Development of a Conceptual Framework of Sexual Well-being for Women with Physical Disability

Published:March 23, 2022DOI:



      Women with physical disability (WWPD) experience more sexual dysfunction, are typically less sexually active, and engage in fewer intimate relationships than women without physical disability. Although patient-reported outcome measures can help researchers and providers to meet the needs of this population, current measures fail to reflect the relevant experiences of WWPD. The purposes of this study were to 1) understand the experiences of WWPD related to sexual wellness, 2) identify the gaps in the current Patient-Reported Outcomes Measurement Information System Sexual Function and Satisfaction, and 3) develop a conceptual framework for the measurement of sexual well-being on which a new supplemental measure will be built.


      WWPD (n = 59) were recruited from an online health registry through a large academic medical center and took part in semistructured focus groups and interviews exploring experiences with sexuality, intimate relationships, sexual function, and sexual and reproductive health care. Interviews were transcribed and coded using an inductive approach to thematic analysis.


      Participants expressed that their sexual well-being extends beyond simply physical function and includes aspects of their environment, society, and intrapersonal and interpersonal factors. From themes that emerged from the qualitative data, we developed a conceptual framework of sexual well-being, which includes sexual health and sexual self-efficacy. The framework is composed of five constructs that impact sexual health and sexual self-efficacy: physical factors, intrapersonal factors, environmental factors, relationships and partner opportunity, and stigma.


      This conceptual framework can be used to develop patient-reported outcome measures items relevant to the experiences of WWPD, facilitate conversations between providers and patients, and identify areas to target for sexual wellness interventions.
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      Mara B. Nery-Hurwit, PhD, MPH, is a disability health researcher with interests in women's health, increasing health equity, and community-based participatory approaches to developing health promotion programs for individuals with disability.


      Claire Z. Kalpakjian, PhD, MS, is an Associate Professor at the University of Michigan Medical School. Dr. Kalpakjian's research focuses on the reproductive health of women with physical disabilities using mixed methods to develop tools and interventions that promote health, independence, self-advocacy, and health care equity.


      Jodi M. Kreschmer, MSW, is a research area specialist associate for the University of Michigan's Department of Physical Medicine and Rehabilitation. Her research interests include health equality for people with disabilities, and sexual health of people with disabilities.


      Elisabeth H. Quint, MD, is a Professor in OB/GYN and Director of the Pediatric and Adolescent Gynecology fellowship at the University of Michigan. Her research interests and expertise are in pediatric and adolescent gynecology and reproductive health care for women with disabilities.


      Susan Ernst, MD, is an Associate Professor of Obstetrics and Gynecology. Dr. Ernst is the Director of the reproductive health clinic for adolescents and women with disabilities at the University of Michigan. Her research focuses on reducing health care disparities for adolescents and women with disabilities.