Sexual distress with partnered face-to-face sexual activity: An exploratory qualitative study with heterosexual cis people who seek and do not seek professional help

Patrícia M. Pascoal^1,2,3*Gerhard Andersson^1,4,5,6Vinicius J. Fischer⁷Andreia A. Manão¹Cátia Oliveira¹Catarina F. Raposo^1,8Pedro J. Rosa^1,9Magda Sofia Roberto¹⁰Graça Santos¹¹Nuno Tomada^12,13

• ¹Lusófona University, HEI-Lab: Digital Human-Environment Interaction Labs, Portugal, Lisbon, Portugal
• ²Clínica Universitária de Psiquiatria e Psicologia Médica, Faculdade de Medicina, Universidade de Lisboa, Lisboa, Portugal
• ³PSYLAB, Instituto de Saúde Ambiental (ISAMB), Faculdade de Medicina, Universidade de Lisboa, Lisbon, Portugal, Lisbon, Portugal
• ⁴Department of Behavioural Sciences and Learning, Linköping University, Linköping, Östergötland, Sweden
• ⁵Department of Neuroscience, Karolinska Institutet (KI), Stockholm, Stockholm, Sweden
• ⁶Department of Health, Education and Technology, Luleå University of Technology, Luleå, Norrbotten, Sweden
• ⁷Centre Hospitalier Neuro-psychiatrique (CHNP), Rehaklinik, Zentrum fir Psychotherapie, Ettelbruck, Luxembourg
• ⁸Center for Psychology at the University of Porto, Faculty of Psychology and Educational Sciences of the University of Porto, Portugal, Porto, Portugal
• ⁹Instituto Superior Manuel Teixeira Gomes, Portimão, Faro, Portugal
• ¹⁰Centro de Investigação em Ciência Psicológica, Faculdade de Psicologia, Universidade de Lisboa, Lisbon, Lisbon, Portugal
• ¹¹Hospital da Luz Lisboa, Lisbon, Lisboa, Portugal
• ¹²Instituto de Investigação e Inovação em Saúde, Universidade do Porto, Porto, Porto, Portugal
• ¹³School of Psychology and Life Sciences (EPCV) of Lusófona University, Lisbon, Portugal, Lisbon, Portugal

Introduction: Sexual distress negatively impacts mental health and relationship quality and is fundamental for establishing a diagnosis of sexual dysfunction, even though it also affects people who do not seek help. Research on sexual distress related to partnered sexual activity is limited, and no comprehensive model exists to guide research or clinical interventions. Using an online cross-sectional qualitative study, we aimed to explore reasons for not seeking help among people who experience sexual distress and compare how people who seek and do not seek help describe their experiences of sexual distress with partnered sexual activity. Methods: We performed reflexive thematic analysis on 438 heterosexual people answers (Mage = 41.06, SD = 12.19), including 306 women (69.7%) and 132 men (30.1%). Results: Most participants (54.1%) had not sought help but wanted to do so. Some participants (13.2%) expressed a desire for clinical consultations but reported financial or time constraints. Using the qualitative data provided, we created three themes: (1) Sexual (dys)function (It's the function), which focuses on sexual function and lack of pleasure; (2) Intimacy dynamics (It's us!), which discusses relationship challenges; (3) Intrapersonal struggles (It's me!), which highlight individual factors, some influenced by social messages. Comparison across groups revealed that people who seek help emphasise genital function and negative emotions, and women highlighted experiencing sexual pain, while men emphasised desire discrepancies and erectile disorder. Discussion: Our results demonstrate that difficulties related to sexual pleasure and with penetrative sex are important sources of distress in partnered sexual activity, which is in line with DSM and ICD frameworks of sexual dysfunction. Participants' accounts show that pre-existing psychological characteristics, partnered communication, cognitive, and emotional factors are key factors to shape the experience of sexual distress related to sexual dysfunctions. This has implications for clinical work as interventions should integrate transdiagnostic factors that may not be sexual specific (e.g., repetitive negative thinking) as well as couple-level factors (e.g., communication). Internet-based integrative therapies directed at these factors may be a promising venue for those who are reluctant to seek in-person sexual healthcare.