https://orcid.org/0009-0007-0233-1419
ABSTRACT
Sexual satisfaction is essential to relational well-being, physical health, and overall quality of life, yet it is under-researched in sexual minority women. This systematic review presents a synthesis of the available data exploring differences in women’s sexual satisfaction as a function of sexual identity. In addition, the review presents an evaluation of measures used in sexual satisfaction assessment and a summary of key mechanisms used to explain the differences between women of different sexual identities. Four areas of sexual satisfaction research were identified across 43 studies (N = 84,584): general sexual satisfaction, orgasm occurrence, sexual frequency, and sexual duration. While the findings on general sexual satisfaction were mixed, the findings on orgasm occurrence, sexual frequency and duration reported more consistent results. Lesbian women reported the highest orgasm frequency, followed by bisexual women, with heterosexual women having the lowest orgasm frequency. Lesbian women also outperformed heterosexual women on sexual duration, while heterosexual women outperformed lesbian and bisexual women on sexual frequency. A range of measures were used to assess sexual satisfaction, with several of these measures consistently yielding non-significant results. Finally, several mechanisms explaining the differences in sexual satisfaction are discussed in the context of future directions for this field of research.
KEYWORDS:
Sexual satisfaction has been defined as a multifaceted concept, consisting of both physical and emotional aspects of sex (Soltani et al., Citation2017). Sexual satisfaction has been unequivocally linked to positive outcomes, including relationship satisfaction (Call et al., Citation1995; Sprecher & Cate, Citation2004), positive mental health outcomes (Frohlich & Meston, Citation2002; Van Minnen & Kampman, Citation2000), and overall quality of life (Rosen & Bachmann, Citation2008). The primary aim of this paper is to examine differences in women’s sexual satisfaction as a function of their sexual identity. To achieve this aim, this systematic review of the literature identifies and synthesises data on any form of sexual satisfaction that compares two or more sexual identity groups (e.g. heterosexual compared to lesbian women). Secondary aims include examining the nature and quality of sexual satisfaction measures and identifying potential mechanisms that explain sexual satisfaction differences in these groups.
Sexual satisfaction and sexual identity
A substantial body of research on sexual satisfaction has examined group differences. Researchers have explored gender differences, consistently finding that sexual satisfaction differs between men and women (Archer, Citation2017; Barr et al., Citation2002; Dunkley et al., Citation2016; Mueller et al., Citation2014). For example, sexual dissatisfaction was found to be more common among women (Shahhosseini et al., Citation2014), with a large proportion of American women reporting sexual difficulties, including issues with reaching orgasm or unpleasant sex (43% in women vs 31% in men; Laumann et al., Citation1999). Further, researchers identified an ‘orgasm gap’ – a term that describes the higher number of orgasms experienced by heterosexual men compared to women (Frederick et al., Citation2018; Lentz & Zaikman, Citation2021).
This well-established literature is limited by its exclusive use of heterosexual samples. Breyer et al. (Citation2010) highlighted that many large-scale studies exclude non-heterosexual participants in favour of collecting a homogenous sample. Given that over 3.5% of adults in America – approximately 9 million people – have a sexual minority identify, available evidence on sexual satisfaction may not generalise to these populations (Gates, Citation2011). A few studies that examined sexual satisfaction in sexual minority women highlight several differences to their heterosexual counterparts. Heterosexual women report higher frequency of sexual activity than lesbian and bisexual women, and this effect gets stronger as the relationship length increases (Blair & Pukall, Citation2014; Frederick et al., Citation2021). In fact, a decline in sexual frequency in long-term lesbian relationships has been termed the ‘lesbian bed death’ by researchers (Blumstein & Schwartz, Citation1983; Cohen & Byers, Citation2014). Furthermore, a different pattern of findings emerge based on how the construct of sexual satisfaction is operationalised. For example, large-scale studies from the United States found that lesbian women reported higher orgasm frequency, longer durations of sex, and a wider variety of sexual activities than heterosexual women (Frederick et al., Citation2021; Willis et al., Citation2018). Similar patterns of differences were reported by researchers in Canada (Blair & Pukall, Citation2014). Thus, this systematic review is vital to developing a comprehensive understanding of sexual satisfaction in sexual minorities, which has been traditionally overlooked.
Defining, operationalising, and measuring sexual satisfaction
The definitions, and thus the subsequent measurement, of sexual satisfaction varies widely throughout the literature. For example, sexual satisfaction has been defined both globally – as an appraisal of individual’s quality of sex life (Holmberg & Blair, Citation2009), and multidimensionally (e.g. an evaluation of both positive and negative aspects of individual’s sexual relationships, Lawrance & Byers, Citation1995). In a large thematic analysis of lay people’s definitions of sexual satisfaction, Pascoal et al. (Citation2014) identified two main categories: (1) personal sexual well-being, that focuses on individual’s personal assessment of their sex life, independent of a sexual partner and (2) didactic processes, that involves sexual fulfilment within a sexual relationship. The first category encompassed positive feelings, pleasure, desire, orgasm, sexual openness and arousal and the latter included intimacy, frequency and ludic sexuality (i.e. the ability to act desires out). Several of these concepts are used within research on sexual satisfaction.
First, orgasm – a psychophysiological experience of intense pleasure accompanied by rhythmic contractions of pelvic and vaginal muscles – is one of the most common aspects of sexual satisfaction (Masters & Johnson, Citation1966). While orgasm is not synonymous with sexual satisfaction, there is a body of evidence linking the two constructs (Haavio-Mannila & Kontula, Citation1997; McClelland, Citation2014; Philippsohn & Hartmann, Citation2009). Orgasm frequency also varies as a function of sexual identity, with several studies finding that lesbian women have higher orgasm frequency than their heterosexual counterparts (Coleman et al., Citation1983; Frederick et al., Citation2017; Tilos et al., Citation2014).
Second, frequency of sexual activity is commonly used to quantify sexual satisfaction (Blair & Pukall, Citation2014; Blumstein & Schwartz, Citation1983). Sexual frequency (i.e. the number of times within a set timeframe that a couple engages in sexual activity; Blair & Pukall, Citation2014) does not always increase sexual satisfaction, but it can contribute to it (Bridges et al., Citation2004). Unlike orgasm occurrence, heterosexual women have been found to outperform lesbian women on frequencies of sex (Frederick et al., Citation2021; Hurlbert & Apt, Citation1993). Finally, sexual duration (i.e. the average time of a couple’s sexual encounter, Blair & Pukall, Citation2014) does not equate to sexual satisfaction, but, like frequency of sex, it can contribute to it – particularly when activities that are more likely to lead to orgasm in women are more time-consuming (Blair & Pukall, Citation2014).
In addition to the variety of definitions and operationalisations of sexual satisfaction, there is also a wide range of methods used to assess this construct. Indeed, Baldwin and colleagues (Baldwin Herbenick et al., Citation2019) argue that varying definitions of sexual satisfaction are a key reason for inconsistent measurements across studies. For instance, orgasm occurrence, sexual duration and frequency are observed variables which are typically measured using single-item measures, such as ‘Over the past month, how many times did you engage in sexual activity?’, and are heavily reliant on retrospect. Conversely, sexual satisfaction is a latent construct and is typically measured using validated scales such as the Index of Sexual Satisfaction (ISS; Hudson et al., Citation1981) and Female Sexual Function Index (FSFI; Rosen et al., Citation2000). Single-item measures can be problematic because women evaluate satisfaction differently – for example, they may be anorgasmic (i.e. experiencing absence or infrequency of orgasms), but satisfied. Accordingly, in an evaluation of several sexual satisfaction measures, Mark and colleagues found that single-item measures had lower test–retest reliability scores than more complex, several-item measures.
Objectives
The systematic review presents and synthesises the findings from all available literature that compared women’s sexual satisfaction as a function of sexual identity. Further, the review examines the range of the measurements used to capture various constructs that fall under the umbrella term of sexual satisfaction. Finally, it identifies key mechanisms used to explain the differences in sexual satisfaction between sexual identity groups. A comprehensive review such as this can inform the current state of research on sexual satisfaction in women, contribute to limited research in factors that underpin sexual satisfaction in sexual minorities, and reduce future inconsistencies of measures on sexual satisfaction.
Method
Search strategy
Article searches were conducted using PsychInfo, Web of Science, PsychEXTRA, Proquest Psychology Database, and Psychology and Behavioural Sciences Collection databases. The search strategy focused on titles and abstracts and consisted of terms that targeted the constructs of women, sexual satisfaction, and sexual identity (See , for outcomes of the search, see ).
Figure 1. Flowchart of study selection, screening, and inclusion.
Table 1. Search strategy terms.
Inclusion criteria
To be eligible for inclusion in the systematic review, studies had to meet the following criteria: (1) measure women’s sexual satisfactionFootnote1; (2) compare sexual satisfaction in at least two sexual identities, measured using sexual orientation (e.g. heterosexual vs lesbian women) and/or partner’s gender (e.g. ‘mixed-sex’ vs ‘same-sex’)Footnote2; (3) be published in a peer-reviewed academic journal, and (4) be available in English.
Further, studies were excluded if they (1) employed only qualitative methods; (2) presented no new data (e.g. review, meta-analysis, commentary, etc.); (3) involved a clinical sample of participants (e.g. medical conditions such as obesity, cancer, sclerosis, or endometriosis); or (4) measured sexual desire or arousal rather than sexual satisfaction.
Screening and extraction
After duplicates were removed, studies were screened for eligibility. The first stage of screening was conducted by two researchers at the title and abstract level and identified studies relevant to the aims of the systematic review. Discrepancies between researchers (n = 47) were resolved prior to the second stage. The second stage of screening was conducted by the first author at the full-text level, who assessed whether studies met the inclusion criteria. Any studies that were excluded were double checked by the last author.
Studies were further excluded if (1) the data for women could not be extracted (e.g. findings combined men and women’s data); (2) the data for individual sexual identities could not be extracted (e.g. findings combined the results of all sexual identities); or (3) the articles were not available, or the data was not reported in a way that would allow extraction.
After both stages of screening were completed, all eligible studies were included in the systematic review and the data from each article was extracted into a custom-made Microsoft ExcelTM file. Extracted information included the country where the study was conducted, sexual identities of participants, population characteristics (including age, ethnicity, education level and relationship status, if reported), details of the measures of sexual satisfaction, and between-group findings relevant to sexual satisfaction differences (including the descriptive data). Further, the mechanisms explaining the findings (including theories and post hoc author explanations of the results) were extracted. Where appropriate, the multivariate findings (including the data on moderators, mediators, and covariates of the main findings) were also included. The information from all extracted studies is summarised in .
Table 2. Results of all studies comparing aspects of sexual satisfaction in women as a function of sexual identity.
Analytic strategy
Firstly, the synthesis involved the development of a systematic overview of all available studies that compared sexual satisfaction in two or more sexual identities in women. The extracted findings were summarised and then grouped thematically by sexual identities and measures of sexual satisfaction (based on the premise of thematic analyses, see Braun & Clarke, Citation2006). Further, the analysis included comparing the main findings of the studies (including descriptive data), and subsequently, identifying meaningful patterns in the data (including differences in measures, population characteristics and countries of studies).
Results
Descriptive data
Forty-three studies (N = 84,054), published between 1986 and 2022, were included in the systematic review (see ). Majority of the studies (n = 28) were conducted in the United States of America, and a smaller number were conducted in Canada (n = 5), Spain and Colombia (n = 3), Portugal (n = 2), Brazil (n = 2), Italy (n = 1), Hungary (n = 1), The Netherlands (n = 1), Taiwan (n = 1) and Hong Kong (n = 1). There was a wide range of sample sizes (32 < ns > 2,793) and participant ages (15.7 < M > 65+) in the literature. On average within each paper, most of the participants were White, had a university education, and were in relationship. presents a full overview of descriptive data for all studies included in the review.
Measures of sexual satisfaction
The findings were analysed thematically, revealing four methods of operationalising sexual satisfaction – general sexual satisfaction, orgasm occurrence, sexual frequency, and sexual duration (see ). General sexual satisfaction was measured by 37 studies. Of those, 24 studies used validated multiple-item measures and 12 studies used bespoke questions. Further, 15 studies measured orgasm occurrence, with 10 studies employing single-item questions and 5 studies using validated measures. Sexual frequency was measured by 9 studies. Of those, 6 studies used single-item questions and 3 studies used validated measures. Sexual duration was the least common measure of sexual satisfaction, measured by three studies using bespoke questions.
Table 3. Summary of sexual satisfaction measures.
Of the 15 measures used to examine sexual satisfaction and satisfaction-related factors in this review, bespoke measures (i.e. measures that were created by researchers, usually consisting of 1–3 items) were the most common (n = 18), followed by ISS (n = 6), GMSEX (n = 5) and FSFI (n = 3). The remaining 10 scales were used in one paper each, although SSS, SSS-W, and NSSS-S are all versions of the Sexual Satisfaction Scale. Most of the established scales used in this review (all, excluding NSSS-S, SRS, SDSE and SDS) focus on physical and psychological sexual functioning, where a low sexual satisfaction score is a sign of sexual dysfunction. The items in these scales, including ‘How difficult was it to become lubricated (“wet”) during sexual activity or intercourse?’ (Item 8, FSFI) and ‘I feel that my partner wants too much sex from me’ (Item 11, ISS), pathologize sexual satisfaction and may explain a high prevalence of bespoke measures in this review, which aim to measure sexual intimacy, pleasure, and other non-pathological factors of sexual satisfaction.
Differences in sexual satisfaction across sexual identities and partner’s genders
Several methods of quantifying sexual identity were used in this review (see ). Specifically, 34 studies examined sexual satisfaction as a function of sexual identity (i.e. heterosexual vs lesbian vs bisexual), 8 studies examined sexual satisfaction as a function of partner’s gender (i.e. women in same-gender vs women in mixed-gender relationships), and 1 study incorporated both methods.
Table 4. Summary of participants’ sexual identities.
Four components of sexual satisfaction were analysed in this systematic review – general sexual satisfaction, orgasm occurrence, sexual frequency, and sexual duration. The final summary of the findings is presented in .
Table 5. Summary of findings on sexual satisfaction differences.
First, studies on general sexual satisfaction yielded a conflicting pattern of results. Almost half the studies (n = 18) found no differences in sexual satisfaction reports between sexual identities. Of those, nine studies found no differences between lesbian, heterosexual and bisexual women, seven studies found no differences between lesbian and heterosexual women and two studies found no differences between bisexual and lesbian women. The remaining studies (n = 25) reported patterns of differences. Across sexual identities, four studies found that lesbian women had higher sexual satisfaction than heterosexual women, but two studies found the opposite effect. Further, bisexual women reported higher satisfaction than heterosexual women in one study, but lower satisfaction than heterosexual women in two studies. Across partner’s genders, sexual satisfaction results were also mixed. Four studies found that women in same-gender relationships reported higher sexual satisfaction than women in mixed-sex relationships, but three studies found no differences between these groups. Similarly, two studies found that sexual minority (including lesbian and bisexual) women had higher satisfaction than heterosexual women, but two studies found no differences between these groups.
The studies that found no differences in sexual satisfaction between sexual identities or partner’s genders (n = 23) shared several similarities. The participants in these studies were predominantly between 25 and 35 years old (with only three studies employing participants aged 38–50). Further, most of the participants were in a relationship, with 16 studies reporting the entire sample consisting of people in relationship, four studies reporting large percentages of people in relationships (75–90% of the sample) and three studies not reporting participants’ relationship status. Finally, these studies employed similar measures, including FSFI (n = 3), ISS (n = 4) and bespoke several-item measures (n = 7).
Conversely, studies that examined orgasm occurrence, sexual frequency and sexual duration reported consistent results. Firstly, lesbian women reported higher orgasm frequency than heterosexual women, and women that have sex with women reported higher orgasm frequencies than women that have sex with men. Further, bisexual women reported lower orgasm frequency than lesbian women in three studies, and higher orgasm frequency than heterosexual women in another three studies. Thus, orgasm occurrence measures found that bisexual women were situated between lesbian and heterosexual women in their orgasm reports.
Moreover, nine studies assessed sexual frequency, reporting largely consistent results. The studies found that heterosexual women largely outperformed bisexual and lesbian women in sexual frequency (n = 5), or had similar frequencies (n = 3), with only one study finding higher sexual frequency in women that have sex with women. Finally, all three studies that examined sexual duration found that sexual minority women outperformed heterosexual women on average durations of sexual activity.
Mechanisms explaining sexual satisfaction differences
The studies identified by this review proposed several mechanisms (see ) to explain the differences in sexual satisfaction and related constructs. A thematic style of analysis was employed to group the proposed mechanisms. Majority of the studies (n = 19) did not propose any mechanisms that explained sexual satisfaction differences beyond explanations rooted in limitations (e.g. no differences were detected due to the sample consisting predominantly of religious women or women with sexual dysfunction symptoms). The most common explanations for higher sexual satisfaction and orgasms among women that have sex with women were: (1) better understanding of partner’s body (n = 7); (2) a belief in orgasm equity and lack of beliefs in penetrative sex as means to an orgasm (n = 7); (3) higher emphasis placed on communication and emotional closeness in sex; (4) wider range of orgasm-inducing sexual practices (n = 4), and; (5) longer sexual encounters (n = 4).
Table 6. Summary of mechanisms explaining sexual satisfaction differences.
Further, relationship length (n = 6) was used to explain the lower sexual satisfaction in women that have sex with women (sometimes referred to as ‘lesbian bed-death’) – due to lower sexual frequency in long-term same-gender relationships – but also to explain the higher sexual satisfaction in women that have sex with women – due to better emotional connection.
Finally, two mechanisms pertained to lower sexual satisfaction in women that have sex with men, including unequal divisions of labour in mixed-gender relationships (n = 1) and higher body dissatisfaction, related to higher self-objectification in this group (n = 1). Three mechanisms explained lower sexual satisfaction and sexual frequency in women that have sex with women, including lower level of LGBTQ acceptance (n = 3), internalised homophobia (n = 2), and ‘time availability’ (n = 1), suggesting that longer sexual duration in women that have sex with women makes finding the time for sex more challenging, reducing sexual frequency.
Discussion
This systematic review identified and synthesised all the available data comparing sexual satisfaction in women of different sexual identities to examine sexual identity effects for women’s sexual satisfaction. Addressing the primary aim, the results identified several aspects of sexual satisfaction – general sexual satisfaction, orgasm occurrence, sexual frequency and sexual duration – and presented compelling evidence that sexual identity influences sexual satisfaction. Specifically, while sexual satisfaction findings were heterogeneous, orgasm frequency was consistently found to be the highest among lesbian women, followed by bisexual women, with heterosexual women reporting the lowest orgasm frequency. Further, lesbian women outperformed heterosexual women on sexual duration, and heterosexual women largely outperformed lesbian and bisexual women on sexual frequency.
Addressing the secondary aims, this review examined the measures used in sexual satisfaction research and identified the mechanisms used to explain differences in sexual satisfaction reports among sexual identity groups.
Sexual satisfaction differences and mechanisms behind them
First, this review yielded conflicting findings on sexual satisfaction reports across sexual identities. The lack of differences in a number of studies can be explained by several similarities between these studies. First, most of these studies recruited participants aged 25–35 years old – a younger age which predicts higher sexual satisfaction (Frederick et al., Citation2017; Haavio-Mannila & Kontula, Citation1997). Second, almost all participants in these studies were in a relationship, which likely resulted in high sexual satisfaction in all groups. Indeed, researchers highlighted that people in relationships have more opportunities to engage in sexual activity and have better knowledge of partner’s sexual preferences, which elevates sexual satisfaction regardless of sexual identity (Amos & McCabe, Citation2017; Barrientos & Páez, Citation2006).
Importantly, mixed sexual satisfaction findings are contrasted with consistently higher reports of sexual frequency amongst heterosexual women and consistently higher orgasm and sexual duration reports in sexual minority women. This contrast points to the presence of other factors that either contribute to heterosexual women’s sexual satisfaction (despite lower orgasm and duration reports) or to lesbian women’s sexual satisfaction (despite lower sexual frequency). These factors would also explain bisexual women’s fluctuation in sexual satisfaction reports – where they report sexual satisfaction closer to that of lesbian or heterosexual women across studies.
Indeed, several researchers found that different factors contribute to sexual satisfaction of women of different sexual identities. For example, sexual satisfaction was found to be more associated with (1) genital touching, (2) frequency of orgasms, and (3) emotional intimacy in women in same-gender relationships compared to women in mixed-sex relationships (Cohen & Byers, Citation2014; Holt et al., Citation2021; Scott et al., Citation2018). Accordingly, several studies concluded that women in same-gender relationships engage in a wide variety of sexual activities (including genital touching), which are more likely to result in orgasm than vaginal-penile penetration (Coleman et al., Citation1983; Dyar et al., Citation2019. Engagement in these activities may also explain higher orgasm frequency in lesbian and bisexual women, found in the review (Frederick et al., Citation2021, Garcia et al., Citation2014; Hurlbert & Apt, Citation1993). Further, sexual minority women place higher value on emotional intimacy. Frederick et al. (Citation2021) coined the term ‘lesbian bed intimacies’ to describe behaviours – including deep kissing, playing music during sex, and making time for romance – that uniquely elevate lesbian women’s sexual satisfaction. Thus, emotional intimacy and a variety of sexual behaviours (i.e. genital touching) uniquely contribute to sexual satisfaction of sexual minority women.
Conversely, Holt et al. (Citation2021) found that heterosexual women endorsed frequency of sex as more important to their sexual satisfaction, than did lesbian or bisexual women. Heterosexual women may use sexual frequency as a barometer for a healthy relationship, or – due to lower sexual durations – engage in more frequent sex to achieve orgasm and pleasure. Alternatively, heterosexual women may engage in more sex to induce feelings of closeness, which may be lacking due to lower emotional intimacy in heterosexual relationships (Duncombe & Marsden, Citation1993). Additionally, heterosexual women were found to endorse orgasm occurrence as more important to sexual satisfaction than lesbian or bisexual women – possibly because they experience them less often than other groups (Holt et al., Citation2021). Thus, sexual frequency and orgasm occurrence are unique contributors to heterosexual women’s sexual satisfaction.
Finally, bisexual women were found to endorse acceptance of their sexual identity as more important to their sexual satisfaction and strength of their relationship as less important than did heterosexual or lesbian women (Holt et al., Citation2021). Importance placed on acceptance of bisexual women’s sexuality may point to biphobia experienced by this group – frequently within their own relationships (Friedman et al., Citation2014; Holt et al., Citation2021). Further, the lack of importance placed on strength of the relationship may point to a unique independence factor related to bisexual women’s sexual satisfaction Holt et al. (Citation2021). Thus, independence and acceptance of sexual identity may uniquely contribute to bisexual women’s sexual satisfaction.
In summary, studies that found no differences in sexual satisfaction across sexual identities in this review may have included numerous factors that individually elevated each group’s sexual satisfaction. For example, if emotional intimacy is uniquely important to lesbian women and high sexual frequency is uniquely important to heterosexual women, then in samples consisting almost entirely of women in relationships – as was the case in this review – both groups may score equally high, resulting in no found differences, but due to different factors.
The results of this review also revealed consistent effects of sexual identity on orgasm frequency, sexual frequency and sexual duration. Firstly, lesbian women reported the highest orgasm frequency. Studies proposed several explanations for these findings, including lesbian women (1) better understanding what feels good on a female body and therefore being able to elicit orgasm in female partners; (2) being more likely to employ activities suited for reaching orgasms (e.g. clitoral stimulation); and (3) being more likely to believe in orgasm equity and engage in ‘turn-taking’ (Coleman et al., Citation1983; Dyar et al., Citation2019; Frederick et al., Citation2021; Garcia et al., Citation2014; Willis et al., Citation2018).
Notably, this review found that bisexual women fluctuated between orgasm frequencies of lesbian and heterosexual women. Garcia et al. (Citation2014) proposed that the bisexual identity might obscure partner’s sex. For example, if a bisexual woman predominantly partners with men, her orgasm frequency may align with that of lesbian women, whereby if she partnered with a man, her sexual frequency may align with that of heterosexual women. This may explain the discrepancy in bisexual women’s orgasm and sexual satisfaction reports, reported by previous studies (Frederick et al., Citation2017; Gusakova et al., Citation2020; Henderson et al., Citation2008). Indeed, the gender of women’s sexual partners may be a better predictor of their sexual satisfaction than their sexual identity. Since orgasm frequency is higher with female partners, it is important to measure partner(s)’ gender(s)’ over sexual orientation since the latter does not necessarily capture the sexual experience that influences sexual satisfaction and related outcomes. It is also worth noting that the review likely does not cover data from women who have partners who do not align with expectations of how the researchers asked about their sexuality (e.g. women who are behaviourally bisexual, but identify as heterosexual or lesbian would likely have not been eligible to participate in the studies that were identified in this review if those studies only asked about identity).
This review also found that heterosexual women mostly outperformed sexual minority women on sexual frequency. This finding can be explained by higher rates of initiation by male partners and heterosexual women’s adherence to sexual scripts that value penetrative intercourse and male orgasm as essential to sex (Frederick et al., Citation2021; Willis et al., Citation2018). Further, Blair and Pukall (Citation2014) used the concept of ‘time availability’ to explain the difference, arguing that if sexual encounters last 15–30 min on average (as in heterosexual relationships), then women can commit to that timeframe more frequently than if they last 30–45 min (as in lesbian relationships, Blair & Pukall, Citation2014). There are also speculative explanations that could be considered around menstrual cycles. On the assumption that sex occurs less frequently during the menstrual cycle, this could impact women having sex with men for around 5–7 days per month, but this impact could be up to doubled for women having sex with women (i.e. if there is no overlap in their cycles).
Finally, this review found sexual minority women had longer durations of sex than heterosexual women. Researchers proposed that a wider range of sexual activities, higher importance placed on sexual intimacy and ‘turn-taking’ culture among sexual minority women require more time, explaining the difference (Frederick et al., Citation2021; Garcia et al., Citation2014). Blair and Pukall (Citation2014) also propose a theory of ‘optimal sexuality’, in which sexual minority women trade off frequency for duration to achieve deeper physical and emotional sexual intimacy.
Measures of sexual satisfaction
Finally, the review examined common measures of sexual satisfaction and revealed that studies that found no differences in sexual satisfaction used some of the same measures. Thus, all studies that used FSFI and 4 of 6 studies that used ISS found no differences in sexual satisfaction across sexual identity groups.
First, the FSFI assesses sexual satisfaction using three items. The measure evaluates both emotional closeness – a factor important to lesbian women’s sexual satisfaction – and overall satisfaction with partnered sex – which likely includes an evaluation of sexual frequency for heterosexual women, possibly resulting in similar ratings of sexual satisfaction.
Similarly, four of six studies using ISS yielded no significant results. ISS is a 25-item measure, which evaluates the participants’ sexual satisfaction within their relationship. Since women evaluate their sexual satisfaction as a combination of their and their partner’s sexual satisfaction – their scores may be elevated (Lentz & Zaikman, Citation2021). Thus, heterosexual women’s scores may be elevated because heterosexual men report the highest sexual satisfaction of all sexual identity groups, and lesbian women’s scores may be elevated because lesbian women report the highest rates of partner orgasms of all sexual identity groups (Frederick et al., Citation2017; Lentz & Zaikman, Citation2021). Moreover, two other studies that used ISS have methodological issues. One study found a very weak difference, that disappeared after conducting SEM analysis (Holmberg et al., Citation2010). Another study compared lesbian women’s sexual satisfaction in their heterosexual and lesbian relationship, which is expected to differ, since lesbian women likely did not find sex with male partners sexually satisfying (Fioravanti et al., Citation2021). Thus, both measures may elevate the groups’ sexual satisfaction, yielding equally high results – but due to different factors.
The evidence synthesis presented in this review reveals that the most appropriate measure of sexual satisfaction (in the context of women of differing sexual identities) is the New Sexual Satisfaction Scale (NSSS; Brouillard et al., Citation2019). A 20-item measure, used by one study in this review, employs items such as ‘The intensity of my sexual arousal’ and ‘My “letting go” and surrender to sexual pleasure during sex’, and examines the aspects of sexual satisfaction that focus on intimacy, emotional closeness, and partner pleasure, without pathologising sexual satisfaction by equating it to sexual (dys)function. The scale is also gender and sexual-orientation neutral and is well-suited to measuring sexual satisfaction in women of differing sexual identities (Brouillard et al., Citation2019).
Limitations, future directions, and implications
There are several limitations to the systematic review. Firstly, bisexuality was a self-defined sexual identity, that described attraction to women and men. However, women’ sexual satisfaction reports may vary depending on their partner’s gender. For example, women that predominantly have sex with women may have higher orgasm frequency and sexual durations – in line with lesbian women’s reports. Further, this review focused on sexual satisfaction and excluded sexual desire and arousal, which includes a further pattern of conflicting results and its subsequent effect on sexual satisfaction.
Furthermore, there were several limitations in the literature. Overwhelmingly, sexual satisfaction research specifies only two genders – men and women – and excludes numerous gender identities that may differ in satisfaction and satisfaction-relevant factors (e.g. pansexual women that have sex with non-binary people). The studies included in this systematic review largely avoided specifying gender identities of participating women, and either actively recruited cisgender women or presumed all women participants to be cisgender. Further, majority of research is cross-sectional with no longitudinal studies conducted in this area, besides sexual satisfaction changing with age, sexual experience, and relationship length. Finally, few studies have examined sexual frequency and duration in sexual minority women, yet both factors are shown to influence women’s sexual satisfaction.
Future research should include more detailed demographic questions on non-cisgender identities when studying gender differences in sexual satisfaction and satisfaction-related factors. Further, sexual frequency and duration’s influence on women’s sexual satisfaction should be examined further. Finally, research should investigate further factors that differentiate sexual satisfaction in women, including the role of heteronormative sexual scripts, phallocentric imperatives, and emotional intimacy.
There are a range of implications from this review. For instance, clinicians working with women on their sexual satisfaction (and related presentation issues, including relationship satisfaction, broader self-esteem issues) will benefit from being aware of the role of their clients’ gender and the influence that this has on their presentation issue/s. Similarly, and for this same reason, this knowledge will benefit educators women who are themselves trying to understand their own experiences with sex and their related levels of satisfaction, particularly if new to having sex with a different gender. The findings could also have implications for those developing or evolving theory in this domain and methodical implications for future research. We recommend researchers collect (and report) more nuanced demographic data concerning gender identity of participants, that capture non-binary, trans and gender-fluid participants, which are largely missing from research on sexual satisfaction differences. Further, as indicated by this review, the gender of sexual partners’ is one of the key influences on sexual satisfaction, orgasm occurrences, sexual frequent and duration and yet it is scarcely measured. Finally, studies on sexual satisfaction should include constructs beyond sexual dysfunction, and therefore use measures that capture emotional closeness, pleasure, and communication with partner (e.g. NSSS).
Conclusions
This review systematically synthesised available literature on sexual satisfaction differences across sexual identities in women, examined the measures used to assess them and identified key mechanisms explaining the differences. The review found differences in orgasm occurrence, sexual frequency, and sexual duration between sexual identities. Findings pertaining to general sexual satisfaction require further exploration. By highlighting major differences in sexual minority and heterosexual women’s sexual satisfaction, this review facilitates further research exploring factors differentiating women’s sexual satisfaction, which may impact clinical practice and promotion of sexual well-being.
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Data availability statement
The data that support the findings of this study are available from the corresponding author, [Joel Anderson - [email protected]], upon reasonable request.
Supplemental data
Supplemental data for this article can be accessed online at https://doi.org/10.1080/19419899.2024.2360998.
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Notes
1. We acknowledge here our inclusive approach to women, in which transwomen were included in studies. However, we acknowledge that we did not include transwomen as part of the search terms, and so if the authors of the papers included in this review had excluded transwomen, we would be carrying forward that bias in our synthesis of the literature. We also acknowledge that none of the authors reported what proportion of their sample were trans or gender diverse, and so we cannot know whether or not this subsample of women are represented in this systematic review.
2. Majority of literature employs the terms ‘mixed-sex’ to refer to ‘man-woman pairings’ and ‘same-sex’ to describe ‘woman-woman pairings’– and that is how they are defined in the extraction – however, we use the term gender when referring to men and women to avoid conflation of sex and gender in this paper.
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