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This study assessed key characteristics of this subgroup of men who have sex with men MSM in China. Of eligible MSM, Besides marriage as a strong predictor odds ratio: H omosexuality has a long history in China, and can be traced with historical evidence back to the Shang dynasty in — BC. In the past decade, men who have sex with men MSM have become visible; 3 however, homosexual behaviors still carry a stigma in Chinese society and the stigma for MSM is mainly due to social norms against homosexuality, males' responsibility to carry the family line, and their high risks for human immunodeficiency virus HIV infections or sexually transmitted infections STIs.

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There are around 14 million Tongqi wives whose needs for support are often overshadowed. This phenomenon has been largely under researched, this review is the first to address the current data on the Tongqi.

The aim of this systematic review is to begin to provide insight into the pre-existing data and the further support that is needed for the wives of MSM. Handsearching was also completed to provide a rich data set. : The articles were summarized and analyzed for thematic clusters.


These themes often intersected to provide a complex understanding of the current gaps in support provided to Tongqi. Conclusion: Tongqi wives remain a hidden population in Chinese mainstream society, who deserves a sensitive approach to women china looking for sex.

The study revealed that the MSM wives suffer severe mental, physical, health, and life related harms. However, instead of situating them into the victim roles, many women take on an identity of empowerment and are working together, aiming to make social changes. In order to address the Tongqi phenomenon, it is also essential to reduce the discrimination toward homosexuality. Tongqi are a special group of Chinese women, they require further intensive research attention.

international studies have focused on the mixed-orientation marriages between homosexual men and heterosexual wives Higgins, ; Hernandez et al. For investigating these mixed-orientation marriages, it is important to consider the contextual environment, social, and cultural context Kissil and Itzhaky, With the legalization of homosexual marriage in a wide range of countries, the legal marriage right for homosexual population has ificantly changed.

In China, due to discrimination, men who have sex with men MSM are a sexual minority and remain hidden as a population Zhu, There is a scarcity of research focusing on Chinese women who married with gay men. Tongqi is the victimized population shadowed behind this hidden population, whom have insufficient power to make their voice be heard.


With the increasing visibility of the MSM population, many wives have started to question the sexual orientation of their husbands Zhu, This visibility has resulted in the growing of Tongqi in China. According to a recent estimation, there is over In Chinese culture, getting married and producing offspring is a social and familial obligation Zhou, ; Chen et al.

Thus, Chinese MSM face pressure and expectations from their parents to have grandchildren to continue the family line Chow et al. There are also pressures on Tongqi women as well to stay married that are similar to the pressure faced by the men.


Given the marriage is fraudulent the wife risks exposing the MSM husband, not only will this bring the wives shame but they will receive no compensation. There is also the unintended effect of outing the discrete MSM husband, which may create further hate toward the gay community Zhu, ; Pan, Noticeably, Tongqi suffer from profound intimate partner violence IPV, i. Tongqi, as a group of minority women in China, require urgent support and substantial research attention. Thus, we aimed to conduct a comprehensive review to better understand the situation of Chinese Tongqi.

This systematic review covers original studies on Tongqi in China.


No restrictions were applied in study settings and des due to the lack of research. Studies published either in English or Chinese that focused on Tongqi population were included. To extract further literature, the researchers RC and ZH also hand-searched the reference lists of review papers and articles. To reach agreement, any inconsistencies during screen and data extraction were resolved through discussion between the researchers.

The following information was extracted from the included articles: first author with publication year, province, study setting, study de, recruitment method, sample size, demographic information of participants, assessed aspect of the participants, main findings, and marriage related information.


From the database and handsearching articles were initially identified and 11 studies Tang and Zhang, ; Liu and Tang, a ; Tang and Liu, ; Tang and Yu, ; Zhang et al. Tongqi in China are a high-risk population of HIV and sexual transmitted diseases. For instance, Li et al. Li et al.


Tongqi in the articles reviewed frequently suffered from IPV. As reported by Zhang et al. In addition, Tongqi also suffered from family cold violence. Family cold violence refers to the indifferent behaviors in conflicts and arguments, such as silence, sarcasm, stopping sex, insult, and other mentally hurtful informal violent behaviors.

Zhang et al. More recently, using a sample of Chinese Yan et al.

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The higher the total score on the scale reflects more frequent family cold violence and indicates there is a severity of suffering from family cold violence. The research found that most of Tongqi received a high total score measured by this scale. Tongqi were at high risk of mental ill health in the studies reviewed.


For example, Li X. Liu and Tang a conducted a qualitative study with using a sample of eight Tongqi aged from 27 to Those participants discussed that they experienced suffering from insomnia, depression, and revealed that they had attempted suicide. Another survey including Chinese Tongqi showed that There was very little satisfaction found from Tongqi wives, they expressed desperation in their marriages and had overall a low marital satisfaction Tang and Zhang, ; Tang and Liu, ; Tang and Yu, In addition to a lack of sexual satisfaction, 9.

In addition, Tang and Yu reported that some Tongqi wives had never initiated physical intimate contact with their husbands, nor did they engage in sexual intercourse. After knowing the truth, those who chose to divorce tended to be a younger age. The older in age, the more likely the wives were to decide to maintain the marriage and continue to endure Li X.

The literature identified the following reasons for Tongqi to maintain marriage including concerns about children, mutual properties, economic concerns, parental pressure to avoid divorce, worry about finding new partners, reputation, affection for husband, and pressure from parents and responsibilities. The participants were also concerned that it would be difficult to find a new partner after breaking-up. Out of the eight, five participants said they prefer divorce but could not deal with the pressure from multiple sources such as parents, women china looking for sex, social opinion, and family responsibilities.


In order to overcome their unsatisfactory marriage, Tongqi applied different coping strategies, including turning to religion, ing online support groups, and having extramarital sex partners. Liu and Tang a also reported that some participants ed online Tongqi wife support groups in order to have a place where they could receive and give mutual encouragement to be positive about life.

Noticeably, Wu et al. The coping style of the MSM wives had a full mediating effect on the association between IPV and suicidal ideation and a partial mediating effect on suicide attempts Wu et al. However, the self-invented coping strategies women china looking for sex not sufficient for this group. Most of the participants said that they required professional psychological intervention to cope with the stress that came with being a Tongqi wife.

The current study can be considered as a cornerstone for the future research in this area. From the literature reviewed five themes, discussed in depth above, were generated. The study revealed that Chinese Tongqi suffer severe mental, physical, health, and life related harms. The Tongqi phenomenon in China is embedded within the Chinese socio-cultural context.

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Compared with western developed countries, discrimination toward the homosexual population is still relatively more severe in China Wang et al. Like other cultures, the Chinese environment tends to push women into marriage. Due to the lack of laws concerning homosexual marriage and the pressure on MSM in China to continue the family line, it is more likely women enter into marriage without carefully considerations, which could consequently increase the population of Tongqi.

MSM then tended to have unprotected sexual intercourse with their wives Wu et al. Wives of MSM are at high risk for HIV because they were often unaware that their husband had extra marital affairs and therefore perceived that they were at low risk of contraction Solomon et al. In China, between spouse and any regular sexual partner, the use of a condom implies a lack of fidelity or lack of women china looking for sex trust Li X.

Moreover, unprotected sex is considered to be a normal part of heterosexual marriage Ren and Yuan, However, to date there are little to no knowledge based Chinese interventions to support MSM to reduce their risk of transmission. The showed that Tongqi women have various susceptibilities to serious mental health disorders, such as suicide.

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Suicide is considered taboo within Chinese culture; with the stigma attached to suicide it is even shameful to admit suicidal behaviors. It is debated whether men or women have a higher suicide rate in China, but like the Tongqi wives in this review, women are more likely than men to have suicidal ideations and attempts Cao et al. Those wives who participated in anal sex were 7. In general, Tongqi women had little support to cope with suicidal ideations Li X. The qualitative studies in this review also suggested the Tongqi suffered from insomnia.


This supports findings from research, which suggest women have higher rates of insomnia in China Cao X. Depression has been known to co-occur with IPV, if a Chinese woman is a victim of violence from an intimate partner she is more likely to exhibit depression. In the current review, it is unknown whether the Tongqi wives were depressed before IPV and there is no mention of low self-esteem in the literature reviewed.