Exploring How Christian Women with Sexual Pain and Difficulty Make Sense of Sexual Functioning in Marriage

Female sexual difficulties such as pain and dysfunction occur within a complex biopsychosocial ecosystem that evolves across the lifespan. This qualitative study explored how a large sample of Christian women (N = 629) who have experienced sexual difficulties in marriage construct meaning around key dimensions of their sexual functioning, including sexual satisfaction and desire. Reflexive thematic analysis of open-ended survey responses revealed the multifactorial attributions Christian women make when accounting for stability and change in their sexual functioning over time. Findings indicate that for married Christian women experiencing sexual pain and difficulty, attainment of desired sexual health is shaped by sociocultural, biological, psychological, relational, and situational factors that are frequently overlapping and interdependent. Changes in one partner's health, beliefs, or circumstances may disrupt this biopsychosocial-spiritual ecosystem, thereby enhancing or diminishing women's sexual functioning. Notably, emotionally and spiritually supportive relationships appeared to mitigate the negative effects of diminished functioning. We conclude with recommendations, such as refined assessment tools and timing of interventions, for researchers and practitioners working with women presenting with sexual pain or difficulty, particularly women affected by the Evangelical Purity Movement.