Type D Personality and Sexual Outcomes in Adults: Attachment-Related Processes and Sex and Gender as Potential Boundary Conditions—A Narrative Review

Sexual well-being extends beyond the absence of sexual dysfunction and includes relational, emotional, and autonomy-related dimensions. This integrative narrative review synthesised direct evidence concerning Type D personality, attachment, intimacy, and sexuality, and considered it alongside complementary literature on emotion regulation, communication, self-disclosure, and partner responsiveness. Direct evidence was identified through PubMed/MEDLINE and Scopus, supplemented by Google Scholar and backward and forward citation searching. Seventeen peer-reviewed empirical studies met the eligibility criteria. The evidence was limited, heterogeneous, and predominantly cross-sectional, with only limited prospective data. Most studies operationalised Type D personality categorically, and current evidence does not establish that the co-occurrence or interaction of negative affectivity and social inhibition contributes beyond their independent effects. Outcomes included erectile functioning, premature-ejaculation-related outcomes, female sexual functioning, sexual satisfaction, sexual symptoms, and sexual quality of life; these narrower outcomes should not be equated with broader multidimensional sexual well-being, which has not been comprehensively assessed. Differences in populations and outcome measures, together with scarce formal sex-based interaction analyses and limited assessment of gender-related constructs, preclude robust conclusions about sex- and gender-related differences. We therefore propose two candidate pathways: an emotional pathway linking negative affectivity with distress, negative self-evaluation, performance-related concerns, and cognitive distraction, and an interpersonal pathway linking social inhibition with restricted communication, limited self-disclosure, reduced partner support, and difficulties in intimacy. Attachment insecurity is considered a distinct relational context and a potential moderator of associations between Type D personality dimensions and sexual outcomes, while perceived partner responsiveness is proposed as a candidate moderator of interpersonal processes. The framework is heuristic and hypothesis-generating rather than sequential, mediational, or causal.