Insight Therapy

Psychologically-informed reflections on how we interact.

Sexual Satisfaction: Highly Valued, Poorly Understood

Our understanding of sexual satisfaction is unsatisfactory

Sexual satisfaction is an important goal, a key component in a good relationship and a good life. Yet, surprisingly, our understanding of the concept is quite limited and incomplete.

One reason for this limited knowledge is that sexual gratification, like many large psychological concepts (intelligence, love, etc.), is easy to experience and comprehend intuitively but difficult to define and measure with precision. Here’s a quick thought experiment: How would you define and calculate ‘sexual satisfaction?’ Is it about the number of orgasms per sexual encounter? Or perhaps per month? Or perhaps the number of orgasms in relation to your partner, or your friends, or what you had in your previous relationship? Or maybe you prefer to focus on the intensity of the orgasm—quality over quantity? Or perhaps it is the feelings of intimacy and emotional closeness arising from sex, regardless of orgasm? Or perhaps it is a particular combination of all of these? But if so, what mix? Sexual satisfaction, it turns out, is a slippery and subjective notion, not easily dissected and analyzed with scientific tools.

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Another reason we know so little is that the study of sex in general, and female sex in particular, is a relatively new and fraught endeavor. In many societies around the world the subject is still taboo. Historically, even in societies considered advanced, it was until quite recently held that women did not particularly enjoy sex, were definitely not entitled to sexual pleasure, and—given their low social-economic-political status—did not merit serious study.

Today, however, we know that the question of sexual satisfaction is relevant for men and women alike. Both men and women have the capacity, desire, and right to experience a satisfying sexual life.

The Spanish researcher Maria de la Sanchez Fuentes and her colleagues in 2013 published an extensive summary of the literature on sexual satisfaction. The authors reviewed the results of 197 scientific studies, published between 1979 and 2012, which included some 40 different measures of sexual satisfaction. The findings showed no significant difference between the level of sexual satisfaction of men and women. The researchers found that, as expected, healthy people are more sexually satisfied. Physical (heart disease, diabetes, etc.) and psychological (depression, anxiety) problems were correlated with reduced levels of satisfaction.

As expected, sexual functioning itself is important for sexual satisfaction. Those who experience strong sexual desire and whose sexual instruments work properly (arousal, erection, vaginal lubrication, orgasm) report more satisfaction than those who experience pain, erectile dysfunction, vaginal dryness, or lack of orgasm. Social support, good family relations, and high economic status also predict sexual satisfaction.

In addition to ill health and physical impairment, a number of other factors have been linked in the literature to decreased sexual satisfaction. A history of abuse or sexual trauma predicts lower levels of satisfaction. People with sexual guilt or those who are flooded with negative or threatening cognitions during intercourse ("It's immoral," "I do not look good," etc.) tend to experience lower satisfaction level. The use of pornography also predicts lower level of satisfaction, as does financial, family, or personal stress. Sexual satisfaction as a rule declines with age, as do the frequency of sex and of thoughts about sex.

In addition, the findings paint a clear picture: sexual satisfaction goes hand in hand with good relationships. People in more intimate relationship, with good communication and mutual support, experience greater sexual satisfaction. In the context of relationships, sexual assertiveness (the ability to stand your ground, establish clear boundaries, clarify what you want and need in sex, what works for you and what doesn’t) predicts increased satisfaction. In addition, partners who have similar personalities tend to experience greater sexual satisfaction. Birds of a feather flock together, happily. Sexual satisfaction increases with level of education, but appears to be inversely related to the number of sexual partners. On the whole, more partners = less satisfaction. 

The researcher Uzma S. Rehman at University of Waterloo in Canada and her colleagues published in 2013 a more specific summary of the research on sexual satisfaction among heterosexual women. Many of the findings reviewed by Rehman align with those reviewed by Sanchez Fuentes. Among women, the quality of intimate relationship predicts the level of sexual satisfaction. Women in an intimate relationship with mutual trust reported a higher level of satisfaction. Married women reported higher sexual satisfaction than singles. Additionally, women (particularly young ones) with positive self-esteem and body image tend to report higher levels of sexual satisfaction, regardless of their objective weight and actual body shape.  Sexual satisfaction among women, in general, decreases with age. Individual characteristics are also related to sexual satisfaction. Women high on the personality trait of neuroticism (anxiety, tendency toward negative emotions, low mood, irascibility) reported reduced sexual satisfaction.

In addition, Rehman reports that attachment style predicts sexual satisfaction. In short, attachment theory, conceived by the British psychologist John Bowlby in the sixties, claims that children, through their interactions with caregivers, internalize a specific ‘attachment style’—a working model of the world and its inhabitants. This attachment style shapes the child’s patterns of emotional response and interpersonal behavior into the future. Three main attachment styles have been identified: secure attachment (“The world is benign and orderly. I can trust people. My needs can be met"), anxious-ambivalent attachment (“The world is complicated. People may hurt me. I want to get close to others but fear they will not reciprocate"), or avoidant attachment style (“The world is rotten. People are useless. Better to stay away from people and rely only on myself"). Rehman and her colleagues have found, as expected, that a secure attachment style predicts increased sexual satisfaction.

The consistent link in the literature between relationship quality and level of sexual satisfaction suggests that sexual satisfaction, as experienced in the lives of most people, is essentially an 'emergent property' of our intimate contact and relationships, rather than a merely personal, private, and solitary experience or a skill to be mastered alone in one’s basement. Good relationships and satisfying sex go hand in hand.

So we know some things. Still, our understanding of the processes of sexual satisfaction is far from complete. Existing research has been limited in several important ways.

First, for obvious reasons, most of the research on sexual satisfaction has been based on participants' self-reports rather than on objective measures or direct observation. Self-reported data are inherently vulnerable to various biases and distortions, including ignorance, poor memory, social desirability effects, and lying.

Second, most studies reported in the literature are correlational in nature. Correlations between variables do not explain cause and effect relationships. For example, if we find a correlation between relationship satisfaction and sexual satisfaction, we still do not know what causes what. Maybe relationship bliss leads to great sex. But maybe great sex facilitates a great relationship. Or perhaps the link between the two is indirect, created entirely by a third variable such as shared values, or level of stress. Finding cause and effect requires controlled experiments. Controlled experiments on the subject of sexual satisfaction are difficult to conduct and consequently extremely rare.

Finally, most studies on sexual satisfaction have not been based on theory. This is a problem because a theory in science is a kind of roadmap that enables us to understand the reality around us ("Why is it so noisy here? Oh, highway 70 is a block west”), to communicate effectively ("I'm at the corner of Main and State, a block east of City Hall”), and to accurately predict the future ("If you go north on Main for two hundred yards, then turn right on State Street, you’ll see City Hall on your left"). Science advances and solves problems by constructing sound theories. In the absence of a theory, we are left with a pile of reports, observations, and experiences, but without a way to combine those individual pieces of information together into a coherent whole picture.

One theory of sexual satisfaction that has been supported by data was offered in the nineties by the Canadian researchers Kelly-Ann Lawrance and E. Sandra Byers. The researchers defined sexual satisfaction as: “An affective response arising from one's subjective evaluation of the positive and negative dimensions associated with one's sexual relationship.” They proposed that such sexual satisfaction depended on four equations: 1. Satisfaction with overall relationships. 2. Relationship between the level of rewards and costs in a relationship, 3. Level of rewards and costs compared to our expectations. 4. Level of equality in rewards and costs between the partners.

'Rewards' according to this theory are positive aspects in a relationship like those that bring joy and satisfaction. ‘Costs’ are events that cause pain, embarrassment, or anxiety, or require effort. Benefits and costs can be physical and behavioral or mental in nature. Lawrance and Byers found that while men and women did not differ in the average number of rewards and costs they endorsed or the reward-to cost-ratio, women were more likely to endorse psychological aspects of the relationship as rewards (“He loves me. I feel like a queen with him”) and physical and behavioral aspects as costs (“I do things in bed that I don’t like because he likes them”).

According to this theory, sexual satisfaction will increase when relationship satisfaction is high, when the level of rewards in sex exceeds the level of costs, when rewards are high and costs are low relative to expectations, and when there is equality between the benefits and costs both partners experience. Sexual gratification in this approach also takes into account the history of the relationship: If in most of the years past a couple has experienced higher costs and lower benefits, one week of high rewards and low costs will not compensate for the negative history.

Thus, if your overall relationship is sound, if your sex life brings more fun than pain, if the fun level exceeds expectations and the level of pain is lower than expected, if you feel that there is equality between you and your partner in the levels of fun and pain experienced, and if this situation has been going on for some time, then you are, according to this formula, sexually satisfied.

Sounds like good news, which you and your partner may want to, shall we say, celebrate

Noam Shpancer, Ph.D., is a professor of psychology at Otterbein College and a practicing clinical psychologist in Columbus, Ohio.

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