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Sexual Relationships in Hispanic Countries: a Literature Review

Sexuality is a complex dimension for which culture seems to play an important role, particularly in countries that are more traditional. This review summarizes the knowledge about sexual relationships in Hispanic countries, considering sexual debut, attitudes, behaviors, and satisfaction. In line with the literature reviewed, the sexual double standard seems to be continuing to influence sexual relationships. Some countries show more open expressions of sexuality based on the level of gender inequality or sexualized context, and within countries, variables such as religious commitment, family characteristics, and access to resources may play important roles in sexuality. Future research, policies, and interventions should consider these specific characteristics, including these forms of expression of sexuality, in the adjustment of cross-cultural and cross-national strategies.


Introduction
Sexuality is a complex dimension that contributes to our quality of life [1]. The expression of sexuality includes thoughts, attitudes, motivations, and behaviors, for which the cultural context plays an essential role [2]. In this sense, sociocultural values and traditions guide sexual manifestations within a community.
Clearly, this influence interacts with the characteristics of each person who, at the individual level, draws on sociocultural influences in expressing his or her own sexuality. The result is the existence of specific nuances of sexuality and likely many common aspects within communities (Table 1).
Some studies have revealed cross-cultural differences in sexual attitudes and behaviors. In a comparison among the USA, Turkey, and Ukraine, which represent both individualist and collectivist cultures, North American people reported more satisfaction with their relationships and lower judgments of sexual experiences than people from Ukraine, who reported higher scores than Turkish people [15]. Another cross-national study comparing countries reported lower gender differences in sexuality in countries characterized by egalitarian social standards [16]. In addition, some dissimilarities are also found in more similar contexts. In a study of four European countries, certain differences were observed between Portuguese people, who identified an important role of sex for well-being, and people from Belgium and Denmark, who did not report this role of sex [17].
Most of these studies emphasize the relevance of sexual attitudes, motivations, and behaviors on sexual satisfaction [15,18], as well as the role of gender differences and traditional values, which may lead to the underestimation of women's sexuality [19]. This article is part of the Topical Collection on Clinical Therapeutics Gil-Llario, Giménez, Ballester-Arnal, Cárdenas-López, Durán-Baca (2017) [7] Spain and Mexico 840 (48% men; 52% women): 17-26 years old Gender differences for both countries: men report more masturbation, more sexual partners and more instances of being unfaithful.
Women report more steady partners and longer lengths of relationships. There are greater gender differences between Mexican men and women than between Spanish men and women in terms of sexual frequency, sexual orientation, and infidelity. This situation seems to be more noticeable in traditional cultures, such as Hispanic culture, which is characterized by conservative conceptions that regularly hinder sexual expression that deviates from family planning [20]. Conventionally, machismo and marianismo have facilitated a double standard in sexual development in which the role of women is based on being passive and committed, while the role of men is associated with being sexually active and experiencing physical pleasure [21,22]. However, some differences in sexual expression among Hispanic countries have been reported [7]. Additionally, beyond these common bounds, some studies have also reported differences within countries based on specific aspects, such as religious beliefs, social development, ethnicity, or access to education that may influence sexuality regardless of personal traits [23][24][25]. Considering this complex situation, it is necessary to characterize what is known about the sexuality of Hispanic people for the development of effective policies and strategies aimed at this population. For this reason, this study describes specific evidence about sexuality (sexual debut, attitudes, behaviors, and sexual satisfaction) in different Hispanic countries.

Methods
This scoping review was based on five stages, as proposed by Arskey and O'Malley (2005) [26]: [1] define the research question, [2] identify relevant studies, [3] select appropriate studies, [4] organize the data, and [5] summarize the results. Considering the diversity of studies and methodologies, we carried out a qualitative analysis of the content and main findings (see table 1).
The research question was as follows: What are the main characteristics of sexual relationships in Hispanic countries? To identify relevant and contemporary studies, we conducted a review in four databases (Psycinfo, PubMed, Scielo, and Redalyc) searching the following keywords: "sexual debut", "sexual attitudes", "sexual relationship", "sexual behavior", "sexual activity", "sexual satisfaction", AND each country (Argentina, Bolivia, Brazil, Chile, Colombia, Costa Rica, Cuba, Dominican Republic, Ecuador, El Salvador, Guatemala, Honduras, Mexico, Nicaragua, Panama, Paraguay, Puerto Rico, Peru, Spain, Uruguay, and Venezuela). The inclusion criteria were papers written in English or Spanish language with a publication date from 2014 to 2019 that were based on Hispanic countries and included a detailed description of qualitative or quantitative methodologies. The exclusion criteria were as follows: studies based on Hispanic migrant people or acculturation processes and studies focused on physical, psychological, or social risks or hazards (STD exposure, unwanted pregnancy, sexual violence, sexual dysfunctions, sexual orientation discrimination, and sexuality in physical or mental diseases) or reproductive health. We also excluded papers without full access. Of the 1678 studies identified in the databases, 40 were included in the analyses based on the inclusion criteria and after the removal of duplicates (see Fig. 1). To facilitate the comprehension of the results, information was organized according to the following variables: sexual debut, sexual attitudes and motivations, sexual behavior, and sexual satisfaction.

Sexual Debut
Regarding sexual debut, there are some differences among Hispanic countries. Studies from Mexico report an average age of sexual debut from 11.4 (SD = 1.8) [27] to 17.3 (SD = 1.9) [28] years, with an earlier debut for men and younger people. In Spain, for non-penetrative practices, young people report their sexual debut at approximately 13 years old, and for penetrative practices, the debut is reported to be 2 years later [5•]. In Peru, sexual debut is reported at 14 years old and as earlier than 15 years old for 17.6% of adolescents [29,30]. Colombian young people report sexual debut slightly later, at 15.3 years old (SD = 1.6) [31], and in Nicaragua, 33% of Fig. 1 Flowchart of study selection adolescent men, and 21% of adolescent women report being sexually active at that age [32]. In Brazil, 26.5% of people initiate sexual experience at age 13 or younger [33], but the median age at first intercourse is 15 years old [34]. Finally, young Chilean people report their first sexual experience at 16.38 (SD = 2.36) years old [4], and in Argentina, 40-50% of women report being sexually active at this age [35].
Despite the differences, some variables seem to facilitate earlier sexual debut in most of these countries. First, men usually report earlier sexual debut than women in countries such as Mexico [36,37], Brazil [38], and Spain [5•]. Moreover, lower socioeconomic status and less communication with parents are also associated with earlier sexual debut in countries such as Mexico [36,37,39], Spain [40], and Peru [6,30], where being less religious is also an important factor, as well as in Argentina [35], Spain [41], and Mexico [10]. According to the last study, Catholic boys internalize more sexual double standards regarding premarital sex and virginity than nonreligious boys.
Most studies report progressive sexual development, for example, in Mexico [27], Spain [5•], or Peru [30], where genital kissing and touching are reported to be more frequent than anal/vaginal intercourse among adolescents. Additionally, some studies report an increasingly early sexual debut over generations in Chile [4].

Attitudes Towards Sexuality
Attitudes seem to be related to sexual experiences. Spanish young people report more permissive sexual values than Peruvian and Costa Rican young people [42]. In Ecuador, attitudes seem to be more conservative, as 74% of young people agree that sexual onset should occur upon marriage, and the affective dimension of sexuality is dominant over sexual desire or pleasure [43]. In contrast, in Puerto Rico, approximately 61.8% of young and adult people agree that they would participate in casual sexual encounters [44].
In this context, most of the studies, except for those in Puerto Rico [44] and Ecuador [43], report gender differences. In Spain, young men are more likely to have erotophilic attitudes than women, have more open views towards different sexual behaviors in isolated or social contexts [45,46] and have more accepting and pleasant thoughts about sexuality [47]. In particular, these trends are observed among men who self-identify as masculine, while those who self-identify as feminine are more likely to be erotophobic [48]. Moreover, Spanish adolescents report gender differences regarding sexual motivations [3•]. Men are more likely to enjoy sexual interaction, while women are more likely to have affective intentions. A similar result is found for Colombian adolescents [3•] and young Mexican people [49,50]. Mexican men associate casual sexuality with pleasure, whereas women are more likely to connect it to irresponsibility. In addition, in some regions of Mexico such as Veracruz, 33% women are opposed to masturbation and report anxiety about sexuality [51]. In Oaxaca, indigenous women still report shame and passive roles, with virginity and motherhood being important values [52]. In any case, younger generations seem to report slight changes from the views of older generations, and specific groups such as college students report a more equalitarian and permissive view of sexuality [53].
Once again, religion is indicated as an important factor in modulating sexual attitudes. This phenomenon occurs in Spain, where Christian people do not report positive thoughts about sexuality [47], as well as in Peru, Costa Rica [42], and Puerto Rico [44].

Sexual Behavior
Regarding sexual practices, the literature notes some differences among countries. According to some studies, most people from Puerto Rico (93%) [54] and Spain (93%) [7] report past sexual experience. This percentage decreases in the case of Argentina (86%) [23] and Mexico (70%) [7] and particularly in Ecuador (60%) [13] and Peru (51.5%) [55]. The latter two countries report higher gender differences; in Ecuador, men exceed women in sexual experience by approximately 20% [13], and in Peru, men report more than double the sexual experience of women [55].
Some studies report online sexual activities [11,45] for which Spanish people exceed Mexican people in engagement in sex chats (approximately 32.5% vs 15%), masturbation while on the Internet (approximately 83.5% vs 28.5%) and use of the Internet to experiment with sexuality (approximately 31.5% vs 21.5%). The proportion of Mexican young people who report engaging in sex chats increase, reaching 35%, and the proportion engaging in masturbation also increase, reaching 73%; the proportion of both Spanish and Mexican people engaging in experimentation with sexuality is also higher. Older people also show online sexual activities, but their percentages are have decreased [8,56]. In the case of Spain, among people over the age of 70, there seems to be a qualitative decrease in sexuality, which also seems to be more based on petting and masturbation than other sexual activities (44% of women who are older than 50) [8,57].
These results show gender differences in most of the countries, including Mexico [27], Colombia [3•], Ecuador [13], and Peru [55]; in Spain, there are particularly gender differences in practices such as masturbation [7]. This type of difference is particularly relevant in Ecuador [13] and Peru [55] as well in Colombia and Mexico when they are compared with Spain [3,7]. In Puerto Rico, this gender dissimilarity is present in religious communities but not for nonreligious people [14,44]. The relevance of gender among religious people is also reported in Ecuador [9,13] and Mexico [10].

Sexual Satisfaction
Regarding sexual satisfaction, a study in Mexico [58] indicates that 42.8% of men report being sexually satisfied, while 40.29% of women report being sexually satisfied. These percentages are higher in Spain and Chile. In one study, 58.6% of men and 44.9% of women report sexual satisfaction [59]. In Chile, a study [60] shows that 83.8% of men and 66.1% of women report sexual satisfaction. Finally, in Colombia, the sexual satisfaction is moderate [61], but only 36% of people report sexual satisfaction.
For sexual satisfaction, most of the studies revealed gender differences. In Mexico, men report more sexual satisfaction than women at sexual onset [28], as well as among the youngest sexually active individuals [50]. In Chile [4], adult men report more sexual satisfaction than women, but adolescent women have slightly higher satisfaction than men, supporting other results [62] that report lower sexual satisfaction of women in the adult stage. Among Chilean couples [63], men indicate more sexual dissatisfaction than women. Similarly, another study [12] does not report gender differences in young and adult people. In Spain, there are also controversial findings. Some authors [59] observe gender differences, with men having higher satisfaction than women, while others [64•] do not reveal gender differences and state that men report lower satisfaction because of their lower frequency of engagement in sexual activities.
Regarding quality factors, there are some gender differences. In Mexico, women associate pleasure with emotions more frequently, while men usually associate pleasure with the physical dimension and sexual sensation [50]. In Chile [12], a study notes that 47.4% of sexual satisfaction is related to sexual frequency, happiness, and perception of health. In Spain [59], a relevant role of sexual assertiveness for men and women is identified, and women also report positive sexual thoughts [65]. In Colombia, a study shows that sexual satisfaction is related to self-esteem in men and women [66].
Some studies focus on women, and the relevance of sexual attitudes to satisfaction seems to be common. For Mexican women, sexual satisfaction is related to lower religiosity, more sexual education and open-minded sexual attitudes towards masturbation, premarital sex, and lower anxiety about sexuality [51], as well as egalitarian attitudes [58]. This result is in line with those of some authors [59,67] that indicate the relevant role of sexual attitudes in sexual satisfaction for Spanish women. Regarding sexual orientation, a Spanish study on adult women reports more satisfaction among lesbian women than among heterosexual women [8•]. Regarding age, sexual satisfaction is higher among younger women who report a greater variety of sexual practices and affective behaviors [68].

Conclusion
In general, terms, sexual relationships among Hispanic people are still strongly related to gender roles and scripts that frequently modulate attitudes, beliefs and behaviors in different Hispanic countries [3,5,13,36,38,45,49]. In this sense, men usually report an earlier sexual onset [29,31,32], more sexual experience and sexual partners [7,41], as well as liberal attitudes towards sexuality [47,49,51]. Such gender differences are also noticeable in new practices such as online sexual activities that are reported in countries such as Spain [69], Mexico [11•], and Peru [70]. However, regarding sexual satisfaction, the findings show inconsistent results for countries such as Chile [4,63] and Spain [59,64], while Mexico maintains gender differences [58]. Mexican women still prioritize emotions and commitment; meanwhile, for men, desire, and physical aspects are more important. Some studies report sexual differences across generations, with younger people seeming to be more sexually open [4,53].
In general, gender differences in Hispanic countries are higher than those presented in other studies based on cultures such as Northern Europe [17]. In line with past studies [16,71] that relate more gender-egalitarian regions to lower double standards in sexual expressions, sexual expression in Hispanic countries differs from that in countries that report more equality between men and women. In fact, among Hispanic countries, Spain, which has a better position on the gender inequality index [72], seems to show more liberal attitudes and experiences, as well as lower gender differences. Moreover, concerning the level of satisfaction, the studies report higher percentages of satisfaction in Spain and Chile than in Mexico or Colombia, even though an important percentage of people are unsatisfied with their sexuality in the former countries. In addition, Spain and Puerto Rico seem to be characterized by more open-minded sexual attitudes and sexual behaviors, particularly in comparison with countries such as Peru and Ecuador. Puerto Rico, which belongs to the Caribbean culture, also shows more open expressions of sexuality, as some authors have noted [73]. Men and women in the Caribbean context seem to report more open attitudes and behaviors related to sexuality, differentiating affection and love from sexual desire and behavior more frequently than people in other countries. In contrast, more inhibited cultures may contribute to low sexual expression, as some authors have reported in other cultural contexts such as China [74].
Going beyond the common sexual scripts to include attention to international differences in the gender inequality index [7,42], some of the results suggest how these differences may be larger by comparing different socioeconomic and ethnic groups in each country [52]. Some authors who examine different countries reveal the importance of specific factors such as family and peer support [6]; religious commitment, particularly among women [10]; and the level of access to resources [38], which may modulate sexual relationships beyond the influence of factors related to one's place of origin. These variables have been shown to be relevant in multiple countries. In particular, the role of religion has been demonstrated in cross-cultural studies [75], as well as in specific contexts such as Ghana [76], the USA [77], and Malaysia [78].
Obviously, these results should be considered in light of the studies analyzed. This paper reports some findings of specific studies, which likely do not represent all cross-cultural characteristics and characteristics within countries where there is substantial diversity. In addition, the different methodologies and collected data make it difficult to draw conclusions about sex-related variables. To overcome these limitations, other reviews should analyze in detail the sexuality of specific Hispanic groups, such as the LGTB community or people with disabilities or mental diseases, who are usually excluded in studies of Hispanic sexual traditions. Additionally, to determine the relevance of specific subgroup factors, cross-cultural comparisons and comparison of different subcultures and socioeconomic levels in each country should be conducted to tailor interventions for each population.
Despite these limitations, these findings support the relevance of the double standard, as well as other factors, such as religion, to sexual experiences in Hispanic countries. In addition, this study reveals some differences in sexual expression that may be based on gender inequality and human development, such as in Spain, or cultural traits, such as in Puerto Rico. Therefore, to adjust policies and interventions, different aspects, such as gender inequality, religious commitment or sexualized subcultures, should be considered, including traditional and new scenarios of sexuality.

Compliance with Ethical Standards
Human and Animal Rights and Informed Consent This article does not contain any studies with human or animal subjects performed by any of the authors.

Conflict of Interest
The authors declare that they have no conflict of interest.