The Role of Stress in Sexual Well-Being as a Function of Gender and
Relationship Status Marlene A. Werner 6154069 Dr. Lourens Waldorp Bachelorproject 2015 29-05-2015
Word Count: Abstract: 163; Introduction: 3844; Method: 3423; Results: 5239; Discussion: 2955
Abstract
Sexual well-being is a neglected topic in sexology, despite its contribution to general
well-being and the WHO’s affirmation of its importance in sexual health. By means of network
methodology, the role of stress in the sexual well-being of committed and single men and
women was investigated specifically as well as the nature of sexual well-being more generally.
Undirected weighted graphs based on regularized partial correlations and centrality statistics of
self-report questionnaire data were estimated and plotted. Stress appeared to play a negative yet
peripheral role in the sexual well-being of all groups, while single men seemed largely
unaffected by it. Consequently, stress does not represent a target for enhancing sexual
well-being. Emotional rewards played a more central role in female sexual well-being, while
pleasure did so in male sexual well-being. However, explorative analyses revealed that orgasm
re/acted more centrally in female than male sexual well-being. The applicability of network
methodology to sexual well-being is demonstrated by its fruitful insights into this complex
Table of Contents
List of Tables..………...…… p. iii
List of Figures ………...…… p. iv
Introduction - The Complexity of Sexual Well-being……….... p. 1
Stress and Sexual Well-Being……….….... p. 4 Limitations of the existent studies………..………. p. 8 Preview of the Current Study………. p. 10 Method………..… p. 12 Participants……….………...…… p. 12 Materials……….………...…… p. 12 Procedure……….………...………...…… p. 16 Plan of Analysis……….……….………..…… p. 18 Results………...…...…… p. 22 Data Preparation and Description………...………...…… p. 22 The Role of Stress in Sexual Well-being………..………..…...…… p. 25 Mediation and Moderation………..………...……...…… p. 36 Comparisons and Explorative Discoveries………..………..…… p. 39 Discussion………..………...…… p. 48
References………..………...…… p. 57 Notes………...………...…...…… p. 69 Appendix………..………..………..… p. 72
A. Definitions of Sexual Function Attributes Definition.………...…...…… p. 72 B. Literature Study Key Words………...…………...……...…… p. 73 C. Associations between Stress and Sexual Attributes for Men and Women…....… p. 76 D. Questionnaire...………..….…………...…...…… p. 87 E. Code and Syntax.………....………...…… p. 95 F. Correlation Matrices...………...…...…… p. 98
List of Tables
Table 1. Associations between Stress and Sexual Attributes for Men and Women……..… p. 76
Table 2. Description of the Samples………..… p. 22
Table 3. Hypothesized and Network Associations between Stress and Sexual Attributes for
Women and Men………...… p. 28
Table 4. Interaction Effect of (external) Stress and Sexual Relationship Satisfaction on
List of Figures
Figure 1. Sex is scary (Men in Relationships).………..… p. 24
Figure 2. Sex is pleasurable (Women in Relationships).………...… p. 24
Figure 3. Sex is repulsive (Single Men).………....… p. 24
Figure 4. Sex is a priority (Single Women).………..… p. 24
Figure 5. Circular and Spring Network Women in Relationships (N = 91).……...….….… p. 26
Figure 6. Centrality Women in Relationships (N = 91).………...…….… p. 27
Figure 7. Circular and Spring Network Single Women(N = 64)..……….…… p. 31
Figure 8. Centrality Single Women(N = 64)..………...…….……... p. 32
Figure 9. Circular and Spring Network Men in Relationships (N = 44).………..… p. 33
Figure 10. Centrality Men in Relationships (N = 44)..………..… p. 34
Figure 11. Circular and Spring Network Single Men (N = 49)..………...…… p. 35
Figure 12. Centrality Single Men (N = 49)..……….…….… p. 35
Figure 13. Standardized Regression Coefficients for the Relationship between Stress and Subjective Frequency of Sexual Activity as ‘mediated’ by Positive Feelings…..… p. 38 Figure 14. Circular Networks Women (left) and Men (right) in Relationships...……..…... p. 40
Figure 15. Spring Networks Women (left) and Men (right) in Relationships…...…….… p. 42
Figure 16. Centrality Women and Men in Relationships……….. p. 43
Figure 17. Circular Networks Single Women (left) and Men (right)…...……….…… p. 44
Figure 18. Spring Network Single Women (left) and Men (right)..………..…… p. 46
The Complexity of Sexual Well-being
Searching for “sexual health” in any search-engine results in a bombardment with
warnings of, mostly casual, sex and its consequences. While researching the adversity of
unprotected sexual encounters and their remedies is crucial (e.g. Noar, 2008), it is peculiar that
this one-sided interest has not been balanced by attention to the positive aspects of human
sexuality and how sexual health might be protected and enhanced (Arakawa, Flanders, Hatfield,
& Heck, 2013; Rosen & Bachman, 2008). The latter oversight is especially surprising
considering that the (unofficial) working definition of the WHO states that,
sexual health is a state of physical, emotional, mental and social well-being in relation to sexuality; it is not merely the absence of disease, dysfunction or infirmity. Sexual health requires a positive and respectful approach to sexuality and sexual relationships, as well as the possibility of having pleasurable and safe sexual experiences (italics added; WHO, 2006, p. 5).
According to the experts convening on behalf of the WHO, sexual health/well-being requires
more insight into sexuality than a remedial focus can offer, especially as sexual pathology and
sexual well-being should be considered related but partially independent constructs
(Stephenson & Meston, 2010a).
The current study aims to elucidate what sexual well-being entails for men and women
in- and outside committed relationships. The point of departure is the application of positive
psychology tenets to sexological research, defined by Stephenson and Meston (2015) as “understanding factors that improve [sexual] well-being and quality of life, and those that contribute to resiliency in the face of stressors” (p. 26). Sexual well-being is seen as someone’s
subjective appraisal of his or her behavioral, psychological, physiological and relational sexual
functioning (Oberg, Fugl-Meyer, & Fugl-Meyer, 2002; Laumann et al., 2006; cited in Hooghe,
2012). In this respect, the concept encompasses subjective assessments of one’s sexual
functioning, the experienced satisfaction and distress concerning one’s sexual functioning, -life
Special attention is paid to the role of a common adversary, i.e. stress, which is known
to negatively relate to general well-being (Gutman & Nemeroff, 2011; Bekkouche, Holmes,
Whittaker, & Krantz, 2011), whereas its relation with sexual well-being has not been elucidated
as thoroughly. In this regard, the relationships between indicators of sexual functioning (e.g.
frequency of sexual activity), sexual appeal (how positively and negatively someone feels about
sex and how important sex is to someone), and sexual and relationship satisfaction and -distress
will be explored and the role of stress therein will be clarified.
In order to elucidate the complexity of these relations, network methodology, a to
psychology novel approach to data visualization and analysis will be employed (examples of
psychological network conceptualizations include, among others, intelligence, Van der Maas et
al., 2006; depression, Cramer, Borsboom, Aggen, & Kendler, 2012a; and personality, Cramer
et al., 2012b). The network perspective on psychological phenomena holds that related
attributes and their inter-correlations are not the result of a latent cause, but make up a system
in which the attributes are causally related to each other (Borsboom, 2008; Cramer, 2012;
Schmittmann et al., 2013). A non-correlated attribute does not make part of the structure, as it
does not relate (in)directly to any of the other attributes, rather than that the attribute does not
measure the underlying construct (Cramer, 2012). Consequently, the relationships between the
attributes are relevant in themselves, since they tell about the structure of the emanating
construct.
This conceptualization goes against traditional theories of sexuality, dating back to
theorists such as Krafft-Ebing (1892) and Freud (1962), who postulated an inherent energetic
force that fuels all sexual motivation, thoughts and behavior – i.e. libido. This biomedical
conceptualization is not dead (Pinkerton, Bogart, Cecil, & Abramson, 2003) as the assumption
underlying the creation and marketing of a so-called ‘lust pill’ exemplifies.2 It is suggested that
tinkering with neurochemistry, especially with the recurrent candidate testosterone, will
(Bloemers et al., 2013; Poels et al., 2013; van Rooij et al., 2013).3 Simply put, how often
someone wants sex, engages in sex, and likes sex is eventually causally related to his or her
level of testosterone (or sensitivity to it) and the strong covariation of these sexual attributes
can be explained by their common source (i.e. they are locally independent regarding
testosterone (sensitivity) levels, Schmittmann et al., 2013). Also, differences between men and
women in frequency of these sexual attributes is due to women generally scoring lower on this
dimension (see ‘the dimensional view’ in Borsboom, 2008).4
The current study follows the thinking of another theoretical framework of sexual
functioning (Toates, 2009; Laan & Both, 2008), which chimes in with the network
conceptualization. Embarking from the tenets of incentive motivation theory (Singer & Toates,
1987) and reward learning theory (Berridge, 2001), this framework suggests that the sexual
organism is a responsive and dynamic entity, whose behavior is contingent upon the interplay
between excitation and inhibition depending on the organism’s sensitivity to contextual stimuli,
their presence and strength, and their positive and negative associations (Toates, 2009; Laan &
Both, 2008). The processing of the incentive value and sexual meaning of a stimulus is
determined via conscious and unconscious information processing when a sexual or sexually
associated stimulus is encountered (Spiering & Everaerd, 2007; Janssen, Everaerd, Spiering, &
Janssen, 2000).
Excitation of the sexual system can result from unconscious processing of
reward-associated-stimuli (of which genital arousal itself can make part as an additional stimulus) and
might be enhanced or even initiated by positive conscious sexual representations and appraisal
(Toates, 2009). Inhibition of the sexual system results from aversive cognitive associations (i.e.
bottom-up inhibition due to associated disgust or fear) or goal-directed top-down control (i.e.
active restraint or withdrawal due to other priorities or limitations; Toates, 2009; Bancroft,
definitions) is circular and dynamic in nature instead of linear and self-contained in time,5 in
the sense that stimuli, arousal, desire and the rewarding experience of physical pleasure,
closeness and orgasm during sex all interact to determine the attractiveness and potentiality of
sexual stimuli, the likelihood of excitation and inhibition in response to these and whether
someone is motivated to engage in sex and experience pleasure while engaging in it (Spiering
& Everaerd, 2007; Janssen, Everaerd, Spiering, & Janssen, 2000; Toates, 2009).
By integrating this framework and the network conceptualization, one could picture the
sexual system as a network in which the attributes (positive and negative sexual associations,
genital and subjective arousal, sexual desire, rewards and aversive experiences during sexual
activity) make up the nodes and their edges represent which attributes relate to each other in
what manner.6 Furthermore, it allows the inclusion of additional attributes, in order to study
how these relate to the attributes of the sexual system. Thereby, a network can be devised which
includes the factors that make up the sexual system as described by Toates (2009) in addition
to factors which have been shown important in contributing to sexual dis/satisfaction, which
results in a network representation of sexual well-being as defined above. Last but not least, the
role of stress in the network can be studied systematically by including stress as a node in the
network, while attributes of the network can be derived that buffer against possible negative
relations with stress, a topic to which we will now turn in more detail.
Stress and Sexual Well-Being
Stress can have detrimental effects on general well-being and health (Gutman &
Nemeroff, 2011; Bekkouche, Holmes, Whittaker, & Krantz, 2011). Stress is “a process in which
environmental demands tax or exceed the adaptive capacity of an organism, resulting in
psychological and biological changes that may place a person at risk for disease” (Cohen,
Kessler, & Gordon, 1997, p. 3, cited in Contrada, 2011, p. 1). Dearth on the theoretical side of
and blind spots in the research evidence on the role of stress in the sexual well-being of men
interrelationships (see note 7 for some theoretical suggestions concerning two sexual attributes,
i.e. stress and relationship satisfaction and stress and genital arousal). Most existent research
has focused on participants involved in committed relationships, wherefore insights into how
male and female singles fare sexually in times of stress is sparse. Additionally, stress’ role in
female sexual function has been the main focus, which is why evidence concerning male sexual
function and sexual well-being in general is provisional at best.
Some conclusions concerning the relationships between stress and sexual well-being
can nevertheless be drawn on the basis of summarizing the existing empirical results. The
results from the different studies on the relationship between stress, sexual functioning and
satisfaction can be found in table 1 (in appendix C). These are organized according to the sexual
attributes discussed above which were included in the studies (i.e. sexual activity, sexual desire,
subjective and genital arousal, orgasm and sexual and relationship satisfaction). The table thus
shows most but not all attributes that will be included in the network in the current study.8 The
existent studies made a crucial distinction between stress resulting from the relationship and
stress resulting from extra-dyadic sources, a distinction that will be included in the current study
as these types of stress relate differently to some of the sexual attributes. However, only external
stress will be discussed thoroughly as it is most comparable to the stress experienced by singles
investigated in the current study, be it also for brevity’s sake.
When it comes to the results according to sex (see table 1, appendix C), men’s sexual attributes did show varying relationships with stress depending on the stress’ source while both types of stress mostly related negatively to women’s sexuality or the relationship was unclear. Consequently, it is expected that (external/general) stress will relate positively to most sexual
indicators and negatively to some in the male case, while the prediction in the female case is
less straightforward, yet presumably overall negative in nature. The exact predictions per
The importance of including relationship satisfaction was shown by its positive
association with sexual satisfaction and sexual activity (Morokoff & Gillilland, 1993;
Bodenmann, Ledermann, & Bradbury, 2007; Bodenmann et al., 2010).9 Satisfaction with the
sexual relationship goes along with satisfaction with the relationship in general and increased
frequency of sexual activity. Relationship satisfaction also moderated the link between
frequency of sexual activity and external stress for men and women (with differences in
direction, Bodenmann et al., 2007; Ein-Dor & Hirschberger, 2012). These studies suggest that
the satisfaction with the relationship embeds the association between sexual experience and
external stress in differing contexts, which results in an attenuation of this link when
relationship satisfaction is high compared to when it is low. However, the nature of the
relationship between external stress and frequency of sexual activity was differently affected
by relationship satisfaction for men and women, with women scoring high on relationship
satisfaction not showing differences in sexual activity according to stress levels, while women
who scored low on satisfaction and high on stress had less sex than those scoring low on stress.
Men showed the exact opposite pattern in terms of moderation, with highly satisfied men not
reporting differences in sexual activity according to stress, but lowly satisfied men reporting
more sex when stressed than when not.
These results are in accordance with McNulty, Wenner and Fisher (2014) and
Stephenson and Meston (2010b), as well as Stephenson and Meston (2015), who have shown
the moderating role of relationship satisfaction for the sexual distress and general well-being
link and for the aversive sexual experiences and sexual distress link, respectively. Taking the
latter insights into account, it is expected that (sexual) relationship satisfaction will moderate
the relation between external stress and sexual activity (according to the above mentioned
differences for men and women). Hopefully, the network will give clearer insight into possible
Furthermore, it is crucial to include variation in mood as a mediating factor between stress and sexual function, as stress’ relationship with mood has been shown to mediate the relationship between stress and sexual activity (Hamilton & Julian, 2014), with stress relating
negatively to (positive) mood, which in turn related positively to sexual activity. Along similar
lines, frequency of good-quality sleep will be included in the network as another control factor.
Kalmbach, Arnedt, Pillai, and Ciesla (2015) have recently shown the importance of
good-quality sleep in the sexual functioning of women. Also, stress has been shown to disrupt the
quality of sleep, while loss of sleep makes one more prone to being stressed, in addition to
sleep-loss being associated with changes in mood and even depression (Heffner et al., 2012;
Minkel et al., 2014). Consequently, it appears wise to not only control for the possible mediating
role of mood but also quality of sleep during the last weeks. It remains to be seen how these
four factors relate to each other, when all others are controlled for.
As the current study employs a different method and operationalizes the attributes by
means of single frequency items, the predictions must be considered cautiously. By controlling
for a lot of factors in the network the direct relationships between the attributes and stress might
change and not be in accordance with the above predictions. However, if the relationships were
replicated within the network, this would represent more convincing evidence than has been
collected to date.
In terms of network characteristics, it can be expected that the attributes concerning
stress and sexuality will show stronger clustering internally than in relation with each other for
both sexes in and outside relationships as they measure related attributes. In terms of centrality,
it is difficult to make supported predictions as no study exists which applied network
methodology or a comparable method to the current topic. Theoretically, emotional rewards
and the desire to be emotionally close as well as the desire to be desired might figure more
Limitations of the existent studies. As has been mentioned above, the existent studies
did not include all attributes that will be investigated in the current study. Firstly, the experience
of emotional closeness during sex was added as it is an important aspect of female sexual
functioning (i.e., in the words of the current framework, as a desire and reward) and has been
shown to relate positively to female sexual satisfaction (Basson, 2000; Bancroft & Graham,
2011; research also shows its importance in male sexual satisfaction, Janssen, McBride, Yarber,
Hill, & Butler, 2008).
Secondly, sexual pleasure will be added as separate from sexual satisfaction and orgasm
(two of which it is often erroneously conflated with in other studies, Schönbucher, 2007).10
Sexual pleasure appears crucial for enjoyable sexual activity as a goal in itself for men and
women (Meston & Buss, 2007; de Graaf, 2012; i.e. in the words of the current framework, it
makes sex rewarding and therefore more likely to be desired or engaged in) and as a further
support for genital arousal and intercourse without pain (i.e. it may act as a sexual stimulus
itself; Laan, 2013).
Thirdly, following Stephenson and Meston’s (2015) suggestion to conceptualize sexual well-being not only as the positive aspects (i.e. ratings of satisfaction and pleasure) of one’s
sexual experience, the current study will include sexual distress (how distressed someone has
been regarding his or her sexual life and relationship(s)) and negative experiences during sex
(i.e. pain, erection and orgasm problems11) as further attributes of sexual well-being. Their
inclusion also makes sense considering the discussed theoretical framework, which states that
positive and negative sexual experiences codetermine the reward value of sex and thereby
likelihood to desire and engage in it. None of the studies had included sexual distress as a
distinct attribute, while some did investigate pain, erection-, and orgasm problems.
The stress studies suffer from further limitations, besides the neglect of emotional
closeness, sexual pleasure and sexual distress. Firstly, all studies consider sexual activity and
committed relationship or in terms of sexual activity with some kind of partner. In order to gain
insight into human sexual well-being in relation to stress, it is necessary to consider single individuals’ sexuality as well. Moreover, it could be suggested that the role of stress and its interaction with sexual activity is complicated by the fact that engaging in sexual intercourse
with another requires more steps to be taken in order to arrive at the desired result than sexual
activity with oneself, i.e. masturbation.12 In addition, the partner might be indirectly affected by one’s own level of experienced stress (Bodenmann et al., 2007), which in turn might affect the likelihood of sexual activity to take place.
For these reasons, experienced stress should be studied in relation to partnered sexual
activity as well as in relation to the frequency of masturbation. Also, sexual activity with a
partner and masturbation might be engaged in for different reasons (e.g. emotional closeness
versus sexual release; Pinkerton et al., 2003; Gerressu, Mercer, Graham, Wellings, & Johnson,
2008; Bancroft et al., 2003), which could underlie differing associations between the two and
experienced level of stress. In any case, it appears wise to start an exploration into the
relationships between stress and these two types of sexual activity.
In addition to the stress studies, a couple of studies have investigated the relationship
between (depressed and anxious) mood, masturbation and sexual activity with a partner
(Bancroft et al., 2003; Lykins, Janssen, & Graham, 2006; Janssen, Macapagal, & Mustanski,
2013) and have pointed to the inter-individual variation in how people react sexually in affective
states. Some participants reported an increase in their sexual interest and activity (including
masturbation), others do not report being affected and some report a decrease in interest and
activity. The in-depth interviews of these studies suggest that decreasers prioritize other things
in times of depression or anxiety or do not consider sex a worthwhile or rewarding intermezzo,
while those who report an increase consider sexual activity rewarding in the sense of lifting the
regard sex generally, i.e. whether they consider it positive (e.g. desirable or pleasurable)
negative (e.g. scary or repulsive) and whether they consider it a priority, as this seems to affect
the likelihood to engage in sexual activity.14
The latter also coheres with the current study’s theoretical framework, wherein sexual
stimuli arouse the sexual system and motivate sexual behavior in interaction with their positive
and negative associations and depending upon someone’s active restraint or withdrawal due to
other priorities or limitations. For these reasons, questions will be included that represent positive and negative sexual appeal and the priority of sex in one’s life.
Preview of the Current Study
Research into the interrelationships between experienced stress and sexual well-being
is in need of further clarification, in addition to clarifying the role of mood, quality of sleep and
relationship satisfaction herein. Not all of these relationships have been adequately elucidated
due to limited, absent or equivocal evidence, while more established relationships require
further substantiation in more substantively controlled studies. The current study aims to
achieve this by using a novel methodology, by controlling for mood, quality of sleep, (sexual)
relationship satisfaction and appraisal of sex, by including singles as subjects whose sexual
activity differs from couples in general (de Graaf, 2012), and by including masturbation as
another type of sexual activity, which might show clearer relationships with stress than sexual
activity with another individual. It remains to be seen how stress relates to the general appraisal
of sex and desiring it to take place (i.e. factors that promote or halt sexual activity), the
experience during sexual activity (i.e. decreased arousal, pleasure or aversive experiences) or
inter-relational factors (i.e. distress or decreased satisfaction with the relationship) and whether
particular association patterns might be induced.
As Baron and Kenny (1986) and McNulty and Fincham (2012) suggest, weaker than
theoretically expected or equivocal relationships may be clarified by means of conditioning on
unrelated variables may show clearer and possibly changed interrelations because the
variability in the measurement is explained by the other variable differently on different levels
of the moderator (Kieviet, Frankenhuis, Waldorp, & Borsboom, 2013). It will be seen whether
this is the case for the interrelationships between stress and sexual activity.
In addition, the current study has some exploratory goals. By means of network analysis,
the interrelationships between sexual- and relationship satisfaction and distress, sexual activity
and masturbation should be unraveled more precisely. The relative importance of the different
rewards, aversive experiences and sexual appeal and their relationship with satisfaction and
distress will be explored separately for men and women. Differences and similarities in global
and local network structure between men and women in- and outside relationships should give
interesting insights into what sexual well-being entails for them.
In sum, the following predictions and aspects will be investigated. No distinction can be
made between women and men in- and outside relationships due to lack of specific evidence
about the latter. In the male case, (external/general) stress’ relationships with the sexual
attributes are expected to be mostly positive in nature and negative in some (see table 1 in
appendix C for the predictions per attribute), while the relationships between (external/general)
stress and sexual attributes in the female case are expected to be negative in nature overall.
Relationship satisfaction is expected to moderate these relationships (i.e. limited to sexual activity for brevity’s sake) with highly satisfied women showing no relationship between stress and subjective frequency of sexual activity and less satisfied women showing a gradually
stronger negative relationship between the two. This moderating effect is opposite in the male
case, with highly satisfied men also showing no relationship between sexual activity and stress,
but dissatisfied men showing a positive relationship between stress and sexual activity. Mood
is expected to mediate the relationship between stress and sexual activity, with increases in
to mood). Emotional rewards and the desire to be emotionally close as well as the desire to be
desired are expected to play a more central role in female sexual well-being while pleasure and
orgasm should do so in male sexual well-being. Last but not least, the networks for committed
men and women, and single men and women will be compared and similarities and differences
in the network structure of sexual well-being will be pinpointed.
Method Participants
Participants were approached via posts with an anonymous link to the survey on social
media platforms (see below for a description of the questionnaire and appendix D for a list of
the items). In addition, participants were recruited via the research online platform of the
University of Amsterdam (UvA), on which students were able to participate in return for credit
points as a requirement for their studies. The original sample consisted of N = 328 cases, of
which 172 were recruited via social media and 156 via the UvA research online platform. Cases
with missing values, paradoxical answers, indicating a non-heterosexual preference, or long
distance relationships were excluded from further analysis. A more detailed description of the
excluded cases and the final datasets can be found in the results section. The final four datasets
encompassed N = 49 single men, N = 64 single women, N = 44 men and N = 91 women in a
relationship.
Materials
All data of this study were collected via an online-based questionnaire created in
Qualtrics. As the research was conducted in collaboration with other students, who investigated different topics, the questionnaire encompassed more aspects than the ones investigated in the
current study. However, only the questions relevant to this study will be described. Firstly, in
order to create the groups necessary for comparison, participants were asked to indicate their
long-distance relationship, a committed non-long-long-distance relationship). It was chosen to
differentiate for long-distance relationships as the distance affects the likelihood with which
participants were able to engage in sexual activity (at least with their committed partner). It was
decided to exclude these participants from the analysis. Additional demographics covered
sexual orientation (Kuyper & Vanwesenbeeck, 2011), age, level of education and origin.
Secondly, in accordance with the theoretical framework discussed above and the
empirical evidence concerning attributes of sexual well-being and the literature on stress, the
final questionnaire relating to sexuality encompassed 30 items covering the following sexual
attributes: 1. sexual functioning attributes, all of which were asked for sexual activity and
masturbation separately (subjective estimation of frequency of intercourse and masturbation,
subjective frequency of subjective sexual arousal as well as genital arousal, the latter
differentiating between men and women, subjective estimation of orgasm frequency, and
frequency of experienced sexual pleasure) in addition to subjective frequency of sexual desire
(encompassing a question asking about spontaneously thinking of sex with desire and interest,
responsive desire, the desire to be desired [Bancroft & Graham, 2011], and the desire to be
emotionally close to someone through sex [Bancroft & Graham, 2011; Janssen et al., 2008]).
Desire was operationalized in all these ways as this raises the likelihood for women to relate to
the questions and be able to indicate their frequency of sexual desire, such that no
underestimation in comparison with men is made, which is likely to occur when only
spontaneous desire is included (Bancroft & Graham, 2011); 2. subjective frequency of feeling
emotionally close during sexual activity with a partner; 3. subjective frequency of aversive
experiences (pain during sex for women, erection difficulties for men and orgasm difficulties for both); 4. subjective frequency of sexual satisfaction relating to one’s sexual relations and one’s sexual life in general 5. subjective frequency of sexual distress concerning one’s sexual relations and one’s sexual life in general; 6. sexual appeal (among which positive appeal,
and frightening one finds sex, and importance, i.e. in how far sex is a priority to someone). All
items, besides the sexual appeal ones (which referred to someone’s feelings in general),
pertained to the last four weeks.
Subjective estimates instead of precise frequencies were investigated as the study is
interested in relative estimations of sexual activity and related attributes and their relationships
with perceived level of stress. Interest goes out to whether someone considers the sexual activity
having occurred in the last four weeks as a lot for him or herself (which encompasses a relative
estimation of increase or decrease relative to a personally considered desired or experienced
baseline) and how this estimation relates to how often someone has felt stressed in the same
time period, instead of how often someone actually did have sex. Furthermore, this manner of asking minimizes people’s tendency to give socially desirable answers compared to asking for actual frequencies (Waldorp, 2015, personal communication). In order to raise the likelihood
that participants answered the items in relation to themselves instead of others, it was stressed
repeatedly that they should answer the questions in relation to themselves.
McCroskey and Richmond’s (1989) Generalized Attitude Measure formed the basis for the sexual appeal items. However, the items themselves were self-devised, with the theoretical
framework of this study in mind. These items were scored on Likert-scales with five response
options reaching from 1 (not at all) to 5 (very much). The sexual function, strength of emotional
closeness, aversive experiences, and sexual desire, satisfaction and distress items were inspired
by the item construction of the Female Sexual Function Index (FSFI; Rosen et al., 2000; Ter
Kuile, Brauer, & Laan, 2006) and the International Index of Erectile Function (IIEF; Rosen et
al., 1997). These items were scored on Likert-scales with five response options reaching from
1 (never) to 5 (very often). Some items required a not applicable response, which is why some
items had six instead of five response options. The sixth response option was visually set-off in
The FSFI and IIEF items were chosen as inspiration because they were used in many of
the cited stress studies, because the measured attributes relate well to the sexual function
attributes as defined in the introduction, and also because they overlap in content with each
other which was helpful for the comparability of the items for men and women. However, the
items were adjusted such that each of them related either to sexual activity with a partner or
masturbation. In addition, the ordering of the words of the items was changed so that the most
important aspects stood at the end of the question (Oosterveld & Vorst, 1998). Response options
were adjusted for all items such that they were equal for similar questions (which eases
understanding for the participant as well as analysis). The response options themselves were
created such that the labels related to amounts or levels with more or less equal distances
between subsequent steps. Furthermore, the labels were balanced on the outer edges such that
readability was enhanced. Never was included as a distinct response option because it is
possible for men and women to not have experienced any of the sexual experiences during
sexual activity during the last four weeks.
Three questions were asked concerning someone’s subjective experience of stress during the last four weeks in general, and split according to being stressed due to happenings inside and outside one’s relationship (if applicable to the participant). The items were inspired by a Perceived Stress Scale item (Cohen, Kamarck, & Mermelstein, 1983) but changed almost
completely to fit the structure of the items relating to the sexual attributes. The items were
answered on the same Likert-scale with the same response options as the items tapping the
subjective frequency of sexual attributes.
Besides the main variables considered in this study frequency of positive mood was
controlled for in the network, due to the fact that the relationship between stress and sexual
well-being attributes might be mediated by stress and sex’s relationship with mood (Hamilton
of the whole questionnaire of the project as stated above. Last but not least, frequency of
good-quality sleep was included in the network as a recent study has described its role in the
frequency of sexual activity and sexual function among women (Kalmbach, Arnedt, Pillai, &
Ciesla, 2015). Both of these were rated on the same five-point Likert-Scale ranging from 1
(never) to 5 (very often). The whole questionnaire of this study encompassed 41 items and can
be found in appendix D.
Procedure
Participants were invited by means of an anonymous link which was either accessible
via posts on social media platforms, posted there by the researching students, or via the online
platform of the UvA, on which students were able to participate in return for credit points as a
requirement for their studies. Upon clicking on the link, participants were forwarded to the
Qualtrics questionnaire, which started with an informational text that introduced the study. Herein participants were informed about the rationale, content, procedure, confidentiality,
duration, non-existence of potential risks, and contact persons of the study in addition to being
informed that their participation occurred on a voluntary basis. In this respect, participants were
informed about their choice to leave questions blank with which they felt uncomfortable. For
some questions forced response was required to insert display logic of the following items.
Participants could indicate with a separate response option that they did not want to answer this
kind of question. Also, participants were reminded that they would be able to stop their
participation at any moment without this entailing any consequences. Participants were advised
not to participate in case they might take unsurmountable offense by the nature of the questions.
Anonymity of their response was emphasized repeatedly.
Single participants who had engaged in sexual activity and masturbation were presented
with the baseline amount of questions (30 items). Participants in relationships were presented
with two additional questions as the stress question split into two additional questions
participants who indicated to either not having engaged in sexual activity or masturbation were
not shown the questions concerning sexual activity or masturbation respectively and allotted a
zero for all of these answers automatically. The same applied to people who had indicated that
they did not want to answer one of these questions; however, they were excluded from the
analysis as no information could be inferred from their answers. Participants who had indicated
not wanting to answer both the frequency of sexual activity and masturbation question were not
shown any other sexual items, as their response could not have been used in the analysis
anyways. Everyone else (participants having answered both or just one item and not the other)
was shown the questions concerning sexual desire, satisfaction, distress and appeal, as these are
independent of whether someone has engaged in sexual activity or masturbation. Questions
were presented in this manner in order to assure that participants would not be presented with
questions that did not apply to them. Furthermore, thereby enough data could still be collected
such that, in the worst case scenario, analyses could be conducted on masturbation and sexual
activity separately.
Men and women were presented with different questions that adjusted the wording to
female and male sexuality with regard to erection problems or pain during sexual activity and
genital arousal. Otherwise, each participant answered equally phrased questions, which were
constructed such that they would fit male and female sexuality as well as being
non-discriminating against different sexual orientations and applicable to singles and people in
relationships.
To preclude simple-order or priming effects, questions regarding sexual function and
rewarding and aversive experiences during sexual activity with a partner and masturbation, and
questions regarding sexual desire, sexual satisfaction and distress were randomized within their
respective sexual activity, masturbation and general sexual well-being blocks. The sexual
frequency of sexual activity and masturbation was necessary to tailor the following question
presentation.
In total the whole questionnaire encompassed questionnaires relating to eight different
topics (demographics, sexual well-being, general well-being, coping styles, humor styles,
self-esteem and social media use). The sexual well-being, coping style, humor style, self-self-esteem
and social media use blocks were randomized among each other. Demographics and general
well-being was always presented first in order for participants to acclimatize. Completion of
the questionnaire took approximately half an hour. After completion, participants were thanked,
informed of a contact person in case they had any questions and instructed to close the window.
Plan of Analysis
Initially, the collected data will be checked for missing data. Only participants who
answered all questions will be included in the final sample, in order to plot networks which
include all discussed attributes (in case analyses are still possible on the resulting amount of
cases). Responses of participants that indicate inattentive answering, such as paradoxical
answers, will be deleted as well. Furthermore, data from participants in long distance
relationships and homosexual participants can only be included in the analysis if a sufficiently
large number responded to the survey.
Analyses will be conducted for all four groups separately according to sex (male and
female) and relationship status (single or being in a non-long distance relationship). Before
conducting the main analyses, the item-distribution will be checked for anomalies (strong skew
or kurtosis and restricted range) for each item and all groups separately. Furthermore, initial
analyses will be run to check whether the four groups differ strongly on any of the other
demographic variables (age, origin, level of education) to secure that any differences found are
more likely attributable to the grouping variables instead of one of these factors. In order to do
origin and level of education as the dependent variable. These analyses will be conducted in
IBM SPSS Statistics 22.
The network visualizations and analyses will be conducted in RStudio version 0.98.1103
by means of the qgraph package version 1.3.1 (Epskamp, Cramer, Waldorp, Schmittmann, &
Borsboom, 2012). In order to test the hypotheses about the role of (external) stress in relation
to the sexual attributes, two kinds of population-based networks will be plotted for each group
separately using the original datasets (i.e. with possibly unequal N) . These networks will not
be used for the (explorative) comparison of the networks. Undirected weighted graphs based
on regularized partial correlations will be plotted by means of the glasso package (Friedman,
Hastie & Tibshirani, 2011) with a tuning parameter of 0 and a maximum of 1 to set the width
and color of the edges in relation to a comparable and not their relative maximum.
In order to analyze the local role of (external) stress in the network, the (external) stress’ node edges’ strength and quality will be inspected in group-based circular networks with forced positioning of the nodes. Networks with a spring layout (which positions the nodes according
to the Fruchterman Reingold Algorithm, Epskamp et al., 2012) will be plotted in order to visualize and inspect the global role (external) stress plays in the networks as the nodes’ placement is herein determined by the strength of their edges, with relatively strongly connected
edges being placed more centrally.
The latter aspect will also be investigated by means of descriptive comparison of several
centrality statistics. In the current study, strength, closeness and betweenness will be used
(Opsahl, Agneessens, & Skvoretz, 2010). Strength is determined by summing the weights of
all edges that are directly connected to a node (Barrat, Barthelemy, Pastor-Satorras, &
Vespignani, 2004). The strength statistic should be interpreted cautiously, as it does not take
the global structure of the network into account and might lead to mislead conclusions about a node’s actual importance (Opsahl et al., 2010). Closeness is based on the inverse of the sum of
nodes are from a particular node and vice versa (i.e. they communicate easily with each other,
when closeness is high; Boccaletti, Latora, Moreno, Chavez, & Hwang, 2006; Opsahl et al.,
2010). Betweenness represents the amount of times a node lies on the shortest path between two other nodes, relative to that position of the other nodes in the network, which represents a node’s role in channeling activation throughout the network (Barrat et al., 2004; Bringman et al., 2013).
Nodes with high betweenness can thus be seen as bridging nodes in a network, which means
that they have control over the activation reaching one part of a structure from another.
Secondly, it will be checked whether the association (external) stress might show with
subjective frequency of sexual activity is mediated by means of mood (Hamilton & Julian,
2014). In case (external) stress only or more strongly connects to this node via mood (in addition
to others), mediation between (external) stress and sexual activity is likely. Depending on
whether this is the case, this initial analysis will be followed by a mediation analysis conducted
in IBM SPSS Statistics 22 by Hayes’ PROCESS tool (Hayes, 2012; cited in Field, 2013), with
(external) stress as the independent variable, sexual activity as the dependent variable and mood
as the mediator variable.
Thirdly, it will be investigated whether (sexual) relationship satisfaction moderates the
association between (external) stress and subjective frequency of sexual activity. This can be
seen in the network if a loop exists between (external) stress, sexual activity and (sexual)
relationship satisfaction, even if that loop flows through other nodes. The strongest evidence
for moderation (and mediation for that matter) would be found if these three nodes are
positioned in direct relation with each other building a triangular or path-like shape (as the
network is bidirectional). In this case one of the nodes could be a collider (common effect or
moderator, i.e. if a path exists between x and y and y and z but not, or less so, between x and z,
however, that relationship appears when one conditions on y), a confound (common cause) or a mediator (Waldorp, 2013). The nodes’ roles in such a triangle can be (tentatively) determined based on theoretical considerations, but also changes in relationship strength depending on
inclusion of other variables in the model. If such a constellation is found for (external) stress,
(sexual) relationship satisfaction and sexual activity (also via other nodes), this discovery will
be followed by a moderation analysis conducted in IBM SPSS Statistics 22 by Hayes’ PROCESS
tool (Hayes, 2012; cited in Field, 2013), with (external) stress as the independent variable,
sexual activity as the dependent variable and (sexual) relationship satisfaction as the moderator
variable. For all latter analyses the networks based on the original datasets will be used and
plotted as described above.
Finally, the networks of single men and single women, and men and women in
relationships will be compared with each other to uncover interesting aspects, similarities and
differences in the aspects of their sexual well-being networks in an explorative fashion. In case
these groups differ in number of cases, random samples will be drawn from the group with
more cases, as the comparability of networks depends not only on the nodes included, but also
the power with which edges might be detected. Differences could then be based on mere
difference in power and not actual differences in structure. Firstly, the weighted sum of all edges
of the networks will be compared by means of the Network Comparison Test (NCT) in order to
indicate whether single men’s and or women’s, and committed men’s and women’s networks
differ in terms of overall connectivity (Van Borkulo et al., 2015). Secondly, differences in the networks’ connection typography will be compared by means of comparing the sum of the squared differences between the edges of two networks (Van Borkulo, 2015, personal
communication). Finally, the networks will be described and compared descriptively by
pointing out interesting quantitative and qualitative aspects in local (edge strength and quality)
and global structure (connectivity, overall typography clustering and/or centrality) separately
for each network, and differences and similarities herein between the networks. Example syntax
and codes of the conducted analyses can be found in appendix E.
why these were either non-existent or not feasible in the context of the current study.
Furthermore, most results that will be discussed are explorative in nature as the current study is
the first to apply this methodology to this topic. Replications are therefore, as always, necessary.
Results Data Preparation and Description
The original sample consisted of N = 328 cases, of which 172 were recruited via social
media and 156 via the research online platform of the UvA. Due to large amounts of missing
values and paradoxical answers (indicating having had sex with another person on an initial
question, but finally indicating not having had sexual contact with anyone) and indicating being
in a long-distance relationship, 61 cases had to be excluded from the analyses. In addition, 19
cases had to be deleted as they did not identify as being completely or predominantly attracted
to the opposite sex. A general overview of descriptive characteristics of the eventual samples
can be found in table 2.
Table 2
Description of the Samples
SM SW MiR WiR
N 49 64 44 91
Age Group (freq.)
< 20 9 16 4 16 20-29 38 46 27 63 30-39 2 0 9 5 40-49 0 2 1 3 50-59 0 0 3 3 > 60 0 0 0 1 Origin (freq.) Dutch 42 57 35 81 EU 2 4 4 8 Turkish 1 0 0 0 Surinamese 0 1 2 0 Aruba/Dutch Antilles 1 0 0 1 Middle-East 1 0 1 0 Asian 2 1 1 0 Other non-Western 0 1 1 0 Other Western 0 0 0 1
Level of Education
(freq.) Primary education 1 0 1 1
Basic applied education (MAVO, VMBO) 2 0 3 0 Secondary applied education (MBO) 4 1 8 3 Higher general continued education (HAVO) 3 3 3 7 Preparatory scholarly education (VWO) 25 47 9 49 Higher applied education (HBO) 6 1 6 11 Academic education (WO – Bachelor) 8 9 6 14 Academic education (WO – Master) 0 3 8 6
The final four datasets encompassed N = 49 single men, N = 64 single women, N = 44
men in a relationship, N = 91 women in a relationship. Exact Fisher Tests were run for all three
descriptive variables as outcome and group membership as the predictor variable in order to
check whether the groups differed on these variables. The planned χ² tests could not be run as
there were too many expected counts not exceeding five, which violates the assumptions of the χ² test. Group membership and age group appeared to be dependent (two-sided,28.196, p < .01) due to the fact that there were more 30 to 39-year-olds in the committed male group than there
were in the other groups. As the deviance in age was not large, the data were not corrected for
that fact. Origin did not display dependence (two-sided, 23.552, p = .227). Unfortunately, not
even a 10-minute time limit per test allowed the computation of the Exact Fisher statistic for
the level-of-education variable. Keeping in mind that the assumptions are violated, the χ² test
indicated that the committed male group showed some differences in educational levels
compared to the other groups (MBO, VWO, Master frequencies compared to frequencies of
single men, see table 2). The other groups did not differ from each other in terms of educational
levels. It would not have been an option to reduce the other groups to a level matching the
committed male educational distribution as this would have led to a large loss in power. The
fact that the distribution of educational level was not concentrated around VWO/WO levels in
the committed male group should nevertheless be kept in mind while considering the results of
In terms of item distribution, not all items were approximately normally distributed and
some items were fairly skewed, had a restricted range and limited variance (floor- and ceiling
effects). This was the case for approximately 10 items in the committed male and female case
and 12 items in the single male and female case. Most strongly affected were the sexual appeal
items (besides the items asking for the priority of sex, see figure 4). These kinds of distributions negatively affect the items’ capacity to discriminate sufficiently between people and may affect the fitting of the network structure. Even though item distribution was not optimal, the
non-normal distribution was equally represented in the to-be-compared groups, which secures that
differences in structure should not be due to differences in non-optimal item distribution.
Furthermore, all items still encompassed at least three response options. Eventually, it was
decided to not exclude any of the items from the final analysis.
Figure 1
Sex is scary (Men in Relationships)
Figure 2
Sex is pleasurable (Women in Relationships)
Figure 3
Sex is disgusting (Single Men)
Figure 4
The Role of Stress in Sexual Well-being
As can be seen in figure 5 and table 3, external stress (ExS) plays a largely negative role
in the sexual well-being of women in relationships (the correlation matrices, on which the
networks are based, can be found in appendix F). Controlling for all other associations, external
stress (ExS) relates positively to finding sex disgusting (Dsg) and negatively to considering it
a priority (Prr) and desiring it spontaneously (SpD), in addition to being positively related to
orgasm problems (SAOP) and pain during and/or after sex (SAA). Also external stress relates
negatively to satisfaction with one’s sexual life (SSL) and positively to distress with one’s
sexual life (DSL) and relationship (DSR). Only one relationship falls outside of this pattern,
with external stress relating positively to genital arousal during masturbation (MGA). However,
as can be seen in figure 5 and figure 6, while external stress (ExS) might show some connections
with other nodes as shown by its strength, it does not communicate easily with these nodes
(closeness) as the relationships are weak and its control over the flow in the network is
negligible. In that sense external stress does play a (negative) role in committed female sexual
Figure 5. Circular and Spring Network Women in Relationships (N = 91).
General Well-Being (red): Positive Feelings (PsF), Frequency of Good Quality Sleep (Slp), Internal Stress (InS), External Stress (ExS) (General Stress (Str)); Sexual Appeal (yellow): Sex is Scary (Scr), Sex is Desirable (Dsr), Sex is Disgusting (Dsg), Sex is Pleasurable (Pls), Sex is a Priority (Prr); Sexual Activity (grass green): Frequency of Sexual Activity (SxA), Frequency of Subjective Arousal during Sex (SAS), Frequency of Genital Arousal during Sex (SAG), Frequency of Orgasm during Sex (SxAO), Frequency of Feeling Emotionally Close during Sex (SAE), Frequency of Having Pleasurable Sex (SAP), Frequency of Aversive Experiences during Sex (Pain for Women/Erection Difficulties for Men; SAA), Frequency of Orgasm Problems during Sex (SAOP); Masturbation (mint green): Frequency of Masturbation (Mst), Frequency of Subjective Arousal during Masturbation (MSA), Frequency of Genital Arousal during Masturbation (MGA), Frequency of Orgasm during Masturbation (MsO), Frequency of Pleasurable Masturbation (MsP), Frequency of Orgasm Problems during Masturbation (MOP); Desire (light blue): Spontaneous Desire (SpD), Responsive Desire (RsD), Desire to be Desired (DTB), Desire to be Emotionally Close through Sex (DEC); Satisfaction (dark blue): Satisfaction with Sexual Life (SSL), Satisfaction with the Sexual Relationship (SSR); Distress (pink): Distress with Sexual Life (DSL), Distress with the Sexual Relationship (DSR).
Table 3
Predicted and Network Associations between Stress and Sexual Attributes for Women and Men (Hypotheses based on Participants in Relationships)
WOMEN Sexual Attribute
Frequency of Sexual Intercourse Sexual Desire Subjective Sexual Arousal Genital Arousal
Hypothesis Equivocal results (50% of studies
positive relationship, other 50% negative)
Equivocal results Equivocal results, with tendency for no relationship; (however different sort of measurement) or negative relationship (however, confounded outcome, i.e. not purely subjective arousal)
Genital arousal seems to be negatively associated with chronic stress (or positively with lubrication problems; however, partly different measurement) Stress also relates positively to pain
Networks Women in Relationships
External No direct relationship with external stress
Negative relationship between external stress and spontaneous desire (not replicated in subsample)
No direct relationship with external stress
Positive relationship between external stress and genital arousal during masturbation (and during sex in subsample)
Positive relationship between external stress and pain during or after intercourse
Internal No direct relationship with internal stress
Positive relationship between internal stress and spontaneous desire
No direct relationship with internal stress
No direct relationship between genital arousal and internal stress
Single Women (explorative)
No direct relationship with general levels of stress
Negative relationship between general stress and spontaneous desire (not replicated in subsample)
No direct relationship with general levels of stress
No direct relationship between genital arousal and general levels of stress
General stress is positively related with pain during or after sexual activity
Orgasm Sexual Satisfaction Relationship Satisfaction
Hypothesis Tendency towards no relationship (possibly
negatively related to internal stress)
Negative relationship between sexual satisfaction and stress (possibly especially intra-dyadic and personal ones)
Negative relationship between stress and relationship satisfaction (especially internal) Networks
Women in Relationships
External Positive relationship between external stress and orgasm problems during intercourse
Negative relationship between external stress and satisfaction with one’s sexual life (not in subsample), positive relationship between external stress and distress with sexual life
Positive relationship between external stress and distress with the sexual relationship
Internal Negative relationship between internal stress and orgasm frequency during sexual activity; positive relationship between internal stress and orgasm problems during sex (not in subsample)
No direct relationship with internal stress (in subsample negative relationship between internal stress and satisfaction with sexual life and positive relationship between internal stress and distress with the sexual life)
Negative relationship between internal stress and satisfaction with the sexual relationship, positive relationship between internal stress and distress concerning the sexual relationship
Single Women (explorative)
No direct relationship with general levels of stress No direct relationship with general levels of stress
No direct relationship with general levels of stress (in subsample positive relationship between stress and distress with the sexual relationship)
MEN Sexual Attribute
Frequency of Sexual Intercourse Sexual Desire Subjective Sexual Arousal Genital Arousal
Hypothesis Positive relationship with external
and negative relationship with internal stress
Positive relationship with external stress (and possibly negative with internal/personal stress)
No conclusion possible as only measure taps subjective assessment of erectile strength instead of subjective arousal as defined here
Negative relationship with internal stress while external stress might be positively related
Men in Relationships
External No direct relationship with external stress
No direct relationship with external stress
No direct relationship with external stress
Positive relationship between external stress and genital arousal during masturbation Internal No direct relationship with internal
stress
No direct relationship with internal stress
No direct relationship with internal stress
No direct relationship with internal stress
Single Men (explorative)
No direct relationship with general levels of stress
No direct relationship with general levels of stress
No direct relationship with general levels of stress
No direct relationship with general levels of stress
Orgasm Sexual Satisfaction Relationship Satisfaction
Hypothesis Orgasm problems might be positively related with
stress
Most recent studies indicate a negative relationship between sexual satisfaction and (especially internal) stress
Negative relationship between internal stress and relationship satisfaction
Not clear concerning external stress Network
Men in Relationships
External Positive relationship between external stress and orgasm problems during sexual activity with another
Negative relationship between external stress and satisfaction with the sexual life
No direct relationship with external stress
Internal Positive relationship between internal stress and orgasm problems during masturbation
No direct relationship with internal stress Positive relationship between internal stress and distress with the sexual relationship Single Men
(explorative)
No direct relationship with general levels of stress No direct relationship with general levels of stress
No direct relationship with general levels of stress
When it comes to single females (see figure 7 and 8), general stress (Str) shows a
negative relationship with spontaneous desire (SpD), a positive relationship with pain during
and/or after sex (SAA), and a positive relationship with finding sex scary (Scr), but also a
positive relationship with considering sex a priority (Prr) and frequency of masturbation (Mst). In that sense, stress appears to play a more ambivalent role in single women’s sexuality. As the directionality of these relationships is unclear and the literature on single women’s sexual
well-being and stress is sparse, it is hard to draw firm conclusions. Despite these relationships, stress
again appears to play a negligible role when it comes to its importance in the network as a
whole, as its relationships are weak in nature (see strength in figure 8).
Figure 8. Centrality Single Women (N = 64).
In this regard, as can be seen in table 3, the hypotheses considering the relationships
between stress and the sexual attributes were largely supported in the female case. Stress
appears to play a foremost detrimental role in female sexual function and satisfaction, however, the impact of that detriment is moderate, considering stress’ centrality. Based on the used methodology, it is possible to suggest that there exists no direct causal relationship between stress and subjective arousal (‘horniness’) during sexual activity (SAS) and masturbation (MSA), whereas the equivocal relationship between frequency of sexual activity (SxA) and
stress can be clarified by the following.
Both women in and outside relationships show an interesting pathway between
(external/general) stress (ExS and Str), positive feelings (PsF), good quality sleep (Slp) and
frequency of sexual activity (SxA) (while the sleep-sexual activity path flows via priority (Prr)
of sex for women in relationships). It could be suggested that stress makes one feel less happy (and the other way round), which affects one’s quality of sleep (and the other way round), while
