JAMA Viewpoint on Sexual Health in America

June 23, 2015

Experts say we can only meet sexual health challenges by shifting away from the current focus on diseases and moving towards a perspective that promotes health and wellness.

In a Journal of the American Medical Association (JAMA) Viewpoint published online June 18, 2015, Sexual Health in America: Improving Patient Care and Public Health, former Surgeon General David Satcher, MD, PhD, former ASHA Board Chair Edward W. Hook III, MD, and current ASHA Board member Eli Coleman, PhD, say we can move towards solutions by embracing a comprehensive sexual health framework that looks towards the promotion of health and wellness rather than a narrow fixation on diseases.

The status of sexual health as a public health priority is well justified: sexual health significantly impacts the overall health, happiness and well-being of individuals, families, and communities. Sexual health has long been approached from a model that largely looks at diseases and negative outcomes, with an obligatory recitation of statistics that includes an estimated 20 million new sexually transmitted infections (STIs), 3 million unintended pregnancies annually, and 1 million people raped.

The sexual health framework includes:

  • An emphasis on wellness
  • Focus on positive, respectful relationships
  • Acknowledgment of the impact of sexual health on overall health
  • An integrated approach to prevention

The authors say the lynchpin of this approach is shifting the focus to wellness, a critical step in reducing shame associated with these conditions: “…[S]ince STIs and other adverse health outcomes are highly stigmatized conditions, use of a broader, sex-positive, health-focused framework has the potential to reduce the stigma, fear, and discrimination associated with these conditions.”

They point out that by reducing stigma, we’ll remove a persistent barrier that impedes access to prevention services and care. “Patients and providers alike are not comfortable raising the issues and the visits are often too short and crowded with other matters, so sexual health discussions suffer. This lack of communication harms not only sexual health care but also personal and sexual relationships,” says Dr. Coleman.

The sexual health framework will also amplify prevention efforts by engaging a new, diverse set of partners at the state and local levels. Additionally, prevention efforts will be enhanced and made more efficient by “…[P]ackaging an array of messages and services within a comprehensive structure. Effective service integration and message bundling can reduce health care costs while enhancing efficiency of health care encounters and improving health on the part of patients.” Given the estimated medical costs of STIs alone are $16 billion annually, this is no small balm to public health dollars that are stretched thin.

The authors say another element of the shift in attitude is recognizing that sexual health impacts (and is impacted by) overall health: “Sexuality fulfills an array of personal, reproductive, and social needs, which influence behaviors and affect health,” they write. Dr. Coleman elaborates: “Sexual health is both an effect of health and diagnostic of health.” He says that discussing sexual health could lead to a diagnosis of underlying health conditions that are not directly related to sex and points out “There’s a clear link between sexual health and general health.”

The JAMA Viewpoint is available here.

Dr. Satcher is Director of the Satcher Health Leadership Institute at the Morehouse School of Medicine. Dr. Hook is Director, Division of Infectious Diseases and Professor of Medicine at the University of Alabama, Birmingham. Dr. Coleman is Director and Academic Chair in Sexual Health at the University of Minnesota Medical School.

Corresponding author is Dr. Coleman, Program in Human Sexuality, Department of Family Medicine and Community Health, University of Minnesota Medical School, 1300 S. Second St., Ste. 180, Minneapolis, MN, 55454.

ASHA media contact: Fred Wyand, 919.361.3124

The American Sexual Health Association is a trusted, non-profit organization that has advocated on behalf of patients to help improve public health outcomes since 1914. ASHA is recognized by the public, patients, providers and policy makers for developing and delivering accurate, medically reliable information about STIs and sexual health.

Filed in: Sexual health

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