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The impact of novelty on sexual desire and sexual satisfaction in committed relationships Morton, Heather 2016

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	   	   The Impact of Novelty on Sexual Desire and Sexual Satisfaction in Committed Relationships   by  Heather Morton  B.Sc., The University of British Columbia, 2009  M.A., The University of British Columbia, 2012    A THESIS SUBMITTED IN PARTIAL FULFILLMENT OF  THE REQUIREMENTS FOR THE DEGREE OF   DOCTOR OF PHILOSOPHY  in  The Faculty of Graduate and Postdoctoral Studies (Psychology)   THE UNIVERSITY OF BRITISH COLUMBIA  (Vancouver)   July 2016   © Heather Morton, 2016          	  	   	   	   	   ii	  	  	  Abstract   Evidence from several areas of research suggests that sexual functioning declines in response to partner familiarity and increases in response to partner novelty in men and women.  This evidence includes findings from studies examining habituation of sexual arousal in response to erotic material, expressed desire for multiple sexual partners, declines in sexual functioning in long-term relationships, and the prevalence of extra-dyadic behavior. What is unknown however, is whether the benefits to sexual functioning that arise with a novel partner may be replicated by introducing novelty within long-term relationships. This is a common recommendation of self-help books, websites, and marriage counselors, and yet there has been no research to date directly examining the efficacy of this intervention. The purpose of this line of research was to conduct a series of studies investigating 1) associations between the variety of leisure and sexual activities that couples engage in and their levels of sexual desire and satisfaction, and 2) the impact of a novelty intervention on sexual desire, satisfaction, and desire for one’s partner.  Results of Study 1 revealed an association between engaging in novel activities and sexual desire and satisfaction in women.  However, this was not the case for men. In Studies 2 and 3 no differences were found between couples assigned to the novelty intervention and those in the control and wait-list conditions with regards to sexual desire, sexual satisfaction, or desire for one’s partner.  Together, the findings from this line of research suggest that there is a relationship between novel activities and sexual functioning in women in long-term relationships.  However, no support was found for an online intervention which encouraged couples to engage in novel sexual activities. This set of studies has important implications for couple therapy and self-help resources aimed at benefiting couples who want to enhance their sexual desire and satisfaction.  	  	   	   	   	   iii	  	  	  Preface This dissertation is an original intellectual product of the author, H. Morton. The research presented in this dissertation was approved by the University of British Columbia Behavioural Research Ethics Board and was covered by certificates H11-03163 (initial item generation), H12-03545 (Study 1), H14-01339 (Study 2), and H15-00089 (Study 3).    	  	   	   	   	   iv	  	  	  Table of Contents Abstract  ......................................................................................................................................... ii Preface  .......................................................................................................................................... iii Table of Contents ......................................................................................................................... iv List of Tables .............................................................................................................................. viii List of Figures ................................................................................................................................ x Introductionu ................................................................................................................................ 1  Partner Novelty and Sexual Functioning ............................................................................... 2  Evolutionary Rationale for Partner Novelty ............................................................ 2  Evidence from Nonhuman Species ......................................................................... 4  Habituation to Erotic Material ................................................................................. 6  Preference for Multiple Sexual Partners ................................................................. 9  Sexual Functioning in Long-term Relationships ................................................... 11  Extra-dyadic Behavior ........................................................................................... 14  Novelty within Long-term Relationships ............................................................................ 18 Novel Leisure Activity .......................................................................................... 18  Novel Sexual Activity ........................................................................................... 19 Initial Item Generation ............................................................................................................... 23  Method ................................................................................................................................. 24   Participants ...........................................................................................................  24  Measures ................................................................................................................ 25   Procedure ............................................................................................................... 25  Data Analysis & Results ....................................................................................... 26 	  	   	   	   	   v	  	  	  Study 1: Variety of Sexual and Leisure Activities as Predictors of Sexual Desire and Satisfaction within Long-term Relationships ........................................................................... 27  Method ................................................................................................................................. 28  Participants ............................................................................................................ 28  Measures ................................................................................................................ 30  Procedure ............................................................................................................... 32  Data analysis ......................................................................................................... 33  Results ............................................................................................................................. 33  Women: Variety of Sexual Activities and Sexual Desire and Satisfaction ........... 33  Women: Variety of Leisure Activities and Sexual Desire and Satisfaction ......... 36  Men: Variety of Sexual Activities and Sexual Desire and Satisfaction ................ 38  Men: Variety of Leisure Activities and Sexual Desire and Satisfaction ............... 40  Discussion ........................................................................................................................... 42 Study 2: The impact of a Novelty Intervention on a Couple’s Sexual Relationship in an Amazon Turk Sample of Couples .............................................................................................. 48  Method ................................................................................................................................. 50   Participants ............................................................................................................ 50  Measures ................................................................................................................ 51  Procedure ............................................................................................................... 53  Data Analysis ........................................................................................................ 55  Results ................................................................................................................................. 56  Path of Participants ................................................................................................ 56  Preliminary Analyses ............................................................................................ 56 	  	   	   	   	   vi	  	  	   Main Analyses ..................................................................................................................... 58  Feedback Questions ............................................................................................................. 61  Discussion ........................................................................................................................... 62 Study 3: The impact of a Novelty Intervention on a Couple’s Sexual Relationship in a Sample of Couples Seeking Assistance ...................................................................................... 66  Method ................................................................................................................................. 67  Participants ............................................................................................................ 67  Measures ................................................................................................................ 68   Procedure ............................................................................................................... 68  Data Analysis ........................................................................................................ 69  Results ................................................................................................................................. 70  Path of Participants ................................................................................................ 70 Preliminary Analyses ............................................................................................ 71  Main Analyses ....................................................................................................... 73  Feedback Questions ............................................................................................... 76  Discussion ........................................................................................................................... 76 General Discussion ...................................................................................................................... 82 References .................................................................................................................................... 96 Appendices ................................................................................................................................. 117 Appendix I: Demographic Information ...................................................................................... 117 Appendix II: Leisure Activities Checklist .................................................................................. 119 Appendix III: Sexual Activities Checklist .................................................................................. 123 Appendix IV: Female Sexual Functioning Index (FSFI) ...........................................................  126 	  	   	   	   	   vii	  	  	  Appendix V: International Index of Erectile Function (IIEF)  ................................................... 131 Appendix VI: Partner Specific Sexual Wanting Scale (PSSW) ................................................  134 Appendix VII: The Global Sexual Satisfaction Index (GSSI)  ................................................... 136 Appendix VIII: Feedback Questions .......................................................................................... 137 Appendix IX: Novelty Intervention ............................................................................................ 138 Appendix X: Control Intervention .............................................................................................. 140 Appendix XI: Revised Novelty Intervention .............................................................................. 141   	  	   	   	   	   viii	  	  	  List of Tables Table 1: Demographic Characteristics of Female (n = 78) and Male (n = 113) Participants ..................... 24 Table 2: Demographic Characteristics of Female (n = 339) and Male (n = 351) Participants ................... 30 Table 3: Women: Sexual Variety and Sexual Functioning Descriptive Statistics and Correlations (n = 281) .............................................................................................................................................................. 34 Table 4: Women: Sexual Variety and Sexual Desire Regression Results (n = 281) .................................. 35 Table 5: Women: Sexual Variety and Sexual Satisfaction Regression Results (n = 281) .......................... 35 Table 6: Women: Leisure Variety and Sexual Functioning Descriptive Statistics and Correlations (n = 308) .............................................................................................................................................................. 36 Table 7: Women: Leisure Variety and Sexual Desire Regression Results (n = 308) ................................. 37 Table 8: Women: Leisure Variety and Sexual Satisfaction Regression Results (n = 306) ......................... 38 Table 9: Men: Sexual Variety and Sexual Functioning Descriptive Statistics and Correlations (n = 288) ....  ..................................................................................................................................................................... 38 Table 10: Men: Sexual Variety and Sexual Desire Regression Results (n = 288) ...................................... 39 Table 11: Men: Sexual Variety and Sexual Satisfaction Regression Results (n = 284) ............................. 40 Table 12: Men: Leisure Variety and Sexual Functioning Descriptive Statistics and Correlations (n = 313) ..................................................................................................................................................................... 40 Table 13: Men: Leisure Variety and Sexual Satisfaction Regression Results (n = 313) ............................ 41 Table 14: Men: Leisure Variety and Sexual Satisfaction Regression Results (n = 312) ............................ 42 Table 15: Demographic Characteristics for Couples in the Intervention (n = 48), Control (n = 49), and Wait-list (n = 55) Conditions ...................................................................................................................... 57 Table 16: Pre-intervention and Post-intervention Levels of Sexual Satisfaction, Sexual Desire, and Desire for One’s Partner ......................................................................................................................................... 59 Table 17: Four-month Follow-up Levels of Sexual Satisfaction, Sexual Desire, and Desire for One’s Partner for Couples in the Intervention Condition (n = 21) ........................................................................ 61 	  	   	   	   	   ix	  	  	  Table 18: Demographic Characteristics for Couples in the Intervention (n = 54), Control (n = 47), and Wait-list (n = 41) Conditions ...................................................................................................................... 71 Table 19: Pre-intervention and Post-intervention Levels of Sexual Satisfaction, Sexual Desire, and Desire for One’s Partner ....................................................................................................................................... 74 Table 20: Four-month Follow-up Levels of Sexual Satisfaction, Sexual Desire, and Desire for One’s Partner in Couples in the Intervention Condition ...................................................................................... 75   	  	   	   	   	   x	  	  	   List of Figures Figure 1: Model of the Hypothesized Impact of Partner Familiarty and Novel Activities on Sexual Functioning ................................................................................................................................................. 17    	  	   	   	   	   1	  	  	  Introduction Long-term relationships have been associated with decreased sexual desire, frequency, and satisfaction (Call, Sprecher, & Schwartz, 1995; Durr, 2009; Klusmann, 2002; Murray & Milhausen, 2012; Schmiedeberg & Schroder 2015; Sprecher, 2002; Woloski-Wruble, Oliel, Leefsma, & Hochner-Celnikier, 2010). As well, relationship length has been associated with an increased risk of sexual dysfunction (Ishak, Low & Othman, 2010; Oniz, Keskinoglu & Beziroglu, 2007).  Nonetheless, the vast majority of people still plan to enter long-term sexually exclusive relationships (Pedersen, Miller, Putcha-Bhagavatula, & Yang, 2002). Therefore, there is a need for strategies that long-term couples can use to enhance their sexual relationship. One area of research that may result in assistance for those in long-term relationships struggling with declining sexual desire and satisfaction is the investigation of the impact of novelty on long term-relationships. Self-help books, websites, and marriage counselors often encourage couples to “spice up” their sex life by introducing novelty to their relationship (e.g. Gottman & Gottman, 2005; McCarthy, Ginsberg, & Ginsberg, 2006; Mintz, 2009). Suggestions often involve changes to a couple’s sexual routine (e.g., introducing lingerie, or sex toys), and engaging in new leisure activities together (e.g., salsa dancing, or a cooking class).  Despite the frequency with which this strategy is recommended, there has been no research to date investigating the impact that this strategy actually has on sexual functioning.   There is however an evolutionary basis for the potential benefit of increasing novelty in romantic relationships, which has been supported by a wide array of empirical studies (Morton & Gorzalka, 2015).  Evolutionary theorists suggest that having multiple sexual partners had adaptive benefits for our ancestors, and as a result women and men may have evolved to experience enhanced sexual desire with novel partners (Buss & Schmitt, 1993). If this is indeed 	  	   	   	   	   2	  	  	  the case, then perhaps it is possible to recreate this effect with long-term partners by introducing novelty in other ways.  In addition to being physically different, novel partners are also associated with new locations, new people, new activities, new ways of expressing affection, new ways of engaging in sexual activity, and so on. Therefore, although a familiar partner is unable to transform into a different person physically, he or she can utilize novelty in other ways, potentially resulting in similar benefits to sexual functioning.   Partner Novelty and Sexual Functioning Evolutionary Rationale for Partner novelty There are many factors that influence sexual desire on an individual basis, for example, relationship functioning, stress, physiological, and medical factors (Basson, 2001; Ferreira, Narciso, & Novo, 2012; Frohlich & Meston, 2002; McNabb & Henry, 2006; Tiefer, 2001). Examining evolutionary factors, however, can provide insight into underlying trends. Sexual behavior is clearly fundamental to evolutionary theory, given that evolutionary success is based upon producing the maximum number of viable (able to reproduce) descendants. Consequently, an important focus of evolutionary theorists has been to determine which mating strategies best accomplished this goal for our ancestors. It is clear that in many modern societies, men and women are no longer trying to produce the maximum number of offspring possible.  For example, the average number of children born per woman in 2015 was 1.87 in the United States, and 1.59 in Canada (Central Intelligence Agency, 2016) However, modern humans have inherited the adaptations that led to their ancestors fulfilling this goal. Consequently, the evolutionary advantages and disadvantages of engaging in sexual activity with a familiar versus novel partner are central to understanding how sexual functioning today may be influenced in different situations. 	  	   	   	   	   3	  	  	  Sexual desire is a motivating force for sexual behavior, and sexual arousal is a strong motivator and reinforcer of this behavior.  As a result, both are likely to have a strong influence on the choice of sexual partner. Sexual arousal and desire therefore, must have evolved to promote successful mating strategies.  If having several novel short-term sexual partners was the best strategy for producing the greatest number of offspring who survive to procreate, then sexual desire and arousal should be greatest in these situations. It has been proposed that having multiple short-term mating partners is the most adaptive strategy for men. Perhaps the most frequently discussed evolutionary advantage for pursuing short-term mating strategies is that men will have an increase in the number of potential offspring produced (Betzig, 1986). Men who impregnate multiple mates have the ability to produce multiple children in a nine-month period, as opposed to the single child likely produced in a monogamous long-term strategy. There are also, however, potential benefits for women of short-term mating strategies, such as extraction of resources, using short-term mating to evaluate long-term prospects, and gaining increased protection (Buss & Schmitt, 1993).   It has also been proposed that women may be able to access better genes for their offspring through short-term mating, as males of higher mate value may be more likely to engage in this strategy. This proposal is known as the “good genes” hypothesis (Gangestad & Thornhill, 1997). In line with this theory, Patricia Draper and her colleagues proposed that men could be categorized in terms of mating strategies. ‘Cads’ specialize in short-term mating, these men have high genetic quality which they promote to women by being highly competitive, dominant and brave (Belsky, Steinberg, & Draper, 1991; Draper & Belsky, 1990). ‘Dads’ have a long-term mating strategy, where they compensate for their genetic quality with their potential to invest in their offspring by showing compassion, kindness and industriousness. A recent study examining 	  	   	   	   	   4	  	  	  both behavioral and anatomical indices estimated the ratio of Cads: Dads to be 57:43 (Wlodarski, Manning, & Dunbar, 2015). Following this theory, it would be most beneficial for women to engage in long-term relationships with Dads in order to provide the most care for their offspring; however, if the opportunity presents itself short-term affairs with ‘Cads’ may provide them with offspring of better genetic quality. Laboratory studies have found that women are able to distinguish between description of ‘Cads’ and ‘Dads’ and select the former for short-term relationships and the latter for long-term relationships (Kruger & Fisher, 2005; Aitken, Lyons, & Jonason, 2013). Therefore there are clear adaptive benefits for both men and women to experience higher levels of sexual desire and arousal with novel partners.  Evidence from Nonhuman Species The impact on sexual functioning of partner novelty has been directly examined in nonhuman species, often driven by the potential for extrapolation to human behavior.  In laboratory studies, a male mammal typically copulates with an estrous female several times and then stops.  When the original female is replaced with a new estrous female, the male begins to copulate with the novel female (Symmons, 1979).  This phenomenon of renewed sexual interest in response to the introduction of a novel female is referred to as the Coolidge Effect (Wilson, Kuehn & Beach 1963), and has been the focus of a large number of studies in nonhuman species. The desire to extrapolate this phenomenon to explain human behavior is even evident in the origins of the term.  The term “Coolidge effect” is derived from a story of which the veracity is unknown about the then President of the United States visiting a government poultry farm with his wife. Mrs. Coolidge asked the farmer if the rooster copulates more than once each day. "Dozens of times" he responded. "Please tell that to the President," Mrs. Coolidge requested. Later, when the President was told about the rooster, he asked "Same hen every time?" "Oh no, 	  	   	   	   	   5	  	  	  Mr. President, a different one each time." The President nodded, and then said "Tell that to Mrs. Coolidge" (Bermant, 1976). The Coolidge effect has been studied primarily in male rodents (Beach & Ransom, 1967; Brown, 1974; Bunnell, Boland & Dewsbury, 1977; Dewsbury, 1970; Fisher, 1962; Gray & Dewsbury, 1975; Krames, 1971).  There is little evidence of the Coolidge effect occurring in female rodents; however it has been reported to occur in female hamsters (Lester & Gorzalka, 1988; Lisk & Baron, 1982), whereas a Coolidge effect has not been reported in male hamsters. Unlike other rodents, the female hamster is larger than the male and more aggressive and sexually dominant than the male.  Thus it appears, at least in non-primate species, that the Coolidge effect is more likely to be observed in the sexually dominant member of a male-female pair.  Preference by males towards novel females has also been found in nonhuman primates, such as chimpanzees and rhesus monkeys (Allen, 1981; Michael & Zumpe, 1978). While much of the published research on the Coolidge effect has been performed in mammals, the effect likely is ubiquitous to most nonhuman species.  For example, evidence indicates that male fruit flies (Drosophila melanogaster) preferentially court novel females over familiar females whereas female fruit flies do not show a preference for novel males (Tan, et al, 2013).   It is clear from the literature in nonhuman species that having a novel partner increases the motivation of members of several species to engage in copulatory behavior.  It remains to be determined to what extent these findings can be extrapolated to human behavior. Although it is not likely that the Coolidge effect will ever be investigated in humans employing methods analogous to those used in nonhuman species, there are several areas of research that, upon examination, may improve our understanding of this topic. 	  	   	   	   	   6	  	  	    Habituation to Erotic Material Most laboratory studies investigating habituation to erotic material have employed similar methodology. During habituation trials the same erotic stimulus (e.g., an erotic film clip) is shown repetitively, it is then followed by a novel stimulus (e.g., a different erotic film clip), and then again followed by the original stimulus. Both physiological and subjective arousal is measured throughout. Parallels are often drawn in this literature between exposure to familiar versus unfamiliar erotic stimuli and familiar versus unfamiliar sexual partners.  The majority of this research has been conducted with male participants. Habituation of sexual arousal in response to a familiar stimulus has been found to occur in response to a number of different forms of sexual stimuli (Lalumière & Quinsey, 1998; O’Donohue & Geer, 1985; Zillmann & Bryant, 1988).  Studies have also consistently found a reinstatement of sexual arousal in the novel stimulus trial (Koukounas & Over, 1993; 1999; 2000).   A small number of studies have examined habituation of female sexual arousal.  Laan and Everaerd (1995) found no differences in changes to sexual arousal between women presented the same erotic slide, and those who were shown different slides. They attributed this to a floor effect, as the slides yielded low levels of sexual arousal.  Replication of this study with the inclusion of film stimuli and a greater number of trials resulted in lower levels of physiological arousal in the constant condition, and an increase in subjective and physiological arousal with the introduction of novel stimuli.  Nonetheless, participants in the constant condition still showed considerable subjective and physiological arousal. Other research has found exposure to repeated presentations of erotic film clips, as well as repeatedly engaging in 	  	   	   	   	   7	  	  	  the same sexual fantasy, reduces subjective and physiological arousal in women, and novel presentations of the stimuli lead to a recovery of sexual arousal (Meuwissen & Over, 1990). Previous studies have also compared the habituation and reinstatement of sexual arousal in men and women.  Surprisingly Both, Laan and Everaerd (2011) found only a reduction in women’s genital responses. However, other studies found both men and women’s physiological arousal to decline significantly (Dawson, Lalumière, Allen, Vasey, & Suschinsky, 2013; Dawson, Suschinsky, & Lalumière, 2013). The majority of habituation studies have measured sexual arousal within a single day, with multiple trials ranging from 8-20 presentations of the stimulus.  This is clearly not an accurate representation of the frequency of typical sexual behavior, which reportedly occurs an average of 5-6 times per month in North American adults aged 25-45 (Eisenberg, Shindel, Smith, Breyer & Lipshultz, 2010; Mercer et al., 2013). Better models of habituation in long-term relationships include less frequent presentations of erotic stimuli over a longer period of time.  Howard, Reifler, and Liptzin (1970), found evidence of habituation of sexual arousal when stimuli were presented once every 24 hours.  The same effect was found when the frequency of stimulus presentation was reduced to twice a week (Plaud, Gaither, Amato-Henderson & Devitt, 1997), as well as when presented weekly (O’Donohue & Plaud, 1991). These studies provide a better model for the reductions in sexual arousal that may occur over time with the same sexual partner.   Another limitation with this line of research is that the stimuli involve watching others engage in sexual activities, or imagining oneself engaged in these activities; therefore, it is unknown from this research whether habituation occurs as a result of actually engaging in sexual activity. Perhaps the most critical flaw with this methodology was raised by Schaefer and Colgan 	  	   	   	   	   8	  	  	  (1977), who noted that these studies may be measuring extinction, as opposed to habituation. Considering principles of operant conditioning, sexual arousal (the response) may decline with repeated exposure to the stimulus due to a lack of reinforcement (sexual gratification).  Another methodological issue is that in the majority of these studies, the novel stimuli differed from the original stimuli in multiple ways, including the sexual activities performed, the actors, and the environment.  Therefore it is unknown which aspects of novelty were triggering higher levels of arousal. Kelley and Musialowski (1986) compared men’s and women’s reactions to stimuli, which varied exclusively in terms of actors or sexual activities.  Men were found to have a greater increase in sexual arousal in response to different actors engaging in the same activity, whereas women had a greater increase in sexual arousal to the same actors engaging in different activities. Dawson, Lalumière, et al. (2013), found that subjective sexual arousal, but not genital sexual arousal, was maintained in men and women when they were repeatedly shown film stimuli in which the couple remained the same, but the sexual positions changed.  This suggests that increases in arousal resulting from novel partners may also be activated in part by novel sexual activities.  Research on the habituation of sexual arousal has also investigated potential underlying mechanisms of this effect, specifically the role of attention. Koukounas and Over (1993) found that absorption, experiencing oneself as a participant in the sexual activity shown in the film segment or depicted in the fantasy, decreased with repeated exposure to the stimulus, and recovered with the introduction of novel stimuli. Koukounas and Over (2001) further investigated this effect in a study in which participants were instructed to either employ a participant oriented view or a spectator oriented view while watching an erotic film clip.  Those who employed a participant oriented perspective had higher rates of arousal overall, however 	  	   	   	   	   9	  	  	  there was no difference in the rate at which sexual arousal habituated.  The authors also noted that there was no difference in the rate at which absorption shifted over the trials, indicating that participants may have been unable to control their level of attention over time. Both et al. (2011) conducted a similar study, but included women as well as men, and also found attentional control had no effect on the rate of habituation. In the former studies attention was measured solely by self-report, as a result it is possible subjects may have rated their absorption based on how sexually aroused they were. Koukounas and Over (1999) controlled for this possibility by measuring reaction time to a secondary task, hitting a button in response to a tone.  As predicted, the decrease in sexual arousal in response to repeated exposure of the sexual stimulus was accompanied by a faster reaction to the tone.  Reaction time to the tone was reduced with the introduction of a novel stimulus.  Due to the correlational nature of these data caution is advised when speculating about the direction of this effect, as it possible that levels of sexual arousal have an impact on levels of attention. However, it is also possible that habituation of sexual arousal is due to a decline in attention in response to familiar stimuli, and that reinstatement of sexual arousal is due to an increase in attention in response to novel stimuli. This possibility is consistent with the fact that mindfulness has been shown to be an effective intervention for women with sexual arousal and desire complaints (Brotto, Basson, & Luria, 2008; Brotto, Seal & Rellini, 2012). If novelty does result in greater attention, and greater attention is associated with greater levels of arousal and desire, then it follows that engaging in novel sexual activity would likely benefit sexual functioning. Preference for Multiple Sexual Partners If novel partners are indeed associated with higher levels of sexual arousal and desire, it seems reasonable to predict that people would desire having multiple sexual partners in their 	  	   	   	   	   10	  	  	  lifetime. Schmitt, Shackelford, Duntley, Tooke and Buss (2001) found that male college students reported desiring an average of 18 sex partners, and female college students reported desiring four or five. Men have been repeatedly found to report a greater desire for short-term sex partners (Buss & Schmitt, 1993; Schmitt et al., 2001).  This was true across 10 major world regions (Schmitt, 2003). However, this sex difference may be due to the fact that women’s sexual behavior tends to be more restricted than men’s across culture.  Another potential reason for the low proportion of women reporting a desire for multiple partners in these studies may be that this line of research has not been capturing the specific circumstances where this is most adaptive. When women were given descriptions of a man who was  competitive, dominant, and brave (Cads), and one who was  compassionate, romantic, and industrious (Dads); they were more likely to select the latter for long-term relationships and the former for short-term relationships (Kruger & Fisher, 2005; Aitken, Lyons, & Jonason, 2013). Therefore, it is possible that this desire for a specific kind of short-term mate may not be captured by the broad questions asked in these studies.  Studies have also found that women near ovulation experience a greater desire to engage in short-term relationships with Cads, yet the majority of studies overlook factors related to  women’s menstrual cycle (Gangestad, Garver-Apgar, Simpson & Cousins, 2007; Gangestad, Simpson, Cousins, Garver-Apgar & Christensen, 2004; Gangestad, Thornhill & Garver-Apgar, 2010; Durante, Griskevicius, Simpson, Cantú & Li, 2012). Given that many studies are conducted with college aged women it is likely the majority are taking hormonal birth control medication.  Women currently taking the pill have been shown to provide lower ratings of desire towards both Cads and Dads (Aitken et al., 2013).    It is important to note that despite the high number of desired lifetime partners reported in these studies, the modal number of desired sexual partners for both men and women is one, with 	  	   	   	   	   11	  	  	  46-50% of men, and only 20-25% of women desiring multiple partners (Schmitt et al., 2001; Schmitt, 2003). When asked to select their ideal mating arrangement, both men and women overwhelmingly preferred strict monogamy to risk free casual extra-pair sex (Stone, Goetz & Shackelford, 2005). The majority of people do appear ultimately to want long-term relationships; however, this may be based more on other benefits that accompany these unions, such as emotional support, intimacy, and practical benefits such as pooling of resources, as opposed to maximal levels of sexual arousal and desire.  One way of examining sexual desire more directly in relation to partner novelty is to examine the content of sexual fantasies. Compared to women, men reported fantasizing about a greater number of different partners during an average day (Ellis & Symons, 1990) and report more frequent fantasies involving multiple partners (Kings, DeCicco, & Humphreys, 2009; Wilson, 1997). When asked about fantasizing about someone other than their current sexual partner in the past two months, 98% of men and 80% of women reported having had such a fantasy (Hicks & Leitenberg, 2001).  Men also reported a higher percentage of their fantasies involved someone other than their current partner compared to the women in the study. As well, 57% of women, and 88% of men indicated that they have switched partners during the course of a single sexual fantasy (Ellis & Symons, 1990). These studies suggest that a large proportion of men and women may experience a desire to engage in sexual activity with novel partners; however, this appears to be more common in men.  Sexual Functioning in Long-Term Relationships  A consistent finding in marital research is that the frequency of sexual activity declines over the course of a marriage (Call et al., 1995; Doddridge, Schumm & Bergen, 1987; James, 1981; 1893; Kinsey, Pomeroy, & Martin, 1948; Kinsey, Pomeroy, Martin & Gebhard, 1953; 	  	   	   	   	   12	  	  	  Michael, Gagnon, Laumann & Kolata, 1994). However, it is difficult to decipher whether this is solely the result of factors such as age, the presence of children, and deteriorating health, or whether partner familiarity is playing a role as well. There is evidence that marital duration is associated with sexual inactivity independent of other factors such as age (Call et al., 1995; Karraker & DeLamater, 2013). As well, remarriage has been shown to result in increases in marital sex, and lower odds of sexual inactivity (Call et al., 1995; Karraker & DeLamater, 2013).  Sexual satisfaction has been found to decline in both men and women over the course of a relationship (Klusmann, 2002; Sprecher, 2002).  Similarly, Liu (2003) found marital duration to have a small negative effect on marital sex quality.  He also found that women were less satisfied with their marital sex life than men. This gender difference was also reported by Cheung et al. (2008) in a Hong Kong sample. Heiman et al. (2011), reported results that contradict the habituation hypothesis in that sexual satisfaction was associated with partner duration in five different countries. Schmiedeberg and Schroder (2015) examined how sexual satisfaction changes over the course of a relationship using nationally representative longitudinal data from Germany.  They found that sexual satisfaction tended to increase over the first year of a relationship, followed by a steady decline.   Sexual desire has also been found to decline with relationship duration in women (Hayes, Dennerstein, Bennett, Sidat, Gurrin, & Fairley, 2008; Klusmann, 2002; Murray & Milhausen, 2012), but not in men (Klusmann, 2002; Murray & Milhausen, 2012). In a qualitative study, women identified experiencing spontaneous desire towards their partners early on in their relationships, but that this declined over time (Durr, 2009).  Furthermore, these women still professed love to their partners; suggesting their lack of sexual desire was not the result of other problems within the relationship.  A qualitative study investigating women’s sexual desire in 	  	   	   	   	   13	  	  	  emerging adulthood also found that many women experienced declines in sexual desire over the course of their relationships, however other participants reported experiencing increases in sexual desire, while others reported ebbs and flows in their sexual desire throughout their relationship (Murray, Sutherland, & Milhausen, 2012). Therefore, the majority of women may experience declines in sexual desire over the course of a relationship, but this may not be the case for all women. Murray et al. (2012) also found that the impact of sexual desire on sexual satisfaction may be due to the extent to which women view declines as normal versus problematic, as opposed to absolute levels of sexual desire. Previous research has also shown that sexual desire discrepancies are associated with lower relationship satisfaction and quality of sexual experience in women, and lower sexual satisfaction in men (Davies, Katz, & Jackson, 1999; Mark, 2014; Mark & Murray, 2012). Therefore, if a woman’s sexual desire declines with relationship duration while her male partner’s desire remains constant, both partners may perceive this as a mismatch and, as a consequence, sexual satisfaction may decline. The studies presented are correlational in design, and therefore causal inferences about the impact of relationship duration on sexuality cannot be drawn. However, qualitative research has examined underlying factors, which may provide insight into the association between relationship duration and sexual complaints. Married women with low sexual desire identified over-familiarity as a primary contributing factor to declines in sexual desire. In fact some women felt certain that their desire would return in response to a new partner (Sims & Meana, 2010). As well, some women who reported a reduction in sexual desire towards their partner, continued to experience strong sexual desire towards other men (Durr, 2009; Murray et al., 2012). Men in long-term relationships revealed that they view sexual boredom as an inevitable feature of all sexually exclusive relationships, rationalizing it as the price one must pay for long-term 	  	   	   	   	   14	  	  	  companionship (Tunariu & Reavey, 2003). When asked what they believed were the underlying causes of their sexual boredom, men’s most frequent responses involved over-familiarity, whereas women most frequently suggested themes of complacency (Tunariu & Reavey, 2007). These findings are consistent with Perel’s (2006) clinical and theoretically derived argument that intimacy and closeness leads to a reduction in sexual desire. Quantitative analyses however, have not found factors associated with relationship length to be significant predictors of sexual boredom (Tunariu & Reavey, 2007; Watt & Ewing, 1996).  However, these results should be interpreted with caution as Watt and Ewing (1996) examined relationship status as opposed to duration, and the majority of participants in the Tunariu and Reavey (2007) study were in relatively recently initiated relationships.  Extra-dyadic Behavior Perhaps one of the most common arguments proposed as support for humans having a natural desire for novel partners is the existence of infidelity.  The presence of extra-marital sexual behavior has been reported to range between 20-40% in men and 12-25% in women (Greeley, 1994; Tafoya & Spitzberg, 2007; Traeen, Holmen, & Stigum, 2007; Wiederman, 1997). This is even greater among dating couples, who report a 70% incidence of infidelity (Allen & Baucom, 2006). If extra-dyadic affairs were driven by a desire for partner novelty, then familiarity to one’s current partner would likely increase this risk. A number of studies have found that greater marital duration predicts the greater occurrence of extra-marital behavior (Fisher et al., 2009; Spanier & Margolis, 1983; Traeen et al., 2007). Forste and Tanfer (1996) found that each month in a relationship increased the risk of this behavior by 2%. However, these findings may simply reflect the fact that people who have been in longer relationships have had more time to engage in extra-dyadic sexual activity.  DeMaris (2009) found marital familiarity to 	  	   	   	   	   15	  	  	  have the opposite effect, the more spouses interacted with one another on a daily basis, the less likely they were to engage in extramarital affairs.  There are however other potential explanations, for instance, when people have affairs they are likely to spend less time with their original partner. Liu (2003) found that the likelihood of extramarital sex decreases with marital duration at a constant rate among women. In men, the likelihood of extramarital sex decreases, and subsequently increases.  From an evolutionary perspective this makes sense, as once a woman is no longer fertile there is no adaptive benefit to her engaging in sexual activity with novel partners. Men however, do not lose their ability to procreate in middle age, and given that their monogamous partner is no longer able to bear more children, a desire to procreate outside the union increases his chances of producing more offspring.   If familiarity leads to declines to sexual functioning and novelty leads to increases in sexual functioning, then those engaging in extra-dyadic behavior should find sexual activity to be more frequent and pleasurable with their new partner.  Spanier and Margolis (1983) found that 86% of respondents reported that their extramarital sexual relations were somewhat or very satisfying, yet only 38% of females and 25% of men reported quality of sex during the marriage as low.  Research from several areas of the literature provides support for hypotheses that familiar sexual partners contribute to declines in sexual functioning, whereas novel sexual partners are associated with increases in sexual functioning. What is unclear however is whether this effect can be mimicked within long-term sexually exclusive relationships by introducing novelty in other ways, such as varied leisure and sexual activities.  There are of course a number of factors that contribute to aspects of sexual functioning beyond familiarity, for instance sexual desire is impacted by factors such as the presence of 	  	   	   	   	   16	  	  	  children, relationship distress, and stress, as well as physiological, and medical factors (Basson, 2001; Ferreira, Fraenkel, Narciso, & Novo, 2012; Frohlich & Meston, 2002; Hayes et al., 2008; McNabb & Henry, 2006; Tiefer, 2001). Sexual satisfaction is also closely associated with other factors such as relationship stability, relationship satisfaction, quality of intimate communication, and congruency of partners’ levels of sexual desire (Byers, 2005; Laumann, Gagnon, Michael, & Michaels, 1994; Davies et al., 1999; Sprecher, 2002). However, familiarity appears to be a contributing factor to declines in sexual desire and satisfaction, and therefore increasing novelty within one’s relationship may be a viable strategy to restore sexual functioning for long-term couples.  The model in Figure 1 outlines the impact of partner familiarity on sexual functioning, and the hypothesized benefit of engaging in novel activities.  Relationship duration leads to partner familiarity, which results in the habituation of sexual desire, and a corresponding reduction in sexual satisfaction. The introduction of novel activities is hypothesized to lead to the reinstatement of sexual desire, and increased sexual satisfaction.   	  	   	   	   	   17	  	  	   Figure 1 Model of the Hypothesized Impact of Partner Familiarty and Novel Activities on Sexual Functioning    	  	   	   	   	   18	  	  	  Novelty within Long-term Relationships Novel Leisure Activity  Previous research has examined the impact of leisure activities on relationship functioning, and found that shared participation in leisure activities is associated with relationship satisfaction, especially when these activities are interactive (Holman & Jacquart, 1988; Orthner, 1975). More recently, a small number of studies have sought to investigate the impact of novelty with regards to leisure activity in long-term relationships. However, in these designs novelty has been combined with additional variables. For instance, O’Leary, Acevedo, Aron, Huddy, and Mashek (2012), asked participants about their participation in “shared novel and challenging activities,” which they found were associated with being very intensely in love among those married for over 10 years.  In a series of studies conducted by Aron, Norman, Aron, McKenna, and Heyman (2000), novel activities were defined as “exciting and arousing” activities. They found activities fitting this description were associated with relationship satisfaction both in correlational and experimental studies targeting this variable.  Similarly, Coulter and Malouff (2013), instructed couples to engage in “exciting activities” over a four-week period which resulted in higher levels of romantic relationship excitement, positive affect, and relationship satisfaction compared to wait-list controls.  Neither of these studies examined the impact of novel leisure activities on sexual functioning.  However, in a recent qualitative study, both male and female members of long-term couples expressed that change, such as new experiences, increases their sexual desire (Ferreira, Fraenkel, Narciso, & Novo, 2015). Therefore, although the impact of new or unfamiliar leisure activities in long-term relationships has not been directly studied, previous research suggests this may be an effective strategy in enhancing sexual functioning in long-term couples.  	  	   	   	   	   19	  	  	  Novel Sexual Activity  A few studies have provided evidence of utilization and desire for novel sexual activity within long-term relationships. For instance, engaging in novel sexual activities was one of several strategies listed by women in relationships of five years or longer for resolving sexual desire discrepancies in their relationship (Herbenick, Mullinax & Mark, 2014).  As well, eroticism, such as dyadic use of films or lingerie, was also a common theme among men and women in long-term relationships expressing ways of promoting sexual desire (Ferreira et al., 2015). In addition, a study investigating older women’s sexuality in Israel found that these women were not satisfied with the limited variety in their sex life (Woloski-Wruble, Oliel, Leefsma, & Hocher-Celnikier, 2010). Another study examined gender differences with regards to desire for novelty versus desire for love and intimacy in sexual activity, and found that men rated a number of items associated with sexual variety higher than women did (Hatfield, Sprecher, Pillemer, Greenberger, & Wexler, 1988). However, there were a number of problems with this study, for instance the analyses focused on differences between single items as opposed to comparing the means of these two categories. As well, the categorization of these items was somewhat arbitrary, as many of the items in the “desire for love and intimacy” category could also be related to sexual variety if these were not part of the couple’s normal sexual routine. Rafatmah, Nazari, and Nasrollahi (2011) also concluded that seeking sexual variety was higher in men compared to women. They found no relationship between sexual variety seeking and relationship satisfaction.  However, the sexual variety seeking measure used in this study included not only the variety of sexual behaviors, but also sexual partner variety, intimacy seeking, moral orientation, and idealistic distortion.    	  	   	   	   	   20	  	  	   Although the impact of novel sexual activity on sexual functioning in long-term relationships has not been studied directly, research has examined the impact of specific novel activities.  For instance, women who use vibrators have been found to have higher scores on sexual functioning measures, and partner knowledge and perceived liking of vibrators has been associated with greater sexual satisfaction (Herbenick, Reece, Sanders, Dodge, Ghassemi & Fortenberry, 2010).  Vibrator use among men has also been associated with greater sexual functioning, such as higher intercourse satisfaction and sexual desire among married men (Reece, Herbenick, Dodge, Sanders, Ghassemi, & Fortenberry, 2010). The primary reasons given for using vibrators was “for fun” or to “spice things up.”  Viewing of erotica has produced more mixed results with regards to sexual functioning. Viewing erotic material has been found to be associated with positive effects such as a broader sexual repertoire (Weinberg, Williams, Kleiner, & Irizarry, 2010), and greater likelihood of engaging in sexual activity with one’s partner following these films (Both, Spiering, Everaerd, & Laan, 2004). However, researchers have also found repeated exposure to erotic films has been associated with experiencing difficulties in intimate relationships (Paolucci, Genuis, & Violato, 2000), and diminished perceptions of partner’s physical appeal, sexual performance, sexual curiosity, and affection and sexual dissatisfaction (Yucel & Gassanov, 2010). The majority of this research has focused on solitary viewing of erotic films although a small number of studies have examined the impact of viewing these films with one’s partner. These studies have found benefits such as increases in desire to be close to one’s partner (Staley & Prause, 2013), better communication about sex and fewer sexual problems (Daneback, Traeen, & Mansson, 2009), and greater likelihood of sexual activity on film viewing nights than on non-film viewing nights 	  	   	   	   	   21	  	  	  (Mann, Sidman, & Starr, 1973). However, couples viewing erotic films also reported greater anxiety and guilt (Mann, Berkowitz, Sidman, Starr, & West, 1974; Staley & Prause, 2013). Research from a number of areas in the literature suggests that sexual desire and satisfaction may decrease with partner familiarity and increase with partner novelty. This may have encouraged our ancestors to engage in short-term mating to create the greatest number of offspring.  However, producing the maximum amount of offspring is no longer seen as beneficial in many modern societies. In our current environment, long-term relationships are associated with a number of benefits.  Compared to single men, married men live longer, have better mental and physical health, and make more money; there is evidence that women also benefit in these areas; however, the results are less consistent (Hersche & Stratton, 2000; Horwitz, White, & Howell-White, 1996; Joung, van de Mheen, Stronks, van Poppel, & Mackenbach 1994; Schone & Weinick, 1998; Waldron, Hughes, & Brooks, 1996; Williams, Takeuchi & Adair, 1992).  Therefore, modern humans find themselves in a dilemma. When weighing the costs and benefits, the decision to enter a long-term relationship is clear.  However, aspects of sexual functioning may be pulling them in opposing directions. For some, this may lead to sexually unfulfilling relationships, or risking the continuing benefits of a long-term partnership to engage in extra-dyadic behavior.  This struggle may be one of many contributing factor to the high rate of marital dissolution. Therefore, there is a need for an intervention to help people maintain sexual satisfaction in long-term relationships who hope to reap other benefits of these unions and avoid the hardships of divorce. Given the evidence examined in support of partner novelty increasing sexual desire and arousal, it is possible introducing novelty within one’s relationship could produce these same effects.  Couple leisure activity has been shown to influence relationship functioning; however, the impact on sexual functioning remains unknown. Both men and women 	  	   	   	   	   22	  	  	  have expressed a desire for greater novelty within their sexual relationship, and there is evidence that specific novel sexual activities are associated with greater sexual functioning; however, no one has directly examined the impact of novel sexual activity on sexual functioning.  The purpose of the following line of research is to investigate the effect of novelty on sexual desire and satisfaction in long-term relationships. The major objectives of this dissertation are to: (1) examine the relationship between variety of sexual and leisure activities that couples engage in and aspects of sexual functioning in men and women (Study 1), (2) test whether a novelty based intervention is effective in enhancing sexual functioning in both men and women in long-term relationships (Study 2), and (3) test whether a modified version of this intervention can enhance sexual functioning in a sample of couples who are seeking help for their sexual relationship (Study 3). If the proposed series of experiments support the hypothesis that novelty within long-term relationships improves sexual functioning, these studies would contribute to the development of evidence-based sexual enhancement strategies in long-term relationships and potentially contribute to a reduction in marital distress.   	  	   	   	   	   23	  	  	  Initial Item Generation As discussed previously, there has been a paucity of research on the impact of novelty within long-term relationships.  As a result, research measures assessing the extent to which people engage in novel activities with their romantic partners are also lacking.  One way of examining novelty within relationships is to measure the range of activities in which couples engage. Couples who engage in a greater number of activities are more likely to experience a sense of unfamiliarity during these activities than couples who engage in a small number of activities repeatedly.  For instance, couples that engage in a wide array of sexual positions are less likely to experience over-familiarly with their partners than those who engage in the same sexual position repeatedly at a similar frequency of sexual activity.  Variety of activities as opposed to strictly newness of activities was selected so that results were not confounded with relationship length. For instance, a couple who has been together for 15 years may have engaged in a large number of leisure and sexual activities during the span of their relationship and therefore have a smaller list of activities that are strictly new than the couple who has only been together for one year.  In order to assess the effects of activities in which couples engage, researchers first need to know in what activities couples are engaging.  Previous researchers created an extensive checklist of leisure activities in which couples may engage (Crawford, Godbey, & Crouter, 1986). However, the list does not include more modern activities such as surfing the Internet or going to the gym. With regards to sexual activity measures, researchers have created measures including basic sexual behaviors (Byers, 2011; Derogatis & Melisaratos, 1979), as well as short lists of sexual fantasies (Derogatis & Melisaratos, 1979).  However, there are currently no 	  	   	   	   	   24	  	  	  extensive published checklists of sexual activities that capture the numerous ways couples may vary their sexual activity. The purpose of this study was to gather an extensive list of sexual and leisure activities in which couples engage together.  These items were compiled into two checklists that were used in the studies reported later in the dissertation to assess the variety of leisure and sexual activities in which couples engage. Method Participants. Participants were 113 males and 78 females from North America.  Participants ranged in age from 18 to 45, and in relationship length from 1 to 40 years. All participants were recruited through Amazon Mechanical Turk to participate in the study. Given the nature of the measures, participation was limited to individuals who reported being sexually active and identified as heterosexual. Demographic data are shown in Table 1. Table 1 Demographic Characteristics of Female (n = 78) and Male (n = 113) Participants.  Women Men Age    M (SD) 30.21 (5.93)  28.74(6.97) Education level    High school 15% (n = 12) 11% (n = 13 )  Post-secondary  64% (n = 50 ) 63% (n = 71)  Graduate 21% (n = 16 ) 26% (n = 29) Ethnicity    Caucasian 86% (n = 67) 83% (n = 94)  African American 9% (n = 7) 9% (n = 10)  Asian American 5% (n = 4) 8% (n = 9) Relationship Status    Single 6% (n = 5) 9% (n = 10)  Committed 45% (n = 35) 60% (n = 68)  Married 49%  (n = 38 ) 28% (n = 32)  Separated/ Divorced 0% (n =0) 3% (n = 3) Relationship Length     M (SD) 4.00 (3.58)  3.67(6.08) 	  	   	   	   	   25	  	  	  Children    Yes 40% (n = 31) 25% (n = 28)  No 60% (n = 47) 75% (n = 85)  Measures Demographic information. This is an 11-item measure assessing basic demographic information designed by the researcher (Appendix I).  Leisure Activities. Participants were asked the following open-ended prompt: “List all of the pleasurable things you and your partner have done when spending time together. (For example: hiking, going to a party, watching YouTube videos, going out for dinner, etc.)” Sexual Activities. Participants were asked the following open-ended prompt:  “List all of the different things you have done with your partner to keep sexual activity exciting (For example: using a vibrator, being tied up or bound during sexual activity, having sex in the kitchen, etc.)” Procedure. Participants were informed of our study through the online crowdsourcing website Amazon Mechanical Turk. Previous research has found that the data quality from these studies is reasonably high and compares well to data from laboratory studies (Berinsky, Huner, & Lenz, 2012; Crump, McDonnell, & Gureckis, 2013; Peer, Vosgerau, & Acquisiti, 2013).  Interested participants were directed to a website to complete the web-based questionnaire. After reading through and indicating agreement with the consent form that appeared before the survey, participants could then complete the online questionnaire. The final page of the questionnaire included a debriefing form which provided more information about the purpose of this study and contact information for the researchers running the study in case participants would like to ask any questions or express any concerns. Following completion of the questionnaire, participants were given $1.50 through Amazon Mechanical Turk. 	  	   	   	   	   26	  	  	  Data Analysis & Results The author and a research assistant each independently reviewed the participants’ responses and noted those that were either identical or similar with minor wording changes.  Responses that both the author and research assistant marked as similar were deleted or compiled into one combined response.  This resulted in a total of 123 distinct leisure activities and 65 distinct sexual activities.  Additional leisure items were added from Crawford, Godbey, and Crouter (1986) that were not already represented by participants’ responses, resulting in 149 distinct leisure activities.  Items from the Derogatis Sexual Functioning Index (Derogatis & Melisaratos, 1979) were included in order to further specify sexual activities, resulting in 74 distinct sexual activities. These activities were compiled into two questionnaires, “Leisure Activities Checklist” (Appendix II) and “Sexual Activities Checklist” (Appendix III).    	  	   	   	   	   27	  	  	  Study 1: Variety of Sexual and Leisure Activities as Predictors of Sexual Desire and Satisfaction within Long-term Relationships  Partner familiarity has been found to have a negative impact on sexual functioning, including reductions on measures such as sexual frequency, desire, and satisfaction (Call, Sprecher, & Schwartz, 1995; Durr, 2009; Ishak et al., 2010; Klusmann, 2002; Murray & Milhausen, 2012; Oniz, Keskinoglu & Beziroglu, 2007; Schmiedeberg & Schroder 2015; Sims & Meana, 2010; Sprecher, 2002; Woloski-Wruble et al., 2010).  Evidence from several areas of the literature suggests that partner novelty may increase aspects of sexual functioning. This has been investigated through the presentation of familiar and novel sexual stimuli, examination of men’s and women’s sexual fantasies, and qualitative interviews with those in long-term relationships (Both et al., 2011; Durr, 2009; Hicks & Leitenberg, 2001; Kelley & Musialowski, 1986; Koukounas & Over, 1993; 1999; 2000; Meuwissen & Over, 1990; Murray et al., 2012; Sims & Meana, 2010).   Previous research has primarily focused on the impact of novel sexual partners, and has not examined the impact of other forms of novelty on sexual functioning within long-term relationships.  It is therefore unknown whether couples can protect themselves from the negative impact of familiarity, and continue to reap the gains associated with novelty by engaging in a greater variety of behaviors within their relationship.   Research has shown the importance of leisure activity in long-term relationships.  Engaging in leisure activity as a couple has been associated with relationship satisfaction, particularly when activities involve a high degree of interaction (Holman & Jacquart, 1988; Orthner, 1975).  Aron et al. (2000) conducted a series of studies designed to examine the impact of shared participation in novel and arousing leisure activities on long-term relationships and 	  	   	   	   	   28	  	  	  found that this resulted in greater relationship satisfaction.  However, the researchers measured this variable by asking participants “how exciting are the things you do with your partner,” therefore capturing excitement as opposed to aspects of novelty such as newness or unusualness. No research to date has investigated the impact of novel leisure activity on sexual functioning.  Even less is known about the impact of novel sexual activities. A small number of studies has examined the impact of specific activities, for instance using a vibrator with one’s partner was associated with greater sexual functioning (Reece et al., 2010). Watching pornography with one’s partner has been associated with benefits such as better communication, fewer sexual problems, and higher frequency of sexual activity (Daneback et al., 2009; Mann et al., 1973), as well as negative consequences such as greater guilt and anxiety (Staley & Prause, 2013). However, the influence of a wider array of novel sexual experiences on sexual functioning in long-term relationships is unknown. Before an intervention utilizing this strategy is designed, it first needs to be known whether this strategy is associated with any sexual functioning benefits.  The objective of this study is to examine whether engaging in a greater number of leisure and sexual activities is associated with enhanced sexual desire, and greater overall sexual satisfaction. Data from this study will provide evidence of whether novelty can have a positive impact within monogamous relationships, and provide the impetus for further research in the area, including the potential for novelty based interventions.  Method Participants. Participants were recruited through Amazon Mechanical Turk.  Four hundred and forty North American females and 456 North American males participated in this study. Participation was restricted to those 19 years of age or older and, due to the measures 	  	   	   	   	   29	  	  	  included, was limited to individuals who were sexually active and identified as heterosexual. Participation was also limited to those in a committed relationship of at least one year. As a result, 59 male and 34 female participants were removed from analyses because they did not meet these criteria.  A potential limitation of recruiting through Amazon Mechanical Turk is the quality of the data.  Previous research has found that most participants are not primarily motivated by the financial returns, instead they chose to participate because they find the tasks enjoyable, however, a small number of them are solely motivated by financial gain (Buhrmester, Kwang, & Gosling, 2011). To control for this risk it has been suggested to determine a lower limit on the amount of time required to complete the survey and filter out responses that fall below this threshold (Mason & Suri, 2011). The minimum time needed to complete the survey was determined to be 10 minutes.  As a result, 67 female and 46 male participants were removed from the study, resulting in a total of 339 female participants and 351 male participants. Female participants ranged in age from 19 to 70 and their average age was 32.5. With regards to relationship status, 56% of women identified being in a committed relationship, 4% as common law, and 40% as married. Average relationship length was 5.96 years, ranging between 1 to 34 years. Forty seven percent of the women had children and 53% did not. Male participants ranged in age from 19 to 72 and their average age was 31.7. With regards to relationship status, 57% of men identified being in a committed relationship, 1% as common law, and 42% as married. Relationship length ranged between 1 to 43 years, with an average of 6.20 years. Thirty-six percent of the men had children and 64% did not. Demographic data are shown in Table 2.    	  	   	   	   	   30	  	  	  Table 2 Demographic Characteristics of Female (n = 339) and Male (n = 351) Participants.  Women Men Age    M (SD) 32.47 (10.48) 31.66 (10.09) Education level    High school 24% (n = 80) 24% (n = 86)  Post-secondary  65% (n = 220) 60% (n = 209)  Graduate 11% (n = 39) 16% (n = 55) Ethnicity    Caucasian 82% (n = 276) 85% (n = 297)  African American 9% (n = 31) 6% (n = 22)  Asian American 4% (n = 14) 7% (n = 24)  Other 5% (n = 18) 2% (n = 8) Relationship Status    Committed 56% (n = 189) 57% (n = 199)  Common-law 4%  (n = 13) 1% (n = 3)  Married 40% (n =137) 42% (n = 149) Relationship Length     M (SD) 5.96 (6.22) 6.20 (7.25) Children    Yes 47% (n = 160) 36% (n = 124)  No 53% (n = 178) 64% (n = 225)    Measures  Demographic Information. This is an 11-item measure assessing basic demographic information designed by the researcher.  Leisure Activities Checklist. This is a researcher-designed measure assessing the variety of leisure activities in which couples engage. This is composed of a checklist of 149 distinct 	  	   	   	   	   31	  	  	  leisure activities (Appendix II). Participants were instructed to indicate whether or not they engaged in each activity with their partner over the past month.  Participants were also instructed to include additional sexual activities which they engage in that may have been missing from the list and also indicate whether they engaged in this activity over the past month. The total number of activities engaged in over the past month was summed as a measure of leisure activity variety. Higher scores indicate a greater degree of variety. This measure also includes a single item asking participants how much time per week they spent engaging in shared leisure activities with their partner. Sexual Activities Checklist. This is a researcher-designed measure assessing the variety of sexual activities in which couples engage. This is composed of a checklist of 74 distinct sexual activities (Appendix III).  Participants were instructed to indicate whether or not they engaged in these activities with their partner over the past month (Appendix II). Participants were also instructed to include additional sexual activities in which they engaged that may have been missing from the list and also indicate whether they engaged in this activity over the past month.  The total number of activities engaged in over the past month was summed as a measure of sexual activity variety. Higher scores indicate a greater degree of variety. In addition, participants were asked to indicate the frequency with which they engaged in sexual activity with their partner over the past month.  Female Sexual Function Index (FSFI; Rosen et al., 2000). The FSFI is a 19 item self-report measure assessing desire, subjective arousal, lubrication, orgasm, satisfaction, and pain during sexual activity over the past month (Appendix IV). This measure was included to obtain detailed information about female participants’ current sexual functioning. Subscales on the FSFI were scored according to the instructions in Rosen et al. (2000). Higher scores on each subscale 	  	   	   	   	   32	  	  	  indicate better levels of sexual functioning (Rosen et al, 2000). Test-retest reliability was relatively high for all of the domains (r = .79 to .86) and for the total scale (r = .88). Internal consistency was determined with a Cronbach’s alpha of .97.  International Index of Erectile Function (IIEF; Rosen et al, 1997). The IIEF is a 15 item self-report measure, which aims to assess erectile function, orgasmic function, sexual desire, intercourse satisfaction, and overall satisfaction (Appendix V). This measure was included to obtain detailed information about male participant’s current levels of sexual functioning. Internal consistency was supported with Cronbach’s alpha ranging from .91 to .96 depending on the sample. Test retest reliability was examined for administrations of the measure four weeks apart with the correlation between all of the items being r = .82.  Procedure. Participants were informed of our study through the online website Amazon Mechanical Turk. Interested participants were directed to a website to complete the web-based questionnaire. After reading through and indicating agreement with the consent form that appeared before the survey, participants then completed the online questionnaire. The consent form informed participants that they have the freedom to withdraw from the study at any point without negative consequences, to skip over any questions that they do not wish to answer, and reiterated to participants the information that they read in our online advertisement. The final page of the questionnaire included a debriefing form, which provided information about the purpose of the study.  This form also included contact information for the researchers running the study, in case participants would like to ask any questions or express any concerns. At this point, participants were remunerated for their participation with $1.00.  The order of the measures in the questionnaire was: Demographic Information, Leisure Activities Checklist, Sexual Activities Checklist, FSFI (female participants) IIEF (male participants).  	  	   	   	   	   33	  	  	   Data Analysis  Hierarchical multiple regression analyses were used for the purpose of investigating the contribution of variety of sexual and leisure activities in predicting sexual desire and satisfaction. Separate analyses were run for men and women, and for each dependent variable. For analyses examining the impact of variety of sexual activities, relationship duration and sexual activity frequency were entered in step one, and the total from the sexual activities checklist was entered in step two.  For analyses examining the impact of variety of leisure activities, relationship duration and time spent in leisure activities were entered in step one, and the total from the leisure activities checklist was entered in step two. This method determined the unique contribution of variety of activities on sexual desire and satisfaction over and above the effects of relationship duration and frequency of sexual activity/ leisure activity. Analysis of the female data used domains from the FSFI (Sexual Desire and Sexual Satisfaction) as the dependent variables.  Analyses of the men’s data included domains from the IIEF (Sexual Desire and Sexual Satisfaction) as the dependent variables. In all cases a p level of less than .05 was deemed statistically significant. Results  Women: Variety of Sexual Activities and Sexual Desire and Satisfaction. Hierarchical multiple regression analyses were performed to investigate the ability of variety of sexual activities to predict sexual desire and sexual satisfaction, after controlling for relationship duration, and frequency of sexual activity. Preliminary analyses were conducted to test for violations of the assumptions of linearity, independence of errors, homoscedasticity, and normality; no violations were found. Outliers for frequency of sexual activity (60 and above) 	  	   	   	   	   34	  	  	  were identified (more than three standard deviations above or below the mean) and removed, as these were likely incorrect responses.. Nine individuals were removed this way.  There were no outliers for variety of sexual activity. Additionally, the correlations amongst the predictor variables (relationship duration, frequency of sexual activity, and variety of sexual activities) included in the study were examined and these are presented in Table 3. All correlations were weak to moderate, which indicates that multicollinearity was unlikely to be a problem (Tabachnick and Fidell, 2007).  Table 3 Women: Sexual Variety and Sexual Functioning Descriptive Statistics and Correlations (n = 281)  Mean SD 1 2 3 4 1. Desire 4.10 1.21     2. Satisfaction 4.59 1.44 .38***    3. Sexual activity variety 20.65 11.88 .35*** .41***   4. Relationship duration  5.66 5.74 -.22*** -.08 -.19*  5. Sexual activity frequency 12.72 11.33 .43*** .39*** .38*** -.25*** *p < .05. **p <. 01. ***p < .001.  In the first step of hierarchical multiple regression, two predictors were entered: frequency of sexual activity, and relationship duration. This model was statistically significant (F(2, 279) = 34.43, p < .001) and explained 19.8% of variance in sexual desire (Table 4). After entry of variety of sexual activity at step two, the total variance explained by the model as a whole was 23.4% (F(3, 278) = 28.28, p < .001). The introduction of variety of sexual activity explained an additional 3.6% of variance in sexual desire, after controlling for frequency of sexual activity, and relationship duration (F Change(1, 278) = 13.02, p < .001). In the final model, two of the three predictor variables were statistically significant, with frequency of sexual activity recording a higher Beta value (β = .33, p < .001) than variety of sexual activity (β = .21, p < .001) and relationship duration (β = -.01, p = .070) 	  	   	   	   	   35	  	  	   Table 4 Women: Sexual Variety and Sexual Desire Regression Results (n = 281)  R2 Δ R2 B SE ß t Step 1 .198***       Relationship duration   -.04 .02 -.12* -2.12  Sexual activity frequency   .07 .01 .40*** 7.22 Step 2 .234*** .036***      Relationship duration    -.04 .02 -.10 -.182  Sexual activity frequency   .08 .01 .33*** 5.64  Sexual activity variety   .04 .01 .21*** 3.61 *p < .05. **p <. 01. ***p < .001.  In the first step of hierarchical multiple regression, frequency of sexual activity and relationship duration were entered. This model was statistically significant (F(2, 278) = 25.12, p < .001) and explained 15.3% of variance in sexual satisfaction (Table 5). After entry of variety of sexual activity in step two, the total variance explained by the model as a whole was 23.6% (F(3, 277) = 28.57, p < .001). The introduction of variety of sexual activity explained an additional 8.3% variance in sexual satisfaction, after controlling for frequency of sexual activity, and relationship duration (F Change(1, 277) = 30.20, p < .001). In the final model both variety of sexual activity, (β = .31, p < .001), and frequency of sexual activity (β = .29, p < .001) were statistically significant.  Relationship duration was not significant (β = .053, p = .329). Table 5 Women: Sexual Variety and Sexual Satisfaction Regression Results (n = 281)  R2 Δ R2  B SE ß t Step 1 .153***       Relationship duration   .02 .04 -.02 .42  Sexual activity frequency   .13 .02 .40*** 6.95 Step 2 .236*** .083***      Relationship duration    .03 .03 .05 .98  Sexual activity frequency   .09 .02 .33*** 4.95  Sexual activity variety   .10 .02 .31*** 5.50 *p < .05. **p <. 01. ***p < .001.  	  	   	   	   	   36	  	  	  Women: Variety of Leisure Activities and Sexual Desire and Satisfaction.  Hierarchical multiple regression analyses were also performed to investigate the ability of variety of leisure activities to predict sexual desire and sexual satisfaction, after controlling for relationship duration, and time spent in couple leisure activity. Preliminary analyses were conducted to test for violations of the assumptions of linearity, independence of errors, homoscedasticity, and normality; no violations were found. Outliers for time spent in leisure activity were identified (330 hours and above), and six participants were removed, as these were likely incorrect responses. Outliers for variety of leisure activity were identified (96 activities and over), and three participants were removed, as these were likely incorrect responses. Additionally, the correlations amongst the predictor variables (relationship duration, time spent in couple leisure activity, and variety of leisure activities) included in the study were examined and are presented in Table 6. All correlations were weak to moderate, which indicates that multicollinearity was unlikely to be a problem (Tabachnick and Fidell, 2007). Table 6 Women: Leisure Variety and Sexual Functioning Descriptive Statistics and Correlations (n = 308)  Mean SD 1 2 3 4 1. Desire 4.10 1.21     2. Satisfaction 4.59 1.44 .38***    3. Leisure activity variety 23.40 16.07 .03 .19**   4. Relationship duration  5.66 5.74 -.25*** -.13* -.03  5. Time in leisure activity 61.42 57.87 .14** .21*** .20*** -.01 *p < .05. **p <. 01. ***p < .001.  In the first step of hierarchical multiple regression, two predictors were entered: time spent in couple leisure activity, and relationship duration. This model was statistically significant (F(2, 306) = 13.39, p < .001) and explained 8.0% of variance in sexual desire (see Table 7). After entry of variety of leisure activity at step two the model remained statistically significant 	  	   	   	   	   37	  	  	  (F(3, 305) = 8.90, p < .001), but did not explain any additional variance (F Change(1, 305) = 0.00, p = .961).  In the final model relationship duration (β = -.25, p < .001), and time spent in leisure activity (β = .13, p = .018) were statistically significant, but variety of leisure activities was not (β = .00, p = .961). Table 7 Women: Leisure Variety and Sexual Desire Regression Results (n = 308)  R2 Δ R2 B SE ß t Step 1 .080***       Relationship duration   -.08 .02 -.25*** -4.54  Time in leisure activity   .01 .00 .13* 2.44 Step 2 .080*** .000      Relationship duration   -.08 .02 -25*** -4.53  Time in leisure activity   .01 .00 .13* 2.39  Leisure activity variety   .00 .01 .00 .05 *p < .05. **p < .01. ***p < .001.  In the first step of hierarchical multiple regression, time spent in couple leisure activity, and relationship duration were entered. This model was statistically significant (F(2, 305) = 9.56, p < .001) and explained 5.9% of variance in sexual satisfaction (see Table 8). After entry of variety of leisure activity in step two, the total variance explained by the model as a whole was 8.0% (F(3, 304) = 8.84, p < .001). The introduction of variety of leisure activity explained additional 2.1% variance in sexual satisfaction, after controlling for time spent in joint leisure activity and relationship duration (F Change(1, 304) = 7.02, p = .008). In the final model all three predictor variables were statistically significant, with time spent in couple leisure activity recording the highest Beta value (β = .18, p = .002), followed by variety of leisure activity (β = .15, p = .008), and relationship duration (β = -.13, p = .029).   	  	   	   	   	   38	  	  	  Table 8 Women: Leisure Variety and Sexual Satisfaction Regression Results (n = 306)  R2 Δ R2 B SE ß t Step 1 .059***       Relationship duration   -.07 .03 -.13* -2.25 Time in leisure activity   .01 .00 .20*** 3.73 Step 2 .080*** .021**      Relationship duration   -.07 .03 -.12* -2.19  Time in leisure activity   .01 .00 .18** 3.17  Leisure activity variety    .03 .01 .15* 2.61 *p < .05. **p < .01. ***p < .001.  Men: Variety of Sexual Activities and Sexual Desire and Satisfaction. Hierarchical multiple regression analyses were performed to investigate the ability of variety of sexual activities to predict sexual desire and sexual satisfaction, after controlling for relationship duration, and frequency of sexual activity. Preliminary analyses were conducted to test for violations of the assumptions of linearity, independence of errors, homoscedasticity, and normality; no violations were found. Ten outliers for frequency of sexual activity were identified and removed (70 and above), as these were likely incorrect responses.  There were no outliers for variety of sexual activity. Additionally, the correlations amongst the predictor variables (relationship duration, frequency of sexual activity, and variety of sexual activities) included in the study were examined and these are presented in Table 9. All correlations were weak to moderate, which indicated that multicollinearity was unlikely to be a problem (Tabachnick and Fidell, 2007). Table 9 Men: Sexual Variety and Sexual Functioning Descriptive Statistics and Correlations (n = 288) Variables Mean SD 1 2 3 4 1. Desire 8.10 1.60     2. Satisfaction 7.97 2.03 .35***    3. Sexual activity variety  20.42 11.43 .13* .22***   4. Relationship duration 6.10 6.92 -.19** -.25*** .19**  5. Sexual activity frequency 14.27 11.43 .16** .39*** .25*** -.32*** *p < .05. **p < .01. ***p < .001. 	  	   	   	   	   39	  	  	  In the first step of hierarchical multiple regression, two predictors were entered: frequency of sexual activity, and relationship duration. This model was statistically significant (F(2, 286) = 7.01, p = .001) and explained 4.7% of variance in sexual desire (Table 10). After entry of variety of sexual activity in step two, the total variance explained by the model as a whole was 5.3% (F(3, 285) = 5.33, p = .001). The introduction of variety of sexual activity explained an additional 0.6% of variance in sexual desire, after controlling for frequency of sexual activity, and relationship duration (F Change(1, 285) = 1.93, p = .166). In the final model, only relationship duration (β = -.14, p = .023) was statistically significant. Table 10 Men: Sexual Variety and Sexual Desire Regression Results (n = 288)  R2 Δ R2 B SE ß t Step 1 .047**       Relationship duration   -.04 .01 -.15* -2.47  Sexual activity frequency   .02 .01 .12 1.88 Step 2 .053** .006      Relationship duration    -.03 .01 -.14* -2.29  Sexual activity frequency   .01 .01 .10 1.56  Sexual activity variety    .01 .01 .08 1.39 *p < .05. **p < .01. ***p < .001. In the first step of hierarchical multiple regression, frequency of sexual activity and relationship duration were entered. This model was statistically significant (F(2, 282) = 28.52, p < .001) and explained 16.8% of variance in sexual satisfaction (Table 11). After entry of variety of sexual activity in step two, the total variance explained by the model as a whole was 17.9% (F(3, 281) = 20.44, p < .001). The introduction of variety of sexual activity explained additional 1.1% variance in sexual satisfaction, after controlling for frequency of sexual activity (F Change(1, 281) = 3.72, p = .055). In the final model only relationship duration (β = -.13, p = .027), and frequency of sexual activity (β = .32, p < .001) were statistically significant.    	  	   	   	   	   40	  	  	  Table 11 Men: Sexual Variety and Sexual Satisfaction Regression Results (n = 284)  R2 Δ R2 B SE ß t Step 1 .168***       Sexual activity frequency   .06 .01 .34*** 5.98  Relationship duration   -.04 .02 -.14* -2.46 Step 2 .179*** .011      Sexual activity frequency   .06 .01 .32*** 5.46  Relationship duration   -.04 .02 -.13* -2.23  Sexual activity variety    .02 .01 .11 1.93 *p < .05. **p < .01. ***p < .001.  Men: Variety of Leisure Activities and Sexual Desire and Satisfaction.  Hierarchical multiple regression analyses were also performed to investigate the ability of variety of leisure activities to predict sexual desire and sexual satisfaction, after controlling for relationship duration, and time spent in couple leisure activity.  Preliminary analyses were conducted to test for violations of the assumptions of linearity, independence of errors, homoscedasticity, and normality; no violations were found. Outliers for time spent in leisure activity (300 hours and above) and variety of leisure activity (81 activities) were identified and five participants were removed, as these were likely incorrect responses.  Additionally, the correlations amongst the predictor variables (relationship duration, time spent in couple leisure activity, and variety of leisure activities) included in the study were examined and these are presented in Table 12. All correlations were weak to moderate, which indicates that multicollinearity was unlikely to be a problem (see Tabachnick and Fidell, 2007). Table 12  Men: Leisure Variety and Sexual Functioning Descriptive Statistics and Correlations (n = 313)  Mean SD 1 2 3 4 1. Desire 8.13 1.61     2. Satisfaction 7.96 2.04 .35***    3. Leisure activity variety 20.45 15.61 -.05 .13**   4. Relationship duration  6.12 6.83 -.21*** -.28*** -.11*  5. Time in leisure activity 66.82 56.62 .10 .15** .22*** -.04 	  	   	   	   	   41	  	  	  *p < .05. **p < .01. ***p < .001. In the first step of hierarchical multiple regression, two predictors were entered: time spent in couple leisure activity, and relationship duration. This model was statistically significant (F(2, 311) = 8.32, p < .001) and explained 5.4% of variance in sexual desire (Table 13). After entry of variety of leisure activity in step two, the model was statistically significant (F(3, 310) = 6.50, p < .001), however variety of leisure activities only explained 0.1% of the variance (F Change (1, 303) = .201, p = .654). The only statistically significant predictor of sexual desire in in the final model was relationship duration (β = -.21, p < .001). Table 13 Men: Leisure Variety and Sexual Satisfaction Regression Results (n = 313)  R2 Δ R2 B SE ß t Step 1 .054***       Relationship duration   -.05 .01 -.21*** -3.74  Time in leisure activity   .00 .00 .08 1.50 Step 2 .054*** .001      Relationship duration   -.05 .01 -.22*** -3.90  Time in leisure activity   .00 .00 .10 1.83  Leisure activity variety   -.01 .01 -.10 -1.66 *p < .05. **p < .01. ***p < .001. In the first step of hierarchical multiple regression, time spent in couple leisure activity, and relationship duration were entered. This model was statistically significant (F(2, 310) = 16.50, p < .001) and explained 9.8% of variance in sexual satisfaction (Table 14). After entry of variety of leisure activity in step two, the total variance explained by the model as a whole remained at 10.6% (F(3, 309) = 11.75, p < .001). The introduction of variety of sexual activity explained an additional 0.8% of variance in sexual satisfaction, after controlling for time spent in joint leisure activity and relationship duration (F Change(1, 309) = 2.69, p = .102). In the final model only, time spent in couple leisure activity (β = .12, p = .033), and relationship duration (β = -.27, p < .001) were statistically significant.  	  	   	   	   	   42	  	  	  Table 14 Men: Leisure Variety and Sexual Satisfaction Regression Results (n = 312) *p < .05. **p < .01. ***p < .001. Discussion The results of this study revealed a significant association between engaging in a variety of sexual activities and sexual functioning in women.  The results indicated that women who engage in a greater variety of sexual activities tend to experience greater levels of sexual desire and sexual satisfaction, independent of the length of their relationship, and the frequency with which they engage in sexual activity. However, the contribution of sexual variety on sexual desire (R2 Change = .036) and on sexual satisfaction (R2 Change = .083) was relatively small.  In the final model predicting sexual desire, only frequency of sexual activity and variety of sexual activity were significant predictors; the impact of relationship duration was no longer significant. Therefore, the variety of sexual activity in which a couple engages, and the frequency with which they engage in sexual activity, may have a greater impact on female sexual desire than the length of the couple’s relationship. This suggests that the frequently reported declines in women’s sexual desire (Hayes et al., 2008; Murray & Milhausen, 2012; Klusmann, 2002) may not be an inevitable consequence of long-term relationships, and instead suggest the possibility that engaging in novel sexual activities may help women maintain desire in their relationships. However, it is also possible that having greater sexual desire leads one to engage in  R2 Δ R2 B SE ß t Step 1 .098***       Relationship duration   -.08 .02 -.27*** -5.05  Time in leisure activity   .01 .00 .14* 2.53 Step 2 .106*** .008      Relationship duration   -.08 .02 -.27*** -4.89  Time in leisure activity   .00 .00 .12* 2.18  Leisure activity variety    .01 .01 .08 1.46 	  	   	   	   	   43	  	  	  a greater variety of activities, or that there is a third variable driving both such as a couple’s willingness to communicate about sex. Surprisingly, no significant relationship was found between women’s sexual satisfaction and relationship duration. With the exception of the finding by Heiman et al. (2011), this is inconsistent with several previous studies, which have found women’s sexual satisfaction to decline with relationship duration (Cheung et al., 2008; Klusmann, 2002; Liu, 2003; Schmiedeberg & Schroder, 2015; Sprecher, 2002). One explanation for the lack of relationship between sexual satisfaction and relationship duration in the present study is that participants were only required to be in a relationship of one-year duration, as a result 25% of participants were in a relationship of less than two-years duration, and 55% of participants were in a relationship of less than four years duration, which may not be a sufficient amount of time for familiarity to have a significant impact.   The impact of variety of sexual activity on women’s sexual functioning supports the hypothesis that the benefits to sexual functioning that accompany a novel partner may be replicated within a long-term relationship by engaging in other forms of novelty. The results of previous qualitative studies have suggested that engaging in novel sexual activities may be an effective strategy in increasing women’s sexual desire (Herbenick et al., 2014; Ferreira et al., 2015). However, the present study is the first to provide quantitative support for the hypothesis that novelty within a long-term relationship is associated with greater sexual desire and satisfaction in women. Variety of leisure activity also significantly predicted levels of sexual satisfaction, independent of time spent in couple leisure activities and relationship duration.  However, the contribution of leisure variety to sexual satisfaction was relatively small (R2 Change = .021). 	  	   	   	   	   44	  	  	  Variety of leisure activity did not have a significant impact on women’s sexual desire. This suggests that for women, engaging in a greater variety of leisure activities may potentially have a small impact on sexual satisfaction, but is unlikely to have an impact on sexual desire.  However, it is also possible that having greater sexual satisfaction causes women to engage in a greater variety of leisure activities, or that a third variable is at play such as relationship satisfaction.  Variety of leisure activity was hypothesized to improve sexual functioning in couples in long-term relationships due to the fact that novel partners are associated with novel activities, and therefore engaging in these activities may lead to similar increases in desire and satisfaction. The finding in the present study that variety of leisure activities is associated with sexual satisfaction is consistent with previous studies which have found that novel leisure activities contribute to greater relationship satisfaction (Aron et al., 2000; Coulter & Malouff, 2013).  The lack of relationship between variety of leisure activities and sexual desire however, is inconsistent with previous research, which found change, such as engaging in new activities, to increase sexual desire in long-term couples (Ferreira et al., 2015).  However, given that leisure activities are less directly tied to sexual functioning than sexual activities, it is not surprising that it had a lesser impact.  The results in men did not support the hypothesis that novel activities lead to greater sexual desire and satisfaction. Men’s sexual desire was not significantly predicted by variety of sexual activities or variety of leisure activities, the only significant predictor was relationship duration. Frequency of sexual activity, time spent in leisure activity, and relationship duration significantly predicted sexual satisfaction in men, however variety of sexual activity and variety of leisure activity did not.  	  	   	   	   	   45	  	  	  The results of the present study indicate that relationship duration has a negative impact on sexual desire in men. This is inconsistent with previous research, which found that relationship length did not predict levels of men’s sexual desire (Klusmann, 2002; Murray & Milhausen, 2012). However, these studies involved a university sample and therefore may not have captured the impact of familiarity. Also, relationship length is shorter in university samples. The present study also found that relationship duration has a negative impact on men’s sexual satisfaction, which is consistent with previous findings (Klusmann, 2002; Schmiedeberg & Schroder 2015; Sprecher, 2002). Relationship duration has also been found to have a lesser impact on men’s sexual satisfaction than it has on women’s sexual satisfaction (Cheung et al., 2008; Liu, 2003), which was not the case in the present study. The lack of relationship between variety of activities and men’s sexual functioning is surprising given the accumulation of data supporting the hypothesis that partner novelty enhances men’s sexual functioning (Both et al. 2011; Call et al., 1995; Hicks & Leitenberg, 2001; Karraker & DeLamater, 2013; Koukounas & Over, 1993; 1999; 2000; Meuwissen & Over, 1990).  As well, there are clear evolutionary advantages for men to have adapted to desire short-term mating with novel partners (Betzig, 1986; Buss & Schmitt, 1993). One potential explanation for the lack of relationship between variety of sexual activities, and variety of leisure activities with sexual desire is that the men in the study were not comfortable disclosing reductions in their sexual desire due to the sexual double standard, which suggests men should always have high desire (Milhausen & Herold, 1999).  It is also possible that the benefits to men’s sexual functioning resulting from novel partners, cannot be replicated by novel sexual activity within a long-term relationship. This is consistent with a previous study which found that men experience a greater increase in sexual arousal in response to film stimuli with different 	  	   	   	   	   46	  	  	  actors engaging in the same activity, compared to women who experienced a greater increase in sexual arousal in response to the same actors engaging in different activities (Kelley & Musialowski, 1986). This suggests that engaging in novel activities within a long-term relationship may have a greater impact on female sexual functioning than male sexual functioning.  There are a number of limitations, which may affect the conclusions drawn from this study. First of all, the data for this study were composed of a convenience sample recruited through Amazon Mechanical Turk, which may reduce the generalizability of these findings.  As well, although previous research has established that the majority of participants are not solely motivated by financial gain (Buhrmester et al., 2011), and we eliminated participants who did not spend the minimum time needed to complete the survey, it is still possible that some participants did not respond appropriately.  This is particularly important for the present study given that the number of questions answered has a large impact on the independent variable being examined. Second, as mentioned previously, participation was limited to individuals who have been in a relationship for one year or longer. With greater relationship duration, participants’ level of sexual desire and satisfaction would have been more influenced by familiarity, and therefore engaging in novel sexual activities might have had a greater impact. Third, the sexual desire measures included in this study may have captured desire beyond one’s monogamous partner. The IIEF and FSFI inquire about sexual desire in general as opposed to specifically towards one’s partner.  Therefore, desire towards one’s partner may have been reduced, but individuals would likely continue to experience desire in response to other individuals (Durr, 2009).  Therefore this measure may not be capturing the potential impact of novel sexual activities on sexual desire for one’s long-term partner.  This may have contributed 	  	   	   	   	   47	  	  	  to the lack of significant impact of novel sexual activities on men’s sexual desire, and the relatively small impact on women’s sexual desire. Fourth, the present study examined variety of activities as opposed to strictly newness.  Thus it is possible that strictly newness of an activity may have had a greater impact on sexual functioning.  Finally, due to the correlative nature of the present study causal inferences cannot be drawn from the results.  Therefore it is unknown whether variety of sexual activities leads to greater desire and satisfaction in women or if these aspects of sexual functioning lead one to engage in a greater variety of activities, or if there is a third variable driving all three.   The results from this study indicate that engaging in a variety of sexual activities is associated with greater  sexual desire and satisfaction in women in committed relationships.  The results also suggest that engaging in a greater variety of leisure activities is associated with greater sexual satisfaction in women. However, there was no significant association between sexual activity variety or leisure activity variety and male sexual functioning. It is unknown, however, whether this is due to the limitations mentioned previously, or if novelty within long-term relationships has no impact on men’s sexual functioning.  Therefore further research is needed that includes a sample of participants in longer term relationships, examines desire specifically towards one’s partner, and follows an experimental design so that causality can be determined.  Sexual desire and satisfaction have been frequently reported to decline in long-term relationships (Durr, 2009; Hayes et al., 2008; Liu, 2003; Klusmann, 2002). Low sexual desire is the most common presenting problem at sex therapy clinics (Hawton, Catalan & Fagg, 1991) and lower levels of sexual desire and satisfaction have been associated with relationship instability and dissolution (Edwards & Booth, 1994; Sprecher, 2002; Veroff, Douvan, & Hatchett, 1995). Therefore, there is a need for interventions targeting these difficulties in long-term relationships.  	  	   	   	   	   48	  	  	  The results of the present study indicate that an intervention targeting novelty could potentially enhance women’s sexual desire and satisfaction. The results also suggest that novel sexual activity is likely to have a greater effect on sexual functioning than is novel leisure activity. Therefore future research investigating interventions aimed at enhancing sexual desire and satisfaction within long-term relationships are more likely to be successful if they focus on novel sexual activities.       	  	   	   	   	   49	  	  	  Study 2: The impact of a Novelty Intervention on a Couple’s Sexual Relationship in an Amazon Mechanical Turk Sample The results of Study 1 suggest that novelty may enhance sexual functioning within long-term relationships. Specifically, women who engage in a greater variety of sexual activities have higher levels of sexual desire and satisfaction. As well, women who engage in a greater variety of leisure activities have greater sexual satisfaction. There was however no relationship between activity variety and sexual functioning in men. Despite the fact that Study 1 revealed a relationship between women’s sexual functioning and novel activities, it is not possible to draw conclusions about causality, due to the correlational nature of this study. Therefore, it is unknown whether variety of activities is causing greater sexual desire and satisfaction, if the reverse is true, or whether there is a third variable influencing both sexual functioning and variety of activities.  Therefore an experimental design is needed to determine whether the greater levels of sexual desire and satisfaction found in Study 1 are indeed driven by novelty.  A small number of studies have examined the impact of novelty within an experimental design.  Aron et al. (2000), randomly assigned couples to either a task deemed to be novel and arousing or a mundane task and found those in the novel and arousing task reported higher levels of relationship quality.  However these researchers examined excitement as opposed to newness or unusualness. Coulter & Malouff (2013) created an online intervention, which again focused on exciting activities as opposed to new or unusual activities. This intervention was found to have positive effects on relationship excitement, however sexual functioning was not assessed. The purpose of Study 2 was to investigate whether novel sexual activity enhances sexual functioning in men and women within long-term relationships.  Given that in Study 1, variety of sexual activities was more strongly associated with sexual functioning, Study 2 focused solely on 	  	   	   	   	   50	  	  	  this area.  The aim of Study 2 was to assess the efficacy of an online intervention, which encouraged couples to engage in sexual activity outside of their usual routine.  It was hypothesized that couples assigned to the online intervention would experience higher levels of sexual desire, satisfaction, and desire for one’s partner.  A limitation of Study 1 was that the measures of sexual desire included in the study (FSFI and IIEF) assess sexual desire in general as opposed to sexual desire specifically targeted towards one’s partner. Therefore Study 2 also included the Partner-Specific Sexual Wanting Scale (Krishnamurti & Loewenstein, 2012), which captures sexual desire for one’s romantic partner. The Global Sexual Satisfaction Index (GSSI; Derogatis & Melisaratos, 1979) was also included in Study 2, to measure the dependent variable sexual satisfaction. The advantage of the GSSI over the FSFI/ IIEF measures of sexual satisfaction used in Study 1 is that the GSSI is valid for both male and female members of a heterosexual couple.  However, the FSFI and IIEF were used in Study 2 to measure sexual desire as these indexes are composed of identical questions. Therefore these data can be considered in the same analysis. A surprising finding in Study 1 was that despite the fact that engaging in a variety of sexual and leisure activities was associated with higher levels of sexual functioning in women, there was no such impact on male sexual functioning. This is particularly surprising given previous findings which suggest male sexual functioning is enhanced by partner novelty (Both et al. 2011; Call et al., 1995; Hicks & Leitenberg, 2001; Karraker & DeLamater, 2013; Koukounas & Over, 1993; 1999; 2000; Meuwissen & Over, 1990), as well as the strong evolutionary rationale for male sexual functioning to have adapted to benefit from short term mating (Betzig, 1986; Buss & Schmitt, 1993). Therefore it remains unclear whether there is indeed a gender difference with regards to how novelty within a relationship impacts sexual functioning. As a 	  	   	   	   	   51	  	  	  result, in addition to examining the impact the intervention has on the couple’s sexual desire, sexual satisfaction, and desire for one’s partner, Study 2 also investigated whether the impact differs with the partner’s gender. Given that this was the first study to implement a novelty intervention, feedback about the intervention was solicited from participants in order to assess any difficulties they might have in understanding or implementing the intervention.  This feedback will be used to improve the intervention for Study 3.  The results from this study not only may further our understanding of the impact of novelty on long-term relationships but also have the potential to contribute to the development of interventions for couples in long-term relationships that are not satisfied with their current sexual relationship. If this intervention is efficacious in an online format it could result in a low cost and easily accessible option for couples.  Method Participants. An a priori power analysis was computed for a within-between ANCOVA; three groups, two repetitions (each member of the couple’s score) on GPower 3.1 (Faul, Erdfelder, Lang, & Buchner, 2007). The correlation between measures was entered as r = 0.2. This was chosen based on correlations of couples’ sexual functioning in previous studies (Heiman et al., 2007; Nelson, Shindel, Naughton, Ohebshalom, & Mulhall, 2008; Shindel, Quayle, Yan, Husain, & Naughton, 2005). Due to a lack of previous research in this area, it is not possible to estimate an effect size based on prior research.  Therefore Cohen’s (1988) effect size guidelines were used to detect a small effect size (f = 0.20). In order to have a 95% chance of detecting effect size, a sample size of 53 couples per group was required. We planned to recruit an additional 21 couples per group (40% increase), given that similar online studies have 	  	   	   	   	   52	  	  	  reported a 60% response rate at follow-up (Berinsky, Huber, & Lenz, 2012; Buhrmester et al., 2011).  Participants were recruited through Amazon Mechanical Turk. This form of recruitment was selected in order to gather a large number of participants quickly to provide an initial evaluation of the intervention. Participation was restricted to those who were 19 years of age or older, and due to the measures included were limited to individuals who were sexually active and identified as heterosexual. As well participation was restricted to those in a committed relationship of at least one year. Participants ranged in age from 19 to 69, and in relationship length from 1 to 35 years. Of the 349 couples that initially visited the preliminary survey page, 200 North American couples completed the preliminary survey. Participants ranged in age from 19 to 82, (Female: M = 32.23, SD = 9.25; Male: M = 34.64, SD = 10.11).  With regards to marital status, 85 couples indicated that they were married (42%), nine couples identified as common-law (5.0%), and 106 identified as being in committed relationships (54%).  The average length of relationships was 6.35 (SD = 6.58) years, and ranged from one to 35 years.     Measures   Demographic information. This is an 11-item measure assessing basic demographic information designed by the researcher.   Female Sexual Function Index (FSFI; Rosen et al, 2000). Described in Study 1. The sexual desire index was used as an outcome variable to assess the efficacy of the intervention.  International Index of Erectile Function (IIEF; Rosen et al, 1997). Described in Study 1. The sexual desire index was included as an outcome variable to assess the efficacy of the intervention. 	  	   	   	   	   53	  	  	   Partner-Specific Sexual Wanting Scale (PSSW; Krishnamurti & Loewenstein, 2012).  This is a 5-item self-report measure, which assesses motivation to engage in sexual activity with one’s partner (Appendix VI).  It was included as an outcome variable in order to assess the impact of the intervention on motivation to engage in sexual activity with one’s partner. Higher scores on this scale indicate higher levels of desire for one’s partner. Test retest reliability is relatively stable (r = .70). Internal consistency was determined with a Cronbach’s alpha of .87. The PSSW scale displayed satisfactory discriminant and convergent validity with measures of sexual desire and satisfaction and relationship functioning. The Global Sexual Satisfaction Index (GSSI; Derogatis & Melisaratos, 1979). The GSSI is a single item index of the Derogatis Scale of Sexual Functioning (DSFI) (Appendix VII). The DSFI is a multidimensional measure of various aspects of psychological and sexual function, which comprises 10 subscales. Single subscales can be chosen to suit specific research design; the Sexual Satisfaction Subscale consists of nine items reflecting the individual level of sexual fulfillment. The DSFI has been found to have high internal consistency ranging between .60 and .97, and test–retest reliability ranging between .70 and .90 (Derogatis & Melisaratos, 1979; Herold, 1985). The GSSI represents quality of sexual functioning on a 9-point scale anchored at the lower extreme by (0), “could not be worse” to (8), and “could not be better” at the upper limit.  This index was included as an outcome variable in order to assess the impact of the intervention on sexual satisfaction. Adherence question. Couples were also asked how many times they engaged in sexual activity outside of their normal routine. This was used to determine the extent to which participants in the intervention condition engaged in the intervention.  	  	   	   	   	   54	  	  	  Feedback Questions.  Five open-ended questions were included in the follow-up questionnaire for those who were assigned to the intervention (Appendix VIII). These questions were designed to give the participants an opportunity to provide feedback about the intervention and any potential difficulties they may have had.  These data were used to modify the intervention for Study 3. Procedure. Participants were informed of the study through the online website Amazon Mechanical Turk. Interested participants were directed to a website to complete the preliminary web-based questionnaire. The consent form was at the beginning of the survey, which informed participants of the three parts of the study, and that they had the freedom to withdraw from the study at any point without negative consequences. After reading through and indicating agreement with the consent form, participants completed the online preliminary questionnaire. The female portion of the questionnaire included: Demographic information, FSFI, GSSI, and the PSSW. The male portion of the questionnaire included all of the same measures except for the IIEF, which replaced the FSFI.  Participants were asked to complete the research questionnaire independently of their partners. Upon completion of the questionnaire, participants were randomly assigned to the wait-list condition, experimental condition, or control condition and the corresponding instructions were provided. Couples assigned to the wait-list condition were informed that they would be given the intervention in four weeks. To motivate continued participation during the control and experimental interventions, weekly emails were sent to couples reminding them of the intervention or control condition instructions as well as the opportunity to ask any questions they may have. Four weeks following the completion of the preliminary questionnaire, participants in all groups were sent a link to a questionnaire that included the same measures that were administered at pre-intervention, as well as an additional 	  	   	   	   	   55	  	  	  adherence question. To assess long-term maintenance of any improvements, couples in the intervention condition were sent these same measures four months later, as well as five open-ended feedback questions.  Novelty Intervention. Written instructions were given to couples which asked them to jointly compile and write down a list of 10 sexual activities outside of their normal sexual routine that sound pleasurable to both of them and that they both would feel comfortable trying. The instructions provided a list of ideas of novel sexual activities that they might try (from the Sexual Activities Checklist).  Couples were then asked to make a specific plan to engage in as many of these activities as possible over the next four weeks.  They were instructed to write down details such as when and where these activities would take place, as well as any items that might need to be purchased.  They were then encouraged to put this plan somewhere that they would be able to see it over the next four weeks. Coulter and Malouff (2013) employed a similar intervention format in their study, which encouraged couples to engage in exciting activities together, and resulted in high levels of adherence.  For the complete instructions see Appendix IX.  Control Intervention. The control intervention was designed to control for the possibility that talking about sex and planning sexual activity may be driving potential sexual functioning benefits seen in the intervention condition. Couples in the control group were given written instructions asking them to discuss how often they would ideally like to engage in sexual activity over the next four weeks and then to make a specific plan for how to achieve this.  They were asked to write this plan down and put it somewhere visible.  For the complete instructions see Appendix X.   	  	   	   	   	   56	  	  	  Data Analysis  Given that the objective of this study was primarily exploratory, and the high attrition rate in previous studies with this population (Berinsky et al., 2012; Buhrmester et al., 2011), a “per protocol” analysis was conducted in which only those who completed the four-week follow-up survey were included in the analyses. This strategy has been argued to be appropriate for studies of this nature (Armijo-Olivo, Warren, & Magee, 2009).  Preliminary data analysis included checks for adequate randomization of participants to conditions. Analysis of variance (ANOVA) was used to ensure that there were no significant differences with regards to participant age, relationship duration and pre-intervention levels of sexual functioning between the three groups. Paired sample t-tests were used to ensure there were no significant differences in age, relationship duration, or baseline levels of sexual desire, sexual satisfaction, or desire for one’s partner between participants who completed the post-intervention survey and those who did not. In order to assess the impact of adherence to the intervention on outcome, response the adherence question was correlated with post-intervention levels of sexual desire, sexual satisfaction, and desire for one’s partner.   Analysis of covariance (ANCOVA) was used to examine differences between treatment groups as well as the role of gender.  For these analyses, the couple was considered the unit of analysis.  This approach has been frequently recommended (Kashy & Snyder, 1995; Kenny, Kashy, & Cook, 2006; Kraemer & Jacklin, 1979; Maguire, 1999), as it allows the interaction between treatment group and partner gender to be investigated, determining whether the effect of treatment condition differs for male and female members of a couple. The use of ANCOVA has been recommended when groups have pre- and post- assessment on the same measures, and assesses whether post-intervention means, adjusted for pre-intervention means, differ between 	  	   	   	   	   57	  	  	  groups (Tabachinick & Fidell, 2001).  Gender was a within-subjects factor in all analyses to take into account dependency between men and women’s scores (Kashy & Snyder, 1995; Kenny et al., 2006; Kraemer & Jacklin, 1979; Maguire, 1999), and assigned treatment group (Intervention, Control, Wait-list) was entered as the between subject factor. Participants’ pre-intervention data for the outcome variable being examined were entered as covariates. The outcome variables included desire for one’s partner (PSSW), sexual satisfaction (GSSI), and sexual desire (FSFI sexual desire index, and IIEF sexual desire index).  The sexual desire indexes on the FSFI and IIEF are measured by identical questions and calculated the same way; therefore these data can be considered in the same analysis. Results Path of Participants: Of the 200 participants who completed the preliminary questionnaire, 152 (76%) completed the four-week follow up questionnaire, including 48 (78%) of 61 in the intervention group, 49 (70%) of 70 of the control group, and 55 (80%) of 69 of the wait-list group. There were no significant differences in couple attrition rates between the three conditions (X2 (2, N = 200) = 2.14, p = .342). With regards to the four-month follow up assessment, 21 (44%) of the 48 couples in the intervention group completed this survey. Preliminary Analyses: Table 15 provides demographic characteristics of the 152 couples included in the analyses across the three groups. A one-way analysis of variance (ANOVA) showed the randomization of the 152 couples yielded groups with no significant differences in age, relationship duration, or baseline levels of sexual desire, sexual satisfaction, or desire for one’s partner.  Analyses also revealed there were no significant differences between participants who completed the post-intervention survey and those who did not in age, relationship duration, or baseline levels of sexual desire, sexual satisfaction, or desire for one’s partner.    	  	   	   	   	   58	  	  	  Table 15 Demographic Characteristics for Couples in the Intervention (n = 48), Control (n = 49), and Wait-list (n = 55) Conditions  Intervention Control Wait-list  Men Women Men Women Men Women Age        M 35.21 33.58 35.45 33.33 35.82 32.29  SD 11.75 11.98 8.21 7.64 11.29 8.89 Education level        High school 14(29%) 22(46%) 12(25%) 14(29%) 18(33%) 21(38%)  Post-secondary  27(56%) 17(35%) 25(51%) 27(55%) 30(55%) 30(55%)  Graduate 7(15%) 9(19%) 12(24%) 8(16%) 7(13%) 4(7%) Ethnicity        Caucasian 41(85%) 40(83%) 43(88%) 42(88%) 48(87%) 46(84%)  African American 1(2%) 3(6%) 3(6%) 3(6%) 1(2%) 0 (0%)  Asian American 5(10%) 4(8%)  3(6%) 2(4%) 1(2%) 4(7%)  Other 1(2%) 1(2%)  1(2%) 5(9%) 5(9%) Relationship status     Committed 26(54%) 21(43%) 29(53%)  Common-law 1(2%) 1(2%) 2(4%)  Married 21(44%) 27(55%) 24(44%) Relationship length      M 6.69 6.97 6.56  SD 7.65 5.42 7.63 Children     Yes 20(42%) 27(55%) 33(60%)  No 28(58%) 22(45%) 22(40%)   Forty-seven couples in the intervention group responded to the adherence question regarding frequency of novel sexual activities over the previous four weeks. Of those, 10 (21%) did not engage in any novel sexual activity, 12 (26%) engaged in novel sexual activity 1-2 times, 9 (19%) engaged in novel sexual activity 3-4 times, 6 (12%) engaged in 5-6 novel activities, 5 (10%) engaged in 7-8 novel activities, and 5 (11%) engaged in 10-15 novel activities.  The number of novel activities couples engaged in was significantly correlated with sexual desire (r = .33, p = .025), sexual satisfaction (r = .30, p = .039), and desire for one’s partner in women (r = .38, p = .009), as well as partner desire for one’s partner in men (r = .31, p = .035), but not with sexual desire (r = .29, p = .050), or sexual satisfaction in men (r = .23, p = .122).  	  	   	   	   	   59	  	  	  Preliminary checks on the data revealed the normality assumption was violated as determined by the Shapiro-Wilk statistic for: women’s sexual satisfaction in all three conditions, men’s sexual satisfaction in the control, and wait-list conditions, women’s sexual desire in the intervention condition, and men’s sexual desire in all three groups. However, ANOVA has been found to be robust with respect to violations of normality.  As a result the data were not transformed (Glass, Peckham, & Sanders, 1972; Norman, 2010; Pearson, 1931).  According to Levene’s test, the assumption of homogeneity of variance was met (p > .05) for all dependent variables. Sphericity is always met when there are two levels of a repeated measures factor, and it was therefore unnecessary to evaluate. No violations were found with regards to the assumption of linearity between pre-intervention and post-intervention levels of sexual desire, satisfaction, or desire for one’s partner.  Inter-correlations between covariates (men and women’s pre-intervention levels) ranged between .30 and .69, therefore multicollinearity was unlikely to be a problem (Tabachnick & Fidell, 2007).  The assumption of homogeneity of regression was also tested to ensure the relationship between each covariate and dependent variable was consistent across treatment groups. There were no statistically significant interaction effects between pre-intervention scores and treatment group, therefore the assumption of homogeneity of regression was met for all analyses. Main Analyses Table 16 shows the means at pre-intervention and post-intervention, for all three groups. An ANCOVA was conducted to compare the effect of treatment group on sexual desire for both members of the couple. There was no significant interaction between gender and treatment group (Wilk’s Lambda = 1.00, F(2, 147) = .05, p = .948, η2 = .001). The main effect of gender was not significant (Wilk’s Lambda = 1.00, F(2, 147) = .45, p = 0.503, η2 = .003). The main effect of the 	  	   	   	   	   60	  	  	  treatment group was also not significant (F(2, 147) = .87, p = .423, η2 = .012).  An ANCOVA was also conducted to compare the effect of treatment group on desire for one’s partner for male and female partners. There was no significant interaction between gender and treatment group (Wilk’s Lambda = 1.00, F(2, 147) = 0.20, p = 0.820, η2 = .003). The main effect of gender was not significant (Wilk’s Lambda = .98, F(1, 147) = 2.83, p = .095, η2 = .019). The main effect of treatment group was also not significant (F(2, 147) = .32, p = .724, η2 = .004).  An ANCOVA was conducted to compare the effect of treatment group on sexual satisfaction for both members of the couple. There was no significant interaction between gender and treatment group (Wilk’s Lambda = .99, F(2, 147) = 1.16, p = .318, η2 = .015). The main effect of gender was not significant (Wilk’s Lambda = 1.00, F(1, 147) = .004, p = .945, η2 = .000).  The main effect of the treatment group was also not significant (F(2, 147) = 1.03, p = .359, η2 = .014).  Table 16 Pre-intervention and Post-intervention Levels of Sexual Satisfaction, Sexual Desire, and Desire for One’s Partner  Intervention Control Wait-list  Pre  (n = 61) Post (n = 48) Pre (n = 70) Post (n = 49) Pre (n = 69) Post (n = 55)  M F M F M F M F M F M F Satisfaction   M  SD  6.33 1.53  5.98 1.58  6.58 1.32  6.17 1.51  6.55 1.42  6.04 1.58  6.27 1.63  6.27 1.55  6.22 1.76  5.93 1.81  6.11 1.95  6.05 1.70 Desire    M   SD  5.06 0.90  4.25 1.01  5.11 0.93  4.38 1.17  5.13 0.80  4.38 1.16  5.09 1.03  4.41 0.94  5.03 1.06  4.44 0.98  4.93 1.15  4.25 0.95 Partner Desire  M  SD  23.15 4.50  19.98 5.21  23.52 4.74  20.25 5.06  23.47 5.16  20.98 5.46  23.27 5.20  20.84 5.63  23.25 5.01  19.65 5.34  22.89 6.36  19.84 5.51   Given that ANCOVA is relatively conservative there is the possibility of unnecessary rejection of the null hypothesis.  Therefore, I compared baseline values for all outcome variables and found them to be similar thus justifying the use of the more powerful change score analyses 	  	   	   	   	   61	  	  	  via ANOVA separately for men and women. These analyses also did not reveal any significant differences in sexual desire, desire for one’s partner, or sexual satisfaction between treatment groups, which suggests that the ANCOVA results were not likely erroneous. Twenty-three (48%) of the 48 couples in the intervention group completed the four-month follow-up questionnaire. In order to determine whether there were improvements four months after the intervention, within-group t-tests were conducted.  There were no significant differences in female intervention participants’ scores at four-month follow-up compared with pre-intervention on level of desire (t = 0.44, p = .665), desire for one’s partner (t = 0.744, p = .465), and satisfaction (t = 0.49, p = .630). There were also no significant difference in male intervention participants’ scores at follow-up compared with pre-intervention on level of desire (t = 0.52, p = .610), desire for one’s partner (t = 1.21, p = .239), and satisfaction (t = 0.66, p = .514). Table 17 shows the means at four-month follow-up for couples in the intervention condition.  Twenty-three couples responded to the adherence question at four-month follow-up regarding frequency of novel sexual activities over the previous four weeks. Of those, nine couples (39%) had not engaged in any novel sexual activity over the previous four weeks, seven couples (30%) engaged in novel sexual activity 1-2 times, four couples (17%) engaged novel sexual activity 3-4 times, and two couples (9%) engaged in novel sexual activity 5-6 times, and one couple (4%) engaged in novel sexual activity more than six times. The number of novel activities couples engaged in was not significantly correlated with sexual desire in men (r = .39, p = .067) and women (r = .29, p = .185), sexual satisfaction in men (r = .15, p = .469) and women (r = .34, p = .111), or with desire for one’s partner in men (r = .26, p = .229), and women (r = .23, p = .296).  	  	   	   	   	   62	  	  	  Table 17 Four-month Follow-up Levels of Sexual Satisfaction, Sexual Desire, and Desire for One’s Partner  for Couples in the Intervention Condition (n = 21)  Male Female Satisfaction M (SD)  6.17 (1.85)  6.13 (1.98) Desire  M (SD)  5.03 (0.94)   4.38 (1.28) Partner Desire M (SD)  22.04 (6.52)  20.00 (6.95)  Feedback Questions 1. What aspects of the intervention did you find helpful?  Twenty-one couples responded to this question.  The primary themes were: excitement/fun (n = 11), and desire/arousal (n = 7), and greater sexual frequency (n = 2). One couple indicated that they did not find the intervention helpful. 2. Were you able to implement the intervention?  If not what got in the way?  Twenty-one couples responded to this question. Fifteen of these couples indicated that they were able to implement the intervention and six indicated that they were unable to do so.  The primary obstacles reported were: no need for change (n = 3), lack of time (n = 4), difficulty agreeing on what to try (n = 2), physical pain (n = 2), and forgetting (n = 1). 3. Are there any changes you would suggest to help couples implement the interventions? Twelve couples provided suggestions. The primary themes were: encourage couples to make time for the intervention (n = 7), emphasize communication (n = 3), send more reminders or include the list of activities in the reminders (n = 2), encourage couples to take their time implementing changes (n =1). 4. Other comments/ Suggestions: Ten couples responded to this question. All comments were expressing thanks.  	  	   	   	   	   63	  	  	  Discussion: Overall, the results of this study do not support the efficacy of an online novelty intervention. Participants assigned to the novelty intervention did not differ in levels of sexual desire, sexual satisfaction, or desire for their partner compared to participants in the control or wait-list conditions. Participants assigned to the intervention condition also showed no improvements four-months following the intervention compared to pre-intervention levels of sexual desire, sexual satisfaction, or desire for their partner. The only support for the novelty intervention was that adherence to the intervention condition, as measured by frequency of novel sexual activity over  a four week period, was significantly correlated with sexual desire, sexual satisfaction, and desire for one’s partner in women, as well as desire for one’s partner in men. However, these associations were not maintained four months following the intervention.  As well, due to the correlative nature of this finding, it is possible that women with greater sexual desire, satisfaction and desire for their partner, and men with greater desire for their partner were more likely to engage in novel sexual activity, as opposed to novel sexual activity leading to enhancement in these areas, or that a third variable is driving both of these variables. One interpretation of the results of the present study is that engaging in novel sexual activities is not an effective strategy to enhance sexual functioning in couples in committed relationships.  This is inconsistent with previous studies, which have found evidence that partner novelty may have a positive impact on men’s and women’s sexual functioning (Both et al. 2011; Call et al., 1995; Durr, 2009; Hicks & Leitenberg, 2001; Karraker & DeLamater, 2013; Koukounas & Over, 1993; 1999; 2000; Meuwissen & Over, 1990; Sims & Meana, 2010).  In addition, previous qualitative studies suggest that familiarity is a primary contributing factor to declines in sexual desire in women (Durr, 2009; Sims & Meana, 2010), which suggests that 	  	   	   	   	   64	  	  	  novelty may be an effective strategy in enhancing women’s sexual desire. As well, women in long-term relationships suggested engaging in novel sexual activities as a potential strategy for enhancing sexual desire although other strategies including scheduling sexual activity were also suggested (Ferreira et al., 2015; Herbenick et al., 2014).  The interpretation that engaging in novel activities does not result in enhanced sexual functioning is inconsistent with the finding in Study 1 that variety of sexual activities predicts sexual desire and sexual satisfaction in women. However, it is consistent with the finding in Study 1 that variety of sexual activities does not predict sexual desire or sexual satisfaction in men.  There was however no effect of partner gender with regards to the impact of treatment conditions in the present study, which suggests the intervention was similarly ineffective in both men and women. Interestingly however, women who engaged in more novel sexual activities did experience greater levels of sexual desire, satisfaction, and desire for their partner, whereas men only experienced greater levels of desire for their partner. It is also possible however, that engaging in novel activities can enhance sexual functioning in men and women, and that the negative findings in the present study are due to methodological limitations.  This was the first study to create and implement a novelty intervention, therefore it is possible that there were shortcomings with the intervention itself. The response to the feedback questions by the couples in the intervention group provide insight into the strengths and weaknesses of the intervention. The majority of responses indicated that participants believed the intervention might work. Couples expressed that the intervention was exciting or fun, and that it enhanced their desire or arousal. Only one couple expressed that it was not helpful. However, only 23 couples completed the feedback questions, therefore it is unknown whether those who did not provide a response would report a similar experience. With 	  	   	   	   	   65	  	  	  regards to barriers that may have interfered with implementing the intervention, participants expressed being satisfied with their current sexual relationship, not having enough time, difficulty agreeing on what to try, physical pain, and forgetting. Suggested changes included encouraging couples to make time for the intervention and communicate about it, sending more reminders, and including the list of activities in the reminders. Therefore, future studies examining the efficacy of a novelty intervention may benefit from emphasizing the importance of agreement, communication, and prioritizing the intervention.  As well, future studies may benefit from encouraging couples to set up reminders to ensure that they don’t forget about the intervention in the following weeks.  In addition to the potential weaknesses of the intervention, there are a number of other methodological limitations. The sample for this study was recruited through Amazon Mechanical Turk. As a result, participants may have been motivated by monetary gain as opposed to improving their relationship. This may have led to reduced engagement with the intervention and less accurate responses on the questionnaire.  The results indicate that 21% of couples in the intervention did not engage in any novel activities over the four-week period following the intervention, and 26% of the intervention group only engaged in one or two novel activities over the four-week period. Therefore the null effect of the intervention in the present study may have been a result of lack of adherence to the intervention, as opposed to the strategy being ineffective.  This possibility is supported by the fact adherence to the intervention was significantly correlated with sexual desire, sexual satisfaction, and desire for one’s partner in women, as well as desire for one’s partner in men. One possibility for the lack of engagement with the intervention is that these couples were not dissatisfied with their sexual relationship, which may have reduced their motivation to engage in the intervention.  Three participants 	  	   	   	   	   66	  	  	  expressed this sentiment in the feedback questions. As well, participants were only required to have been in a relationship for one year.  As a result, they may not yet have experienced declines in sexual functioning due to familiarity.  Another limitation with the present study was the high attrition rate. As a result, only per protocol analyses were conducted, and therefore only conclusions about participants who completed the study can be drawn.   In conclusion, the results of this study suggest an online novelty intervention does not lead to improvements in sexual desire, sexual satisfaction, or desire for one’s partner in couples in committed relationships. However, there were a number of limitations that may have contributed to these findings. As a result, there is a need for future studies in this area with couples that are seeking help for their sexual relationship, and have been together for a longer period of time to ensure they have experienced declines in sexual functioning due to familiarity and are motivated to engage in the intervention.  Limiting participation to couples that live together may also increase the likelihood that couples are experiencing declines in desire and satisfaction due to familiarity. As well, the feedback from the participants in this study should be taken account in the design of future novelty interventions and changes should be made such as emphasizing communication and agreement, as well as prioritizing the intervention.    	  	   	   	   	   67	  	  	  Study 3: The impact of a Novelty Intervention on a Couple’s Sexual Relationship in a Sample of Couples Seeking Help  The results of Study 2 suggest that an online novelty intervention does not enhance sexual functioning in couples in committed relationships. This may reflect the fact that novel sexual activities indeed have no impact on sexual desire, sexual satisfaction, or desire for one’s partner or, as previously discussed, the impact of the intervention may have been obscured by methodological limitations. These limitations included the fact that participants were recruited through Amazon Mechanical Turk and therefore may have been motivated by monetary gain, as opposed to a desire to improve their sexual relationships.  As well, couples only needed to be together for one year in order to participate in the study and therefore may not have experienced declines in sexual functioning due to familiarity.  Given the range of studies which suggest that partner novelty may enhance sexual functioning (Both et al. 2011; Call et al., 1995; Durr, 2009; Hicks & Leitenberg, 2001; Karraker & DeLamater, 2013; Koukounas & Over, 1993; 1999; 2000; Meuwissen & Over, 1990; Sims & Meana, 2010), and the association between novel sexual activity and women’s sexual desire and satisfaction found in Study 1, it is possible that the null effect of the novelty intervention on sexual desire and desire for one’s partner in Study 2 may have been a result of methodological limitations as opposed to a lack of relationship between these variables. This possibility is further supported by the fact that adherence to the intervention was significantly correlated with sexual desire, satisfaction, and desire for one’s partner in women, and desire for one’s partner in men. Therefore, Study 3 was designed with the objective of reconciling the previous equivocal results by recruiting a sample of couples seeking to improve their sexual relationship. The study advertisement and recruiting locations were designed to specifically target those who were 	  	   	   	   	   68	  	  	  experiencing declines in sexual functioning due to familiarity. In addition, participants were not paid for their participation in order to eliminate participants motivated solely by monetary gain.  As well, participation in the study was restricted to those who have been in their relationship for a minimum of four years and who currently live together.  The four-year relationship duration criterion was selected because individuals in relationships of this duration have been found to have reductions in passionate love (Acevedo & Aron, 2009), and experience fewer cues that trigger sexual desire (Carvalheria, Brotto, & Maroco, 2011). In addition, the intervention in Study 3 was modified based on the feedback provided by participants in Study 2. The instructions were revised to emphasize the importance of selecting novel activities that both members of the couple were comfortable trying.  As well, this list of activities was rearranged so that activities ranged from less adventurous to more adventurous, and participants were encouraged to start at the top if they were feeling hesitant. The list of activities was also included in the email reminders in case couples needed additional ideas or reminders of their plan.  In addition, more detailed instruction was given with regards to scheduling activities and ideas were provided such as placing reminders in their phones.  As well, partners were asked to make a commitment to one another to make the intervention a priority.  Couples were also asked to consider anything that might interfere with their ability to complete their plan and to troubleshoot accordingly. Method  Participants. Recruitment methods included postings on online relationship forums (e.g., www.thenest.com, http://www.reddit.com/r/deadbedrooms, www.loveadviceforum.com) as well as advertisements on Craigslist and Facebook.  This form of recruitment was selected in order to achieve a sample of couples that were seeking ways to enhance their sexual relationships. All 	  	   	   	   	   69	  	  	  participants were living within North America, 19 years or older, and due to the measures included, limited to individuals who were sexually active and identified as heterosexual. As well, participation was restricted to those who were currently cohabitating and had been together for at least four-years. Participants ranged in age from 19 to 64, and in relationship length from 4 to 37 years.   Measures. The measures used in this study were identical to those in Study 2.  Procedure. Participants were informed of the study through posts on online relationship forums, Craigslist, and Facebook. Interested participants were directed to a website to complete the preliminary web-based questionnaire. The consent form at the beginning of the survey informed participants of the three parts of the study and that they would have the freedom to withdraw from the study at any point without negative consequences. After reading through and indicating agreement with the consent form, participants completed the online preliminary questionnaire. The female portion of the questionnaire included Demographics information, FSFI, GSSI, and the PSSW. The male portion of the questionnaire included all of the same measures except that the IIEF replaced the FSFI.  Participants were asked to complete the research questionnaire at all times independently of their partners. The questionnaire takes approximately 20 minutes for the couple to complete. Upon completion of the questionnaire, participants were randomly assigned to the wait-list condition, experimental condition, or control condition, and the corresponding instructions were provided. Couples on the wait-list were informed that they would be provided the intervention in four weeks. To motivate continued participation during the control and experimental interventions, weekly emails were sent to couples reminding them of the intervention and to contact the researchers should they have any questions. Four weeks following the completion of the preliminary questionnaire, participants in 	  	   	   	   	   70	  	  	  all groups were sent a link to a questionnaire that included the same measures that were administered at pre-intervention, as well as an additional adherence question. To assess long-term maintenance of any improvements, couples in the intervention condition were sent these same measures, as well as five open-ended feedback questions, four months after they completed the study.   Control Intervention. The control intervention was the same as described in Study 2.  Novelty Intervention. The novelty intervention was modified according to feedback provided by participants in Study 2.  These changes included: emphasizing the importance of selecting novel activities that both members of the couple felt  comfortable trying, rearranging the novel activities list from less adventurous to more adventurous items and suggesting that couples who have a difficult time agreeing on items begin with earlier items, providing more detailed instruction with regards to scheduling activities, asking partners to make a commitment to one another to prioritize the intervention, and adding suggestions regarding troubleshooting.  See the revised intervention in Appendix XI. Data Analysis  The main analyses used an Intention-to-Treat (ITT) procedure, which is the preferred approach for analyzing randomized clinical trials, because it maintains the benefit of randomization and assesses how effective the treatment would be if implemented in a real life setting (Armijo-Olivo et al., 2009). ITT analysis includes all participants who were randomly assigned, regardless of subsequent attrition. Last Observation Carried Forward (LOCF), was used to estimate the missing data for participants who did complete the study, as recommended by Kendall, Flannery-Schroeder, and Ford (1999).  This technique replaces participant’s missing data with their last provided response. 	  	   	   	   	   71	  	  	   Preliminary data analysis included checks for adequate randomization of participants to treatment conditions. Analysis of variance (ANOVA) was used to ensure that there were no significant differences with regards to participant age, relationship duration and baseline levels of sexual desire, sexual satisfaction, and desire for one’s partner between the three groups.  Paired sample t-tests were used to ensure there were no significant differences between participants who completed the post-intervention survey and those who did not in age, relationship duration, or baseline levels of sexual desire, sexual satisfaction, or desire for one’s partner. In order to assess the impact of adherence to the intervention on outcome, response the adherence question was correlated with post-intervention levels of sexual desire, sexual satisfaction, and desire for one’s partner.  Analysis of covariance (ANCOVA) was used to examine differences between treatment groups as well as the role of gender within the couple. For these analyses the couple was considered the unit of analysis. For each analysis, partner gender was entered as the within subjects factors and assigned treatment group (Intervention, Control, Wait-list) was entered as the between subject factors. The outcome variables included desire for one’s partner (PSSW), sexual satisfaction (GSSI), and sexual desire (FSFI sexual desire index, and IIEF sexual desire index). Participant’s pre-intervention data for the outcome variable being examined were entered as covariates. Results Path of Participants: of the 142 couples who completed the preliminary questionnaire, 63 couples (44%) competed the four-week follow up questionnaire, including 24 (44%) of 54 in the intervention group, 19 (40%) of 47 of the control group, and 20 (49%) of 41 of the wait-list group. There were no significant differences in couple attrition rates between the three conditions 	  	   	   	   	   72	  	  	  (X2 (2, N = 142) = 0.62, p = .734). Lack of time (n = 3), and break up (n = 3) were the reasons provided for withdrawal, and, 10 couples provided invalid email addresses (n = 10). The remaining 64 couples that did not complete the post-intervention study did not provide a reason for withdrawal. With regards to the four-month follow up assessment, 16 (30%) of the 54 couples assigned to the intervention group completed this survey. Preliminary Analyses: Table 18 provides demographic characteristics of the 142 couples included in the analyses across the three groups. A one-way analysis of variance (ANOVA) showed the randomization of the 142 couples yielded groups with no significant differences in age, relationship duration, and pre-intervention levels of sexual desire, sexual satisfaction, and desire for one’s partner. There were also no differences between those who completed the post-intervention survey and those who did not with regards age, relationship duration, and pre-intervention levels of sexual desire, sexual satisfaction, and desire for one’. Table 18 Demographic Characteristics for Couples in the Intervention (n = 54), Control (n = 47), and Wait-list (n = 41) Conditions   Intervention Control Wait-list  Men Women Men Women Men Women Age        M 37.13 34.07 34.49 33.02 34.26 32.83  SD 10.95 10.45 8.90 9.35 9.99 10.79 Education level        High school 16(30%) 7(13%) 13(28%) 10(21%) 7(17%) 6(15%)  Post-secondary  25(46%) 36(67%) 22(47%) 25(53%) 30(73%) 27(66%)  Graduate 13(24%) 11(20%) 12(26%) 12(26%) 4(10%) 8(19%) Ethnicity        Caucasian 44(82%) 40(74%) 34(72%) 38(81%) 30(73%) 25(61%)  African American 2(4%) 2(4%) 5(11%) 1(2%) 0(0%) 2(5%)  Asian American 1(2%) 4(7%) 2(4%) 4(9%) 6(15%) 5(12%)  Other 7(13%) 8(15%) 6(13%) 4(9%) 5(12%) 9(22%) Relationship status     Committed 13(24%) 11(23%) 18(44%)  Common-law 13(24%) 5 (11%) 8(20%)  Married 28(52%) 31(66%) 15(36%) 	  	   	   	   	   73	  	  	   Intervention Control Wait-list  Men Women Men Women Men Women Relationship length      M 9.00 8.66 8.90  SD 5.68 5.10 7.94 Children     Yes 26(48%) 24(51%) 14(34%)  No 28(52%) 23(49%) 27(66%)   Twenty-four couples in the intervention group responded to the adherence question regarding frequency of novel sexual activities over the previous four weeks. Of those, three (13%) couples engaged in no novel sexual activities, 10 (42%) couples engaged in 1-2 novel activities, four (17%) couples engaged in 3-4 novel activities, six (25%) couples engaged in 5-6 novel activities, and one couple (4%) engaged in more than six novel activities. The number of novel activities couples engaged in was significantly correlated with women’s sexual desire (r = .69, p < .001), and men’s sexual satisfaction (r = .49, p = .015), but not with sexual desire in men (r = -.17, p = .428.), sexual satisfaction in women (r = .18, p = .401), or desire for one’s partner in men (r = .17, p = .43) and women (r = .13, p = .552). Preliminary checks on the data revealed the normality assumption was violated as determined by the Shapiro-Wilk statistic for: women’s sexual desire in the wait-list condition, men’s desire for their partner in the intervention condition, and women’s desire for their partner in the wait-list condition. However, ANOVA has been found to be robust with respect to violations of normality, as a result the data was not transformed (Glass, et al., 1972; Norman, 2010; Pearson 1931).  According to Levene’s test, the assumption of homogeneity of variance was met (p > .05) for all dependent variables.  Sphericity is always met when there are two levels of a repeated measures factor, and it was therefore unnecessary to evaluate.  No violations were found with regards to the assumption of linearity between pre-intervention and post-intervention 	  	   	   	   	   74	  	  	  levels of sexual desire, satisfaction, or desire for one’s partner.  Inter-correlations between covariates (men and women’s pre-intervention levels) ranged between .16 and .54, and therefore multicollinearity was unlikely to be a problem (Tabachnick & Fidell, 2007).  The assumption of homogeneity of regression was also tested to ensure the relationship between each covariate and dependent variable was consistent across treatment groups. There were no statistically significant interaction effects between pre-intervention scores and treatment group, therefore the assumption of homogeneity of regression was met for all analyses. Main Analyses Table 19 shows the means at pre-intervention, post-intervention for all three groups. An ANCOVA was conducted to compare the effect of treatment group on sexual desire for both members of the couple. There was no significant interaction between gender and treatment group (Wilk’s Lambda = .99, F(2, 137) = .96, p = .385, η2 = .01). The main effect of gender was not significant (Wilk’s Lambda = 0.99, F(1, 137) = 1.62, p = .205, η2 = .01). The main effect of the treatment group was also not significant (F(2, 137) = 0.26, p = .774, η2 = .00).  An ANCOVA was also conducted to compare the effect of treatment group on desire for one’s partner for male and female participants. There was no significant interaction between gender and treatment group (Wilk’s Lambda =.97, F(2,137) = 1.98, p = .142, η2 = .03). The main effect of gender was not significant (Wilk’s Lambda = .1.00, F(1,137) = .15, p = .701, η2 = .00). The main effect of treatment group was also not significant (F(2,137) = 2.79, p = .065, η2 =.04).  An ANCOVA was conducted to compare the effect of treatment group on sexual satisfaction for each member of the couple. There was no significant interaction between gender and treatment group (Wilk’s Lambda = .98, F(2, 137) = 1.61, p =.203, η2 = .02). The main effect 	  	   	   	   	   75	  	  	  of gender was not significant (Wilk’s Lambda = 1.00 F(1,137) = .52, p = .474, η2 = .00).  There was also no significant effect of the treatment group (F(2,137) = 1.33, p = .269, η2 =.02).  Table 19 Pre-intervention and Post-intervention Levels of Sexual Satisfaction, Sexual Desire, and Desire for One’s Partner  Intervention Control Wait-list  Pre  (n = 54) Post (n = 54) Pre (n = 47) Post (n = 47) Pre (n = 41) Post (n = 41) Gender M F M F M F M F M F M F Satisfaction   M  SD  4.79 1.96  4.28 2.18  4.93 2.09  4.44 2.20  4.13 2.07  3.62 1.78  4.34 1.93  3.64 1.19  4.27 2.05  4.42 1.94  4.34 1.93   4.29 1.87 Desire    M   SD  4.67 1.03  3.62 1.35  4.48 1.06  3.88 1.28  4.47 1.23  3.42 1.17  4.49 1.25  3.64 1.19  4.74 1.01  3.56 1.38  4.67 1.11  3.64 1.38 Partner Desire  M  SD  18.81 6.13  14.39 6.13  18.44 6.95  14.83 6.31  17.79 6.22  13.57 5.68  18.43 6.30  14.94 6.43  18.81 6.25  15.83 6.53  18.63 6.25  15.05 6.47  Again, as in Study 2, exploratory analyses were also conducted in which ANOVAs were run separately for men and women using change scores of outcome variables.   These analyses did not reveal significant differences in sexual desire, desire for one’s partner, or sexual satisfaction between treatment groups in men.  Nor did they reveal any significant differences in sexual desire, or sexual satisfaction between treatment groups in women.  However, there were however significant group differences in change in desire for one’s partner (F(2, 139) = 6.10, p = .003, η2 = .08). Pairwise comparisons indicated that women in the intervention (MD = 1.23, p = .041) and control conditions (MD = 2.14, p = .001) experienced greater change in desire for their partner than women in the wait-list condition, whereas no differences were found between the control and intervention conditions.  Sixteen (30%) of the 54 couples assigned to the intervention group completed the four-month follow-up questionnaire. In order to determine whether improvements persisted four months after the intervention, within-group t-tests were conducted.  There were no significant 	  	   	   	   	   76	  	  	  differences in female intervention participants’ scores at follow-up compared with pre-intervention on level of desire (t = -1.39, p = .171), and satisfaction (t = -0.51, p = .613). However, female participants’ scores were significantly greater at four-month follow-up compared to pre-intervention levels of desire for one’s partner (t = 2.12, p = .032). There were no significant differences in male intervention participants’ scores at follow-up compared with pre-intervention on level of desire (t = .637, p =.527), desire for one’s partner (t = -.20, p = .844), and satisfaction (t = .56, p = .576). Table 20 shows the means at four-month follow-up for couples in the intervention condition. Sixteen couples responded to the adherence question regarding frequency of novel sexual activities over the previous four weeks. Of those, five (31%) couples engaged in no novel sexual activities, eight (50%) couples engaged in 1-2 novel activities, two (13%) couples engaged in 4 novel activities, and one couple (6%) engaged in more than 20 novel activities. The number of novel activities couples engaged in was significantly correlated with women’s sexual desire (r = .60, p = .259), but not with sexual desire in men (r = .23, p = .383), sexual satisfaction in men (r = .30, p = .015), and women (r = .43, p = .099), or desire for one’s partner in men (r = .30, p = .265) and women (r = .43, p = .095). Table 20 Four-month Follow-up Levels of Sexual Satisfaction, Sexual Desire, and Partner Desire for One’s Partner in Couples in the Intervention Condition  Follow-up (n = 54) Gender Male Female Satisfaction M (SD)   4.67(2.30)   4.46(2.36) Desire  M (SD)  4.61(1.13)   3.79(1.33) Partner Desire M (SD)   18.89(7.10)   15.43(6.71)   	  	   	   	   	   77	  	  	  Feedback Questions 1. What aspects of the intervention did you find helpful?  Fourteen couples responded to this question.  The primary themes were: engaging in new sexual activities (n = 5), communication about sexual activity (n = 4), enhanced desire/arousal (n = 3). Three couples indicated that they did not find the intervention helpful, and one couple indicated that they were not able to execute the intervention. 2. Were you able to implement the intervention?  If not what got in the way?  Fifteen couples responded to this question. Eleven of these couples indicated that they were able to implement the intervention and four indicated that they were unable to do so.  The primary obstacles reported were: lack of time (n = 4), discrepancy in partner’s sexual desire (n = 1), and forgetting (n = 1). 3. Are there any changes you would suggest to help couples implement the interventions? Five couples provided suggestions. The primary themes were: encourage couples to make time for the intervention (n = 2), emphasize communication (n = 1), run for a longer period of time (n = 1), and send more reminders (n = 1). 4. Other comments/ Suggestions: Four couples responded to this question. All comments were expressing thanks.   Discussion The results from the main analyses indicated that an online novelty intervention for the most part did not lead to greater sexual desire, satisfaction, or desire for one’s partner. The corresponding effect sizes ranged between η2 = .00, to η2 = .04, indicating that differences between the three groups were small (Cohen, 1988) and the null effect cannot simply be explained by lack of power due to sample size. . However, when analyses were conducted 	  	   	   	   	   78	  	  	  separately for men and women and change scores were examined, the intervention and control conditions differed with greater change in desire for one’s partner in women than the wait-list condition.  The corresponding effect size was still relatively small  (η2 = .08). Four months following the intervention women experienced greater desire for their partners compared to their baseline level.  However, given that only 30% of participants completed the four-month follow-up survey this positive finding should be interpreted with great caution.  These results suggest that it is possible for women in long-term relationships to increase their desire for their partner by engaging in novel sexual activities, and that these improvements may be maintained four months following the intervention.  However, the impact of this strategy on women’s desire for their partners does not appear to differ from simply scheduling sexual activities. The impact of the novelty intervention on women’s desire for their partners is consistent with previous evidence that novel partners are associated with greater sexual functioning (Both et al. 2011; Call et al., 1995; Durr, 2009; Hicks & Leitenberg, 2001; Karraker & DeLamater, 2013; Koukounas & Over, 1993; 1999; 2000; Meuwissen & Over, 1990; Sims & Meana, 2010), and previous data which suggest that these benefits to sexual functioning may be replicated by engaging in novel activities (Dawson et al., 2013; Ferreira et al., 2015; Herbenick et al., 2014). As well, although desire for one’s partner was not examined in Study 1, sexual desire was predicted by variety of sexual activity in women but not men. Therefore the findings from both of these studies suggest that the novelty intervention may benefit women but not men in long-term relationships. In Study 2 however, there were no differences between groups in levels of desire for one’s partner in men or women. However this may have been a result of the methodological limitations mentioned previously. 	  	   	   	   	   79	  	  	  It was surprising that the intervention did not have a greater impact on desire for one’s partner in women than simply scheduling sexual activity. In the only previous study to examine the impact of scheduling sexual activity, it was one of many strategies (including novelty) suggested in a self-help book found to increase sexual desire, arousal, and satisfaction in women (Mintz, Balzer, Zhao & Bush, 2012), therefore it is unclear which strategies contributed to greater levels of sexual functioning. Despite the lack of empirical support for scheduling sexual activity, it is a commonly suggested strategy (Gottman & Gottman, 2007; Mintz, 2009). More research is needed to determine whether scheduling sexual activity is an effective strategy for enhancing sexual satisfaction. Another area of support for the intervention was that adherence, measured by the frequency with which couples engaged in novel activities, was associated with greater sexual desire in women, and sexual satisfaction in men.  However, adherence was not associated with the other outcome variables, and only the association with women’s sexual desire was maintained at four month follow-up. Due to the correlative nature of these findings causation cannot be determined, it is possible that women with greater desire, and men with greater sexual satisfaction are more likely to engage in novel sexual activities, or that this relationship is due to the impact of a third variable.  It was surprising that the novelty intervention did not differ from the control or wait-list conditions with regards to sexual desire or sexual satisfaction. This is in contrast to the results in Study 1, which indicated a relationship between novel sexual activities and sexual satisfaction and sexual desire in women, as well as the finding in the present study that engaging in novel sexual activities is associated with sexual desire in women and sexual satisfaction in men. The lack of effect of the novelty intervention on sexual desire and satisfaction in the present study is 	  	   	   	   	   80	  	  	  consistent with the results of Study 2, in which couples in the novelty condition also did not differ from those in the control or wait-list conditions with regards to sexual desire, or sexual satisfaction. Study 3 however, was designed to overcome the methodological limitations in Study 2 by recruiting participants who were seeking help for their sexual relationship and not motivated by monitory gain, as well as restricting participation to couples that have been together for four years, and who currently live together in order to increase the impact of familiarity on sexual functioning.  In addition, the intervention was modified based on the feedback of participants in Study 2 to make the intervention more “user friendly.”  Therefore the limited impact of the intervention on sexual functioning in Study 3 was particularly surprising. The response to the feedback questions indicated that the majority of participants who completed the four-month follow-up survey found the intervention helpful. In addition to the three couples who reported greater sexual desire or arousal, five couples expressed engaging in new activities and getting out of their routine helpful, and four couples expressed that the intervention led to greater communication about sexual activity. This suggests that although the intervention only led to one significant group difference, couples may have experienced other benefits not captured by the measures included in the current study.  However these data should be interpreted with great caution as only 30% of participants completed the follow-up measure. Participants noted a lack of time as the primary obstacle, suggesting future studies could benefit from further emphasis on the importance of making time for the intervention and assisting couples in doing so. Despite the improvements from Study 2, there are a number of limitations that may have influenced the results of the present study.  The results indicate that three couples in the intervention group did not engage in any novel activities, and 10 couples only engaged in one or 	  	   	   	   	   81	  	  	  two novel activities over the four-week period.  Therefore the limited differences between the treatment groups may have been due to a lack of adherence, as opposed to the strategy being ineffective. This possibility is supported by the significant association between adherence to the intervention and women’s sexual desire and men’s sexual satisfaction.  One factor that may have influenced adherence is that the intervention was provided in an online format, which has been associated with lower levels of engagement (Donkin, Christensen, Naismith, Neal, Hickie, & Glozier, 2011). Another limitation of the present study was the high attrition rate. Although ITT analyses were conducted, which is the gold standard for randomized control trials and is associated with numerous advantages, with dropout rates that exceed 20% there is an increased risk of Type 1 error and loss of power (Armijo-Olivo et al., 2009). This is another aspect of the present study that may have benefited from an in person component, as self-guided online interventions have been associated with relatively high attrition rates (Cavanagh et al., 2013; Christensen, Griffiths, & Farrer, 2009; Waller & Gilbody, 2009).  However, despite the limitations associated with online interventions, other treatments in this format have been found to be efficacious (Cavanagh et al., 2013; Gow, Trace, Mazzeo, 2010; Wagner, Horn, Maerker, 2014).  The results of the present study suggest that advice to long-term couples to “spice-up their sex life” should be given with caution. The intervention led to greater desire for one’s partner in women compared to the wait-list condition however, the treatment groups did not differ on any of the other outcome variables. Past research does support the possibility that partner novelty results in enhanced sexual functioning (Both et al. 2011; Call et al., 1995; Durr, 2009; Hicks & Leitenberg, 2001; Karraker & DeLamater, 2013; Koukounas & Over, 1993; 1999; 2000; Meuwissen & Over, 1990; Sims & Meana, 2010), and previous findings in the current line 	  	   	   	   	   82	  	  	  of research support the possibility that novel sexual activities are associated with greater sexual desire and satisfaction in women.  As well, in the present study adherence to the intervention was associated with greater sexual desire in women and greater sexual satisfaction in men. Therefore, more research is needed to understand the impact of novelty on sexual functioning in couples in long-term relationships.   	  	   	   	   	   83	  	  	  General Discussion  Evidence from several areas of research have suggested that partner familiarity may lead to declines in sexual functioning in men and women, and that partner novelty may restore sexual functioning in men and women. This evidence includes declines in sexual functioning with greater relationship duration in men and women (Call et al., 1995; Cheung et al., 2008; Doddridge, et al, 1987; Durr, 2009; Hayes et al., 2008; James, 1981; 1893; Kinsey et al., 1948; 1953; Klusmann, 2002; Liu, 2003; Michael et al., 1994; Murray & Milhausen, 2012; Schmiedeberg & Schroder, 2015; Sims & Meana, 2010; Sprecher, 2002; Tunariu & Reavey, 2003), the prevalence of extra-dyadic behavior (Allen & Baucom, 2006; Greeley, 1994; Tafoya & Spitzberg, 2007; Traeen et al. 2007; Wiederman, 1997) and its association with relationship duration (Fisher et al., 2009; Forste & Tanfer, 1996; Spanier & Margolis, 1983; Traeen et al., 2007). Support has also been found in the expressed preference for short-term sexual encounters (Aitken, et al., 2013; Kruger & Fisher, 2005; Schmitt, 2003; Schmitt et al., 2001), and the content of sexual fantasies (Ellis & Symons, 1990; Hicks & Leitenberg, 2001; Kings et al., 2009; Wilson, 1997). Laboratory studies have repeatedly found sexual arousal to habituate in response to familiar sexual stimuli and to be reinstated with the introduction of novel sexual stimuli (Both et al., 2011; Howard et al., 1970; Kelley & Musialowski, 1986; Koukounas & Over, 1993; 1999; 2000; Lalumiere & Quinsey, 1998; Meuwissen & Over, 1990; O’Donohue & Geer, 1985; O’Donohue & Plaud, 1991; Plaud et al., 1997; Zillmann & Bryant, 1988). The Coolidge effect has been found to occur in a wide range of non-human animal studies (Allen, 1981; Beach & Ransom, 1967; Brown, 1974; Bunnell, Boland & Dewsbury, 1977; Dewsbury, 1970; Fisher, 1962; Gray & Dewsbury, 1975; Krames, 1971; Lester & Gorzalka, 1988; Lisk & Baron, 1982; Michael & Zumpe, 1978; Tan, et al, 2013).  Finally, evolutionary theory has pointed to adaptive 	  	   	   	   	   84	  	  	  benefits for both men and women to experience enhanced sexual functioning with novel partners (Betzig, 1986; Belsky et al., 1991; Buss & Schmitt, 1993; Draper & Belsky, 1990; Gangestad & Thornhill, 1997).   In addition, previous research has found that couples in long-term relationships that engage in novel leisure activity experience greater relationship satisfaction (Aron et al., 2000; Coulter & Malouff, 2013). The impact on sexual functioning was not examined in these studies. However in a recent qualitative study, both male and female members of long-term couples expressed that change, such as new experiences, increases their sexual desire (Ferreira, et al., 2015). Engaging in novel sexual activities was also one of several strategies listed by women in long-term relationships used to resolve sexual desire discrepancies between them and their partners (Herbenick et al., 2014). As well, the impact of specific novel sexual activities, such as the use of sex toys or pornography, has been associated with greater sexual functioning in both men and women (Daneback et al., 2009; Herbenick et al., 2010; Reece et al., 2010). However, the overall strategy of implementing novel activities within long-term relationships has not been investigated until now. Despite the fact that the efficacy of this approach has not been investigated prior to the present set of studies, this strategy is commonly suggested by self-help books, websites, and couples’ therapists (e.g. Gottman & Gottman, 2005; McCarthy et al., 2006; Mintz, 2009).   The current line of research was the first to examine the impact of engaging in novel activities on the sexual functioning of men and women in long-term relationships. This research provides the first evidence that engaging in novel leisure activities is associated with higher levels of sexual satisfaction in women, regardless of relationship duration or time spent in couple leisure activities.  This research also provides the first evidence that engaging in novel sexual 	  	   	   	   	   85	  	  	  activities is associated with greater sexual desire and sexual satisfaction in women regardless of relationship duration or sexual activity frequency. In fact, results from Study 1 indicated that the variety of sexual activity a couple engages in, and the frequency with which they engage in sexual activity, have a greater association with female sexual desire and satisfaction than does the length of the couple’s relationship. This suggests that the frequently reported declines in women’s sexual desire and satisfaction (Cheung et al., 2008; Hayes et al., 2008; Murray & Milhausen, 2012; Klusmann, 2002; Liu, 2003; Schmiedeberg & Schroder, 2015; Sprecher, 2002) may not be an inevitable consequence of long-term relationships, and instead suggest that engaging in novel sexual activities may help women maintain desire and satisfaction in their relationships. However, no significant associations between novel leisure or sexual activities and sexual desire or satisfaction were found in men. This was surprising, given the range of evidence supporting the hypothesis that partner novelty leads to greater sexual functioning in men, and the strong evolutionary rational for men to engage in short-term mating.  In addition, this line of research was the first to examine the impact of a self-help intervention encouraging couples to engage in sexual activities outside of their current routine. In Study 2, which was composed of a sample of couples recruited through an online survey program, the intervention did not differ from the control or wait-list condition in its impact on sexual desire, sexual satisfaction, or desire for one’s partner. The only support for the intervention were associations between adherence to the intervention and sexual desire, sexual satisfaction, and desire for one’s partner in women, and an association between adherence to the intervention and desire for one’s partner in men. In Study 3, which was composed of a sample of couples seeking help for their sexual relationship, the intervention also did not differ from the control or wait-list conditions in its impact on sexual desire sexual satisfaction in men and 	  	   	   	   	   86	  	  	  women, or desire for one’s partner in men.  Women in the intervention and control conditions did, however, experience greater change in desire for their partners compared to those in the wait-list condition.  However, no differences were found between women in the control and intervention conditions. There were also significant associations between adherence to the intervention and sexual desire in women, and sexual satisfaction in men. Four months following the intervention women’s levels of desire for their partners were significantly greater than their pre-intervention levels.  However, given that only 30% of participants completed the four-month follow-up questionnaire, this finding should be interpreted with great caution.  Together, the findings from this line of research suggest that there is a relationship between novel activities and sexual desire and satisfaction in women in long-term relationships, however an online intervention which encouraged long-term couples to engage in novel sexual activities resulted in limited benefits to sexual functioning compared to control and wait-list conditions. The relationship between novel activities and sexual functioning in women is consistent with the hypothesis put forth, that the benefits to sexual functioning that accompany a novel partner can be replicated within a long-term relationship by engaging in other forms of novelty. However, it was also hypothesized that there would be a relationship between novel activities and sexual functioning in men.  In addition, with the exception of the finding in Study 3 that women’s desire for their partner was greater in the intervention and control conditions, compared to the wait-list condition, no differences were found between groups in Studies 2 and 3, which is contrary to the original hypotheses which predicted that the novelty intervention would lead to greater sexual desire, sexual satisfaction, and desire for one’s partner in men and women compared to the wait-list and control conditions.  	  	   	   	   	   87	  	  	  Therefore, one possibility is that engaging in novel sexual activity is not an effective strategy for enhancing sexual desire and satisfaction in long-term couples. Consistent with this possibility, are the findings from a qualitative study with long-term couples who self-defined as having “great sex.” These couples provided a number of characteristics to explain their success including factors such as being present, authenticity, intense emotional connection, sexual and erotic intimacy, communication and transcendence (Kleinplatz & Menard, 2007). Novelty, however, was not among the characteristics listed, suggesting that it may not be a fruitful strategy for those hoping to increase their sexual desire or satisfaction within a long-term relationship. This is in opposition however, to women who reported engaging in novel sexual activities as a way of reconciling sexual desire discrepancies in their long-term relationships (Herbenick et al., 2014). As well, it would be surprising if engaging in novel sexual activities does not lead to greater sexual functioning in long-term couples, given the range of evidence supporting the hypothesis that partner novelty leads to enhanced sexual functioning and that partner familiarity leads to declines in this area. However, despite the range of support for this hypothesis, it is important to remember that no research prior to the present set of studies has directly examined whether this effect can be replicated by engaging in novel sexual activities in men and women in long-term relationships.  Therefore, the first direct support for the potential benefit of a novelty intervention is the finding in Study 1 that sexual variety predicts women’s sexual desire and satisfaction, regardless of sexual frequency and relationship duration. Due to the correlational nature of this study it is unknown however, whether engaging in a greater variety of sexual experiences leads to greater sexual desire and satisfaction in women, or whether women with greater sexual desire and satisfaction are more likely to engage in a greater variety of sexual activities. It is also possible 	  	   	   	   	   88	  	  	  that a third variable such as, beliefs about sexuality, or a couple’s ability to communicate about sex, was contributing to sexual desire, satisfaction and novel activities. In Study 3, a causal relationship was detected between the intervention and desire for one’s partner in women.  However both the intervention and control condition differed from the wait-list condition in levels of change in desire for one’s partner, and the intervention and control condition did not differ from one another. Additional support for the potential efficacy of engaging in novel sexual activities are the associations in Studies 2 and 3 between adherence to the intervention and treatment outcome.  In Study 2, engaging in a greater frequency of novel sexual activity was associated with greater levels of sexual desire, satisfaction, and desire for one’s partner in women, and greater levels of desire for one’s partner in men. In Study 3, engaging in a greater frequency of novel sexual activity was associated with greater sexual desire in women and greater sexual satisfaction in men.  These findings suggest that engaging in novel sexual activity may increase sexual functioning, although there were inconsistencies with regards to the specific areas benefited. However, these findings were also correlational in nature, and therefore it remains a possibility that men and women with greater levels of sexual functioning were more likely to engage in novel activities, or that there was a third variable at play.   Another possibility is that the efficacy of this strategy is limited in a self-help format, but may be more beneficial within an in-person therapy context.  Previous meta-analyses have revealed bibliotherapy to be particularly effective for sexual dysfunction (Gould & Clum, 1993; Marrs, 1995), but the studies included in these analyses targeted sexual dysfunction in individuals as opposed to sexual desire and satisfaction in couples. Mintz et al. (2012) examined the impact of bibliotherapy on sexual desire, arousal, and satisfaction in women, and found that it led to greater levels in each area. Interestingly, the book being examined included a chapter on 	  	   	   	   	   89	  	  	  novelty, however a number of other strategies were included as well, such as communication, and scheduling sexual activities. Therefore it is unclear which aspects of the intervention led to these changes. The study by Mintz et al. (2012) supports the possibility that self-help resources can enhance sexual desire and satisfaction in women, however it remains unknown whether this strategy would be efficacious when both members of the couple are included. Previous studies targeting relationship variables outside of sexual functioning have found self-help resources for couples to be effective (Braithwaite & Fincham, 2007; Bodenmann, Hilpert, Nussbeck, & Bradbury, 2014), however no previous studies have examined the efficacy of self-help intervention targeting sexual desire and satisfaction with couples in long-term relationships. Within a self-help context factors such as relationship distress and communication difficulties may interfere with couples’ abilities to implement interventions targeting aspects of sexuality, whereas within a therapy context the couple are provided with assistance resolving conflict and learning communication skills. Thus the novelty intervention may be more effective within a therapy setting. It is also possible that a novelty intervention can be effective within a self-help context, and that the limited support in the current line of research was due to limitations of the intervention and study methodology. Primary challenges with Studies 2 and 3 were low adherence and high attrition.  Modifications to the intervention and study design that increase adherence and reduce drop-out are needed.  One possibility is to provide information about the theory behind the intervention and previous research supporting it, in order to increase participants’ motivation to engage in the intervention.  Another potential modification to the intervention is to provide modules to assist couples with areas that may interfere with their ability to implement the intervention, for instance including a communication skills module prior 	  	   	   	   	   90	  	  	  to the intervention.  Previous research has shown that men and women have a difficult time communicating about their sexual preferences (MacNeil & Byers, 2009; Miller & Byers, 2004), therefore assistance in this area may help couples in the creation and implementation of their novel sexual activities plan. Additional modules included in the intervention could be included in the control condition to control for the possibility that they are the primary factor leading to changes in sexual functioning.  Another limitation of the intervention used in the present line of research is that participants were immediately provided with suggestions of novel sexual activities to engage in, as opposed to fostering their own ideas.  Therefore, the intervention may be improved by beginning with open-ended questions to assist couples in a discussion of their fantasies before providing them with additional ideas. If couples create a novel activities plan based on their own specific desires, they may be more motivated to carry it out.    The studies created for this line of research also had methodological limitations, which may have influenced the results, as well as the conclusions that could be drawn. First, the high attrition rates and low adherence to the intervention in Studies 2 and 3, which are not uncommon for self-guided online interventions (Cavanagh et al., 2013; Christensen et al., 2009; Waller & Gilbody, 2009), make it difficult to draw conclusions with regards to the impact of engaging in novel sexual activities on sexual functioning in long-term relationships. The associations between adherence with the intervention and some of the outcome variables in Studies 2 and 3, suggest that engaging in novel sexual activities may be an effective strategy in enhancing sexual functioning in long-term relationships, and that the limited effect of the intervention may have been a result of poor adherence to the intervention. However, it is also possible that couples with greater sexual functioning were more likely to engage in more novel sexual activities. A second limitation is that Study 1 was correlational in nature, as a result it is unknown whether engaging 	  	   	   	   	   91	  	  	  in novel activities enhances sexual satisfaction and desire in women, or whether women with higher levels of sexual satisfaction and desire are more likely to engage in a greater variety of sexual activities, or if there is a third variable driving both variety of activities and sexual functioning. Third, participants for Studies 1 and 2 were recruited through Amazon Mechanical Turk. Although, a previous study found that most Amazon Mechanical Turk users are not primarily motivated by financial gain, this is the case for a subset of users (Buhrmester et al., 2011). Therefore, some of the participants in these studies may have taken questions on the survey less seriously and provided inaccurate responses as a result.  Fourth, participants in Studies 1 and 2 were only required to be in a relationship of one-year duration.  As a result, the sexual functioning of some of the participants in these studies may not have been impacted by familiarity, and therefore novelty may not yet have a significant impact. Fifth, the intervention was hypothesized to benefit couples who have experienced reductions in sexual desire and satisfaction that result from partner familiarity. Therefore, recruitment in Study 3 was designed to target couples who are seeking help for this problem, however it is possible that factors such as relationship distress, or psychosocial stressors, were the primary contributors to reduced sexual desire and satisfaction for some participants, in which case the intervention was less likely to be successful for these individuals. Therefore, future studies may benefit from screening and excluding participants for whom there are other factors having a greater impact than does familiarity on their sexual functioning. Sixth, participants in this line of research were primarily Caucasian, and generally highly educated. As well, due to the measures included in this set of studies, participation was restricted to those who identify as primarily heterosexual.  Therefore, the findings in the present line of research may not apply to a more diverse group of couples.   	  	   	   	   	   92	  	  	   The current research points to a number of directions for future research.  First, further research is needed to determine whether there is a gender difference with regards to the impact of novelty. In Study 1, novel activities were associated with greater sexual desire and satisfaction in women, however no associations between novel activities and sexual functioning were found in men. There were also gender differences in Study 2 with regards to the relationship between adherence to the intervention and outcome. The frequency with which couples engaged in novel sexual activity was associated with sexual desire, satisfaction, and desire for one’s partner in women, whereas only desire for one’s partner was associated with adherence in men. As well, in Study 3 women’s desire for their partners was significantly greater in the intervention and control conditions compared to the wait-list condition, however no group differences were found in men.  These findings are surprising, given the support for the hypothesis that partner novelty enhances men’s sexual functioning, and the strong evolutionary rationale for men to have adapted to desire short-term mating with novel partners. One possibility is that the benefits to men’s sexual functioning resulting from novel partners, may not be as readily replicated by engaging novel sexual activity within a long-term relationship. This is consistent with a previous study, which found that men experience a greater increase in sexual arousal in response to film stimuli with different actors engaging in the same activity, compared to women who experienced a greater increase in sexual arousal in response to the same actors engaging in different activities (Kelley & Musialowski, 1986). There is also evidence that women’s sexual desire and satisfaction are more negatively impacted by partner familiarity than men’s (Cheung et al., 2008; Klusmann, 2002; Liu, 2003; Murray & Milhausen, 2012), therefore it may also be more positively impacted by the introduction of novel activities. However, the novelty intervention in Study 2 as well as Study 3, with the exception of desire for one’s partner, did not have a 	  	   	   	   	   93	  	  	  differential impact on women compared to men.  As well, in Study 3, the frequency of novel sexual activity was associated only with sexual desire in women as well as sexual satisfaction in men.  Therefore, it remains unclear whether this strategy differs in its benefit for men and women.   Given the fact that women’s sexual desire has been found to be more impacted by relationship duration than men’s (Klusmann, 2002; Murray & Milhausen, 2012), and the negative impact sexual desire discrepancies within couples has on sexual and relationship satisfaction (Davies et al., 1999; Mark, 2014; Mark & Murray, 2012), it is particularly important to understand whether this strategy differentially impacts men and women. The intervention could negatively impact the couple if it further enhances desire in the partner with greater preliminary levels of desire and does not enhance desire in the partner with lower preliminary levels. Similarly, this strategy may prove particularly beneficial if it does indeed have a greater impact on women’s sexual desire than men’s, as this would help resolve sexual desire discrepancy resulting from relationship duration in the majority of couples. Second, the online nature of the intervention likely contributed to the high attrition rate and low adherence to the novelty intervention. As well, it is possible that couples ran into difficulties such as communicating about the intervention that they may have needed assistance working through.  As a result, research investigating the effectiveness of this strategy within an in-person therapy context would build our understanding of whether novelty in an effective strategy for long-term couples. Third, despite the limitations associated with an online self-guided intervention, there are a number of benefits associated with this mode of treatment.  For instance, this form of intervention can be implemented with minimal cost, and as a result can be accessible to couples 	  	   	   	   	   94	  	  	  that are unable to pay for therapy services.  As well, this method of treatment affords couples greater anonymity, which may encourage more couples to utilize the resource. As a result, those seeking help for sexual concerns are more likely to turn to self-help resources than seek help from a mental health professional (Catania, Pollack, McDermott, Qualls, & Cole, 1990). Therefore, methods of reducing attrition and increasing engagement with the novelty intervention in an online format should also be explored and evaluated.  Fourth, it is possible that specific novel sexual activities vary in their ability to replicate aspects of a novel partner, and therefore vary in their impact on sexual functioning.  For example changes to one’s appearance, or engaging in “role-playing” activities may better approximate the changes associated with a novel partner than engaging in different sexual positions, and as result these activities may lead to greater sexual functioning benefits.  Therefore studies are needed that compare the impact of specific novel activities on sexual functioning in men and women in long-term relationships.  Finally, it would also be interesting to further examine the impact of scheduling sexual activity on sexual functioning. This strategy is commonly suggested for couples in long-term relationships (Gottman & Gottman, 2007; Mintz, 2009) however, with the exception of a bibliotherapy study in which scheduling sexual activity was one of several suggested strategies (Mintz et al., 2012), no previous research has examined its impact on sexual functioning in men and women. In Study 3 however, both scheduling sexual activity and engaging in novel sexual activities led to greater changes in desire for one’s partner in women compared to the wait-list condition.  As well, in Study 1 frequency of sexual activity was the greatest predictor of sexual desire in women and sexual satisfaction in men and women. Therefore scheduling sexual activity may be a beneficial strategy for men and women looking to enhance their sexual relationship, 	  	   	   	   	   95	  	  	  however more research is needed before this can be recommended as an effective strategy.   While more research is needed in order to understand the impact novelty has on sexual functioning in men and women in long-term relationships, the findings from this research provide preliminary evidence that engaging in novel activities is associated with greater sexual desire and satisfaction in women, independent of relationship duration and sexual activity frequency.  As well, both scheduling sexual activity and engaging in a variety of sexual activities resulted in greater desire for one’s partner in women compared to the wait-list condition. However, no other differences between groups were detected, and it therefore remains unclear whether engaging in novel sexual activities is an effective strategy to enhance sexual desire, and sexual satisfaction in men and women, and desire for one’s partner in men.  The results of this research have important implications for couple therapy. Relationship duration has been found to lead to declines in sexual desire in women (Durr, 2009; Hayes et al., 2008; Murray & Milhausen, 2012), and declines in sexual satisfaction in men and women (Cheung et al., 2008; Klusmann, 2002; Liu, 2003; Schmiedeberg & Schroder, 2015; Sprecher, 2002).  Concerns regarding sexual desire are the most common presenting problem at sex therapy clinics (Hawton et al., 1991), and complaints regarding sexual desire and sexual satisfaction have been associated with relationship instability and dissolution (Edwards & Booth, 1994; Sprecher, 2002; Veroff et al., 1995). Therefore, there is a need for strategies to aide these couples. However, no previous research has investigated strategies to assist couples that hope to counteract declines in sexual desire and arousal that result from greater relationship duration. Therefore, if engaging in novel sexual activity does enhance sexual desire, sexual satisfaction, or desire for one’s partner in long-term couples, this may prove to be a helpful strategy for those who hope to counteract declines in these areas. The findings from the current line of research 	  	   	   	   	   96	  	  	  suggest that this strategy may lead to a small increase in desire for one’s partner in women, as well correlations between adherence to the intervention and sexual functioning in men and women suggest that this is a promising area for further study. However, over all the current line of research provided only limited support for an online novelty intervention, and therefore more research is needed before this can be recommended, if ever, as an effective intervention.  Therefore caution is advised to therapists who suggest this strategy to their clients, or create self-help resources based on this strategy, as it is remains unclear whether or not it benefits sexual desire, sexual satisfaction, or desire for one’s partner in men and women.            	  	   	   	   	   97	  	  	  References Acevedo, B. P., & Aron, A. (2009). Does a long-term relationship kill romantic love?. 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Sexual  activities, sexual and life satisfaction, and successful aging in women.  Journal of Sexual  Medicine, 7, 2401–10. doi:10.1111/j.1743-6109.2010.01747.x Yucel, D., & Gassanov, M. A. (2010). Exploring actor and partner correlates of sexual satisfaction  among married couples. Social Science Research, 39(5), 725-738. Zillmanm, D. & Bryant, J. (1988). Effects of prolonged consumption of pornography on family  values. Journal of Family Issues, 9, 518-544. doi:10.1177/019251388009004006      	  	   	   	   	   118	  	  	  Appendix 1: Demographic Information  Screener Questions  1. Are you currently in a heterosexual committed relationship?  Y/N     a.  If currently in a relationship, number of months together: _____________________   2. Are both members of the couple present to complete the questionnaire? Y/N  3. Please provide your email address below:  (this will allow us to contact you with a link to the post-intervention questionnaire in 4-weeks time, and the follow up questionnaire in four months time.  Those who did not initially receive the intervention will be emailed it in four months time) ________________________________  4. Create your anonymous participant ID code based on the following:  This information should be based on the female participant’s information.  Enter the first letter of father’s first name (A–Z), the month of your mother’s birthday (01-12), and the date of your birthday (01-31). _________________________________  The first section of the Questionnaire is to be completed by the female member of the couple.  Please do so in a private space without the presence of your male partner.    Demographic Information:  1.  Gender  Male/ Female  2. Age: _____________  3.  Ethnicity: ________________________    4. Country of Birth: ______________________ a.  Number of Years in Canada: ________________  5.  Education Level: __________________  6.  English Language Reading/Comprehension Ability (please circle):   1  2 3 4 5 Poor (Difficulty Reading/Comprehending  Fair (Some Difficulties Reading/Comprehending  Excellent (No Difficulties Reading/Comprehending 	  	   	   	   	   119	  	  	  Written English) Written English) Written English)   Relationship Information    7.  Current Relationship Status (please circle):  1  2 3 4 5 6 7 Single Committed Relationship Common-Law Married Separated Divorced Widow/ Widower    8.  Do you have any children? YES  NO   a.  If YES, how many?  _______________  9.  Sexual Orientation (please circle):  0 1 2 3 4 5 6 Exclusively Heterosexual   Bisexual   Exclusively Homosexual  10. How many times have you and your partner engaged in sexual activity together over the past 4-weeks? (Sexual Activity: can include caressing, foreplay, masturbation and vaginal intercourse) _________  11. How many times have you and your partner engaged in vaginal intercourse together over the past 4-weeks? _________   	  	   	   	   	   120	  	  	   Appendix II: Leisure Activities Checklist Leisure Activities Checklist: Please select which leisure activities you have engaged in with your partner in the past month.  If there are other leisure activities you have engaged in with your partner missing from the list please include them below.  Activity:  Month Play baseball/ softball  Play football  Play basketball  Play tennis  Play racquetball/ handball  Play badminton  Play golf  Play soccer  Play volleyball  Play Frisbee  Go jogging or running  Go to the gym/ lift weights  Go walking  Go bicycle riding  Go rollerblading  Go hunting  Go fishing  Go sailing  Go canoeing/ kayaking  Go speed boating  Go swimming  Go surfing  Go water skiing/ wake boarding  Go sea-doing  Go tubing  Go horseback riding  Go hiking  Go rock-climbing  Go camping  Go downhill skiing/ snowboarding  Go cross-country skiing  Go ice skating  Go snowshoeing  Do yoga  Do Tai Chi  	  	   	   	   	   121	  	  	  Go paragliding  Go skydiving  Play in the snow (e.g. snow ball fight, make snowman)  Attend a football game  Attend a baseball game/ softball game  Attend a basketball game  Attend a hockey game  Attend a wrestling match  Attend a car race or motorcycle race  Attend a horse race  Play a musical instrument  Dance  Sing   Listen to music  Attend a play  Attend a pop/ rock concert  Attend a symphony  Attend a comedy show  Sing karaoke  Go to a bar  Go to a nightclub  Play a drinking game  Go to a casino/ gamble  Attend a religious ceremony/ activity (e.g. go to Church)  Engage in prayer or meditation  Go shopping/ browsing  Go to a garage sale  Go to an auction  Go to a flea market/ swap-meet  Go to thrift/ antique stores  Read a fiction book  Read a nonfiction book  Read newspaper/ magazine  Play pool, foosball, or pinball  Play a video game/ computer game  Play a board game  Go bowling  Play word games  Play knowledge games  Play jigsaw puzzles  Do cross-word puzzles  Play a card game  Play a role playing game (e.g. Dungeons and Dragons)  Play a trading card game (e.g. Magic: The Gathering)  Go to the Library  	  	   	   	   	   122	  	  	  Go to a cooking class   Go to a dance lesson  Study a foreign language  Go to a meeting of a service club  Go to a meeting of a hobby club or interest group  Go to a meeting of a community organization   Go to a meeting of a political group  Attend public lecture  Attend a book club  Give public talk   Volunteer  Go for a drive  Go for a motorcycle/ scooter ride  Go out for dinner  Have breakfast in bed  Go out for coffee/ Tea  Go out for dessert  Cook/bake together  Go out for brunch  Go out for lunch  Order takeout food  Go wine tasting  Go to a park   Have a picnic  Go to the beach  Go to a fair, outdoor show, or exhibit  Go to a car show/ car rally  Go to a farmers market  Go to an amusement park  Go to a water park  Go to a museum  Go to an art gallery  Go to the zoo  Plan a party  Entertain friends or relatives in own home  Go out with friends   Attend a party  Visit friends or relatives in their home  Do household repairs   Do woodwork/carpentry   Do home renovations  Watch TV   Watch videos online (e.g. YouTube)  Research a topic on the internet  Shop online  	  	   	   	   	   123	  	  	  Look at real estate  Watch a fiction movie  Watch a nonfiction (documentary) movie  Planning a trip  Travel out of town   Travel out of state/ province   Travel abroad    Go on a cruise  Go on a road trip  Collect something (e.g. stamps, coins, action figures…)  Garden indoor/ outdoor  Write letters/ emails  Sewing/ knitting/ needlework  Creative writing  Engage in photography   Paint/ draw   Babysit  Play with kids  Play with pets  Have a pillow fight  Wrestle   Go the spa  Watch sunrise/ sunset  Take a bath    Other:           1) Approximately how many hours per month do and your partner spend doing leisure activities together? _________   	  	   	   	   	   124	  	  	  Appendix III: Sexual Activities Checklist  Sexual Activities Checklist: Please select which sexual experiences you have engaged in with your partner in the past month.  If there are other sexual experiences you and your partner have had together which are missing from the list please include them below.  Activity: Month Male lying prone on female (clothed).  Stroking and petting your sexual partner’s genitals.  Erotic embrace (clothed).  Intercourse - vaginal entry from rear.  Having genitals caressed by your sexual partner.  Mutual oral stimulation of genitals.  Oral stimulation of your partner’s genitals.  Intercourse side-by-side.  Kissing of sensitive (non-genital) areas of the body.  Intercourse-sitting position.  Male kissing female’s nude breasts.  Having your anal area caressed.  Breast petting (clothed).  Caressing your partner’s anal area.  Intercourse – female superior position.  Mutual petting of genitals to orgasm.  Having your genitals orally stimulated.  Mutual undressing of each other.  Deep kissing  Intercourse – male superior position.  Anal intercourse.  Kissing on the lips.  Breast petting (nude)  Masturbation (in front of partner)  Having an additional sexual partner at the same time (e.g. threesome).  Whipping or beating   Forcing partner to submit to sexual acts.  Being forced to submit to sexual acts.  Dressing in clothes of the opposite sex.  Using a vibrator  Using vaginal penetrative toys  Using anal toys  Using toys to maintain/ enhance erection (e.g. cock ring)  Being tied up or bound  Degrading your partner.  	  	   	   	   	   125	  	  	  Being sexually degraded.  Dressing in erotic garments.  Sexual activity in the bedroom  Sexual activity in a car  Sexual activity outdoors  Sexual activity in a public place  Sexual activity in a hotel  Sexual activity in a room of your house other than your bedroom  Sexual activity in someone else’s house  Sexual activity in the shower/ bath  Sexual activity in the work place  Sexual activity in a pool  Sexual activity in the afternoon  Erotic dancing  Incorporate food into sexual activity  Massage one another  Videotape sexual activity  Watch video of your own sexual activity  Watch heterosexual pornography  Watch male on male pornography  Watch female on female pornography  Watch BDSM pornography  Send/ receive suggestive text messages  Take suggestive/ nude photographs  Phone sex  Sexual activity over video chat  Act out a sexual role play  Using different kinds of condoms (e.g. studded, flavored…)  Choking  Spanking  Use lubricant  Use blindfolds  Use gags  Read erotica  Talk dirty  Play sexual games  Sexual activity under the influence of drugs/ alcohol  Scented candles  Play music during sexual activity    Other  ______________  ______________  	  	   	   	   	   126	  	  	  _______________          1) Approximately how many times in the past month did you and your partner engage in sexual activity together? (Sexual activity includes: intercourse, caressing, and foreplay)  	  	   	   	   	   127	  	  	   Appendix IV: Female Sexual Functioning Index (FSFI)  FSFI: These questions ask about your sexual feelings and responses during the past 4 weeks. Please answer the following questions as honestly and clearly as possible.  In answering these questions the following definitions apply: Sexual Activity: can include caressing, foreplay, masturbation and vaginal intercourse Sexual Intercourse: penile penetration (entry) of the vagina Sexual Stimulation: includes situations like foreplay with a partner, self-stimulation (masturbation), or sexual fantasy Sexual Desire/Interest: feeling that includes wanting to have a sexual experience, feeling receptive to a partner’s sexual initiation, and thinking or fantasizing about having sex Sexual Arousal: feeling that includes both physical and mental aspects of sexual excitement. It may include feelings of warmth or tingling in the genitals, lubrication (wetness), or muscle contractions.  1. Over the past 4 weeks, how often did you feel sexual desire or interest?     5 Almost always or always  4 Most times (more than half the time)  3 Sometimes (about half the time)  2 A few times (less than half the time)  1 Almost never or never  2.  Over the past 4 weeks, how would you rate your level (degree) of sexual desire or interest? 5 Very high 4 High 3 Moderate 2 Low 1 Very low or none at all  3.  Over the past 4 weeks, how often did you feel sexually aroused (“turned on”) during sexual activity or intercourse?  0 No sexual activity  5 Almost always or always  4 Most times (more than half the time)  3 Sometimes (about half the time)  2 A few times (less than half the time)  1 Almost never or never	  	   	   	   	   128	  	  	  4.  Over the past 4 weeks, how would you rate your level of sexual arousal (“turn on”) during sexual activity or intercourse?  0 No sexual activity  5 Very high  4 High  3 Moderate  2 Low  1 Very low or none at all  5.  Over the past 4 weeks, how confident were you about becoming sexually aroused during sexual activity or intercourse? 0 No sexual activity 5  Very high confidence 4 High confidence 3 Moderate confidence 2 Low confidence 1 Very low or no confidence  6.  Over the past 4 weeks, how often have you been satisfied with your arousal (excitement) during sexual activity or intercourse?  0 No sexual activity  5 Almost always or always  4 Most times (more than half the time)  3 Sometimes (about half the time)  2 A few times (less than half the time)  1 Almost never or never  7.  Over the past 4 weeks, how often did you become lubricated (“wet”) during sexual activity or        intercourse?  0 No sexual activity  5 Almost always or always  4 Most times (more than half the time)  3 Sometimes (about half the time)  2 A few times (less than half the time)  1 Almost never or never  8.  Over the past 4 weeks, how difficult was it to become lubricated (“wet”) during sexual activity or intercourse?  0 No sexual activity  1 Extremely difficult or impossible  2 Very difficult  3 Difficult  4 Slightly difficult  5 Not difficult  	  	   	   	   	   129	  	  	  9.  Over the past 4 weeks, how often did you maintain your lubrication (“wetness”) until completion of sexual activity or intercourse? 0 No sexual activity 5 Almost always or always 4 Most times (more than half the time) 3 Sometimes 2 A few times (less than half the time) 1 Almost never or never  10.  Over the past 4 weeks, how difficult was it to maintain your lubrication (“wetness”) until         completion of sexual activity or intercourse? 0 No sexual activity 1 Extremely difficult or impossible 2 Very difficult 3 Difficult 4 Slightly difficult 5 Not difficult  11.  Over the past 4 weeks, when you had sexual stimulation or intercourse, how often did you reach orgasm (climax)? 0 No sexual activity 5 Almost always or always 4 Most times (more than half the time) 3 Sometimes (about half the time) 2 A few times (less than half the time) 1 Almost never or never  12.  Over the past 4 weeks, when you had sexual stimulation or intercourse, how difficult was it for you to reach orgasm (climax)? 0 No sexual activity 1 Extremely difficult or impossible 2 Very difficult 3 Difficult 4 Slightly difficult 5 Not difficult  13.  Over the past 4 weeks, how satisfied were you with your ability to reach orgasm (climax) during sexual activity or intercourse?  0 No sexual activity  5 Very satisfied  4 Moderately satisfied  3 About equally satisfied and dissatisfied  2 Moderately dissatisfied  1 Very dissatisfied  	  	   	   	   	   130	  	  	  14.  Over the past 4 weeks, how satisfied have you been with the amount of emotional closeness during sexual activity between you and your partner?  0 No sexual activity  5 Very satisfied  4 Moderately satisfied  3 About equally satisfied and dissatisfied  2 Moderately dissatisfied  1 Very dissatisfied  15.  Over the past 4 weeks, how satisfied have you been with your sexual relationship with your partner?  5 Very satisfied  4 Moderately satisfied  3 About equally satisfied and dissatisfied  2 Moderately dissatisfied  1 Very dissatisfied  0 No partner  16.  Over the past 4 weeks, how satisfied have you been with your overall sexual life?  5 Very satisfied  4 Moderately satisfied  3 About equally satisfied and dissatisfied  2 Moderately dissatisfied  1 Very dissatisfied  17.  Over the past 4 weeks, how often did you experience discomfort or pain during vaginal penetration? 0 Did not attempt intercourse 1 Almost always or always 2 Most times (more than half the time) 3 Sometimes (about half the time) 4 A few times (less than half the time) 5 Almost never or never    18.  Over the past 4 weeks, how often did you experience discomfort or pain following vaginal          penetration? 0 Did not attempt intercourse 1 Almost always or always 2 Most times (more than half the time) 3 Sometimes (about half the time) 4 A few times (less than half the time) 5 Almost never or never   	  	   	   	   	   131	  	  	  19.  Over the past 4 weeks, how would you rate your level (degree) of discomfort or pain during or following vaginal penetration? 0 Did not attempt intercourse 1 Very high 2 High 3 Moderate 4 Low 5 Very low or none at all    	  	   	   	   	   132	  	  	  Appendix V: International Index of Erectile Function (IIEF)  IIEF: These questions ask about your sexual feelings and responses during the past 4 weeks. Please answer the following questions as honestly and clearly as possible.   In answering these question the following definitions apply:  Sexual activity: includes intercourse, caressing, foreplay and masturbation Sexual intercourse: is defined as penile penetration of your partner (entry of the vagina) Sexual stimulation: includes situation such as foreplay, erotic pictures etc. Ejaculation: is the ejections of semen from the penis (or the feeling of this) Orgasm: is the fulfillment or climax following sexual stimulation or intercourse   1. Over the past 4 weeks, how often were you able to get an erection during sexual activity?   0 No Sexual Activity  1 Almost never/ never 2 A few times (much less than half the time) 3 Sometimes (about half the time) 4 Most times (much more than half the time) 5 Almost Always or always  2. Over the past 4 weeks, when you had erections with sexual stimulation, how often were your erections hard enough for penetration?   0 No Sexual Activity  1 Almost never/ never 2 A few times (much less than half the time) 3 Sometimes (about half the time) 4 Most times (much more than half the time) 5 Almost Always or always   3. Over the past 4 weeks, when you attempted sexual intercourse, how often were you able to penetrate (enter) your partner?   0 Did not attempt intercourse 1 Almost never/ never 2 A few times (much less than half the time) 3 Sometimes (about half the time) 4 Most times (much more than half the time) 5 Almost Always or always   4. Over the past 4 weeks, during sexual intercourse, how often were you able to maintain your erection after you had penetrated (entered) your partner?   0 Did not attempt intercourse 1 Almost never/ never 2 A few times (much less than half the time) 3 Sometimes (about half the time) 4 Most times (much more than half the time) 	  	   	   	   	   133	  	  	   5 Almost Always or always   5. Over the past 4 weeks, during sexual intercourse, how difficult was it to maintain your erection to completion of intercourse?  0 Did not attempt intercourse 1 Extremely difficult 2 Very difficult 3 Difficult 4 Slightly difficult  5 Not difficult  6. Over the past 4 weeks, how many times have you attempted sexual intercourse? 0 No attempts  1 One or two attempts  2 Three or four attempts  3 Five to six attempts  4 Seven to Eight Attempts  5 Eleven + attempts  7. Over the past 4 weeks, when you attempted sexual intercourse, how often was it satisfactory for you?   0 Did not attempts intercourse  1 Almost never/ never  2 A few times (much less than half the time)  3 Sometimes (about half the time)  4 Most times (much more than half the time)  5 Almost always/ always  8. Over the past 4 weeks, how much have you enjoyed sexual intercourse?  0 No intercourse  1 No enjoyment  2 Not very enjoyable  3 Fairly enjoyable  4 Highly enjoyable  5 Very highly enjoyable  9. Over the past 4 weeks, when you had sexual stimulation or intercourse, how often did you ejaculate?  0  No sexual stimulation/ intercourse  1 Almost never/ ever  2 A few times (much less than half the time  3 Sometimes (about half the time)  4 Most times (much more than half the time)  5 Almost always/ always   	  	   	   	   	   134	  	  	    10. Over the past 4 weeks, when you had sexual stimulation or intercourse, how often did you have the feeling of orgasm or climax? 0  No sexual stimulation/ intercourse  1 Almost never/ ever  2 A few times (much less than half the time  3 Sometimes (about half the time)  4 Most times (much more than half the time)  5 Almost always/ always  11. Over the past 4 weeks, how often have you felt sexual desire?  1 Almost never/ never  2 A few times (much less than half the time)  3 Sometimes (about half the time)  4 Most times (much more than half the time)  5 Almost always/ always  12. Over the past 4 weeks, how would you rate your level of sexual desire? 1 Very low/ none at all 2 Low 3 Moderate 4 High 5 Very high  13. Over the past 4 weeks, how satisfied have you been with your overall sex life? 1 Very dissatisfied  2  Moderately dissatisfied  3 About equally satisfied and dissatisfied  4 Moderately satisfied  5 Very satisfied  14. Over the past 4 weeks, how satisfied have you been with your sexual relationship with your partner 1 Very dissatisfied  2  Moderately dissatisfied  3 About equally satisfied and dissatisfied  4 Moderately satisfied  5 Very satisfied  15. Over the past 4 weeks, how do you rate your confidence that you get and keen an erection? 1 Very low 2 Low 3 Moderate 4 High 5 Very high 	  	   	   	   	   135	  	  	  Appendix VI: Partner Specific Sexual Wanting Scale  These questions are designed to measure the degree of desire and satisfaction you have in your sexual relationship with your primary sexual partner. Answer each question by selecting the response option that best reflects your belief.  11. Thinking about the last month, how often have you had sexual thoughts about your primary sexual partner when you were not engaging in sexual activity? 1 = Not at all 2 = Once or twice a month 3 = Once a week 4 = Twice a week 5 = 3 or 4 times a week 6 = Once a day 7 = A couple of times a day 8 = Many times a day   12. When you have sexual thoughts about your primary sexual partner, how would you rate the intensity of those feelings? 0. Not at all strong  1  2  3  4. Somewhat strong  5  6  7  8. Extremely strong   13.  When you look at your primary sexual partner, how often does this result in physical sexual arousal (e.g., an erection, increased heart rate, lubrication, etc.)? 1 = Rarely or never  2 = Occasionally or some of the time  3 = moderate amount of the time  4 = Often or most of the time  5  = Always  14. When you think about your primary sexual partner, how often does this result in physical sexual arousal? 1 = Rarely or never  	  	   	   	   	   136	  	  	  2 = Occasionally or some of the time  3 = moderate amount of the time  4 = Often or most of the time  5  = Always  15. When you have physical contact with your primary sexual partner (e.g., hugging, holding hands or touching), how often does this result in physical sexual arousal?1 = Rarely or never  2 = Occasionally or some of the time  3 = moderate amount of the time  4 = Often or most of the time  5  = Always	     	  	   	   	   	   137	  	  	  Appendix VII: The Global Sexual Satisfaction Index (GSSI)  GSSI: Below is a rating scale upon which we would like you to record your personal evaluation of how satisfying your sexual relationship is. The rating is simple. Make your evaluation by circling the number that best describes your present sexual relationship.  8 Could not be better 7 Excellent 6 Good 5 Above Average 4 Adequate 3 Somewhat inadequate 2 Poor 1 Highly inadequate 0 Could not be worse    	  	   	   	   	   138	  	  	  Appendix VIII: Feedback Questions  1. What aspects of the intervention did you find helpful? What changes did you notice? (e.g., more attracted to partner, increase in sexual desire…)   2. Were you able to implement the intervention?  If not, what got in the way? (e.g., difficulty remembering, not agreeing with your partner on what to try, lack of time…)  3. Are there any changes you would suggest to help couples follow through with the intervention in the future?  4. Other comments/ Suggestions:   	  	   	   	   	   139	  	  	  Appendix IX: Novelty Intervention  Instructions for Enhancing your Sexual Relationship:  Make a list: Together with your partner, please compile a list of 10 sexual experiences outside of your normal sexual routine (ex. experiences you have never had together or have not done frequently). Select experiences that sound pleasurable to both of you and that you both feel comfortable trying.  See the list below for some ideas. Feel free to come up with your own ideas as well. Aim to try as many of these activities as possible over the next 4-weeks.           Draw up a plan: When you have jointly chosen the activities you would like to try over the next 4-weeks make a specific plan for how to integrate each of these items into your sexual relationship. When and where will each of these take place? Are there any items that need to be purchased beforehand? Write down the details in the space below as well as making a hardcopy for yourselves.  Put the plan somewhere you can see it (ex. On your bedside table).            Here are some examples of experiences that may be outside your normal sexual routine:  Stroking and petting your sexual partner’s genitals. Kissing of sensitive (non-genital) areas of the body. 	  	   	   	   	   140	  	  	  Intercourse - vaginal entry from rear. Intercourse-sitting position. Having genitals caressed by your sexual partner. Male kissing female’s nude breasts. Mutual oral stimulation of genitals. Watch heterosexual pornography Oral stimulation of your partner’s genitals. Watch male on male pornography Intercourse side-by-side. Watch female on female pornography Having your genitals orally stimulated. Having your anal area caressed. Mutual undressing of each other. Breast petting (clothed). Intercourse – male superior position. Caressing your partner’s anal area. Anal intercourse. Intercourse – female superior position. Kissing on the lips. Mutual petting of genitals to orgasm. Breast petting (nude) Watch BDSM pornography Masturbation (in front of partner) Send/ receive suggestive text messages Dressing in clothes of the opposite sex. Take suggestive/ nude photographs Using a vibrator Phone sex Using vaginal penetrative toys Sexual activity over video chat Using anal toys Act out a sexual role play Using toys to maintain/ enhance erection (e.g. cock ring) Using different kinds of condoms (e.g. studded, flavored…) Being tied up or bound Spanking Dressing in erotic garments. Use lubricant Sexual activity in the bedroom Use blindfolds Sexual activity in a car Use gags Sexual activity outdoors Read erotica Sexual activity in a public place Talk dirty Sexual activity in a hotel Play sexual games Sexual activity in a room of your house other than your bedroom Sexual activity under the influence of drugs/ alcohol Sexual activity in someone else’s house Scented candles Sexual activity in the shower/ bath Play music during sexual activity Sexual activity in the work place Massage one another Sexual activity in a pool Videotape sexual activity Sexual activity in the afternoon Watch video of your own sexual activity Erotic dancing Incorporate food into sexual activity    	  	   	   	   	   141	  	  	  Appendix X: Control Intervention  Instructions for Enhancing your Sexual Relationship:  Discuss together how often you would like to engage in sexual activity over the next 4 weeks.  Decide on a frequency of sexual activity that sounds pleasurable to both of you, and that you are both comfortable with.  Make a specific plan for how to achieve this during the next 4 weeks. When will each instance of sexual activity take place? Write down the details in the space below as well as making a hardcopy for your selves.  Put the plan somewhere you can see it (ex. On your bedside table).              	  	   	   	   	   142	  	  	   Appendix XI: Revised Novelty Intervention  Instructions for Enhancing your Sexual Relationship:  Make a list: Together with your partner, please compile a list of 10 sexual experiences outside of your normal sexual routine (ex. experiences you have never had together or have not done frequently). It is most important that you select experiences that sound pleasurable to both of you and that you both feel comfortable trying. Items near the beginning of the list may be a good starting place if one or both partners are feeling hesitant. It doesn’t matter what you do so long as it is outside of your usual routine. See the list below for some ideas. Feel free to come up with your own ideas as well. Aim to try as many of these activities as possible over the next 4-weeks.           Draw up a plan: When you have jointly chosen the activities you would like to try over the next 4-weeks make a specific plan for how to integrate each of these items into your sexual relationship. When and where will each of these take place? Are there any items that need to be purchased beforehand? Do you need to arrange childcare?  Set aside specific times to engage in the activity. Write down the details in the space below as well as making a hardcopy for yourselves.  Put the plan somewhere you can see it (ex. On your bedside table). Set reminders on your phone, and or write your plan on your calendar to help remind yourselves during busy weeks. Make a commitment to each other to make this plan a priority over the next 4 weeks. Is there anything else that could get in the way? If so trouble shoot this now.          	  	   	   	   	   143	  	  	     Here are some examples of experiences that may be outside your normal sexual routine:  Massage one another Light Scented candles Play music  Lights on/ Lights off (whichever you don’t normally do) Send/ receive suggestive text messages Kissing of sensitive (non-genital) areas of the body. Breast petting (clothed/ nude). Male kissing female’s nude breasts. Having genitals caressed by your sexual partner/ Stroking and petting your sexual partner’s genitals. Mutual petting of genitals to orgasm. Dressing in lingerie. Read erotica Use lubricant A sexual position you don’t normally do (male superior position, female superior position, side-by-side, sitting position, vaginal entry from rear etc.) Having your genitals orally stimulated/ Oral stimulation of your partner’s genitals. Mutual oral stimulation of genitals. Sexual activity somewhere other than your bedroom (another room in your house, shower/bath, hotel, car, someone else’s house, workplace, pool, outdoors, public place,  Sexual activity at a different time of day (e.g. morning, afternoon, middle of the night) Play strip poker Talk dirty Sexual activity in front of a mirror One partner be dominant and the other submissive Having your anal area caressed/ Caressing your partner’s anal area. Using different kinds of condoms (e.g. studded, flavored…) Using a vibrator Using vaginal penetrative toys Using toys to maintain/ enhance erection (e.g. cock ring) Incorporate food into sexual activity (e.g. whipped cream, chocolate sauce) Phone sex Use blindfolds Spanking Dress in erotic costume Take suggestive/ nude photographs Masturbation (in front of partner) Erotic dancing/ strip tease Sexual activity over video chat 	  	   	   	   	   144	  	  	  Watch pornography (heterosexual, male on male, female on female, BDSM) Sexual activity under the influence of drugs/ alcohol Being tied up or bound Dressing in clothes of the opposite sex Using anal toys Anal intercourse Play sexual games Act out a sexual role play Videotape sexual activity Watch video of your own sexual activity   

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