Navigating Sexual Challenges as a Couple in the Context of Vulvar Lichen Sclerosus: A Reflexive Thematic Analysis Informed by Sexual Script Theory.

Vulvar lichen sclerosus (VLS) is a chronic, inflammatory skin condition that can lead to vulvar itch and pain as well as challenges in sexual relationships. Yet, little research explores how couples coping with VLS navigate sexual challenges. Informed by sexual script theory and the concept of sexual script flexibility (i.e., adapting a typical sexual routine in response to a sexual problem), we aimed to examine the sexual challenges faced by couples coping with VLS and the strategies they used to cope and maintain satisfying sexual lives. A sample of 98 couples (196 individuals) independently completed two open-ended survey questions about VLS-related sexual challenges and coping strategies, which were analyzed using a reflexive thematic and abductive approach. Couples were found to cope with sexual challenges in three main ways, by 1) using sexual aids, but with varied experiences (3 subthemes), 2) focusing on the partner, for better or worse (2 subthemes), and 3) redefining the sexual relationship as a couple (4 subthemes). Within each of the three themes and nine subthemes, we discuss how couple members' coping strategies align with sexual script flexibility or not, and couples' nuanced reactions to implementing flexible strategies in their sexual lives.