The Good (Sex) Life: Toward a Fulfilling Sexual Well-Being Model

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What are the ingredients for emotional connection during sexual activity (e.g., Blumenstock et al., 2020; Štulhover et al., 2014)? Can we move away from the black-and-white, good-or-bad perspectives and investigate the nuances of how casual sex impacts partners’ mental health (e.g., Kaestle & Evans, 2018)? How can partners in monogamous marriages and long-term relationships not only keep their sexual spark for one another burning (e.g., Mark & Lasslo, 2018), but thriving (e.g., Ménard et al., 2015)? These are all examples of the kinds of conversations that emerge when one applies a green-cape lens, rather than a red-cape lens, to human sexuality studies. 

To understand the distinction between the red- and green-cape approaches, imagine that you have two magical capes in front of you. One cape is red, and the other is green. Putting on the red cape endows you with the power to combat all that is bad in the world. Putting on the green cape grants the power to create, grow, and multiply all that is good in the world. Which cape would you choose? Please take a few minutes to contemplate this question, and if anyone is around you, I encourage you to discuss this question.

Some of you may be familiar with James Pawelski’s (2016) thought experiment. The point behind it is to demonstrate the importance of both red- and green-cape approaches in life. If we view the world too narrowly with either a green- or red-caped lens, we are missing something very important. In most areas of inquiry, scholars have historically overfocused on viewing the world through a red-cape lens (Crowell et al., 2018). One of positive psychology’s signature contributions as a field is its emphasis on viewing the world through a green-caped lens and contributing green-cape strategies to the world. This is not because red-cape approaches are not also important, but because the equally crucial green-cape strategies typically get overlooked.

Today, few areas of work could benefit more from a green-cape makeover than human sexuality studies (Anderson, 2013). Despite a hopeful rise in articles slapping the label, “positive sexuality,” onto their titles (e.g., Coleman et al., 2018), less than 1 in 20 articles focused on sexual issues today emphasize green-cape aspects of or approaches to sexuality (Crowell et al., 2018). This is especially true of studies about people of color and other minority populations. Research highlighting marginalized populations overwhelmingly focuses on red-cape issues (Crowell et al., 2018), which causes much harm to the very communities that authors aim to support (Vaughan & Rodriguez, 2014). I am tempted to write more about how big of an issue this is, but that would be for a red-cape article, and this is a green-cape article.

There are numerous areas of research in dire need of more green-cape attention. The items listed in the intro to this article are just a fraction of them. Perhaps the most basic green-cape question of all, however, looks something like this: What does it mean to sexually thrive? If one wanted to capture the meaning of a healthful and flourishing sexual life, what, precisely, would that look like? What are the ingredients of the good life when it comes to one’s sex life? As it stands, the literature currently lacks a detailed, thorough review of what sexual thriving truly means. Due to this gap, articles that reference sexual well-being typically rely on very simplistic models (e.g., Dawson et al., 2022; Vaillancourt-Morell et al., 2017) if they rely on any at all. 

Why is it important to have good models of sexual well-being? To name just a few reasons, such a model can provide more targeted treatment goals for psychotherapists addressing sexual matters with their clients, empower individuals and their partners with tools they can use to learn more about their own sexual needs and desires, and inform relevant public policy. One might think that such work would primarily benefit people who are already relatively sexually healthy, but in fact, history has taught us that putting on the green cape tends to be even more helpful for depressed, anxious, and otherwise more clinical populations than it does for the general populous (Chakhssi et al., 2018). The same is likely true when it comes to sexuality. A more thorough, detailed understanding of sexual well-being may provide a critical advantage to treatment approaches that target sexual trauma (e.g., Baggett et al., 2017), compulsive sexual behavior (e.g., Lewis, in press), and marginalized populations (e.g., Vaughan & Rodriguez, 2014), for example.

When I began my studies at the University of Pennsylvania’s Master of Applied Positive Psychology (MAPP) program, there was one person everyone kept pointing me to. As soon as I shared my interest in positive sexuality, almost everyone I spoke to wanted to know if I’d talked yet with Brianna Booth. Dr. Booth, who is now the Director of Positive Sexuality at Stanford University, did indeed contribute an incredibly valuable starting point for the question of defining sexual well-being. To construct her sexual well-being model, which she published as her doctoral thesis at Widener University, she conducted qualitative research with a diverse sample of participants. The complex theory she ultimately proposed focuses on safety and connection, and it posits that the skills of attunement and setting and navigating boundaries are key components for creating safety and connection (Booth, 2014). This brilliant theory advances the discussion of sexual wellness immensely. Its key limitation, however, may be its scope: It focuses almost exclusively on the relationship between sexual partners. It does not go into great detail concerning other aspects of sexual well-being.

More recently, Mitchell et al. (2023) took a different tack. The team underwent a very rigorous, multi-step process that produced the following components: “sexual safety and security, sexual respect, resilience in relation to sexual experiences, forgiveness (of self and others) of sexual harms, self-determination in one’s sex life, and comfort with sexuality” (p. 3). This is undoubtedly a well-considered, thoughtful, and absolutely necessary contribution to the positive sexuality literature. As the components quickly reveal, however, the model focuses a lot on red-cape aspects of sexual health rather than on the so-often overlooked, equally critical green-cape aspects. This emphasis may be a function of its focus on sexual well-being, rather than on the question of what it means to be sexually thriving.

Still, between these two models it would appear that the building blocks of a more detailed and thorough overview of sexual well-being may be starting to form. One final model worth mentioning in this cursory view is Kleinplatz and colleagues’(2009) “portrait of great sex” (p. 1). As the name implies, this team did not set out to define overall sexual well-being, but they did procure a model of “optimal sexual experiences” (p. 1), or, in other words, the team determined the ingredients to a wonderful sexual encounter. Although sexual encounters are only a part of what contributes to a person’s sexual well-being, I would think one can be reasonably certain that they are a very important contributor. To compose their model of great sex, the team underwent a thorough qualitative investigation that included participants who had been in romantic relationships for at least 20 years, LGBTQ+ and kinky participants, and sex therapists. Out of this sample, the team landed on the following eight ingredients: being present, connection, deep sexual and erotic intimacy, extraordinary communication, interpersonal risk-taking and exploration, authenticity, vulnerability, and transcendence (Kleinplatz et al., 2009). Perhaps equally useful are what the team refers to as the two “minor components” of great sex. These are components that one might have expected to be included in the model, but which only came up sometimes as compared to the major eight. Those minor components are pleasure and chemistry. The sample that the team interviewed seemed to indicate that having intense orgasms and feeling a strong spark were things that often happened during great sex, but the sample did not seem to endorse these two things as essential ingredients to a wonderful sexual experience.

So, what does it mean to have more-than-just-healthy sexual wellness? We still don’t know. But that will soon change. Thanks to the bravery, vision, fortitude, and brilliance of the newest member of the University of Pennsylvania’s Positive Psychology Center, Dr. Vera Ludwig, and thanks to a generous, multi-million dollar grant Dr. Ludwig has secured, a new team of researchers will investigate this and many related questions. For a more green cape—or should I say green blanket—approach to human sexuality studies, stay tuned.

References

Anderson, R. M. (2013). Positive sexuality and its impact on overall well-being. Bundesgesundheitsbl, 56, 208–214.

Baggett, L. R., Eisen, E., Gonzalez-Rivas, S., Olson, L. A., Cameron, R. P., & Mona, L. R. (2017). Sex-positive assessment and treatment among female trauma survivors. Journal of Clinical Psychology, 73(8), 965–974.

Blumenstock, S. M., Quinn-Nilas, C., Milhausen, R. R., & McKay, A. (2020). High emotional and sexual satisfaction among partnered midlife Canadians: Associations with relationship characteristics, sexual activity and communication, and health. Archives of Sexual Behavior, 49, 953–967.

Booth, B. (2014). Toward sexual well-being: A grounded theory study of the lived experience of sexuality (3581999) [Doctoral dissertation, Widener University].

Chakhssi, F., Kraiss, J. T., Sommers-Spijkerman, M., & Bohlmeijer, E. T. (2018). The effect of positive psychology interventions on well-being and distress in clinical samples with psychiatric or somatic disorders: A systematic review and meta-analysis. BMC Psychiatry, 18, 1–17.

Coleman, E., Dickenson, J. A., Girard, A., Rider, G. N., Candelario-Pérez, L. E., Becker-Warner, R., Kovic, A. G., & Munns, R. (2018). An integrative biopsychosocial and sex positive model of understanding and treatment of impulsive/compulsive sexual behavior. Sexual Addiction & Compulsivity, 25(2–3), 125–152.

Crowell, C., Mosley, D. V., & Stevens-Watkins, D. (2018). Studying sex: A content analysis of sexuality research in counseling psychology. Counseling Psychology 45(4), 528–546.

Dawson, S., Jang, G. E., & Goldberg, S. Y. (2022). A brief psychoeducational sexual mindfulness intervention to bolster sexual well-being. Mindfulness, 13, 2827–2844.

Hannier, S., Baltus, A., & de Sutter, P. (2018). The role of physical satisfaction in women’s sexual self-esteem. Sexologies, 27(4), e85–e89.

Kaestle, C. E., & Evans, L., M. (2018). Implications of no recent sexual activity, casual sex, or exclusive sex for college women’s sexual well-being depend on sexual attitudes. Journal of American College Health, 66(1), 32–40.

Kleinplatz, P. J., Ménard, A. D., Paquet, M.-P., Paradis, N., Campbell, M., Zuccarino, D., & Mehak, L. (2009). The components of optimal sexuality: A portrait of “great sex.” The Canadian Journal of Human Sexuality, 18(1-2), 1–13.

Lammers, J., & Stoker, J. I. (2018). Power affects sexual assertiveness and sexual esteem equally in women and men. Archives of Sexual Behavior, 48, 649–652.

Lewis, A. (In press). Intuitive sexuality: A sex-positive model for understanding and treating compulsive sexual behavior. In E. Prior & D. Williams (Eds.), The Handbook of Positive Sexuality. Routledge.

Mark, K. P., & Lasslo, J. A. (2018). Maintaining sexual desire in long-term relationships: A systematic review and conceptual model. The Journal of Sex Research, 55(4–5), 563–581.

Menard, A. D., Kleinplatz, P. J., Rosen, L., Lawless, S., Paradis, N., Campbell, M., & Huber, J. D. (2015). Individual and relational contributors to optimal sexual experiences in older men and women. Sexual and Relationship Therapy, 30(1), 78–93.

Mitchell, K. R., Palmer, M. J., Lewis, R., Pérez, R. B., Maxwell, K. J., Macdowall, W., Reid, D., Bonell, C., Mercer, C. H., Sonnenburg, P., Fortenberry, J. D., & the Ntasal-4 team (2023). Development and validation of a brief measure of sexual well-being for population surveys: The Natsal Sexual Wellbeing Measure (Natsal-SW). The Journal of Sex Research, 1–11.

Muise, A., Preyde, M., Maitland, s. B., & Milhausen, R. R. (2010). Sexual identity and sexual well-being in female heterosexual university students. Archives of Sexual Behavior, 39(4), 915–925.

Pawelski, J. O. (2016). Defining the ‘positive’ in positive psychology: Part II. A normative analysis. The Journal of Positive Psychology, 11(4), 357–365.

Štulhofer, A., Ferreira, L. C., & Landripet, I. (2014). Emotional intimacy, sexual desire, and sexual satisfaction among partnered heterosexual men. Sexual and Relationship Therapy, 29(2), 229–244.

Vaillancourt-Morel, M.-P., Blais-Lecours, S., & Labadie, C., Bergeron, S., Sabourin, S., & Godbout, N. (2017). Profiles of cyberpornography use and sexual well-being in adults. The Journal of Sexual Medicine, 14(1), 78–85.

Vaughan, M. D., & Rodriguez, E. M. (2014). LGBT strengths: Incorporating positive psychology into theory, research, training, and practice. Psychology of Sexual Orientation and Gender Diversity, 14(1), 325–334.

About the author | Ari Lewis (C’18) is a Licensed Mental Health Counselor at the Sexuality, Attachment, and Trauma Project and at Ari Lewis Therapy in New York City. He also teaches part-time at the Graduate School of Social Work of Touro University. A graduate of MAPP ’18, Ari’s capstone went on to play a critical role in shaping the Positive Psychology Center's newest research initiative on sexual health at the University of Pennsylvania. You can read Ari’s chapter on a positive sexuality informed approach to treating compulsive sexual behavior in the Routledge edition of The Handbook of Positive Sexuality (in press). His essay on compulsive sexual behavior and consensual non-monogamy is now available in the 2nd edition of Kathy Labriola’s Love in Abundance (2024). After MAPP, Ari went on to earn a Master of Education (EdM) in Mental Health Counseling, a Master of Arts (MA) in Psychological Counseling, and an Advanced Certificate in Sexuality, Women, and Gender from Columbia University. You can reach him at ari@satproject.com, www.arilewistherapy.com, or 929-299-6681.