2690

Dysfunctional Sexual Beliefs: A Comparative Study of

Heterosexual Men and Women, Gay Men, and Lesbian Women
With and Without Sexual Problems

Maria Manuela Peixoto, MSc and Pedro Nobre, PhD

Faculdade de Psicologia e de Ciências da Educação, Universidade do Porto, Porto, Portugal

DOI: 10.1111/jsm.12666

ABSTRACT

Introduction. Conservative and dysfunctional sexual beliefs are commonly associated with sexual problems among
heterosexual men and women. However, little is known about the role of sexual beliefs in sexual problems in gay men
and lesbians.
Aim. The present study aimed at analyzing the role of sexual beliefs in sexual dysfunction in a sample of heterosexual
and homosexual men and women.
Main Outcome Measures. Participants answered questions about self-perceived sexual problems and completed the
Sexual Dysfunctional Beliefs Questionnaire.
Methods. Two hundred twelve men (106 gay) and 192 women (96 lesbian) completed a Web survey.
Results. Findings indicated that men with sexual dysfunction (regardless of sexual orientation) reported significantly
more conservative beliefs and more erroneous beliefs related to partner’s sexual satisfaction compared with sexually
healthy men. Also, gay men with sexual dysfunction (but not heterosexual men) scored higher on belief in sex as an
abuse of men’s power compared with healthy controls. In addition, heterosexual men scored higher on “macho”
beliefs, beliefs regarding partner’s sexual satisfaction, and partner’s power, compared with gay men. For women, a
main effect was found for sexual orientation, with lesbian women scoring higher on sexual desire as a sin, age-related
beliefs, and affection primacy and lower on beliefs related to motherhood primacy.
Conclusions. Overall, findings suggest that dysfunctional sexual beliefs may play a role as vulnerability factors for
sexual dysfunction regardless of sexual orientation, particularly in men. Peixoto MM and Nobre P. Dysfunctional
sexual beliefs: A comparative study of heterosexual men and women, gay men, and lesbian women with and
without sexual problems. J Sex Med 2014;11:2690–2700.
Key Words. Sexual Beliefs; Sexual Dysfunctions; Sexual Myths; Sexual Orientation; Sexual Problems

Introduction Zilbergeld [6] described several sexual myths

based on his clinical work with sexually dysfunc-

C ultural background and religious-based edu-

cation promote conservative beliefs towards
sexuality. Likewise, social expectations regarding
sexual performance also play a major role in dys-
functional sexual beliefs. Furthermore, conserva-
tive attitudes towards sexuality and unrealistic
expectations regarding sexual performance are
commonly related to sexual difficulties in hetero-
sexual men and women [1–6].
tional couples. Myths related to men’s sexual per-
formance (e.g., “A real man performs in sex”) and
to sexual scripts (e.g., “Good sex is spontaneous,
with no planning and no talking”; “All touching is
sexual or should lead to sex”) reinforce unrealistic
expectations for both men and women, promoting
sexual problems. Besides male myths, Hawton [1]
proposed a list of female beliefs reflecting the
double standard, permissive but demanding for

J Sex Med 2014;11:2690–2700 © 2014 International Society for Sexual Medicine

Dysfunctional Sexual Beliefs
men (e.g., “Sex must only ever occur at the insti-
gation of the man”; “Men should not express their
feelings”; “When a man gets an erection it is bad
for him not to use it to get an orgasm very soon”)
and repressive for women (e.g., “Any woman who
initiates sex is immoral”). Heiman and LoPiccolo
[3] added dimensions related to the role of age and
physical appearance (e.g., “Sex is only for those
under 30” and “A woman’s sex life ends with
menopause”) and beliefs about women’s perfor-
mance (e.g., “Normal women have an orgasm
every time they have sex” and “Women who can’t
have an orgasm quickly and easily have something
wrong”).
Data with clinical samples have supported these
proposals. Baker and de Silva [7] found that men
with sexual dysfunction present significantly
higher beliefs in Zilbergeld’s myths compared
with a group of sexually functional individuals.
Moreover, Nobre and Pinto-Gouveia [5] found
that men and women with sexual dysfunction
reported higher scores on a scale of dysfunctional
sexual beliefs [8] when compared with sexually
healthy men and women [5]. Men in the clinical
sample were more likely to present “macho”
beliefs related to excessive sexual performance
demands (e.g., “A real man has sexual intercourse
very often”; “In sex, getting to the climax is the
most important”; “Sex without orgasm can’t be
good”) and beliefs about women’s sexual satisfac-
tion and their reaction to men’s failure (e.g., “The
quality of the erection is what most satisfies
women”; “A woman may have doubts about a
man’s virility when he fails to get an erection
during sexual activity”; “A man who doesn’t sexu-
ally satisfy a woman is a failure”) [5].
Several studies have also been conducted in
samples with specific sexual problems. In men with
erectile dysfunction, the most common beliefs
were the “macho” belief, the primacy of coitus,
and the demands regarding women’s sexual satis-
faction [9,10]. Men with sexual desire problems
often reported restrictive attitudes toward sexual-
ity, along with nonerotic thoughts and erection
concerns [11,12]. Moreover, women with sexual
desire problems more frequently reported beliefs
regarding interpretation of sexual desire as a sin
[13], more conservative attitudes and beliefs
regarding sexuality [14–20], and more beliefs con-
cerning the role of aging in sexuality [12,13].
Female orgasmic disorder was related to body
image beliefs, and women’s sexual arousal and
lubrication difficulties were correlated with sexual
conservatism and sexual desire as a sin [13]. Vagi-
2691
nismus was associated with aging beliefs [13] and a
conservative view of sexuality [21]. Finally, women
complaining about persistent genital sexual arousal
reported significantly more beliefs regarding
sexual conservatism, interpreting sexual desire as a
sin, and fewer affection primacy beliefs compared
with sexually healthy controls [22].
Although research on sexual beliefs has usually
been conducted with heterosexual samples, Hart
and Schwartz [23] described the role of dysfunc-
tional sexual beliefs on erectile disorder in gay men
based on clinical evidence. Specific dysfunctional
sexual beliefs among gay men were mainly related
to sex labels (e.g., “Gay men must be either the top
or the bottom”; “A ‘good top’ is always erect
during sexual encounters”). Among Latino gay
men, beliefs related to appearance and masculinity
traits were likely to influence sex labels and sex
roles. For instance, “versatile” Latino gay men
prefer to adopt a “top” sex role when they perceive
their partner as more feminine or shorter, while
they tend to adopt a “bottom” sex role when the
partner is perceived as more aggressive, taller, and
with more masculine features [24]. Also, according
to Moskowitz and Hart [25], penis size and mas-
culinity traits are significant characteristics in
identifying “top” and “bottom” gay men, with
“top” gay men reporting larger penises and more
masculinity traits compared with “bottom” gay
men.
We found no studies regarding sexual beliefs in
lesbian women in the literature. However, a con-
troversial belief about intimate and sexual relation-
ships among lesbians was discussed in one study.
Described as a “notorious drop-off in sexual activ-
ity about two years into long-term lesbian rela-
tionships” [26] (p. 112), “lesbian bed death” lacks
scientific evidence. Even so, empirical data suggest
that women have less sexual desire than men
[27,28] and are more submissive in sexual interac-
tions [26,29–31].
Aims
Due to the lack of empirical data regarding the
role of sexual beliefs in vulnerability to sexual dys-
functions in nonheterosexual samples, the current
study aimed at analyzing the main differences
regarding sexual beliefs between sexually func-
tional and dysfunctional heterosexual and homo-
sexual men and women. It was hypothesized that
men and women with sexual dysfunction would
report significantly more dysfunctional sexual
beliefs compared with sexually healthy controls
J Sex Med 2014;11:2690–2700
2692
regardless of sexual orientation. More specifically,
it was expected that “macho” beliefs, conservative
beliefs, and beliefs about the partner’s sexual sat-
isfaction would be more frequent in heterosexual
and gay men with sexual dysfunction, and that
sexual conservatism, sexual desire as a sin, and age-
related beliefs would be more common in women
with sexual dysfunction, regardless of sexual ori-
entation. Due to lack of empirical evidence on
sexual beliefs in gay men and lesbians, no predic-
tions were made for differences regarding sexual
orientation in men and women.
Methods
Participants and Procedures
Seven-hundred twenty-nine men and 1,274
women from the general Portuguese population
completed an online survey about sexual problems
and sexual beliefs. The online survey was publi-
cized on several Portuguese LGBT forums, web-
sites, and social networks. Also, an invitation by
email was sent by university mailing lists. Partici-
pants received the link and a full explanation about
the purpose of the study. First, participants were
invited to select the option with which they iden-
tified in terms of sexual orientation (gay men; het-
erosexual men; lesbian women; heterosexual
women). After reading the explanation and giving
informed consent, participants were invited to
answer the survey. The online survey took 20
minutes, and no incentives or monetary compen-
sation were given. The sample was collected
between May 2012 and May 2013. In order to
safeguard the privacy and anonymity of partici-
pants, data were collected and stored on an Aveiro
University server, and no IP address was recorded.
The study was approved by the appropriate ethics
committee.
Participants self-identifying as gay men who
scored 4 or above on the seven-point Likert scale of
sexual orientation (n = 26) or reported engaging in
sexual activity with a woman in the previous 6
months (n = 6) were excluded from the final
sample. Likewise, men identifying as heterosexual
who scored 4 or less on the sexual orientation scale
(n = 6) or indicated sexual activity with another
man in the previous 6 months (n = 5) were also
excluded. Men reporting at least one sexual
problem (erectile difficulties, premature ejacula-
tion, orgasmic difficulties, or lack of sexual desire)
over the past 6 months 50% or more of the time and
with associated distress levels ranging from 4 to 7
on a seven-point Likert scale were selected to con-
J Sex Med 2014;11:2690–2700
Peixoto and Nobre
stitute the clinical group. The male clinical group
was constituted by 106 participants (53 gay men and
53 heterosexual men). The principal sexual prob-
lems in the gay men were sexual desire problems
(33.9%), orgasmic difficulties (28.3%), erectile
difficulties (18.9%), and premature ejaculation
(18.9%). Overlapping sexual problems were found
for 20.8% of gay men. The principal sexual prob-
lems in the heterosexual men were sexual desire
problems (30.2%), premature ejaculation (26.4%),
orgasmic difficulties (22.6%), and erectile difficul-
ties (20.8%). Comorbid sexual problems were
reported by 24.5% of heterosexual men. No signifi-
cant differences were found between gay and het-
erosexual men in the distribution of sexual
problems: for erectile difficulties, χ2(1) = 0.673,
P = 0.412; for premature ejaculation, χ2(1) =
0.194, P = 0.659; for delayed ejaculation, χ2(1) =
0.179, P = 0.672; and for lack of sexual desire,
χ2(1) = 0.358, P = 0.550. A total of 53 gay men and
53 heterosexual men without sexual problems were
selected randomly from the database in order to
match the sociodemographic characteristics (age,
marital status, educational level) of the clinical
sample. No significant differences were found
between the four groups in age (F(3,208) = 0.376,
P = 0.771) or educational level (χ2(3) = 2.228,
P = 0.898). However, significant differences
were found between groups in marital status
(χ2(3) = 20.688, P < 0.001) with heterosexual men
reporting higher rates of being married or living
with their partner. Table 1 shows the sociodemo-
graphic characteristics of the sample.
Participants self-identifying as lesbian women
who scored 4 or above on the seven-point Likert
scale of sexual orientation (n = 35) or reported
engaging in sexual activity with a man in the pre-
vious 6 months (n = 19) were excluded from the
final sample. Likewise, women identifying as het-
erosexuals who scored 4 or less on the sexual ori-
entation scale (n = 23) or indicated sexual activity
with another woman in the previous 6 months
(n = 15) were also excluded. Women reporting at
least one sexual problem (lack of sexual desire,
sexual arousal difficulties, orgasmic difficulties,
and sexual pain) over the past 6 months 50% or
more of the time and with distress levels ranging
from 4 to 7 on a seven-point Likert scale were
selected to constitute the clinical group. The
female clinical group was constituted by 96 women
(48 lesbian and 48 heterosexual women). The prin-
cipal sexual problems in the lesbian clinical group
were sexual pain (45.8%), sexual desire problems
(25%), orgasmic difficulties (18.8%), and sexual
Dysfunctional Sexual Beliefs 2693

arousal difficulties (10.4%). Overlapping sexual

Control group

25.75 (6.56)
problems were reported by 43.8% of lesbian

Heterosexual women (n = 96)

(n = 48)
women. For heterosexual women, the main sexual

75.0
25.0

0.0
35.4
64.6
problems were: sexual pain (39.6%), sexual desire
problems (22.9%), orgasmic difficulties (22.9%),
and sexual arousal problems (14.6%). Comorbid
Clinical group sexual problems were reported by 41.7% of the

26.52 (7.97)
(n = 48)
heterosexual women. No significant differences
were found between lesbian and heterosexual
77.1
22.9

0.0
29.2
70.8
women in the distribution of sexual problems:
orgasmic difficulties, χ2(1) = 0.045, P = 0.832; lack
of sexual desire, χ2(1) = 1.124, P = 0.289; sexual
arousal difficulties, χ2(1) = 0.182, P = 0.670; sexual
Control group

27.17 (7.23)

pain, χ2(1) = 0.042, P = 0.838. A total of 48 lesbian

(n = 48)

women and 48 heterosexual women were selected

81.3
18.8

2.1
35.4
62.5
Lesbian women (n = 96)

randomly from the database in order to match the

sociodemographic characteristics (age, marital
status, educational level) of the clinical sample.
Clinical group

26.33 (9.46)

No significant differences were found between

the four groups regarding age (F(3,188) = 0.263,
(n = 48)

P = 0.852), marital status (χ2(3) = 0.837, P =

81.3
18.8

2.1
35.4
62.5

0.841), or educational level (χ2(3) = 2.759, P =

0.838). Table 1 shows the sociodemographic char-
acteristics of the female sample.
Control group

31.68 (10.38)
Heterosexual men (n = 106)

(n = 48)

58.5
41.5

1.9
37.7
60.4

Main Outcome Measures

Sociodemographic Questionnaire
Sociodemographic characteristics were evaluated
Clinical group

32.08 (10.61)

by several questions about personal information

(n = 53)

(age, education, marital status). Regarding sexual

58.5
41.5

1.9
37.7
60.4

orientation, participants answered the question

Sociodemographic characteristics of the sample (n = 404)

“How would you define your sexual orientation?”

according to a Likert scale (from 1—exclusively
Control group

homosexual—to 7—exclusively heterosexual).

30.11 (11.91)

Also, participants answered the question “Over the

(n = 53)

past 6 months, how often did you engage in sexual

94.1
5.9

1.9
45.3
52.8

activity with a man?” (lesbian women and hetero-

sexual men) or “Over the past 6 months, how often
Gay men (n = 106)

did you engage in sexual activity with a woman?”

Clinical group

30.02 (10.94)

(gay men and heterosexual women).

(n = 53)

86.8
13.2

1.9
45.3
52.8

Sexual Problems Questionnaire—Male Version

In order to assess perceived sexual problems (erec-
tile difficulties, premature ejaculation, orgasmic
Married/living with partner

difficulties, and lack of sexual desire), a specific

Age (years), mean (SD)

questionnaire was developed. In order to evaluate

Educational level (%)

erectile difficulties, participants answered the

13 or more years
Marital status (%)

question “Over the last 6 months, have you expe-

10–12 years

rienced marked decrease in erectile rigidity or

0–9 years

inability to obtain/maintain an erection until the

Table 1

Single

completion of sexual activity?” Premature ejacula-

tion was assessed by the question “Over the last 6

J Sex Med 2014;11:2690–2700

2694
months, how rapidly have you usually ejaculated
after beginning sexual activity?” For difficulties in
reaching orgasm, participants answered the ques-
tion “Over the last 6 months, have you experi-
enced delay in or absence of ejaculation?” Lack of
sexual desire was assessed by the question “Over
the past 6 months, have you experienced absent or
markedly reduced interest in sexual activity?” Par-
ticipants answered according to a seven-point
Likert scale (1—no/never happened; 7—yes, in all
sexual encounters/always). For premature ejacula-
tion, answer options were specifically related to
time until ejaculation (1—60 seconds or more;
7—prior to start of sexual activity). Regarding dis-
tress levels, participants answered the question:
“How would you classify the rate (degree) of asso-
ciated distress?” Answers were given in a seven-
point Likert scale (1—no distress; 7—extreme
distress).
Sexual Problems Questionnaire—Female Version
A specific questionnaire was developed in order to
assess perceived sexual problems, namely orgasmic
difficulties, lack of sexual desire, arousal difficul-
ties, and sexual pain. In order to evaluate orgasmic
difficulties, participants answered the question
“Over the past 6 months, have you experienced an
absence of orgasm?” Lack of sexual desire was
assessed by the question “Over the past 6 months,
have you experienced absent or markedly reduced
interest in sexual activity?” For arousal difficulties,
participants answered the question “Over the past
6 months, have you experienced absent or reduced
sexual excitement or pleasure during sexual activ-
ity?” Participants answered according to a seven-
point Likert scale (1—never; 7—always). Finally,
for sexual pain, participants answered the question
“How much pain do you feel during (attempted)
penetration?” according to a seven-point Likert
scale (1—no pain; 7—extreme pain). An option for
“0—no sexual activity” was also included. In order
to assess distress levels, participants answered the
question “How would you classify the rate (degree)
of associated distress?” using a seven-point Likert
scale (1—no distress; 7—extreme distress).
Sexual Dysfunctional Beliefs Questionnaire—
Male Version
The Sexual Dysfunctional Beliefs Questionnaire
(SDBQ)—Male Version [8] is a 40-item self-
reported measure that allows assessment of
sexuality-related beliefs in men. Participants
answered the questions on a five-point Likert scale
(1—completely disagree; 5—completely agree).
J Sex Med 2014;11:2690–2700
Peixoto and Nobre
Five domains are assessed: sexual conservatism
(e.g., “Foreplay is a waste of time”; “In sex, the
quicker/faster the better”); “macho” beliefs (e.g.,
“A real man has sexual intercourse very often”; “A
man must be capable of maintaining an erection
until the end of any sex”); beliefs about partner’s
sexual satisfaction (e.g., “A man who doesn’t sexu-
ally satisfy the partner is a failure”; “Penis erection
is essential for partner’s sexual satisfaction”);
restrictive attitudes toward sex (e.g., “It is not
appropriate to have sexual fantasies during sexual
intercourse”; “Repeated engagement in oral/anal
sex can cause serious health problems”); sex as an
abuse of men’s sexual power (e.g., “Sex is an abuse
of the male’s power”; “Sex is a violation of the
partner’s body”); and partner’s sexual power (e.g.,
“If a man lets himself go sexually he is under a
partner’s control”; “The consequences of a sexual
failure are catastrophic”). Scales were computed as
sums, with higher scores indicating more dysfunc-
tional sexual beliefs. For gay men, specific modifi-
cations were made, specifically the change to top/
bottom gay men for questions related to man/
woman interaction (e.g., “Bottom men have no
other choice but to be sex-subjugated by top men’s
power”/“Women have no other choice but to be
sex-subjugated by men’s power”). Psychometric
studies supported test–retest reliability (r = 0.73)
and discriminant validity and internal consistency
(Cronbach’s alpha value of 0.93) [8] of the ques-
tionnaire. For the current study, Cronbach’s alpha
values of 0.73 for the gay sample and 0.71 for the
heterosexual sample were found.
Sexual Dysfunctional Beliefs Questionnaire—
Female Version
The SDBQ—Female Version [8] is a 40-item
self-reported measure assessing beliefs related to
sexuality in women. Participants answered the
questions using a five-point Likert scale
(1—completely disagree; 5—completely agree).
The SDBQ—Female Version assesses six dimen-
sions: sexual conservatism (e.g., “Masturbation is
wrong and sinful”; “Oral sex is one of the biggest
perversions”); sexual desire and pleasure as sin (e.g.,
“Sex is dirty and sinful”; “Experiencing pleasure
during sexual activity is not acceptable in a virtuous
woman”); age-related beliefs (e.g., “After meno-
pause women can’t reach orgasm”; “As women age
the pleasure they get from sex decreases”); body-
image beliefs (e.g., “Women who are not physically
attractive can’t be sexually satisfied”; “An ugly
woman is not capable of sexually satisfying her
partner”); motherhood primacy (e.g., “Sex is meant
Dysfunctional Sexual Beliefs
only for procreation”; “The most wonderful emo-
tions that a woman can experience are maternal”);
and affection primacy (e.g., “Love and affection
from a partner are necessary for good sex”; “Sex
without love is like food without flavor”). Scores
were computed as sums. For SDBQ total score, the
affection primacy subscale was not used. Higher
scores were associated with more dysfunctional
sexual beliefs. For the lesbian version, male pro-
nouns were modified to female pronouns. Items
such as “In bed, the man is the boss” were not used
for this study. Psychometric studies indicated good
test–retest reliability (r = 0.80), internal consis-
tency (Cronbach’s alpha = 0.81), and discriminant
validity [8]. Internal consistency of the measure in
the current study was satisfactory (Cronbach’s
alpha of 0.71 for the lesbian sample and 0.77 for the
heterosexual sample).
Results
Dysfunctional Sexual Beliefs, Sexual Orientation, and
Male Sexual Problems
In order to assess the main effects of sexual
function/dysfunction, sexual orientation, and their
interaction on sexual beliefs in men, a 2 × 2 manova
(sexually functional vs. dysfunctional × gay vs. het-
erosexual) was performed. The dimensions from
the SDBQ—Male Version [8] were introduced as
dependent variables. Marital status was introduced
as covariate in order to control the effect on
sexual beliefs (Wilk’s λ = 0.976, F(6,197) = 0.806,
P = 0.566, partial η2 = 0.024).
Table 2 presents means and standard deviations
for the total and dimension scores on the
SDBQ—Male Version [8]. Significant main effects
were found for sexual function/dysfunction (Wilk’s
λ = 0.780, F(6,197) = 9.255, P < 0.001, partial
η2 = 0.220), for sexual orientation (Wilk’s
λ = 0.845, F(6,197) = 6.035, P < 0.001, partial
η2 = 0.155), and for the interaction sexual function/
dysfunction × sexual orientation (Wilk’s λ = 0.926,
F(6,197) = 2.624, P = 0.018, partial η2 = 0.074).
As shown in Table 3, univariate effects indicated
that sexually dysfunctional men reported signifi-
cantly more conservative beliefs (P = 0.005; partial
η2 = 0.039), erroneous beliefs about partner’s
sexual satisfaction (P = 0.018; partial η2 = 0.027),
and beliefs that sex is an abuse of men’s power
(P < 0.001; partial η2 = 0.140), compared with
healthy controls. Additionally, univariate tests
indicated that gay men scored lower on “macho”
beliefs (P = 0.001; partial η2 = 0.050), beliefs about
partner’s sexual satisfaction (P = 0.024; partial
2695
η2 = 0.025), and beliefs about partner’s sexual
power (P < 0.001; partial η2 = 0.066) compared
with heterosexuals. Finally, univariate tests also
indicated that gay men with sexual dysfunction
reported significantly more beliefs in sex as an
abuse of “top” men’s power compared with
healthy gay men (P = 0.001; partial η2 = 0.053),
whereas no differences were found between
heterosexual men with and without sexual
dysfunction.
Dysfunctional Sexual Beliefs, Sexual Orientation, and
Female Sexual Problems
Table 2 shows means and standard deviations of the
total and subscale scores on the SDBQ—Female
Version [8]. A 2 × 2 manova (sexually functional vs.
dysfunctional × lesbian vs. heterosexual) was per-
formed in order to assess the effects of sexual
function/dysfunction, sexual orientation, and their
interaction on dysfunctional sexual beliefs. The
subscales from the SDBQ—Female Version [8]
were introduced as dependent variables. Significant
main effects were found for sexual orientation
(Wilk’s λ = 0.110, F(6,179) = 242.564, P < 0.001,
partial η2 = 0.890), but not for sexual function/
dysfunction (Wilk’s λ = 0.960, F(6,179) = 1.236,
P = 0.290, partial η2 = 0.040) or for the interaction
sexual function/dysfunction × sexual orientation
(Wilk’s λ = 0.969, F(6,179) = 0.944, P = 0.465,
partial η2 = 0.031).
As shown in Table 3, univariate effects indicated
that lesbian women scored higher on the beliefs
regarding sexual desire and pleasure as a sin
(P = 0.012; partial η2 = 0.034), beliefs related to
age concerns (P < 0.001; partial η2 = 0.194), and
beliefs regarding affection primacy (P < 0.001;
partial η2 = 0.862), and lower on sexual beliefs
related to motherhood primacy (P < 0.001; partial
η2 = 0.300). Although no significant main effects
were found for sexual function/dysfunction, uni-
variate effects indicated that women with sexual
dysfunction (regardless of sexual orientation)
reported significantly more beliefs regarding
sexual desire and pleasure as a sin (P = 0.026;
partial η2 = 0.027) compared with sexually healthy
women.
Discussion
Sexual myths were conceptualized as vulnerability
factors for the development and maintenance of
sexual problems among heterosexual men and
women [5]. Due to the lack of empirical data
regarding sexual beliefs among gay men and
J Sex Med 2014;11:2690–2700
 2696

Table 2

J Sex Med 2014;11:2690–2700

Sexual beliefs as functions of sexual function/dysfunction and sexual orientation (n = 404)
Clinical group Control group Total
Possible
Dysfunctional sexual beliefs in men score range Gay Heterosexual Total Gay Heterosexual Total Gay Heterosexual Total

Sexual conservatism 9–45 11.77 (0.32) 11.14 (0.33) 11.46 (0.23) 10.62 (0.32) 10.59 (0.32) 10.60 (0.22) 11.20 (0.22) 10.86 (0.23) 11.03 (2.34)
“Macho” belief 4–20 7.91 (0.48) 9.94 (0.49) 8.92 (0.34) 7.28 (0.48) 8.72 (0.48) 8.00 (0.34) 7.59 (0.34) 9.33 (0.34) 8.44 (3.60)
Beliefs about partner’s sexual satisfaction 5–25 11.40 (0.62) 13.40 (0.64) 12.40 (0.44) 10.64 (0.62) 11.23 (0.62) 10.93 (0.44) 11.02 (0.44) 12.31 (0.44) 11.64 (4.58)
Restrictive attitude toward sex 3–15 4.59 (0.26) 4.72 (0.27) 4.65 (0.19) 4.74 (0.26) 4.57 (0.26) 4.65 (0.19) 4.66 (0.19) 4.64 (0.19) 4.65 (1.90)
Sex as an abuse of men’s power 3–15 6.34 (0.18) 6.08 (0.18) 6.21 (0.13) 4.83 (0.18) 5.66 (0.18) 5.25 (0.12) 5.59 (0.12) 5.87 (0.13) 5.72 (1.39)
Partner’s sexual power 7–35 15.68 (0.67) 18.02 (0.69) 16.85 (0.48) 15.30 (0.67) 17.98 (0.67) 16.64 (0.48) 15.49 (0.48) 18.0 (0.48) 16.73 (5.03)
Total 31–155 57.68 (1.77) 63.30 (1.82) 60.49 (1.27) 53.42 (1.77) 58.74 (1.77) 56.08 (1.25) 55.55 (1.25) 61.02 (1.27) 58.21 (13.26)

Clinical group Control group Total

Possible
Dysfunctional sexual beliefs in women score range Lesbian Heterosexual Total Lesbian Heterosexual Total Lesbian Heterosexual Total
Sexual conservatism 8–40 11.0 (0.41) 10.80 (0.42) 10.90 (0.30) 9.91 (0.41) 10.52 (0.42) 10.22 (0.30) 10.46 (0.29) 10.66 (0.30) 10.56 (2.87)
Sexual desire/pleasure as a sin 5–25 5.79 (0.14) 5.50 (0.14) 5.65 (0.10) 5.54 (0.14) 5.11 (0.14) 5.33 (0.10) 5.67 (0.10) 5.30 (0.10) 5.49 (1.00)
Age-related beliefs 3–15 7.73 (0.32) 5.89 (0.33) 6.81 (0.23) 7.58 (0.32) 5.15 (0.33) 6.37 (0.23) 7.66 (0.23) 5.52 (0.23) 6.61 (2.45)
Body image beliefs 4–20 8.15 (0.20) 8.26 (0.20) 8.20 (0.14) 8.17 (0.20) 8.20 (0.20) 8.18 (0.14) 8.16 (0.14) 8.23 (0.14) 8.19 (1.34)
Motherhood primacy 4–20 4.48 (0.24) 6.50 (0.25) 5.49 (0.17) 4.21 (0.24) 6.54 (0.25) 5.38 (0.17) 4.34 (0.17) 6.52 (0.18) 5.41 (1.99)
Denying affection primacy* 6–30 17.65 (0.25) 25.83 (0.25) 21.74 (0.18) 17.27 (0.25) 26.12 (0.25) 21.69 (0.18) 17.46 (0.18) 25.98 (0.18) 21.63 (4.60)
Total 24–120 37.15 (0.89) 36.96 (0.91) 37.05 (0.64) 35.42 (0.89) 35.52 (0.91) 35.47 (0.64) 36.28 (0.63) 36.24 (0.64) 36.26 (6.17)

Data represent scores on the Sexual Dysfunctional Beliefs Questionnaire; data for groups are given as mean (SD).
*Not included in total score.
Peixoto and Nobre
Dysfunctional Sexual Beliefs 2697

Table 3 Interaction effects of sexual function/dysfunction, sexual orientation, and group × sexual orientation with regard
to dysfunctional sexual beliefs (n = 404)
Sexual function/dysfunction
Sexual function/dysfunction Sexual orientation × sexual orientation
Dysfunctional sexual beliefs in men F(4,202) P η F(4,202) P η F(4,202) P η
Sexual conservatism 8.198 0.005 0.039 0.390 0.533 0.002 1.272 0.261 0.006
“Macho” belief 3.507 0.063 0.017 10.573 0.001 0.050 0.398 0.529 0.002
Beliefs about partner’s sexual satisfaction 5.682 0.018 0.027 5.176 0.024 0.025 1.159 0.283 0.006
Restrictive attitude toward sex 0.004 0.951 0.000 0.234 0.629 0.001 0.277 0.599 0.001
Sex as an abuse of men’s power 31.972 <0.001 0.140 2.668 0.104 0.013 11.197 0.001 0.053
Partner’s sexual power 0.175 0.676 0.001 14.203 <0.001 0.066 0.128 0.721 0.001

Sexual function/dysfunction
Sexual function/dysfunction Sexual orientation × sexual orientation
Dysfunctional sexual beliefs in women F(3,184) P η F(3,184) P η F(3,184) P η

Sexual conservatism 2.666 0.104 0.014 0.240 0.625 0.001 0.916 0.340 0.005
Sexual desire and pleasure as a sin 5.056 0.026 0.027 6.455 0.012 0.034 0.245 0.621 0.001
Age-related beliefs 1.898 0.170 0.010 44.175 <0.001 0.194 0.853 0.357 0.005
Body image beliefs 0.013 0.910 0.000 0.134 0.715 0.001 0.048 0.827 0.000
Motherhood primacy 0.215 0.643 0.001 79.036 <0.001 0.300 0.412 0.522 0.002
Denying affection primacy 0.034 0.854 0.000 1,149.54 <0.001 0.862 1.716 0.192 0.009

Multivariate analysis of variance; Bonferroni adjustment for multiple comparisons.

lesbians, the current study aimed at analyzing the
role of dysfunctional sexual beliefs in sexual prob-
lems among heterosexuals, gay men, and lesbians.
As expected, dysfunctional sexual beliefs differ-
entiated between sexually functional and dysfunc-
tional men, regardless of sexual orientation.
Specifically, sexually dysfunctional men reported
significantly more conservative beliefs as well as
beliefs regarding partner’s satisfaction. Moreover,
there was also a trend for the dysfunctional groups
to present with more “macho” beliefs. Previous
research has shown that sexually dysfunctional
heterosexual men reported significantly more
beliefs concerning women’s satisfaction and
“macho” beliefs [5]. Current data allowed replica-
tion of these findings in a sample of gay men. Both
heterosexual and gay men tend to believe that
partner’s sexual satisfaction is mostly determined
by gay or heterosexual men’s penile erection (e.g.,
“Penile erection is essential for a woman’s/bottom
gay man’s sexual satisfaction”). Also, gay and het-
erosexual men with sexual dysfunction tend to
catastrophize the consequences of not satisfying
the partner (e.g., “A man who doesn’t sexually
satisfy the partner is a failure”). Regarding conser-
vative beliefs, the findings suggest that ideas such
as “In sex, the quicker/faster the better” and
“Foreplay is a waste of time” can impair sexual
functioning among gay and heterosexual men.
Moreover, there was an interaction effect indi-
cating that sexually dysfunctional gay men
reported significantly more beliefs in sex as an
abuse of men’s power compared with healthy con-
trols, whereas no differences were found in the
heterosexual sample. The domain of sex as an
abuse of men’s power describes beliefs related to
the idea that sex is an abuse of the partner’s body.
One possible explanation for this finding is that
sexually dysfunctional gay men tend to view the
role of the “top” gay man as a violation of the
“bottom” gay man’s body during anal sex, for
instance. Another possibility may be that gay men
who believe that sex is an abuse of power may have
been victims of sexual abuse during childhood or
of domestic violence [32–35].
Regarding sexual orientation effects on sexual
beliefs, heterosexual men scored higher on
“macho” beliefs, beliefs regarding partner’s satis-
faction, and beliefs related to partner’s power,
compared with gay men. “Macho” beliefs and
beliefs regarding partner’s satisfaction are mostly
centered on erectile function as a necessary condi-
tion for having sex and sexually satisfying the
partner. It is possible that both types of dysfunc-
tional sexual beliefs centered on erection perfor-
mance reported by heterosexual men were acting
in a bidirectional pathway, promoting each other.
A possible explanation for gay men reporting less
sexual beliefs related to falling under partner’s
sexual power could be their sex-role versatility.
Gay men can adopt two different sex roles during
penetrative intercourse (insertive or receptive).
Therefore, flexibility in sex roles adopted by gay
men may promote equality in sexual relationships.

J Sex Med 2014;11:2690–2700

2698
Also, being comfortable with their own sexuality
and sexual orientation may act as a protective
factor against dysfunctional attitudes related to sex
roles in gay men [24].
Regarding the women’s study, a main effect was
found for sexual orientation, with lesbians report-
ing more beliefs related to sexual desire as a sin,
age-related beliefs, and affection primacy and fewer
beliefs related to motherhood primacy compared
with heterosexual women. Current findings
regarding lesbians may help explain the lower sex-
contact among lesbian couples [29]. Both sexually
functional and dysfunctional lesbians scored higher
on beliefs related to sexual desire and pleasure as a
sin. Therefore, lesbians were more likely to believe
that a woman should not engage in sexual activity.
Regarding affection primacy, data suggest that les-
bians globally considered love, affection, and inti-
macy as fundamental aspects of sexuality. This
finding was consistent with previous data, suggest-
ing that lesbians value intimacy and affection in
their relationships [31,36]. Curiously, lesbians
scored higher on age-related sexual beliefs,
showing that lesbians tend to believe more in ideas
like “After menopause women lose their sexual
desire” or “As women age, the pleasure they get
from sex decreases”. This finding seems consistent
with a previous study conducted with older lesbi-
ans, in which more than half of the women consid-
ered that sexual relationships were important only
until 55 years old, whereas less than a quarter
believed sex was still relevant after that age [37].
Finally, heterosexual women scored higher on
motherhood primacy beliefs (e.g., “The most won-
derful emotions that a woman can experience are
maternal”; “Sex is meant only for procreation”). It
is possible that heterosexual women emphasize
more motherhood related-issues due to social and
cultural pressure.
Unexpectedly, the current results did not indi-
cate a significant main effect of sexual function/
dysfunction, suggesting that sexual beliefs were not
significantly different in women with or without
sexual dysfunction, regardless of their sexual orien-
tation. Although previous studies have suggested
that dysfunctional sexual beliefs play a major role in
women’s sexual dysfunction [4,5,14,15], a recent
study with women reporting sexual pain also found
no significant differences between sexually healthy
women and women with sexual pain [38]. A possible
explanation for this unexpected result may be due
to the overrepresentation of young and well-
educated women in both studies, which may have
hidden some beliefs commonly reported in older
J Sex Med 2014;11:2690–2700
Peixoto and Nobre
and less educated samples. Also, this finding sug-
gests that the pattern of beliefs that may be relevant
to distinguish between sexually healthy and sexually
dysfunctional individuals among younger and more
highly educated women may be different from what
is usually found in studies with more representative
samples (e.g., the importance of performance
demand beliefs, which was not assessed by the
SDBQ). Nonetheless, univariate analysis indicated
that women with sexual dysfunction reported sig-
nificantly more beliefs in sexual desire as a sin
compared with sexually healthy women, regardless
of sexual orientation. Previous studies also sug-
gested that women with sexual difficulties more
often reported beliefs related to sexual desire and
pleasure as sin [13,22].
The current study presents some limitations;
therefore, results should be considered with
caution. A Web survey was used for the recruit-
ment of the sample; consequently, only volunteers
with Internet access were able to participate. Addi-
tionally, participants’ mean age was not represen-
tative of the Portuguese community, and the
younger sample may have biased the results, as
younger adults are more exposed to liberal ideas.
Finally, and despite the use of specific criteria in
assessing sexual dysfunction, including the fre-
quency of the symptoms and the levels of associ-
ated distress, clinical diagnoses according to the
Diagnostic and Statistical Manual of Mental Disorders
[39] cannot be made.
The present findings highlight the role of con-
servative beliefs and sexual performance expecta-
tions in sexual problems among gay and
heterosexual men. However, since this study used a
cross-sectional design, no causal link can be
assumed, and further studies using experimental or
longitudinal designs should be developed to test
causality. Finally, current findings support the idea
that health professionals should pay attention to
similarities and specificities among same-sex and
opposite-sex couples in the treatment of sexual
problems.
Acknowledgments
This study was funded by a doctoral scholarship from
the Portuguese Foundation for Science and Technology
(Reference: SFRH/BD/72919/2010).
Corresponding Author: Maria Manuela Peixoto, MSc,
Faculdade de Psicologia e de Ciências da Educação da
Universidade do Porto, Rua Alfredo Allen, Porto
4200-135, Portugal. Tel: +351 220 428 908; Fax: +351
226 079 725; E-mail: nelinha.peixoto@gmail.com
Dysfunctional Sexual Beliefs
Conflict of Interest: The authors report no conflicts of
interest.
Statement of Authorship
Category 1
(a) Conception and Design
Maria Manuela Peixoto; Pedro Nobre
(b) Acquisition of Data
Maria Manuela Peixoto; Pedro Nobre
(c) Analysis and Interpretation of Data
Maria Manuela Peixoto; Pedro Nobre
Category 2
(a) Drafting the Article
Maria Manuela Peixoto
(b) Revising It for Intellectual Content
Pedro Nobre
Category 3
(a) Final Approval of the Completed Article
Maria Manuela Peixoto; Pedro Nobre
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