What is sexual health?

“Love is blind, they say; sex is impervious to reason and mocks the power of all philosophers. But, in fact, a person's sexual choice is the result and sum of their fundamental convictions” (Rand, N.D.).

Sexuality is the purest form of self-expression. It is the place where we just are. It’s a place of vulnerability; and an area that is worthy of protection. I have believed these statements to be true; and I have journeyed more than five decades to express my own sexual health with confidence.

As a healthcare professional, I see people struggle with their sexual health. Whether it is from aging, disease, or previous trauma; sexual unhealth effects whole health. Most people do not consider their sexuality as an entity of health, rather sexuality just as the act of sex. It can be quite comforting to discover all the connections that sexual health has with mental, physical, and spiritual health. As the definition of determinants of health evolves, the regular incorporation of sexual health into healthcare interactions will soon be the norm.

I have frequent in-depth interactions with people and opportunities to assist them with customized treatment plans. My current framework of an action plan includes lifestyle adjustments, non-prescription options, prescribed choices, and alternative methods. Tools like The Sexuality Wheel and the Guide to Sexual Concerns and Pleasure creatively depict the broadness of sexual health by referencing all the parts and how they connect and influence our health or unhealth.

Influencers like Queen and Comella present sexual health in a way that “allows for and in fact celebrates sexual diversity, differing desires and relationship structures, and individual choices based on consent.” It’s in this framework of cultural philosophy that sexuality can be seen as a potentially positive or even a negative force in one’s life. The difference between the two extremes has been seen as a problem of having too little information, support, and opportunity for choice, which can also be an opportunity to influence sex positivity for individuals and communities.

Sex positivity

The respectful phrase for sexual health is “sex positivity”, which has been described as “In a sex positive world, everyone would have the freedom and resources to create a sex life that delights and empowers them”. Utopian idea?

Along with sex positivity comes sex negativity. In a review, it was found that both men and women that had “negative first sexual experiences and less stable relationships at the onset of sexual activity contribute more to later sexual difficulties than the age of sexual initiation”.

Sex negativity

There is much research in the area of sex negativity, for example the importance of sexual inhibition as it relates to erectile dysfunction; the harm of too much focus on intercourse as the only means of successful sexual pleasure; performance anxiety and mental distraction and its relationship with sexual problems; depression and loss of sexual interest; the effects of substance use and intimacy on sex; and, the impact of intimate partner violence.

The World Health Organization has much to say about sexual health: “sexual health is about well-being, not merely the absence of disease”. Perhaps one day, this WHO guideline WILL be incorporated into mainstream healthcare, and all primary health interactions will include sexual health in their information gathering agenda. Many have termed “cradle to grave” as a great description of sexual health throughout the lifespan.

How do we learn about sexuality?

Much of what is believed about personal sexual health comes from how we humans seek understanding from our surroundings; where we live and work; and our personal history and culture; “understanding that we are all born into a world of meaning bestowed upon us by our culture”.

Historically, what really determined how well we lived and how long we lived, was what our grandparents always knew: find a safe place to live, eat good food, take care of what is yours, and always be ready to help your family and friends. We have now made this “list” more complex because humans are that way – complicated. Health Canada has established a detailed list of things that can affect how well we live. This list is officially called “determinants of health” and includes a broad range of personal, social, economic, and environmental factors that affect our health and the health of our communities. For more on determinants of health please see my previous post.

Sexual functioning and sexual response, is a very good example for determinants of sexual health by considering how chronic illnesses like depression, PTSD, cardiovascular disease, and diabetes can be present along with sexual dysfunction. Chronic illness can cause a feeling of loss of control for people and adding sexual dysfunction onto that is even more burdensome.

Aside from illness, there are many factors that can contribute to sexual dysfunction, namely culture, religion, body image, historical experiences of abuse or trauma, social expectations, relationships, mental health factors, and sometimes a lack of education or understanding of sexual functioning from a physiological perspective. Additional factors with potential negative sexual health impact include illicit drug use or overuse of alcohol, as is previous intimate partner violence.

Talk about it

Having a discussion about sexual health is difficult, and some of the discomfort lies in having insufficient education to provide the self-awareness when something “isn’t quite right”. Social discrimination, language barriers, or even ageing changes make it difficult to start the conversation. Other factors that shape personal experiences that can add to discrimination are shame of sexual desire or un-desire, confidence or low self-esteem, and lack of clear definition on sexual harms all can prevent discussion or even result in victim silencing. Of course, to have a conversation at all about sexual dysfunction requires a respectful and safe relationship with a healthcare provider.

Part of understanding sexual health is breaking it down into its pieces. Some researchers have done just that and have detailed the stages of a sexual experience, namely: desire, arousal, lubrication, orgasm, satisfaction, and sex-related distress. “Mindfulness makes space for everything – good and bad”.

Be safe

Let’s don’t forget about sexually transmitted and blood borne infections (STBBIs), like bacterial, viral, vaginal, and ectoparasitic (scabies, lice, etc.) infections. Some bacterial and vaginal infections are in fact treatable in a community pharmacy, which makes access so much easier for people. There is stigma with respect to STBBIs, like discrimination, stereotypes, prejudice, anger, fear, and institutional factors which can reduce seeking out health resources when needed.

HOW TO prevent STBBIs, starts with abstinence, monogamy with someone who does not have an STBBI, and condom use. Additional precautions may also be needed, like oral dams, proper protection while using sex toys, and getting tested for STBBIs. Did you know that the number of reported cases of STBBIs in Canada for adults 60 years of age and older, has been on an upward trend since 2003?

It starts in childhood

So many things that we learn in childhood stay with us forever, like riding a bike and good manners. Learning about sexual health in an informed positive way would serve every human throughout their life. Being told the facts about body parts: how they work, how they will change, and how they are private seems essential. Having a child understand this about themselves and respect that everyone has the same right to protect their parts and their boundaries, also seems mandatory. Learning about what their family values and believes, and how they may feel the same or different as they age, and to have a safe person to talk to about sexuality, also seems an obvious need.

Of course, not all children have the opportunity to learn and to thrive. Much is being understood about traumatic childhood events such as abuse, neglect, and witnessing experiences like crime, parental conflict, mental illness, and substance abuse that can result in long-term negative effects on learning, behavior, and health. The term adverse childhood experiences refers to dangerous levels of stress that can derail healthy brain development, and increase risk for unhealthy habits like smoking, alcoholism, and impact the understanding of healthy sexuality and relationships. Adverse childhood experiences can also lead to depression, heart disease, diabetes, stroke, and other illnesses.

Building resilience in people (at any age) can prevent traumas from becoming part of chronic unhealth. Having access to a positive school environment and community supports, and to instill a sense of inclusion are all fundamental solutions. Some Indigenous communities in Canada have historically been denied access to such services, and I would add that many rural northern communities share the same disadvantage.

Stages

As I consider the sexual stage of puberty and adolescence, I could see many similarities with this age group and the older adult. Both stages of sexual health have many physical, social and emotional changes that are mainly due to hormonal surges or declines. The young and the old both learn to accept themselves as a sexual being (for the first time or once again) as they explore romantic and sexual relationships. With the older adult, divorce and death of a partner or chronic illness can change sexual satisfaction but does not indicate the end of sexual behaviours.

Healthy relationships can lead to healthy dating and healthy intimacy. The key Ingredients of a relationship are often seen as: communication, balance of power, self-esteem, intimacy, responsibility, equality, positivity, physical and emotional safety, care, and trust.

I have been thrilled and hugely enlightened by Emily Nagoski through her book, Come As You Are. Here she describes the homologous traits (sameness) of the male and female fetus at about 6 weeks gestation, with both having the same biological origins with different functions. It’s only after 6 weeks gestation that the fetus further develops sexually with the physical male and female parts (genitalia). We all really do come from the same place, we share sexual sensitivities, and biological origins, but have different functions: “Same beautiful parts, just organized differently”.

So what IS good sexual health?

“For sexual health to be attained and maintained, the sexual rights of all persons must be respected, protected, and fulfilled”.

(References available upon request)