The sexual health and psychosocial well-being in Chinese adult women of diverse sexual identities : a mixed-method study

Abstract

Existing sex research has disproportionately relied on the mainstream cisgender heterosexual population or male sexual minorities, leading to an inadequate or ambiguous understanding of sexual and gender minority women (SGMW). Health disparities among sexual minorities have been extensively studied in Western populations; however, such knowledge is still lacking in less sexually permissive cultures such as China, particularly among the more invisible SGMW. Therefore, this study aimed to 1) systematically review the holistic health of Chinese homosexual and bisexual adults; 2) culturally adapt the new sexual satisfaction scale and validate the adapted female sexual function index; 3) comprehensively investigate the sexual health and psychosocial well-being among Chinese adult women, and make comparisons between cisgender heterosexual women (CHW) and SGMW; 4) exploratively examine the in-depth relationships between sexual identity and quality of life and sleep quality; and 5) reflexively understand the perceptions and experiences of sexuality and sexual health among women with diverse sexual identities. A systematic scoping review was first conducted, with a total of 2,879 references included in the final analysis, indicating that previous research focused more on male than female sexual minorities, thereby emphasizing the high demand for investigations centered on sexual minority women. A cross-sectional sequential mixed methods study was then performed on this population using convenience and respondent-driven sampling methods. The final sample size of the online survey was 509, comprising 250 CHW and 259 SGMW. Validation of the two measures indicated that both could be used as reliable and appropriate instruments in a diverse female population. Regarding psychosocial well-being, SGMW reported significantly lower levels of self-esteem, sleep quality, social support, and quality of life than CHW, along with higher levels of depressive and anxiety symptoms than CHW. Concerning sexual health, SGMW reported significantly lower levels of sexual satisfaction and positive sexuality than CHW, although there were no significant differences in the total score of sexual function. Furthermore, mental health and social support were indicated to play important roles in the relationship between sexual identity and sleep quality, respectively. In-depth interviews were conducted with 33 participants recruited from survey respondents expressing willingness to participate. The reflexive thematic analysis involving a six-phase process was adopted. The overarching themes identified were 1) the long-standing invisibility of women’s sexuality remains but is changing; 2) subtle relationships between diverse sexual identities and varied sexual practices; 3) bond between female sexual function and sense of self-worth; and 4) disparities in the awareness and practice of safer sex. These themes underscore the crucial role of sexual identity in the articulation and experiences of women’s sexuality and sexual health. This is the first study to comprehensively investigate the psychosocial well-being and sexual health of Chinese women with diverse sexual identities, and the first to conduct comparisons between SGMW and CHW. The results reveal concerning health disparities for SGMW and underscore the urgent need for increased healthcare attention and social services for this vulnerable group. Future efforts should focus on conducting longitudinal studies and implementing evidence-based intervention programs to address the unique needs of SGMW.