Redefining sexual health for benefits throughout life

Sexual health is relevant throughout a person’s life, through to adolescence and into  older age – not only during their reproductive years.

It is determined by the quality and safety of people’s relationships: with oneself and other individuals, with family and friends, and the society in which we live, including the gender norms that shape our experiences. These relationships are themselves dependent on whether everyone’s human rights related to their sexuality are realized and protected.

WHO’s working definition of sexual health emphasizes a positive and respectful approach to sexuality and sexual relationships, that is much more than just physical – one that cannot be separated from sexual well-being:

Sexual health is a state of physical, emotional, mental and social well-being related 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.

“Sexual health is not a fixed state of being, and every person’s needs will change across the life course,” said Ian Askew, former Director of the WHO Sexual and Reproductive Health and Research, including the United Nations Special Research Programme HRP, and co-author of a new publication exploring the role of sexual pleasure in sexual and reproductive health and rights (SRHR) programming. “This is why it is crucial to undertake a range of activities across this continuum: from support of sexual well-being, to prevention and management of disease.”

Pleasure as a consideration for the success of sexual health interventions

new analysis was published in the open-access journal PLOS ONE on the need to consider sexual pleasure, not only risk of disease, in designing sexual health programmes.

What is the added value of incorporating pleasure in sexual health interventions? A systematic review and meta-analysis shows this can be an important success factor for improving knowledge around sex and uptake of safer sex practices such as condom use.

Looking at outcomes from various initiatives, the research recommends redesigning sexual education and health interventions to incorporate sexual pleasure considerations, including when promoting safer sex. This means acknowledging the reasons why people have sex – and recognizing that sexual experiences can and should be pleasurable.

“Sexual health education and services have traditionally promoted safer sex practices by focusing on risk reduction and preventing disease, without acknowledging how safer sex can also promote intimacy, pleasure, consent, and wellbeing,” said Dr Lianne Gonsalves, World Health Organization, paper co-author.

“This review provides a simple message: programmes which better reflect the reasons people have sex – including for pleasure – see better health outcomes. The hope is that these results galvanize the sexual and reproductive health and rights community to promote services that educate and equip users to engage in sex that is safe, consensual, and pleasurable.’

What next for sexual health and well-being?

Interventions specifically intended to improve sexual well-being are gradually emerging.

A major milestone is the new edition of the International Classification of Diseases (ICD) which has a chapter on sexual health for the first time. By providing the latest evidence-based definitions, WHO is facilitating the diagnosis and appropriate management for a wide variety of conditions related to sexual health. Countries began using this chapter from January 2022.

Comprehensive sexuality education (CSE) is a curriculum-based process of teaching and learning about the cognitive, emotional, physical and social aspects of sexuality. WHO recently collaborated with partners, including HRP, to develop guidance for out-of-school CSE programmes that are appropriate and safe for different groups of children and young people. This complements the guidance developed by the United Nations on school-based sexuality education. Both these guidance documents reiterated that sexual activity is part of normal and healthy living, as is giving and receiving sexual pleasure.

Another recommendation is for policy-makers to integrate brief sexuality-related communication when possible, a clinical tool for behaviour change which takes a holistic and positive understanding of sexual health and sexuality.

Sadly, this is not everyone’s reality. Many women, girls and gender-diverse persons experience non-consensual and violent sexual activity. WHO and HRP are supporting national efforts around the world to prevent and manage the consequences of all forms of sexual violence.

To eliminate diseases that affect sexual health, WHO is developing new global strategies to address STIs, including HIV – while taking into account the current pandemic-induced health system disruptions.

Given the many evidence gaps for achieving universal access to STI/HIV services, WHO is currently prioritizing a research agenda for improving the implementation of national STI programmes. This agenda will complement WHO’s leadership in developing  innovative point of care tests for quicker and more accurate diagnostic testing, and in specifying the “Global STI Vaccine Roadmap” to guide research and development for new vaccines against STIs.

A central aspect of being human

Good sexual health is fundamental to the overall health and well-being of individuals, couples and families, and to the social and economic development of communities and countries.

WHO is committed to identifying and promoting sexual health itself, so that everyone, everywhere is able to fulfil their human rights related to their sexuality and sexual well-being.