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. Author manuscript; available in PMC: 2019 Jul 19.
Published in final edited form as: J Sex Marital Ther. 2019 Mar 12;45(6):497–509. doi: 10.1080/0092623X.2019.1572680

The role of sexual mindfulness in sexual wellbeing, Relational wellbeing, and self-esteem

Chelom E Leavitt a, Eva S Lefkowitz b, Emily A Waterman c
PMCID: PMC6640099  NIHMSID: NIHMS1010765  PMID: 30714489

Abstract

In this study we examine the role of sexual mindfulness in individuals’ sexual satisfaction, relational satisfaction, and self-esteem. Midlife U.S. men and women (N = 194 married, heterosexual individuals; 50.7% female; 94% Caucasian, age range 35–60 years) completed an online survey. More sexually mindful individuals tended to have better self-esteem, be more satisfied with their relationships and, particularly for women, be more satisfied with their sex lives. Some of these associations occurred even after controlling for trait mindfulness. These findings may also allow researchers and therapists to better address an individual’s sexual wellbeing, relational wellbeing, and self-esteem by teaching sexual mindfulness skills.

Maintaining a satisfying romantic relationship and sex life contributes to physical and mental wellbeing. Researchers have examined the role of trait mindfulness in enhancing healthy sexual relationships through greater intimacy (Lucas, 2012; McCarthy & Metz, 2008) and diminished cognitive distraction (Newcombe & Weaver, 2016), which may contribute to healthy relationships and wellbeing (Yeh, Lorenz, Wickrama, Conger, & Elder 2006).

Despite past research on trait mindfulness and romantic and sexual relationships, little work has considered sexual mindfulness, a sub-type of state mindfulness, which may be more closely tied to relationships. Practicing sexual mindfulness – that is, remaining mindful during sex in particular, a context that is often high in anxiety (Barnes, Brown, Krusemark, Campbell, & Rogge, 2007) – may require greater application of attention and nonjudgment than practicing mindfulness in other less stressful settings. For example, being mindful while practicing yoga is quite different from maintaining mindfulness while having sex (Kleinplatz et al., 2018).

In the current study, we consider the contribution of sexual mindfulness to midlife adults’ sexual wellbeing, relational wellbeing, and self-esteem beyond the contribution of trait mindfulness. Trait mindfulness may be necessary but not sufficient for achieving mindfulness during sexual experiences. Individuals who are mindful in their daily routine may experience obstacles to mindfulness during sexual experiences, such as being overly goal-oriented, self-critical, or sexually anxious (Barnes et al., 2007; Rowland, Cempel, & Tempel, 2018). Consequently, in contrast to other researchers who focus solely on trait mindfulness (e.g. Khaddouma, Gordon, & Bolden, 2015; Newcombe & Weaver, 2016; Pepping, Cronin, Lyons, & Caldwell, 2018), we examine sexual mindfulness. Understanding the association of sexual mindfulness with sexual wellbeing, relational wellbeing, and self-esteem above and beyond the association with trait mindfulness could provide important information to intervention designers and relationship and sex therapists working with individuals and couples.

Sexual mindfulness and sexual wellbeing

Although prior work has established associations between mindfulness and relational satisfaction (e.g., Atkinson, 2013; Davis & Hayes, 2011), researchers have only begun to examine mindfulness during sex. In fact, satisfaction within a romantic and a sexual relationship are interrelated and bidirectional, and thus, we would expect that mindfulness may be important for sexual wellbeing in general, and sexual satisfaction in particular. Most researchers have considered the role of trait mindfulness in relational and sexual outcomes (e.g. Khaddouma, Gordon, & Bolden, 2015; Newcombe & Weaver, 2016; Pepping, Cronin, Lyons, & Caldwell, 2018), rather than considering sexual mindfulness in particular. Research demonstrates that trait mindfulness may help alleviate cognitive interference during sex (Newcombe & Weaver, 2016) and is associated with less exaggerated or suppressed sexual concerns or behaviors (Pepping et al., 2018). One reason mindfulness may contribute to healthy sexual outcomes is that being more aware of the present enables better emotion regulation and more intentional behavior (Karremans, Schellekens, & Kappen, 2017). Thus, we expect that individual’s sexual mindfulness will be associated with sexual satisfaction.

Sexual mindfulness and relational wellbeing

Sexual experiences play an important role in individuals’ relational wellbeing (Ein-Dor & Hirschberger, 2012; McNulty, Wenner, & Fisher, 2016; Yeh et al., 2006), and being attentive to physical sensation and one’s partner can directly enhance the sexual and the romantic relationship (McNulty et al., 2016). Mindfulness skills encourage individuals to observe their thoughts and feelings without immediately reacting, which may be one mechanism for how mindfulness contributes not only to sexual satisfaction but also to relational satisfaction (Boorstein, 1996; Karremans et al., 2017). Individuals who are mindful in their relationships are generally more satisfied with their relationships and experience less relationship stress (Barnes et al., 2007; Davis & Hayes, 2011; Karremans et al., 2017). Therefore, we expect that sexual mindfulness will be associated with relational satisfaction.

Sexual mindfulness and Self-Esteem

Self-esteem contributes to sexual (Sánchez-Fuentes, Santos-Iglesias, & Sierra, 2014) and relational wellbeing (Erol & Orth, 2017; Neyer & Asendorpf, 2001). Trait mindfulness helps people process social interactions, which may lead to more positive self-evaluations (Brown et al., 2007). Sexual mindfulness may uniquely contribute to self-esteem because individuals are often self-critical in a sexual context, which increases their anxiety (Davison & McCabe, 2005; Wiederman, 2000). Thus, we expect sexual mindfulness to be associated with self-esteem.

The role of age, Gender, and marital length in sexual mindfulness

In the current study, we account for demographic factors that may be associated with sexual mindfulness, sexual wellbeing, relational wellbeing, and/or self-esteem. In regard to age, we examine associations of sexual mindfulness during midlife (ages 35 to 60 years), given that it is a particularly demanding, understudied and unique period (Lachman, Teshale, & Agrigoroaei, 2015), when some sexual problems may increase (e.g. Laumann, Paik, & Rosen, 1999; Waite, Laumann, Das, & Schumm, 2009). Trait mindfulness increases with age (Splevins, Smith, & Simpson, 2009), but less is known about sexual mindfulness. Thus, we control for age.

Like age, gender influences heterosexual sexual interactions through gender-specific norms, and thus, men and women may experience sexual mindfulness differently. Women may be less sexually mindful given less awareness of their physical arousal and more focus on their partner’s pleasure compared to men (Chivers, Seto, Lalumiere, Laan, & Grimbos, 2010; Sanchez, Kiefer, & Ybarra, 2006). On the other hand, men may be less sexually mindful due to pressure to be sexually assertive (Siann, 2013; Waite et al., 2009). Thus, we examine differential associations between sexual mindfulness and men’s and women’s sexual wellbeing, relational wellbeing, and self-esteem.

In terms of marital length, research has suggested a curvilinear association between marital length and relational satisfaction (VanLaningham, Johnson, & Amato, 2001). Couples may experience faster decline in sexual and relational satisfaction earlier and less decline later in marriage (McNulty et al., 2016). Therefore, we control for marital length.

The present study

In the present study, we examine the association of sexual mindfulness with sexual wellbeing, relational wellbeing, and self-esteem, above and beyond the association with trait mindfulness, and whether these associations differ by gender, controlling for age, gender, and marital length. We predict that sexual mindfulness will be associated with sexual satisfaction, relational satisfaction, and self-esteem above and beyond associations with trait mindfulness (Research Question 1 [Hypothesis 1/H1]). Because past work is not conclusive, we explore differential associations between sexual mindfulness and wellbeing by gender, without specific predictions (Research Question 2 [RQ 2]).

Method

Participants and procedures

Midlife men and women (N=320 married, heterosexual individuals) accepted invitations to participate in a study about committed relationships and sexuality. The study invitation explained that participants must be married, ages 35–60, and heterosexual. The invitation included a survey link on the authors’ and colleagues’ Facebook pages. Some participants were recruited through similar paid advertisements on Facebook. In addition, through snowball sampling, individuals who completed the survey could share the survey with others. Participation was voluntary and required informed consent. As incentive, participants could enter their name in a drawing for one of four $50 gift certificates. Screening questions asked if the participant was in the target age range of 35–60, heterosexual, married for at least 2 years, not pregnant (we included this criterion to avoid sexual complications related to pregnancy), lived in the U.S., and spoke English. Despite these screening questions, four participants who completed the survey reported ages outside the target range and we therefore excluded them from analyses. Because not all participants answered all questions, data on key variables were missing for some participants, resulting in an analytic sample of 194 participants. Rates of missing data were higher on questions about sexual behavior.

Analytic sample participants ranged in age from 35 to 60 years old (M=45.3, SD=6.01). Ninety-four percent of participants were European American. Approximately half of the participants were female (50.7%); 79.9% of participants reported being Christian, 4.4% Jewish, 2.3% another religion (Hindu, Muslim, and Pagan), and 13.4% reported not being religious. Individuals reported their household income in the following categories: less than $30,000 (2.3%), $30,000 to $60,000 (9.8%), $60,001 to $120,000 (35.7%), and over $120,000 (52.2%). Approximately 26% of participants reported children 5 years old and under living in the house, 88% reported children 6 to 17 years old living in the house, and 34% reported children 18 or older living in the house. When asked to rate their general health, 82.6% of participants rated their health as quite good or very good, 14.4% as neither good nor poor, and 3.0% as quite poor or very poor. Ratings of partner’s health were similar, with 79.9% as very good or quite good, 16.1% as neither good nor poor, and 4.0% as quite poor or very poor. Participants reported being married between 2 and 42 years and the average reported marriage length was 18.4 years (SD=8.7).

We tested for differences between the analytic sample (N=194) and participants excluded from analyses due to missing data (N=122) using independent t-tests of age, income, marriage length, number of children in the household, health, and relationship satisfaction. The groups only differed on relationship satisfaction, with participants in the analytic sample more satisfied than participants not in the analytic sample, t(296) = 1.01, p<05. The groups also did not differ by gender, χ2 < .03, p > .05.

Measures

Trait mindfulness

The Five Facet Mindfulness Questionnaire (FFMQ, Baer et al., 2008) is a previously validated 39-item scale that measures five factors of mindfulness. The FFMQ included questions such as “I pay attention to sounds such as clocks ticking, birds chirping or cars passing.” Participants responded using a 5-point scale ranging from 1 (never or rarely true) to 5 (very often or always true). Reliability in the current sample was acceptable (αs = .94 women, .91 men).

The Mindful Attention Awareness Scale (MAAS, Brown & Ryan, 2003) contains 15 items and is a previously validated one-factor measure of mindfulness. The MAAS included questions such as “I do jobs or tasks automatically, without being aware of what I’m doing.” Participants respond using a 6-point scale ranging from 1 (almost always) to 6 (never). The MAAS demonstrated acceptable reliability in this sample (α = .87 women, .79 men).

Sexual mindfulness measure

We developed the Sexual Mindfulness Measure (SMM) based on the FFMQ (Baer et al., 2008) and using similar wording, but specifically focused on mindfulness within a sexual experience. Each item corresponds to a respective item in the FFMQ, with new wording focused on sexual experiences. For instance, the SMM item “I pay attention to sexual sensations” is based on the FFMQ item “I pay attention to sensations, such as the wind in my hair or sun on my face” and the SMM item “I pay attention to my emotions during sex” is based on the FFMQ item “I pay attention to how my emotions affect my thoughts and behaviors.” Participants respond using a 5-point scale ranging from 1 (never or rarely true) to 5 (very often or always true). We began with 28 items and performed exploratory factor analysis using Promax rotation with Kaiser normalization (Matsunaga, 2010) to allow for realistic occurrence of some correlation in factors. The rotations converged in three iterations and indicated two strong factors for sexual mindfulness: awareness and non-judgment of experience. We then constrained the items to load onto two factors. We eliminated items that had crossloadings above .20 on both factors and used a minimum loading threshold of .55.

To examine model fit, we used a Structural Equation Model (SEM) to measure the strength of each loading separately by gender, age group (35–48 years old and 49–60 years old), and length of marriage (married < 10 years and married ≥ 10 years). Seven items contributed to the model and had strong loadings, with acceptable model fit (χ2 = 40.816, p = .056; RMSEA = .038, CFI = .956), and comparable model fit when we constrained the estimate paths to be equal across gender, age, or length of marriage. The final measure included two subscales: awareness (4 items) non-judgement of experience (3 items).

The reliability of the SMM was acceptable (awareness αs = .78 women, .71 men; non-judgment of experience αs = .74 women, .70 men). We further considered reliability among sub-groups by calculating alpha separately by gender, age group, and length of marriage. Alphas for each gender, age, and marriage length category indicated acceptable reliability in all sub-groups (αs = .69 to .81).

To test for convergent validity, we performed correlations between the two SMM factors and two measures of trait mindfulness, the FFMQ and the MAAS. The SMM observation factor was correlated with the FFMQ observe and describe factors. The SMM factor of non-judgment of experience was correlated with the MAAS, and the FFMQ describe, aware, non-judgement, and non-reactivity factors. Overall, these correlations were small to moderate, in the range of r = .02 to .49. Thus, there is evidence that the SMM factors are associated with but also distinct from trait mindfulness. The correlation matrix and the full measure are available from the authors on request.

Sexual satisfaction

The New Sexual Satisfaction Scale (NSSS, Štulhofer, Buško, & Brouillard, 2010) is a 12-item previously validated measure of how satisfied an individual is with his/her sexual experiences. The stem question for all items is “Thinking about your sex life during the last six months, please rate your satisfaction with the following aspects.” An example item is “The quality of my orgasms.” Participants respond using a 5-point scale from 1 (not at all satisfied) to 5 (extremely satisfied). Reliability in the current sample was good (αs=.94 women, .91 men).

Relational satisfaction

The Couple Satisfaction Index (CSI, Funk & Rogge, 2007) is a 4-item measure previously validated to assess individual satisfaction within relationships. Scales vary by item. An example question is “Please indicate the degree of happiness, all things considered, in your relationship.” This question uses a 7-point scale, from 0 (extremely unhappy) to 6 (perfect). The CSI demonstrated acceptable reliability (αs=.82 women, .79 men).

Self-Esteem

The Rosenberg Self-Esteem scale (RSE, Rosenberg, 1979) is a 10-item previously validated scale designed to measure self-esteem. An example question is “On the whole, I am satisfied with myself.” Participants answer on a 4-point scale ranging from 1 (strongly agree) to 4 (strongly disagree). The reliability of the RSE was acceptable (αs = .92 women, .89 men).

Analytic plan

As a preliminary step, we performed correlations, separately by gender, to consider bivariate associations between all variables. To examine associations of sexual mindfulness with sexual satisfaction, relational satisfaction, and self-esteem, and whether the association of sexual mindfulness with these constructs existed above and beyond their association with trait mindfulness, we performed three hierarchal regressions. In Step 1, we entered three control variables: age, gender, and marital length. In Step 2, we entered trait mindfulness. In Step 3, to test H1, we entered the two factors of sexual mindfulness: awareness and non-judgment of experience. In Step 4, to test RQ2, we added two interaction terms of gender with each of the sexual mindfulness factors. To follow up any significant interactions, we ran the same regressions separately by gender, dropping gender and the interaction terms.

Results

Descriptive statistics

Table 1 presents correlations between all variables. Neither trait mindfulness nor sexual mindfulness differed by gender or by age. However, in regard to sexual mindfulness, individuals who had been married for less time reported being more aware during sex. The non-judgement aspect of sexual mindfulness was not significantly associated with marital length.

Table 1.

Correlations of study variables by gender.

1 2 3 4 5 6 7 8
1. SMM Aware 1.00 24* .20* −.26** −.23* .03 .36** .04
2. SMM Non-judgement .06 1.00 .46** .08 −.04 .19 .35** .24*
3. Trait Mindfulness .35* .28** 1.00 −.07 −.16 .13 .33** .15
4. Age .00 .05 −.05 1.00 .67** .04 .03 .04
5. Marital Length −.07 −.04 −.05 .65* 1.00 .00 .02 20
6. Relational Satisfaction −.09 .18 .01 −.11 −.04 1.00 .48** .03
7. Sexual Satisfaction .01 .27** .13 −.10 .06 .62** 1.00 .10
8. Self-Esteem .00 .39** .24* −.03 −.09 .40** .17 1.00
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Note: Correlations for women are above the diagonal; correlations for men are below the diagonal.

*

p < .05.

**

p < .01

N = 92–99.

Hypothesis testing

Table 2 presents the results of the three hierarchal regressions. In the relational satisfaction model (Model 1, see Table 2), although Step 3 was not significant, the change in R2 for Step 3 was significant, indicating that the addition of sexual mindfulness explained variance in sexual satisfaction above and beyond trait mindfulness. In support of H1, individuals who were more sexually mindful in non-judging ways were more satisfied with their relationships. In addition, sexual mindfulness was correlated with relational satisfaction at the bivariate level (see Table 1). The interaction terms in Step 4 were not significant.

Table 2.

Regressions predicting wellbeing from sexual mindfulness above and beyond trait mindfulness.

B(SE) β R2 Δ R2
Model 1: Relational satisfaction .00 –
Step 1
 Age −.02 (.06) −.03
 Gender .39 (.62) .05
 Marital length .00 (.05) .00
Step 2 .01 .00
 Age −.02 (.06) −.03
 Gender .41 (.63) .05
 Marital length .00 (.05) .01
 FFMQ .13 (.15) .07
Step 3 .04 .03*
 Age −.04 (.06) −.07
 Gender .32 (.62) .04
 Marital length .01 (.05) .02
 FFMQ .03 (.16) .01
 SMM awareness −.41 (.41) −.08
 SMM non-judgment of experience 1.07 (.44) .19*
Step 4 .04 .00
 Age −.04 (.06) −.06
 Gender .33 (.62) .04
 Marital length .01 (.05) .02
 FFMQ .04 (.17) .02
 SMM awareness .39 (1.29) .07
 SMM non-judgment of experience .95 (1.28) .17
 Gender* SMM awareness −.53 (.81) −16
 Gender* SMM non-judgment of experience .06 (.85) .01
Model 2: Sexual satisfaction .01 –
Step 1
 Age −.01 (.01) −.10
 Gender −.18 (.12) −.11
 Marital length .01 (.01) .11
Step 2 .06*** .06***
 Age −.01 (.01) −.10
 Gender −.16 (.12) −.10
 Marital length .01 (.01) .14
 FFMQ .09 (.03) .24***
Step 3 .11*** .06**
 Age −.02 (.01) .13
 Gender −.19 (.11) −.12
 Marital length .02 (.01) .17
 FFMQ .05 (.03) .12
 SMM awareness .11 (.08) .10
 SMM non-judgment of experience .27 (.08) .25**
Step 4
 Age −.01 (.01) −.11 .13*** .03
 Gender −.18 (.11) −.11
 Marital length .02 (.01) .17
 FFMQ .06 (.03) .15
 SMM awareness .64 (.23) .63**
 SMM non-judgment of experience .16 (23) .15
 Gender*SMM awareness −.36 (.15) −.93*
 Gender*SMM non-judgement of experience .06 (.15) .17
Model 3: Self-Esteem
Step 1
 Age .00 (.00) −.08 .01 –
 Gender −.01 (.03) −.03
 Marital length .00 (.00) .12
Step 2 .05 .04**
 Age .00 (.00)
 Gender −.01 (.03)
 Marital length .00 (.00)
 FFMQ .02(.01) .20**
Step 3 .12*** .07***
 Age −.01 (.00) −.14
 Gender −.02 (.03) −.04
 Marital length .00 (.00) .18
 FFMQ .01(.01) .11
 SMM awareness −.02(.02) .05
 SMM non-judgment of experience .08(.02) .29***
Step 4
 Age .00 (.00) −.14 .13*** .01
 Gender −.02 (.03) −.04
 Marital length .00 (.00) .18
 FFMQ .01 (.01) .11
 SMM awareness .00 (.06) .02
 SMM non-judgment of experience −.01 (.06) −.03
 Gender* SMM awareness −.01 (.04) −.07
 Gender* SMM non-judgment of experience .07 (.04) .33
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N=187–190 due to missing data.

*

p < .05.

**

p < .01.

***

p < .001.

In the sexual satisfaction model (Model 2, see Table 2), in support of H1, the change in R2 for Step 3 was significant, indicating that the addition of sexual mindfulness explained variance in sexual satisfaction above and beyond trait mindfulness. Specifically, individuals who were more sexually mindful in being non-judging reported being more satisfied with their relationships. Although the change in R2 for Step 4 was not significant (p = .055), the interaction between gender and the awareness factor of sexual mindfulness was significant, which we report, because, as some argue, it may be difficult to detect interaction effects in regression models (Jaccard & Wan, 1995; McClelland & Judd, 1993). The follow up regressions performed separately by gender indicated that the association between the awareness factor of sexual mindfulness and sexual satisfaction was not significant for men (β = −.03; p>0.05), but was for women (β = .28; p<0.01; see Figure 1). Specifically, women who practiced more sexual mindfulness through awareness were more satisfied with their sex lives than women who were less sexually mindful, but this association was not significant for men.

Figure 1.

Figure 1.

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The interaction of gender and the sexual mindfulness factor awareness.

In the self-esteem model (Model 3, see Table 2), in support of H1, the change in R2 for Step 3 was significant, indicating that the addition of sexual mindfulness explained variance in self-esteem above and beyond trait mindfulness. Specifically, individuals who were more sexually mindful in being non-judging reported better self-esteem. The interaction terms in Step 4 were not significant.

Discussion

In the current paper, more sexually mindful midlife adults were more satisfied with their relationships and sex lives, and had better self-esteem. In some cases, the sexual mindfulness association was above and beyond the association with trait mindfulness. In addition, the association between sexual mindfulness and sexual satisfaction differed by gender. These results suggest that mindful awareness during sex may play a more important role in women’s sexual satisfaction than it plays in men’s sexual satisfaction. These findings may also allow researchers and therapists to better address an individual’s sexual wellbeing, relational wellbeing, and self-esteem by teaching sexual mindfulness skills.

Limited prior work has shown that improving women’s trait mindfulness leads to improved sexual functioning (Brotto et al., 2012; Mize, 2015; Stephenson & Kerth, 2017). In addition, we know that anxiety affects sexual arousal and functioning (Hofmann, Sawyer, Witt, & Oh., 2010; Kabat-Zinn, 1994). In the current study, more sexually mindful individuals were more satisfied with their sex lives, and this association remained above and beyond associations with trait mindfulness. Thus, the current study suggested that not only generalized trait mindfulness, but the ability to be mindful in a sexual context, may contribute to sexual satisfaction. That is, the ability to avoid judging oneself or one’s partner is uniquely associated with sexual wellbeing. Sexual mindfulness may be particularly useful in midlife populations in dealing with sexual issues, such as erectile dysfunction and female arousal problems (Leavitt & Lefkowitz, 2018; Rosenbaum, 2013), which become particularly salient during midlife (Laumann et al., 1999). Engaging in mindfulness may address some of the anxiety that can interfere with positive sexual experience (Barnes et al., 2007; Brown & Ryan, 2003). Therefore, therapists may use sexual mindfulness to help clients who feel dissatisfied with their sex lives. Although sexual mindfulness is somewhat similar to sensate focus (Weiner & Avery-Clark, 2014), an exercise of touching and being touched by a partner, one important distinction is that sexual mindfulness does not require a partner’s participation (Brotto, 2013). Thus, individuals could use sexual mindfulness to practice a focus on breathing during sex, awareness of sexual sensation, and letting go of self-judgment during sexual experiences without the buy in of a partner. Sexual mindfulness creates an added freedom and ability for the individual to independently address his or her sexual experience, which could provide a greater sense of self-efficacy.

More previous research has considered the association between trait mindfulness and relational satisfaction, demonstrating that more mindful individuals are more satisfied with their relationships (Barnes et al., 2007; Carson, Carson, Gil, & Baucom 2004; Davis & Hayes, 2011). In the current study we found that more sexually mindful individuals were more satisfied with their relationships, and relational satisfaction did not vary by trait mindfulness. It is not clear why we did not replicate prior studies that found associations between trait mindfulness and relational satisfaction. Future work should consider the individual and contextual factors that may moderate whether different types of mindfulness are associated with relational satisfaction. We did, however, demonstrate that sexual mindfulness is associated with relational satisfaction. The practice of slowing down thoughts and responses may provide individuals with time to better process interactions and respond more intentionally, which allows for more positive connections (Boorstein, 1996). One mechanism that may explain this association is that remaining non-judgmental during sex may reduce stress in the overall relationship, leading to improved satisfaction within the relationship. Future research should consider the potential mechanisms of this association and should further examine the role of trait and sexual mindfulness within midlife relationships.

Past research has shown a positive association between trait mindfulness and self-esteem (Brown & Ryan, 2003; Brown et al., 2007; Heppner & Kernis, 2007). The current study replicated this finding and further found that more sexually mindful individuals tended to have better self-esteem, even after accounting for the association with trait mindfulness. Given that self-esteem is not a sex-specific indicator of wellbeing, this finding suggests that sexual mindfulness may matter for more general aspects of wellbeing. The ability to be non-judgmental during a sexual experience may be particularly important to wellbeing because the heightened anxiety of sexual situations requires an additional level of skill in mindfulness in a sexual context (Rowland et al., 2018). Given that when individuals have high self-esteem, they better manage negative emotions and performance anxiety (Bajaj, Robins, & Pande, 2016), it is possible that this improved coping with negativity during sex could lead to more sexual mindfulness. Consequently, therapists may consider exploring whether sexual issues contribute to the challenges of clients struggling with self-esteem, and whether increased awareness and non-judgment in sexual contexts may help the client’s self-esteem.

There was limited evidence of gender differences in the importance of being mindful during a sexual experience for wellbeing. To our knowledge, prior work on associations between mindfulness and sexual satisfaction have been limited to women, although some researchers and therapists have suggested that mindfulness may help men with erectile dysfunction (Baker & Absenger, 2013; McCarthy & Metz, 2008). In the current study, although sexual mindfulness was not associated with sexual satisfaction for men, more sexually mindful women were more satisfied with their sex lives. These gender differences may be due to differential socialization of men and women (Brotto & Barker, 2014; Sanchez et al., 2006; Siann, 2013). For instance, women may benefit more from sexual mindfulness than men because sexual mindfulness helps women to overcome the socialized tendency to pay attention to their partner’s pleasure more than their own pleasure (Brotto & Barker, 2014; Sanchez et al., 2006). Therapists should consider exploring women’s ability to remain aware of their own pleasure and arousal rather than only focusing on their partner’s pleasure.

Limitations and future directions

This study has several limitations. First, we used online self-report measures through convenience and snowball sampling. Thus, the sample was not demographically representative of the U.S. (Szolnoki & Hoffmann, 2013) on a number of dimensions. Our sample included midlife adults who were heterosexual, married, predominantly White, high SES, physically healthy, and generally satisfied in their relationships. These findings may not be generalizable to more diverse samples that include couples in early and later adulthood, LGBTQ individuals, cohabiting individuals, racially/ethnically diverse couples, or couples with additional stressors such as lower SES, poor health, or higher conflict in their relationship. Future research should use more representative samples. Additionally, the sample was somewhat small and therefore we may not have had the power to detect small effect sizes. Future research should include larger samples to ensure adequate power in detecting the effects of sexual mindfulness. Second, our sample included only one person per relationship, but future research could collect couple-level data. Given that sex is a partnered activity, individuals’ mindfulness may also be associated with their partner’s sexual wellbeing, relational wellbeing, and self-esteem. Researchers could use dyadic data to examine associations of the individuals’ sexual mindfulness and their wellbeing, and their partners’ sexual mindfulness and the individuals’ wellbeing.

Third, this research was cross-sectional and therefore cannot determine causal effects. Future research should consider longitudinal methods and the use of sexual mindfulness in interventions. Researchers could train couples in sexual mindfulness and evaluate the long term effects of this training, which would inform our understanding of the temporal ordering of associations of sexual mindfulness with sexual wellbeing, relational wellbeing, and self-esteem. Interventions could provide evidence of a causal effect of sexual mindfulness on these outcomes.

Finally, individuals trained in mindfulness may be more aware of their sexual arousal and desire, and feel less sexual distress (Brotto & Basson, 2014; Brotto et al., 2012). The participants in this study were not experienced meditators and may have rated themselves higher in mindfulness than individuals more familiar with mindfulness. Future research may consider how experienced meditators differ from individuals who evaluate their mindfulness levels without a knowledgeable understanding of a mindfulness practice. Assessing mindfulness among individuals with limited experience in meditation measures awareness of daily mindfulness skills rather than the more transformative form of meditative mindfulness (Baer et al., 2008).

Conclusion

Sexual mindfulness plays an important role in sexual wellbeing, relational wellbeing, and self-esteem for midlife men and women. Our findings suggest that therapists should consider helping clients develop skills in mindfulness during sexual experiences. Maintaining mindfulness within a sexual experience may not be as simple as improving mindfulness skills within a daily context, but instead may require a more specific focus on mindfulness in sexual situations. These sex-specific mindfulness skills may contribute to wellbeing beyond general mindfulness skills. Although achieving mindfulness in sexual situations may present more challenges than everyday mindfulness, it may be more malleable than trait mindfulness. For instance, some scholars suggest that one can encourage mindfulness by simply suggesting a new perspective in approaching a common problem (Langer, 2000). Similarly, sexual mindfulness may reach a similar goal by teaching individuals how to approach the sexual experience with greater awareness and less judgement. Sexual mindfulness provides a skill that individuals can develop without a partner’s participation and may help address the client’s struggle with sexual wellbeing, relational wellbeing, and self-esteem.

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