LGB Adults Research Articles

Intimate partner violence among LGB and heterosexual adults: Prevalence and associated minority stress factors

Intimate partner violence among LGB and heterosexual adults: Prevalence and associated minority stress factors

Abstract B042: Gender-affirming cessation support for LGBTQ+ tobacco users: Establishing TheQuitAlliance

Abstract Background. The LGBTQ+ community faces various stressors, including stigma, discrimination, and harassment, which are linked to their sexual orientation or gender identity. Additionally, they are targeted by tobacco companies through marketing, which increases tobacco use and other health problems. LGB adults use commercial tobacco products at a higher rate than the general population (25.1% versus 18.8%), and tobacco use is even higher among transgender adults according to the CDC. Without peer support, counseling, nicotine replacement therapy (NRT), and community resources to address barriers to quitting, tobacco users are less likely to succeed in quitting. Research has shown that gender-affirming tobacco cessation interventions can be highly effective in helping LGBTQ+ individuals quit tobacco; however, little is known about its effectiveness in Latinx communities and other groups with intersectional identities. Methods. To improve access to culturally tailored and gender-affirming cessation resources that acknowledge the unique experiences and stressors faced by our community, Cedars-Sinai Cancer COE developed TheQuitAlliance, a LGBTQ+ focused tobacco cessation program. This multi-level approach involved web-based resources, information and presentation to the community. A series of gender affirming support groups facilitated by trained Spanish speaking tobacco cessation specialists who are members of the LGBTQ+ community was offered to tobacco users. The first steps involved improving their knowledge on how tobacco affects specific populations, such as transgender, non-binary, gender non-conforming individuals, people living with HIV, youth, and the types of nicotine replacement therapies available. RESULTS: In 2023, our partners The Wall Las Memorias and Latino Equality Alliance implemented a screening tool using the Ask, Advise, and Refer model, expanded outreach efforts, and successfully identified N=242 LGBTQ+ tobacco users who were referred to our virtual gender affirming support group. Among current smokers who participated in a series of three support groups, 85% (17 of 20) indicated positive attitudes towards the importance of changing their smoking behaviors, readiness to change, and having control over their ability to make positive change right now, while 90% are committed to taking steps towards change right now (18 of 20). In 2024, The Wall Las Memorias reached 500 LGBTQ+ community members and linked 70 tobacco users to cessation support groups. Conclusion. Our survey indicated that participating in a gender affirming cessation intervention can increase self-efficacy to take steps towards quitting tobacco. Through safe spaces created by The Quit Alliance, we found that LGBTQ+ tobacco users are also able to make connections with others to be supported in their journey to becoming tobacco free. Citation Format: Victor Crisanto, Alexandra Caro, Reener Balingit, Zul Surani. Gender-affirming cessation support for LGBTQ+ tobacco users: Establishing TheQuitAlliance [abstract]. In: Proceedings of the 17th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2024 Sep 21-24; Los Angeles, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2024;33(9 Suppl):Abstract nr B042.

Higher prevalence of polysubstance use among older lesbian, and gay US adults

IntroductionPolysubstance use (i.e., the use of more than one substance) is a major public health concern in the US that disproportionately hinders those from marginalized groups by sexual identity and age. Little research has examined this concern among lesbian, gay, and bisexual (LGB) older adults, and no study has measured past-30 day polysubstance use prevalence among these groups. The objective was to examine polysubstance use among older LGB adults compared to their heterosexual same-age peers and younger LGB counterparts. MethodsWe used the National Survey of Drug Use and Health 2021 and 2022 datasets with an analytic sample of 86,254 participants. Past-30 day polysubstance use prevalence was survey-weighted and adjusted by sociodemographic factors. We constructed Weighted multinomial models to compare polysubstance use between older LGB adults (65+ years old) with their same-age heterosexual and younger LGB counterparts. ResultsOlder Gay/Lesbian adults had a significantly higher polysubstance use prevalence than their heterosexual counterparts (OR = 27.94; p <0.001) while heterosexual participants showed a decline in polysubstance use with age (OR = 0.27; p < 0.001). Polysubstance use among gay/lesbian (OR = 0.67; p = 0.491) and bisexual (OR = 1.04; p = 0.969) older adults did not significantly differ from their younger counterparts. ConclusionsPolysubstance use is a public health concern for older gay/lesbian adults. Interventions are needed to address polysubstance use for older LGB adults, including early detection of polysubstance use and prevention strategies that are age and LGB inclusive.

Protective and stress factors for psychological distress: a comparative analysis of LGB and non-LGB older adults

Objectives Population ageing raises major public health and psychosocial challenges. Particularly, lesbian, gay, and bisexual (LGB) older people may face increased vulnerabilities and marginalization when compared to their non-LGB (heterosexual) counterparts, which may entail more risks for their mental health. The aim of this study was to comparatively evaluate the levels of protective – social support, spirituality, and resilience and stress factors – loneliness and ageism – among LGB and non-LGB older adults, and their impact on psychological distress (PD). Method A sample of 647 people aged 60 years or older (M = 66.01; SD = 4.93) was collected, 368 non-LGB and 279 LGB. Participation was carried out through an online survey in Portugal. Results LGB older adults had lower scores on all protective factors, except on social support from friends, and higher levels on all stress factors, except on hostile ageism, compared to non-LGB older adults. Further, resilience and loneliness were the main predictors of PD regardless of the sexual orientation. Stress factors explained the levels of PD over and above the effects of protective factors, both among LGB and non-LGB older adults. Conclusion Psychological distress in aging presents different protective and stressful factors according to the sexual orientation of older adults. More comparative studies are suggested in the intersection between ageing and sexual orientation.

S117 - Exploring Substance Use Among LGB Adults Through the National Institutes of Health All of Us Research Program

S117 - Exploring Substance Use Among LGB Adults Through the National Institutes of Health All of Us Research Program

Investigating the Interrelationships Among Mental Health, Substance Use Disorders, and Suicidal Ideation Among Lesbian, Gay, and Bisexual Adults in the United States: Population-Based Statewide Survey Study.

Mental health disparities have been documented among lesbian, gay, and bisexual (LGB) adults in the United States. Substance use disorders and suicidal ideation have been identified as important health concerns for this population. However, the interrelationships among these factors are not well understood. This study aims to investigate the interrelationships among mental health, substance use disorders, and suicidal ideation among LGB adults in the United States using a population-based statewide survey. Our study was an observational cross-sectional analysis, and the data for this study were collected from a sample of LGB adults who participated in the statewide survey. The survey collected information on mental health, substance use disorders, and suicidal ideation using validated measures. Descriptive statistics and inferential data analysis were conducted to explore the interrelationships among these factors. The results showed that LGB adults who reported higher levels of depression and drug abuse and dependence also reported higher levels of suicidal tendency and mental illness. Inferential data analysis using χ2 tests revealed significant differences in depression score (χ22=458.241; P<.001), drug abuse and dependence score (χ22=226.946; P<.001), suicidal tendency score (χ22=67.795; P<.001), and mental illness score (χ22=363.722; P<.001) among the 3 sexual identity groups. Inferential data analysis showed significant associations between sexual identity and mental health outcomes, with bisexual individuals reporting the highest levels of depression, drug abuse and dependence, suicidal tendency, and mental illness. This study provides important insights into the interrelationships among mental health, substance use disorders, and suicidal ideation among LGB adults in the United States. The findings underscore the need for targeted interventions and research aimed at addressing the mental health needs of sexual minority populations. Future research should aim to better understand the underlying mechanisms driving these disparities and develop culturally sensitive and tailored interventions that meet the unique needs of LGB individuals. Reducing stigma and discrimination against sexual minority populations is also crucial to improving their mental health outcomes.

Aging well in an aging society: physical health in older lesbian, gay, and bisexual adults.

Older sexual minority people meet a double stigma in our society related to their sexual identity and chronological age. The present study explores how experiences of discrimination and prejudice, coming out, and personal resiliency influence physical health of older lesbian, gay, and bisexual (LGB) adults. Respondents were recruited through online advertisements and an online-based survey. The sample included 82 Italian cisgender LGB adults over 65 years: young older adults (65-70 years; 78%) and old-old adults (over 71 years; 22%). Regarding sexual orientation, the sample was composed of sexual minority women (n = 30; 37%) and sexual minority men (n = 52; 63%). ANOVAs' findings showed that sexual minority women described lower levels of physical health compared to sexual minority men. At the same time, old-old adults reported higher experiences of discrimination and prejudice compared to young older adults. Moreover, findings from hierarchical multiple regression analysis described that coming out, higher levels of personal resiliency, and fewer experiences of discrimination were predictors of physical health, regardless of age and sexual minority categories. These findings seem to align with previous studies that underline the relevance of investigating aging well in sexual minority people. Knowledge and awareness of LGBTQ+ issues are necessary for recognizing the unique needs and resources of older LGB people for promoting a healthy aging process.

Distress as a Function of Social Exclusion and Assertiveness among Homosexual/Bisexual People.

Homosexual (lesbian or gay) and bisexual (i.e., LGB) people tend to suffer from social exclusion and thus distress. To prevent or relieve distress, the people's assertiveness about justice and rights is an advocated means, but its effectiveness is uncertain, considering possible conflict with social exclusion. To clarify the effectiveness, this study analyzed data collected from 189 Chinese LGB adults in Hong Kong, which is a special administrative region of China generally Westernized and liberal to sexual orientation. Controlling for prior distress reported, the analysis showed that distress was lower when assertiveness was higher or social exclusion experienced was lower. However, distress was higher when both assertiveness and social exclusion experienced were higher. The higher distress implies a conflict between assertiveness and social exclusion to raise distress. It also implies the need to avoid conflict when promoting assertiveness and eliminating social exclusion to prevent distress in LGB people.

Patterns and Reasons for Being Uninsured Among Sexual Minority Adults Before and After the Affordable Care Act Implementation.

Purpose: We aimed to identify the self-reported reasons for being uninsured and sociodemographic factors associated with uninsurance among lesbian, gay, or bisexual (LGB) adults before and after the Affordable Care Act (ACA). Methods: We analyzed the 2013-2018 National Health Interview Survey data using multivariable logistic regression models to estimate the odds of being uninsured and the prevalence of self-reported reasons for not having insurance among LGB adults aged 18-64 years. Results: The study included 2124 LGB adults. The weighted uninsured rate decreased significantly from 19.6% in 2013 to 13.2% in 2017-2018 (odds ratio 0.61; 95% confidence interval 0.47-0.78). The primary reason cited for not having insurance post-ACA was similar to pre-ACA, with cost-related factors being the most commonly reported (31.5%). Conclusion: The overall uninsured rate decreased among LGB adults from 2013 to 2018, whereas disparities across subpopulations remained. Cost-related factors remained significant barriers to obtaining insurance coverage.

Intimate Partner Violence Among Lesbian, Gay, and Bisexual Adults: A Cross-Sectional Survey in Hong Kong.

Purpose: This study investigated the prevalence rates of various types of intimate partner violence (IPV) among lesbian, gay, and bisexual (LGB) adults in Hong Kong and examined the associations between IPV and different addictive behavior and mental health problems. Methods: A total of 759 LGB adults completed an online cross-sectional survey between November 2021 and February 2022. Data on past-year IPV and LGB-specific tactics (whether perpetrated or experienced by participants), addictive behavior, anxiety, depression, and demographics were collected and analyzed with descriptive statistics and logistic regressions. Results: Psychological aggression was the most common type of IPV within an LGB relationship (22.1%), followed by physical assault (10.8%) and IPV-related injury (4.1%). LGB-specific tactics were experienced by 39.0% of the LGB adults. Depression, anxiety, and frequent gambling were significantly associated with specific types of IPV and LGB-specific tactics. Conclusion: IPV was prevalent in the LGB population. Findings on correlates provided insights for future development of IPV detection and intervention.

Abstract P172: Potential Contribution of Social Factors in Reducing Population Disparities in Cardioprotective Health Behavior Between Bisexual, Gay/Lesbian, and Straight Adults

Background: Studies have demonstrated disparities in cardioprotective behavior by sexual orientation. Social factors have been associated with individual outcomes, but their impact on population disparities is unclear. We assessed if hypothetically intervening on social factors may reduce health behavior disparities by sexual orientation. Methods: We analyzed the intake survey data from the 2015-2023 Kaiser Permanente Research Bank. We compared unadjusted and demographics-standardized prevalence of selected health behaviors by sexual orientation (gay/lesbian or bisexual (LGB) vs straight adults (reference)). We then assessed the potential impact of hypothetically intervening on a single social factor (neighborhood safety, discrimination, education, income) on population disparities using a gap-closing estimand approach (i.e., modified inverse propensity weighting with g-computation). Results: We included 166,479 adults (mean age = 59 years), with 4.5% (7,476) gay/lesbian and 3% (4,936) bisexual. A higher proportion of LGB adults had documented current smoking, binge drinking, and low fruit intake compared to straight adults. Also, a higher proportion of bisexual adults had a high fast-food diet and inadequate sleep. Standardized prevalence of smoking, binge drinking, and inadequate sleep (bi only) remained higher in LGB adults. In gap-closing analysis, no change in gay/lesbian-straight disparities were observed. Reduction in bi-straight disparities in smoking (-2.5%, 95%CI: -3.5, -1.7) and sleep (-2.4%, 95%CI: -3.6, -1.1) may occur with higher college education rates. The sleep disparity (-2.4, 95%CI: -4.0, -0.93) may also decrease by reducing discrimination rates. None of the factors reduced the binge drinking disparity. (Table) Conclusion: LGB adults had higher prevalence of smoking, drinking, and inadequate sleep (bi only). Addressing single factors could reduce some LGB health behavior disparities but multi-factor interventions may be necessary to attain equity across orientations.

Marriage Expectations Among Different Groups of Gender and Sexual Minority Youth in the United States

Objective The study aims to analyze marriage expectations among sexual minority youth in the United States. Background The possibility of marriage for same-sex couples is recent in the United States. As same-sex couples used to be excluded from getting married, LGB adults have expressed concerns about the institution of marriage and have been less likely than their heterosexual peers to consider it for themselves. However, research is lacking when considering marriage expectations and attitudes regarding marriage among LGBTQ youth. Method We use wave 2 of the SOGI-Q Health Study, a community sample of 542 LGBTQ youth aged 15–21 collected in 2013, a time prior to federal marriage equality. We assessed measured marriage expectations, both to a same-sex partner and to a different-sex partner, as well as attitudes regarding marriage. Results Results indicated that gay and lesbian youth were more likely than queer and bisexual youth to expect to get married to a same-sex partner. Individual factors (e.g., higher levels of disclosure to family members) and structural factors (e.g., knowing a married same-sex couple), were associated with higher marriage expectations to a same-sex partner. Religiosity was associated with higher expectations of marriage to a different-sex partner. Conclusion Sexual identity, religiosity, disclosure, and knowing married same-sex couples were significantly associated with LGBTQ youths’ expectations to marry a same-sex and/or different-sex partner, as well as their attitudes about marriage more broadly. Implications Attitudes and expectations regarding marriage among sexual minority youth have implications for their future couple and family formation, which are broadly associated with well-being across the adult lifespan.

And how do LGB adults rate their orgasms in a relational context?

Subjective orgasm experience (SOE) refers to the perception, assessment, and/or sensation of orgasm on a psychological level, with the particularity that the study of SOE in nonheterosexual populations is currently very scarce. The study sought to analyze differences in SOE dimensions, comparing the intensity of each adjective of the Orgasm Rating Scale (ORS) and creating a ranking of the adjectives that better represent it in LGB men and women. In a sample of 1475 adults organized into 4 groups according to the type of sexual relationships reported, comparisons were made using multivariate analysis of variance and chi-square tests. Differences were obtained in the intensity of all the SOE dimensions, and in 23 of the 25 ORS adjectives. Lesbians and bisexual women reported higher intensity in SOE compared with bisexual and gay men. Because the ORS has been established as a good tool for detecting orgasmic difficulties in nonheterosexual populations, this study could provide LGBT affirmative psychotherapy with evidence on how these individuals evaluate their orgasms in a relational context. This study extends prior limited knowledge about how LGB people evaluate their orgasmic experiences in the context of sexual relationships. Despite this, the study poses limitations such as nonprobability sampling or the inclusion of exclusively cisgender and young individuals, making it difficult to generalize the results. Although significant differences were found between LGB men and women, all groups agree on the adjectives they use to describe the subjective experience of orgasm in the context of sexual relationships; therefore, evidence is provided about how LGB people evaluate their orgasmic experiences in this context.

WIDENING SEXUAL ORIENTATION INEQUITIES IN SMOKING AMONG OLDER ADULTS IN THE UNITED STATES, 2015–2019

Abstract A recent editorial in Tobacco Control noted the neglect of older adults in the field of tobacco control, arguing that we must do better. This study seeks to answer that call and amplify its message by assessing what is missed in health equity research when older adults are ignored in another area of inequity: differences in smoking by sexual orientation. We used pooled data from the 2015-2019 National Survey on Drug Use and Health. We estimated smoking prevalence for older adults aged ≥50 (N=43,956) by gender and sexual identity. Following the National Center for Health Statistics guidelines for analysis of trends, we used logistic regression to examine the association between continuous year (time) and smoking controlling for sexual identity. We also tested inequities in change using an interaction between year and sexual identities. In Model 1, there was a significant decreasing trend of smoking among all older adults: With each passing year, the odds of smoking went down (aOR 0.98, 95%CI 0.95-1.00). Heterosexual men, gay men, bisexual women), and lesbian women had a higher likelihood of smoking than heterosexual women. In Model 2, there was a significant interaction between year and sexual identity (aOR 1.34, 95%CI 1.02-1.75). That is, the change in likelihood of smoking from 2015 to 2019 for bisexual women was significantly different than the change for heterosexual women. Widening inequities in current smoking across some sexual identities among older adults indicate the importance of ensuring cessation campaigns for LGB adults are not just reaching younger adults.

Mental Health of Older Adults by Sexual Minority Status: Evidence From the 2021 National Health Interview Survey.

This study explored differences among older adults in mental health by sexual minority status. Data came from the 2021 U.S. National Health Interview Survey. The study sample included older adults (or those aged ≥50years, N = 15,559), and of those, two percent (n = 380) self-identified as lesbian, gay, or bisexual (LGB). Older LGB adults had significantly higher odds of reporting a diagnosis of depression and anxiety and experiencing serious psychological distress than older non-LGB adults. Additionally, older LGB adults reported higher odds of experiencing depression and anxiety more frequently than older non-LGB adults. Significant covariates included age, sex, housing, food security, and social support. Increased risk for mental illness may be long-term consequences of stigma and discrimination that this population has experienced over the life course. The combination of structural interventions and affirming mental healthcare that recognizes the cumulative negative experience among older LGB adults is necessary to achieve mental health equity.

Intersectional microaggressions, mental health outcomes, and the role of social support among Black LGB adults.

The present study explored the relationship between intersectional microaggressions (racism and heterosexism) and psychological distress outcomes among a sample of 370 Black lesbian, gay, and bisexual (LGB) adults. Additionally, social support from family, friends, and significant others was examined as potential moderators. Results showed that intersectional microaggressions were associated with greater depression, anxiety, and stress. Also, a significant moderating effect for family social support was found, suggesting that Black LGB adults with higher family social support reported greater levels of depression and stress as their microaggression experiences increased compared to those with less family social support. These results highlight the deleterious effects of intersectional microaggressions on the health of Black LGB adults and important clinical considerations pertaining to the role of social support. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

“How Will That Consent Play Out?”: Factors Involved in Lesbian, Gay, and Bisexual Individuals’ Understandings of Sexual Consent

Due to a lack of research on sexual consent in sexual minority communities, we know little about how and what individuals who identify as lesbian, gay, or bisexual (LGB) learn about consent. To this end, a convenience sample of 25 LGB adults (N = 25) was interviewed about the factors that have shaped their perceptions and approaches to sexual consent. Data was analyzed using a constant comparative approach wherein data was collected and analyzed simultaneously. Participants identified interpersonal resources, such as past partners, friends, and family, as influential in their views of consent. They also described the lack of inclusive sexual health resources and inadequacies in school-based sexual education as obstacles in the learning process.

Analysis of Psychiatric Symptoms and Suicide Risk Among Younger Adults in China by Gender Identity and Sexual Orientation

Younger adults in China who are transgender and gender nonconforming (TGNC) and lesbian, gay, and bisexual (LGB) experience high levels of minority stress (eg, stigma and bullying) and adverse mental health symptoms. However, there is a lack of research documenting mental health disparities compared with their cisgender and heterosexual peers. Studies that disaggregate TGNC and LGB individuals and are conducted in nonmetropolitan regions are also needed. To examine whether younger adult students' psychiatric symptoms and suicide risk vary by sexual orientation and gender identity and identify risk factors within LGB younger adults and TGNC younger adults. This cross-sectional study surveyed students at 63 universities in Jilin Province, China, between October 24 and November 18, 2021. Analyses were completed May 6, 2022. Gender identity (TGNC vs cisgender) and sexual orientation (LGB vs heterosexual). Psychiatric outcomes included depression, anxiety, traumatic stress, and nonsuicidal self-injury (NSSI), which were measured by the Patient Health Questionnaire-9, Generalized Anxiety Disorder-7, Trauma Screening Questionnaire, and self-reported NSSI behaviors. The Suicide Behaviors Questionnaire-Revised was used to assess suicide risk. The analytic sample included 89 342 younger adults (mean [SD] age, 19.60 [1.75] years), including 51 438 assigned female at birth and 37 904 assigned male at birth. The sample included 2352 individuals who were TGNC, 6501 who were cisgender LGB, and 80 489 who were cisgender heterosexual. Compared with their cisgender heterosexual peers, TGNC and LGB younger adults were more likely to experience increased psychiatric symptoms across categories and suicide risk, as well as more severe forms of symptoms. In particular, overall suicide risk was 43.03% among TGNC individuals, 36.21% among LGB individuals, and 11.70% among cisgender heterosexual younger adults. Controlling for demographic variables and compared with cisgender heterosexual peers, TGNC young adults had higher odds of suicide risk (adjusted odds ratio, 5.38; 95% CI, 4.94-5.86; P < .001) and of past-year NSSI (adjusted odds ratio, 6.55; 95% CI, 5.87-7.30; P < .001). Separate within-group analyses for LGB and TGNC younger adults highlighted the vulnerability of bisexual women and gender nonbinary groups, as well as the relevance of minority stress-related risk factors, including peer bullying and assault and loneliness. This study noted disparities of mental health issues among LGB, transgender, or queer or questioning younger adults in China and suggests a high urgency to address psychological health and prevent suicide in this population. Targeted public health initiatives may be needed to reduce stigma and discrimination, train competent health care professionals, and create affirmative mental health policies and systems of care.

Cumulative life-course victimization and inflammation in a U.S. national sample: Comparing intersections based on sexual orientation, gender, race/ethnicity, and education

Violence victimization has been associated with low-grade inflammation. Lesbian, Gay, and Bisexual (LGB) individuals are at greater risk for victimization in childhood and young adulthood compared to heterosexuals. Moreover, the intersection of LGB identity with gender, race/ethnicity, and educational attainment may be differentially associated with victimization rates. However, no previous study has examined the role of cumulative life-course victimization during childhood and young adulthood in the association between 1) LGB identity and low-grade inflammation during the transition to midlife, and 2) intersection of LGB identity with gender, race/ethnicity, and educational attainment and low-grade inflammation during the transition to midlife. We utilized multi-wave data from a national sample of adults entering midlife in the United States– the National Longitudinal Study of Adolescent to Adult Health (Add Health; n = 4573) - and tested four bootstrapped mediation models. Results indicate LGB identity, LGB and White, and LGB and Black identities were indirectly associated with low-grade inflammation during the transition to midlife via higher levels of cumulative life-course victimization. Moreover, among LGB adults, the association between 1) less than college education and 2) some college education, and low-grade inflammation was mediated by cumulative life-course victimization. For LGB females, there was a direct association between identity and low-grade inflammation and this association was mediated by cumulative life-course victimization . Reducing accumulation of victimization could be critical for preventing biological dysregulation and disease onset among LGB individuals, particularly for those with multiple marginalized identities.

Associations between Relationship Status, Anxiety, Sexual Function, and Sexual Satisfaction in Lesbian, Gay, and Bisexual People

Objectives The purpose of this study was to describe associations between relationship status, anxiety, and sexual function and satisfaction in lesbian, gay, and bisexual (LGB) adults. Methods Linear regression determined associations between sexual function, relationship characteristics and anxiety in 979 LGB participants. Results Relationship status was not related to sexual interest in gay men. Partnered relationship status was associated with higher sexual satisfaction for gay men, lesbians, and bisexual women. Anxiety symptoms were negatively associated with sexual interest, satisfaction, and orgasm pleasure for gay men but not associated with sexual outcomes in lesbian women. Conclusion Using a nationally representative sample of LGB adults, differences were found in factors related to sexual function and satisfaction by gender and sexual orientation.