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. Author manuscript; available in PMC: 2022 Feb 1.
Published in final edited form as: J Sex Res. 2020 Sep 21;58(2):183–194. doi: 10.1080/00224499.2020.1820933

Interpersonal and Intrapersonal Influences on Sexual Satisfaction in Young Male Couples: Analyses of Actor-Partner Interdependence Models

Michael E Newcomb 1,2,a, Gregory Swann 1,2, Junye Ma 2, David Moskowitz 1,2, Emily Bettin 1,2, Kathryn Macapagal 1,2, Sarah W Whitton 3
PMCID: PMC7855530  NIHMSID: NIHMS1628235  PMID: 32955948

Abstract

Very little research has examined sexual satisfaction in young gay, bisexual, queer, and other men who have sex with men (YMSM). Sexual satisfaction has important implications for individual wellbeing and is a central component of romantic relationship functioning and satisfaction. In order to fill this gap, this study examined interpersonal and intrapersonal factors associated with sexual satisfaction in a large sample of young male couples. Data for these analyses came from the baseline visits of two ongoing randomized controlled trials of 2GETHER, a relationship education and HIV prevention program for young male couples. Participants for the current analytic sample were 419 couples (individual N = 838) from across the United States who were diverse in terms of race/ethnicity, HIV status, and geographic region. Analyses found that relationship functioning (i.e., relationship satisfaction, communication) was positively associated with sexual satisfaction, while not having a specified relationship agreement (i.e., monogamy/non-monogamy agreement) was associated with less sexual satisfaction. Intrapersonal factors (i.e., depression, substance use) were associated with sexual satisfaction, but most of these effects became non-significant in a full multivariate model. Relationship functioning plays a central role in sexual satisfaction and should be addressed in couples-based programs to optimize relationship functioning and sexual health.

Keywords: young men who have sex with men, couples, sexual satisfaction, romantic relationships

Extant research on the sexual health of young gay, bisexual, queer and other men who have sex with men (YMSM) has largely focused on their risk for acquiring or transmitting HIV (Mustanski et al., 2014). Indeed, YMSM bear a disproportionate burden of the HIV epidemic in the United States, and their rate of new infections is not decreasing similarly to other groups, such as heterosexual women and people who inject drugs (Centers for Disease Control and Prevention, 2019). While research focused on HIV is critical to both individual and public health, the simultaneous lack of research on other aspects of sexual health, such as satisfaction and functioning, is problematic. A large body of research indicates that healthy romantic relationships improve individual health and wellbeing (see Kiecolt-Glaser & Newton, 2001), including those of young same-sex couples (Whitton et al., 2018), and a central component of relationship health is sexual satisfaction (Christopher & Sprecher, 2000). The current study aimed to improve understanding of various factors associated with sexual satisfaction in a large sample of young male couples in order to inform efforts to optimize both relationship functioning and sexual health in this population.

Theoretical Underpinnings of Relationship and Sexual Satisfaction

The Vulnerability-Stress-Adaptation model (VSA; Karney & Bradbury, 1995) of relationship functioning describes the various factors that influence couples’ relationship functioning. The VSA asserts that negative relationship outcomes, including sexual dissatisfaction, are explained by: (1) each individual partner’s specific vulnerabilities (e.g., negative affect, substance use), (2) stressors faced outside the relationship (e.g., general stress, stigma), and (3) deficits in adaptive couple processes (e.g., communication). In this model, both individual vulnerabilities and external stressors impact the ability to effectively engage in adaptive couple processes, which in turn may lead to relationship dissatisfaction, dysfunction and dissolution. Conversely, maintaining adaptive couple processes can help buffer against the negative impact of individual vulnerabilities and stress on negative relationship outcomes, including sexual dissatisfaction.

Sexual minorities, including YMSM, experience elevated stress resulting from having a stigmatized identity (Meyer, 2003) in the form of both distal stigma-based stressors (e.g., victimization, microaggressions) and proximal stress processes (e.g., internalized stigma). In the context of the VSA model, these unique stressors may help explain why same-sex relationships tend to dissolve more frequently than different-sex relationships (Balsam et al., 2017); this additive stigma-based stress increases the likelihood that YMSM enter into relationships with individual vulnerabilities (e.g., depression; Newcomb & Mustanski, 2010) and undermines the ability of couples to utilize adaptive couple processes (LeBlanc et al., 2015). Thus, our ability to understand relationship and sexual satisfaction in young male couples necessitates examination of both intrapersonal factors (i.e., individual vulnerabilities, stressors) and interpersonal factors (i.e., adaptive couple processes). Further, it remains unknown whether young male couples who do possess adaptive couple processes are buffered against the negative impact of stress and individual vulnerabilities on sexual satisfaction.

Couple Interdependence Theory (Lewis et al., 2006) further posits that it is not sufficient to examine self-reported data of individuals in relationships in order to understand relationship health and related outcomes. Instead, each individual’s experiences can impact the health of oneself (i.e., actor effect) and one’s partner (i.e., partner effect). Further, certain relationship dynamics that are shared by both members of the dyad (e.g., relationship length) influence relationship health. Thus, analyses that aim to characterize relationship health must account for couple-level, actor, and partner effects. The current analyses drew from both the VSA (Karney & Bradbury, 1995) and Couple Interdependence (Lewis et al., 2006) frameworks and sought to examine the effects of couple-level (e.g., relationship length), intrapersonal (i.e., individual vulnerabilities, stress) and interpersonal variables (i.e., adaptive couple processes) on sexual satisfaction among young male couples. For intrapersonal and interpersonal factors, we aimed to examine both actor and partner pathways on sexual satisfaction. Finally, we aimed to examine whether better relationship functioning buffered against the negative impact of intrapersonal factors on sexual satisfaction.

Factors Associated with Sexual Satisfaction in Different-Sex Couples

A host of interpersonal relationship factors have been found to be associated with sexual satisfaction among different-sex couples. First, there is a well-documented cross-sectional association between relationship satisfaction and sexual satisfaction (Byers, 2005; Christopher & Sprecher, 2000; Jones et al., 2018; Mark & Jozkowski, 2013), with relationship satisfaction accounting for close to 50% of the variance in sexual satisfaction. Some longitudinal studies suggest that sexual and relationship satisfaction change concurrently over time (Byers, 2005; Sprecher, 2002), while others suggest that sexual satisfaction predicts later relationship satisfaction rather than vice versa (Fallis et al., 2016; Yeh et al., 2006). Couple communication processes also appear to be key to sexual satisfaction in different-sex couples; studies find that general communication between partners, and communication about sex in particular, are positively associated with sexual satisfaction both concurrently and over time (Byers, 2005; Jones et al., 2018; MacNeil & Byers, 1997; Mark & Jozkowski, 2013; Scott et al., 2012).

Several individual-level aspects of physical and psychological health (i.e., intrapersonal vulnerabilities, stressors) have also been identified as important correlates of sexual functioning and satisfaction in different-sex couples. Sexual satisfaction has been associated with various aspects of wellbeing and mental health, including fewer depressive and anxiety symptoms (e.g., Frohlich & Meston, 2002; Holmberg et al., 2010; Scott et al., 2012), and lower likelihood of mental health disorders, including major depressive disorder and bipolar disorder, anxiety disorders, and substance use disorders (e.g., Vanwesenbeeck et al., 2014). Furthermore, acute and chronic stress have a detrimental impact on women’s sexual satisfaction and arousal in laboratory studies (Hamilton & Meston, 2013), as well as a negative effect on both male and female partner’s satisfaction in observational studies of couples (Leavitt et al., 2017). Evidence additionally suggests that minor (but chronic) daily stressors tend to have a larger influence on satisfaction than acute and intense stress experiences (Bodenmann et al., 2007). Finally, chronic alcohol and drug use have been associated with suboptimal sexual functioning and satisfaction (for a review, see Peugh & Belenko, 2001). Together, findings indicate that both interpersonal factors (e.g., aspects of relationship functioning) and intrapersonal experiences (e.g., individual vulnerabilities, stressors) are important to our understanding of sexual satisfaction.

Research on Sexual Satisfaction in Male Couples

Far less research has been conducted on sexual satisfaction in male couples. Nonetheless, the limited existing literature suggests that male couples’ sexual satisfaction is similarly influenced by both interpersonal aspects of relationship functioning and intrapersonal vulnerabilities and stress. First, relationship satisfaction, emotional intimacy, and higher levels of relationship commitment (i.e., dedication) have each been found to be positively associated with male couples’ sexual satisfaction (Carvalheira & Costa, 2015; Deenen et l., 1994; Shepler et al., 2018). Little is known about the specific role of communication between partners as a predictor of sexual satisfaction in male couples, pointing to an important gap in the literature. However, based on the existing literature among different-sex couples (e.g., Byers, 2005), it would stand to reason that healthy communication patterns would be similarly associated with sexual satisfaction in male couples, given that open and effective communication would facilitate productive dialogue about sexual pleasure and preferences.

Various intrapersonal factors, or individual-level vulnerabilities and stressors, have also been found to be associated with sexual satisfaction in male couples, including dimensions of mental health, stress, and substance use. Research on male couples has linked increased psychological distress and sexual compulsivity to reduced sexual satisfaction in the relationship (Remien et al., 2003; Starks et al., 2013). Studies of same-sex couples more broadly have documented reduced sexual satisfaction in the relationship when individual members of the dyad had an anxious or avoidant attachment style (Mark et al., 2018), as well as when individuals endorsed more stress, sexual anxiety, and body dissatisfaction (Shepler et al., 2018; Totenhagen et al., 2012). Further, at least one study has linked stigma-based sexual minority stress to decreased sexual satisfaction in a large sample of single and partnered young sexual minority men (Li et al., 2019). Given that more minor chronic stressors tend to have a more detrimental effect on relationship functioning (Bodenmann et al., 2007), stigma-based microaggressions would likely have a stronger influence on sexual satisfaction among male couples than overt victimization. Evidence also suggests that substance use may be linked to sexual satisfaction in male couples. One study of serodiscordant male couples found that alcohol use was negatively associated with sexual satisfaction, but marijuana and cocaine use were unassociated with satisfaction (Dolezal et al., 2005). Based on the limited existing literature on sexual satisfaction among male couples, and the larger literature on different-sex couples, findings indicate that interpersonal and intrapersonal factors likely play an important role in determining sexual satisfaction in male couples’ relationships.

With regard to couple-level influences on sexual satisfaction, research has examined how sexual satisfaction may be impacted by certain couple dynamics that are unique to, or more common among, MSM. First, research indicates that one’s partner’s HIV status may be associated with sexual satisfaction. For example, research conducted in the earlier years of the HIV epidemic found that stigma and fear related to HIV infection were strongly associated with reduced sexual satisfaction among MSM who were having sex with HIV-positive partners (Remien et al., 1995). Importantly, it is unclear whether this finding would persist with more recent developments in biomedical HIV prevention, which can make the risk of HIV transmission negligible in the context of adherent pre-exposure prophylaxis use among HIV-negative individuals (Grant et al., 2010) and/or undetectable viral load among HIV-positive individuals (Cohen et al., 2012).

Another factor that may influence sexual satisfaction in male couples is each partner’s preference about sexual position during anal sex. Men who enter into relationships frequently have predefined position preferences, and in many cases identities related to these preferences (Dangerfield et al., 2017; Moskowitz & Roloff, 2017). Broadly, these identities are “top” (i.e., preference to be the insertive partner), “bottom” (i.e., preference to be the receptive partner), and “versatile” (i.e., openness to being the insertive or the receptive partner) (Johns et al., 2012; Pachankis et al., 2013). Moskowitz and Garcia (2019) explored the relevance of sexual position preferences and behaviors to sexual satisfaction in a sample of men in same-sex relationships. They found that men whose position preferences were discordant with their behaviors (e.g., bottoms who most often top in their relationship; tops who most often bottom in their relationship) had significantly less sexual satisfaction than those whose preferences were concordant with their behaviors.

Relationship agreement type (i.e., a monogamous or non-monogamous agreement) is another factor that may influence sexual satisfaction in one’s relationship, and non-monogamy arrangements are not uncommon in male couples (Grov et al., 2014; Hoff & Beougher, 2010). Qualitative research has documented that some male couples establish non-monogamous relationship agreements in order to optimize sexual satisfaction both individually and within the primary partnership, while other couples maintain monogamous agreements in order to protect intimacy, satisfaction, and health (Mitchell et al., 2017). Given these differing motivations for establishing relationship agreements, it is perhaps not surprising that research has not observed significant differences in sexual satisfaction across agreement types (Parsons et al., 2012). It is also important to note that relationship agreements are far more varied than a simple distinction between monogamous and non-monogamous, and these more nuanced distinctions have potentially important implications for satisfaction and health (Grov et al., 2014; Hoff & Beougher, 2010; Parsons et al., 2011). For example, some research has distinguished between “monogamish” (i.e., sex with outside partners is allowed only when both partners are present) and “open” relationships (i.e., each individual can have sex with outside partners separately), and men in monogamish relationships tend to report fewer depressive symptoms and a lower likelihood of having condomless sex compared to those in open and monogamous arrangements (Parsons et al., 2011). These findings indicate that it may be important to account for various types of non-monogamous agreements when examining their association with sexual satisfaction in the relationship.

Finally, age-discrepancies between partners may produce differences in power, which may influence relationship health, and studies have observed that younger partners in age-discrepant male couples tend to have more decision-making power than older partners (Perry et al., 2016). At the same time, having older partners has been found to be a specific risk factor for HIV among YMSM (see Mustanski & Newcomb, 2013), indicating that age-discrepancies may impact aspects of relationship functioning in different ways. It is possible that having an older partner would be associated with greater sexual satisfaction among YMSM because an older partner would be more likely to have sexual experience, but having a much older partner may be associated with decreased satisfaction as interest in sex tends to decline with age (e.g., Araujo et al., 2004).

Current Study

The current analyses aimed to fill gaps in the literature by examining the influence of couple-level dynamics (i.e., relationship length, couple age difference, HIV status arrangement, relationship agreement type, and sexual position compatibility), interpersonal factors (i.e., relationship satisfaction, positive and negative communication) and intrapersonal experiences (i.e., depression, alcohol problems, marijuana problems, stigma-based microaggressions) on sexual satisfaction in the relationship using a large sample of young male couples from across the United States. With regard to couple-level demographics, we hypothesized that HIV-positivity in the relationship, sexual position incompatibility, relationship length, and partner age-discrepancies would be negatively associated with sexual satisfaction. Given mixed findings in the literature, we made no specific hypothesis about the influence of relationship agreement type (i.e., monogamous, monogamish, open). In terms of interpersonal factors, we expected that relationship quality (i.e., high relationship satisfaction and positive communication, low negative communication) would be positively associated with sexual satisfaction. For intrapersonal factors, we predicted that depression, microaggressions, alcohol problems, and marijuana problems would each be negatively associated with sexual satisfaction. We anticipated that the effects of intrapersonal and interpersonal variables would not differ between actor and partner effects. Finally, we hypothesized that better relationship functioning (i.e., relationship satisfaction, communication) would buffer against (i.e., moderate) the association between intrapersonal variables and sexual satisfaction.

Method

Participants

Data for these analyses came from the baseline visits of two ongoing randomized controlled trials of 2GETHER, a relationship education and HIV prevention program for young male couples (Newcomb et al., 2017). The 2GETHER Chicago study is evaluating the efficacy of 2GETHER relative to an attention-matched control, administered face-to-face in a university setting. The 2GETHER USA study is conducting a comparative effectiveness trial of 2GETHER relative to existing public health practice, administered online via videoconference to couples across the United States (Newcomb et al., 2020). Both trials utilize the same baseline self-report questionnaire, which allows for combining the two baseline samples into a single analytic sample.

Participants for the current analytic sample were recruited between August 2017 and April 2020 and included 419 couples (individual N = 838). We utilized baseline data from 156 couples from 2GETHER Chicago and 263 couples from 2GETHER USA, and we included data from couples who were eligible and completed baseline but were not randomized because they were either awaiting assignment to a cohort or were lost to follow-up (42 and 96 had not been randomized in 2GETHER Chicago and 2GETHER USA, respectively). Including couples in the present analyses that never made it to randomization for various reasons (e.g., uninterested in the program, relationship dissolution) improves generalizability of this treatment-seeking sample.

Across both studies, participants were recruited via paid advertisements on social media (e.g., Facebook) and geosocial dating apps, organic social media engagement (e.g., Reddit), local ad campaigns (e.g., public transit ads), and Chicago-based venues (e.g., PrideFest, bars, clinic referrals). Inclusion criteria were the following: 1) both partners were cisgender men; 2) both partners were at least 18 years old and one partner was 18–29 years old; 3) both partners considered one another main or primary partners; 4) partners reported oral or anal sex with each other in the last three months; 5) at least one partner reported condomless anal sex with a serodiscordant or status unknown partner (all casual partners were considered status unknown); 6) both partners could read and speak English at an 8th grade level or higher; and 7) partners agreed to audio recording of future intervention sessions. There were two additional inclusion criteria in 2GETHER USA: 1) at least one partner reported binge-drinking or illicit drug use in the last 30 days; and 2) partners had consistent Internet access. We acknowledge that requiring at least one member of the dyad to report HIV risk behavior in both samples, and recent binge-drinking or drug use in the national sample, limits generalizability of the combined sample somewhat. However, we note that these thresholds are met by a large proportion of couples in this population.

See Table 1 for participant demographics. The mean age of the analytic sample was 28.2 years (SD = 6.4); excluding partners aged 30 or older (22.6% were 30+), the mean age of the analytic sample was 25.7 years (SD = 2.9). With regard to race/ethnicity, 54.9% of the analytic sample was White, 20.3% Hispanic/Latinx, 14.9% Black/African American, and 9.9% was another race (i.e., Asian, Pacific Islander, American Indian, and multiracial combined). Most participants identified as gay (82.7%), while 10.4% identified as bisexual, 6.0% identified as queer, and 1.0% had some other identity. With regard to HIV status, 74.3% of participants reported being HIV-negative, 14.9% HIV-positive, and 10.7% had never been tested or were unsure of their HIV status. Finally, the majority of participants lived in the Midwest (47.9%), followed by the South (26.4%), West (16.6%), Northeast (8.7%), and Puerto Rico (0.5%).

Table 1.

Demographic Characteristics of Analytic Sample of Young Male Couples

Individual-Level Descriptives N M (SD) or %
Study
 2GETHER Chicago 312 37.2
 2GETHER USA 526 62.8
Age
 All participants 838 28.2 (6.4)
 Participants under 30 649 25.7 (2.9)
Race/Ethnicity
 American Indian or Alaska Native 2 0.2
 Asian 27 3.2
 Black or African American 125 14.9
 Native Hawaiian or Other Pacific Islander 3 0.4
 White 460 54.9
 Multi-racial 44 5.3
 Other 7 0.8
 Hispanic or Latino 170 20.3
Sexual Orientation
 Gay 693 82.7
 Bisexual 87 10.4
 Queer 50 6.0
 Not listed 8 1.0
HIV Status
 HIV-positive 125 14.9
 HIV-negative 623 74.3
 Unsure/never tested 90 10.7
Sexual Position Identity
 Bottom or versatile bottom 310 37.0
 Versatile 179 21.4
 Top or versatile top 349 41.6
Region
 Northeast 73 8.7
 Midwest 401 47.9
 South 221 26.4
 West 139 16.6
 Puerto Rico 4 0.5
Dyad-Level Descriptives N M (SD) or %
Relationship Length (in months) 419 34.2 (27.3)
Age Discordance (in years) 419 5.7 (6.8)
HIV Status Arrangement
 Seroconcordant negative or unknown 310 74.0
 Serodisordant 93 22.2
 Seroconcordant positive 16 3.8
Sexual Position Compatibility
 Compatible 382 91.2
 Incompatible 37 8.8
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Procedure

After both members of the couple completed an eligibility screener and both completed a couple confirmation phone call (i.e., to screen out fake couples), each member of the couple completed a self-administered, computer assisted questionnaire via REDCap (Harris et al., 2009). Participants in 2GETHER Chicago completed the survey in person in a university setting, while those in 2GETHER USA completed the survey remotely. Study staff verified consistency between eligibility screener and baseline survey responses as a final eligibility check. Upon completion of baseline, couples were scheduled into groups and randomized to either 2GETHER or the respective control condition for each trial.

Measures

Demographics

Participants reported their age, relationship length in months, race/ethnicity, sex assigned at birth, sexual orientation, and HIV status. We also asked participants to describe their current sexual position identity (i.e., preferred anal sex position), with the following response options: top (always or almost always top), versatile top (mostly top, sometimes bottom), versatile (top and bottom equally), versatile bottom (mostly bottom, sometimes top), or bottom (always or almost always bottom).

Couple-Level Characteristics

We used these individually-reported demographic data to compute four couple-level variables for analyses. First, we calculated age discordance by taking the absolute value of the age difference between partners. Second, couple-level relationship length was computed by calculating the mean of each individual’s response to the relationship length item. Third, HIV-positivity in the relationship was dichotomized into couples in which at least one member was HIV-positive (coded 1) and couples in which neither was HIV-positive (coded 0). Finally, couples were designated as sexual position incompatible if both members selected “top” or “versatile top,” or if both members selected “bottom” or “versatile bottom” (coded 1). All other position combinations were coded compatible (coded 0).

Sexual Satisfaction

Sexual satisfaction with one’s partner was measured with a 12-item scale based on the Derogatis Sexual Functioning Inventory (DSFI; Derogatis, 1975). This scale used two of the original DSFI items, combined with 10 DSFI items adapted by Parsons and colleagues (2012) in order to reduce heterosexist bias and be culturally appropriate for male couples. Example items are: “I am satisfied with [PARTNER NAME] as a sexual partner,” and “I am pleased with the frequency with which [PARTNER NAME] and I have sex.” Responses are captured on a 4-point Likert-type agreement scale (1 = strongly disagree; 4 = strongly agree) and averaged to create a total score. For this and all other continuous measures, we calculated reliability by randomly selecting one participant within each dyad, as this approach minimizes inflation of reliability in nested data. Reliability in this sample was excellent (α = .92).

Relationship Agreement Type

Based on the work of Hoff and colleagues (2010), participants were asked the following question to assess their relationship agreement type: “Which of the following scenarios best describes the sexual agreement that you and [partner name] have?” Responses options were: 1) we cannot have any sex with an outside partner, 2) we can only have sex with other people when both of us are present, 3) we can have sex with outside partners on our own but with some restrictions, 4) we can have sex with outside partners on our own without any restrictions, 5) we do not have an agreement. We categorized these responses into four groups: monogamous (i.e., response option 1; 27.3% of sample), monogamish (i.e., response option 2; 20.4% of sample), open (response options 3 and 4; 43.6% of sample), and no agreement (response option 5; 8.7% of sample).

Relationship Satisfaction

The 4-item version of the Couples Satisfaction Index (CSI) (CSI; Funk & Rogge, 2007) was used to measure participants’ satisfaction in their relationship. Participants were asked to rate how accurate they found three statements, such as “I have a warm and comfortable relationship with my partner.” These items were rated on a 6-point scale (0 = not at all; 5 = completely). The fourth statement, “Please indicate the degree of happiness, all things considered, of your relationship” was rated on a 7-point scale (0 = extremely unhappy; 6=perfect). The scale has a possible range of 0–21, with higher scores indicating higher satisfaction. Reliability was excellent (α = .91).

Communication

Relationship communication skills were assessed with an investigator-adapted version of the Communication Skills Test (CST; Jenkins & Saiz, 1995). CST items were modified to improve: readability, clarity about whether the item referred to one’s own behavior, their partner’ behavior, or a couple behavior pattern, and relevance to same-sex couples and skills taught in the 2GETHER intervention. The 35-item scale consists of 5 facets within a positive communication subscale, and 4 facets within a negative communication subscale. Examples of positive communication items include: “During discussions, I check with my partner to see if I am getting the point,” and “We try to fully understand each other’s feelings about a relationship problem before we start trying to solve it.” Examples of negative communication items include: “I say mean things to my partner when I get angry,” and “I shut down and do not respond during arguments even though I am boiling or hurt inside.” Within the positive communication subscale, one facet was dropped (“I Statements,” 4-items) due to low reliability. All items were rated on a 7-point scale (1 = never happens; 4 = sometimes; 7 = happens most of the time). The positive communication and negative communication subscales were used in these analyses. Reliability of the positive communication subscale was α = .85. For negative communication, the reliability was α = .90.

Depression

Depression was assessed using the Patient-Reported Outcomes Measurement Information System (PROMIS) Depression-Short Form 8A instrument (Pilkonis et al., 2011). The 8-item instrument assesses self-reported negative mood, views of self, social cognition, and decreased positive affect and engagement in the past seven days. Example items include: “I felt worthless” and “I felt unhappy.” Participants were asked to respond how often they felt that way on a 5-point Likert scale (1 = never, 5 = always). Individual items were summed and converted into standardized T-scores (M = 50, SD = 10) to create a composite score with higher scores indicating greater levels of depression. Scale reliability was excellent (α = .94).

Alcohol Use and Associated Problems

The Alcohol Use Disorder Identification Test (AUDIT), a 10-item tool assessing consumption, behaviors, and problems related to alcohol use in the past six months, was administered (Saunders, Aasland, Babor, de la Fuente, & Grant, 1993). Example items include: “How often do you have a drink containing alcohol?” and “Have you or someone else been injured because of your drinking?” Individual items were summed to create a composite score (range: 0–40) with higher scores indicating higher levels of problematic drinking. Reliability was α = .81.

Marijuana Use and Associated Problems

The Cannabis Use Disorder Identification Test-Revised (CUDIT-R), an 8-item tool assessing consumption, behaviors, and problems related to cannabis use in the past six months, was administered (Adamson et al., 2010). The CUDIT-R was adapted from the 10-item CUDIT, which was a direct modification of the AUDIT (Adamson & Sellman, 2003). Example items include: “How often do you use marijuana?” and “How often during the past 6 months did you fail to do what was normally expected from you because of using marijuana?” Individual items were summed to create a composite score (range: 0–32) with higher scores indicating higher levels of problematic cannabis use. Reliability of the CUDIT was α = .80.

Microaggressions

Participants’ experiences of microaggressions were measured using the 10 highest loading items from the Sexual Orientation Microaggressions Inventory (SOMI; Swann, Minshew, Newcomb, & Mustanski, 2016). Items assess all four subscales: anti-gay attitudes and expressions (e.g., “You were told not to ‘act so gay.’”), denial of homosexuality (e.g., “You were told that being gay is just a phase.”), heterosexism (e.g., “You were told you’re not a ‘real’ man.”), and societal disapproval (e.g., “Someone said homosexuality is a sin or immoral.”). Response options assess how often these experiences occurred in the prior three months on a 5-point scale (1 = not all, 3 = about every month, 5 = about every day). Items were averaged into a single score, with higher scores indicating more frequent experiences of sexual orientation microaggressions. Reliability in the present sample was α = .83.

Analytic Plan

Actor-partner interdependence models (APIMs) were run in MPlus to test for associations between couple-level factors, interpersonal relationship dynamics, intrapersonal experiences, and participant reports of sexual satisfaction within their primary relationship. The purpose of using APIMs was to understand how both the participant’s (actor) and their partner’s reports of each predictor was associated with their sexual satisfaction within their relationship. Initially, we ran four APIMs. Model 1 included couple-level (i.e., between-dyad; Level 2) effects only, including relationship length, couple age-discrepancy, HIV-positivity in the dyad (i.e., at least one partner is HIV-positive), and sexual position incompatibility, predicting sexual satisfaction, and controlled for cohort differences between the two 2GETHER studies. Model 2 included within-dyad (i.e., Level 1) interpersonal actor and partner relationship effects on sexual satisfaction while controlling for the between-dyad effects from the first model. The interpersonal within-couple effects included two variables. First, relationship agreement type enter as a dummy-coded variable (i.e., monogamish v. monogamous; open v. monogamous; no agreement v. monogamous). Second, to reduce the total number of predictors in the model, we created a latent relationship quality factor formed from the scales for relationship satisfaction, positive communication skills, and negative communication skills (we disaggregate this factor in follow-up analysis below). Model 3 included within-couple (i.e., Level 1) actor and partner intrapersonal effects on sexual satisfaction while controlling for the between-dyad effects from the first model. The intrapersonal effects tested were PROMIS depression scores, alcohol-related problems, marijuana-related problems, and experiences of sexual orientation-based microaggressions. Model 4 was a full multivariate model that included all of the predictors from the first three models.

We conducted two follow-up analyses in order to provide more context to our findings. First, we re-ran Model 2 (i.e., interpersonal relationship effects), except that we disaggregated our latent relationship quality factor so that we could understand differences in the effects of relationship satisfaction, positive communication, and negative communication on sexual satisfaction. Second, we re-ran Model 4 with the inclusion of our latent relationship quality factor as a moderator of the intrapersonal effects in the model (PROMIS depression scores, alcohol-related problems, marijuana-related problems, and microaggressions) in order to examine whether relationship quality buffered against the negative impact of intrapersonal factors on sexual satisfaction.

Results

Descriptive Statistics for Study Variables

Participants reported a mean sexual satisfaction score of 3.21 (SD = 0.58; range 1–4), which reflects generally high sexual satisfaction with one’s primary partner. Self-reported relationship satisfaction had a mean of 15.42 (SD = 3.95; range 0–21), while positive communication had a mean of 4.46 (SD = 0.96; range 1–7) and negative communication had a mean of 3.06 (SD = 1.07; range 1–7). The mean PROMIS Depression T-score (M = 54.12, SD = 8.84) fell within a standard deviation of the population mean, and the mean AUDIT (M = 5.96, SD = 4.84) and CUDIT scores (M = 5.11, SD = 6.06) both fell below the cut point for hazardous use. Sexual orientation-based microaggressions were endorsed with low frequency, on average (M = 1.41, SD = 0.44). With regard to couple-level demographics, the mean relationship length was 34.4 months (SD = 27.6 months), 16.6% had an age-discrepancy of at least 10 years, and 9.1% were sexual position incompatible. Nearly one quarter of couples had at least one partner who was known HIV-positive (24.4%); of those, 83.4% of couples were serodiscordant and 16.6% were concordant HIV-positive.

Couple-Level Effects (Model 1)

See Table 2 for a summary of couple-level, actor and partner effects across all models. Sexual position preference was associated with sexual satisfaction in the relationship (β = −0.23, p < .01). Couples who were sexual position incompatible (i.e., reported the same anal sex position preference as their partner) reported less sexual satisfaction. Relationship length, partner age discrepancy, and HIV-positivity in the relationship were not associated with sexual satisfaction in the relationship. There were also no significant differences between the 2GETHER cohorts.

Table 2.

Actor-Partner Interdependence Models of Associations of Between- and Within-Couple Effects on Sexual Satisfaction within the Relationship

Model 1 Model 2 Model 3 Model 4
Couple-Level Effects Couple + Interpersonal Effects Couple + Intrapersonal Effects Full Model
β (SE) p-value β (SE) p-value β (SE) p-value β (SE) p-value
Within-Dyad
 Agreement (Monogamous ref.)
  Monogamish (Actor) - - .03 (.06) 0.582 - - .03 (.06) 0.630
  Open (Actor) - - −.11 (.07) 0.111 - - −.11 (.07) 0.100
  No Agreement (Actor) - - −.21 (.07)** 0.002 - - −.21 (.07)** 0.002
 Agreement (Monogamous ref.)
  Monogamish (Partner) - - .05 (.06) 0.388 - - .07 (.06) 0.269
  Open (Partner) - - −.04 (.07) 0.552 - - −.03 (.07) 0.679
  No Agreement (Partner) - - −.07 (.07) 0.348 - - −.06 (.07) 0.379
 Relationship Quality Factor (Actor) - - .42 (.03)*** <.001 - - .40 (.03)*** <.001
 Relationship Quality Factor (Partner) - - −.01 (.03) 0.758 - - .00 (.03) 0.998
 SO Microaggressions (Actor) - - - - −.04 (.05) 0.339 −.02 (.04) 0.625
 SO Microaggressions (Partner) - - - - .07 (.04) 0.094 .06 (.04) 0.090
 Depression (Actor) - - - - −.02 (.00)*** <.001 .00 (.00) 0.102
 Depression (Partner) - - - - −.01 (.00)** 0.004 .00 (.00) 0.967
 Alcohol Problems (Actor) - - - - −.01 (.00) 0.142 .00 (.00) 0.399
 Alcohol Problems (Partner) - - - - .00 (.00) 0.982 .00 (.00) 0.534
 Marijuana Problems (Actor) - - - - .00 (.00) 0.905 .00 (.00) 0.834
 Marijuana Problems (Partner) - - - - .01 (.00)* 0.050 .01 (.00)* 0.043
 Residual Variance .18 (.02)*** <.001 .14 (.01)*** <.001 .17 (.01)*** <.001 .14 (.01)*** <.001
Between-Dyad
 Relationship Length .00 (.00) 0.252 .00 (.00) 0.929 .00 (.00) 0.101 .00 (.00) 0.991
 Age Discrepancy .00 (.00) 0.361 .00 (.00) 0.268 .00 (.00) 0.633 .00 (.00) 0.249
 At Least 1 Partner HIV-Positive .03 (.06) 0.661 .07 (.05) 0.133 .00 (.06) 0.997 .07 (.05) 0.173
 Sexual Position Incompatibility −.23 (.09)** 0.009 −.26 (.07)*** <.001 −.22 (.09)** 0.010 −.26 (.07)** 0.001
 Study (2GETHER Chicago ref.)
  2GETHER USA −.06 (.05) 0.219 −.08 (.04) 0.060 −.03 (.05) 0.569 −.08 (.04) 0.090
 Intercept 3.34 (.09)*** <.001 3.40 (.08)*** <.001 3.73 (.15)*** <.001 3.37 (.14) <.001
 Residual Variance .14 (.02)*** <.001 .09 (.01)*** <.001 .13 (.02)*** <.001 .09 (.01) <.001
Open in a new tab

Notes:

***

p < .001

**

p < .01

*

p < .05.

SO = Sexual Orientation.

Interpersonal Actor and Partner Effects (Model 2)

There were several significant actor effects for associations between interpersonal relationship functioning and sexual satisfaction in the relationship. We observed a positive association between the relationship quality latent factor and participants’ sexual satisfaction (actor effect; β = 0.42, p < .001). Reporting that one did not have a relationship agreement was associated with significantly less sexual satisfaction in the relationship compared to those reporting a monogamous agreement (β = −0.21, p < .01), but there were no differences between reported open and monogamous agreements, or between monogamish and monogamous agreements in sexual satisfaction. There were no significant partner effects.

Intrapersonal Actor and Partner Effects (Model 3)

Depression was significantly associated with sexual satisfaction in the relationship. One’s own report of depression was associated with less sexual satisfaction (i.e., actor effect; β = −0.02, p < .001). One’s partner’s report of depression (i.e., partner effect; β = −0.01, p < .01) was also negatively associated with one’s own sexual satisfaction in the relationship. The actor effect for marijuana problems was not significant, but the partner effect was significant (β = 0.01, p < .01). Participants reported more sexual satisfaction in the relationship when their partners reported more marijuana problems. There were no significant actor or partner effects of experiencing microaggressions or alcohol problems.

Full Multivariate Model Effects

In the full multivariate model, all previously-described couple-level and interpersonal effects retained significance. In contrast, all but one intrapersonal effect became non-significant in the full multivariate model. The partner effect for a positive association between marijuana problems and sexual satisfaction retained significance.

Follow-Up Analyses

We conducted two sets of follow-up analyses. First, we disaggregated the relationship quality latent factor to examine the individual effects of relationship satisfaction, positive communication and negative communication. Considered separately, actor relationship satisfaction (β = 0.06, p < .001) and positive communication (β = 0.10, p < .001) were positively associated with sexual satisfaction. Actor report of negative communication (β = −0.05, p < .05) was associated with lower sexual satisfaction. There were no significant associations between partner report of relationship satisfaction (β = 0.01, p = .28) or positive communication (β = 0.02, p = .52) and sexual satisfaction. There was a positive association between partner negative communication and sexual satisfaction (β = 0.05, p < .05). Participants reported more sexual satisfaction when their partner reported higher negative communication skills.

Second, we examined whether the relationship quality latent factor moderated the effects of intrapersonal factors (i.e., depression, microaggressions, alcohol problems, marijuana problems) on sexual satisfaction. There was a significant interaction effect of partners’ relationship quality latent factor and partner depression scores with sexual satisfaction (β = −0.01, p < .05). This interaction indicates that one’s partner’s depression has a stronger negative impact on one’s own sexual satisfaction when relationship quality is high. None of the other moderating effects were significant.

Discussion

The current study used data from a unique, large sample of young male couples from across the United States to examine the influence of interpersonal and intrapersonal factors on relationship sexual satisfaction. These analyses provide compelling evidence for the importance of various couple-level demographics and aspects of relationship functioning in the experience of sexual satisfaction in young male couples. Furthermore, while certain intrapersonal factors were also associated with relationship sexual satisfaction (i.e., depression, substance use), these effects were less robust that those of the couple-level and interpersonal effects, as most of these intrapersonal effects lost significance in a full multivariate model. These findings point to the importance of addressing relationship dynamics, including those common to all couples and unique to male couples, in couple-level interventions that aim to optimize relationship functioning and sexual health.

Interpersonal Factors and Sexual Satisfaction

Consistent with prior studies of both male couples (Carvalheira & Costa, 2015; Deenen et al., 1994; Shepler et al., 2018) and different-sex couples (e.g., Byers, 2005), our analyses observed that better relationship functioning (i.e., high levels of relationship satisfaction and positive communication, lower levels of negative communication) was associated with more relationship sexual satisfaction, and the actor effect of relationships functioning retained significance in the full multivariate model. These findings are consistent with hypotheses and the Vulnerability Stress Adaptation (VSA) model (Karney & Bradbury, 1995), and they make intuitive sense. Sexual satisfaction is a central component of overall relationship satisfaction (Christopher & Sprecher, 2000), and these constructs co-vary in couples over time (Byers, 2005; Sprecher, 2002). While these findings may not be ground-breaking, they point to the importance of addressing sexual satisfaction in relationship education and other couple-based interventions that aim to optimize relationship functioning in young male couples. Indeed, sexual satisfaction is seen as a central component to several recently-developed relationship education programs for same-sex couples (Newcomb et al., 2017; Newcomb et al., 2020; Whitton et al., 2016; Whitton et al., 2017), and excluding this topic from interventions may be detrimental to their efficacy. In our follow-up analysis that disaggregated the relationship quality latent variable to examine each indicator’s effect on sexual satisfaction, we observed an unexpected finding that one’s partner’s report of negative communication was associated with higher sexual satisfaction. While this is counterintuitive, it may be that slightly elevated rates of negative communication as reported by one’s partner may be an indicator of passion that could enhance sexual satisfaction in the moment. However, we would expect that consistent patterns of negative communication over time would degrade both relationship and sexual satisfaction. Importantly, there are numerous facets of both negative communication (e.g., hostility, withdrawal) and positive communication (e.g., active listening, problem solving), and future research should examine whether these various dimensions have differential associations with sexual satisfaction and other relationship outcomes among male couples.

Intrapersonal Factors and Sexual Satisfaction

Consistent with hypotheses and the VSA model (Karney & Bradbury, 1995), these analyses found that several intrapersonal factors (i.e., individual vulnerabilities) were also associated with relationship sexual satisfaction, including depression and substance use. As in prior work (e.g., Remien et al., 2003), we observed significant actor and partner effects of depression. In other words, both one’s own and one’s partner’s experiences with depression were negatively associated with sexual satisfaction in the relationship. Several key symptoms of depression may negatively impact sexual satisfaction with one’s primary partner by nature of decreasing connectedness and intimacy, including feelings of loneliness and social isolation, anhedonia (i.e., general loss of interest), and loss of interest in sex (American Psychiatric Association, 2013). Similarly, and also consistent with previous research (Dolezal et al., 2005), the actor effect of alcohol problems was negatively associated with sexual satisfaction. While drinking in small to moderate amounts may increase sexual arousal under certain conditions (Peugh & Belenko, 2001), heavy or problematic drinking impairs sexual functioning and decreases interest in sexual activity.

In contrast to these negative associations with sexual satisfaction, these analyses found that one’s partner’s report of marijuana problems was associated with more sexual satisfaction in the relationship. It is possible that the calming physiologic effects of marijuana may be associated with reduced anxiety and inhibitions, which could improve sexual satisfaction. However, we might also expect that very heavy use of marijuana might decrease sexual arousal and interest, so more research is needed to understand the impact of marijuana use at varying levels on sexual functioning and satisfaction, including longitudinal research that can assess causal relationships. Finally, previous research has linked stress to reduced sexual satisfaction (Hamilton & Meston, 2013; Leavitt et al., 2017), but sexual orientation-based microaggressions were not associated with sexual satisfaction in this sample. Some research indicates that more chronic daily stressors have a stronger negative impact on health and wellbeing than less frequent ones (e.g., Bodenmann et al., 2007), and microaggressions were not commonly reported in this sample. Although not measured in this study, it is possible that more consistent daily stressors have a negative impact on young male couples’ sexual satisfaction. Importantly, and in contrast with expectations, nearly all intrapersonal effects lost significance in the full multivariate model (with the exception of the marijuana problems partner effect), indicating that these intrapersonal effects may be less robust than some of the other variables in the model.

In follow-up analysis, we examined whether our relationship quality latent factor moderated the effects of intrapersonal variables on sexual satisfaction. Overall, we found no evidence that better relationship quality buffered against the negative impact of individual vulnerabilities (i.e., depression, substance use) or stress (i.e., microaggressions) on sexual satisfaction. In fact, the only significant moderating effect observed that one’s partner’s depressive symptoms had a stronger negative impact on sexual satisfaction when relationship quality was high. Couples with better relationship quality are likely more interdependent, and therefore, one’s partner’s difficulties would have a stronger impact on one’s own satisfaction. Together, these findings indicate that young male couples would benefit from interventions that help them to apply their relationship skills to difficulties encountered by one or both partners.

Couple-Level Factors and Male Couples’ Relationship Dynamics

In addition to the previously described interpersonal and intrapersonal effects, our analyses point to the importance of certain relationship dynamics that are unique to, or more common among, male couples in their experience of sexual satisfaction. First, not having a specific relationship agreement in place was associated with less sexual satisfaction compared to those in monogamous relationships. Couples who do not have a relationship agreement are likely those that have difficulty discussing their sexual desires and needs with their partner, which in turn would lead to a higher likelihood that partners would not have their sexual needs met. These analyses did not observe differences in sexual satisfaction between those in two different types of non-monogamous relationships (i.e., open and monogamish) and those in monogamous relationships. There are many different ways that couples can be non-monogamous, and these analyses indicate that no one type of relationship agreement optimized sexual satisfaction more than another, so long as the couple had a specific relationship agreement in place. These findings point to the importance of accounting for different types of non-monogamous relationships, as well as couples’ motivations for non-monogamy, when examining couple health.

Couples in which both partners endorsed the same anal sex role preference (i.e., sexual position incompatibility) also reported less relationship sexual satisfaction. This finding is consistent with prior research (Moskowitz & Garcia, 2019) and suggests that when individuals in relationships take on a less preferred sexual role, it may ultimately degrade sexual satisfaction with one’s partner, in the absence of efforts to enhance sexual pleasure. It is important to note that anal sex, while central to many male couples’ sexuality, is not the only sexual behavior that may be pleasurable and satisfying in a sexual relationship. Thus, it may be particularly important for couples in which both partners endorse the same anal sex role preference to receive education about strategies for increasing sexual pleasure in the context of less preferred sex roles and other (non-anal) sexual behaviors. Even if each individual’s sexual needs are met by establishing a non-monogamous arrangement in order to have sex with more compatible outside sexual partners, sexual satisfaction with one’s primary partner is still central to relationship functioning. Indeed, evidence suggests that sexual satisfaction with one’s partner predicts later overall relationship satisfaction (Fallis et al., 2016; Yeh et al., 2006), so focused efforts to improve sexual satisfaction in the relationship are likely to benefit long-term relationship health.

Contrary to expectations and prior research (Remien et al., 1995), we found no association between HIV seropositivity and sexual satisfaction. Most of the prior research on this topic was conducted before the more recent advances in biomedical HIV prevention (i.e., PrEP, viral suppression) (Cohen et al., 2012; Grant et al., 2010), so the present findings indicate that HIV-negative YMSM may be less anxious about being in relationships with HIV-positive partners as a result of these advances, while HIV-positive YMSM may be less anxious about transmitting HIV to a partner. Not only do these advances have important implications for HIV transmission, but they may also be leading to reduced stigma and fear related to anal sex with HIV-positive partners. Finally, it is important to note that all of these couple-level and relationship dynamic effects retained significance in the full multivariate model, pointing to their importance in understanding sexual satisfaction in young male couples.

General Conclusions and Limitations

One particularly novel contribution of these analyses is that we were able to examine the relative influence of couple-level, interpersonal and intrapersonal effects by adding all independent variables into a single multivariate model. In the full model, nearly all of the intrapersonal effects lost significance, indicating that the couple-level and interpersonal effects were more robust correlates of sexual satisfaction in the relationship. Thus, consistent with prior research linking various aspects of relationship functioning to sexual satisfaction in different-sex couples (Byers, 2005; Christopher & Sprecher, 2000; Jones et al., 2018; Mark & Jozkowski, 2013), intervening with couples (as opposed to individuals) to address aspects of relationship functioning may be key to improving sexual satisfaction. More specifically, relationship education approaches have been shown to effectively improve connectedness, communication, and general relationship satisfaction (see Hawkins et al., 2008), and these approaches will also likely improve sexual satisfaction within the dyad. In addition to these aspects of general relationship functioning, certain relationship dynamics that are unique to, or more common among, male couples are important to address in dyadic interventions, including monogamy/non-monogamy arrangements and anal sex role preferences. While these issues may add complexity to couples’ sex lives, relationships can be both high-functioning and sexually satisfying across various different arrangement and sexual preference types.

These findings also have important implications for sexual health promotion and HIV prevention interventions for young male couples. YMSM are at high risk for HIV acquisition in the United States (Centers for Disease Control and Prevention, 2019), and a large proportion of new infections occur in the context of primary partnerships (Goodreau et al., 2012; Sullivan et al., 2009). Thus, interventions that address relationship dynamics, including sexual satisfaction, are critically important to curbing the high rate of new infections (Newcomb et al., 2017; Newcomb et al., 2020). Optimizing the functioning of the relationships of YMSM via improved communication and satisfaction may be a critical first step to reducing their risk of acquiring or transmitting HIV because it will allow couples to have more effective discussions about maximizing their sexual satisfaction (both within and outside of the dyad) while minimizing the risk of HIV transmission. Further, there is increasing concern that YMSM are experiencing fatigue related to prevention programs that focus exclusively on HIV, so providing strategies for enhancing sexual pleasure, intimacy, and satisfaction may help to reduce this fatigue by addressing the broader sexual health needs of these young people.

It is important to acknowledge several limitations to these analyses. First, the data are cross-sectional, so causal relationships cannot be inferred. Longitudinal datasets of same-sex couples are extremely rare and would help to understand the temporal ordering of effects. For example, longitudinal analyses are need to understand if relationship functioning predicts later sexual satisfaction, sexual satisfaction predicts future relationship quality, or the two variables co-vary over time. Second, this is not a population-based sample that is representative of young male couples. However, community-based samples that are large and diverse are valuable in that they allow for the assessment of experiences unique to certain groups (e.g., anal sex position preferences in male couples), which often does not occur in representative datasets. Finally, this dataset was created by combining the baseline samples of two ongoing efficacy trials of a relationship education and HIV prevention program for young male couples. Thus, these couples likely have experiences that differ from those who are not eligible for, or are not willing to enroll in, these trials. However, given that the trials are preventive in nature and are not specifically recruiting distressed couples, the possibility of differences between these couples and the broader population is likely somewhat reduced. Finally, most of the effects observed in these analyses were small to moderate in size, which indicates that there may be more proximal predictors of sexual satisfaction in young male couples that need to be examined. However, most of the effects observed in these analyses retained significance across multiple models, lending support the robustness and importance of these findings.

Despite these limitations, this manuscript presents novel data from a large and diverse sample of young male couples from across the United States that sheds light on various factors associated with relationship sexual satisfaction. Specifically, these analyses highlight the importance of various relationship dynamics (i.e., sexual position compatibility, relationship agreements) and aspects of relationship functioning (i.e., communication, overall satisfaction) in understanding sexual satisfaction in young male couples. Our study points to the high potential of couple-based interventions to train male couples to use relationship skills to enhance sexual satisfaction. Further, couple-based interventions that do not shy away from having frank conversations about enhancing sexual pleasure and satisfaction (both within and outside of the relationship) may be critical to curbing the high rate of new HIV infections in YMSM, many of which occur in the context of serious romantic relationships.

Acknowledgements

The research described in this manuscript is funded by grants from the National Institute on Alcohol Abuse and Alcoholism (R01AA024065; PI: M. Newcomb) and National Institute on Drug Abuse (DP2DA042417; PI: M. Newcomb). REDCap is supported at the Feinberg School of Medicine by the Northwestern University Clinical and Translational Science (NUCATS) Institute, which is supported by a grant from the National Institute of Health’s National Center for Advancing Translational Sciences (UL1TR001422; PI: D. Lloyd-Jones). The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health. The authors would like to thank study staff and the research participants for their time.

Footnotes

The authors have no known conflicts of interest to disclose.

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