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Communicating about Sex Is Important in Generating Positive Perceptions about One’s Sexual and Romantic Life. The Last Decade Has Provided Insight into the Theoretical Applications on Sex Communication Research. While the Focus on Extant Research Focuses

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02 March 2024

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04 March 2024

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Abstract
Communicating about sex is important in generating positive perceptions about one’s sexual and romantic life. The last decade has provided insight into the theoretical applications on sex communication research. While the focus on extant research focuses on the psychological processes’ individuals employ to talk about sex, no theoretical framework exists that identifies key constructs that provides a parsimonious understanding about the communicative processes of sex and sexuality. This review sought to identified key constructs that are suitable to develop a sex talk theory. In the current project, we reviewed 24 studies including 8,698 participants (Mage = 24.98) that applied a theoretical framework to sex research. This review identified three salient constructs (e.g., disclosure, cognitive, and relational and behavioral) that are important for a sex talk theory. Last, this review indicated that scholarship should explain the relationships between the key constructs. We provided several recommendations that scholars should take when developing a theory in sex communication research.
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Subject: Social Sciences  -   Gender and Sexuality Studies
Sexual communication “is important to the development and maintenance of satisfying sexual relationships” (MacNeil & Byers, 2005; p. 170). Sex talk is grounded in open and honest communication about sexual matters, and a willingness to put one’s social identity at risk of vulnerability (Montesi et al., 2013). Sex talk also allows individuals to disclose their sexual preferences with each other (i.e., likes and dislikes; Cupach & Comstock, 1990). Research demonstrates that sex talk serves important functions in sexual and relational satisfaction (Byers & Demmons, 1999), disclosures of one’s HIV status (Bird et al., 2017) and information seeking about other’s sexual health (Afifi & Weiner, 2006). Additionally, sex talk often occurs nonverbally than verbally (pulling out a condom versus directly requesting sex; Blunt-Vinti et al., 2019), and is linked to sexual function in men and women (Roels & Janssen, 2020).
Yet not all conversations about sex may lead to positive outcomes. For example, individuals may actively avoid communicating about sex because disclosures can potentially lead to feelings of shame and embarrassment (Rehman et al., 2019), uncertainty about the dynamics of the relationship (Theiss & Estlein, 2014), and other negative emotional experiences during sex talk (Theiss & Solomon, 2007). Sex talk can also be face-threatening and generate perceptions about being less competent in making safer sex decisions (Tardy & Dindia, 2006). Thus, the ebbs and flows of sex talk is marked by how open and willing individuals are to communicate about diverse sexual topics in their relationships (Hullman et al., 2022).
Given that sex talk is imperative in close relationships, it is important to understand the various ways in which it is conceptualized and defined within research. Scholars have defined sex talk as an interactive and dynamic process that involves the exchanges of sexual messages between partners (Byers, 2011), disclosures about sexual topics (Byers & Demmons, 1999), negotiation of safer sex practices (Noar et al., 2006; Noar, 2007), assertive sex communication (Quina et al., 2000), and the quality and frequency of sex communication (Mallory et al., 2019). Indeed, scholars across the communication and psychology disciplines have proffered a variety of conceptual and operational definitions to guide their research agendas on sex talk (Widman et al., 2022). Further, when scholars do apply a theoretical framework to examine an aspect of sex talk it is unclear how communication fits into their tenets (Widman et al., 2022). As individuals often discuss various sexual topics in ongoing relationships such as in friendship (Fedd & Samp, 2023), family (Widman et al., 2016), and romantic settings (Faulkner & Lannutti, 2010), it seems logical to guide theory development to understand how interpersonal communication influences sexual health at multiple levels of analysis.
Therefore, this study provides a much-needed scoping review of sexual communication. Such a review provides a synthesis of key concepts, gaps, and sources of evidence to inform research and practice (Pham et al., 2014). We chose a scoping review because it serves to: 1) map out the body of literature in a specific area; 2) be inclusive of a greater range of study designs and methodologies; and 3) provides a descriptive overview of the reviewed studies (Pham et al., 2014). Thus, we seek to highlight and identify key concepts that explains how sex talk can improve theory building and offer practical solutions. In other words, identifying theoretical constructs to develop a sexual communication theory is warranted because it can provide a roadmap that carefully explains how and why interconnected relationships work together in a comprehensive, parsimonious fashion (Berger, 2010; Shoemaker et al., 2004).

Setting the Agenda

Scholars suggest that sexuality is a multidimensional construct that encompasses the human experiences (Sprecher, 2006). Specifically, extant research on sexuality has focused on biological, behavioral (Sprecher, 2006), emotional, cognitive (Theiss & Solomon, 2007), physiological (Denes & Afifi, 2014), and dyadic or extradyadic outcomes (Birnbaum et al., 2019; Denes & Speer, 2018). Prior studies examining sex communication have used theories such as the theory of reasoned action/planned behavior (Roberto et al., 2015), and the extended parallel process model (Witte, 1992) to name a few. Despite these advances in sexual communication research that focus on behavioral changes at the individual level (Noar, 2007), scholars have also criticized this approach because it does not consider the relational process of sexual communicative interactions (Noar et al., 2006; c.f., Theiss, 2011). Other scholars have called for interpersonal sex communication scholarship that makes logical, parsimonious predictions about sex and sexuality. For instance, Manning (2021) challenged scholars to theorize sex talk as a communicative interaction. Specifically, Manning (2021) proposes that scholars should seek to answer difficult questions about how sex talk informs interpersonal communication and relationships. Thus, this review seeks to answer Manning’s calling for theory-driven sexual communication research.
Widman et al. (2022) posits that theory-building can help our understanding of how the different components fit together to make meaning of sexual and health related outcomes. Yet it remains unclear about what components goes into a sex talk theory. Additionally, less is known about how they would work together to explain their relationships. Several communication scholars have proffered guidance to developing communication theories. For instance, scholars suggest that theory builders should advance theory by explaining the causal links between the theory and hypotheses (Berger, 2010; Roloff, 2015). Specifically, scholars should explain how the cause of one phenomenon influences the outcome of another phenomenon (Roloff, 2015). In the sexual context, research demonstrates that being primed to think about sex can influence individuals’ relational goals (Birnbaum et al., 2017). Thus, by examining the underlying mechanisms that help guide careful predictions about sexual communicative interactions, we believe this review will help guide future research to begin putting the pieces together to careful predictions about sex talk.

Method

Search Strategy

We used Widman et al.’s (2022) methodology of conducting a scoping review to guide our methodological choices. Additionally, we conducted our search of the literature in two waves using the PRISMA-ScR guidelines for scoping reviews (Tricco et al., 2018). In the first wave, we conducted a comprehensive search of Communication and Mass Media Complete, CINAHL, APA PsychINFO, Google Scholar, and the Journal of Sex Research databases to extract relevant studies that focus on communication about sex from January 1, 2010, through May 30, 2022. We chose these specific dates to identify relevant studies that examined sexual communication to guide their research efforts using a theoretical framework within the last decade.
Although Widman et al.’s (2022) scoping review did not include specific theoretical frameworks in their search terms, we included specific theories in our search strategy to generate studies that applied a theoretical framework to the study of sexual communication. Further, we did not limit our search to only relational or behavioral outcomes because recent research indicates that sex talk can influence both relational and health dynamics (Fedd & Samp, 2023; Machette et al., 2022). As such, we applied the following search terms (“sex communication” and “intimate relationships” and “dual-process model” and “sexual behaviors” and “message production” and “multiple goals theory”) or (“message processing” and “social support”). This search produced an initial 8,082 articles. In the second wave, we conducted an additional search through Google Scholar and Journal of Sex Research databases. Specifically, we searched the reference lists of the cited articles that were identified in Wave 1 to generate additional studies using similar search terms. This yielded an additional 464 articles. Together Waves 1 and 2 yielded a total of 8,546 articles.

Inclusion Criteria

Relevant studies were included if they were: 1) a quantitative only, qualitative only, or a mixed methods study that examined sexual communication in cognitive, relational, and health outcomes; 2) application of theory to the study of sexual communication; and 3) published in an English language peer-refereed journal. Studies were excluded if they were a duplicate of the same articles identified in Waves 1 and 2. Additionally, articles were excluded if they were a theoretical essay, thematic analysis, systematic literature review, scoping review, meta-analysis, persuasive health campaigns, media, dissertation, and no focus on sex communication or relational dynamics. These criteria resulted in a final sample of 24 articles. Figure 1 provides a diagram of the PRISMA-ScR.

Data Extraction

Two of the authors doubled coded the studies to extract demographic and study characteristics (e.g., gender, age, sample size, and sexual orientation). We also coded for the sexual health context of the study (e.g., sexual health communication), and the study design (e.g., quantitative only, qualitative only, or mixed methods). Further, we coded for communication outcomes, and major themes that emerged from each study (e.g., condom use social norms) that are discussed below. We coded for key factors we thought would complement a sexual communication theory (e.g., disclosure, cognitive processing). Lastly, we coded for the type of communicative dynamics (e.g., relational-focused, health-focused without intervention, and health-focused with intervention).

Results

Sample and Study Characteristics

Table 1 provides a summary of the sample characteristics from studies that are included in the current scoping review. A total of 8,698 participants (mean age = 24.98, SD = 9.49) were enrolled across 24 studies that assessed sexual communication using theory-driven approaches (see Table 2 for complete list of studies). Twenty-two studies (91.7%) were conducted in the United States. Studies were also conducted in Canada and China. Majority of the studies (87.5%) were quantitative, two (8.3%) were mixed methods, and one (4.2%) were qualitative.
For participant demographics, 16 studies included both cis-gender women and men in their samples. Over half of the studies focused exclusively on heterosexual participants and/or had more female participants than male participants, one study included mixed cis-gender women and sexual and gender minority samples (Rubinsky & Cooke-Jackson, 2018), 2 included individuals identifying as heterosexual or a sexual and gender minority in their samples (Knobloch & Theiss, 2011; McManus & Lucas, 2018), and 5 studies focused solely on women (Cornaccione & Smith, 2017; Curran et al., 2016; Francis et al., 2021; Li et al., 2018; Mou et al., 2020). Additionally, only one study did not include participants’ sexual orientation in their samples (Lui et al., 2021). Further, participants across studies were single (54.2%), dating (29.2%), married (8.3%), or they did not include the participants’ relational status (4.2%). In sum, participants were relatively racially/ethnically diverse across all 24 studies and with few outside the U.S. context.

Theories Guiding Sexual Communication Research

The 24 studies included in this review included a theoretical framework to examine an aspect of communicating about sex and sexuality. Specifically, these studies directly tied a theory to guide their hypotheses and research questions. The theories that were referenced the most were (16.7%) the multiple goals theory (Cornaccione & Smith, 2017; Li et al., 2018; McManus & Lucas, 2018; Mongeau et al., 2004), (8.3%) cognitive-emotional theory of esteem-supportive messages (Holmstrom et al., 2021; Shebib et al., 2020), (8.3%) the theory of motivated information management (Afifi & Weiner, 2006; McManus, 2020), and (8.3%) dual-process theory of supportive communication (Burleson et al., 2011; Holmstrom et al., 2015).
Additional studies that took a theory-driven approach to answer their hypotheses and questions about sexual communication were communication theory of identity (Rubinsky & Cooke-Jackson, 2018), congruence hypothesis (Nan, 2012), ecological model (Albritton et al., 2014), family communication patterns and affectionate exchange theory (Horan et al., 2018), integrative model of behavioral predictions and theory of gender and power (Francis et al., 2021), information-motivation-behavioral skills model (Mou et al., 2020), indirect effects model (High & Solomon, 2016), prospect theory (Nan et al., 2019), relational uncertainty (Knobloch & Theiss, 2011), social skills deficit hypothesis (Curran et al., 2016), socioemotional theory (Liu et al., 2021), and theory of planned behavior (Simms & Byers, 2013).

Context of Sexual Communication Research

Across all 24 studies scholars have examined a wide variety of contexts to examine sex talk interactions. For instance, studies have examine seeking information about one’s sexual health (Afifi & Weiner, 2006), risky sexual behaviors among African American women (Curran et al., 2016), how messages are framed to increase knowledge about HPV vaccinations (Nan, 2016), and how romantic partners initiate sex (Simms & Byers, 2003). Additionally, scholars have examined how sexual health intervention generate conversations about safer sex practices among African American women conversations (Francis et al., 2021), and how family communication patterns influence conversations about sexual risks and safety. Table 2 provides additional information regarding contexts of sex communication research.

Communicative Outcomes

The majority (29.2%) of the studies within this review examined social support (Brisini et al., 2022; Burleson et al., 2011; Cornaccione & Smith, 2017; High and Solomon, 2016; Holmstrom et al., 2015; Holmstrom et al., 2021; Shebib et al., 2020), sex/sexual behaviors (e.g., condom use) (Francis et al., 2021), sexual risk communication (Albrittion et al., 2021; Curran et al., 2016; Horan et al., 2018), safer sex communication (Mou et al., 2020), Information management (Kuang & Kettings, 2011; McManus, 2018), and language use/(un) scripted sex communication (Li et al., 2018). Additional studies focused on conceptualizations of sex and sexual health (Rubinsky & Cooke-Jackson, 2018), community-level perceptions regarding HPV vaccination (Nan et al., 2019), and longitudinal effects on relationship talk (Knobloch & Theiss, 2011).

Sexual Communication as an Interaction and Dynamic Process

Given the various ways in which sexual communication research has been operationalized, we identified salient factors that re-occurred across the studies. Specifically, studies focused social skills (Li et al., 2018; Nan et al., 2019), gendered-based messages (Mou et al., 2020), relational support (Burleson et al., 2011), self-efficacy (High & Solomon, 2018), and difficult sex topics (McManus & Lucas, 2018).

Key Constructs in Sex Communication Research

Across all studies we identified key constructs that are useful to guide a roadmap to beginning making predictions about sex talk in a comprehensive manner. Most of the studies focused on aspects of disclosures about sex and how it influences condom negotiation strategies (Li et al., 2018), individuals’ ability and willingness to disclose sexual health information (Afifi & Weiner, 2006), and women disclose more information about sex than men regarding a sexual health threat (Albritton et al., 2014).
Another component that has been identified across studies is cognitive evaluations about sex talk. Specifically, studies examined how individuals evaluated the costs/benefits of seeking sexual health information (Afifi & Weiner, 2016), individuals’ perceptions about sex influence their conversational behaviors (Curran et al., 2016), and individuals’ responses towards framed messages (i.e., gain-frame, loss-frame) is influenced by their cognitive schema (Nan et al., 2019). We identified an additional component label other. Because sexual communication research is multidimensional, we did not want to specify a particular construct that may limit the theory’s reach to other contexts of sex talk. Across all studies scholars suggest that sexual health interventions should focus their efforts on improving individuals’ social skills when communicating about sex (Curran et al., 2016), and a comprehensive theory is needed to explain how and why individuals respond to certain supportive messages and not others (Holmstrom et al., 2015). Additional studies indicated that sex interventions should address how the usage of personal pronouns may influence their formative research process (Li et al., 2018), and more population specific tailored sex interventions (Nan et al., 2019).

Discussion

This scoping review of the sexual communication literature revealed 18 theory-driven approaches across 24 studies. This project included over 8,000 individuals across 3 countries. Our review revealed the need for future theory-driven sexual communication research, as a theory-driven approach can advance research on how individuals’ think and communication about sex and sexuality. The 24 studies reviewed included a focus on interpersonal and health contexts, various communication outcomes, and key constructs to guide sexual communication research. Below, we highlight our findings regarding areas of opportunities for sexual communication research and discuss recommendations for future work.

Application of Theoretical Frameworks

This review suggest that sexual communication research relies heavily on socio-psychological theories to make predictions or give an explanation about sex and sexuality. For instance, results indicated that sex talk is a goal-driven process (i.e., desired-end state; Li et al., 2018) that can influence how individuals manage sexual information. Specifically, individuals may be driven to pursue multiple sex goals (e.g., task, identity, and relational; McManus & Lucas, 2018), when managing information about others’ sexual health (Afifi & Weiner, 2006).
Additionally, this study revealed that individuals’ sexual identities, behaviors and attitudes are influenced by their interpersonal relationships (Rubinsky & Cooke-Jackson, 2018; Simms & Byers, 2013). While the theories have examined cognitive factors of sex research, most of these studies relied solely on individual-level perspectives. This may be problematic from a theory-building perspective because while sex talk is defined as an interactive process that involves to interactants (Byers, 2011), research continues to examine individual-level processes. Future research can greatly benefit from theories that make predictions about dyadic-level interactions.

Contextualizing Sex-Talk Research

Sexual communication research is context-specific and is influenced by what and how individuals communicate about sex and sexuality. Stated differently, conversations about initiating sex (Simms & Byers, 2013) may have different systematic processes through which individuals may have conversations about HPV vaccinations (Nan, 2012). Moreover, most studies appear to focus on how conversations about sex may influence individuals’ sexual behaviors. Indeed, positive conversations about sex between close others can lead greater safer sex practices (Francis et al., 2021). Yet, supportive others’ sexual health expertise can also generate positive supportive messages for support seekers (McManus, 2020). However, there are notable limitations that need to be discussed. Most of the studies focused on individuals who were assumed to be single individuals. This severely limits ecological validity, as individuals in ongoing relationships may have different concerns about sexual conversations than individuals who may be casually dating. The nature of how individuals think their relationships are intertwined with how they communicate with each other (Knobloch & Theiss, 2011). Research should continue to examine how sexual communication influences the foundation in which individuals are involved within the relationships.

Theoretical Tenets to Guide Development of a Sex Talk Theory

The findings of this review provided a clear argument for scholars to begin developing a sex talk theory. The most salient construct that has been identified through this project is disclosure. Most studies within this review conceptualized disclosures about sex as a process that involves individuals’ ability and willingness to talk about sex. From a theoretical standpoint, this makes sense because prior theory suggests that individuals may employ numerous strategies to disclose or gain information about each other (Chaudior & Fisher, 2010; Baxter & Wilmot,1985; Omarzu, 2000). For instance, the Risk Revelation Model (RRM; Steuber, 2009) assumes that decisions to reveal information is grounded in communicators’ assessments of how individuals may response to the revelation and the potential negative consequences that will follow from such revelations. Additionally, individuals may set privacy boundaries around how much or little information is shared. If an individual perceives that the other may have a negative reaction to revelation, then they will reveal less. On the other hand, if they perceive that the receiver of the message is open and acceptive of such revelation, then they will reveal more (Afifi & Steuber, 2009). While disclosure, as a global construct, was identified as a main tenet of a sex talk theory, studies within this review also examined dimensions of disclosure such as communication efficacy, target efficacy (Afifi & Weimer, 2006) and sex communication self-efficacy (Curran et al., 2016). However, it is unclear about the role of disclosure in the theory-building process. Does it serve as an antecedent, intervening, or outcome variable? Does it unfold across a conversation? Or is it a self-regulating process that explains communication phenomena? These are important questions to ask because it will help to provide a clearer roadmap to understand what processes and outcomes influence sex talk interactions. Future research should seek to continue providing theoretical clarity about how and why disclosure influences sex communication outcomes, and why they may have the intended or unintended effects (Berger, 2010), to understand sex and sexuality. Perhaps Li and colleagues’ line of research (Li & Samp, 2018; Li & Samp, 2019; Li & Samp. 2020) may offer an additional avenue to understand the processes and outcomes of sex disclosures.
An additional construct identified from this review is cognitive evaluations about sex communicative interactions. Notably, these studies focused on appraisals about the potential benefits/risks of engaging in sexual behaviors. Theoretical frameworks such as the Elaboration Likelihood Model (ELM; Petty & Cacioppo, 1986) and the Heuristic-Systematic Model (HSM; Chaiken, 1980) both specify that individuals devote cognitive effort towards messages that are highly persuasive than less persuasive resources. When individuals perceive that they have the cognitive resources (e.g., ability and motivation) to process certain messages they will thoroughly evaluate the positive or negative outcomes of the message (High & Solomon, 2016; Holmstrom et al., 2021; Liu et al., 2021). Most studies in this review relied on self-reported surveys, which could lead to participant bias and overestimation of cognitive, behavioral, and communicative assessments. While self-reported measures have its merits and limitations (Haeffel & Howard, 2010), scholars propose that combining the strengths of self-reported measures with behavioral assessment may provide a richer perspective of the communicative processes’ individuals navigate when discussing sex (Widman et al., 2022). This can greatly strengthen the support for a sex talk theory.
A final goal of this review was to identify a third construct to advance theory and research in sexual communication. This review revealed a clear focus on what outcome variables were salient for their research programs. As discussed earlier, we included studies that applied a theory to understand how individuals’ sex and sexuality influence how they communicate about difficult topics. In instances where studies focused on relational dynamics in interpersonal settings, the outcomes of interest centered around support quality (Brisini et al., 2022), first date goals (Mongeau et al., 2004), durable effects of relational talk (Knobloch & Theiss, 2011), receiving supportive messages about a sex uncertainty (McManus, 2020), and esteem-supportive messages from close others (Holmstrom et al., 2021). On the other hand, most of the studies focused on a sexual behavioral outcome (e.g., Albritton et al., 2014; Horan et al., 2018; Kuang & Gettings, 2011). While this not only limits theoretical advancements for sex research, it may also limit insight into what relational factors may have a direct association with, intervene between, and/or have a moderating effect on behavioral outcomes. A similar argument can be made about the association between sex behaviors and relational dynamics. However, this area has received limited research because scholars typically devote their theoretical attention to explaining the psychological processes and outcomes about sex (Impett et al., 2014; Muise et al., 2018), without addressing the communicative processes about sex and sexuality. Future sex research should strongly consider their theory-building efforts on how the nuance of communication influences their sexual and relational behaviors. This will guide research agendas to strengthen the sub-discipline of sexual communication.

Limitations and Future Directions

This scoping review sought to provide the argument that theoretical advancements can be made to explain or make predictions about sex and sexuality. While the efforts of this review are noteworthy, there are glaring limitations that need to be addressed. First, studies identified within this review were conducted in the U.S. Additionally, we limited our focus on studies published in English. This leaves a large gap in the understanding of how communication about sex in other parts of the world are different. Further, participation came from individuals’ who identified as being heterosexuality. While a few studies in this review focused on sexual and gender minority individuals, sexual minorities navigate sex and sexuality differently than their heterosexual counterparts. Research should continue advancing theory on research surrounding sexual and gender minorities populations. This will help in integrating their unique experiencing in providing a roadmap to understand their communicative processes. Another limitation of the review was that cultural norms and expectations were not highlighted. While several studies were inclusive of how one’s culture and sexual norms influence their sexual decision-making, this was not as clear across all studies. Future, research is needed in this area to inform us on how cultural influences the relationship among theoretical constructs.

Conclusion

This project provided insight on theoretical applications on sex communication research, and identified key constructs that future research should take up to begin making theory-driven predictions or explanations about sex. While there are lingering questions that this review did not consider and addressed, we attempted to generate a potential roadmap to begin developing a sex talk theory. We hope that future research continues forging the path to challenge current notions about sex and sexuality and provide a clearer understanding about the importance of communication in our everyday lives.

Conflicts of Interest

We have no known conflicts of interest to disclose.

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Preprints 100384 g001
Figure 1. A diagram of the PRISMA-ScR.
Figure 1. A diagram of the PRISMA-ScR.
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Table 1. Study sample and characteristics (n = 24 studies).
Table 1. Study sample and characteristics (n = 24 studies).
n %
Gender
  Female only 5 20.8%
  Female and sexual minorities 1 4.2%
  Men and women 16 66.7%
  Did not specify gender identity 2 8.3%
Sexual Orientation
  Heterosexual onlya 13 54.2%
  LGB 3 12.5%
Relational Type
  Single 13 54.2%
  Married 2 8.3%
  Dating 7 29.2%
  Parent-Child 1 4.2%
  Did not specify 1 4.2%
Race/Ethnicity
  Black/African American Onlyb 4 16.8%
  White 17 70.8%
  Hispanic/Latin(x)(a)(o) 15 62.5%
  Asian/Asian American 12 50%
  Black/African American 14 58.3%
  Native American 4 16.8%
  Otherc 12 50%
Country
  U.S. 22 91.7%
  Non-U.S. study 2 8.3%
a “Heterosexul only” was coded for studies that did not specify the sexual orientations of their partners and thus assumed by the researchers to focus on this particular population. b “Black/African American only” was coded for studies this sampled this population. c “Other” was coded for participants that did not specify their race/ethnicity and participants that were coded as other across the studies.
Table 2. Overview of systematic studies.
Table 2. Overview of systematic studies.
Study Authors Theory Context/Topic Study Design Sample Size Communicative Outcome Themes Main Findings
Afifi & Weiner (2006) TMIM Information-seeking about sexual health problem Quantitative (wave 1 and wave 2 individual survey)
129 males; 136 females		 Experimental (n = 92), control group (n = 97), or no-pretest group (n = 77) Information-seeking about sexual health Measured components of efficacy
Sexual assertiveness
Sexual decision-making
 Disclosure
Ability and willingness to disclose sexual health information.
Cognition
Evaluation of cost/benefits analysis of seeking sexual health information.
Other
Develop theory that examines ability and willingness to produce messages; examine perceptual bias.
Albritton et al. (2014) Ecological Model Sexual risk communication among young pregnant couples Quantitative (cross-sectional dyadic survey)
 296 expecting couples
 Sexual risk communication Individual, interpersonal, and social level factors
 Disclosure
Women disclose more sexual information than men.
Other
Interventions to improve sexual communication skills.
Brisini et al. (2022) RTT Relational turbulence and supportive messages Quantitative (cross-sectional individual survey) 479 individuals Support quality Relational/social support
Psychological reactance
Person-centered messages		 Disclosure
Ability and willingness to disclose issue to a relational source.
Cognition
Chaos influence evaluation about the meaning of supportive messages.
Other
Supportive others should engage in perspective taking.
Burleson et al. (2011) DPT of Supportive Communication Processing supportive messages Quantitative (cross-sectional individual survey) 207 individuals (i.e., study 1); 103 individuals (i.e., study 2) Comforting messages (i.e., study 1); grief management messages (i.e., study 2) Processing ability; relational/social support
 Cognition
Women’s ability and motivation to process supportive messages higher than men.
Cornaccione & Smith (2017) Multiple Goals Perspective Women on probation and parole officers Quantitative survey; open-ended questions 402 women in quantitative; 394 women in qualitative Difficult issues/needs Relational/social support
Primary and secondary goals		 Other
Situational factors influence how women initiate conversations with parole officers.
Curran et al. (2016) Social skills deficit hypothesis Sexual risk among African American women Quantitative (cross-sectional individual survey)
 557African American women Sexual risk communication Sexual communication self-efficacy Destructive conflict tactics Social skills
 Disclosure
Negative psychological factors decrease sexual communication self-efficacy.
Cognition
One’s own and communicative partners’ communication influence their conversational behaviors
Other
Sexual health interventions should address social skills with main partners.
Francis et al. (2021) IMBe and TGP Sexual health intervention to generate conversations among Black women Mixed methods 105 women (survey)
10 women (interview)		 Intervention to examine condom dispenser uptake Relational partners matter
Examine condom use social norms		 Other
Communication partners, content, mode, valence, and impact influenced positive interaction with condom dispenser.
High & Solomon (2016) Indirect Effects Model (dual-process theory) Long-term effects of supportive messages Quantitative (cross-sectional dyadic survey) 255 dyads Message evaluations and message outcomes, respectively Cognitive awareness
Sex differences in cognitive processes
 Cognition
Thorough scrutiny of supportive messages is influenced by higher levels of communicative ability and motivation.
Holmstrom et al. (2015) DPT of Supportive Communication Testing the complex interactions of source, message, contextual, and recipient constructs Quantitative (cross-sectional individual survey)
 328 individuals Perceived support availability and
Severity of problem on support quality, respectively		 Relational status with recipient
Environmental cues
Memory		 Cognition
The severity of the problem and perceived support availability influence motivation to process supportive messages.
Other
Comprehensive theory is needed to explain how and why supportive messages have the effects they do.
Holmstrom et al. (2021) CETESM Emotion-focused versus problem-focused esteem messages Quantitative (cross-sectional individual survey)
 173 individuals Esteem-supportive messages Message content
Style of message
Degree, quantity, and relevance		 Disclosure
Discussing esteem threatening situation and receiving emotion-focused esteem support influence greater state self-esteem.
Cognitive
What supportive others say has an impact on support recipients’ appraisal about the potential damage to their self-esteem.
Horan et al. (2018) FCP and AET Family communication patterns, sexual communication, and young adults’ safety/risks Quantitative (cross-sectional individual survey)
 195 individuals Sexual risk communication Communication patterns
Communication about sex in families		 Disclosure
Conversation orientations predict better open and are less avoidant to communicate about sex topics with parents.
Knobloch & Theiss (2011) Relational Uncertainty Relational uncertainty influence on relationship talks Quantitative (cross-sectional dyadic survey) 135 dyads Longitudinal effects of relationship talk Perceived threats to relationship
Examining sensitive topics		 Other
Relational uncertainty and relationship talk is a dynamic process that changes over time.
Kuang and Gettings (2011) TMIM Uncertainty discrepancy and information management Quantitative (cross-sectional individual survey) 248 individuals Information management in sexual communication Examined how relational assessments moderate the associations of TMIM variables Disclosure
Relational factors (i.e., marital quality, closeness, and communal coping) influence information management strategies.
Cognitive
Reappraisal of information
Li et al. (2018) Multiple Goals Perspective Sexual negotiation goals and goal pursuit Quantitative (cross-sectional individual survey) 193 African American women Language use in sexual settings Self-oriented goals
Other-oriented goals
Relational goals		 Disclosure
Language choice influence relevance of condom negotiation strategies.
Other
Sexual health interventions should consider the usage of personal pronouns in formative research efforts.
Liu et al. (2021) SST Promoting behaviors from a cognitive and emotional perspective Quantitative (cross-sectional experimental survey) 80 individuals Framed health messages Mental representation
Perceived effectiveness
Message processing		 Cognitive
Loss-framed messages took longer to process that gain-framed messages.
Cognitive processes influence emotional responses to framed health messages.
McManus (2020) TMIM Information management and sexual health expertise Quantitative (cross-sectional individual survey) 424 individuals Support provision about sexual health uncertainty Communication and coping efficacy
Experience
Expertise		 Disclosure
Communication and target efficacy have different effects on evaluation of support provision.
Providers with more expertise provided less blame support.
McManus & Lucas (2018) Multiple Goals Perspective Multiple communicative goals in friend’s sex talk Quantitative (cross-sectional individual survey) 139 individuals Received support (i.e., information, tangible, and nurture) Stigmatizing sex-related concerns
Interaction goals		 Other
Goals serve multiple functions in evaluating the meaning of messages about a sex-related concern.
Goal interference is influenced by goal importance.
Mongeau et al. (2004) Multiple Goals Perspective First date goals Quantitative (cross-sectional individual survey) 144 individuals (study 1)
241 individuals (study 2)
218 individuals (Study 3)		 Communicative goals
 Sociobiological sex differences (Study 1-3)
Scale development (study 2)
Situational context (study 3)		 Other
Across all three studies individuals aim to reduce uncertainty during first dates.
Multiple goal structures influence subsequent communicative interactions.
Mou et al. (2020) IMB Behavioral skills model to examine condom use Quantitative (cross-sectional individual survey) 1,247 female individuals Safer sex negotiation skills Culture, context, and agency
Sexual assertiveness
Gender roles		 Other
Contraceptive information and motivation influence safer sex practices.
Gender roles influence holding traditional sexual values.
Nan (2012) Congruence Hypothesis HPV vaccine message frames Quantitative (cross-sectional individual survey) 229 individuals HPV vaccination intentions Behavioral intentions
Motivational behaviors
Gender
Efficacy		 Cognitive
Avoidance-oriented individuals preferred more loss-frame messages than gain-frame individuals.
Other
Women were more concerned about HPV vaccine safety than men.
Nan et al. (2019) Prospect Theory HPV vaccination policy and African Americans parent support Quantitative (cross-sectional individual survey) 211 individuals HPV vaccine mandates Perceived risk
Persuasion		 Cognitive
Individuals’ cognitive response to gain- and loss-frame messages is influenced by their construal.
Other
Health communication interventions should consider how specific populations consider future consequences regarding health behaviors.
Rubinsky & Cooke-Jackson (2018) Communication Theory of Identity Conceptualiza-tion of sex and sexuality Qualitative study (open-ended questions) 186 women and gender minorities Define sex, sexuality, and sexual health Gender
Emotional health
Sexual identity
Framing of sexual scripts		 Disclosure
Expressions of sexuality influence how people identify with sex talk (i.e., personal, enacted, and relational identity).
Other
Emotional experiences shape how individuals define sex.
Women and gender minorities define sex as an activity and identity.
Shebib et al. (2020) CETESM Gender and sex differences in the provision of esteem support Quantitative (cross-sectional individual survey) 396 individuals Quality of esteem supportive messages Gender differences
Sex differences
Emotion-focused
Problem-focused		 Disclosure
Females and individuals high in femininity produce highly emotional-focused messages.
Biologically, females endorsed more problem-focused message to male support recipients.
Cognitive
Females and individuals high in femininity more frequently experience multiple cognitions and emotions associated with esteem threats.
Simms & Byers (2013) Theory of Planned Behavior Sexual initiation behaviors of romantic partners Quantitative (cross-sectional individual survey) 151 individuals Sexual initiation behaviors Gender
Social norms
Attitudes
Behavioral intentions		 Cognitive
Positive perceptions regarding partner approval and intentions influence sexual initiation outcomes.
Sexual frequency associate with positive relational outcomes.
Other
Men endorsed more permissive sexual behaviors than women. Aligning with traditional sexual scripts.
Notes. TMIM = theory of motivated information management; RTT = relational turbulence model; DPT = dual-process theory, IMBe = integrative model of behavioral prediction; TGP = theory of gender and power; CETESM = cognitive-emotional theory of esteem-supportive messages; MGT = multiple goals theory; FCP = family communication patterns; AET = affective exchange theory; SST = socioemotional theory; IMB = information-motivation-behavioral skills model.
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