Gender-based differences in sexual satisfaction: A network analysis

doi:10.21203/rs.3.rs-4682657/v1

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Gender-based differences in sexual satisfaction: A network analysis

https://doi.org/10.21203/rs.3.rs-4682657/v1

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For several decades, gender differences related to sexual satisfaction (SS) have been discussed. However, these subtle differences in the importance of SS indicators and their associations have not been fully understood. This study aims to analyze differences in the network structures of items of an SS scale between men and women. The participants included 205 men (M_age = 21.6 ± 2.13) and 219 women (M_age = 22.1 ± 2.21) from Peru. Using network analysis, we identified the central elements in young men and women and compared the network structures based on gender. Results showed that “concentration during sexual activity” is an important and characteristic aspect of men’s SS, whereas “variety of sexual activities” is the most relevant aspect for women to perceive themselves as sexually satisfied. Accordingly, differences and similarities in the elements that contribute to SS are described for males and females, highlighting that strategies designed to promote SS for both groups should take these differences into account.

Biological sciences/Psychology/Human behaviour

Biological sciences/Psychology

Health sciences/Health care

Sexual satisfaction

Gender differences

Network analysis

One of the most studied aspects in sexuality is sexual satisfaction (SS), which is defined as an “affective response arising from one’s subjective evaluation of the positive and negative dimensions associated with one’s sexual relationship” (p. 268) [1]. In general, SS refers to the level of pleasure or displeasure resulting from an individual’s subjective appreciation of their sexual life, encompassing the enjoyment of sexual activity, and relating to the fulfillment of an erotic desire. Additionally, SS is linked to the possibility of having pleasurable and safe sexual experiences where human rights are respected, protected, and fulfilled [2]. Thus, SS becomes an indicator of enjoyment and pleasure in sexual contact, both at personal and interpersonal levels, involving subjective judgments related to body evaluation and performance, partner relationships, and how they satisfy each other [3].

For several decades, SS has been a topic of interest to researchers from different disciplines. Its relevance is evident because it has become a key indicator of overall well-being and quality of life [3–5]. In women, sexual dissatisfaction has been associated with lower levels of psychological well-being, life satisfaction, and vitality [6, 7]. Furthermore, in both men and women, SS has been identified as a domain related to life satisfaction [8] and can positively impact successful aging and overall well-being in older adults [9, 10]. In young adults, high levels of SS have been linked to lower levels of depression [11]. In clinical practice, it is considered as an indicator of general health and sexual health [12].

The relevance of SS for couple relationships has been demonstrated by its association with not only the frequency of sexual activity, the frequency and consistency of orgasms, and better sexual communication [13, 14] but also partner satisfaction, conflict resolution styles, and marital satisfaction [15–17]. Research has also found that a satisfying sexual life and a warm interpersonal climate are more important than a higher frequency of sexual relations for marital satisfaction [18]. Therefore, SS can be considered as an important factor in the maintenance and well-being of relationships.

However, SS is not often a focus of interventions promoting people’s health and mental well-being, and some figures from recent surveys indicate concerning results. For example, an international study conducted with 29,000 people found that 54% reported having low or no SS [19]. Moreover, in the Peruvian context, few studies have addressed the SS of the population, so there is no updated information to guide intervention practices.

One of the primary reasons for the incipient state of SS research in the Peruvian context is related to the lack of measurement instruments adapted to the population’s characteristics and with adequate psychometric properties. The New Sexual Satisfaction Scale (NSSS) is one of the few instruments used to measure SS in studies with Peruvian samples [3]. It is an instrument created from reviewing psychotherapeutic guidelines and the fundamentals of intervention with sexually dysfunctional or dissatisfied people, addressing three conceptual perspectives related to individual characteristics and habits; the interpersonal perspective and emotional exchange with the sexual partner; and sexual experiences linked to the frequency, variety, and intensity of sexual activity. The scale comprises two dimensions. The first dimension refers to a person’s self-perception of their sexual sensations and awareness as well as their functioning and enjoyment during sexual activity. The second dimension focuses on the partner’s behaviors and sensations, encompassing sexual exchange, emotional attachment, and overall sexual activity, including aspects such as variety, frequency, or duration [3].

Additionally, SS is influenced by numerous factors, including individual sociodemographic variables (such as age, sexual orientation, and personality, among others), as well as those related to the dynamics of the context (religiousness, culture, and beliefs), in the sense that a person’s perception of sexual activity can be influenced by the environment [4]. To better understand the complexity and dynamics of SS, this study focuses on gender as a relevant variable.

Regarding gender, differences in sexuality between men and women have been studied for several decades. A meta-analytic study published at the end of the last century reported that these differences were centered on a higher incidence of masturbation and a more positive attitude toward casual sex among men. In contrast, no differences were found in attitudes toward homosexuality or SS [20]. Subsequently, an update of this analysis found that men reported more sexual behavior related to masturbation, the use of pornography, and casual sex, as well as more permissive attitudes toward casual sex than women. Additionally, men reported more SS than women, who reported feeling more fear, anxiety, or guilt about sex [21]. Moreover, differences in expressions of affection after sexual activity have been reported, which are more relevant for women because their enjoyment is more associated with the affective dimension, whereas men’s sexual enjoyment is more related to the orgasmic experience [22].

Specifically, regarding SS, a recent study reported that although there were no significant differences in the total score of an SS scale (the NSSS), item response analysis found that men were more likely to report satisfaction compared to women, especially on items from the subscale centered on personal pleasure [23]. Conversely, another study reported that women had higher overall SS than men. However, the effect size was small, and the authors cautioned that the total score includes items related to female-centered orgasms, with higher scores for women than men [24].

It has also been reported that there are differences between men and women in the association between SS and other psychological variables. For example, men show a stronger relation between SS and mental health indicators [5, 12], whereas the relation between SS and life satisfaction are stronger in women [5]. Moreover, differences have been found in how SS predicts the quality of life for men and women, with intrapersonal satisfaction being a more relevant predictor for men, whereas interpersonal satisfaction has greater predictive power for women [5]. This relates to previous studies that reported women are more attentive to interpersonal enjoyment [25] and have greater motivation to ensure their partner experiences an orgasm [26].

Although gender-based differences in SS have been widely studied, our understanding of the nuances of this differentiation remains limited, and research in the Peruvian context is still at an early stage. Further, results on SS differences between men and women vary across studies [20, 21, 23, 24]. Therefore, novel and rigorous methodologies are needed to capture the nuanced differences in the various elements of SS between men and women. In this context, network analysis emerges as an alternative to conventional comparative analyses, aiming to offer a novel perspective and provide solid evidence. Thus, this study aims to explore the differences in the network structures of the elements composing the NSSS between men and women. Specifically, it seeks to (1) identify the central elements of SS in men and women and (2) compare the SS element networks between genders based on connectivity indicators.

It should be noted that this study is being conducted with samples of young Peruvians, given the fact that sexual activity is one of the functions that begins to emerge during adolescence and early adulthood. Indeed, in Peru, according to the Demographic and Family Health Survey [27], adolescents initiate their sexual life between 16 and 19 years of age, and as early as 2010, Peru’s Ministry of Health reported that 19.7% of adolescents, secondary school students, had experienced sexual intercourse. Therefore, sexuality and SS of Peruvian adolescents and young adults are topics demanding attention [28].

Participants

This study assessed data from a group of 424 young volunteers and included cisgender men and women with active sexual lives, irrespective of their sexual orientation or whether they were in a stable romantic relationship. Thoroughly examining the data confirmed that no participants needed to be excluded from the study. The participants had an average age of 21.85 years and were all university students from Lima, Peru. Regarding sex, the female population constituted a slight majority, representing 51.70% of the total participants. Among the participants, 85.60% identified as heterosexual, whereas 9.67% identified as bisexual. The rest identified with other sexual orientations. Regarding marital status, 53.10% were unmarried, whereas the remaining participants were in various types of relationships. Most participants reported having sexual relations between one and six times per month, indicating a broad range of frequencies in their intimate relationships.

Instrument

The NSSS in Spanish measures SS on both a personal level and in relation to one’s partner [3]. It comprises 20 items, with the first 10 assessing personal SS and the remainder assessing satisfaction with the partner. Responses are given on a Likert scale ranging from 1 (not at all satisfied) to 5 (very satisfied).

Procedures

To collect data, a virtual questionnaire was designed; this included informed consent, a form to collect sociodemographic data, and the NSSS. A virtual call was conducted to contact university students, and all participants provided informed consent to participate in the study. The informed consent outlined the study’s objective and emphasized the anonymous and voluntary nature of participation. Data collection occurred over a period of four weeks.

The study was approved by the Teaching Review Board corresponding to the Psychology Program Department of the Universidad San Ignacio de Loyola based on ethical guidelines within the institutional regulations, the Helsinki Convention, and the Code Ethics of Colegio de Psicólogos del Perú [29].

Data Analysis

The R programming language was used to conduct statistical analyses through the RStudio platform. Various packages were used in this process, including “EGAnet” [30], “qgraph” [31], “bootnet” [32], “tidyverse” [33], and “PsyMetricTools” [34].

Initially, a preliminary analysis of the scale was conducted using the EGAnet library version 2.0.6 [30] to verify the number of communities and the dynamic internal structure of the NSSS-20. This procedure identified unstable items in their community membership, suggesting their elimination.

Next, an independent network evaluation was performed using the ggmModSelect method along with a Spearman correlation matrix, an effective combination for analyzing Likert-scale items [35]. Nodes were ranked according to their significance using the Strength index, which has been identified as the most stable index in psychology [36].

Network stability was evaluated using the bootnet package version 1.6 [37], employing non-parametric bootstrapping with 1,000 resamples. The correlation stability coefficient was used to establish the upper limit of cases that can be omitted while maintaining a 95% probability of retaining a minimum correlation of .70. It is recommended that the CS should not be less than .25 and preferably greater than .50.

Node centrality calculation was based on their strength, calculating the absolute values of all their connections, representing a psychological construct [38]. Network comparisons were conducted using the NetworkComparisonTest library version 2.2.1 [39], with a seed set for 2024. An omnibus test was conducted to determine if the connections between the networks were the same, using a two-tailed permutation test with 1,000 repetitions to reorder the data randomly. The null hypothesis posits no significant differences between networks if the p-value is below .05. Additionally, adjacency matrices were compared using the Spearman coefficient to determine the effect size between them.

Previous Psychometric Review

Figure 1 illustrates the dimensionality and stability of items in two distinct psychometric network models, both before and after adjustments in item selection. Using the first model (M1), we observe a network containing 20 items (nsss1 to nsss20), grouped into two communities and differentiated by color, with certain items like nsss1, nsss3, and nsss4 showing notable connections. The stability of these items, indicated in the stability graph, shows variability in their replication levels. In the second model (M2), after removing some items like nsss10, nss11, nsss8, nsss9, nsss12, nsss14, nsss15, and nsss7, the network is restructured with changes in groupings and the stability of the remaining items, affecting the dimensional structure and interrelationships between the items. There is a notable stability in M2, with most items achieving high replication values, demonstrating robust dimensional consistency in most replicated samples.

Figure 2 shows the psychometric networks evaluated for two gender-defined groups: men (1) and women (2). Each network illustrates the connectivity among 12 items, with a density of 33.33% for men and 36.36% for women, indicating that 22 and 24 out of 66 possible connections are non-zero. The average strength of these connections is .082 for men and .079 for women, showing a slight difference in the intensity of interactions by gender. Additionally, the maximum strength of connections is notably higher in men (.48) compared to women (.34), whereas the minimum observed strength is also higher in men (.15) than in women (.10).

The NSSS analysis shows notable differences in correlations between items for men and women. In the men’s graph, the strongest interactions are found among items focused on the partner, such as nsss17 and nsss19 (r = .48), and between nsss16 and nsss17 (r = .36). The connection between nsss4 and nsss6 (r = .31) also stands out. The strongest correlations appear in the women’s graph between nsss19 and nsss20 (r = .34), and between nsss16 and nsss17 (r = .32).

Comparatively, in women, the correlations within the self-focused community are generally higher, as seen in the connection between nsss4 and nsss5 (r = .20). Meanwhile, men show more prominent interactions in the partner-focused community, suggesting differences in how each gender perceives or values aspects of SS related to self-focus or partner-focus. However, the most central node is nsss4 for men and nsss19 for women.

Generally, the Spearman correlation value is .56, indicating the presence of differences between the adjacency matrices. Moreover, the p-values in all cases are greater than .05, which indicates that the networks are invariant according to the global invariance test and that their connectivity (Global Strength) is nearly identical.

Figure 3A shows mean centrality strength values by gender. In men, the Strength centrality starts at .56 and decreases to .20, reflecting variability in the networks with fewer participants. For women, the values start at .94 and drop to .29, remaining higher than men’s, indicating greater stability and cohesion in their SS networks. This difference suggests significant variations in the perception of SS between genders.

In Fig. 3B, the differences between the original association values and those obtained after bootstrapping are illustrated for men and women, respectively. In both sexes, an overlap between the red (the data) and black lines (resampling) is observed. Nevertheless, in men, the smallest differences occur in nsss3 to nsss19 and the largest in nsss5 to nsss19. However, in women, the smallest observed difference is in nsss4 to nsss13 and the largest in nsss18 and nsss19. These values reflect precision in the connections for both men and women.

Gender differences in SS have been discussed for several decades. However, the subtle differences in the centrality of SS elements and their associations are still not fully understood. This study aimed to analyze the differences in the network structures of NSSS elements between men and women. Specifically, it seeks to (1) identify the central elements of SS in men and women and (2) compare the SS element networks between genders.

We found that although there are similarities in the density of network structures between men and women, the strength of the connections is significantly greater among men. This may indicate that in this group, the activation of one SS-related element is more likely to be followed by the activation of other network elements, which may influence how men perceive and experience SS. The most central node for men is item nsss4 (Your concentration during sexual activity). This finding is consistent with a previous study [23], wherein men were significantly more likely to report satisfaction linked to item 4 of the NSSS than women. It has also been previously reported that men’s sexual performance issues are related to distractions and a lack of attention to sexual stimuli during sexual activity [40], highlighting the importance of mindfulness during sexual activity for men’s SS. In contrast, for women, the most central node is item nsss19 (The variety of your sexual activities), indicating that the diversification of sexual experiences is crucial for women’s SS. Furthermore, women have shown greater stability and cohesion in their SS network. These results align with previous research findings, which reported that women show more SS than men when engaging in a wide range of sexual practices [41], including non-orgasmic activities and foreplay [24, 42].

Other notable differences in node centrality are found in items nsss5 (The way you respond sexually to your partner) and nsss2 (The quality of your orgasms), which have the lowest centrality indices in the men’s group. However, the women’s group shows centrality above the node average. This indicates that for men, sexual receptivity to partner-provided stimuli and the evaluation of orgasm quality have limited influence on their SS assessment. In other words, men’s sexual dissatisfaction is generally not related to issues with achieving sexual arousal or orgasm during sexual activity, whereas these aspects are relevant for women. Indeed, the study by Lee et al. [9] found that the most common concerns of sexually active women were linked to sexual arousal and orgasm attainment. These concerns make sense, considering the well-established fact that men have orgasms significantly more frequently than women [41]. It has also been reported that women with arousal issues find it more challenging to reach an orgasm, negatively impacting their SS [43].

Furthermore, the centrality of the node represented by item nsss20 (The frequency of your activity) also differs based on gender. It has the lowest centrality index in the women’s group, whereas it shows centrality above the average in the men’s group. Thus, the frequency of sexual activity seems more important for men, whereas for women, frequency is not closely linked to other SS elements. For women, aspects related to arousal and orgasm quality are more important. This is consistent with previous findings that men are more concerned with the frequency of their sexual activities than women [9] and that this can be a significant reason for their sexual dissatisfaction [44]. Indeed, a previous study reported that sexually dissatisfied men had a very high likelihood of wanting sex more frequently, whereas only two-thirds of sexually dissatisfied women desired more frequent sex. It was also found that men were less satisfied compared to women with their current frequency of sexual relations [42]. These results indicate that when women assess their SS, they place greater emphasis on the quality of sex, including foreplay and a greater variety of sexual practices, compared to men [41, 42].

A noteworthy difference is also observed in the correlations between the NSSS items for men and women. In the men’s graph, the strongest interactions are between item nsss17 (Your partner’s sexual creativity) and item nsss19 (The variety of your sexual activities), suggesting that men’s perception of their sexual experience diversity is closely linked to their partner’s creative behavior, i.e., their partner’s ability to explore and diversify sexual experiences. Another notable connection is between item nsss4 (Your concentration during sexual activity) and item nsss6 (Your body’s sexual functioning), revealing that men’s sexual awareness is related to self-perception of bodily functioning and enjoyment during sexual activity. Thus, being fully present during sexual activity may enhance SS and, specifically, satisfaction with bodily functions. This could also indicate that cognitive functions, including automatic and distracting thoughts during sexual activity, are linked to bodily functions, consistent with studies reporting that the most frequently reported concerns of sexually active men were related to erectile function and sexual performance [9, 45].

In the women’s graph, the strongest correlation appears between general aspects of sexual experience, such as item nsss19 (The variety of your sexual activities) and item nsss20 (The frequency of your activity), which indicates that women are more likely to engage in sexual activities more frequently when they have more diverse and novel sexual experiences as they find them interesting, exciting, and satisfying. Another important relation is between items nsss4 (Your concentration during sexual activity) and nsss5 (The way you respond sexually to your partner), meaning that women’s sexual awareness is associated with their body’s receptivity to partner-provided stimuli. Greater mindfulness during sexual activity allows women to experience more pleasurable physiological and emotional responses in intimate situations with their partners. This finding also suggests that women’s difficulties with attention during sexual activity manifested as automatic distracting thoughts are linked to disconnection and lack of arousal [45]. It has been previously reported that difficulty in becoming sexually aroused was associated with higher levels of concern in women [9].

Additionally, for both men and women, significant relations were found between items nsss16 (The way your partner considers your sexual needs) and nsss17 (Your partner’s sexual creativity), indicating that for both groups, the attention and interest shown by the partner toward one’s needs, desires, and preferences during sexual experiences are mainly linked to the partner’s openness to exploring fantasies, innovating sexual practices, and diversifying these experiences. Therefore, sexual creativity appears to be a fundamental element for SS in both men and women.

The significance of these findings lies in the fact that this study is one of the first that attempts to examine the subtle gender differences in SS through network analysis. It is important for health professionals to pay attention to the central and unique characteristics of SS in both men and women and develop strategies that promote healthy and fulfilling sexuality specifically. This research has identified that concentration during sexual activity for men and various sexual activities for women are crucial aspects influencing their SS. Therefore, it may be useful to consider these as priorities in interventions to improve SS. For example, practicing mindfulness, which has proven to be an effective technique for enhancing SS and functioning, could be especially beneficial for men by helping them concentrate during sexual activity [40]. For women, encouraging creativity and variety in sexual life could be more beneficial, helping diversify sexual experiences and enhance satisfaction. These specific approaches could significantly contribute to designing more effective and personalized interventions for promoting sexual health.

However, some limitations of this study need to be reported. First, the current sample is a convenience sample, and large samples based on representativeness criteria are required to ensure the generalization of the results. Second, the cross-sectional nature of the research design does not allow for causal conclusions regarding the interactions of SS elements. Third, differences in network connectivity have been explored only considering gender as a sexual identity, leaving the exploration of differences with respect to other relevant variables, such as sexual orientation or age, pending.

Future studies should replicate the research in other population groups to evaluate the consistency of the findings. Additionally, longitudinal studies should be developed to identify causal relationships in the interactions of SS elements and evaluate the evolution of these connections over time. Furthermore, future research should evaluate how SS elements are associated with aspects related to sexual behavior and overall well-being through network analysis.

Last, it has been demonstrated that the network analysis model provides new avenues for exploring gender-based differences in complex constructs such as social security. As a result, it is concluded that gender-specific interventions focusing on the central indicators of SS might have greater effects if they are tailored to these indicators.

Author contributions

S.L.H. designed the research. A.R.H., and A.C.T. collected data. J.V.L. analyzed and interpreted data. S.L.H. and J.V.L. drafted the manuscript and were major contributors in writing manuscript. All authors read, critically revised, and approved the final manuscript.

Data availability statement

The datasets generated and/or analysed during the current study are not publicly available but are available from the corresponding author on reasonable request.

Competing interests’ statement

The authors declare no competing interests.

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Gender-based differences in sexual satisfaction: A network analysis

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