Public Health

Sexual Wellbeing

For over a decade, the Sexual Health and Wellbeing (SHAW) research group - in collaboration with the Natsal Study, Public Health Scotland and Scottish Government - have undertaken research to conceptualise, measure and improve Sexual Wellbeing. This page is intended for researchers and professionals seeking to use these research outputs.

What is sexual wellbeing and why does it matter for public health?

We define 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.

Our viewpoint paper in Lancet Public Health explains that sexual wellbeing is one of four essential pillars of a public health approach to sex and sexuality. It is distinct but overlapping with sexual health, sexual pleasure and sexual justice.

Conceptualising and measuring sexual wellbeing

For the Natsal study, we developed and validated a brief measure of sexual wellbeing for adults, the Natsal-SW. This 13-item measure has robust psychometric properties and is deigned for use in population health research. It is being translated and validated in multiple languages, including Chinese, Japanese, Turkish and Flemish.

Information about scoring and cut-offs for the Natsal-SW can be found here.

Examples of studies using the Natsal-SW include population-based cohort study of post-partum mothers in Switzerland and a study of student health and wellbeing in South Africa.

The Natsal-SW is grounded in qualitative work with adults in UK which explored how our seven domains of sexual wellbeing resonated with lived experience.

We have also developed the Adol-SW measure of sexual wellbeing for adolescents. Co-produced with young people and psychometrically validated, it is brief (13-items) and designed for adolescents with and without sexual experience.

Our Good Measure website has resources for researchers and practitioners seeking to measure adolescent sexual wellbeing or other aspects of sex and sexuality in health research. It includes a measure finder, a catalogue of measures and brief questionnaires for use in research with adolescents. 

Research on sexual wellbeing

We systematically reviewed Global qualitative evidence on young people’s sexuality to understand how sexual wellbeing manifests. Across contexts, we found six feelings that were universally indicative of high sexual wellbeing:

• Congruence between their sexual thoughts, feelings, values and emerging identities
• Driven by curiosity or desire rather than pressure
• Able to advocate for their wants and boundaries
• Deserving of care, respect and support
• Able to authentically express themselves
• Hopeful about their sexual futures

With colleagues on the Natsal study we show how sexual wellbeing is patterned in the British population (paper and summary forthcoming).

Other research groups have adopted our Framework of Sexual wellbeing, for example in addressing equity in sexual wellbeing among gender minority groups, to explore the meaning of LGBTQ+ people in the Netherlands, and to address sexuality in therapy with gender minority groups.

A framework of sexual wellbeing for Scotland

For the Scottish Government Sexual Health and Blood Borne Virus Action Plan 2023-2026 we led a Delphi consensus process with national and international stakeholders to develop a Consensus Framework of Sexual Wellbeing for Scotland.

Monitoring sexual wellbeing in Scotland

In collaboration with Public Health Scotland and in consultation with national Sexual Health and Blood Born Viruses (SHBBV) stakeholders, the SHAW team designed indicators to track progress on sexual wellbeing in Scotland.

These indicators are included in the SHBBV National Monitoring plan.

As part of the 2023-2026 SHBBV Action plan for Scotland, the SHAW team and Public Health Scotland undertook a National Survey of Sexual Wellbeing for Scotland 2025, which provides a population-baseline for monitoring future progress.

Applying sexual wellbeing in practice

The SHAW team is working with NHS, third sector and private sector to apply sexual wellbeing approaches in practice.

This animated video for health and allied professionals, explains what sexual wellbeing is and how it can be applied in practice.

This blog, co-written with Dr Karen Gurney, author of Mind the Gap, explains how sexual wellbeing is relevant in counselling and therapy: Sexual Wellbeing in Therapeutic Conversations.

Resources for clients, service users and general public

This article in Psychology Today outlines seven ways your sexual wellbeing may be suffering and builds from our seven domains.