Sexual health issues
Sexual health is a broad area that encompasses many inter-related challenges and problems. Key among the issues and concerns are human rights related to sexual health, sexual pleasure, eroticism (see below), and sexual satisfaction, diseases (HIV/AIDS, STIs, RTIs), violence, female genital mutilation, sexual dysfunction, and mental health related to sexual health.
List of sexual health concerns and problems
During a meeting held in Antigua, Guatemala in May 2000, an expert group convened by the Pan American Health Organization and WHO in collaboration with the World Association for Sexology (WAS) compiled an overview of sexual concerns and problems that should be addressed in order to advance sexual health (PAHO/WHO 2000). Sexual health concerns are life situations that can be addressed through education about sexuality and society-wide actions in order to promote the sexual health of individuals. The health sector has a role to play in assessment, and in providing counselling and care.
Sexual health concerns
1. Sexual health concerns related to body integrity and to sexual safety
- Need for health-promoting behaviours for early identification of sexual problems (e.g. regular check-ups and health screening, breast and testicular self-scans).
- Need for freedom from all forms of sexual coercion and sexual violence (including rape, sexual abuse and harassment).
- Need for freedom from body mutilations (e.g. female genital mutilation).
- Need for freedom from contracting or transmitting STIs (including HIV).
- Need for reduction of sexual consequences of physical or mental disabilities.
- Need for reduction of impact on sexual life of medical and surgical conditions or treatments.
2. Sexual health concerns related to eroticism
- Need for knowledge about the body, as related to sexual response and pleasure.
- Need for recognition of the value of sexual pleasure enjoyed throughout life in safe and responsible manners within a values framework that is respectful of the rights of others.
- Need for promotion of sexual relationships practised in safe and responsible manners.
- Need to foster the practice and enjoyment of consensual, non-exploitative, honest, mutually pleasurable relationships.
3. Sexual health concerns related to gender
- Need for gender equality.
- Need for freedom from all forms of discrimination based on gender.
- Need for respect and acceptance of gender differences.
4. Sexual health concerns related to sexual orientation
- Need for freedom from discrimination based on sexual orientation.
- Need for freedom to express sexual orientation in safe and responsible manners within a values framework that is respectful of the rights of others.
5. Sexual health concerns related to emotional attachment
- Need for freedom from exploitative, coercive, violent or manipulative relationships.
- Need for information regarding choices or family options and lifestyles.
- Need for skills, such as decision-making, communication, assertiveness and negotiation, that enhance personal relationships.
- Need for respectful and responsible expression of love and divorce.
6. Sexual health concerns related to reproduction
- Need to make informed and responsible choices about reproduction.
- Need to make responsible decisions and practices regarding reproductive behaviour regardless of age, sex and marital status.
- Access to reproductive health care.
- Access to safe motherhood.
- Prevention of and care for infertility.
Sexual health problems
- Sexual health problems are the result of conditions, either in an individual, a relationship or a society, that require specific action for their identification, prevention and treatment.
- The expert working group of PAHO/WHO proposed a syndromic approach to classification that makes problems easier to identify by both health workers and the general public, and easier to report for epidemiological considerations.
- All of these sexual health problems can be identified by primary health workers. Some can be addressed by trained health workers at a primary level, but for others referral to a specialist is necessary.
- Clinical syndromes that impair sexual functioning (sexual dysfunction) such as sexual aversion, dysfunctional sexual arousal and vaginismus in females, and erectile dysfunction and premature ejaculation in males.
- Clinical syndromes related to impairment of emotional attachment or love (paraphilias) such as exhibitionism, paedophilia, sadism and voyeurism.
- Clinical syndromes related to compulsive sexual behaviour such as compulsive sexual behaviour in a relationship.
- Clinical syndromes involving gender identity conflict such as adolescent gender dysphoria.
- Clinical syndromes related to violence and victimization such as clinical syndromes after being sexually abused as a child (including post-traumatic stress disorder); clinical syndromes after being sexually harassed; clinical syndromes after being violated or raped; clinical phobia focused on sexuality; patterns of unsafe sexual behaviour placing self and/or others at risk for HIV infection or/and other STIs.
- Clinical syndromes related to reproduction such as sterility, infertility, unwanted pregnancy, abortion complications.
- Clinical syndromes related to sexually transmitted infections such as genital ulcers, urethral, vaginal or rectal discharge, lower abdominal pain in women, asymptomatic STIs.
- Clinical syndromes related to other conditions such as clinical syndromes secondary to disability or infirmity, secondary to mental or physical illness, secondary to medication.