Definition and framework of sexual wellbeing for population health: a modified Delphi study

BACKGROUND: Sexual well-being is rarely prioritised as a distinct goal in national or international sexual health strategies. A major barrier is the absence of a widely accepted definition of sexual well-being. This study aimed to establish consensus on a definition and framework to inform public policy in Scotland and internationally. METHODS: A two-stage, online, modified Delphi process involving Scottish and international experts from government, non-governmental organisations and academia. Panellists rated and commented on the clarity and importance (scale: 1-9) of a proposed definition and domains of sexual wellbeing. Consensus was defined as ≥70% participants rating 7-9. Qualitative comments were synthesised and revised statements were re-rated. Statements were further refined via a consensus meeting. RESULTS: Ninety-five panellists completed Round 1 (53% Scotland-based; 65% >10 years' professional experience) and 66 completed Round 2 (69.5% retention). Panellists reached consensus on a definition of sexual wellbeing as "feeling respected, safe, at ease and supported, while also having a sense of self-worth and agency in relation to sex and sexuality" (>90% consensus). Definition statements for six domains of sexual wellbeing also achieved high consensus: sexual respect, safety, agency and support (>90% consensus) and comfort with sexuality and sexual self-esteem (>80% consensus). CONCLUSIONS: This is the first consensus definition and framework of sexual wellbeing for population health. It provides a foundation for goals and indicators to support multisector efforts aimed at promoting positive sexuality alongside mitigation of negative outcomes. Further work is required to understand the framework's transferability across diverse cultural and policy environments.