We examined how relational and sexual health in Ukraine compares to relational and sexual health in the United States (U.S.) and Turkey. Given these countries’ differences in cultural orientation, religion, and gender attitudes, reference group theory suggests that individuals will adopt group norms and therefore differ across countries. Married midlife adults ages 35–60 years old (United States n = 315, 50.8% female participants; Ukraine n = 322, 46.3% female participants; Turkey n = 563, 38.9% female participants,) completed an Internet survey about relational and sexual health. Ukrainian adults were less satisfied with their relationships, more satisfied with their sexual communication, kissed less, had oral and vaginal sex more frequently, and were more judging of sexual experiences than U.S. adults. However, Ukrainian adults were more satisfied with their relationships, had more frequent vaginal sex, were less judging of sexual experiences, and reported more sexual desire than Turkish adults. These findings suggest that specific cultural features may differentially contribute to cross-cultural differences and demonstrate the important role of culture in understanding relational and sexual health.
This is a preview of subscription content, access via your institution.
Buy single article
Instant access to the full article PDF.
Tax calculation will be finalised during checkout.
Subscribe to journal
Immediate online access to all issues from 2019. Subscription will auto renew annually.
Tax calculation will be finalised during checkout.
Adams, G., Anderson, S. L., & Adonu, J. K. (2004). The cultural grounding of closeness and intimacy. In D. J. Mashek & A. P. Aron (Eds.), The handbook of closeness and intimacy (pp. 321–339). Mahwah, NJ: Lawrence Erlbaum Associates.
Amato, P. R., Johnson, D. R., Booth, A., & Rogers, S. J. (2003). Continuity and change in marital quality between 1980 and 2000. Journal of Marriage and the Family,65, 1–22.
Ataca, B., & Sunar, D. (1999). Continuity and change in Turkish urban family life. Psychology and Developing Societies,11, 77–90.
Attwood, F. (2014). Introduction. In F. Attwood (Ed.), Mainstreaming sex: The sexualization of Western culture (pp. i–xiii). IB Tauris: London.
Barreto, M. E., Ryan, M. K., & Schmitt, M. T. (2009). The glass ceiling in the 21st century: Understanding barriers to gender equality. DC: American Psychological Association.
Barrett, A. E. (2005). Gendered experiences in midlife: Implications for age identity. Journal of Aging Studies,19, 163–183.
Baumeister, R. F., & Stillman, T. (2006). Erotic plasticity: Nature, culture, gender, and sexuality. In R. D. McAnulty & M. M. Burnette (Eds.), Sex and sexuality (pp. 343–359). Westport, CT: Praeger Press.
Boiger, M., Güngör, D., Karasawa, M., & Mesquita, B. (2014). Defending honour, keeping face: Interpersonal affordances of anger and shame in Turkey and Japan. Cognition and Emotion,28, 1255–1269.
Borysenko, L. (2017). Ukrainian culture: Individualism or collectivism? Retrieved from https://www.researchgate.net/publication/309546635_Ukrainian_culture_individualism_or_collectivism.
Boss, P. (2014). Family stress. In A. Michalos (Ed.), Encyclopedia of quality of life and well-being research (pp. 2202–2208). Berlin: Springer.
Brezsnyak, M., & Whisman, M. A. (2004). Sexual desire and relationship functioning: The effects of marital satisfaction and power. Journal of Sex and Marital Therapy,30, 199–217.
Brody, S. (2007). Vaginal orgasm is associated with better psychological functioning. Sexual and Relationship Therapy,22, 173–191.
Brody, S., & Costa, R. M. (2009). Satisfaction (sexual, life, relationship, and mental health) is associated directly with penile-vaginal intercourse, but inversely with other sexual behavior frequencies. The Journal of Sexual Medicine,6, 1947–1954.
Brotto, L. A., Bitzer, J., Laan, E., Leiblum, S., & Luria, M. (2010). Women’s sexual desire and arousal disorders. The Journal of Sexual Medicine,7, 586–614.
Brown, K. W., & Ryan, R. M. (2003). The benefits of being present: Mindfulness and its role in psychological well-being. Journal of Personality and Social Psychology,84, 822–848.
Busby, D. M., Holman, T. B., & Taniguchi, N. (2001). RELATE: Relationship evaluation of the individual, cultural, and couple contexts. Family Relations,50, 308–316.
Buyum. (2018). How women activists keep fighting in Turkey in a climate of fear. Retrieved from http://time.com/5254444/how-women-activists-in-turkey-keep-fighting-in-a-climate-of-fear/.
Byers, E. S., & Demmons, S. (2010). Sexual satisfaction and sexual self-disclosure within dating relationships. Journal of Sex Research,36, 180–189.
Cahill, L. S. (1996). Sex, gender, and Christian ethics. Cambridge: Cambridge University Press.
Chao, J. K., Lin, Y. C., Ma, M. C., Lai, C. J., Ku, Y. C., Kuo, W. H., et al. (2011). Relationship among sexual desire, sexual satisfaction, and quality of life in middle-aged and older adults. Journal of Sex and Marital Therapy,37, 386–403.
Cherlin, A. J. (2009). The marriage-go-round. New York, NY: Vintage Books.
Chung, M. (2016). Individualism-collectivism revisited. Asian Communication Research,13, 58–79.
Coffelt, T. A., & Hess, J. A. (2014). Sexual disclosures: Connections to relational satisfaction and closeness. Journal of Sex and Marital Therapy,40, 577–591.
Council of Europe. (2018). Counsel of Europe trying to enhance gender equality in Ukraine. Retrieved from http://www.coe.int/en/web/kyiv/-/council-of-europe-working-to-enhance-gender-equality-in-ukraine.
Crawford, M. (2017). International sex trafficking. Women & Therapy,40, 101–122.
Dakin, J., & Wampler, R. (2008). Money doesn’t buy happiness, but it helps: Marital satisfaction, psychological distress, and demographic differences between low-and middle-income clinic couples. The American Journal of Family Therapy,36, 300–311.
De Munck, V., Korotayev, A., & McGreevey, J. (2016). Romantic love and family organization: A case for romantic love as a biosocial universal. Evolutionary Psychology,14, 1–13.
Dean, J., Shechter, A., Vertkin, A., Weiss, P., Yaman, O., Hodik, M., et al. (2013). Sexual Health and Overall Wellness (SHOW) survey in men and women in selected European and Middle Eastern countries. Journal of International Medical Research,41, 482–492.
del Mar Sánchez-Fuentes, M., Santos-Iglesias, P., & Sierra, J. C. (2014). A systematic review of sexual satisfaction. International Journal of Clinical and Health Psychology,14, 67–75.
DeLamater, J. D., & Sill, M. (2005). Sexual desire in later life. Journal of Sex Research,42, 138–149.
Dennerstein, L., Hayes, R., Sand, M., & Lehert, P. (2009). Attitudes toward and frequency of partner interactions among women reporting decreased sexual desire. The Journal of Sexual Medicine,6, 1668–1673.
Durkheim, E. (1995). The elementary forms of religious life. (K. E. Fields Trans.). New York, NY: Free Press. (Original work published 1912).
Floyd, K., Boren, J. P., Hannawa, A. F., Hesse, C., McEwan, B., & Veksler, A. E. (2009). Kissing in marital and cohabiting relationships: Effects on blood lipids, stress, and relationship satisfaction. Western Journal of Communication,73, 113–133.
Forbes, M. K., Eaton, N. R., & Krueger, R. F. (2017). Sexual quality of life and aging: A prospective study of a nationally representative sample. The Journal of Sex Research,54, 137–148.
Frederick, D. A., Lever, J., Gillespie, B. J., & Garcia, J. R. (2017). What keeps passion alive? Sexual satisfaction is associated with sexual communication, mood setting, sexual variety, oral sex, orgasm, and sex frequency in a national US study. The Journal of Sex Research,54, 186–201.
Funk, J. L., & Rogge, R. D. (2007). Testing the ruler with item response theory: Increasing precision of measurement for relationship satisfaction with the Couple Satisfaction Index. Journal of Family Psychology,21, 572–583.
Gager, C. T., & Yabiku, S. T. (2010). Who has the time? The relationship between household labor time and sexual frequency. Journal of Family Issues,31, 135–163.
Gehring, D. (2003). Couple therapy for low sexual desire: A systemic approach. Journal of Sex and Marital Therapy,29, 25–38.
Gibson-Davis, C. M., Edin, K., & McLanahan, S. (2005). High hopes bet even higher expectations: The retreat from marriage among low-income couples. Journal of Marriage and Family,67, 1301–1312.
Goodwin, R. (2013). Personal relationships across cultures. New York, NY: Routledge.
Gottman, J. M. (2014). What predicts divorce?: The relationship between marital processes and marital outcomes. New York, NY: Psychology Press.
Grimm, S. D., Church, A. T., Katigbak, M. S., & Reyes, J. A. S. (1999). Self-described traits, values, and moods associated with individualism and collectivism testing IC: Theory in an individualistic (US) and a collectivistic (Philippine) culture. Journal of Cross-Cultural Psychology,30, 466–500.
Heiman, J. R., Long, J. S., Smith, S. N., Fisher, W. A., Sand, M. S., & Rosen, R. C. (2011). Sexual satisfaction and relationship happiness in midlife and older couples in five countries. Archives of Sexual Behavior,40, 741–753.
Hiew, D. N., Halford, W. K., Van de Vijver, F. J., & Liu, S. (2015). Relationship standards and satisfaction in Chinese, Western, and intercultural Chinese–Western couples in Australia. Journal of Cross-Cultural Psychology,46, 684–701.
Hofstede Insights. (2017). Country comparison. Retrieved from https://www.hofstede-insights.com/country-comparison/turkey,ukraine/.
Hughes, D. M. (2000). The” Natasha” trade: The transnational shadow market of trafficking in women. Journal of International Affairs,53, 625–651.
Hughes, S. M., Harrison, M. A., & Gallup, G. G., Jr. (2007). Sex differences in romantic kissing among college students: An evolutionary perspective. Evolutionary Psychology,5, 612–631.
İmamoğlu, E. O., & Selcuk, E. (2018). Cultural and self-related considerations in relationship well-being: With particular reference to marriage in Turkey. In C. C. Weisfeld, G. E. Weisfeld, & L. M. Dillon (Eds.), The psychology of marriage: An evolutionary and cross-cultural view (pp. 89–106). New York, NY: Lexington Books.
Inglehart, R., & Norris, P. (2003). Rising tide: Gender equality and cultural change around the world. New York, NY: Cambridge University Press.
Jackson, J. B., Miller, R. B., Oka, M., & Henry, R. G. (2014). Gender differences in marital satisfaction: A meta-analysis. Journal of Marriage and Family,76, 105–129.
Jankowiak, W. R., Volsche, S. L., & Garcia, J. R. (2015). Is the romantic–sexual kiss a near human universal? American Anthropologist,117, 535–539.
Kapoor, S., Hughes, P. C., Baldwin, J. R., & Blue, J. (2003). The relationship of individualism–collectivism and self-construal to communication styles in India and the United States. International Journal of Intercultural Relations,27, 683–700.
Karney, B. R., & Bradbury, T. N. (1995). The longitudinal course of marital quality and stability: A review of theory, methods, and research. Psychological Bulletin,118, 3–34.
Kornrich, S., Brines, J., & Leupp, K. (2013). Egalitarianism, housework, and sexual frequency in marriage. American Sociological Review,78, 26–50.
Lachman, M. E., Teshale, S., & Agrigoroaei, S. (2015). Midlife as a pivotal period in the life course: Balancing growth and decline at the crossroads of youth and old age. International Journal of Behavioral Development,39, 20–31.
Laumann, E. O., Nicolosi, A., Glasser, D. B., Paik, A., Gingell, C., Moreira, E., et al. (2005). Sexual problems among women and men aged 40–80 y: Prevalence and correlates identified in the Global Study of Sexual Attitudes and Behaviors. International Journal of Impotence Research,17, 39–57.
Laumann, E. O., Paik, A., Glasser, D. B., Kang, J. H., Wang, T., Levinson, B., et al. (2006). A cross-national study of subjective sexual well-being among older women and men: Findings from the Global Study of Sexual Attitudes and Behaviors. Archives of Sexual Behavior,35, 143–159.
Laurenceau, J. P., Rivera, L. M., Schaffer, A. R., & Pietromonaco, P. R. (2004). Intimacy as an interpersonal process: Current status and future directions. In D. J. Mashek & A. Aron (Eds.), Handbook of closeness and intimacy (pp. 61–78). Mahwah, NJ: Lawrence Erlbaum Associates.
Leavitt, C. E., Lefkowitz, E. S., & Waterman, E. A. (2019). The role of sexual mindfulness in sexual wellbeing, relational wellbeing, and self-esteem. Journal of Sex and Marital Therapy,45, 497–509.
Lefkowitz, E. S., & Espinosa-Hernandez, G. (2007). Sex-related communication with mothers and close friends during the transition to university. Journal of Sex Research,44, 17–27.
Lefkowitz, E. S., Gillen, M. M., Shearer, C. L., & Boone, T. L. (2004). Religiosity, sexual behaviors, and sexual attitudes during emerging adulthood. Journal of Sex Research,41, 150–159.
Lefkowitz, E. S., Shearer, C. L., Gillen, M. M., & Espinosa-Hernandez, G. (2014). How gendered attitudes relate to women’s and men’s sexual behaviors and beliefs. Sexuality and Culture,18, 833–846.
Lykes, V. A., & Kemmelmeier, M. (2014). What predicts loneliness? Cultural difference between individualistic and collectivistic societies in Europe. Journal of Cross-Cultural Psychology,45, 468–490.
Mark, K. P., & Jozkowski, K. N. (2013). The mediating role of sexual and nonsexual communication between relationship and sexual satisfaction in a sample of college-age heterosexual couples. Journal of Sex and Marital Therapy,39, 410–427.
Marshall, T. C. (2008). Cultural differences in intimacy: The influence of gender-role ideology and individualism-collectivism. Journal of Social and Personal Relationships,25, 143–168.
Mitchell, K. R., Mercer, C. H., Ploubidis, G. B., Jones, K. G., Datta, J., Field, N., et al. (2013). Sexual function in Britain: Findings from the third National Survey of Sexual Attitudes and Lifestyles (Natsal-3). The Lancet,382, 1817–1829.
Moscovici, S., & Duveen, G. (2000). Social representations: Explorations in social psychology (Vol. 41). Cambridge: Polity Press.
Müftüler-Bac, M. (1999). Turkish women’s predicament. Women’s Studies International Forum,22, 303–315.
Nicolosi, A., Laumann, E. O., Glasser, D. B., Moreira, E. D., Paik, A., & Gingell, C. (2004a). Sexual behavior and sexual dysfunctions after age 40: The global study of sexual attitudes and behaviors. Urology,64, 991–997.
Nicolosi, A., Moreira, E. D., Jr., Villa, M., & Glasser, D. B. (2004b). A population study of the association between sexual function, sexual satisfaction and depressive symptoms in men. Journal of Affective Disorders,82, 235–243.
Oliver, M. B., & Hyde, J. S. (1993). Gender differences in sexuality: A meta-analysis. Psychological Bulletin,114, 29–51.
Özyeşil, Z. (2012). Mindfulness and psychological Needs: A cross-cultural comparison. İlköğretim Online,11, 151–160.
Petersen, J. L., & Hyde, J. S. (2010). A meta-analytic review of research on gender differences in sexuality, 1993–2007. Psychological Bulletin,136, 21–38.
Pew Research. (2017). Religious commitment and practice. Retrieved from https://www.pewforum.org/2017/05/10/religious-commitment-and-practices/.
Pew Research Center. (2015). America’s changing religious landscape. Retrieved from http://www.pewforum.org/2015/05/12/americas-changing-religious-landscape/.
Quinn-Nilas, C., Milhausen, R. R., McKay, A., & Holzapfel, S. (2018). Prevalence and predictors of sexual problems among midlife Canadian adults: Results from a national survey. The Journal of Sexual Medicine,15, 873–879.
Religious Freedom Report. (2016). Ukraine 2014 international religious freedom report. Retrieved from https://www.reliefweb.int/report/world/2014-international-religious-freedom-report.
Robles, T. F., Slatcher, R. B., Trombello, J. M., & McGinn, M. M. (2014). Marital quality and health: A meta-analytic review. Psychological Bulletin,140, 1–80.
Rossi, A. S. (1980). Life-span theories and women’s lives. Signs,6, 4–32.
Sani, G. M. D., & Quaranta, M. (2017). The best is yet to come? Attitudes toward gender roles among adolescents in 36 countries. Sex Roles,77, 30–45.
Segrin, C., & Nabi, R. L. (2002). Does television viewing cultivate unrealistic expectations about marriage? Journal of Communication,52, 247–263.
Štulhofer, A., Buško, V., & Brouillard, P. (2010). Development and bicultural validation of the New Sexual Satisfaction Scale. Journal of Sex Research,47, 257–268.
Swanbrow, D. (2007). Study identifies worldwide rates of religiosity and church attendance. Michigan News. Retrieved from http://ns.umich.edu/new/releases/1835.
Szolnoki, G., & Hoffmann, D. (2013). Online, face-to-face and telephone surveys—Comparing different sampling methods in wine consumer research. Wine Economics and Policy,2, 57–66.
Tang, N., Bensman, L., & Hatfield, E. (2013). Culture and sexual self-disclosure in intimate relationships. Interpersona: An International Journal on Personal Relationships,7, 227–245.
Træen, B., Carvalheira, A. A., Hald, G. M., Lange, T., & Kvalem, I. L. (2019). Attitudes towards sexuality in older men and women across Europe: Similarities, differences, and associations with their sex lives. Sexuality and Culture,23, 1–25.
United Nation Development Programme (UNDP). (2017). Human development reports. Retrieved from http://hdr.undp.org/en/indicators/68606#.
United Nations High Commissioner for Refugees (UNHCR). (2007). Refworld | Country profile—Turkey. World Factbook. CIA Unhcr.org. Retrieved from http://www.refworld.org/pdfid/45ffefcd2.pdf.
USAID. (2016). Gender equality and women’s empowerment. Retrieved from https://www.usaid.gov/sites/default/files/documents/1863/Ukraine_USAID_CDCS_2019-2024_Public_EN_12.pdf.
VanLaningham, J., Johnson, D. R., & Amato, P. (2001). Marital happiness, marital duration, and the U-shaped curve: Evidence from a five-wave panel study. Social Forces,79, 1313–1341.
Varışoğlu, Y. Y., & Oskay, Ü. Y. (2018). The meaning of sexuality in advanced age: A qualitative study in Turkey. Sexuality and Culture,22, 1507–1515.
Wheeless, L. R., Wheeless, V. E., & Baus, R. (1984). Sexual communication, communication satisfaction, and solidarity in the developmental stages of intimate relationships. Western Journal of Communication,48, 217–230.
Whitehouse, H., Lanman, J. A., Downey, G., Fredman, L. A., Swann, W. B., Jr., Lende, D. H., et al. (2014). The ties that bind us: Ritual, fusion, and identification. Current Anthropology,55, 1–10.
Wlodarski, R., & Dunbar, R. I. (2013). Examining the possible functions of kissing in romantic relationships. Archives of Sexual Behavior,42, 1415–1423.
Worsley, R., Bell, R. J., Gartoulla, P., & Davis, S. R. (2017). Prevalence and predictors of low sexual desire, sexually related personal distress, and hypoactive sexual desire dysfunction in a community-based sample of midlife women. The Journal of Sexual Medicine,14, 675–686.
Yakushko, O. (2005). Ambivalent sexism and relationship patterns among women and men in Ukraine. Sex Roles,52, 589–596.
Yeh, H. C., Lorenz, F. O., Wickrama, K. A. S., Conger, R. D., & Elder, G. H., Jr. (2006). Relationships among sexual satisfaction, marital quality, and marital instability at midlife. Journal of Family Psychology,20, 339–343.
Zaleski, E. H., & Schiaffino, K. M. (2000). Religiosity and sexual risk-taking behavior during the transition to college. Journal of Adolescence,23, 223–227.
This was no funding to report for this study.
Conflict of interest
The authors declare that they have no conflict of interest.
All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Katia Serduk—Retirement, Kyiv Taras Shevchenko University.
About this article
Cite this article
Leavitt, C.E., Lefkowitz, E.S., Akyil, Y. et al. A Cross-Cultural Study of Midlife Relational and Sexual Health: Comparing Ukraine to the U.S. and Turkey. Sexuality & Culture 24, 649–670 (2020). https://doi.org/10.1007/s12119-019-09654-y
- Oral sex
- Sexual desire