LGBTQIA+ sexual health: a SITCC clinical framework for integrating cognitive-behavioral therapy and sexual medicine.

INTRODUCTION: 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.

OBJECTIVES: To present an evidence-informed Italian Society of Behavioral and Cognitive Therapy (SITCC) clinical framework for integrating cognitive-behavioral therapy (CBT), minority stress-informed 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.

METHODS: 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.

RESULTS: 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-including 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-may 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.

CONCLUSION: 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' needs, agency, and sexual well-being.