Amanda N. Gesselman

The emergence of a marketplace for digital sexual content has expanded opportunities to meet sexual needs, but emerging research suggests that these interactive spaces could also facilitate emotional intimacy and connection. In this scoping review, we focus on erotic webcam modeling sites (“camsites”) as a context in which sexual commerce and relational processes interact. Synthesizing emerging empirical work, we provide an overview of camsites and the features that allow many customers and performers to develop personal, meaningful relationships. We also introduce the Relational Continuum Model of Digitally Mediated Intimacy, which proposes that customer–performer interactions can range from impersonal viewing of sexual content with very little interaction to familiar, mutual, and emotionally consequential bonds. We discuss how platform features, individual differences, and societal stigma could impact progression along this continuum by influencing whether those emotional bonds are perceived as authentic. Finally, we review evidence suggesting that customer–performer interactions and emotional intimacy could produce effects beyond the camming platform, including impacts on offline romantic and sexual relationships. Altogether, this review aims to demonstrate the relational elements underlying some commercial sexual interactions, and provide a framework for understanding how intimacy is pursued, understood, and maintained in these digital spaces.

BACKGROUND: Epilepsy is a chronic neurological disease affecting more than 3.5 million Americans. Epilepsy requires lifelong self-management, the most important predictor of epilepsy-related outcomes. There is a lack of epilepsy self-management interventions that comprehensively address psychological motivations underlying self-management: autonomy, competency, and relatedness. Most existing interventions specifically focus on autonomy and competence via self-efficacy and/or patient activation; while somewhat effective, their effects wane over time. A more comprehensive intervention that addresses all 3 components of motivated behavior, including relatedness, is needed. We developed an intervention targeting autonomy, competence, and relatedness—in the form of intimate relationship satisfaction—to improve epilepsy self-management in people with epilepsy. Because no similar interventions exist, we implemented a mini-Delphi technique to garner perspectives on our intervention from invested parties before formal testing. METHODS: The Delphi technique gathers evaluations on a new method through repeated rounds of discussion with experts or other invested parties. These repeated discussions lead to gradual improvement until all participants agree that the method is satisfactory. We established 2 advisory boards of invested parties: 1 with professionals (eg, a Clinical Nurse Specialist) and 1 with people with epilepsy. Advisory boards reviewed the intervention and provided qualitative and quantitative feedback. RESULTS: Advisory board members’ feedback provided guidance on inclusion criteria, participant compensation, intervention timelines, and content structure. After iterative revisions and rounds of feedback over a 3-month period, all members gave the finalized version of the intervention a highly positive evaluation. CONCLUSIONS: Guidance from the advisory boards allowed us to refine intervention content, delivery structure, and implementation strategies. The mini-Delphi technique provided a practical advantage in our development process, offering a low-cost, efficient way to obtain meaningful feedback from a diverse group of people with varied expertise and lived experience.

BackgroundRecent increases in the use of glucagon-like peptide-1 receptor agonists (GLP-1s) have generated widespread public interest in their physical and psychological effects, yet little research has examined how these medications may shape romantic and sexual experiences.AimThe present study investigated associations between GLP-1 use for weight loss and dating outcomes, sexual experiences, and perceived stigma among single adults in the United States.MethodsParticipants were 2,002 demographically representative single adults residing in the United States who completed measures assessing GLP-1 use, perceived changes in dating and sexual experiences, and concerns about judgment related to medication use.OutcomesPrimary outcomes included perceived changes in dating experiences, sexual experiences, confidence, sexual functioning, and stigma associated with GLP-1 use.ResultsOverall, 7.7% of participants reported using GLP-1 medications for weight loss in the past year. Among users, approximately one-third reported improvements in their dating lives and sex lives, although substantial variability emerged across outcomes. Some participants reported increased confidence, greater dating engagement, improved sexual functioning, and enhanced body comfort, whereas others reported reduced dating interest, lower confidence, or worsened sexual experiences. Gender differences also emerged. Men were more likely than women to report increases in dating confidence, changes in dating behavior, improvements in sexual functioning, and greater concern about being judged for using GLP-1 medications. Women were more likely to report no changes in sexual outcomes and lower concern about stigma.Clinical TranslationHealthcare and mental health professionals should recognize that GLP-1 medications may meaningfully shape patients’ romantic confidence, sexual experiences, and stigma concerns, highlighting the importance of addressing psychosocial and relational changes, not just physical outcomes, when initiating and managing GLP-1 treatment.Strengths and LimitationsStrengths of the study include the use of a large, demographically representative sample and the examination of an emerging but understudied topic related to sexuality and relationships. Limitations include cross-sectional design, reliance on self-reported outcomes, and inability to determine causal associations between GLP-1 use and relational or sexual experiences.ConclusionThe findings suggest that the relational and sexual consequences of GLP-1 use are heterogeneous and embedded within broader gendered, relational, and sociocultural contexts.

The COVID-19 pandemic has profoundly affected various aspects of personal life, including romantic relationships. While existing research has explored the pandemic’s impact on relationship quality and behavior, little attention has been given to the influence of the pandemic on infidelity. This study aims to explore how the COVID-19 pandemic may have influenced both the increased desire for and the actual engagement in infidelity among individuals in relationships, with a particular emphasis on parents. We conducted a cross-sectional survey of romantically partnered U.S. adults (N = 1,070), to examine self-reported increased desire for and engagement in infidelity. Using linear and binary logistic regressions, we investigated how parental status (parent vs. non-parent) affected this desire or engagement, with gender (men vs. women) included as a moderating variable and controlling for the occurrence of one or more stressful relationship events during the COVID-19 pandemic. Our findings indicated that parents (vs. non-parents) reported increased desire for, and engagement in, infidelity; men also reported increased desire and engagement than did women, but gender did not moderate the links between parental status and infidelity. These results suggest that parents and men may be especially vulnerable to high stress like that brought about by the COVID-19 pandemic; these individuals and their current romantic relationships may benefit from targeted social support.

Background: Telemedicine is an important way to fill in the access gap to in-person health care services during challenging times like pandemics. Objective: This study aimed to investigate the role that telemedicine played during the COVID-19 pandemic by multicountry comparison of the use of telemedicine prior to and during the pandemic. Methods: This study analyzes data from the second wave of the International Sexual Health and Reproductive Health study. This included data collected between April 2021 and July 2022 in 8 countries, including Armenia (n=296), Egypt (n=889), Germany (n=138), Moldova (n=311), Nigeria (n=205), Portugal (n=951), Singapore (n=13), and Spain (n=54). This study covered sociodemographics, sexual and reproductive health (SRH), and telemedicine use. Descriptive statistics and multilevel modeling were used to assess the factors influencing the use of telemedicine. Results: Overall, 2857 participants were recruited. Approximately 57.6% (n=1646) of participants had never used telemedicine prior to COVID-19 measures, while 45.9% (n=1311) of participants required health care but reported not using telemedicine services following the introduction of COVID-19 measures. In high-income countries, the most common mode reported was audio-based telemedicine services, with 283 (71.8%) and 417 (73.5%) participants doing so before and during COVID-19, respectively. This was followed by text-based telemedicine services, with 152 (38.6%) and 173 (30.5%) participants doing so before and during COVID-19, respectively. In low- to middle-income countries, many participants also reported using audio-based telemedicine services, with 288 (35.3%) and 237 (40.8%) participants doing so before and during COVID-19, respectively. This was followed by chat-based telemedicine services, with 265 (32.4%) and 217 (37.3%) participants doing so before and during COVID-19, respectively. Multilevel modeling revealed that those who were older (adjusted odds ratio [aOR] 0.99, 95% CI 0.99-1.00) and were in countries with a higher gross domestic product per capita (aOR 0.99, 95% CI 0.98-1.00) were less likely to have ever used telemedicine. Participants who were of male sex assigned at birth (aOR 0.79, 95% CI 0.65-0.96) were less likely to use telemedicine during the pandemic. Participants who perceived that they were worse off financially were more likely to have switched to telemedicine during COVID-19 (aOR 1.39, 95% CI 1.02-1.89) and were more likely to report having a poor or fair experience of telemedicine services (aOR 1.75, 95% CI 1.34-2.29). When sexual orientation was included in the model, nonheterosexual individuals were more likely to ever use telemedicine prior to COVID-19 (aOR 1.35, 95% CI 1.08-1.69), more likely to have used telemedicine during COVID-19 (aOR 1.58, 95% CI 1.24-2.02), and more likely to have switched to telemedicine during COVID-19 (aOR 1.55, 95% CI 1.09-2.21). Conclusions: Telemedicine played a key role in addressing health care needs during the COVID-19 pandemic. Age, sex, economic status, and sexual orientation influenced its use.

A significant portion of U.S. men experience body dissatisfaction, which can be harmful and limiting to their overall quality of life and well-being. Positive interactions, especially those occurring in the context of sexual behavior, have the potential to enhance men’s body self-perceptions. In this study, we explored the impact of engagement with erotic camsites on men’s comfort with their own bodies via web-based survey. A sample of 5,828 predominantly heterosexual, cisgender men recruited from LiveJasmin.com reported their demographics, camsite behaviors, and whether camsite use increased their body comfort. Our findings revealed that 19% of participants (n = 1,088) reported increased body comfort. We thematically coded qualitative responses to identify mechanisms for increased comfort. Key mechanisms included receiving positive feedback from models (i.e., performers), engaging in self-exposure on video, discussing body and sexual preferences with models, and experiencing perspective shifts. These results provide preliminary evidence that camsites are interactive environments in which feedback and self-expression might positively influence body comfort. While these findings suggest potential benefits, they also raise questions about the broader implications of such digital interactions for body image, highlighting the need for further research to understand the complexities of these technologically-mediated spaces.

Assessing the relationships between emoji use and traits related to communication and interpersonal skills can provide insights into who employs emojis and the psychological mechanisms underlying computer-mediated communications. This online study investigated associations between emoji use frequency, attachment style, and emotional intelligence across genders and relationship types in a Mechanical Turk sample of 320 adults (≥18y; 191 women, 123 men, and 4 transgender individuals). Correlational analyses showed that emotional intelligence was positively related to emoji use with friends, while avoidant attachment was negatively related to emoji use with friends and dating or romantic partners. This pattern of associations varied across genders and relationship types, with women using emojis more frequently than men with friends and family. Such findings suggest that individuals higher on emotional intelligence with secure attachment may employ emojis more frequently across contexts where more conventional non-verbal cues are lacking. These findings are important given the prevalence of virtual communications in our everyday lives.

While early uses of technology in the sex industry centered on increasing accessibility to pornography or expanding advertising opportunities for direct service sex workers, the growing prevalence of personalized, platform-based sexual technologies reflects the postindustrial paradigm of sexual labor in which "authentic" emotional and physical connection is increasingly prioritized. In this study, we explored how erotic webcam modeling platforms (e.g. LiveJasmin) exemplify "bounded authenticity" by offering clients an experience of "genuine" intimacy that is nevertheless constrained by both its transactional nature and technological reality. We conducted a web-based survey of LiveJasmin clients (N = 2,047) in 2020. We assessed participants' perceptions of the authenticity of their emotional bonds with models - and the boundaries that potentially constrain these relationships - via quantitative and qualitative measures. Quantitative results revealed that 65% of participants reported having ever experienced an emotional bond with a model, with over half of participants (51.6%) reporting that they believed the models cared about their lives outside the platform. Providing nuance to these findings, qualitative results illustrated the ways in which participants' perceptions of the emotional authenticity and boundaries of these relationships varied, with participants reporting a range of experiences that extended from perceived "real" connections to those that feel transactional and hollow, but nevertheless shaped by the platform. Our findings ultimately underscore how camsite clients' perceptions of these relationships mirror the tension between desiring genuine feelings of emotional intimacy from the models and the market and technological constraints of these experiences.