JOURNAL OF https://doi.org/10.1080/00918369.2019.1618647

Correlates and Predictors of Sexual Satisfaction for Older Adults in Same-Sex Relationships

Jane M. Fleishman, PhDa, Betsy Crane, PhDb, and Patricia Barthalow Koch, PhDc aIndependent Researcher; bCenter for Studies, Widener University, Chester, Pennsylvania, USA; cCollege of Health and Human Development, Penn State University, State College, Pennsylvania, USA

ABSTRACT KEYWORDS Study explored correlates and predictors of sexual satisfaction LGBTQ; older adults; among older adults in same-sex relationships by examining relationship satisfaction; internalized , resilience, sexual communication, same-sex relationships; and relationship satisfaction. Online survey elicited 265 partici- sexual satisfaction; aging pants (54% female, 46% male), aged 60–75, in same-sex rela- tionships from 1 to 47 years. Participants reported high levels of relationship satisfaction and resilience, moderate levels of sexual communication and sexual satisfaction, and low levels of internalized homophobia. Stepwise multiple regression ana- lysis indicated relationship satisfaction contributed uniquely to the prediction of sexual satisfaction. Relationship satisfaction was positively correlated with sexual satisfaction and resilience and negatively correlated with internalized homophobia. Internalized homophobia was also negatively correlated with resilience. Recent estimates indicate there are over three million U.S. citizens over 65 who consider themselves LGBTQ, many of whom are in same-sex relationships. Therefore, given the paucity of research and misconceptions about this population, findings, and recommendations are of value to educators, clinicians, and policymakers.

Introduction Humans are sexual beings and remain sexual throughout their lives (Santos- Iglesias, Byers, & Moglia, 2016). In the past decade, LGBTQ (, , bisexual, , /questioning) individuals have become more visible in the United States, although they still remain an under-researched segment of the population, particularly as they age (Fredriksen-Goldsen & Kim, 2017). With estimates of eight million LGBTQ adults in the U.S. and with approximately 780,000 Americans in same-sex (Gates & Newport, 2015), these sexual minority relationships comprise approximately 3.5% of the adult U.S. population (Gates, 2011). With more than three million U.S. citizens over 65 who consider themselves LGBTQ, their numbers are expected to double by the year 2030 (Espinoza, 2014).

CONTACT Jane M. Fleishman [email protected] 16 Munroe Street, Northampton, MA 01060, USA. Color versions of one or more of the figures in the article can be found online at www.tandfonline.com/wjhm. © 2019 Taylor & Francis Group, LLC 2 J. M. FLEISHMAN ET AL.

While LGBTQ relationships among older adults are increasingly more visible, scant research has been conducted on the sexual satisfaction experi- enced in these relationships. Sexual satisfaction is very important, as evi- denced by a review of 197 scientific papers concluding that it is a key factor in individual’s sexual health, overall well-being, and quality of life (Sánchez- Fuentes, Santos-Iglesias, & Sierra, 2014). However, most research on sexual satisfaction has been conducted on heterosexuals who are dating (Sprecher, 2002) or in marital or long-term relationships (Byers, 2005; Litzinger & Gordon, 2005; MacNeil & Byers, 2005; Young, Luquis, Denny, & Young, 1998). Thus, it is important to expand research on sexual satisfaction on same-sex (i.e., homosexual) relationships. The purpose of this study was to assess sexual satisfaction of women and men ages 60–75 years who were in same-sex relationships and the extent to which sexual satisfaction varied by levels of internalized homophobia, resilience, sexual communication, and relationship satisfaction. Theoretical frameworks that guidedthisstudyincludedsexualminor- itystresstheory,throughwhichmembersofminoritygroupsaresubject to chronic stress related to their stigma (Meyer, 1995, 2003;Meyer& Dean, 1998); gender socialization theory, the process through which learning the social expectations and attitudes generally associated with one’s gender and the rationale for why gendered males and females behave in different ways (Fagot, Rodgers, & Leinbach, 2001); stereotype embodiment theory, whereby older adults are affected by the internaliza- tion of stereotypes of aging (Levy, 2009); dynamical systems theory, in which is considered in a non-linear manner (Diamond, 2008), and ecological theory, in which individual develop- ment is affected by the interaction of individual, environmental, and social forces (Bronfenbrenner, 1994).

Older adults and sexual expression

While public perceptions of older adults may be that they are weak, fragile, lonely, less energetic, less adventurous, and not as excited about sex as younger adults, researchers have found otherwise (Hodson & Skeen, 1994). Much of the research on older adults’ sexual expression relates to mixed-sex (i.e., heterosexual) relationships, as will be noted below. In the National Social Life, Health, and Aging Study, Waite, Laumann, Das, and Schumm (2009) obtained a national probability sample of 1550 heterosexual women and 1455 heterosexual men, ages 57 to 85. They found that many of these older adults still engaged in sexual activity but that the prevalence declined with age (73% among 57–64-year-olds, 53% among 65–74-year-olds, and 26% among 75–85-year-olds). Women were signifi- cantly less likely than men to report sexual activity in all age groups. JOURNAL OF HOMOSEXUALITY 3

Sexual expression was both a component and a consequence of the satisfac- tion that individuals felt within their relationships. Among the 57–85-year- old women in sexual relationships, between 88.4% and 89.0% reported being physically satisfied; whereas among the same age group of men, 94.7– 96.5% reported the same. DeLamater’s(2012) meta-analysis of 61 studies on older adults’ sexuality reveals that most of that research was biased toward a biomedical or problem- oriented perspective. He noted that most articles cited specific illnesses, med- ications, hormonal shifts, and age itself as negatively affecting sexual function- ing. He found that adults over 50 remain sexually active into their 70s and 80s and aging-related physical changes do not necessarily lead to reduced sexual functioning. Good physical and mental health, positive attitudes toward sex in later life, and access to a healthy partner were key factors leading to long-term sexual activity. There is scant correlative research focusing on the sexual expression among older adults in same-sex relationships.

Sexual satisfaction: Gender and sexual orientation comparisons Sexual satisfaction is an overall, global appraisal of the quality of one’ssexlife (Holmberg & Blair, 2009). In a study of 325 African-American men and 398 African-American women in same-sex relationships, Peplau, Cochran, and Mays (1997) found high levels of sexual satisfaction with their partners. More recently, an online survey with a total of 423 participants in both mixed-sex and same-sex relationships, of which 322 were women and 101 were men, Holmberg and Blair (2009) found that women in both mixed-sex and same- sex relationships had slightly higher levels of sexual satisfaction than men in both mixed-sex and same-sex relationships. Focusing on 1,009 couples in midlife and older (ages 40–70) in five countries (Brazil, Germany, Japan, Spain, & U.S), Heiman et al. (2011) found that, compared to men, women showed lower sexual satisfaction early in the relationship and more satisfaction later in the relationship. In addition, physical intimacy was a more consistent and salient predictor of sexual satisfaction for men than women. Cohen and Byers (2015) found that, in a sample of 586 sexual minority women, ages 18–72 where 68% identified as lesbian, they experienced similar sexual satisfaction. Mark, Garcia, and Fisher (2015) examined sexual satisfaction across seven sexual relationship contexts through an online survey of 6,955 sexually diverse populations. Men reported significantly more sexual satisfaction than women in all relationship contexts except for those in a committed, unmarried relation- ship. Men in same-sex relationships reported experiencing the most sexual satisfaction during casual sex, whereas women in same-sex relationships reported the least amount of sexual satisfaction from casual sex. 4 J. M. FLEISHMAN ET AL.

Older women’s sexual satisfaction in same-sex relationships

A phenomenon known colloquially as dominated early discussions of lesbian sexuality. This idea, which assumes that have sex less frequently than other couple types and that sexual frequency declines rapidly in lesbian relationships (Cohen & Byers, 2014), was originally uttered at a political rally in 1987 (Iasenza, 2000) based on research conducted by Blumstein and Schwartz (1983). This idea planted the seeds for a bountiful harvest of literature investigating the legitimacy of the phenomenon. The controversy over the sexual nature of lesbian relationships continued for decades (Cohen & Byers, 2014; Iasenza, 2000, 2002; Nichols, 2004, 2005). In a sample of 1,072 women in same-sex relationships, Bridges and Horne (2007) argued against assuming that is indicative of lower sexual satisfaction. In a sample of 822 individuals in differing sexual relation- ship structures (male same-sex, female same-sex, and mixed-sex relation- ships), Blair and Pukall (2014) found that the frequency of sex among women in same-sex relationships does not significantly differ from other types of relationships. Henderson, Lehavot, and Simoni (2009) reported that women in same-sex relationships reported a higher frequency of sexual activity than women in mixed-sex relationships in a sample of 253 women consisting of 139 married heterosexual women and 114 lesbian or bisexual women. Garnets and Peplau (2006) emphasized that sampling discrepancies are inherent in research on women in same-sex relationships. More specifically, the sexual satisfaction of older women in same-sex relationships has not been a widely researched area. In a qualitative study of 39 heterosexual, midlife women ages 45–60, both negative and positive changes in sexual function were reported. Negative changes included decreased frequency, low desire, vaginal dryness, and anorgasmia. Positive changes included better communication skills and more sexual fulfillment (Thomas, Hamm, Hess, & Thurston, 2017). Sexual satisfaction was reported in a sample of 586 women of all ages in same-sex relationships and women with higher relationship satisfaction reported better sexual functioning including sexual satisfaction (Cohen & Byers, 2015) and in a sample of 1,031 women and gender diverse individuals who have sex with women (Bazarsky, 2011). Bazarsky additionally found that 20.8% of those over the age of 70 reported being completely sexually satisfied, the highest percentage of all age groups in her sample.

Older men’s sexual satisfaction in same-sex relationships

Research on sexual satisfaction for older men in same-sex relationships is dwarfed by the literature on men in mixed-sex relationships (Mustanski & Parsons, 2014, 2015). Studies of men in same-sex relationships are often related JOURNAL OF HOMOSEXUALITY 5

to the etiology of homosexuality, HIV transmission, and condom use. Though ’s sexuality has often been characterized as risky and casual, recent research on gay men has diverged from the past and instead focused on positive effects of parenting (Goldberg, 2010), the sexual health of men in same-sex marriages (Herek, 2006) and the importance of love in sexual relationships (Rosenberger, Herbenick, Novack, & Reece, 2014). Frost and Meyer (2009), with a sample of 396 lesbian, gay, and bisexual people (mean age = 32.4; SD = 9.2), found that internalized homophobia had a significant effect on relation- ship problems including sexual functioning. In one of the few studies on older men in same-sex relationships, Lyons, Pitts, and Grierson (2013)foundthat,in a sample of 840 older men in same-sex relationships (mean age= 49), 40% of those over 60 reported being highly sexually satisfied.

Theoretical framework: Ecological theory Bronfenbrenner’s ecological theory (1994) has been shown to be a useful framework to guide the study of sexual satisfaction. This theory posits that individual development is affected by the interaction of individual character- istics with environmental and social conditions. These influences are orga- nized into four interrelated levels: the microsystem (e.g., individual characteristics), the mesosystem (e.g., relationships between microsystems), the exosystem (e.g., broader social systems), and the macrosystem (e.g., institutional and societal factors). Using structural equation modeling, Henderson et al. (2009) successfully utilized an ecological model to explain sexual satisfaction in lesbian, bisexual, and heterosexual women. In their systematic review of 197 scientific papers on sexual satisfaction (Sánchez- Fuentes et al., 2014) identified numerous variables on all four levels of ecological theory associated with sexual satisfaction. It should be noted that many of the studies using ecological theory have been conducted with non- sexual minority individuals and/or young to midlife adults. The current study focuses on older LGBTQ individuals since, using stereotype embodiment theory (Levy, 2009), it is believed that older individuals are exposed to stereotypes over their lifetime and that these stereotypes may have a substantial influence on their health and functioning as they age. Using ecological theory and the research literature, the following variables were identified to be included in the current study of sexual satisfaction among older adults in same-sex relationships: internalized homophobia, resilience, relationship satisfaction, and sexual communication. Internalized homophobia (a microsystem factor reflecting macrosystem factors including stigma and discrimination) was selected since it is a phenomenon that older men and women in same-sex relationships would have contended with beginning in their youth and throughout their lives. According to Meyer (2015), this population must cope with the minority stress that they 6 J. M. FLEISHMAN ET AL. experience throughout their lives and attempt to become resilient (a micro- system factor). On the mesosystem level, relationship satisfaction and sexual communication were selected as important components of sexual relationships.

Internalized homophobia

A term originally coined by Weinberg (1972) represents the sexual minority person’s direction of negative social attitudes toward the self (Frost & Meyer, 2009). Meyer (1995, 2003) identified minority stress theory through which members of minority groups are subject to chronic stress related to the stigma they encounter from society. Internalized homophobia has been identified as the most insidious of all minority stress processes (Meyer & Dean, 1998). Issues that have been shown to be affected by internalized homophobia in an aging LGBTQ population include health, security, and social support concerns (Espinoza, 2014), isolation, distress, loss of self- esteem (Laumann et al., 2005; Lindau et al., 2007), and emotional and social loneliness (Kuyper & Fokkema, 2010). A few studies have examined the association of internalized homophobia and relationship satisfaction among men and women in same-sex relation- ships. Among 90 female same-sex couples in the south midwest of the U.S. (mean age = 32.4; range = 18–58), internalized homophobia related signifi- cantly to higher levels of relationship conflict and lower levels of intimacy and overall relationship satisfaction (Otis, Riggle, & Rostosky, 2006). Similarly, in an online sample of 170 lesbians (mean age = 38.7; SD = 10.13) and 92 gay men (mean age = 37.3; SD = 8.96), higher levels of internalized homophobia and discrimination were predictive of less favorable perceptions of relationship quality (Otis, Rostosky, Riggle, & Hamrin, 2006). In a community sample of 396 lesbian, gay, and bisexual individuals (mean age = 32.43; SD = 9.24), depressive symptoms mediated the relationship between internalized homophobia and relationship problems, which included loneliness, relationship strain, and problems in sexual excitement, desire, and (Frost & Meyer, 2009). However, only one study could be found that examined the relationship between internalized homophobia and sexual satisfaction in same-sex relationships. Henderson et al. (2009) examined sexual satisfaction of 139 married heterosexual women (mean age = 32.9; SD = 7.67) and 114 lesbian and bisexual women (mean age = 33.4; SD = 8.31) through an online survey in the Seattle area. Structural equation modeling found that relationship satisfaction mediated the relationship between social support and sexual satisfaction in both groups of women. Additionally, relationship satisfaction mediated the relationship of social support and internalized homophobia in lesbian/bisexual women. It should be noted that none of this research focused on older individuals. JOURNAL OF HOMOSEXUALITY 7

Resilience

Conceptually, resilience appears in the field of psychology as a protective factor or safe harbor for individuals dealing with rising tides of turbulence in their lives. The American Psychological Association defines resilience as “the process of adapting well in the face of adversity, trauma, tragedy, threats, or significant sources of stress” (APA, 2015, p. 1). Meyer (2015) notes that while LGBTQ individuals face minority stress throughout their lives, research on resilience in this population has lagged behind research into other popula- tions. However, Carry (2010) found that higher levels of resilience were associated with greater acceptance in a sample of 137 Black and Latina self-identified same-sex attracted women (mean age = 30; SD = 9.0). Frost and Meyer (2009), in a sample of 396 sexual minorities (mean age = 32.4; SD = 9.2) indicated positive self-esteem can improve sexual minorities’ resilience in the face of discrimination and suggested coping mechanisms important to sexual minorities. In addition, resilience and sexual minority stressors have been correlated for same-sex parents (Titlestad & Pooley, 2014), those living with HIV/AIDS (Bidell, 2010), and those using club drugs and engaging in risky sex (Dentato, Halkitis, & Orwat, 2013). Since stress accumulates throughout a lifetime (MacLeod, Musich, Hawkins, Alsgaard, & Wicker, 2016), there is a call to study resilience among older LGBTQ individuals, particularly how it affects their sexuality and relation- ships (de Vries, 2015).

Relationship satisfaction

Relationship satisfaction has been defined as the overall level of positive affect experienced in the relationship and the extent to which important needs are being met in the relationship (Kurdek, 2006). In one study of intimacy in heterosexual and same-sex relationships, Mackey, Diemer, and O’Brien (2000) found that older lesbians (mean age = 57; SD = 10.24) in long-term relationships (mean length of relationship = 32 years; SD = 10.28) reported high levels of intimacy and relationship satisfaction if they also reported a positive sexual relationship. Cohen and Byers (2015) expanded on earlier research (Henderson et al., 2009) and found an association between relationship satisfaction and sexual satisfaction in a sample of 596 women in lesbian relationships (mean age = 34.5; SD = 10.7). Kurdek (2008) compared the relationship satisfaction for partners from 95 women’s same-sex relationships, 92 men’s same-sex relationships, and 538 women and men in mixed-sex relationships and found little difference by gender or orientation. Prior research has found that relationship satisfaction and sexual satisfaction are significantly associated with mixed-sex relation- ships among young and midlife adults. In a review of existing literature on 8 J. M. FLEISHMAN ET AL. relationship satisfaction and sexual satisfaction, Sprecher and Cate (2004) found sexual satisfaction to be a predictor for relationship satisfaction in married, heterosexual couples. In a longitudinal study of 87 individuals (mean age = 37.7, SD = 10.0) in long-term heterosexual relationships (mean length of relationship = 12.2, SD = 9.3), Byers (2005) found that relationship satisfaction and sexual satisfaction changed concurrently.

Sexual communication

Sexual communication is the process of discussing aspects of one’ssexlifewith one’s partner both verbally and non-verbally (Holmberg & Blair, 2009). Pioneering couples’ researchers found an association between lack of commu- nication or miscommunication, sexual dysfunction, and incompatibility among mixed-sex couples (Kaplan, 1974; Masters & Johnson, 1970). (1979) later found that male and female same-sex couples were far more likely to communicate sexually with each other about what they want and enjoy than their mixed-sex counterparts. Same-sex couples may talk with each other more often about what they want and like sexually, since the particular sexual script that exists for mixed-sex relationships (i.e., penetration as the final stage in a sexual encoun- ter) may not similarly exist for same-sex relationships. Decades later, research with heterosexual college couples (Mark & Jozkowski, 2013), married couples (Litzinger & Gordon, 2005; Theiss, 2011; Timm & Keiley, 2011), and a national online survey of over 38,000 mixed-sex couples (Frederick, Lever, Gillespie, & Garcia, 2017) repeatedly found that sexual satisfaction is higher among couples who have better sexual communication. Gottman, Levenson, and Swanson (2003) studied 20 mixed-sex couples and 20 same-sex couples (mean age of women = 29.3; mean age of men = 32.5). They found that same-sex partners showed higher levels of communication around conflict than mixed-sex partners and same-sex couples began conflict discussions with less negative and more positive affect than did mixed-sex partners. In addition, they found some interactions of gender and sexual orientation dependent on whether the communication was more positive or negative. It should be noted that very few of the participants in these reviewed studies were older adults.

The study

As older LGBTQ individuals become more visible and strive for equality in U.S. society, they still suffer from a dual “invisibility” in sexuality research due to their aging and sexual minority statuses. Sexuality research on LGBTQ individuals and same-sex couples is dwarfed by research on heterosexual individuals and mixed-sex couples. This is evident in research focusing on sexual satisfaction, an important aspect of sexual relationships no matter one’s age, gender, or sexual orientation. Using ecological theory and prior JOURNAL OF HOMOSEXUALITY 9 research, the present study aimed to examine correlates and predictors for sexual satisfaction of older adults in same-sex relationships. The following independent variables were chosen for this study: internalized homophobia and resilience (microsystem factors) and relationship satisfaction and sexual communication (mesosystem factors). The research questions for this study are as follows. For people, ages 60–75, in same-sex relationships:

(1) What are the associations between internalized homophobia, resili- ence, sexual communication, relationship satisfaction, and sexual satisfaction? (2) What are the predictors of sexual satisfaction?

Methods Data collection Because this is an often hidden population (Ellard-Gray, Jeffrey, Choubak, & Crann, 2015; Van Sluytman & Torres, 2014), we conducted a purposive, non- random study using a confidential, online survey tool for participant self- reports through SurveyMonkey™. We used three inclusion criteria in the study sample: respondents must be between the ages of 60 and 75, reside in either the United States or Canada, and currently be part of a same-sex relationship. We decided to include LGBTQ adults who came of age around the time of Stonewall and early LGBTQ civil rights movements, and we chose to specifically focus on 60–75-year-olds in this study since those adults approximate the “baby boomer” years of birth from the mid-1940s to the mid-1960s. Therefore, they were more likely to be influenced by the nascent “gay” liberation and other social movements of the 1970s. After approval by the Widener University Institutional Review Board, we conducted our recruitment process from June to September 2015. Given that some older adults do not self-identify using the current sexual orientation terms (such as gay, lesbian, bisexual, trans, queer/questioning, or LGBTQ), participants needed only to self-identify as being part of a same-sex relation- ship to participate in this study. In order to obtain a diverse sample of older adults in same-sex relationships, we actively recruited participants using purposive sampling from online postings on the SAGE (Services and Advocacy for GLBT Elders) website and affiliated websites, other relevant social media sites, over 50 LGBTQ community centers, LGBTQ senior organizations, gay choruses, lesbian softball teams, and other trans and queer networks. To increase our reach, we also used snowball sampling by distributing flyers in areas with large populations of older LGBTQ indivi- duals, for instance, Provincetown, Massachusetts; Michigan Womyn’s Music Festival; and Ohio lesbian music festival, to name a few. 10 J. M. FLEISHMAN ET AL.

Measurement We used an instrument with 74 survey questions using 5-point Likert scales. The instrument included 27 questions on sexual satisfaction, five questions on internalized homophobia, 25 questions on resilience, four questions on rela- tionship satisfaction, and 13 questions on sexual communication. Participants were also asked to provide the following demographic information: age, place of residence, type of same-sex relationship, length of current relationship, exclusivity of relationship, gender identity, education, race/ethnicity, religion of family of origin, and current religion (if any). Each of the scales used in the survey were adapted for uniformity by using 5-point Likert responses.

Sexual satisfaction. We measured the major variable of interest, sexual satisfaction, using the 25-item self-report Index of Sexual Satisfaction (ISS) developed by Hudson, Harrison, and Crosscup (1981). Responses to the items are on a 5-point Likert-type scale from 1 (rarely)to5(most of the time). Higher scores on the ISS indicate a higher level of sexual satisfaction. A sample item is “Sex is fun for my partner and me.” The ISS has been used fairly recently in other research on same-sex relationships and has yielded a Cronbach’s alpha of .91 using three samples of adults 40–80 years of age (Holmberg & Blair, 2009). We added two single-item questions using a 5-point Likert-type scale: “Do you find your sexual relationship with your partner satisfactory?” and “Over the past four weeks, how satisfied have you been with your overall sex life?” for a total of 27 questions.

Internalized homophobia. To measure internalized homophobia, we used the revised five-item Internalized Homophobia (IHP-R) Scale (Herek, Gillis, & Cogan, 2009). Responses to each item are on a 5-point Likert-type scale ranging from 1 (strongly disagree)to5(strongly agree). Higher scores on this scale indicate higher internalized homophobia. A sample item is “I have tried to stop being attracted to women in general.” This scale has been used in many other studies (Hamilton & Mahalik, 2009; Lewis, Milletich, Derlega, & Padilla, 2014; Mason & Lewis, 2015), has yielded a Cronbach’s alpha of .86, and is highly correlated with the full IHP for all sexual orientation groups (Herek et al., 2009).

Resilience. To measure resilience, we used the 25-item Resilience Scale designed to identify the degree of personal competence and acceptance of self and life (Wagnild & Young, 1993). Responses range on a 5-point Likert- type scale ranging from 1 (strongly disagree)to5(strongly agree). Higher numbers indicate more resilience. A sample item is “I usually manage one way or another.” Reliability was high with Cronbach's alpha of .91 established with a sample of 810 older adults (Wagnild & Young, 1993). JOURNAL OF HOMOSEXUALITY 11

Relationship satisfaction. To measure relationship satisfaction, we used a shortened (four-item) version of the Couples’ Satisfaction Index (CSI), a 32-item scale designed to measure one’s satisfaction in a relationship (Funk & Rogge, 2007). Responses range on a 5-item Likert-type scale from 1(not at all true)to5(completely true), with higher scores indicating greater relationship satisfaction. A sample item is “How rewarding is your relation- ship with your partner?” Funk and Rogge tested the CSI against eight other well-validated self-report measures of relationship satisfaction including the two most widely cited measures of relationship adjustment: the Marital Adjustment Test (MAT; Locke & Wallace, 1959) and the Dyadic Adjustment Scale (DAS; Spanier, 1976), and an additional 75 potential satisfaction items. These were given to 5,315 online participants (mean age= 26; SD = 10.5). When compared with the MAT and the DAS, the CSI scales were shown to have higher precision of measurement (less noise) and correspondingly greater power for detecting differences in levels of satisfac- tion. Funk and Rogge reported that the CSI scales demonstrated strong convergent validity and excellent construct validity. In a meta-analysis, the CSI was found to have an average Chronbach’s alpha of .94 (Graham, Diebels, & Barnow, 2011). Funk and Rogge created three versions of the CSI measure with lengths appropriate to a variety of different applications: 32-item, 16-item, and 4-item scales. They found that even the brief four-item scale surpassed the MAT and DAS scales.

Sexual communication. We measured sexual communication using the Dyadic Sexual Communication Scale, a 13-item scale designed to assess respondents’ perceptions of the communication process encompassing sexual relationships (Catania, 1998). Responses range on a 5-point Likert-type scale ranging from 1 (strongly disagree)to5(strongly agree), with higher scores indicating better sexual communication. A sample item is “My partner and I can usually talk calmly about our sex life.” A Cronbach’s alpha of .81 was established with a sample of 500 adults (Catania, 1998). This scale has been used in previous research on same-sex relationships (Holmberg & Blair, 2009).

Analytic plan After considering the findings and limitations of previous studies, we chose a quantitative analytic approach to examining sexual satisfaction in older adults’ same-sex relationships with two hypotheses. The first hypothesis was tested through SPSS using bivariate correlations for associations between internalized homophobia, resilience, sexual communication, relationship satisfaction, and sexual satisfaction. The second hypothesis was tested through stepwise multiple regressions using sexual satisfaction as the depen- dent variable and the other variables as independent variables as predictors. 12 J. M. FLEISHMAN ET AL.

Table 1. Demographics of the sample. Variable n % Age 60–64 137 52 65–69 87 33 70–75 41 16 Ethnicity African/African American/Black/Caribbean 4 2 Asian/Asian American/South Asian/Pacific Islander/Hawaiian 1 <1 Latino (a)/Hispanic/Latin American 5 2 Multiracial 9 4 Native American/American Indian 1 <1 White/European American 217 92 Educational level Some high school 1 <1 High school diploma/GED 2 1 Some college/university 28 12 College degree 65 27 Graduate degree 140 60 Geographic region Midwest 23 9 Northeast 93 35 South 53 20 West 61 23 Canadian Provinces 35 13 Type of same-sex relationship Female same-sex 144 54 Male same-sex 121 46 Gender identity Female 125 53 Male 107 46 Transgender 3 1 Other 3 1 Length of relationship (years) 1–95522 10–19 78 32 20+ 113 46 Exclusivity of relationship Totally monogamous 175 74 Somewhat monogamous 45 19 Non-monogamous 17 7

Sample After cleaning the data, the final sample consisted of 265 older adults whose demographics are presented in Table 1. Of these respondents, 51.7% were between the ages of 60 and 64, 32.8% were between the ages of 65 and 69, and 15.5% were between the ages of 70 and 75. Participants were widely dispersed throughout most of the United States and Canada with heaviest concentrations in the east and west coasts: Massachusetts (13.6%), California (7.9%), New York (5.7%), and British Columbia (5.3%). The sample was divided between those identifying as part of a female same-sex relationship (54.3%) and those in a male same-sex relationship (45.7%). Participants were primarily in longer-term rela- tionships. Almost half of the sample (42.6%) reported 20 or more years in their JOURNAL OF HOMOSEXUALITY 13 current relationship, almost one-third of the sample (29.4%) reported 10–19 years in their current relationship, and approximately one-fifth of the sample (20.8%) reported 1–9 years in their current relationship. Men (51%) were more likely than women (42%) to be in relationships of 20 or more years. Almost three-quarters (73.8%) reported their relationship as totally monogamous, 19% reported their relationship as somewhat monogamous, and 7.2% reported their relationship as non-monogamous. Approximately one-half of the respondents identified as female (47.2%), 40.4% of the sample identified as male, and 1.1% reported their gender identity as either trans or as another term such as genderqueer, androgyne, and female androgynous. The vast majority of the sample were highly educated with over 58.8% having attained a graduate degree, 27.3% having earned a college degree, 11.8% having some college or university education, 0.8% having a high school diploma or GED, and 0.4% having attained some high school. Over 90% (91.6%) identified as White/European American, 3.8% identified as Multiracial, 2.1% identified as Latino(a)/Hispanic/Latin American, 1.7% identified as African/African American/Black/Caribbean, 0.4% identified as Asian/Asian American/South Asian/Pacific Islander/ Hawaiian Native, and 0.4% identified as Native American/American Indian. The total number of participants (N= 265) was deemed to have sufficient statistical power to decrease the chances of a Type II error or false negative and the ability to detect an effect if the effect actually existed.

Limitations There were a number of limitations to this study. Research using a random sampling method would have provided more generalizable results. Purposive sampling was used since LGBTQ individuals and especially those between the ages of 60–75 comprise a mostly hidden population due to their historical margin- alization. In the future, with societal and cultural change, the characteristics of this target population may be more readily known and more generalizable results may be obtained. This research was publicized as an online sexuality survey and therefore, may only have garnered participants who were comfortable answering survey questions about sexuality. Though the goal was to get a large cross-section of the aging LGBTQ population in the U.S. and Canada, persons from the middle of the U.S., non-White ethnic backgrounds, and with less education are under- represented. Gosling, Vazire, Srivastava, and John (2004) researched whether online surveys might skew the participant responses toward those with higher educational levels/higher incomes and reduce the probability of a representative sample yet found no significant difference from traditional surveys. With an LGBTQ population, there may actually be some advantages of an online survey including greater participant motivation to respond thoughtfully to questions with less socially desirable responses and the ability to reach a population of individuals that might otherwise be difficult to recruit. Further, this research relied solely on self-reports of participants in an online environment. There is conflicting evidence 14 J. M. FLEISHMAN ET AL.

related to the validity of self-reporting. Some have postulated that there may be unconscious or conscious bias on the part of the participants who might want to skew the results to look more favorably on their lives (Schroder, Carey, & Vanable, 2003). Others, including the researchers of this study, consider self-reports as a valid tool for collecting data on sensitive topics such as sexual satisfaction (Durant & Carey, 2002).

Results

First, we produced measures of central tendency generating mean, median, standard deviation, and minimum/maximum values for continuous (interval/ ratio) variables as well as percentages for categorical (ordinal) variables. We then inspected the distribution for all variables for non-normality; no non-normality was detected. Table 2 presents the mean value differences including number of respondents, minimum, maximum, mean, and standard deviation for each of the five scales included in this study. The low mean score on the Internalized Homophobia Scale (M = 1.22; SD = .48) indicates that this sample of older individuals in same-sex relationships generally had low levels of internalized homophobia. The high mean scores on the Resilience Scale (M = 4.09; SD = .38) and the Couples Satisfaction Index (M = 4.27; SD = .67) indicate a very high level of resilience and relationship satisfaction among this sample. The mean score on the Dyadic Sexual Communications Scale (M = 2.77; SD = .27) indicates a mid- range level of sexual communications among this sample. The mean score on the Index of Sexual Satisfaction (M = 2.82; SD = .45) indicates a mid-range level of sexual satisfaction among this sample and was lower than that for relationship satisfaction.

Analysis of H1: What are the associations between internalized homophobia, resilience, sexual communication, relationship satisfaction, and sexual satisfaction?

Using SPSS, Pearson’s correlation coefficients were conducted using a two-tailed test of significance (p < .05) for each of the scales to assess associations between internalized homophobia, resilience, sexual communication, relationship satis- faction, and sexual satisfaction using a confidence interval of 95%. A Pearson’s

Table 2. Minimum, maximum, mean, and standard deviation of variables. N Minimum Maximum Mean Std. Deviation Internalized Homophobia 209 1.00 5.00 1.22 .48 Resilience 237 1.00 5.00 4.09 .38 Sexual Communication 224 1.00 5.00 2.77 .27 Relationship Satisfaction 238 1.00 5.00 4.27 .67 Sexual Satisfaction 211 1.00 5.00 2.82 .45 JOURNAL OF HOMOSEXUALITY 15

r data analysis indicated four significant correlations between variables: inter- nalized homophobia was significantly negatively correlated with both relation- ship satisfaction (r=-.51,p< .05) and resilience (r=-.25,p< .01) and relationship satisfaction was significantly positively correlated with resilience (r= .20, p<.01) and sexual satisfaction (r=.31,p< .01). (See Table 3)

Analysis of H2: What are the predictors of sexual satisfaction?

Using SPSS, a stepwise multiple regression analysis was performed in order to predict the effects of the independent variables (internalized homophobia, resilience, relationship satisfaction, and sexual communication) on the dependent variable of sexual satisfaction. Each independent variable was entered to find its predictive power, controlling for the variance of the previous predictors. As indicated in Table 4, an analysis of variance (ANOVA) tested the statistical significance (p < .05) of the model at each step. Relationship satisfaction was the only independent variable that met the output criteria in the model, F(1) = 33.994, p< .001, as a predictor for sexual satisfaction. Therefore, the other independent variables were excluded from the model since they co-vary but do not predict. In Tables 5 and 6, regression analysis indicated that relationship satisfac- tion is the only predictor variable in the model (Adjusted R2 = .137, p < .05), explaining 13.7% of the variance in sexual satisfaction. A model (see Figure 1) helps to further illustrate the correlations as well as the results of the stepwise linear regression. Significant negative correlations

Table 3. Bivariate pearson correlations using main variables. Sexual Internalized Sexual Commu Relationship Resil Satisfaction Homophobia nication Satisfaction ience Sexual Pearson – −.047 .052 .307** −.026 Satisfaction Correlation Sig. – .496 .451 .000 .709 (2-tailed) Internalized Pearson −.047 – .067 −.151* −.247** Homophobia Correlation Sig. .496 – .333 .029 .000 (2-tailed) Sexual Pearson .052 .067 – .017 −.015 Communic- Correlation ation Sig. .451 .333 – .804 .822 (2-tailed) Relationship Pearson .307** −.151* .017 – .204** Satisfaction Correlation Sig. .000 .029 .804 – .002 (2-tailed) Resilience Pearson −.026 −.247** −.015 .204** – Correlation Sig. .709 .000 .822 .002 – (2-tailed) 16 J. M. FLEISHMAN ET AL.

Table 4. Analysis of variance of relationship satisfaction as a predictor of sexual satisfaction. Model Sum of Squares df Mean Square F Sig. Regression 4.249 1 4.249 33.994 .000b Residual 25.749 206 .125 Total 29.998 207 Dependent Variable: Sexual Satisfaction Predictors: (Constant), Relationship Satisfaction

Table 5. Model summary. Model R R2 Adjusted R2 Std. Error of the Estimate .376 .142 .137 .35,355 Dependent Variable: Sexual Satisfaction Predictors: (Constant), Relationship Satisfaction

were found between internalized homophobia and resilience; internalized homophobia and relationship satisfaction; and a significant positive correla- tion was found between resilience and relationship satisfaction. Relationship satisfaction subsequently predicts sexual satisfaction.

Discussion

Unraveling what we know about the sexual lives of older adults in same-sex relationships is important because, although these individuals are becoming more visible in society, little is empirically known about their sexual relation- ships. Sexual satisfaction has been shown to be important for the quality of life and mental and physical health of older and non-sexual minority individuals (DeLamater, 2012; Whipple, Knowles, Davis, Gianotten, & Owens, 2007). Therefore, this study focused on the correlates and predictors of sexual satisfac- tion experienced by 265 individuals in same-sex couples between the ages of 60–75. Over 45% of the sample reported being in a male same-sex relationship yet only 40.4% reporting being male-identified. This may be an artifact of response rate; only 89.8% responded to the question of gender identity, whereas there was a 100% rate of response to the question of gender of same-sex relationship. The sample is disproportionately more educated than the overall U.S. population and the U.S. population over 65 (33% women and 32% men have attained a bachelor’s degree or higher) respectively (Ryan & Bauman, 2016). Thus, the responses were highly skewed toward well-educated indivi- duals. In addition, the responses were highly skewed toward White/European

Table 6. Standardized coefficients. Model Beta t Sig. (Constant) 11.105 .000 Relationship Satisfaction .376 5.830 .000 JOURNAL OF HOMOSEXUALITY 17

Internalized Homophobia

Relationship Sexual Satisfaction r=.31, p<.01 Satisfaction <.01

p Predictor Adj r2=.137, p<.05 Outcome Variable Variable =-.25, =-.25, r

Resilience

Figure 1. Regression model with correlations, predictor, and outcome variables.

Americans (81.9%) while the U.S. population of White/European Americans over 65 is 77.3% (Roberts, Ogunwole, Blakeslee, & Rabe, 2018). Using the Index of Sexual Satisfaction, the sample had a mean score of 2.82 on a 5-point Likert-type scale, indicating moderate sexual satisfaction for both men (M = 2.84; SD = .40) and women (M= 2.81; SD = .48). This finding is supported by previous research on same-sex relationships. Among younger adults, Holmberg and Blair (2009) also found that men in mixed-sex and same-sex relationships were moderately sexually satisfied, although women in these types of relationships had higher levels of sexual satisfaction than the men. Among older adults, Lyons et al. (2013) found that 40% of the gay men who were older than 60 reported being very sexually satisfied. Bazarsky (2011) found the 30- and 70-year-olds in her study of women and sexually diverse individuals in relationships with women had the highest levels of sexual satisfaction compared to women in other age groups. Our study has contributed to a growing literature indicating that moderate to high levels of sexual satisfaction can be experienced by older adults regardless of gender in same-sex relationships. Guided by ecological theory, analyses indicated the important roles that microsystem and mesosystem factors play in the experience of sexual 18 J. M. FLEISHMAN ET AL. satisfaction. More specifically, internalized homophobia, resilience, relation- ship satisfaction, and sexual communication are all factors that have been theoretically and empirically associated with sexual satisfaction, particularly in younger and non-sexual minority individuals. We tested these associations using Pearson’s correlation coefficients with our sample of older adults in same-sex relationships and found a few significant correlations. Internalized homophobia was significantly negatively correlated with both resilience and relationship satisfaction. Since resilience is the process of adapting well in the face of significant sources of stress like internalized homophobia (Meyer, 1995, 2003, 2015), it makes conceptual sense that persons who must deal with the variety of sexual minority stressors are challenged to become more resilient. Previous studies found a mitigating effect of resilience on other types of stressors among samples of other sexual minority individuals (Bidell, 2010; Dentato et al., 2013; Titlestad & Pooley, 2014). Our study has expanded the literature to show that older adults in same-sex relationships with lower levels of internalized homophobia report higher levels of resilience and vice versa. A few prior studies of young adult gay men, lesbians, and bisexuals have found indirect correlations between internalized homophobia and over- all relationship satisfaction (Meyer & Dean, 1998; Otis et al., 2006), quality of relationships (Otis et al., 2006), and relationship satisfaction (Balsam, 2002; Balsam & Szymanski, 2005). Our study is the first to demonstrate that older individuals in same-sex relationships who have lower levels of internalized homophobia tend to have higher levels of relationship satisfaction and vice versa. In addition, we found that resilience and relationship satisfaction were significantly positively correlated among our sample of older adults in same- sex relationships. In previous research examining the relationship of inter- nalized homophobia to various aspects of same-sex relationships, Frost and Meyer (2009) found that internalized homophobia was associated with greater relationship problems. It should be noted that, contrary to the find- ings of previous studies, sexual communication was not significantly corre- lated with any of the other variables. Upon reflection, the Dyadic Sexual Communication Scale may not have been the best measurement instrument to use with a population of older LGBTQ individuals. However, relationship satisfaction was significantly positively correlated with sexual satisfaction. Further, using multiple stepwise regression analysis, relationship satisfaction was also the only variable to emerge as a significant predictor of sexual satisfaction. Previous research with younger couples (Byers, 2005; Sprecher & Cate, 2004) and same-sex couples (Bryant & Demina, 1994; Kurdek, 1998) has also found significant associations between relationship satisfaction and sexual satisfaction. Yet, ours is the only research that studied these variables on older individuals in same-sex relationships. JOURNAL OF HOMOSEXUALITY 19

Summary and recommendations This study has broken ground in examining the sexual satisfaction of older adults (ages 60–75) in same-sex relationships. In doing so, some important findings emerged regarding older adults in same-sex relationships.

(1) Ecological theory is useful in studying sexual satisfaction. (2) Individuals with lower levels of internalized homophobia tend to have higher levels of resilience and vice versa. (3) Individuals with lower levels of internalized homophobia tend to have higher levels of relationship satisfaction and vice versa. (4) Individuals with higher levels of resilience tend to have higher levels of relationship satisfaction and vice versa. (5) Relationship satisfaction is a positive predictor of sexual satisfaction.

We recommend that our findings be the springboard for future research on this under-researched and growing population of older adults in same-sex relationships. Our research can be expanded to examine the sexual satisfac- tion of older individuals of various ages, of differing racial/ethnic and educational backgrounds, and in different types of same-sex relationships. Using ecological theory, additional variables describing various aspects of the relationship (mesosystem), sexual repertoires (mesosystem), minority stress (exosystem), socioeconomic status (exosystem), and religion (macrosystem) can be studied as correlates and predictors of sexual satisfaction. Qualitative research would also help to illuminate the experience of sexual satisfaction. Given the paucity of sexuality research on older adults in same-sex relationships, there are some important implications of this study, such that these findings would be useful to incorporate into educational, clinical, and policy-making settings. To dispel myths, unearth discrepancies in knowledge, and impart new ways of thinking, we recommend that the findings be used to educate those who are preparing for professional careers as clinicians, sexuality educators, gerontologists, social workers or policy- makers working with older adults, particularly those in LGBTQ popula- tions. For clinicians working with older individuals in same-sex relationships, focusing on the client’s internalized homophobia and resi- lience would be key to improving the relationship and sexual satisfaction. Those who make policies affecting older LGBTQ adults should be cognizant of the importance of sexual satisfaction and the factors that improve this important aspect of relationships. People should be armed with scientific findings in order to discern fact from fiction and disarm the myths and stereotypes that surround this population. 20 J. M. FLEISHMAN ET AL.

Disclosure statement

No potential conflict of interest was reported by the authors.

References

American Psychological Association. (2015). The road to resilience. Retrieved from http:// www.apa.org/helpcenter/road-resilience.aspx Balsam, K. F. (2002). Traumatic victimization in the lives of lesbian and bisexual women: A contextual approach. Journal of Lesbian Studies, 7(1), 1–14. doi:10.1037/0893- 3200.16.2.144 Balsam, K. F., & Szymanski, D. M. (2005). Relationship quality and domestic violence in women’s same-sex relationships: The role of minority stress. Psychology of Women Quarterly, 29, 258–269. doi:10.1111/j.1471-6402.2005.00220.x Bazarsky, D. E. (2011). The love that dares speak its name: Identity and behavior of women and gender diverse people who are sexually intimate with women (Unpublished disserta- tion). Widener University, Chester, PA. Bidell, M. P. (2010). Can nature heal? The impact of adventure-based counseling for gay/ bisexual men living with HIV/AIDS. Counseling Outcome Research and Evaluation, 1(2), 68–79. doi:10.1177/2150137810367801 Blair, K. L., & Pukall, C. F. (2014). Can less be more? Comparing duration vs. frequency of sexual encounters in same-sex and mixed-sex relationships. The Canadian Journal of Human Sexuality, 23(2), 123–136. doi:10.3138/cjhs.2393 Blumstein, P., & Schwartz, P. (1983). American couples: Money, work and sex. New York, NY: Pocket Books. Bridges, S. K., & Horne, S. G. (2007). Sexual satisfaction and desire discrepancy in same sex women’s relationships. Journal of Sex and Marital Therapy, 33,41–53. doi:10.1080/ 009262306009984466 Bronfenbrenner, U. (1994). Ecological models of human development. In T. Husen & T. N. Postlethwaite (Eds.), International encyclopedia of education (Vol. 3, 2nd ed., pp. 3–44). Oxford, UK: Elsevier. Bryant, A. S., & Demina. (1994). Relationship characteristics of American gay and lesbian couples: Findings from a national survey. Journal of Gay and Lesbian Social Services, 1(2), 101–117. doi: 10.1300/J041v01n02_06 Byers, E. S. (2005). Relationship satisfaction and sexual satisfaction: A longitudinal study of individuals in long-term relationships. Journal of Sex Research, 42(2), 113–118. doi:10.1080/00224490509552264 Carry, M. (2010). ‘In spite of it all’: Resilience, sexual identity acceptance, and disclosure among Black and Latina same-sex attracted women (Unpublished doctoral dissertation). Emory University, Atlanta, GA. Catania, J. A. (1998). Dyadic sexual communication scale. In C. M. Davis, W. L. Yarber, R. Bauserman, G. Schreer, & S. L. Davis (Eds.), Handbook of sexuality-related measures (pp. 129–130). Thousand Oaks, CA: Sage. Cohen, J. N., & Byers, E. S. (2014). Beyond lesbian bed death: Enhancing our understanding of the sexuality of sexual-minority women in relationships. Journal of Sex Research, 51(8), 893–903. doi:10.1080/00224499.2013.795924 Cohen, J. N., & Byers, E. S. (2015). Minority stress, protective factors, and sexual functioning of women in a same-sex relationship. Psychology of Sexual Orientation and Gender Diversity, 2(4), 391–403. doi:10.1037/sgd000010 JOURNAL OF HOMOSEXUALITY 21

de Vries, B. (2015). Stigma and LGBT aging: Negative and positive marginality. In N. A. Orel & C. A. Fruhauf (Eds.), The lives of LGBT older adults: Understanding challenges and resilience (pp. 55–71). Washington, DC: American Psychological Association. DeLamater, J. (2012). Sexual expression in later life: A review and synthesis. Journal of Sex Research, 49(2–3), 125–141. doi:10.1080/00224499.2011.603168 Dentato, M. P., Halkitis, P. N., & Orwat, J. (2013). Minority stress theory: An examination of factors surrounding sexual risk behavior among gay and bisexual men who use club drugs. Journal of Gay and Lesbian Social Services, 25(4), 509–525. doi:10.1080/ 10538720.2013.829395 Diamond, L. M. (2008). Female from adolescence to adulthood: Results from a 10-year longitudinal study. Developmental Psychology, 44(1), 5–14. doi:10.1037/0012- 1649.44.1.5 Durant, L. E., & Carey, M. P. (2002). Reliability of retrospective self-reports of sexual and nonsexual health behaviors among women. Journal of Sex & Marital Therapy, 28(4), 331–338. doi:10.1080/00926230290001457 Ellard-Gray, A., Jeffrey, N. K., Choubak, M., & Crann, S. E. (2015). Finding the hidden participant: Solutions for recruiting hidden, hard-to-reach, and vulnerable populations. International Journal of Qualitative Methods, 14(5). doi:10.1177/1609406915621420 Espinoza, R. (2014). Out and visible: The experiences and attitudes of lesbian, gay, bisexual and transgender older adults, ages 45–75. Retrieved from https://www.sageusa.org/resource- posts/out-visible-the-experiences-and-attitudes-of-lesbian-gay-bisexual-and-transgender- older-adults-ages-45-75-by-the-numbers-full-report/ Fagot, B. I., Rodgers, C. S., & Leinbach, M. D. (2001). Theories of gender socialization. In T. Eckes & H. M. Trautner (Eds.), The developmental social psychology of gender (pp. 65–89). Mahwah, NJ: Lawrence Erlbaum Associates, Inc. Frederick, D. A., Lever, J., Gillespie, B. J., & Garcia, J. R. (2017). What keeps alive? Sexual satisfaction is associated with sexual communication, mood setting, sexual variety, oral sex, orgasm, and sex frequency in a national US study. The Journal of Sex Research, 54 (2), 186–201. doi:10.1080/00224499.2015.1137854 Fredriksen-Goldsen, K. I., & Kim, H. J. (2017). The science of conducting research with LGBT older adults-an introduction to aging with pride: National health, aging, and sexuality/gender study (NHAS). The Gerontologist, 17(1), 1–14. doi:10.1093/geront/gnw212 Frost, D. M., & Meyer, I. H. (2009). Internalized homophobia and relationship quality among lesbians, gay men, and bisexuals. Journal of Counseling Psychology, 56(1), 97–109. doi:10.1037/a0012844 Funk, J. L., & Rogge, R. D. (2007). Testing the ruler with item response theory: Increasing precision of measurement for relationship satisfaction with the couples satisfaction index. Journal of Family Psychology, 21, 572–583. doi:10.1037/0893-3200.21.4.572 Garnets, L., & Peplau, L. A. (2006). Sexuality in the lives of aging lesbian and bisexual women. In D. C. Kimmel, T. Rose, & S. David (Eds.), Lesbian, gay, bisexual, and transgender aging (pp. 70–90). New York, NY: Columbia University Press. Gates, G. J. (2011). How many people are lesbian, gay, bisexual and transgender? The Williams Institute. Retrieved from https://escholarship.org/uc/item/09h684x2 Gates, G. J., & Newport, F. (2015). An estimated 780,000 Americans in same-sex marriages. UCLA: The Williams Institute. Retrieved from https://escholarship.org/uc/item/1pr4m1pr Goldberg, A. E. (2010). Lesbian and gay parents and their children: Research on the family life cycle. Washington, DC: American Psychological Association. doi:10.1037/12055-000 Gosling, S. D., Vazire, S., Srivastava, S., & John, O. P. (2004). Should we trust web-based studies? A comparative analysis of six preconceptions about internet questionnaires. American Psychologist, 59(2), 93–104. doi:10.1037/0003-066X.59.2.93 22 J. M. FLEISHMAN ET AL.

Gottman, J. M., Levenson, R. W., & Swanson, C. (2003). Observing gay, lesbian, and heterosexual couples’ relationships: Mathematical modeling of conflict interaction. Journal of Homosexuality, 45,65–91. doi:10.1300/J082v45n01_04 Graham, J. M., Diebels, K. J., & Barnow, Z. B. (2011). The reliability of relationship satisfac- tion: A reliability generalization meta-analysis. Journal of Family Psychology, 25(1), 39–48. doi:10.1037/a0022441 Hamilton, C. J., & Mahalik, J. R. (2009). Minority stress, masculinity, and social norms predicting gay men’s health risk behaviors. Journal of Counseling Psychology, 56(1), 132. doi:10.1037/a0014440 Heiman, J. R., Long, J. S., Smith, S. N., Fisher, W. A., Sand, M. S., & Rosen, R. C. (2011). Sexual satisfaction and relationship happiness in midlife and older couples in five countries. Archives of Sexual Behavior, 40(4), 741–753. doi:10.1007/s10508-010-9703-3 Henderson, A. W., Lehavot, K., & Simoni, J. M. (2009). Ecological models of sexual satisfac- tion among lesbian/bisexual and heterosexual women. Archives of Sexual Behavior, 38, 50–65. doi:10.1007/s10508-008-9384-3 Herek, G. M. (2006). Legal recognition of same-sex relationships in the United States: A social science perspective. American Psychologist, 61(6), 607–621. doi:10.1037/0003- 066X.61.6.607 Herek, G. M., Gillis, J. R., & Cogan, J. C. (2009). Internalized stigma among sexual minority adults: Insights from a social psychological perspective. Journal of Counseling Psychology, 56,32–43. doi:10.1037/a0014672 Hodson, D. S., & Skeen, P. (1994). Sexuality and aging: The hammerlock of myths. Journal of Applied Gerontology, 13(3), 219–235. doi:10.1177/073346489401300301 Holmberg, D., & Blair, K. L. (2009). , communication, satisfaction, and prefer- ences of men and women in same-sex versus mixed-sex relationships. Journal of Sex Research , 46(1), 57–66. doi:10.1080/00224490802645294 Hudson, W. W., Harrison, D. F., & Crosscup, P. C. (1981). A short-form scale to measure sexual discord in dyadic relationships. Journal of Sex Research, 17(2), 157–174. doi:10.1080/ 00224498109551110 Iasenza, S. (2000). Lesbian sexuality post-stonewall to post-modernism: Putting the “lesbian bed death” concept to bed. Journal of Sex Education & Therapy, 25(1), 59–69. doi:10.1080/ 01614576.2000.11074330 Iasenza, S. (2002). Beyond “lesbian bed death”: The passion and play in lesbian relationships. Journal of Lesbian Studies, 6(1), 111–120. doi:10.1300/J155v06n01_10 Kaplan, H. S. (1974). The new . New York, NY: Brumner/Mazel. Kurdek, L. A. (1998). Relationship outcomes and their predictors: Longitudinal evidence from heterosexual married, gay cohabiting, and lesbian cohabiting couples. Journal of and the Family, 60(3), 553–568. doi:10.2307/353528 Kurdek, L. A. (2006). Differences between partners from heterosexual, gay, and lesbian cohabiting couples. Journal of Marriage and Family, 68(2), 509–528. doi:10.1111/j.1741- 3737.2006.00268.x Kurdek, L. A. (2008). Change in relationship quality for partners from lesbian, gay male, and heterosexual couples. Journal of Family Psychology, 22(5), 701–711. doi:10.1037/t02175-000 Kuyper, L., & Fokkema, T. (2010). Loneliness among older lesbian, gay, and bisexual adults: The role of minority stress. Archives of Sexual Behavior, 39(5), 1171–1180. doi:10.1007/ s10508-009-9513-7 Laumann, E. O., Nicolosi, A., Glasser, D. B., Paik, A., Gingell, C., Moreira, E., & Wang, T. (2005). Sexual problems among women and men aged 40–80 years: Prevalence and correlates identified in the global study of sexual attitudes and behaviors. International Journal of Impotence Research, 17,39–57. doi:10.1038/sj.ijir.3901250 JOURNAL OF HOMOSEXUALITY 23

Levy, B. (2009). Stereotype embodiment: A psychosocial approach to aging. Current Directions in Psychological Science, 18(6), 332–336. doi:10.1111/j.1467-8721.2009.01662.x Lewis, R. J., Milletich, R. J., Derlega, V. J., & Padilla, M. A. (2014). Sexual minority stressors and psychological aggression in lesbian women’s intimate relationships: The mediating roles of rumination and relationship satisfaction. Psychology of Women Quarterly, 38(4), 535–550. doi:10.1177/0361684313517866 Lindau, S. T., Schumm, L. P., Laumann, E. O., Levinson, W., O’Muircheartaigh, C. A., & Waite, L. J. (2007). A study of sexuality and health among older adults in the United States. The New England Journal of Medicine, 357(8), 762–774. doi:10.1056/NEJMoa067423 Litzinger, S., & Gordon, K. C. (2005). Exploring relationships among communication, sexual satisfaction, and marital satisfaction. Journal of Sex and Marital Therapy, 31(5), 409–424. doi:10.1080/00926230591006719 Locke, H., & Wallace, K. (1959). Short marital-adjustment and prediction tests: Their reliability and validity. Marriage and Family Living, 21(3), 251–255. doi:10.2307/348022 Lyons, A., Pitts, M., & Grierson, J. (2013). Growing old as a gay man: Psychosocial well-being of a sexual minority. Research on Aging, 35(3), 275–295. doi:10.1177/0164027512445055 Mackey, R. A., Diemer, M. A., & O’Brien, B. A. (2000). Psychological intimacy in the lasting relationships of heterosexual and same-gender couples. Sex Roles, 43(3–4), 201–227. doi:10.1023/A:1007028930658 MacLeod, S., Musich, S., Hawkins, K., Alsgaard, K., & Wicker, E. R. (2016). The impact of resilience among older adults. Geriatric Nursing, 37(4), 266–272. doi:10.1016/j. gerinurse.2016.02.014 MacNeil, S., & Byers, E. S. (2005). Dyadic assessment of sexual self-disclosure and sexual satisfaction in heterosexual dating couples. Journal of Social and Personal Relationships, 22 (2), 169–181. doi:10.1177/0265407505050942 Mark, K. P., Garcia, J. R., & Fisher, H. E. (2015). Perceived emotional and sexual satisfaction across sexual relationship contexts: Gender and sexual orientation differences and similarities. The Canadian Journal of Human Sexuality, 24(2), 120–130. doi:10.3138/ cjhs.242-A8 Mark, K. P., & Jozkowski, K. N. (2013). The mediating role of sexual and nonsexual communication between relationship and sexual satisfaction in a sample of college-age heterosexual couples. Journal of Sex & Marital Therapy, 39(5), 410–427. doi:10.1080/ 0092623X.2011.644652 Mason, T. B., & Lewis, R. J. (2015). Minority stress and binge eating among lesbian and bisexual women. Journal of Homosexuality, 62(7), 971–992. doi:10.1080/ 00918369.2015.1008285 Masters, W. H., & Johnson, V. E. (1970). Human sexual inadequacy. Boston, MA: Little, Brown & Company. Masters, W. H., & Johnson, V. E. (1979). Homosexuality in perspective. Boston, MA: Little, Brown & Company. Meyer, I. H. (1995). Minority stress and mental health in gay men. Journal of Health and Social Behavior, 36(March), 38–56. doi:10.2307/2137286 Meyer, I. H. (2003). Prejudice, social stress, and mental health in lesbian, gay, and bisexual populations: Conceptual issues and research evidence. Psychological Bulletin, 129(5), 674–697. doi:10.1037/0033-2909.129.5.674 Meyer, I. H. (2015). Resilience in the study of minority stress and health of sexual and gender minorities. Psychology of Sexual Orientation & Gender Diversity, 2(3), 209–213. doi:10.1037/sgd0000132 Meyer, I. H., & Dean, L. (1998). Internalized homophobia, intimacy, and sexual behavior among gay and bisexual men. In G. M. Herek (Ed.), Stigma and sexual orientation: 24 J. M. FLEISHMAN ET AL.

Understanding prejudice against lesbians, gay men, and bisexuals (pp. 160–186). Thousand Oaks, CA: Sage Publications. Mustanski, B., & Parsons, J. T. (2014). Introduction to the special section on sexual health in gay and bisexual male couples. Archives of Sexual Behavior, 43(1), 17–19. doi:10.1007/ s10508-013-0228-4 Mustanski, B., & Parsons, J. T. (2015). Introduction to the special section on sexual health in gay and bisexual men. Archives of Sexual Behavior, 44(7), 1769–1771. doi:10.1007/s10508- 015-0598-x Nichols, M. (2004). Lesbian sexuality/female sexuality: Rethinking ‘lesbian bed death’. Sexual and Relationship Therapy, 19(4), 363–371. doi:10.1080/14681990412331298036 Nichols, M. (2005). Is ‘lesbian bed death’ for real? Gay & Lesbian Review Worldwide, 12(4), 18–20. Otis, M. D., Riggle, E. D., & Rostosky, S. S. (2006). Impact of mental health on perceptions of relationship satisfaction and quality among female same-sex couples. Journal of Lesbian Studies, 10(1/2), 267–283. doi:10.1300/J155v10n01_14 Otis, M. D., Rostosky, S. S., Riggle, E. D., & Hamrin, R. (2006). Stress and relationship quality in same-sex couples. Journal of Social and Personal Relationships, 23(1), 81–99. doi:10.1177/0265407506060179 Peplau, L. A., Cochran, S. D., & Mays, V. M. (1997). A national survey of the intimate relationships of African American lesbians and gay men: A look at commitment, satisfac- tion, sexual behavior, and HIV . In B. Greene (Ed.), Ethnic and cultural diversity among lesbians and gay men (pp. 11–38). Thousand Oaks, CA: Sage. Roberts, A. W., Ogunwole, S. U., Blakeslee, L., & Rabe, M. A. (2018). The population 65 years and older in the United States: 2016. American Community Survey Reports, U.S. Department of Commerce, U.S. Census Bureau, October 2018, ACS-38. Retrieved from https://www.census.gov/content/dam/Census/library/publications/2018/acs/ACS-38.pdf Rosenberger, J., Herbenick, D., Novack, D., & Reece, M. ( 2014). What’s love got to do with it? Examinations of emotional perceptions and sexual behaviors among gay and bisexual men in the United States. Archives of Sexual Behavior, 43(1), 119–128. doi:10.1007/s10508-013- 0223-9 Ryan, C. L., & Bauman, K. (2016). Educational attainment in the United States: 2015 population characteristics. Current Population Reports, U.S. Department of Commerce, U.S. Census Bureau, March 2016, P20-578. Retrieved from https://www.census.gov/con tent/dam/Census/library/publications/2016/demo/p20-578.pdf Sánchez-Fuentes, M. D. M., Santos-Iglesias, P., & Sierra, J. C. (2014). A systematic review of sexual satisfaction. International Journal of Clinical and Health Psychology, 14(1), 67–75. doi:10.1016/S1697-2600(14)70038-9 Santos-Iglesias, P., Byers, E. S., & Moglia, R. (2016). Sexual well-being of older men and women. Canadian Journal Human Sexuality, 25(2), 86–98. doi:10.3138/cjhs.252-A4 Schroder, K. E., Carey, M. P., & Vanable, P. A. (2003). Methodological challenges in research on sexual risk behavior: II. Accuracy of self-reports. Annals of Behavioral Medicine, 26(2), 104–123. doi:10.1207/S15324796ABM2602_03 Spanier, G. (1976). Measuring dyadic adjustment: New scales for assessing the quality of marriage and similar dyads. Journal of Marriage and Family, 38(1), 15–28. doi:10.2307/ 350547 Sprecher, S. (2002). Sexual satisfaction in premarital relationships: Associations with satisfac- tion, love, commitment, and stability. The Journal of Sex Research, 39(3), 190–196. doi:10.1080/00224490209552141 Sprecher, S., & Cate, R. M. (2004). Sexual satisfaction and sexual expression as predictors of relationship satisfaction and stability. In J. H. Harvey, A. Wenzel, & S. Sprecher (Eds.), The JOURNAL OF HOMOSEXUALITY 25

handbook of sexuality in close relationships (pp. 235–256). Mahwah, NJ: Lawrence Erlbaum Associates. Theiss, J. A. (2011). Modeling dyadic effects in the associations between relational uncer- tainty, sexual communication, and sexual satisfaction for husbands and wives. Communication Research, 38(4), 565–584. doi:10.1177/0093650211402186 Thomas, H. N., Hamm, M., Hess, R., & Thurston, R. C. (2017). Changes in sexual function among midlife women: “I’m older and I’m wiser”. Journal of North American Society, 25(3), 286–292. doi:10.1097/GME.0000000000000988 Timm, T. M., & Keiley, M. K. (2011). The effects of differentiation of self, adult attachment, and sexual communication on sexual and marital satisfaction: A path analysis. Journal of Sex and Marital Therapy, 37(3), 206–223. doi:10.1080/0092623x.2011.564513 Titlestad, A., & Pooley, J. A. (2014). Resilience in same-sex parented families: The lived experience of adults with gay, lesbian, or bisexual parents. Journal of GLBT Family Studies, 10(4), 329–353. doi:10.1080/1550428X.2013.833065 Van Sluytman, L. G., & Torres, D. (2014). Hidden or uninvited? A content analysis of elder LGBT of color literature in gerontology. Journal of Gerontological Social Work, 57(2–4), 130–160. doi:10.1080/01634372.2013.877551 Wagnild, G. M., & Young, H. M. (1993). Development and psychometric evaluation of the resilience scale. Journal of Nursing Measurement, 1(2), 165–178. Waite, L. J., Laumann, E. O., Das, A., & Schumm, L. P. (2009). Sexuality: Measures of partnerships, practices, attitudes, and problems in the national social life, health, and aging study. The Journals of Gerontology: Series B, 64B(1), i56–i66. doi:10.1093/geronb/ gbp038 Weinberg, G. (1972). Society and the healthy homosexual. New York, NY: St. Martin’s Press. Whipple, B., Knowles, J., Davis, J., Gianotten, W. L., & Owens, A. E. (2007). The health benefits of sexual expression. Sexual Health, 1(1), 17–42. Young, M., Luquis, R., Denny, G., & Young, T. (1998). Correlates of sexual satisfaction in marriage. The Canadian Journal of Human Sexuality, 7(2), 115–127.