Abstract
Prior research suggests that better mental health and higher relationship quality are associated with better sexual function and satisfaction. Such insights can inform intervention development for mental, relationship, and sexual health concerns. This study examined the interactions among these variables in a racially and ethnically diverse group of young men who have sex with men (YMSM) in serious relationships (N = 348). Data were drawn from wave 5 of a longitudinal cohort study. We examined cross-sectional associations between depression and stress (predictors) and sexual function, sexual satisfaction, and anal discomfort (outcomes) and to what extent these associations were moderated by relationship quality. Higher endorsement of depression and stress was associated with worse sexual functioning, lower sexual satisfaction, and more anal discomfort. We also found that fewer negative interactions, stronger commitment, and higher relationship satisfaction were associated with better sexual functioning and higher sexual satisfaction. Higher relationship satisfaction and commitment were found to attenuate the association between stress and sexual satisfaction. Contrary to expectations, higher relationship satisfaction also showed a trend toward exacerbating the association between depression and sexual functioning. These results suggest that, for YMSM, high relationship satisfaction and commitment may protect sexual satisfaction from being negatively impacted by high stress. However, YMSM in highly satisfying relationships may experience poor sexual functioning associated with depression as particularly distressing. This study addressed a major gap in the literature by focusing on mental, relationship, and sexual health in a diverse sample. Future research should examine a wider range of sexual functioning outcomes and include minority stress in study design.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
Data Availability
Not applicable.
References
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). American Psychiatric Association.
Bancroft, J., Graham, C. A., Janssen, E., & Sanders, S. A. (2009). The dual control model: Current status and future directions. Journal of Sex Research, 46(2–3), 121–142. https://doi.org/10.1080/00224490902747222
Bancroft, J., Herbenick, D., Barnes, T., Hallam-Jones, R., Wylie, K., & Janssen, E. (2005). The relevance of the dual control model to male sexual dysfunction. Sexual and Relationship Therapy, 20(1), 13–30. https://doi.org/10.1080/14681990512331298275
Bancroft, J., Janssen, E., Strong, D., & Vukadinovic, Z. (2003). The relation between mood and sexuality in gay men. Archives of Sexual Behavior, 32(3), 231–242. https://doi.org/10.1023/A:1023461500810
Barbonetti, A., D’Andrea, S., Cavallo, F., Martorella, A., Francavilla, S., & Francavilla, F. (2019). Erectile dysfunction and premature ejaculation in homosexual and heterosexual men: A systematic review and meta-analysis of comparative studies. Journal of Sexual Medicine, 16(5), 624–632. https://doi.org/10.1016/j.jsxm.2019.02.014
Benjamini, Y., & Hochberg, Y. (1995). Controlling the false discovery rate: A practical and powerful approach to multiple testing. Journal of the Royal Statistical Society Series B (Methodological), 57(1), 289–300.
Boddi, V., Fanni, E., Castellini, G., Fisher, A. D., Corona, G., & Maggi, M. (2015). Conflicts within the family and within the couple as contextual factors in the determinism of male sexual dysfunction. Journal of Sexual Medicine, 12(12), 2425–2435. https://doi.org/10.1111/jsm.13042
Burri, A., Spector, T., & Rahman, Q. (2012). The etiological relationship between anxiety sensitivity, sexual distress, and female sexual dysfunction is partly genetically moderated: Genetic correlation FSD, distress, anxiety. Journal of Sexual Medicine, 9(7), 1887–1896. https://doi.org/10.1111/j.1743-6109.2012.02710.x
Busby, D. M., Christensen, C., Crane, D. R., & Larson, J. H. (1995). A revision of the dyadic adjustment scale for use with distressed and nondistressed couples: Construct hierarchy and multidimensional scales. Journal of Marital and Family Therapy, 21(3), 289–308. https://doi.org/10.1111/j.1752-0606.1995.tb00163.x
Byers, E. S., O’Sullivan, L. F., & Hughes, K. (2021). Sexual functioning of late adolescents and young adults in relationships: Association with individual characteristics and relationship factors. Sexual and Relationship Therapy, 36(2–3), 178–197. https://doi.org/10.1080/14681994.2019.1626982
Candlish, J., Teare, M. D., Dimairo, M., Flight, L., Mandefield, L., & Walters, S. J. (2018). Appropriate statistical methods for analysing partially nested randomised controlled trials with continuous outcomes: A simulation study. BMC Medical Research Methodology, 18(1), 105. https://doi.org/10.1186/s12874-018-0559-x
Carcedo, R. J., Fernández-Rouco, N., Fernández-Fuertes, A. A., & Martínez-Álvarez, J. L. (2020). Association between sexual satisfaction and depression and anxiety in adolescents and young adults. International Journal of Environmental Research and Public Health, 17(3), 841. https://doi.org/10.3390/ijerph17030841
Chen, J., Walters, M. L., Gilbert, L. K., & Patel, N. (2020). Sexual violence, stalking, and intimate partner violence by sexual orientation, United States. Psychology of Violence, 10(1), 110–119. https://doi.org/10.1037/vio0000252
Cohen, S., & Janicki-Deverts, D. (2012). Who’s stressed? Distributions of psychological stress in the United States in probability samples from 1983, 2006, and 2009. Journal of Applied Social Psychology, 42(6), 1320–1334. https://doi.org/10.1111/j.1559-1816.2012.00900.x
Corbeil, R. R., & Searle, S. R. (1976). Restricted maximum likelihood (REML) estimation of variance components in the mixed model. Technometrics, 18(1), 31. https://doi.org/10.2307/1267913
Flynn, K. E., Lin, L., Cyranowski, J. M., Reeve, B. B., Reese, J. B., Jeffery, D. D., Smith, A. W., Porter, L. S., Dombeck, C. B., Bruner, D. W., Keefe, F. J., & Weinfurt, K. P. (2013). Development of the NIH PROMIS® sexual function and satisfaction measures in patients with cancer. Journal of Sexual Medicine, 10, 43–52. https://doi.org/10.1111/j.1743-6109.2012.02995.x
Forbes, M. K., Baillie, A. J., & Schniering, C. A. (2016). A structural equation modeling analysis of the relationships between depression, anxiety, and sexual problems over time. Journal of Sex Research, 53(8), 942–954. https://doi.org/10.1080/00224499.2015.1063576
Forbes, M. K., & Schniering, C. A. (2013). Are sexual problems a form of internalizing psychopathology? A structural equation modeling analysis. Archives of Sexual Behavior, 42(1), 23–34. https://doi.org/10.1007/s10508-012-9948-0
Hall, W. J. (2018). Psychosocial risk and protective factors for depression among lesbian, gay, bisexual, and queer Youth: A systematic review. Journal of Homosexuality, 65(3), 263–316. https://doi.org/10.1080/00918369.2017.1317467
Harris, P. A., Taylor, R., Minor, B. L., Elliott, V., Fernandez, M., O’Neal, L., McLeod, L., Delacqua, G., Delacqua, F., Kirby, J., & Duda, S. N. (2019). The REDCap consortium: Building an international community of software platform partners. Journal of Biomedical Informatics, 95, 103208. https://doi.org/10.1016/j.jbi.2019.103208
Hart, T. A., Mustanski, B., Ryan, D. T., Gorbach, P. M., Stall, R. D., Surkan, P. J., & Plankey, M. (2015). Depression and sexual dysfunction among HIV-positive and HIV-negative men who have sex with men: Mediation by use of antidepressants and recreational stimulants. Archives of Sexual Behavior, 44(2), 399–409. https://doi.org/10.1007/s10508-014-0279-1
Hendrick, S. S. (1988). A generic measure of relationship satisfaction. Journal of Marriage and the Family, 50(1), 93–98. https://doi.org/10.2307/352430
Hickson, F., Davey, C., Reid, D., Weatherburn, P., & Bourne, A. (2017). Mental health inequalities among gay and bisexual men in England, Scotland and Wales: A large community-based cross-sectional survey. Journal of Public Health, 39, 266–273. https://doi.org/10.1093/pubmed/fdw021
Hirshfield, S., Chiasson, M. A., Wagmiller, R. L., Remien, R. H., Humberstone, M., Scheinmann, R., & Grov, C. (2010). Sexual dysfunction in an internet sample of U.S. men who have sex with men. The Journal of Sexual Medicine, 7(9), 3104–3114. https://doi.org/10.1111/j.1743-6109.2009.01636.x
Ivanković, I., Šević, S., & Štulhofer, A. (2015). Distressing sexual difficulties in heterosexual and non-heterosexual croatian men: Assessing the role of minority stress. Journal of Sex Research, 52(6), 647–658. https://doi.org/10.1080/00224499.2014.909381
Janssen, E., Macapagal, K. R., & Mustanski, B. (2013). Individual differences in the effects of mood on sexuality: The revised mood and sexuality questionnaire (MSQ-R). Journal of Sex Research, 50(7), 676–687. https://doi.org/10.1080/00224499.2012.684251
Jenkins, N., Saiz, C. C. (1995). The Communication Skills Test. University of Denver.
Langston, M. E., Fuzzell, L., Lewis-Thames, M. W., Khan, S., & Moore, J. X. (2019). Disparities in health information-seeking behaviors and fatalistic views of cancer by sexual orientation identity: A nationally representative study of adults in the United States. LGBT Health, 6(4), 192–201. https://doi.org/10.1089/lgbt.2018.0112
Lee, C., Oliffe, J. L., Kelly, M. T., & Ferlatte, O. (2017). Depression and suicidality in gay men: Implications for health care providers. American Journal of Men’s Health, 11(4), 910–919. https://doi.org/10.1177/1557988316685492
Li, D. H., Newcomb, M., Macapagal, K., Remble, T., & Mustanski, B. (2020). Condom-associated erectile function, but not other domains of sexual functioning, predicts condomless insertive anal sex among young men who have sex with men. Archives of Sexual Behavior, 49(1), 161–174. https://doi.org/10.1007/s10508-020-01642-w
Li, D. H., Remble, T. A., Macapagal, K., & Mustanski, B. (2019). Stigma on the streets, dissatisfaction in the sheets: Is minority stress associated with decreased sexual functioning among young men who have sex with men? Journal of Sexual Medicine, 16(2), 267–277. https://doi.org/10.1016/j.jsxm.2018.12.010
Madireddy, S., & Madireddy, S. (2022). Supportive model for the improvement of mental health and prevention of suicide among LGBTQ+ youth. International Journal of Adolescence and Youth, 27(1), 85–101. https://doi.org/10.1080/02673843.2022.2025872
Maxwell, J. A., & McNulty, J. K. (2019). No longer in a dry spell: The developing understanding of how sex influences romantic relationships. Current Directions in Psychological Science, 28(1), 102–107. https://doi.org/10.1177/0963721418806690
McMillan, E., Adan Sanchez, A., Bhaduri, A., Pehlivan, N., Monson, K., Badcock, P., Thompson, K., Killackey, E., Chanen, A., & O’Donoghue, B. (2017). Sexual functioning and experiences in young people affected by mental health disorders. Psychiatry Research, 253, 249–255. https://doi.org/10.1016/j.psychres.2017.04.009
Mills, T. C., Paul, J., Stall, R., Pollack, L., Canchola, J., Chang, Y. J., Moskowitz, J. T., & Catania, J. A. (2004). Distress and depression in men who have sex with men: The Urban Men’s Health Study. American Journal of Psychiatry, 161(2), 278–285. https://doi.org/10.1176/appi.ajp.161.2.278
Morris, D. D. A., Fernandes, V., & Rimes, K. A. (2022). Sexual minority service user perspectives on mental health treatment barriers to care and service improvements. International Review of Psychiatry, 34, 230–239. https://doi.org/10.1080/09540261.2022.2051445
Mustanski, B., Greene, G. J., Ryan, D., & Whitton, S. W. (2015) Feasibility Acceptability and initial efficacy of an online sexual health promotion program for LGBT youth: The Queer Sex Ed Intervention. Journal of Sex Research. 52(2), 220–230. doi https://doi.org/10.1080/00224499.2013.867924
Mustanski, B., Morgan, E., D’Aquila, R., Birkett, M., Janulis, P., & Newcomb, M. E. (2019). Individual and network factors associated with racial disparities in HIV among young men who have sex with men: Results from the RADAR Cohort Study. JAIDS Journal of Acquired Immune Deficiency Syndromes, 80(1), 24–30. https://doi.org/10.1097/QAI.0000000000001886
Newcomb, M. E., Moran, K., Feinstein, B. A., Forscher, E., & Mustanski, B. (2018). Pre-exposure prophylaxis (PrEP) use and condomless anal sex: Evidence of risk compensation in a cohort of young men who have sex with men. JAIDS Journal of Acquired Immune Deficiency Syndromes, 77(4), 358–364. https://doi.org/10.1097/QAI.0000000000001604
Newcomb, M. E., Swann, G., Ma, J., Moskowitz, D., Bettin, E., Macapagal, K., & Whitton, S. W. (2021). Interpersonal and intrapersonal influences on sexual satisfaction in young male couples: Analyses of actor-partner interdependence models. Journal of Sex Research, 58(2), 183–194. https://doi.org/10.1080/00224499.2020.1820933
Peixoto, M. M., & Nobre, P. (2014). Dysfunctional sexual beliefs: A comparative study of heterosexual men and women, gay men, and lesbian women with and without sexual problems. Journal of Sexual Medicine, 11(11), 2690–2700. https://doi.org/10.1111/jsm.12666
Peixoto, M. M., & Nobre, P. (2016). Distressing sexual problems and dyadic adjustment in heterosexuals, gay men, and lesbian women. Journal of Sex & Marital Therapy, 42(4), 369–381. https://doi.org/10.1080/0092623X.2015.1053020
Pilkonis, P. A., Choi, Ss. W., Reise, S. P., Stover, A. M., Riley, W. T., & Cella, D. (2011). PROMIS Cooperative Group Item banks for measuring emotional distress from the patient-reported outcomes measurement information system (PROMIS®): Depression, anxiety, and anger. Assessment, 18(3), 263–283. https://doi.org/10.1177/1073191111411667
Preacher, K. J., Curran, P. J., & Bauer, D. J. (2006). Computational tools for probing interactions in multiple linear regression, multilevel modeling, and latent curve analysis. Journal of Educational and Behavioral Statistics, 31(4), 437–448. https://doi.org/10.3102/10769986031004437
Roberti, J. W., Harrington, L. N., & Storch, E. A. (2006). Further psychometric support for the 10-item version of the perceived stress scale. Journal of College Counseling, 9(2), 135–147. https://doi.org/10.1002/j.2161-1882.2006.tb00100.x
Rosser, B. R. S., Short, B. J., Thurmes, P. J., & Coleman, E. (1998). Anodyspareunia, the unacknowledged sexual dysfunction: A validation study of painful receptive anal intercourse and its psychosexual concomitants in homosexual men. Journal of Sex & Marital Therapy, 24(4), 281–292. https://doi.org/10.1080/00926239808403963
Smith, J. F., Breyer, B. N., Eisenberg, M. L., Sharlip, I. D., & Shindel, A. W. (2010). Sexual function and depressive symptoms among male North American medical students. Journal of Sexual Medicine, 7(12), 3909–3917. https://doi.org/10.1111/j.1743-6109.2010.02033.x
Spanier, G. B. (1976). Measuring dyadic adjustment: New scales for assessing the quality of marriage and similar dyads. Journal of Marriage and the Family, 38(1), 15. https://doi.org/10.2307/350547
Tutino, J. S., Shaughnessy, K., & Ouimet, A. J. (2018). Looking at the bigger picture: Young men’s sexual health from a psychological perspective. Journal of Health Psychology, 23(2), 345–358. https://doi.org/10.1177/1359105317733321
Ventus, D., Gunst, A., Kärnä, A., & Jern, P. (2017). No evidence for long-term causal associations between symptoms of premature ejaculation and symptoms of anxiety, depression, and sexual distress in a large, population-based longitudinal sample. Journal of Sex Research, 54(2), 264–272. https://doi.org/10.1080/00224499.2016.1255301
Weinfurt, K. P., Lin, L., Bruner, D. W., Cyranowski, J. M., Dombeck, C. B., Hahn, E. A., Jeffery, D. D., Luecht, R. M., Magasi, S., Porter, L. S., Reese, J. B., Reeve, B. B., Shelby, R. A., Smith, A. W., Willse, J. T., & Flynn, K. E. (2015). Development and initial validation of the PROMIS® sexual function and satisfaction measures version 2.0. The Journal of Sexual Medicine, 12(9), 1961–1974. https://doi.org/10.1111/jsm.12966
Whitton, S. W., Dyar, C., Mustanski, B., & Newcomb, M. E. (2019). Intimate partner violence experiences of sexual and gender minority adolescents and young adults assigned female at birth. Psychology of Women Quarterly, 43(2), 232–249. https://doi.org/10.1177/0361684319838972
Whitton, S. W., Olmos-Gallo, P. A., Stanley, S. M., Prado, L. M., Kline, G. H., St. Peters, M., & Markman, H. J. (2007). Depressive symptoms in early marriage: Predictions from relationship confidence and negative marital interaction. Journal of Family Psychology, 21(2), 297–306. https://doi.org/10.1037/0893-3200.21.2.297
Zamboni, B. D., & Crawford, I. (2007). Minority stress and sexual problems among African-American gay and bisexual men. Archives of Sexual Behavior, 36(4), 569–578. https://doi.org/10.1007/s10508-006-9081-z
Funding
This work was supported by the National Institute on Drug Abuse at the National Institutes of Health (U01DA036939; PI: Mustanski). The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institute on Drug Abuse or the National Institutes of Health. The sponsor had no involvement in the conduct of the research or the preparation of the article.
Author information
Authors and Affiliations
Contributions
LL-C, MN, DTR, and BM contributed to the study conception and design. Material preparation, data collection, and analysis were performed by LL-C and DTR. The first draft of the manuscript was written by CC and LL-C, and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.
Corresponding author
Ethics declarations
Conflicts of interest
The authors have no conflicts of interest to declare.
Ethical Approval
All study activities were conducted with oversight from the Northwestern University Institutional Review Board.
Informed Consent
Participants provided written consent, and parental/guardian consent was waived for those < 18 years old.
Additional information
Publisher's Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Rights and permissions
Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.
About this article
Cite this article
Lapping-Carr, L., Mustanski, B., Ryan, D.T. et al. Stress and Depression Are Associated with Sexual Function and Satisfaction in Young Men Who Have Sex with Men. Arch Sex Behav 52, 2083–2096 (2023). https://doi.org/10.1007/s10508-023-02615-5
Received:
Revised:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s10508-023-02615-5