Addressing a Conceptual Gap in Sexual and Gender Minority Individuals' Health: The Need for Evolutionary Integration in Sexual and Mental Health Models.

Abstract

Mental health disparities among sexual and gender minority (SGM) populations remain a clinical concern. Existing mental health models have advanced understanding, but often overlook sexual health as a key outcome. We propose that integrating minority and intraminority stress within an evolutionary framework (highlighting processes, e.g., shame, arrested flight, insecure striving) may offer a unifying perspective. We suggest stigma triggers threat-defense systems that shape sexual behavior around survival-oriented social motives (e.g., avoiding rejection), rather than intimacy, pleasure, and care. This commentary highlights the need for clinicians to assess sexual and relational functioning with an evolutionarily-informed framework when working with SGM patients.