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ORIGINAL ARTICLE
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Understanding same-sex relationships in gay individuals


 Department of Psychiatry, Government Medical College and Hospital (GMCH), Chandigarh, India

Date of Submission15-Nov-2021
Date of Decision12-Feb-2022
Date of Acceptance15-Feb-2022

Correspondence Address:
Aarzoo Gupta,
Department of Psychiatry, Level 5, Block D, Government Medical College and Hospital (GMCH), Sector 32, Chandigarh - 160 031
India
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/mjdrdypu.mjdrdypu_890_21

  Abstract 


Background: The social demands and pressure often lead individuals of the sexual minority to enter heterosexual marriages resulting in the termination of ongoing same-sex relationships. Consequently, short-lived relations and multiple romantic or sexual partners. Methods and Material: The study aimed to assess couple satisfaction in relation to sexual satisfaction, mental health, and stigma in gay individuals. It was a correlational cross-sectional study conducted online through social media platforms using Google Forms. The assessment measures used were: Couple Satisfaction Index, New Sexual Satisfaction Scale, General Health Questionnaire, and Self-Stigma Scale. Out of a total of 115 posts, 92 responses were received from which a sample of 30 was analyzed using Statistical Package for the Social Sciences version 28. Descriptive statistics, Spearman's correlation, and regression were computed to determine predictors of relationship satisfaction. Results: The correlation between sexual satisfaction and couple satisfaction (r = 0.52, P ≤0.01) was significant indicating that sexual satisfaction increases couple satisfaction. Psychological distress and stigma were inversely related to couple satisfaction but not to sexual satisfaction. Conclusions: Sexual satisfaction largely determined the couple's satisfaction while psychological distress or stigma accounts for a small percentage of couple satisfaction.

Keywords:  Gay men, LGBT, same-sex relationship, sexual satisfaction



How to cite this URL:
Malick T, Gupta A, Arun P. Understanding same-sex relationships in gay individuals. Med J DY Patil Vidyapeeth [Epub ahead of print] [cited 2022 Dec 7]. Available from: https://www.mjdrdypv.org/preprintarticle.asp?id=343059




  Introduction Top


Lesbian, Gay, Bisexual, Transgender, Queer, and intersex (LGBTQI) is an umbrella term that is often associated with identifying and defining one's sexual behavior, identity, or attraction on a continuous spectrum.[1] Sexual orientation is one's perception of self in terms of emotional, romantic, or sexual attraction, or even desire and affection for another person.[2] Gender identity, on the other hand, is independent of sexual orientation and is usually referring to one's internal and psychological sense of being male, female, both, or neither.[3] Hence, the terminology is ever-expanding and encompasses a larger variety of sexual orientations and gender identities, each being uniquely different with certain commonalities.

Gay refers to an individual whose primary sexual orientation is toward a person of the same sex, and often used by both males and females; hence, a gay man would have a sexual attraction toward another man. Some homosexual or gay women, that is, women who are attracted to other women, may prefer to use the term “lesbian” instead.[1] The worldwide estimates suggest that 2% to 14% of the global population identifies as LGBTQ.[1] India, unlike other countries, also has a growing LGBTQ population and the abolishment on section 377 of the Indian Penal Code in 2018 has allowed freedom for the individuals' to express their sexuality and gender identity. Information about sexual orientation or same-sex relationships of individuals was not collected in Census of 2011, but estimate was made from the worldwide prevalence and web-based data suggesting approximately 45.4 million individuals in the LGBTQ community in India.[4]

Social relations are primary to human existence as it involve interdependence and enhances well-being.[5] Romantic relationships are further means of satisfying emotional as well as sexual intimacy. However, there are individual differences attributed to personality, attachment styles, and socio-cultural practices that determine the extent of closeness in relationships.[6],[7],[8],[9],[10] In addition, the expression and fulfillment of sexual needs vary between genders, women are driven for sexual intimacy after the escalation of emotional closeness while men are biologically driven.[11] The duration of relationship also affects the dynamics of a relationship, though only relationship satisfaction but not sexual satisfaction.[12],[13] Research and theories have explored various aspects pertaining to heterosexual relationships, and marital satisfaction but nuances and dynamics of the same-sex relationships still demand delving.[14],[15],[16] There is global literature investigating various aspects of romantic and sexual relationships in sexual minorities but research from India is very limited. The clinical practice and literature revealed how social demand and pressure to enter heterosexual marriages result into termination of ongoing same-sex relationship contributing to frequent changing of partners as well as short-lived relations.[17],[18] This directed the authors to study relationship and sexual satisfaction among gay individuals. Further, to assess mental health (MH) and stigma in relations may help to gain greater insights.


  Methodology Top


Settings

The study aimed to assess couple satisfaction in relation to sexual satisfaction, MH, and stigma in gay individuals. It was a correlational cross-sectional research design using purposive and snowball sampling.[19] The estimated sample size was 29 rounded off to 30.[20] The data were collected through various social media platforms using Google Forms (GFs).

Inclusion and exclusion criteria

The sample was 30 self-identified cisgender male. Those between 18 and 45 years of age, having homosexual orientation, minimum 10 years of formal education. and currently or in the past have been in a relationship and sexually active with a same-sex partner were included. The study excluded those belonging to other sexual or gender minorities, having any unstable serious medical condition, and seeking any therapy or psychological help for sexual orientation or relationship issues.

Assessment tools

Couple Satisfaction Index (CSI) is a 32-item scale to examine an individuals' relationship satisfaction.[21] Based on the individuals' responses, a higher score would indicate a higher level of relationship satisfaction. The scale has been used for both heterosexual as well as sexual minorities and has been observed to be reliable with a Cronbach's alpha of 0.94.[22] It takes approximately 10 min to complete.

New Sexual Satisfaction Scale (NSSS) is a 5-dimensional measure examining various aspects of sexual satisfaction emphasizing the importance of sexual activity, sexual exchange, sexual sensations, sexual awareness/focus, and emotional closeness.[23] The scale includes 20-items on a 5-point Likert type rating scale with 1 being “not at all satisfied” to 5 being “extremely satisfied.” The scale has two subscales namely, ego-focused (EF), which measures satisfaction generated by personal experiences/sensations, and partner/activity-focused (PF), which measures satisfaction obtained from partner's sexual behavior and reactions as well as the diversity or frequency of sexual activities.[21] The reported Cronbach's alpha ranged from. 87 to. 94 suggestive of good reliability; furthermore, the scale also is suggestive of adequate validity with a significant association with global measures of life satisfaction and other sexual satisfaction scales.

General Health Questionnaire (GHQ-28) aids in screening for common mental disorders as well as general measure of psychiatric well-being.[24] It is a self-reported measure with 28-items examining the severity of a psychiatric problem over a few weeks. The items are rated using a 4-point scale, with total scores ranging from 0 to 84, higher scores indicative of worse conditions with a score of 23/24 as a threshold of presence of distress. GHQ has been divided on four subscales, namely, somatic symptoms (SOM) (items 1–7), anxiety/insomnia symptoms (ANX) (items 8–14), social dysfunction (SD) (items 15–21), and severe depression (DEP) (items 22–28).[25] The questionnaire takes approximately 10 minutes to complete and has a Cronbach's alpha of 0.90 to 0.95.[26]

Self-Stigma Scale (SSS) is a 9-item self-reported measure and it measures an individual's stigma toward oneself due to his minority status.[27] Items are rated on a 4-point scale and are distributed among affective (AFF), cognitive (COG), and behavioral (BEH) components of stigma. The scale has been used for both heterosexual as well as sexual minorities and has been observed to be reliable with a Cronbach's alpha of 0.87.[27]

Procedure

The work was carried out at out-patient department of Psychiatry as part of curriculum of MPhil Clinical Psychology course run by the Department of Psychiatry of an urban tertiary care teaching hospital. Due to the pandemic, the Department of Psychiatry had tele-psychiatry services, viewing which the authors considered to conduct the research using GF. The primary researcher expressed interest in LGBT population and this further encouraged the authors to use GF ensuring greater confidentiality. To begin with, the authors searched the methodology used in GF.[28] Following this, the variables were identified, permissions to use tools were sought, and a sample of GF was created to run before submitting the proposal to Institution Ethics Committee (GMCH/IEC/2020/339). The proposal was submitted to IEC by May' 2020 and on approval, the researchers started to create the GF for the current study.

The researcher accessed the web link to create GF.[29] The webpage displayed two options: Personal and Business, the primary researcher chose personal and clicked on go to google forms, opening the template gallery, from which the researcher selected a blank template. The blank template is auto-created with two tabs, namely, untitled form and untitled question. Untitled form was used for labeling headings of the sections while untitled question was used for typing the text of statement or question. The multiple choices on the side gave option to select applicable type of response style for each category to question or statement. To move to the next statement of question, the floating menu on the side of this template gave options namely, add questions, import questions, add title and description (text), add image, add video, and add section; the researcher selected title and description (text). GF was created following the above options, sections were split using the add section option from the floating menu.

Section 1 contained approximately 30 words including aim of the research, name, and phone number of the primary researcher. Section 2 included the information (107 words) about the study under the headings namely, method, time taken, benefits, risks, confidentiality, and freedom to withdraw. At the end of section 2, a statement for consent was provided, requiring the participant to respond with Yes or No. Section 3 required the participants to fill in the sociodemographic details such as name (optional), age, education, occupation, religion, city of residence, length of stay in current study among which age and years of education was in form of short answer where only numerical response was permitted, and the remaining were in a multiple choice format where participants could choose the one applicable response. Section 4 was for the relationship and sexual profile, wherein all the statements were multiple choice and the participant had to choose an applicable answer. The information pertaining to gender identity, sexual orientation, current relationship, relationship style, and length of relationship was enquired. Section 5 was for the clinical profile, where the statements enquired about pharmacological or non-pharmacological treatment for psychiatric condition (multiple choice), psychiatric diagnosis (short answer, optional), need for MH services (multiple choice), reason for MH service (short answer, optional), and difficulties in sexual life (checkboxes as it permitted the participant to select more than one sexual difficulty from the mentioned options). Section 6 had option to submit personal contact details if the participant was willing to be contacted by the researcher (Yes/No) to share Form B, following which, an optional question pertaining to the preferred mode of contact was added with checkboxes permitting the participant to respond with their preferences. The section ended with a tab where the participant could leave his contact details (number, email, WhatsApp, FB, and IG) in the short answer.

A second GF, Form B, was also created comprising all the standardized tools namely, GHQ-28, CSS, NSSS, and SSS, respectively. This form B was to be circulated to those who consented and met the criteria after filtration of the received data. One section was created for each measure, typing each item with its corresponding response option. Once the GF was prepared, it autosaved in the researcher's Google drive. The researcher then chose the send option from the header tab, which auto-created a shareable link to the GF. In addition, the option to shorten uniform resource locator (URL) was selected by the researcher to make sharing the link more convenient. The entire process of preparing two GFs A and B thus having two URLs.

The GF thereafter was accessed using GF link/URL. A trial was run among the authors to review. The forms were circulated to four colleagues of the researchers to check for any error or difficulty in responding. Further, Forms A and B were sent to a member of LGBTQ community for trial and feedback. The suggestion received was to combine the Forms A and B instead of sending twice as it demanded contact details. This was then discussed among the researchers and considering consequences of losing data sections were added to Form A. Section 7 introduced the participants to the four measures using a general instruction statement: “Each question has multiple options, one can rotate the screen or slide to view all options.” This section was added to avoid errors in responding, considering new or inexperienced user may face the difficulty to view all given options due to lack of familiarity with the interface. Sections 8, 9, 10, and 11 contained the standardized tools namely, GHQ-28, CSS, NSSS, and SSS, respectively. The participants were thanked in the last 12th section and contact information of the researcher was restated. GF was tested, revisited, and revised by Authors and sent to the same person and two more members of LGBTQ community for feedback and from this point, it was now ready to be posted for data collection. It took 1 month's time with 5 to 7 hours of discussions and 2 to 3 hours to transfer the text from the finalized hard copies into GF.

Next step was to search the portals to post GF. The primary researcher had spent time exploring various social media portals like Facebook (FB), Instagram (IG), websites of non-profit organizations (NGO's) working with LGBTQ+ individuals, WhatsApp groups of LGBTQ+, and search continued through friends or acquaintances and other sources. A total of 15 LGBTQ+ FB pages were contacted to post the link, out of which no engagement was observed in the form of likes or responses, except one page where GF link was reposted thrice with a gap of 4 weeks (15 + 3 = 18). IG business accounts (13) catering to LGBTQ+ content were also contacted to share the GF link with their followers. The one IG profile that was responsive was requested to repost 12 times with a gap of every 2 to 4 weeks (13 + 12 = 25). Personal IG accounts (55) were also contacted through direct messages and requested to participate in the study, some of them responded while others denied saying 40 min is a long time period. A total of 9 individuals were contacted via WhatsApp as well as 3 WhatsApp community groups where it was shared thrice (9 + 6 = 15). In addition, two NGO's were contacted via email but were unresponsive. Out of the total 92 responses, a sample of 30 was selected [Figure 1]. However, the number of individuals who did not respond to the GF link remains unknown.
Figure 1: Procedure of recruitment of sample

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Once a participant filled and submitted the responses, the researcher accessed it via opening the respective form in Google drive, and selecting the responses option, next to the questions option at the center of the header tab. On selecting the responses option, the page displayed the number or responses as well as an option to view responses in sheets, which when selected, created a Google sheet in the linked drive to which the responses are automatically transferred and saved. A new excel was created by the researcher using data from the auto-created Google sheet to add recruited participants based on inclusion and exclusion criteria. The data were filtered and transferred regularly (to track number of recruited participants) and the link was continually posted until the sample size was completed. Once the target sample was obtained, a final excel sheet was created with coded data for analysis.

Statistical analysis

Data were analysed using Statistical Package for the Social Sciences version 28. Descriptive statistics was computed for demographic variables and scores of measures. Spearman's correlation was computed to assess the relationship among all measures of assessment. Further regression analysis was computed to determine predictors of relationship satisfaction.


  Results Top


[Table 1] depicts the participant characteristics and distribution of nature of relationship. The average age range of respondants was from 21 to 29 years with 15 average years of education. [Table 2] shows the descriptive statistics of scores on the assessment measures.
Table 1: Participant characteristics

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Table 2: Mean and SD of scores on assessment measures

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[Table 3] revealed significant correlations between sexual satisfaction (NSSS) and couple satisfaction (CSI; r = 0.52, P ≤0.01). Further both subscales, ego-focused (EF) as well as partner and activity focused (PF), were significantly correlated with couple satisfaction (CSI; r = 0.49 and r =0.53, P ≤.01). The observed positive correlations between the said measures indicated that as sexual satisfaction increases the couple satisfaction also increases. Also, MH (GHQ) was negatively correlated with couple satisfaction (CSI), indicating psychological distress (GHQ; r = 0.37, P ≤.05) and anxiety (ANX: r = 0.46, P ≤.05) were inversely related with couple satisfaction (CSI). The BEH subscale of stigma (SSS) was negatively or inversely correlated with couple satisfaction (CSI; r = 0.36, P ≤.05). Psychological distress (GHQ) had no significant correlation with sexual satisfaction (NSSS). The COG subscale of internalized stigma (SSS) was inversely related with ego-focused (EF) subscale of sexual satisfaction (NSSS; r = 0.38, P ≤.05).
Table 3: The relationship among the measures using correlation analysis (n=30)

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Further regression was computed for variables having significant correlations with sexual and couple satisfaction as dependent variables (see [Table 4]); It determined the coefficient of determination (R2), predicting the amount of change in the dependent variable (DV) contributed by the independent variable (IV). The couple satisfaction (CSI) accounted for 24% of the total variation in sexual satisfaction (NSSS), ranging from 21% to 25%. This means 75% to 79% variation is accounted by other factors affecting couple satisfaction. Psychological distress (GHQ) accounts for 10% of total variation in couple satisfaction and 18% is anxiety (ANX) per se, while BEH subscale of stigma (SSS) accounted only 10% determining that 90% of variation in couple satisfaction (CSI) is largely affected by other factors.
Table 4: The regression analysis of significantly correlated measures with relationship and sexual satisfaction as DV

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  Discussion Top


This study showed that couple satisfaction increases as sexual satisfaction increases. Psychological distress and stigma were inversely related to couple satisfaction but not to sexual satisfaction. Sexual satisfaction largely determined the couple satisfaction while psychological distress or stigma account to a small percentage of couple satisfaction. A causal association between relationship and sexual satisfaction was reported because greater relationship satisfaction lead to higher sexual satisfaction among gay population as well as in bisexual men.[30],[31] Psychological distress affects the relationship satisfaction by impairing the sexual functioning, as less satisfied individuals tend to deal with more psychological, interpersonal, and social difficulties.[32] These difficulties tend to further increase manifold for the same-sex couples who usually experience a higher level of daily stress and a poorer relationship quality.[33] A study comparing levels of distress among the bisexual and gay sample found that bisexuals had higher lifetime rates of anxiety disorders, mood disorders, suicidality, and substance abuse.[34],[35],[36] This may be attributed to the demands of heterosexual society conflicting with one's bisexuality. Another study concluded that same-sex relationships match the heterosexual relationships in terms of emotional qualities, interpersonal communication style, and conflict resolution skills of partners.[37],[38]

Stigma was observed to have no significant correlation with other variables like relationship or sexual satisfaction and psychological distress. The reason may be that all the participants were accessed through social media determining their active participation on social media platforms. This suggests that they might be actively communicating with other members of LGBT community and sharing their experiences. Social support also plays a major role in influencing stigma either offline or via online communities, therefore minimizing the effect of stigma.[39] Being part of the support group (s) tends to enhance problem-solving as well as coping style and is known to reduce depressive symptoms.[40] The cohesiveness in sexual minorities strengthens the adaptive coping and cognitive flexibility both linked with one's psychological well-being and greater relationship satisfaction.[41],[42] The prevalence of societal stigma also contributes to the emergence of various support groups that tend to increase self-awareness as well as self-acceptance, therefore preventing the internalization of stigma. The membership of such support groups is also negatively correlated with depression, perceived stress, and anxiety while individuals with lower clarity and higher sexual identity confusion reported higher self-stigma rooted in lower self-esteem.[43],[44] Furthermore, there has been an increased media representation of LGBQT role models which has been shown to positively influence the LGBTQ identity.[45] LGBTQ population being marginalized is still paving its way into the integrated society or inclusive social structure and social media has been instrumental to create awareness and sensitize the masses about the LGBTQ population and their issues. The media also appears to have enhanced access to intra-community support providing various portal to members of the LGBT community to come forward and share their experiences protecting against the sense of internalized stigma.

In this study, stigma determined a small ratio of couple and sexual satisfaction. While short-lived relationships and related factors contribute significantly to psychological distress or MH issues, the evolving cohesiveness in LGBT community may neutralize such experiences. The communication within the group has made the members accept the nature of same-sex relationships, including break-ups or emotional upheavals as well as stay optimistic to find a new partner through various dating websites (social media platforms).[46] Thus, it's easier to share grief for those who earlier progressed to MH issues due to unresolved grief and unavailable social or emotional support. In addition, social media platforms have shown path for dual life, where an LGBT person adapts to heterosexual society but at the same time have a liberal expression of one's orientation or identity among its members.

Stigma and discrimination are common social phenomena affecting each individual on various parameters despite which most of the individual are resilient and live a usual life.[47],[48] This points toward the protective factors that safeguards any individual against bully or discrimination or stigma or labels, etc.[49] It will be useful to know the protective factors prevailing among LGBT population. This insight may guide the professionals to integrate these while addressing MH issues in LGBTQ community.

The sample in this study was largely from an urban population and is therefore hard to generalize, as the sample is not representative of the entire LGBTQ+ population. The authors did not enquire about the gender of the partner of bisexual individuals which could contribute to individual's distress or interaction with the respective environmental factors. Authors also did not enquire about individual's outness as well as any protective factors in their environment. However, since the LGBTQ+ sample is still relatively understudied in India, the study has been able to provide beneficial results and a direction for further research. It also helps us better understand LGBTQ+ relationships in the Indian cultural context. When working within a therapeutic setup, interpersonal relationship issues between sexual minority partners may be addressed independent of social factors such as stigma and relationship satisfaction may be improved via working on internal factors like sexual behaviors or activities.

Acknowledgements

The authors would like to thank Dr Janette L Funk and Dr Ronald D Rogge of Department of Clinical and Social Sciences in Psychology, University of Rochester, USA. We also thank Dr Aleksandar Štulhofer and Dr Vesna Buško, Faculty of Humanities and Social Sciences, University of Zagreb, Croatia as well as to Dr Pamela Brouillard, Department of Psychology and Sociology, Texas A&M University-Corpus Christi. Also, we thank Dr Winnie W S Mak, Department of Psychology, The Chinese University of Hong Kong, Shatin, and to Dr Rebecca YM Cheung, Department of Early Childhood Education (ECE).

The Education University of Hong Kong.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
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    Figures

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    Tables

  [Table 1], [Table 2], [Table 3], [Table 4]



 

 
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