Intimacy and sexual well-being in couples coping with sexual interest/arousal disorder: the importance of perceived partner responsiveness

Abstract

Background

Sexual Interest/Arousal Disorder (SIAD) is one of the most common sexual issues reported by women and a leading reason for seeking sex and couple therapy—yet is rarely studied from a dyadic perspective. Intimacy is one interpersonal factor that could promote greater sexual well-being in individuals with SIAD and their partners.

Aim

Using a dyadic cross-sectional design, this study examined the associations between the three components of intimacy (self-disclosure, perceived partner disclosure, and perceived partner responsiveness) and sexual satisfaction, sexual distress and sexual function among 263 couples coping with SIAD. The moderating role of couple type (cisgender heterosexual vs sexual/gender diverse) was also assessed.

Method

263 individuals with SIAD (M_age = 34.16) and their partners (M_age = 35.71) completed validated questionnaires through the secure online survey platform Qualtrics.

Outcomes

Outcomes were The Global Measure of Sexual Satisfaction; The Sexual Distress Scale and the Sexual Function Evaluation Questionnaire.

Results

Results showed that when partners of individuals with SIAD perceived greater responsiveness from the individual with SIAD, it was associated with their own higher sexual satisfaction and sexual function, and lower sexual distress, as well as with the individual with SIAD’s greater sexual satisfaction. Additionally, in sexual/gender-diverse relationships, individuals with SIAD who perceived greater partner responsiveness reported better sexual function. In cisgender heterosexual relationships, when partners perceived higher responsiveness from individuals with SIAD, this was also linked to the individual with SIAD’s greater sexual function. However, self-disclosure and perceived partner disclosure were not associated with sexual well-being in the couple.

Clinical Implications

Enhancing feelings of closeness and connection through clinical interventions focusing on perceived partner responsiveness could help couples with SIAD better cope with the sexual challenges of SIAD.

Strengths & Limitations

Strengths of this study include the large and diverse clinical sample of couples coping with SIAD, the dyadic design, and the use of moderation to examine the role of couple type in the associations between intimacy and sexual well-being. However, the cross-sectional design limits our ability to establish causation, and the interpretation of results should consider the reliance on self-report questionnaires.

Conclusion

Findings underscore the importance of understanding interpersonal dynamics in SIAD, highlighting the potential positive impact of perceived partner responsiveness on sexual well-being for individual with SIAD and their partners. The moderating effects of couple type on the individuals with SIAD’s sexual function also underline the importance of including a diverse sample of couples in research on sexual dysfunction.

Introduction

At some point in the course of their romantic relationship, most long-term couples are likely to experience conflicting sexual interests or sexual desire.¹ Studies suggest that couples who experience greater levels of differing sexual desire encounter higher sexual distress on a daily basis and over time.^2-4 Sexual desire discrepancy is therefore one of the most frequent reasons for seeking sex and couple therapy.^5-7 A common cause of couples’ experience of sexual desire discrepancy is when one of the romantic partners is coping with Sexual Interest/Arousal Disorder (SIAD¹; American Psychiatric Association [APA]).⁸

Sexual Interest/Arousal Disorder is a female sexual dysfunction introduced into the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) in 2013 (combining the formerly distinct diagnoses of hypoactive sexual desire disorder and sexual arousal disorder) and characterized by reduced sexual interest and arousal as well as sexual distress, ie, sexuality-related negative emotions (eg, worry, feeling of inadequacy, and frustration).^9-11 In fact, according to population-based prevalence rates, 39% of women indicate having low sexual desire, 26% report low sexual arousal, and 30% of those with low desire also experience sexual distress, making SIAD the most common sexual dysfunction among women.^9–11 Controlled studies indicate that women with SIAD are more likely to report higher sexual distress, lower relational and sexual satisfaction, and lower overall sexual function, ie, sexual desire, arousal, and orgasm.^12-15 Partners of women with SIAD also experience sexual difficulties, such that heterosexual male partners report lower sexual function, sexual satisfaction (subjective evaluation of the positive and negative aspects of one’s sexual relationship¹⁶), and sexual communication, as well as more sexual distress than control partners.¹⁵ Taken together, these findings highlight the need to examine interpersonal factors among couples coping with SIAD and to adopt a dyadic approach—heretofore neglected —, since both partners experience lower sexual and relationship well-being and higher distress.

Given that couples with SIAD often face multiple sexual challenges, identifying factors that can enhance their well-being is essential. Intimacy (ie, self-disclosure, perceived partner disclosure, perceived partner responsiveness) is one interpersonal factor that has been associated with better sexual well-being.^17-20 Although studies on intimacy and sexual well-being (eg, sexual satisfaction, sexual distress, and sexual function) within clinical samples of sexual dysfunction are still limited and focus on genito-pelvic pain, they support the positive role of intimacy.^18,19 As intimacy can foster connection, closeness, and open communication,^21,22 it may help couples adapt to the sexual challenges brought upon by SIAD,^17,23 potentially serving as a compensatory mechanism that enhances emotional closeness and relationship satisfaction when sexual function is hindered. In fact, when other aspects of the relationship, such as sexual well-being, are under strain, emotional connection becomes increasingly vital, underscoring intimacy’s unique importance in this specific sample facing sexual dysfunction. The present study examined associations between the three components of intimacy and sexual well-being among couples coping with SIAD.

Interpersonal factors and sexual desire

Despite the conceptualization of sexuality as an interpersonal construct,^24,25 research focusing on the interpersonal factors involved in sexual desire remains limited. Some studies have demonstrated an association between relationship factors and sexual desire among community samples, including, among others, marital satisfaction, relationship quality, closeness, as well as conflicts and communication.^26-31 More recently, a handful of studies examined interpersonal dynamics in the context of SIAD.^15,32-36 For instance, a daily diary study investigating daily attraction to one’s partner and sexual desire, satisfaction and distress in couples coping with SIAD found that on days when partners reported greater attraction, both they and individuals with SIAD experienced higher levels of desire.³² These findings indicate that relational factors may influence daily variations in sexual desire. Additional research has highlighted the positive associations between interpersonal dynamics (eg, sexual self-expansion, partner responses to sexual rejection) and sexual well-being in couples with SIAD.^33,34,36

Theoretical models also suggest that sexual desire can be influenced by relational factors, as proposed in Basson’s intimacy-based Biopsychosocial Model of women’s sexual response.³⁷ According to this model, intimacy may have a stronger influence than physiological factors on female sexual function, such that a lack of emotional intimacy can reduce desire and arousal, ultimately leading to lower sexual satisfaction within the couple.^38,39 This model is particularly relevant as it has been primarily validated in women with sexual dysfunction, which aligns with the targeted population of this study. However, intimacy can also play a significant role in sexual arousal/desire for men in romantic relationships, highlighting its relevance for both partners’ sexual experiences.⁴⁰ Emerging theories, such as the Interpersonal Emotion Regulation Model of Women’s Sexual Dysfunction,²⁵ further support the need to conceptualize interpersonal factors, including intimacy, as key influences on couples’ sexual outcomes. This model suggests that one’s distal or proximal interpersonal factors are associated with one’s own relational, sexual and psychological functioning as well as that of one’s partner. Proximal factors are those present before, during, or immediately after sexual activity, and can affect ongoing sexual dysfunction (eg, sexual motivation). In contrast, distal factors refer to the relational dynamics or contexts that exist prior to the onset of sexual dysfunction and influence how couples interact and navigate challenges together.²⁵ Both types of factors are supported by empirical evidence.^33,41 This model also suggests that intimacy may serve as a distal factor influencing couples’ sexual well-being when facing sexual dysfunction since interactions between couples where partners feel more understood, cared for and validated can encourage better sexual and relationship adjustment.^25,42

Intimacy and sexual well-being

According to the well-validated model by Reis and Shaver (1988), intimacy encompasses three components: self-disclosure, perceived partner disclosure and perceived partner responsiveness.²² It is an interpersonal and dynamic process wherein an individual shares feelings, thoughts, and personal information with a partner, and interprets their partner’s response as understanding, validating, and caring.²² Intimacy thus evolves through multiple interactions considered intimate by both partners, making it a recursive process that develops over time. As partners engage in these interactions, they foster a closer bond. This model of intimacy and its components have been validated by several studies.^43-46

Results from previous studies among community couples suggest that intimacy could play a key role in fostering positive outcomes in couples’.^47-50 However, few studies have specifically examined the association between intimacy and sexual well-being in clinical samples experiencing sexual dysfunction.^18,19,33 Additionally, most studies on intimacy and sexual well-being have primarily focused on heterosexual couples, while the few that included gender or sexually diverse couples often did not consider their gender or sexual orientation in the primary analyses.^33,47 Current findings nonetheless suggest a positive association between intimacy and specific aspects of sexual well-being. In an observational study on the association between intimacy, sexual distress and sexual satisfaction in a sample of 50 women diagnosed with genito-pelvic pain and their partners, women’s greater observed empathic response was associated with their own greater sexual satisfaction and their own lower sexual distress, as well as their partner’s lower sexual distress.¹⁹ Empathic response and disclosure were coded by two independent research associates, and self-reported by participants following a laboratory discussion. Women’s greater observed self-disclosure was associated with their own greater sexual satisfaction, and their partner’s lower sexual distress. Partners’ higher observed self-disclosure was associated with their own greater sexual satisfaction and with lower sexual distress in the women with genito-pelvic.¹⁹ These findings corroborate the results of a prior cross-sectional study on intimacy, sexual satisfaction, and sexual function in a sample of heterosexual couples coping with women’s genito-pelvic pain.¹⁸ Another study on heterosexual couples coping with genito-pelvic pain reported similar findings using a dyadic daily diary design.¹⁷ On days when the couple was sexually active, greater perceived partner’s empathic response from women was associated with their own greater sexual function and greater sexual satisfaction, as well as that of their partner’s.¹⁷ Yet, no studies have examined intimacy and sexual well-being in SIAD, though this focus could be valuable, as a closer bond may help couples better navigate the unique challenges of SIAD, including sexual well-being difficulties for both partners.¹⁵

Gender and sexual diversity

Few studies on women’s sexual dysfunction have included diverse samples based on gender and sexual orientation.^34,51 Some studies among community samples have reported differences in sexual well-being between heterosexual individuals and sexual/gender diverse individuals (sexual and gender diverse, SGD). One cross-sectional study demonstrated that sexual function and sexual satisfaction differed by sexual orientation among adults in the United States, as sexual diverse men and women experienced more sexual function difficulties than heterosexual individuals, and gay and bisexual men reported lower sexual function compared to heterosexual men.⁵² Another study showed differences in levels of sexual satisfaction based on sexual orientation, where bisexual women and men reported less sexual satisfaction than heterosexual and lesbian/gay women and men.⁵³ Heteronormative scripts, minority stress, and societal norms may contribute to differences in the sexuality of cisgender heterosexual individuals and that of SGD individuals, as these factors shape sexual experiences in distinct ways, potentially influencing sexual well-being.^54,55 However, existing findings remain scarce and inconsistent, making it difficult to establish clear hypotheses regarding these differences. For instance, a recent scoping review examining the relationship between minority stress and sexual well-being—including sexual satisfaction, sexual function, and sexual distress—among 2SLGBTQIA+ individuals found inconsistent results across 13 peer-reviewed studies.⁵⁶

These inconsistencies in the literature highlight the need for further research on sexual well-being that includes gender and sexual diverse populations. Hence, with the exception of Jodouin and colleagues’ study (2021) on sexual desire discrepancy and sexual distress in community couples, previous studies on low sexual desire have mainly focused on cisgender heterosexual couples, overlooking the experience of sexual and gender diverse couples coping with SIAD. Given the mixed findings of prior studies concerning the sexual well-being of sexual and gender diverse individuals, it is crucial to investigate potential distinctions within a clinical sample. This is particularly relevant as individuals with SIAD often experiences greater distress compared to individuals without sexual dysfunction.¹⁵

Aims

The present dyadic study first aimed to examine cross-sectional associations between the three components of intimacy (ie, self-disclosure, perceived partner disclosure and perceived partner responsiveness) and sexual well-being (ie, sexual satisfaction, sexual distress and sexual function) for individuals with SIAD and their partners. Based on the Interpersonal Emotion Regulation Model of Women’s Sexual Dysfunction,²⁷ and previous empirical results,^17,19,47 we hypothesized that both individuals coping with SIAD and their partners’ greater scores on the three separate components of intimacy would be associated with their own greater sexual satisfaction and sexual function as well as their own lower sexual distress. As for cross-partner associations, due to the limited number of dyadic studies on SIAD in the literature,^15,32-36 we did not formulate hypotheses. The second aim of this study was to examine the moderating role of couple type (cisgender heterosexual couples vs SGD couples) in the associations between intimacy and sexual well-being. Because little is still known about gender and sexual diverse couples coping with SIAD and given the limited results on sexual well-being among sexual/gender diverse individuals, we did not formulate a hypothesis for this aim.

Methods

Participants

The sample consisted of 263 couples (M_ageP1 = 34.16, SD = 9.95_; M_ageP2 = 35.71, SD = 10.56) who had been together for an average of 9 years (SD = 7.7). Participants were recruited as part of a bi-center prospective study. Recruitment took place at two sites, Université de Montréal and Dalhousie University, through mostly online advertisement (eg, Facebook, Instagram, blogs). Couples were eligible to participate if they were 18 years of age or older, residing in Canada or the United States, and in a relationship for at least one year with a minimum of 4 in-person contacts per week within the last month. One member of the couple had to identify as a woman or be an individual who was assigned female at birth and meet the DSM-5 diagnostic criteria for SIAD.⁸ Couples were ineligible if the person with SIAD was pregnant, breastfeeding, less than a year postpartum, trying to conceive, receiving hormonal therapy related to sexual desire (oral contraceptive accepted), or receiving a treatment for SIAD at the beginning of the study.

A total of 292 couples were initially enrolled in the study following a clinical interview (see Procedure). Of those, 27 couples had at least one partner who did not complete the survey and 2 couples were withdrawn for failing attention checks which were embedded in the baseline survey. These couples were therefore not included in the final sample, resulting in a total of 263 couples. Most individuals with SIAD identified as cisgender women (n = 239), while 24 identified as gender diverse. As for partners, the majority identified as cisgender, man or woman, (n = 230), and 33 as gender diverse. In terms of sexual orientation, most individuals with SIAD identified as heterosexual (n = 174), as did their partners (n = 207), while 89 individuals with SIAD and 56 partners identified with sexual diversity. This sample was well educated with an average of 16.14 years (SD = 2.97) of schooling since first grade for individuals with SIAD and 15.09 years (SD = 3.13) for partners, with most participants occupying a full-time job. Detailed sociodemographic characteristics of the sample are listed in Table 1.

Table 1.

Sample characteristics (N = 263 couples).

Characteristics	Individuals with SIAD  M ± SD or n (%)	Partners  M ± SD or n (%)
Age (years)	34.16 + 9.95	35.71 + 10.56
Sexual orientation
Straight/heterosexual	174 (66.2%)	207 (78.7%)
Bisexual	35 (13.3%)	17 (6.5%)
Lesbian	13 (4.9%)	17 (6.5%)
Gay	0 (0.0%)	2 (0.8%)
Asexual	4 (1.5%)	1 (0.4%)
Pansexual	17 (6.5%)	8 (3.0%)
Queer	12 (4.6%)	8 (3.0%)
Questioning	5 (1.9%)	3 (1.1%)
Not listed	3 (1.1%)	0 (0.0%)
Gender
Cisgender	239 (90.9%)	230 (87.5%)
Gender minority	24 (9.1%)	33 (12.5%)
Indigenous (eg, two-spirit)	2 (0.8%)	0 (0.0%)
Non-binary (eg, gender fluid)	15 (5.7%)	10 (3.8%)
Transgender	7 (2.7%)	7 (2.7%)
Other	2 (0.8%)	3 (1.1%)
Annual individual income
$000-$39 999	47 (17.8%)	40 (15.2%)
$40 000-$99 999	117 (44.5%)	113 (42.9%)
$100 000-$159 999	75 (28.5%)	83 (31.6%)
$160000-and over	22 (8.4%)	25 (9.5%)
Relationship duration (months)	108.23 + 93.30	–
SIAD duration (months)	85.03 + 92.69	–
Employment
Employed inside/outside of the home (full-time)	149 (56.7%)	195 (74.1%)
Employed inside/outside of the home (part-time)	31 (11.8%)	16 (6.1%)
Student (full-time or part-time)	46 (17.5%)	27 (10.3%)
Unemployed	11 (4.2%)	11 (4.2%)
Othera	26 (9.9%)	14 (5.3%)
Education (in years)	16.14 + 2.97	15.09 + 3.13
Culture
Québécois/French Canadian	118 (44.9%)	105 (39.9%)
English Canadian	110 (41.8%)	111 (42.2%)
White	73 (27.8%)	81 (30.8%)
European	31 (11.8%)	31 (11.8%)
Otherb	52 (19.8%)	61 (23.2%)

Abbreviations: M = mean; SD = standard deviation; SIAD = Sexual interest/arousal disorder.

^aIncludes Unemployed, Retired, Parental leave, Unable to work due to disability and Other

^bIncludes Indigenous (eg, First Nations, Métis, Inuit), American, South Asian, East Asian, Southeast Asian, Middle Eastern/Central Asian, Hispanic, Latino/Latina/Latinx, Latin American, Black/African American, African, Biracial/Multiracial, Native Hawaiian

Procedure

This study was part of a larger prospective bicentric study conducted at Université de Montréal and Dalhousie University. The larger study design included three time points of data collection (baseline, 6-month, and 12-month follow-up) along with 56 daily diary surveys completed after the baseline. Two prior publications used the data from the baseline.^32,34 The present study included the baseline surveys only. Data collection took place between December 2020 and May 2022. Interested participants contacted our research team through email to schedule an eligibility call of about 15 minutes. If participants were found to be eligible after this first screening call, then a semi-structured clinical interview was scheduled with the individual with low sexual desire to determine if their difficulties met the SIAD diagnostic criteria.⁸ A consent form was sent to the individual with SIAD prior to the interview. The semi-structured clinical interviews were administered by clinical psychology graduate students trained in assessing sexual difficulties, supervised by a registered psychologist specialized in sex and couple therapy. Eligible couples were then sent online questionnaires of 40 to 60 minutes through the secure online survey platform Qualtrics and were asked to complete them separately from their partner. To ensure that the participants completed their survey within the four-week deadline, they received a phone call reminder after 2 days and 2 weeks, and online automated email reminders from Qualtrics after 1 week and 3 weeks. Each participant received a compensation of CAD$15 (or 11.04$ USD) after the completion of the baseline questionnaire either in the form of gift cards or electronic money transfer. Participants were also provided with a list of resources relevant to SIAD at the end of the larger study. This study was approved by both institutions’ research ethics boards.

Measures

Demographics

Participants completed a short demographic questionnaire assessing their ethnicity, menopause status, sexual orientation, gender, economic status, age, education, the duration and status of their romantic relationship, the use of contraceptives and the duration of SIAD. Gender identity was measured following prior recommendations^57,58 at the time of study design with the following item: “Which best describes your current gender (i.e., today that is, for the purposes of this survey)? (Please select all that apply.)”. The response options were “Man”; “Woman”; “Indigenous (eg, Two-Spirit) or other cultural gender identity (eg, Fa’afafine)”, “Non-binary (eg, genderfluid, genderqueer)”, and “I identify my gender as something else (with specification)”. Following best practices, participants’ sexual orientation was assessed using the following question^57,59: “People describe their sexual orientation in different ways. Which expression best describes your current sexual orientation? If no expression describes yourself, check ‘Not listed’ and write the answer that describes you personally”. Responses options were “Bisexual”; “Asexual”; “Gay”; “Lesbian”; “Straight/Heterosexual”; “Pansexual”; “Queer”; “I have not figured out my sexual orientation or am in the process of figuring it out (Questioning)” or “Not listed (with specification)”.

Intimacy

Relational intimacy was assessed based on the Interpersonal Process Model of Intimacy²² and adapted from the diary measure of Laurenceau, Barrett, and Rovine (2005). Participants rated eight items on a 7-point Likert scale ranging from 1 (not at all) to 7 (a lot). This questionnaire is divided in 3 subscales which reflect the components of intimacy according to Reis and Shaver (1988) involving: (1) 2 items measuring self-disclosure (eg, How much do you disclose your feelings to your partner?), (2) 2 items measuring perceived partner disclosure (eg, How much does your partner disclose their feelings to you?), and (3) 4 items measuring perceived partner responsiveness (eg, How much do you feel your partner understands you?). Higher scores in each of the three subscales indicate a greater level of this specific component of intimacy within the relationship. This questionnaire demonstrated good construct validity whereby all 3 subscales were found to predict intimacy in a romantic relationship, as well as good internal consistency.⁴⁵ In the current study, Cronbach’s alphas for self-disclosure were 0.88 for individuals with SIAD and 0.89 for their partners. For perceived partner disclosure, Cronbach’s alphas were 0.90 for individuals with SIAD and 0.83 for partners and for perceived partner responsiveness, α =0.87 for both individuals with SIAD and their partners.

Sexual satisfaction

Sexual satisfaction was assessed using the Global Measure of Sexual Satisfaction.⁶⁰ Participants rated 5 items on a 7-point bipolar scale indicating their global satisfaction towards their sexuality: good-bad, pleasant-unpleasant, positive–negative, satisfying-unsatisfying, valuable-worthless. Total scores range from 5 to 35, with higher scores indicating greater sexual satisfaction. This questionnaire has shown good internal consistency (α = .87 for individuals with SIAD and α = .92 for partners) as well as a good 2-week and 3-month test–retest reliability.^15,16 In the current study, Cronbach’s alphas were .87 for individuals with SIAD and .87 for partners.

Sexual distress

Sexual distress was measured using the Sexual Distress Scale.¹⁰ This measure consists of five items rated on a 4-point Likert scale ranging from 0 (never) to 4 (always) evaluating participants’ negative emotions (eg, frustration, distress, worry, stress, and inadequate) towards their sexuality (eg, How often did you feel distressed about your sex life? How often did you feel frustrated by your sexual problems?). Total scores vary from 0 to 20 with a higher score indicating greater sexual distress. This measure demonstrated good internal consistency among men and women.¹⁰ In the present study, Cronbach’s alphas were .86 for individuals with SIAD and .87 for partners.

Sexual function

Sexual function was measured with the Sexual Function Evaluation Questionnaire (SFEQ),⁶¹ which includes the best 16 items from the Natsal-SF Clinical Version and the National Sexual Outcomes Group 1, gathered into 4 factors: Problem Distress, Partner Relationship, Overall Sex Life, and Sexual Confidence. For the purpose of this study, one single factor of this measure was used, ie, Problem Distress, which assesses different sexual difficulties based on seven categories: (1) interest in sex, (2) enjoyment during sex, (3) excitement/arousal during sex, (4) pain during sex, (5) difficulty reaching climax (orgasm), (6) reaching climax too quickly, and (7) vaginal dryness/erectile difficulties. Participants were initially asked to indicate if they had experienced any sexual difficulties within the past 4 weeks (response options included: “yes,” “no,” “did not engage in sexual activity due to [problem],” or “did not engage in sexual activity, but for another reason.”). Following the scoring guidelines, those who responded “yes” were further prompted to assess the distress level (ie, severity) associated with the issue on a scale ranging from 1 (not distressed at all) to 4 (highly distressed). A response of “no” was scored as 0, while “did not have sex due to [problem]” was assigned a score of 4 (indicating high distress). If the response was “did not have sex, but for a different reason,” it was marked as missing for scoring purposes. To account for potential measurement biases, a dyadic Complementary confirmatory Factor Analysis (CFA) with distinguishable dyads was conducted using the WLSMV estimator for categorical variables. We then saved standardized factor scores from this model for further analysis. This dyadic CFA analysis showed acceptable model fit: χ² (275) = 682.41, P < .001; CFI = 0.89; TLI = 0.87; RMSEA = 0.075, 90% CI [0.07, 0.08]. Higher scores indicate a lower sexual function.

Data analysis

Descriptive analyses were computed in SPSS 26.0 to examine sample characteristics and normality of variables, as well as bivariate correlations to ensure the interdependence of both partners’ scores. The study hypotheses were tested by computing path analyses using the Actor-Partner Interdependence Model (APIM)⁶² on Mplus 8.0.⁶³ APIM analyses allow examination of the actor effect, eg, the associations between one’s report of self-disclosure and one’s own sexual well-being (ie, sexual satisfaction, sexual distress, and sexual function) and partner effects, eg, the associations between one’s reported self-disclosure and one’s partner’s sexual well-being, while also controlling for the interdependence of both partners’ scores. The dyads in this sample were considered distinguishable as one member of the couple, who self-identified as a woman and/or female bodied, had received a diagnosis of SIAD (Partner 1). Partners of individuals with SIAD were assigned as Partner 2.

Three APIM models were tested, one for each sexual well-being outcome (sexual satisfaction, sexual distress and sexual function). All 3 components of intimacy (self-disclosure, perceived partner disclosure and perceived partner responsiveness) were included simultaneously in each model. To determine if the associations between intimacy and sexual well-being varied based on gender identity and sexual orientation, moderation analyses were also conducted within every model. To do so, one dichotomous variable named “couple type” was created based on both partners’ gender identities and sexual orientations to determine whether the couple belonged to a sexual and/or gender diverse couple or not (0 = sexual and/or gender diverse couple, ie, couple in which at least one partner does not identify as cisgender man or woman and/or does not identify as heterosexual; 1 = heterosexual cisgender couple). An interaction term was then created with each intimacy component and added to each model as a further step.

The maximum likelihood parameter estimates with standard errors and chi-square test (MLR) were used and missing data were treated using Full Information Maximum Likelihood (FIML).⁶⁴ Each model tested was fully saturated, resulting in perfect fit indices (ie, χ² = 0; df = 0, Comparative Fit Index (CFI) = 1.00; Tucker Lewis Index (TLI) = 1.00; Root-Mean-Square Error of Approximation (RMSEA) = 0.00).

Since no sociodemographic covariate (eg, age, duration of the relationship, duration of SIAD, number of children, education, employment, and income) showed a correlation coefficient > 0.30 with one or more components of sexual well-being, none were included in the models.⁶⁵

Results

Descriptive statistics

The sample’s sociodemographic information is presented in Table 1. Means and standard deviations for the three components of intimacy, sexual satisfaction, sexual distress, and sexual function for individuals with SIAD and their partners are presented in Table 2.

Table 2.

Descriptive statistics for intimacy, sexual satisfaction, sexual distress and sexual function for individuals with SIAD and their partners.

Variables	Individuals with SIAD		Partners
	M (range)	SD	M (range)	SD
Intimacy	48.06 (20-63)	9.05	46.85 (15-63)	9.41
Perceived partner disclosure	9.14 (2-14)	3.35	10.26 (2-14)	3.03
Self-disclosure	10.75 (4-14)	2.63	9.44 (2-14)	3.05
Perceived partner responsiveness	22.84 (7-28)	4.66	22.02 (5-28)	4.92
Sexual satisfaction	21.91 (5-35)	6.54	24.37 (5-35)	6.46
Sexual distress	12.00 (0-20)	4.33	8.05 (0-20)	4.72
Sexual function	.07 (−2.58−3.61)	1.32	.18 (−1.84−3.11)	.94

Abbreviation: SIAD, sexual interest/arousal disorder

Bivariate associations

Correlations between variables are shown in Table 3. The findings indicated small to medium correlations between the variables of individuals with SIAD and their partners. The results of the correlations showed preliminary support for most of our hypotheses.

Table 3.

Bivariate correlations between intimacy, sexual satisfaction, sexual distress and sexual function for individuals with SIAD and their partners.

Variables	1.	2.	3.	4.	5.	6.	7.	8.	9.	10.	11.
1. Perceived partner disclosure P1	-	-	-	-	-	-	-	-	-	-	-
2. Perceived partner disclosure P2	.03	-	-	-	-	-	-	-	-	-	-
3. Self-disclosure P1	.07	.36**	-	-	-	-	-	-	-	-	-
4. Self-disclosure P2	.44**	.19**	−.14*	-	-	-	-	-	-	-	-
5. Perceived partner responsiveness P1	.51**	.11	.22**	.20**	-	-	-	-	-	-	-
6. Perceived partner responsiveness P2	.26**	.32**	.10	.41**	.38**	-	-	-	-	-	-
7. Sexual satisfaction P1	.16**	.12	.08	.09	.22**	.24**	-	-	-	-	-
8. Sexual satisfaction P2	.14*	.25**	.15*	.19**	.10	.33**	.33**	-	-	-	-
9. Sexual distress P1	.08	−.03	.01	.11	.04	.07	−.12*	−.04	-	-	-
10. Sexual distress P2	−.02	−.21**	−.14*	−.02	−.12	−.24**	−.16**	−.49**	.14*	-	-
11. Sexual function P1	−.06	−.07	.03	−.07	−.09	−.10	−.34**	−.13*	.28**	.03	-
12. Sexual function P2	−.03	−.10	−.04	−.16**	−.07	−.21**	−.14*	−.24**	−.01	.38**	.18**

Note. P1 = individuals with SIAD, P2 = non-SIAD partner.

Abbreviation: SIAD, sexual interest/arousal disorder

^* P < .05; ^**P < .01; ^***P < .001

Actor-partner interdependence models

Sexual satisfaction

A first model was tested examining the dyadic associations between the three components of intimacy and sexual satisfaction (Figure 1). Results showed both actor and partner effects. Partners’ higher perceived partner responsiveness was positively associated with their own greater sexual satisfaction (β = .27, P = .001) and with individuals with SIAD’s greater sexual satisfaction (β = .18, P = .018), both with small effect sizes. Partner’s self-disclosure and perceived partner disclosure were not associated with their own or individuals with SIAD’s sexual satisfaction. In addition, individuals with SIAD’s self-disclosure, perceived partner disclosure and perceived partner responsiveness were not associated with their own or their partner’s sexual satisfaction. This model explained 8.4% of the variance in individuals with SIAD’s sexual satisfaction and 14.8% in partners’ sexual satisfaction.

Figure 1.

Actor–partner interdependence model of the associations between intimacy and sexual satisfaction in individuals with sexual interest/arousal disorder (SIAD) and their partners. Legend: Note. Considering that these are distinguishable dyads, P1 refers to individuals with SIAD and P2 refers to non-SIAD partners. We depicted partner effects in bold and actor effects in a regular black line. To simplify presentation, only significant standardized coefficients are depicted in this figure. All covariances between intimacy subscales and between sexual and relationship outcomes were estimated in the model. ^*P < .05; ^**P < .01; ^***P < .001.

Moderation analyses indicated no significant effect of the interaction terms including the three intimacy constructs and the dichotomous variable “couple type” on sexual satisfaction. Therefore, the couple’s sexual/gender identity did not act as a significant moderator of the associations between self-disclosure, perceived partner disclosure, or perceived partner responsiveness and sexual satisfaction.

Sexual distress

A second model was tested examining the associations between the three components of intimacy and sexual distress (Figure 2). The results indicated one significant actor effect, showing that when partners reported greater perceived partner responsiveness, they also reported lower levels of sexual distress (β = −.22, P = .008), with a small effect size. Additionally, a marginally significant actor effect was observed whereby greater partners’ perceived partner disclosure was associated with their own lower levels of sexual distress (β = −.13, P = .062). Partners’ self-disclosure was not associated with their own or the sexual distress of individuals with SIAD. Additionally, none of the three components of intimacy were related to sexual distress in individuals with SIAD. This model explained 1.9% of the variance in sexual distress for individuals with SIAD and 9.2% of the variance for partners.

Figure 2.

Actor–partner interdependence model of the associations between intimacy and sexual distress in individuals with sexual interest/arousal disorder (SIAD) and their partners. Legend: Note. Considering that these are distinguishable dyads, P1 refers to individuals with SIAD and P2 refers to non-SIAD partners. To simplify presentation, only significant standardized coefficients are depicted in this figure. All covariances between intimacy subscales and between sexual and relationship outcomes were estimated in the model. ^*P < .05; ^**P < .01; ^***P < .001.

Moderation analyses did not reveal significant interactions between the three intimacy constructs and the dichotomous variable “couple type” on sexual distress. Therefore, the couple’s sexual/gender identity did not act as a significant moderator of the association between intimacy and sexual distress.

Sexual function

A third model was tested examining the associations between the three components of intimacy and sexual function (Figure 3). Results showed only one significant positive actor effect, whereby when partners reported greater perceived partner responsiveness, they also reported greater sexual function (β = −.16, P = .024), with a small effect size. Partner’s self-disclosure and perceived partner disclosure were not associated with their own or individuals with SIAD’s sexual function. Individuals with SIAD’s three components of intimacy were not associated with their own or their partner’s sexual function. This model explained 2.1% of the variance in sexual function for individuals with SIAD and 5.5% of the variance for partners.

Figure 3.

Actor–partner interdependence model of the associations between intimacy and sexual function in individuals with sexual interest/arousal disorder (SIAD) and their partners. Legend: Note. Considering that these are distinguishable dyads, P1 refers to individuals with SIAD and P2 refers to non-SIAD partners. To simplify presentation, only significant standardized coefficients are depicted in this figure. All covariances between intimacy subscales and between sexual and relationship outcomes were estimated in the model. ^*P < .05; ^**P < .01; ^***P < .001.

Results for the moderating role of couples’ sexual/gender identity (couple type) are shown in Table 4. The association between individuals with SIAD’s perceived partner responsiveness and their own sexual function was moderated by couples’ sexual/gender identity as the dichotomous sexual and gender diverse couple type interaction term was significant (b = −0.43, SE = 0.16, P = .007), with a moderate effect size. The simple slopes test reported in Table 4 indicated that when individuals with SIAD in an SGD couple reported higher perceived partner responsiveness, they also reported better sexual function, compared to individuals with SIAD in heterosexual/cisgender couples. The association between partners’ perceived partner responsiveness and the individuals with SIAD’s sexual function was also moderated by couples’ sexual/gender identity as the dichotomous cisgender heterosexual couple type interaction term was significant (b = 0.39, SE = 0.16, P = .014), with a moderate effect size. The simple slopes test reported in Table 4 indicated that when partners belonging to a cisgender heterosexual couple reported higher perceived partner responsiveness; women with SIAD indicated having better sexual function, compared to when partners belonged to an SGD couple. Couples’ sexual/gender identity did not act as a significant moderator between self-disclosure, perceived partner disclosure and sexual function.

Table 4.

Associations between individuals with SIAD and partner’s perceived partner responsiveness (PPR) and sexual function based on couple type.

			95% CI
Fixed effects	Estimate (SE)a	p	Lower	Upper
Actor Effect
Individuals with SIAD PPR	0.04 (0.09)	0.71	−0.15	0.22
Couple type	0.22 (0.13)	0.08	−0.03	0.47
Individuals with SIAD PPR X Couple’s type	−0.43 (0.16)	0.01	−0.75	−0.12
Simple slope tests for couple type – Actor effect
Individuals with SIAD PPR, cisgender heterosexual couple	0.04 (0.09)	0.71	−0.15	0.22
Individuals with SIAD PPR, sexual minority couple	−0.40 (0.13)	0	−0.66	−0.14
Partner Effect
Partner PPR	−0.17 (0.07)	0.02	−0.32	−0.03
Couple type	0.22 (0.13)	0.08	−0.03	0.47
Partner PPR X Couple’s type	0.39 (0.16)	0.01	0.08	0.69
Simple slope tests for couple type – Partner effect
Partner PPR, cisgender heterosexual couple	−0.17 (0.07)	0.02	−0.32	−0.03
Partner PPR, sexual minority couple	0.21 (0.14)	0.12	−0.05	0.48

Note.

^a = estimates are standardized regression coefficients, SE = standard error, CI = confidence interval.

Abbreviations: SIAD, sexual interest/arousal disorder; PPR = perceived partner responsiveness

Coefficients in bold are significant at P < .05.

Discussion

The present study examined cross-sectional associations between intimacy, ie, self-disclosure, perceived partner disclosure, perceived partner responsiveness, and three components of sexual well-being, ie, sexual satisfaction, sexual distress, and sexual function in a large sample of couples coping with SIAD. The moderating role of couple type (cisgender heterosexual couples vs SGD couples) in the associations between intimacy components and sexual well-being were also assessed. Results showed that when partners reported greater perceived partner responsiveness, that is, perceived the individual with SIAD’s responses as more understanding, validating and caring, they reported greater sexual satisfaction, greater sexual function and lower sexual distress. Greater partners’ perceived partner responsiveness was also associated with greater sexual satisfaction in individuals with SIAD—but not with their sexual distress or function. No significant associations were found between self-disclosure and any components of sexual well-being. Additionally, individuals with SIAD’s perceived partner disclosure and perceived partner responsiveness were not significantly related to their own or their partner’s sexual well-being. Finally, partners’ perceived partner disclosure was unrelated to their own sexual well-being or to that of individuals with SIAD. Moderations based on couple type revealed that when individuals with SIAD belonging to SGD couple reported higher perceived partner responsiveness, they also reported greater sexual function. Lastly, when partners belonging to a cisgender heterosexual couple reported higher perceived partner responsiveness, women with SIAD reported greater sexual function. Findings corroborate previous work concerning associations between facets of intimacy and sexual well-being in couples coping with sexual dysfunction¹⁷ and underscore the importance of assessing interpersonal factors when treating SIAD, as they can play a key role in both partners’ sexual satisfaction, function and distress, as per the Interpersonal Emotion Regulation Model of Women’s Sexual Dysfunction.²⁵

Intimacy and sexual satisfaction

Partners’ perceived partner responsiveness was associated with both their own and individuals with SIAD’s greater sexual satisfaction. These results support and extend previous findings on intimacy and sexual well-being in couples coping with women’s sexual dysfunction.^17,19 An observational study conducted among 50 couples coping with genito-pelvic pain showed that greater perceived partner responsiveness was associated with greater sexual satisfaction for both partners and affected women.¹⁹ A recent daily diary study on perceived partner responsiveness, sexual satisfaction and sexual function in couples coping with genito-pelvic pain also showed that when partners reported greater perceived partner responsiveness, their own and the women’s sexual satisfaction was higher.¹⁷ These results show that not only can receiving an understanding and caring response from a partner may influence sexual satisfaction, but also that providing such a response can be beneficial.^66,67 As partners feel more understood, validated, and cared for, they may find it easier to engage in more adaptive emotion regulation strategies, such as problem-solving. This could help them adapt more effectively to each other’s sexual needs, facilitating a broader range of sexual activities that align with their preferences. In turn, both partners’ sexual experiences may become more enjoyable and fulfilling.³⁵

Intimacy and sexual distress

Partners’ perceived partner responsiveness was associated with their own lower sexual distress but not with that of individuals with SIAD. These findings align with existing literature on SIAD and prior research on intimacy. For instance, a study examining intimacy, sexual satisfaction, and sexual distress among couples coping with genito-pelvic pain showed that partners who perceived greater empathic responses from their partner with pain reported experiencing less sexual distress.¹⁹ It has been demonstrated that partners of individuals with SIAD tend to experience higher levels of sexual distress compared to control partners.¹⁵ This may be explained by the fact that partners of individuals with SIAD develop feelings of sexual inadequacy and worry, ie, sexual distress, due to their lack of understanding of the reasons for their partner’s low sexual arousal and/or desire.⁶⁸ However, when partners feel understood, accepted, and supported by their significant other grappling with a sexual difficulty, it could alleviate sexual anxieties and feelings of inadequacy, thereby reducing overall sexual distress.

Intimacy and sexual function

Partners’ greater perceived partner responsiveness was also associated with their own greater sexual function, but not to that of individuals with SIAD. This result is in line with findings from a daily dyadic study in couples coping with genito-pelvic pain, which showed that when partners’ perceived partner responsiveness was higher, their sexual function was also greater, meaning that when partners felt understood and cared for, and they experienced greater desire, arousal, and orgasm.¹⁷ Partners of individuals with SIAD report more difficulties with their orgasmic and erectile functioning compared to partners of women with no sexual difficulties.¹⁵ Since individuals with SIAD might be less responsive to sexual/erotic cues and sexual advances,⁸ their partners might find themselves fully concentrating on stimulating and maintaining the women’s arousal during sexual activities, possibly creating performance anxiety. They may find themselves increasingly attentive to cues indicating their partner’s lack of arousal, diverting their focus towards less enjoyable aspects of the sexual encounter, thereby contributing to sexual function difficulties. In fact, performance anxiety and cognitive distraction have been found to play a major role in sexual dysfunction.^69,70 Conversely, when a partner feels understood and supported by their significant other with SIAD, they may approach sexual activities with a different perspective, prioritizing closeness over performance and consequently enhancing their sexual function.

Couple type as a moderator of the association between intimacy and sexual well-being

Results showed that couple type, ie, belonging to a cisgender heterosexual couple versus to an SGD couple, played a moderating role for individuals with SIAD’s sexual function. When individuals with SIAD belonging to an SGD couple reported higher perceived partner responsiveness, they also reported better sexual function, relative to those in a cisgender/heterosexual couple. Based on the Minority Stress Model,^55,71 individuals from minority groups face additional stressors due to their stigmatized social status. For individuals with SIAD in SGD couples, this means enduring stress associated with both their sexual dysfunction and the societal pressures they face from their identity and couple status. Research suggests that chronic stress can lead to reduced genital arousal in women,⁷² potentially affecting sexual function in SGD couples. Understanding and care from their partners may play a crucial role for individuals with SIAD in SGD relationships, as it could alleviate some of their stress, and hence improve their sexual function.

Results also showed that when partners belonging to a cisgender heterosexual couple reported higher perceived partner responsiveness, women with SIAD indicated having better sexual function, while this effect was not present for partners in SGD couples. Heteronormativity often dictates that women assume nurturing caregiving roles, extending into their relationships with male partners.^54,73 When male partners feel cared for, understood, and validated, their emotional needs are likely to be fulfilled, perhaps making them more receptive to their partners’ sexual preferences or discomfort regarding sexual dysfunction. Indeed, as they might feel more satisfied within their relationship, they may become more willing to explore alternatives to conventional sexual activities, aligning more closely with the woman with SIAD’s sexual needs. This, in turn, could lead to improved sexual function for women with SIAD in heterosexual relationships. No moderations were found for the associations between the three components of intimacy and sexual satisfaction or distress.

Beyond self-disclosure and intimacy

The study’s results indicated that self-disclosure was not significantly associated with any of the three dimensions of sexual well-being in individuals with SIAD or their partners. This suggests that intimacy-related disclosure may play a lesser role in sexual well-being compared to perceived partner responsiveness. These findings align with previous research, which has shown significant associations with perceived partner responsiveness, while self-disclosure was less consistently linked to sexuality-related outcomes.^19,42,74 Reis (2017) also proposed that the intimacy process model views self-disclosure mostly as a means of eliciting partner responsiveness, which may be the more critical factor in fostering intimacy.²¹ This perspective further supports the idea that responsiveness, rather than disclosure itself, could be a more influential component in shaping couples’ sexual well-being. Moreover, apart from the moderation results, no actor associations between intimacy components and sexual well-being were found for individuals with SIAD, with also only one partner effect related to their well-being, ie, partners’ perceived partner responsiveness and individuals with SIAD’s sexual satisfaction. This suggests that factors beyond intimacy may have a greater impact on the sexual well-being of individuals with SIAD. This is further demonstrated by the small to moderate effect sizes found in the results, suggesting that other factors play an important role in the sexual well-being of these couples, potentially even more so for individuals with SIAD. Indeed, a qualitative study examining the consequences of low sexual desire in women and their higher-desire partners in heterosexual couples revealed a range of challenges these couples may face related to their sexual well-being. These included negative emotions such as guilt, anxiety, and sadness, as well as negative thoughts like reduced self-esteem, fears of infidelity, and concerns about the relationship ending (eg, sexual distress).⁷⁵ It may be necessary to consider intimacy alongside other interpersonal dynamics (eg, communication) to effectively enhance couples with SIAD’s sexual well-being.

Strengths, limitations, and futures studies

One major strength of the present study lies in its comprehensive approach to both independent and dependent variables. Sexual well-being was measured via three components (sexual satisfaction, sexual distress, and sexual function), which sets it apart from previous research that often focused on only two of these constructs.^17-19,33,76 Additionally, intimacy was measured following the well validated theorical Interpersonal Process Model of Intimacy^44,45 and included its three facets (self-disclosure, perceived partner disclosure, and perceived partner responsiveness). Findings shed light on the ways in which distal interpersonal factors could influence sexual outcomes for couples and provide support for the Interpersonal Emotion Regulation Model of Women’s Sexual Dysfunction.²⁵ Moreover, incorporating both partners allowed us to move beyond intra-individual conceptualizations of sexual dysfunction and to examine dyadic cross-partner effects. Individuals diagnosed with SIAD met the DSM-5 criteria⁸ as confirmed through structured clinical interviews, contributing to high internal validity. The large sample was inclusive of sexual and gender diversity, with 34.8% of individuals with SIAD identifying as sexually diverse and 10.1% as gender diverse. This is particularly important as the limited diversity in couples and sexuality research can lead to biases and constrain our understanding of the challenges experienced by couples across all gender identities and sexual orientations.⁷⁷ However, most of the sample identified as White, limiting the generalization of the results to a more racially diverse population. Further, results indicated small to moderate effect sizes, implying that other factors influence the sexual well-being of these couples. Lastly, given the cross-sectional and correlational design of this study, causation and directionality cannot be inferred. Future research should therefore incorporate longitudinal data and cross-panel analyses to better understand the influence of intimacy on sexual well-being and assess potential bidirectional associations.

Clinical implications

Given that difficulties with sexual desire ranks among the most common motivations for individuals to seek sex and couple therapy,^5-7 and that couples coping with SIAD are more likely to experience sexual and relational difficulties and distress than couples without sexual dysfunction,¹⁵ it is important to develop clinical interventions that can better respond to their needs. Since intimacy is a modifiable factor, fluctuating on a day-to-day basis,⁴⁹ it is a promising target for sex and couple therapy interventions for SIAD. Specifically, results indicated more positive associations between perceived partner responsiveness and sexual well-being for partners of individuals with SIAD, highlighting the necessity of including partners in therapy. Indeed, their involvement in therapy may serve as a critical step to help promote better overall sexual well-being within these couples. Therefore, strengthening feelings of connection and closeness through enhanced partner responsiveness may render sexual difficulties more manageable for partners as well as afflicted women.

Conclusions

Findings highlight the significance of focusing on the interpersonal dynamics surrounding SIAD, extending beyond women’s role in their sexual difficulties and that of biological factors. Perceived partner responsiveness was positively associated with all aspects of sexual well-being for partners and with sexual satisfaction for individuals coping with SIAD. Type of couple moderated associations between intimacy and sexual wellbeing, such that higher perceived partner responsiveness for individuals with SIAD in a SGD couple and for men partners in a cisgender heterosexual couple was associated with greater sexual function in individuals with SIAD. Findings support a couple approach to treatment^78,79 as intimacy is modifiable and can be targeted in sex and couple therapy for SIAD.

Author contributions

Delphine P. Léonard, Natalie O. Rosen and Sophie Bergeron contributed to conceptualization.

Delphine P. Léonard, Natalie O. Rosen, Noémie Bigras, Maude Massé-Pfister, and Sophie Bergeron contributed to methodology. Delphine Perrier Léonard, Noémie Bigras, and Maude Massé-Pfister performed formal analysis.

Investigation: Delphine Perrier Léonard, Natalie O. Rosen, Noémie Bigras, and Sophie Bergeron.

Delphine Perrier Léonard performed writing—original draft.

Natalie O. Rosen, Noémie Bigras, Delphine Perrier-Léonard, Maude Massé-Pfister and Sophie Bergeron performed writing—review and editing.

Natalie O. Rosen, Sophie Bergeron, and Amy Muise made funding acquisition.

Natalie O. Rosen and Sophie Bergeron contributed to resources.

Noémie Bigras and Sophie Bergeron made supervision.

Funding

This research was supported by a grant from the Canadian Institutes of Health Research (CIHR) awarded to S. Bergeron, N.O. Rosen, and A. Muise (grant number: PJT-165945).

Conflicts of interest

None declared.