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. Author manuscript; available in PMC: 2025 Sep 18.
Published in final edited form as: Mindfulness (N Y). 2025 Apr 1;16(5):1288–1301. doi: 10.1007/s12671-025-02566-z

The Mediating Role of Sexual Mindfulness on the Relationship Between Black Women’s Psychological and Sexual Functioning

Natalie Malone 1, Kasey E Vigil 1, Kaylee A Palomino 1, Brenice Duroseau 2, Shemeka Thorpe 3
PMCID: PMC12442435  NIHMSID: NIHMS2110721  PMID: 40969737

Abstract

Objectives

This study examined the mediating role of sexual mindfulness on the relationship between indicators of Black women’s psychological functioning and sexual functioning.

Method

A total of 448 Black women (82% Black American, Mage = 34, SD = 8.71) completed an online survey between January and February of 2023. Self-report measures were demographic information, sexual functioning, indicators of psychological functioning (i.e., psychological distress, perceived stress, and post-traumatic stress symptoms), and sexual mindfulness (comprised of mindful awareness and mindful non-judgment during sex). Data analysis consisted of descriptives and frequencies, bivariate correlations, and mediation analysis.

Results

We observed a significant indirect effect of (1) psychological distress on sexual function via mindful awareness (B = −0.06, β = −0.07, CI = −0.10, −0.02) and mindful non-judgment (B = −0.06, β = −0.08, CI = −0.10, −0.03) during sex; and (2) perceived stress on sexual functioning via mindful awareness (B = −0.07, β = −0.09, CI = −0.13, −0.03) and mindful non-judgment (B = −0.05, β = −0.06, CI = −0.09, −0.02) during sex. Regarding post-traumatic stress, only mindful non-judgment during sex mediated the relationship between sexual functioning and intrusive symptoms (B = −0.18, β = −0.04, CI = −0.37, −0.04), avoidance-based symptoms (B = −0.25, β = −0.03, CI = −0.47, −0.06), and hypervigilance (B = −0.21, β = −0.03, CI = −0.44, −0.04).

Conclusions

Findings suggest that interventions aimed at enhancing sexual mindfulness could benefit Black women’s psychological and sexual functioning, providing valuable insights for sex therapists working with this population and researchers interested in the benefits of mindfulness-based interventions.

Preregistration

This study is not preregistered.

Keywords: Black women, Sexual mindfulness, Sexual functioning, Psychological distress, Stress, PTSD

Advancing scholarship on Black American women’s sexuality necessitates a continued focus on their sexual functioning, comprised of desire, arousal, orgasm, pleasure, and satisfaction. Concerns related to Black women’s sexual functioning are well-documented in the existing literature (Azim et al., 2023; Chmielewski et al., 2020; Malone et al., 2022, 2023; Thorpe et al., 2022; Townes et al., 2019). For example, Black women report higher levels of pain during sexual intercourse than White women (Azim et al., 2023; Townes et al., 2019). However, limited research examines the influence of Black women’s psychological functioning on their sexual functioning. This gap is particularly concerning given that Black women experience higher rates of mental health concerns compared to White women and non-Black women of color (Barnes & Bates, 2019), including higher levels of depressive symptoms (Spence et al., 2011), increased exposure to traumatic events (Kofman et al., 2024), and greater distress (Hearne, 2021).

Research demonstrates a reciprocal relationship between indicators of women’s psychological and sexual functioning, such that positive changes in one domain often promote improvements in the other. For instance, Hall et al. (2019) found that Black women reporting higher levels of sexual satisfaction also experienced lower levels of depression and anxiety. If this reciprocal relationship holds, it becomes crucial to investigate the mechanisms contributing to the connection between Black women’s psychological and sexual functioning. Identifying such mechanisms could provide valuable insights into potential intervention points that benefit both domains. Sexual mindfulness is a possible mechanism explaining the relationship between Black women’s psychological and sexual functioning.

Leavitt et al. (2019) defined sexual mindfulness as a sub-type of state mindfulness employed during sex. Sexual mindfulness is of interest based on studies revealing a positive association between mindfulness and psychological functioning (Waldron & Burnett-Ziegler, 2022; Wielgosz et al., 2019). Complementary or alternative health approaches, like sexual mindfulness, steadily gain traction in sexuality and mental health settings treating women’s psychological (Davies et al., 2024; Waldron & Burnett-Ziegler, 2022) and sexual concerns (Brotto et al., 2022; Thomas et al., 2023; Velten et al., 2018). Of relevance, Black women in the United States (US) report diverse embodiment practices like mindfulness and an interest in using mindfulness to support their sexual (Malone & Hargons, 2021; Thorpe et al., 2022) and mental health (Burnett-Zeigler et al., 2019; Hargons et al., 2023; Watson-Singleton et al., 2019). To our knowledge, no studies on Black women’s sexual functioning have explicitly focused on sexual mindfulness. Understanding the role of sexual mindfulness for Black women can help us learn of its potential utility for this population.

Psychological functioning is comprised of the cognitive, emotional, and behavioral processes contributing to mental health (Brown et al., 2023). Importantly, sociocultural context shapes psychological functioning (World Health Organization, 2022), such that lived experiences and cultural norms and values improve and/or diminish psychological well-being and quality of life. This is particularly true for Black women whose gendered racial identities expose them to unique stressors informed by gendered racism and discrimination (Lewis et al., 2017). These unique stressors also affect Black women’s sexual functioning.

Indicators of psychological functioning include psychological distress, perceived stress, and post-traumatic stress. Psychological distress is “a state of emotional suffering” (p. 105) characterized by symptoms of depression and/or anxiety in response to stressful life events (Drapeau et al., 2011). Psychological distress – specifically anxiety and depression – is associated with women’s impaired sexual functioning (e.g., reduced sexual activity, decreased sexual desire, and low sexual arousal; Maru et al., 2019; Waldinger, 2015).

A second mental health concern of interest is perceived stress. Perceived stress refers to the degree to which a person appraises their life situations as stressful, overwhelming, unpredictable, and/or uncontrollable (Wang et al., 2019). Perceived stress from life events influences women’s sexual functioning (Basson et al., 2019; Hamilton & Julian, 2014; Hamilton & Meston, 2013). For example, a study by Hamilton and Meston, (2013) found that women with high chronic stress experienced lower genital sexual arousal. In addition, Black women experience a unique type of perceived distress connected to their identities. Identity-based stressors associated with experiences of gendered racism and discrimination compound Black women’s perceived stress across all wellness domains, including psychological and sexual functioning (Lewis et al., 2017; Moody & Lewis, 2019; Thorpe et al., 2024a). For instance, participants in a qualitative study by Thorpe et al. (2024b) identified fear of endorsing gendered racial sexual stereotypes about Black women, such as the hypersexual Jezebel, as a source of sexual anxiety negatively impacting their sexual functioning.

Post-traumatic stress disorder (PTSD) is characterized by “exposure to actual or threatened death, serious injury, or sexual violence” and the “presence of one or more intrusive symptoms associated with the traumatic event(s)” (American Psychiatric Association, 2022, p. 301). It is worth noting that several individuals experience post-traumatic stress without a formal diagnosis (American Psychiatric Association, 2022). This statement is relevant to Black women who are often undiagnosed or misdiagnosed (American Psychiatric Association, 2022). Black women have more frequent, severe, and chronic PTSD or post-traumatic stress symptoms when compared to their male counterparts (Gran-Ruaz et al., 2022) and other racial/ethnic groups of women (Roberts et al., 2011). Studies report that Black women’s post-traumatic stress stems from increased exposure to traumatic life events, like violence and childhood abuse (Gluck et al., 2021), sexual assault victimization (Valentine et al., 2019), and/or gendered racial microaggressions (Moody & Lewis, 2019), to name a few sources. Specific to sexual functioning, Hosain et al. (2013) identified associations between poor sexual functioning and Black women’s experiences of sexual abuse and assault-related trauma. Taken together, the state of Black women’s psychological functioning, comprised of post-traumatic stress, perceived stress, and psychological distress, has implications for Black women’s sexual functioning.

Sexual mindfulness is a possible mechanism explaining the relationship between Black women’s psychological and sexual functioning. The most popularized definition of mindfulness in the US is that of John Kabat-Zinn (2023), who defined it as “paying attention in a particular way: on purpose, in the present moment, and nonjudgmentally” (p. 4). Brotto (2018) described mindfulness as “the simple practice of paying attention, nonjudgmentally, moment by moment” (p. 12) and emphasized its potential for improving women’s sexual difficulties. While there are several definitions, Baer et al. (2004) attributed the following qualities to most, if not all, mindfulness definitions and mindfulness-based instruments or treatments employed in research and practice: nonjudgment, observation, awareness, and describing. Several scholars describe mindfulness as a state or a trait. State mindfulness refers to present-moment awareness (Tang & Braver, 2020). Trait or dispositional mindfulness is an individual’s predisposition toward daily mindfulness (Tang & Braver, 2020). Distinctions between state and trait mindfulness emerge in contemporary definitions of sub-types of mindfulness, including sexual mindfulness.

Leavitt et al. (2019) described sexual mindfulness as a sub-type of state mindfulness employed during sex. To date, research on sexual mindfulness demonstrates its relevance to sexual and relational factors like sexual satisfaction and relational well-being (Leavitt et al., 2019; Leonhardt et al., 2023). Typically, these quantitative studies employ the sexual mindfulness measure (Leavitt et al., 2019) or the sexual five-facet mindfulness questionnaire (Adam et al., 2015). A discussion on psychometric properties is outside of the scope of this paper. However, we mention these measures because scholars have differing opinions regarding whether mindfulness is context-specific (e.g., mindfulness unique to sexual encounters), such that clarifications are needed between sub-types of mindfulness and general state or trait mindfulness (Baer, 2011).

To add, we would be remiss not to acknowledge the cultural origins of mindfulness in non-European regions (predominantly Asia) and spiritual philosophies (including, but not limited to, Buddhism and Jainism; Fleming et al., 2022). These origins undergird contemporary, Westernized interpretations of mindfulness in psychological and sexological interventions (Kabat-Zinn, 2013; Lo, 2024; Weiner & Avery-Clark, 2014). Notably, the disposition of African- and Black feminist derived onto-epistemologies, or ways of being and knowing, are inherently mindful or contemplative (Harrell, 2022). Accordingly, some Black women endorse culturally, intergenerationally, and ancestrally knowing mindfulness and/or practicing it (Evans, 2021). For example, “Be still” is an adage shared within Black communities suggesting rest and assurance of peace in the present moment (Hersey, 2022). Nevertheless, Black women may struggle to be mindful in their daily lives and during sex when inundated with psychological distress.

Mindfulness is associated with improved psychological functioning, such that it facilitates decreased stress (Creswell et al., 2014) and improvements in mental health symptomology associated with anxiety (Hoge et al., 2013), depression (Lopez-Maya et al., 2019), and PTSD (Kelly & Garland, 2016). Several studies also find these improvements in Black women’s psychological functioning (Burnett-Zeigler et al., 2019; Waldron & Burnett-Zeigler, 2022; Watson-Singleton et al., 2019). For example, Waldron and Burnett-Ziegler (2022) found a mindfulness treatment to be effective in treating severe trauma-related symptoms in a sample of 36 Black women with trauma symptoms. After an 8-week mindfulness-based intervention, participants with moderate to severe symptoms reported decreased depressive symptoms and perceived stress. Participants with severe symptoms also reported decreased post-traumatic stress. Another study by Burnett-Ziegler et al. (2016) found that an 8-week mindfulness program decreased depressive symptoms and stress among Black women. In addition to reduced symptomology, Black women in this study also experienced increased mindfulness, self-acceptance, and growth.

Regarding sexual functioning, studies on state mindfulness and sexual functioning have examined women’s sexual arousal during and following a mindfulness intervention. These studies found improved overall sexual functioning among women with sexual interest and arousal issues (Brotto et al., 2018; Velten et al., 2020). Research demonstrates the benefit of trait mindfulness interventions to improve women’s sexual functioning (Brotto & Basson, 2014; Brotto et al., 2022; Velten et al., 2018).

While studies provide preliminary support for the positive impact of mindfulness interventions on women’s psychological (Fahs & Swank, 2015; Malone & Hargons, 2021; Proulx et al., 2020) and sexual functioning (Hargons et al., 2024; Thorpe et al., 2022), no studies explicitly examine its role in explaining the relationship between the two for Black women without experiencing a treatment as part of an experiment. Findings on mindfulness, sexual functioning, and psychological functioning support a potential relationship between the three constructs. Accordingly, this cross-sectional study examined the mediating role of sexual mindfulness in the relationship between Black women’s psychological and sexual functioning. Specifically, we addressed the following research questions: Does sexual mindfulness mediate the relationship between (1) psychological distress, (2) perceived stress, (3) post-traumatic stress symptoms and sexual functioning? We hypothesized a mediation effect for each model, as we anticipated that fostering nonjudgment and awareness during sex helped mitigate the psychological challenges Black women navigated, which could manifest in sexual encounters and ultimately affect their sexual functioning.

Method

Participants

The sample included 448 Black women. Black women were, on average, 34 years old (SD = 8.71), with ages ranging from 19 to 67 years. Most women were ethnically Black American (n = 371, 82.8%), heterosexual (n = 170, 37.9%) and graduate/professional degree holders (n = 192, 42.9%). See Table 1 for a full presentation of participant demographic information.

Table 1.

Demographics and descriptives

N (%) or M ± SD (Range)
Demographics Age 33.6 ± 8.71 (19–67)
Ethnicity
African American 371 (82.8%)
African 18 (4%)
Caribbean 29 (6.5%)
Bi-racial 22 (4.9%)
Afro-Latina 5 (1.1%)
Multiethnic 3 (0.7%)
Sexual Orientation
Heterosexual 278 (62.1%)
Queer 170 (37.9%)
Education
Less than high school 1 (0.2%)
High school diploma 15 (3.3%)
Some college 67 (15%)
2-year degree 29 (6.5%)
4-year degree 143 (31.9%)
Graduate/professional degree 192 (42.9%)
Sexual Functioning Sum Score 46.7 ± 6.30 (28–61)
Psychological Well-being Psychological Distress
Psychologically well 138 (30.8%)
Mild distress 93 (20.8%)
Moderate distress 105 (23.4%)
Severe distress 103 (23%)
Perceived Stress
Low 57 (12.7%)
Moderate 311 (69.4%)
High 70 (15.6%)
PTSD Symptoms
PTSD: Intrusion 1.95 ± 1.23 (0–4)
PTSD: Avoidance 1.12 ± 0.85 (0–2)
PTSD: Hypervigilance 1.05 ± 0.81 (0–2)
Sexual Mindfulness Mindful Awareness 3.64 ± 0.82 (1.25–5)
Mindful non-Judgment 2.94 ± 0.91 (1–4.67)
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Procedure

These data were from the IRB-approved BeWell Project. The BeWell Project quantitatively examined relationship satisfaction, psychological functioning, sexual functioning, and minority stressors among Black women. Eligible respondents identified as (1) Black or African American, (2) cisgender, and (3) 18 years of age or older. Additionally, respondents had to report sexual intercourse within the last six months before their study participation. Study enrollment occurred from January to February 2023. The primary investigator led recruitment, which consisted of social media posts. Black sexuality professionals also assisted in recruitment by virtually sharing the study flyer.

Interested respondents first completed an online eligibility screener using Qualtrics. The target sample size for the BeWell Project was 400 participants. After removing duplicate, fraud, and bot cases, 448 eligible respondents remained. The principal investigator contacted these 448 Black women by email to complete the BeWell Project Survey. First, participants reviewed and completed an online informed consent form. Next, participants completed a 20-to-25-min survey on Qualtrics. The survey asked participants demographic questions and included questionnaires for the constructs above. All participants entered a raffle for one of 40 Amazon e-gift cards.

Measures

In addition to self-reported demographics (e.g., age, ethnicity, sexual orientation, and education), this study included measures for sexual functioning, psychological functioning, and sexual mindfulness.

Sexual Functioning

The Changes in Sexual Functioning Questionnaire (CSFQ; α = 0.75) (Clayton et al., 1997) is a self-report instrument used to assess sexual functioning. The CSFQ consists of 14 items scored on a 5-point Likert scale from 1 (never) to 5 (every day). Higher scores represent greater sexual functioning. This study used the female version of the questionnaire, which provides a total sexual functioning score and eight scaled scores for (1) Desire/Frequency, (2) Desire/Interest, (3) Arousal/Excitement, (4) Orgasm, and (5) Pleasure. Example items for each of the subscales include: “How frequently do you engage in sexual activity now?” (Desire/Frequency), “How often do you desire to engage in sexual activity?” (Desire/Interest), “Are you easily aroused?” (Arousal/Excitement), “Are you able to have an orgasm when you want to?” (Orgasm), and “How much pleasure or enjoyment do you get from orgasms?” (Pleasure). This study used the sexual functioning sum score only. Sum scores less than or equal to 41 suggested sexual dysfunction.

Psychological Functioning

Indicators of psychological functioning included measures for psychological distress, perceived stress, and post-traumatic stress disorder. Psychological distress was measured using the Kessler Psychological Distress Scale (K10; α = 0.88) (Kessler et al., 2002). The K10 provides a global measure of distress based on the past 30 days. Participants responded to 10 items using a 5-point Likert scale from 1 (none of the time) to 5 (all of the time). Example items included, in the past 30 days, how often have you felt “depressed,” “worthless,” “nervous,” or “restless or fidgety.” Sum scores ranged from 10–50, with higher scores representing higher psychological distress. We also computed a categorical psychological distress variable consisting of severe distress (0–13), moderate distress (14–26), mild distress (27–40), and psychologically well (40–50).

The Perceived Stress Scale (PSS; α = 0.85) (Cohen et al., 1983) measured participants’ thoughts and feelings during the last month. The PSS consists of 10 items using a 5-point Likert scale from 0 (never) to four (very often). Example items included, in the last month, how often have you “found that you could not cope with all the things you had to do,” “felt nervous or stressed, and “felt difficulties were piling up so high that you could not overcome them.” We computed continuous and categorical perceived stress variables. Higher sum scores indicated higher perceived stress on the continuous variable. The categorical perceived stress variable consisted of low (0–13), medium (14–26), and high (27–40) values.

The Post Traumatic Stress Disorder Scale (PTSD-8) measures symptoms experienced during traumatic events using three subscales: (1) Intrusion (4 items; α = 0.80), (2) Avoidance (2 items; α = 0.79), and (3) Hypervigilance (2 items; α = 0.75) (Hansen et al., 2010). Participants respond to items using a 4-point Likert scale from 1 (not at all) to 4 (most of the time). Example items for each of the subscales were: “recurrent thoughts or memories of the event (Intrusion), “avoiding activities that remind you of the event” (Avoidance), and “feeling on guard” (Hypervigilance). Four items were reverse coded. Scores of three or greater met the criteria for each subscale.

Sexual Mindfulness

The Sexual Mindfulness Measure (SMM) (Leavitt et al., 2019) yields a sexual mindfulness score for two subscales: (1) Mindful awareness (4 items; α = 0.81) and (2) Mindful non-judgment (3 items; α = 0.78). Participants respond to seven items using a 5-point Likert scale from 1 (never or rarely) to 5 (very often or always true). Example items were, “I pay attention to sexual sensations” (mindful awareness) and “During sex, I sometimes get distracted by evaluating myself or my partner” (mindful non-judgment). Two items were reverse coded. Higher scores represented greater mindful awareness and mindful non-judgment during sex. It should be noted that the subscales are scored separately and not combined to form a sum score.

Data Analyses

Data analyses were conducted using IBM SPSS Version 29 (SPSS Inc., 2023) and SPSS PROCESS macro v3.0 (Hayes, 2017). To assess the potential indirect effects of psychological functioning on sexual functioning via sexual mindfulness, we conducted ten mediation analyses (Model 4) in the SPSS PROCESS macro utilizing 5,000 resampled 95% confidence intervals (CI). Significant mediation models were identified if the confidence interval for the indirect effect did not include zero (Hayes & Rockwood, 2017). Due to the usage of confidence intervals when analyzing mediation models in PROCESS (Hayes, 2017), we will not report null hypothesis significance testing indicators (e.g., p-values; Téllez et al., 2015). Standardized coefficients are reported as a measure of effect size (Hayes, 2017).

Positionality Statements

Reflecting on researcher identity and its role in interpreting quantitative findings accompanies researchers in advancing their understanding of social scientific inquiry outside the bounds of post-positivism (Jamieson et al., 2023; Lakew, 2017; Luoma & Hietanen, 2024). We include positionality statements in this paper to demonstrate our use of self-reflexivity. As a team of predominantly Black cisgender women and queer researchers, we recognize that lived experiences influence all forms of scientific inquiry, including quantitative research, which can both enrich and potentially bias the interpretation of statistical data (Jamieson et al., 2023). While self-reflexivity—entailing the recursive observation and documentation of our motivations, values, and data interpretations—served as a check on interpretation bias, it also enhanced the validity of our findings. We believe that our collective Black feminist and queer wisdom contributes to the credibility of this work and its relevance to Black women’s experiences of sexual mindfulness, psychological well-being, and sexual functioning in the US.

The first author is a Black queer ciswoman from the South who is a counseling psychology doctoral candidate. She has training in the yoga system, including mindfulness, and maintains a consistent practice that started in 2017. The second author is a white queer and genderqueer woman from the South whose research focuses on barriers and facilitators of enjoyable sexual experiences. The third author is a queer, biracial Black woman from the South whose research prioritizes the psychosocial and sexual well-being of historically marginalized groups. The fourth author is a Black heterosexual ciswoman from the North. As a nurse practitioner and a doctoral candidate, her academic and professional journey focuses on women’s sexual and reproductive health, with an emphasis on Black women, through lenses of intersectionality, justice, Black feminism, and pleasure. The senior author is an assistant professor, sexuality researcher and principal investigator of the BeWell study. She identifies as a Black queer woman from the South whose research focuses on the sexual well-being using Black feminisms and sex positive frameworks.

Results

Participants’ average sexual functioning score was higher than the cutoff score of 41 (M = 46.7, SD = 6.30); however, their scores ranged from 28 to 61. Most participants were psychologically well (n = 138, 30.8%), followed by moderate distress (n = 105, 23.4%), severe distress (n = 103, 23%), and mild distress (n = 93, 20.8%). A total of n = 311 (69.4%) of participants had moderate perceived stress, followed by high (n = 70, 15.6%) and low (n = 57, 12.7%) perceived stress. Regarding PTSD symptoms, participants’ average scores were M = 1.70 (SD = 1.70) for intrusion, M = 0.94 (SD = 0.85) for avoidance, and M = 0.90 (SD = 0.80) for hypervigilance. Scores ranged from zero to four on the intrusion subscale and zero to two for the avoidance and hypervigilance subscales.

Regarding bivariate correlations (Table 2), sexual functioning was significantly positively correlated with PTSD: hypervigilance (r = 0.126), mindful awareness (r = 0.461), and mindful non-judgment (r = 0.157). Mindful awareness during sex was significantly positively correlated with age (r = 0.107) and education (r = 0.204) and significantly negatively associated with psychological distress (r = −0.135) and perceived stress (r = −0.153). In other words, greater mindful awareness during sex was associated with older age, higher education, less psychological distress, and less perceived stress. Mindful non-judgment during sex was significantly positively correlated with age (r = 0.252) and significantly negatively associated with education (r = −0.014), psychological distress (r = −0.375), perceived stress (r = −0.354), PTSD intrusion (r = −0.232), PTSD avoidance (r = −0.191), and PSTD hypervigilance (r = −0.165). Accordingly, greater mindful non-judgment during sex was associated with older age, less education, less psychological distress, less perceived stress, and less PTSD intrusion, avoidance, and hypervigilance.

Table 2.

Bivariate correlations

r
Sexual Functioning
Age 0.013
Education 0.073
Psychological Distress 0.042
Perceived Stress −0.057
PTSD: Intrusion 0.030
PTSD: Avoidance 0.049
PTSD: Hypervigilance 0.121*
Sexual Mindfulness: Awareness 0.461**
Sexual Mindfulness: Non-Judgment 0.157**
Sexual Mindfulness: Awareness
Age 0.107*
Education 0.204**
Psychological Distress −0.135**
Perceived Stress −0.153**
PTSD: Intrusion −0.021
PTSD: Avoidance −0.031
PTSD: Hypervigilance 0.027
Sexual Mindfulness: Non-Judgment
Age 0.252**
Education −0.014
Psychological Distress −0.375**
Perceived Stress −0.354**
PTSD: Intrusion −0.248**
PTSD: Avoidance −0.212**
PTSD: Hypervigilance −0.170**
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Note.

*

p < .05,

**

p < .01

Despite several predictor variables not demonstrating significant correlation with sexual functioning, we elected to conduct mediation analyses, because correlations between the predictor and outcome variables are not a mandatory precondition for assessing indirect effects (Hayes, 2017). To assess whether the relationship between psychological distress and sexual functioning is mediated by either mindful awareness or mindful non-judgment during sex, we conducted two mediation analyses (Fig. 1). Among our sample, we detected a significant indirect effect of psychological distress on sexual function via the mediating process of engaging in mindful awareness (B = −0.06, β = −0.07, CI = −0.10, −0.02). In other words, Black women who experienced lower psychological distress were more likely to report engaging in mindful awareness during sex and, in turn, experienced more optimal sexual functioning. Similarly, we detected a significant indirect effect of psychological distress onto sexual function via mindful non-judgment (B = −0.06, β = −0.08, CI = −0.10, −0.03). This result indicates that Black women who were low in psychological distress were more likely to practice non-judgment of their sexual experiences and, in turn, experience more optimal sexual functioning.

Fig. 1.

Fig. 1

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Sexual mindfulness mediating psychological distress and sexual functioning

We tested two additional mediation analyses to determine whether the two facets of mindfulness mediated the relationship between perceived stress and sexual functioning among Black women (Fig. 2). We detected a significant indirect effect of perceived stress on sexual functioning through the mediating process of mindful awareness (B = −0.07, β = −0.09, CI = −0.13, −0.03). Additionally, we detected a similar indirect effect via the mediating process of mindful non-judgment (B = −0.05, β = −0.06, CI = −0.09, −0.02). These results suggest that Black women who reported low levels of perceived stress were more likely to engage in mindful awareness and mindful non-judgment during sex and, in turn, experienced better sexual functioning.

Fig. 2.

Fig. 2

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Sexual mindfulness mediating perceived distress and sexual functioning

We conducted six mediation models to assess whether the two facets of sexual mindfulness mediate the relationships between PTSD symptoms (i.e., intrusion, avoidance, and hypervigilance) and sexual functioning among Black women who have ever experienced a traumatic event (n = 312; Figs. 3, 4 and 5). Interestingly, the indirect effect of intrusive symptoms on sexual functioning via mindful awareness during sex was not significant (B = 0.03, β = 0.01, CI = −0.19, 0.27), but this indirect effect was significant when assessing mindful non-judgment as the mediator (B = −0.18, β = −0.04, CI = −0.37, −0.04). Similarly, the indirect effect of avoidance-based symptoms on sexual function via mindful awareness during sex was not significant (B = −0.06, β = −0.01, CI = −0.39, 0.27), but was significant when assessing mindful non-judgment as the mediator (B = −0.25, β = −0.03, CI = −0.47, −0.06). When assessing the indirect effect of hypervigilance on sexual functioning, we did not detect significance in the model assessing mindful awareness as the mediator (B = 0.09, β = 0.01, CI = −0.25, 0.43). However, the indirect effect of hypervigilance on sexual functioning via the mediating process of mindful non-judgment was significant (B = −0.21, β = −0.03, CI = −0.44, −0.04). These results suggest that overall, Black women who endorsed lower rates of PTSD symptoms (i.e., intrusion, avoidance, and hypervigilance) were more likely to report non-judgment of their sexual experiences and, in turn, experienced better sexual functioning.

Fig. 3.

Fig. 3

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Sexual mindfulness mediating PTSD symptomology: Intrusion and sexual functioning

Fig. 4.

Fig. 4

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Sexual mindfulness mediating PTSD symptomology: Avoidance and sexual functioning

Fig. 5.

Fig. 5

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Sexual mindfulness mediating PTSD symptomology: Hypervigilance and sexual functioning

Discussion

This study examined the potential mediating role of sexual mindfulness on Black women’s psychological and sexual functioning. Our interest in sexual mindfulness (comprised of mindful awareness and mindful non-judgment during sex) as a mediator emerged from studies reporting Black women’s general interest in and endorsement of embodiment practices for improving their sexual health (Hargons et al., 2023; Malone & Hargons, 2021; Thorpe et al., 2022). Study results partially confirmed our hypotheses. Participants with greater psychological distress and perceived stress were less likely to report mindful awareness and mindful non-judgment during sex. Accordingly, they experienced less optimal sexual functioning. Several studies reported associations between women’s psychological and sexual functioning (Basson et al., 2019; Hamilton & Julian, 2014; Hamilton & Meston, 2013; Maru et al., 2019). This study confirms similar relationships between these variables in a sample of Black women. Additionally, although several of our psychological functioning variables were not significantly correlated with sexual functioning at the bivariate level, our mediation results showed that sexual mindfulness could be the process through which psychological distress, perceived stress, and PTSD symptoms impact this sample’s sexual functioning. Contrary to our hypotheses regarding the impact of PTSD symptoms on sexual functioning, we detected a significant correlation between hypervigilance and sexual functioning. Previous research identified that sexual responses (e.g., sexual arousal, orgasm) can occur during traumatic events, due to the activation of the sympathetic nervous system increasing blood flow to the genitals at a sub-cortical level (Levin & van Berlo, 2004). As a result, it is possible that, for some participants, sexual response increased alongside PTSD symptoms due to the heightened activation of their sympathetic nervous system. It is important to state that we consider this type of sexual response outside of the context of consensual and sought-after events strictly physiological and unrelated to Black women enjoying a traumatically stressful life event.

It is unclear whether participants truly engaged in sexual mindfulness (i.e., state mindfulness engaged in during sexual encounters; Leavitt et al., 2019) or relied on trait mindfulness (i.e., a disposition toward mindful attention and an open, non-judgmental attitude; Tang & Braver, 2020). Nevertheless, improving Black women’s psychological functioning seems necessary to improve their sexual mindfulness and, in turn, their sexual functioning. Black women are more likely than their racial/ethnic counterparts to experience poor psychological functioning (Barnes & Bates, 2019). Scholars identified Black women’s increased risk of exposure to traumatic life events and chronic stressors, including identity-based stress associated with gendered racism and discrimination, as significant contributors to their mental health (Lewis et al., 2017; Moody & Lewis, 2019; Thorpe et al., 2024a) and sex lives (Crooks et al., 2021). Thus, addressing contributors to Black women’s mental health is a worthwhile step.

Indeed, sexual mindfulness may be a valuable tool for improving psychological and sexual functioning. The intentional use of mindful awareness and non-judgment during sex likely addresses maladaptive cognitive, emotional, and behavioral aspects of psychological functioning, leading to improvements in sexual functioning. For example, Black women may become aware of stress held in their bodies or recognize, without judgment, behaviors such as spectatoring or persistent worry about sexual performance. However, our findings present a causal dilemma in that participants’ mental health challenges seem to prevent their mindful awareness and mindful non-judgment during sex. Supporting Black women’s trait mindfulness development could facilitate their improved psychological functioning, resulting in conditions ideal for their sexual mindfulness engagement. Trait mindfulness has been found to moderate the relationship between mental health outcomes and various stressors and life experiences among Black Americans (Graham et al., 2013) and their ability to select proactive coping strategies during stressful events (Womack & Sloan, 2022). Developing trait mindfulness, or a disposition toward daily mindful living, could be beneficial for Black women whose traumatic experiences and chronic stressors pervade their lives and sexual encounters.

To conclude, it is noteworthy that participants reporting higher rates of PTSD symptoms (i.e., intrusion, avoidance, and hypervigilance) were less likely to report mindful non-judgment during sex, thus experiencing less optimal sexual functioning. This finding questions the sample’s capacity for self-compassion. Self-compassion is associated with an individual’s ability to practice openness and non-judgment towards oneself (Neff, 2018). Some Black women endorse cultural coping mechanisms like the Superwoman Schema (Woods-Giscombé, 2010) that promote superhuman demonstrations of strength and resilience to cope with distressing experiences. Additionally, studies found Black women’s greater endorsement of Superwoman Schema was associated with decreased compassion (Volpe et al., 2024). While cultural coping proves beneficial for Black women in attaining desired outcomes in some settings, it may pose a barrier to their mindful non-judgment during sex and, in turn, their sexual functioning. For instance, Black women participants in Lackey’s (2023) study were less likely to be non-judgmental and mindful overall if they endorsed emotional suppression as part of coping via the Superwoman Schema. Since Black women’s cultural coping can negatively impact their mental health (Knighton et al., 2022; Leath et al., 2022) and sexual functioning (Thorpe et al., 2024c), it warrants deeper investigation within the context of sexual mindfulness.

Limitations and Future Research

This study, while contributing valuable insights into the intersection of sexual mindfulness, psychological functioning, and sexual functioning among Black women, has several limitations. We investigated a composite score for sexual functioning rather than domains of sexual functioning normally applied to women. The utilization of a composite score to assess sexual functioning may obscure the nuanced dynamics of distinct domains of sexual functioning traditionally applied to women and vulva owners. Additionally, our selected psychological measures represent only a few indicators of psychological functioning. Future research could benefit from a disaggregated approach, examining how sexual mindfulness comprehensively influences aspects of Black women’s sexual functioning, such as sexual desire, arousal, orgasm, and pleasure. Similarly, future studies should investigate other psychological functioning indicators like depression and positive psychological variables, including psychological flourishing and happiness.

In addition to the low percentage of participants without college experience, no trans or gender-expansive participants and the marginal inclusion of sexual minority participants identifying as asexual or on the ace spectrum are methodological limitations. The employed measure of sexual functioning may not adequately reflect the experiences of sexual desire for gender minority or ace/asexual Black women (Whitney et al., 2022; Yule et al., 2015). This oversight underscores a broader issue within sexual health research, where definitions and instruments for sexual functioning problematize and/or pathologize sexual functioning expressions that are not cisgender, heterosexual, and/or allosexual (Brown, 2022). Future studies should consider the development and use of more inclusive measures that respect and represent a diversity of sexual identities and experiences. Additionally, future studies should intentionally diversify or stratify samples to ensure better educational representation.

Despite this study’s efforts to support the psychometric properties of the sexual mindfulness measure within our sample, the validation process for Black American women remains incomplete. The construct of sexual mindfulness within cultural contexts necessitates further investigation to ensure its relevance, accuracy, and sensitivity. This gap signifies an essential area for future research aimed toward solidifying the measure’s applicability and reliability across diverse populations (Leavitt et al., 2019).

The cross-sectional design of the current study limits our ability to draw causal inferences or track changes over time. Longitudinal studies are needed to elucidate the dynamics of sexual mindfulness, psychological functioning, and sexual functioning. Longitudinal studies could also clarify the directionality of these effects, helping to identify whether changes in psychological functioning precede improvements in sexual functioning or if the relationship works in the opposite direction. Furthermore, longitudinal studies can provide valuable insights into the stability of these relationships across different life stages or in response to significant life events, thereby deepening our understanding of the dynamics involved.

Finally, the influence of existing mindfulness or embodiment practices (e.g., yoga, meditation; Cook-Cottone et al., 2023) on Black women’s sexual functioning still needs exploration. We did not collect data on participants’ previous or current engagement in mindfulness in general. Additionally, the project that produced these data did not include a measure of general mindfulness. The frequency of one’s embodiment practices could significantly affect the relationship between psychological functioning, sexual mindfulness, and sexual functioning. Comparative studies that account for varying degrees of engagement with mindfulness or embodiment practices could elucidate how these practices interact with and influence sexual and psychological functioning among Black women. Such research could offer nuanced insights into the potential mediating role of these practices in enhancing sexual health and overall functioning. Addressing these gaps will not only refine our understanding of these constructs but also contribute to the development of more inclusive, sensitive, and effective research aimed at enhancing the sexual functioning of Black women.

In addition to the recommendations for future research, study findings could benefit practitioners treating Black women presenting with psychological health and sexual functioning concerns. As mindfulness increases in popularity as a complementary health approach, so does the necessity for continuing education regarding its utility within specific contexts like sex and within understudied populations like Black women, who could significantly benefit from it. It will be especially fruitful for practitioners to partner with researchers to advance works by scholars who propose culturally adapted mindfulness and other mind–body therapies for Black women (Hargons et al., 2023; Watson-Singleton et al., 2019). Their collaborative efforts could extend or adapt existing therapeutic approaches to mindfulness grounded in Black women’s ways of knowing to accommodate the distinctive elements of mindfulness during sexual encounters.

In conclusion, this study adds to the burgeoning field of research on sexual mindfulness and its implications for researchers and practitioners. The results presented provide support for continued study of and interest in sexual mindfulness as a tool contributing positively to Black women’s psychological and sexual health.

Footnotes

Conflicts of Interest We have no known conflict of interest to disclose.

Ethics Approval This study was approved by the University of Kentucky IRB (Protocol #83653).

Informed Consent All participants in this study completed an informed consent form provided digitally at the beginning of the online survey.

Use of Artificial Intelligence No AI tools were used to develop this manuscript.

Data Avaliability

Data supporting this study will not be made available.

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Data Availability Statement

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