Sexual Health: A Public Health Perspective
Chapter 1 - Sexual Health: Theoretical Perspectives
➤Intro
• The term sexual health is becoming more common. Further research now derives from the connotations
of disease and pathology and focuses more on behavior, prevention as well as treatment in communities,
not clinics.
• There is little agreement on how the concept of sexual health should be defined. While the definition of
the WHO is quite inclusive (e.g. addressing pleasure and not only the absence of disease), it is also quite
ideological.
• Theories about sexual health fall into two main categories: the essentialist and the social constructionist.
➤Essentialist theories: Sexuality as instinctual and innate
• The belief that the determinants of sexual expression are found in instinct has a long history, dating from
Greek philosophers to late 19th-century sexologists.
• In the latter period, sex was seen as a science in studies, observing natural laws. The aim was to uncover
a truth about sexuality that originates from biology or psychology.
• The concept of sex as a biological imperative was reflected in much of the language used by early
sexologists. Freud for example stated that sex instinct is the natural drive for the survival of the species.
• The constant reference to ‘normal’ and ‘abnormal’ in Freud’s texts was common in the writings of
sexologists at that time and it identified and categorized sexual pathology.
• Evolutionary psychological and socio-biological theories of sexuality also are forms of essentialism.
While most evolutionary theorists accept that reproduction is no longer the central theme of sex, socio-
biology is still used by some to justify uncontrollable male lust.
• Despite some differences, all the early sexologists agreed that sex is an overpowering natural force
needing either to be contained, channeled, and controlled to allow the orderly working of society or else
to free us from repressive damaging forces.
• Kinsey described sexual expression in terms of diversity rather than uniformity.
➤Sexuality as Socially Constructed
• Sexuality is also seen as a product of social and historical forces. It began to attract post-Kinsey era.
• Emerging awareness of the marked differences in sexual practices within and between cultures
persuaded people that variety, not uniformity, was the norm.
• Social constructionists pointed to variation between social groups to argue for the cultural relativity of
sexual behavior. According to this view, there are no universals.
• They do not deny biology or psychology, but they focus on cultural and social influences as decisive
factors in explaining human sexuality.
➤Social Constructionist Theories
• Symbolic interactionism: A wide range of conventional meanings we express through words and actions
is how we learn to adopt and play social roles. Through symbolically mediated patterns of reciprocal
expectations.
• Scripting theory: With our interactional skills we develop scripts with cues and appropriate dialogue as
means of organizing our sexual behavior. Acquiring patterns and reproducing those with minor
individual adaptations.
• Choice theory: Individuals choose between different sexual activities or partnerships according to
different goals. Choices made depend on the personal values of the goals, the certainty in attaining them,
and the factors limiting choice.
• Network theory: People tend to broadly treat their sexual partners like others in their social circle. They
tend to have sex with people they likely would have other kinds of relationships with.
• Michel Foucault focused on how sexual conduct changes over time and how the notion of sexuality
itself is historically situated.
➤The Regulation of Sexual Behavior & Barries to the Improvement of Sexual Health
• Both sides of the nature-nurture debate help to understand sexuality and sexual behavior.
• Although human sexual capacity is universal, its expression is defined, regulated, and given meaning by
cultural norms.
, • Societies vary in the extent to which they impose constraints on the polar opposites of monogamy and
heterosexual behavior to procreate. Diverse mechanisms have been used to regulate sexual behavior.
• While back in the day it was through legislation and religion, now it’s through medicine and psychology.
• Sexual health presents particular challenges for public health. Behaviors involved are often stigmatized.
• The public health endeavor contributes to the social construction of sexuality.
Chapter 2 - Sexually Transmitted Infections
➤Sex, Sickness & Sin
• STIs include bacterial infections, viral infections, and parasites. They have a higher probability of
transmission by sexual contact than by any other means.
• In an attempt to regulate and control sexual behavior, the threat of STIs has long been used. STIs are
often described as punishment for sin.
• Because of the negative moral connotations of STIs, the tendency through history is to see them as the
“other” and this continues today. This has negative consequences for public health.
• STIs represent a major burden of disease and prevalence remains high in most of the world. They have
far-reaching health, social, and economic consequences.
➤Determinants of STI Transmissions
• Biomedical factors: What organism is involved, the part of the body it enters, and the integrity of the
skin or mucosal barrier.
• Behavioral factors: How easily infections can be acquired varies by sexual practice, what type of risk-
reduction strategies were used, the circumcision of a male, and partnerships & partner change.
• Sexual networks and sexual mixing patterns: Assortative mixing (similar social & behavioral
characteristics with partner) has a lower potential for the spread of STIs than dissortative mixing. Age
mixing can be an important determinant of STI/HIV prevalence in young people. Individuals with the
highest rates of partner change (core group) contribute disproportionately to the spread of STIs.
• Health service provision and use: Prompt and effective treatment of STIs plays a key role in curbing
the spread. Therapeutic remedies, medicine, and vaccines can help. Though delays in treatment result
from failure to seek health care on the part of those in need.
• Social and political conditions: Marked changes in sexual behavior have influenced the transmission of
STIs. The increases in travel, social disruption due to war & political instabilities, gender roles &
inequities, and power relations in sexual relationships have also contributed to increasing the possibility
of STIs.
➤Understanding changes in STI prevalence
• Multiple things can influence STI transmission, these determinants have considerable interaction.
• Sometimes a determinant has a greater effect on the prevalence.
• There is an absence of correlation between risk behavior and STIs prevalence. Instead, it might lie with
risk reduction practice for lowering the prevalence.
➤The Scope for Intervention
• Efforts to control STIs have evolved over time and continue to do so.
• The use of legislation to do so has however decreased. A mix of STI control strategies is needed.
Therapies are not enough and control programs require a variety of approaches tailored to the
prevalence.
• Educational interventions aimed at reducing the risk of infection through the adoption of maintenance of
safer sex behaviors will continue to be needed.
Chapter 3 - Unplanned Pregnancies
➤Meaning and Measurement
• The concept of unplanned pregnancy may come with confusion due to the interchangeable use of terms
like “planned”, “intended” and “wanted”, and the uncritical application of the term “unplanned”.
• As not all unplanned pregnancies are desired to be terminated or vice versa.
• A measure of unintended pregnancy was developed and tested among British women either seeking
abortion or continuing a pregnancy. Dimensions such as stopping contraceptive use, preparation for
pregnancy, timing in relation to life goals, and discussion and agreement with a partner were used to
measure unplanned pregnancies alongside expressed intentions.
Chapter 1 - Sexual Health: Theoretical Perspectives
➤Intro
• The term sexual health is becoming more common. Further research now derives from the connotations
of disease and pathology and focuses more on behavior, prevention as well as treatment in communities,
not clinics.
• There is little agreement on how the concept of sexual health should be defined. While the definition of
the WHO is quite inclusive (e.g. addressing pleasure and not only the absence of disease), it is also quite
ideological.
• Theories about sexual health fall into two main categories: the essentialist and the social constructionist.
➤Essentialist theories: Sexuality as instinctual and innate
• The belief that the determinants of sexual expression are found in instinct has a long history, dating from
Greek philosophers to late 19th-century sexologists.
• In the latter period, sex was seen as a science in studies, observing natural laws. The aim was to uncover
a truth about sexuality that originates from biology or psychology.
• The concept of sex as a biological imperative was reflected in much of the language used by early
sexologists. Freud for example stated that sex instinct is the natural drive for the survival of the species.
• The constant reference to ‘normal’ and ‘abnormal’ in Freud’s texts was common in the writings of
sexologists at that time and it identified and categorized sexual pathology.
• Evolutionary psychological and socio-biological theories of sexuality also are forms of essentialism.
While most evolutionary theorists accept that reproduction is no longer the central theme of sex, socio-
biology is still used by some to justify uncontrollable male lust.
• Despite some differences, all the early sexologists agreed that sex is an overpowering natural force
needing either to be contained, channeled, and controlled to allow the orderly working of society or else
to free us from repressive damaging forces.
• Kinsey described sexual expression in terms of diversity rather than uniformity.
➤Sexuality as Socially Constructed
• Sexuality is also seen as a product of social and historical forces. It began to attract post-Kinsey era.
• Emerging awareness of the marked differences in sexual practices within and between cultures
persuaded people that variety, not uniformity, was the norm.
• Social constructionists pointed to variation between social groups to argue for the cultural relativity of
sexual behavior. According to this view, there are no universals.
• They do not deny biology or psychology, but they focus on cultural and social influences as decisive
factors in explaining human sexuality.
➤Social Constructionist Theories
• Symbolic interactionism: A wide range of conventional meanings we express through words and actions
is how we learn to adopt and play social roles. Through symbolically mediated patterns of reciprocal
expectations.
• Scripting theory: With our interactional skills we develop scripts with cues and appropriate dialogue as
means of organizing our sexual behavior. Acquiring patterns and reproducing those with minor
individual adaptations.
• Choice theory: Individuals choose between different sexual activities or partnerships according to
different goals. Choices made depend on the personal values of the goals, the certainty in attaining them,
and the factors limiting choice.
• Network theory: People tend to broadly treat their sexual partners like others in their social circle. They
tend to have sex with people they likely would have other kinds of relationships with.
• Michel Foucault focused on how sexual conduct changes over time and how the notion of sexuality
itself is historically situated.
➤The Regulation of Sexual Behavior & Barries to the Improvement of Sexual Health
• Both sides of the nature-nurture debate help to understand sexuality and sexual behavior.
• Although human sexual capacity is universal, its expression is defined, regulated, and given meaning by
cultural norms.
, • Societies vary in the extent to which they impose constraints on the polar opposites of monogamy and
heterosexual behavior to procreate. Diverse mechanisms have been used to regulate sexual behavior.
• While back in the day it was through legislation and religion, now it’s through medicine and psychology.
• Sexual health presents particular challenges for public health. Behaviors involved are often stigmatized.
• The public health endeavor contributes to the social construction of sexuality.
Chapter 2 - Sexually Transmitted Infections
➤Sex, Sickness & Sin
• STIs include bacterial infections, viral infections, and parasites. They have a higher probability of
transmission by sexual contact than by any other means.
• In an attempt to regulate and control sexual behavior, the threat of STIs has long been used. STIs are
often described as punishment for sin.
• Because of the negative moral connotations of STIs, the tendency through history is to see them as the
“other” and this continues today. This has negative consequences for public health.
• STIs represent a major burden of disease and prevalence remains high in most of the world. They have
far-reaching health, social, and economic consequences.
➤Determinants of STI Transmissions
• Biomedical factors: What organism is involved, the part of the body it enters, and the integrity of the
skin or mucosal barrier.
• Behavioral factors: How easily infections can be acquired varies by sexual practice, what type of risk-
reduction strategies were used, the circumcision of a male, and partnerships & partner change.
• Sexual networks and sexual mixing patterns: Assortative mixing (similar social & behavioral
characteristics with partner) has a lower potential for the spread of STIs than dissortative mixing. Age
mixing can be an important determinant of STI/HIV prevalence in young people. Individuals with the
highest rates of partner change (core group) contribute disproportionately to the spread of STIs.
• Health service provision and use: Prompt and effective treatment of STIs plays a key role in curbing
the spread. Therapeutic remedies, medicine, and vaccines can help. Though delays in treatment result
from failure to seek health care on the part of those in need.
• Social and political conditions: Marked changes in sexual behavior have influenced the transmission of
STIs. The increases in travel, social disruption due to war & political instabilities, gender roles &
inequities, and power relations in sexual relationships have also contributed to increasing the possibility
of STIs.
➤Understanding changes in STI prevalence
• Multiple things can influence STI transmission, these determinants have considerable interaction.
• Sometimes a determinant has a greater effect on the prevalence.
• There is an absence of correlation between risk behavior and STIs prevalence. Instead, it might lie with
risk reduction practice for lowering the prevalence.
➤The Scope for Intervention
• Efforts to control STIs have evolved over time and continue to do so.
• The use of legislation to do so has however decreased. A mix of STI control strategies is needed.
Therapies are not enough and control programs require a variety of approaches tailored to the
prevalence.
• Educational interventions aimed at reducing the risk of infection through the adoption of maintenance of
safer sex behaviors will continue to be needed.
Chapter 3 - Unplanned Pregnancies
➤Meaning and Measurement
• The concept of unplanned pregnancy may come with confusion due to the interchangeable use of terms
like “planned”, “intended” and “wanted”, and the uncritical application of the term “unplanned”.
• As not all unplanned pregnancies are desired to be terminated or vice versa.
• A measure of unintended pregnancy was developed and tested among British women either seeking
abortion or continuing a pregnancy. Dimensions such as stopping contraceptive use, preparation for
pregnancy, timing in relation to life goals, and discussion and agreement with a partner were used to
measure unplanned pregnancies alongside expressed intentions.
