I would like to begin a conversation about sexual health by starting with some questions for you to ask yourself.
What impact does sexual health have on overall wellbeing?
How does access to comprehensive sexual healthcare support health?
What does the impact of comprehensive sexuality education or lack there of on have on a person's wellbeing?
Do you have open conversations with your healthcare providers about sexual health?
Is sexual health addressed during your annual wellness exam or only if you bring it up as a problem?
Through my experiences as a healthcare provider, a woman, a mom, a wife, sexuality educator and most importantly as a human, I find sexuality and sexual health to be a key aspect of overall wellness. I also find this to be one of the biggest gaps in medical care, amongst both conventional and integrative circles. In PA school we were taught to take a sexual health history that included only a few questions or boxes to check off during intake paperwork, it was very heteronormative and risk based. We were not taught to fully address sexuality as apart of whole health.
Sexual health in the medical setting is addressed through a risk based approach; how to prevent a sexually transmitted infection (STI), how to prevent pregnancy or how to become pregnant. This risk based assessment rarely opens up the space for conversations to include identity, expression, sexual rights or sexual pleasure all fundamental aspects of being fully human.
I was recently introduced to assessing sexual health through a triangle paradigm. The triangle links sexual health, sexual rights and sexual pleasure. For a deeper dive check out this review article on intersections and influences of a comprehensive look into sexual health.
Let's take a look at some "working" definitions from the World Health Organization and the Global Advisory Board For Sexual Health and Wellbeing.
Sexual Health
“ … a state of physical, emotional, mental and social well-being in relation to sexuality; it is not merely the absence of disease, dysfunction or infirmity. Sexual health requires a positive and respectful approach to sexuality and sexual relationships, as well as the possibility of having pleasurable and safe sexual experiences, free of coercion, discrimination and violence. For sexual health to be attained and maintained, the sexual rights of all persons must be respected, protected and fulfilled.”
Sexuality
“ … a central aspect of being human throughout life encompasses sex, gender identities and roles, sexual orientation, eroticism, pleasure, intimacy and reproduction. Sexuality is experienced and expressed in thoughts, fantasies, desires, beliefs, attitudes, values, behaviors, practices, roles and relationships. While sexuality can include all of these dimensions, not all of them are always experienced or expressed. Sexuality is influenced by the interaction of biological, psychological, social, economic, political, cultural, legal, historical, religious and spiritual factors .”
Sexual Rights
“The application of existing human rights to sexuality and sexual health constitute sexual rights. Sexual rights protect all people's rights to fulfill and express their sexuality and enjoy sexual health, with due regard for the rights of others and within a framework of protection against discrimination.”
Rights critical to the realization of sexual health include:
the rights to equality and non-discrimination
the right to be free from torture or to cruel, inhumane or degrading treatment or punishment
the right to privacy
the rights to the highest attainable standard of health (including sexual health) and social security
the right to marry and to found a family and enter into marriage with the free and full consent of the intending spouses, and to equality in and at the dissolution of marriage
the right to decide the number and spacing of one's children
the rights to information, as well as education
the rights to freedom of opinion and expression, and
the right to an effective remedy for violations of fundamental rights.
The responsible exercise of human rights requires that all persons respect the rights of others. The application of existing human rights to sexuality and sexual health constitute sexual rights. Sexual rights protect all people’s rights to fulfil and express their sexuality and enjoy sexual health, with due regard for the rights of others and within a framework of protection against discrimination.' (WHO, 2006a, updated 2010)
Sexual Pleasure
“Sexual pleasure is the physical and/or psychological satisfaction and enjoyment derived from solitary or shared erotic experiences, including thoughts, dreams and autoeroticism. Self-determination, consent, safety, privacy, confidence and the ability to communicate and negotiate sexual relations are key enabling factors for pleasure to contribute to sexual health and wellbeing. Sexual pleasure should be exercised within the context of sexual rights, particularly the rights to equality and non-discrimination, autonomy and bodily integrity, the right to the highest attainable standard of health and freedom of expression. The experiences of human sexual pleasure are diverse and sexual rights ensure that pleasure is a positive experience for all concerned and not obtained by violating other people’s human rights and wellbeing.”
Sexual pleasure, sexual health and sexual rights are directly intertwined. The triangle can be entered from any of the 3 aspects if a person is supported in their sexual health and feels safe, seen and heard through an honoring their sexual rights, their experience of sexual pleasure is enhanced. A person’s experience of sexual pleasure is tied to their sexual health and dependent on the extent to which their sexual rights are respected, protected and fulfilled. All three aspects are critical to support whole person health. In our current medical model we rarely includes sexual rights and sexual pleasure in the equation.
The need for sexual health transformation is necessary across all spectrums of healthcare; conventional and integrative healthcare settings. I would like to leave you with this simple sex positive definition from the Global Advisory Board online toolkit, as a way to begin to change the paradigm by which we view, address and embrace sexual health.
Sex Positive : an attitude that celebrates sexuality as part of life that can enhance happiness. Sex positive approaches strive to achieve ideal experiences, rather than solely aiming to prevent negative outcomes.
In the spirit of whole health and optimal wellbeing,
Lynn Joselyn She, Her, Hers, PA-C, IFMCP, CFSP™