, J. (1997). After the affair: Healing the
perceived attractiveness, and the reshaping and chang- pain and rebuilding trust when a partner has been
ing of lifestyles in retirement. unfaithful. New York: HarperCollins.
Furthermore, no data are available on how major Ahlborg, T., Dahlof, L.-G., & Hallberg, L. (2005). Quality
changes in family values and dating opportunities af- of the intimate and sexual relationship in first-time
fect sexuality in committed couples. For example, eco- parents six months after delivery. Journal of Sex
nomic pressures may force young couples to return to Research, 42, 167–174.

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Althof, S. E., O’Leary, M. P., Cappelleri, J. C., Glina, S., Bridges, S. K., Lease, S. H., & Ellison, C. R. (2004). Pre-
King, R., Li-Jung, T., et al. (2006). Self-esteem, dicting sexual satisfaction in women: Implications
confidence, and relationships in men treated with for counselor education and training. Journal of
sildenafil citrate for erectile dysfunction. Journal of Counseling & Development, 82, 158–166.
General Internal Medicine, 21, 1069–1074. Bringle, R. G., & Buunk, B. (1991). Extradyadic rela-
Apt, C., Hurlbert, D. F., Pierce, A. P., & White, C. L. tionships and sexual jealousy. In K. McKinney &
(1996). Relationship satisfaction, sexual character- S. Sprecher (Eds.), Sexuality in close relationships
istics and the psychosocial well-being of women. (pp. 135–154). Hillsdale, NJ: Lawrence Erlbaum
The Canadian Journal of Human Sexuality, 5, Associates.
195–210. Buunk, B. (1981). Jealousy in sexually open marriages.
Atkins, D. C., Baucom, D. H., & Jacobson, N. S. (2001). Alternative Lifestyles, 4, 357–372.
Understanding infidelity: Correlates in a national Byers, E. S. (2005). Relationship satisfaction and sexual
random sample. Journal of Family Psychology, 15, satisfaction: A longitudinal study of individuals in
735–749. long-term relationships. Journal of Sex Research,
Avis, N. E., Crawford, S., & Johannes, C. B. (2002). 42, 113–118.
Menopause. In G. M. Wingood & R. J. DiClemente Calamidas, E. G. (1997). Promoting healthy sexuality
(Eds.), Handbook of women’s sexual and repro- among older adults: Educational challenges for
ductive health (pp. 367–391). New York: Springer. health professionals. Journal of Sex Education &
Bancroft, J. (2002). The medicalization of female sexual Therapy, 22, 45–49.
dysfunction: The need for caution. Archives of Sex- Call, V., Sprecher, S., & Schwartz, P. (1995). The inci-
ual Behavior, 31, 451–455. dence and frequency of marital sex in a national
Bancroft, J., Loftus, J., & Long, J. S. (2003). Distress sample. Journal of Marriage and Family, 57, 639–
about sex: A national survey of women in hetero- 652.
sexual relationships. Archives of Sexual Behavior, Campbell, S. M., Aleks, M., Stevens, J. C., & St. John,
32, 193–208. J. (2002, July). Gay marriage: A descriptive study
Banfield, S., & McCabe, M. P. (2001). Extra relationship of civil unions in Vermont. Paper presented at the
involvement among women: Are they different from 11th International Conference on Personal Rela-
men? Archives of Sexual Behavior, 30, 119–140. tionships, Halifax, Nova Scotia, Canada.
Basson, R. (2000). The female sexual response: A differ- Cann, A., Mangum, J. L., & Wells, M. (2001). Distress
ent model. Journal of Sex & Marital Therapy, 26, in response to relationship infidelity: The roles of
51–65. gender and attitudes about relationships. Journal
Basson, R., Leiblum, L., Brotto, L., Derogatis, L., of Sex Research, 38, 185–190.
Fourcroy, J., Fugl-Meyer, K., et al. (2003). Defini- Clements, M. (1996, March). Sex after 65. Parade Mag-
tions of women’s sexual dysfunction reconsidered: azine, 4-5, 7.
Advocating expansion and revision. Journal of Psy- Costa, R. M., & Brody, S. (2007). Women’s relationship
chosomatic Obstetrics & Gynecology, 24, 221–229. quality is associated with specifically penile-vaginal
Baumeister, R. F. (2000). Gender differences in erotic intercourse orgasm and frequency. Journal of Sex
plasticity: The female sex drive as socially flexible and & Marital Therapy, 33, 319–327.
responsive. Psychological Bulletin, 126, 347–374. Cove, J., & Boyle, M. (2002). Gay men’s self-defined sexual
Billy, J. O. G., Tanfer, K., Grady, W. R., & Klepinger, D. problems, perceived causes and factors in remission.
H. (1993). The sexual behavior of men in the United Sexual and Relationship Therapy, 17, 137–147.
States. Family Planning Perspectives, 24, 52–60. Cowan, P., Cowan, C., Heming, G., Garrett, E., Coysh,
Blumstein, P., & Schwartz, P. (1983). American couples: W., Curtis-Boles, H., et al. (1985). Transition to par-
Money, work and sex. New York: William Morrow. enthood: His, hers, and theirs. Journal of Family
Bozon, M. (2001). Sexuality, gender, and the couple: A Issues, 6, 451–481.
sociohistorical perspective. Annual Review of Sex Davies, S., Katz, J., & Jackson, J. L. (1999). Sexual de-
Research, 12, 1–32. sire discrepancies: Effects on sexual and relation-
Brezsnyak, M., & Whisman, M. A. (2004). Sexual desire ship satisfaction in heterosexual dating couples.
and relationship functioning: The effects of marital Archives of Sexual Behavior, 28, 553–567.
satisfaction and power. Journal of Sex & Marital Davis, S. R., Davison, S. L., Donath, S., & Bell, R. J.
Therapy, 30, 199–217. (2005). Circulating androgen levels and self-reported

March 2009 Vol. 6, No. 1 14

SEXUALITY RESEARCH & SOCIAL POLICY Journal of NSRC

sexual function in women. Journal of the American heterosexual male and female respondents. Journal
Medical Association, 294, 91–96. of Sex & Marital Therapy, 33, 93–113.
Deenen, A. A., Gijs, L., & Van Naerssen, A. X. (1994). In- Haugen, E. N., Schmutzer, P. A., & Wenzel, A. (2004).
timacy and sexuality in gay male couples. Archives Sexuality and the partner relationship dur-
of Sexual Behavior, 23, 421–431. ing pregnancy and the postpartum period. In
DeJudicibus, M. A., & McCabe, M. P. (2002). Psychologi- J. H. Harvey, A. Wenzel, & S. Sprecher (Eds.),
cal factors and the sexuality of pregnant and postpar- Handbook of sexuality in close relationships
tum women. Journal of Sex Research, 39, 94–103. (pp. 411–436). Mahwah, NJ: Lawrence Erlbaum
DeLamater, J. D., & Sill, M. (2005). Sexual desire in later Associates.
life. Journal of Sex Research, 42, 139–149. Henderson-King, D. H., & Veroff, J. (1994). Sexual sat-
Edwards, J. N., & Booth, A. (1994). Sexuality, marriage, isfaction and marital well-being in the first years of
and well-being: The middle years. In A. S. Rossi marriage. Journal of Social and Personal Relation-
(Ed.), Sexuality across the life course (pp. 233– ships, 11, 509–534.
260). Chicago: University of Chicago Press. Hochschild, A. R., & Machung, A. (1990). The second
Elliott, S. A., & Watson, J. P. (1985). Sex during preg- shift: Working parents and the revolution at home.
nancy and the first postnatal year. Journal of Psy- London: Piatkus Books.
chosomatic Research, 29, 541–548. Hurlbert, D. F., Apt, C., Hurlbert, M. K., & Pierce, A. P.
Fassinger, R. E., & Morrow, S. L. (1995). Overcome: (2000). Sexual compatibility and the sexual desire-
Repositioning lesbian sexualities. In L. Diamont & motivation relation in females with hypoactive
R. D. McAnulty (Eds.), The psychology of sexual sexual desire disorder. Behavior Modification, 24,
orientation, behavior, and identity: A handbook 325–347.
(pp. 197–219). London: Greenwood. Hyde, J. S., DeLamater, J. D., & Hewitt, E. C. (1998).
Feeney, J., & Noller, P. (2004). Attachment and sexual- Sexuality and the dual-earner couple: Multiple roles
ity in close relationships. In J. H. Harvey, A. Wen- and sexual functioning. Journal of Family Psychol-
zel, & S. Sprecher (Eds.), Handbook of sexuality in ogy, 12, 354–368.
close relationships (pp. 183–202). Mahwah, NJ: Hyde, J. S., DeLamater, J. D., Plant, E. A., & Byrd, J.
Lawrence Erlbaum Associates. M. (1996). Sexuality during pregnancy and the year
Gagnon, J., & Simon, W. (1973). Sexual conduct: postpartum. Journal of Sex Research, 33, 143–151.
The social sources of human sexuality. Chicago: Jasso, G. (1985). Marital coital frequency and the pas-
Aldine. sage of time: Estimating the separate effects of
Gallicchio, L., Schilling, C., Tomic, D., Miller, S. R., Za- spouses’ ages and marital duration, birth and mar-
cur, H., & Flaws, J. A. (2007). Correlates of sexual riage cohorts, and period influences. American
functioning among mid-life women. Climacteric: Sociological Review, 50, 224–241.
The Journal of Adult Women’s Health & Medicine, Jensen, S. B., & Soren, B. (1986). Sexual dysfunction in
10(2), 132–142. insulin-treated diabetics: A six year follow-up study
George, L. (2004, July 19). Can science give you a better of 101 patients. Archives of Sexual Behavior, 25,
sex life? [Electronic version]. Maclean’s, p. 28. 271–283.
Giddens, A. (1992). The transformation of intimacy: Kaplan, S. A., Reis, R. B., Kohn, I. J., Ikeguchi, E. F.,
Sexuality, love and eroticism in modern societies. Laor, E., Te, A. E., et al. (1999). Safety and efficacy
Palo Alto, CA: Stanford University Press. of sildenafil in postmenopausal women with sexual
Goh, V. H. H., Tain, C.-F., Tong, Y.-Y., Mok, P.-P., & Ng, dysfunction. Urology, 53, 481–486.
S.-C. (2004). Sex and aging in the city: Singapore. Kaschak, E., & Tiefer, L. (Eds.). (2001). A new view of
The Aging Male, 7, 219–226. women’s sexual problems. New York: Haworth
Gossmann, I., Mathieu, M., Julien, D., & Chartrand, E. Press.
(2003). Determinates of sex initiation frequencies Kelly, M. P., Strassberg, D. S., & Turner, C. M. (2004).
and sexual satisfaction in long-term couples’ rela- Communication and associated relationship issues
tionships. The Canadian Journal of Human Sexu- in female anorgasmia. Journal of Sex & Marital
ality, 12, 169–181. Therapy, 30, 263–276.
Haning, R. V., O’Keefe, S. L., Randall, E. J., Kommor, M. Kingsberg, S. A. (2005). The testosterone patch for
J., Baker, E., & Wilson, R. (2007). Intimacy, orgasm women. International Journal of Impotence Re-
likelihood, and conflict predict sexual satisfaction in search, 17, 465–466.

March 2009 Vol. 6, No. 1 15

SEXUALITY RESEARCH & SOCIAL POLICY Journal of NSRC

Koch, P. B., Mansfield, P. K., Thurau, D., & Carey, M. Loulan, J. (1988). Research on the sex practices of 1566
(2005). “Feeling frumpy”: The relationships between lesbians and the clinical applications. Women &
body image and sexual response changes in midlife Therapy, 7, 221–234.
women. Journal of Sex Research, 42, 215–223. Love, S. M. (2003). Dr. Susan Love’s menopause and
Kolodny, R. C., Masters, W. H., & Johnson, V. E. hormone book: Making informed choices. New
(1979). Textbook of sexual medicine. Boston: Little, York: Crown.
Brown, & Co. Mackey, R. A., Diemer, M. A., & O’Brian, B. A. (2000).
Kronenberg, F. (1994). Hot flashes. In R. A. Lobo (Ed.), Psychological intimacy in the lasting relationships
Treatment of the postmenopausal woman: Basic of heterosexual and same-gender couples. Sex
and clinical aspects (pp. 97–119). New York: Raven Roles, 43, 201–225.
Press. Mackey, R. A., Diemer, M. A., & O’Brian, B. A. (2004). Re-
Kumar, R., Brant, H., & Robson, K. (1981). Childbearing lational factors in understanding satisfaction in the
and maternal sexuality: A prospective survey of 119 lasting relationships of same-sex and heterosexual
primiparae. Journal of Psychosomatic Research, couples. Journal of Homosexuality, 47 (1), 111–136.
25, 373–383. MacNeil, S., & Byers, E. S. (1997). The relationships be-
Kurdek, L. A. (1991). Sexuality in homosexual and het- tween sexual problems, communication, and sexual
erosexual couples. In K. McKinney & S. Sprecher satisfaction. The Canadian Journal of Human Sex-
(Eds.), Sexuality in close relationships (pp. 177– uality, 6, 277–289.
191). Hillsdale, NJ: Lawrence Erlbaum Associates. Masters, W. H., & Johnson, V. E. (1966). Human sexual
Kurdek, L. A. (1998). Relationship outcomes and their response. Boston: Little, Brown, & Co.
predictors: Longitudinal evidence from heterosex- Maurice, W. L. (1999). Sexual medicine in primary care.
ual married, gay cohabiting, and lesbian cohabit- New York: Mosby.
ing couples. Journal of Marriage and Family, 60, McNulty, J. K., & Fisher, T. D. (2008). Gender differences
553–568. in response to sexual expectancies and changes in
LaSala, M. C. (2004). Extradyadic sex and gay male sexual frequency: A short-term longitudinal study
couples: Comparing monogamous and nonmo- of sexual satisfaction in newly married couples. Ar-
nogamous relationships. Families in Society, 85, chives of Sexual Behavior, 37, 229–240.
405–413. Metz, M., & Epstein, N. (2002). Assessing the role of re-
Laumann, E. O., Gagnon, J. H., Michael, R. T., & Mi- lationship conflict in sexual dysfunction. Journal of
chaels, S. (1992). National Health and Social Life Sex & Marital Therapy, 26, 293–320.
Survey. Chicago: University of Chicago Press. Meyerowitz, J. H., & Feldman, H. (1966, January). Tran-
Laumann, E. O., Gagnon, J. H., Michael, R. T., & Mi- sition to parenthood. Psychiatric Research Report,
chaels, S. (1994). The social organization of sexual- 20, 78–84.
ity: Sexual practices in the United States. Chicago: Miller, S. A., & Byers, E. S. (2004). Actual and desired
University of Chicago Press. duration of foreplay and intercourse: Discordance
Laumann, E. O., & Michael, R. T. (Eds.). (2001). Sex, love, and misperceptions within heterosexual couples.
and health in America: Private choices and public Journal of Sex Research, 41, 301–309.
policies. Chicago: University of Chicago Press. Milsten, R., & Slowinski, J. (1999). The sexual male:
Laumann, E. O., Paik, A., & Rosen, R. C. (1999). Sexual Problems and solutions. New York: W. W. Norton.
dysfunction in the United States: Prevalence and National Council on the Aging. (1998). Healthy sexual-
predictors. Journal of the American Medical Asso- ity and vital aging: Executive summary. Washing-
ciation, 281, 537–544. ton, DC: Author. Retrieved August 27, 2008, from
Lawrence, K., & Byers, E. S. (1995). Sexual satisfaction http://www.ncoa.org/attachments/SexualitySur-
in long-term heterosexual relationships: The in- veyExecutiveSummary.pdf
terpersonal exchange model of sexual satisfaction. Otis, M. D., Rostosky, S. S., Riggle, E. D. B, & Hamrin, R.
Personal Relationships, 2(2), 267–285. (2006). Stress and relationship quality in same-sex
Lever, J. (1995, August 22). The 1995 Advocate survey of couples. Journal of Social and Personal Relation-
sexuality and relationships: The women. The Advo- ships, 23, 81–99.
cate, pp. 22–30. Parkinson, A. B. (1991). Marital and extramarital sexual-
Levesque, M. J., & Vichesky, D. R. (2006). Raising the bar ity. In S. J. Bahr (Ed.), Family research: A sixty-
on the body beautiful: An analysis of the body image year review, 1930–1990, volume 1 (pp. 65–96).
concerns of homosexual men. Body Image, 3, 45–55. New York: Lexington Books.

March 2009 Vol. 6, No. 1 16

SEXUALITY RESEARCH & SOCIAL POLICY Journal of NSRC

Peplau, L. A., Cochran, S. D., & Mays, V. M. (1997). Tiefer, L. (2004). Sex is not a natural act and other es-
A national survey of the intimate relationships of says (2nd ed.). Boulder, CO: Westview Press.
African American lesbians and gay men: A look at Wagner, G. J., Remien, R. H., & Carballo-Dieguez, A.
commitment, satisfaction, sexual behavior, and (2000). Prevalence of extradyadic sex in mixed HIV
HIV disease. In B. Green (Ed.), Psychological status and its relationship to psychological stress
perspectives on lesbian and gay issues, volume and relationship quality. Journal of Homosexual-
3: Ethnic and cultural diversity among lesbians ity, 39(2), 31–46.
and gay men (pp. 11–38). Thousand Oaks, CA: Waite, L., & Joyner, K. (2001). Emotional and physical
Sage. satisfaction with sex in married, cohabiting, and dat-
Peplau, L. A., Fingerhut, A., & Beals, K. P. (2004). Sexual- ing sexual unions: Do men and women differ? In E.
ity in the relationships of lesbians and gay men. In J. O. Laumann & R. T. Michaels (Eds.), Sex, love, and
H. Harvey, A. Wenzel, & S. Sprecher (Eds.), Hand- health in America: Private choices and public policies
book of sexuality in close relationships (pp. 349– (pp. 239–269). Chicago: University of Chicago Press.
369). Mahwah, NJ: Lawrence Erlbaum Associates. Walker, C. L., Cesen-Cummings, K., Houle, C., Baird, D.,
Perry-Jenkins, M., Repetti, R. L., & Crouter, A. C. (2000). Barrett, J. C., & Davis, B. (2001). Protective effect of
Work and family in the 1990s. Journal of Marriage pregnancy for development of uterine leiomyoma.
and the Family, 62, 981–998. Carcinogenesis, 22, 2049–2052.
Pollitt, K. (2008). Learning to drive: And other life sto- Wellings, K., Collumbien, M., Slaymaker, E., Singh, S.,
ries. New York: Random House. Hodges, Z., Patel, D., et al. (2006). Sexual behav-
Purnine, D. M., & Carey, M. P. (1997). Interpersonal iour in context: A global perspective. The Lancet,
communication and sexual adjustment: The roles of 368, 1706–1728.
understanding and agreement. Journal of Consult- White, L., & Keith, B. (1990). The effect of shift work on
ing and Clinical Psychology, 65, 1017–1025. the quality and stability of marital relations. Jour-
Renaud, C., Byers, E. S., & Pan, S. (1997). Sexual and re- nal of Marriage and Family, 52, 453–462.
lationship satisfaction in Mainland China. Journal Wiederman, M. W. (1997). Extramarital sex: Prevalence
of Sex Research, 34, 399–410. and correlates in a national survey. Journal of Sex
Richters, J., Grulich, A. E., Visser, R. O., Smith, A. M. Research, 34, 167–174.
A., & Rissel, C. E. (2003). Sex in Australia: Sexual Wright, L. K. (1993). Alzheimer’s disease and marriage:
and emotional satisfaction in regular relationships An intimate account. Newbury Park, CA: Sage.
and preferred frequency of sex among a representa- Wyllie, M. G. (2003a). As we enter the new year, several
tive sample of adults. Australian and New Zealand new drugs will be launched globally. BJU Interna-
Journal of Public Health, 27, 171–179. tional, 91, 115–116.
Schiavi, R. C. (1999). Aging and male sexuality. Cam- Wyllie, M. G. (2003b). The Second International Con-
bridge, England: Cambridge University Press. sultation on Erectile Dysfunction: Highlights from
Schwartz, P. (1994). Peer marriage: How love between the pharmaceutical industry. BJU International,
equals really works. New York: Free Press. 92, 645–646.
Schwartz, P., & Rutter, V. (1998). The gender of sexual- Yang, Y. (2008). Social inequalities in happiness in the
ity. Thousand Oaks, CA: Pine Forge Press. U.S. 1972–2004: An age-period-cohort analysis.
Spoil The Ending. (2008). Fashion Viagra. Retrieved Au- American Sociological Review, 73, 204–226.
gust 21, 2008, from http://spoiltheending.blogspot. Yeh, H.-C., Lorenz, F. O., Wickrama, K. A. S., Conger,
com/2008/05/fashion-viagra.html R. D., & Elder, G. H. (2006). Relationships among
Sprecher, S. (2002). Sexual satisfaction in premarital sexual satisfaction, marital quality, and marital in-
relationships: Associations with satisfaction, love, stability at midlife. Journal of Family Psychology,
commitment, and stability. Journal of Sex Research, 20, 339–343.
39, 190–196. Young, M., Denny, G., Luquis, R., & Young, T. (1998).
Staheli, L. (1998). Affair-proof your marriage: Under- Correlates of sexual satisfaction in marriage. The
standing, preventing and surviving an affair. New Canadian Journal of Human Sexuality, 7, 115–127.
York: HarperCollins. Yun, A. J., & Daniel, S. M. (2005). Sympathetic and
Tiefer, L. (2001). A new view of women’s sexual prob- T-helper (Th)2 bias may ameliorate uterine fibroids,
lems: Why new? Why now? Journal of Sex Re- independent of sex steroids. Medical Hypotheses,
search, 38, 89–93. 65, 1172–1175.

March 2009 Vol. 6, No. 1 17