The Mediating Role of Psychological Resilience Between Adult Attachment Styles and Sexual Functioning in Couples Undergoing Assisted Reproductive Technology: A Cross-Sectional Study

Assisted reproductive technology (ART) represents a significant life challenge that can impact psychological well-being and intimate relationships. This cross-sectional study examined whether psychological resilience mediates the association between adult attachment insecurity (anxiety and avoidance) and sexual dysfunction in 198 Italian individuals (99 heterosexual couples) undergoing ART. Path analyses were conducted separately by gender. Results showed that attachment anxiety (βmen = −.35, p <.001; βwomen= −.34, p <.001) and avoidance (βmen = −.48, p <.001; βwomen = −.57, p <.001) were significantly and negatively associated with resilience, which in turn was strongly linked to sexual dysfunction (βmen = −.66, p <.001; βwomen = −.74, p <.001). The indirect effects of anxious attachment (women: estimate = 0.127, p <.001, 95% CI [0.063, 0.192], men: estimate = 0.233, p <.001, 95% CI [0.189, 0.562]), and avoidant attachment (women: estimate = 0.273, p <.001, 95% CI [0.171, 0.376], men: estimate = 0.375, p =.015, 95% CI [0.046, 0.420]) on sexual functioning via resilience were significant. The models explained 53% of the variance in female sexual dysfunction and 44% in male sexual dysfunction. These findings highlight the role of psychological resilience as a key mechanism linking insecure attachment to sexual difficulties during ART and support its potential as a target for couple-based interventions.