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International Journal of Sexual Health logoLink to International Journal of Sexual Health
. 2023 Nov 29;35(4):543–554. doi: 10.1080/19317611.2023.2264285

Psychological and Psychosexual Adjustment in University Students as a Function of Sexual Activity and Relationship Type

Ángel Castro 1,✉, Ana Belén Correa 1
PMCID: PMC10903592  PMID: 38601808

Abstract

The objective of the present study was to examine the differences in some variables of psychological (depression, anxiety, physical self-esteem) and psychosexual (self-esteem as a sexual partner, satisfaction with sexual life, sexual preoccupation) adjustment in a sample of university students, as a function of gender, and divided into three groups: (1) those who had a stable partner; (2) those who did not have a stable partner but did have casual sexual relations; and (3) those who had neither a stable partner nor casual relationships. Participants were 980 students from a mid-size Spanish university, of both sexes (71.3% women, 28.7% men), aged between 18 and 26 years (M = 20.87, SD = 1.88), who completed an online battery of questionnaires. Differences were found in psychological and psychosexual adjustment variables depending on the reference group and both in men and women. Some of these differences were explained by having a partner and others by having sexual relations, regardless of the partner with whom they had sex. These differences and their impact on young people’s psychological adjustment and wellness should be taken into account when designing sexual health prevention and promotion programs.

Keywords: Sexual relationships, romantic partner, casual sex, psychosocial and psychosexual adjustment, university students

Sexuality is a fundamental part of life, essential for well-being. Traditionally, there has been a negative approach to sexuality, relating it to risks, diseases, and victimization (Anderson, 2013; Kagesten & van Reeuwijk, 2021). But in recent decades, and especially after the definition of sexual health proposed by the World Health Organization (2006) as a state of physical, emotional, mental, and social well-being concerning sexuality, it seems that the perception has changed, and the approach of positive sexuality is now predominant (Mitchell et al., 2021). This perspective highlights the importance and power of the positive aspects of sexuality, such sexual satisfaction, sexual self-efficacy, sexual self-esteem, and sexual pleasure (Anderson, 2013; Gianotten et al., 2021; Laan et al., 2021).

Many studies highlight the positive effects of sexual activity and its relationship with general well-being. Anderson (2013) claimed that sexual activity, in contrast to abstinence, provides more health, both physical and mental. Some literature emphasizes the benefits of having sex, both from the physiological point of view (e.g., better blood circulation, muscle activation, disease prevention; Levin, 2007) as well as at the personal and relational level (e.g., higher self-worth, knowledge of the body, recognition of feelings of sexual pleasure and desire, mutual respect, egalitarian relationships; Kagesten & van Reeuwijk, 2021).

The association between sexual activity and well-being has been found in different groups, although the most studied is that of adolescents and young people, given that emergence adulthood is considered the stage with the most experimentation with sexuality (Castro & Santos-Iglesias, 2016; Kaestle & Evans, 2018). As in other groups, among young adults, it has been found that having an active, healthy, and satisfying sex life is associated with greater well-being and psychological adjustment (Debrot et al., 2017; Stronge et al., 2019), whereas not having sex at this stage has been linked to negative self-perceptions and poorer interpersonal adjustment (Gesselman et al., 2017).

Sexual activity, type of partner, both or neither?

In the existing literature, it is not clear whether the positive or beneficial impact associated with having sex depends only on the fact of having sex or whether the type of partner with whom one has sex also influences its impact (Dosch et al., 2016; Furman & Collibee, 2014; Wesche et al., 2017). Most studies associate having casual sex with a poorer psychological adjustment than if one has sex with a stable romantic partner (Bersamin et al., 2014; Fielder et al., 2014; Kaestle & Evans, 2018; Stronge et al., 2019). However, other studies find no differences depending on the type of partner with whom one has sex, and some even highlight the benefits of casual or non-committed sex (Eisenberg et al., 2009; Strokoff et al., 2015; Vrangalova, 2015; Wesche et al., 2021).

In the first group of studies cited, casual sex is associated with a more significant symptomatology of anxiety and non-clinical depression and/or lower self-esteem (Bersamin et al., 2014; Fielder et al., 2014; Fielder & Carey, 2010; Furman & Collibee, 2014). This is explained by the fact that casual and non-committed relationships usually occur in recreational contexts, coinciding with substance use (Wesche et al., 2017). Casual sex has been linked to feelings of worry, vulnerability, guilt, and regret, more frequent in women than in men (Hehman & Salmon, 2020; Wesche et al., 2021; Woerner & Abbey, 2017).

If measures of psychological adjustment and sexual satisfaction are considered among people who have sex with a stable partner compared to those who have sex with occasional partners, the results are more conclusive. The romantic partner’s affectivity increases the positive effects of having sex (Debrot et al., 2017; Kaestle & Evans, 2018; Stronge et al., 2019), although just the fact of maintaining a committed romantic relationship has been associated with lower levels of depression and better mental health (Berli et al., 2020; Gómez-López et al., 2019). Differences have also been found in these results according to gender, which has to do with perceived social support. Stronge et al. (2019) found greater benefits of having sex with stable partners for men than for women. The reason they propose is that romantic partners are usually the first and almost only resource of social support for men, whereas women have other resources.

Having sex with a stable partner has been linked to greater sexual satisfaction than having sex with a casual partner, which can be explained by the other person’s knowledge and affectivity, mutual trust, and emotional bonding with the partner (Berli et al., 2020; Gómez-López et al., 2019). In their study of young people who had had sex both with stable and casual partners, Fielder and Carey (2010) found that sexual encounters with a stable partner were more pleasurable. In addition, women’s greater ease of reaching orgasm in sex with stable partners than with occasional partners has been observed (Armstrong et al., 2012).

Other studies, however, have found no direct association between having sex without commitment and poorer psychological adjustment (Eisenberg et al., 2009; Vrangalova, 2015; Wesche et al., 2021), or even propose that having casual sex has positive benefits and correlates (Fielder & Carey, 2010; Owen & Fincham, 2011; Strokoff et al., 2015). Among the benefits of casual sex would be the exploration of one’s sexuality (Berntson et al., 2014) or the fact of obtaining sexual gratification without the need to bond with a partner (Lyons et al., 2014), thus increasing the person’s psychological adjustment when sexual contact is desired but no romantic partner is available. These positive effects would be more significant among men than women (Hehman & Salmon, 2020; Wesche et al., 2021).

On the other hand, in terms of psychosexual adjustment, greater satisfaction with sexual life and higher self-esteem as a sexual partner have been found among people without a partner who have casual sex, compared to people who have neither a partner nor casual sex (Correa et al., 2017). This could indicate that when one does not have a romantic relationship, having sex without commitment would be better for the person’s perception of their sex life and psychosexual well-being than not having sex (Kaestle & Evans, 2018).

Thus, according to the above, it can be concluded that having or not having sex, regardless of the kind of partner, can be associated differently with the person’s general adjustment, both at the psychological level (i.e., symptoms of depression, anxiety, or self-esteem) and sexual level (i.e., self-esteem as a sexual partner, satisfaction with sex life, preoccupation with sex).

The present study

The problem arises because when analyzing the literature, some limitations are identified that have to do with the groups and variables evaluated. If the different and possible combinations between having or not having a partner and having or not having sex are analyzed, four groups are distinguished: (1) people with a stable partner who have sex with that partner; (2) people with a stable partner who have no sexual activity with that partner, which would comprise a minority group; (3) people without a stable partner but who have casual and non-committed sex; and (4) people who do not have a stable partner and do not have casual sex.

In the existing literature, different studies have compared: (1) people who had sex without commitment, mainly without a stable partner, compared to those who did not have sex, including people with and without a partner, regardless of whether or not they had sex (Fielder et al., 2014; Fielder & Carey, 2010; Strokoff et al., 2015; Vrangalova, 2015); (2) people who had no partner or sex versus those who had sex without commitment, discarding all those who had a stable partner (Bersamin et al., 2014; Correa et al., 2017; Owen et al., 2011; Vrangalova & Ong, 2014); or (3) people who had sex without commitment versus people who had sex in a stable relationship, ruling out those who had neither partner nor sex (Furman & Collibee, 2014; Sandberg-Thoma & Kamp, 2014).

Thus, the first comparison does not allow solid conclusions to be drawn, as it equates different groups, whereas the other two options represent a significant loss of sample, so only partial conclusions can be drawn from these studies. The study of Kaestle and Evans (2018) overcomes these limitations, classifying young university women according to their well-being: participants with exclusive sex, participants without exclusive sex but with casual sex, and participants without sexual relations. But this study was conducted only with women, and given the relevance of gender in this topic, its results can also be considered partial.

Therefore, we need to include a comparison that covers in the same study people who have sex within a romantic relationship, people who do not have a stable relationship but who have casual sex, and people who have neither a stable partner nor casual sex. In addition, this should take gender into account and analyze the differences between men and women. The objective of the present study was to examine the differences in different variables related to psychological (i.e., depression, anxiety, physical self-esteem) and psychosexual adjustment (i.e., self-esteem as a sexual partner, satisfaction with sexual life, sexual preoccupation) between the indicated three reference groups (in a relationship – casual sex – no romantic relationship or casual sex) in a sample of young university students, paying particular attention to the differences according to the participants’ gender. Thus, we intended to clarify how having or not having sexual activity and the type of partner (in those who have sex) affects the psychological and psychosexual well-being of young people of both sexes. Given the current relational context, characterized by a lower number of marriages, a later age of marriage and, therefore, a longer period of premarital sex (Elias et al., 2015), it is relevant to analyze the differences between the groups proposed.

Method

Participants and Procedure

This study was part of a larger project carried out at a Spanish university, which aimed to explore several aspects of young university students’ sexuality. The initial sample comprised 1,592 participants (M = 23.67, SD = 6.59). Based on criteria from previous studies with university samples (Barrada et al., 2021; de Rivas et al., 2023), three inclusion criteria were used: (1) to be studying a university degree at the time of data collection (293 participants excluded); (2) aged between 18 to 26 years (239 participants excluded); and (3) correctly answering a control question (80 participants excluded). We decided to maintain the consistency with previous studies using similar samples to reduce researchers´ degrees of freedom and, thus, avoid potential p-hacking (Wicherts et al., 2016).

Considering all these criteria, the final sample included 980 university students (71.3% women, 28.7% men) aged between 18 and 26 (M = 20.87, SD = 1.88). Of the participants, 85.6% (n = 839) described themselves as heterosexual, 8.3% (n = 81) as bisexual, 4.5% (n = 44) as homosexual, and 1.6% (n = 16) as other. Due to the small sample size of the non-heterosexual groups, and only to characterize the sample, these participants were combined into a sexual minority category (14.4%). Concerning relationship status, 55.3% (n = 542) had a romantic partner at the time of data collection, with a mean relationship duration of 27.97 months (SD = 21.26). On the other hand, 24.8% (n = 243) did not have a romantic partner at the time of data collection but reported having had casual sex sometime in the previous 12 months. Finally, 19.9% (n = 195) of the participants did not have a romantic partner and reported not having casual sex in the last 12 months at the time of data collection. Study descriptive data sorted by gender, sexual orientation, and reference group (in a relationship – casual sex – no relationship or casual sex) are summarized in Table 1.

Table 1.

Descriptives sorted by gender and reference group.

  In a relationship Casual sex No sex or relationship
Mean age (SD)      
 Women 20.84(1.94) 20.95(1.85) 20.44(1.73)
 Men 21.24(1.91) 20.78(1.54) 20.94(1.98)
Gender (%)      
 Women 76.2% 70% 59.5%
 Men 23.8% 30% 40.5%
Sexual orientation (%)      
 Women 85.7% heterosexual
14.3% not heterosexual		 89.4% heterosexual
10.6% not heterosexual		 90.5% heterosexual
9.5% not heterosexual
 Men 88.4% heterosexual
11.6% not heterosexual		 74% heterosexual
26% not heterosexual		 75.9% heterosexual
24.1% not heterosexual
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Regarding the procedure, data were collected in April 2018, using a Google Forms survey. Participants were recruited from a mid-size university in Spain using a nonrandom sampling procedure employing the university e-mail distribution list for students. Each student registered on this distribution list received an e-mail explaining the purpose of the study, contact information of the principal researcher, and the link to the online survey. Participants provided informed consent after reading the description of the study, where the anonymity of the responses was clearly stated. The survey remained open for 14 days. This procedure was approved by the Ethics Review Board for Clinical Research of the region (PI18/058).

Instruments

Sociodemographic questionnaire

We asked participants about their gender (woman, men), age, sexual orientation (heterosexual, homosexual, bisexual, other), and whether they were in a relationship.

Casual sexual relations during the past 12 months

We asked whether the participants had engaged in this type of relationship (“In the past year, did you ever have sexual relations with a partner without any affective commitment?” Yes/No).

Depression and anxiety scales of the Patient-Reported Outcomes Measurement Information System (PROMIS)

We used a Spanish translation of the short form proposed by the authors of the original scale (Pilkonis et al., 2011). It comprises 16 items written in the first person, past tense, with a 7-day timeframe (e.g., "I felt depressed", "I felt anxious") to assess Depression (eight items; α = .91) and Anxiety (eight items; α = .89). It is rated on a five-point response scale reflecting frequency, ranging from 1 = never to 5 = always.

Short version of the Sexuality Scale (SSS)

We used the Spanish adaptation of Soler et al. (2016). This instrument has 15 items that assess the perceptions of onés own sexuality through three components: Self-esteem as a sexual partner (e.g., “I am a good sexual partner;” α = .91), Dissatisfaction with sexual life (e.g., “I’m depressed about the sexual aspects of my life;” α = .86), and Sexual preoccupation (e.g., “I’m constantly thinking about having sex;” α = .87). The items are rated on a five-point Likert-type scale ranging from 1 = strongly disagree to 5 = strongly agree (Snell & Papini, 1989; Wiederman & Allgeier, 1993).

Control question

Embedded in the SS as its sixteenth item and to check whether the participants paid enough attention to the wording of the items, we introduced an item asking the participants to respond to it with disagree. Those participants responding with a different option (5% of respondents) were considered to be distracted and were eliminated from the final sample.

Appearance evaluation scale of the Multidimensional Body-Self Relations Questionnaire-Appearance Scales (MBSRQ)

We used the Spanish adaptation of Roncero et al. (2015). This scale is composed of seven items that assess beliefs and feelings of satisfaction or dissatisfaction with one’s appearance (e.g., “I like my looks just the way they are”). Each item is scored on a 5-point response scale, ranging from 1 = definitely disagree to 5 = definitely agree. Cronbach’s alpha in the present sample was .85 (Cash, 2000).

Data analysis

Before conducting data analysis, Kolgomorov-Smirnov normality tests were carried out to check all the outcome variables for normality by reference group (in a relationship – casual sex – no relationship or casual sex). As non-normality was found, nonparametric tests were performed to examine differences between the three study groups, sorted by gender.

Differences in depression, anxiety, self-esteem as a sexual partner, sexual dissatisfaction, sexual preoccupation, and physical self-esteem by group of reference (in a relationship – casual sex – no relationship or casual sex) were analyzed via Kruskal-Wallis H- tests, with significant results in all the dependent variables (summarized in Table 2). Accordingly, post-hoc Mann-Whitney U-tests were used to compare all pairs of groups and determine which groups did indeed differ in each outcome variable. Effect sizes for non-parametric data (η2 for kruskal-wallis tests and r for Mann-Whitney U-tests, Fritz et al., 2012; Tomczak & Tomczak, 2014) are included in Table 2.

Table 2.

Comparison between groups sorted by gender.

Participants median (Q1;Q3)
    
  1. In a relationship (Women n = 413
Men n = 129)		 2. Casual sex
(Women = 170
Men n = 73)		 3. No sex or relationship
(Women n = 116
Men n = 79)		 χ2 (df = 2)a
(Post hoc M-w)b 		Effect sizes
η2c
(r)d
Depression          
  Women 13 (Q1 = 10;Q3 = 17) 15 (Q1 = 12;Q3 = 22) 16 (Q1 = 11;Q3 = 22) 30.897***
(1 < 2***; 1 < 3***) 		.042
(.20;.16)
  Men 12 (Q1 = 9;Q3 = 12) 13 (Q1 = 10;Q3 = 21) 16 (Q1 = 11;Q3 = 23) 16.701***
(1 < 2*;1 < 3***) 		.053
(.14; .28)
Anxiety          
  Women 17 (Q1 = 13;Q3 = 22) 20 (Q1 = 15;Q3 = 25) 18 (Q1 = 13;Q3 = 24) 11.502**
(1 < 2***) 		.014
(.14)
  Men 14 (Q1 = 11;Q3 = 20) 16 (Q1 = 13;Q3 = 21.5) 18 (Q1 = 13;Q3 = 22) 7.639*
(1 < 3**) 		.020
(.18)
Self-esteem as a sexual partner          
  Women 20 (Q1 = 17;Q3 = 22) 19 (Q1 = 16;Q3 = 21) 17 (Q1 = 14;Q3 = 20) 40.623***
(1 > 3***; 2 > 3***) 		.056
(.28;.28)
  Men 20 (Q1 = 18;Q3 = 23) 20 (Q1 = 18;Q3 = 21) 17 (Q1 = 15;Q3 = 20) 25.545***
(1 > 3***; 2 > 3***) 		.085
(.33; .30)
Dissatisfaction with sexual life          
  Women 7 (Q1 = 5;Q3 = 9) 9 (Q1 = 7;Q3 = 12) 12 (Q1 = 7;Q3 = 17.75) 134.352***
(1 < 2***; 1 < 3***; 2 < 3***) 		.190
(.35; .42; .22)
  Men 7 (Q1 = 5;Q3 = 10) 11 (Q1 = 7.5;Q3 = 12.5) 14 (Q1 = 10;Q3 = 18) 72.652***
(1 < 2***; 1 < 3***; 2 < 3***) 		.254
(.36; .55; .31)
Sexual preoccupation          
  Women 8 (Q1 = 6;Q3 = 11) 8 (Q1 = 7;Q3 = 12) 6.5 (Q1 = 5;Q3 = 10) 20.944***
(1 < 2**; 1 > 3**; 2 > 3***) 		.027
(.11; .13; .26)
  Men 11 (Q1 = 7.5;Q3 = 14) 11 (Q1 = 7;Q3 = 15) 10 (Q1 = 7;Q3 = 14) 1.297 .002
Physical self-esteem          
  Women 25 (Q1 = 20.5;Q3 = 29) 25 (Q1 = 20;Q3 = 29) 23 (Q1 = 23;Q3 = 27) 13.436***
(1 > 3***; 2 > 3*) 		.016
(.16; .14)
  Men 27 (Q1 = 24;Q3 = 30) 26 (Q1 = 21;Q3 = 29) 25 (Q1 = 20;Q3 = 28) 11.133**
(1 > 3***) 		.032
(.23)
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a

Kruskal-Wallis analysis of variance. bDifferences according to Post hoc Mann-Whitney U-test between groups – 1. In a relationship vs. 2. Casual sex, 1. In a relationship vs. 3. No sex or relationship, 2. Casual sex vs. 3. No sex or relationship. cEffect size calculation for Kruskal-Wallis analysis (small, η2=.01; medium, η2=.06; large, η2=.14 or higher). dEffect size calculation for Mann-Whitney U-tests (small, r=.1; medium, r=.3; large, r=.5 or higher, size effects intervals by Cohen, 1988). *p < .05. **p < .01. ***p < .001.

Results

Depression and anxiety

For both male and female samples, adults in a romantic relationship showed lower depression scores than those who engaged in casual sex (women, U = 256770.00, p < .001; men, U = 3922.00, p = .048) or did not have sex or a romantic relationship (women, U = 18184.00, p < .001; men, U = 3386.00, p < .001). No significant differences were found between the two unpartnered groups (women, U = 9468.00, p = .712; men, U = 2416.50, p = .084).

For anxiety measures, men in a relationship reported lower scores than men who did not have a relationship or casual sex (U = 3888.50, p = .010). No differences were found between unpartnered samples for men (U = 2594.50, p = .346). On the other hand, women in a relationship reported lower anxiety scores than women who engaged in casual sex (U = 28370.00, p = .001), but they did not significantly differ from unpartnered women who had no casual sex (U = 22074.00, p = .253). As for men, unpartnered samples did not differ from each other regarding anxiety (U = 8782.50, p = .135).

Self-esteem as a sexual partner, sexual dissatisfaction, and sexual preoccupation measures

Both men and women in a relationship reported higher sexual self-esteem scores than those who did not have a relationship or casual sex (women, U = 14747.50, p < .001; men, U = 3072.00, p < .001). Also, men and women who engaged in casual sex reported higher sexual self-esteem than those who did not have a relationship or casual sex (women, U = 6659.00, p < .001; men, U = 1868.00, p < .001). No significant differences were found for those in a relationship compared with those who engaged in casual sex (women, U = 32974.00, p = .247); men, (U = 4323.00, p = .331).

Both men and women in a relationship reported less dissatisfaction with their sexual life than those who engaged in casual sex (women, U = 19748.50, p < .001; men, U = 2660.00, p < .001) and unpartnered adults who did not engage in casual sex (women, U = 10007.50, p < .001; men, U = 1782.50, p < .001). When comparing unpartnered samples, men and women who engaged in casual sex were less dissatisfied (women, U = 7348.00, p < .001; men, U = 1855.00, p < .001).

Interestingly, concerning sexual preoccupation (thinking about sex), no significant group differences were found for the male sample in the Kruskal-Wallis tests (χ2 = 1.297, p = .523), with similar median scores for all three groups (see Table 2). For the female sample, those who engaged in casual sex thought the most about sexuality compared to those in a relationship (U = 30302.00, p = .009) and to unpartnered women who did not have casual sex (U = 6804.50, p < .001). On the other hand, women in a relationship also showed higher sexual preoccupation than those who were not in a relationship and did not have casual sex (U = 19564.50, p = .002).

Physical self-esteem

Both men and women in a relationship reported higher physical self-esteem than those who did not have casual sex or a romantic relationship (women, U = 18573.50, p < .001; men, U = 3715.50, p = .001). None of the samples significantly differed when comparing those in a relationship with those who engaged in casual sex (women, U = 33497.00, p = .384); men, U = 4037.00, p = .092). On the other hand, women (U = 8193.00, p = .015) but not men (U = 2497.00, p = .153) differed when comparing unpartnered samples, with higher self-esteem scores in women who engaged in casual sex than those who did not have casual sex or a romantic relationship.

Discussion

Healthy and active sexuality has been related to greater well-being and psychological adjustment especially in recent decades (Debrot et al., 2017; Mitchell et al., 2021; Stronge et al., 2019). According to the existing literature, having or not having sexual relations, as well as the type of partner with whom one has sex, can be differentially associated with young people’s psychological and psychosexual adjustment (Dosch et al., 2016; Furman & Collibee, 2014; Wesche et al., 2017). However, the consulted literature does not clarify the differences in psychological and psychosexual adjustment between those who have a romantic relationship, those who do not have a partner but do have casual sex, and those who have neither partner nor casual sexual relations. Therefore, the objective of this study was to examine the differences in variables of psychological (i.e., depression anxiety, physical self-esteem) and psychosexual adjustment (self-esteem as a sexual partner, sexual satisfaction, sexual preoccupation) between the three indicated reference groups (in a relationship – casual sex – no relationship or casual sex) in a sample of young university students, taking gender into account and analyzing the differences between men and women.

The results allow us to conclude that there are differences in the psychological and psychosexual adjustment of young people, depending on wether they have a romantic relationship, they have casual sex, or they have neither a relationship or sexual relations. As will be discussed below, it has been found that associations between some of the variables evaluated (e.g., depression, anxiety, satisfaction with sexual life), and having or not having a partner seems to be more important. In contrast, in other variables (e.g., self-esteem as a sexual partner, physical self-esteem), differences appear between people who have sex, regardless of the type of partner, and those who do not. These differences have been found in both men and women, with few differences between them, and the results allow us to cover some limitations of the existing literature. In any case, it should be emphasized that causal explanations must be avoided with the results obtained. The conclusions are drawn from the differences found in the associations between variables.

Specifically, it was found that young university students—both men and women—who were in a romantic relationship had better psychological adjustment (less depression and less anxiety) than participants without a partner, regardless of whether or not the latter had casual sex. These results reaffirm the conclusions of previous studies, as it seems that the affectivity of the romantic partner, mutual knowledge, and emotional bonding with the partner may be associated to the positive effects of having sex (Berli et al., 2020; Kaestle & Evans, 2018; Stronge et al., 2019). No differences were found in these variables among young people who did not have a partner, regardless of whether or not they had casual sex, except for a nuance for anxiety in the group of women. We recommend analyzing this lack of differences in more depth to determine whether it is habitual, or whether there may be some mediating variables, such as the reasons for having casual sex (Barrada et al., 2021). Some studies conclude that if the reasons for casual sex are adaptive (e.g., pleasure-seeking), it is related to a better adjustment, whereas if the motives are maladaptive (e.g., pleasing someone), it may be associated with poorer psychological adjustment (Townsend et al., 2020).

In this first group of variables, the only notable difference according to gender is that women who had a partner showed less anxiety than those who had casual sex, but there were no differences with those who had neither a partner nor casual sex. In this case, casual sex is likely to remain a stressor for some young women, as it has been linked to feelings of worry, vulnerability, guilt, and regret to a greater extent than for men (Hehman & Salmon, 2020; Woerner & Abbey, 2017). This may still be a consequence of the traditionally prevailing sexual double standard (Wesche et al., 2021).

Regarding psychosexual adjustment, various conclusions can be drawn depending on the variables evaluated. In the case of self-esteem as a sexual partner, participants in a relationship and those who had casual sex, obtained higher scores than those who did not have sex. In this case, the positive effects of having sex in both men and women could again stand out (Anderson, 2013; Kaestle & Evans, 2018; Kagesten & van Reeuwijk, 2021; Levin, 2007), while a higher sexual self-esteem may also be related to sexual activity. Satisfaction with sex life follows a different pattern: participants with a partner—both men and women—showed greater satisfaction with their sex life than those who did not have a partner but who had casual sex. This result may also be added to the positive effects of affectivity and confidence provided by having a stable partner in sexual relations, as well as knowledge of each other provided by a long-term interpersonal relationship (Berli et al., 2020; Kaestle & Evans, 2018; Stronge et al., 2019).

Gender differences in sexual preoccupation were found. Among women, higher scores were observed for those who had casual sex than for the rest. This result may affect the above-mentioned comments concerning the stressful but also exciting aspect of casual sex for some women (Hehman & Salmon, 2020). On the other hand, a recent meta-analysis proposed that men think and fantasize about sex more than women (Frankenbach et al., 2022), which could explain why the scores of the different groups of the male sample are equal and do not show significant differences.

Finally, in terms of physical self-esteem, it was also found that people who have sex—both men and women and regardless of the type of partner with whom they have sex—obtained higher scores. In this section, we note the results obtained for people who do not have either a partner or casual sexual relations. These people have poorer adjustment, both psychological and psychosexual. In some cases, it could be inferred that this is related to the fact of not having a partner and, in others, to not having sex. However, it is worth considering that other mediating variables could be affecting this result. This group is heterogeneous: there are people who do not wish to have sex, but others who want it and who, for reasons that would have to be studied, do not have sex. We should determine these reasons and also target this group for intervention. For example, previous meta-analyses have found a bidirectional relationship between measures of physical self-esteem and social relationships (Harris & Orth, 2020).

Limitations and future directions

The study has a number of limitations, mainly related to the representativeness of the sample and with the scope and generalization of the results. Among the final participants, the sample was mostly female, aged between 18 and 26, and from a single university, making the results difficult to generalize to all university students and still less to young non-university students. Moreover, while the sample is representative of the population of this university campus in terms of age, is not fully representative in terms of gender because the presence of female participants is significantly higher than of males, which differs from the current gender distribution of this university environment. Upon segmenting the sample and analyzing the sex differences, we found such differences were not so relevant, but it would be desirable to have a higher proportion of men to generalize the results. For the same reason, it would also be desirable to include participants who do not self-identity as male or female in this type of study. Sexual orientation was taken into account only for the description of the sample. It would be interesting to include it as a variable of comparison, and also the different orientations evaluated (at least, heterosexual, homosexual, and bisexual) to determine the patterns of relational and sexual behavior, as well as their relationship with the psychological and psychosexual adjustment of the different groups.

One of the studýs main limitations is related to the data collection and the distribution of the participants in the comparison groups. In this data collection, we did not ask whether the participants with a romantic partner had sexual relations with that partner. This implies that: (1) the “in a relationship” group might include a small proportion (less than 5% according to other data collected by the research team) of people who do not have sexual relations with their romantic partner; and (2) this minority group (people who had a stable partner but did not have sex with that partner) was not taken into account as a fourth group to be evaluated. This limitation implies a reduction in the scope and relevance of the results and, therefore, should be noted.

Other relational realities, such as consensual non-monogamy, were not considered, nor did we ask about sexual relations outside the stable couple, as the evaluation of infidelity was not one of the study’s objectives. Lastly, like other studies based on self-selected samples and self-reported measures, our results may be limited by response and recall bias.

These limitations should be addressed in future studies. In them, the four original reference groups must be clearly included and differentiated: (1) people with a stable partner who have sex with that partner; (2) people with a stable partner who have no sexual activity with that partner, which would comprise a minority group; (3) people without a stable partner but who have casual and non-committed sex; and (4) people who do not have a stable partner and do not have casual sex. These future studies also need more balanced samples in terms of gender (including people who do not identify as either male or female) and sexual orientation, which would allow analyzing the differences between the different groups of gender and sexual minorities, an aspect that can significantly enrich the analysis. Likewise, they should include comparisons with other relational realities other than those included in this study.

In addition, it would be necessary and interesting to include different variables that could act as mediators (e.g., motives for having or not having sex, sexual pleasure) and/or enable a causal explanation of the associations found in this study. These future studies should be include information on some sexual behaviors, such masturbation, that may be important for well-being. It would also be interesting to conduct longitudinal studies, which would allow analyzing the changes in psychological and psychosexual adjustment over time and as a function of the four reference groups described (allowing us to assess whether these changes concur with possible changes in relational status, of course, also considering that additional factors may incur). It is feasible to think that if some situations are unintentionally prolonged (e.g., not having either a partner or sexual relations), this can affect young people’s well-being.

Conclusions

In spite of these limitations, we consider that the present paper makes important contributions. Differences in psychological and psychosexual adjustment are examined based on three possible scenarios: having a stable partner, not having a stable partner but having casual sex, and not having either a stable partner or casual sex. And this was also done adding a gender perspective. This allows us to cover some existing limitations in the literature and establish conclusions about whether having a partner, having sex, both, or neither are relevant.

In view of the results obtained, it is concluded that having a partner and/or having sex could be associated to better psychological and psychosexual adjustment, both in men and women. Specifically, young people with a stable partner showed lower levels of depression and anxiety and greater satisfaction with sex life than those without a partner. Young people who had sex, regardless of the type of partner, showed both more self-esteem as a sexual partner and physical self-esteem.

These results are relevant for the prevention and promotion of sexual health in adolescents and young people, as they pose different scenarios to consider depending on the situation of each person at each time. It again shows the need to educate in sexuality following the current and predominant approach of positive sexuality: form an early age, providing young people with resources for healthy sex (or not having sex if they do not wish to), and according to their needs and desires, always within a framework of sexual pleasure and mutual respect (Mark et al., 2021; Zaneva et al., 2022).

Ethical approval

This study was approved by the Ethics Board for Clinical Research of the Government of Aragon (Spain; PI18/058).

Funding Statement

This work was supported by the Ministry of Science, Innovation and Universities, Government of Spain, under grant PGC2018-097086-A-I00; and Government of Aragon (Department of Science, University and Knowledge Society). Group S31_23R.

Disclosure statement

No potential conflict of interest was reported by the author(s).

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