Table 1.

Hierarchical organization of the preliminary framework about SDRSF.

Themes	Subthemes	Codes	Description	Examples quotes
Burning from the inside		Negative emotions	Negative emotional states related to individuals' SDRSF	“Psychological distress associated with a sexual problem or sexual dysfunction.” (R.Q., psychiatrist) “[Is when] I feel bad, I feel anxious, I feel sad, most of the time in relation to my sexual and intimate sphere.” (J.R., clinical psychologist)
		Loneliness	Intensified feelings of isolation and profound loneliness	“[SDRSF] turns out to be something experienced almost in a very lonely way.” (L.D., clinical psychologist) “[people with SDRSF] may feel less supported.” (F.G., clinical psychologist)
Wicked games	Navigation societal norms	Gender scripts	Cultural gender scripts that women and men are compelled to fulfill	“I have to do this [in sexual intercourse] because it is part of my skills as a wife […] woman as a caregiver. [...] “There is all this pressure to men be Latin machos.” (S.M., general practitioner/family doctor)
		Media pressure	Transmission of ideas and beliefs that amplify comparisons and social pressure to conform to a sexual norm	“I do it because everyone does it, but I do not like it.” (G.Z., clinical psychologist) “I feel that I have to have five or six orgasms all in a row.” (J.R., clinical psychologist)
		Internalized sexual stigma	Stigma associated with aspects of sexual activity that individuals internalize as abnormal	“And it was challenging, for example, he had a boyfriend, but the sexual relationship with his boyfriend did not work out well because for him [homosexual men] sex was something filthy, very wrong. [...] “He was clearly in distress, and this came from this issue of internalized homophobia, which nowadays is debated whether it is internalized homophobia or if we are talking about discrimination.” (J.R., clinical psychologist)
	Relational dynamics	Communication difficulties	Challenges in debating and expressing views and experiences related to sexuality in a clear way	“He also did not know how to approach the topic […] so his way of approaching was to leave the lube on the bedside table so that she would realize that he wanted to have sex, and then this had a tremendous impact on the couple […] they were no longer able to communicate with each other.” (J.R., clinical psychologist) “If we do not have clear and conscious communication with the other person, we may also not give them a clear understanding of what we want […], and they will not correspond to what we expect.” (E.S., clinical psychologist)
		Committed relationships' stressors	Experience of SDRSF in individuals in committed relationships	“In the clinical sessions, I realized that these partners are not predisposed to be understanding and collaborate in the psychotherapeutic process.” (T.N., clinical psychologist) “I think that [premature ejaculation] turns out to be a distress for them when they realize that the partner is dissatisfied and when there is pressure from the partner.” (M.V., clinical psychologist)
		Relationships' avoidance	Interference of SDRSF in the possibility of having a committed relationship	“For some people, it can be more facilitating because they don't feel so exposed that there was a situation that did not go well. If they do not go back […] to see that person, they will no longer deal with that anxiety or something that made them feel bad because they won't see that person again. It is as if there could be a relief.” (F.G., clinical psychologist) “This creates a massive barrier in the search to be with someone sexually because they have many difficulties, and then they avoid it.” (I.C., clinical psychologist)
Running up that hill	Levels of sexual function	Sexual function impairment	The levels of existing impairment with sexual function's domains are seen as a risk factor for developing and maintaining SDRSF	“Hypoactive sexual desire”, “genital-pelvic pain” (J.R., clinical psychologist); “dyspareunia”, “sexual pain” (R.Q., psychiatrist); “premature ejaculation”, “vaginismus” (C.Z., general practitioner/family doctor)
	Physical illness	Medical condition	Medical conditions are mentioned as a risk factor for developing and maintaining SDRSF	“Hypertension”, “cardiovascular problems” (I.J., clinical psychologist); “diabetes”, “endometriosis” (J.R., clinical psychologist); “obesity” (L.D., clinical psychologist); “oncological diseases” (S.M., general practitioner/family doctor); “sexually transmitted infections” (F.G., clinical psychologist) “[women with postpartum incontinence] I see them a lot, and there is immense discomfort with themselves and their partners.” (C.Z., general practitioner/family doctor)
	Detrimental psychological factors	Emotional disorders	Psychological and emotional problems mentioned as risk factors for developing and maintaining SDRSF	“Mood disorders.” (I.C., clinical psychologist) “If there is any mental health disorder, if the person has depression or if they have an anxiety disorder, if there is already some pathology, both physical and mental, in reality.” (S.M., general practitioner/family doctor)
		Personality	Personality traits or disorders reported as being associated with SDRSF	“Personality structure”; (T.N., clinical psychologist) “I was thinking here of people who meet the criteria for borderline personality disorder.” (J.R., clinical psychologist)
		Body-disconnection	Negative relationship with one's own body coupled with a limited awareness of personal bodily pleasure preferences	“A non-acceptance of one's own body.” (F.G., clinical psychologist) “When I realize they do not know what they like best [in sexual activity], do not know what kind of practices they prefer [in sexual activity], do not know how to ask how [can] they reach [sexual] satisfaction.” (J.R., clinical psychologist)