(PS1-35) Let’s Talk About Sex (And Recovery): An Examination of Sexual Wellbeing Among Women in Early Substance Use Remission

Sexual Wellbeing (SW) is an important facet of overall health, though remains relatively unexamined in the context of substance use disorder (SUD) remission. This dearth of literature is particularly relevant among women and femmes who use substances. Substance use is often linked to sexual behaviors, serving both excitatory (e.g., making sex more pleasurable, facilitating substance procurement) and inhibitory (e.g., coping with sexual trauma) purposes. As women enter remission, sexual activity and SW are likely to be redefined. This study examined the relationship between SW, concerns around engagement in sober sex, attachment orientation, and quality of life. Participants (N = 153) aged 20-75 (M = 35.3, SD = 11.26) in their first year of SUD remission were recruited from community-based sources and Prolific. Women (cisgender, n  = 137, 89.5%) completed an online mixed-method survey comprised of demographic, attachment, SW, and quality of life satisfaction measures. Worries about engaging in sober sex were endorsed by 40% of the sample and were highly correlated with insecure attachment and sexual dysfunction. Sober sex worries were also negatively associated with quality-of-life domains (i.e., physical, psychological, social, and environmental), sexual satisfaction, and sexual self-concept (ps < 0.05). Concerns did not differ by demographic variables or substance-of-choice. While concerns and insecure attachment orientations were inversely associated with quality-of-life domains, several facets of SW (e.g., sexual satisfaction, self-esteem, assertiveness) were associated with improved life satisfaction. Insecure attachment was significantly predictive of response to solicitation [F(5,147) = 5.245], sexual dysfunction [F(5,134) = 3.883] sexual satisfaction [F(5,145) = 7.401], and sexual self-concept domains, including self-esteem [F(5,144) = 3.061], anxiety [F(5,144) = 6.272], and assertiveness [F(5,144) = 3.763], ps < 0.05. Regression analyses indicated that anxious attachment significantly predicted sober sex concerns (β = 0.242), sexual self-esteem (β = -0.520), and sexual assertiveness (β = 0.242), while avoidant attachment predicted sexual self-esteem (β = -0.600), sexual assertiveness (β = -0.516), and was uniquely predictive of sexual satisfaction (β = -0.506), ps < 0.05. Qualitative responses captured a range of themes related to sober sex concerns, including fear of partner-related relapse, inability to cope with prior sexual trauma, and negatively perceived changes in body image.

To our knowledge, this is the first study to examine both positive aspects of SW as well as concerns around engagement in sober sex for women in early substance remission. Results reveal the complexity of SW among women in early remission, highlighting the prevalence of sober sex concerns and the negative impact on sexual satisfaction and overall quality of life. Findings underscore the importance of integrating SW assessment and interventions into SUD treatment programs in order to improve overall wellbeing and to potentially reduce risk for relapse. Future research should explore targeted SW interventions within this population.