Disrupting Sexual Scripts in Couples: An SDSRH Framework for Addressing Identity Role Misalignment

Intimacy within romantic relationships is shaped by the broader sociocultural and structural conditions in which couples are embedded. Sexual scripts, socially constructed frameworks guiding how individuals interpret and enact intimate behaviors, serve as a mechanism through which these structural forces operate. When internalized scripts conflict with a person's authentic sense of self, a clinically significant tension emerges. This paper synthesizes sexual script theory and structural competence frameworks to introduce the concept of identity-role misalignment: the experience arising when socially prescribed sexual and intimate roles diverge from an individual's genuine identity, producing disconnection, reduced satisfaction, and impaired communication in couple relationships. Applying the Social Determinants of Sexual and Reproductive Health framework as extended to integrative sex and couples counseling, this paper situates sexual distress within structural and sociocultural contexts. By examining sexual scripts and erotic templates as structurally produced phenomena, it centers identity-role misalignment as a clinical focus and proposes sexual script renegotiation as a primary mechanism of therapeutic change. These dynamics are illustrated through a fictional cisgender heterosexual case vignette. Implications for structurally competent counseling practice and future research directions are discussed.