Facilitators and Inhibitors of Healthy Sexuality Across the Life Course: A Qualitative Study of Sexual Trajectories, Reflection, and Agency.

Abstract

Healthy sexuality has recently been proposed as a broader developmental framework that complements conventional concepts of sexual health. However, little empirical research has examined how healthy sexuality develops across the life course through lived experience. This study explores healthy sexuality by identifying facilitators and inhibitors of healthy sexuality and sexual satisfaction and by examining how they accumulate within individuals' sexual trajectories. Twenty semi-structured life-history interviews were conducted with participants aged 28-32 years in Slovakia. Data were analyzed using a combination of thematic analysis and narrative-phenomenological analysis. Facilitators and inhibitors were organized into four interrelated domains: intrapsychic, interaction with social norms, interpersonal, and physical. Paradoxical facilitators and inhibitors demonstrated that healthy sexuality and sexual satisfaction are not identical and may diverge under specific circumstances. Analysis of participants' sexual trajectories revealed three developmental pathways: (1) reflective development trajectories characterized by reflection, agency, and positive change; (2) reflective stagnation trajectories characterized by reflection without substantial behavioral change; (3) unreflective satisfaction trajectories characterized by apparent sexual satisfaction despite limited developmental potential for healthy sexuality. Findings support the conceptualization of healthy sexuality as a developmental process rather than a fixed state. The proposed framework may be inspirational for sexuality education, counseling, psychotherapy, and future research.