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Gender role and women's health: Effects of feminine gender role stress and femininity on somatic symptoms and sexual functioning

Dissertation
Author: Kristen L. Perry
Abstract:
Feminine gender role stress (FGRS) involves the cognitive appraisal of specific situations as stressful for women. While the negative relationship between stress and health has been well documented, gender specific stress has received little attention. This study sought to explore the relationships between FGRS and somatic symptoms and FGRS and sexual functioning, as well as the predictive ability of FGRS versus traditional femininity within these relationships. While FGRS and traditional femininity are based on the feminine gender role, previous research indicates that the two constructs are only weakly related. Undergraduate women from two local universities were invited to participate in this study, and data was collected either online or in person with paper copies. A total of 243 women participated in this study, of which 224 completed an adequate amount of data for analysis. Participant age ranged from 18 to 23-years-old ( M = 18.94, SD = 1.14), and the majority of participants were Caucasian (77.2%). Results of the correlation and multiple regression analyses suggested FGRS ( r = .20, p = .01; R2 = .04, adjusted R2 = .03, F [1, 153] = 6.37, p = .01), but not femininity ( r = .02, p = .41; R2 = .00, adjusted R2 = -.01, F [1, 153] = .05, p = .82), was significantly related to and a predictor of somatic symptoms. Neither FGRS nor femininity was found to be correlated with sexual functioning (r = -.11, p = .10, r = -.05, p = .32, respectively). Neither construct was a significant predictor of sexual functioning ( R2 = .01, adjusted R2 = .01, F [1, 127] = 1.68, p = .20, R2 = .00, adjusted R2 = -.01, F [1, 127] = .23, p = .63, respectively). However, this finding is questionable given participant demographics suggesting low to no current sexual activity. Interestingly, FGRS and femininity were found to be moderately related (r = .39, p = .00). Results mirror previous research in supporting FGRS as a stronger predictor of negative outcomes compared to femininity, and also suggest that gender specific stress is an important component in examining somatic complaints among women.

Gender Role and Women’s Health ii Table of Contents Table of Contents ................................................................................................................ ii List of Tables ..................................................................................................................... iv List of Figures ..................................................................................................................... v List of Appendices ............................................................................................................. vi Abstract ………………………………………………………………..…………………………………. vii A. Chapter I: Introduction and Literature Review .............................................................. 9 1. Introduction ................................................................................................................. 9 2. Literature Review ...................................................................................................... 12 2.1. Femininity and Feminine Gender Role Stress..................................................... 12 2.1.1. Gender Role Development and Socialization ............................................. 12 2.1.2. Femininity ................................................................................................... 15 2.1.3. Feminine Gender Role Stress...................................................................... 16 2.1.4. Relationship between Femininity and Feminine Gender Role Stress ......... 17 2.2. Somatic Symptoms .............................................................................................. 17 2.2.1. In Relation to Stress .................................................................................... 18 2.2.2. Among Women ........................................................................................... 19 2.3. Sexual Functioning .............................................................................................. 20 2.3.1. Among Women ........................................................................................... 22 2.3.2. In Relation to Stress .................................................................................... 24 2.4. Summary of Literature Review ........................................................................... 24 3. Hypotheses................................................................................................................. 25 B. Chapter II: Method ....................................................................................................... 27 1. Measures .................................................................................................................... 27 1.1. Feminine Gender Role Stress .............................................................................. 27 1.2. Femininity ........................................................................................................... 33 1.3. Somatic Symptoms .............................................................................................. 37 1.4. Sexual Functioning .............................................................................................. 40 1.5. Demographic Questions ...................................................................................... 43 2. Procedures ................................................................................................................. 43 C. Chapter III: Results ...................................................................................................... 47

Gender Role and Women’s Health iii 1. Research Design ........................................................................................................ 47 1.1. Power Analysis .................................................................................................... 47 1.2. Participants .......................................................................................................... 47 2. Preliminary Analyses ................................................................................................. 48 2.1. Analysis for Descriptive Statistics ...................................................................... 49 2.2. Independent-Samples t Tests ............................................................................... 51 3. Primary Analyses ....................................................................................................... 53 3.1. Multiple Correlation and Regression Analyses ................................................... 53 3.1.1. Somatic symptoms ...................................................................................... 53 3.2.2. Sexual functioning ...................................................................................... 54 4. Post Hoc Analyses ..................................................................................................... 54 4.1. Normative Comparisons ...................................................................................... 55 4.1.1. Compared to Normals ................................................................................. 55 4.1.2. Compared to Women with Back Pain ......................................................... 56 4.1.3. Compared to Individuals with Clinical Pain ............................................... 56 D. Chapter IV: Discussion ................................................................................................ 58 1. Correlational Relationships ....................................................................................... 58 2. Predictive Abilities of FGRS and Traditional Femininity ......................................... 59 2.1. Somatic Symptoms .............................................................................................. 60 2.2. Sexual Functioning .............................................................................................. 60 3. Limitations ................................................................................................................. 61 4. Conclusions ............................................................................................................... 61 E. References .................................................................................................................... 63 F. Appendices ................................................................................................................... 73

Gender Role and Women’s Health iv List of Tables Table 1. Possible Range of Values on Each Measure Compared to Range of Values in the Present Sample ....................................................................................................50 Table 2. Means (Standard Deviations) and Pearson Correlation Values for Somatic Symptoms Data Set .............................................................................................51 Table 3. Means (Standard Deviations) and Pearson Correlation Values for Sexual Functioning Data Set...........................................................................................51 Table 4. Means, Standard Deviations, and Sample Sizes for the MSPQ...........................55 Table 5. Pearson Correlation Values Among the FGRS Factors and Total Scale .............76 Table 6. Significant Factor Loadings of EFA Rotated Solutions Compared to FGRS Original Five-Factor Structure and Factor Loadings ..........................................77 Table 7. Significant Factor Loadings of EFA Rotated Solutions, Constrained to Five Factors, Compared to FGRS Original Five-Factor Structure and Factor Loadings ..............................................................................................................79

Gender Role and Women’s Health v List of Figures Figure 1. Hypothesized predictors of somatic symptoms ..................................................11 Figure 2. Hypothesized predictors of sexual functioning ..................................................12 Figure 3. Model for confirmatory factor analysis of the FGRS Rating Scale ...................32

Gender Role and Women’s Health vi List of Appendices Appendix A. Factor Analysis .............................................................................................74 Appendix B. IRB Application............................................................................................82 Appendix C. Document of Informed Consent for Online Participation ............................91 Appendix D. Document of Informed Consent for In-Person Participation .......................94 Appendix E. Informed Consent Checklist .........................................................................97 Appendix F. Recruitment Materials .................................................................................100 Appendix G. Assessment Instruments .............................................................................102 G.1. Feminine Gender Role Stress Rating Scale ..........................................................103 G.2. Personal Attributes Questionnaire ........................................................................106 G.3. Modified Somatic Perceptions Questionnaire ......................................................108 G.4. Brief Index of Sexual Functioning for Women ....................................................110 G.5. Demographic Questionnaire .................................................................................117

Gender Role and Women’s Health vii Kristen Perry 350 words Abstract Feminine gender role stress (FGRS) involves the cognitive appraisal of specific situations as stressful for women. While the negative relationship between stress and health has been well documented, gender specific stress has received little attention. This study sought to explore the relationships between FGRS and somatic symptoms and FGRS and sexual functioning, as well as the predictive ability of FGRS versus traditional femininity within these relationships. While FGRS and traditional femininity are based on the feminine gender role, previous research indicates that the two constructs are only weakly related. Undergraduate women from two local universities were invited to participate in this study, and data was collected either online or in person with paper copies. A total of 243 women participated in this study, of which 224 completed an adequate amount of data for analysis. Participant age ranged from 18 to 23-years-old (M = 18.94, SD = 1.14), and the majority of participants were Caucasian (77.2%). Results of the correlation and multiple regression analyses suggested FGRS (r = .20, p = .01; R² = .04, adjusted R² = .03, F [1, 153] = 6.37, p = .01), but not femininity (r = .02, p = .41; R² = .00, adjusted R² = -.01, F [1, 153] = .05, p = .82), was significantly related to and a predictor of somatic symptoms. Neither FGRS nor femininity was found to be correlated with sexual functioning (r = -.11, p = .10, r = -.05, p = .32,respectively). Neither construct was a significant predictor of sexual functioning (R² = .01, adjusted R² = .01, F [1, 127] = 1.68, p = .20, R² = .00, adjusted R² = -.01, F [1, 127] = .23, p = .63, respectively). However, this finding is questionable given participant demographics suggesting low to no current sexual activity. Interestingly, FGRS and femininity were found to be moderately related

Gender Role and Women’s Health viii (r = .39, p = .00). Results mirror previous research in supporting FGRS as a stronger predictor of negative outcomes compared to femininity, and also suggest that gender specific stress is an important component in examining somatic complaints among women.

Gender Role and Women’s Health 9 A. CHAPTER I: Introduction and Literature Review I. Introduction Significant differences occur between men and women in physical and mental health. For example, men are more likely to be diagnosed with alcohol dependence and antisocial personality (Seeman, 1995) while women are twice as likely to be diagnosed with depression and dependent personality (Danielsson & Johansson, 2005). Kajantie and Phillips (2006) have suggested that one of the most important determining factors of human health is whether an individual is male or female. It may be the case that such sex differences in pathology are mediated by gender role adherence (Farmer Huselid & Cooper, 1994; Polefrone & Manuck, 1987). So, beyond sex or gender, some aspects of gender role may place people more or less at risk for specific health outcomes. Although American men and women may internalize and display both masculine and feminine characteristics, society continues to expect men to be masculine and women to be feminine (Sirin, McCreary, & Mahalik, 2004). Deviation from gender role norms is socially discordant and thus may be experienced by many men and women as emotionally stressful. Many stressors, perhaps most, are likely equal for men and women. For instance, most people, male or female, are equally stressed by common frustrations such as losing one’s keys, and more severely by major trauma such as losing one’s spouse. Yet other gender specific situations, such as difficulties with sexual performance or parent/child problems may be experienced as differentially stressful by men and women. Based on gender role expectations, good men are almost always sexually potent and good women are maternal, no matter what else they might also be good at. The experience of emotional stress triggers an activation of several physiological

Gender Role and Women’s Health 10 systems, which have been found to show a gender specific pattern of response. Feminine specific stressors such as social rejection, for example, elicit more intense bodily responses in women than men. Conversely, masculine specific stressors such as a math and verbal challenge produce stronger stress responses in men (Stroud, Salovey, & Epel, 2002). The negative effects of stress, overall, have been well documented. Poor health outcomes such as heart disease, type 2 diabetes, and depression are all associated with adverse stress responses (Orth-Gomér & Leineweber, 2004). The Feminine Gender Role Stress (FGRS; Gillespie & Eisler, 1992) rating scale is a self-report measure of those events that women, compared to men, perceive as being more stressful. Consequently, women who over-identify with the feminine ideal experience greater stress in situations of perceived failure to achieve the standards of the feminine gender role. In accordance with this theory, Martz, Handley, and Eisler (1995) found that women with elevated scores on the FGRS rating scale exhibited greater heart rate reactivity to a feminine stress condition (a body fat percentage test) than women with lower scores.The FGRS rating scale was designed to measure the relationship between feminine specific stress and health. Thus far, researchers have found FGRS to be related to depression (Gillespie & Eisler, 1992), eating disorders (Bekker & Boselie, 2002; Martz et al., 1995), and general health and mental health disturbances (Tang & Lau, 1995). Apart from health outcomes, additional studies have found FGRS to be related to proneness to shame (Efthim, Kenny, & Mahalik, 2001), social dysfunction (Tang & Lau, 1996), and commitment to one’s partner (Truman-Schram, Cann, Calhoun, & Vanwallendael, 2001). The goal of my study was to further examine the relationship between feminine

Gender Role and Women’s Health 11 gender role stress (FGRS) and health, including somatic symptoms and sexual functioning among women. Gender and stress have both been separately implicated in the development of somatic symptoms and poor sexual functioning among women, but gender specific stress has yet to be addressed in these areas. Specifically, it was hypothesized that women who experience a greater degree of physical somatic complaints, and who experience poorer sexual functioning will have greater FGRS. This study additionally sought to compare the predictive ability of FGRS with the construct of traditional femininity among the aforementioned relationships. It was hypothesized that women who report a more traditional femininity will also experience a greater degree of physical somatic complaints and poorer sexual functioning. It was expected that traditional femininity would not be strongly related, or may perhaps be inversely related, to FGRS. Therefore, it was not expected that traditional femininity would be a greater predictor of somatic symptoms or sexual functioning as compared to FGRS. The proposed relationships are illustrated in Figure 1 and Figure 2. In essence, the present study sought to expand the literature on women’s stress and health, as well as to help clarify the relationships among these variables. Figure 1. Hypothesized predictors of somatic symptoms. Feminine Gender Role Stress Femininity Somatic Symptoms

Gender Role and Women’s Health 12 Figure 2. Hypothesized predictors of sexual functioning. 2. Literature Review 2.1. Femininity and Feminine Gender Role Stress 2.1.1. Gender role development and socialization. The division between male and female operates as a basic organizing principle for every human culture (Bem, 1981). All cultures assign roles on the basis of biological sex and expect this allocation in the socialization of their children to behave in an accordingly masculine or feminine nature. Children begin to use gender labeling as early as 24 to 26 months (Martin, Ruble, & Szkrybalo, 2002), and by the age of two, children show a preference for gender appropriate toys (Knafo, Iervolino, & Plomin, 2005). By five-years-old, children are able to use gender as a defining category for themselves as well as others (Martin & Ruble, 2004). Prominent theories of development examine gender most often from either a biological approach, which emphasizes the role of sex hormones, or from a social learning paradigm, which stresses the role of environmental influences. During development inutero, the fetus is generally exposed to a specific combination of sex hormones which are determined by the child’s genetic makeup. These hormones have influence over the differentiation of the gonads as well as brain development, which undergoes sexual differentiation in accordance with the biological Feminine Gender Role Stress Femininity Sexual Functioning

Gender Role and Women’s Health 13 sex (Gooren, 2006). Evidence supporting the effects of sex hormones on gender are available from research with animals, where it has been reported that the administration of prenatal androgen, a masculinizing hormone, is associated with an increase in the level of aggressive play, a predominantly masculine behavior, in male rats as well as female rhesus monkeys (Archer & Lloyd, 2002). Further evidence regarding the role of biology in gender role development may be found among research of females with congenital adrenal hyperplasia (CAH), a genetic condition in which the developing fetus is exposed to unusually high levels of androgen. Girls diagnosed with CAH have been found to behave in a more masculine manner (Hines, Brook, & Conway, 2004; Meyer-Bahlburg et al., 2004), and to prefer masculine toys over feminine toys (Pasterski et al., 2005). Of additional interest, the severity of CAH has been found to be related to the degree of observed masculinity, with more severe CAH associated with greater masculinity. For instance, girls with more severe CAH are more likely to strongly endorse desire for a stereotypically masculine career (Servin, Nordenstrom, Larsson, & Bohlin, 2003). Alternatively, social learning theory emphasizes the importance of the child’s interpersonal and cultural environments as the main sources of influence on gender development, with all differences between and within the sexes attributed to the same social processes (Maccoby, 2000). Socialization agents, such as parents, teachers, and peers contribute to this process by reinforcing children either positively or negatively for appropriate or inappropriate gendered behavior, respectively. Children typically receive more punishment for playing with gender inappropriate toys (Paterski et al., 2005), while parents’ nonverbal responses have been found to be more positive for gender appropriate toys (Caldera, Huston, & O’Brien, 1989). Reinforcement may also involve learning via

Gender Role and Women’s Health 14 observation of same-sex peers or modeling of the same-sex parent. Somewhat similar to social learning theory, psychoanalytic theory, based on Freud’s psyschosexual stages of development focuses on the child’s identification with the same-sex parent (Hargreaves, 1987). The psychoanalytic paradigm suggests that resolution of the Oedipus complex results in internalization of socially normative behavior, including appropriate gender behavior, and hence, development of gender role identity. Cognitive theory places a greater emphasis on the role of the child in acquiring gender knowledge through his or her role as an active interpreter of the world (Helgeson, 2005). The development of gender identity, or self-categorization as boy or girl, becomes a new way of classifying and evaluating the environment. Cognitive maps including knowledge of two, separate gender categories, guide and organize the child’s social perceptions and expectations, leading him or her to identify with members of the same sex (Maccoby, 2000). According to gender role socialization, social, culturally constructed norms determine expectancies regarding personality traits and behaviors that males and females take on and enact. Such societal standards of evaluation based upon gender are internalized, and additionally become self-expected. Hence, gender role guides individual behavior and holds influence regarding our judgments of others. The level of gender role socialization is not the same for all individuals, as individuals internalize gender roles to a lesser or greater extent. Highly sex-typed individuals are those that are strongly motivated to keep behavior consistent with one’s internalized gender role standards, a goal that may be accomplished by suppressing any behavior that is incongruent or inappropriate for one’s sex (Kohlberg, 1966).

Gender Role and Women’s Health 15 2.1.2. Femininity.Traditional concepts of masculinity and femininity assumed that an individual possessed either masculine or feminine characteristics, but not both. Men were classified on the masculine end of the bipolar gender role continuum while women were classified on the feminine end of the continuum. Current conceptualizations assume masculinity and femininity to be separate and independent, enabling an individual to consequently possess both masculine and feminine characteristics (Gaa & Liberman, 1981; O’Grady, Freda, & Mikulka, 1979; Wilson & Cook, 1984). Individuals that possess mostly feminine traits are labeled as feminine, and conversely, those that possess mostly masculine traits are labeled as masculine. Individuals that possess an equal number of masculine and feminine traits are termed androgynous, and those that possess very few masculine or feminine traits are labeled as undifferentiated. The construct traditional femininity, for the purposes of this study, involved the socially desirable or ideal traits associated with the female gender role. This construct has generally been associated with an expressive orientation and an affective concern for the wellbeing for others (Bem, 1974). Feminine characteristics such as helpful to others, tactful, and understanding may be applicable to both men and women, yet are associated more strongly with women, compared to men. Hence, women are labeled as traditionally feminine according to the degree to which their self-perceptions include adherence to such traditional feminine traits. In relation to health, traditional femininity has been found to be associated with weight concern and lack of body satisfaction as well as depressive symptomatology and decreased sexual satisfaction (Bay-Cheng, Zucker, Stewart, & Pomerleau, 2002; Kimlicka, Cross, & Tarnai, 1983).

Gender Role and Women’s Health 16 2.1.3. Feminine gender role stress.The construct FGRS was developed based on the theory of masculine gender role stress (MGRS), which involves “the cognitive appraisal of specific situations as stressful for men” (Eisler & Skidmore, 1987, p. 125). Accordingly, FGRS is the cognitive appraisal of specific situations, including thoughts, behaviors, and environmental events, as stressful for women. Traditional feminine gender roles suggest that women are likely to experience such stress in situations of perceived failure to achieve the standards of the feminine gender role. These situations may not be unanimously appraised as challenging to the feminine gender role by all women, based on one’s level of gender role socialization, yet women cognitively consider such situations as significantly more stressful than do men. As previously reported, FGRS is associated with certain health related variables, with the majority of research focusing on body image and eating disorders. Scores on FGRS have been found to be able to distinguish women with eating disorders from those with other psychiatric disorders and from healthy women (Martz et al., 1995). Symptoms of disordered eating, specifically including dietary restraint and eating concern have also been found to be related to FGRS (Mussap, 2007). Bekker and Boselie (2002) found that women diagnosed with bulimia nervosa endorsed higher FGRS compared to healthy women, though these women also endorsed high MGRS and high general stress scores, suggesting that stress in general may be the greater contributor to eating disorders. Shame-proneness, a variable which has been associated with eating disordered symptomatology, has been reported as the dominant affective response related to FGRS (Efthim et al., 2001). Aside from eating disordered symptomatology, a relationship among mental

Gender Role and Women’s Health 17 health and FGRS has been identified. Positive relationships between FGRS and depression (Gillespie & Eisler, 1992) and FGRS and psychological distress among women in the preoperative phase of contraceptive sterilization (Tang & Chung, 1997) have been reported. Also, Chinese nurses who endorsed a high level of FGRS reported an elevated level of health and mental health disturbances including general anxiety, insomnia, social dysfunction, and depressive ruminations (Tang & Lau, 1995). 2.1.4. Relationship between femininity and feminine gender role stress. Previous research on the relationship between femininity and FGRS supported a nonsignificant correlation among the constructs of FGRS and traditional femininity (Gillespie & Eisler, 1992). The authors hypothesized that although both constructs focus on feminine gender role attributes, traditional femininity involves the positive aspects of the feminine gender role while FGRS involves the more negative attributes of the feminine gender role. Hence, the two constructs may be tapping into different dimensions of the feminine gender role. 2.2. Somatic Symptoms Unexplained somatic symptoms are a common problem in primary care settings across cultures, and are related to significant health problems and disability (Bäärnhielm, 2000). Research focusing on the presence of physical or bodily symptoms generally refers to these sensations as either somatic symptoms or somatization. Depending on the type and quantity of reported symptomatology, individuals may be classified as either hyper vigilant regarding bodily sensations or as suffering from a somatization disorder. According to DSM-IV-TR (American Psychiatric Association, 2000) criteria, a diagnosis of somatization disorder involves the presence of multiple physical symptoms, which

Gender Role and Women’s Health 18 suggest the presence of a general medical condition, but that cannot be fully explained by a general medical condition, as resulting from a substance, or as resulting from another mental disorder. Additionally, the reported symptoms are neither purposely feigned nor produced. For the purposes of this study, somatic symptoms were defined as the presence or perception of physical bodily symptoms. Participants were not assessed for the presence of a somatic disorder, and therefore the term somatization was not employed. 2.2.1. In relation to stress.The stress response evokes a sequence of biological reactions that directly and indirectly contribute to physical symptoms (Horn Mallers, Almeida, & Neupert, 2005). Lazarus (1977) suggested three ways in which stress may contribute to somatic illness. First, somatic illness may be the result of a disturbance of the body’s tissue functioning via neurohormonal influences. While under stress, epinephrine and norepinephrine are released via the adrenal medulla in response to sympathetic stimulation. These hormones enhance respiratory and cardiac functions, elevate blood sugar levels, and increase blood volume in the body. Second, engaging in coping behaviors that are harmful to health may result in somatic illness. Coping broadly refers to efforts to manage environmental and internal demands and conflicts among such demands, and its role may be influential in several ways (Holroyd & Lazarus, 1982). Coping may influence the incidence, strength, and patterning of the body’s neuroendocrine stress response. Illness behavior, such as the report of somatic symptoms, may serve as a coping mechanism, or coping may contribute to illness by involving a change toward negative health behaviors such as alcohol or tobacco use. Finally, the third method in which stress may contribute to somatic illness involves psychological and/or

Gender Role and Women’s Health 19 sociological factors which constantly lead an individual to minimize the significance of various symptoms. The significant relationship between daily stressors and somatic symptoms or illness is a strongly supported finding (DeLongis, Folkman, & Lazarus, 1988; Zarski, 1984). Daily stressors are a significant predictor of somatic illness (Zarski, 1984). Taking gender into account, daily stressors are more strongly related to somatic symptoms in women than men (Sandanger, Nygård, Sørensen, & Moum, 2004). Gender specific stressors have also been implicated in the development of somatic symptomatology among women, such that women who are exposed to events that threaten their interpersonal relationships, a typically feminine concern, are at a greater risk for physical symptoms of poor health (Horn Mallers et al., 2005). 2.2.2. Among women. Consistent findings suggest that women are not only more likely to develop anxiety and depression, but are also more likely to experience somatic symptoms and somatic illness (Karvonen et al., 2007; Klonoff, Landrine, & Campbell, 2000; Sandanger et al., 2004). In fact, women have an odds ratio of 1.49 for the development of severe somatic symptoms, and an odds ratio of 1.95 to develop somatic complaints of any degree (Hiller, Rief, & Brähler, 2006). Several reasons for this gender difference have been proposed including (a) that it is socially acceptable for a woman but not a man to report bodily complaints, (b) that women have a decreased threshold for seeing a doctor, (c) because women are more likely to develop anxiety and depression, they are also more likely to report somatic symptoms as such symptoms are commonly related to those disorders, (d) somatic symptoms are more likely to reported among individuals that live alone, and because women have greater life expectancy than men,

Gender Role and Women’s Health 20 they are more likely to live alone, and (e) women are simply more sensitive to bodily stimuli (Nakao et al., 2001). 2.3. Sexual Functioning The traditional and perhaps most well known model of sexual response was developed over 40 years ago, with the publication of the Masters and Johnson (1966) four-stage model of sexual response, including excitement, plateau, orgasm, and resolution. This work was based on observations of 10,000 sexual response cycles of both men and women. The excitement stage involves vascular engorgement of the genitalia resulting from an increased blood flow to the pelvic region. This phase may vary in terms of the sources of stimulation as well as duration. The second stage, plateau, involves a general and widespread increase in muscle tension, with further physical changes related to vasocongestion. The stage of orgasm is characterized by ejaculation in men and rhythmic contractions in both sexes, though women generally experience a greater duration of contractions. The final stage, resolution, is characterized by vascular decongestion of the genitalia and muscle relaxation. While some women in the resolution phase may respond to additional stimulation and may experience additional orgasms, men experience a refractory period of varying amounts of time during which another erection cannot be achieved. There are two approaches to defining sexual function versus sexual dysfunction (Nathan, 2003). The objective approach compares an individual’s behavior with established norms of sexual functioning, where a defined level determines where good functioning ends and dysfunction begins. Generally, good sexual functioning may be related to the successful completion of all four stages of the Masters and Johnson sexual

Gender Role and Women’s Health 21 response model. The second approach, the functional approach, is not concerned with how one’s sexuality is comparable with the normative standard, but with how it promotes pleasure or causes problems for the individual, the partner structure, or both. While the Masters and Johnson model was intended to define normative sexual functioning, an alternate model, specific to sexual dysfunction has since been proposed. In development of this model, Barlow (1986) first identified five factors that seem to differentiate sexually functional individuals from sexually dysfunctional individuals. These include the role of negative affect, report and perception of sexual arousal, distraction by non-sexual performance related stimuli, distraction by performance related sexual stimuli, and anxiety. In greater detail, Barlow noted that sexually dysfunctional individuals consistently reported greater negative affect regarding sexual content and that sexually dysfunctional individuals were more likely to underreport their level of sexual arousal and to report less control over their arousal. Further, and specifically among men, sexually dysfunctional individuals were not distracted by non-sexual performance related stimuli but were distracted by performance related sexual stimuli, as measured by a decrease versus maintenance of erectile response, respectively. Finally, sexual arousal in sexually dysfunctional individuals was inhibited by anxiety. Based on these observations, Barlow developed a model of sexual dysfunction which posits that a process of cognitive interference in addition to anxiety is responsible for sexual dysfunction, specifically related to inhibited sexual excitement in both men and women. Both the Masters and Johnson model of sexual response and Barlow’s model of sexual dysfunction were designed to be applicable to both men and women. While these models may be generally applicable for use with both sexes, there are several gender

Gender Role and Women’s Health 22 differences in male and female sexuality. A meta-analysis of these discrepancies found that the greatest difference was in frequency of masturbation, with men reporting greater incidence (Oliver & Shibley Hyde, 1993). Men also reported more permissive attitudes regarding premarital intercourse when the couple was engaged or in a committed relationship, extramarital intercourse, and sexual permissiveness. Men reported a higher frequency of intercourse, being younger when they experienced their first sexual partner, and having a greater number of sexual partners. Findings among women suggested that women endorsed a higher level of anxiety or guilt regarding sex and that they felt they experienced a double standard regarding sexuality. These gender differences in sexuality may be a result of gender role socialization such that in the area of sexuality, it is expected that masculine males are, and should be, sexually dominant while feminine females are, and should be, sexually passive (Howells, 1987). 2.3.1. Among women. Alternate sexual response and sexual dysfunction models have been proposed to be specifically applicable to women. Unlike the linear sexual response model designed by Masters and Johnson (1966), the proposed model of the female sexual response cycle is circular in nature (Basson, 2003). In this model, emotional intimacy precedes sexual neutrality, followed by sexual stimuli. Psychological and biological influences contribute to sexual arousal, which then accompanies further sexual arousal and desire. This stage is followed by emotional and physical satisfaction, which has the potential to positively influence emotional intimacy. The feminized model of sexual dysfunction among women, by Nobre and Pinto- Gouveia (2008), places an emphasis on the role of self-schemas. They assert that women with sexual dysfunction are more susceptible to activation of incompetence self-schemas

Gender Role and Women’s Health 23 whenever they experience an unsuccessful sexual situation. The self-critical schemas, once triggered, elicit a system of negative automatic cognitions that prevent them from focusing on sexual stimuli and produce negative emotions, consequently impairing the sexual response. Issues of sexual dysfunction applicable to women include disorders of sexual desire, such as hypoactive sexual desire disorder and aversion disorder, sexual arousal disorder, orgasmic disorder, and disorders of sexual pain, such as dyspareunia, vaginismus. The etiology of such difficulties may include emotional, psychological, physiological, endocrinologic, and/or medical variables. Body image issues, a typically feminine stressor, have been found to be associated with decreased sexual functioning (Yamamiya, Cash, & Thompson, 2006), and specifically associated with orgasmic difficulties in women (Nobre & Pinto-Gouveia, 2008). The role of relationship has been identified as a prevalent element associated with hypoactive sexual desire, a finding which is consistent with the interpersonal focus of the female gender role (Farley Hurlbert et al., 2005). It has also been proposed that decreased sexual desire among women may be associated with gender role constraints such that women are socialized to be sexually inhibited (Drew, 2003), though this hypothesis has yet to be examined. The vast majority of research on women’s sexual functioning has involved issues surrounding menopause and age, sexual dysfunction, and medical variables such as cancer and disability. My study focused on women’s sexual functioning, ranging from good to poor, but did not classify participants as sexually functional or dysfunctional. Unfortunately, few studies have examined the potential relationships among sexual functioning and femininity. As previously reported in relation to femininity, women who

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Abstract: Feminine gender role stress (FGRS) involves the cognitive appraisal of specific situations as stressful for women. While the negative relationship between stress and health has been well documented, gender specific stress has received little attention. This study sought to explore the relationships between FGRS and somatic symptoms and FGRS and sexual functioning, as well as the predictive ability of FGRS versus traditional femininity within these relationships. While FGRS and traditional femininity are based on the feminine gender role, previous research indicates that the two constructs are only weakly related. Undergraduate women from two local universities were invited to participate in this study, and data was collected either online or in person with paper copies. A total of 243 women participated in this study, of which 224 completed an adequate amount of data for analysis. Participant age ranged from 18 to 23-years-old ( M = 18.94, SD = 1.14), and the majority of participants were Caucasian (77.2%). Results of the correlation and multiple regression analyses suggested FGRS ( r = .20, p = .01; R2 = .04, adjusted R2 = .03, F [1, 153] = 6.37, p = .01), but not femininity ( r = .02, p = .41; R2 = .00, adjusted R2 = -.01, F [1, 153] = .05, p = .82), was significantly related to and a predictor of somatic symptoms. Neither FGRS nor femininity was found to be correlated with sexual functioning (r = -.11, p = .10, r = -.05, p = .32, respectively). Neither construct was a significant predictor of sexual functioning ( R2 = .01, adjusted R2 = .01, F [1, 127] = 1.68, p = .20, R2 = .00, adjusted R2 = -.01, F [1, 127] = .23, p = .63, respectively). However, this finding is questionable given participant demographics suggesting low to no current sexual activity. Interestingly, FGRS and femininity were found to be moderately related (r = .39, p = .00). Results mirror previous research in supporting FGRS as a stronger predictor of negative outcomes compared to femininity, and also suggest that gender specific stress is an important component in examining somatic complaints among women.