Sexual health is an essential element of health and well-being. The CDC describes sexual health as “a state of well-being in relation to sexuality across the life span that involves physical, emotional, mental, social, and spiritual dimensions.” The World Health Organization defines sexual health as “a state of physical, emotional, mental 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.” (World Health Organization, 2006)
The 9 sexual rights that are described by the World Health Organization include:
- The right to equality and non-discrimination.
- The right to be free from torture or to cruel, inhumane or degrading treatment or punishment.
- The right to privacy.
- The right to the highest attainable standard of health (including sexual health) and social security.
- The right to marry and to establish a family and enter into marriage with the free and full consent of the intending spouses, and to equality in and at the dissolution of marriage.
- The right to decide the number and spacing of one’s children.
- The rights to information, as well as education.
- The rights to freedom of opinion and expression.
- The right to an effective remedy for violations of fundamental rights.
There has been ongoing debate about adding an additional sexual right which would include the right to accurate knowledge and access to sexual health services which are free from prejudice (Savolainen, J., 2021). There is a growing consensus that all healthcare providers need to be trained in sexual health topics. One critical topic to be addressed is implicit bias (a deep-seated, unconscious cultural stereotype that can negatively affect a person’s interactions with members of stigmatized groups, including sexual and gender minorities) as it relates to sexual health (McDowell et al., 2020).
The World Health Organization further explains that sexual health cannot be defined or understood without a broad consideration of sexuality. The ever-evolving definition of sexuality is: “A central aspect of being human throughout life encompasses sex, gender identities and roles, sexual orientation, eroticism, pleasure, intimacy and reproduction. Sexuality is experienced and expressed in thoughts, fantasies, desires, beliefs, attitudes, values, behaviors, practices, roles and relationships. While sexuality can include all of these dimensions, not all of them are always experienced or expressed. Sexuality is influenced by the interaction of biological, psychological, social, economic, political, cultural, legal, historical, religious and spiritual factors” (World Health Organization, 2006). Sexuality is diverse and multi-dimensional, and it is an important aspect of both physical and mental health (Weir,K, 2019).
As we examine this important topic, there are five emerging trends to be aware of:
The Intersection of Sexual Health and Health Equity
Sexual health is a fundamental aspect of a person’s overall and health and well-being, this an important aspect of achieving health equity. Sexual health is impacted by socioeconomic and cultural contexts—including policies, practices, and services—that support healthy outcomes for individuals, families, and their communities. Equity within sexual health ensures that everyone has access to positive, equitable, and respectful approaches to sexuality. It means that all people are free of coercion, fear, discrimination, stigma, shame, and violence related to their sexuality. In addition, every person understands the benefits, risks, and responsibilities of sexual behavior; the prevention and care of disease and other adverse outcomes; and the possibility of fulfilling sexual relationships. (Douglas, J. M., & Fenton, K. A., 2013).
Expanded Research for Marginalized Populations
Historically, treatment for sexual problems has focused primarily on treating upper white/middle class married couples, however sexuality research is now beginning to take a broader perspective (Weir,K, 2019). As we work to become more inclusive and honor the full span of human sexuality (i.e., gender identity, same-sex relationships, sexual experiences for older adults, and people in non-monogamous relationships) new research and innovations are being explored (Weir,K, 2019). In addition, research has taken mostly a preventative health approach to sexually transmitted diseases and tends to look at sexuality as a social problem (i.e., behavioral risk for HIV/AIDS or STD transmission, or teen pregnancy). Within this approach, Diane Di Maruo, a sexuality and education researcher, argues that sexuality becomes conceptualized as a problematic aspect of health. As we move beyond the disease prevention approach, emerging trends include: the need to understand the connection between biological, social, and cultural aspects of sexual health, studying the connection between hormonal influences with regard to social and cultural aspects of sexual health, and looking at the cultural differences of sexuality and sexual functioning (Di Mauro, D., 2019).
Addressing Gender Inequities
There is a growing movement to focus on women’s health and gender inequities to support women’s sexual health. Several key goals have been identified by the World Health Organization (2021) which include:
- Promoting body autonomy for women and girls by enabling them to make informed sexual, reproductive, and healthcare decisions.
- Ensuring the harmful practices that impact sexual health are no longer accepted (i.e., early forced marriage, genital mutilation).
- Guaranteeing universal health coverage for women’s healthcare, childcare,, and paid parental/family leave.
- Assigning value to unpaid caregiver roles.
- Addressing bias in the development of medical interventions (i.e. pharmaceuticals, diagnostics, and vaccines).
- Eliminating sexual harassment and violence from the workplace.
- Ensuring women hold leadership positions within government, global organizations, and health and development agencies (World Health Organization, 2021).
Psychotherapy as the Primary Intervention over Medications
Pharmacological treatments continue to be prescribed for sexual health problems (i.e. Viagra for erectile dysfunction, and Addyi for low sexual desire in premenopausal women). These pharmaceuticals are often used as a primary intervention, rather than a secondary intervention to psychotherapy. Psychosocial factors are clear risk factors for sexual dysfunction, and to address the root cause of the problem, psychotherapy continues to be an important intervention. In addition, even when medications are used there is still often psychological factors that need to be addressed (i.e. self-confidence, self-esteem and/or issues with intimacy). (Weir,K, 2019)
Mindfulness is being applied as an intervention for arousal and desire problems, pain during penetration, lack of orgasm, and sexual problems following medical problems. Mindfulness has been found to be a supportive practice for increasing emotional regulation, re-connecting a person back to their sense of self, and helping a person feel more connected to their body. Clinical psychologist, Lori Brotto. Developed an 8-week, group intervention that is modeled after mindfulness-based cognitive therapy. Within the program, patients learn to tune into erotic sensations, and how to integrate the techniques into their sexual encounters. Mindfulness-based interventions have been found to increase sexual desire, sexual function, and sex-related distress after medical treatment (Weir,K, 2019).
There is a growing need for clinicians to take a greater interest in sexuality, and sexual health. The vast majority of sexual dysfunction is psychological, and there is a growing need for clinicians to participate in sex-specific training, especially for practitioners to confront their own beliefs, biases and discomfort around sex (Weir, K. 2019).
Ready to Learn More?
CASAT Learning is offering a series (February 22, March 22, April 22 and May 24) that will explore topics related to sexual health in therapy with the goal to build and maintain competence in working with sexual health. These sessions will include case presentations, case studies, and discussion-based learning. Cases will include individual and relational concerns with a range of content including diversity, communication, consent, vulnerability, fragility (i.e., problems with sexual response cycle – desire, arousal, orgasm), “out of control” behavior, sexual configuration (think sexual orientation advanced), ethics, theory, transference/countertransference, and more. Participants are encouraged to bring cases and ask for emergent topics they would like to see covered. Beginning to advanced providers are welcome. This series is facilitated by Dr. Mary Minten, PhD, MFT, CST, LCADC
Continuing Education Units: Each monthly session is approved for 1.5 CEUs by the following professional organizations: