{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,8]],"date-time":"2026-10-08T12:58:57Z","timestamp":1791464337355,"version":"4.3.4"},"reference-count":109,"publisher":"Oxford University Press (OUP)","issue":"11","license":[{"start":{"date-parts":[[2026,10,8]],"date-time":"2026-10-08T00:00:00Z","timestamp":1791417600000},"content-version":"vor","delay-in-days":1,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,10,7]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>Sexual and gender diverse (LGBTQIA+) individuals experience significant sexual health disparities shaped by minority stress processes, trauma exposure, mental health burden, and historically heteronormative and cisnormative clinical frameworks. Although international guidelines, standards of care, and professional guidance documents increasingly endorse affirmative and evidence-informed care, their integration into routine sexual medicine and psychotherapeutic practice remains inconsistent, particularly in the assessment and clinical management of sexual dysfunctions in LGBTQIA+ populations.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>To present an evidence-informed Italian Society of Behavioral and Cognitive Therapy (SITCC) clinical framework for integrating cognitive-behavioral therapy (CBT), minority stress\u2013informed formulation, trauma-informed assessment, and sexual medicine in affirmative care for LGBTQIA+ individuals, with attention to queer-specific sexual dysfunctions, gender-affirming care, non-normative relationships, and multidisciplinary practice.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>This clinical framework was developed within the SITCC through a structured, multistage institutional process involving multidisciplinary discussion, manuscript development, and formal Society review and approval. It was informed by a narrative synthesis of international clinical guidelines, standards of care, professional guidance documents, and empirical and conceptual literature. Targeted, non-systematic searches of PubMed, PsycINFO, and Google Scholar in 2025 covered 2015-2025 publications, complemented by earlier foundational sources and working-group suggestions.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>The SITCC working group identified minority stress as a central framework linking stigma, internalized stigma, concealment, hypervigilance, psychological distress, relational functioning, embodiment, and sexual health. Trauma and PTSD\/CPTSD symptoms, when clinically present, emerged as relevant dimensions of assessment and treatment, particularly when sexual difficulties are associated with shame, dissociation, embodied unsafety, disrupted agency, or relational insecurity. Queer-specific sexual dysfunctions\u2014including genito-pelvic pain in women who have sex with women, anodyspareunia in men who have sex with men, and sexual function changes related to gender-affirming hormone therapy and surgeries\u2014may be insufficiently captured by heteronormative and cisnormative diagnostic frameworks. The framework emphasizes the integration of affirmative CBT, trauma-informed care, psychosocial sex therapy interventions, and sexual medicine to address psychological, relational, anatomical, endocrinological, and social determinants of sexual distress. Its clinical specificity is greater for lesbian, gay, and transgender and gender-diverse populations, with less extensive evidence for bisexual populations and provisional applicability to intersex and asexual-spectrum individuals.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>The SITCC framework provides an evidence-informed foundation for integrating affirmative CBT, trauma-informed assessment, and sexual medicine in LGBTQIA+ care. By linking minority stress and psychological, relational, and medical dimensions of sexual health, it translates affirmative principles into a shared approach to individualized case formulation and multidisciplinary care planning, centered on patients\u2019 needs, agency, and sexual well-being.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/jsxmed\/qdag316","type":"journal-article","created":{"date-parts":[[2026,9,23]],"date-time":"2026-09-23T11:59:27Z","timestamp":1790164767000},"source":"Crossref","is-referenced-by-count":0,"title":["LGBTQIA+ sexual health: a SITCC clinical framework for integrating cognitive-behavioral therapy and sexual medicine"],"prefix":"10.1093","volume":"23","author":[{"ORCID":"https:\/\/orcid.org\/0009-0006-4640-3595","authenticated-orcid":false,"given":"Gabriele","family":"Einaudi","sequence":"first","affiliation":[{"name":"Department of Psychology, University of Turin , 10124 Turin ,","place":["Italy"]},{"name":"Centro Clinico Crocetta, Scuola di Specializzazione in Psicoterapia Cognitiva , 10129 Turin ,","place":["Italy"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Federico","family":"Dibennardo","sequence":"additional","affiliation":[{"name":"Department of Medicine and Surgery, University of Parma , 43126 Parma ,","place":["Italy"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sarah","family":"Finzi","sequence":"additional","affiliation":[{"name":"Department of Psychology, University of Turin , 10124 Turin ,","place":["Italy"]},{"name":"Centro Clinico Crocetta, Scuola di Specializzazione in Psicoterapia Cognitiva , 10129 Turin ,","place":["Italy"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gaia","family":"Polloni","sequence":"additional","affiliation":[{"name":"Centro Terapia Cognitiva , 22100 Como ,","place":["Italy"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fabio","family":"Ratti","sequence":"additional","affiliation":[{"name":"Studio Psicoterapia Cognitiva , 6900 Lugano ,","place":["Switzerland"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9359-7955","authenticated-orcid":false,"given":"Daniele","family":"Tienforti","sequence":"additional","affiliation":[{"name":"Andrology Unit, Department of Clinical Medicine, Life, Health and Environmental Sciences, University of L'Aquila , 67100 L'Aquila ,","place":["Italy"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ilaria","family":"Baiardini","sequence":"additional","affiliation":[{"name":"Department of Health and Life Sciences, European University of Rome , 00163 Rome ,","place":["Italy"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Carla","family":"Iuliano","sequence":"additional","affiliation":[{"name":"School of Cognitive Psychotherapy (SPC) , 80122 Naples ,","place":["Italy"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Luca","family":"Amato","sequence":"additional","affiliation":[{"name":"Sexology Interest Group (AIS), Italian Society of Behavioral and Cognitive Therapy (SITCC), 00185 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jacopo","family":"Stringo","sequence":"additional","affiliation":[{"name":"Department of Human and Social Sciences, University of Bergamo , 24129 Bergamo ,","place":["Italy"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stefania","family":"Traini","sequence":"additional","affiliation":[{"name":"Sexology Interest Group (AIS), Italian Society of Behavioral and Cognitive Therapy (SITCC) , 00185 Rome ,","place":["Italy"]},{"name":"S.I.R.U. Societ\u00e0 Italiana della Riproduzione Umana, 00198 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Carolina","family":"Moretto","sequence":"additional","affiliation":[{"name":"Andrology Unit, Department of Clinical Medicine, Life, Health and Environmental Sciences, University of L'Aquila , 67100 L'Aquila ,","place":["Italy"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Camilla","family":"Corradelli","sequence":"additional","affiliation":[{"name":"Sexology Interest Group (AIS), Italian Society of Behavioral and Cognitive Therapy (SITCC) , 00185 Rome ,","place":["Italy"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Arcangelo","family":"Barbonetti","sequence":"additional","affiliation":[{"name":"Andrology Unit, Department of Clinical Medicine, Life, Health and Environmental Sciences, University of L'Aquila , 67100 L'Aquila ,","place":["Italy"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fabio","family":"Monticelli","sequence":"additional","affiliation":[{"name":"Department of Human Sciences, European University of Rome , 00163 Rome ,","place":["Italy"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Francesca","family":"Cavallo","sequence":"additional","affiliation":[{"name":"School Integrated Psychotherapy (SPI) , 20121 Milan ,","place":["Italy"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2026,10,8]]},"reference":[{"key":"2026100808250223000_ref1","doi-asserted-by":"publisher","first-page":"Article e44","DOI":"10.1017\/S2045796023000586","article-title":"Post-traumatic stress disorder among LGBTQ people: a systematic review and meta-analysis","volume":"32","author":"Marchi","year":"2023","journal-title":"Epidemiol Psychiatr Sci"},{"key":"2026100808250223000_ref2","doi-asserted-by":"publisher","first-page":"2433","DOI":"10.2105\/AJPH.2009.168971","article-title":"Pervasive trauma exposure among US sexual orientation minority adults and risk of posttraumatic stress disorder","volume":"100","author":"Roberts","year":"2010","journal-title":"Am J Public Health"},{"key":"2026100808250223000_ref3","doi-asserted-by":"publisher","first-page":"6533","DOI":"10.3390\/ijerph17186533","article-title":"A systematic review of the health and healthcare inequalities for people with intersex variance","volume":"17","author":"Zeeman","year":"2020","journal-title":"Int J Environ Res Public Health"},{"key":"2026100808250223000_ref4","doi-asserted-by":"publisher","first-page":"16","DOI":"10.7202\/1089782ar","article-title":"Intersex stigma and discrimination: effects on patient-centred care and medical communication","volume":"5","author":"Charron","year":"2022","journal-title":"Can J Bioeth"},{"key":"2026100808250223000_ref5","doi-asserted-by":"publisher","first-page":"3811","DOI":"10.1111\/jocn.13862","article-title":"Understanding asexual identity as a means to facilitate culturally competent care: a systematic literature review","volume":"26","author":"Jones","year":"2017","journal-title":"J Clin Nurs"},{"key":"2026100808250223000_ref6","doi-asserted-by":"publisher","first-page":"422","DOI":"10.1037\/sgd0000058","article-title":"Asexual-identified clients in clinical settings: implications for culturally competent practice","volume":"1","author":"Foster","year":"2014","journal-title":"Psychol Sex Orientat Gend Divers"},{"key":"2026100808250223000_ref7","volume-title":"Guidelines for Psychological Practice with Sexual Minority Persons","author":"American Psychological Association","year":"2021"},{"key":"2026100808250223000_ref8","doi-asserted-by":"publisher","first-page":"832","DOI":"10.1037\/a0039906","article-title":"Guidelines for psychological practice with transgender and gender nonconforming people","volume":"70","author":"American Psychological Association","year":"2015","journal-title":"Am Psychol"},{"key":"2026100808250223000_ref9","volume-title":"APS Inclusive Language Guide for LGBTIQA+ Communities","author":"Australian Psychological Society","year":"2022"},{"key":"2026100808250223000_ref10","volume-title":"Guidelines for Psychologists Working with Gender, Sexuality and Relationship Diversity","author":"British Psychological Society","year":"2019"},{"key":"2026100808250223000_ref11","doi-asserted-by":"publisher","first-page":"S1","DOI":"10.1080\/26895269.2022.2100644","article-title":"Standards of Care for the Health of transgender and gender diverse people, version 8","volume":"23","author":"Coleman","year":"2022","journal-title":"Int J Transgender Health"},{"key":"2026100808250223000_ref12","doi-asserted-by":"publisher","first-page":"3869","DOI":"10.1210\/jc.2017-01658","article-title":"Endocrine treatment of gender dysphoric\/gender-incongruent persons: an Endocrine Society clinical practice guideline","volume":"102","author":"Hembree","year":"2017","journal-title":"J Clin Endocrinol Metab"},{"key":"2026100808250223000_ref13","volume-title":"Position Statement on the Promotion of Gender Diversity and Expression and Prevention of Gender-Related Hate and Harm","author":"Canadian Psychological Association","year":"2022"},{"key":"2026100808250223000_ref14","volume-title":"Clinical Guidelines for LGBTQIA-Affirming Marriage and Family Therapy","author":"American Association for Marriage and Family Therapy","year":"2022"},{"key":"2026100808250223000_ref15","doi-asserted-by":"publisher","first-page":"875","DOI":"10.1037\/ccp0000037","article-title":"LGB-affirmative cognitive behavioral therapy for young adult gay and bisexual men: a randomized controlled trial of a transdiagnostic minority stress approach","volume":"83","author":"Pachankis","year":"2015","journal-title":"J Consult Clin Psychol"},{"key":"2026100808250223000_ref16","doi-asserted-by":"publisher","first-page":"246","DOI":"10.1080\/16506073.2024.2434021","article-title":"Cognitive behavioural therapy for internalizing symptoms in LGBTQ+ people: a preliminary meta-analysis","volume":"54","author":"Dunn","year":"2025","journal-title":"Cogn Behav Ther"},{"key":"2026100808250223000_ref17","volume-title":"Manuale di Sessuologia Clinica: Sesso, Genere e Orientamento. Nuove Sfide e Competenze in Psicoterapia","author":"Cavallo","year":"2025"},{"key":"2026100808250223000_ref18","doi-asserted-by":"publisher","first-page":"5","DOI":"10.3280\/qpc57-2025oa23106","article-title":"Editoriale","volume":"57","author":"Cavallo","year":"2026","journal-title":"Quad Psicoter Cognit"},{"key":"2026100808250223000_ref19","doi-asserted-by":"publisher","first-page":"674","DOI":"10.1037\/0033-2909.129.5.674","article-title":"Prejudice, social stress, and mental health in lesbian, gay, and bisexual populations: conceptual issues and research evidence","volume":"129","author":"Meyer","year":"2003","journal-title":"Psychol Bull"},{"key":"2026100808250223000_ref20","doi-asserted-by":"publisher","first-page":"461","DOI":"10.1089\/lgbt.2018.0118","article-title":"National Findings from an LGBT healthcare organizational needs assessment","volume":"5","author":"Goldhammer","year":"2018","journal-title":"LGBT Health"},{"key":"2026100808250223000_ref21","doi-asserted-by":"publisher","first-page":"392","DOI":"10.1080\/09540261.2022.2051443","article-title":"Looking into the LGB affirmative therapies over the last fifty years - a mixed method review synthesis","volume":"34","author":"Broadway-Horner","year":"2022","journal-title":"Int Rev Psychiatry"},{"key":"2026100808250223000_ref22","first-page":"139","article-title":"Demarginalizing the intersection of race and sex: a black feminist critique of antidiscrimination doctrine, feminist theory and antiracist politics","volume":"1989","author":"Crenshaw","year":"1989","journal-title":"Univ Chic Leg Forum"},{"key":"2026100808250223000_ref23","doi-asserted-by":"publisher","first-page":"401","DOI":"10.1080\/19359705.2022.2089427","article-title":"Prevalence and correlates of mental health difficulties amongst LGBTQ people in Southeast Asia: a systematic review","volume":"27","author":"Tan","year":"2023","journal-title":"J Gay Lesbian Ment Health"},{"issue":"10","key":"2026100808250223000_ref24","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pgph.0004682","article-title":"Intersectional disparities in mental healthcare utilization by sex and race\/ethnicity among US adults: an NHANES study","volume":"5","author":"Olisaeloka","year":"2025","journal-title":"PLOS Glob Public Health"},{"issue":"11","key":"2026100808250223000_ref25","doi-asserted-by":"publisher","first-page":"1125","DOI":"10.1176\/appi.ps.20230252","article-title":"Intersectional discrimination in mental health care: a systematic review with qualitative evidence synthesis","volume":"75","author":"Hempeler","year":"2024","journal-title":"Psychiatr Serv"},{"key":"2026100808250223000_ref26","doi-asserted-by":"publisher","first-page":"221","DOI":"10.1037\/pri0000055","article-title":"Cultural humility: a therapeutic framework for engaging diverse clients","volume":"2","author":"Mosher","year":"2017","journal-title":"Pract Innov"},{"key":"2026100808250223000_ref27","doi-asserted-by":"publisher","first-page":"203","DOI":"10.1037\/pri0000263","article-title":"Cultural humility with transgender and gender diverse clients","volume":"10","author":"Schmidt","year":"2025","journal-title":"Pract Innov"},{"key":"2026100808250223000_ref28","doi-asserted-by":"publisher","first-page":"2353","DOI":"10.1007\/s10508-020-01755-2","article-title":"LGBQ+ self-acceptance and its relationship with minority stressors and mental health: a systematic literature review","volume":"49","author":"Camp","year":"2020","journal-title":"Arch Sex Behav"},{"key":"2026100808250223000_ref29"},{"key":"2026100808250223000_ref30","volume-title":"Minority Stress and Lesbian Women","author":"Brooks","year":"1981"},{"key":"2026100808250223000_ref31","doi-asserted-by":"crossref","first-page":"38","DOI":"10.2307\/2137286","article-title":"Minority stress and mental health in gay men","volume":"36","author":"Meyer","year":"1995","journal-title":"J Health Soc Behav"},{"key":"2026100808250223000_ref32","doi-asserted-by":"publisher","first-page":"271","DOI":"10.1037\/0003-066X.62.4.271","article-title":"Racial microaggressions in everyday life: implications for clinical practice","volume":"62","author":"Sue","year":"2007","journal-title":"Am Psychol"},{"key":"2026100808250223000_ref33","doi-asserted-by":"publisher","DOI":"10.1007\/s40519-025-01772-x","article-title":"Seeing clearly: why gender and sexual diversity must remain in eating disorder science","volume":"30","author":"Meneguzzo","year":"2025","journal-title":"Eat Weight Disord"},{"key":"2026100808250223000_ref34","doi-asserted-by":"publisher","first-page":"1019","DOI":"10.1016\/j.cpr.2010.07.003","article-title":"Internalized homophobia and internalizing mental health problems: a meta-analytic review","volume":"30","author":"Newcomb","year":"2010","journal-title":"Clin Psychol Rev"},{"key":"2026100808250223000_ref35","doi-asserted-by":"publisher","first-page":"142","DOI":"10.1080\/00224499.2011.637247","article-title":"Victimization experiences of lesbian, gay, and bisexual individuals: a meta-analysis","volume":"49","author":"Katz-Wise","year":"2012","journal-title":"J Sex Res"},{"key":"2026100808250223000_ref36","doi-asserted-by":"publisher","first-page":"22","DOI":"10.1007\/s10865-024-00539-6","article-title":"Minority stress in relation to biological outcomes among sexual and gender minority people: a systematic review and update","volume":"48","author":"Flentje","year":"2025","journal-title":"J Behav Med"},{"key":"2026100808250223000_ref37","doi-asserted-by":"publisher","first-page":"521","DOI":"10.1177\/1745691613497965","article-title":"Minority stress and physical health among sexual minorities","volume":"8","author":"Lick","year":"2013","journal-title":"Perspect Psychol Sci"},{"key":"2026100808250223000_ref38","doi-asserted-by":"publisher","DOI":"10.1016\/j.socscimed.2019.112463","article-title":"Structural stigma and all-cause mortality among sexual minorities: differences by sexual behavior?","volume":"244","author":"Hatzenbuehler","year":"2020","journal-title":"Soc Sci Med"},{"key":"2026100808250223000_ref39","doi-asserted-by":"publisher","first-page":"357","DOI":"10.1080\/15299716.2021.1984363","article-title":"Internalized Binegativity, LGBQ\u2009+\u2009community involvement, and definitions of bisexuality","volume":"21","author":"Pollitt","year":"2021","journal-title":"J Bisex"},{"key":"2026100808250223000_ref40","doi-asserted-by":"publisher","first-page":"1100","DOI":"10.1007\/s13178-024-00990-9","article-title":"Bisexual discrimination, internalized binegativity and their impact on mental health","volume":"21","author":"Velasco","year":"2024","journal-title":"Sex Res Soc Policy"},{"key":"2026100808250223000_ref41","doi-asserted-by":"publisher","first-page":"6","DOI":"10.1525\/srsp.2004.1.2.6","article-title":"Beyond \u201chomophobia\u201d: thinking about sexual prejudice and stigma in the twenty-first century","volume":"1","author":"Herek","year":"2004","journal-title":"Sex Res Soc Policy"},{"key":"2026100808250223000_ref42","doi-asserted-by":"publisher","first-page":"525","DOI":"10.1177\/0011000007309489","article-title":"Internalized heterosexism: measurement, psychosocial correlates, and research directions","volume":"36","author":"Szymanski","year":"2008","journal-title":"Couns Psychol"},{"key":"2026100808250223000_ref43","doi-asserted-by":"publisher","first-page":"489","DOI":"10.1037\/sgd0000201","article-title":"Relations between gender expression, minority stress, and mental health in cisgender sexual minority women and men","volume":"3","author":"Puckett","year":"2016","journal-title":"Psychol Sex Orientat Gend Divers"},{"key":"2026100808250223000_ref44","doi-asserted-by":"publisher","first-page":"65","DOI":"10.1037\/sgd0000081","article-title":"Development of the gender minority stress and resilience measure","volume":"2","author":"Testa","year":"2015","journal-title":"Psychol Sex Orientat Gend Divers"},{"key":"2026100808250223000_ref45","doi-asserted-by":"publisher","first-page":"1208","DOI":"10.1111\/pere.12511","article-title":"The effects of sexual and gender minority stress on relationship functioning: a meta-analysis","volume":"30","author":"Bresin","year":"2023","journal-title":"Pers Relat"},{"key":"2026100808250223000_ref46","doi-asserted-by":"publisher","first-page":"2996","DOI":"10.1111\/fare.13068","article-title":"Minority stress and relationship satisfaction in same-sex couples: a meta-analysis","volume":"73","author":"Song","year":"2024","journal-title":"Fam Relat"},{"key":"2026100808250223000_ref47","doi-asserted-by":"publisher","DOI":"10.53841\/bpsrep.2024.rep129b","article-title":"Guidelines for psychologists working with gender, sexuality and relationship diversity (2nd ed.)","author":"Richards","year":"2024","journal-title":"Br Psychol Soc"},{"key":"2026100808250223000_ref48","doi-asserted-by":"publisher","first-page":"1107","DOI":"10.1111\/jsm.12856","article-title":"PTSD and sexual dysfunction in men and women","volume":"12","author":"Yehuda","year":"2015","journal-title":"J Sex Med"},{"key":"2026100808250223000_ref49","doi-asserted-by":"publisher","first-page":"1398","DOI":"10.1016\/j.jsxm.2021.05.011","article-title":"Relationship between posttraumatic stress disorder and sexual difficulties: a systematic review of veterans and military personnel","volume":"18","author":"Bird","year":"2021","journal-title":"J Sex Med"},{"key":"2026100808250223000_ref50","volume-title":"ICD-11: International Classification of Diseases (11th Revision).","author":"World Health Organization","year":"2022"},{"key":"2026100808250223000_ref51","doi-asserted-by":"publisher","first-page":"628","DOI":"10.1037\/tra0001440","article-title":"Factor structure of the international trauma questionnaire in trauma exposed LGBTQ+ adults: role of cumulative traumatic events and minority stress heterosexist experiences","volume":"15","author":"Charak","year":"2023","journal-title":"Psychol Trauma Theory Res Pract Policy"},{"key":"2026100808250223000_ref52","doi-asserted-by":"publisher","first-page":"629","DOI":"10.1016\/j.cbpra.2019.06.001","article-title":"Trauma recovery in the transgender and gender diverse community: extensions of the minority stress model for treatment planning","volume":"26","author":"Shipherd","year":"2019","journal-title":"Cogn Behav Pract"},{"key":"2026100808250223000_ref53","doi-asserted-by":"publisher","first-page":"Article 101579","DOI":"10.1016\/j.copsyc.2023.101579","article-title":"Minority stress theory: application, critique, and continued relevance. Current opinion","volume":"51","author":"Frost","year":"2023","journal-title":"Psychology"},{"key":"2026100808250223000_ref54","doi-asserted-by":"publisher","first-page":"750","DOI":"10.1037\/tra0000258","article-title":"Trauma cognitions are related to symptoms up to 10 years after cognitive behavioral treatment for posttraumatic stress disorder","volume":"9","author":"Scher","year":"2017","journal-title":"Psychol Trauma Theory Res Pract Policy"},{"key":"2026100808250223000_ref55","doi-asserted-by":"publisher","first-page":"Article e2136921","DOI":"10.1001\/jamanetworkopen.2021.36921","article-title":"Comparison of prolonged exposure vs cognitive processing therapy for treatment of posttraumatic stress disorder among US veterans: a randomized clinical trial","volume":"5","author":"Schnurr","year":"2022","journal-title":"JAMA Netw Open"},{"key":"2026100808250223000_ref56","doi-asserted-by":"publisher","first-page":"537","DOI":"10.1080\/19317611.2021.1961965","article-title":"Trauma-informed sex positive approaches to sexual pleasure","volume":"33","author":"Fava","year":"2021","journal-title":"Int J Sex Health"},{"key":"2026100808250223000_ref57","doi-asserted-by":"publisher","first-page":"134","DOI":"10.1037\/ser0000540","article-title":"Trauma-informed and affirmative mental health practices with LGBTQ+ clients","volume":"20","author":"Levenson","year":"2023","journal-title":"Psychol Serv"},{"key":"2026100808250223000_ref58","doi-asserted-by":"publisher","volume":"50","journal-title":"Arch Sex Behav.","DOI":"10.1007\/s10508-020-01776-x"},{"key":"2026100808250223000_ref59","doi-asserted-by":"crossref","first-page":"348","DOI":"10.1016\/j.jana.2009.07.004","article-title":"\u201cI Don\u2019t think this is theoretical; this is our lives\u201d: how erasure impacts health care for transgender people","volume":"20","author":"Bauer","year":"2009","journal-title":"J Assoc Nurses AIDS Care"},{"key":"2026100808250223000_ref60","doi-asserted-by":"publisher","first-page":"124","DOI":"10.1080\/19359705.2012.653255","article-title":"The removal of homosexuality from the DSM: its impact on today's marriage equality debate","volume":"16","author":"Drescher","year":"2012","journal-title":"J Gay Lesbian Ment Health"},{"key":"2026100808250223000_ref61","doi-asserted-by":"publisher","first-page":"189","DOI":"10.1080\/19419899.2013.876445","article-title":"Sexual fluidity in young adult women and men: associations with sexual orientation and sexual identity development","volume":"6","author":"Katz-Wise","year":"2015","journal-title":"Psychol Sex"},{"key":"2026100808250223000_ref62","doi-asserted-by":"publisher","first-page":"831","DOI":"10.1037\/bul0000271","article-title":"Sexual orientation concealment and mental health: a conceptual and meta-analytic review","volume":"146","author":"Pachankis","year":"2020","journal-title":"Psychol Bull"},{"key":"2026100808250223000_ref63","doi-asserted-by":"publisher","DOI":"10.32872\/cpe.11323","article-title":"A systematic review of evidence-based cognitive and\/or behavioural interventions targeting mental health in LGBTQ+ populations","volume":"6","author":"Tudor-Sfetea","year":"2024","journal-title":"Clin Psychol Eur"},{"key":"2026100808250223000_ref64","doi-asserted-by":"publisher","first-page":"263","DOI":"10.1089\/lgbt.2020.0489","article-title":"Sexual minority disparities in health and well being as a consequence of the COVID-19 pandemic differ by sexual identity","volume":"8","author":"Fish","year":"2021","journal-title":"LGBT Health"},{"key":"2026100808250223000_ref65","doi-asserted-by":"publisher","first-page":"959","DOI":"10.1007\/s00787-024-02552-1","article-title":"Prevalence, severity and risk factors for mental disorders among sexual and gender minority young people: a systematic review of systematic reviews and meta-analyses","volume":"34","author":"O'Shea","year":"2025","journal-title":"Eur Child Adolesc Psychiatry"},{"key":"2026100808250223000_ref66","doi-asserted-by":"publisher","first-page":"205","DOI":"10.1111\/j.1744-6171.2010.00246.x","article-title":"Family acceptance in adolescence and the health of LGBT young adults","volume":"23","author":"Ryan","year":"2010","journal-title":"J Child Adolesc Psychiatr Nurs"},{"key":"2026100808250223000_ref67","volume-title":"Defining Sexual Health: Report of a Technical Consultation on Sexual Health, 28-31 January 2002","author":"World Health Organization","year":"2006"},{"key":"2026100808250223000_ref68","doi-asserted-by":"publisher","first-page":"2002572","DOI":"10.1080\/20008198.2021.2002572","article-title":"A systematic review of the neural correlates of sexual minority stress: towards an intersectional minority mosaic framework with implications for a future research agenda","volume":"13","author":"Nicholson","year":"2022","journal-title":"Eur J Psychotraumatol"},{"key":"2026100808250223000_ref69","doi-asserted-by":"crossref","DOI":"10.1176\/appi.books.9780890425787","volume-title":"Diagnostic and Statistical Manual of Mental Disorders","author":"American Psychiatric Association","year":"2022","edition":"5"},{"key":"2026100808250223000_ref70","doi-asserted-by":"publisher","first-page":"448","DOI":"10.1055\/s-0037-1604455","article-title":"Sexual dysfunction in lesbian women: a systematic review of the literature","volume":"35","author":"Sobecki-Rausch","year":"2017","journal-title":"Semin Reprod Med"},{"key":"2026100808250223000_ref71","doi-asserted-by":"publisher","first-page":"437","DOI":"10.1016\/j.ucl.2021.06.004","article-title":"Sexual dysfunction in transgender people: a systematic review","volume":"48","author":"Mattawanon","year":"2021","journal-title":"Urol Clin North Am"},{"key":"2026100808250223000_ref72","doi-asserted-by":"publisher","first-page":"130","DOI":"10.1016\/j.sxmr.2021.01.002","article-title":"Sexual dysfunction in men who have sex with men","volume":"10","author":"Cheng","year":"2022","journal-title":"Sex Med Rev"},{"key":"2026100808250223000_ref73","doi-asserted-by":"publisher","first-page":"1839","DOI":"10.1007\/s40618-025-02580-x","article-title":"Improving care for individuals with gender incongruence: establishing a multidisciplinary approach in Italy","volume":"48","author":"Scala","year":"2025","journal-title":"J Endocrinol Investig"},{"key":"2026100808250223000_ref74","doi-asserted-by":"crossref","DOI":"10.4324\/9781315630038","volume-title":"Sensate Focus in Sex Therapy: The Illustrated Manual","author":"Weiner","year":"2017"},{"key":"2026100808250223000_ref75","doi-asserted-by":"publisher","first-page":"230","DOI":"10.1080\/14681994.2015.1127909","article-title":"Sensate focus: a critical literature review","volume":"31","author":"Linschoten","year":"2016","journal-title":"Sex Relatsh Ther"},{"key":"2026100808250223000_ref76","doi-asserted-by":"publisher","DOI":"10.47626\/2237-6089-2021-0459","article-title":"Mindfulness-based intervention and sexuality: a systematic review","volume":"46","author":"Ciaurriz Larraz","year":"2024","journal-title":"Trends Psychiatry Psychother"},{"key":"2026100808250223000_ref77","doi-asserted-by":"publisher","first-page":"1581","DOI":"10.1016\/j.jsxm.2019.07.019","article-title":"A systematic review on mindfulness meditation-based interventions for sexual dysfunctions","volume":"16","author":"Jaderek","year":"2019","journal-title":"J Sex Med"},{"key":"2026100808250223000_ref78","doi-asserted-by":"publisher","first-page":"1064","DOI":"10.1093\/jsxmed\/qdae108","article-title":"Homework adherence in mindfulness-based cognitive interventions for female sexual dysfunction: a scoping review","volume":"21","author":"Bonato","year":"2024","journal-title":"J Sex Med"},{"key":"2026100808250223000_ref79","doi-asserted-by":"publisher","volume":"12","journal-title":"Mindfulness","DOI":"10.1007\/s12671-021-01710-9"},{"key":"2026100808250223000_ref80","doi-asserted-by":"publisher","first-page":"1318","DOI":"10.1016\/j.beth.2024.02.011","article-title":"State of the science: LGBTQ-affirmative psychotherapy","volume":"55","author":"Burger","year":"2024","journal-title":"Behav Ther"},{"key":"2026100808250223000_ref81","doi-asserted-by":"publisher","first-page":"145","DOI":"10.1111\/andr.12909","article-title":"European academy of andrology guidelines on Klinefelter syndrome","volume":"9","author":"Zitzmann","year":"2021","journal-title":"Andrology"},{"key":"2026100808250223000_ref82","doi-asserted-by":"publisher","first-page":"956","DOI":"10.1111\/jsm.12832","article-title":"Prevalence of endocrine and metabolic disorders in subjects with erectile dysfunction: a comparative study","volume":"12","author":"Maseroli","year":"2015","journal-title":"J Sex Med"},{"key":"2026100808250223000_ref83","doi-asserted-by":"publisher","first-page":"27","DOI":"10.1016\/j.endien.2022.11.007","article-title":"Gender identity: current concepts and gender-affirming hormone therapy","volume":"70 Suppl 1","author":"P\u00e9rez","year":"2023","journal-title":"Endocrinol Diabetes Nutr (Engl Ed)"},{"key":"2026100808250223000_ref84","doi-asserted-by":"publisher","first-page":"128","DOI":"10.1007\/s13669-024-00390-1","article-title":"Sexual function after gender-affirming surgery","volume":"13","author":"Sahmoud","year":"2024","journal-title":"Curr Obstet Gynecol Rep"},{"key":"2026100808250223000_ref85","volume-title":"Sex and Gender Identification and Implications for Disability Evaluation","author":"Slack","year":"2024"},{"key":"2026100808250223000_ref86","doi-asserted-by":"publisher","first-page":"815","DOI":"10.1097\/PSY.0000000000000465","article-title":"Effects of medical interventions on gender dysphoria and body image: a follow-up study","volume":"79","author":"van de Grift","year":"2017","journal-title":"Psychosom Med"},{"key":"2026100808250223000_ref87","doi-asserted-by":"publisher","DOI":"10.1097\/GOX.0000000000006014","article-title":"Impact of gender-confirming chest surgery on sexual health: a prospective study","volume":"12","author":"de Schoulepnikoff","year":"2024","journal-title":"Plast Reconstr Surg Glob Open"},{"key":"2026100808250223000_ref88","doi-asserted-by":"publisher","first-page":"qeaf060","DOI":"10.1093\/sxmrev\/qeaf060","article-title":"Sexual health outcomes following gender affirming metoidioplasty: a systematic review","volume":"14","author":"Goldstein","year":"2026","journal-title":"Sex Med Rev"},{"key":"2026100808250223000_ref89","doi-asserted-by":"publisher","first-page":"1744","DOI":"10.1111\/andr.13022","article-title":"Sexual health after vaginoplasty: a systematic review","volume":"9","author":"Kloer","year":"2021","journal-title":"Andrology"},{"key":"2026100808250223000_ref90","doi-asserted-by":"publisher","first-page":"424","DOI":"10.1080\/0092623X.2016.1178675","article-title":"Prevalence of experiences with consensual nonmonogamous relationships: findings from two national samples of single Americans","volume":"43","author":"Haupert","year":"2017","journal-title":"J Sex Marital Ther"},{"key":"2026100808250223000_ref91","doi-asserted-by":"publisher","first-page":"1481","DOI":"10.1007\/s10508-025-03119-0","article-title":"A qualitative exploration of the experiences of disclosing non-monogamy","volume":"54","author":"Anderson","year":"2025","journal-title":"Arch Sex Behav"},{"key":"2026100808250223000_ref92","doi-asserted-by":"publisher","first-page":"1439","DOI":"10.1007\/s10508-018-1178-7","article-title":"Open relationships, nonconsensual nonmonogamy, and monogamy among U.S. adults: findings from the 2012 National Survey of sexual health and behavior","volume":"47","author":"Levine","year":"2018","journal-title":"Arch Sex Behav"},{"key":"2026100808250223000_ref93","doi-asserted-by":"publisher","first-page":"563","DOI":"10.1002\/erv.70055","article-title":"Exploring the intersection of gender identity and eating behaviours in gender-diverse populations","volume":"34","author":"Meneguzzo","year":"2026","journal-title":"Eur Eat Disord Rev"},{"key":"2026100808250223000_ref94","doi-asserted-by":"publisher","first-page":"879","DOI":"10.1037\/ccp0000349","article-title":"Harmful and helpful therapy practices with consensually non-monogamous clients: toward an inclusive framework","volume":"86","author":"Schechinger","year":"2018","journal-title":"J Consult Clin Psychol"},{"key":"2026100808250223000_ref95","doi-asserted-by":"crossref","first-page":"261","DOI":"10.1007\/978-3-031-14498-1_16","volume-title":"Handbook of the Psychology of Fatherhood","author":"Goldberg","year":"2022"},{"key":"2026100808250223000_ref96","doi-asserted-by":"crossref","first-page":"743","DOI":"10.1037\/0000099-041","volume-title":"APA Handbook of Contemporary Family Psychology: Foundations, Methods, and Contemporary Issues across the Lifespan","author":"Goldberg","year":"2019"},{"key":"2026100808250223000_ref97","doi-asserted-by":"publisher","first-page":"1158","DOI":"10.1037\/fam0001269","article-title":"Future parenthood ideas among child-free LGBTQ+ adults: the roles of stigma and LGBTQ+ community connections","volume":"38","author":"Cashen","year":"2024","journal-title":"J Fam Psychol"},{"key":"2026100808250223000_ref98","doi-asserted-by":"crossref","first-page":"193","DOI":"10.1007\/978-3-030-84189-8_12","volume-title":"Parenting and Couple Relationships among LGBTQ+ People in Diverse Contexts","author":"Gato","year":"2021"},{"key":"2026100808250223000_ref99","doi-asserted-by":"publisher","volume":"38","journal-title":"J Fam Psychol.","DOI":"10.1037\/fam0001203"},{"key":"2026100808250223000_ref100","doi-asserted-by":"publisher","first-page":"429","DOI":"10.1037\/fam0001324","article-title":"Parental sensitivity and child\u2013parent attachment security in lesbian and gay parent families through assisted reproduction","volume":"39","author":"Carone","year":"2025","journal-title":"J Fam Psychol"},{"key":"2026100808250223000_ref101","doi-asserted-by":"publisher","first-page":"38","DOI":"10.1097\/DBP.0000000000000726","article-title":"Gender development in children with gay, lesbian, and heterosexual parents: associations with family type and child gender","volume":"41","author":"Carone","year":"2020","journal-title":"J Dev Behav Pediatr"},{"key":"2026100808250223000_ref102","doi-asserted-by":"publisher","first-page":"e1374","DOI":"10.1542\/peds.2013-0377","article-title":"Promoting the well-being of children whose parents are gay or lesbian","volume":"131","author":"Perrin","year":"2013","journal-title":"Pediatrics"},{"key":"2026100808250223000_ref103","doi-asserted-by":"publisher","first-page":"252","DOI":"10.1037\/dev0000228","article-title":"Does parental sexual orientation matter? A longitudinal follow-up of adoptive families with school-age children","volume":"53","author":"Farr","year":"2017","journal-title":"Dev Psychol"},{"key":"2026100808250223000_ref104","doi-asserted-by":"publisher","first-page":"183","DOI":"10.3390\/ejihpe15090183","article-title":"The burden of the past: a systematic review of childhood trauma and mental health in transgender and gender nonconforming individuals","volume":"15","author":"Di Fini","year":"2025","journal-title":"Eur J Investig Health Psychol Educ"},{"key":"2026100808250223000_ref105","doi-asserted-by":"publisher","DOI":"10.1542\/peds.2019-1725","article-title":"Pubertal suppression for transgender youth and risk of suicidal ideation","volume":"145","author":"Turban","year":"2020","journal-title":"Pediatrics"},{"key":"2026100808250223000_ref106","doi-asserted-by":"publisher","first-page":"699","DOI":"10.1016\/j.jadohealth.2019.12.018","article-title":"Psychological functioning in transgender adolescents before and after gender-affirmative care compared with cisgender general population peers","volume":"66","author":"van der Miesen","year":"2020","journal-title":"J Adolesc Health"},{"key":"2026100808250223000_ref107","doi-asserted-by":"publisher","first-page":"2017","DOI":"10.1093\/eurjpc\/zwac133","article-title":"Cardiovascular outcomes in transgender individuals in Sweden after initiation of gender-affirming hormone therapy","volume":"29","author":"Karalexi","year":"2022","journal-title":"Eur J Prev Cardiol"},{"key":"2026100808250223000_ref108","doi-asserted-by":"publisher","first-page":"1993","DOI":"10.1007\/s10508-018-1362-9","article-title":"Late-onset transgender identity development of adolescents in psychotherapy for mood and anxiety problems: approach to assessment and treatment","volume":"48","author":"Sevlever","year":"2019","journal-title":"Arch Sex Behav"},{"key":"2026100808250223000_ref109","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pgph.0001478","article-title":"A PRISMA systematic review of adolescent gender dysphoria literature: (3) treatment","volume":"3","author":"Thompson","year":"2023","journal-title":"PLOS Glob Public Health"}],"container-title":["The Journal of Sexual Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/academic.oup.com\/jsm\/article-pdf\/23\/11\/qdag316\/71717815\/qdag316.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/jsm\/article-pdf\/23\/11\/qdag316\/71717815\/qdag316.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,10,8]],"date-time":"2026-10-08T12:25:11Z","timestamp":1791462311000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/jsm\/article\/doi\/10.1093\/jsxmed\/qdag316\/8885496"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,10,7]]},"references-count":109,"journal-issue":{"issue":"11","published-print":{"date-parts":[[2026,10,7]]}},"URL":"https:\/\/doi.org\/10.1093\/jsxmed\/qdag316","relation":{},"ISSN":["1743-6095","1743-6109"],"issn-type":[{"value":"1743-6095","type":"print"},{"value":"1743-6109","type":"electronic"}],"subject":[],"published-other":{"date-parts":[[2026,11]]},"published":{"date-parts":[[2026,10,7]]},"article-number":"qdag316"}}