higher rates of sexual risk taking. In a study of 342 self-identified gay men attending a pride event in Denver, Nettles and colleagues (2009) found that more than 25 percent (n = 89) reported having ever used medication for erectile dysfunction. Among this group, there were significantly more acts of sexual risk taking. Likewise, a study involving a convenience sample of 1,186 HIV-positive gay and bisexual men in New York and San Francisco demonstrated that using medication for erectile dysfunction (n = 144) was associated with unprotected insertive anal intercourse (Purcell et al., 2005). It is important to note that these studies did not determine whether respondents who used erectile dysfunction medication actually suffered from underlying problems with sexual function. The association between the use of erectile dysfunction medication and risky behaviors may be attributable to recreational use of the drugs.

A study that used primarily the Internet to recruit participants (139 married heterosexual women and 114 lesbian/bisexual women in relationships) applied a proposed ecological model to examine sexual satisfaction among women (Henderson et al., 2009). The survey results indicated that sexual satisfaction was influenced in both groups by similar factors, including relationship satisfaction and sexual functioning, suggesting that gender may play a greater role than sexual orientation in sexual satisfaction.

Transgender people may struggle with sexual functioning problems. For example, among 181 transgender-identified participants in a sexual health seminar in Minnesota aged 20–73 (141 transgender women and 34 transgender men), 38 percent reported difficulty becoming sexually aroused, 34 percent reported low sexual desire, 28 percent had difficulty reaching orgasm with a partner, and 35 percent had difficulty reaching orgasm alone (Bockting et al., 2005b). In a sample of 50 transsexual women in Belgium who had had sex reassignment surgery at least 6 months prior to the study, concerns about sexual function were reported, related in particular to arousal, lubrication, and pain (Weyers et al., 2009). While feminizing hormones would be expected to lower sexual desire, this expectation has not been unequivocally supported by empirical research (see Klein and Gorzalka, 2009, for a review). Research on the effects of masculinizing hormone therapy on sexual functioning among transgender men is limited; however, findings to date show increased sexual arousal and orgasmic ability (Klein and Gorzalka, 2009). Orgasmic ability after male-to-female genital reconstructive surgery appears to have improved with advances in surgical technique over the years; 85 percent of a sample of 232 patients of a U.S. surgeon reported achieving orgasm, with 67 percent reporting it as pleasurable or more pleasurable than before surgery (Lawrence, 2005).

Apart from studies of sexually transmitted infections (STIs) that are relevant to reproductive capabilities, very little research has focused specifically on reproductive health among LGBT adults. Reproductive health

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