The association between sexual costs and sexuai satisfaction in women: An exploration of tiie Interpersonal Exchange Model of Sexual Satisfaction

Recent research has suggested that female sexual functioning may be strongly tied to sexual satisfaction In some cases and weakly tied in others. The.Interpersonal Exchange Model of Sexual Satisfaction (IEMSS) constitutes a validated theoretical framework within which to explore this complex association. The aim of the current study was to explore whether sexual functioning represents an Important sexual cost that is closely linked to sexual satisfaction, and for whom. Data from 200 female undergraduates were analyzed to determine if sexuai functioning accounted for the association between sexuai costs and sexual satisfaction In women and whether this indirect effect was dependent on adult attachment anxiety. We found a significant simpie indirect effect wherein sexuai functioning accounted for the association between sexuai costs and sexuai satisfaction for the sampie as a whoie. However, attachment anxiety moderated this indirect effect; sexual functioning accounted for the association between sexual costs and satisfaction for women reporting low ievels of attachment anxiety, but not for women reporting high levéis of attachment anxiety. These findings suggest that, depending on individual attachment orientation, difficulties with sexual functioning may or may not represent key sexuai costs that are associated with levels of sexual satisfaction. Theoretical and practicai implications are discussed. Acknowledgement: This pubiication was supported by Grant Number ROl HD51676 from the Nationai Institute for Chiid Heaith and Human Deveiopment to Cindy M. Meston. Introduction though difficulties with sexual functioning must be detrimental to personal and/or interpersonal Sexual satisfaction has been defined as "an affective well-being to be considered clinically relevant response arising from one's subjective evaluation (Ferenidou, et al., 2008; King, Holt, & Nazareth, of the positive and negative dimensions associated 2007). Additionally, when sexual satisfaction is with one's sexual relationship" (Byers, 1999, pg. measured, the conceptualization and method of 98). Sexual satisfaction has been linked to a number assessment varies widely across studies (Ahrold, of important variables including relationship Stephenson, & Meston, in press), ranging from single satisfaction (Byers, 2005) and self-esteem (Hally & item measures assessing only global sentiments to Pollack, 1993), and is one of the strongest predictors more comprehensive and specific measures that of marital stability for both men and women (Kíirney often include related but distinct constructs such as & Bradbury, 1995). Thus, it is not surprising that sexual functioning and sexual distress (Stephenson sexual satisfaction is an important component of well& Meston, 2010). These inconsistencies in tlie study being for most individuals (Mulhall, King, Glina, & of sexual satisfaction underscore the fact that we Hvidsten, 2008). currently have few organized theories within which to study factors that determine how satisfied individuals Despite its importance, measures of subjective sexual are with their sex lives, well-being are rarely included in epidemiological studies of female sexual dysfunction (e.g., Shifren, However, one validated theory in this area is the Monz, Russo, Segreti, & Johanes, 2008), even Interpersonal Exchange Model of Sexual Satisfaction Correspondence concerning this article shouid be addressed to Kyie Stephenson, The Sexual Psychophysioiogy i^b. The University of Texas at Austin, 2400 Inner Campus Drive, Austin, TX 78712. E-mail: [email protected] 32 The Canadian Journal of Human Sexuality, Voi. 20 (1) 2011 (lEMSS). The lEMSS posits that sexual satisfaction is a product of four primary factors: the balance of sexual rewards and sexual costs in tlie relationship, the way that sexual rewards and costs compare to one's expected level of sexual rewards and costs, the perceived equality of sexual rewards and costs between partners, and the quality of the nonsexual aspects of the relationship (Lawrance & Byers, 1992). This model has been partially validated in a number of studies (e.g., Byers & MacNeil, 2006) and can account for up to 79% of the variance in sexual satisfaction ratings. Although the IEMSS provides a potentially useful framework within which to study sexual satisfaction, relatively few researchers have utilized it to guide research and even fewer have used it to study questions related to the treatment of sexual dysfunction. One possible reason for this neglect is that the components of the model have not yet been comprehensively described. For example, while the model is essentially based on levels of sexual rewards and costs, it is not clear exactly what constitutes a reward or cost and which types of rewards and costs are most important in determining levels of satisfaction. In proposing the IEMSS, the authors suggested a number of potential costs and rewards including foreplay, physical or emotional expressions of love, and various aspects of sexual functioning (Lawrance & Byers, 1992) and a list of other potential factors is included in the IEMSS questionnaire (Lawrance & Byers, 1998). However, we are aware of only three studies that empirically identified particular sexual rewards and costs. Specifically, studies have suggested that self-disclosure positively affects levels of sexual satisfaction through its beneficial effects on the perceived balance of rewards and costs in the relationship (Byers, Demmons, & Lawrence, 1998) and/or its beneficial effect on the relationship in general (MacNeil & Byers, 2009). Also, Lawrence and Byers ( 1995) found that women were more likely than men to identify relational qualities of the sexual relationship (e.g., how one's partner treats you when having sex) as rewards, and physical aspects of sexuai interactions (e.g., difficulty reaching orgasm) as costs. The link between physical aspects of sexual interactions (i.e. sexual functioning: sexual desire, sexual arousal, orgasm, and sexual pain) and sexual satisfaction has been an important target of recent research. Specifically, although past studies have established an association between sexual functioning and sexual satisfaction (Hoon, 1983; Huribert, Apt, & Rabehl, 1993), a number of studies have found that difficulties with sexual functioning are not always associated with low levels of satisfaction in women. For example, a study by Ferenidou and colleagues (Ferenidou et al., 2008) found that 72.5% of women who score below the clinical cut-off score of the Female Sexual Function Index report high levels of sexual satisfaction. Other researchers have identified moderators of the association between sexual functioning and subjective sexual well-being, showing that sexual fiinctioning is strongly tied to distress in some cases and weakly tied in others (Stephenson & Meston, 2010). The IEMSS provides a convenient framework within which to explore this connection between difficulties with sexual functioning and sexual satisfaction. Specifically, difficulties wifh sexual functioning may constitute one of the sexual "costs" that is most closely associated with sexual satisfaction. Indeed, for many women sexual functioning may be one of the primary determinants of sexual satisfaction and, thus, difficulties in this area would account for much of the association between sexual costs and sexual satisfaction. One way to test this hypothesis is through testing an indirect effect model wherein tlie association between two factors is accounted for by a third factor. In this case, if difficulties with sexual functioning constitute a sexual cost that is closely associated with sexual satisfaction, then controlling for sexual functioning should weaken or eliminate the association between reported sexual costs and sexual satisfaction. Alternatively, if difficulties with sexual functioning are a cost weakly tied to sexual satisfaction, then controlling for sexual functioning should minimally affect the association between reported costs and satisfaction. It is likely that difficulties with sexual functioning may not be an equally important sexual cost for all women (i.e., for some women, difficulties with sexual functioning may not be a sexual cost closely tied to sexual satisfaction). One moderating variable that may be important in this regard is adult attachment anxiety. Modern iterations of The Canadian Journal of Human Sexuality, Vol. 20 (1) 2011 33 attachment theory suggest that an adult's method of relating to romantic partners can be placed along two independent continua: attachment anxiety and attachment avoidance. A number of recent studies have suggested that adult attachment anxiety in particular, which can be understood as the degree to which individuals fear neglect and abandonment in romantic relationships, is important in shaping women's sexual experiences (Birnbaum, 2007; Birnbaum, Reis, Mikulincer, Gillath, & Opraz, 2006; Butzer& Campbell, 2008). Specifically, studies have shown that anxiously attached women are more likely to have sex to meet attachment needs (e.g., increasing closeness and intimacy) as opposed to reasons such as experiencing pleasure (Davis, Shaver, & Vernon, 2004; Impett, Gordon, & Strachman, 2008) and that some difficulties with sexual functioning are distressing for anxiously attached women only in the context of relationships with little intimacy (Stephenson & Meston, 2010). Based on these findings, we can predict that difficulties with sexual functioning may be of relatively less importance in determining levels of sexual satisfaction for women who report high attachment anxiety because they are less likely to be motivated by factors such as sexual pleasure that are disrupted as a result of sexual functioning difficulties. On the other hand, women reporting low attachment anxiety are more likely to have sex to experience physical pleasure and tend to be similarly distressed by difficulties with sexual functioning regardless of levels of relational intimacy (Davis, et al., 2004; Stephenson & Meston, 2010), suggesting that the sexual costs most closely tied to sexual satisfaction for these women may be sexual functioning. The goal of the current study was to test whether sexual functioning accounts for the association between sexual costs on sexual satisfaction in women, which would suggest that sexual functioning is a key sexual cost that is closely tied to sexual satisfaction. It is important to note that, according the IEMSS, sexual exchanges including high or low levels of sexual functioning can be viewed by the individual as either costly, rewarding, both costly and rewarding, or neither costly nor rewarding. Additionally, the IEMSS includes perceived comparison levels and the quality of non-sexual aspects ofthe relationship. Thus, a full exploration of the model would include not only costs and rewards, but also an individual's perception of available alternatives and many aspects of the overall romantic relationship. In the present study, we tested a simple indirect effects model wherein sexual functioning accounts for the association between reported costs and sexual satisfaction. We also tested a moderated indirect effects model, also known as a conditional indirect effect model. Our hypotheses was that the indirect effect of sexual functioning would be moderated by attachment anxiety such that sexual functioning would account for the association between sexual costs and sexual satisfaction for women reporting low attachment anxiety, but not those reporting high attachment anxiety.