The analysis of open-minded attitudes towards sexuality in general requires a construct based on attitudinal dimensions. Although several existing studies involve sexual attitudes, they differ substantially and standardized conceptual work is missing. Thus, the authors introduce the latent variable sexual openness to develop a construct based on self-oriented attitudes towards different sexual topics. Available survey data of female German students in a steady relationship allowed providing a first empirical test for the applicability of this construct. Five subdimensions are acknowledged central for sexual openness: sexual practices, masturbation, bisexuality, permissiveness, and pornography consumption. Confirmatory factor analysis and correlations confirmed the idea of an underlying mechanism with an impact on all five variables. Though further validation of the construct of sexual openness is required, the findings strongly support the notion of an overarching latent attitude variable, which influences the individual relation to everything sexual. The results were compared to other studies and potential approaches for future analyses were proposed.
Citation: Rausch D, Dekker A, Rettenberger M (2017) The construct of sexual openness for females in steady intimate relationships. PLoS ONE 12(6): e0172274. https://doi.org/10.1371/journal.pone.0172274
Editor: Devon Hensel, Indiana University School of Medicine, UNITED STATES
Received: October 23, 2015; Accepted: February 2, 2017; Published: June 21, 2017
Copyright: © 2017 Rausch et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
Data Availability: The minimal underlying data set necessary for replication of this study is accessible at the Open Science Framework (https://osf.io/pqvs2/) the identifiers are: DOI 10.17605/OSF.IO/PQVS2 and ARK c7605/osf.io/pqvs2.
Funding: The project was funded by the German Research Foundation (Deutsche Forschungsgemeinschaft, DFG); funding number MA 5351/1-1 (recipient: AD). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.
Competing interests: The authors have declared that no competing interests exist.
Sexual well-being is known to have positive effects on mental health, self-confidence, quality of partnership, and body image [1–6]. Similarly, sexual dysfunction is associated with a reduced quality of life. This is due to the impact on depression, anxiety, and distressed feelings [7–9]. An increased level of sexual well-being is connected to open attitudes towards sexuality [10–12]. These attitudes are influenced by the complexity of personal experience, as well as the cultural and social environment [13–22]. Because of its apparent impact on the quality of life we introduce the construct sexual openness for systematic research and model development of sexual functioning.
Although no previous research used sexual openness as proposed in this study there are several works, which tap parts of the construct. Many different measures of individual dispositions towards sexuality have been proposed [23–25]. In the following erotophilia-erotophobia and the concept of sexual liberalism serve as the main theoretical links of sexual openness to previous research in this field.
Erotophilia-erotophobia is defined as “the disposition to respond to sexual cues along a negative-positive dimension of affect and evaluation” [26, 27]. Since this concept was operationalized with the Sexual Opinion Survey (SOS) it has been used as a basis for research on several sexual issues. This includes topics such as sexual arousal, reactions to sexual stimuli, body image, and masturbation [9, 28–33].
An advantage of the SOS is the measurement of a diversity of sexual topics. Although erotophilia-erotophobia consists of affective responses to sexual cues, it is often used to characterize sexual attitudes. The correlation of the SOS scores and sexual attitudes or behavior are just weak to moderate , which emphasizes the requirement of new integrated constructs and corresponding measurement tools.
Updates of the SOS partially address the mentioned aspects but mostly from a measurement perspective. They tend to concentrate on single subdimensions (e.g., Sexual Anxiety Scale, ; emphasize on pornography and practices) or societal norms related to sexuality, which strongly depend on the cultural environment (e.g. Sexual Attitude Scale, : Premarital sex may be a sign of a decaying social order, I think sex should be reserved for marriage). Some scales present a confused classification of items (e.g., Sexual Attitudes Scale, : sexual practices measured as a mixture of birth control, sex education, sex toy usage and masturbation) or focus on a few aspects of sexual liberalism (e.g., Inventory of Dyadic Heterosexual Preferences, : erotophilia measured by only eight items on specific practices and preferences; Sexual Attitudes Scale, see : subdimension communion contains items measuring the satisfaction with and quality of sexuality).
However, most of these scales also have conceptual benefits. For example, the Sexual Attitudes Scale introduced by Hendrick and Hendrick  contains a comprehensive operationalization of the construct permissiveness, which is still largely up to date. Fallis et al.  criticize the SOS items and propose the Sexual Anxiety Scale as an alternative. They explained most of the variance in their data with a factor that mainly includes items about pornography, masturbation, sexual practices, and statements about reactions to possible embarrassing situations (e.g., overhearing other people having sex, seeing two people kissing or fondling each other). The Trueblood Sexual Attitudes Questionnaire consists of a compilation of items on attitudes towards others, and the same amount of items on individual attitudes, which are applicable today [39, 40].
In summary, the revision and adjustments of erotophilia-erotophobia and sexual liberalism mainly focus on the measurement while no major theoretical revisions of the original constructs have been conducted. This study aims to focus on the overarching construct behind attitudes towards sexuality, independent of the specific instruments used to measure it.
The present study
The purpose of this study is to structure, rearrange, and add to the ideas of erotophilia and sexual liberalism to propose an attitude-based construct named sexual openness. The big five personality trait openness to experience is an important basis for the development of attitudes towards different sexual content and thus for the individual formation of sexual openness. However, sexual openness is more responsive to external influences and might change significantly over time. Previous research on openness towards sexual topics serves as a basis for the new integrated construct sexual openness. Individual attitudes towards masturbation, pornography, permissiveness, bisexuality, and sexual practices form the five subdimensions of this new latent variable. Positive attitudes towards masturbation indicate a higher level of acceptance for the own sexual desires [41, 42]. A liberal view of bisexuality and sexual practices signifies high interest in new sexual experiences . We will also include permissiveness in our conceptualization of sexual openness . Finally, sexuality-related media are able to provoke positive emotions or resentment [45–51]. Based on these relationships and their theoretical background, the five mentioned subdimensions should highly correlate and cover central aspects of individual sexual openness (see Fig 1). We will estimate their distinctiveness and investigate whether these aspects are part of one latent construct.
p < .001 for all estimated factor loadings.
The statistical analysis employs data of a survey about sexuality in students conducted by the Institute for Sex Research and Forensic Psychiatry at the University Medical Center Hamburg-Eppendorf . Due to its different focus, many of the items measured sexual behavior, which represents only the manifest part of sexual openness as an association of attitudes towards sexual topics. Thus we had to operationalize sexual openness relying on behavioral measures. However, the emphasis is on the underlying latent attitude independent of partnership and society.
Unfortunately, using items referring to sexual behavior has implications for the composition of the sample. It is expected that the sexuality of people in steady partnerships differs substantially from those without a partner [53–56]. For example, the lack of a sexual partner affects the frequency of sexual behavior. Thus, we had to exclude singles in our final sample, although their attitudes are supposed to align with the same construct. Additionally, attitudes towards several sexuality-related topics such as pornography or masturbation are unequal in men and women [5, 32, 57–59]. These findings imply gender differences in a global concept for sexual attitudes. Several studies estimated higher levels of sexual dissatisfaction for women than for men due to arousal and interest problems [2, 7, 60]. Thus, research on female sexuality is of particular importance and we decided to focus on women in this study. Of course the sexual openness of men and the expected differences to women should be covered in future analyses.
Therefore, the main goal of the statistical analysis is to provide evidence for the construct of sexual openness independent of the used measurement model. We expected interrelations of all subdimensions due to their connection to the latent construct sexual openness. We used confirmatory factor analysis (CFA) as statistical method and tested different estimation algorithms to account for the effect of non-normality and the sample size. As asymptotically distribution free (ADF) estimation is recommended for usage in case of non-normal distribution, a more accurate estimation was expected for ADF. This opposes the widespread tendency to use maximum likelihood estimation in many analyses [31, 61, 62].
The used data derived from a survey, which was the fourth in a series of similar surveys since 1966 and part of a research project of the Institute for Sex Research and Forensic Psychiatry at the University Medical Center Hamburg-Eppendorf . The aim of the project is to analyze the current state and changes in sexual behavior and attitudes of German students (for other publications related to this longitudinal study see, for example, [63–65]. The project was funded by the German Research Foundation (Deutsche Forschungsgemeinschaft, DFG). The study design was approved by the Data Protection Supervisor of the Free and Hanseatic City of Hamburg (federal state of Germany; approval number: D4/17.06-00/1). A further ethical statement according to the APA standards was included in the cover letter of the present manuscript. Written informed consent was not given by participants but the participants’ information was anonymized and de-identified prior to analysis. There was no clinical data or material used, i.e., there was no analysis of patients’ information. The data was collected at 15 universities located in different cities all-over Germany between May and December 2012. Participants answered with a response rate of nearly 28%, which resulted in a final sample of 2,081 German students consisting of 1,280 women and 796 men. The participants’ age ranged from 16 to 54 (M = 24.24, SD = 4.00). Of all respondents 63.74% (n = 1,327) indicated being in a relationship with a partner; however more female (66.87%) than male (58.79%) students affirmed this question. For our analyses, the group of interest consisted of women committed in a relationship, resulting in a final sample of n = 859. This data enabled us to conduct statistical analyses dependent on larger sample sizes, but we had to choose from predetermined items to construct our measurement model.
Under consideration of erotophilia and other concepts like sexual liberalism we constructed the model of sexual openness consisting of the five subdimensions sexual practices, masturbation, bisexuality, permissiveness, and pornography [27, 34, 35, 38, 39, 41, 66–69]. In order to measure these subdimensions, questions from the questionnaire sections about sexual experiences, sexuality in the new media, and sexual well-being were taken into account. We chose 18 items to establish the measurement model. The items were used as indicators for the latent variables representing the students’ attitudes. The recoded items and subscales assign higher values to increasing sexual openness. As a final step, 14 scales with standardized values were constructed to distinguish the different subdimensions (see Fig 1).
Participants reported which practices they performed with their partner during the most recent sexual intercourse, such as an active or passive form of manual sex, oral sex, vaginal sex, or anal sex. By adding one point for every practice, we constructed an additive scale with a range from 0 to 8. Additionally, the elapsed time after performing these practices was examined. This resulted in a further scale with higher values representing a more recent activity. The students could choose between within last 4 weeks, within last 12 month, earlier, and never.
We used two indicators to measure the participants’ attitude towards masturbation: the actual frequency of masturbation and their reported feelings and thoughts after masturbation. We constructed an additive scale from affirmative responses to I was sexually satisfied, I enjoyed it, I felt relaxed, and I was happy. These four items showed high correlations and were chosen as collinear representatives of positive feelings towards masturbation. The final scale ranged from 0 to 4, with the maximum value assigned to a positive view of masturbation.
Three items were used to measure the attitude towards sexual experiences with partners of the same sex. We examined whether the students feel attracted to the same sex, could imagine a pleasurable sexual experience with partners of the same sex, and how they would describe their sexual orientation. Higher scores indicated a higher sexual flexibility, whereas lower scores implied a stronger sexual affection towards one gender.
We constructed three different scales to measure permissiveness. First, we used the desire to have sex outside the relationship as an indicator. A second scale was based on the respondents’ definition of faithfulness and its importance in a relationship. Every disagreement to one of the following statements corresponded to one point on the scale: My partner is unfaithful if he… flirts/ kisses/ loves/ has sex with someone else/ masturbates/ consumes pornography/ flirts on the internet. Finally, participants were asked about the number of other people they had sex with during their relationship. If they had such experience, further points were added if they described their subsequent feelings as positive.
In order to examine students’ attitudes towards pornography, we inquired whether pornography is exciting to them, when they consumed pornography on the internet last time, and with whom they did it. Additionally, we considered participants as having an increasingly open-minded attitude towards pornography the more topics they were interested in. Some examples of these topics are different combinations of actor/actress, practices, and several other contents such as sex-toys and bondage.
Data analytic strategy
All statistical analyses were performed using STATA 12. Using confirmatory factor analysis (CFA), we investigated the existence of an underlying construct composed of the mentioned five subdimensions. CFA is able to verify existing theoretical assumptions about a latent construct with consciously attributed measurement items. The subdimensions of sexual openness were coded as latent variables and their correlations were estimated. A good CFA model fit indicates the alignment of data distribution with the latent construct tested. To check for robustness regarding different estimation algorithms maximum likelihood (without missing values: ML; with missing values: MLMV) and asymptotically distribution free (ADF) estimation were compared. ADF is a weighted least squares estimator with robust standard errors corrected for smaller samples in STATA 12 .
To evaluate CFA model fit different metrics are available [71–75]. χ2-based tests like the normal χ2-value or the Satorra-Bentler χ2-value  focus on the amount of deviation from the model’s assumptions in the data. This means that a high χ2-value and a significant test result indicate that the data deviates from the researchers’ model . However, large sample sizes tend to result in rising χ2-values independent of model qualification . χ2 divided by its degrees of freedom can give further information with values lower than 3 indicating a good model fit despite their statistical significance .
The root mean square error of approximation (RMSEA) is an alternative to χ2 to assess CFA model fit. It represents the discrepancy of the model assumptions and the empirical covariance matrix and yields a result between 0 and 1 with values below 0.05 indicating a good model fit.
The Tucker-Lewis-index (TLI or NNFI) analyzes the discrepancy of the χ2-values of the constructed model and the null model (all latent variables and measurement items in the model are connected by covariances) and reports the quality of model fit on a scale from 0 to 1 with 1 indicating the best model fit (excellent model fit > 0.95).
Similar to the RMSEA the comparative fit index (CFI) does not use the χ2-value to determine model fit but instead focusses on the comparison of empirical data and model produced estimations. It is corrected for sample size and results in index values from 0 to 1 with 1 indicating the best model fit (excellent model fit > 0.95).
The metrics described above were used to assess model fit in this study.
Furthermore, we tested the reliability of the latent variables with the average variance extracted (AVE) and conducted a discriminant validity test to confirm the difference of the subdimensions. A reduced model without subdimensions but instead all items as independent indicators for sexual openness was estimated to provide further information to assess the complete model. After evaluation of model fit, the subdimensions were used to calculate Cronbach’s α to get insight whether the concept of sexual openness can be appropriately described by the measured latent variables.
We cross-validated the developed concept by statistical analyses with another survey item. The item examined what kind of sexual activities the participant had already done and what she could imagine to try in future. It covered 15 different aspects, for example watching pornography, using sex toys, having sex with more than one person at the same time, using bonds/handcuffs, or using sexually stimulating substances. An additive scale with a range from 0 to 15 was constructed by adding one point for every practice which the respondent could imagine to or did engage in. We calculated this item’s correlations with the values for sexual openness based on the estimations for all subdimensions. According to our understanding of sexual openness the measure should correlate with the introduced construct of sexual openness.
Model fit and comparison of estimation methods
We tested a five-factor model for sexual openness using confirmatory factor analysis (see Fig 1). Goodness-of-fit indices calculated for ML and MLMV resulted in similar outcomes like those for ADF. There were no considerable differences between estimation methods (see Table 1). In the following we will refer to the results of ADF estimation as it is suggested for non-normality and our sample size complies with the requirements [70, 79, 80]. All calculated fit-indices suggested an adequate model fit, CFI = 0.961, TLI = 0.947, RMSEA = 0.044, except of the χ2-statistic, χ2(68) = 174.40, p < .001. This is a well-known phenomenon and can be attributed to the χ2-test’s sensitivity to sample size and model complexity [81–83]. However, the relative χ2 of 2.56 (ratio of χ2 to its degrees of freedom) represents a good model fit. Values lower than 3 are recommended . Satorra-Bentler-scaled χ2-statistics for ML estimation was significant providing no further evidence in favor of the model, Satorra-Bentler χ2(67) = 172.18, χ2/df = 2.57 . The reduced model performed significantly worse, χ2(78) = 836.67, p < .001, CFI = 0.720, TLI = 0.673, RMSEA = 0.109, which confirms the importance of the chosen subdimensions for the construct sexual openness.
Factor loadings, factor reliability, and discriminant validity
All estimated factor loadings were highly significant and ranged between .60 and .92 (see Fig 1). Two outliers occurred: one item on sexual practices (sexual practices during last intercourse, factor loading = .51) and another item on pornography (pornography exciting, factor loading = .44). The highest factor loadings were identified for pornography items measuring the time period since last consumption (factor loading = .91) and the preference of different topics in pornography (factor loading = .87). Additionally, the question about the time period since performing different sexual practices showed a high factor loading (factor loading = .92).
The calculated composite reliabilities in Table 2 ranged between .69 and .85 and thus suggest an acceptable measurement (values greater .6 recommended; ). The smallest values were identified for the subdimensions of sexual practices and permissiveness. For sexual practices, a composite reliability of .697 was calculated. The subdimension of permissiveness consistently showed the smallest factor loadings with values between .60 and .71, resulting in the minimal composite reliability of .689.
As presented in Table 2, for correlations of the subdimensions values between .18 and .47 were calculated. The highest correlations were estimated for bisexuality and permissiveness (r = .47, p < .001), and for masturbation and pornography (r = .45, p < .001). The lowest correlation was examined for permissiveness and pornography (r = .18, p < .001). Based on the Fornell-Larcker-criterion the average variance extracted (AVE) of every factor was compared to the corresponding squared correlations with each other factor. We estimated values between .42 and .64 for the AVE. Only for the subdimension permissiveness a value lower than .5 was calculated (AVE = .42). For all other latent variables, the threshold of .5 was exceeded . As the squared correlations ranged between .03 and .22. Consequently the values were lower than the respective AVE and discriminant validity was verified for all factors.
We calculated Cronbach’s α with help of the predicted values for the five subdimensions to evaluate the internal consistency of the developed construct (α = .76).
Further construct validation
For the item, which covered 15 different sexual activities, a correlation of r = .58 (p < .001) between the amount of affirmative replies and the estimated value for openness was examined. The highest correlations with single subitems were calculated with sex with more than one person (r = .51, p < .001) and using sex toys (r = .42, p < .001), whereas the lowest values occurred for wearing clothes of the other sex (r = .02, p < .001) and using sexually stimulating substances (r = .13, p < .001).
The aim of this study was to examine whether attitudes towards different sexuality-related topics can be summarized in one latent construct. The results obtained by CFA suggest that the five subdimensions sexual practices, masturbation, bisexuality, permissiveness, and pornography can be subsumed to a global concept which we introduced as sexual openness. Due to the small number of indicators the value of Cronbach’s α is acceptable [87, 88] and implies high internal consistency of the five subdimensions.
ML and MLMV estimation were tested because of their widespread implementation even with non-normal distributed data [31, 61, 62]. Despite the missing normality assumption both methods resulted in an appropriate estimation. Moreover, ADF estimation was tested as recommended for non-normal distributed data. This method uses an asymptotical calculation and works best for larger sample sizes above 500 . As expected, ADF estimation provided the best model fit. This indicated that all three methods are viable to estimate model fit, although the sample does not suffice with all method assumptions.
It was important to analyze the composite reliability as well as the discriminant validity to be sure that the five subdimensions represent different aspects of sexual openness. The small factor loadings for permissiveness correspond to the restrictive wording of two measurement items directly asking for wanting or having sex outside the relationship, what resulted in a small composite reliability as well. For the same reason, the threshold value for the AVE could not be obtained for permissiveness, whereas the factor loadings for all other subdimensions sufficed. Because of moral concerns most of the participants tend to negate such questions . Nevertheless, emotionally faithful respondents might show a general interest in sexual contact with others and slightly increased levels of permissiveness. The small composite reliability for sexual practices alludes to its measurement with two items, one with a small factor loading of .51. This item solely examines the sexual practices for one given event, which may differ from the average. The time period since performing different practices last time allows a more comprehensive evaluation, which is reflected by its high factor loading (.92).
Guerra and Gouveia  constructed a measure for sexual liberalism and differentiated between two subscales: the liberalism towards the own sexuality (self scale, SS) and towards other peoples’ sexuality (other scale, OS). This is consistent with the approach of Hannon et al. , who estimated significant differences between the other and self scale, as participants reported more conservative attitudes towards the own behavior than towards others’. The measurement of sexual openness as outlined in the present study focused on the perception of the own sexuality and excluded the other scale because it is more a question of tolerance than of personal preferences. Sexual openness should not include general social conditions like different value systems or social peer pressure. However, external factors might have strong influence on individual levels of sexual openness.
Beyond the overall model fit the correlations of different estimated subdimensions were analyzed. High values were calculated for the correlation of pornography and masturbation representing the sexually arousing effect of sexually explicit material [57, 90–92]. The coefficient for bisexuality and permissiveness shows a more indirect relation, possibly due to the problematic measurement of permissiveness. This could be an indicator that non-heterosexual women are interested in having sexual experiences with other people of the same sex, even if they are living in a stable intimate relationship.
The strong relationship of pornography consumption and sexual behavior is an argument for the relevance this subdimension . Recently, positive effects of pornography on sexuality are considered more frequently [45, 94–97]. The idea that sexually explicit media can have an educating and mind-opening effect towards different practices is supported by the results of the present study. On the other hand, the notion that a high level of pornography consumption is related to a lesser degree of sexual faith is not supported by the results of the present study. Inconsistent to findings of Wright et al. , at least for women, this hypothesis is questionable as the correlation between pornography and permissiveness showed low values. Additionally, the relationships between pornography and bisexuality as well as between pornography and sexual practices imply an association between consumption of sexually explicit material and the formation of the personal sexual background and self-perception. A positive connection between the frequency of purchasing pornography and the score for erotophilia was also examined by Fisher et al. with the help of the SOS.
Consistent with the findings of Gerressu et al. , Guerra and Gouveia , and Guerra et al.  high correlations were also estimated for less obvious relations, for example masturbation and bisexuality, or masturbation and permissiveness. Altogether, the widespread moderate correlations of distinct measured variables as shown in Table 2 suggest an underlying concept beyond the five subdimensions.
The evaluation of areas of sexual exploration measured by an item, which covered attitudes towards 15 different sexual activities, provided further support for this model. Especially high correlations of sexual openness with positive answers to sex with more than one person and the usage of sex toys correspond to the theoretical arguments. However, the subitems wearing clothes of the other sex and using sexually stimulating substances showed no correlations with sexual openness. These items are related to very specific sexual preferences instead of more general aspects explained by sexual openness. Despite the wide range of the covered sexual preferences, the correlation of the estimated sexual openness and an additive scale consisting of all 15 subitems is high (r = .58, p < .001), which supports our argument. Consequently, sexual openness is able to explain the overall relation to sexuality but does not provide precise estimations of specific preferences.
Although this study examined important aspects and evidence for the latent construct sexual openness, it has some limitations. The data used in the present study was derived from a survey project by the Institute of Sex Research and Forensic Psychiatry at the University Medical Center Hamburg-Eppendorf , which contained research questions independent of the present study. Hence, the present sample had an acceptable size but the items show some deficits in wording and scale construction for the purpose of this study. This resulted in non-normal distribution in the data. The item about excitation due to pornography highlights this problem. The small factor loading refers not only to the potential difference of excitement and approving attitudes, but to the scale construction as well. Participants could choose between yes, yes, but only some and no, resulting in a share of 70% for the middle category.
Other limitations result from the sample structure: Because the UKE study is focused on the student population it was not possible to include other socioeconomic groups, which should be part of future studies on this topic.
Social desirability problems especially occurred in relation to the subdimension permissiveness. It was operationalized using three different items/scales, two of them asking for sexual contact outside the relationship. Because of an aversion to answer truthfully, the results could be biased and a more sensitive wording would have been appropriate. Further conceptual work is necessary to determine whether unfaithful behavior should be part of sexual openness at all. Reflecting these issues the calculated statistical parameters were worst for permissiveness.
Conclusion and future prospects
The present study aimed to demonstrate the existence of sexual openness as the underlying concept of apparently distinct attitudes towards sexual topics. The conceptual work was influenced by existing constructs like erotophilia and sexual liberalism and focused on the five subdimensions sexual practices, masturbation, bisexuality, permissiveness, and pornography. The consideration of a five-factor model led to a balanced emphasis on the different subdimensions in comparison to previous constructs.
The current study provides an impulse for further research to unify former concepts of attitudes towards sexuality. Further investigation is necessary, and the idea of sexual openness should be validated by items deliberately constructed to measure its subdimensions. The usage of more sensitive scales could provide more detailed information about the relationships of the five subdimensions. For future studies it would be valuable to cross-validate these findings with a new sample, which includes women of different age groups and education levels. Additionally, the examination of the concept of sexual openness in men or single people is of high interest.
Sexual openness is a useful variable for developing theories to explain sexual behavior, problems, and attitudes. Its subdimensions are influenced by the conception of moral and religion, sexual subjectivity, body image, communication, and a broad range of experiences [15, 28, 82, 83, 98–100]. Conversely, they interact with variables such as sexual communication or satisfaction [29, 31, 101]. Therefore, sexual openness is expected to have a high influence on individual well-being and happiness. Further research on this topic serves to reach a more comprehensive understanding of human sexual functioning and can provide insights for clinical application.
- Conceived and designed the experiments: DR AD MR.
- Performed the experiments: DR AD MR.
- Analyzed the data: DR MR.
- Contributed reagents/materials/analysis tools: DR AD MR.
- Wrote the paper: DR AD MR.
- 1. Byers ES. Relationship satisfaction and sexual satisfaction: A longitudinal study of individuals in long-term relationships. J Sex Res. 2005 May;42(2):113–8. pmid:16123841
- 2. Carpenter LM, Nathanson CA, Kim YJ. Physical women, emotional men: Gender and sexual satisfaction in midlife. Arch Sex Behav. 2009 Feb;38(1):87–107. pmid:17851747
- 3. Castellanos-Torres E, Alvarez-Dardet C, Ruiz-Muñoz D, Pérez G. Social determinants of sexual satisfaction in Spain considered from the gender perspective. Ann Epidemiol. Elsevier Inc; 2013 Mar;23(3):150–6. pmid:23317925
- 4. Seal BN, Bradford A, Meston CM. The association between body esteem and sexual desire among college women. Arch Sex Behav. 2009 Oct;38(5):866–72. pmid:19280331
- 5. Stephenson RK, Meston MC. The association between sexual costs and sexual satisfaction in women: An exploration of the Interpersonal Exchange Model of Sexual Satisfaction. Can J Hum Sex. 2011;20(1/2):31–40.
- 6. Zimmer-Gembeck MJ, Ducat WH, Boislard-Pepin MA prospective study of young females’ sexual subjectivity: Associations with age, sexual behavior, and dating. Arch Sex Behav. 2011 Oct;40(5):927–38. pmid:21491139
- 7. Heiman JR. Sexual dysfunction: Overview of prevalence, etiological factors, and treatments. J Sex Res. 2002 Feb;39(1):73–8. pmid:12476261
- 8. Hinchliff S, Gott M, Wylie KA qualitative study of heterosexual women’s attempts to renegotiate sexual relationships in the context of severe sexual problems. Arch Sex Behav. 2012 Oct;41(5):1253–61. pmid:22318469
- 9. Nelson AL, Purdon C. Non-erotic thoughts, attentional focus, and sexual problems in a community sample. Arch Sex Behav. 2011 Apr;40(2):395–406. pmid:21136147
- 10. Montesi JL, Conner BT, Gordon EA, Fauber RL, Kim KH, Heimberg RG. On the relationship among social anxiety, intimacy, sexual communication, and sexual satisfaction in young couples. Arch Sex Behav. 2013 Jan;42(1):81–91. pmid:22476519
- 11. Rehman US, Rellini AH, Fallis E. The importance of sexual self-disclosure to sexual satisfaction and functioning in committed relationships. J Sex Med. 2011 Nov;8(11):3108–15. pmid:21883943
- 12. Smith CV. In pursuit of “good” sex: Self-determination and the sexual experience. J Soc Pers Relat. 2007;24:69–85.
- 13. Brown JD, L’Engle KL, Pardun CJ, Guo G, Kenneavy K, Jackson C. Sexy media matter: Exposure to sexual content in music, movies, television, and magazines predicts black and white adolescents’ sexual behavior. Pediatrics. 2006 Apr;117(4):1018–27. pmid:16585295
- 14. Fahs B, Swank E. Social identities as predictors of women’s sexual satisfaction and sexual activity. Arch Sex Behav. 2011 Oct;40(5):903–14. pmid:20878224
- 15. Hartmann U, Philippsohn S, Heiser K, Rüffer-Hesse C. Low sexual desire in midlife and older women: Personality factors, psychosocial development, present sexuality. Menopause J North Am Menopause Soc. 2004;11(6):726–40.
- 16. Hill A. Sexualität in Zeiten des Internet [Sexuality in the internet age]. Psychotherapeut. 2011 Oct 20;56(6):475–84.
- 17. Lehmann A. Psychosoziale Einflussfaktoren auf das weibliche Sexualerleben. 2007.
- 18. L’Engle KL, Brown JD, Kenneavy K. The mass media are an important context for adolescents’ sexual behavior. J Adolesc Heal. 2006 Mar;38(3):186–92.
- 19. Pronier C, Monk-Turner E. Factors shaping women’s sexual satisfaction: A comparision of medical and social models. J Gend Stud. 2014;23(1):69–80.
- 20. Sanders SA, Graham CA, Milhausen RR. Predicting sexual problems in women: The relevance of sexual excitation and sexual inhibition. Arch Sex Behav. 2008 Apr;37(2):241–51. pmid:17902042
- 21. Stephenson KR, Sullivan KT. Social norms and general sexual satisfaction: The cost of misperceived descriptive norms. Can J Hum Sex. 2009;18(3):89–105.
- 22. Taylor LD. Effects of visual and verbal sexual television content and perceived realism on attitudes and beliefs. J Sex Res. 2005 May;42(2):130–7. pmid:16123843
- 23. Arrington R, Cofrancesco J, Wu AW. Questionnaires to measure sexual quality of life. Qual Life Res. 2004 Dec;13(10):1643–58. pmid:15651536
- 24. Fisher TD, Davis CM, Yarber WL, Davis SL. Handbook of Sexuality-Related Measures. 3rd ed. New York: Routledge; 2011.
- 25. Richter D, Spangenberg L, Matthes A, Brähler E, Strauß B. Standardisierte Verfahren in der empirischen Sexualforschung–Ein Update [Standardized Methods of Empirical Sexual Sciene–An Update]. Zeitschrift für Sex. 2012;25:93–130.
- 26. Fisher W. The Sexual Opinion Survey. In: Davis C, Yarber W, Bauserman R, Scheer G, Davis S, editors. Handbook of Sexuality-Related Measures. Thousand Oaks, CA; 1998. p. 213–23.
- 27. Fisher W, White L, Byrne D, Kelley K. Erotophobia-erotophilia as a dimension of personality. J Sex Res. 1988;25(1):123–51.
- 28. Le Gall A, Mullet E, Shafighi S. Age, religious beliefs, and sexual attitudes. J Sex Res. 2002;39(3):207–16. pmid:12476268
- 29. Macapagal KR, Janssen E. The valence of sex: Automatic affective associations in erotophilia and erotophobia. Pers Individ Dif. Elsevier Ltd; 2011 Oct 1;51(6):699–703. pmid:21869852
- 30. Nobre PJ, Wiegel M, Bach AK, Weisberg RB, Brown TA, Wincze JP, et al. Determinants of sexual arousal and accuracy of its self-estimation in sexually functional males. J Sex Res. 2004 Nov;41(4):363–71. pmid:15765276
- 31. Santos-Iglesias P, Sierra JC, Vallejo-Medina P. Predictors of sexual assertiveness: The role of sexual desire, arousal, attitudes, and partner abuse. Arch Sex Behav. 2013 Aug;42(6):1043–52. pmid:22875718
- 32. Thompson AE, O’Sullivan LF. Gender differences in associations of sexual and romantic stimuli: Do young men really prefer sex over romance? Arch Sex Behav. 2012 Aug;41(4):949–57. pmid:21755380
- 33. Wiederman MW. The state of theory in sex therapy. J Sex Res. 1998;35(1):88–99.
- 34. Rye BJ, Meaney GJ, Yessis J, McKay A. Uses of the “Comfort with Sexual Matters for Young Adolescents” scale: A measure of erotophobia-erotophilia for youth. Can J Hum Sex. 2012;21(2):91–101.
- 35. Fallis EE, Gordon C, Purdon C. Sexual Anxiety Scale. In: Fisher TD, Davis CM, Yarber WL, Davis SL, editors. Handbook of Sexuality-Related Measures. 3rd ed. New York: Routledge; 2011. p. 228–31.
- 36. Hundson W, Murphy G, Nurius PA short-form scale to measure liberal vs. conservative orientations toward human sexual expression. J Sex Res. 1983;19:258–72.
- 37. Hendrick S, Hendrick C. Multidimensionality of sexual attitudes. J Sex Res. 1987;23(4):502–26.
- 38. Purnine D, Carey M, Jorgensen R. The inventory of dyadic heterosexual preferences: Development and psychometric evaluation. Behav Res Ther. 1996;34(4):375–87. pmid:8871371
- 39. Hannon R, Hall D, Gonzalez V, Cacciapaglia H. Trueblood Sexual Attitudes Questionnaire. In: Fisher TD, Davis CM, Yarber WL, Davis SL, editors. Handbook of Sexuality-Related Measures. 3rd ed. New York: Routledge; 2011. p. 68–71.
- 40. Trueblood K, Hannon R, Hall D. Development and validation of a measure of sexual attitudes. Paper presented at the meeting of the Society fot the Scientific Study of Sexuality Western Region Annual Conference, Honululu, HI; 1998.
- 41. Gerressu M, Mercer CH, Graham CA, Wellings K, Johnson AM. Prevalence of masturbation and associated factors in a British national probability survey. Arch Sex Behav. 2008 Apr;37(2):266–78. pmid:17333329
- 42. Kaestle CE, Allen KR. The role of masturbation in healthy sexual development: Perceptions of young adults. Arch Sex Behav. 2011 Oct;40(5):983–94. pmid:21293916
- 43. Draganic J. Sexual Fluidity and Women’s Bisexual Identity Development. University of North Dakota; 2013.
- 44. Conley TD, Ziegler A, Moors AC, Matsick JL, Valentine B. A critical examination of popular assumptions about the benefits and outcomes of monogamous relationships. Personal Soc Psychol Rev. 2012 May;17(2):124–41.
- 45. Brajdić Vuković M, Došen K, Ghazzawi L, Tarokić S. Može li pornografija pozitivno utjecati na žensku seksualnost? Utjecaj učestalog konzumiranjan [Can pornography have a positive influence on female sexuality? Influence of frequent pornography consumption on the sexual lives of women: A qualitative study]. Rev Sociol. 2014;43(2):133–58.
- 46. Collins RL, Elliott MN, Berry SH, Kanouse DE, Kunkel D, Hunter SB, et al. Watching sex on television predicts adolescent initiation of sexual behavior. Pediatrics. 2004 Sep;114(3):e280–9. pmid:15342887
- 47. Döring N. Sex 2.0—Chancen und Risiken für Mädchen und Frauen [Sex 2.0 –Opportunities and risk for girls and women]. In: Kampmann B, Keller B, Knippelmeyer M, Wagner F, editors. Die Frauen und das Netz. Wiesbaden: Gabler Verlag; 2013. p. 275–88.
- 48. Hald GM, Malamuth NM. Self-perceived effects of pornography consumption. Arch Sex Behav. 2008 Aug;37(4):614–25. pmid:17851749
- 49. Schmidt G, Matthiesen S. „What do boys do with porn?“. Zeitschrift für Sex. 2011;24:353–78.
- 50. Wright PJ. Mass media effects on youth sexual behavior. In: Salmon CT, editor. Communication Yearbook 35. New York, London: Routledge; 2011. p. 343–86.
- 51. Wright PJ. A longitudinal analysis of US adults’ pornography exposure. J Media Psychol Theor Methods, Appl. 2012 Jan 1;24(2):67–76.
- 52. UKE. Forschungsprojekt Studentische Sexualität im Wandel: 1966–1981–1996–2011 [Research project about the change of students‘ sexuality: 1966–1981–1996–2011] [Internet]. 2014. Available from: http://dfg.studentensexualitaet.de/
- 53. Armstrong EA, England P, Fogarty ACK. Accounting for women’s orgasm and sexual enjoyment in college hookups and relationships. Am Sociol Rev. 2012 May 7;77(3):435–62.
- 54. Büsing S, Hoppe C, Liedtke R. Sexuelle Zufriedenheit von Frauen - Entwicklung und Ergebnisse eines Fragebogens [Sexual satisfaction of women–development and results of a questionnaire]. Psychother Psychosom Med Psychol. 2001;51:68–75. pmid:11268782
- 55. Schmidt R. Lebensthema Sexualität [Lifetime issue sexuality]. Opladen: Leske + Budrich; 2003.
- 56. von Irmer J. Die Rolle des Sexuallebens in einer romantischen Partnerschaft für die Beziehungszufriedenheit [The role of sexuality for relationship satisfaction in romantic partnership]. Zeitschrift für Fam. 2008;3.
- 57. Carvalho J, Gomes AQ, Laja P, Oliveira C, Vilarinho S, Janssen E, et al. Gender differences in sexual arousal and affective responses to erotica: The effects of type of film and fantasy instructions. Arch Sex Behav. 2013 Aug;42(6):1011–9. pmid:23519591
- 58. Hendrick S, Hendrick C. Gender differences and similarities in sex and love. Pers Relatsh. 1995;2:55–65.
- 59. Rupp H, Wallen K. Sex differences in viewing sexual stimuli: An eye-tracking study in men and women. Horm Behav. 2007;51:524–33. pmid:17362952
- 60. Schmidt G, Matthiesen S, Dekker A, Starke K. Spätmoderne Beziehungswelten [Postmodern Relationships]. Wiesbaden: VS Verlag für Sozialwissenschaften; 2006.
- 61. Curran PJ. The robustness of confirmatory factor analysis to model misspecification and violations of normality. Arizona State University; 1994.
- 62. Kliem S, Job AK, Kröger C, Bodenmann G, Stöbel-Richter Y, Hahlweg K, et al. Entwicklung und Normierung einer Kurzform des Partnerschaftsfragebogens (PFB-K) an einer repräsentativen deutschen Stichprobe [Development and normalization of a short version of the partnership questionnaire (PFB-K)]. Z Klin Psychol Psychother. 2012 Jan 1;41(2):81–9.
- 63. Klusmann D. Sexual motivation and the duration of partnership. Arch Sex Behav. 2002 Jun;31(3):275–87. pmid:12049023
- 64. Matthiesen S, Böhm M. Wie organisieren Studierende Beziehungen und Sexualität? [How do college students organize their relationships and sexuality] profamilia Mag. 2013;3:4–8.
- 65. Schmidt G, Klusmann D, Dekker A, Matthiesen S. Changes in student’s sexual behaviour: 1966–1981–1996. A first report on a logitudinal study in West Germany. Scand J Sexol. 1998;1:157–73.
- 66. del Río Olvera FJ, López Vega DJ, Cabello Santamaría F. Adaptación del cuestionario Sexual Opinion Survey: Encuesta revisada de Opinión Sexual [Adaptation of the Sexual Opinion Survey: Revised Sexual Opinion Survey]. Rev Int Andrología. SECOT; 2013 Jan;11(1):9–16.
- 67. Guerra VM, Gouveia VV. Liberalismo/conservadorismo sexual: Proposta de uma medida multi-fatorial [Sexual liberalism/conservatism: Proposal of a multi-factorial measurement]. Psicol Reflex e Crit. 2007;20(1):43–53.
- 68. Guerra VM, Gouveia VV, Sousa DM, Lima TJ, Freires LA. Sexual liberalism-conservatism: The effect of human values, gender, and previous sexual experience. Arch Sex Behav. 2012 Aug;41(4):1027–39. pmid:22566134
- 69. Hendrick C, Hendrick S, Reich D. The brief sexual attitudes scale. J Sex Res. 2006;43(1):76–86. pmid:16817070
- 70. StataCorp LP. Stata Structural Equation Modeling Reference Manual Release 12. College Station, Texas: Stata Press; 2011.
- 71. Browne M, Cudeck R. Alternative ways of assessing model fit. In: Bollen K, Long J, editors. Testing structural equation models. Newbury Park, CA: Sage; 1993. p. 136–62.
- 72. Hu L, Bentler PM. Fit indices in covariance structure modeling: Sensitivity to underparameterized model misspecification. Psychol Methods. 1998;3(4):424–53.
- 73. Hu L, Bentler PM. Cutoff criteria for fit indexes in covariance structure analysis: Conventional criteria versus new alternatives. Struct Equ Model A Multidiscip J. 1999;6:1–55.
- 74. Schermelleh-Engel K, Moosbrugger H, Müller H. Evaluating the fit of structural equation models: Tests of significance and descriptive goodness-of-fit measures. Methods Psychol Res Online 2003. 2003;8(2):23–74.
- 75. Tucker LR, Lewis C. A reliability coefficient for maximum likelihood factor analysis. Psychometrika. 1973 Mar;38(1):1–10.
- 76. Satorra A, Bentler PM. A scaled difference chi-square test statistic for moment structure analysis. Psychometrika. 2001;66(4):507–14.
- 77. Bollen KA. Structural equations with latent variables. New York: Wiley; 1989.
- 78. Byrne BM. Structural equation modeling with AMOS: Basic concepts, applications, and programming. Vol. 1. Mahwah, NJ: Lawrence Erlbaum Associates; 2001.
- 79. Ledermann T, Bodenmann G, Rudaz M, Bradbury TN. Stress, communication, and marital quality in couples. Fam Relat. 2010 Apr;59(2):195–206.
- 80. Ullman JB. Structural equation modeling: Reviewing the basics and moving forward. J Pers Assess. 2006 Aug;87(1):35–50. pmid:16856785
- 81. Carvalho J, Vieira AL, Nobre P. Latent structures of female sexual functioning. Arch Sex Behav. 2012 Aug;41(4):907–17. pmid:22170444
- 82. Muise A, Preyde M, Maitland SB, Milhausen RR. Sexual identity and sexual well-being in female heterosexual university students. Arch Sex Behav. 2010 Aug;39(4):915–25. pmid:19330438
- 83. Parish WL, Luo Y, Stolzenberg R, Laumann EO, Farrer G, Pan S. Sexual practices and sexual satisfaction: A population based study of Chinese urban adults. Arch Sex Behav. 2007 Feb;36(1):5–20. pmid:17187219
- 84. West SG, Taylor AB, Wu W. Model fit and model selection in structural equation modeling. In: Hoyle RH, editor. Handbook of Structural Equation Modeling. New York: Guilford Press; 2012. p. 209–31.
- 85. Bagozzi RP, Yi Y. On the evaluation of structural equation models. J Acad Mark Sci. 1988;16(1):74–94.
- 86. Fornell C, Larcker DF. Evaluating structural equation models with unobservable variables and measurement error. J Mark Res. 1981;18(1):39–50.
- 87. Bland JM, Altman DG. Cronbach’s alpha. BMJ. 1997;314:572. pmid:9055718
- 88. Peterson RA. A meta-analysis of Cronbach’s coefficient alpha. J Consum Res. 1994;21(2):381–91.
- 89. Flora DB, Curran PJ. An empirical evaluation of alternative methods of estimation for confirmatory factor analysis with ordinal data. Psychol Methods. 2004 Dec;9(4):466–91. pmid:15598100
- 90. Laier C, Pawlikowski M, Brand M. Sexual picture processing interferes with decision-making under ambiguity. Arch Sex Behav. 2014 Apr;43(3):473–82. pmid:23733155
- 91. Parvez ZF. The labor of pleasure: How perceptions of emotional labor impact women’s enjoyment of pornography. Gend Soc. 2006;20(5):605–31.
- 92. Staley C, Prause N. Erotica viewing effects on intimate relationships and self/partner evaluations. Arch Sex Behav. 2013 May;42(4):615–24. pmid:23224749
- 93. Wright PJ, Bae S, Funk M. United States women and pornography through four decades: Exposure, attitudes, behaviors, individual differences. Arch Sex Behav. 2013 Oct;42(7):1131–44. pmid:23733153
- 94. Grov C, Gillespie BJ, Royce T, Lever J. Perceived consequences of casual online sexual activities on heterosexual relationships: A U.S. online survey. Arch Sex Behav. 2011 Apr;40(2):429–39. pmid:20174862
- 95. Maddox AM, Rhoades GK, Markman HJ. Viewing sexually-explicit materials alone or together: Associations with relationship quality. Arch Sex Behav. 2011 Apr;40(2):441–8. pmid:20039112
- 96. Matthiesen S, Martyniuk U, Dekker A. „What do girls do with porn?“. Zeitschrift für Sex. 2011 Dec 15;24(04):326–52.
- 97. Poulsen FO, Busby DM, Galovan AM. Pornography use: Who uses it and how it is associated with couple outcomes. J Sex Res. 2013;50(1):72–83. pmid:22449010
- 98. DeLamater J, Friedrich WN. Human sexual development. J Sex Res. 2002 Feb;39(1):10–4. pmid:12476250
- 99. Giraldi A, Rellini AH, Pfaus J, Laan E. Female sexual arousal disorders. J Sex Med. 2013 Jan;10(1):58–73. pmid:22974112
- 100. Hess J, Coffelt T. Verbal communication about sex in marriage: Patterns of language use and its connection with relational outcomes. J Sex Res. 2012;29(6):603–12.
- 101. Schönbucher V. Sexuelle Zufriedenheit von Frauen: Psychosoziale Faktoren. Zeitschrift für Sex [Sexual satisfaction of women: Psychosocial factors]. 2007 Mar;20(1):21–41.