Redefining Intimacy: A Qualitative Study on Sexual Function Experiences and Perspectives Among Migrant and Refugee Women in South Australia

Redefining Intimacy: A Qualitative Study on Sexual Function Experiences and Perspectives Among Migrant and Refugee Women in South Australia | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Redefining Intimacy: A Qualitative Study on Sexual Function Experiences and Perspectives Among Migrant and Refugee Women in South Australia Negin Mirzaei Damabi, Jodie C Avery, Mumtaz Begum, Salima Meherali, and 1 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-6173847/v1 This work is licensed under a CC BY 4.0 License Status: Published Journal Publication published 28 Aug, 2025 Read the published version in International Journal for Equity in Health → Version 1 posted 11 You are reading this latest preprint version Abstract Background Sexual health is a fundamental aspect of well-being, yet migrant and refugee women from low- and middle-income countries (LMICs) often face unique challenges in navigating intimacy and sexual function post-migration. Sociocultural norms, migration-related stressors, and healthcare access influence their experiences, yet these perspectives remain underexplored. Methods This qualitative study examines the transition of sexual function experiences among first-generation migrant and refugee women residing in South Australia. Semi-structured interviews were conducted with 20 reproductive-aged women from diverse cultural backgrounds. Thematic analysis was used to identify key influences on sexual health and intimacy. Results Participants reported that cultural norms, sociocultural expectations, and migration-related stressors shaped their sexual experiences. Many described difficulties in navigating cultural taboos, communication barriers, and limited access to culturally sensitive healthcare services. While migration provided opportunities for increased sexual autonomy, self-discovery, and improved partner communication, deeply ingrained cultural beliefs and emotional struggles continued to impact their sexual well-being. Conclusions The findings highlight the need for culturally sensitive, gender-appropriate sexual health services and the removal of financial, linguistic, and systemic barriers in healthcare access. Healthcare providers, policymakers, and community organizations play a crucial role in fostering inclusive environments that support migrant and refugee women's sexual health and well-being. Sexual function Migrant Refugee Women BACKGROUND Female sexual dysfunction (FSD) is a multifaceted condition encompassing physiological, psychological, and social components that can significantly impact a woman’s well-being. FSD includes distressing concerns such as low sexual desire, arousal difficulties, and pain during intercourse. Globally, the burden of FSD is substantial; a meta-analysis of 21 studies estimated its pooled prevalence to be 50.75% [ 1 ]. In Australia, 36% of women reported experiencing at least one new sexual dysfunction (SD) within 12 months [ 2 ]. The recognition of sexual well-being as a critical aspect of overall health has grown in recent years. The 2021 World Association of Sexual Health Declaration highlighted sexual pleasure as an essential part of health promotion and education strategies [ 3 ]. This evolution marks a necessary shift from traditionally reactive healthcare approaches—focused on preventing negative outcomes—to proactive strategies that foster positive sexual health and satisfaction [ 4 , 5 ]. Evidence underscores the far-reaching benefits of positive sexual experiences, linking sexual satisfaction to improved psychological well-being, stronger interpersonal relationships, and enhanced quality of life [ 6 – 8 ]. However, significant disparities persist in women’s sexual health experiences, particularly in access to care. Women continue to report less satisfactory sexual experiences compared to men [ 9 ] reflecting systemic inequities shaped by gender, socioeconomic status, and cultural background[ 10 , 11 ]. Limited access to resources and societal stigma further exacerbate these challenges, leaving many women without adequate support for their sexual well-being [ 3 , 12 ]. For instance, research has shown that 27% of divorced women attribute their divorce to decreased sexual desire [ 13 ], while women diagnosed with Hypoactive Sexual Desire Disorder (HSDD) experience notable declines in health-related quality of life, particularly mental well-being [ 13 ]. The barriers to sexual healthcare access become even more pronounced for women from disadvantaged or marginalized groups. Social determinants such as low socioeconomic status, limited healthcare resources, and cultural stigma, contribute to compounded difficulties in accessing care [ 14 ]. Additionally, the role of healthcare practitioners as intermediaries is critical, yet their approach is often influenced by personal beliefs, cultural attitudes, and inconsistent implementation of health policies [ 15 ]. A significant challenge in addressing FSD lies in the inadequate preparation of healthcare providers, particularly in primary care settings [ 16 ]. Studies indicate that small proportion of primary care physicians routinely inquire about female patients' sexual function, with many reporting discomfort or lack of preparedness in discussing these topics [ 16 , 17 ]. This deficiency in training and confidence among healthcare providers creates a substantial barrier for women seeking help for sexual health concerns [ 17 ]. Furthermore, the financial burden associated with diagnostic procedures, such as ultrasounds and hormone panels, often recommended in FSD evaluation, can be prohibitive, especially for those without comprehensive health insurance coverage [ 16 ]. These financial barriers disproportionately affect women from lower socioeconomic backgrounds and migrant communities, further exacerbating healthcare disparities in sexual health. In Australia, where 30.7% of the population is overseas-born as of 2023 [ 18 ], understanding the sexual health experiences of migrant and refugee women is both timely and essential. The influx of women from Low- and Middle-Income Countries (LMICs), particularly from Asian and African regions, introduces cultural complexities that require culturally sensitive care. Migrant and refugee women face unique challenges, including language barriers, cultural taboos, and the difficulties of adapting to a new healthcare system [ 19 , 20 ]. Despite Australia’s increasingly diverse population, research addressing sexual function and satisfaction among migrant and refugee women remains limited [ 21 , 22 ]. Existing studies often neglect these populations, with less than 10% of evaluations focusing on sexual health outcomes in migrant contexts. This gap in knowledge underscores the urgent need for comprehensive investigations that incorporate both healthcare provider and consumer perspectives to ensure equitable and culturally appropriate sexual healthcare delivery. This study seeks to address this gap by exploring perspectives on sexual function among migrant and refugee women in South Australia. METHODS Study Design and Aim This qualitative exploratory study was designed to investigate the perspectives and experiences of sexual function among migrant and refugee women in South Australia, with a particular focus on their interactions with healthcare providers. A qualitative exploratory approach was chosen because it is well-suited for examining under-researched and sensitive topics, such as sexual health, where limited prior knowledge exists. This design enables an in-depth exploration of participants’ lived experiences, allowing themes and insights to emerge naturally from the data without relying on pre-existing theories or frameworks [ 23 ]. The study aimed to understand participants' knowledge of sexual function, changes in sexual function post-migration, and their experiences engaging with healthcare providers, including the facilitators and barriers they encountered. This approach ensured that the study captured the complex interplay of cultural, social, and individual factors shaping sexual health and healthcare experiences in this population. Participant Recruitment The study recruited 20 reproductive-aged women (18–49 years) from migrant and refugee backgrounds who had migrated from LMICs and were currently residing South Australia. Eligibility criteria included being first-generation migrants, heterosexual, and sexually active (defined as having had sexual intercourse within the past four weeks [ 24 , 25 ]). Women who were born in Australia, those living with intellectual disabilities, and those unwilling to participate were excluded from the study. Given the sensitive and culturally taboo nature of the topic, recruitment utilized multiple culturally appropriate approaches to ensure accessibility and trust-building. Flyers with the heading "We want to hear your story" were distributed through organizations supporting migrant and refugee populations, including the Australian Migrant Resource Centre, International Organization for Migration, Refugee Advocacy Service of South Australia, Australian Refugee Association, Vinnies Refugee & Asylum Seeker Service, and FBW Gynaecology Plus Clinic. Social media outreach through institutional networks, such as the University of Adelaide, Robinson Research Institute (RRI), and Healthy Development Adelaide (HDA), further complemented these efforts. To enhance accessibility and participant engagement, the research team developed the Refugee and Immigrants Sexual Health Endeavor (RISE) website. The platform featured multi-language translation capabilities, comprehensive study information, an online appointment booking system, and downloadable participant information sheets. This multi-channel recruitment strategy was designed to address barriers such as language, cultural stigma, and trust, which often hinder participation in research involving sexual health. Data Collection Semi-structured interviews were conducted in participants’ preferred languages to ensure comfort, inclusivity, and the establishment of trust. The research team’s multilingual capabilities, including fluency in Urdu, Persian, Hindi, and Dari, enabled direct communication with participants, while professional interpreters were engaged when additional language support was needed. For participants speaking languages beyond the team’s expertise, arrangements for qualified translators were made. Interviews were conducted either in-person or virtually, depending on participants’ preferences and logistical needs. Private, safe settings were prioritized to facilitate open and honest discussions, recognizing the personal and sensitive nature of the topic. Interviews were audio-recorded with participants’ consent and transcribed verbatim for analysis. As there were no directly comparable studies or established questionnaires addressing the sexual health and function of migrant and refugee women in the Australian context, the interview schedule was developed specifically for this study. The development process involved a systematic review of the literature to identify key themes related to sexual function and migration, informal consultations with healthcare providers experienced in working with migrant communities, and feedback from cultural advisors to ensure cultural sensitivity and appropriateness of the questions. The final interview schedule included demographic questions to contextualize participants’ experiences and open-ended questions organized into key themes, such as cultural perspectives on sexual function, post-migration sexual function and well-being, understanding of sexual function, healthcare experiences, and suggestions for service improvement. The interview schedule was divided into two main sections. The first section, demographic questions, gathered basic information about participants' age, ethnicity, migration history, marital status, and other relevant background details. The second section, thematic questions, consisted of open-ended questions that explored participants' experiences and perceptions of sexual health and function, focusing on cultural influences, migration-related changes, and interactions with healthcare services. A detailed list of the demographic and thematic questions is provided in APPENDIX 1 for reference. Ethical Considerations This study was conducted in accordance with the National Statement on Ethical Conduct in Human Research and the Declaration of Helsinki [ 26 , 27 ]. It was approved by the University of Adelaide Human Ethics Research Committee (approval no. H-2024-011). Before participation, all participants received a written consent form outlining the study’s objectives, procedures, potential risks, and confidentiality measures. They provided informed consent by signing and returning the form before the study commenced. Additionally, verbal consent was reaffirmed at the beginning of each interview to ensure continued willingness to participate. Consent to Participation and Publication Informed consent was obtained from all participants in the study. Participants were provided with an information sheet detailing the study's purpose, procedures, and any potential risks or burdens associated with their participation. They were also given the opportunity to ask questions and discuss any concerns before agreeing to participate. Written consent was obtained for participation in the interviews, ensuring that participants understood the voluntary nature of their involvement. Participants were informed that they could withdraw from the study at any time without consequence. However, they were also made aware that, due to the nature of the study, data already provided during the interview could not be withdrawn after the interview session had concluded. In addition to consent for participation, participants were asked to provide informed consent for the publication of anonymized data derived from their interviews. The participants were assured that any identifying details would be omitted, and that their personal information would not be disclosed in any published materials. Consent for the publication of data was obtained in writing, and the signed consent forms are held securely by the researchers. Data Analysis Thematic analysis, guided by social constructivist epistemology, was employed to identify, analyse, and interpret patterns within the interview data [ 28 ]. The analysis process was systematic and iterative. Initially, team members independently reviewed a subset of interview transcripts to generate first-order codes, such as “sexual function changes after migration,” “how Australia is different,” and “barriers to accessing sexual health services.” These codes were discussed, refined, and organized into broader themes during team meetings to ensure a consistent analytical approach. NVivo software was used to facilitate data management, coding, and organization. Themes were developed iteratively, with continuous comparison across transcripts to ensure the robustness of findings. Exemplar quotations were selected to illustrate key themes and were presented to provide context and amplify their voices. The analysis prioritized reflexivity, with the research team reflecting on their own cultural positions and biases throughout the process. To enhance rigor, the researchers acknowledged their positionality, including their professional backgrounds and personal experiences, and how these may have shaped the research process and interpretation of the findings. Data saturation was achieved when no new themes emerged from the interviews, ensuring the comprehensiveness of the findings. Researchers' reflexivity The research team employed several strategies to ensure both methodological rigor and cultural sensitivity throughout the study. A shared migrant background among team members, including the lead researcher, provided significant cultural insights that enriched the study. This common experience facilitated a deeper understanding of the participants’ lived realities, fostering empathy and trust, which were especially important when discussing sensitive topics such as sexual health. While cultural familiarity proved to be a valuable asset, the research team remained mindful of its potential drawbacks, often described as a "double-edged sword" [ 29 ]. Participants may have assumed the researchers’ familiarity with their experiences, potentially leading to less detailed or nuanced disclosures during interviews. To mitigate this risk, the researchers emphasized open-ended questioning, active listening, and the importance of participants sharing their unique perspectives, ensuring their voices were fully heard and understood. To ensure inclusivity and respect for participants' diverse needs, interviews were offered in participants' preferred languages, and access to study materials was made available via the multilingual RISE website. This platform enabled participants to access comprehensive information, further enhancing the study’s accessibility. The lead researcher maintained a reflexive approach throughout the study, continuously reflecting on their positionality and the impact it may have on data collection and interpretation. Emphasizing the importance of active listening, the researcher prioritized participant comfort and agency, creating a space where participants felt heard and respected. This participant-cantered approach was crucial in navigating conversations around sexual health, a subject often considered taboo in many cultural contexts. Challenges encountered during recruitment—such as cultural sensitivities and stigma surrounding the topic of sexual health—were met with proactive strategies. The team made clear the study's commitment to confidentiality and its objectives, providing transparency to potential participants. Collaboration with local community organizations played a pivotal role in building trust, while multilingual materials and the RISE website ensured accessibility for participants from varied linguistic backgrounds. Additionally, post-interview support was offered to participants through information on sexual health services, both online and in-person, ensuring they had access to continued support if necessary. RESULTS The study involved 20 women from diverse cultural backgrounds, all originating from LMICs. The participants included six women from South Asia (three each from Pakistan and India), two from East Asia (China), seven from various African nations, and five from the Middle East (three from Afghanistan and two from Iran). Despite the availability of interpreters and multilingual interview options, all participants chose to have their interviews in English. These women represented a range of demographic characteristics, including varying ages, education levels, employment statuses, and lengths of residence in Australia. All participants were in heterosexual relationships of differing durations. The sample also encompassed women with different visa statuses, religious backgrounds, and pregnancy histories, residing across various regions or suburbs in Adelaide, reflecting diverse socioeconomic areas. Analysis of the interview data revealed three major themes: cultural and sociocultural factors influencing sexual function, sexual function transitions after migration, and navigating sexual healthcare services and systemic challenges. Cultural and Sociocultural Factors Influencing Sexual Function The analysis revealed that cultural beliefs and practices profoundly influenced participants' sexual experiences, attitudes, and behaviours. This influence manifested through several interconnected dimensions: deep-rooted cultural taboos, emotional conflicts between traditional values and new experiences, and challenges in navigating different cultural approaches to sexuality. Cultural norms and family expectations in the country of origin Cultural norms and family expectations significantly shaped participants' understanding and communication about sexual function, especially in cultures where discussing sexuality is taboo or even considered illegal. In some cultures, particularly in the Middle East and South Asia, sexuality remains a highly sensitive subject. One participant described the severity of this taboo in her country: “In my country, sexual activity is very much taboo. Even now in 2024, it’s getting a little better, but still… it’s not something we discuss openly. It’s especially difficult when you're not married—then it becomes not just taboo but socially unacceptable. You have to hide relationships from your family, from police, from everyone.” (Middle Eastern – Age 28) For many participants, the pressure to adhere to these cultural and familial expectations created significant internal conflict. One participant described the emotional toll of living in a new country while still carrying the weight of their cultural programming: "This is very complicated for me... [long pause] Being 35 and having my first relationship here, I feel like a teenager sometimes. But I also carry all these years of cultural... how to say... programming? I often feel guilty, even though I know I'm not doing anything wrong. The hardest part is that I can't talk to my family about any of this…Sometimes after being intimate with my partner, I cry because I feel like I'm living a double life. But at the same time, I feel I deserve to experience love and relationship like anyone else." (Middle Eastern – Age 35) This internal struggle was often accompanied by feelings of guilt and shame, especially related to sexual activity. One participant reflected on the burden of these emotions: " I still carry a lot of guilt and shame when I have sexual activity. Sometimes I think, 'What would my parents think if they knew?' or 'Am I taking advantage of their trust?' There's also worry about... if this relationship doesn't work out, what will my next partner think about my previous relationship? " (East Asian – Age 39) As participants reflected on the cultural divide between their home countries and Australia, many pointed out the contrast in sexual attitudes. One participant spoke about their own family’s reluctance to discuss sex, which sometimes led to misunderstandings within their relationship: "I never had an open conversation with my mom about sex life. Even though I was getting married, she didn't tell me anything, and I didn't have any sisters. So back in my mind, I think I'm still not very open to try new things or even talk about it, which sometimes, you know, like, creates misunderstanding between the couple as well." (South Asian – Age 38) Cultural practices and their consequences: Female Genital Mutilation (FGM) and sexual function Migrant women from countries where Female Genital Mutilation (FGM) is practiced often bring with them complex cultural beliefs and experiences that influence their sexual health and well-being. FGM, although illegal in many countries, persists in certain communities due to deeply rooted cultural traditions. Participants in this study highlighted the diversity of views and experiences surrounding FGM, with some demonstrating only vague awareness of the practice, while others shared personal encounters. Many participants acknowledged the existence of FGM in their home countries but expressed discomfort discussing it. They mentioned the practice of FGM is not uniform across all communities, and it varies significantly between ethnic groups. FGM is often justified by traditional beliefs, particularly those related to controlling female sexuality and enhancing fertility. One participant shared: "It's like a traditional belief that it helps the female become more fertile... They think if they do this, they can conceive better." (African – Age 20) In some communities, FGM is also perceived as a way to prevent infidelity within marriage. As one participant recalled: “Some of the responses that I got... they say ladies should undergo that process so that they cannot cheat in their marriages." (African – Age 29) However, for many women who have undergone FGM, the experience is often described as traumatic, especially as they grow older and become more aware of its harmful consequences. One participant shared her experience of undergoing FGM as an infant: "I was being circumcised while I was still a baby... But now when I grow up, I see the way they do it. It's not good. I don't like it anymore... I wouldn't have allowed someone to circumcise me because they do use unsterilized equipment." (African – Age 32) This shift in perspective is common among women who underwent FGM in childhood, as they later recognize both the physical and emotional harm it caused. Many participants also expressed awareness of FGM as a human rights violation, acknowledging its harmful impact not only in their home countries but also in Australia. This reflects the ongoing challenges migrant women face in navigating cultural traditions that conflict with local laws and human rights standards. Influence of host country norms on sexual health and function Migration to Australia played a pivotal role in the personal growth and self-esteem of many participants, offering them a chance to regain control over their lives and sexual well-being. The shift in their circumstances was often accompanied by newfound freedom, allowing them to make decisions independently, without the constraints of family or societal expectations from their home countries. This sense of autonomy was reflected in various aspects of their lives, such as living arrangements, financial independence, and personal choices. However, despite this greater sense of freedom, some participants found it challenging to fully embrace it, as traditional beliefs and values from their home countries remained deeply ingrained. As one participant reflected: "Now I live alone in a first-world country, and I can make my own decisions. There's no family asking where I'm going, no [social] police to be afraid of. I can go out, date, be in contact with people... But it's interesting because even with all this freedom, those traditional beliefs are still deep inside me." (Middle Eastern – Age 32) This testimony highlights the complex nature of cultural transition - while physical distance provided freedom from external constraints, internalized cultural values remained influential in shaping participants' decisions and experiences. Participants frequently highlighted the stark differences between Australian sexual health norms and those of their home countries, particularly regarding gender dynamics and sexual agency. The Australian context was characterized by greater openness and respect for individual choice, contrasting sharply with more restrictive norms in their countries of origin. One participant illustrated this contrast in discussing women's sexual agency: "They [Australians] communicate openly... sexual life here, versus the one in my home country, is kind of different, everyone seems to respect each other's opinion and choice here. But in over there [home country], even a married woman can never say no to a husband [when it comes to sex]." (African – Age 42) This sentiment was echoed by another participant who emphasized the transformative impact of Australia's more open cultural environment: "Being in Australia, I've learned to be outspoken about my feelings, be expressive about sexual desires... But in my home country, when you talk about stuff like that, it's like you degrading yourself or you've been cheap." (East Asian – Age 33) The navigation between different cultural expectations emerged as a significant challenge for participants. This was particularly evident in how they reconciled traditional values with new cultural norms regarding sexual behaviour and expression. One participant, for instance, described the complex dynamics of sexual expectations, particularly the pressure women face to preserve their sexual autonomy and avoid being labelled as "cheap": "In our culture, sex for women is kind of treasure you hold, and if you give it away too easily, then you're cheap... So that kind of gives you this weird concern when you have sex with even your boyfriend, they're like, oh, he hasn't proposed... Would he think that I'm an easy girl?” (East Asian – Age 39) For some participants, religious beliefs added another layer of complexity to this cultural navigation. As one 32-year-old participant explained: "I felt like I need to be more intentional with, first of all, I am a Christian, and I had to make a personal decision not to do things which are opposite of what is expected of me as a Christian... So that is one of the factors." (African – Age 32) Sexual Function Transitions After Migration Migration brings profound changes to various aspects of life, including intimate relationships and sexual experiences. Participants in this study described a complex journey of sexual adaptation and discovery following their migration, encompassing challenges in maintaining intimacy, shifts in sexual desire, experiences with sexual pain, understanding of orgasm, and overall sexual satisfaction. Their narratives reveal how the intersection of cultural transition, increased access to information, and personal growth shaped their sexual experiences in their new country. The initial period of migration presented significant challenges that impacted participants' sexual function and intimate relationships. These challenges were primarily related to settlement stress, changes in living arrangements, postpartum recovery, and navigating cultural and healthcare differences. Participants described how the demands of settling into a new country, such as finding housing and employment, significantly affected intimacy: "When we were new here, we were under a lot of stress, like, looking for a place and work. We weren't probably doing much because we both were under stress. But down the line, once we got our rental place, once we both had our jobs, it was pretty much easier." (South Asian – Age 44) Changes in living arrangements and work schedules further disrupted intimacy: "Sexual functionality was at the all-time low because we were going through a lot of changes …. My husband had to take up a night job, it was just hard, and the kids started sleeping with me." (South Asian – Age 29) Sexual desire changes As participants adjusted to their new environment, many experienced shifts in their sexual desire and expression. Migration often provided a more open and encouraging environment, fostering greater sexual arousal and willingness to explore new experiences, despite busy lifestyles: “I feel more sexually aroused here, and I am more willing to try various things... But still, the environment here encourages me to explore more.” (African – Age 49) Notably, some women experienced a transformation in their sexual agency, describing a sense of empowerment to initiate intimacy, contrasting with the more passive roles often expected in their home countries: “I think I’m now willing to engage. Sometimes I will even be the one to engage in the activities that I have the desire to engage.” (African – Age 29) Sexual pain experiences The navigation of sexual pain emerged as a significant aspect of participants' post-migration sexual experiences, influenced by factors such as adaptation, communication, knowledge, and physical health. For some women, initial pain during sexual activity improved through learning and open communication: “Initially, I experienced very bad sexual pain, but it got better after practicing and having more sexual activity. I think me and my partner, we... progressed as we proceeded. We did research and learned how everything could be better.” (African – Age 33) Other participants connected their pain to a lack of communication and limited sexual knowledge, which they attributed in part to cultural differences. Some participants demonstrated increased awareness of physical factors contributing to sexual pain, reflecting greater health literacy: “It’s quite easy to feel painful during sex if the person is not doing it right. I think I am probably allergic to semen because if we don’t use a condom, I get quite a burning sensation afterwards.” (East Asian – Age 33) Orgasm changes Understanding and experiencing orgasm emerged as a complex journey influenced by cultural background, education, and personal discovery. Several women expressed initial confusion about the concept of orgasm, highlighting the impact of limited sexual education in their home countries. One participant shared: “I didn’t understand what orgasm actually is. So, I had to research it, it’s really rare for me to experience it. I think it has been constant. I experienced it [lack of orgasm] back in my home country, and also here.” (African – Age 49) This quote highlights both the challenges faced by some participants in understanding their own sexual experiences and the self-initiated process of learning about orgasm after migration. It also reflects that, despite the geographical and cultural transition, the frequency of experiencing orgasm remained unchanged for them. For other participants, emotional and psychological factors emerged as barriers to experiencing orgasm, reflecting internalized beliefs and societal expectations: “I think this is just something which is really hard for women to experience. So, I was just, maybe thinking I could experience it one day. I don’t know. But maybe it depends also on the person I’m with.” (Middle Eastern – Age 39) The post-migration environment provided opportunities for self-education and exploration, though some participants continued to navigate cultural and personal barriers: “I have not quite had actual systematic sexual education or a set discussion. So, I know I can definitely get an orgasm by myself. I can also get good pleasure from sex with my partner, but it feels different. It’s not quite the same thing. So, I’m not entirely sure if that means I don’t get orgasm from sex, or it’s just there are different types of orgasm.” (African – Age 42) This statement highlights the complexity and fluidity of sexual pleasure, as well as the uncertainty that can arise in the absence of comprehensive education or open discussions about sexual health. Sexual satisfaction changes The impact of migration on sexual satisfaction varied significantly among participants, revealing the complex interplay between cultural transition, personal growth, and intimate relationships. While some women reported persistent challenges: “In general, I am not satisfied... I have never been. I have always had problems with sexual activity. These are things that are inside me, I think.” (African – Age 32) Others described migration as a catalyst for positive change through increased access to information and personal development: “It’s changed immensely... I was able to learn, and I was able to get to know myself in that area... I was exposed to resources that helped me gain this idea about the recent changes.” (South Asian - Age 39) A few participants noted improvements in their sexual performance after migration, attributing these changes to personal development or shifts in circumstances. Navigating Sexual Healthcare Services and Systemic Challenges Cultural dynamics in sexual health communication Participants described complex dynamics in discussing sexual matters with their partners, reflecting both cultural transitions and personal growth. Some participants reported positive evolution in their communication comfort, often attributing this to the supportive Australian environment and access to mental health resources. However, many participants still struggled with explicit sexual communication, particularly regarding satisfaction and discomfort: “I just have the fear of the unknown because if I say, I don't experience orgasm, maybe they could blame themselves.” (African − 44) Some participants developed adaptive strategies, using non-verbal cues to navigate sensitive topics while maintaining cultural comfort levels: “I never bring it up. So, for example, if we're in bed and something he did actually hurts me, I'll stop him, but I'm not going to say much about it. I'm not going to say, oh, you can't push from that angle. It hurts me. I'll just pull away and hope that over time, he's going to learn not to do it in a certain way because I'll always pull away from that direction.” (East Asian – Age 33) The transition to Australian healthcare settings marked a significant shift in participants' experiences of sexual health communication with healthcare providers. Many found the Australian healthcare environment more conducive to open discussions. However, for others, the differences in communication were evident when comparing their experiences in Australia to those in their home countries. In some cultures, discussing sexual health with a provider is still viewed as inappropriate or uncomfortable, often due to the stigma surrounding the topic. Systemic barriers to accessing sexual and reproductive health services Participants reported significant challenges in accessing Sexual and Reproductive Health (SRH) services due to limited awareness, financial barriers, cultural factors, and gaps in provider knowledge. For many, accessing care required encouragement from partners or sustained effort to overcome systemic and cultural barriers. They felt too shy, overwhelmed, or uncertain about where to seek help. So, they turned to the internet or informal networks for guidance: “I was too shy to reach out to doctors. I just tried to search online, finding podcasts or go on social media to help myself.” (South Asian – Age 44) Financial constraints emerged as a recurring barrier, particularly for migrant women without access to Medicare: “They [healthcare services] are expensive as a migrant who doesn't have Medicare. Sometimes I have more urgent needs rather than my... orgasm problems.” (South Asian – Age 29) Limited awareness of sexual health services further compounded these challenges: “I've never heard of that [sexual health clinic]. Honestly, it did not even click my mind to search for some sort of sexual health clinic.” (African – Age 29) Additionally, Australia’s healthcare structure, including privacy regulations and referral systems, can unintentionally create barriers to SRH care. Participants also highlighted the complexities of navigating referrals and long waiting times for specialized care. One participant described the difficulty of finding a female doctor who could address her premenopausal concerns: "Some GPs and specialists are not taking new patients. I tried two specialists, and both refused because they were full." (South Asian – Age 39) Facilitators to access and service expectations Participants identified a range of preferences in accessing SRH services, shaped by gender, cultural background, language, cost, and provider attitudes. Their insights underscored the need for culturally sensitive, gender-appropriate, and affordable care to meet the unique needs of migrant and refugee women. A consistent theme among participants was a strong preference for female healthcare providers. Many women expressed discomfort in discussing sexual health concerns with male practitioners due to cultural norms, personal shyness, and fears of judgment: “I would become very uncomfortable in sharing this personal sort of thing with a male person. Probably, I would be more comfortable with a female.” (African – Age 44) Participants also held diverse and sometimes conflicting views on the cultural backgrounds of healthcare providers. Some women preferred practitioners outside their community to safeguard privacy and avoid judgment: “I prefer female doctors who aren't from my background... our community is small here; everyone knows each other. I don't want someone who might know me or my family.” (Middle Eastern – Age 33) Conversely, others valued cultural understanding and expressed comfort with providers from similar or neighbouring cultural backgrounds: “It doesn’t have to be someone from my home country, but maybe similar They understand how things are different in our cultures when it comes to sexuality.” (South Asian - Age 44) Language played a nuanced role in shaping access to care. While English was preferred by some participants for its emotional distance when discussing sensitive topics, it also presented challenges: “I prefer speaking English for these topics. Saying these words in my native language feels… wrong. In English, it's like I’m a different person—more professional, more open.” (Middle Eastern – Age 28) Conversely, others found that using their native language facilitated deeper communication and trust. Participants emphasised the importance of precise and meaningful communication, noting that translating concepts from their native language to English could cause misinterpretation. “If I can communicate and the other person can grasp the message in my own language, then I’ll be more open. Language is the first barrier.” (Middle Eastern – Age 33) Financial barriers were significant, particularly for women without Medicare coverage or those on student visas. These reflections highlight the urgent need for affordable, accessible sexual health services for migrant and refugee women. Building trust also emerged as a central factor in improving access to sexual health services. Participants emphasized the need for safe, supportive environments where women feel accepted and comfortable sharing sensitive concerns Access to trustworthy, culturally appropriate information was highlighted as a critical facilitator. DISCUSSION The study revealed several interconnected themes that profoundly influence sexual function among migrant and refugee women, highlighting the complex interplay between cultural background, migration experiences, and sexual well-being. The primary themes identified centre around cultural norms, traditional beliefs, and the challenges of navigating between different cultural contexts. A significant finding was the pervasive impact of cultural taboos and family expectations from participants' countries of origin. These deeply ingrained cultural norms created persistent internal conflicts, particularly regarding sexual expression and relationships. Participants frequently reported experiencing guilt, shame, and emotional distress when their sexual behaviours conflicted with traditional values, even after relocating to Australia. This was especially evident among participants from Middle Eastern and Asian backgrounds, where sexuality remains a highly sensitive and often prohibited topic of discussion. These findings align with the study conducted by Alvarez et al. [ 30 ] which highlights how female migrants often carry with them deeply ingrained beliefs, attitudes, and behaviours regarding sexuality, contraceptive use, and perceptions of what is deemed socially acceptable. These perspectives are heavily shaped by both explicit and implicit social norms from their countries of origin. This alignment emphasizes the enduring influence of cultural conditioning on sexual health outcomes, even in new socio-cultural environments. However, the study also revealed a contrasting yet complementary dynamic. Migration, while bringing cultural and emotional baggage, can also create opportunities for renegotiating sexual norms and behaviours. A nuanced understanding emerged, indicating that the impact of migration on sexual health and autonomy is not uniform and varies based on individual circumstances, resilience, and the broader socio-cultural environment in the host country. For some participants, migration acted as a catalyst for increased sexual autonomy and willingness to explore sexuality. The exposure to a more open cultural environment in Australia, combined with reduced social surveillance and greater access to sexual health resources, allowed these women to reconstruct their sexual identities and feel more empowered in expressing their sexual desires. This dual narrative underscore the complexity of migration experiences. On one hand, cultural norms and values from the country of origin may persist, creating internal barriers to sexual freedom and self-expression. On the other hand, migration can also serve as an opportunity for liberation from these constraints, enabling women to reframe their sexual identities in a more accepting and less judgmental cultural context. These two trajectories are not mutually exclusive but rather reflect different facets of the same migration experience, shaped by personal, cultural, and situational factors. This dynamic created a complex pattern of adaptation where women actively negotiated between traditional expectations and new cultural norms, particularly in relation to sexual decision-making and relationship dynamics. Consistent with findings from other studies, participants’ sexual beliefs and behaviours were also shaped by education and women with limited education or from lower socioeconomic backgrounds were more likely to exhibit reserved or submissive sexual behaviours, while those with higher education levels tended to express themselves more openly about sexuality, were more inclined to seek sexual health services, and maintained more communicative and transparent relationships with their partners and broader social networks [ 30 ]. The second major theme of this study explored the transitions in sexual function following migration, revealing multifaceted changes and adaptations. During the initial settlement period, participants faced considerable challenges that directly impacted their sexual functioning, primarily stemming from settlement stress, altered living arrangements, and adaptation to new cultural contexts. These immediate post-migration stressors often resulted in decreased sexual activity and disrupted intimacy patterns within relationships. The study revealed that the new cultural environment often facilitated greater sexual autonomy and willingness to explore sexuality, with some women reporting increased comfort in initiating intimate encounters - a marked shift from traditional gender roles in their countries of origin. This finding suggests that migration can serve as a catalyst for sexual empowerment and the reconstruction of sexual identity. Notably, participants also described how restrictive cultural attitudes and insufficient sexual health education in their home countries led to problematic conceptualizations of sexuality and consent. For instance, one East Asian participant revealed how intense cultural shame around sexual desire led to the development of concerning sexual fantasies as a means of reconciling pleasure with cultural prohibitions. However, exposure to more sex-positive cultural attitudes post-migration enabled many participants to develop healthier perspectives on sexual agency and intimacy. These findings underscore how excessive cultural control over sexuality, combined with inadequate sexual health literacy, can foster potentially harmful ideas about sex - highlighting the critical importance of comprehensive sexual education and the need for culturally sensitive approaches to sexual health support for migrant women. Our findings on the transitions in sexual function following migration align with recent research while offering new perspectives on this complex issue. A 2022 study by Ussher et al. found that migrant women from Middle Eastern and North African backgrounds experienced significant changes in sexual practices and pleasure post-migration [ 31 ], which is consistent with our observations of increased sexual autonomy and exploration among some participants. The results also offer new perspectives on the concept of orgasm among migrant women, revealing confusion and lack of clarity for some participants. The varying experiences of sexual pain and satisfaction reported in our study align with recent work by Hawkey et al. (2021), which found that cultural beliefs and practices significantly impact sexual health outcomes for migrant women [ 32 ]. However, our study provides a more nuanced understanding of how these factors interact with the migration experience over time, offering insights into both challenges and opportunities for growth in sexual function. The results of this study highlight the evolving comfort of migrant and refugee women in discussing sexual health as they adapt to new cultural environments. However, significant barriers persist, particularly in openly addressing issues related to sexual satisfaction or discomfort. These challenges often stem from deeply rooted cultural taboos and the fear of judgment from both partners and healthcare providers. Many participants resorted to non-verbal communication strategies to navigate these sensitive topics. These findings align with prior research, such as Metusela et al., which emphasized that migrant women often face difficulties in discussing sexual health due to cultural norms and language barriers [ 33 ]. Our study also suggests that the sexual agency of migrant and refugee women is shaped by the intersection of patriarchal cultural and religious narratives, with these factors influencing their relationships with their spouses and the psychological and practical consequences of resisting these norms. Echoing the work of Hawkey et al. (2018), our findings emphasize that migrant and refugee women are not a homogeneous group, and it is crucial for healthcare providers and sexual health educators to be mindful of the cultural and religious nuances that shape how women navigate these issues within their marital relationships [ 34 ]. Additionally, the research identified several systemic barriers that hinder access to sexual health services. These included limited awareness of available resources, financial constraints, and the complexities of navigating the healthcare system. These barriers were especially pronounced among migrants without access to Medicare, prompting some participants to seek help through informal networks or online platforms. A consistent theme across interviews was the call for more accessible, affordable, and culturally sensitive healthcare services to meet the needs of these women. Another key theme that emerged from this study was the preference for female healthcare providers and culturally appropriate care, which participants viewed as essential for building trust and ensuring open communication. Many participants expressed a preference for providers from similar cultural backgrounds to mitigate the risk of judgment and ensure confidentiality. This preference reflects the broader cultural sensitivity needed in healthcare settings to foster comfort and trust. Language also played a significant role in facilitating effective communication; while some participants preferred speaking in English, others felt more at ease using their native language, believing it ensured more accurate and meaningful interactions. These findings resonate with the results of a systematic review by Sánchez et al., which highlighted similar barriers in sexual and reproductive health (SRH) service access. According to the review, the most common barriers to SRH services included lack of information (57%), language barriers (43%), cultural differences (39%), economic challenges (25%), administrative hurdles (25%), and discrimination (14%) [ 35 ]. The findings of this study make significant contributions to multiple theoretical frameworks in sexual health, migration studies, and cultural psychology. First, they expand Berry's Acculturation Theory by illuminating the complex dynamics of sexual health acculturation among migrant women [ 36 ]. While Berry's model traditionally describes four broad acculturation strategies (integration, assimilation, separation, and marginalization), our findings reveal a more nuanced process in the domain of sexual health. Participants demonstrated what we term "selective sexual health acculturation" - a dynamic process where women strategically adopt certain Australian sexual health practices and attitudes while maintaining traditional values in other areas. This selective approach appears to be particularly evident in how women navigate healthcare seeking behaviours versus intimate relationship dynamics. The study also advances the Health Belief Model (HBM) by demonstrating how cultural factors fundamentally reshape its core constructs in migrant populations. Traditional HBM components - perceived susceptibility, severity, benefits, and barriers - are profoundly influenced by cultural beliefs and migration experiences. For instance, our findings show that perceived barriers to sexual healthcare are not merely practical (like language or cost) but are deeply rooted in cultural schemas about sexuality, shame, and gender roles. This suggests that the HBM, when applied to migrant sexual health, must be expanded to incorporate cultural determinants as primary rather than secondary factors [ 37 ]. Furthermore, this research advances intersectional theory in health research by revealing the complex interplay between multiple social identities in shaping sexual health experiences. Building on Hankivsky's intersectional framework, our findings demonstrate how gender, cultural background, migration status, and socioeconomic position create unique configurations of privilege and disadvantage that influence sexual health outcomes [ 38 ]. Particularly notable is how these intersecting identities create both constraints and opportunities for sexual agency and health-seeking behaviours. For example, higher education levels appeared to moderate the influence of traditional cultural norms, while religious identity often intensified cultural barriers to sexual health services. Theoretically, this study also introduces the concept of "cultural sexual resilience" - the capacity of migrant women to maintain sexual well-being while navigating conflicting cultural expectations. This concept extends existing resilience frameworks by specifically addressing how women develop adaptive strategies to manage sexual health in cross-cultural contexts. The findings of this study have significant implications for healthcare providers, policymakers, and community programs. Healthcare providers must adopt culturally sensitive approaches to address the unique SRH needs of migrant and refugee women, ensuring trust, safety, and open communication in clinical interactions. Policymakers should prioritize accessible, affordable SRH services and education programs tailored to diverse cultural backgrounds. Community programs can play a crucial role in breaking cultural taboos by promoting sexual health awareness and providing resources in multiple languages. Strategies such as gender-specific services, culturally competent training for healthcare staff, and community-based education initiatives can enhance sexual health outcomes for migrant and refugee women. This study offers several notable strengths that enhance its contribution to the field. The diverse sample, representing a wide array of cultural backgrounds, provides a rich tapestry of experiences and perspectives, offering a comprehensive view of the challenges faced by migrant and refugee women. The adoption of a reflexive research approach ensured a high degree of sensitivity to cultural nuances, allowing for a more authentic representation of participants' voices. Furthermore, the implementation of multilingual strategies significantly enhanced participant comfort and engagement, facilitating more open and honest discussions on sensitive topics. However, it is important to acknowledge the study's limitations to contextualize its findings appropriately. The relatively small sample size, while providing depth, may limit the breadth of experiences captured. One key challenge is the reliance on English as the primary language of communication, despite participants being free to choose their preferred language. Although all participants opted for English, it remained their second language, potentially limiting their ability to fully express complex or deeply personal experiences. This linguistic barrier could have led to nuanced meanings being lost or misunderstood during data collection and analysis. Additionally, the sensitive nature of sexual health topics could have influenced participants' willingness to fully disclose their experiences, potentially impacting the comprehensiveness of the data. Additionally, despite efforts to minimize bias, the risk of interviewer influence or response bias cannot be entirely eliminated in qualitative research of this nature. Future research should explore sexual health experiences among migrant and refugee women in larger, more diverse cohorts across different regions in Australia. Longitudinal studies could provide insights into how sexual health perceptions and experiences evolve over time post-migration. Furthermore, studies focusing on healthcare providers' perspectives and training needs could help bridge communication gaps. Lastly, intervention-based research evaluating culturally tailored sexual health programs would offer practical solutions for addressing identified barriers. CONCLUSION In conclusion, this study provides a foundation for understanding and addressing the complex SRH needs of migrant and refugee women in Adelaide, Australia. The insights gained highlight the importance of culturally sensitive healthcare practices, targeted policy interventions, and community-based initiatives in improving sexual health outcomes for this vulnerable population. By implementing the recommended strategies and conducting further research, we can work towards creating more inclusive and effective SRH services. This, in turn, will contribute to better overall health outcomes and improved quality of life for migrant and refugee women, fostering their integration and well-being in their new communities. As global migration continues to increase, addressing these issues becomes not just a local concern, but a critical component of global public health and social equity. Abbreviations FSD Female Sexual Dysfunction SD Sexual Dysfunction HSDD Hypoactive Sexual Desire Disorder LMICs Low–and Middle–Income Countries RRI Robinson Research Institute HDA Healthy Development Adelaide RISE Refugee and Immigrants Sexual Health Endeavor NVivo (Qualitative Data Analysis Software) SRH Sexual and Reproductive Health FGM Female Genital Mutilation HBM Health Belief Model Declarations Ethics approval and consent to participate This study was approved by the University of Adelaide Human Ethics Research Committee (approval no. H-2024-011). Prior to participation, all participants received a written consent form detailing the study objectives, procedures, potential risks, and confidentiality measures. Participants provided informed consent by signing and returning the form before the study commenced. Additionally, verbal consent was obtained at the beginning of each interview to reaffirm their willingness to participate. Availability of data and materials The data generated and analysed during this study are available from the corresponding author upon reasonable request. Due to ethical and legal considerations, access to some data may be restricted to protect participant confidentiality. The data will be shared in a relevant public data repository once the conditions for anonymization and de-identification have been met. Competing interests The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article’. Funding This is a PhD research project of NMD supported by the University of Adelaide and funded by the International Society for the Study of Women's Sexual Health (ISSWSH) Research Grant. ZSL (#GNT2009730) is on the National Health and Medical Research Council (NHMRC) Emerging Leadership 2 (EL2) Fellowship. ZSL is also supported by the Women's Health Research, Translation and Impact Network (WHRTN) Early and Mid-Career Researcher (EMCR) Funded Award 2023. JCA is funded via the Medical Research Future Fund (MRFF) PHRDI000014. Authors’ contributions Zohra S. Lassi, Negin Mirzaei Damabi, Mumtaz Begum, and Jodie C Avery conceptualized and developed the study idea. All authors contributed to the methodology design. Negin Mirzaei Damabi conducted the interviews and analysed the data. Negin Mirzaei Damabi wrote the initial manuscript draft. Zohra S. Lassi, Mumtaz Begum and Jodie C Avery supervised the project and contributed to data interpretation. All authors reviewed and revised the manuscript for important intellectual content. All authors approved the final version of the manuscript. Acknowledgment We sincerely thank all participants across South Australia who generously shared their experiences in these interviews. Their invaluable insights have greatly contributed to advancing our understanding of sexual function among migrant and refugee women. References Alidost F, et al. Sexual dysfunction among women of reproductive age: A systematic review and meta-analysis. Int J Reprod Biomed. 2021;19(5):421–32. Smith AM, et al. Incidence and persistence/recurrence of women's sexual difficulties: findings from the Australian Longitudinal Study of Health and Relationships. J Sex Marital Ther. 2012;38(4):378–93. Ford JV, et al. The World Association for Sexual Health’s declaration on sexual pleasure: A technical guide. Int J Sex Health. 2021;33(4):612–42. Mitchell KR, et al. What is sexual wellbeing and why does it matter for public health? Lancet Public Health. 2021;6(8):e608–13. Landers S, Kapadia F. The Public Health of Pleasure: Going Beyond Disease Prevention. Am J Public Health. 2020;110(2):140–1. Anderson RM. Positive sexuality and its impact on overall well-being. 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Assessing the Burden of Illness Associated with Acquired Generalized Hypoactive Sexual Desire Disorder. J Womens Health (Larchmt). 2022;31(5):715–25. Higgins JA, Hirsch JS, Trussell J. Pleasure, prophylaxis and procreation: a qualitative analysis of intermittent contraceptive use and unintended pregnancy. Perspect Sex Reprod Health. 2008;40(3):130–7. Kiapi-Iwa L, Hart GJ. The sexual and reproductive health of young people in Adjumani district, Uganda: qualitative study of the role of formal, informal and traditional health providers. AIDS Care. 2004;16(3):339–47. Kingsberg SA, et al. Female Sexual Health: Barriers to Optimal Outcomes and a Roadmap for Improved Patient-Clinician Communications. J Womens Health (Larchmt). 2019;28(4):432–43. Stead ML, et al. Lack of communication between healthcare professionals and women with ovarian cancer about sexual issues. Br J Cancer. 2003;88(5):666–71. Australian Bureau of Statistics. 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DHS, StatCompiler., Current Use of Any Method of Contraception (Sexually Active Unmarried Women). Demographic and Health Survey. 2017; Available from: https://www.statcompiler.com/en/ Association WM. World Medical Association Declaration of Helsinki: ethical principles for medical research involving human subjects. JAMA. 2013;310(20):2191–4. Mathur R, Swaminathan S. National ethical guidelines for biomedical & health research involving human participants, 2017: A commentary. Indian J Med Res. 2018;148(3):279–83. Naeem M, et al. A Step-by-Step Process of Thematic Analysis to Develop a Conceptual Model in Qualitative Research. Int J Qualitative Methods. 2023;22:16094069231205789. Ganga D, Scott S. Cultural insiders and the issue of positionality in qualitative migration research: Moving across and moving along researcher-participant divides . in Forum Qualitative Sozialforschung/Forum: Qualitative Social Research . 2006. Alvarez-Nieto C, et al. Sexual and reproductive health beliefs and practices of female immigrants in Spain: a qualitative study. Reproductive health. 2015;12:1–10. Ussher JM, et al. Negotiating discourses of shame, secrecy, and silence: Migrant and refugee women’s experiences of sexual embodiment. Arch Sex Behav. 2017;46:1901–21. Hawkey AJ, Ussher JM, Perz J. What do women want? Migrant and refugee women’s preferences for the delivery of sexual and reproductive healthcare and information. Ethn Health. 2022;27(8):1787–805. Metusela C, et al. In my culture, we don’t know anything about that: sexual and reproductive health of migrant and refugee women. Int J Behav Med. 2017;24:836–45. Hawkey AJ, Ussher JM, Perz J. Negotiating sexual agency in marriage: The experience of migrant and refugee women. Health Care Women Int. 2019;40(7–9):870–97. Pérez-Sánchez M, et al. Access of migrant women to sexual and reproductive health services: A systematic review. Midwifery. 2024;139:104167. Berry JW. Theories and models of acculturation. Oxf Handb acculturation health. 2017;10:15–28. Jones CL, et al. The health belief model as an explanatory framework in communication research: exploring parallel, serial, and moderated mediation. Health Commun. 2015;30(6):566–76. Hankivsky O, et al. The odd couple: using biomedical and intersectional approaches to address health inequities. Global health action. 2017;10(sup2):1326686. Appendix 1 Appendix 1 is not available with this version. Additional Declarations No competing interests reported. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-6173847","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":440612322,"identity":"e3b68fc8-e27b-4627-8cc4-c147ff875433","order_by":0,"name":"Negin Mirzaei Damabi","email":"","orcid":"","institution":"University of Adelaide","correspondingAuthor":false,"prefix":"","firstName":"Negin","middleName":"Mirzaei","lastName":"Damabi","suffix":""},{"id":440612323,"identity":"8105991d-8f1d-47bb-84b0-5643d767dcd7","order_by":1,"name":"Jodie C Avery","email":"","orcid":"","institution":"University of Adelaide","correspondingAuthor":false,"prefix":"","firstName":"Jodie","middleName":"C","lastName":"Avery","suffix":""},{"id":440612324,"identity":"62046837-e317-4829-ba1b-27b487bd6aaa","order_by":2,"name":"Mumtaz Begum","email":"","orcid":"","institution":"University of Adelaide","correspondingAuthor":false,"prefix":"","firstName":"Mumtaz","middleName":"","lastName":"Begum","suffix":""},{"id":440612325,"identity":"3b7abd9f-b0d9-4540-8327-520c243aa315","order_by":3,"name":"Salima Meherali","email":"","orcid":"","institution":"University of Alberta","correspondingAuthor":false,"prefix":"","firstName":"Salima","middleName":"","lastName":"Meherali","suffix":""},{"id":440612326,"identity":"66b58c3a-2196-46b5-bd18-89b3f4b3fd3c","order_by":4,"name":"Zohra S Lassi","email":"data:image/png;base64,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","orcid":"","institution":"University of Adelaide","correspondingAuthor":true,"prefix":"","firstName":"Zohra","middleName":"S","lastName":"Lassi","suffix":""}],"badges":[],"createdAt":"2025-03-07 00:08:14","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-6173847/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-6173847/v1","draftVersion":[],"editorialEvents":[{"content":"https://doi.org/10.1186/s12939-025-02614-z","type":"published","date":"2025-08-28T15:57:32+00:00"}],"editorialNote":"","failedWorkflow":false,"files":[{"id":90344995,"identity":"3f36b615-1a30-447c-a89a-bcc9d08bb8fb","added_by":"auto","created_at":"2025-09-01 16:09:03","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":900772,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-6173847/v1/64379abe-4cdb-4c18-a3c2-df61169dad79.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Redefining Intimacy: A Qualitative Study on Sexual Function Experiences and Perspectives Among Migrant and Refugee Women in South Australia","fulltext":[{"header":"BACKGROUND","content":"\u003cp\u003eFemale sexual dysfunction (FSD) is a multifaceted condition encompassing physiological, psychological, and social components that can significantly impact a woman\u0026rsquo;s well-being. FSD includes distressing concerns such as low sexual desire, arousal difficulties, and pain during intercourse. Globally, the burden of FSD is substantial; a meta-analysis of 21 studies estimated its pooled prevalence to be 50.75% [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. In Australia, 36% of women reported experiencing at least one new sexual dysfunction (SD) within 12 months [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThe recognition of sexual well-being as a critical aspect of overall health has grown in recent years. The 2021 World Association of Sexual Health Declaration highlighted sexual pleasure as an essential part of health promotion and education strategies [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. This evolution marks a necessary shift from traditionally reactive healthcare approaches\u0026mdash;focused on preventing negative outcomes\u0026mdash;to proactive strategies that foster positive sexual health and satisfaction [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e, \u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]. Evidence underscores the far-reaching benefits of positive sexual experiences, linking sexual satisfaction to improved psychological well-being, stronger interpersonal relationships, and enhanced quality of life [\u003cspan additionalcitationids=\"CR7\" citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eHowever, significant disparities persist in women\u0026rsquo;s sexual health experiences, particularly in access to care. Women continue to report less satisfactory sexual experiences compared to men [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e] reflecting systemic inequities shaped by gender, socioeconomic status, and cultural background[\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e, \u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]. Limited access to resources and societal stigma further exacerbate these challenges, leaving many women without adequate support for their sexual well-being [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e, \u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]. For instance, research has shown that 27% of divorced women attribute their divorce to decreased sexual desire [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e], while women diagnosed with Hypoactive Sexual Desire Disorder (HSDD) experience notable declines in health-related quality of life, particularly mental well-being [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThe barriers to sexual healthcare access become even more pronounced for women from disadvantaged or marginalized groups. Social determinants such as low socioeconomic status, limited healthcare resources, and cultural stigma, contribute to compounded difficulties in accessing care [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]. Additionally, the role of healthcare practitioners as intermediaries is critical, yet their approach is often influenced by personal beliefs, cultural attitudes, and inconsistent implementation of health policies [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eA significant challenge in addressing FSD lies in the inadequate preparation of healthcare providers, particularly in primary care settings [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e]. Studies indicate that small proportion of primary care physicians routinely inquire about female patients' sexual function, with many reporting discomfort or lack of preparedness in discussing these topics [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e, \u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e]. This deficiency in training and confidence among healthcare providers creates a substantial barrier for women seeking help for sexual health concerns [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e]. Furthermore, the financial burden associated with diagnostic procedures, such as ultrasounds and hormone panels, often recommended in FSD evaluation, can be prohibitive, especially for those without comprehensive health insurance coverage [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e]. These financial barriers disproportionately affect women from lower socioeconomic backgrounds and migrant communities, further exacerbating healthcare disparities in sexual health.\u003c/p\u003e \u003cp\u003eIn Australia, where 30.7% of the population is overseas-born as of 2023 [\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e], understanding the sexual health experiences of migrant and refugee women is both timely and essential. The influx of women from Low- and Middle-Income Countries (LMICs), particularly from Asian and African regions, introduces cultural complexities that require culturally sensitive care. Migrant and refugee women face unique challenges, including language barriers, cultural taboos, and the difficulties of adapting to a new healthcare system [\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e, \u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e]. Despite Australia\u0026rsquo;s increasingly diverse population, research addressing sexual function and satisfaction among migrant and refugee women remains limited [\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e, \u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e]. Existing studies often neglect these populations, with less than 10% of evaluations focusing on sexual health outcomes in migrant contexts. This gap in knowledge underscores the urgent need for comprehensive investigations that incorporate both healthcare provider and consumer perspectives to ensure equitable and culturally appropriate sexual healthcare delivery.\u003c/p\u003e \u003cp\u003eThis study seeks to address this gap by exploring perspectives on sexual function among migrant and refugee women in South Australia.\u003c/p\u003e"},{"header":"METHODS","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eStudy Design and Aim\u003c/h2\u003e \u003cp\u003eThis qualitative exploratory study was designed to investigate the perspectives and experiences of sexual function among migrant and refugee women in South Australia, with a particular focus on their interactions with healthcare providers. A qualitative exploratory approach was chosen because it is well-suited for examining under-researched and sensitive topics, such as sexual health, where limited prior knowledge exists. This design enables an in-depth exploration of participants\u0026rsquo; lived experiences, allowing themes and insights to emerge naturally from the data without relying on pre-existing theories or frameworks [\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThe study aimed to understand participants' knowledge of sexual function, changes in sexual function post-migration, and their experiences engaging with healthcare providers, including the facilitators and barriers they encountered. This approach ensured that the study captured the complex interplay of cultural, social, and individual factors shaping sexual health and healthcare experiences in this population.\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eParticipant Recruitment\u003c/h3\u003e\n\u003cp\u003eThe study recruited 20 reproductive-aged women (18\u0026ndash;49 years) from migrant and refugee backgrounds who had migrated from LMICs and were currently residing South Australia. Eligibility criteria included being first-generation migrants, heterosexual, and sexually active (defined as having had sexual intercourse within the past four weeks [\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e, \u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e]). Women who were born in Australia, those living with intellectual disabilities, and those unwilling to participate were excluded from the study.\u003c/p\u003e \u003cp\u003eGiven the sensitive and culturally taboo nature of the topic, recruitment utilized multiple culturally appropriate approaches to ensure accessibility and trust-building. Flyers with the heading \"We want to hear your story\" were distributed through organizations supporting migrant and refugee populations, including the Australian Migrant Resource Centre, International Organization for Migration, Refugee Advocacy Service of South Australia, Australian Refugee Association, Vinnies Refugee \u0026amp; Asylum Seeker Service, and FBW Gynaecology Plus Clinic. Social media outreach through institutional networks, such as the University of Adelaide, Robinson Research Institute (RRI), and Healthy Development Adelaide (HDA), further complemented these efforts. To enhance accessibility and participant engagement, the research team developed the Refugee and Immigrants Sexual Health Endeavor (RISE) website. The platform featured multi-language translation capabilities, comprehensive study information, an online appointment booking system, and downloadable participant information sheets.\u003c/p\u003e \u003cp\u003eThis multi-channel recruitment strategy was designed to address barriers such as language, cultural stigma, and trust, which often hinder participation in research involving sexual health.\u003c/p\u003e\n\u003ch3\u003eData Collection\u003c/h3\u003e\n\u003cp\u003e Semi-structured interviews were conducted in participants\u0026rsquo; preferred languages to ensure comfort, inclusivity, and the establishment of trust. The research team\u0026rsquo;s multilingual capabilities, including fluency in Urdu, Persian, Hindi, and Dari, enabled direct communication with participants, while professional interpreters were engaged when additional language support was needed. For participants speaking languages beyond the team\u0026rsquo;s expertise, arrangements for qualified translators were made. Interviews were conducted either in-person or virtually, depending on participants\u0026rsquo; preferences and logistical needs. Private, safe settings were prioritized to facilitate open and honest discussions, recognizing the personal and sensitive nature of the topic. Interviews were audio-recorded with participants\u0026rsquo; consent and transcribed verbatim for analysis.\u003c/p\u003e \u003cp\u003eAs there were no directly comparable studies or established questionnaires addressing the sexual health and function of migrant and refugee women in the Australian context, the interview schedule was developed specifically for this study. The development process involved a systematic review of the literature to identify key themes related to sexual function and migration, informal consultations with healthcare providers experienced in working with migrant communities, and feedback from cultural advisors to ensure cultural sensitivity and appropriateness of the questions. The final interview schedule included demographic questions to contextualize participants\u0026rsquo; experiences and open-ended questions organized into key themes, such as cultural perspectives on sexual function, post-migration sexual function and well-being, understanding of sexual function, healthcare experiences, and suggestions for service improvement.\u003c/p\u003e \u003cp\u003eThe interview schedule was divided into two main sections. The first section, demographic questions, gathered basic information about participants' age, ethnicity, migration history, marital status, and other relevant background details. The second section, thematic questions, consisted of open-ended questions that explored participants' experiences and perceptions of sexual health and function, focusing on cultural influences, migration-related changes, and interactions with healthcare services.\u003c/p\u003e \u003cp\u003eA detailed list of the demographic and thematic questions is provided in APPENDIX 1 for reference.\u003c/p\u003e\n\u003ch3\u003eEthical Considerations\u003c/h3\u003e\n\u003cp\u003eThis study was conducted in accordance with the National Statement on Ethical Conduct in Human Research and the Declaration of Helsinki [\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e, \u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e]. It was approved by the University of Adelaide Human Ethics Research Committee (approval no. H-2024-011). Before participation, all participants received a written consent form outlining the study\u0026rsquo;s objectives, procedures, potential risks, and confidentiality measures. They provided informed consent by signing and returning the form before the study commenced. Additionally, verbal consent was reaffirmed at the beginning of each interview to ensure continued willingness to participate.\u003c/p\u003e\n\u003ch3\u003eConsent to Participation and Publication\u003c/h3\u003e\n\u003cp\u003eInformed consent was obtained from all participants in the study. Participants were provided with an information sheet detailing the study's purpose, procedures, and any potential risks or burdens associated with their participation. They were also given the opportunity to ask questions and discuss any concerns before agreeing to participate. Written consent was obtained for participation in the interviews, ensuring that participants understood the voluntary nature of their involvement.\u003c/p\u003e \u003c/p\u003e \u003cp\u003eParticipants were informed that they could withdraw from the study at any time without consequence. However, they were also made aware that, due to the nature of the study, data already provided during the interview could not be withdrawn after the interview session had concluded.\u003c/p\u003e \u003cp\u003eIn addition to consent for participation, participants were asked to provide informed consent for the publication of anonymized data derived from their interviews. The participants were assured that any identifying details would be omitted, and that their personal information would not be disclosed in any published materials. Consent for the publication of data was obtained in writing, and the signed consent forms are held securely by the researchers.\u003c/p\u003e \u003cdiv id=\"Sec8\" class=\"Section2\"\u003e \u003ch2\u003eData Analysis\u003c/h2\u003e \u003cp\u003eThematic analysis, guided by social constructivist epistemology, was employed to identify, analyse, and interpret patterns within the interview data [\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e]. The analysis process was systematic and iterative. Initially, team members independently reviewed a subset of interview transcripts to generate first-order codes, such as \u0026ldquo;sexual function changes after migration,\u0026rdquo; \u0026ldquo;how Australia is different,\u0026rdquo; and \u0026ldquo;barriers to accessing sexual health services.\u0026rdquo; These codes were discussed, refined, and organized into broader themes during team meetings to ensure a consistent analytical approach. NVivo software was used to facilitate data management, coding, and organization. Themes were developed iteratively, with continuous comparison across transcripts to ensure the robustness of findings. Exemplar quotations were selected to illustrate key themes and were presented to provide context and amplify their voices.\u003c/p\u003e \u003cp\u003eThe analysis prioritized reflexivity, with the research team reflecting on their own cultural positions and biases throughout the process. To enhance rigor, the researchers acknowledged their positionality, including their professional backgrounds and personal experiences, and how these may have shaped the research process and interpretation of the findings. Data saturation was achieved when no new themes emerged from the interviews, ensuring the comprehensiveness of the findings.\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eResearchers' reflexivity\u003c/h3\u003e\n\u003cp\u003eThe research team employed several strategies to ensure both methodological rigor and cultural sensitivity throughout the study. A shared migrant background among team members, including the lead researcher, provided significant cultural insights that enriched the study. This common experience facilitated a deeper understanding of the participants\u0026rsquo; lived realities, fostering empathy and trust, which were especially important when discussing sensitive topics such as sexual health.\u003c/p\u003e \u003cp\u003eWhile cultural familiarity proved to be a valuable asset, the research team remained mindful of its potential drawbacks, often described as a \"double-edged sword\" [\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e]. Participants may have assumed the researchers\u0026rsquo; familiarity with their experiences, potentially leading to less detailed or nuanced disclosures during interviews. To mitigate this risk, the researchers emphasized open-ended questioning, active listening, and the importance of participants sharing their unique perspectives, ensuring their voices were fully heard and understood.\u003c/p\u003e \u003cp\u003eTo ensure inclusivity and respect for participants' diverse needs, interviews were offered in participants' preferred languages, and access to study materials was made available via the multilingual RISE website. This platform enabled participants to access comprehensive information, further enhancing the study\u0026rsquo;s accessibility.\u003c/p\u003e \u003cp\u003eThe lead researcher maintained a reflexive approach throughout the study, continuously reflecting on their positionality and the impact it may have on data collection and interpretation. Emphasizing the importance of active listening, the researcher prioritized participant comfort and agency, creating a space where participants felt heard and respected. This participant-cantered approach was crucial in navigating conversations around sexual health, a subject often considered taboo in many cultural contexts.\u003c/p\u003e \u003cp\u003eChallenges encountered during recruitment\u0026mdash;such as cultural sensitivities and stigma surrounding the topic of sexual health\u0026mdash;were met with proactive strategies. The team made clear the study's commitment to confidentiality and its objectives, providing transparency to potential participants. Collaboration with local community organizations played a pivotal role in building trust, while multilingual materials and the RISE website ensured accessibility for participants from varied linguistic backgrounds.\u003c/p\u003e \u003cp\u003eAdditionally, post-interview support was offered to participants through information on sexual health services, both online and in-person, ensuring they had access to continued support if necessary.\u003c/p\u003e"},{"header":"RESULTS","content":"\u003cp\u003eThe study involved 20 women from diverse cultural backgrounds, all originating from LMICs. The participants included six women from South Asia (three each from Pakistan and India), two from East Asia (China), seven from various African nations, and five from the Middle East (three from Afghanistan and two from Iran). Despite the availability of interpreters and multilingual interview options, all participants chose to have their interviews in English.\u003c/p\u003e \u003cp\u003eThese women represented a range of demographic characteristics, including varying ages, education levels, employment statuses, and lengths of residence in Australia. All participants were in heterosexual relationships of differing durations. The sample also encompassed women with different visa statuses, religious backgrounds, and pregnancy histories, residing across various regions or suburbs in Adelaide, reflecting diverse socioeconomic areas.\u003c/p\u003e \u003cp\u003eAnalysis of the interview data revealed three major themes: cultural and sociocultural factors influencing sexual function, sexual function transitions after migration, and navigating sexual healthcare services and systemic challenges.\u003c/p\u003e \u003cdiv id=\"Sec11\" class=\"Section2\"\u003e \u003ch2\u003eCultural and Sociocultural Factors Influencing Sexual Function\u003c/h2\u003e \u003cp\u003eThe analysis revealed that cultural beliefs and practices profoundly influenced participants' sexual experiences, attitudes, and behaviours. This influence manifested through several interconnected dimensions: deep-rooted cultural taboos, emotional conflicts between traditional values and new experiences, and challenges in navigating different cultural approaches to sexuality.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec12\" class=\"Section2\"\u003e \u003ch2\u003eCultural norms and family expectations in the country of origin\u003c/h2\u003e \u003cp\u003e Cultural norms and family expectations significantly shaped participants' understanding and communication about sexual function, especially in cultures where discussing sexuality is taboo or even considered illegal. In some cultures, particularly in the Middle East and South Asia, sexuality remains a highly sensitive subject. One participant described the severity of this taboo in her country:\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003e\u0026ldquo;In my country, sexual activity is very much taboo. Even now in 2024, it\u0026rsquo;s getting a little better, but still\u0026hellip; it\u0026rsquo;s not something we discuss openly. It\u0026rsquo;s especially difficult when you're not married\u0026mdash;then it becomes not just taboo but socially unacceptable. You have to hide relationships from your family, from police, from everyone.\u0026rdquo; (Middle Eastern \u0026ndash; Age 28)\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e \u003cp\u003eFor many participants, the pressure to adhere to these cultural and familial expectations created significant internal conflict. One participant described the emotional toll of living in a new country while still carrying the weight of their cultural programming:\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003e\"This is very complicated for me... [long pause] Being 35 and having my first relationship here, I feel like a teenager sometimes. But I also carry all these years of cultural... how to say... programming? I often feel guilty, even though I know I'm not doing anything wrong. The hardest part is that I can't talk to my family about any of this\u0026hellip;Sometimes after being intimate with my partner, I cry because I feel like I'm living a double life. But at the same time, I feel I deserve to experience love and relationship like anyone else.\" (Middle Eastern \u0026ndash; Age 35)\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e \u003cp\u003eThis internal struggle was often accompanied by feelings of guilt and shame, especially related to sexual activity. One participant reflected on the burden of these emotions:\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003e\" I still carry a lot of guilt and shame when I have sexual activity. Sometimes I think, 'What would my parents think if they knew?' or 'Am I taking advantage of their trust?' There's also worry about... if this relationship doesn't work out, what will my next partner think about my previous relationship? \" (East Asian \u0026ndash; Age 39)\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e \u003cp\u003eAs participants reflected on the cultural divide between their home countries and Australia, many pointed out the contrast in sexual attitudes. One participant spoke about their own family\u0026rsquo;s reluctance to discuss sex, which sometimes led to misunderstandings within their relationship:\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003e\"I never had an open conversation with my mom about sex life. Even though I was getting married, she didn't tell me anything, and I didn't have any sisters. So back in my mind, I think I'm still not very open to try new things or even talk about it, which sometimes, you know, like, creates misunderstanding between the couple as well.\" (South Asian \u0026ndash; Age 38)\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec13\" class=\"Section2\"\u003e \u003ch2\u003eCultural practices and their consequences: Female Genital Mutilation (FGM) and sexual function\u003c/h2\u003e \u003cp\u003eMigrant women from countries where Female Genital Mutilation (FGM) is practiced often bring with them complex cultural beliefs and experiences that influence their sexual health and well-being. FGM, although illegal in many countries, persists in certain communities due to deeply rooted cultural traditions. Participants in this study highlighted the diversity of views and experiences surrounding FGM, with some demonstrating only vague awareness of the practice, while others shared personal encounters.\u003c/p\u003e \u003cp\u003eMany participants acknowledged the existence of FGM in their home countries but expressed discomfort discussing it. They mentioned the practice of FGM is not uniform across all communities, and it varies significantly between ethnic groups. FGM is often justified by traditional beliefs, particularly those related to controlling female sexuality and enhancing fertility. One participant shared:\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003e\"It's like a traditional belief that it helps the female become more fertile... They think if they do this, they can conceive better.\" (African \u0026ndash; Age 20)\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e \u003cp\u003eIn some communities, FGM is also perceived as a way to prevent infidelity within marriage. As one participant recalled:\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003e\u0026ldquo;Some of the responses that I got... they say ladies should undergo that process so that they cannot cheat in their marriages.\" (African \u0026ndash; Age 29)\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e \u003cp\u003eHowever, for many women who have undergone FGM, the experience is often described as traumatic, especially as they grow older and become more aware of its harmful consequences. One participant shared her experience of undergoing FGM as an infant:\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003e\"I was being circumcised while I was still a baby... But now when I grow up, I see the way they do it. It's not good. I don't like it anymore... I wouldn't have allowed someone to circumcise me because they do use unsterilized equipment.\" (African \u0026ndash; Age 32)\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e \u003cp\u003eThis shift in perspective is common among women who underwent FGM in childhood, as they later recognize both the physical and emotional harm it caused. Many participants also expressed awareness of FGM as a human rights violation, acknowledging its harmful impact not only in their home countries but also in Australia. This reflects the ongoing challenges migrant women face in navigating cultural traditions that conflict with local laws and human rights standards.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec14\" class=\"Section2\"\u003e \u003ch2\u003eInfluence of host country norms on sexual health and function\u003c/h2\u003e \u003cp\u003eMigration to Australia played a pivotal role in the personal growth and self-esteem of many participants, offering them a chance to regain control over their lives and sexual well-being. The shift in their circumstances was often accompanied by newfound freedom, allowing them to make decisions independently, without the constraints of family or societal expectations from their home countries. This sense of autonomy was reflected in various aspects of their lives, such as living arrangements, financial independence, and personal choices. However, despite this greater sense of freedom, some participants found it challenging to fully embrace it, as traditional beliefs and values from their home countries remained deeply ingrained. As one participant reflected:\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003e\"Now I live alone in a first-world country, and I can make my own decisions. There's no family asking where I'm going, no [social] police to be afraid of. I can go out, date, be in contact with people... But it's interesting because even with all this freedom, those traditional beliefs are still deep inside me.\" (Middle Eastern \u0026ndash; Age 32)\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e \u003cp\u003eThis testimony highlights the complex nature of cultural transition - while physical distance provided freedom from external constraints, internalized cultural values remained influential in shaping participants' decisions and experiences. Participants frequently highlighted the stark differences between Australian sexual health norms and those of their home countries, particularly regarding gender dynamics and sexual agency. The Australian context was characterized by greater openness and respect for individual choice, contrasting sharply with more restrictive norms in their countries of origin. One participant illustrated this contrast in discussing women's sexual agency:\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003e\"They [Australians] communicate openly... sexual life here, versus the one in my home country, is kind of different, everyone seems to respect each other's opinion and choice here. But in over there [home country], even a married woman can never say no to a husband [when it comes to sex].\" (African \u0026ndash; Age 42)\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e \u003cp\u003eThis sentiment was echoed by another participant who emphasized the transformative impact of Australia's more open cultural environment:\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003e\"Being in Australia, I've learned to be outspoken about my feelings, be expressive about sexual desires... But in my home country, when you talk about stuff like that, it's like you degrading yourself or you've been cheap.\" (East Asian \u0026ndash; Age 33)\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e \u003cp\u003eThe navigation between different cultural expectations emerged as a significant challenge for participants. This was particularly evident in how they reconciled traditional values with new cultural norms regarding sexual behaviour and expression. One participant, for instance, described the complex dynamics of sexual expectations, particularly the pressure women face to preserve their sexual autonomy and avoid being labelled as \"cheap\":\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003e\"In our culture, sex for women is kind of treasure you hold, and if you give it away too easily, then you're cheap... So that kind of gives you this weird concern when you have sex with even your boyfriend, they're like, oh, he hasn't proposed... Would he think that I'm an easy girl?\u0026rdquo; (East Asian \u0026ndash; Age 39)\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e \u003cp\u003eFor some participants, religious beliefs added another layer of complexity to this cultural navigation. As one 32-year-old participant explained:\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003e\"I felt like I need to be more intentional with, first of all, I am a Christian, and I had to make a personal decision not to do things which are opposite of what is expected of me as a Christian... So that is one of the factors.\" (African \u0026ndash; Age 32)\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec15\" class=\"Section2\"\u003e \u003ch2\u003eSexual Function Transitions After Migration\u003c/h2\u003e \u003cp\u003eMigration brings profound changes to various aspects of life, including intimate relationships and sexual experiences. Participants in this study described a complex journey of sexual adaptation and discovery following their migration, encompassing challenges in maintaining intimacy, shifts in sexual desire, experiences with sexual pain, understanding of orgasm, and overall sexual satisfaction. Their narratives reveal how the intersection of cultural transition, increased access to information, and personal growth shaped their sexual experiences in their new country.\u003c/p\u003e \u003cp\u003eThe initial period of migration presented significant challenges that impacted participants' sexual function and intimate relationships. These challenges were primarily related to settlement stress, changes in living arrangements, postpartum recovery, and navigating cultural and healthcare differences. Participants described how the demands of settling into a new country, such as finding housing and employment, significantly affected intimacy:\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003e \u003cem\u003e\"When we were new here, we were under a lot of stress, like, looking for a place and work. We weren't probably doing much because we both were under stress. But down the line, once we got our rental place, once we both had our jobs, it was pretty much easier.\" (South Asian \u0026ndash; Age 44)\u003c/em\u003e \u003c/p\u003e\u003c/div\u003e\u003c/p\u003e \u003cp\u003eChanges in living arrangements and work schedules further disrupted intimacy:\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003e \u003cem\u003e\"Sexual functionality was at the all-time low because we were going through a lot of changes \u0026hellip;. My husband had to take up a night job, it was just hard, and the kids started sleeping with me.\" (South Asian \u0026ndash; Age 29)\u003c/em\u003e \u003c/p\u003e\u003c/div\u003e\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec16\" class=\"Section2\"\u003e \u003ch2\u003eSexual desire changes\u003c/h2\u003e \u003cp\u003e As participants adjusted to their new environment, many experienced shifts in their sexual desire and expression. Migration often provided a more open and encouraging environment, fostering greater sexual arousal and willingness to explore new experiences, despite busy lifestyles:\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003e\u003cem\u003e\u0026ldquo;I feel more sexually aroused here, and I am more willing to try various things... But still, the environment here encourages me to explore more.\u0026rdquo; (African \u0026ndash; Age 49)\u003c/em\u003e\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e \u003cp\u003eNotably, some women experienced a transformation in their sexual agency, describing a sense of empowerment to initiate intimacy, contrasting with the more passive roles often expected in their home countries:\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003e\u0026ldquo;I think I\u0026rsquo;m now willing to engage. Sometimes I will even be the one to engage in the activities that I have the desire to engage.\u0026rdquo; (African \u0026ndash; Age 29)\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec17\" class=\"Section2\"\u003e \u003ch2\u003eSexual pain experiences\u003c/h2\u003e \u003cp\u003e The navigation of sexual pain emerged as a significant aspect of participants' post-migration sexual experiences, influenced by factors such as adaptation, communication, knowledge, and physical health. For some women, initial pain during sexual activity improved through learning and open communication:\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003e\u0026ldquo;Initially, I experienced very bad sexual pain, but it got better after practicing and having more sexual activity. I think me and my partner, we... progressed as we proceeded. We did research and learned how everything could be better.\u0026rdquo; (African \u0026ndash; Age 33)\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e \u003cp\u003e Other participants connected their pain to a lack of communication and limited sexual knowledge, which they attributed in part to cultural differences. Some participants demonstrated increased awareness of physical factors contributing to sexual pain, reflecting greater health literacy:\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003e\u0026ldquo;It\u0026rsquo;s quite easy to feel painful during sex if the person is not doing it right. I think I am probably allergic to semen because if we don\u0026rsquo;t use a condom, I get quite a burning sensation afterwards.\u0026rdquo; (East Asian \u0026ndash; Age 33)\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec18\" class=\"Section2\"\u003e \u003ch2\u003eOrgasm changes\u003c/h2\u003e \u003cp\u003eUnderstanding and experiencing orgasm emerged as a complex journey influenced by cultural background, education, and personal discovery. Several women expressed initial confusion about the concept of orgasm, highlighting the impact of limited sexual education in their home countries. One participant shared:\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003e\u003cem\u003e\u0026ldquo;I didn\u0026rsquo;t understand what orgasm actually is. So, I had to research it, it\u0026rsquo;s really rare for me to experience it. I think it has been constant. I experienced it [lack of orgasm] back in my home country, and also here.\u0026rdquo; (African \u0026ndash; Age 49)\u003c/em\u003e\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e \u003cp\u003e This quote highlights both the challenges faced by some participants in understanding their own sexual experiences and the self-initiated process of learning about orgasm after migration. It also reflects that, despite the geographical and cultural transition, the frequency of experiencing orgasm remained unchanged for them. For other participants, emotional and psychological factors emerged as barriers to experiencing orgasm, reflecting internalized beliefs and societal expectations:\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003e\u003cem\u003e\u0026ldquo;I think this is just something which is really hard for women to experience. So, I was just, maybe thinking I could experience it one day. I don\u0026rsquo;t know. But maybe it depends also on the person I\u0026rsquo;m with.\u0026rdquo; (Middle Eastern \u0026ndash; Age 39)\u003c/em\u003e\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e \u003cp\u003eThe post-migration environment provided opportunities for self-education and exploration, though some participants continued to navigate cultural and personal barriers:\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003e\u0026ldquo;I have not quite had actual systematic sexual education or a set discussion. So, I know I can definitely get an orgasm by myself. I can also get good pleasure from sex with my partner, but it feels different. It\u0026rsquo;s not quite the same thing. So, I\u0026rsquo;m not entirely sure if that means I don\u0026rsquo;t get orgasm from sex, or it\u0026rsquo;s just there are different types of orgasm.\u0026rdquo; (African \u0026ndash; Age 42)\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e \u003cp\u003eThis statement highlights the complexity and fluidity of sexual pleasure, as well as the uncertainty that can arise in the absence of comprehensive education or open discussions about sexual health.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec19\" class=\"Section2\"\u003e \u003ch2\u003eSexual satisfaction changes\u003c/h2\u003e \u003cp\u003e The impact of migration on sexual satisfaction varied significantly among participants, revealing the complex interplay between cultural transition, personal growth, and intimate relationships. While some women reported persistent challenges:\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003e\u0026ldquo;In general, I am not satisfied... I have never been. I have always had problems with sexual activity. These are things that are inside me, I think.\u0026rdquo; (African \u0026ndash; Age 32)\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e \u003cp\u003eOthers described migration as a catalyst for positive change through increased access to information and personal development:\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003e\u0026ldquo;It\u0026rsquo;s changed immensely... I was able to learn, and I was able to get to know myself in that area... I was exposed to resources that helped me gain this idea about the recent changes.\u0026rdquo; (South Asian - Age 39)\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e \u003cp\u003eA few participants noted improvements in their sexual performance after migration, attributing these changes to personal development or shifts in circumstances.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec20\" class=\"Section2\"\u003e \u003ch2\u003eNavigating Sexual Healthcare Services and Systemic Challenges\u003c/h2\u003e \u003cdiv id=\"Sec21\" class=\"Section3\"\u003e \u003ch2\u003eCultural dynamics in sexual health communication\u003c/h2\u003e \u003cp\u003e Participants described complex dynamics in discussing sexual matters with their partners, reflecting both cultural transitions and personal growth. Some participants reported positive evolution in their communication comfort, often attributing this to the supportive Australian environment and access to mental health resources. However, many participants still struggled with explicit sexual communication, particularly regarding satisfaction and discomfort:\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003e\u0026ldquo;I just have the fear of the unknown because if I say, I don't experience orgasm, maybe they could blame themselves.\u0026rdquo; (African \u0026minus;\u0026thinsp;44)\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e \u003cp\u003eSome participants developed adaptive strategies, using non-verbal cues to navigate sensitive topics while maintaining cultural comfort levels:\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003e\u0026ldquo;I never bring it up. So, for example, if we're in bed and something he did actually hurts me, I'll stop him, but I'm not going to say much about it. I'm not going to say, oh, you can't push from that angle. It hurts me. I'll just pull away and hope that over time, he's going to learn not to do it in a certain way because I'll always pull away from that direction.\u0026rdquo; (East Asian \u0026ndash; Age 33)\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e \u003cp\u003eThe transition to Australian healthcare settings marked a significant shift in participants' experiences of sexual health communication with healthcare providers. Many found the Australian healthcare environment more conducive to open discussions. However, for others, the differences in communication were evident when comparing their experiences in Australia to those in their home countries. In some cultures, discussing sexual health with a provider is still viewed as inappropriate or uncomfortable, often due to the stigma surrounding the topic.\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv id=\"Sec22\" class=\"Section2\"\u003e \u003ch2\u003eSystemic barriers to accessing sexual and reproductive health services\u003c/h2\u003e \u003cp\u003eParticipants reported significant challenges in accessing Sexual and Reproductive Health (SRH) services due to limited awareness, financial barriers, cultural factors, and gaps in provider knowledge. For many, accessing care required encouragement from partners or sustained effort to overcome systemic and cultural barriers. They felt too shy, overwhelmed, or uncertain about where to seek help. So, they turned to the internet or informal networks for guidance:\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003e\u0026ldquo;I was too shy to reach out to doctors. I just tried to search online, finding podcasts or go on social media to help myself.\u0026rdquo; (South Asian \u0026ndash; Age 44)\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e \u003cp\u003eFinancial constraints emerged as a recurring barrier, particularly for migrant women without access to Medicare:\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003e\u0026ldquo;They [healthcare services] are expensive as a migrant who doesn't have Medicare. Sometimes I have more urgent needs rather than my... orgasm problems.\u0026rdquo; (South Asian \u0026ndash; Age 29)\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e \u003cp\u003eLimited awareness of sexual health services further compounded these challenges:\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003e\u0026ldquo;I've never heard of that [sexual health clinic]. Honestly, it did not even click my mind to search for some sort of sexual health clinic.\u0026rdquo; (African \u0026ndash; Age 29)\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e \u003cp\u003eAdditionally, Australia\u0026rsquo;s healthcare structure, including privacy regulations and referral systems, can unintentionally create barriers to SRH care. Participants also highlighted the complexities of navigating referrals and long waiting times for specialized care. One participant described the difficulty of finding a female doctor who could address her premenopausal concerns:\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003e\"Some GPs and specialists are not taking new patients. I tried two specialists, and both refused because they were full.\" (South Asian \u0026ndash; Age 39)\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e \u003cdiv id=\"Sec23\" class=\"Section3\"\u003e \u003ch2\u003eFacilitators to access and service expectations\u003c/h2\u003e \u003cp\u003eParticipants identified a range of preferences in accessing SRH services, shaped by gender, cultural background, language, cost, and provider attitudes. Their insights underscored the need for culturally sensitive, gender-appropriate, and affordable care to meet the unique needs of migrant and refugee women.\u003c/p\u003e \u003cp\u003eA consistent theme among participants was a strong preference for female healthcare providers. Many women expressed discomfort in discussing sexual health concerns with male practitioners due to cultural norms, personal shyness, and fears of judgment:\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003e\u0026ldquo;I would become very uncomfortable in sharing this personal sort of thing with a male person. Probably, I would be more comfortable with a female.\u0026rdquo; (African \u0026ndash; Age 44)\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e \u003cp\u003eParticipants also held diverse and sometimes conflicting views on the cultural backgrounds of healthcare providers. Some women preferred practitioners outside their community to safeguard privacy and avoid judgment:\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003e\u0026ldquo;I prefer female doctors who aren't from my background... our community is small here; everyone knows each other. I don't want someone who might know me or my family.\u0026rdquo; (Middle Eastern \u0026ndash; Age 33)\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e \u003cp\u003eConversely, others valued cultural understanding and expressed comfort with providers from similar or neighbouring cultural backgrounds:\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003e\u0026ldquo;It doesn\u0026rsquo;t have to be someone from my home country, but maybe similar They understand how things are different in our cultures when it comes to sexuality.\u0026rdquo; (South Asian - Age 44)\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e \u003cp\u003e Language played a nuanced role in shaping access to care. While English was preferred by some participants for its emotional distance when discussing sensitive topics, it also presented challenges:\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003e\u0026ldquo;I prefer speaking English for these topics. Saying these words in my native language feels\u0026hellip; wrong. In English, it's like I\u0026rsquo;m a different person\u0026mdash;more professional, more open.\u0026rdquo; (Middle Eastern \u0026ndash; Age 28)\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e \u003cp\u003eConversely, others found that using their native language facilitated deeper communication and trust. Participants emphasised the importance of precise and meaningful communication, noting that translating concepts from their native language to English could cause misinterpretation.\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003e\u0026ldquo;If I can communicate and the other person can grasp the message in my own language, then I\u0026rsquo;ll be more open. Language is the first barrier.\u0026rdquo; (Middle Eastern \u0026ndash; Age 33)\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e \u003cp\u003eFinancial barriers were significant, particularly for women without Medicare coverage or those on student visas. These reflections highlight the urgent need for affordable, accessible sexual health services for migrant and refugee women.\u003c/p\u003e \u003cp\u003eBuilding trust also emerged as a central factor in improving access to sexual health services. Participants emphasized the need for safe, supportive environments where women feel accepted and comfortable sharing sensitive concerns Access to trustworthy, culturally appropriate information was highlighted as a critical facilitator.\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e"},{"header":"DISCUSSION","content":"\u003cp\u003eThe study revealed several interconnected themes that profoundly influence sexual function among migrant and refugee women, highlighting the complex interplay between cultural background, migration experiences, and sexual well-being. The primary themes identified centre around cultural norms, traditional beliefs, and the challenges of navigating between different cultural contexts. A significant finding was the pervasive impact of cultural taboos and family expectations from participants' countries of origin. These deeply ingrained cultural norms created persistent internal conflicts, particularly regarding sexual expression and relationships. Participants frequently reported experiencing guilt, shame, and emotional distress when their sexual behaviours conflicted with traditional values, even after relocating to Australia. This was especially evident among participants from Middle Eastern and Asian backgrounds, where sexuality remains a highly sensitive and often prohibited topic of discussion. These findings align with the study conducted by Alvarez et al. [\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e] which highlights how female migrants often carry with them deeply ingrained beliefs, attitudes, and behaviours regarding sexuality, contraceptive use, and perceptions of what is deemed socially acceptable. These perspectives are heavily shaped by both explicit and implicit social norms from their countries of origin. This alignment emphasizes the enduring influence of cultural conditioning on sexual health outcomes, even in new socio-cultural environments.\u003c/p\u003e \u003cp\u003eHowever, the study also revealed a contrasting yet complementary dynamic. Migration, while bringing cultural and emotional baggage, can also create opportunities for renegotiating sexual norms and behaviours. A nuanced understanding emerged, indicating that the impact of migration on sexual health and autonomy is not uniform and varies based on individual circumstances, resilience, and the broader socio-cultural environment in the host country. For some participants, migration acted as a catalyst for increased sexual autonomy and willingness to explore sexuality. The exposure to a more open cultural environment in Australia, combined with reduced social surveillance and greater access to sexual health resources, allowed these women to reconstruct their sexual identities and feel more empowered in expressing their sexual desires. This dual narrative underscore the complexity of migration experiences. On one hand, cultural norms and values from the country of origin may persist, creating internal barriers to sexual freedom and self-expression. On the other hand, migration can also serve as an opportunity for liberation from these constraints, enabling women to reframe their sexual identities in a more accepting and less judgmental cultural context. These two trajectories are not mutually exclusive but rather reflect different facets of the same migration experience, shaped by personal, cultural, and situational factors. This dynamic created a complex pattern of adaptation where women actively negotiated between traditional expectations and new cultural norms, particularly in relation to sexual decision-making and relationship dynamics.\u003c/p\u003e \u003cp\u003eConsistent with findings from other studies, participants\u0026rsquo; sexual beliefs and behaviours were also shaped by education and women with limited education or from lower socioeconomic backgrounds were more likely to exhibit reserved or submissive sexual behaviours, while those with higher education levels tended to express themselves more openly about sexuality, were more inclined to seek sexual health services, and maintained more communicative and transparent relationships with their partners and broader social networks [\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThe second major theme of this study explored the transitions in sexual function following migration, revealing multifaceted changes and adaptations. During the initial settlement period, participants faced considerable challenges that directly impacted their sexual functioning, primarily stemming from settlement stress, altered living arrangements, and adaptation to new cultural contexts. These immediate post-migration stressors often resulted in decreased sexual activity and disrupted intimacy patterns within relationships. The study revealed that the new cultural environment often facilitated greater sexual autonomy and willingness to explore sexuality, with some women reporting increased comfort in initiating intimate encounters - a marked shift from traditional gender roles in their countries of origin. This finding suggests that migration can serve as a catalyst for sexual empowerment and the reconstruction of sexual identity. Notably, participants also described how restrictive cultural attitudes and insufficient sexual health education in their home countries led to problematic conceptualizations of sexuality and consent. For instance, one East Asian participant revealed how intense cultural shame around sexual desire led to the development of concerning sexual fantasies as a means of reconciling pleasure with cultural prohibitions. However, exposure to more sex-positive cultural attitudes post-migration enabled many participants to develop healthier perspectives on sexual agency and intimacy. These findings underscore how excessive cultural control over sexuality, combined with inadequate sexual health literacy, can foster potentially harmful ideas about sex - highlighting the critical importance of comprehensive sexual education and the need for culturally sensitive approaches to sexual health support for migrant women.\u003c/p\u003e \u003cp\u003eOur findings on the transitions in sexual function following migration align with recent research while offering new perspectives on this complex issue. A 2022 study by Ussher et al. found that migrant women from Middle Eastern and North African backgrounds experienced significant changes in sexual practices and pleasure post-migration [\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e], which is consistent with our observations of increased sexual autonomy and exploration among some participants. The results also offer new perspectives on the concept of orgasm among migrant women, revealing confusion and lack of clarity for some participants.\u003c/p\u003e \u003cp\u003eThe varying experiences of sexual pain and satisfaction reported in our study align with recent work by Hawkey et al. (2021), which found that cultural beliefs and practices significantly impact sexual health outcomes for migrant women [\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e]. However, our study provides a more nuanced understanding of how these factors interact with the migration experience over time, offering insights into both challenges and opportunities for growth in sexual function.\u003c/p\u003e \u003cp\u003eThe results of this study highlight the evolving comfort of migrant and refugee women in discussing sexual health as they adapt to new cultural environments. However, significant barriers persist, particularly in openly addressing issues related to sexual satisfaction or discomfort. These challenges often stem from deeply rooted cultural taboos and the fear of judgment from both partners and healthcare providers. Many participants resorted to non-verbal communication strategies to navigate these sensitive topics. These findings align with prior research, such as Metusela et al., which emphasized that migrant women often face difficulties in discussing sexual health due to cultural norms and language barriers [\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eOur study also suggests that the sexual agency of migrant and refugee women is shaped by the intersection of patriarchal cultural and religious narratives, with these factors influencing their relationships with their spouses and the psychological and practical consequences of resisting these norms. Echoing the work of Hawkey et al. (2018), our findings emphasize that migrant and refugee women are not a homogeneous group, and it is crucial for healthcare providers and sexual health educators to be mindful of the cultural and religious nuances that shape how women navigate these issues within their marital relationships [\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e]. Additionally, the research identified several systemic barriers that hinder access to sexual health services. These included limited awareness of available resources, financial constraints, and the complexities of navigating the healthcare system. These barriers were especially pronounced among migrants without access to Medicare, prompting some participants to seek help through informal networks or online platforms. A consistent theme across interviews was the call for more accessible, affordable, and culturally sensitive healthcare services to meet the needs of these women.\u003c/p\u003e \u003cp\u003e Another key theme that emerged from this study was the preference for female healthcare providers and culturally appropriate care, which participants viewed as essential for building trust and ensuring open communication. Many participants expressed a preference for providers from similar cultural backgrounds to mitigate the risk of judgment and ensure confidentiality. This preference reflects the broader cultural sensitivity needed in healthcare settings to foster comfort and trust. Language also played a significant role in facilitating effective communication; while some participants preferred speaking in English, others felt more at ease using their native language, believing it ensured more accurate and meaningful interactions. These findings resonate with the results of a systematic review by S\u0026aacute;nchez et al., which highlighted similar barriers in sexual and reproductive health (SRH) service access. According to the review, the most common barriers to SRH services included lack of information (57%), language barriers (43%), cultural differences (39%), economic challenges (25%), administrative hurdles (25%), and discrimination (14%) [\u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThe findings of this study make significant contributions to multiple theoretical frameworks in sexual health, migration studies, and cultural psychology. First, they expand Berry's Acculturation Theory by illuminating the complex dynamics of sexual health acculturation among migrant women [\u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e]. While Berry's model traditionally describes four broad acculturation strategies (integration, assimilation, separation, and marginalization), our findings reveal a more nuanced process in the domain of sexual health. Participants demonstrated what we term \"selective sexual health acculturation\" - a dynamic process where women strategically adopt certain Australian sexual health practices and attitudes while maintaining traditional values in other areas. This selective approach appears to be particularly evident in how women navigate healthcare seeking behaviours versus intimate relationship dynamics.\u003c/p\u003e \u003cp\u003eThe study also advances the Health Belief Model (HBM) by demonstrating how cultural factors fundamentally reshape its core constructs in migrant populations. Traditional HBM components - perceived susceptibility, severity, benefits, and barriers - are profoundly influenced by cultural beliefs and migration experiences. For instance, our findings show that perceived barriers to sexual healthcare are not merely practical (like language or cost) but are deeply rooted in cultural schemas about sexuality, shame, and gender roles. This suggests that the HBM, when applied to migrant sexual health, must be expanded to incorporate cultural determinants as primary rather than secondary factors [\u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eFurthermore, this research advances intersectional theory in health research by revealing the complex interplay between multiple social identities in shaping sexual health experiences. Building on Hankivsky's intersectional framework, our findings demonstrate how gender, cultural background, migration status, and socioeconomic position create unique configurations of privilege and disadvantage that influence sexual health outcomes [\u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e]. Particularly notable is how these intersecting identities create both constraints and opportunities for sexual agency and health-seeking behaviours. For example, higher education levels appeared to moderate the influence of traditional cultural norms, while religious identity often intensified cultural barriers to sexual health services.\u003c/p\u003e \u003cp\u003eTheoretically, this study also introduces the concept of \"cultural sexual resilience\" - the capacity of migrant women to maintain sexual well-being while navigating conflicting cultural expectations. This concept extends existing resilience frameworks by specifically addressing how women develop adaptive strategies to manage sexual health in cross-cultural contexts.\u003c/p\u003e \u003cp\u003eThe findings of this study have significant implications for healthcare providers, policymakers, and community programs. Healthcare providers must adopt culturally sensitive approaches to address the unique SRH needs of migrant and refugee women, ensuring trust, safety, and open communication in clinical interactions. Policymakers should prioritize accessible, affordable SRH services and education programs tailored to diverse cultural backgrounds. Community programs can play a crucial role in breaking cultural taboos by promoting sexual health awareness and providing resources in multiple languages. Strategies such as gender-specific services, culturally competent training for healthcare staff, and community-based education initiatives can enhance sexual health outcomes for migrant and refugee women.\u003c/p\u003e \u003cp\u003eThis study offers several notable strengths that enhance its contribution to the field. The diverse sample, representing a wide array of cultural backgrounds, provides a rich tapestry of experiences and perspectives, offering a comprehensive view of the challenges faced by migrant and refugee women. The adoption of a reflexive research approach ensured a high degree of sensitivity to cultural nuances, allowing for a more authentic representation of participants' voices. Furthermore, the implementation of multilingual strategies significantly enhanced participant comfort and engagement, facilitating more open and honest discussions on sensitive topics. However, it is important to acknowledge the study's limitations to contextualize its findings appropriately. The relatively small sample size, while providing depth, may limit the breadth of experiences captured. One key challenge is the reliance on English as the primary language of communication, despite participants being free to choose their preferred language. Although all participants opted for English, it remained their second language, potentially limiting their ability to fully express complex or deeply personal experiences. This linguistic barrier could have led to nuanced meanings being lost or misunderstood during data collection and analysis. Additionally, the sensitive nature of sexual health topics could have influenced participants' willingness to fully disclose their experiences, potentially impacting the comprehensiveness of the data. Additionally, despite efforts to minimize bias, the risk of interviewer influence or response bias cannot be entirely eliminated in qualitative research of this nature.\u003c/p\u003e \u003cp\u003eFuture research should explore sexual health experiences among migrant and refugee women in larger, more diverse cohorts across different regions in Australia. Longitudinal studies could provide insights into how sexual health perceptions and experiences evolve over time post-migration. Furthermore, studies focusing on healthcare providers' perspectives and training needs could help bridge communication gaps. Lastly, intervention-based research evaluating culturally tailored sexual health programs would offer practical solutions for addressing identified barriers.\u003c/p\u003e"},{"header":"CONCLUSION","content":"\u003cp\u003eIn conclusion, this study provides a foundation for understanding and addressing the complex SRH needs of migrant and refugee women in Adelaide, Australia. The insights gained highlight the importance of culturally sensitive healthcare practices, targeted policy interventions, and community-based initiatives in improving sexual health outcomes for this vulnerable population. By implementing the recommended strategies and conducting further research, we can work towards creating more inclusive and effective SRH services. This, in turn, will contribute to better overall health outcomes and improved quality of life for migrant and refugee women, fostering their integration and well-being in their new communities. As global migration continues to increase, addressing these issues becomes not just a local concern, but a critical component of global public health and social equity.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cdiv class=\"DefinitionList\"\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eFSD\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eFemale Sexual Dysfunction\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eSD\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eSexual Dysfunction\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eHSDD\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eHypoactive Sexual Desire Disorder\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eLMICs\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eLow\u0026ndash;and Middle\u0026ndash;Income Countries\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eRRI\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eRobinson Research Institute\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eHDA\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eHealthy Development Adelaide\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eRISE\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eRefugee and Immigrants Sexual Health Endeavor\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eNVivo\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003e(Qualitative Data Analysis Software)\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eSRH\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eSexual and Reproductive Health\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eFGM\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eFemale Genital Mutilation\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eHBM\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eHealth Belief Model\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003c/div\u003e"},{"header":"Declarations","content":"\u003ch2\u003eEthics approval and consent to participate\u003c/h2\u003e\n\u003cp\u003eThis study was approved by the University of Adelaide Human Ethics Research Committee (approval no. H-2024-011). Prior to participation, all participants received a written consent form detailing the study objectives, procedures, potential risks, and confidentiality measures. Participants provided informed consent by signing and returning the form before the study commenced. Additionally, verbal consent was obtained at the beginning of each interview to reaffirm their willingness to participate.\u0026nbsp;\u003c/p\u003e\n\u003ch2\u003eAvailability of data and materials\u003c/h2\u003e\n\u003cp\u003eThe data generated and analysed during this study are available from the corresponding author upon reasonable request. Due to ethical and legal considerations, access to some data may be restricted to protect participant confidentiality. The data will be shared in a relevant public data repository once the conditions for anonymization and de-identification have been met.\u003c/p\u003e\n\u003ch2\u003eCompeting interests\u003c/h2\u003e\n\u003cp\u003eThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article\u0026rsquo;.\u003c/p\u003e\n\u003ch2\u003eFunding\u003c/h2\u003e\n\u003cp\u003eThis is a PhD research project of NMD supported by the University of Adelaide and funded by the International Society for the Study of Women\u0026apos;s Sexual Health (ISSWSH) Research Grant. ZSL (#GNT2009730) is on the National Health and Medical Research Council (NHMRC) Emerging Leadership 2 (EL2) Fellowship. ZSL is also supported by the Women\u0026apos;s Health Research, Translation and Impact Network (WHRTN) Early and Mid-Career Researcher (EMCR) Funded Award 2023. JCA is funded via the Medical Research Future Fund (MRFF) PHRDI000014.\u0026nbsp;\u003c/p\u003e\n\u003ch2\u003eAuthors\u0026rsquo; contributions\u003c/h2\u003e\n\u003cp\u003eZohra S. Lassi, Negin Mirzaei Damabi, Mumtaz Begum, and Jodie C Avery conceptualized and developed the study idea. All authors contributed to the methodology design. Negin Mirzaei Damabi conducted the interviews and analysed the data. Negin Mirzaei Damabi wrote the initial manuscript draft. Zohra S. Lassi, Mumtaz Begum and Jodie C Avery supervised the project and contributed to data interpretation. All authors reviewed and revised the manuscript for important intellectual content. All authors approved the final version of the manuscript.\u0026nbsp;\u003c/p\u003e\n\u003ch2\u003eAcknowledgment\u0026nbsp;\u003c/h2\u003e\n\u003cp\u003eWe sincerely thank all participants across South Australia who generously shared their experiences in these interviews. Their invaluable insights have greatly contributed to advancing our understanding of sexual function among migrant and refugee women.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eAlidost F, et al. Sexual dysfunction among women of reproductive age: A systematic review and meta-analysis. Int J Reprod Biomed. 2021;19(5):421\u0026ndash;32.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSmith AM, et al. Incidence and persistence/recurrence of women's sexual difficulties: findings from the Australian Longitudinal Study of Health and Relationships. J Sex Marital Ther. 2012;38(4):378\u0026ndash;93.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eFord JV, et al. The World Association for Sexual Health\u0026rsquo;s declaration on sexual pleasure: A technical guide. Int J Sex Health. 2021;33(4):612\u0026ndash;42.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMitchell KR, et al. What is sexual wellbeing and why does it matter for public health? Lancet Public Health. 2021;6(8):e608\u0026ndash;13.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLanders S, Kapadia F. The Public Health of Pleasure: Going Beyond Disease Prevention. Am J Public Health. 2020;110(2):140\u0026ndash;1.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAnderson RM. Positive sexuality and its impact on overall well-being. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz. 2013;56(2):208\u0026ndash;14.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eDiamond LM, Huebner DM. Is good sex good for you? Rethinking sexuality and health. Soc Pers Psychol Compass. 2012;6(1):54\u0026ndash;69.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eGalinsky AM, Sonenstein FL. The Association Between Developmental Assets and Sexual Enjoyment Among Emerging Adults. J Adolesc Health. 2011;48(6):610\u0026ndash;5.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eFrederick DA, et al. Differences in Orgasm Frequency Among Gay, Lesbian, Bisexual, and Heterosexual Men and Women in a U.S. National Sample. Arch Sex Behav. 2018;47(1):273\u0026ndash;88.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBaumeister RF. Gender differences in erotic plasticity: the female sex drive as socially flexible and responsive. Psychol Bull. 2000;126(3):347.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eEshuis J. Dertig jaar evolutionair psychologisch perspectief op seksualiteit. Tijdschrift voor Seksuologie. 2020;44(4):181\u0026ndash;97.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAllen L, Carmody M. Pleasure has no passport\u0026rsquo;: re-visiting the potential of pleasure in sexuality education. Sex Educ. 2012;12(4):455\u0026ndash;68.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSimon JA, et al. Assessing the Burden of Illness Associated with Acquired Generalized Hypoactive Sexual Desire Disorder. J Womens Health (Larchmt). 2022;31(5):715\u0026ndash;25.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHiggins JA, Hirsch JS, Trussell J. Pleasure, prophylaxis and procreation: a qualitative analysis of intermittent contraceptive use and unintended pregnancy. Perspect Sex Reprod Health. 2008;40(3):130\u0026ndash;7.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKiapi-Iwa L, Hart GJ. The sexual and reproductive health of young people in Adjumani district, Uganda: qualitative study of the role of formal, informal and traditional health providers. AIDS Care. 2004;16(3):339\u0026ndash;47.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKingsberg SA, et al. Female Sexual Health: Barriers to Optimal Outcomes and a Roadmap for Improved Patient-Clinician Communications. J Womens Health (Larchmt). 2019;28(4):432\u0026ndash;43.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eStead ML, et al. Lack of communication between healthcare professionals and women with ovarian cancer about sexual issues. Br J Cancer. 2003;88(5):666\u0026ndash;71.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003e\u003cem\u003eAustralian Bureau of Statistics. Australia's Population by Country of Birth\u003c/em\u003e. 2022; Available from: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www.abs.gov.au/statistics/people/population/australias-population-country-birth/2022\u003c/span\u003e\u003cspan address=\"https://www.abs.gov.au/statistics/people/population/australias-population-country-birth/2022\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAbubakar I, et al. The UCL-Lancet Commission on Migration and Health: the health of a world on the move. Lancet. 2018;392(10164):2606\u0026ndash;54.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSaito S, et al. Response to language barriers with patients from refugee background in general practice in Australia: findings from the OPTIMISE study. BMC Health Serv Res. 2021;21(1):921.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eReeske A, Razum O. Maternal and child health\u0026mdash;from conception to first birthday. Migration health Eur Union, 2011. 139.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eGissler M, et al. Stillbirths and infant deaths among migrants in industrialized countries. Acta Obstet Gynecol Scand. 2009;88(2):134\u0026ndash;48.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eStebbins RA. Exploratory research in the social sciences. Volume 48. Sage; 2001.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMacQuarrie KL. \u003cem\u003eUnmet need for family planning among young women: levels and trends.\u003c/em\u003e 2014.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eDHS, StatCompiler., \u003cem\u003eCurrent Use of Any Method of Contraception (Sexually Active Unmarried Women). Demographic and Health Survey.\u003c/em\u003e 2017; Available from: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www.statcompiler.com/en/\u003c/span\u003e\u003cspan address=\"https://www.statcompiler.com/en/\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAssociation WM. World Medical Association Declaration of Helsinki: ethical principles for medical research involving human subjects. JAMA. 2013;310(20):2191\u0026ndash;4.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMathur R, Swaminathan S. National ethical guidelines for biomedical \u0026amp; health research involving human participants, 2017: A commentary. Indian J Med Res. 2018;148(3):279\u0026ndash;83.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eNaeem M, et al. A Step-by-Step Process of Thematic Analysis to Develop a Conceptual Model in Qualitative Research. Int J Qualitative Methods. 2023;22:16094069231205789.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eGanga D, Scott S. \u003cem\u003eCultural insiders and the issue of positionality in qualitative migration research: Moving across and moving along researcher-participant divides\u003c/em\u003e. in \u003cem\u003eForum Qualitative Sozialforschung/Forum: Qualitative Social Research\u003c/em\u003e. 2006.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAlvarez-Nieto C, et al. Sexual and reproductive health beliefs and practices of female immigrants in Spain: a qualitative study. Reproductive health. 2015;12:1\u0026ndash;10.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eUssher JM, et al. Negotiating discourses of shame, secrecy, and silence: Migrant and refugee women\u0026rsquo;s experiences of sexual embodiment. Arch Sex Behav. 2017;46:1901\u0026ndash;21.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHawkey AJ, Ussher JM, Perz J. What do women want? Migrant and refugee women\u0026rsquo;s preferences for the delivery of sexual and reproductive healthcare and information. Ethn Health. 2022;27(8):1787\u0026ndash;805.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMetusela C, et al. In my culture, we don\u0026rsquo;t know anything about that: sexual and reproductive health of migrant and refugee women. Int J Behav Med. 2017;24:836\u0026ndash;45.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHawkey AJ, Ussher JM, Perz J. Negotiating sexual agency in marriage: The experience of migrant and refugee women. Health Care Women Int. 2019;40(7\u0026ndash;9):870\u0026ndash;97.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eP\u0026eacute;rez-S\u0026aacute;nchez M, et al. Access of migrant women to sexual and reproductive health services: A systematic review. Midwifery. 2024;139:104167.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBerry JW. Theories and models of acculturation. Oxf Handb acculturation health. 2017;10:15\u0026ndash;28.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eJones CL, et al. The health belief model as an explanatory framework in communication research: exploring parallel, serial, and moderated mediation. Health Commun. 2015;30(6):566\u0026ndash;76.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHankivsky O, et al. The odd couple: using biomedical and intersectional approaches to address health inequities. Global health action. 2017;10(sup2):1326686.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"},{"header":"Appendix 1","content":"\u003cp\u003eAppendix 1 is not available with this version.\u003c/p\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"international-journal-for-equity-in-health","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"ijeh","sideBox":"Learn more about [International Journal for Equity in Health](http://equityhealthj.biomedcentral.com)","snPcode":"12939","submissionUrl":"https://submission.nature.com/new-submission/12939/3","title":"International Journal for Equity in Health","twitterHandle":"@equityhealthj","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"em","reportingPortfolio":"BMC/SO AJ","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Sexual function, Migrant, Refugee, Women","lastPublishedDoi":"10.21203/rs.3.rs-6173847/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-6173847/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e \u003cp\u003eSexual health is a fundamental aspect of well-being, yet migrant and refugee women from low- and middle-income countries (LMICs) often face unique challenges in navigating intimacy and sexual function post-migration. Sociocultural norms, migration-related stressors, and healthcare access influence their experiences, yet these perspectives remain underexplored.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003eThis qualitative study examines the transition of sexual function experiences among first-generation migrant and refugee women residing in South Australia. Semi-structured interviews were conducted with 20 reproductive-aged women from diverse cultural backgrounds. Thematic analysis was used to identify key influences on sexual health and intimacy.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003e Participants reported that cultural norms, sociocultural expectations, and migration-related stressors shaped their sexual experiences. Many described difficulties in navigating cultural taboos, communication barriers, and limited access to culturally sensitive healthcare services. While migration provided opportunities for increased sexual autonomy, self-discovery, and improved partner communication, deeply ingrained cultural beliefs and emotional struggles continued to impact their sexual well-being.\u003c/p\u003e\u003ch2\u003eConclusions\u003c/h2\u003e \u003cp\u003eThe findings highlight the need for culturally sensitive, gender-appropriate sexual health services and the removal of financial, linguistic, and systemic barriers in healthcare access. Healthcare providers, policymakers, and community organizations play a crucial role in fostering inclusive environments that support migrant and refugee women's sexual health and well-being.\u003c/p\u003e","manuscriptTitle":"Redefining Intimacy: A Qualitative Study on Sexual Function Experiences and Perspectives Among Migrant and Refugee Women in South Australia","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-04-11 04:07:46","doi":"10.21203/rs.3.rs-6173847/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2025-05-27T08:05:59+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-05-20T06:29:39+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"247083058154061535330411970209649337346","date":"2025-05-06T05:12:12+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"282833127996103474112503476754235065487","date":"2025-05-02T14:34:06+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"69985585109242739530352965411504182779","date":"2025-04-30T12:44:19+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-04-14T11:08:50+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"50965162420011094366263075441229575632","date":"2025-04-12T13:05:26+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"319076430810312307404476804507307392022","date":"2025-04-11T08:25:08+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2025-04-09T08:19:42+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-03-26T03:09:12+00:00","index":"","fulltext":""},{"type":"submitted","content":"International Journal for Equity in Health","date":"2025-03-25T22:51:09+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"international-journal-for-equity-in-health","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"ijeh","sideBox":"Learn more about [International Journal for Equity in Health](http://equityhealthj.biomedcentral.com)","snPcode":"12939","submissionUrl":"https://submission.nature.com/new-submission/12939/3","title":"International Journal for Equity in Health","twitterHandle":"@equityhealthj","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"em","reportingPortfolio":"BMC/SO AJ","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"aff3f46e-e20d-4495-acd4-0db266a56cdf","owner":[],"postedDate":"April 11th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[],"tags":[],"updatedAt":"2025-09-01T16:04:48+00:00","versionOfRecord":{"articleIdentity":"rs-6173847","link":"https://doi.org/10.1186/s12939-025-02614-z","journal":{"identity":"international-journal-for-equity-in-health","isVorOnly":false,"title":"International Journal for Equity in Health"},"publishedOn":"2025-08-28 15:57:32","publishedOnDateReadable":"August 28th, 2025"},"versionCreatedAt":"2025-04-11 04:07:46","video":"","vorDoi":"10.1186/s12939-025-02614-z","vorDoiUrl":"https://doi.org/10.1186/s12939-025-02614-z","workflowStages":[]},"version":"v1","identity":"rs-6173847","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-6173847","identity":"rs-6173847","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}