The association between pornography, motives for watching pornography and sexual satisfaction in transgenders

Graduate School of Psychology

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The Association between Pornography, Motives for

Watching Pornography and Sexual Satisfaction in

Transgenders

Status: Final version Date: 03/ 05 / 2016

1. WHO AND WHERE Student

Name : Suzanne Slagt

Student ID number : 10000271

Address : Polanenstraat 5-4

Postal code and residence : 1013 VX Amsterdam

Telephone number : 0626792405

Email address : suzanneslagt@hotmail.com

Supervisor(s)

Within ResMas (obligatory) : Agneta Fischer

Specialisation : Social psychology

External supervisor(s), if any : Baudewijntje Kreukels & Thomas Steensma

Second assessor : Corine van Dijk

Research center / location : VU medisch centrum, kennis- en zorgcentrum genderdysforie

Number of credits (1 ec = 28 hrs) : 27

Abstract

In the current study, a questionnaire was developed to explore the relationship between watching pornography, motives people have for watching pornography and sexual satisfaction, in transgenders compared to a control group. One-hundred-twelve patients with gender dysphoria (GD) and 99 students without gender dysphoria completed the questionnaire. We found no relationship between pornography and sexual satisfaction. However, the motives people have for watching pornography explain a significant proportion of variance in sexual satisfaction. Motives related to educating oneself, rather than motives related to a negative body image, are predictors of higher sexual satisfaction. In addition, we explored other factors associated with sexual satisfaction in the separate groups; having romantic partners, paraphilia’s and use of sex toys turned out to be more important to transgenders than to people without GD. Clinical implications are discussed, as well as recommendations for future research, including the emphasis on motivation and the differences between transwomen and transmen.

Introduction

Sexual Dissatisfaction in Transgenders

Gender dysphoria (GD) is a psychological condition, marked by a feeling of discomfort about one’s assigned sex (Cohen-Kettenis & Pfafflin, 2010). Transgenders experience incongruence between their assigned/biological gender and their experienced/expressed gender; they often have a strong desire to live as a member of another gender (Kreukels et al., 2012). The focus of the current study is sexual satisfaction in transwomen (biological men) and transmen (biological women), compared to people without GD.

Sexual satisfaction is an important variable associated with general life satisfaction (Davis, 2010; Woloski-Wruble, Oliel, Leefsma, & Hochner-Celnikier, 2010). Most people with GD experience problems in their sexual life; sexual satisfaction does not come naturally for them (Rutgers WPF, 2013). Most studies in the past have only focused on sexual satisfaction after sex reassignment. Those studies concluded that treatment with hormones or genital surgery can lead to a more satisfying sex life (Wiercks et al., 2013; Klein & Gorzalka, 2009). However, little is known about sexual satisfaction of transgenders who are still at the start of their transition (Rutgers WPF, 2013). Furthermore, nowadays a growing number of people with GD does not desire a complete sex reassignment, mostly because of the perceived risks and outcomes of surgery (Beek et al., 2015). They have to deal with their body sexually, even though it differs remarkably from their gender identity.

In 2013, Rutgers WPF (a center of expertise on sexual and reproductive health and rights in the Netherlands) carried out a large study on transgender sexuality. Of 576 participants, almost 50% reported not having sex at all, which led to dissatisfaction for most of them. In another study by Cerwenka et al. (2014), the majority of transwomen (72%) and transmen (59%) did report to masturbate, but a considerable part of them did not always enjoy masturbating (70% for transwomen, 31% for transmen). However, in the Rutgers WPF study 26.5% of transwomen and

31.9% of transmen did report to be satisfied with their sexual life; they indicated to be able to enjoy sexual activities. To date, it is unclear why some transgenders are sexually satisfied and others are not. If these reasons can be examined, the latter transgenders may be helped in a clinical setting to increase their sexual satisfaction. The current study will therefore focus on sexuality in transgenders. Specifically, we will explore sexual satisfaction in transgenders who have not started any medical treatment, as well as in transgenders who use hormones but did not (yet) have any surgery.

Explanations for Dissatisfaction

An important factor that possibly leads to sexual dissatisfaction is a negative body image (Cash, Fleming, Alindogan, Steadman, & Whitehead, 2004), which means being dissatisfied about one’s own body. Most transgenders are known to have a negative body image (Kraemer, Delsignore, Schnyder, & Hepp, 2008). Cash et al. (2004) found that a negative body image can indeed lead to sexual dissatisfaction. This may happen, for instance, through self-spectatoring, a form of cognitive distraction during sex (Meana & Nunnink, 2006). Self-spectatoring means focusing on the self instead of the sexual activity or partner. Meana and Nunnink (2006) found that self-spectatoring is related to a negative body image and sexual dissatisfaction. One may argue that an external focus during sexual activities can lead to less self-spectatoring, which may be beneficial for people with a negative body image, such as transgenders.

Another possible problem that may lead to sexual dissatisfaction is that it is hard to fantasize about a body one desires, when being confronted with one’s own body during sexual activities. During sex, more than half of the surveyed people with GD fantasizes about having a body that fits with how they feel (Rutgers WPF, 2013). One possibly helpful addition to one’s sexual life, that distracts from the own body and at the same time can help imagining a body one desires, may be watching pornography.

Benefits of Watching Pornography

Hald and Malamuth (2008) report young adults perceive pornography as beneficial for several life domains. Watching pornography could lead to more sexual knowledge, positive sexual attitudes, higher sexual satisfaction and higher general life satisfaction. Naturally, watching a lot of pornography in an addictive manner, may lead to severe negative consequences (Schiebener et al., 2015), but most people do not use it in a compulsive way. Maddox, Rhoades and Markman (2011) add that watching pornography with one’s romantic partner can be beneficial for sexual satisfaction and overall relationship satisfaction. It is unknown if transgenders watch pornography as an addition to their regular sex life and if this is beneficial for their sexual satisfaction as well. In the current study, we examine whether watching pornography could have an even more positive influence in sexuality of transgenders than of people without GD. We assume that these beneficial effects are related to the motives people have for watching pornography.

Motives for Watching Pornography

People can have different motives for watching pornography. The Kinsey Institute surveyed more than 10000 respondents using an online survey to examine why people watch pornography (PBS, 2002). They concluded that the five most common underlying motives to watch pornography are: to masturbate, to sexually arouse one self, to satisfy curiosity, to fantasize about things one would not necessarily want in real life and to distract oneself. A less frequently mentioned motive to watch pornography was ‘to be able to fantasize about a body that fits me better (Bryant & Jae Woong, 2008). However, this latter motive may be a particularly important motive for transgenders, since 50% of people with GD fantasizes about having a different body during sexual activities (Rutgers WPF, 2014). A second motive that may be especially important for transgenders is the need for an external focus, because of the earlier described self-spectatoring (Meana & Nunnink, 2006). An external attentional focus like pornography may reduce the negative focus on one’s own body. It is proposed that these two motives explain a greater part of sexual satisfaction than, for example ‘to satisfy curiosity’, a common motive in people without GD. In sum, we expect that transgenders and controls have different motives for watching pornography. We propose that the gender-related motives ‘fantasizing about a desired body’ and ‘distracting attention from one’s own body’ are predictors of a higher sexual satisfaction, compared to other motives. In other words, through the motives for watching pornography, pornography may contribute to transgenders’ sexual satisfaction more, than to sexual satisfaction of people without GD.

Research Questions

Key hypotheses

1. A quadratic association is expected between watching pornography and sexual satisfaction in the transgender group as well as the control group; watching more pornography is generally positively associated with sexual satisfaction, but watching pornography too much will be negatively associated with sexual satisfaction. What ‘too much’ means is different for every person, therefore no specific expectations are made about the ‘turning point’ of this relationship.

2. Transgenders have different motives for watching pornography than people without gender dysphoria. The motives ‘to help fantasize about a body that fits me better’ and ‘to focus my attention on something else than my own body during sexual activities’ are hypothesized to be more important for transgenders than for people without GD. 3. The five most common motives that were found through the Kinsey Institute survey

(PBS, 2002), are more important for people without GD than for transgenders. We do not have hypotheses about other motives.

4. The generally positive association between watching pornography and sexual satisfaction (hypothesis 1) will be moderated by motives for watching pornography. It is expected that the motives ‘to help fantasize about a body that fits me better’ and ‘to focus my attention on something else than my own body during sexual activities’ will explain a larger part of the association between watching pornography and sexual satisfaction, than other motives.

Control questions

In the key hypotheses a few assumptions are made; those will be checked before examining the key hypotheses and moderating variables. Assumptions are:

 Sexual satisfaction of transgenders is lower than sexual satisfaction of participants in the control group.

 Body image of transgenders is more negative than body image of the control group. Moderating variables

A number of variables may influence the relationships described in the main hypotheses. Therefore, they will be examined in the current study as moderators.

 The phase transgenders are in, which is the diagnostic phase or hormone treatment phase. Possibly body image is less negative in the hormone phase than in the diagnostic phase, due to physical changes because of the hormones. Also, libido might change because of hormones, which in itself can influence the relationships described above (Klein & Gorzalka, 2009).

 Having a romantic partner: when someone has a partner, motives for watching pornography may change (Bryant & Jae Woong, 2015). People may be searching for inspiration for one’s sexual life, or may want to get aroused before having sex together. The motives we focus on in the hypotheses may become less important.

 Use of sex toys: sex toys, like vibrators, may contribute to fantasies about a body one desires, for example when transmen use a vibrator as a substitute penis. For transgenders who use sex toys, watching pornography might be less relevant (no current research on transgenders and use of sex toys available).

 Paraphilia’s: According to the DSM-5 (American Psychiatric Association, 2013), a paraphilia is an atypical sexual interest, marked by personal distress about the interest, and/or another person’s psychological distress or physical injuries. People with a paraphilia fantasize about their object of sexual fascination, but rarely make their fantasy reality by engaging in sexual deviant behavior (Williams et al., 2009). It is imaginable that for those people, sexual satisfaction is even more dependent of watching pornography.  Religion: previous research found that religious people don’t watch less porn (Stack et al.,

2004). However, almost all religious people who watch porn, consider it morally wrong (Nelson et al., 2010). This may have influence on the motives people report for watching pornography. Another possibility is they even do not want to admit they watch pornography.

Methods

Participants

Power analysis

Since three different types of analyses have been used, we calculated how many participants we needed through three G*power analyses, based on a power of .8, a p-value of .05 and a medium effect size of .5. In the literature about watching pornography, as well as in literature about sexual satisfaction in transgenders and people without GD, we did not find effect sizes. Moreover, even if we would have found effect sizes, it is questionable if these effect sizes would have been useful for current power analyses, since the current research questions differ quite a lot from previous research.

The power analysis for the MANOVA analysis revealed that 50 participants were needed, whereas 38 participants were needed for the correlation analysis and 70 participants for the regression analysis. Therefore, we tried to recruit a minimum of 35 transgenders and 35 controls (70 in total). However, since several moderators are examined, it was our goal to find as many participants as possible. One-hundred-ninety-two participants initially filled in the questionnaire: Sixty-nine transwomen and 53 transmen are currently patients at the VU medical center. Thirteen control males and 57 control females are psychology students at the University of Amsterdam. Since the group of control males was so much smaller than the other three groups, male students from other study directions have been asked to participate as well. Eventually, 42 contol males filled in the questionnaire, leading to 221 completed questionnaires.

Participants in the transgender group who already had surgery were excluded from the sample, as well as participants in the control group who reported to be transgender or to use hormones for medical reasons. This resulted in 12 excluded participants: Ten transwomen had to be excluded since they already had undergone surgery. Two female controls had to be excluded, since we found an indication they experience feelings of gender dysphoria; they reported to feel both man and woman, or neither woman nor man. With regard to the transgenders, all transmen and transwomen reported a difference between assigned and experienced gender.

Procedure

In the waiting room of the center of Expertise on Gender Dysphoria, at the VU Medical Centre, patients with GD were asked to fill in the questionnaire while they were waiting for the appointment with their psychologist to start. The secretary, psychologists and researchers helped with recruiting patients. Patients who agreed to participate, first read the participants information letter and signed informed consent. In those documents we explained the importance of research focusing on sexuality and stated that all information would be processed anonymously, that participation had no influence on their relationship with the psychologist and that they could withdraw from participation at any moment. If patients did not feel comfortable finishing the questionnaire in public, they got the opportunity to take it home and send it per mail without costs. The data were collected for four months at the VU medical Centre. To collect data from

people without GD, psychology students at the University of Amsterdam were asked to fill in the questionnaire during a lecture on GD and sexuality. It took participants approximately 10 minutes to fill in the questionnaire. If they wanted to have more information about the results, they could write their e-mail address on a separate piece of paper. Participants did not receive a reward for participation.

Materials

We administered a questionnaire, which can be found in the Appendix. The questionnaire operationalized the various constructs in the following way:

Frequency of watching pornography; watching pornography is measured with 1 item on a 7-point likert scale: How often do you watch pornography (scale: 0 = never; 6= several times a day)?

Sexual satisfaction: sexual satisfaction is measured with 1 item on a 11-point likert scale: How satisfied are you with your sex life (0 = not satisfied at all; 10 = very satisfied)?

Sexual satisfaction often is measured through large questionnaires, containing hundreds of items. However, other studies have shown that this one item, measured on a 7-point likert scale, can be reliable as well (Edwards & Booth, 1994; Greeley, 1991).

With regard to the relationship between sexual satisfaction and watching pornography, one open question was added: ‘what does watching pornography mean for your sexual life?’ This question was implemented since the current study is the first about transgenders and pornography. If the results do not match the hypotheses, the answers to this question may help in designing future studies.

Motives for watching pornography: motives are measured with 14 items on 11-point likert scales, every item representing one motive. The 14 motives are introduced: ‘on a scale of 0 (not at all) to 10 (a lot), to what extent is any of the following reasons relevant for you when you watch pornography? I watch pornography…’ Examples of reasons are ‘out of curiosity’, ‘to sexually arouse myself’ and ‘because I have a stronger sexual drive than my partner’.

In previous studies on motives for watching pornography (Bryant & Jae Woong, 2008; PBS, 2002) no scales were used. In those studies participants received a list of motives and could mark every relevant motive. In the current study, this method does not seem sufficient, since we examine if one motive is more relevant for transgenders than for controls (the particular motive might be a motive for controls as well, just not as relevant as it is for transgenders). Therefore, a scale is used. No information on reliability or validity is available. Twelve motives are derived from the study of Bryant & Jae Woong (2008), who used all examined motives from previous research on pornography. Two motives were added that may be important for transgenders in particular, those are ‘to be able to fantasize about a body that fits me better’ and ‘to focus my attention on something else than my own body during sexual activities’.

Body image: body image is measured through the Body Image (BI-1) scale (Lindgren & Pauly, 1975), which consists of 32 items, each representing a single body characteristic, like ‘nose’ or ‘weight’. Participants rate the body characteristics on a 5- point likert scale (1 = very satisfied; 3 = neutral; 5 = very dissatisfied). They could also report a characteristic was not applicable; for control males and transwomen this was the case for vagina, clitoris and ovaries/uterus, for control women and transmen this was the case for adam’s apple, penis and testicles.

Use of sex attributes: the question about sex attributes is copied from Herbenick et al. (2010): ‘Do you ever use tools during sexual activities (e.g. vibrators or other sex toys)?’, followed by a question in open answer format, in which participants could specify the attribute(s) they use. Paraphilia: we used the same format for paraphilia’s. The question ‘have you ever been sexually aroused by something that other people would consider to be strange?’ was used, after which participants could specify their a-typical sexual interest.

(Sexual) background information: a few questions are copied from the background questionnaires that new patients fill in when they start their diagnostic phase. These include questions about biological sex, age, religion, sexual orientation, number of sexual partners, masturbation, use of sexual organs and sexual fantasies.

Difference between questionnaires for people with and for people without GD: transgenders report their experienced gender, followed by the question if they use hormones. Controls get a short introduction about gender dysphoria, after which they are asked about their own experienced gender.

Results

Sample Characteristics

Data of 209 participants have been used for the analyses: 59 transwomen, 53 transmen, 42 control males and 55 control females. Of the transwomen, 52.5% was in the diagnostic phase and 47.5% was in the hormone phase. Of transmen, 50.9% was in the diagnostic phase and 49.1% in the hormonal phase. Transwomen have a mean age of 33.68 years (SD = 14.18), transmen 26.45 (SD = 10.73), female controls 22.15 (SD = 3.25) and male controls 23.21 (SD = 2.37). Comparing the groups with regard to age, the controls turn out to be significantly younger than the transgenders, t (209) = 5.65, p = .0003. Moreover, the transmen are also younger than the transwomen, t (110) = 3.01, p = .003.

The distribution of sexual orientation for the different groups is displayed in Figure 1. The distribution is more homogeneous for the control group than for the transgenders. Most tramsmales reported to be mainly or entirely attracted to women, which is scored as ‘heterosexual’. 7.5% reported to feel sexually attracted to ‘other’, they reported to be attracted to ‘no one’ (3x) and ‘to people, not to gender’ (1x). In transwomen, just as much heterosexuals as

bisexuals and homosexuals can be found. Note that in this group heterosexual means ‘being mainly or entirely attracted to men’. 5.1% reported ‘other’. They are ‘asexual’ (2x) or stated ‘gender doesn’t matter’ (1x).

Figure 1. Distribution sexual orientation per group

Sexual Satisfaction and Body Image

Firstly, we looked at the control questions. We assumed transgenders to be less sexually satisfied than controls. Transgenders reported a mean sexual satisfaction of 4.9 (SD= 2.77) on a scale of 0 to 10, controls reported a mean sexual satisfaction of 6.9 (SD = 1.81), which is a significant difference between the groups, t (207) = -6.104, p = .0003). When looking more closely at the data, the transwomen seem to be more dissatisfied (M = 4.22, SD = 2.88) than the transmen (M = 5.70, SD = 2.43), t (110) = -2.92, p = .0004).

The second assumption is that controls have a less negative body image than transgenders. Since we looked at 32 body characteristics, we tried to reduce the data through factor analysis. However, no comprehensible sets of characteristics could be made. Moreover, since the results differed so much between the 4 groups, it seemed to be impossible to find one adequate set of factors to be able to compare the 4 groups. Since comparison is essential for this control question, we decided to carry out a MANOVA on all separate characteristics as well. This MANOVA was carried out with all body parts as univariate tests. We found a statistically

significant difference in evaluation of body characteristics based on having/not having gender dysphoria, F (26, 159) = 7.12, p = .0003, partial η2_{= .527. This means transgenders gave higher}

ratings to body parts than controls (1 meaning ‘very satisfied’, 5 meaning ‘very dissatisfied’). When looking at the univariate tests, transgenders gave higher ratings to gender related body parts like their chest (F (1, 184) = 127.96, p = .0003) or facial hair, (F (1, 184) = 50.50, p = .0003). However, they also gave higher ratings to all body parts that were expected to be rated as neutral, like nose (F (1,184)= 5.57, p = .019) or calves (F (1, 184) = 10.79, p = .001). In fact, transgenders gave higher ratings than the control group to all 32 body parts. To apply some nuance in these results, we looked at the 4 groups separately as well, by adding post-hoc Bonferroni tests to the MANOVA. It turns out that not only differences between controls and transgenders can be found, but also between transwomen and transmen (table 1).

Table 1. Mean scores body characteristics per group (1 = very satisfied, 5 = very dissatisfied).

Transwomen Transmen F Controls M controls Nose 3.03A _2.41B _2.51AB _2.24B Shoulders 3.03A _2.55B _2.26BC _1.98C Hips 3.00A _4.00B _2.47C _2.14C Chin 2.87A _2.83A _2.68A _2.07B Calves 2.59A _2.77A _2.53A _1.95B Chest 3.74A _4.26B _2.18C _2.31C Hands 2.76A _2.42AB _2.18B _2.10B Adam’s apple 3.29A _{- - 2.19}B Vagina - 4.17A _2.37B _- Body height 2.91A _3.34A _2.18B _1.95B Thighs 2.69A _3.87B _3.01A _2.17C Arms 2.69A _2.64A _2.44AB _2.14B Eyebrows 2.68A _2.53A _2.18AB _1.93B Clitoris - 3.94A _2.04B _- Penis 4.59A _{- - 1.86}B Waist 3.09A _3.59B _2.32C _2.21C Muscles 2.91A _2.96A _2.30B _2.38B Buttocks 2.88A _3.47B _2.25AC _2.19C Facial hair 4.19A _3.24B _2.57C _2.64C Face 2.97A _2.98A _2.19B _2.04B Weight 3.12AB _3.40A _2.77B _2.21C Biceps 3.09A _3.12A _2.65AB _2.43B Uterus/ovaries - 4.26A _2.42B _- Testicles 4.66A _{- - 2.05}B Hair 3.00A _2.15B _1.96B _1.93B Voice 3.74A _2.81B _2.44BC _2.12C Feet 3.05A _2.49B _2.49B _2.12B Figure 3.03A _3.92B _2.47AC _2.29C

Body hair 3.76A _2.83B _2.64B _2.31B

Volume chest 3.28A _3.57A _2.39B _2.31B

Way of moving 2.84A _2.60AB _2.19B _2.21B

Appearance 3.16A _3.08A _2.09B _2.07B Note: Means in one row with different superscripts differ at least at p < .05.

Of the 26 body parts that are applicable for both transwomen and transmen, the 2 groups differ from each other on 13 body parts. Transwomen were more dissatisfied about their nose, shoulders, hair, voice, facial hair, feet and bodily hair than transmen, while transmen were more dissatisfied about their hips, chest, thighs, waist, bottom and figure. Table 1 also shows that the difference between controls and transgenders can often be explained through the relatively low scores of the male control group, for example with regard to arms, eyebrows and figure. On these characteristics, female controls scored between transgenders and male controls and did not differ significantly from either of them. In sum, transgenders are more dissatisfied with all body characteristics than the control group, but multiple nuances can be made when dividing the groups in males and females.

Watching Pornography

Thirty-two percent of the transwomen reported to never watch porn, for transmen this is even 45.3%. For female controls, 33% reported not watching porn. However, all male controls reported to watch pornography. When comparing transgenders to controls, transgenders watch significantly less pornography, t (199.97) =-3.35, p < .001. However, when looking at the groups separately, this difference seems to be determined by the relatively high use of pornography by the male controls, as can be seen in figure 2.

Figure 2. Boxplots of frequency pornography use per group. Y-as: 0 = never, 7 = several times a day. X-as: MF = transwomen, FM = transmen, F = control females, M = control males.

As illustrated, watching pornography seems to be infrequent for all groups except for male controls, who on average watch pornography several times a week (M = 4.74, SD = .18). Transmen (M = 1.87, SD = .28) and transwomen (M = 2.07, SD = .24) don’t differ significantly in their reported frequency of watching pornography, and female controls watch the least pornography (M = 1.49, SD =.174). Control males reported to watch more pornography than the other groups, but the other three groups do not differ significantly from each other in the reported frequency of watching pornography, F (2, 166) = 1.11, p = .331.

With regard to the context, the majority of participants reported to watch pornography alone. This is not the case for control females, who watch pornography alone as well as with their partner. Control females watch pornography more with their partners than the transmen and transwomen, F (2,105) = 10.23, p < .001, and more than the control males, t (79) = 3.99, p < .001.

Watching Pornography and Sexual Satisfaction

The first hypothesis in the current study is that a quadratic relationship would be found between watching pornography and sexual satisfaction; essentially a positive relationship between watching pornography and sexual satisfaction was expected, except for people who watch pornography excessively. The result of testing a linear and quadratic association simultaneously, can be seen in Figure 3.

As can be seen in Figure 3, the observations are scattered quite randomly. Indeed, no linear model (F (1, 207) = .197, p = .658) or quadratic model (F (2, 206)= .180, p = .836) can be fitted onto the data. Because watching pornography differs between groups, we also examined the groups separately. No significant correlations, fitting linear models or quadratic models were found in any of the groups.

One other way of looking at the data is to carry out a regression analysis with sexual satisfaction as dependent variable and frequency of watching pornography as predictor. Consistent with earlier findings, frequency of watching pornography is not a significant predictor of sexual satisfaction, β= .024, p = .724. Frequency of watching pornography does not explain a significant proportion of variance in sexual satisfaction, R2 _{= .001, F (1,209) = .125, p = .724. In sum, no}

association between sexual satisfaction and watching pornography has been found in the quantitative data. We anticipated this result by adding the straightforward question ‘what does pornography mean for your sexual satisfaction?’ to the questionnaire, with an open answer format.

Of 53 transmen, 47.2% did not write anything (most of them because they do not watch pornography). Of the other 28 transmen, 39.3% reported pornography means ‘nothing’, is ‘not important’ or ‘is not in any way associated with my sexual satisfaction.’ The other 60.7% reported sentences that are related to the earlier described motives. Three transmen said they watch pornography because they do not have a partner, e.g. ‘it was nice before, when I had a partner.’ Five transmen reported physical motives like ‘it is easier to orgasm’, one reported education motives, whereas two reported fiction motives. Two transmen literally wrote down the two dysphoria motives: ‘it is not nice without porn, because then I focus to much on my own body’ and ‘through porn I can fantasize about being a man.’

Of 59 transwomen, 37.3% did not write anything. Of the other 37 transwomen, 45.9% reported pornography does not mean anything (‘… and my sex drive is dead anyway.’), or reported something like ‘it doesn’t help me with my gender dysphoria’ or ‘I would rather have a real partner than watch pornography’. Of the other 44.1%, participants reported sentences that are similar to the earlier described motives: six transwomen reported physical reasons like ‘it helps to sleep better’. They did not mention the two Dysphoria motives. Three transwomen wrote a positive comment that was not related to the earlier described motives, e.g. ‘I like watching it’, or ‘pleasant’.

Of control females only 23% said that watching pornography means something with regard to their sexual satisfaction, e.g. ‘making it better’, ‘enhances sexual satisfaction’ or ‘it is easy’. Of control males, 64.3% stated watching pornography is important for their sexual satisfaction in some way, e.g. it is ‘nice to have on the side’, ‘enhances satisfaction’ or ‘contributes to sexual satisfaction, but only on the short term’.

Motives for Watching Pornography

Our second hypothesis was that transgenders and controls have different motives for watching pornography. We conducted a factor analysis with all 14 motives to make the results more clarifying. The component Matrix, rotated through Varimax, can be seen in table 2.

Table 2. Rotated Component matrix, containing all motives for watching pornography Motives Components 1 2 3 4 5 curiosity .067 .081 .127 .122 .741 * distraction .697 * .340 * -.096 .091 .151 arousal .743 * -.311 .241 .017 -.034 Discharge .812 * -.103 .199 .081 -.139 easier than sex

with partner .157 .119 -.068 .785 * -.043 See things I can’t

find in real life .190 .207 .718 * .341 * .101 Improving mood .635 * .331 * .013 .120 .233 I don’t have a partner .164 .251 .216 -.059 -.498 Education .093 .091 .239 -.124 .670 * Stronger drive than partner .016 -.012 .173 .804 * .076 Fantasy about better fitting body -.184 .845 * .063 .113 -.008 See things I don’t

want in real life .031 .083 .845 * -.020 .231 Fantasize being

individual in porn

.312 * .408 * .434 * -.197 -.124 Distract attention

from own body .156 .626 .177 .053 .081

Note: loadings >. 30 are followed by a *

From this factor analysis, five underlying constructs can be discovered:

1. Physical Factor: contains the items ‘distraction’, ‘arousal’, ‘discharge’ and ‘improving mood.’ 2. Fiction Factor: contains the motives ‘to see things I can’t find in real life’, ‘because it helps

me to fantasize about things I would not necessarily want in real life’ and ‘to help fantasize I am one of the individuals in the porno.’

3. Dysphoria Factor: contains the motives ‘to help fantasize about a body that fits me better’ and ‘to focus my attention on something else than my own body during sexual activities’. 4. Partner Factor: contains the variables ‘because is it easier than having sex with my partner’

and ‘because I have a stronger sex-drive than my partner’.

5. Education Factor: contains the motives ‘out of curiosity’ and ‘to educate myself/to learn new things’.

The two motives that were hypothesized to be more important for transgenders can indeed be combined in one factor, which we labeled the Dysphoria factor. However, the motives that were hypothesized to be more important to the control group, fit in different factors: Physical, Fiction and Education. A MANOVA with the 5 factors, labeled based on the factor loadings, was conducted. There is a significant difference in reported motives when comparing transgenders to controls, F (5, 143) = 23.80, p = .0003, partial η2 _{= .454. The control group}

considers motives related to physical needs more important than the transgender group F(1, 147) = 7.86, p = .006. The factor Dysphoria is more important to the transgenders than to the control group, F (1, 147) = 75.39, p = .0003. However, no difference could be found between transgenders and controls for the factors Fiction (F (1, 147) = .020, p = .888), Partner (F (1, 147) = .088, p = .767) and Education (F (1, 147) = 3.235, p = .074). ‘Not having a partner’ (the only motive that did not fit into one of the factors) was also not more important for transgenders or controls, F (1, 147) = 2.146, p = .145. In sum, motives that are associated with strengthening one’s fantasies, having/not having a romantic partner and educating oneself are as important to transgenders as they are to the control group.

Since the groups are heterogeneous in how often and in which setting they watch pornography, they were also examined separately with regard to the motives for watching pornography. In table 3 one can see the means and standard deviations for every factor per group. Differences between groups have been examined again through post-hoc Bonferroni tests.

Table 3. Mean scores (SD) per motive factor per group.

Transwomen Transmen F Controls M Controls Physical 2.8 (1.8)A _{4.8 (1.9)}AB _{4.2 (2.2)}AB _{5.7 (1.7)}B Fiction 2.8 (1.8)A _{3.8 (2.9)}A _{2.9 (2.6)}A _{3.4 (2.3)}A Dysphoria 4.0 (2.6)A _{4.9 (2.5)}A _{1.2 (1.8)}B _{1.2 (1.6)}B Partner 1.5 (2.2)A _{2.0 (2.5)}A _{1.5 (2.2)}A _{1.9 (2.0)}A Education 3.9 (2.4)A _{4.2 (2.3)}A _{5.1 (2.1)}A _{4.3 (2.2)}A No partner 4.4 (3.6) A _{2.7 (3.5)}AB _{1.8 (3.0)}B _{3.8 (4.0)}AB Note: Means in one row with different superscripts differ at least at p < .05.

As one can see the earlier described significant difference with regard to the factor Physical between the transgender group and the control group, is only determined by the difference between the transwomen and control males. This means that the dysphoria related motives are the only differentiating motives for watching pornography between transgenders and controls.

Finally, it was examined if trangenders have different motives for watching pornography, depending on the phase of the medical process. No significant differences could be found between transgenders in the diagnostic phase and the hormone phase. Although the Education Factor seems to become slightly more important when using hormones (diagnostic phase: M = 3.74, SD = 2.29, hormone phase: M = 4.42, SD = 2.40), this difference is not significant, t (60.93) = -1.18, p = 2.44.

Motives as Predictors of Watching Pornography and Sexual Satisfaction

Fourthly, we hypothesized that the association between watching pornography and sexual satisfaction is moderated by motives for watching pornography. It was hypothesized that the gender dysphoria- related motives would explain a larger part of this association than other motives. Despite the fact no relationship was found between watching pornography and sexual satisfaction, the relationship between the motives, watching pornography and sexual satisfaction could still be examined through regression analyses. In the first regression analysis, watching pornography is the dependent variables and the motive factors are the predictors. A higher score on the Physical factor is a predictor for watching more pornography, β = .518, p = .0003. Predictors for watching less pornography are higher scores on the Dysphoria factor, β = -.171, p = .019, and higher scores on the Education factor, β = -.182, p = .012. The factors Fiction (β = .153, p = .055) and Partner (β = -.04, p = 569) are not significant predictors of the frequency of watching pornography. Together, this model with three predictors explains a significant proportion of variance in the frequency of watching pornography, R2 _{= .336, F (5,143) = 14.469,}

p = .0003. When looking at the transgenders and controls separately, a difference between groups becomes clear. The Physical factor (β = .580, p = .0003) and the Dysphoria factor (β = -.242, p = .035) seem to be relevant for the transgenders, R2 _{= .315, F (3,64) = 9.799, p = .0003.}

For the controls, the Physical factor (β = .588, p = .0003) and the Education factor (β = -.239, p = .014) seem to be relevant, R2 _{= .342, F (3, 77) = 13.357, p = .0003.}

In the next regression analysis, we use sexual satisfaction as the dependent variables and again the motive factors are the predictors. We hypothesized that having gender dysphoria related motives for watching pornography would explain a larger part of the presumably positive relationship between watching pornography and sexual satisfaction, than other motives. Despite the fact that no relationship between pornography and satisfaction was found, one could argue that transgenders with a high score on Dypshoria motives, will report a higher sexual satisfaction than transgenders who do not score high on this factor. However, it actually seems to be the other way around. When examining the whole group, the Dysphoria factor is a predictor of being less sexually satisfied, β = -.356, p = .0003. This is still the case when examining transgenders separately, β = -.273, p = .042. On the other hand, a high score on the Education factor is a predictor of higher sexual satisfaction. This is the case for the whole group, β = .293, p = .0003, as well as for the transgenders (β = .292, p = .027) and the controls (β = .267, p = .019) separately. The other motives are not significant predictors of sexual satisfaction. The described model with two predictors, the Dysphoria factor and the Education factor, explains a significant proportion of variance in sexual satisfaction in transgenders, R2 _{= .227, F (5,143) = 8.388, p}

= .0003.

Since the groups are so heterogeneous, we have examined the transwomen, transmen, control females and control males separately. However, no significant predictors have been found in the four groups separately, due to a lack of power.

These results make clear that, although the relationship between frequency of pornography use and sexual satisfaction can not be explained through the motives, the motives appear to be associated with both constructs.

Other Predictors of Watching Pornography and Sexual Satisfaction

Besides the earlier described motives for watching pornography, we examined four variables which could also be related to the frequency of watching pornography, as well as to sexual satisfaction: religion, having romantic partners, sex toys and paraphilia’s. In table 4 the distribution of the four variables among the four groups can be seen.

Table 4. Percentage of participants for whom the examined variable is relevant, per group

Transwomen Transmen F Controls M controls Being religious 16.9% 20.8% 12.3% 2.4%

Having a romantic partner

32.2% 47.2% 66.7% 45.2%

Use of sex toys 32.2% 30.2% 43.9% 21.4%

Paraphilia 25.4% 13.2% 7% 9.5%

With regard to the question about paraphilia’s, participants who reported to have ‘ever been sexually aroused due to something that other people would consider to be strange’, were asked to write down their focus of sexual desire. It is interesting to see the difference in reported atypical sexual interests. Transgenders reported fantasies that are considered deviant according to the DSM-5, like ‘blood play’, ‘diapers’ or ‘little boys’. Controls, on the other hand, mostly reported sexual activities as ‘a threesome’ or ‘anal sex’, which are not considered to be deviant in the DSM-5, since they do not cause any psychological distress to the actor, or cause harm to other people necessarily. In the current study only the fantasies that can be categorized as deviant according to the DSM-5, have been included.

To analyze the 4 variables in relation to watching pornography and sexual satisfaction, two regression analyses have been carried out, just like we did with the motives for watching pornography. With regard to watching pornography, using sex toys (β = .145, p = .043) and having a paraphilia (β = .145, p = .039) are predictors of watching more pornography, whereas having a romantic partner is a predictor of watching less pornography (β = -.159, p = .023). Being religious is not a predictor of watching more or less pornography, (β = -.06, p = .372). The described model with three predictors explains a significant proportion of variance in watching pornography, R2 _{= .071, F (4,205) = 3.923, p = .004. When looking at transgenders}

and controls separately, the model turns out to be not significant for controls, R2 _{= .078, F (4,}

94) = 1.976, p = .104. In other words, the described model with three predictors only explains a significant proportion of variance in watching pornography with regard to transgenders, R2 ₌

With regard to sexual satisfaction, having a romantic partner is a significant predictor of being sexually more satisfied when examining all participants, β = .288, p = .000. On the other hand, being religious is a predictor of being less sexually satisfied, β = -.206, p = .002. Using sex toys (β = .055, p = .420) or having a paraphilia (β = -.103, p = .122) are both not significant predictors of sexual satisfaction. The described model with two predictors explains a significant proportion of variance in sexual satisfaction R2 _{= .148, F (4,205) = 8.919, p = .0003. When}

looking at the transgenders and controls separately, it turns out the model with two predictors again is only significant for transgenders, R2 _{= .138, F (4, 106) = 4.229, p = .003, whereas it does}

not explain a significant proportion of variance in sexual satisfaction with regard to controls, R2

= .071, F (4, 94) = 1.803, p = .135.

Since the groups are so heterogeneous, we also looked at the transwomen, transmen, control females and control males separately. The results can be seen in table 5a and 5b. Note, however, that insufficient power and a lack of variance in separate groups (e.g. in the male control group only 2.4% reports to be religious, see table 4) possibly influenced the results.

Table 5a. Predictors of pornography use per group

Transwomen Transmen F controls M controls

β p β p β p β p Being religious .189 .114 -.097 .001 .997 .476 .067 .546 Having a romantic partner -.384 .002* _{-.076 -.164 .317 .589 -.035 .758}

Using sex toys .257 .040* _{.245 -.230 .170 .097 .516 .000}*

Having a paraphilia

.239 .047* _{.208 .132 .416 .158 .224 .061}

Table 5b. Predictors of sexual satisfaction per group

Transwomen Transmen F controls M controls

β p β p β p β p Being religious -.182 .169 -.292 -.299 .119 .031* _{-.062 .653} Having a romantic partner .299 .027* _{.198 .263 .081 .148 .029 .839}

Using sex toys .025 .852 .057 .211 .166 .688 -.115 .422

Having a paraphilia

-.088 .504 .175 -.281 .061 .219 -.062 .653 * Note: p < .05

Although this analysis lacks power, it turned out to be rather insightful. For example, the predictors of watching pornography in transgenders, seem to be primarily relevant in

transwomen. Moreover, although being religious and having a relationship are both predictors of sexual satisfaction, being religious is only a predictor in transmen, whereas having a romantic partner is only a predictor in transwomen.

Interest in Sex in Transgenders: Exploratory

In the current study, watching pornography and sexual satisfaction turned out to be unrelated. However, transgenders did report to be less sexually satisfied than the controls, and to watch less pornography than the control males. In the current paragraph, we reflect on a third variable that could explain these results.

In fact, watching pornography is not the only sexual activity in which transgenders engage less than controls. Whereas 100% of control males and females reported to use their genitals during sexual contact, 57.6% of transwomen and 34% of transmen reported they do not use their sexual organs during sexual activities. Of all controls, only one female reported to never had sexual intercourse, while 25.4% of transwomen and 17% of transmen never had sex. Additionally, 32.3% of transwomen and 39.6% of transmen reported they do not masturbate at all. Of the controls, only 15.8% of females and 2.4% of males do not masturbate at all. This might be related to the sexual fantasies participants have: 22.1% of transwomen reported not to have sexual fantasies about themselves (of which 10.2% no fantasies at all), for transmen this is 30.2% (of which 17% no fantasies at all). In comparison, of control females 7.1% reported not to have sexual fantasies about themselves (of which 1.8% no sexual fantasies at all), of control males, this is 4.8% (of which 2.4% no fantasies at all).

The lack of sexual fantasies and sexual activities suggests that transgenders are less sexually engaged; they might put less effort in trying to achieve sexual satisfaction. One could imagine that the discomfort with one’s own body results in being less interested in sex. In other words; transgenders might consider sex less important. If this would be the case, research should not only focus on the question how sexual satisfaction can be enhanced, but also if transgenders actually want their sexual satisfaction to be enhanced, for example by asking ‘to what extent would you like your sexual life to change?’ Unfortunately, in the current study no direct measurement of ‘level of sexual interest’ was added to the questionnaire.

Therefore, it was examined if certain items in the questionnaire could be used as an indirect measurement of how interested transgenders are in having sex. One possible indirect measurement is a regression analysis with sexual satisfaction as a dependent variable and ‘masturbation’, ‘having sexual partners’ and ‘using sexual organs during sexual activities’ as possible predictors. If transgenders are uninterested in sexual activities, engaging in those activities will not necessarily lead to higher sexual satisfaction than not engaging in these activities. Indeed, these variables do not significantly predict sexual satisfaction; this is not the case for masturbating, β = -.08 , p = .459, having experience with sexual intercourse, β = -.006, p = .953 or using one’s sexual organs during sexual activities, β =.055 , p = .637. In other words, transgenders are not more sexually satisfied when they engage in these activities, than when they

don’t. The model with three predictors does not predict a significant portion of the variance in sexual satisfaction, R2 _{= .006, F (3, 101) = .20, p = .896.}

We also had a closer look at one of the predictors, ‘having experience with sexual intercourse’. As can be expected from the previous regression analysis, transwomen who did not have sex (M = 4.13, SD = 3.34) and transwomen who did have sex (M = 4.26, SD = 2.73) do not differ in their sexual satisfaction, t (22.89) = -.14, p = .890. However, the 44 transmen with sexual experience reported an average sexual satisfaction of 5.52 (SD = 2.43), whereas the 9 transmen without sexual experience reported an average of 6.56 (SD = 2.4). Even though this result is not significant either, t (11.59) =1.17, p = .264 (probably due to the sample sizes), it seems to be a considerable difference, which leads to the question if it is really plausible that transmen who do not have sex, are actually sexually more satisfied than transmen who do have sex.

The difference between the transmen with and without sexual experience seems to be explained entirely through the sexual fantasies transmen report to have. Of the 9 transmen who did not have sexual intercourse, 3 reported to not have sexual fantasies at all, whereas 6 reported they do have sexual fantasies. The 3 transmen without sexual fantasies reported an average of 8.33 with regard to their sexual satisfaction, whereas the 6 transmen without sexual fantasies reported a 5.67. In other words: transmen without sexual fantasies seem to be satisfied about the fact they do not have sexual experience, whereas transmen with sexual fantasies are dissatisfied about their lack of sexual experience.

Although the power in these analyses is not even close to being sufficient, we argue these results should be taken seriously, since they show that at least a part of transgenders, especially transmen, does not seem to be interested in enhancing sexuality.

Discussion

Watching Pornography and Sexual Satisfaction

In the current study, we hypothesized that watching pornography and sexual satisfaction are related, for all participants but especially for transgenders. However, no relationship has been found. One important question is why this association does not exist in the current study, while in other studies this relationship has been found (e.g. Haavio-Mannila & Kontula, 1997, Hald & Malamuth, 2008)). One possible explanation is that young people consider watching pornography to be different from real life sex. In answer to the open question, several people reported that ‘porn and real life sex are two different things’. When people do not consider their pornography use as a part of their actual sex life, they will not take it into account when thinking about their sexual satisfaction. However, Hald and Malamuth (2008) studied young people as well and did find a relationship between watching pornography and sexual satisfaction.

Possibly methodological differences between the studies may explain the difference in findings. For example, the current sample may not have enough variance. In three groups a lot of participants reported to not watch pornography at all, while on the other hand all male controls

said to use pornography. Obviously, no correlation can be calculated when a group does not include people who watch less or no pornography. Another difference with the research by Hald and Malamuth (2008) is the order in which the questions were posed. Their questionnaire contains questions about watching pornography, after which the positive and negative consequences of pornography are examined. In that way, participants might have been primed to think about the link between pornography and sexual satisfaction, which could be the explanation for the positive relationship observed. We did not find this relationship in the current study, in which participants were first asked about their sexual satisfaction and only later about pornography use. However, it should be noted that when participants answered an open question about the direct effect of pornography use on their sexual satisfaction, more than half of the people who watch pornography reported that it is important for their sexual satisfaction in some way.

Motives for Watching Pornography

With respect to the motives for watching pornography, the initial hypotheses were mostly confirmed. The items related to gender dysphoria loaded on the Dysphoria factor were more important to transgenders than to the control group. These results seem to emphasize that transgenders indeed fantasize about having a different body during sexual activities (Rutgers WPF, 2014) and consider pornography as a tool to make fantasizing easier. In addition to the motive about fantasizing, we also found support for the idea that transgenders consider pornography useful, since it helps them to focus on something else than their own body. In other words, we suggest that transgenders perceive pornography as a useful external focus to decrease self-spectatoring (Meana & Nunnink, 2006). It is also important to note that all participants had the opportunity to add a motive that was not yet in the list. The fact that this opportunity was not used, suggests that we captured all relevant motives with our questionnaire. The Physical factor is more important for people without GD and transmen, than for transwomen. This factor includes the motives distraction, arousal, discharge and improving mood. With regard to the factors Education, Partner and Fiction, no differences between the groups have been found. In other words, transgenders and controls do not differ in their reasons for watching pornography when it comes to motives based on learning new things, having a partner and strengthening one’s fantasies. These results suggest that transgenders and control males and females do not differ much with regard to the reasons they have for watching pornography. We expected that the motives that turned out to be important for controls in previous research, would be less important for transgenders. However, this was not the case. For example, the Dysphoria factor is very important for transwomen, but the Physical factor appears to be just as important for them.

It was hypothesized that transgenders who considered the motives in the Dysphoria factor to be more important, would feel sexually more satisfied than transgenders who considered the Dysphoria factor to be less important. The underlying idea was that wanting to fantasize about being someone else and simultaneously needing an external focus, will have a higher impact on sexual satisfaction than, for example, ‘improving mood’. However, we found that high scores on

the Dysphoria factor are actually a predictor of a lower sexual satisfaction. Moreover, higher scores on the Education factor turn out to be a predictor of higher sexual satisfaction.

Possibly the underlying idea about the positive influence of dysphoria-related motives is not valid. One might argue that these motives are actually resulting from a negative, underlying core thought: ‘I do not like my body’. As already found in previous research and confirmed in the current study, most transgenders are very dissatisfied with their own body (Kraemer, Delsignore, Schnyder, & Hepp, 2008). Possibly, watching pornography out of dysphoria-related motives emphasizes their negative body image, instead of making them forget their negative body image. One could imagine that if transgenders watch pornography out of curiosity and because they want to teach themselves more about sexuality (which are the motives in the Education Factor), they approach their sexuality in a more positive way. Hald and Malamuth (2008) report that watching pornography can be beneficial for gaining more sexual knowledge and positive sexual attitudes. When looking at the results from the current study, one could say that those beneficial effects of watching pornography are related to the motives people, and especially transgenders, have for watching pornography. When focusing on their own body and/or distraction from the own body, pornography might not lead to the results that have been found in previous research. However, when transgenders focus on pornography in a curious, exploring way, it may actually contribute to more sexual knowledge and an overall higher sexual satisfaction.

Predictors of Watching Pornography and Sexual Satisfaction

Next to the motives for watching pornography, we hypothesized that several other moderators would influence the relationship between sexual satisfaction and watching pornography. This is indeed the case, but only for transgenders. Transwomen who have a romantic partner watch less pornography, whereas transwomen who use sex toys or have a paraphilia watch more pornography. It is known that people with paraphilia’s fantasize about their object of sexual fascination, but almost never make their fantasy reality by engaging in sexual deviant behavior (Williams et al., 2009). Therefore, watching pornography about their object of fantasy may be one way of dealing with their deviant fantasies. Additionally, religious transmen do not watch less pornography than non-religious transgenders, but they are sexually more dissatisfied. Stack et al. (2004) already found that religious people do not watch less porn. Nelson et al. (2010) added that most of them consider watching porn morally wrong. This might be an explanation for the lower sexual satisfaction of religious transmen in the current sample.

Although no relationship between watching pornography and sexual satisfaction has been found, these results show that several motives and other predictors are related to both constructs. Since the described relationships might be hard to grasp in text, three figures have been made to present the association between the concepts ‘watching pornography’ and ‘sexual satisfaction’ and several predictors. With a + or – it is shown if the predictor leads to higher (+) or lower (-) frequency of watching pornography/sexual satisfaction.

Figure 4a. Predictors of watching pornography and sexual satisfaction for control males and females

Figure 4c. Predictors of watching pornography and sexual satisfaction for transwomen

As one can see, especially for transwomen a lot of factors are predictors of frequency of watching pornography and/or for sexual satisfaction. Possibly, sexuality is more complex and depends on more factors for transgenders than for controls. One possible explanation for this difference, might be that transgenders experience more frustration during sexual activities, because regular sexual activities, like intercourse or watching pornography, do not lead to sexual satisfaction for them, as it does for control males or females. Possibly, they are more dependent of other factors to contribute to their sexual life, in order to get some satisfaction. One possible explanation for the fact transwomen have a more complex model than transmen, is that they might feel even more frustrated. They report a lower sexual satisfaction than transmen. Almost 90% of transwomen experiences sexual fantasies, but 57% of transwomen does not use their sexual organs during sexual activities. Experiencing fantasies but not allowing oneself to act on them, might be very frustrating to transwomen, leading them to look for alternative ways of dealing with their sexual arousal. Another factor that may contribute is age; the transwomen in the current study are significantly older than the transmen. Possibly, being older simply means that people have had more time to look at different ways to give meaning to their sexual life.

Limitations

One methodological issue in the current study is the fact that we used questionnaires. It is not known if participants took their time to read all the questions and think them through before answering. Moreover, most transgenders completed the questionnaire in the waiting room, while most of the control participants filled it out in a large lecture room. Regarding the lack of privacy, as well as the fact that very personal information has been asked, it is possible that participants have been answering in a socially desirable way. One example in which this could

have been the case, is the rating for ‘penis’ in the male control group; in the current study 80.1% of men reported to be satisfied or very satisfied with their own penis, which seems like a lot. In a study by Lever, Frederick and Peplau (2006), only 55% of men was satisfied with his penis. Possibly male controls did not feel comfortable saying they are insecure about their penis when they have the feeling peers can find out. However, when considering the personal answers participants in all groups gave in reaction to the question about paraphilia’s, we think that this disadvantage has been kept to a minimum in the current study. We tried to stimulate honest answers by giving the opportunity of taking the questionnaire home, which was done by 3 transgenders.

The original purpose of the study was to compare people with and without GD. However, in the current study the samples turned out to be very heterogeneous, with considerable differences between control men and women and between transmen and transwomen. The latter two differ in body image, watching pornography, sexual satisfaction, but also in the concepts that are related to sexual satisfaction, as can be seen in the visuals 1b and 1c. Therefore, in the current study analyses often have been done for 2 groups, as well as for 4 groups. However, while executing the power analyses and determining the sample sizes beforehand, we anticipated on 2 groups: controls and transgenders. The regression analyses therefore sometimes lacked enough power, for example when examining motives for watching pornography, with regard to pornography watchers within the female controls, within the control group. We argue that the current study shows transgenders and controls should be perceived as 4 separate groups. Therefore, larger samples are recommended for future research. It is preferable that those samples differ less with regard to age and background. For example, in the current study the transwomen were older than the other three groups and the controls were all students, which was not the case for the transgenders.

Future Research

In future research, next to examining possible positive influences to transgender’s sexual satisfaction, it would be insightful to focus on motivation for changing sexual habits as well. In the introduction we stated: ‘to date, it is unclear why some transgenders are sexually satisfied and others are not. If these reasons can be examined, the latter transgenders may be helped in a clinical setting to improve their sexual satisfaction.’ However, helping them in a clinical setting might become problematic if transgenders do not really want to change. Exploratory analyses in the current study show that not all transgenders seem to associate engaging in sexual activities with being more satisfied. It would be interesting to verify if that subgroup is really not interested in sex, in other words, if they are asexual. Another possibility would be that they report being uninterested and not having sexual fantasies at all, as a coping mechanism to deal with their dissatisfaction. Future research could focus more on the question to what extent transgenders want their sexual life to change.

In conclusion, the current study is the first study on watching pornography and sexual satisfaction, in which comparisons are made between transgenders and a control group without gender dysphoria. New information is presented about sexuality, especially watching pornography, in trangenders. Sexual satisfaction in transgenders may be particularly enhanced