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Abstract

Sexual script theory posits that sexual behaviour is socially scripted. As such, individuals and couples may develop a sexual script that guides their typical sexual routine. People may differ in the content of their sexual scripts, and in their ability to change their typical script in response to sexual challenges (e.g., low sexual desire, orgasm difficulties, pain during sex). The ability to adapt sexual scripts is known as sexual script flexibility, which has been associated with improved sexual health outcomes in community and clinical samples (e.g., greater sexual satisfaction and sexual desire). Although sexual activity often occurs between two people, little research has investigated associations between sexual script flexibility and sexual health outcomes in couples. Additionally, the current measure of sexual script flexibility requires revision to be used with couples. In Chapter 1, I introduce sexual script theory, sexual script flexibility, and sexual wellbeing amongst couples. In Chapter 2, I developed and tested the validity and reliability of a dyadic version of the SexFlex Scale adapted for couples (SexFlex Scale-Dyadic; SFS-D), finding evidence for adequate validity and strong reliability. I used the SFS-D with community couples and found using multilevel modelling that individuals’ greater sexual script flexibility at baseline was associated with their own greater dyadic sexual desire for a partner at baseline and their own lower sexual function problem distress 4 months later. No partner effects were found. In Chapter 3, I used the SFS-D to test associations between sexual script flexibility and sexual health outcomes in a clinical sample of couples coping with vulvar lichen sclerosus (VLS), an inflammatory skin disease associated with poor sexual health outcomes. Using multilevel modelling I found that for women and individuals with VLS, greater sexual script flexibility was associated with better sexual function, greater sexual satisfaction, and lower sexual distress. Partners’ greater sexual script flexibility was associated with their own better sexual function at baseline, and greater sexual distress at follow-up for women and individuals with VLS. In Chapter 4, I discussed the study results within the context of broader literature on couples’ sexual health, and explored limitations and future directions.