How To Meet Girls

See discussions, stats, and author profiles for this publication at: https://www.researchgate.
net/publication/321958258
“I Want to Feel Like a Full Man”: Conceptualizing Gay, Bisexual, and

Heterosexual Men’s Sexual Difficulties
Article in The Journal of Sex Research · December 2017

DOI: 10.1080/00224499.2017.1410519
CITATIONS READS
2 384
5 authors, including:
Lorraine K. McDonagh Daragh T. Mcdermott

University College London Anglia Ruskin University
26 PUBLICATIONS 80 CITATIONS 31 PUBLICATIONS 114 CITATIONS
SEE PROFILE SEE PROFILE
Nathan Davies Todd G Morrison

University College London University of Saskatchewan
55 PUBLICATIONS 389 CITATIONS 146 PUBLICATIONS 2,830 CITATIONS
SEE PROFILE SEE PROFILE
Some of the authors of this publication are also working on these related projects:
psychology View project
Methodologies in Queer Data Research: A Systematic Review View project
All content following this page was uploaded by Todd G Morrison on 17 January 2018.
The user has requested enhancement of the downloaded file.

The Journal of Sex Research
ISSN: 0022-4499 (Print) 1559-8519 (Online) Journal homepage: http://www.tandfonline.com/loi/hjsr20
“I Want to Feel Like a Full Man”: Conceptualizing

Gay, Bisexual, and Heterosexual Men’s Sexual
Difficulties
Lorraine K. McDonagh, Elly-Jean Nielsen, Daragh T. McDermott, Nathan

Davies & Todd G. Morrison
To cite this article: Lorraine K. McDonagh, Elly-Jean Nielsen, Daragh T. McDermott, Nathan
Davies & Todd G. Morrison (2017): “I Want to Feel Like a Full Man”: Conceptualizing Gay,
Bisexual, and Heterosexual Men’s Sexual Difficulties, The Journal of Sex Research, DOI:
10.1080/00224499.2017.1410519
To link to this article: https://doi.org/10.1080/00224499.2017.1410519
Published online: 20 Dec 2017.
Submit your article to this journal
Article views: 39
View related articles
View Crossmark data
Full Terms & Conditions of access and use can be found at

http://www.tandfonline.com/action/journalInformation?journalCode=hjsr20
THE JOURNAL OF SEX RESEARCH, 00(00), 1–19, 2017
Copyright © The Society for the Scientific Study of Sexuality
ISSN: 0022-4499 print/1559-8519 online
DOI: https://doi.org/10.1080/00224499.2017.1410519
“I Want to Feel Like a Full Man”: Conceptualizing Gay, Bisexual,

and Heterosexual Men’s Sexual Difficulties
Lorraine K. McDonagh
Research Department of Primary Care and Population Health, University College London
Elly-Jean Nielsen
Department of Psychology, University of Saskatchewan
Daragh T. McDermott
Department of Psychology, Anglia Ruskin University
Nathan Davies
Research Department of Primary Care and Population Health, University College London
Todd G. Morrison
Department of Psychology, University of Saskatchewan
Current understandings of sexual difficulties originate from a model that is based on the study of
heterosexual men and women. Most research has focused on sexual difficulties experienced by
heterosexual men incapable of engaging in vaginal penetration. To better understand men’s
perceptions and experiences of sexual difficulties, seven focus groups and 29 individual inter-
views were conducted with gay (n = 22), bisexual (n = 5), and heterosexual (n = 25) men. In
addition, the extent to which difficulties reported by gay and bisexual men differ from hetero-
sexual men was explored. Data were analyzed using thematic analysis applying an inductive
approach. Two intercorrelated conceptualizations were identified: penis function (themes: med-
icalization, masculine identity, psychological consequences, coping mechanisms) and pain
(themes: penile pain, pain during receptive anal sex). For the most part, gay, bisexual, and
heterosexual men reported similar sexual difficulties; differences were evident regarding alter-
native masculinity, penis size competition, and pain during receptive anal sex. The results of this
study demonstrate the complexity of men’s sexual difficulties and the important role of socio-
cultural, interpersonal, and psychological factors. Limitations and suggested directions for
future research are outlined.
Introduction dysfunction refers to a persistent or recurrent disturbance in

sexual function that causes distress; it is also used to describe
Sexual difficulties, or reduced sexual function (Rowland, sexual difficulties when a clinical diagnosis has been made
2007), have the potential to negatively affect a man’s social (Wincze & Weisberg, 2015). The term sexual difficulty, on the
and psychological well-being and quality of life (e.g., Althof, other hand, refers to the more general concept of low sexual
2002; Laumann, Paik, & Rosen, 1999). Traditionally, sexual function, where the presence of distress is not clear and has not
functioning refers to the human sexual response cycle, which been clinically diagnosed (Hayes, Bennett, Fairley, &
is the sequence of physiological responses that occurs during Dennerstein, 2006). Over time, however, a sexual difficulty
sexual stimulation (including intercourse and masturbation; may develop into a sexual dysfunction and can play a role in
Basson, 2015; Masters & Johnson, 1966). The term sexual the maintenance of a sexual dysfunction (Brotto et al., 2016).
Most research on sexual difficulties and sexual dysfunctions
is anchored in Masters and Johnson’s (1966) human sexual
Correspondence should be addressed to Lorraine K. McDonagh, response model, a model derived from the study of heterosexual
University College London Medical School, Royal Free Campus, Rowland men and women. This theory was further revised; the first
Hill Street, London, United Kingdom NW3 2PF. E-mail: l.mcdonagh
@ucl.ac.uk
revision was primarily to incorporate the sexual desire phase
Color versions of one or more of the figures in the article can be found to the cycle (Kaplan, 1974), and the second revision was to
online at www.tandfonline.com/HJSR. reflect the psychopathological perspective of the time; that is,
MCDONAGH, NIELSEN, MCDERMOTT, DAVIES, AND MORRISON
seeking to treat or change nonheterosexuality (Masters & partner = 84%). This was followed by oral sex (receiving
Johnson, 1979; Sandfort & De Keizer, 2001). Although homo- oral sex = 71%; giving oral sex = 72%), with anal inter-
sexuality was removed from the Diagnostic and Statistical course being the least reported sexual practice (insertive
Manual of Mental Disorders (DSM) in 1973 (American anal intercourse = 20%; receptive anal intercourse = 16%;
Psychiatric Association [APA], 1973), a heterocentric and phal- Grulich et al., 2014). Discernibly, the differences between
locentric perspective has prevailed, with most research focusing gay and heterosexual intercourse can be discussed on many
on sexual difficulties experienced by heterosexual men incap- levels—anatomical, medical, behavioral, motivational, psy-
able of engaging in vaginal penetration (Hollows, 2007). chological, and gender related; as such, diagnostic and
Despite a conceptual shift from the DSM-IV-TR (APA, 2000) classification comparisons may be erroneous (Hollows,
to the most recent iteration, the DSM-5 (APA, 2013), appro- 2007). It would follow, then, that further research is required
priate inclusion or consideration of nonheterosexuality has still to shed light on the sexual difficulties gay, bisexual, and
not occurred (McCabe et al., 2016; Sungur & Gündüz, 2013). heterosexual men face (McDonagh, Bishop, Brockman, &
To illustrate: one sexual dysfunction in the DSM-5 concerns Morrison, 2014; McDonagh, Stewart, Morrison, &
men’s issues with premature ejaculation “approximately 1 min- Morrison, 2016).
ute after vaginal penetration” (APA, 2013, p. 442). An addi-
tional note is included in the DSM-5 stating that a diagnosis of
Epidemiology of Sexual Difficulties
early (premature) ejaculation can be applied to individuals enga-
ging in “nonvaginal sexual activities”; however, a specific time Previous research in this area has been conducted
frame has not been established for nonvaginal sex. through quantitative methodologies, that is, by way of
self-report questionnaires (e.g., Cove & Boyle, 2002;
Hirshfield et al., 2010; Lau, Kim, & Tsui, 2008; Mao
Critique of the Heteronormative Perspective
et al., 2009). Several authors have pointed to differences
Examining gay men’s sexuality from a heteronormative in prevalence rates (e.g., Hirshfield et al., 2010; Lau, Kim,
perspective is inappropriate for a number of reasons. First, & Tsui, 2005; Lau et al., 2008; Laumann et al., 1999; Mao
gay and heterosexual men differ regarding the context et al., 2009) and experiences (e.g., Bancroft, Carnes,
through which they develop their sexuality (Campbell & Janssen, Goodrich, & Long, 2005; Cove & Boyle, 2002;
Whiteley, 2006). Heterosexual men operate in accordance Damon & Rosser, 2005; Rosser, Metz, Bockting, &
with a heterosexual script that they are taught from child- Buroker, 1997; Rosser, Short, Thurmes, & Coleman, 1998;
hood regarding how to act, feel, and behave in sexual Ussher, Perz, et al., 2016) of sexual difficulties between
experiences (Sandfort & De Keizer, 2001). In contrast, gay heterosexual and gay men. In studies examining heterosex-
men define their sexuality through the coming-out process, ual men, experiences of having at least one sexual difficulty
which consists of rejecting the heterosexual script in the previous year vary from 31% (Laumann et al., 1999)
(Campbell & Whiteley, 2006). Second, the sexual acts per- to 51% (Lau et al., 2005). Rates of sexual difficulties appear
formed between a man and a woman or between two men to be even higher among gay men, varying from 43% (Lau
may appear similar but encompass divergent power et al., 2008) to 79% (Hirshfield et al., 2010) in the past year.
dynamics (Philaretou & Allen, 2001; Underwood, 2003). In a recent prevalence study, pain during receptive anal sex
Heterosexual men are expected to be the active partner, and lack of sexual desire were the most frequently reported
whereas heterosexual women are expected to be the recep- issues for gay men, while premature ejaculation was at the
tive partner (Sandfort & De Keizer, 2001). In sexual forefront for heterosexual men (Peixoto & Nobre, 2015).
encounters between two men, power dynamics are more According to Peixoto and Nobre (2015), their findings sug-
complex (Kippax & Smith, 2001). Further, while sexual gest that issues concerning one’s penis might be more acute
practices can be guided by normative understandings of for heterosexual men, whereas pain during receptive anal
masculinity and femininity, adoption of certain “roles” sex—a problem which is entirely absent from the DSM-5
(e.g., “top” or “bottom”) may stem from the physical plea- (APA, 2013)—is a core issue for gay men. At the same
sure one receives from a particular position (Johns, Pingel, time, both groups of men reported concerns over erectile
Eisenberg, Santana, & Bauermeister, 2012; Moskowitz & difficulties at comparable rates. Thus, both similarities and
Hart, 2011). Third, in contrast to heterosexual relationships, differences have been highlighted, but qualitative aspects of
in same-sex interactions noncoital sexual activity, such as these findings remain unclear (except for men who have a
genital touching (manual stimulation) and oral sex, is more lift-threatening illness; see Ussher, Perz, et al., 2016;
common, and there is generally no a priori assumption that Ussher, Rose, & Perz, 2016). Scholars have argued that
penetration will occur (e.g., Blumstein & Schwartz, 1983; further exploration of the social, cultural, and physical
Grulich et al., 2014; Laumann, Gagnon, Michael, & aspects (Hirshfield et al., 2010) of sexual difficulties of
Michaels, 1994). For example, Grulich et al. (2014) reported men who have sex with men, especially pain during anal
that, in a sample of 400 men, genital touching (manual sex (Rosser et al., 1998), is crucial for more accurate assess-
stimulation) was the most common sexual practice during ment and refinement of criteria.
participants’ most recent sexual encounters (manual stimu- There is an apparent gap in our knowledge base in
lation of participant = 81%; manual stimulation of relation to gay men’s sexual functioning; what is known is
2
QUALITATIVE EXPLORATION MEN’S SEXUAL DIFFICULTIES
based on a model using heterosexual men and women (see Teijlingen & Pitchforth, 2006). A large body of work sug-
McDonagh et al., 2014; McDonagh et al., 2016). This has a gests that focus groups can enhance the disclosure of sex-
direct influence on what is considered to be a sexual dys- related information in numerous ways (e.g., Frith, 2000;
function or sexual difficulty (Cove & Boyle, 2002), which is Janssen, McBride, Yarber, Hill, & Butler, 2008; Newman,
problematic when assessing sexual functioning in nonheter- Tepjan, & Rubincam, 2017; Överlien, Aronsson, & Hydén,
osexuals. Quantitative methodologies are advantageous 2005). For example, for some people, the conversational
when examining a well-established topic; however, these ambience experienced within a focus group may feel less
methodologies are limited if researchers are uncertain as to daunting in comparison to a one-on-one interview with a
what precisely constitutes the focus of interest. If research- researcher. Awareness of common and shared experiences
ers decide a priori what issues are to be considered, partici- between group members may encourage participants to feel
pants are unable to provide their own interpretation of what more comfortable or secure, and less on guard, when dis-
constitutes a sexual difficulty. cussing sensitive issues. Data from interviews and focus
Due to a reliance on quantitative methods employed groups can reveal overlapping yet complementary findings,
within a heterosexist framework, many key questions have which contribute to a more nuanced understanding of a
gone unanswered. For example: What exactly do gay men topic. If applied to men’s sexual functioning, the use of
consider to be sexual difficulties? How do they characterize both interviews and focus groups may further enrich con-
or conceptualize these problems? How do these accounts ceptualizations of this construct.
compare to those of heterosexual men? The best means to
answer such questions and achieve a more in-depth under-
Current Study: Inductive Thematic Analysis
standing of sexual difficulties would be to ask gay men, in
their own words, to particularize what this concept means to An inductive approach to qualitative research aims to
them (e.g., Nassar-McMillan, Wyer, Oliver-Hoyo, & Ryder- generate analysis from the bottom (the data) up (Braun &
Burge, 2010; Singh, 2008). Clarke, 2006, 2013). The current study aimed to give voice
to a topic/group of people with little existing understanding.
This study was geared toward identifying patterns of mean-
Qualitative Inquiry
ings across the data set. For these reasons, inductive the-
The use of qualitative methods of data collection (i.e., matic analysis was employed. Participants’ interpretations
open-ended discussions) and analysis (i.e., thematic categor- were prioritized over existing knowledge in the field; thus,
ization) could broaden understandings of gay men’s sexual themes bear close resemblance to the data (Braun & Clarke,
difficulties. Qualitative methods are particularly valuable in 2006, 2013). With this being said, disciplinary knowledge
the early stages of theory development when a topic needs will always, to some extent, influence the research; hence,
to be explored in great detail with no boundaries on its our positions as psychologists were used advantageously to
conceptualization. Notably, qualitative research allows for determine themes and patterns in the data.
results that go beyond the forced-response formats of the Gaining understanding about the social, cultural, and
questionnaire to participants’ own framing of an issue physical aspects of sexual difficulty symptoms in gay and
(Braun & Clarke, 2013). Qualitative researchers explore bisexual men will help researchers and clinicians more
the context and social meaning of a phenomenon and how accurately assess and refine criteria for sexual difficulties
it affects individuals (Rowan & Wulff, 2007). This type of as they relate to this group. The two aims of this study were
inquiry is flexible, allowing novel areas relevant to the to qualitatively explore men’s sexual difficulties and exam-
research topic to arise which were not necessarily predicted ine how these difficulties are conceptualized and to explore
by the researcher. These areas can be further probed, enhan- possible differences and similarities among heterosexual,
cing the overall purpose and outcomes of the research and gay, and bisexual men. Although research suggests there
allowing a more holistic view of the phenomenon under are differences in the experiences of sexual difficulties
investigation. between heterosexual and nonheterosexual men (e.g., Cove
Numerous authors have argued for the combined use of & Boyle, 2002; Damon & Rosser, 2005; Rosser et al., 1997;
multiple qualitative methods (such as interviews and focus Rosser et al., 1998), this assumption has not been explored
groups) to enhance the analysis of a subject and expand its qualitatively; thus, heterosexual men were included in this
conceptualization (e.g., Gothberg et al., 2013; Lambert & study. The exploratory and inductive nature of this under-
Loiselle, 2008; Linhorst, 2002). In particular, while both studied topic was such that we did not want to exclude any
methods permit participants to give detailed accounts of men’s understandings. In a similar vein, within this explora-
their experience in their own words, this multifaceted tory project, both focus group and interview methods were
approach is beneficial in providing a range of general over- employed to ensure depth and breadth of discussion and to
views (focus groups) as well as in-depth descriptions (indi- elicit data that might be derived from different techniques.
vidual interviews) of personal experiences (Lambert & One-on-one interviews were used to gain in-depth descrip-
Loiselle, 2008). Focus groups can provide a setting where tions of personal experiences and focus groups were used to
certain individuals feel more comfortable discussing sensi- gain general overviews of the area. Furthermore, providing
tive issues in comparison to one-on-one interviews (Van participants with options as to how they share their
3
experiences (i.e., via individual interviews or focus groups) Table 1. Demographic Characteristics of Sample
meant that men who may have been reluctant about taking
Demographics n %
part could be reached.
In short, the desired outcome was to capture a full range Age range
of experiences and accounts on this neglected topic of 18–29 years 22 42
research. Our specific research questions were as follows: 30–39 years 14 27
40–49 years 5 10
50+ years 11 21
1. What do men consider sexual difficulties to be and Sexual orientation
Heterosexual 25 48
how are these difficulties conceptualized? Gay 22 42
2. What are the differences and similarities in experi- Bisexual 5 10
ences of sexual difficulties among heterosexual, gay, Relationship status
and bisexual men? Single 16 31
Casually dating one or more people 1 2
Dating one person exclusively 13 25
Cohabiting 8 15
Engaged or planning to marry 1 2
Method Married or civil partnership 7 13
Divorced or separated 6 12
Participants Current occupation
Student 14 26
A total of 52 men between the ages of 18 and 66 years Government workers 10 19
(M = 35.38, SD = 12.62) participated in 29 individual inter- Sales and services 10 19
views (15 heterosexual; 12 gay; and two bisexual) and seven Financial services 4 8
Health services 2 4
focus groups (consisting of one group of two discussants; three Trades 2 4
groups of three discussants; and three groups of four discus- Communication (media) 2 4
sants). Focus groups were composed exclusively of heterosex- Unemployed 4 8
ual (focus groups 1, 2, 3; two groups of four, one group of Retired 4 8
three), gay (focus groups 4, 5, 6; one group of four, one of Religiosity
Very religious 2 4
three, one group of two), or bisexual (focus group 7; one group Somewhat religious 8 15
of three) men; that is, participants were grouped according to Not very religious 15 29
sexual orientation. All of the focus groups were constructed, Not at all religious 27 52
meaning that none of the groups was naturally occurring (i.e.,
participants had never met before). Constructed focus group
discussions have been found to be more animated and enthu- (GiGSoc)) were contacted and asked to distribute informa-
siastic, with greater divergent views and more complexities of tion about the study to members (n = 8). Chain-referral
the topic explored in comparison to naturally occurring groups sampling also was used, whereby acquaintances of the first
(Leask, Hawe, & Chapman, 2001). The participants were author were asked to inform other men about the study
recruited in Ireland and included men resident in all four (n = 15). All advertisements and invitations clearly stated
provinces: Connaught (19 participants), Leinster (16 partici- that the purpose of the study was to explore men’s under-
pants), Munster (13 participants), and Ulster (four partici- standings of sexual difficulties and stressed that no personal
pants). This geographic sampling strategy was executed to experience with sexual difficulties was required (although
capture a range of accounts in the Irish context. The demo- such personal experience was welcome). This ensured that
graphic characteristics of the sample are presented in Table 1. men could not have self-selected into the study based on
their experience of sexual difficulties.
Data Collection
Procedure
Participants were recruited through a variety of means. A
national campaign was launched seeking participation from Interviews and focus groups were conducted by the first
all men aged 18 years and over. Advertisements were placed author (LMD) either in person (17 interviews; two focus
in local and national newspapers (n = 8 participants groups) or over the phone (12 interviews; five focus
recruited via this method) and on Irish websites (n = 2). groups), and in a variety of settings (depending on the
The research was discussed on the national television news needs of the participants). Locations included on-campus
(n = 2) and on national and local radio stations (n = 11). In laboratories situated at multiple universities in Ireland, as
addition, information on the study was distributed at lesbian, well as in participants’ homes. Phone focus groups were
gay, bisexual, and transgender (LGBT) pride events around facilitated by web-conferencing technology (Skype), which
the country (n = 6). Irish LGBT organizations (e.g., Gay and provided participants with the option of a voice (anon-
Lesbian Equality Network (GLEN), Gay in Galway Society ymous) or video call.
4
Telephone and In-Person Interviews and Focus that were more personal in nature (e.g., “Have you ever
Groups. All contributors were given the option of experienced a sexual difficulty?”). The topic guide (i.e., the
participating over the phone or in person, and in a one-on- set of guiding questions used to facilitate discussion of
one interview or a focus group, for two reasons. First, it was relevant topics) is provided in Table 2.
important to enable men from a variety of geographical
locations throughout Ireland to participate, particularly to Ethical Considerations. Ethical approval was obtained
access hard-to-reach populations, such as those living in from the Research Ethics Committee of the university of the
remote rural areas and those who would be reluctant to first author (LMD). For face-to-face interviews and focus
participate in person (Fielding, Lee, & Blank, 2008; Frazier groups, participants were provided with an information sheet
et al., 2010; Miller, 1995; Sturges & Hanrahan, 2004; Tausig and consent form. Men participating via telephone were
& Freeman, 1988). Second, due to the sensitive nature of the e-mailed a copy of the information sheet and consent form at
topic, some participants are more comfortable discussing least one day before the interview; consent was completed
embarrassing topics while remaining anonymous. Phone verbally and digitally recorded. Focus group participants
interviews (Fenig, Levav, Kohn, & Yelin, 1993; Greenfield, were asked to be respectful of others and not to share
Midanik, & Rogers, 2000; Sturges & Hanrahan, 2004) and information discussed within the group with other people. To
phone focus groups (Cooper, Jorgensen, & Merritt, 2003; maintain confidentiality, all names provided in the quoted
Frazier et al., 2010; Krueger & Casey, 2014; Smith, material are pseudonyms. Upon completion, participants
Sullivan, & Baxter, 2009b) have been found to increase could enter a competition to win one of four gift vouchers
participants’ perceptions of anonymity, which in turn may worth €50 each.
increase data quality. To illustrate, a direct comparison of
phone interviews versus in-person interviews transcripts
Data Analysis
data found no significant differences in data (i.e., both
produced similar data; Sturges & Hanrahan, 2004). On average, interviews lasted 57 minutes and focus groups
Regarding telephone focus groups, one common concern is lasted 120 minutes. Interviews and focus groups were tran-
that the lack of nonverbal cues could limit interactions and scribed verbatim (i.e., paralinguistic cues such as “em” and
dynamics among participants. However, lack of visual “um” were included). The data were subject to inductive the-
contact can work in a positive way for some people, matic analysis employing Braun and Clarke’s (2006) recom-
especially for sensitive topics. For example, in comparing mendations. Due to time constraints, data collection and data
telephone focus groups and in-person focus groups, Frazier analysis was conducted simultaneously by the first author
et al. (2010) demonstrated that interactions occurred in both (LMD). Transcripts from interviews and focus groups were
and similar elements of experiences were discussed across analyzed using the same procedure; this analysis did not probe
the two types of groups. Importantly, participants disclosed for group interaction, as the purpose of conducting focus
certain emotionally sensitive experiences only during the groups and interviews was to encourage participants’ confi-
telephone focus groups. While relatively uncommon in the dence in their ability to share sensitive experiences.
psychological literature to date, it is important to note that Specifically, the following procedure was employed.
phone focus groups have been used in other health research
fields, such as public health, for the past decade (Chong, Step 1: Data Familiarization. The first interview
Alayli-Goebbels, Webel-Edgar, Muir, & Manson, 2015; (Interview 01) was transcribed by the first author and the
Gothberg et al., 2013; Horowitz, Siriphant, Canto, & Child, transcription was checked for accuracy (i.e., the researcher
2002; Koskan et al., 2014; Ross, Stroud, Rose, & Jorgensen, listened to the audio recording while reading the transcript).
2006; Smith, 2014; Smith, Sullivan, & Baxter, 2009a). Next, the field notes for Interview 01 were read; these were
notes created by the researcher after conducting the
Topic Guide. A semistructured interview guide was interview regarding behaviors, activities, events, and other
developed to facilitate discussions. The same guide was features of the interaction. The field notes were not used as
used in interviews and focus groups. Participants were data but were used to supplement the interview data by
asked about sexual dysfunctions and sexual difficulties setting the scene for the context in which it took place.
separately, using the same questions for each. The Next, the transcript was read several times to increase
interviewer briefly communicated the distinction between familiarity with the data. During the first several readings,
the two concepts prior to the interview commencing. The notes were made regarding initial thoughts and interesting
questions focused on (1) the types of sexual difficulties and points made by the interviewee. This was initially done
sexual dysfunctions men could experience; (2) the effects of using pen and paper and was then transferred to NVivo9
these difficulties and dysfunctions; and (3) coping strategies to aid data management in the next step.
for sexual difficulties and sexual dysfunctions. To promote
participant comfort and disclosure, a funneling technique Step 2: Generating Initial Codes. The use of the
(Smith & Osborn, 2008) was used; that is, the interviewer statistical software package NVivo9 aided in managing the
began by asking general questions (e.g., “What are the sexual coding of the data set; once familiar with the data for
dysfunctions that men may experience?”) before asking those Interview 01, the transcript was loaded into the software,
5
Table 2. Topic Guide for Interviews and Focus Groups information that can be assessed in a meaningful way
regarding the phenomenon” (Boyatzis, 1998, p. 63). To
Begin by explaining what is meant by the terms sexual dysfunction and
sexual difficulties. illustrate, the following extract was coded as “Viagra”:
Men in general: Participant I guess then when you get older then you
1. What do you think a sexual dysfunction could be for men? actually—the muscles are no longer working,
2. [Alternative wording] What would count as a sexual dysfunction for
men? Can you give examples?
and it’s not getting it up and that’s when you
a. How could this impact a man’s life? move to Viagra. Which has its own implica-
b. [Alternative wording] What are the consequences of these problems tions. I’d say actually people who are on
for men? Can you tell me more … Viagra probably have a lot of issues about it.
c. How do you think men cope with this problem? Interviewer Yeah?
d. [Alternative wording] How do you think men deal with this type of
issue?
Participant Thinking that you have to take a pill in order
Experiences of people they know: to perform, especially if you, ya know, I think
1. Do you know anyone who has ever experienced this dysfunction? it’s associated—Viagra is associated with old
2. What impact did it have on their life? people. So if you end up having to go on it in
3. How did they cope/deal with it? your thirties or, you know, something like
Personal experience:
1. Have you ever experienced a sexual dysfunction? Can you tell me
that, then I’d say that would cause a lot of
about it? dysfunctions or possibly becoming dependent
2. What impact did this have on your life? on it.
3. How did you deal with it?
4. What characteristics or qualities might help a man deal with a sexual At this stage, sections of text were assigned multiple codes
dysfunction?
Same questions for sexual difficulties.
where relevant. Similarly to Step 1, memos were used to
Go through list of issues not raised (below). record any interesting thoughts regarding the data. Steps 1
Closing: Is there anything else you think I should know that we haven’t and 2 were repeated for each transcript. Once all transcripts
discussed already? were coded, the first author revisited each transcript, starting
at Interview 01, to ensure all relevant text was coded.
Additional areas to probe on if not raised by participant. Apply questions
above to each.
1. Desire: Lack of interest in being sexual and in engaging in sexual Step 3: Searching for Themes. Once all the data were
relations by oneself or with a partner coded, a list of all of the different codes identified across the
2. Arousal: Difficulty achieving and maintaining an erection data set was constructed. The codes on the list were sorted
3. Orgasm: Premature ejaculation/coming too soon into provisional themes and subthemes (i.e., codes were
4. Orgasm: Not able to reach orgasm
5. Pain: Pain during sex (dyspareunia)
examined for potential overlap to form an overarching
6. Pain: Pain during anal sex theme). In this way, the themes and subthemes identified
7. Body image self-consciousness were strongly linked to the data themselves; no preexisting
8. Hypervigilance regarding partner’s satisfaction coding framework was used. Some codes did not belong
9. Differences in type of sexual behavior desired within any provisional themes or subtheme but were not
10. Differences in type of relationship wanted
11. Differences in age of partners
deleted; these were categorized under the theme of “other,”
12. Frequency of sex (not having enough casual sex/relationship) as we believed they could be important for Step 4. Diagrams
13. Inhibiting psychological state (before or during sex) and mind maps were used as a way to make sense of and
14. Negative psychological state during/after the encounter visualize the connections between themes and subthemes
15. General dislike of casual sex (similar to the refined map in Figure 1). For example, the
16. Anxiety about sexual performance
17. Fear of contracting STDs
codes “Viagra” and “mechanistic view/get fixed” were
18. Fear of getting partner pregnant categorized under the theme “phallocentrism.”
19. Unsuitable locations (cold)
20. Fear of discovery Step 4: Reviewing Themes. Step 4 involved
21. Fear of arrest/assault/blackmail refinement of the list of themes. The researcher returned to
22. Partner’s psychological problems
23. Differences in sexual experience of the partners
the coded data and transcripts for each theme to review
24. Differences in attraction to partner whether the theme adequately represented the data. Further
25. Communication difficulties connections between the coding and the theme were sought.
26. Decrease in sexual feelings/satisfaction with partner At this stage, the sexual orientation of participants
represented in the coded data was examined for
commonalities and differences within the themes. If a
which then facilitated the organization and structuring of the theme did not have enough data to support, it was
coding process. The first author then read the transcript collapsed into another related theme. Some themes were
again, selecting important sections of discussion and found to be too complex and were broken down into
attaching a label or a code which described them. A code separate themes. An example from this stage of analysis is
is “the most basic segment, or element, of the raw data or that “Viagra,” “mechanistic views,” and “phallocentrism”
6
Sexual
Difficulties
Penis Function
Masculine Psychosocial Coping

Medicalization
Identity Consequences Mechanisms
Penis Size Restrictive Alternative

Concerns Emotionality Masculinity
Competition Porn Psychosocial Physical
Pain
Pain during
Penile Pain
Receptive Anal Sex
Psychological Physical Acceptance Physical Psychosocial Coping
Physique Preparation Medical Partner Fear Guilt
Figure 1. Graphical illustration of themes and subthemes.
were collapsed into the theme of “medicalization,” which Results

was grouped under the overarching theme of “physical
function.” Across the three subgroups (heterosexual, gay, and bisex-
ual) of participants, a distinction was made between sexual
Step 5: Defining and Naming Themes. When all difficulties in terms of penis functioning and pain. For each
transcripts were analyzed, a final refined list of themes and broad category, salient themes and subthemes emerged
subordinate themes was created. A detailed analytical which speak to the complexity surrounding sexual difficul-
description was written about each theme describing what ties for men. An overview of themes and related subthemes
that theme means and represents. At this stage, how each is presented in Figure 1. A list of key themes and respective
theme and subtheme fit into the overall story about the illustrative quotations are given in Tables 3 and 4.
entire data set in relation to the research questions was
considered. The wording of themes was also reconsidered.
Penis Functioning
For example, the “physical function” overarching theme
was renamed “penis function.” To validate emergent Participants’ responses were characterized by phallo-
findings and ensure a rigorous analysis was achieved centrism (i.e., the focus was on the physical functioning of
(Braun & Clarke, 2013), a subset of transcripts (10 in the penis). A “functioning penis” was defined as one that
total) was reviewed and analyzed using the same could get erect, stay erect, and ejaculate (neither prema-
procedure by the last author (TG). Resultant codes and turely nor “too late”). These three difficulties were further
themes were compared. Minor discrepancies were examined in relation to: (1) medicalization; (2) the role of
discussed and jointly altered. The wider team of coauthors masculine standards; (3) psychological consequences (i.e.,
was then consulted to ensure the data were represented and damage to confidence); and (4) coping mechanisms (i.e.,
displayed in a meaningful and useful manner. overcompensation).
7
Table 3. Penis Function Themes and Respective Illustrative Quotations
Theme Illustrative Quotation
Medicalization “If you can’t get an erection surely a doctor can sort that.” (James, 22 years, heterosexual, interviewee)
Masculine identity “I think erectile dysfunction would be even linked to their sense of self and their sense of masculinity.” (Aaron, 25 years,
bisexual, interviewee)
Penis size concerns “Whether it’s big, small, long, ya know, thick or thin … I just think it is an issue for people always.” (Larry, 34 years, gay,
interviewee)
Competition “If they see another guy with a bigger cock they feel a little inadequate.” (Ben, 35 years, gay, focus group 5)
Pornography “I’d say it’s probably porn’s fault actually [laughs] because everyone, like all men in porn, have like massive penises, and most
guys kind of compare themselves to them.” (Peter, 28 years, gay, interviewee)
Psychosocial impact “For some people it can be a horrible hit to self-confidence.” (Fergal, 23 years, gay, interviewee)
Physical impact “They’re more worried about what the other person thinks of them … and therefore they can no longer enjoy it [sex], and then
they end up with a dysfunction of no orgasms.” (Aaron, 25 years, bisexual, interviewee)
Restrictive emotionality “Men are very backwards in coming forward.” (Keith, 33 years, heterosexual, interviewee)
Alternative masculinity “Well, I suppose somebody that might recognize this [erectile disorder] as a biological issue and isn’t an indication of their
virility or their manhood.” (Pat, 34 years, gay, interviewee)
Psychosocial consequences “Not being able to get an erection would be hugely damaging on self-confidence, I think that’s the main thing.” (Ted, 32 years,
bisexual, interviewee)
Coping mechanisms “Try and counteract it possibly, by acting more masculine, trying to hide it that way.” (James, 22 years, heterosexual, interviewee)
Medicalization. For all subgroups of men (heterosexual, taking the medication, afraid that it might not be effective.
gay, and bisexual) sexual difficulties were conceptualized in a While acknowledging that his erectile difficulties may be
very mechanistic way. For example, the phrases “get it fixed” attributable to a deeper underlying psychological condition,
and “get it sorted” were mentioned frequently. Pharmaceutical he hoped the cause was a physical one. He explained that
interventions such as erectile disorder (ED) drugs were the “within an hour and a half, there it [his erection] was
primary means of resolving physical sexual difficulties. The looking at me, so I was more than delighted! Relief!” In
belief that physical sexual difficulties, erectile difficulties in this interaction, Ian (60 years, bisexual, focus group 7)
particular, are “easy to address” (Alexander, 35 years, agreed with Martin, saying, “Yeah, it is definitely a relief
heterosexual, interviewee) and “rectifiable” (Eddie, 27 years, to have that monster in your hand … seeing an erection is
heterosexual, focus group 1) surfaced. part of being a guy.”
Men who had taken ED drugs for erectile disorder However, not all participants had positive views of ED
expressed a sense of relief after taking them. Martin drugs. Although it was commonly conceived as an “easy
(52 years, bisexual, focus group 7) felt anxious before solution” to sexual difficulties, some men expressed
Table 4. Pain Themes and Respective Illustrative Quotations
Theme Illustrative Quotation
Penile pain “Well, one that I had myself two years ago was that my foreskin was very tight and I had to go and get an operation.” (Robert,
27 years, heterosexual, interviewee)
Physical impact “He couldn’t have anal sex or say couldn’t really do … couldn’t even really masturbate because it was too painful.” (Jason, 24 years,
gay, interviewee)
Psychological impact “I think frustration would be a major thing.” (Albert, 23 years, gay, interviewee)
Pain during anal sex “Well, pain during sex, so for a gay man it could be if you’re receiving anal sex, the pain of penetration.” (Trevor, 23 years,
gay, interviewee)
Acceptance “It [pain] probably comes with the territory. Yeah … if there is anal sex going to go on, there probably is going to be pain, one
comes with the other.” (Ted, 32 years, bisexual, interviewee)
Physical determinants Physique: “I suppose it depends on the size of the penis as well, like if it’s very large it’s gonna hurt more.” (Trevor, 23 years,
gay, interviewee)
Preparation: “People assume the type of thing you see in porn movies where they just kind of open the door and fling each other
against the wall and start fucking. I don’t think in reality it really works like that. There has to be some sort of preparation time.”
(Ben, 35 years, gay, focus group 5)
Medical conditions: “If there is a lot of anal pain, then that could be medical problem, like colon cancer or something like that,
which is something else you need to look at.” (Ian, 60 years, bisexual, focus group 7)
Psychological determinants Sexual partner: “Usually you can work around it. People are normally quite considerate of it. I think people are a lot more
willing, if it is going to cause extreme pain, to say no.” (Aaron, 25 years, bisexual, interviewee)
Fear: “They might be feeling a tiny bit of pain, but they imagine it as a load ’cos they are freaking out.” (Scott, 18 years, gay,
focus group 6)
Sexual guilt: “If people are brought up to believe that it’s wrong for two men to have sex and they’re constantly struggling with
that, and a lot of men are, that the pain might be reinforced that they’re not supposed to be doing it.” (Henry, 33 years, gay,
focus group 4)
Coping mechanisms “If it hurts, it hurts … I say find ways to get around it.” (Albert, 23 years, gay, interviewee)
8
concerns over having to rely on medication for sexual men, pornographic films), in addition to the psychological
activity. To illustrate, Colm (53 years, heterosexual, focus and physical impact of being concerned about one’s penis
group 2) and Kevin (44 years, heterosexual, focus group 2) size, were discussed.
discussed their concerns regarding medication reliance and
stated: “I think it would have a serious effect on my con-
fidence anyway, serious … I don’t want to need any feckin’ Competition and gay men. The main difficulty
Viagra.” expressed by gay and bisexual participants in relation to
penis size concerns occurred due to physical comparisons
Masculine Identity. All heterosexual, bisexual, and with their sexual partners. As same-sex partners have the
some gay participants made connections between same anatomy, in contrast to other-sex partners, there is an
masculinity and a functioning penis. Penis functioning was obvious “direct comparison” (Aaron, 25 years, bisexual,
viewed as an integral part of one’s identity, and thus any interviewee). Aaron, who had dated both men and women,
impairment was seen as a loss of one’s identity as a man. To felt less self-conscious about his penis size when he was
illustrate, Keith (33 years, heterosexual, interviewee) with women compared to when he was with men. In his
explained, “Your sexual side is part of your identity … it’s experience with men, “everything’s a competition,” includ-
the most integral thing in one way; I mean, in one way, it is ing physique, kissing, sexual performance, and penis size,
the most integral thing about yourself.” Harry (55 years, which can cause anxiety for some gay men. Evidently,
heterosexual, focus group 3), who had experienced erectile physical comparisons men make to their partners in same-
difficulties due to low levels of testosterone, revealed the sex relationships have the potential to make them feel infer-
impacts this had on his identity. He stated, “I was no Romeo ior and inadequate.
or Don Juan, but I’d still have a drive, and I feel that drive
now has diminished, and that bothers me because I want to
feel like a full man.” He disclosed feeling as though he was Pornography. When articulating possible reasons why
bordering on depression because this very important part of men have concerns about penis size, several participants
himself was beginning to wane. For him, evidently, erectile held the pornography industry responsible. Similar to com-
difficulties led to a loss of his sense of self and masculine parisons between same-sex partners discussed previously,
identity. many participants spoke about comparisons between their
In focus group five, Cormac (30 years, gay) and Ben penis and those depicted in pornography. For example, Peter
(35 years, gay) discussed masculinity and a crystallized gay (28 years, gay, interviewee) stated, “I’d say it’s probably
identity. Some gay men defined themselves by the sexual porn’s fault, actually, because all men in porn have like
roles and positions (i.e., top, bottom, versatile) they pre- massive penises, and most guys kind of compare themselves
ferred; “top” refers to those who engage in the penetrative/ to them.” Furthermore, Tim (26 years, heterosexual, inter-
insertive role during sexual activity; “bottom” refers to those viewee) referred to large penises shown in pornography and
who engage in the receptive role; and “versatile” refers to described the actors as resembling a “tripod.” The findings
those who engage in both roles (Underwood, 2003). If, as a suggest that expectations to perform according to porno-
result of impaired sexual functioning, a gay man cannot graphic ideals (i.e., physique, performance) and trying to
assume the role he identifies with, according to Cormac, meet these standards could greatly affect sexual perfor-
he will not only experience a loss of identity as a man but mance and detract from sexual satisfaction.
also “a loss of identity because, like, they can’t regard
themselves as an active gay man.” Ben agreed but went
on to say, “There are a lot of other things that make up who Psychological impact of concern over penis size.
you are … I think society would probably make them feel Feelings associated with these concerns were inadequacy, anxi-
like, you know, men are supposed to be kind of virile and ety, and embarrassment. The perception that a large penis is
shagging everything that moves and … if you’re not doing needed to sexually satisfy a partner was evident throughout the
that and can’t do it … I can kind of understand why some- discussions, particularly among heterosexual participants. Men
body would feel less of a man.” spoke about feeling inadequate if their penis was not deemed
large enough to be able to please their partner: “Is it an adequate
Penis size concerns. Concerns over penis size size for a woman, or what will she think when he takes his shirt
emerged as an influence on men’s sexual functioning; off and his pants off? Will she laugh?” (Andrew, 29 years,
these concerns were salient across heterosexual, gay, and heterosexual, interviewee). Peter (28 years, gay, interviewee)
bisexual, participants. The desire for a bigger penis was discussed how anxiety and embarrassment associated with penis
believed to be a natural and common concern. For example, size could prevent a man from seeking out a sexual partner: “It
Peter (28 years, gay, interviewee) commented, “I think most stops them trying to sleep with people or having a relationship or
guys probably aren’t confident about the size of their penis, anything, because they don’t think that any girl or man would
even like guys who are average. I just think like most want to be with someone that has a small penis.” In contrast to
people would like a bigger penis.” The sources of these the belief that a large penis was needed to satisfy a partner, some
concerns (e.g., competition with sexual partners for gay gay men preferred their sexual partner to have a smaller penis
9
than their own. Various reasons were posited for this. Peter Whenever you go to the GP [general practitioner], it’s
(28 years, gay, interviewee) made it clear that a large penis is because you’re bleeding or near dead, you know, it’s not
not always desirable: “I would much rather sleep with a guy if about going to talk about your problems usually … You’re
he had like six, seven inches, to someone who had ten or eleven, a man and you should be out all day cutting trees and, you
know, going and talking about your feelings just doesn’t fit in.
because it would just be painful and not pleasant.” Members of a
focus group also spoke about the desire to have a sexual partner
with a small penis. Their reasoning for this desire was to boost Members of a focus group also reflected on this issue.
one’s own confidence: “It just kind of makes them more secure For example, Ian (60 years, bisexual, focus group 7)
about themselves” (Jimmy, 31 years, gay, focus group 4). commented:
Interestingly, although some men believed a large penis was
I don’t think people would be running to their doctor with
needed to sexually satisfy their partner, they themselves did not
this [sexual difficulty]. It’s a male thing. You don’t go to the
need their partner to have a large penis for their own personal
doctor with something like that; you go if you’ve got a stake
satisfaction. in your chest and it needs pulling out.
Extreme discourse was used to communicate the severity of

Physical influence on sexual functioning. Concerns masculine norms vis-à-vis sexual difficulties. The desire to
over penis size were deemed to have a major influence be self-reliant reflects another societal masculine standard
over one’s physical sexual functioning and were conceived and reinforces the norm that men should be too embarrassed
to be a causal factor in a variety of sexual difficulties. For to admit to others that their penis is not “fully” functioning.
example, Aaron (25 years, bisexual, interviewee) commen-
ted, “If someone is concerned about the size of his penis, he Alternative masculinity. In contrast to the views dis-
is less likely to enjoy sex and, therefore, may not be able to cussed, some men spoke about how the functioning of the
reach orgasm.” Fergal (23 years, gay, interviewee) noted, penis is not (and should not be) a representation of one’s
“People could feel they’re inadequately endowed and have a manhood. Interestingly, all participants who explicitly
lot of hang-ups from that, and that would feed back into expressed this viewpoint were gay men. For example, Pat
sexual dysfunction.” (34 years, gay, interviewee) commented, “It doesn’t reduce
them as a man if they’re having trouble maintaining an
To complete the theme of “masculine identity,” the next erection.” Frank (56 years, gay, interviewee) spoke in detail
two subthemes speak to men’s ways of dealing with the about his own personal experience with erectile difficulties.
sexual difficulties outlined thus far. Due to medical complications at a young age, Frank has
always experienced some difficulty maintaining his erec-
Restrictive emotionality. Another significant subtheme tion. When relaying his experience, he stated, “I guess it’s
of masculine identity was the difficulty expressing one’s affected me but not terribly, no … I think that it’s very
feelings (i.e., restrictive emotionality), which was reported interesting in terms of the fact that certainly, if I’d been a
in a similar way by heterosexual, gay, and bisexual partici- straight man, this would have been something of a disaster.”
pants. When discussing how men could cope with sexual This mirrors research which has found penetrative inter-
difficulties, most participants believed that men would “suf- course to be rather infrequent in same-sex sexual encoun-
fer in silence” (Andrew, 29 years, heterosexual, intervie- ters, in contrast to heterosexual sexual encounters where it is
wee). The common perception was that men would not be considered to be the central focus (e.g., Grulich et al., 2014).
willing to discuss sexual difficulties with their partners, There is a lot more flexibility in gay relationships, particu-
friends, or doctors. larly in terms of individuals’ sexual preferences. For exam-
These beliefs conform to the masculine social norm that men ple, Frank stated, “There are other ways to have a sexual
should not talk about their emotions or problems (e.g., experience than somebody’s got to have a stiff penis.”
Courtenay, 2000). For example, Austin (25 years, heterosexual, Evidently, for some participants, penis functioning was not
interviewee) remarked, “Men are pretty emotionless creatures, an essential part of their masculine identity.
and they don’t express themselves very much, so they just get
on with it.” The rationale for restrictive emotionality was, again, Psychosocial Consequences. The main psychological
linked to the perceived masculine ideal of having a functioning consequence of experiencing difficulties related to penis
penis. Participants revealed men would be too embarrassed to function reported by participants from all subgroups was
deviate from this “ideal.” Participants recognized that men damage to one’s confidence, which was represented by
should seek help from a doctor if they experienced a physical distress, embarrassment, and depression. The impact on
sexual difficulty; however, many participants admitted that men confidence was not solely due to a loss of sexual abilities, but
are generally unwilling to do so. Again, this reflected the idea also due to a loss of masculinity, as discussed. When describing
that it is not “manly” to seek help from a doctor for sexual how distressing it would be to experience sexual difficulties,
issues. Andy (26 years, gay, focus group 4) painted an illustra- Jamie (66 years, gay, interviewee) drew an analogy: “I think
tive picture when he stated: that’d be pretty desperate. It’d be like having eyes and not being
10
able to see or something.” Andrew (29 years, heterosexual, becoming successful in activities that are perceived as
interviewee) explained that if a man could not perform highly masculine (e.g., playing sports, abusing steroids,
sexually it would be “like a serious kick to them, kinda like consuming excessive amounts of alcohol), a man offers
the carpet being pulled underneath their feet, so they’re kind of “proof” to others—and, critically, to himself—that he is
soul destroyed if they can’t.” still a “man” (James, 22 years, heterosexual, interviewee).
Embarrassment could be felt for various reasons. First, a The latter two penis functioning themes explored (i.e.,
man could be embarrassed because he could feel that he had psychological consequences and coping mechanisms) had
failed himself as a man. When relaying his own experience implications on both an individual (i.e., psychological) and
with erectile difficulties, James (22 years, heterosexual, collective (i.e., sociocultural) level. The other broad cate-
interviewee) revealed, “It’s quite shameful, or humiliating, gory, pain, details another sexual difficulty that emerged
embarrassing.” Second, some men thought it would be over the course of analysis. It should be noted that all sexual
embarrassing for their sexual partner to know of their per- difficulties are biopsychosocial phenomena, in other words,
ceived failings as a man. For example, Fred (24 years, gay, they involve an interaction between biological, psychologi-
interviewee) stated, “If there was a case that happened to a cal, and social factors, although the extent to which their
partner of mine, then I’m sure it was very embarrassing [for] cause is determined by these factors varies.
them if they were in the company of another person.” Third,
many men spoke of the embarrassment of having to explain
Pain
a sexual difficulty to a doctor: “You have the embarrassment
of having to go to your doctor and saying, basically admit- Two difficulties related to pain during sexual activity
ting, to—most likely—another man that you can’t perform emerged throughout: (1) penile pain and (2) experiences of
sexually, which would cause a lot of anxiety in life” (Aaron, pain during receptive anal sex.
25 years, bisexual, interviewee). Undoubtedly, the experi-
ence of sexual difficulties relating to penis function could Penile Pain. Penile pain was described by participants
have a profound impact on men’s social and psychological as pain of the penis caused by a tight foreskin (also known
well-being (e.g., Althof, 2002; Laumann et al., 1999). as phimosis). Five participants (three gay men, one
heterosexual man, and one bisexual man) disclosed
Coping Mechanisms. Regarding the consequences of a personal experiences with phimosis and had a
physical sexual difficulty, many heterosexual and bisexual circumcision as a result. In all cases, this difficulty was
participants suggested that men would likely overcompensate viewed as a medical condition which could be “surgically
for the perceived loss of “manliness.” As a result of feeling less sorted out” (Gregor, 46 years, gay, focus group 6).
masculine, some suggested that emotions, such as anger and Compared to other physical sexual difficulties, penile pain
rage, would increase and would manifest physically: was deemed “an easy enough one to sort out” because there
is a surgical solution (Ted, 32 years, gay, interviewee).
Well, if I can’t maintain an erection, then I’m obviously not
a man and I can’t do other manly things like lifting boxes, I Physical impact. Despite having a surgical solution,
dunno, so it’s probably gonna go the other way, and they are phimosis was considered to have a major impact on one’s
gonna start overcompensating in the rest of life and coming sexual functioning, mainly because sexual activity, includ-
across as being possibly over[ly] aggressive to show that ing masturbation, would be extremely painful. According to
they are a man. (Aaron, 25 years, bisexual, interviewee)
Albert (23 years, gay, interviewee), assuming the insertive
role in anal sex would be incredibly difficult “because
Keith (33 years, heterosexual, interviewee) also spoke of
there’s a lot of pressure being put on that particular part of
increased hostility and violence having a negative impact on the body.” In addition, Peter (28 years, gay, interviewee),
one’s relationships when he stated, “Find another way to
who was circumcised because of phimosis, found anal sex
prove your manliness; go and beat the head off somebody,
“nearly impossible” and consequently avoided that sexual
or beat your wife.”
behavior: “Even now [after circumcision] I don’t particu-
None of the participants reported engaging in these com-
larly like it, maybe because I just wasn’t used to it when I
pensatory mechanisms, but they contemplated why they
was younger.” Phimosis also was associated with difficulties
theorized that other men would react this way. The rationale
in reaching orgasm and maintaining an erection. For exam-
provided was that a man would want to conceal his per-
ple, Robert (27 years, heterosexual, interviewee) expressed
ceived “failings” as a man. Some spoke of one’s sexual having difficulty reaching orgasm, which he attributed to
abilities as being invisible to others (except a sexual partner)
experiencing penile pain over a long period. Even after
and, therefore, deficiencies can be hidden through appearing
having a circumcision, he believed he was still psychologi-
“manly” in other areas of life, which is often referred to as
cally scarred from his experience.
“masculine capital” in the literature (Anderson, 2002; de
Visser & McDonnell, 2013; de Visser, Smith, & Psychological impact. The psychological impacts of
McDonnell, 2009). Participants appeared to believe that by phimosis included frustration and embarrassment. Jason
11
(24 years, gay, interviewee) commented that it would be It must be noted that experiencing pain during receptive
“very frustrating because obviously you can get aroused and anal sex was not considered an issue for all gay and bisexual
get an erection but then like, obviously, you can’t like really participants, and many spoke about flexibility in their sexual
ejaculate.” Jason went on to discuss his relationship with a behavior. For instance, Jason (24 years, gay, interviewee)
man who had a “nonretractable foreskin.” This was a source explained if anal sex “isn’t working, you can just do other
of great frustration due to lack of sexual intimacy. Trevor things and it’s probably not a big deal.” Larry (34 years, gay,
(23 years, gay, interviewee) also spoke of his relationship interviewee) believed that anal sex is not part of every gay
with a previous partner who had phimosis. He felt he and man’s sex life. This echoes earlier discussions regarding penis
his partner’s sexual needs were not being met: “They’re not function and the infrequency of penetrative intercourse in
enjoying it, so then I’m not really enjoying it.” However, same-sex sexual encounters (e.g., Grulich et al., 2014).
due to embarrassment, he did not discuss the matter with his Conceptualizations of anal pain (i.e., acceptance), the physical
partner. He found this very “puzzling” because without and psychological determinants of pain, and the most common
discussing the topic, the situation could not be resolved. coping strategy (i.e., avoidance) were identified as subthemes.
Peter (28 years, gay, interviewee), who had this condition,
conveyed his embarrassment: “That’s why I didn’t get cir- Acceptance. Several participants conceptualized pain
cumcised earlier; I was too embarrassed to go to the doctor during receptive anal sex as “normal,” as something to be
basically.” Before he started having sex with men, he didn’t expected. To illustrate, Gary (20 years, gay, interviewee)
realize he had a problem. It was not until he was with commented, “It’s nothing that is to be embarrassed by, ya
someone who looked at his penis with “disgust” that he know, some people can and some people can’t.” According
realized there was a problem. The emotional hurt he felt as a to Fergal (23 years, gay, interviewee), “With the best will in
result motivated him to seek help. He spoke of the first time the world, and doing everything properly, and using appro-
he ejaculated after the surgery, which caused the stitches in priate lubrication and so on, you’re still going to have some
his penis to burst. He was too embarrassed to go back to the degree of pain during penetrative sex.” The explanation for
hospital to seek help. Johnny’s (50 years, bisexual, focus this line of thinking was that the anus is not perceived as an
group 7) narration of medical intervention for penile pain appropriate sex organ or “it is not made for sex” (Aaron,
starkly contrasts Peter’s: 25 years, bisexual, interviewee). For example, Jamie
(66 years, gay, interviewee) spoke of how someone experi-
Once I was circumcised it felt like I was grown up, I was encing pain during receptive anal sex would be unwilling to
dealing with the full deck! [Laughs] I was slightly embar- seek help from a doctor because the anus “isn’t [seen as] a
rassed by the penis that I had. I felt it wasn’t the way that it proper sex organ.” He contrasted this experience to a
should be … Because I wasn’t having anal sex, or penetra- woman suffering from vaginal pain during sex. He believed
tive sex, there wasn’t an occasion where it would have pain during vaginal sex was a typical occurrence and “not
caused a problem. When I started having experiences with
completely off the planet.” Others mirrored this opinion
men, that’s when I realized something was wrong … I’m
absolutely thrilled I had it done. It’s fantastic.
with comments such as “the ass isn’t exactly built for stuff
going up it” (Peter, 28 years, gay, interviewee) and “it’s a
The extracts provided to illustrate penile pain harken back to muscle that shouldn’t be doing that” (Albert, 23 years, gay,
the penis functioning themes of “medicalization” (e.g., the interviewee). For many, pain during anal sex was simply
“get it fixed” mentality) and “masculine identity” (i.e., accepted as something to be expected.
restrictive emotionality) and thus display the intercorrelated
nature of the findings. The final theme concerns pain of a Physical determinants of pain. Physical factors that
different erogenous zone. could influence the experience of pain included one’s phy-
sique, sexual preparation, and medical conditions.
Pain During Receptive Anal Sex. Many of the gay
and bisexual participants introduced the topic of pain during Physique. The experience of pain during anal sex was
receptive anal sex as a sexual difficulty; unsurprisingly, it attributed to physical characteristics of the receptive partner
was not raised by heterosexual participants. Participants (i.e., having a tight anus) or of the insertive partner (i.e.,
expressed different views on how pain during receptive having a large penis). For example, Fred (24 years, gay,
anal sex should be classified (i.e., as a sexual difficulty, an interviewee) disclosed his inability to have anal sex with his
interpersonal difficulty, or undecided). This finding reflects ex-partner because “his arse wasn’t big enough, basically, to
disagreement over its classification found in the literature take it.” He voiced his dissatisfaction with their sexual
(e.g., Hollows, 2007). One participant, for example, encounters when he said they were “as boring as watching
contrasted it to erectile disorder. He observed that erectile paint dry.”
disorder is “seen as there is something wrong with me”;
however, experiencing pain during receptive anal sex “isn’t
your fault … these things just happen” (Aaron, 25 years, Preparation. Practical preparation techniques for anal
bisexual, interviewee). sex were discussed by the majority of participants as being
essential for pain-free anal intercourse, such as the need to
12
use “plenty of lubrication” (Peter, 28 years, gay, intervie- Fear of pain. For some men, the issue raised was the
wee) and loosening the anus using toys or digital stimula- fear of pain as opposed to actually experiencing pain. For
tion (i.e., “get fingered beforehand to loosen you up” example, Sean (25 years, gay, interviewee) remarked, “I
[Cormac, 30 years, gay, focus group 5]). Poppers (i.e., know people who haven’t experienced that at all and who
alkyl nitrites) also were suggested to help relax anal mus- would shy away from it [anal sex] because they think it is
cles, but some men expressed concern over their use. For going to be painful.” Thus, without ever having engaged in
example, two men (Fred, 24 years, gay, interviewee; Andy, anal intercourse, some men may avoid that activity solely
26 years, gay, focus group 4) spoke of men being overly due to the fear of being hurt physically. Some participants
reliant on poppers. In addition, Albert (23 years, gay, inter- suggested that this is more common in younger men who
viewee) expressed concern over the lack of information on have less experience and less knowledge of participating in
the long-term effects of using poppers and revealed that his anal sex. Others suggested that the expectation of pain will
own use of them resulted in a skin rash. result in pain: “They are going to be gripping the table, like
having a tooth pulled” (Gregor, 46 years, gay, focus group
6).
Medical conditions. Other participants mentioned that
pain could be caused by medical issues such as colon
cancer, haemorrhoids, or anal warts. Fergal (23 years, gay, Sexual guilt. One participant discussed the possibility
interviewee) conversed about his partner who had hemor- that if individuals are brought up to believe that it is “wrong
rhoids, which caused “horribly excessive pain” during sex- for two men to have sex” (Henry, 33 years, gay, focus group
ual intercourse. Participants highlighted such cases should 4), the experience of pain during anal sex may reinforce that
be assessed by a doctor but, again, the reluctance to discuss view. This, in turn, could lead to feelings of guilt about their
this issue with a medical professional was apparent. sexual behavior and their sexuality: “They’re not supposed
to be doing it [anal sex].” Ultimately, he concluded it can
cause a constant internal struggle and a real “psychological
Psychological and interpersonal determinants of battle” for individuals. It is possible this concern stems from
pain. Several psychological and interpersonal factors the influence of the Catholic Church in Ireland; this will be
which could influence the experience of pain were explored further in the Discussion section.
described, including one’s sexual partner, fear of pain, and
sexual guilt.
Coping mechanisms. For a substantial number of par-
ticipants, the most commonly suggested method for coping
Sexual partner. The presence of a considerate and with pain during receptive anal sex was to avoid it. Some
trustworthy sexual partner was considered to be of utmost men mentioned that avoidance would be a very common
importance when faced with pain during anal sex. response for someone who had a painful experience during
According to the participants, having a partner who under- their first time, which as a result would “put them off”
stands the possible issues associated with anal sex allows receptive anal sex in the future. Cormac (30 years, gay,
men to actively and effectively deal with the situation. focus group 5) summarized this view succinctly: “If you
Through sexual flexibility (e.g., engaging in a variety of stick your hand into the fire and feel pain, you are hardly
sexual practices together) and mutual trust, a natural state of gonna go back and do it again.”
relaxation could be achieved which would aid in minimiz-
ing anal pain. Other participants reinforced the idea that
when a man experiences difficulties with anal pain, his Discussion
partner plays a vital role: “You need to be completely
relaxed and complexly trust the person you’re with” (Ian, The current study qualitatively explored conceptualizations
60 years, bisexual, focus group 7). “If someone is rough and of sexual difficulties among heterosexual, gay, and bisexual
they just kinda shove it up there, then your muscles don’t men. Two intercorrelated strands of conceptualizations were
have time to relax” (Peter, 28 years, gay, interviewee). The identified: (1) penis function, with nested themes of medicali-
general consensus was that pain is part of anal sex (although zation, masculine identity, psychological consequences, and
not always) and the couple can usually work together to coping mechanisms; and (2) pain, with nested themes of penile
resolve the issue. Participants in this study stated that they pain and pain during receptive anal sex. Several difficulties
would be understanding should this situation occur. were identified that are currently not recognized as sexual
Participants who relayed their own experience with pain difficulties, that is, difficulties relating to penile pain (relevant
during anal sex made statements such as “it’s not your across all sexual orientations) and pain during receptive anal
fault” and “these things happen.” sex (gay and bisexual men). Overall, the results demonstrate
13
that men’s sexual difficulties are complex phenomena with an during anal sex were more commonly raised by younger
interplay of biological, social, and psychological factors. participants, similar to findings by Hirshfield et al. (2010).
In contrast, erectile difficulties discussed via the medicaliza-
tion of sexual function were more commonly discussed
Pain
among older participants, congruent with previous research
The findings suggest that the current understanding of in this field (e.g., Bancroft et al., 2005). This finding is in
sexual difficulties does not provide a complete picture when line with previous research on age and sexual function and
it comes to the experiences of gay and bisexual men (such as can be explained by the natural processes associated with
pain during anal intercourse) and, indeed, of heterosexual aging (e.g., Laumann et al., 1999).
men also (penile pain). This supports previous quantitative
research in the area (Cove & Boyle, 2002; Sandfort & De
Penis Function and Masculinity
Keizer, 2001). Similarly to Hollows’s (2007) argument, it is
unclear whether pain during anal sex should be considered a The pivotal role of societal and cultural standards of mascu-
sexual dysfunction per se, but it is clearly a sexual difficulty linity was evident in the interviews and focus groups. This result
facing some gay men. On the whole, pain during sex experi- supports previous research linking penis functioning and mas-
enced by men has been neglected in the literature (Davis, culinity (Brubaker & Johnson, 2008; Potts, 2004; Rubin, 2004;
Binik, & Carrier, 2009). Perhaps trying to define pain during Zilbergeld, 1992). An “ill-performing” penis is seen as a failure
receptive anal sex in terms of “dysfunction” or “nondysfunc- of masculinity because men feel they are not living up to cultural
tion” may not be as important as understanding the impact expectations of “being a man” (Tiefer, 1986; Zilbergeld, 1978,
this pain has on individuals, the distress associated with it, 1992). Abiding by the standards of hegemonic masculinity can
and how it relates to general health and well-being. For have dangerous consequences for men’s psychological and
example, how does sexual function impact distress and gen- physical health (de Visser & McDonnell, 2013; Goldberg,
eral well-being? Further work is required regarding men’s 1976; Harrison, Chin, & Ficarrotto, 1992; Pollack, 1998).
subjective experience of pain and associated subjective feel- Early in life, boys are taught that “their manhood is tied to
ings of distress to greater understand why impaired sexual their penis, and having and using erections has something to
function causes distress for some and not for others. do with masculinity” (Zilbergeld, 1992, p. 32). Normative mas-
culine sexuality and sexual identity are defined so specifically
that the action (attainment, sustainment, and penetration) of an
Demographic Comparisons
erect penis is essential (e.g., Brubaker & Johnson, 2008; Potts,
On the whole, gay, bisexual, and heterosexual men 2004; Rubin, 2004). Sexual difficulties which result from feel-
reported similar sexual difficulties. For example, physical ings of incompatibility with a partner can present a challenge to
sexual difficulties were viewed in a mechanistic manner one’s masculinity and result in lower levels of sexual satisfac-
across the subgroups of men; penis size concerns were tion. Participants in this study viewed penis function as integral
common, and experiences of penile pain were similarly to one’s identity as a man, and impairment to sexual function
described. Differences were noted between gay, bisexual, was seen as a loss of one’s masculine identity. The current
and heterosexual participants regarding three aspects of findings also echo previous work on “masculine capital,”
sexual function: (1) Gay and bisexual men reported experi- whereby men report striving for success in (or engagement
ences of pain during receptive anal sex; unsurprisingly, this with) one masculine domain to use as “credit” to counteract a
problem was not raised by heterosexual men. (2) Regarding lack of competence in (or refusal to engage with) other mascu-
masculinity, in contrast to heterosexual men, gay and bisex- line domains (Anderson, 2002; de Visser & McDonnell, 2013;
ual made a distinction between manhood and penis function. de Visser & Smith, 2006; de Visser et al., 2009). For example,
(3) Gay and bisexual men reported experiencing concerns participants in the present study reported that men would possi-
over penis size due to physical comparisons with sexual bly attempt to accrue masculine capital by engaging in violence
partners. One cannot conclude that gay and bisexual men (e.g., physical abuse) and self-destructive behaviors (e.g., alco-
have poorer sexual function than heterosexual men (or vice hol and drug abuse) as coping strategies when faced with penile
versa), which one could infer from comparing prevalence difficulties (nonmasculinity). Thus far, available research has
rates of sexual difficulties (e.g., 31% in heterosexual men not examined endorsement of masculine standards in relation to
reported by Hirshfield et al., 2010, versus 79% in men who sexual difficulties in men, except in those who do not have a
have sex with men reported by Laumann et al., 1999). life-threatening illness (Gray, Fitch, Fergus, Mykhalovskiy, &
Instead, our findings illustrate that they may be affected by Church, 2002; Oliffe, 2005; Ussher, Rose, et al., 2016).
different issues, consistent with other research in the field
(e.g., Damon & Rosser, 2005; Hollows, 2007; Rosser et al.,
Complex Contradictions
1997; Rosser et al., 1998), and assert that we should not
view gay and bisexual men’s function from a heteronorma- Several findings (e.g., penis size concerns, alternative
tive viewpoint. masculinity, acceptance of pain during receptive anal sex)
It is interesting to note that some generational differences from this study reveal the complexity and, at times, the
were found among participants. Difficulties relating to pain contradictory nature of sexual difficulties among men.
14
These surprising results warrant further attention as they heterosexist society. Traces of internalized homonegativity
appear to trouble lay understandings, gender and sexual (Mayfield, 2001) are arguably perceptible when they vet
scripts, and existing psychiatric taxonomies (e.g., the anal intercourse as somehow inappropriate, improper, or
DSM). Participants did converse about penis size in cultu- unnatural. Hence, we maintain that the complexities con-
rally predictable ways, such as calling upon the ingrained tained within the current findings have crucial implications
notion that “bigger is better” (Drummond & Filiault, 2007; for better understanding and treatment of men’s sexual
Grov, Parsons, & Bimbi, 2010). Moreover, the current study difficulties and sexual dysfunctions.
supports other research that showed self-reported small
penis size can negatively affect gay men’s psychosocial
Limitations
adjustment (e.g., Grov et al., 2010). Although the subtheme
of “competition among gay men” emerged, discussants also Several limitations warrant discussion. First, participants
provided various reasons for why they might actually prefer who are interviewed in person may underreport true experi-
a sexual partner with a smaller penis. This incongruity in ences of sexual difficulties due to concerns about social
terms of size (i.e., men want bigger penises for themselves stigmatizsation and lack of privacy (Lau et al., 2008;
but not for their partners) has important implications con- Laumann et al., 1999). However, participants in this study
sidering increases in penile augmentation procedures were willing to detail and report both abstract and personal
(Ghanem, Glina, Assalian, & Buvat, 2013). For example, sexual difficulties and sexual dysfunctions. Similarly,
future researchers might endeavor to ask men: Who exactly Hirshfield et al. (2010) found men who have sex with men
is this surgery for? were willing to report and describe their personal sexual
Alternative masculinity was another novel finding; again, functioning.
participants who explicitly expressed alternative viewpoints Second, some may consider the use of phone interviews
on masculinity with respect to penis functioning were gay and focus groups to be a limitation due the absence of visual
men. These men (whose ages ranged greatly) did not neces- and nonverbal cues. However, we felt the advantages of
sarily equate erections with manhood nor deem erectile using these methods (wider geographic coverage and
difficulties as catastrophic—“something of a disaster”— increased sense of anonymity and comfort for participants
within the context of sexual encounters. Rather, discussions disclosing on a sensitive topic) outweighed the disadvan-
focused on the flexibility in gay relationships, which tages, which warranted their use in the current study. It is
appears to buffer against the culturally imagined penetrative worth noting that in this study face-to-face and phone dis-
imperative. Indeed, not all gay and bisexual men participate cussions produced similar data (although conducting a com-
in anal sex (Hollows, 2007). Given that masculinity is a parative methodological analysis is beyond the scope of this
multidimensional construct (e.g., Connell, 1992; de Visser article). Providing participants with options as to how they
& McDonnell, 2013; Halkitis, 2001; Levant, 1996; Levant could take part in the research of such a sensitive topic
et al., 2007), it is possible that sexual difficulties may be meant that many men were reached who would have other-
more strongly associated with other expressions of mascu- wise been reluctant to share their thoughts and experiences.
linity, such as restricted emotionality, sexual prowess, anti- Third, the cultural context of the current study must be
femininity, and internalized homophobia (Levant et al., noted. Specifically, all participants were Irish citizens, resid-
2007). While a select few recent media depictions have ing in Ireland. Since 1993, when homosexuality was decri-
presented gay male sex as nuanced and full of foibles (see minalized in the Republic of Ireland, the country has slowly
Nielsen, 2015), this finding requires further empirical atten- made advances in achieving equality for sexual minorities
tion on an experiential level. (Mac Gréil, 2011). However, there is still strong evidence of
Lastly, the subtheme of “acceptance” of pain during discrimination and stigma toward sexual minorities
receptive anal intercourse problematizes commonplace (Connolly & Lynch, 2016; Gibbons, Manandhar, Gleeson,
understandings of pain as uniformly negative (i.e., that it & Mullan, 2007; Higgins et al., 2016). These attitudes have
is problematic and should be minimized/eliminated). In dis- been influenced by numerous factors, the most significant of
cussing pain during receptive anal sex, Hollows (2007) which is the Catholic Church, which ruled social and cultural
noted that distress may essentially be the consequence of thinking in Ireland for the greater part of the 20th century.
unmet needs or expectations rather than pain itself. Indeed, Furthermore, given this context, it is plausible—indeed,
the current finding that the fear of pain may be more likely—that some issues that are relevant in other cultural
disconcerting than pain itself speaks to the important dis- settings may not have emerged, as they may not be as relevant
tinction Hollows (2007) made. By listening to the accounts in an Irish context. For example, although the use of alkyl
of gay men who engage in receptive anal intercourse, the nitrites (i.e., poppers) was discussed by some participants, the
results of this study showed that pain, in some cases, is use of illicit substances (e.g., methamphetamine, cocaine,
expected, manageable, and, with the “right” partner, hardly marijuana) and their relationship to sexual function was not
cause for concern (see previous sections on physique, pre- raised. Across the international literature, substance use has
paration, and sexual partners). At the same time, the dis- been positively associated with sexual difficulties among
course from this subtheme (and that within the finding of both heterosexual and sexual minority samples (e.g.,
sexual guilt) reveals participants’ conditioning in a Christensen, Grønbæk, Pedersen, Graugaard, & Frisch,
15
2011; Johnson, Phelps, & Cottler, 2004; Lau et al., 2005, sexual difficulties when conducting sex therapy with a gay
2008). Although participants in the current study were not man may neglect to consider how other psychosocial factors
specifically asked about illicit substance use, future research (e.g., masculine standards, personal level of distress, inter-
could benefit from the inclusion of such inquiries. personal relationships) may influence his sexual difficulties.
Fourth, all interviews and focus groups were conducted Broadening our understanding of sexual difficulties to
by a young female researcher. Researchers examining men’s include psychological, social, and physical factors pertinent
health have found that interviewer gender can shape men’s to gay men will better equip clinicians in providing the
talk during interviews (e.g., Broom, 2004; Broom, Hand, & appropriate treatment to those affected.
Tovey, 2009; Oliffe & Mroz, 2005). Men may avoid saying,
or may emphasize, certain things depending on the gender
of the interviewer (Arendell, 1997; Pini, 2005; Williams & Funding
Heikes, 1993). For example, Broom et al. (2009) reported
that when men were interviewed by a male, masculine traits This work was supported by the Higher Education
were emphasized. In contrast, when men were interviewed Authority of Ireland, Programme for Research in Third
by a female, expressions of heightened “professionalism” Level Institutions, Cycle 4 (Irish Social Sciences Platform).
and self-credentialing were evident. The authors hypothe-
sized that such portrayals were an attempt by participants to
match the perceived professional status of the female inter- ORCID
viewer (Broom et al., 2009). Thus, we recommend future
researchers utilize both male and female interviewers and Lorraine K. McDonagh http://orcid.org/0000-0002-5122-
then identify similarities and differences across transcripts. 0156
Daragh T. McDermott http://orcid.org/0000-0001-7005-
Conclusions 6446
Nathan Davies http://orcid.org/0000-0001-7757-5353
The present findings have implications for how sexual
difficulties are classified and understood in clinical practice
and research. The findings reinforce the argument made at References
the beginning of the article that current understandings of
sexual difficulties are biased by a heterosexist understanding Althof, S. E. (2002). Quality of life and erectile dysfunction. Urology, 59,
of sexual function. It is evident that the meaning, contexts, 803–810. doi:10.1016/S0090-4295(02)01606-0
and experiences of sexual difficulties differ for gay or American Psychiatric Association. (1973). Homosexuality and sexual
bisexual men in comparison to heterosexual men; however, orientation disturbance: Proposed change in DSM-II, 6th printing
(Position Statement APA Document Reference No. 730008).
as discussed, there are also important similarities. Washington, DC: Author.
In this study, several difficulties were identified that are not American Psychiatric Association. (2000). Diagnostic and statistical man-
currently acknowledged as sexual difficulties; specifically, these ual of mental disorders (4th ed., text rev.). Washington, DC: Author.
were difficulties relating to penile pain and pain during receptive American Psychiatric Association. (2013). Diagnostic and statistical man-
anal sex. Furthermore, several sexual dysfunctions as categor- ual of mental disorders (5th ed.). Arlington, VA: American Psychiatric
Publishing.
ized by the DSM-5 (APA, 2013) did not emerge as sexual Anderson, E. (2002). Openly gay athletes: Contesting hegemonic masculi-
dysfunctions, or even as sexual difficulties, for the present nity in a homophobic environment. Gender and Society, 16, 860–877.
sample of men. In particular, these were premature ejaculation, doi:10.1177/089124302237892
delayed ejaculation, and low sexual desire. This is not to say that Arendell, T. (1997). Reflections on the researcher-researched relationship:
these are not sexual dysfunctions or sexual difficulties in their A woman interviewing men. Qualitative Sociology, 20, 341–368.
doi:10.1023/A:1024727316052
own right, but perhaps the context in which they occur is more Bancroft, J., Carnes, L., Janssen, E., Goodrich, D., & Long, J. S. (2005). Erectile
important for some men. Nonetheless, these findings pose a and ejaculatory problems in gay and heterosexual men. Archives of Sexual
challenge to how sexual dysfunctions and sexual difficulties Behavior, 34, 285–297. doi:10.1007/s10508-005-3117-7
are categorized, suggesting our current understanding and Basson, R. (2015). Human sexual response. Handbook of Clinical
explanations of reduced sexual function needs to be broadened. Neurology, 130, 11–18. doi:10.1016/B978-0-444-63247-0.00002-X
Blumstein, P., & Schwartz, P. (1983). American couples. New York, NY:
The current findings pose important challenges for clin-
William Morrow.
ical practice and research where sexual difficulties are Boyatzis, R. E. (1998). Transforming qualitative information: Thematic
assessed. The absence of understanding of sexual difficulties analysis and code development. Thousand Oaks, CA: Sage.
among sexual minority men has been emphasized. If inade- Braun, V., & Clarke, V. (2006). Using thematic analysis in psychology.
quate conceptualizations of sexual functioning continue to Qualitative Research in Psychology, 3, 77–101. doi:10.1191/
1478088706qp063oa
be used, a full understanding of the complexities of gay
Braun, V., & Clarke, V. (2013). Successful qualitative research: A practical
men’s sexual difficulties will not be achieved. Researchers guide for beginners. London, United Kingdom: Sage.
and clinicians alike need to consider the factors that affect Broom, A. (2004). Prostate cancer and masculinity in Australian society: A
the sexual functioning of gay men. For example, a sex case of stolen identity? International Journal of Men’s Health, 3, 73–
therapist who focuses on a heterosexist understanding of 91. doi:10.3149/jmh.0302.73
16
Broom, A., Hand, K., & Tovey, P. (2009). The role of gender, environment, employment conducted face to face or by telephone. Qualitative
and individual biography in shaping qualitative interview data. Health Research, 20, 617–627. doi:10.1177/1049732310361466
International Journal of Social Research Methodology, 12, 51–65. Frith, H. (2000). Focusing on sex: Using focus groups in sex research.
doi:10.1080/13645570701606028 Sexualities, 3, 275–297. doi:10.1177/136346000003003001
Brotto, L., Atallah, S., Johnson-Agbakwu, C., Rosenbaum, T., Abdo, C., Ghanem, H., Glina, S., Assalian, P., & Buvat, J. (2013). Position paper:
Byers, E. S., … Wylie, K. (2016). Psychological and interpersonal Management of men complaining of a small penis despite an actually
dimensions of sexual function and dysfunction. Journal of Sexual normal size. Journal of Sexual Medicine, 10, 294–303. doi:10.1111/
Medicine, 13, 538–571. doi:10.1016/j.jsxm.2016.01.019 j.1743-6109.2012.02725.x
Brubaker, S. J., & Johnson, J. A. (2008). “Pack a more powerful punch” Gibbons, M., Manandhar, M., Gleeson, C., & Mullan, J. (2007).
and “lay the pipe”: Erectile enhancement discourse as a body project Recognising LGB sexual identities in health services. Dublin,
for masculinity. Journal of Gender Studies, 17, 131–146. doi:10.1080/ Ireland: Equality Authority and Health Service Executive.
09589230802008899 Goldberg, H. (1976). The hazards of being male: Surviving the myth of
Campbell, T., & Whiteley, C. (2006). Working clinically with gay men with masculine privilege. New York, NY: Signet Press.
sexual performance problems. Sexual and Relationship Therapy, 21, Gothberg, J., Reeves, P., Thurston, L., Applegate, B., Kohler, P., &
419–428. doi:10.1080/14681990600597776 Peterson, L. (2013). Is the medium really the message? A comparison
Chong, E., Alayli-Goebbels, A., Webel-Edgar, L., Muir, S., & Manson, H. of face-to-face, telephone, and Internet focus group venues. Journal of
(2015). Advancing telephone focus groups method through the use of Ethnographic and Qualitative Research, 7, 108–127.
webinar: Methodological reflections on evaluating Ontario, Canada’s Gray, R. E., Fitch, M. I., Fergus, K. D., Mykhalovskiy, E., & Church, K.
Healthy Babies Healthy Children program. Global Qualitative (2002). Hegemonic masculinity and the experience of prostate cancer:
Nursing Research, 2, 1–8. doi:10.1177/2333393615607840 A narrative approach. Journal of Aging and Identity, 7, 43–62.
Christensen, B. S., Grønbæk, M., Pedersen, B. V., Graugaard, C., & Frisch, doi:10.1023/A:1014310532734
M. (2011). Associations of unhealthy lifestyle factors with sexual Greenfield, T. K., Midanik, L. T., & Rogers, J. D. (2000). Effects of telephone
inactivity and sexual dysfunctions in Denmark. Journal of Sexual versus face‐to‐face interview modes on reports of alcohol consumption.
Medicine, 8, 1903–1916. doi:10.1111/j.1743-6109.2011.02291.x Addiction, 95, 277–284. doi:10.1046/j.1360-0443.2000.95227714.x
Connell, R. W. (1992). A very straight gay: Masculinity, homosexual Grov, C., Parsons, J. T., & Bimbi, D. S. (2010). The association between
experience, and the dynamics of gender. American Sociological penis size and sexual health among men who have sex with men.
Review, 735–751. doi:10.2307/2096120 Archives of Sexual Behavior, 39, 788–797. doi:10.1007/s10508-008-
Connolly, M. P., & Lynch, K. (2016). Is being gay bad for your health and 9439-5
wellbeing? Cultural issues affecting gay men accessing and using Grulich, A. E., De Visser, R. O., Badcock, P. B., Smith, A. M., Heywood,
health services in the Republic of Ireland. Journal of Research in W., Richters, J., … Simpson, J. M. (2014). Homosexual experience
Nursing, 21, 177–196. doi:10.1177/1744987115622807 and recent homosexual encounters: The Second Australian Study of
Cooper, C. P., Jorgensen, C. M., & Merritt, T. L. (2003). Report from the Health and Relationships. Sexual Health, 11, 439–450. doi:10.1071/
CDC. Telephone focus groups: An emerging method in public health SH14122
research. Journal of Women’s Health, 12, 945–951. doi:10.1089/ Halkitis, P. N. (2001). An exploration of perceptions of masculinity among
154099903322643866 gay men living with HIV. Journal of Men’s Studies, 9, 413–429.
Courtenay, W. H. (2000). Constructions of masculinity and their influence doi:10.3149/jms.0903.413
on men’s well-being: A theory of gender and health. Social Science Harrison, J., Chin, J., & Ficarrotto, T. (1992). Warning: Masculinity may be
and Medicine, 50, 1385–1401. doi:10.1016/S0277-9536(99)00390-1 dangerous to your health. In M. S. Kimmel & M. A. Messner (Eds.),
Cove, J., & Boyle, M. (2002). Gay men’s self-defined sexual problems, Men’s lives (pp. 271–285). New York, NY: Macmillan Press.
perceived causes, and factors in remission. Sexual and Relationship Hayes, R. D., Bennett, C. M., Fairley, C. K., & Dennerstein, L. (2006).
Therapy, 17, 137–147. doi:10.1080/14681990220121257 Epidemiology: What can prevalence studies tell us about female sex-
Damon, W., & Rosser, B. S. (2005). Anodyspareunia in men who have sex ual difficulty and dysfunction? Journal of Sexual Medicine, 3, 589–
with men. Journal of Sex and Marital Therapy, 31, 129–141. 595. doi:10.1111/j.1743-6109.2006.00241.x
doi:10.1080/00926230590477989 Higgins, A., Doyle, L., Downes, C., Murphy, R., Sharek, D., DeVries, J., …
Davis, S. N., Binik, Y. M., & Carrier, S. (2009). Sexual dysfunction and Smyth, S. (2016). The LGBTIreland report: National study of the
pelvic pain in men: A male sexual pain disorder? Journal of Sex and mental health and wellbeing of lesbian, gay, bisexual, transgender,
Marital Therapy, 35, 182–205. doi:10.1080/00926230802716310 and intersex people in Ireland. Dublin, Ireland: GLEN and BeLonG To.
de Visser, R., & Smith, J. A. (2006). Mister in-between: A case study of Hirshfield, S., Chiasson, M. A., Wagmiller, R. L., Jr., Remien, R. H.,
masculine identity and health-related behaviour. Journal of Health Humberstone, M., Scheinmann, R., & Grov, C. (2010). Sexual dys-
Psychology, 11, 685–695. doi:10.1177/1359105306066624 function in an Internet sample of U.S. men who have sex with men.
de Visser, R. O., & McDonnell, E. J. (2013). “Man points”: Masculine Journal of Sexual Medicine, 7, 3104–3114. doi:10.1111/j.1743-
capital and young men’s health. Health Psychology, 32, 5–14. 6109.2009.01636.x
doi:10.1037/a0029045 Hollows, K. (2007). Anodyspareunia: A novel sexual dysfunction? An
de Visser, R. O., Smith, J. A., & McDonnell, E. J. (2009). “That’s not exploration into anal sexuality. Sexual and Relationship Therapy, 22,
masculine”: Masculine capital and health-related behaviour. Journal of 429–443. doi:10.1080/14681990701481409
Health Psychology, 14, 1047–1058. doi:10.1177/1359105309342299 Horowitz, A. M., Siriphant, P., Canto, M. T., & Child, W. L. (2002).
Drummond, M. J., & Filiault, S. M. (2007). The long and the short of it: Maryland dental hygienists’ views of oral cancer prevention and
Gay men’s perceptions of penis size. Gay and Lesbian Issues and early detection. Journal of Dental Hygiene, 76(3), 186–192.
Psychology Review, 3(2), 121–129. Retrieved from http://www.glhv. doi:10.1034/j.1601-0825.2001.70307.x
org.au/files/GLIP_Review_Vol3_No2_2007.pdf#page=49 Janssen, E., McBride, K. R., Yarber, W., Hill, B. J., & Butler, S. M. (2008).
Fenig, S., Levav, I., Kohn, R., & Yelin, N. (1993). Telephone vs. face-to- Factors that influence sexual arousal in men: A focus group study.
face interviewing in a community psychiatric survey. American Archives of Sexual Behavior, 37, 252–265. doi:10.1007/s10508-007-
Journal of Public Health, 83, 896–898. doi:10.2105/AJPH.83.6.896 9245-5
Fielding, N. G., Lee, R. M., & Blank, G. (2008). The Sage handbook of Johns, M. M., Pingel, E., Eisenberg, A., Santana, M. L., & Bauermeister, J.
online research methods. London, United Kingdom: Sage. (2012). Butch tops and femme bottoms? Sexual positioning, sexual
Frazier, L. M., Miller, V. A., Horbelt, D. V., Delmore, J. E., Miller, B. E., & decision making, and gender roles among young gay men. American
Paschal, A. M. (2010). Comparison of focus groups on cancer and Journal of Men’s Health, 6, 505–518. doi:10.1177/1557988312455214
17
Johnson, S. D., Phelps, D. L., & Cottler, L. B. (2004). The association of McDonagh, L. K., Bishop, C., Brockman, M., & Morrison, T. G. (2014). A
sexual dysfunction and substance use among a community epidemio- systematic review of sexual dysfunction measures for gay men: How
logical sample. Archives of Sexual Behavior, 33, 55–63. doi:10.1023/ do current measures measure up? Journal of Homosexuality, 61, 781–
B:ASEB.0000007462.97961.5a 816. doi:10.1080/00918369.2014.870452
Kaplan, H. S. (1974). The new sex therapy: Active treatment of sexual McDonagh, L. K., Stewart, I., Morrison, M. A., & Morrison, T. G. (2016).
dysfunctions. Oxford, United Kingdom: Brunner/Mazel. Development and psychometric evaluation of the Gay Male Sexual
Kippax, S., & Smith, G. (2001). Anal intercourse and power in sex between Difficulties Scale. Archives of Sexual Behavior, 61, 781–816.
men. Sexualities, 4, 413–434. doi:10.1177/136346001004004002 doi:10.1007/s10508-015-0664-4
Koskan, A. M., Rice, J., Gwede, C. K., Meade, C. D., Sehovic, I., & Quinn, G. Miller, C. (1995). In‐depth interviewing by telephone: Some practical
P. (2014). Advantages, disadvantages, and lessons learned in conducting considerations. Evaluation and Research in Education, 9, 29–38.
telephone focus groups to discuss biospecimen research concerns of doi:10.1080/09500799509533370
individuals genetically at risk for cancer. The Qualitative Report, 19 Moskowitz, D. A., & Hart, T. A. (2011). The influence of physical body
(22), 1–8. Retrieved from http://nsuworks.nova.edu/tqr/vol19/iss22/3 traits and masculinity on anal sex roles in gay and bisexual men.
Krueger, R. A., & Casey, M. A. (2014). Focus groups: A practical guide Archives of Sexual Behavior, 40, 835–841. doi:10.1007/s10508-011-
for applied research. London, United Kingdom: Sage. 9754-0
Lambert, S. D., & Loiselle, C. G. (2008). Combining individual interviews Nassar-McMillan, S. C., Wyer, M., Oliver-Hoyo, M., & Ryder-Burge, A.
and focus groups to enhance data richness. Journal of Advanced (2010). Using focus groups in preliminary instrument development:
Nursing, 62, 228–237. doi:10.1111/j.1365-2648.2007.04559.x Expected and unexpected lessons learned. The Qualitative Report, 15
Lau, J. T. F., Kim, J., & Tsui, H. (2005). Prevalence of male and female (6), 1621–1634. Retrieved from http://nsuworks.nova.edu/tqr/vol15/
sexual problems, perceptions related to sex and association with qual- iss6/19/
ity of life in a Chinese population: A population-based study. Newman, P. A., Tepjan, S., & Rubincam, C. (2017). Exploring sex, HIV
International Journal of Impotence Research, 17, 494–505. and “sensitive” space(s) among sexual and gender minority young
doi:10.1016/S0022-5347(05)64302-9 adults in Thailand. In R. S. Barbour & D. L. Morgan (Eds.), A new
Lau, J. T. F., Kim, J. H., & Tsui, H. Y. (2008). Prevalence and sociocultural era in focus group research (pp. 83–106). London, United Kingdom:
predictors of sexual dysfunction among Chinese men who have sex Springer.
with men in Hong Kong. Journal of Sexual Medicine, 5, 2766–2779. Nielsen, E.-J. (2015). Fucking with distinction: A contextualised film
doi:10.1111/j.1743-6109.2008.00892.x review of I Want Your Love. Psychology and Sexuality, 6, 140–146.
Laumann, E. O., Gagnon, J. H., Michael, R. T., & Michaels, S. (1994). The doi:10.1080/19419899.2014.984519
social organization of sexuality: Sexual practices in the United States. Oliffe, J. (2005). Constructions of masculinity following prostatectomy-
Chicago, IL: University of Chicago Press. induced impotence. Social Science and Medicine, 60, 2249–2259.
Laumann, E. O., Paik, A., & Rosen, R. C. (1999). Sexual dysfunction in the doi:10.1016/j.socscimed.2004.10.016
United States: Prevalence and predictors. JAMA, 281, 537–544. Oliffe, J., & Mroz, L. (2005). Men interviewing men about health and
doi:10.1001/jama.281.6.537 illness: Ten lessons learned. Journal of Men’s Health and Gender, 2,
Leask, J., Hawe, P., & Chapman, S. (2001). Focus group composition: A 257–260. doi:10.1016/j.jmhg.2005.03.007
comparison between natural and constructed groups. Australian and Överlien, C., Aronsson, K., & Hydén, M. (2005). The focus group inter-
New Zealand Journal of Public Health, 25, 152–154. doi:10.1111/ view as an in‐depth method? Young women talking about sexuality.
j.1753-6405.2001.tb01838.x International Journal of Social Research Methodology, 8, 331–344.
Levant, R. F. (1996). The new psychology of men. Professional doi:10.1080/1364557042000119607
Psychology: Research and Practice, 27, 259–265. doi:10.1037/0735- Peixoto, M. M., & Nobre, P. (2015). Prevalence of sexual problems and
7028.27.3.259 associated distress among gay and heterosexual men. Sexual and
Levant, R. F., Smalley, K. B., Aupont, M., House, A. T., Richmond, K., & Relationship Therapy, 30, 211–225. doi:10.1080/14681994.2014.986084
Noronha, D. (2007). Initial validation of the Male Role Norms Philaretou, A. G., & Allen, K. R. (2001). Reconstructing masculinity and
Inventory–Revised (MRNI-R). Journal of Men’s Studies, 15, 83–100. sexuality. Journal of Men’s Studies, 9, 301–321. doi:10.3149/
doi:10.3149/jms.1501.83 jms.0903.301
Linhorst, D. M. (2002). A review of the use and potential of focus groups in Pini, B. (2005). Interviewing men: Gender and the collection and interpre-
social work research. Qualitative Social Work, 1, 208–228. tation of qualitative data. Journal of Sociology, 41, 201–216.
doi:10.1177/1473325002001002620 doi:10.1177/1440783305053238
Mac Gréil, M. (2011). Pluralism and diversity in Ireland. Dublin, Ireland: Pollack, W. (1998). Real boys: Rescuing our sons from the myths of
Columba Press. boyhood. New York, NY: Henry Holt.
Mao, L., Newman, C. E., Kidd, M. R., Saltman, D. C., Rogers, G. D., & Potts, A. (2004). Deleuze on Viagra (or, what can a “Viagra-body” do?).
Kippax, S. C. (2009). Self-reported sexual difficulties and their asso- Body and Society, 10, 17–36. doi:10.1177/1357034X04041759
ciation with depression and other factors among gay men attending Ross, L. E., Stroud, L. A., Rose, S. W., & Jorgensen, C. M. (2006). Using
high HIV-caseload general practices in Australia. Journal of Sexual telephone focus groups methodology to examine the prostate cancer
Medicine, 6, 1378–1385. doi:10.1111/j.1743-6109.2008.01160.x screening practices of African-American primary care physicians.
Masters, W. H., & Johnson, V. E. (1966). Human sexual response. London, Journal of the National Medical Association, 98(8), 1296–1299.
United Kingdom: Churchill Livingstone. Retrieved from http://europepmc.org/abstract/med/16916127
Masters, W. H., & Johnson, V. E. (1979). Homosexuality in perspective. Rosser, B. R. S., Metz, M. E., Bockting, W. O., & Buroker, T. (1997).
London, United Kingdom: Churchill Livingstone. Sexual difficulties, concerns, and satisfaction in homosexual men:
Mayfield, W. (2001). The development of an internalized homonegativity An empirical study with implications for HIV prevention. Journal
inventory for gay men. Journal of Homosexuality, 41, 53–76. of Sex and Marital Therapy, 23, 61–73. doi:10.1080/
doi:10.1300/J082v41n02_04 00926239708404418
McCabe, M. P., Sharlip, I. D., Atalla, E., Balon, R., Fisher, A. D., Rosser, B. R. S., Short, B. J., Thurmes, P. J., & Coleman, E. (1998).
Laumann, E., … Segraves, R. T. (2016). Definitions of sexual dys- Anodyspareunia, the unacknowledged sexual dysfunction: A valida-
functions in women and men: A consensus statement from the Fourth tion study of painful receptive anal intercourse and its psychosexual
International Consultation on Sexual Medicine 2015. Journal of concomitants in homosexual men. Journal of Sex and Marital
Sexual Medicine, 13, 135–143. doi:10.1016/j.jsxm.2015.12.019 Therapy, 24, 281–292. doi:10.1080/00926239808403963
18
Rowan, N., & Wulff, D. (2007). Using qualitative methods to inform scale Sungur, M. Z., & Gündüz, A. (2013). A comparison of DSM‐IV‐TR and
development. Qualitative Report, 12(3), 450–466. Retrieved from DSM‐5 definitions for sexual dysfunctions: Critiques and challenges.
http://nsuworks.nova.edu/tqr/vol12/iss3/7/ Journal of Sexual Medicine, 11, 364–373. doi:10.1111/jsm.12379
Rowland, D. (2007). Sexual health and problems: Erectile dysfunction, Tausig, J. E., & Freeman, E. W. (1988). The next best thing to being there:
premature ejaculation, and male orgasmic disorder. In J. E. Grant & Conducting the clinical research interview by telephone. American
M. N. Potenza (Eds.), Textbook of men’s mental health (pp. 171–204). Journal of Orthopsychiatry, 58, 418–427. doi:10.1111/j.1939-
Washington, DC: American Psychiatric Publishing. 0025.1988.tb01602.x
Rubin, R. (2004). Men talking about Viagra: An exploratory study with Tiefer, L. (1986). In pursuit of the perfect penis: The medicalization of male
focus groups. Men and Masculinities, 7, 22–30. doi:10.1177/ sexuality. American Behavioral Scientist, 29, 579–599. doi:10.1177/
1097184X03257439 000276486029005006
Sandfort, T. G. M., & De Keizer, M. (2001). Sexual problems in gay men: Underwood, S. G. (2003). Gay men and anal eroticism: Tops, bottoms, and
An overview of empirical research. Annual Review of Sex Research, versatiles. Binghamton, NY: Harrington Park Press.
12, 93–120. doi:10.1080/10532528.2001.10559795 Ussher, J. M., Perz, J., Kellett, A., Chambers, S., Latini, D., Davis, I. D., …
Singh, P. (2008). The unexpected rewards of qualitative research in assess- Williams, S. (2016). Health-related quality of life, psychological dis-
ment: A case example. The Qualitative Report, 13(2), 278–300. tress, and sexual changes following prostate cancer: A comparison of
Retrieved from http://nsuworks.nova.edu/tqr/vol13/iss2/9 gay and bisexual men with heterosexual men. Journal of Sexual
Smith, J. A., & Osborn, M. (2008). Interpretative phenomenological ana- Medicine, 13, 425–434. doi:10.1016/j.jsxm.2015.12.026
lysis. In J. Smith (Ed.), Qualitative psychology: A practical guide to Ussher, J. M., Rose, D., & Perz, J. (2016). Mastery, isolation, or accep-
research methods (2nd ed., pp. 53–80). Thousand Oaks, CA: Sage. tance: Gay and bisexual men’s construction of aging in the context of
Smith, J. M., Sullivan, S. J., & Baxter, G. D. (2009a). Massage therapy sexual embodiment after prostate cancer. Journal of Sex Research, 1–
services for healthcare: A telephone focus group study of drivers for 11. doi:10.1080/00224499.2016.1211600
clients’ continued use of services. Complementary Therapies in Van Teijlingen, E., & Pitchforth, E. (2006). Focus group research in family
Medicine, 17, 281–291. doi:10.1016/j.ctim.2009.07.001 planning and reproductive health care. Journal of Family Planning
Smith, J. M., Sullivan, S. J., & Baxter, G. D. (2009b). Telephone focus groups in and Reproductive Health Care, 32, 30–32. doi:10.1783/
physiotherapy research: Potential uses and recommendations. 147118906775275299
Physiotherapy Theory and Practice, 25, 241–256. doi:10.1080/ Williams, C. L., & Heikes, E. J. (1993). The importance of researcher’s
09593980902782496 gender in the in-depth interview: Evidence from two case studies of
Smith, T. M. (2014). Experiences of therapists and occupational therapy male nurses. Gender and Society, 7, 280–291. doi:10.1177/
students using video conferencing in conduction of focus groups. The 089124393007002008
Qualitative Report, 19(19), 1–13. Retrieved from http://nsuworks. Wincze, J. P., & Weisberg, R. B. (2015). Sexual dysfunction: A guide for
nova.edu/tqr/vol19/iss19/3 assessment and treatment (3rd ed.). New York, NY: Guilford Press.
Sturges, J. E., & Hanrahan, K. J. (2004). Comparing telephone and face-to- Zilbergeld, B. (1978). Men and sex. London, United Kingdom: Fontana.
face qualitative interviewing: A research note. Qualitative Research, 4, Zilbergeld, B. (1992). The new male sexuality. New York, NY: Bantam
107–118. doi:10.1177/1468794104041110 Books.
19
View publication stats

How To Meet Girls

Uploaded by

Document Information

Original Title

Copyright

Available Formats

Share this document

Share or Embed Document

Sharing Options

Did you find this document useful?

Is this content inappropriate?

Copyright:

Available Formats

How To Meet Girls

Uploaded by

Copyright:

Available Formats

See discussions, stats, and author profiles for this publication at: https://www.researchgate.

“I Want to Feel Like a Full Man”: Conceptualizing Gay, Bisexual, and

Article in The Journal of Sex Research · December 2017

Lorraine K. McDonagh Daragh T. Mcdermott

SEE PROFILE SEE PROFILE

Nathan Davies Todd G Morrison

SEE PROFILE SEE PROFILE

psychology View project

Methodologies in Queer Data Research: A Systematic Review View project

The user has requested enhancement of the downloaded file.

ISSN: 0022-4499 (Print) 1559-8519 (Online) Journal homepage: http://www.tandfonline.com/loi/hjsr20

“I Want to Feel Like a Full Man”: Conceptualizing

Lorraine K. McDonagh, Elly-Jean Nielsen, Daragh T. McDermott, Nathan

To link to this article: https://doi.org/10.1080/00224499.2017.1410519

Published online: 20 Dec 2017.

Submit your article to this journal

View related articles

View Crossmark data

Full Terms & Conditions of access and use can be found at

“I Want to Feel Like a Full Man”: Conceptualizing Gay, Bisexual,

Introduction dysfunction refers to a persistent or recurrent disturbance in

Masculine Psychosocial Coping

Penis Size Restrictive Alternative

Competition Porn Psychosocial Physical

Psychological Physical Acceptance Physical Psychosocial Coping

Physique Preparation Medical Partner Fear Guilt

Figure 1. Graphical illustration of themes and subthemes.

were collapsed into the theme of “medicalization,” which Results

Table 3. Penis Function Themes and Respective Illustrative Quotations

Theme Illustrative Quotation

Table 4. Pain Themes and Respective Illustrative Quotations

Theme Illustrative Quotation

Extreme discourse was used to communicate the severity of

View publication stats

You might also like