Socioeconomics and Erotic Inequity: A Theoretical Overview and Narrative Review of Associations Between Poverty, Socioeconomic Conditions, and Sexual Wellbeing

Figures & data

Table 1. Search strings used in narrative literature review.

Database	Socioeconomic String	Operator	Sexual string
PubMed	(poverty OR “Poverty” OR impoverish*OR disadvantaged OR “Income” OR income OR “low income” OR low-income OR “economic insecur*” OR “economic secur*” OR “financial strain” OR “financial stress” OR unemploy* OR “Unemployment” OR “housing insecur*” OR “housing secur*” OR socioeconomic OR “SocioeconomicFactors” OR “Economic Status” OR “Social Class” OR “Social Class” OR wealth)	AND	(orgasm* OR “Orgasm” OR “Sexual Arousal” OR “sexual pleasure” OR “Libido” OR libido OR “vaginal lubrication” OR “sexual satisfaction” OR “sexual interest” OR “Sexual Arousal” OR “sexual function” OR “sexual self-esteem” OR “sexual self esteem” OR “sexual confidence” OR “sexual desire” OR “sexual self-efficacy” OR “sexual self efficacy” OR “sexual motivation*” OR “sexual self-perception” OR “sexual self perception” OR “sexual self-consciousness” OR “sexual self consciousness” OR “sexual self-image” OR “sexual self image” OR “sexual assertiveness” OR “sexual awareness” OR “sexual quality of life” OR “sexual attractiveness” OR “sexual closeness” OR “sexual intimacy”)
PsycINFO	(poverty OR “Poverty” OR impoverish* OR disadvantaged OR “Economic Disadvantage” OR “Disadvantaged” OR “low income” OR low-income OR income OR “Income (Economic)” OR “Income Level” OR “economic insecur*” OR “economic secur*” OR “financial strain” OR “financial strain” OR “financial stress” OR unemploy* OR “Unemployment” OR “housinginsecur*”OR “housing secur*”OR socioeconomic OR “Socioeconomic Factors” OR “Socioeconomic Status “OR “educational status” OR “Economic Security” OR “Social Class” OR “Social Class” OR wealth)	AND	(“Sexual Satisfaction” OR “Sexual Satisfaction” OR “Sexual Arousal” OR “Sexual Arousal” OR “Orgasm” OR orgasm* OR “Libido” OR libido OR “vaginal lubrication” OR “sexual interest” OR “sexual pleasure” OR “sexual function” OR “sexual self-esteem” OR “sexual self esteem” OR “sexual confidence” OR “sexual desire” OR “sexual motivat*” OR “sexual self-image” OR “sexual self image” OR “sexual self-perception” OR “sexual self perception” OR “sexual self-consciousness” OR “sexual self consciousness” OR “sexual assertiveness” OR “sexual awareness” OR “sexual quality of life” OR “sexual attractiveness” OR “sexual closeness” OR “sexual intimacy”)
CINAHL	(poverty OR “Poverty+” OR impoverish* OR disadvantaged OR “Income” OR income OR “low income” OR low-income OR “economic insecur*” OR “economic secur*” OR “financial strain” OR “financial stress” OR unemploy* OR “Unemployment” OR “housinginsecur*” OR “housing secur*” OR socioeconomic OR “Socioeconomic Factors” OR “Economic Status” OR MH “Social Class+” OR “social class” OR wealth)	AND	(orgasm* OR “Orgasm” OR “sexual arousal” OR “sexual pleasure” OR libido OR “vaginal lubrication” OR MH “Sexual Satisfaction” OR “Sexual Satisfaction” OR “sexual interest” OR “sexual arousal” OR “sexual function” OR “sexual self-esteem” OR “sexual self esteem” OR “sexual confidence” OR “sexual desire” OR “sexual self-efficacy” OR “sexual self efficacy” OR “sexual motivation*”OR “sexual self-perception” OR “sexual self perception” OR “sexual self-consciousness” OR “sexual self consciousness” OR “sexual self-image” OR “sexual self image” OR “sexual assertiveness” OR “sexual awareness” OR “sexual quality of life” OR “sexual attractiveness” OR “sexual closeness” OR “sexual intimacy”)
Academic Search	(poverty OR “POVERTY” OR impoverish* OR disadvantaged OR “POOR people” OR “INCOME” OR income OR “low income” OR low-income OR “FINANCIAL security” OR “FINANCIAL stress” OR “ECONOMIC security” OR “economic insecur*” OR “economic secur*” OR “financial strain” OR “FINANCIAL stress” OR unemploy* OR “UNEMPLOYMENT” OR “housing insecur*” OR “housing secur*” OR socioeconomic OR “SOCIOECONOMIC factors” OR “SOCIOECONOMIC status” OR “SOCIAL classes” OR “social class” OR wealth)	AND	(orgasm* OR “ORGASM” OR “SEXUAL excitement” OR “sexual arousal” OR “sexual pleasure” OR libido OR “LIBIDO”OR “LUST” OR “vaginal lubrication” OR “sexual satisfaction” OR “SEXUAL attraction” OR “sexual interest” OR “sexual function” OR “sexual self-esteem” OR “sexual self esteem” OR “sexual confidence” OR “sexual desire” OR “sexual self-efficacy” OR “sexual self efficacy” OR “sexual motivation*”OR “sexual self-perception” OR “sexual self perception” OR “sexual self-consciousness” OR “sexual self consciousness” OR “sexual self-image” OR “sexual self image” OR “sexual assertiveness” OR “sexual awareness” OR “sexual quality of life” OR “sexual attractiveness” OR “sexual closeness” OR “sexual intimacy”)
SCOPUS	(poverty OR impoverish* OR disadvantaged OR income OR “low income” OR low-income OR “economic insecur*” OR “economic secur*” OR “financial strain” OR “financial stress” OR unemploy* OR “housing insecur*” OR “housing secur*” OR socioeconomic OR “social class” OR wealth)	AND	(orgasm* OR “sexual arousal” OR “sexual pleasure” OR libido OR “vaginal lubrication” OR “sexual satisfaction” OR “sexual interest” OR “sexual arousal” OR “sexual function” OR “sexual self-esteem” OR “sexual self esteem” OR “sexual confidence” OR “sexual desire” OR “sexual self-efficacy” OR “sexual self efficacy” OR “sexual motivation*”OR “sexual self-perception” OR “sexual self perception” OR “sexual self-consciousness” OR “sexual self consciousness” OR “sexual self-image” OR “sexual self image” OR “sexual assertiveness” OR “sexual awareness” OR “sexual quality of life” OR “sexual attractiveness” OR “sexual closeness” OR “sexual intimacy”)

Figure 1. Flow diagram of narrative review process.

Table 2. Reviewed articles and their salient findings on socioeconomic factors and sexual wellbeing.

Author	Year	Country Setting	Study Population (n)	Methodology	Salient Findings
POSITIVE FINDINGS
Abouzari-Gazafroodi et al.	2015	Iran	Pregnant women between 18–35 years at prenatal health clinics (n = 518)	Cross sectional survey using a convenience sample	Increased education associated with increased sexual function during pregnancy
Afzali et al.	2020	Iran	Women who had been referred to primary care health centers (n = 490)	Cross sectional survey using a convenience sample at randomized recruitment locations	Income sufficiency and increased income associated with increased sexual satisfaction in women.
Amiri et al.	2020	Iran	Women married for at least 1 year who were at primary care or prenatal clinics (n = 500)	Cross sectional survey using a convenience sample	Increased education, increased partner education, and increased income are associated with increased sexual satisfaction.
Aşkin et al.	2019	Turkey	Non-menopausal women between 18–49 years who have used contraception but not hormone therapy (n = 202)	Cross sectional survey using a convenience sample	Perceived income sufficiency associated with increased FSFI scores.
Babayan et al.	2018	Iran	Married women between 45–60 years (n = 330)	Cross sectional survey using a convenience sample	Being employed, increased education level and increased income associated with increased sexual satisfaction
Bancroft et al.	2011	United States	Black or white women between 20–65 years, currently in a hetero relationship of at least 6 months length (n = 987)	Survey using a randomized sample	Increased income associated with increased satisfaction with one’s own sexuality.
Casique	2020	Mexico	High school students between 15–20 years who reported having had vaginal intercourse (n = 4 ,504)	Survey using a multistage randomized sample	Highest SES associated with having had a very satisfying (vs. satisfying) first sexual experience in males
Castellanos-Torres et al.	2013	Spain	Women and men above 16 years who had been sexually active in the last 12 months (n = 7384)	Survey using a randomized sample	Increased social class associated with increased sexual satisfaction in women.
Chedraui et al.	2011	Ecuador	Hispanic women between 40–59 years visiting patients in the maternal/infant unit (n = 262)	Cross sectional survey using a convenience sample	Increased education level associated with increased sexual function.
Chedraui et al	2012	Ecuador	Heterosexual women between 40–59 years visiting patients in the maternal/infant unit (n = 904)	Cross sectional survey using a convenience sample	Increased education and increased partner education are associated with increased sexual function.
Cheng et al.	2014	United States	Unmarried girls in 7^th to 12^th grade over 15 years who were attracted to men	Longitudinal study using a clustered & randomized sample	Increased parental education associated with increased expectation of sexual pleasure and sexual self-efficacy. Increased family income and having a mother who has a paid job associated with increased sexual self-efficacy.
Cornellana et al.	2017	Spain	Postmenopausal women under 70 recruited by their OB/Gyns (n = 3026)	Survey using a convenience sample	Increased education level and being employed associated with increased sexual function.
Cranney	2017	Sub-Saharan Africa	People living in sub-Saharan Africa (n = 25 ,510)	Survey using a randomized sample	Increased income associated with increased sexual satisfaction in West, South, and East African regions. Increased education level associated with increased sexual satisfaction in all regions.
De Graaf et al.	2015	The Netherlands	Male and female adolescents between 12–25 years (n = 7841)	Cross sectional online survey	Increased education associated with increased satisfaction at sexual debut.
Du Lucena and Abdo	2014	Brazil	Women between 18–61 years in a stable relationship with a man for at least one year, recruited at a gynecology clinic during a routine checkup (n = 96)	Survey using a convenience sample	Completion of high school associated with having normal orgasmic ability.
Do et al.	2018	Vietnam	Women married to men (n = 2783)	Survey using a multistage randomized sample	Increased education level, increased income, having a saving account, and owning property associated with increased sexual satisfaction. Affluence associated with increased sexual satisfaction.
Fahs and Swank	2011	United States	Women who have had a sexual partner in the last 12 months (n = 1473)	Survey using a randomized sample	Increased education level and SES associated with being in the high sexual satisfaction/low sexual activity cluster.
Fuchs et al.	2019	Poland	Pregnant women over 18 years with sexual activity in last 4 weeks (n = 726)	Survey using a convenience sample	Completion of college or secondary education associated with increased FSFI scores.
Fuchs et al.	2020	Poland	Sexually active women over 18 years and of childbearing age without a COVID-19 diagnosis (n = 764)	Prospective, observational survey	Increased education level and living conditions associated with increased FSFI scores.
Fuentealba-Torres et al.	2019	Brazil	Women over 18 years whose sexual activity includes PIV sex, and who have breastfed until 23 months after delivery (n = 355)	Cross-sectional survey using a randomized sample	Increased income associated with increased FSFI scores.
Gallup et al.	2014	United States	Women in a committed sexual relationship with a member of the opposite sex (n = 54)	Survey using a convenience sample	Increased partner’s family income associated with increased orgasm frequency
Güleroğlu and Beşer	2014	Turkey	Pregnant women above 18 years who visited the birth clinics (n = 306)	Descriptive survey using a convenience sample	Increased education level, partner education level, and income associated with increased FSFI scores.
Hamilton and Julian	2014	North America	Men and women above 18 years who report previous engagement in sexual activity (n = 246 in full analysis/501 in partial analysis)	Survey using a convenience sample	Absence of financial and SES stressors associated with increased sexual interest, activity, and satisfaction scores for women.
Jain et al.	2019	India	Postmenopausal women between 40–65 years, living with their partner (n = 110)	Prospective, cross-sectional survey using a convenience sample	Increased education level and SES associated with increased sexual function scores.
Jamali et al.	2018	Iran	Iranian women between 15–45 years who were at a women’s health clinic, without a stressful life event in the last 6 months (n = 300)	Cross-sectional survey using a convenience sample	Increased education level, partner education level, partner being employed, and family income associated with increased sexual function scores.
Kim and Kang	2015	Korea	People between 45–60 years who are currently married, without a disorder that could affect sexual function (n = 367)	Survey using a convenience sample	Being employed, increased education level and income associated with increased sexual quality of life scores
Kontula and Miettienen	2016	Finland	Women between 18–81 years old (n = 8204)	Survey using random sampling	Increased income associated with orgasmic frequency
Llaneza et al.	2011	Spain	White partnered postmenopausal women attending annual gyn checkups at an outpatient clinic (n = 117)	Cross-sectional survey using a convenience sample	Increased education level and partner education level associated with increased sexual function scores.
Mamuk and Dissiz	2018	Turkey	Sexually active, married women at the OB/GYN clinic at a public hospital who were not taking a hormone treatment (n = 417)	Descriptive, cross-sectional survey using a convenience sample	Increased education level associated with increased sexual function scores.
Minhat et al.	2019	Malaysia	Married, ambulatory adults 60 or older, without symptoms of dementia (n = 1294)	Cross-sectional survey using a random sample	Increased education level associated with increased sexual intimacy.
Mitchell et al.	2013	Britain	Men and women between 16–74 years (n =  15,162)	Survey using probability sampling	Being employed associated with increased sexual function.
Muhanguzi	2015	Uganda	Married women (n = 40 interviews, 71 focus groups)	Interviews and focus groups based on random sample	Focus group themes documented ways in which poverty, heavy workloads, and fatigue affect sexual desire Women reported economic stresses but also sexual autonomy and pleasure
Pérez-López et al.-	2012	Spain	Women between 40–65 years, accompanying or visiting patients in Ob-gyn facilities who are not lesbians (n = 179)	Cross-sectional survey using a convenience sample	Increased education level and partner education level associated with increased FSFI scores.
Ruiz-Muñoz et al.	2013	Spain	Men and women between 16–44 years who had ever had sexual intercourse (n = 9850)	Cross-sectional survey using multistage randomized sample	Increased education level associated with increased sexual satisfaction.
Smith et al.	2017	United States	Pre- or perimenopausal women between 45–54 years with intact ovaries and uteri who are sexually active (n = 1927)	Cohort study using a convenience sample	Higher income associated with higher frequency of arousal and lower frequency of vaginal dryness, but higher family income associated with lower sexual functioning scores
Tekin et al.	2014	Turkey	Married women between 18–50 years attending their routine gyn exams who have had sex in the last month (n = 176)	Cross-sectional descriptive survey using a convenience sample	Being employed and increased education level associated with increased sexual function scores
Traeen et al.	2018	Norway, Denmark, Belgium, Portugal	Men and women between 60–75 years (n = 3814)	Survey using a probability sample	Increased education associated with increased satisfaction in Portuguese men.
van Hooff and Morris	2021	Britain	People between 25–64 years who are sexually active with at least 1 partner in the prior year (n = 8003)	Survey using a multistage randomized sample	Being in the highest social class associated with increased sexual function
Velten and Margraf	2017	Germany	People over 18 years with a steady partner (n = 964 couples)	Survey using a multistage randomized sample	For women, increased percentage of household income earned by women associated with increased sexual satisfaction.
Weitzman	2020	United States	18- and 19-year-old women (n = 925)	Prospective cohort study using a randomized sample	Enrollment in college associated with increased sexual desire.
Wikle et al.	2020	United States	Heterosexual couples in which at least 1 partner was between 18–36 years old and was marrying for the first time (n = 2044)	Dyadic longitudinal study using a multistage clustered & randomized sample	Economic pressure was negatively associated with individuals’ own sexual satisfaction, but not their partner’s
Zhang et al.	2012	China	First-married heterosexual couples (n = 1083 couples)	Survey using randomized sample	Both partners being employed associated with increased sexual satisfaction for men.
Zhou et al.	2019	China	Partnered women between 40–65 years who visited a menopause clinic (n = 3485)	Cross-sectional survey using a convenience sample	Being employed associated with increased sexual desire.
Zietsch et al.	2011	Australia	Female twins between 19–52 years (n = 2914)	Cross-sectional survey using a convenience sample	Being employed, increased SES, increased education level associated with increased frequency of orgasm during masturbation.
NEGATIVE FINDINGS
Fahs and Swank	2011	United States	Women who have had a sexual partner in the last 12 months (n = 1473)	Survey using a randomized sample	Full time employment associated with decreased sexual satisfaction scores.
Smith et al.	2017	United States	Pre- or perimenopausal women between 45–54 years with intact ovaries and uteri who are sexually active (n = 1927)	Cohort study using a convenience sample	Decreased income associated with increased sexual function scores, frequency of enjoyment of sex, frequency of arousal during sex, decreased frequency of dry sex.
NON-SIGNIFICANT FINDINGS
Castellanos-Torres et al.	2013	Spain	Women and men above 16 years who had been sexually active in the last 12 months (n = 7384)	Survey using a randomized sample	While women’s social class associated with their satisfaction, there was no similar association in men.
De Graaf et al	2015	The Netherlands	Male and female adolescents between 12–25 years (n = 7841)	Cross sectional online survey	Increased education not associated with increased satisfaction.
Galinsky and Sonenstein	2011	United States	Adolescents in grades 7–12 (n = 3488)	Longitudinal study using a randomized sample	SES not associated with sexual enjoyment
Hamilton and Julian	2014	North America	Men and women above 18 years who report previous engagement in sexual activity (n = 246 in full analysis/501 in partial analysis)	Survey using a convenience sample	While women’s financial stressors associated with their sexual interest, activity, and satisfaction; men exhibited no similar association.
Hidalgo and Dewitte	2021	Ecuador	Men and women above 18 years of Ecuadorian nationality or residing in Ecuador, who have been in a committed relationship for at least 6 months and are sexually active (n = 599)	Survey using a convenience sample	Education level and employment status not associated with sexual function or satisfaction.
Kontula and Miettienen	2016	Finland	Women between 18–81 years old (n = 8204)	Survey using random sampling	Education level not associated with orgasm frequency.
Mitchell et al.	2013	Britain	Men and women between 16–74 years (n =  15,162)	Survey using probability sampling	Living in an area of deprivation not associated with sexual function.
Traeen et al.	2018	Norway, Denmark, Belgium, Portugal	Men and women between 60–75 years (n = 2309)	Survey using a probability sample	Increased education not associated with present sexual enjoyment, ranked vs. sexual enjoyment 10 years in the past.
Traeen et al.	2018	Norway, Denmark, Belgium, Portugal	Men and women between 60–75 years (n = 3814)	Survey using a probability sample	Education associated with satisfaction in Portuguese adults but not in Norwegian, Danish, or Belgian adults.
Wikle et al.	2020	United States	Heterosexual couples in which at least 1 partner was between 18–36 years old and was marrying for the first time (n = 2044)	Dyadic longitudinal study using a multistage clustered & randomized sample	While wives’ sexual outcomes were associated with their husbands’ economic pressures, husbands’ outcomes were not associated with their wives’ sexual outcomes.