Introduction

The definition of masculinity, a creation of modern society, has been increasingly investigated and studied in recent years (Connell & Messerschmidt, 2005). Hegemonic masculinity raises traditional norms that are related to feeling’s negation, encouragement to brutality, and the idea of superiority towards femininity. Man is then molded into a culture that imposes an image of a strong and heterosexual being, who must deny any sign of weakness (Rosostolato, 2019).

The concept of hegemonic masculinity has been built through the interpersonal relations of a patriarchal society that promotes a dominant position of men and the subordination of women (Guerra et al., 2004). It is related to the stereotype of the chauvinist male, in which men are courageous, aggressive and do not cry nor feel fear. It is also associated with the concept of possession and power, such as having money, women, a male child, Y chromosome and emotional control (Silva, 2006). These ideas influence male behavior (Guerra et al., 2015), leading to violence, homophobia, sexual promiscuity, less condom use, and even sexual assault (Malamuth, 1996; Poteat et al., 2010; Sheffield, 1989).

The necessity of maintaining their dominant position in the social hierarchy towards women is related to an emotional disconnection with their own feelings, resulting in suffering, apathy and aggressiveness. Guilherme Valadares (2015) affirms that male toxicity is sustained by 7 factors: "excessive aggressiveness, fear of being gay, fear of being weak, fear of being feminine, obsession with power and money, emotional closure and being notice as highly sexual”.

This emotional repression is based on the idea that, by showing signs of weakness, men would be condemned to be weak. Thus, these individuals do not consciously express their emotions and do not speak openly about their feelings. The emotional silence reinforces their masculinity, but also provokes dysfunctional social relationships, which are impoverished by not recognizing and not naming one's own affections (Freire, 2010).

Alexithymia and hegemonic masculinity are connected to Brazilian society, as most boys are still raised in an environment that involves the "macho culture". They are forced to deny everything that is not considered "masculine" and to repress their own feelings, such as sadness (crying), abandonment

and fear. Consequently, it is very common for men to associate and confuse masculinity with alexithymia. According to Breno Rosostolato (2019), since childhood, men are molded into a stereotype that induces inappropriate or

even aggressive and brutal postures.

Alexithymia is a term suggested by Peter E. Sifneos (1972/1977) to refer to a psychological disorder characterized by an individual's inability to identify and express emotions. The word alexithymia

has a Greek origin and literally stands for "without words for emotion”. Currently, alexithymia is considered to be the result of a set of factors involving cognitive and emotional aspects, as for example difficulty

in perceiving and describing subjective feelings, difficulty in distinguishing emotions from physical sensations, having concrete thinking and more objective reasoning, and having a poor capacity to fantasize and imagine.

This psychological disorder may have several etiologies, but Sifneos, in 1991, proposed that this term should be classified in two types: primary alexithymia (biological) or secondary alexithymia (psychosocial) (Carneiro & Yoshida, 2009; Rosostolato, 2019; Taylor, 1984; Taylor & Bagby, 2004).

Primary alexithymia originates from a neuroanatomical alteration in which there is a communication disturbance between the brain hemispheres, with the limbic system, and the cortex (Carneiro & Yoshida, 2009; Rosostolato, 2019). Secondary alexithymia is the result of serious trauma experienced in childhood or adulthood, such as lack of maternal attachment and physical abuse. According

to Sifneos (1991), these traumatic experiences can cause structural changes in psychological functioning, acting on affective component of emotions, resulting in an affective blunting. If trauma occurs before language development,

the person may present difficulties in using words to express emotions and feelings. Thus, emotions could be expressed in behavioral reactions instead of being correlated to thoughts.

Krystal, Giller, and Cicchetti (1986) state that patients who have experienced excesses or privations in mother-child relationships may not be able to adequately develop the capacity for affective expression.

This may lead to the repression of affect and may cause psychosomatic disorders. Besides psychological factors, there is also the possibility of a relation between sociocultural factors and alexithymia. In his research, Taylor

shows that according to cultural communication characteristics from a society, some limitation to emotions verbalization and expression may prevail (Carneiro & Yoshida, 2009; Krystal et al., 1986; Sifneos, 1991; Taylor, 1984).

Being able to fantasize and express emotions is also an essential component of sexual life. Therefore, alexithymia is related to sexual disorders, as for instance erectile dysfunction (Madioni &

Mammana, 2001; Scimeca et al., 2012). When it comes to masculinity, men who resemble traditional male norms report greater endorsement of dysfunctional sexual beliefs than those who resemble modern masculinity. Dysfunctional

sexual beliefs can intensify sexual disorders. In addition, men who fit into the traditional male model, may have a conservative view on female sexuality, negatively affecting their intimate relationships (Clarke et al., 2014).

Another aspect of sexuality that is highly associated with men's sexual behavior is the use of pornography, which has been proven to have a direct impact on the sexual behavior of its consumers (D’Abreu,

2013; Guerra et al., 2004). According to the sociologist Diana Russel, many children see pornography as the only source of sex education during their lives (Postal et al., 2018). Massive exposure to pornography can increase

men's sexual insensitivity to women, decrease satisfaction with their real relationships, and increase the need for sex without emotional involvement (Zillmann & Bryant, 1982). Carlo Foresta, head of the Italian Society

of Andrology and Sexual Medicine (SIAMS), states that adolescents who frequently consume pornography may in the future suffer from difficulties in having sexual relations with a real partner (Postal et al., 2018). In addition,

pornography is also placed as a risk factor for sexual assault (D'Abreu, 2013).

These topics are scarcely addressed in literature, especially when it comes to Latino men. The 'macho man' in Latin culture is associated with the culture of honor. According to Magalhães

(2006), honor is related to the individual's reputation and to external judgment of other people. In this context, a man's reputation is associated with his virility, his ability to maintain dominion over his family,

and control over his emotions. Therefore, for the Latino man, expressing emotions and weaknesses can be understood as a threat not only to masculinity, but mainly to honor. (Guerra et al., 2015).

Nevertheless, this pattern of man as a dominant being is open for a change (Connell & Messerschmidt, 2005). Since the feminist movement resulted in a greater insertion of

women in labor market, this masculinity based on traditional and patriarchal model began to weaken (Silva, 2006). Nowadays, this whole context of masculinity and hegemony currently leads to an idea of toxic masculinity (Rosostolato,

2019). In this way, society is beginning to take a closer look at the concept of masculinity, trying to define a better identity for contemporary men and for the male gender. (Silva, 2006).

The present study sought to achieve a better understanding of masculinity, alexithymia and sexual behavior among Brazilian men. The aim was to investigate the influence of traditional male norms and

alexithymia on sexual behavior (sexual satisfaction, masturbation, and pornography consumption), relationship status and religion.

Methods

Participants

A total of 530 Brazilian men over 18 years of age completed the questionnaire. Two participants were eliminated for failing to answer the control question (e. g. for this item, click the button containing number 4), resulting 528 men as the final sample. The average age was 26,74 (SD=7,08) years, ranging from 18 to 67 years.

Most participants identified themselves as white (82,01%). The sample consisted of a high socioeconomic and educational level, with 71,02% of participants with higher education (concluded or in progress) and 55,87% with at least 5 minimum wages. The South region of Brazil was the most common place of birth (57,58%). From the total of participants, 72,92% declared themselves heterosexual and 35,61% were in a serious relationship. These general characteristics from the sample are detailed in Table 1.

Measures

The survey consisted in 66 questions, including: 8 about general characteristics of the sample, 11 about sexual intercourse, including the Male Sexual Quotient, 4 about masturbation and pornography consumption, 1 control question, 26 from the Toronto Alexithymia Scale (TAS-26) and 16 from the Meanings of Adolescent Masculinity Scale.

Sexual Intercourse

The Male Sexual Quotient, a questionnaire in Portuguese developed and validated by Carmita Abdo (2007) at University of São Paulo (Brazil), was used to assess male sexual satisfaction (Cronbach’s alpha coefficient= 0,60). The scale evaluates physical and emotional aspects of the sexual experience: desire, confidence, foreplay quality, partner satisfaction, erection quality, ejaculatory control, ability to achieve orgasm, and intercourse satisfaction. Each aspect is measured by a Likert scale of five points, where "0" indicates "never" and "5" indicates "always", and a higher score reflects higher sexual satisfaction. Total score is ensued by summing the items and multiplying by two to obtain a final score on a scale of one hundred points. Categories obtained with the score are: Highly satisfied (82-100), Partially satisfied (62-80), Average (42-60), Dissatisfied (22-40) and Highly dissatisfied (0-20). Before the participant answered the Male Sexual Quotient, there was a question whether the participant had ever had sexual intercourse. Those who had a negative answer did not respond the Sexual Quotient, moving forward to the next stage of the survey.

Masturbation and pornography consumption

Masturbation frequency was assessed by a scale of 9 points: less than once a year; once a year, once every six months, once every three months, once a month, once a week, two to three times a week, once a day and more than once a day. Pornography consumption while masturbating was evaluated through the availability of the following options: never, rarely, sometimes, often and always. Use of social media (e. g. WhatsApp) to spread pornography was evaluated through two questions about sending and receiving this type of material in the last six months.

Alexithymia

Levels of alexithymia were assessed by the Toronto Alexithymia Scale - TAS- version in Portuguese. This questionnaire was developed by Taylor and collaborators (1985) and validated for Portuguese (Cronbach’s alpha coefficient= 0,71) by Yoshida (2007). It is a self-assessment questionnaire in which the participant must answer 26 items for alexithymia evaluation. The scale involves questions about the ability to describe feelings and distinguish them from body sensations, daydreaming, externally oriented thinking, and ability to communicate feelings to other people. For each item, the participant should answer using the Likert scale: 1- I totally disagree, 2- I disagree, 3- I don't know, 4- I agree, 5- I totally agree. The following items were considered negative: 1, 5, 6, 9, 11, 12, 13, 15, 16, 21 and 24, and were scored inversely. Values greater than or equal to 74 indicate the presence of alexithymia and values less than or equal to 62 indicate its absence. However, in the present study we only evaluated alexithymia levels, considering the cutoff point was not validated for the questionnaire applied in Portuguese.

Masculinity

The endorsement of traditional male norms was assessed by the Meaning of Adolescent Masculinity Scale, created by Oransky and Fisher (2009) and validated in Portuguese by Guerra and collaborators, presenting satisfactory psychometric characteristics (Guerra et al., 2014). The Portuguese version of the instrument involves three dimensions of masculinity: heterosexism (feminine behavior is not acceptable for men), social teasing (jokes that boys make about each other is part of "being a man"), and emotional restriction (to be considered male, the individual must hide his emotions and not appear vulnerable). The instrument has 16 items, in which the participant must fill in according to a 4-point Likert scale ranging from 1- strongly disagree to 4- strongly agree. The average of the following dimensions were added: Heterosexism (Cronbach’s alpha coefficient= 0,86): items 01, 02, 03, 05, 07,10, 14, 16; Social Teasing (Cronbach’s alpha coefficient= 0,69): 04, 11, 12, 15; Emotional Restriction (Cronbach’s alpha coefficient= 0,72): 06, 08, 09, 13. Higher scores in each dimension represent greater perception of the factor importance to masculinity.

Procedure

This is a cross sectional study, which provided an anonymous and voluntary online survey, made available from October to December 2020. The recruitment happened via social media (Instagram, Facebook and e-mail) and the platform used was Google Forms. Inclusion criteria consisted in being a Brazilian man over 18 years old, which was determined by an introductory text. The participant was informed that the survey would take 20 to 30 minutes to be completed, and that intimate questions would be addressed, including sexuality, feelings, and masculinity. There was an orientation to answer the survey in a private place without interruptions. After the participants read the online consent form, they had to click on a button indicating consent before beginning the survey. The study was approved by the institutional review board.

Statistical Analysis

Descriptive data (mean, standard deviation, frequency and percentages) were calculated and tabulated in Excel© program, as well as the scores obtained in the questionnaires. Distribution of numerical data was judged by the Shapiro-Wilk test (Ghasemi & Zahediasl, 2012). Comparison between groups of categorical variables was analyzed through the Chi-square Test. For comparison between groups of quantitative variables without normal distribution, the Mann Whitney Test was used for 2 groups, and Kruskal Wallis test, followed by the Steel-Dwass-Critchlow-Fligner test for three or more groups. For comparison between groups of quantitative variables with normal distribution, Student T-test (t) was used for 2 groups and One Way ANOVA followed by the Tuckey test for three groups or more. Correlations between variables were established by the Spearman Test (ordinal and quantitative variables without normal distribution). The statistical software used was Jamovi© and the significance adopted was 5%.

Results

Standardized questionnaires descriptive data

Data distribution of the Toronto Alexithymia Scale followed a normal distribution. Regarding the results of the Male Sexual Quotient and Meanings of Adolescent Masculinity Scale, the distribution did not follow the normality patterns. From the total of participants, 27 selected the option of never having experienced sexual intercourse, and therefore they did not respond to the Sexual Quotient. Descriptive data for each questionnaire are detailed in Table 2.

Sexual Satisfaction

There was no association between never having experienced sexual intercourse with levels of alexithymia (Student-T-Test, p=0,10), endorsement of traditional male norms (Mann- Whitney, p=0,29) and its dimensions (heterosexism: p=0,06; social teasing: p=0,50; emotional restriction: p=0,40). Sexual satisfaction was negatively correlated with levels of alexithymia (Spearman's Rho= -0,319, p<0,001). There was no significant correlation between sexual satisfaction and endorsement of traditional male norms (Spearman's Rho= 0,075, p=0,09), including dimensions of heterosexism (Spearman's Rho= 0,065, p=0,14) and emotional restriction (Spearman's Rho= 0,056, p=0,21). There was a weak positive correlation between sexual satisfaction and social teasing (Spearman's Rho= 0,096, p=0,031).

Masturbation and pornography

The most prevalent masturbation frequency was two to three times a week (37,31%), followed by once a day (28.98%). Regarding the use of pornography while masturbating, the most selected option was "often", representing 33,71% of the sample. The sharing of pornography through social media in the last six months was common in this study, with 347 (65,72%) participants receiving and 184 (34,85%) sending pornographic material. There was an association between sending and receiving pornography (Chi-square, p<0,001).

Levels of alexithymia were not correlated with masturbation frequency (Spearman's Rho= 0,070, p=0,10) and frequency of pornography use while masturbating (Spearman's Rho= 0,001, p=0,98). In addition, there was no association between levels of alexithymia and sending (Student-T-Test, p=0,06) or receiving (Student-T-Test, p=0,36) pornography in the last six months through social media.

When it comes to masculinity, there was no significant correlation between masturbation frequency and endorsement of traditional male norms (Spearman's Rho= 0,022, p=0,61), including the dimensions social teasing (Spearman's Rho= -0,083, p=0,06) and emotional restriction (Spearman's Rho= 0,011, p=0,79). There was a weak negative correlation between masturbation frequency and the heterosexism dimension (Spearman's Rho=-0,099, p=0,022). The frequency of pornography use while masturbating was positively correlated with the endorsement of traditional male norms (Spearman's Rho=0,159, p<0,001) as well as its dimensions (social teasing: Spearman's Rho=0,148, p<0,001; emotional restriction: Spearman's Rho=0,090, p<0,039; and heterosexism: Spearman's Rho=0,128, p=0,003). Furthermore, sending (Mann- Whitney, p=0,004) and receiving (Mann- Whitney, p<0,001) pornographic material through social media were associated with greater endorsement of traditional male norms

Nonsexual variables

There was a weak correlation between levels of alexithymia and endorsement of traditional male norms (Spearman's Rho=0,086, p=0,049) as well as its dimensions: heterosexism (Spearman's Rho=0,094, p=0,031) and emotional restriction (Spearman's Rho=0,147, p<0,001). There was no significant correlation between alexithymia and social teasing dimension (Spearman's Rho=0,004, p=0,92).

Men who were married or living together with a partner obtained the lowest levels of alexithymia, with significant difference if compared with men with no relationship (One Way ANOVA, p=0,021). Comparison of levels of alexithymia according to relationship status are represented in Figure 1. Regarding the endorsement of traditional male norms, the difference between relationship status was not significant (Kruskal- Wallis, p=0,64).

The age of the participants was a variable with no correlation with alexithymia levels (Spearman´s Rho= -0,067, p=0,12) and endorsement of traditional male norms (Spearman´s Rho= -0,022, p=0,62). In addition, there was no association between having a religion and levels of alexithymia (One Way ANOVA, p=0,53). However, there was an association between having a religion and greater endorsement of traditional male norms (Kruskal Wallis, p<0,001), as shown in table 3.

Discussion

The present study investigates masculinity, alexithymia and sexual behavior among Brazilian men, in an attempt to understand how traditional male norms and alexithymia may influence sexual behavior and other aspects of men`s life, including interpersonal relationships and religion.

Men with lower sexual satisfaction had higher levels of alexithymia, confirming findings from previous studies (Berenguer, Rebôlo & Costa, 2019; Madioni & Mammana, 2001). Sexual dissatisfaction in alexithymic men may be related to sexual disorders, such as erectile dysfunction (Michetti et al., 2005; Wise et al., 2002). However, in the present research, specific functional sexual disorders were not assessed. Instead, sexual satisfaction was evaluated in a more comprehensive manner, deepening in emotional aspects. These results suggest that alexithymia is not only a contributing factor for sexual disorders but may negatively influence sexual life and could be a barrier to sexual satisfaction.

Relationship status was associated with levels of alexithymia, men who were married or living with a partner had lower levels of alexithymia when compared to men not currently in a relationship. These results indicate that alexithymia may influence men's ability to relate on a intimate level to other people. Mediated by the fear of intimacy, alexithymia is associated with attachment insecurity, and may create a barrier to interpersonal relationships. (Lyvers et al., 2017; Lyvers et al., 2021). Perchance, men with less difficulty of expressing emotions are more likely to remain in lasting relationships and reach higher levels of sexual satisfaction with their partners. Humphreys´ study (2009) presented this negative correlation between levels of alexithymia and satisfaction with intimate relationship, including the sexual aspects of it.

Alexithymic individuals find difficult to understand their partners' emotions, to communicate their emotional needs and to provide emotional support, potentially leading to conflict and dissatisfaction (Lyvers et al., 2021). Although this study brings alexithymia as an important factor in satisfaction level in relationships, other aspects should be considered, such as the ability to resolve conflicts and receptivity. Another issue that could be raised in future studies is how women are affected when relating to alexithymic partners.

Regarding alexithymia and masculinity, higher levels of alexithymia were positively correlated with greater endorsement of traditional male norms, as suggested by Levant (2003), especially heterosexism and emotional restriction dimensions. Parental influence during childhood may contribute to normative male alexithymia (Levant, 1998), in the belief that male feelings should be silenced, perpetuating alexithymic behavior.

There was no correlation between sexual satisfaction and endorsement of traditional male norms, except for the sexual teasing dimension, with a weak positive correlation. Clarke's study (2014) reports that men who resemble traditional male norms have less sexual inhibition due to the threat of failure in sexual performance. Concerning masturbatory behavior, pornography consumption while masturbating was correlated with greater endorsement of traditional male norms and their three dimensions. Furthermore, sending and receiving pornography in social media were associated with conceptions of traditional male norms.

Pornography often shows men in the dominant position and normalizes aggressive behavior and lack of consent in sexual relationships (Shor & Golriz, 2018; Borgogna et al., 2018). When excessively consumed, pornography can reinforce a male stereotype that does not fit into modern society, encouraging sexual aggression (D'Abreu, 2013), and hindering sex with a real partner (Postal et al., 2018). Some men consume pornography in order to avoid negative emotions, complicating the understanding and acceptation of their feelings (Borgogna et al., 2018). It is possible that hegemonic masculinity does not influence interpersonal relationships as much as alexithymia. In fact, the endorsement of traditional male norms may have a greater influence on men's masturbation and pornography consumption, that are sexual behaviors with no emotional interaction (Scimeca et al., 2012).

The present research study the association between pornography consumption and different components of hegemonic masculinity. Future studies could explore this association using validated pornography scales and different questionnaires about gender norms. Furthermore, pornography has undergone several changes since its beginning and still is in constant modification (Garlick, 2011). New studies are often necessary in order to revise how pornography affects people’s life.

Religious men had greater endorsement of traditional male norms, when compared to nonreligious individuals. Studies have shown that religion is associated with patriarchal beliefs, emphasizing conservative gender roles for men and women (Acevedo & Shah, 2015; Brooks & Bolzendahl, 2004; Moore & Vanneman, 2003). Religion has been connected to tradition and stability, providing a steady way of living (Mikołajczak & Pietrzak, 2014). Having spirituality regardless any religion was not associated with traditional male norms, suggesting that patriarchal values are more linked to religion as an organization.

It is necessary to encourage actions that transform and end men’s emotional restriction. The practice of social and emotional learning by parents and school could help men to understand and accept their feelings since childhood (Evans, 2015). However, gender inequality could be a barrier for emotional education. The conceptions of traditional male norms are intrinsic in our society, so a multidimensional intervention is necessary in order to reinvent masculinity, leaving normative concepts behind.

Study limitations

This is one of the first studies that address male behavior in a Brazilian sample, providing acknowledgements about alexithymia and masculinity, and their influence in other variables, especially sexual behavior. However, there are limitations inherent to the study format. In a cross-sectional study, is not plausible to assume cause and effect between variables. Self-reported online survey provides greater privacy to participants, which is advantageous in a study that addresses sexuality. Nonetheless, it is not possible to affirm that all participants responded the survey honestly. Future studies may include instruments on social desirability, to prevent participants from responding according to social expectation. Furthermore, participants who had access to Internet and answered the survey were predominantly white, with high educational and socioeconomic level. Brazil is a continental country with immense diversity among people, therefore, Brazilian population was not fully represented in this study.

Conclusions

Alexithymia seems to influence Brazilian men regarding interpersonal relations, such as sexual satisfaction and relationship status. Lower levels of alexithymia were correlated with sexual satisfaction

and were associated with lasting relationship status. Meanwhile, normative masculinity was connected to personal variables, which did not involve a partner. Pornography use and its sharing in social media were linked to traditional

male norms, as well as having a religion. Since normative masculinity and alexithymia affect men's well-being, being aware of behaviors that are connected to these variables is important in order

to contribute on men´s health assistance.

Supplementary materials

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