In e na ional Jou nal o
En i onmen al Resea ch
and Public Heal h
A icle
Incidence and Rela ed Fac o s o In ideli y among Medical
Doc o s and Nu ses
Sa a Gue e o 1,*, G acia Cas o-Luna 2, Rosa Zapa a Boluda 2, Aida F ei es 1, Ra ael Ga cía1and
Tesi ón Pa ón-Ca eño 2


Ci a ion: Gue e o, S.; Cas o-Luna,
G.; Zapa a Boluda, R.; F ei es, A.;
Ga cía, R.; Pa ón-Ca eño, T.
Incidence and Rela ed Fac o s o
In ideli y among Medical Doc o s
and Nu ses. In . J. En i on. Res. Public
Heal h 2021,18, 5575. h ps://
doi.o g/10.3390/ije ph18115575
Academic Edi o s: Raquel Ala cón,
Ma ia del Ma Requena Mullo and
Da id L. Rowland
Recei ed: 14 Ap il 2021
Accep ed: 18 May 2021
Published: 23 May 2021
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Copy igh : © 2021 by he au ho s.
Licensee MDPI, Basel, Swi ze land.
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dis ibu ed unde he e ms and
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A ibu ion (CC BY) license (h ps://
c ea i ecommons.o g/licenses/by/
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1Facul y o Heal h Sciences, Human Sexuali y Ins i u e, Au onomous Uni e si y o San o Domingo, San o
Domingo 10103, Dominican Republic; [email p o ec ed] (A.F.); [email p o ec ed] (R.G.)
2Facul y o Heal h Sciences, Uni e si y o Alme ia, 04120 Alme ia, Spain; [email p o ec ed] (G.C.-L.);
[email p o ec ed] (R.Z.B.); [email p o ec ed] (T.P.-C.)
*Co espondence: [email p o ec ed]
Abs ac :
Al hough he e is a la ge body o esea ch add essing in ideli y, no s udy, o ou knowledge,
has speci ically add essed in ideli y in doc o s and nu ses and he co ela ion wi h wo k hou s,
schedule and o he a iables. This esea ch aimed o know he incidence o and ac o s ela ed o
in ideli y among doc o s and nu ses. A desc ip i e s udy was ca ied ou , s udying he associa ion
o ce ain a iables. In o al, 367 olun ee pa icipan s comple ed an online su ey. O hem, 21%
ei he ha e o ha e had an un ai h ul ela ionship. The majo i y (81.7%) we e doc o s. Men we e
4.3 imes mo e un ai h ul han women, wi h hese di e ences being s a is ically signi ican (OR =
4.37, p< 0.001). O he pa icipan s in ol ed in an un ai h ul ela ionship wi hin he wo k a ea,
he majo i y we e men. Likewise, hose who epo ed ha ing had sex in he doc o ’s oom on
du y we e also men, wi h hese di e ences being s a is ically signi ican (OR = 12.81, p< 0.01). The
nigh eme gency schedule was 60% mo e equen in un ai h ul people, and hese di e ences we e
s a is ically signi ican (OR = 12.43, p< 0.01). The e is a signi ican a e o in ideli y in doc o s and
nu ses. Men a e mo e likely o be un ai h ul han women a e, and people who wo k nigh ime
eme gencies a e mo e likely o be un ai h ul.
Keywo ds:
ex a-dyadic sexual in ol emen ; in ideli y; shi wo k; doc o s; nu ses; heal h ca e pe -
sonnel
1. In oduc ion
In ideli y is one o he mos complex and di icul o de ine a eas in ela ionship
s udies. Riso de ines i as he lack o he no ma i e pac ha limi s he numbe o people
in ol ed in lo e o an e o ic ela ionship and, he e o e, he p ohibi ion o main aining
o he s in pa allel, whe he occasional o con inuous [1].
Fo Zumaya, he de ini ion o in ideli y is linked o he concep ion o a couple—i
his concep we e unde s ood as he exis ence o a lo ing eeling and a commi men
o emo ional/e o ic exclusi i y be ween wo indi iduals, in ideli y would be a sec e
in e pe sonal ela ionship wi h a pe son ou side o he couple wi h whom emo ional and
a ac ion elemen s o e en ual o con inuous occu ence a e in ol ed [2].
The alue o ideli y has been o mos impo ance o men and women. The iola ion
o his pac o sexual and emo ional exclusi i y can cause di e en con lic s. In some
si ua ions, he solu ion o hem can be concei ed as sepa a ion. Howe e , i is necessa y o
conside ha he alue a ached o in ideli y depends on he social pe cep ion, since an
e en can be in e p e ed as a ansg ession by ce ain people, whe eas o o he s, i does
no imply he b eaking o he ag eed ules. In his sense, social pe cep ion is concep ualized
as he “awa eness ha an indi idual may ha e abou he phenomena ha occu a ound
him, especially his abili y o in e mo i a ions, a i udes o alues om he social beha io
o o he s indi iduals [
3
]. Resea che s ha e app oached i s o igin om a ious a eas,
In . J. En i on. Res. Public Heal h 2021,18, 5575. h ps://doi.o g/10.3390/ije ph18115575 h ps://www.mdpi.com/jou nal/ije ph
In . J. En i on. Res. Public Heal h 2021,18, 5575 2 o 8
including ype o a achmen [
4
,
5
], an h opology [
6
,
7
], cul u e [
8
], pe sonali y [
9
] and
gende [
10
]. Simila ly, in ideli y has been s udied om a wide a ie y o pe spec i es,
such as he easons, ypes, educa ional le el, gende di e ences, ea men , pe sonali y
and occupa ion, among o he s. Acco ding o da a p o ided by he Family Ins i u e o he
Dominican Republic, he numbe o cases o in ideli y in couples has isen o 40% [
11
].
Likewise, acco ding o he Na ional S a is ical O ice o he Dominican Republic (ONE)
da a, 24,772 couples we e di o ced in he Dominican Republic in 2018. They ound
ha equen in ideli y and inancial si ua ion we e he main ac o s ha led hem o
sepa a e [
12
]. Kachadou ian e al. s udied whe he dis ance om he pa ne o wo k
easons (in he mili a y) could be ela ed o in ideli y. O hei s udy popula ion, 22.2%
epo ed ha hei pa ne s we e un ai h ul o hem du ing hei absence [
13
]. Likewise,
Snyde e al., in a s udy wi h he mili a y, s a ed ha he e idence sugges s ha in his
popula ion, especially in hose who a e sepa a ed om hei pa ne o wo k missions,
he a es o in ideli y a e signi ican ly high [
14
]. Amocky e al. epo ed ha high anxie y
and s ess le els could be a p edic o o engaging in un ai h ul beha io [
15
]. Rome o
highligh s he in luence o cul u e in he concep ualiza ion o in ideli y and he pe cei ed
consequences [
16
]. A highe equency and accep ance o in ideli y has been ound in men
han in women [
17
]. A kins e al. ound ha people wi h a highe educa ion le el a e mo e
likely o engage in ex ama i al sex. They concluded a signi ican ela ionship be ween
di o ce and educa ional le el, and he co ela ion be ween educa ion and in ideli y was
only signi ican in di o ced couples [
18
]. Lab ecque and Whisman conduc ed a s udy based
on nine yea s o esea ch and in e iews wi h 13,030 adul s ac oss he Uni ed S a es. This
s udy epo ed ha 53.3% o hose su eyed who acknowledged ha ing been un ai h ul
a i med ha hey had sexual ela ions wi h someone hey knew e y well as a close iend,
while 29.4% did i wi h close people, such as a neighbo o a co-wo ke . Fu he mo e,
21% o he men and 13% o he women in e iewed admi ed ha hey we e un ai h ul
a leas once in hei li e [
19
]. Takase s a ed ha nu sing has su e ed om he gene al
s e eo ype o a long ime [
20
]. One o he causes a ibu ed o he consolida ion o he
nu sing image ha has li le o do wi h cu en eali y is he hie a chical s uc u e be ween
he doc o and he nu se, which emana es om hei espec i e educa ional o igins [
21
].
Pa e a, Jo gelina e al. conduc ed a s udy on sexuali y in heal h pe sonnel. They s a ed
ha he p ac ice o heal h- ela ed p o essions is associa ed wi h physical and psychological
exhaus ion capable o p oducing al e a ions in he le el o sexuali y. Th ough a s uc u ed
and anonymous su ey, hey e alua ed he deg ee o sa is ac ion wi h he quali y o sexual
li e and i s ac o s in doc o s, esiden s and nu ses. O he pa icipan s, 62% a i med ha
since he beginning o he wo k ac i i y, he equency and quali y o hei sexual ela ions
had dec eased; 31% epo ed mo e signi ican a ac ion o o he people and 15% epo ed
in ideli y [
22
]. The main objec i e o his wo k was o unde s and he high incidence o
in ideli y among heal h ca e wo ke s. The e is no s udy speci ically on in ideli y in heal h
ca e wo ke s, al hough he e is such esea ch in long- e m jobs such as he mili a y. The
indings o his s udy will con ibu e o a be e unde s anding o his phenomenon o
bo h u u e esea ch and he apeu ical pu poses.
2. Ma e ials and Me hods
2.1. S udy Design
C oss-sec ional desc ip i e s udy.
2.2. S udy Popula ion
The s udy popula ion consis ed o all he doc o s and nu ses who pa icipa ed in
he esea ch, answe ing an anonymous online su ey whe e ques ions we e included o
e alua e he s udy a iables. The s udy sample consis ed o 367 pa icipan s o di e en
na ionali ies. As he majo i y o he esponses we e om he Dominican popula ion (89.4%),
wi h a minimal numbe o many o he na ionali ies, ha could con ibu e mo e bias o he
s udy han bene i s; i was p e e ed no o include i in he analysis. The su ey was pos ed
In . J. En i on. Res. Public Heal h 2021,18, 5575 3 o 8
on an online po al so ha heal h p o essionals om di e en pa s o he wo ld could ha e
access o i and hus en ich he a ie y o esponses, co e ing di e en na ionali ies and
cul u es. The Google su ey sys em gua an ees anonymi y by no lea ing any ace o who
answe ed he su ey and does no con ain pe sonal da a ha could allow he iden i ica ion
o any pa icipan .
2.3. E hical C i e ia
All pa icipan s included olun a ily ag eed o pa icipa e in his esea ch; he e o e,
he in e na ional guidelines o he e hical p o ocols applied o esea ch wi h human beings
we e aken in o accoun .
2.4. Ins umen
A su ey was designed o include all o he in o ma ion equi ed o mee his esea ch’s
gene al and speci ic objec i es; his su ey was conduc ed in h ee languages Spanish,
English and Po uguese. Na i e speake s o he h ee languages e iewed he e sions in
he co esponding language o ensu e ha he ansla ion was adequa e and p ecise o he
pa icipan s [23].
2.5. P ocedu e
The in i a ion o pa icipa e in he s udy was sen ia he In e ne o doc o s and
nu ses, who we e asked o sha e i wi h colleagues, ega dless o hei loca ion in he wo ld.
This way o collec ing in o ma ion was chosen because i e ec i ely eaches mo e people
in less ime. In addi ion, i was ca ied ou du ing he co ona i us pandemic, whe e he e
was social dis ancing.
2.6. S udy Va iables
The a iables o he s udy we e he ollowing: age, sex, ma i al s a us, special y, ime
spen wi h pa ne , numbe o p e ious ma iages o s able ela ionships, ime spen wi h
he p e ious pa ne , wo k hou s, wi h whom hey ha e been in ol ed, ma i al s a us o
he pe son wi h whom hey we e un ai h ul (i he pe son in ol ed is ela ed o he wo k
a ea), who he pe son is wi h whom hey we e in ol ed, ype o un ai h ul ela ionships,
ype o sexual exchange, place o mee ings and sexual consequences, among o he s.
2.7. Analysis Plan
Wi h he a iables desc ibed abo e, a da abase was c ea ed, and hei s a is ical ea -
men was ca ied ou wi h SPSS e sion 24. A uni a ia e analysis was pe o med. Fo he
quali a i e a iables, equencies wi h hei co esponding pe cen ages we e calcula ed.
Fo he quan i a i e a iables, cen al endency and dispe sion measu es (mean, minimum,
maximum and s anda d de ia ion) we e pe o med. In he bi a ia e analysis, o com-
pa ing quali a i e a iables, he chi-squa ed es (
χ
2) was applied, conside ing a alue o
p< 0.05 o be signi ican . The co esponding ORs we e also calcula ed o 2
×
2 ables.
Fo quan i a i e a iables, a p e ious no mali y es (Kolmogo o –Smi no ) was used, as
well as S uden ’s - es (no mal a iables) and he Mann–Whi ney U es (non-pa ame ic
a iables). The mul i a ia e analysis was pe o med using bina y logis ic eg ession, using
in ideli y as he dependen a iable (yes/no), and as independen a iables, all hose
ha we e signi ican in he bi a ia e analysis and hose ha we e conside ed o in luence
he model. The Hosme –Lemeshow goodness-o - i es was pe o med, and a s a is ical
signi icance le el o p< 0.05 was conside ed o include a iables in he inal model.
3. Resul s
The mean age o he pa icipan s was 41.88 (12.52) yea s, wi h he younges being
22 yea s old and he oldes being 78 yea s old.
The mean age o men, 45.94, was highe han ha o women, 40.40, which was
s a is ically signi ican (p< 001). O hose who we e un ai h ul, he mean age o men
In . J. En i on. Res. Public Heal h 2021,18, 5575 4 o 8
was 46.56 yea s and was also highe han ha o women, 37.76 yea s, wi h his being a
s a is ically signi ican di e ence (p< 001). The dis ibu ion by sex was 58 men (39.2%) and
90 women (60.8%). O he pa icipan s, 21.5% had been in an un ai h ul ela ionship.
People who wo ked nigh ime eme gency hou s had he highes p opo ion o in i-
deli y o 60%, and hose who wo ked pa - ime had he lowes a 9.3%, wi h hese di e -
ences being s a is ically signi ican (Table 1). No women had child en, while se en men
had c ea ed a child in he un ai h ul ela ionship, and hese di e ences we e s a is ically
signi ican (Table 2).
Table 1. Demog aphic Cha ac e is ics.
In ideli y
p-Value OR IC 95%
No Yes
Sex
Women n231 38
0.001 0.230.13–0.39
% 85.9% 14.1%
Men n57 41
% 58.2% 41.8%
Ma i al s a us
Roman ic ela ionship n43 13
0.12 —-
% 76.8% 23.2%
Li ing oge he n34 17
% 66.7% 33.3%
Ma ied n164 36
% 82.0% 18.0%
Single n47 13
% 78.3% 21.7%
Wo k Schedule
Pa - ime n39 4
0.009 —-
% 90.7% 9.3%
Full- ime n173 45
% 79.4% 20.6%
Unp edic able schedule n43 13
% 76.8% 23.2%
Full ime and eme gencies n29 11
% 72.5% 27.5%
Nigh eme gencies n4 6
% 40.0% 60.0%
Table 2.
Dis ibu ion o he ela ionship o sex acco ding o how many child en ha e been c ea ed in
un ai h ul ela ionships.
Men Women To al
None 31 38 69
One 7 0 7
Mo e han one 3 0 3
To al 41 38 79
Likelihood a io = 14.46; p= 0.001.
S a is ically signi ican di e ences we e ound be ween he sex o he pa icipan and
whe he o no hey had had sexual encoun e s wi hin he wo kplace. O he pa icipan s
who epo ed ha ing had sexual encoun e s wi hin he adminis a i e o ices, he majo i y
(88.8%) we e men; likewise, hose who epo ed ha ing had sexual encoun e s in he doc-
o ’s oom on du y (76.9%) we e also mos ly men. These di e ences we e no s a is ically
signi ican (Table 3).
In . J. En i on. Res. Public Heal h 2021,18, 5575 5 o 8
Table 3.
Dis ibu ion o he ela ionship o sex acco ding o whe he he subjec has had sexual
encoun e s wi h people in he wo k a ea.
Sex Inside he Wo k A ea To al
Yes Some o Them No
Sex
Women
n8 14 16 38
% 21.1% 36.8% 42.1% 100.0%
Men n11 20 10 41
% 26.8% 48.8% 24.4% 100.0%
Chi-squa ed 12.80; p= 0.24.
Mos o he women had ela ionships ou side hei wo k en i onmen , al hough he
di e ences we e no s a is ically signi ican (Table 4).
Table 4.
Dis ibu ion o he ela ionship o sex acco ding o whe e hey ha e had sexual encoun e s
wi hin he wo k a ea.
Men Women To al
O ice and oom o he doc o s on du y
8 6 14
Room o he doc o on du y 13 7 20
Adminis a i e o ice 8 1 9
None 9 13 22
To al 41 37 78
Likelihood a io = 14.88; p= 0.061.
Fo he mul i a ia e analysis o bina y logis ic eg ession, in ideli y was chosen as
he dependen a iable, and as independen a iables, sex (1 man, 0 women), age, p o es-
sion, special y, ma i al s a us, ime wi h pa ne , p e ious ela ionships and wo k hou s
we e included.
A Nagelke ke R-squa ed alue o 0.35 was ob ained, and he Hosme and Lemeshow
es was pe o med wi h p= 0.35, indica ing good i ed bina y logis ic eg ession model
o he chosen analysis (Table 5).
Table 5. Bina y logis ic eg ession analysis.
OR 95% CI Pa a EXP (B) p
Lowe Highe
Sex (men) 4.73 2.75 8.14 0.001
Wo k schedule ( ull- ime wo k) 1.96 0.64 5.99 0.240
Wo k schedule (unp edic able schedule) 2.49 0.71 8.67 0.151
Wo k schedule ( ull- ime and eme gencies)
2.62 0.72 9.57 0.144
Wo k schedule (nigh eme gencies) 17.79 3.34 94.87 0.001
Cons an 0.07
The model only included he a iable sex as signi ican , wi h an OR 4.73. Men
we e almos i e imes mo e un ai h ul han women. P o essionals who pe o med nigh
eme gencies showed 17.8 imes mo e isk o being un ai h ul han hose who did pa -
ime wo k.
4. Discussion
In ideli y in he p o essional en i onmen is a highly publicized issue. Su p isingly,
i has no been s udied in he heal h ca e en i onmen , whe e wo ke s sha e e y long
wo king days—ci cums ances ha , a p io i, seem o a o his ype o un ai h ul beha io .
In his esea ch, we ha e de eloped a bina y logis ic model ha included he a iable
sex as signi ican , wi h an OR o 4.73. Men we e almos i e imes mo e un ai h ul han

In . J. En i on. Res. Public Heal h 2021,18, 5575 6 o 8
women, and i was obse ed ha p o essionals who pe o med nigh eme gencies had
17.8 imes mo e isk o being un ai h ul han hose who did pa - ime wo k.
The esul s ag ee wi h hose ob ained by Buunk and Disjks a, who s a ed ha men
a e mo e likely o be un ai h ul and in ol ed in an un ai h ul ela ionship han women [
24
].
Likewise, hey also ag ee wi h he esul s o Ca uso. Mos o he in es iga ions indica e
ha in u ban Wes e n socie ies, he a io o in ideli y in men and women is 3:1 o 2:1. These
pe cen ages inc ease when socie ies om hi d-wo ld coun ies o u al communi ies
a e analyzed, eaching ex eme si ua ions in s ongly eligious coun ies whe e emale
in ideli y has e y low pe cen ages o is almos non-exis en [25].
Simila ly, Camacho a i med ha in ideli y is associa ed mo e wi h he male gende
han wi h he emale one. Men in all cul u es and a all imes we e mo e un ai h ul
han women; ha is a ac , al hough emale in ideli y is becoming mo e common [
10
].
Figue oa and Ca olina s udied sex di e ences in he mo i e o being un ai h ul o a pa ne .
Men we e sex o ien ed and women we e emo ion o ien ed [
26
]. Simila esul s we e
epo ed by Jana Hacka hon and B ian Ashdown abou sexual s. emo ional mo i a ion
o in ideli y [
27
]. Sel e man e al., using an In e ne -based ques ionnai e, ound sexual
desi e, low commi men , lack o lo e and neglec as p edic o s o in ideli y [
28
]. Fishe
e al. published a e iew o he li e a u e and s udies on in ideli y and epo ed ha 1.5–4%
o ma ied men had had an ex ama i al ela ionship a some poin in hei li e. They also
epo ed ha 23.2% o men a e un ai h ul o hei cu en pa ne s, and mul iple s udies
epo ed ha be ween 15% and 50% o men we e un ai h ul h oughou hei li es. These
esul s a e consis en wi h he esul s o ou s udy, whe e i was ound ha men a e mo e
likely o be un ai h ul han women (5.7 imes), ega dless o hei ma i al s a us [29].
Conce ning wo k hou s, we ound ha nigh eme gency hou s we e he mos equen
in people who had been un ai h ul. These di e ences we e s a is ically signi ican .
Kachadou ian e al. s udied whe he dis ance om he pa ne o wo k easons (in
he mili a y) could be ela ed o in ideli y. O hei s udy popula ion, 22.2% epo ed ha
hei pa ne s we e un ai h ul o hem du ing hei absence. O he emaining pa icipan s,
37.8% admi ed o being conce ned abou he possibili y ha hei pa ne may ha e been
un ai h ul o hem du ing hei absence in comba . The pa icipan s who epo ed ce ain y
o in ideli y on he pa o hei pa ne s exhibi ed high le els o symp oms due o pos -
auma ic s ess and signs o se e e dep ession compa ed o he indi iduals who did no
epo in ideli y on he pa o hei pa ne s. This co ela es wi h ou s udy ques ions, as
doc o s and nu ses spend many hou s away om hei homes o wo k easons [13].
We ound ha o he mos pa , he pa icipan s who had been un ai h ul wo ked
eme gency hou s a nigh . Likewise, Snyde e al., in a s udy wi h he mili a y, s a ed ha
he e idence sugges s ha , in his popula ion, especially in hose who a e sepa a ed om
hei pa ne o wo k missions, he a es o in ideli y a e signi ican ly high [14].
Go don and Mi chell s udied whe he he s ess ha he COVID-19 pandemic has
b ough has placed couples a highe isk o in ideli y. The s udy was conduc ed ac oss
he Uni ed S a es and epo ed ha people we e engaging in beha io s highly ela ed o
being in ol ed in an un ai h ul ela ionship [
30
]. Fincham epo ed ha in ideli y is he
mos common cause o di o ce [31].
Mos o he pa icipan s who we e in ol ed wi h people no ela ed o he ins i u ion
we e women. Some au ho s ha e epo ed he ole o cul u e in he way in ideli y is iewed
depending on gende [
16
]. A highe equency and accep ance o in ideli y has been ound
in men han in women [17].
This could be due o he social s igma ela ed o in ideli y in women, since being in-
ol ed wi h people ou side o hei wo k en i onmen would gua an ee g ea e disc e ion.
In ideli y b eaks gende expec a ions o wha is cul u ally accep able in e ms o a woman’s
sexual beha io and how o he s alue he . This s igma iza ion could gene a e guil , shame
and ea .
These esul s a e in line wi h wha is exp essed by Buss ha men a e no socially
condemned o ha ing his ype o encoun e . E en hey allow i hemsel es wi hou much
In . J. En i on. Res. Public Heal h 2021,18, 5575 7 o 8
guil , whe eas women, in gene al, a e socially condemned o his o a leas owned upon,
and hey usually li e wi h much guil and many in e nal ques ions i hey allow i [32].
Limi a ions: This s udy e eals di e en en i onmen al laye s o a iables ela ed o
in ideli y. De e mining he e ec size o he a iables associa ed wi h in ideli y was no
possible due o he he e ogenei y o he in ideli y assessmen ools. In ideli y will con inue
o be a challenge o he ins i u ion o ma iage and couple ela ionships. New a iables
o ac o s ha may in luence in ideli y beha io s such as social media, new echnologies,
a new pe cep ion o gende oles and amily unc ions may equi e esh a en ion om
esea che s o p o ide a new pe spec i e on in ideli y.
5. Conclusions
In conclusion, p o essionals in he ield o medicine, who a e subjec ed o many hou s
o wo k away om home, especially a nigh , ha e a signi ican incidence o in ideli y.
This incidence is highe in men. The mo i es gi en by pa icipan s o ge in ol ed in an
ex ama i al ela ionship we e ela ed o he demands o hei job, such as being away om
home o many hou s; being a way o elease s ess; and because o he na u e o hei
wo k, i was easy o jus i y hei absence om home. All o hese da a sugges ha people
wo king in he medical ield could be mo e exposed o in ideli y. These indings p o ide
in o ma ion ha ale s his popula ion o he impo ance o in es ing quali y ime in hei
ela ionship in hei ee ime, gi en he na u e o he wo k, he hou s equi ed and he
access o p i a e spaces sui able o sexual encoun e s. Ha ing a be e unde s anding o
his phenomenon could educe amily con lic s ela ed o his ma e .
Au ho Con ibu ions:
Concep ualiza ion, S.G.; da a cu a ion, R.Z.B. and G.C.-L.; o mal analysis,
T.P.-C.; in es iga ion, S.G., A.F., T.P.-C. and R.G.; me hodology, T.P.-C. and R.G.; p ojec adminis a ion,
G.C.-L.; esou ces, T.P.-C.; so wa e, S.G. and T.P.-C.; supe ision, R.Z.B. and R.G.; alida ion, S.G. and
G.C.-L.; isualiza ion, R.G.; w i ing—o iginal d a , S.G., R.G., R.Z.B. and T.P.-C.; w i ing— e iew
and edi ing, S.G., A.F. and R.G. All au ho s ha e ead and ag eed o he published e sion o he
manusc ip .
Funding: This esea ch ecei ed no ex e nal unding.
Ins i u ional Re iew Boa d S a emen :
The s udy was conduc ed acco ding o he guidelines o he
Decla a ion o Helsinki and app o ed by he Ins i u ional Re iew Boa d (o E hics Commi ee) o he
Human Sexuali y Ins i u e, Uni e sidad Au onoma o San o Domingo.
In o med Consen S a emen :
In o med consen was ob ained om all subjec s in ol ed in he s udy.
Da a A ailabili y S a emen :
Cas o de Luna, G acia (2021), “DATABASE INFIDELITY”, Mendeley
Da a, V1, doi:10.17632/j7 ys 9k 8.1.
Acknowledgmen s:
The au ho s acknowledge he Human Sexuali y Ins i u e and Alme ia Uni e si y
o all he suppo .
Con lic s o In e es : The au ho s decla e no con lic o in e es .
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