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. Author manuscript; available in PMC: 2026 Jan 23.
Published before final editing as: J Posit Psychol. 2026 Jan 22:10.1080/17439760.2026.2619130. doi: 10.1080/17439760.2026.2619130

Sexuality in Positive Psychology: Toward the Integration of a Neglected Component of Human Flourishing

Vera U Ludwig a,*, Ari Lewis a, James O Pawelski a, Damien L Crone b
PMCID: PMC12826338  NIHMSID: NIHMS2136651  PMID: 41586405

Abstract

Sexuality is central to well-being, relationships, and health. Yet, the science of well-being has traditionally overlooked the topic. To assess whether this gap persists, we conducted a large-scale content analysis of three leading well-being journals. We scraped all abstracts published up to September 2024 (n = 3,094), then used large language models (GPT-4o-mini and Gemini 2.0) for systematic screening. Articles flagged as potentially relevant were reviewed manually. Only 18 articles (0.6%) substantively focused on the topic. Out of these, 8 (0.3%) addressed topics related to minority groups, 6 (0.2%) negative aspects of sexuality such as abuse, and 4 (0.1%) general positive or neutral aspects. Sexuality remains underexplored in well-being science. Integrating it is essential for a complete understanding of human flourishing. We call for a paradigm shift: to move beyond silence toward a research agenda that embraces sexuality as a vital dimension of well-being.

Keywords: well-being, sexuality, sexual health, flourishing, LLM, OpenAI, Gemini, review, sexual well-being

The frequency and quality of consensual sex correlate with happiness and well-being (e.g., Blanchflower & Oswald, 2004; Laumann et al., 2006; Vasconcelos et al., 2024), particularly in the context of relationships (Cheng & Smyth, 2015; Muise et al., 2016). “Love-making and intimacy” has even been identified as the top activity category associated with both happiness and relaxation in a smartphone-based experience sampling study (Bryson & MacKerron, 2017, p. 116). In contrast, sexual difficulties are associated with depressive symptoms, interpersonal problems, stress, and fatigue (Biddle et al., 2009; Bodenmann & Ledermann, 2008; Bodenmann et al., 2010; Rowland et al., 2007), and low sexual satisfaction may be a risk factor for divorce (Daneshfar & Keramat, 2023; Gautam & Batra, 1996). Sexual satisfaction, on the other hand, correlates with relationship satisfaction, love, and commitment (Birnbaum, 2007; Gonin-Spahni, 2017; Schwartz & Young, 2009; Sprecher, 2002), with some evidence suggesting that it also predicts future relationship happiness (Fallis et al., 2016; H. G. Park et al., 2023).

More sex is not always better—higher frequency is not necessarily linked to greater well-being (Loewenstein et al., 2015; Muise et al., 2016), and unwanted sexual experiences are, unsurprisingly, associated with lower happiness across genders (Cheng & Smyth, 2015). Yet, sexuality remains a deeply relevant topic for nearly everyone. In a survey of more than 12,000 people across 27 countries, almost all respondents said they found sex, attraction to their partner, foreplay, and orgasm important (Mulhall et al., 2008). Even for individuals who identify as asexual (approximately 1%; Bogaert, 2004) or those who are voluntarily or involuntarily abstinent, sexuality still plays a role in how people relate to their bodies, identities, and connections with others. Whether we engage in sexual activity or not, we all must make sense of this domain of life and its significance.

Sexuality plays a role in people’s well-being across the lifespan, often up to older age (Herbenick et al., 2010; Laumann et al., 2006; Lee et al., 2016; Træen et al., 2019). In a five-wave longitudinal study of partnered individuals in Germany, Schmiedeberg and colleagues (2017) found that changes in life satisfaction over time were associated with corresponding changes in sexual frequency and sexual satisfaction for both men and women. Similarly, using a 21-day daily diary study with 152 adults, Kashdan et al. (2018) found that sexual activity predicted greater next-day positive affect and meaning, as well as lower negative affect. The inverse was not true: higher well-being on one day was not followed by more sexual activity on the next. For those with higher relationship closeness, the degree of sexual pleasure during a sexual encounter also predicted higher positive affect and meaning the following day. Moreover, positive sexual experiences appear to reduce social anxiety and negative social comparisons (Kashdan et al., 2014).

Given the pivotal role of sexuality in human well-being—across both its positive and negative dimensions—one might expect that positive psychology, and well-being science more broadly, would have devoted substantial attention to this topic. In truth, it has received very little. Mihaly Csikszentmihalyi (1990) wrote about sex as a source of flow. Since then, there have been isolated initial approaches to more fully integrate sexuality into the field of positive psychology and into holistic models of well-being (e.g., Anderson, 2013; Impett et al., 2013). Kate Hefferon (2013) included a chapter on ‘positive sexuality’ in her book Positive Psychology and the Body: The Somatopsychic Side to Flourishing. Among other aspects, she highlighted the importance of touch for human well-being and the health benefits of sexual activity. Brianna Booth (2011) wrote a trailblazing Capstone paper on ‘Human Sexuality and Positive Psychology: Conceptual Beginnings’ for her Penn Master of Applied Positive Psychology (MAPP) degree, advised by Pawelski. In her doctoral thesis (2014) she further argued that sexuality should be viewed as valuable and fulfilling (positive) as well as deep and dynamic (multi-dimensional), replacing the predominant attitude toward sexuality (negative and superficial). Relatedly, Biswas-Diener et al. (2015) proposed that positive psychology should pay more attention to pleasure—one positive aspect of sexuality amongst many others—although the authors only briefly mention sexual pleasure. Ludwig (2020; Tschetter & Murray, 2024) and Lewis (2018, 2024) have also argued for greater attention to sexuality within well-being science, an effort supported by Pawelski and continued by Myers (2025; see also Diamond & Huebner, 2012; Stalder, 2025; Wellings & Johnson, 2013).

When and if sexuality is researched or talked about in education or public discourse, there is typically a focus on mitigating negative issues, such as violence, trauma, sexually transmitted infections, or dysfunction, rather than on fostering or strengthening positive aspects (Booth, 2014; Impett et al., 2013). For example, adolescents are frequently warned about risks (e.g., diseases, unwanted pregnancy) and are less often made aware of potential benefits (e.g., love, connection). Arakawa et al. (2013) estimated that only 7% of the published articles about sexuality in four prestigious sexuality- and medicine-related journals had a positive focus. 58% were classified as negative and 35% as neutral. Articles classified as negative included, for example, risky sexual behavior, violence, or the treatment of dysfunction. Neutral articles dealt with the development of sexual identities, for example, or they contained positive and negative aspects. On the other hand, positively rated articles talked about aspects such as pleasure, fantasies, orgasms, intimacy, sexual satisfaction, positive and healthy relationships. The authors concluded that positive psychology had not yet noticeably influenced scientific research into positive aspects of sexuality. More recently, Hargons et al. (2017) found that only 5% of articles around sexuality in two major psychotherapy journals had adopted a ‘sex-positive’ framework. While these negative aspects of sexuality are absolutely crucial to address, it may be beneficial to also investigate and talk about positive aspects of sexuality.

The sexuality literature shows a growing interest in positive aspects (e.g., Hargons et al., 2018), although such perspectives remain significantly underrepresented. For example, Mitchell et al. (2021) argue for the importance of understanding sexual well-being as a crucial aspect of public health and have developed a model and scale of sexual well-being (Mitchell et al., 2025). Williams et al. (2015) published a framework on positive sexuality, and Prior and Williams (2025) edited and published a book on the field. Furthermore, Ford et al. (2019) and Hull (2008) are amongst the critical voices who emphasize the importance of sexual pleasure for overall well-being, with pleasure being one positive aspect of sexuality and a key motivator for individuals to pursue sex (Meston & Buss, 2007). Recent network-based research likewise highlights that feelings of excitement and enjoyment during sex may be central to sexual well-being (Andreoli et al., 2024). Werner et al. (2023) published a framework of pleasure including a definition and a taxonomy of various rewards experienced during sex. Herbenick et al. (2025) documented Americans’ favorite aspects of partnered sex, including closeness/intimacy, love/caring, and satisfying/pleasing amongst other topics (see also Herbenick et al., 2023); and researchers have studied interventions for increasing sexual well-being (e.g., Beier & Loewit, 2011; Brotto et al., 2016). Pfaus (2025) and others have described in detail the biological basis of positive experiences during sexual activity, and Kleinplatz et al. (2009) published a ‘portrait of great sex,’ a qualitative analysis based on interviews with individuals who reported highly positive sexual experiences.

Yet it remains unclear to what extent journals in the science of well-being and positive psychology have addressed the topic of sexuality. This article examines how often sexuality or sexual well-being are the primary focus of articles in three leading well-being journals as of 2024, and if so, what the prevalent themes are. Through systematic content analysis, we examine whether there has yet been a shift in research focus in well-being journals toward this pivotal area of life.

Materials and Methods

Scraping

In September 2024, we scraped article information and abstracts from the three main positive psychology or well-being focused journals using a Python-based script: Journal of Happiness Studies (JHS), The Journal of Positive Psychology (JPP), and the International Journal of Wellbeing (IJW). We included only articles that contained an abstract and had already been assigned to an issue. The numbers of articles analyzed are shown in Table 1.

Table 1.

Number of articles identified per journal.

The Journal of Positive Psychology (2006) Journal of Happiness Studies (2000) International Journal of Wellbeing (2011) Total
Total number of articles with valid abstracts obtained 1,027 1,812 255 3,094
Number of articles initially flagged as potentially related, by at least one LLM for at least one statement 19 (9 rated as True by both LLMs for both statements) 42 (22 rated as True by both LLMs for both statements) 5 (3 rated as True by both LLMs for both statements) 66 (34 rated as True by both LLMs for both statements)
Manually categorized as
 • Direct focus on sexuality or sexual well-being n = 1 [0.1%] n = 14 [0.8%] n = 3 [1.2%] n = 18 [0.6%]
 • Touching upon the topic or including a relevant variable or sample* n = 10 [1%] n = 13 [0.7%] n = 1 [0.4%] n = 24 [0.8%]
 • Not about the topic (miscategorized) n = 8 n = 15 n = 1 n = 24
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Note.

*

This category is likely not exhaustive given these ratings are based on abstracts. More articles in the journal will have likely mentioned sex or sexuality somewhere in the full-text without focusing on it.

Computational Content Coding Procedure

To determine whether scientific articles addressed sexuality or sexual well-being, we implemented an automated content coding approach using Quallm, a Python library for implementing LLM-assisted content analysis tasks (Crone, 2024). Each article abstract was evaluated with respect to the following two statements:

  1. ‘The paper describes, refers to, or analyzes the topic of sexuality or sexual well-being.’

  2. ‘The paper describes, refers to, or analyzes the topic of sexuality or sexual well-being, including, for example, sexual behaviors and practices, sexual health and well-being, sexual relationships and partnerships, sex education, sexual trauma or violence, sexual orientation, or the psychological, emotional, and social aspects of sexual desires, thoughts, and activities.’

Statement 2 was included in case Statement 1 missed relevant abstracts, and vice versa. Articles were submitted to the LLMs twice—once for each statement—and evaluated independently.

Articles were coded using two independent LLMs: (i) GPT-4o-mini and (ii) Gemini 2.0 Flash. By using two different models and two different statements, we aimed to minimize false negatives. There is now a substantial amount of research suggesting that LLMs can perform content coding tasks with comparable or higher accuracy than humans (Gilardi et al., 2023; Prinzing et al., 2024; Rathje et al., 2024; Törnberg, 2024), justifying their use here.

Both models were prompted to return a response indicating whether the statement was supported by the abstract or title (True or False), along with a brief explanation. Our full code can be found online (see Data Availability Statement). The prompt was worded as follows:

You are a helpful research assistant. You will receive a paper abstract as input. Evaluate the statement about the paper as a whole. If uncertain, choose ‘True’ to avoid missing relevant content.

Any abstract that was rated as potentially relevant by at least one of the models on at least one of the statements was subjected to a manual classification.

General analyses

The LLM output from the Python pipeline was subjected to further analysis using a combination of R analysis scripts (R Core Team, 2020) and manual analysis, as detailed below.

Agreement between the two models on the two statements

We first examined the proportion of instances in which both models agreed on either of the statements. However, with highly sparse positive cases, high agreement could simply reflect both raters consistently choosing the majority class (non-sexuality content) rather than meaningful consensus. To address this, we also conducted a Bayesian variance partitioning analysis using mixed-effects logistic regression to decompose the sources of variation in ratings. We fitted a Bayesian logistic mixed-effects model predicting presence ratings for all non-missing observations using brms in R (Bürkner, 2018) with crossed random effects for abstracts, raters, and statements. The variance partitioning was computed from posterior samples drawn from the estimated model, which properly propagates uncertainty from the variance components through to the final proportions, allowing the estimation of credible intervals (CIs).

Manual classification of sexuality relevance for flagged articles

Each abstract flagged by at least one LLM for at least one of the statements was manually reviewed by author VUL and coded into one of three categories. Categories were based on the extent to which the abstract addressed sexuality and sexual well-being. In nearly all cases, this was based on the abstracts only, as studies with a substantial focus on the topic are expected to describe this in the abstract. The full text was consulted only when the abstract’s wording left substantial room for doubt.

1. Directly focusing on sexuality and sexual well-being

Studies in which sexuality-related topics were the primary constructs under investigation, including, for example, sexual behaviors, motivation, attitudes, sexual health, or a relevant measurement development. When a study’s sample was defined by sexual orientation or gender identity, it was included here if and only if the study’s primary focus was on: (i) sexuality-related constructs (e.g., sexual behaviors) or (ii) experiences uniquely and directly tied to individuals’ sexuality (e.g., stigma related to sexual identity).

2. Touching upon the topic or including a relevant variable or sample

Studies in which sexuality was not the main focus but was present in a meaningful way through:

  • A sample population (e.g., sexual minorities, people living with HIV) or topic (e.g., abortion) with a link to the topic but without focus on sexuality-related constructs

  • A sexuality-related variable as one of several predictors, outcomes, or controls in a broader research question

  • Sexuality as a contextual factor, without being the central research question

  • Sex as an example (e.g., in the context of hedonism or in studies of moral dilemmas)

3. Not relevant

Studies without substantive sexuality-related content in their questions, variables, or sample characteristics. For example, romantic relationship research without an explicit sexuality focus was coded as ‘Not relevant.’

Final manual classification

Articles categorized as directly focusing on the topic were manually organized into three themes that best summarized the results (Table 2).

Table 2.

Manual categorization of articles marked as focusing on sexuality or sexual well-being.

Categorization with article count Authors and year Title
Related to sexual or gender minorities (n = 8) Berggren et al. (2017) Do equal rights for a minority affect general life satisfaction?
Collict et al. (2021) Identity formation among gay men, lesbian women, bisexual and heterosexual samples: Associations with purpose in life, life satisfaction, pathways to purpose and implications for positive sexual minority identity
Jenkins & Vazsonyi (2013) Psychosocial adjustment during the transition from adolescence to young adulthood: Developmental evidence from sexual minority and heterosexual youth
Nouvilas-Pallejà et al. (2017) Stigma consciousness and subjective well-being in lesbians and gays
Prunas et al. (2016) Eudaimonic well-being in transsexual people, before and after gender confirming surgery
Shenkman et al. (2023) The association of couplehood and parenthood with the hedonic and eudaimonic well-being of older gay men
Wong & So-Kum Tang (2003) Personality, psychosocial variables, and life satisfaction of Chinese gay men in Hong kong
Zavala & Waters (2021) Coming out as LGBTQ +: The role strength-based parenting on posttraumatic stress and posttraumatic growth
Sexual risk-taking, violence, sex work [negative correlates], pornography [related to escalation of pornography use], or similar topics (n = 6) Cox et al. (2013) “There is nothing good about this work:” Identity and unhappiness among Nicaraguan female sex workers
D’Orlando (2011) The demand for pornography
Jaskulska et al. (2022) Will you make me happy? The role of dating and dating violence victimisation in happiness among adolescents in Europe
Kashdan et al. (2020) Sexual assault: Exploring real-time consequences the next day and in subsequent days
Lyon et al. (2020) Left / Write // Hook: A mixed method study of a writing and boxing workshop for survivors of childhood sexual abuse and trauma
Zullig et al. (2020) Can a multilevel STI/HIV prevention strategy for high risk African American adolescents improve life satisfaction?
Positive or neutral topics: Sexual motivation, mating value, and sexual well-being overall (n = 4) Gravel et al. (2018) Global, relational, and sexual motivation: A test of hierarchical versus heterarchical effects on well-being
Ko et al. (2023) Functionally calibrating life satisfaction: The case of mating motives and self-perceived mate value
Margolis et al. (2022) Measuring eudaimonic and non-eudaimonic goods in the pursuit of the good life. [‘Rich and sexy well-being scale’]
Štulhofer et al. (2018) Sexual well-being in older men and women: Construction and validation of a multi-dimensional measure in four European countries
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Results

Agreement between the two models and on the two statements

The models (GPT-4o-mini and Gemini-2.0 Flash) agreed on their assessment (True vs. False) in 99.00% of cases for statement 1, and in 98.61% of cases for statement 2. When there was a discrepancy, it was because Gemini marked an abstract with ‘True’ while GPT marked it with ‘False’ (17 times for statement 1 and 23 times for statement 2), and never the other way around. This indicates that GPT adopted a narrow, more literal interpretation of the task instructions. In a few cases, the discrepancy was also due to Gemini missing a response altogether: For GPT, no responses were missing, while for Gemini, 14 responses to statement 1 were missing and 20 responses to statement 2 (with 4 abstracts missing both Gemini responses). We manually reviewed the articles that had missing Gemini responses to ensure that GPT’s responses (all ‘False’) were appropriate. Note that the reasons for missed responses for Gemini could be manifold (e.g., refusal rate for sensitive content, model reliability in returning structured outputs, or service capacity constraints), but we did not assess the specific reason here. The overall consistency of ratings between statement 1 and statement 2 was 99.97% for ratings by GPT and 98.61% for ratings by Gemini (not base rate corrected).

While the raw agreement between GPT-4o-mini and Gemini-2.0 Flash was extremely high, such metrics can be misleading in the presence of a major class imbalance, as is the case here with only around 2% of abstracts flagged as sexuality-related. However, our Bayesian variance partitioning analysis corroborated the simpler inter-rater agreement analyses: 91.5% (95% CI: 51.3–98.7%) of the total variance was attributable to differences between abstracts, while only 6.3% (95% CI: 0.3–47.0%) was due to differences between raters, and a minimal 1.1% (95% CI: 0.0–8.3%) was due to differences between the two statements. The residual variance accounted for just 1.1% (95% CI: 0.5–2.0%) of the total. Wide confidence intervals notwithstanding (reflecting our design only having two models and two statements), the negligible variance attributable to statements and residual error, and the small proportion attributable to model, corroborates the raw agreement metrics, although revising the estimate down slightly.

Articles flagged as relevant to sexuality or sexual well-being

There were 3,094 abstracts available for analysis (Table 1). Sixty-six abstracts overall were flagged as potentially relevant by at least one model for at least one of the statements. These were subjected to further manual review (see Methods). A full list of these articles, including journal information and manual classification, is included in an online repository (Supplementary Table 1; https://osf.io/jr5w2/).

A large proportion of LLM-identified articles (n = 24) were not considered truly about sexuality or sexual well-being after manual review (Table 1). They had been flagged by one of the LLMs (always Gemini), which used more speculative reasoning involving indirect connections, compared to GPT, which interpreted the task more literally. Example justifications for such cases by Gemini included: ‘The abstract mentions relationship status as a predictor of well-being, which can be related to sexual well-being. Therefore, the statement is considered True,’ or ‘The abstract mentions “cohabitation with a partner” and “maternity leave”, which can be loosely related to sexuality or sexual well-being, though it’s not the primary focus. Therefore, erring on the side of caution, I’ll mark it as True.’

There was another group of LLM-identified articles that were tangentially related to the topic (n = 24). Some of these simply mentioned sexuality as one out of many examples (e.g., in the context of hedonism). Others included sexuality-related variables as one of many outcome variables or looked at certain relationship forms (e.g., ‘mingling’ as a less committed form of intimate relating) without making sexuality a key focus. A few additional articles focused on a sample related to the topic (e.g., people living with HIV), but again without making sexuality or sexual identity navigation the focus of the paper.

Finally, 18 articles (0.6% of all articles) were rated as truly and clearly relating to the topic of sexuality or sexual well-being. All identified articles are included in Table 2. After reviewing the article themes, we categorized them into the following groups (Table 2): (i) sexual or gender minority-related topics relevant to sexuality (n = 8), (ii) articles with a focus on negative aspects of sexuality such as sexual risk-taking, violence, negative well-being correlates of sex work, and escalation of pornography use (n = 6), and (iii) neutral or positive topics, related to sexual motivation, mating value, and well-being (n = 4).

Discussion

Positive psychology as a field aims to investigate and promote fulfilling lives and human flourishing (Seligman & Csikszentmihalyi, 2014). Two decades ago, Christopher Peterson (2006) noted the absence of a ‘positive psychology of sexuality’ (p. 20). Our current findings suggest that this gap largely persists. In our LLM-assisted review of leading journals in the science of well-being, we found that only 18 articles out of 3,094 (~0.6%) explicitly focus on sexuality or sexual well-being (see Table 1 for all titles). Several of these articles productively address relatively negative topics such as sexual risk-taking, violence, abuse, escalation of pornography use, or negative well-being correlates of sex work (n = 6). Another group of articles valuably explores the life experiences of sexual and gender minority groups (n = 8). This is relevant to understanding sexuality, but even these articles largely do not address aspects such as sexual behaviors, motives, desires, or the question of what a ‘good sex life’ would look like. Only 4 articles in total (~0.1% of all articles) directly focused on more positive or neutral topics, such as sexual well-being, mating value, or sexual motives (Gravel et al., 2018; e.g., Štulhofer et al., 2018). While we commend the important contributions of all the authors, we argue that the time has come to broaden the scope and attend more thoroughly to the positive dimensions of human sexuality in the context of well-being research.

Of note, a small additional subset of articles (~0.8% of all reviewed) did reference or touch upon the topic of sex or sexuality, or included relevant samples or variables—for example, in some studies on relationships. This is encouraging, as it indicates that the topic is still being acknowledged and considered in some areas of well-being research. Of course, we did not review other journals (e.g., in relationship science) that do include relevant publications, as listed in the introduction, since our goal here was to understand the representation of sexuality specifically within the fields of positive psychology and well-being science.

Our coding process relied on proprietary LLMs, specifically GPT-4o-mini and Gemini-2.0-flash. This may be viewed as a limitation, as such models are not fully transparent or reproducible and require explicit justification in academic research (Palmer et al., 2024). Our rationale is that these models currently represent the performance frontier for publicly accessible LLMs, making them especially well-suited for complex, nuanced coding tasks. Another potential concern is that LLMs may produce inaccurate or unreliable results. However, research suggests that LLM-based approaches can achieve coding performance comparable to or even better than human coders on a range of tasks (Gilardi et al., 2023; Prinzing et al., 2024; Rathje et al., 2024; Törnberg, 2024). Complex LLM-based systems have also demonstrated exceptional capabilities on large-scale reasoning and research synthesis problems (J. S. Park et al., 2024; Skarlinski et al., 2024). This suggests that, while careful oversight is necessary, high-performing LLMs can be a viable and effective tool for systematic coding in academic research.

The high agreement between our models further underlines the reliability of our coding approach, despite the inherent non-determinism of LLMs. The small systematic differences reflect expected variation in how different models set category boundaries, analogous to human coders having slightly different thresholds. And while our abstract-only analysis could miss peripheral mentions of sexuality in full texts, this approach should appropriately capture papers where sexuality is a substantive focus. Well-written abstracts should reflect a paper’s core topics; if sexuality is absent from the abstract, it is unlikely to be central to the paper’s contribution. A limitation of our review is that the distinction between ‘directly focusing on’ and ‘touching upon’ the topic involves a degree of subjectivity and may be open to interpretation. However, the central conclusion remains clear: sex and sexuality—particularly their positive dimensions—are markedly underrepresented in positive psychology and the science of well-being, which is surprising given the substantial role they play in many people’s lives.

Peterson (2006) speculated that this wide omission might be due to researchers’ discomfort with the topic or the difficulties of obtaining funding. These barriers may still be present. Cultural attitudes, especially in the United States, along with widespread shame around sexuality, likely contribute to the continued silence. Based on terror management theory (TMT), it has even been argued that sexuality can evoke awareness of our own mortality (Goldenberg et al., 1999) due to its deeply embodied, biological, and even animalistic nature (but see Chen et al., 2025). One could speculate that this is another reason why sexuality remains in the psychological shadows.

We propose, in line with others before us, that the fields of positive psychology and well-being science more broadly should pay more attention to the topic of sexuality. Moreover, they should move beyond the question ‘How can we deal with what is going wrong with regard to sex?’ to also ask ‘What does a sex life look like when it goes right?’ (see Dehlendorf et al., 2025; Herbenick et al., 2025; Kleinplatz & Ménard, 2007; Mitchell et al., 2021). A common concern is that focusing on the positive aspects of sexuality could promote risk-taking or socially undesirable behaviors. However, emerging research suggests the opposite: For example, incorporating pleasure as a topic in sexuality education appears to produce what are widely considered positive sexual health outcomes (Klein et al., 2022), such as reducing unprotected sex (Zaneva et al., 2022).

Importantly, investigations into sexual well-being should not only focus on momentary pleasure. Rather, we propose that sexual well-being should be understood as relational, contextual, and sustainable. Mirroring Lomas et al.’s (2025) recent framework for flourishing, we argue that true sexual well-being must be sustainable across multiple dimensions: (a) within the self, (b) between self and others, (c) between self and the environment, and (d) across time. For instance, a person who frequently experiences sexual pleasure but does so at the expense of others—such as by violating others’ boundaries—would not be considered to be sexually flourishing. Similarly, someone whose sexual experiences are occasionally enjoyable—such as through short-term encounters—but who often feels hurt, ghosted, or emotionally disconnected afterward may not experience a sense of sexual well-being that is sustainable over time. As another example, a person who is happy sexually but feels ongoing inner turmoil because their experiences conflict with deeply held religious beliefs or values may also struggle to sustain a sense of sexual well-being within themselves. Finally, also someone who hardly ever has sexual experiences could, in theory, experience high sexual well-being if this is aligned with what feels right to them personally. True sexual flourishing may depend on aligning one’s sexual experiences with integrity, mutuality, and long-term well-being (Myers, 2025).

Why study positive sexuality at all? Because if we focus only on what goes wrong, we risk losing sight of what ‘right’ even looks like. We cannot work toward solutions if we do not know what it is we are working toward. Thus, research into positive sexual well-being may hold significant implications for public health: It could support the development of effective health promotion strategies and policies; and it could provide insights for the design of evidence-based programs, health initiatives, or educational programs that address the various needs of different individuals and communities (e.g., see Mitchell et al., 2021; Rao et al., 2024). This, in turn, could contribute to the promotion of healthier sexual behaviors, sexual justice, reduction of stigma, and enhancement of overall well-being. Moreover, research results can guide resource allocation, thereby optimizing education and therapeutic strategies.

When individuals experience sexual fulfillment and develop skills for communication and self-regulation around sexuality, relationships and families may become more resilient and stable (e.g., H. G. Park et al., 2023). Furthermore, young people who understand what healthy sexual relationships can look like may be better equipped to make informed and values-congruent choices in this realm—potentially mitigating challenges associated with modern sexuality, such as the rise of AI-based intimacy substitutes (Adewale & Muhammad, 2025) or problematic pornography use (Mestre-Bach & Potenza, 2023). By enhancing relationship quality and meaning, and by fostering more holistic forms of well-being, this work could potentially even play a role in addressing declining fertility rates (see Platt & Sterling, 2024) and the prevailing “epidemic of loneliness” (Office of the Surgeon General, 2023).

Importantly, the current negative, risk-focused, superficial, or commercialized view (Booth, 2014) on sexuality might have negative consequences for society and individuals, which a shift in research focus might help mitigate. That is, in a society that shuns sexuality as something shameful, certain harmful behaviors may be more prevalent, including sexual violence or harassment, avoiding accountability, and risky sexual health behaviors (Schneider & Hirsch, 2020; Vance, 1984). The latter might encompass neglecting testing for sexually transmitted infections (STIs), failing to discuss sexual health with partners, and engaging in sexual behavior while intoxicated (Robinson et al., 2002; Scheinfeld, 2021). Furthermore, shame and fear of stigma might lead to poor communication about and during sexual encounters, including expressing feelings, setting expectations, and establishing boundaries (Schooler et al., 2005; Ussher et al., 2017). On a societal level, the emerging research field of positive sexuality (Prior & Williams, 2025; see also Williams et al., 2015) may thus help to contribute to more constructive, respectful conversations around sexuality. What is needed next are directions, definitions, frameworks, guidelines, and formalizations to advance the field of positive sexuality within the context of well-being science, building on prior work by others (Williams et al., 2015)—an endeavor we are currently undertaking and will address in detail in a forthcoming article (Lewis et al., 2025).

Recognizing sexuality as a fundamental aspect of human mental health expands our understanding of what it means to live a full and meaningful life. Without considering sexuality, our models of well-being remain incomplete—they leave out a core part of what it means to be an embodied person. Consistently accounting for sexuality in well-being research, as some researchers have started to do, will strengthen our conceptual foundations. It will also allow us to further explore how this important domain of life relates to physical health, mental health, relationships, and overall quality of life. To study well-being without sexuality is to tell only part of the human story.

Supplementary Material

Python Script
Supplementary Table 1
Final Data Set - All Articles

Acknowledgements

This work was supported by the Eunice Kennedy Shriver National Institute of Child Health and Human Development of the National Institutes of Health under award number R01HD114578 to VUL. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health. We are also grateful to Sabrina Sims, Ethan Coston, Henrik Walter, Scott Barry Kaufman, Kandee Myers, Debby Herbenick, Kirstin Mitchell, Marlene Werner, and Nicole Mikanik for feedback and/or helpful discussions on the topic.

Footnotes

Declaration of interest statement

The authors do not report any conflicts of interest.

Use of artificial intelligence

In addition to the methods involving artificial intelligence (AI) described in the article, ChatGPT-4 (OpenAI, 2023) and ChatGPT-4o (OpenAI, 2024) also served as assistive tools for debugging analysis scripts, drafting specific analysis script or small text sections, and improving language flow. The models also provided reflections on conceptual ideas and recommendations for improving the article classification approach. All AI output underwent rigorous review, editing, and validation by VUL. We acknowledge the inherent limitations and risks associated with AI tools; thus, we have employed a careful and critical approach to leverage this technology responsibly.

Data availability statement

The data supporting these findings and the Python code utilized in this study are available in an online repository (https://osf.io/jr5w2).

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Associated Data

This section collects any data citations, data availability statements, or supplementary materials included in this article.

Supplementary Materials

Python Script
NIHMS2136651-supplement-Python_Script.ipynb (8.8KB, ipynb)
Supplementary Table 1
NIHMS2136651-supplement-Supplementary_Table_1.xlsx (99.1KB, xlsx)
Final Data Set - All Articles
NIHMS2136651-supplement-Final_Data_Set_-_All_Articles.csv (10.2MB, csv)

Data Availability Statement

The data supporting these findings and the Python code utilized in this study are available in an online repository (https://osf.io/jr5w2).

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