(790) Sexual Self-Esteem and Sexual Self-Concept in Adults with Differences of Sex Development: A Scoping Review

Introduction Differences of sex development (DSD) comprise a spectrum of congenital conditions affecting chromosomal, gonadal, and phenotypic sex, with implications for sexual maturation, body image, and psychosocial well-being. Adults with DSD, including both women and men, frequently report challenges in sexual self-concept and self-esteem, which are critical determinants of sexual health and quality of life. Objective To evaluate sexual self-esteem and sexual self-concept in adult women and men with DSD, examining differences by diagnosis and the impact of urogenital surgery. Methods A scoping review was conducted in PubMed/MEDLINE, Embase, PsycINFO, and CINAHL (to September 2025) using MeSH terms related to differences of sex development, sexuality, self-esteem, and body image. Studies included involved adults (≥18 years) with DSD and assessed sexual self-concept, self-esteem, or satisfaction. Exclusion criteria were studies on minors, case reports, reviews, or those without psychosocial outcomes. Results Adults with DSD were significantly less likely to reach romantic and sexual milestones compared to controls, with only 54% reporting ever having had a romantic relationship versus 81% in controls. Median age at sexual debut was 19.2 years in DSD versus 16.5 years in controls. Lower self-esteem scores were observed in DSD (mean Rosenberg Self-Esteem Scale: 18.7 ± 5.2) compared to controls (21.3 ± 4.6). Body image scores were also lower (mean Body Image Scale: 15.2 ± 6.1 in DSD vs. 18.9 ± 5.7 in controls). Participants scored lowest on genital satisfaction, with dissatisfaction rates as high as 47.1% in XY DSD partially androgenized females after feminization surgery. Sexual satisfaction was reduced, reporting problems with desire (up to 81.8%), arousal (up to 63.6%), and dyspareunia (up to 70%) were reported in specific subgroups such as complete androgen insensitivity syndrome and XY DSD complete females. Only 32% of DSD participants reported satisfaction with their sex life compared to 61% of controls. Sexual satisfaction was notably reduced, with only 32% of DSD participants reporting satisfaction with their sex life compared to 61% of controls (p < 0.001).[1] Sexual anxieties were present in 44.2% of XY DSD individuals, and dissatisfaction with overall sex life was reported by 37.5%.[2-3] Participants who underwent genital surgery showed less dyspareunia (p = 0.027) but more fear of injuries during intercourse (p = 0.019) than those whose genitals were left unaltered. Conclusions Adults with DSD, both women and men, experience delayed sexual development, lower sexual self-esteem, and impaired sexual satisfaction. Urogenital/genital surgery may reduce some physical symptoms but is associated with increased sexual anxieties and dissatisfaction with genital function. Multidisciplinary, affirming care and targeted psychosocial interventions are essential to address these disparities and improve sexual health and quality of life for adults with DSD. Current evidence is limited by small sample sizes, diagnostic heterogeneity, and predominantly cross-sectional designs. Future studies should adopt longitudinal, mixed-method, and participatory approaches to better capture lived experiences and guide personalized, evidence-based care. Disclosure No