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Summary: Sexual Health: all material, comprehensive
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Summary: Sexual Health, all material, comprehensive, Health and Life, Sustainable Care, Vrije Universiteit Amsterdam. Minor Big Five Issues in Health
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SEXUAL HEALTHIntroductiecollege
Sexual health is a state of physical, emotional 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.
This definition of WHO incorporated more positive aspects of sexual health, extending it to
include enhancement of life and personal relations. But it is vague in the description of ‘a state of
physical, emotional and social well-being’ -> difficult to measure, difficult to attain.
,4 most common subjects to improve sexual health:
1. Unplanned pregnancy
2. Sexually transmitted infection
3. Sexual violence
4. Sexual function
• Sex is associated with pleasure —> it has a positive impact on health and quality of life, but also
a negative impact
The positive impact of sexuality is threatened by:
- Problems with sexual functioning (Erectile dysfunction, pain)
- Risk associated with sexual behaviour and unsafe sexual contexts (STI’s, unplanned pregnancy,
sexual violence)
The negative health outcomes on individual- and population level:
- Large share of disease burden, costs, overall societal wellbeing
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 with protection against discrimination.
- Protected from discrimination, free from violence coercion, discrimination
- Access to sexual and reproductive healthcare information, education, services
Sexual health care Netherlands
1. Municipal Health Services (GGD)
2. Primary care physician/general practitioner (‘GP’)
3. Sexologist
4. Gynecologist
Public Health research:
• Identify determinants of sexually ill health (prevention of ill health)
• Monitor sexual health of groups and identify vulnerable groups —> Public health focusses on
the health of populations, rather than that of individuals
• Prevention, e.g. reduce risk through health promotion & program implementation (promotion
of well-being, rather than on cure and treatment)
• Evaluate effect of sexual health interventions
Sexual health approach is shifting away from medicalization -> not everything is seen as a disease
of pathological and the focus is more on behaviour.
Researches:
1. Sexual Rights Initiative (SRI) —> advance human rights related to sexuality at the UN
2. The National Survey of Sexual Attitudes and Lifestyles (NATSAL) —> largest and most
detailed scientific studies of sexual behaviour in the world.
Political, medical and social environment have a big impact on sexual health:
- access to health care (e.g. clinics, medicine, stigma)
- sexual norms and behaviour
- agency and vulnerability (e.g. gender relations and condom use)
- humanitarian events (war, pandemics...)
,Theoretical approaches
Ontology —> is the branch of philosophy that studies concepts such as existence, being,
becoming, and reality
Epistemology —> the theory of knowledge, especially with regard to its methods, validity, and
scope, and the distinction between justified belief and opinion.
Paradigms —> Shared, explanatory models of our perceived world. They are sources of morality
and practices and are informed by religion, science and culture.
Our sexuality paradigm shapes:
- What we believe is right, ‘natural’, normal, worthy of protection
- What we believe should be regulated or repressed
- How we organise our societies (e.g. family structure, social services, health care)
- What we hold to be true about our bodies, relationships, desires, identities
- How we behave and orient
- Where and how we look for answers to (intellectual) questions and solutions
Scientific sexuality paradigms
Essentialism
Sex is a natural science. Forms of sexual expression are innate, instinctual, sex is driven by
biological forces. Freud describes sex as an instinct, being the natural drive for survival of the
species.
Freudian analytic theory: repression of sex drives is the cause of psychological disequilibrium
and neurosis. Evolutionary psychological and socio-biological theories such as Darwin explain
sexuality in terms of reproductive strategies that ensured survival of the human species.
• Aim: to discover single, fundamental truth about sexuality —> natural law
• Locates this truth in the individual: The physical body and biology (e.g. hormones, DNA, brain)
and the psychology/psychobiology/evolutionary biology (experiences/trauma, psychological
mechanisms, evolution)
• Inescapable: we are what we are, sexuality is innate, an instinct
Gender essentialism is a
concept used to examine the
attribution of fixed, intrinsic,
innate qualities to women and
men. In this theory, there are
certain universal, innate,
biologically or psychologically
based features of gender that
are at the root of observed
differences in the behavior of
men and women.
, Nowadays sex is easily separated from its reproductive consequences. Early sexologists all
thought that sex was an overpowering natural force needing to be channeled, contained and
controlled. Kinsey was the first one to move away from the distinction between ‘normal’ and
‘pathological’ -> his work removed abnormal and unnatural from discussions of sexual behaviour.
The main alternative to gender essentialism is the theory of the social construction of gender. In
contrast to gender essentialism, which views differences between men and women as innate,
universal, and immutable, social constructionism views gender as created and influenced by
society and culture, which differ according to time and place, with roles societally defined as
appropriate for a person of a given sex becoming the standard against which members of that sex
are measured. Theories of the social construction of gender grew out of theories in second-wave
feminism in the latter half of the 20th century.
Social constructionism
Sexual behaviour is shaped by cultural norms and socialization. Social constructionists pointed to
variation between social groups to argue for the cultural relativity of sexual behaviour. If sexuality
were biologically determined there would be no difference between cultures, but there are. They
do not deny limits imposed by biology or psychology, but their focus is on cultural and social
influences as the decisive factor in explaining human sexuality.
• Sexuality is the product of social and historical forces (‘socially constructed’)
• Interactions between people
• Specific to time, context
• Not one ‘natural law’ or essential truth about sexuality (and gender)
• Desire, attraction, behaviour, orientation fluid and changing
• Explains the variety we observe in sexuality across countries and cultures
• Assigns more agency to the individual (human is not a ‘toy to their biology’)
• Limited by biology!
- Scripting theory: we organize our sexual behaviour that we see as being acceptable in our
culture or group, but we make minor individual adaptations to these to fit our own needs. So
there are social-structural factors and individual agency determining sexual expression.
- Choice theory: focuses on how individuals choose between different options in sexual activities
or partnerships according to different goals (sexual pleasure, reproduction, emotional
satisfaction)
- Foucault’s The History of Sexuality. He focused not only on how sexual conduct changes over
time, but on how even the notion of sexuality itself is historically situated.
Judith Butler —> “What it means to be a woman does not remain the same from decade to
decade (...) The historical meaning of gender can change as its norms are re-enacted, refused or
recreated”.
Not 1 theory explains our sexual behaviour, it is shaped by a complex network of factors. It
isn’t solely biological because different groups express different behaviour. But it’s also not
solely cultural because even within 1 group there are different behaviours.
Problems: Many non-procreative sexual practices were/are illegal, monogamy and heterosexuality
is still the way to go in most countries and cultures.
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