The phrase “sexual health” encompasses a range of public health and clinical issues related to prevention of sexually transmitted infections. I use the phrase a lot in my own work and its widening currency is a welcome new paradigm in our field. In fact, the concept of sexual health seems to me of fundamental relevance to all aspects of prevention of sexually transmitted infections.
To be honest, though, all of the talk about sexual health doesn’t seem to have influenced the day-to-day particulars of our work. Sex still is primarily seen as a set of risk factors that we counsel against. I am convinced that this perspective on sex and sexuality as “risk” legitimates the stigma associated with sexually transmitted infections and contributes to our society’s poisonous intolerance of sexual diversity. A sexual health perspective incorporates the concept of personal and epidemiologic risks of sex, but recognizes the pervasive importance of sex in our lives.
However, I’ve begun to wonder if I know what sexual health means in the first place. It’s a big concept, and maybe it’s natural that definitions seem idealistic, overwrought, and self-righteous. Consider the well-known working definition of the World Health Organization:
“Sexual health is 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.”
There is a lot to agree with in this definition, especially in its recognition of the complex physical, emotional, mental and social attributes of sexual health, and the anchoring of sexual health in universal sexual rights. But, I find this definition to be quaintly admonishing and parental (“…the possibility of having pleasurable and safe sexual experiences…”). More importantly, however, the definition is sexually vague. No matter how many times I’ve read, used, and cited this definition, I can’t derive from it even a rudimentary vision of how sexual health operates in people’s daily lives. I feel the same about the more recently wrought definition of the U.S. Centers for Disease Control & Prevention, particularly because sexual rights and of sexual pleasure are absent from that sexual health definition.
So, maybe I need to get clearer with myself about what sexual health is. And, sexual health should be more than just the negatives: not coerced; not discriminated; not violent. The prevalence of these negatives in many people’s lives tells us how far we are from achieving a just and equitable society. But I think that sexual health ultimately requires much more active involvement from all of us, and it seems quite insufficient to hope that sexual health will arise on its own if coercion, discrimination, and violence are finally conquered.
J. Dennis Fortenberry, M.D., M.S.
Indiana University School of Medicine
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