When Tonight Is Not the Night: Sexual Rejection Behaviors and Satisfaction in Romantic Relationships

Abstract

In most long-term romantic relationships, partners experience sexual conflicts of interest in which one partner declines the other partner’s sexual advances. We investigated the distinct ways people reject a partner’s advances (i.e., with reassuring, hostile, assertive, and deflecting behaviors) in Studies 1 and 2. Using cross-sectional (Study 3) and daily experience methods (Study 4), we investigated how perceptions of a partner’s rejection behaviors are linked with the rejected partner’s relationship and sexual satisfaction. We found robust evidence that perceived partner reassuring behaviors were associated with greater satisfaction, whereas perceived partner hostile behaviors were associated with lower levels of satisfaction. Perceived partner responsiveness was a key mechanism underlying the effects. Findings for assertive and deflecting behaviors were limited, but the effect of deflecting behaviors was qualified by levels of hostile behaviors for sexual satisfaction. Findings provide the first empirical investigation of the specific ways partners can decline one another’s advances to preserve satisfaction.

Keywords

sexual rejection satisfaction close relationships sexual communication responsiveness

Rejection, particularly by a romantic partner, can be one of life’s most painful emotional experiences (M. R. Leary et al., 1998; Murray et al., 2006). The stakes of sexual rejection, in particular, can be even higher because the majority of couples are monogamous (Haupert et al., 2017) and partners rely almost exclusively on each other to fulfill their sexual needs. However, situations in which partners’ sexual needs or interests conflict—and in which a person may need to decline their partner’s sexual advances—are common in ongoing romantic relationships (Davies et al., 1999; Mark, 2015; Risch et al., 2003). Almost half of dating partners reported disagreements about desired levels of sex over a 4-month period (Byers & Lewis, 1988), and couples reported experiencing desire discrepancies on more than two-thirds of days over a 3-week period (Day et al., 2015). In fact, conflicts of interest about sex can be one of the most difficult types of issues to successfully resolve in romantic relationships (Sanford, 2003). Given that sexual conflicts of interest are common and sexual rejection is associated with lower relationship satisfaction (Byers & Heinlein, 1989; Dobson et al., 2019), it is essential to understand whether there are ways of communicating sexual disinterest that can convey responsiveness and preserve satisfaction. In investigating how couples can successfully manage situations in which their sexual interests diverge, the bulk of the past research has focused on the factors associated with maintaining or increasing sexual desire. For example, engaging in sex to promote positive outcomes for a partner (i.e., for approach goals; Impett et al., 2005), being communally motivated to meet a partner’s sexual needs (i.e., high in sexual communal strength; Muise et al., 2013), and being made to feel special by a partner (Birnbaum et al., 2016) are all associated with higher sexual desire. However, another key avenue for understanding how couples can navigate differences in their sexual interests may lie in understanding the specific ways partners communicate sexual disinterest and decline one another’s sexual advances that enable couples to maintain relationship and sexual satisfaction.

Sexual Rejection in Relationships

Sexual rejection involves the communication—subtle or explicit—to one’s partner the desire or need to not have sex, usually in response to one’s partner attempting to initiate sex. A key reason why situations of desire discrepancy may be challenging for couples to navigate may be due to the fact that having one’s interests declined by a romantic partner involves being hurt by the person whose acceptance they most desire (Murray et al., 2006). Not only is sexuality a particularly emotionally charged domain of relationships (Banmen & Vogel, 1985; Byers, 2011), but individuals also obtain an important sense of their sexual desirability and attractiveness from their romantic partners. One study found that when respondents were presented with hypothetical scenarios of sexual rejection, they were more uncomfortable and reported greater threats to their self-image and self-esteem when the sexual rejection came from a dating partner than from a friend or an acquaintance (Metts et al., 1992).

Much of the existing research on sexual rejection has ignored the romantic relational context, focusing primarily on rejection communication toward strangers or potential partners (Goodboy & Brann, 2010; Jouriles et al., 2014; Metts et al., 1992). Only two studies have examined sexual rejection in established romantic relationships. In one study, individuals in cohabitating and married relationships reported feeling lower relationship and sexual satisfaction when their sexual initiation was met with refusal, as opposed to acceptance, by their partner (Byers & Heinlein, 1989). In another, people whose sexual advances were rejected by their partner reported lower satisfaction on that same day as well as decreased feelings of satisfaction up to two days later (Dobson et al., 2019). The aim of the current work was to provide the first empirical examination of the range of behaviors in which people engage when declining their partner for sex, as well as to examine how perceptions of a partner’s rejection behaviors are associated with relationship and sexual satisfaction. In this process, we integrate and extend research on risk regulation and communication in relationship to the sexual domain to guide the study of sexual rejection.

Applying Risk Regulation Theory and Relationship Communication Models to the Study of Sexual Rejection

We draw broadly upon two bodies of research—risk regulation theory (Murray et al., 2006) and relationship conflict communication models (e.g., Overall & McNulty, 2017)—to inform our investigation of the range and influence of behaviors in which people engage when rejecting their partner’s sexual advances.

Expressed and Perceived Responsiveness

Risk regulation theory offers a general framework for understanding individuals’ rejection experiences with a partner. An underlying principle of risk regulation theory is that in situations in which rejection concerns are salient, confidence in a partner’s regard (i.e., feeling accepted, valued, and cared for by a romantic partner) provides individuals with a sense of felt security necessary to set aside self-protection goals and seek closeness and connection with a partner. Applied to the sexual domain, tenets of risk regulation theory may be particularly relevant for understanding sexual rejection behaviors and how people may be buffered against feelings of rejection. Given the difficulty and sensitive nature surrounding sexual communication in relationships (Banmen & Vogel, 1985; Byers, 2011) as well as the prevalence with which couples experience discrepant levels of sexual interest (Day et al., 2015), situations of sexual rejection may reflect a regularly occurring relationship event in which concerns about a partner’s regard are activated. Accordingly, perceived partner responsiveness—the feeling that one is understood, validated, and cared for by a partner—is a core feature of satisfying relationships (e.g., Reis et al., 2004) and should buffer against lower satisfaction in response to sexual rejection. While the potential for reassuring rejection strategies to buffer against lower satisfaction is intuitive, it remains an open question whether certain behaviors may translate to a partner feeling the intended reassurance. That is, the link between one partner’s communication strategy (i.e., conveying reassurance) and the other partner’s felt responsiveness is critical, and yet largely absent in descriptions of risk regulation theory. Past observational studies of couple interactions identifying specific responsive behaviors of individuals demonstrate that certain enacted behaviors indeed predict a partner’s subsequent perception of responsiveness (Maisel et al., 2008); this suggests that to understand the effects of received support warrants examining the specific behaviors that provide support for the recipient. In the current research, we therefore attempt to identify behaviors which may (or may not) signal responsiveness to a person’s needs in the context of sexual rejection.

Elements of Relationship Conflict Communication

We also draw upon research on relationship communication—commonly examined during situations of general relationship conflict—to guide a typology of sexual rejection behaviors. This research typically describes behaviors according to valence (i.e., positive and negative behaviors) and directness (i.e., direct and indirect behaviors) (Overall & McNulty, 2017), dimensions which are conceptually similar to various classification systems in the study of personality, behavior, and social judgment (e.g., Carson, 1969; T. Leary, 1957; Wiggins, 1991). As such, in identifying how individuals communicate sexual disinterest and decline their partners’ sexual advances, we expected to find that individuals in romantic relationships also reject their partner for sex in distinct ways that vary along the dimensions of valence and directness.

Communication behavior valence

Research on partner communication during relationship conflict also provides a framework for understanding how distinct sexual rejection behaviors may be associated with relationship outcomes. Positive conflict behaviors such as accommodation (i.e., enacting constructive responses to a partner’s destructive acts) and validation (i.e., communicating understanding and acceptance of a partner’s experience) tend to predict greater relationship well-being and less relationship distress (Maisel et al., 2008; Rusbult et al., 1998). The enactment of positive conflict behaviors during sexual rejection may be particularly important for providing partners with a felt sense of security. In contrast, negative conflict behaviors such as hostility or criticism and greater reciprocity of negative communication are associated with lower relationship satisfaction and increased distress (Karney & Bradbury, 1995; Markman et al., 2010), highlighting how negative conflict behaviors can prevent partners from feeling valued and understood. Incorporating the literature on positive and negative conflict behaviors with the literature on risk regulation models, we expected that sexual rejection delivered in positive ways—such as by communicating affection or showing caring concern—may help sustain satisfaction by demonstrating responsiveness to a partner’s needs. In contrast, sexual rejection that is delivered in negative ways—such as by criticizing the partner and expressing hostility—should be associated with lower satisfaction as it fails to provide partners with assurance or validation.

Communication behavior directness

Research on partner regulation demonstrates that the extent to which relationship behaviors are communicated in a direct (vs. indirect) manner can impact relationship satisfaction (McNulty & Russell, 2010). Notably, however, this work has primarily focused on individuals’ attempts to change their partner’s undesired behaviors or characteristics (i.e., partner regulation; Overall et al., 2009). This work has revealed mixed findings, as the impact of direct and indirect behaviors on relationship outcomes is contingent on a variety of factors, including the valence of the behavior, the severity of the relationship issue, individual differences of the partner receiving the communication (e.g., attachment orientation), and whether effects of the behaviors are assessed in the moment versus over time (Overall et al., 2013). Given that partner change goals may be less relevant and emotion regulation needs may be heightened in the sexual domain, it is unclear whether the effects of direct and indirect sexual communication would play out similarly in the context of sexual rejection.

Furthermore, research on sexual communication suggests both potential benefits and costs of direct communication. People report higher relationship satisfaction to the extent that they are more sexually assertive (Greene & Faulkner, 2005; Hurlbert, 1991), and self-disclosure of sexual preferences is positively correlated with relationship and sexual satisfaction (Byers & Demmons, 1999; Cupach & Comstock, 1990). Yet, while direct sexual communication may be more effective in stopping a partner’s sexual pressure, it can also result in the rejected partner feeling embarrassed or ashamed (Metts et al., 1992). In addition, research shows indirect sexual communication (e.g., the inhibited expression of sexual needs) and avoiding discussion of sexual topics in relationships are associated with decreased sexual satisfaction among partners (Davis et al., 2006; Theiss & Estlein, 2014). Given that the effects of direct and indirect communication behaviors are often contingent on the context in which they are expressed, we did not have firm predictions regarding the link between direct and indirect sexual rejection behaviors and instead examined their links with relationship and sexual satisfaction in an exploratory manner.

Overview of the Current Research

Drawing from risk regulation theory and models of relationship conflict communication, the overarching goals of the current research were twofold. First, we sought to identify the distinct behaviors in which people engage when declining a romantic partner’s sexual advances through the creation and validation of the Sexual Rejection Scale (SRS). In two pilot studies, we used an inductive, data-driven approach to identify distinct sexual rejection behaviors. In Studies 1 and 2, we developed the SRS using exploratory factor analysis (EFA) and confirmatory factor analysis (CFA), demonstrated invariance of the SRS across gender, and provided initial evidence for the convergent and discriminant validity of the SRS.

Second, we sought to determine whether particular rejection behaviors may be best for preserving a rejected partner’s relationship and sexual satisfaction. We examined these links in a cross-sectional study (Study 3) and a naturalistic, ecologically valid 28-day experience sampling study (Study 4). In Study 4, we also explored a potential mechanism (i.e., perceived partner responsiveness) of the link between sexual rejection behaviors and satisfaction. Finally, given the extensive literature on gender differences in sexuality (Peplau, 2003), we assessed the generalizability of our findings across gender in all studies.

Pilot Studies

Using a bottom-up approach, we conducted two pilot studies on Amazon’s Mechanical Turk to identify the different ways that people decline their partner for sex. Participant demographics are reported in Table 1.

Table 1.

Sample Characteristics (All Studies).

Sample	Sample						Age (years)			Relationship length (years)
Sample	Initial N	Final N	% Female	% Caucasian	% Married	% Heterosexual	M	SD	Range	M	SD
Pilot Study 1	232	226	46	74	34	87	34	12	18–73	6	8
Pilot Study 2	233	230	52	74	36	90	31	10	18–63	6	8
Study 1	504	414	52	81	48	91	35	10	18–69	6	7
Study 2	496	411	55	79	43	90	33	11	18–67	7	8
Study 3	333	315	51	84	44	87	35	11	19–71	7	8
Study 4	210	196	51	77	54	86	33	8	21–61	8	5

Note. The initial N indicates the total number of participants recruited for the study. The final N indicates participants who were retained for final analyses.

Research indicates emotion regulation processes are inherent to situations in which romantic partners experience conflicting preferences (Richards et al., 2003), and individuals may regulate both their own and their partner’s positive and negative emotions (Haase, 2014). Accordingly, sexual rejection communication should entail features of partner emotion regulation given that it occurs when partners’ sexual interests conflict. Thus, we sought to identify sexual rejection behaviors which encompass the regulation of positive and negative emotions in these situations. In response to the prompt “When communicating to your partner that you do not want to have sex . . .,” participants then indicated “what are some of the things that you try to do to prevent your partner from feeling any negative emotions (disappointed, rejected, hurt, let down) or ensure that your partner still feels loved” (Pilot Study 1; N = 226) and “what are some of the ways you do this that might make your partner feel negative emotions (hurt, disappointed, rejected, let down)” (Pilot Study 2; N = 230)? In each study, participants also answered comparable questions regarding their perceptions of their partner’s rejection behaviors (e.g., “what are some of the things that your partner tries to do to prevent you from feeling any negative emotions . . .”).

From these responses, we generated an initial list of sexual rejection behaviors. We then used thematic analysis to classify participants’ open-ended responses into distinct themes based on key words or similar content (Braun & Clarke, 2006). Items were generated using an inductive approach (Hinkin, 1998), grouping common thematic elements among responses to produce an initial set of 44 items (see Supplemental Materials).

Study 1

Method

Study 1 consisted of a new sample of 504 sexually active participants over the age of 18 in relationships recruited from Mechanical Turk. A final sample of 414 remained after excluding participants who did not meet eligibility criteria and failed attention checks. Participant demographics are reported in Table 1. Participants indicated how frequently they engaged in each of the sexual rejection behaviors on a 5-point scale (1 = never to 5 = very frequently). We conducted EFA in SPSS using maximum likelihood estimation with promax (i.e., oblique) rotation. We relied on parallel analysis, indexes of model fit, and nested-model comparisons to guide our decision-making regarding factor retention. See Supplemental Materials for full details.

Results

The EFA indicated that the specific items loaded onto four unique factors. Factors are shown in Figure 1 and the final SRS items are shown in the appendix. We retained five items per factor to reliably capture each of the four factors. Items with factor loadings <0.40 or cross-loadings >0.30 were excluded (Hinkin, 1998). We checked for redundancy and to ensure items were clearly worded (Simms & Watson, 2007) and added two items to the assertive subscale to ensure a similar number of items in each factor. Final items were selected based on a combination of high factor loadings, frequency, and the degree to which they were thematically consistent with each subscale. This resulted in a 20-item SRS, with five items per subscale.

Figure 1.

Sexual Rejection Scale confirmatory model in Study 2.

The first factor was labeled reassuring, characterized by showing positive regard for the partner, reappraising negative emotions, and demonstrating care and love. The second factor was labeled hostile, characterized by acting negatively when rejecting the partner and in ways that inflicted hurt toward the partner. The third factor was labeled assertive, characterized by being direct and straightforward about the reason for rejecting the partner without necessarily trying to prevent the partner from feeling negative emotions. The fourth and final factor was labeled deflecting, characterized by enacting passive and non-verbal behaviors and eluding a partner’s affection. Because our final scale only contained 20 of these original 44 items and because we reworded specific items and included others to adequately represent each of the factors, we have included the factor loadings for all 44 items in the Supplemental Materials for interested readers.

Study 2

We next conducted CFA to confirm the factor structure of the SRS in an independent sample (see Figure 1). We tested for invariance by gender to assess the equivalence of factor structure, factor loadings, and item intercepts (Brown, 2014) across men and women. We tested associations with relevant individual personality variables (e.g., attachment, aggression prosociality, sexual assertiveness) to establish convergent and discriminant validity.

Regarding convergent validity, we expected that individuals high in sexual communal strength (i.e., focused on meeting their partner’s sexual needs; Muise et al., 2013) would engage in more reassuring rejection behavior as both constructs demonstrate responsiveness to a partner’s needs. Given their negative valence, we expected hostile behaviors to be linked with trait aggression (e.g., Richardson & Green, 2006). We expected assertive rejection behaviors to be linked with high sexual assertiveness (i.e., comfort in expressing one’s own sexual needs to a partner; Hurlbert, 1991; Morokoff et al., 1997). Finally, we expected that due to their discomfort with intimacy (Overall et al., 2013) and conflict avoidance behaviors (Guerrero et al., 2009), individuals high (vs. low) in attachment avoidance would engage in more deflecting rejection behaviors.

Regarding discriminant validity, to distinguish reassuring from assertive behaviors, we expected that assertive behaviors would not be significantly associated with sexual communal strength, and that reassuring behaviors would have a significant but weaker association with sexual assertiveness than assertive behaviors. To distinguish hostile from deflecting behaviors, we expected that hostile behaviors would be more strongly related to trait aggression than deflecting behaviors, and that deflecting behaviors would be more strongly linked to attachment avoidance than hostile behaviors.

Method

We recruited 496 individuals over the age of 18 who were currently in romantic relationships and sexually active from Mechanical Turk. A final sample of 411 participants remained after removing participants who failed attention checks or did not meet study eligibility criteria. Participant demographics are reported in Table 1. Participants completed a survey with the 20-item SRS, measured on a 5-point scale (1 = never to 5 = very frequently). Each sexual rejection behavior had high internal reliability: reassuring (five items; α = .85; M = 3.19, SD = 1.06), hostile (five items; α = .86; M = 1.60, SD = 0.74), assertive (five items; α = .88; M = 2.93, SD = 1.08), and deflecting (five items; α = .83; M = 1.81, SD = 0.79).

Sexual communal strength assessed the motivation to meet a partner’s sexual needs (e.g., “How far would you be willing to go to meet your partner’s sexual needs?” five items; α = .75; M = 2.87, SD = 0.74; Muise et al., 2013). Trait aggression was assessed using the Brief Aggression Questionnaire (e.g., “I have trouble controlling my temper,” 12 items; α = .85; M = 2.43, SD = 0.76; Webster et al., 2014). Sexual assertiveness was assessed using the Hurlbert Index of Sexual Assertiveness (e.g., “I communicate my sexual desires to my partner,” 25 items; α = .90; M = 3.62, SD = 0.63; Hurlbert, 1991). Attachment avoidance was assessed with the Experiences in Close Relationships Questionnaire–Short-Form (ECR-S; e.g., “I want to get close to my partner, but I keep pulling back,” six items; α = .86; M = 2.40, SD = 1.15; Fraley et al., 2011).

Results

CFA

We performed CFA using the lavaan package (Rosseel, 2012) in R (R Core Team, 2018). We evaluated model fit using a number of standard fit criteria, including a comparative fit index (CFI) ≥.90, root mean square error of approximation (RMSEA) close to .06, and a standardized root mean square residual (SRMR) less than or equal to .08 (Hu & Bentler, 1999). The four-factor model fit the data well, χ²(164) = 404.350, p < .001, CFI = .942, RMSEA = .060 (90% confidence interval [CI] = [.052, .067]), SRMR = .072.¹

Testing measurement invariance by gender

We used the semTools package (Pornprasertmanit et al., 2013) in R to test measurement invariance across gender. A CFI decrease of ≤.01 from less constrained to more constrained models would indicate evidence of measurement invariance between nested models (Cheung & Rensvold, 2002). We found evidence for configural, metric, and scalar invariance (see Table S3 in Supplemental Materials)—indicating that a four-factor structure was appropriate for both genders, and that women and men interpreted and responded to the SRS constructs in a similar manner. Furthermore, a comparison of observed means revealed that women engaged in all four types of rejection behaviors more than men (see Table 2; d_reassuring = .26, d_hostile = .21, d_assertive = .33, d_deflecting = .28).

Table 2.

Gender Differences in Mean Levels of Sexual Rejection Behaviors in Study 2.

Study 2	Men, M (SD)	Women, M (SD)	df	t	d
Reassuring rejection	3.04 (1.10)	3.31 (1.01)	409	2.54*	.26
Hostile rejection	1.52 (0.68)	1.67 (0.78)	409	2.04*	.21
Assertive rejection	2.75 (1.08)	3.10 (1.05)	409	3.37**	.33
Deflecting rejection	1.69 (0.74)	1.91 (0.83)	409	2.85**	.28

p < .05. **p < .01. ***p < .001.

Convergent and discriminant validity

We next examined partial correlations between each sexual rejection behavior and the individual difference measures, as shown in Table 3. Consistent with hypotheses, reassuring rejection was positively associated with sexual communal strength. Hostile rejection, but not deflecting rejection, was positively associated with trait aggression. Assertive rejection, but not reassuring rejection, was positively associated with sexual assertiveness. Finally, both deflecting and hostile rejection were positively associated with attachment avoidance.

Table 3.

Partial and Zero-Order Correlations Between Sexual Rejection Scale Subscales With Personality Measures (Study 2).

Measure	Reassuring		Hostile		Assertive		Deflecting
Measure	r	β	r	β	r	β	r	β
Personality traits
Sexual communal strength	.15**	.23***	−.37***	−.18***	−.04	−.11*	−.37***	−.22***
Aggression	.07	.03	.31***	.27***	.11*	.04	.15**	−.06
Sexual assertiveness	.10	.01	−.27***	−.09	.15**	.17***	−.35***	−.25***
Attachment avoidance	−.17***	−.18***	.43***	.25***	−.07	−.03	.41***	.22***

Note. Bivariate correlations are represented by r. Partial correlations are represented by β and indicate the associations of each SRS behavior controlling for all other SRS behaviors. SRS = Sexual Rejection Scale.

p ≤.05. **p ≤ .01. ***p ≤ .001.

Study 3

Study 3 was guided by three goals. First, we sought to examine associations between perceived frequency of general sexual rejection and relationship and sexual satisfaction. We expected that individuals would be less satisfied when perceiving their partner to engage in sexual rejection more frequently. Our second goal was to adapt the SRS to validate a perceived partner version of the SRS (i.e., assessing perceptions of partner’s rejection behaviors) (see Supplemental Materials for scale items and additional information). Our third goal was to examine how perceptions of a partner’s specific sexual rejection behaviors (i.e., SRS behaviors) are associated with relationship and sexual satisfaction. Drawing broadly from prior work on positive and negative relationship communication (e.g., Maisel et al., 2008; Overall & McNulty, 2017), we expected that perceived reassuring behaviors would be associated with higher relationship and sexual satisfaction,² whereas perceived hostile behaviors would be associated with lower satisfaction. We did not have clear hypotheses about how perceived partner assertive and deflecting behaviors would be associated with satisfaction.

Method

Participants and procedure

We recruited a sample of 333 individuals over the age of 18 who were currently in romantic relationships and sexually active from Mechanical Turk. A final sample of 315 participants remained after screening the data for failed attention checks and large amounts of incomplete data. Participant demographics are reported in Table 1.

Participants completed an online questionnaire containing a variety of questions regarding their relationship and sex life, and a perceived version of the 20-item SRS (i.e., “On average, how often does your partner reject your sexual advances?” (1 = never, 2 = less than once a month, 3 = once a month, 4 = 2–3 times a month, 5 = once a week, 6 = 2–3 times a week, 7 = daily) assessing how often their partner engages in each of the different sexual rejection behaviors. All four subscales demonstrated adequate internal reliability (alphas ranged from .83 to .88). Relationship satisfaction was measured with five items (α = .95) from the Investment Model Scale (Rusbult et al., 1998), on a 7-point scale (1 = not at all to 7 = a lot). Sexual satisfaction was measured with the Global Measure of Sexual Satisfaction (Lawrance & Byers, 1998), a measure consisting of five items in which participants rated their sex life on five 7-point dimensions (1 = not at all to 7 = a lot): good–bad, pleasant–unpleasant, positive–negative, satisfying–unsatisfying, valuable–worthless (α = .95).

Results

Supporting our first hypothesis, perceived partner frequency of sexual rejection was associated with lower relationship (r = −.13, p = .02) and sexual satisfaction (r = −.33, p < .001).

Then, using the same procedures and criteria outlined in Study 2, we conducted a CFA to test the four-factor structure of the perceived SRS. The four-factor model fit the data well, χ²(164) = 303.409, p < .001, CFI = .958, RMSEA = .052 (90% CI = [.043, .061]), SRMR = .065, and we also found evidence for configural, metric, and scalar levels of measurement invariance across participant gender (see Table S3 in Supplemental Materials).

Finally, to test our key predictions linking the four SRS behaviors with satisfaction, we conducted multiple regression analyses in R in which we entered all four perceived partner sexual rejection behaviors simultaneously as predictors (see Table 4). As hypothesized, higher perceived levels of reassuring behaviors were associated with greater relationship and sexual satisfaction, whereas higher perceived levels of hostile behaviors were associated with lower relationship and sexual satisfaction. Neither perceived assertive behaviors nor perceived deflecting behaviors were significantly associated with relationship or sexual satisfaction.³

Table 4.

Study 3 Associations Between Perceived SRS Behaviors and Outcomes.

SRS behaviors	Relationship satisfaction		Sexual satisfaction
SRS behaviors	β [95% CI]	t	β [95% CI]	t
Perceived reassuring	.28 [.10, .45]	4.62***	.25 [.10, .40]	3.98***
Perceived hostile	−.30 [−.56, .04]	−3.91***	−.21 [−.43, 01]	−2.54*
Perceived assertive	.02 [−.15, 19]	0.35	.11 [−.04, 25]	1.75
Perceived deflecting	−.06 [−.31, 18]	−0.81	−.03 [−.24, 18]	−0.35

Note. Multiple regression models with all four behaviors entered as predictors. SRS = Sexual Rejection Scale; CI = confidence interval.

p < .05. **p < .01. ***p < .001.

Study 4

In Study 4, we conducted an ecologically valid 28-day daily experience study of couples to test how within-person fluctuations in perceptions of a partner’s reassuring, hostile, assertive, and deflecting rejection behaviors predict one’s own daily relationship and sexual satisfaction. This design allowed us to control for differences in sexual rejection behaviors at the between-person level to ensure that the effects are not solely driven by individuals who regularly perceive their partner to engage in high levels of any particular rejection behavior.

We predicted that on days when a person perceives their partner as more reassuring in their rejection behaviors than they typically perceive them to be, they would report higher daily relationship and sexual satisfaction. In contrast, we predicted that on days when people perceive their partner as more hostile in their rejection behaviors than typical, they would report lower satisfaction. Given the null findings for perceptions of a partner’s assertive and deflecting rejection in Study 3, we did not make predictions about the daily associations between perceptions of assertive and deflecting rejection.

In addition, we sought to explore a potential mechanism of the effects of reassuring and hostile rejection. Perceived partner responsiveness is a key organizing construct in the study of close relationships (Reis et al., 2004). When individuals feel validated and cared for by their partners, they feel closer and more satisfied in their relationships (Collins & Feeney, 2000; Lemay et al., 2007) and experience greater sexual desire for their partner (Birnbaum et al., 2016). Because reassuring behaviors emphasize positive regard for one’s partner, the benefits of perceiving a partner as reassuring in their rejection may be attributable to the enhanced responsiveness to a partner’s needs that these types of behaviors convey. Thus, we expected that individuals would perceive greater responsiveness on days when they perceived that their partners communicated their sexual disinterest in more reassuring ways, and this would account for the higher relationship and sexual satisfaction experienced on those days. In contrast, given that hostile behaviors are characterized by a lack of responsiveness, we expected individuals would perceive lower responsiveness on days when they perceived their partners reject their advances in more hostile ways, and this would account for the lower relationship and sexual satisfaction experienced on those days.

Finally, this daily experience design allowed for the possibility of testing for interactions between the sexual rejection behaviors and whether there may be effects of assertive (direct) and deflecting (indirect) behaviors based on levels of reassuring (positive) or hostile (negative) behaviors. As individuals can engage in multiple types of behaviors simultaneously (e.g., being assertive about feeling too tired for sex but also reassuring one’s partner about their attractiveness), these analyses would allow us to assess whether certain combinations of sexual rejection behaviors may produce unique effects. We thought it was possible that higher perceived levels of assertive behaviors may be associated with higher satisfaction if accompanied by higher levels of reassuring behaviors, but may result in lower satisfaction if accompanied by low levels of reassuring behaviors. This may be due to the sexual responsiveness uniquely demonstrated through reassuring (but not assertive) behaviors, which buffers individuals from the negative emotions (e.g., shame, embarrassment) linked with direct sexual rejection experiences. In turn, we thought that the negative effect of perceived hostile behaviors may remain at low perceived levels of deflecting behaviors but may be exacerbated at high perceived levels of deflecting behaviors, as research suggests that indirect-negative conflict behaviors in particular are the least likely to benefit couples’ satisfaction and attempts to resolve problems (McNulty & Russell, 2010).

Method

Participants and procedure

Participants were 98 Canadian couples recruited on Kijiji.ca. Participants had to be at least 18 years old, and all couples had to be living together and in a relationship for at least 2 years. Participants were contacted via email to confirm their eligibility and underwent a phone screening by a trained research assistant, who verified the relationship and explained study procedures. Participants were instructed to complete their surveys every evening and that their responses would be ineligible if completed the next day. Participants were told to complete the surveys separately, to not discuss their surveys with their partner, and that if they missed a day, they should leave that particular survey blank.

Each participant was initially sent a background survey in which they provided demographic information (see Table 1). Then, starting the next day, they completed 28 daily surveys delivered electronically at the same time each day. Each daily survey was automatically time-stamped. Only daily surveys completed before 6 a.m. the next morning were treated as valid. In total, participants completed 4,693 daily surveys, an average of 23.9 (out of 28) days per person. Each participant received up to $65 CAD in gift cards for completing all surveys.

Measures

In the background survey, participants reported basic demographic information (i.e., gender, age, ethnicity, relationship length). Then, each day for 28 days, participants completed a survey in which they reported whether they or their partner had higher sexual desire, rated on a 21-point scale (1 = I had much higher desire to 21 = my partner had much higher desire). If participants selected the midpoint value (i.e., 11 = we had equal amounts of desire), they were asked, “If you had to choose, who had the greater level of sexual desire?” (1 = me, 2 = my partner). We used this method to better capture more indirect forms of sexual rejection and to avoid participants solely reporting on instances of explicit rejection. On days when participants did not engage in sex and perceived their partner to have lower desire than they did—which occurred on 717 out of a total of 4,878 days—they indicated the degree to which their partner communicated sexual disinterest (“Today, to what extent did your partner do something to indicate to you that they were not in the mood for sex?” from 1 = not at all to 7 = a lot). Directly following this question, if participants reported a 2 or higher, they responded to items about the degree to which they perceived their partner as engaging in reassuring (M = 3.04, SD = 1.63; ω = .97), hostile (M = 1.88, SD = 1.29; ω = .88), assertive (M = 2.94, SD = 1.97; ω = .92), and deflecting (M = 2.10, SD = 1.30; ω = .86) rejection behaviors, rated on a 7-point scale (1 = not at all to 7 = a lot). We report omega (ω) values to provide an assessment of the within-person reliability of change (Lane & Shrout, 2010). Participants completed a one-item daily measure of relationship satisfaction: “Today, with regard to my relationship, I felt satisfied” (1 = not at all to 7 = a lot). Daily sexual satisfaction was measured with the five items from the Global Measure of Sexual Satisfaction (GMSEX) (Lawrance & Byers, 1998) assessing their sex life that day (1 = not at all to 7 = a lot; α = .98). We used a one-item measure of perceived partner responsiveness (Reis et al., 2004): “Today, with regard to my relationship, I felt understood, validated, and cared for by my partner” (1 = not at all to 7 = a lot). We computed a rejection frequency score for each participant by calculating the proportion of days on which they received the SRS.

Data analysis strategy

We analyzed the data using a two-level cross-classified multilevel model in which daily reports were crossed with the individual and dyad level (Laurenceau & Bolger, 2005). Analyses were conducted using the lmer function in the lme4 package (Bates et al., 2014) in R. Each of the four perceived partner rejection behaviors was within-person centered such that coefficients reflect associations between deviations from a person’s average perception of their partner’s sexual rejection behavior and each daily outcome (Raudenbush et al., 2004). We entered all four perceived partner sexual rejection behaviors simultaneously as predictors. Aggregates of the four perceived partner rejection behaviors as well as the previous day’s outcome variables (i.e., yesterday’s reports of satisfaction) were also included in the model. While the dyadic nature of these data allows for testing effects for both partners’ outcomes, we focused primarily on how perceived rejection behaviors predict one’s own daily satisfaction. However, we controlled for partner’s satisfaction in our analyses to account for the interdependence between partners. To test for interactions between the SRS behaviors, four interaction terms were specified in our models according to valence and directness dimensions. Specifically, we tested for the interactions between (a) reassuring and assertive behaviors, (b) reassuring and deflecting behaviors, (c) hostile and assertive behaviors, and (d) hostile and deflecting behaviors in predicting both relationship and sexual satisfaction. Tests of indirect effects were conducted according to guidelines for a 1-1-1 mediation (Zhang et al., 2009) and used the Monte Carlo Method for Assessing Mediation (MCMAM; Selig & Preacher, 2008) with 20,000 resamples and 95% CIs to test the significance of the indirect effects. No formal power analyses were computed given their complexity in multilevel designs. However, our sample size is above recommendations of sampling at least 50 observations at Level 2 to avoid biased standard error estimates (Maas & Hox, 2005).

Results

First, individuals who reported that their partners communicated sexual disinterest to them on a greater number of days over the course of the diary reported lower relationship, b = −.04, t(96) = −2.30, p = .02, 95% CI = [−.07, −.01], and sexual satisfaction, b = −.05, t(95) = −2.91, p < .01, 95% CI = [−.09, −.02]. Next, we tested our key predictions about the daily associations between perceived partner sexual rejection behaviors and satisfaction. As reported in Table 5, on days people perceived their partners as more reassuring in their rejection behaviors, they reported greater relationship and sexual satisfaction from the previous day, whereas on days when people perceived their partner as communicating their sexual disinterest in more hostile ways, they reported lower relationship satisfaction, but not significantly lower sexual satisfaction. Daily perceptions of assertive and deflecting rejection were not significantly associated with relationship or sexual satisfaction.

Table 5.

Study 4 Perceived Partner Rejection Behaviors Predicting Daily Relationship and Sexual Satisfaction.

Perceived SRS behavior	Relationship satisfaction		Sexual satisfaction
Perceived SRS behavior	b [95% CI]	t	b [95% CI]	t
Perceived reassuring	.19 [.09, .30]	3.68***	.26 [.15, .36]	4.51***
Perceived hostile	−.19 [−.32, −.06]	−2.88**	−.05 [−.18, .09]	−0.70
Perceived assertive	−.01 [−.08, .07]	−0.19	−.04 [−.12, .04]	−1.04
Perceived deflecting	.01 [−.13, .15]	0.13	−.01 [−.16, .14]	−0.27

Note. Effects above are within-person effects controlling for the aggregate of each rejection behaviors, yesterday’s outcome, and partner’s outcome (i.e., sexual or relationship satisfaction). CI = confidence interval.

p < .05. **p < .01. ***p < .001.

Perceived partner responsiveness as a mechanism

Next, we tested whether perceived partner responsiveness accounts for the link between perceived partner rejection and changes in satisfaction on a particular day. We tested a 1-1-1 mediation model with daily perceived partner responsiveness as a mediator of the link between daily perceived sexual rejection and changes in daily satisfaction using the MCMAM (Selig & Preacher, 2008) with 20,000 resamples and 95% CIs.

As reported in Table 6, on days when people perceived their partner as rejecting them in reassuring ways, they perceived their partner as more responsive than the previous day, and greater perceived partner responsiveness was in turn associated with greater daily relationship and sexual satisfaction. In contrast, on days when people perceived their partner as rejecting them in more hostile ways, they perceived their partner as less responsive and in turn reported lower relationship and sexual satisfaction. We also included assertive and deflecting rejection behaviors as predictors in the mediation model, but no significant indirect effects emerged.

Table 6.

Study 4 Estimates for Models With Perceived Partner Responsiveness Mediating the Association Between Perceived Partner Sexual Rejection and Satisfaction.

Estimate	Perceived reassuring rejection	Perceived hostile rejection	Perceived assertive rejection	Perceived deflecting rejection
Estimate	b [95% CI]	b [95% CI]	b [95% CI]	b [95% CI]
a-path coefficient (i.e., predicting perceived partner responsiveness)	.35 [.23, .47]	−.24 [−.39, −.09]	−.04 [−.13, .05]	.08 [−.08, .25]
Relationship satisfaction
b-path coefficient (i.e., perceived partner responsiveness predicting DV)	.42 [.35, .48]	.42 [.35, .48]	.42 [.35, .48]	.42 [.35, .48]
Total effect	.20 [.09, .30]	−.19 [−.32, −.06]	−.01 [−.09, .07]	−.00 [−.15, .14]
Direct effect	.06 [−.04, .15]	−.12 [−.24, −.00]	.01 [−.05, .08]	−.02 [−.15, .11]
Indirect effect of perceived partner responsiveness	[.09, .20]	[−.17, −.04]	[−.05, .02]	[−.04, .10]
Sexual satisfaction
b-path coefficient (i.e., perceived partner responsiveness predicting DV)	.37 [.30, .44]	.37 [.30, .44]	.37 [.30, .44]	.37 [.30, .44]
Total effect	.26 [.15, .37]	−.05 [−.19, .09]	−.04 [−.12, .04]	−.02 [−.18, .13]
Direct effect	.16 [.05, .26]	.03 [−.10, .16]	−.04 [−.11, .04]	−.10 [−.24, .04]
Indirect effect of perceived partner responsiveness	[.08, .18]	[−.15, −.03]	[−.05, .02]	[−.03, .09]

Note. Indirect effects analyses were conducted using bootstrapping procedures and CIs based on 20,000 resamples. CI = confidence interval; DV = dependent variable.

Interactions between SRS behaviors

Subsequent analyses revealed one significant interaction between perceived hostile and deflecting behaviors in predicting daily sexual satisfaction (b = −.17, SE = .06, p < .01, 95% CI = [−.30, −.05]). Specifically, higher perceived levels of deflecting behaviors were associated with lower daily sexual satisfaction at high levels of hostile behaviors (b = −.21, SE = .10, p = .04, 95% CI = [−.41, −.01]), but were not significantly associated with sexual satisfaction at low levels of hostile behaviors (b = .08, SE = .09, p = .37, 95% CI = [−.09, .25]).

General Discussion

Our model of sexual rejection encompassed four distinct sexual rejection behaviors which could be characterized along the dimensions of valence and directness: reassuring (positive), hostile (negative), assertive (direct), and deflecting (indirect). These findings are broadly consistent with models of relationship communication (e.g., Overall et al., 2009; Rusbult & Zembrodt, 1983), yet reflect a specific form of communication during situations in which partners’ sexual interests conflict. As these situations are highly sensitive and emotionally charged in nature, the current research revealed the importance of demonstrating responsiveness and positive regard when rejecting a partner’s sexual advances. Indeed, we found robust evidence across studies that reassuring sexual rejection behaviors represent an important way couples may be able to maintain satisfaction when partners’ sexual interests are at odds. Furthermore, perceived partner responsiveness was identified as a key mechanism of the effects. Specifically, partners experienced higher sexual and relationship satisfaction on days when they perceived reassuring rejection because they perceived their partner to be more responsive to their needs. These findings are consistent with past research showing that “softening” or accommodation during conflict discussions with romantic partners high in attachment insecurity produces less anger and more successful conflict resolution (Overall et al., 2013; Simpson & Overall, 2014).

In contrast to the findings for reassuring behaviors, we found negative effects of hostile behaviors across studies, providing evidence that negative sexual rejection behaviors are associated with the worst outcomes for rejected partners. We found that low perceived partner responsiveness also mediated the negative associations between partner’s hostile behaviors and both relationship satisfaction and sexual satisfaction. These findings are broadly consistent with research on the adverse relationship outcomes associated with destructive conflict behaviors such as criticism, contempt, and hostility (e.g., Gottman, 1994; Karney & Bradbury, 1995). Satisfaction is likely to deteriorate in the presence of hostile behaviors as these behaviors signal low regard for a partner and their needs, and may predict lower sexual desire or motivation to initiate sex in the future, although future research is needed to test this possibility

Across studies, we did not find evidence that assertive or deflecting behaviors reliably predicted relationship or sexual satisfaction. There were no significant associations between perceived assertive or deflecting behaviors and relationship or sexual satisfaction in our cross-sectional sample. Examining the effects of perceived sexual rejection more proximally at the daily level, we found one significant interaction effect between rejection behaviors suggesting that deflecting behaviors may only negatively impact sexual satisfaction when accompanied by hostile behaviors. A replication of this effect may be warranted as we were only able to test this in the final study, but it broadly aligns with research on showing that indirect-negative relationship behaviors rarely benefit couples’ satisfaction or attempts to resolve problems (McNulty & Russell, 2010).

Although we did not find evidence that the effect of assertive behaviors interacted with other SRS behaviors, these results dovetail with previous research which suggests an inconclusive picture as to whether direct communication in relationships during sexual rejection should have positive or negative effects (Greene & Faulkner, 2005; Metts et al., 1992). There may be other important contextual factors which we did not investigate in the current research (i.e., that assertive rejection might change undesired partner sexual behavior) which may shape the potential benefits or costs of assertive behaviors.

Theoretical Contributions and Implications

The current research extends theories of interpersonal rejection and responsiveness as well as models of relationship communication. First, we apply these theoretical frameworks to the sexual domain in a targeted examination of sexual rejection behavior dynamics. Whereas risk regulation theory suggests that perceived responsiveness or positive regard from a partner is a key mechanism which can buffer individuals from feelings of rejection, the current work offers a communication perspective to demonstrate how partners may be able to provide responsiveness through specific behaviors. Here, the findings suggest that not all rejection is alike, and that romantic partners experience rejection—in this case, sexual rejection—in qualitatively different ways, which in turn differentially predicts satisfaction outcomes. In addition, while risk regulation processes in relationships typically focus on people’s global partner evaluations, this work offers insights into how distinct communication patterns can fundamentally shape partners’ feelings of acceptance and rejection in relationships at a more proximal (i.e., state) level of relationships. Given research demonstrating that perceived partner responsiveness can fluctuate across days and situations in relationships (e.g., Ruan et al., 2019), the current work provides insight on the behaviors—at least those enacted during sexual rejection—that can indicate the extent to which partners are responsive to one another’s needs.

The current work also extends research on conflict behavior and partner regulation processes by emphasizing the importance of context when evaluating the effectiveness of partner regulation strategies. Notably, the differential effects observed between reassuring and assertive rejection behaviors (i.e., positive effects of reassuring and null effects of assertive) strongly suggest that communication patterns deemed effective for problem-solving discussions aimed at influencing desired behavior change in a partner (e.g., direct behaviors; Overall & McNulty, 2017) may not be similarly desirable or advantageous for communication aimed at relational buffering and preserving satisfaction and connectedness. Our findings suggest that in relationship contexts in which partner emotion regulation goals are particularly salient, behaviors high in directness may be less impactful and important than positive-valence behaviors focused on communicating reassurance and responsiveness.

Practical Implications

The findings of this work have broad implications for therapists and couples trying to resolve or manage desire discrepancies, conflicts of sexual interest, and other sexual problems. Research shows that sexual desire discrepancies are a common feature and issue among long-term romantic couples, both on a daily basis and over time (e.g., Day et al., 2015; Risch et al., 2003). Yet much of the research in social-personality psychology involving community couples on this topic has focused on factors that may help to boost or maintain desire among romantic partners (Birnbaum et al., 2016; Muise et al., 2013) rather than factors that interfere with desire. The current research focuses on when partners have lower sexual interest, uncovering relationship behaviors which may help sustain satisfaction when individuals are not in the mood while acknowledging that experiencing lower sexual desire for your partner can at times be normative in relationships.

This work has important implications for clinical populations in which one or both partners suffer from sexual problems such as chronically low sexual desire or other sexual dysfunctions that impact sexual interest such as pain during sex or erectile dysfunction. Such couples are especially challenged with communicating their sexual needs—whether that need is to have sex or not to have sex—while maintaining satisfaction with their overall relationship. Indeed, couples affected by sexual dysfunction report more difficulties with sexual communication compared with unaffected couples, and similarly, poorer quality of sexual communication is linked to poorer sexual functioning (Rancourt et al., 2017). Findings are therefore of interest to health care providers, and sex and couple therapists and educators whose aim is to help promote satisfaction among distressed couples. The results suggest that clinicians might encourage partners to use more reassuring responses and discourage the use of hostile responses.

Limitations and Future Directions

Our findings highlight how crucial it is to communicate reassurance when declining a partner’s sexual advances given the sensitive nature of sexual rejection. One limitation of our work is that we did not simultaneously examine rejection processes in nonsexual domains (e.g., rejecting a partner’s request to go out for the evening) to provide a point of comparison for our effects. That is, we are unable to definitively conclude whether the pattern of effects observed for conflicts of sexual interest would equally apply for rejection during nonsexual forms of conflict. However, our investigation drew upon findings from prior work showing that communication in couples’ discussions about sexual topics can be more impactful than nonsexual topics for predicting couples’ relationship quality (Rehman et al., 2017). Although experiencing rejection in relationships is likely hurtful in most situations, we sought to explore the context of sexual rejection given its unique position as one of the most sensitive and emotionally charged areas of a relationship. As romantic partners (in monogamous relationships) cannot get their sexual needs met outside of the relationship, sexual rejection provides one of the strongest contexts with which to determine how partners can sustain relationship and sexual quality when threats to a partner’s self-esteem are especially heightened. In addition, the present research consisted entirely of Western samples; thus, our findings may be limited in their generalizability given cultural differences in sexual norms and sexual communication in intimate relationships (Tang et al., 2013).

While this research was focused on examining the links between perceived partner sexual rejection behaviors and the satisfaction of the rejected partner, there are likely many other processes at play that shape and are shaped by sexual rejection. For instance, the particular ways in which partners engage in sexual initiation and how partners respond after experiencing sexual rejection both represent important accompanying forms of sexual communication that may further shape couples’ relationship and sexual quality. Furthermore, the unique motivations associated with each rejection behavior were not a focus of the current research, but may too differentially shape rejection given past research on sexual motivation in couples (Impett et al., 2005). For example, the motivations that guide individuals’ use of assertive behaviors may importantly shape the direction of their effects; individuals could potentially feel worse in the moment if their partner rejects them in assertive ways because they wish to change their partner’s behavior or resolve an issue (e.g., the way sex was initiated), rather than due to a reason that is not partner-focused (e.g., they are not feeling well).

Finally, although the results from our daily experience study documenting within-person changes in satisfaction from the previous day provide greater insights into the direction of the associations between sexual rejection behaviors and relationship and sexual quality by examining these processes at a more proximal level, we cannot definitively rule out the possibility that individuals’ satisfaction shapes how they perceive their partners as rejecting in different ways.⁴ Following couples over a longer period of time could provide further insights into the direction of the associations, as well as provide novel insights into the short- versus long-term impact of specific sexual rejection behaviors.

Conclusion

The overwhelming majority of research on how to help couples with conflicts of sexual interest has focused on identifying the factors that can reignite desire and increase sexual frequency. Comparatively, almost no research has investigated how couples can maintain intimacy and be buffered against the negative consequences of sexual rejection, an understanding of which has broad implications for the well-being of couples and families (Amato, 2000; Diener & Seligman, 2002). The findings of the present research revealed that people communicate sexual disinterest to their partners in reassuring (positive), hostile (negative), assertive (direct), and deflecting (indirect) ways, and that reassuring rejection behaviors are a key way that partners can demonstrate responsiveness to navigate one of the most challenging issues in relationships with greater success.

Supplemental Material

Kim_Online_Appendix – Supplemental material for When Tonight Is Not the Night: Sexual Rejection Behaviors and Satisfaction in Romantic Relationships

Supplemental material, Kim_Online_Appendix for When Tonight Is Not the Night: Sexual Rejection Behaviors and Satisfaction in Romantic Relationships by James J. Kim, Amy Muise, John K. Sakaluk, Natalie O. Rosen and Emily A. Impett in Personality and Social Psychology Bulletin

Supplemental Material

Supplemental_Materials – Supplemental material for When Tonight Is Not the Night: Sexual Rejection Behaviors and Satisfaction in Romantic Relationships

Supplemental material, Supplemental_Materials for When Tonight Is Not the Night: Sexual Rejection Behaviors and Satisfaction in Romantic Relationships by James J. Kim, Amy Muise, John K. Sakaluk, Natalie O. Rosen and Emily A. Impett in Personality and Social Psychology Bulletin

Footnotes

Appendix

Acknowledgements

This work has been supported by a Social Sciences and Humanities Research Council (SSHRC) CGS fellowship awarded to James J. Kim, and a SSHRC Insight Grant awarded to Emily A. Impett and Amy Muise.

Declaration of Conflicting Interests

The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Funding

The author(s) disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: This work has been supported by a Social Sciences and Humanities Research Council (SSHRC) CGS fellowship awarded to James J. Kim, and a SSHRC Insight Grant awarded to Emily A. Impett and Amy Muise.

ORCID iDs

James J. Kim

Amy Muise

Supplemental Material

Supplemental material is available online with this article.

Notes

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