Sexual Quality of Life in Homosexual and Bisexual Men: The Relative Role of Minority Stress

Abstract

BackgroundMinority stress is an important risk factor for sexual problems in gay and bisexual men. It remains unclear whether and to what extent this stress is associated with the sexual quality of life in these groups. AimTo investigate the significance of minority stress as a factor explaining the sexual quality of life in gay and bisexual men. MethodsThe analysis is based on data collected in an Internet study on the sexuality of Polish gay, bisexual, and straight men. Multiple regression analysis was used to investigate the importance of minority stress in explaining the sexual quality of life in a group of 1,486 non-heterosexual men in the context of other predictors, including demographics, the level of current sexual function, sexual patterns and experiences, and mental and physical health. We used the Sexual Minority Stress Scale based on Ilan Meyer’s Minority Stress Model, with its subscales relating to internalized homophobia, expectation of rejection, concealment, and sexual minority negative events. The level of sexual functioning was evaluated using 2 scales, the International Index of Erectile Functioning and the Premature Ejaculation Diagnostic Tool. Data on the remaining predictors were obtained using a survey that we developed. Main Outcome MeasuresThe men’s sexual quality of life as rated on the Sexual Quality of Life Scale for Men was a dependent variable. ResultsInternalized homophobia (β = −0.28; P < .001) and sexual minority negative events (β = −0.09; P < .001) were statistically significant predictors of sexual quality of life in non-heterosexual men. Internalized homophobia (β = −0.28; P < .001) and erectile function (β = 0.29, P < .001) turned out to be the strongest predictors. Sexual orientation (gay vs bisexual) and its interactions with individual processes of minority stress were statistically nonsignificant. Clinical ImplicationsTo evaluate and improve the sexual quality of life of non-heterosexual men, it is necessary to consider not only their sexual function, but also the minority stress they experience, particularly internalized homophobia. Strengths & LimitationsThe major strengths of the study include a large sample size, a comprehensive assessment of minority stress, and the previously understudied Central European cultural context. The major limitations are the nonrepresentative sampling, retrospective data collection, and cross-sectional design. ConclusionInternalized homophobia predicts poorer sexual quality of life in gay and bisexual men in Poland.Grabski B, Kasparek K, Müldner-Nieckowski Ł, et al. Sexual Quality of Life in Homosexual and Bisexual Men: The Relative Role of Minority Stress. J Sex Med 2019;16:860–871.