1
Sexual Health 2020
HC 1: Introductie
Sexuality = multidimensional and interrelated concept
● Sexual behaviour and practices
● Intimacy ; how we connect and bond with one or more persons.
● Sensuality/ erotica
● Sexual orientation (what we find attractive) which gender identity (how do we identify
ourself) → example: impact of how others see us.
● Power and agency; abuses of power show up in relationships.
● Sexual and reproductive health; do you have access to control your own virility.
● … (fysical) Body, mind and culture context in which the body and mind come
together and cooperate.
Sexuality:
- World Health Organization they difend sexuality as: “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.
- Sexualty is influenced by the interaction of biological, psychological, social,
economic, political, cultural, legal, historical, religious and spiritual factors.” (WHO,
2006a).
The awareness for sexual health is important.
Genieten van seks (onderzoek Rutgers 2017):
● 92% van de mannen genieten van seks.
● 75% van de vrouwen genieten van seks.
→ Place pressuremarks around sexualtity and pleasure / erotica that they are aligned.
All good sex?
● Sex associated with pleasure → positive effect quality of life … but also associated
with problems/ challenges.
○ Positive impact sexuality threatened:
■ Problems sexual functioning
● E.g. erectile dysfunction, pain.
■ Risk sexual behaviour
● E.g. STI’s, unplanned pregnancy, sexual violence.
○ Negative health outcomes individual and population level:
■ Large share of disease burden, costs.
And also there are gender differences. Interesting phenomenon. Men and women and others
do not equally benefit from sexuality.
, 2
What is sexual health? The WHO tried to do so: “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.”
(WHO, 2006a)
- Especially pleasure.
- Talk about safety.
- People have their right to have pleasure.
- Criticism of this definition: physical, emotional, mental and social well being.
Sexual rights:
● The application of international human rights law to sexuality and sexual health.
● “Sexual rights protect all people’s rights to fulfil and express their sexuality and enjoy
sexual health, with due regard for the rights of others and within a framework of
protection against discrimination.” (WHO 2006a, updated 2010)
Sexual Rights Initiative (UN initiative):
● Control and decide freely on matters related to their sexuality;
● Be free from violence, coercion or intimidation in their sexual lives;
● Have access to sexual and reproductive health care information, education and
services.
● To be protected from discrimination based on exercise of their sexuality.
Sexual health care Netherlands:
1. Municipal Health Services (GGD) ; for STI tests.
2. Primary care physician/general practitioner (‘GP’) ; individual care.
3. Sexologist ; more complicated sex issues. A secondary practitioner.
In this course we focus on 1 and 2.
Public Health
● Aim Public Health: Improve health of populations, reduce health inequalities.
● National, regional, local primary care.
● Public Health research:
○ Identify determinants of sexually ill health.
○ Monitor sexual health of groups.
○ Identify vulnerable groups (risk groups).
○ Prevention, e.g. reduce risk through health promotion (harm reduction).
○ Evaluate effect of sexual health interventions.
Context is important:
Political, medical and social environment impact:
● Access to health care (e.g. clinics, medicine, stigma).
● Sexual behaviour.
● Agency and vulnerability (e.g. gender relations and condom use).
, 3
Aim of the course:
Current sexual health issues in their larger societal, medical and scientific context
● Primarily at a population level (book).
● Trends, patterns, vulnerabilities, interventions.
Sexual health research theory and methods
● Think critically about ways in which different sources of knowledge (academic,
popular) can be used to improve sexual health of populations/ individuals.
Explore ways in which aspects of identity and social position play a role in vulnerability for ill
sexual health.
Theoretical frames:
HC 2: Theoretical approach
What is ‘theory’?
● A system of ideas intended to explain something.
● A set of principles on which the practice of an activity is based.
● An idea used to account for a situation or justify a course of action.
● A pair of glasses to understand the world.
Sexual Health
People, everywhere, all the time:
- Whe have sex because..
- We desire what we desire because..
Paradigms:
● Shared, explanatory models of our perceived world.
● Sources of morality and practices.
● Informed by religion, science, culture.
Societal norms or morals we made of think there are:
- No sex before marriage.
- Heterosexual relationsships are the norm.
- Anti-abortus.
, 4
- What a man should do, what a female should do.
- What a man is and what a woman is.
- There are a lot of implications.
Taboos & regulation of sexuality
- Homosexuality (male sexuality the most).
- Masturbation (was a sin).
- Pleasure and enjoying sex was a taboo (especially for woman).
- Why especially women? Combination of religious and cultural factors.
Because it is not necessary condition for women to enjoy sex to procreate,
whereas for men it is quite necessary to reach a point of enjoyment. Might
also be that the gender roles were for women to be docile and submissive, so
enjoying sex might fall outside this gender role. In addition I also think that for
a long time, the female sexuality was thought to be nonexistent. And ‘voor het
zingen de kerk uit’.
- Sexuality and children.
Our ideas about sexuality shape:
● What we believe is right, ‘natural’, normal, worthy of protection.
● How we behave and identify.
● How we organise our societies (e.g. marriage, family structure).
● What we hold to be true about our bodies, relationships, desires, identities.
● Where and how we look for answers to (intellectual) questions.
● We look to the world through a set of frames.
Scientific sexuality paradigms:
1. Essentialism
a. Study of sex as natural science.
b. Aim: discover single, fundamental ‘truth’ about sexuality (“natural law”).
c. Locates this truth in the individual:
i. Physical body and biology (e.g. hormones, DNA, brain, etc.).
ii. Psychology/psychobiology (experiences/trauma, psychological
mechanisms, evolution, etc.).
d. Inescapable: we are what we are, sexuality innate, instinct.
e. Famous essentialist: Charles Darwin and Freud.
f. Impact essentialism on society: the values of norms of the scientist are not
taken with the theories. Essentialisme can take a society in two different
directions, they exist in dynamic society. Conservative direction (regulation of
sexuality was forced with criminalization of homosexuality) and the other is a
direction where ‘Nudity is given by God’. Essentialists have no directions, they
have an impact in society that is already directed.
g. Critique: ...
2. Social constructionism
a. Sexuality product of social and historical forces (‘socially constructed’).
i. Interactions between people.
ii. Specific to time, context.
b. Not one ‘natural law’ or essential truth about sexuality (and gender).
Sexual Health 2020
HC 1: Introductie
Sexuality = multidimensional and interrelated concept
● Sexual behaviour and practices
● Intimacy ; how we connect and bond with one or more persons.
● Sensuality/ erotica
● Sexual orientation (what we find attractive) which gender identity (how do we identify
ourself) → example: impact of how others see us.
● Power and agency; abuses of power show up in relationships.
● Sexual and reproductive health; do you have access to control your own virility.
● … (fysical) Body, mind and culture context in which the body and mind come
together and cooperate.
Sexuality:
- World Health Organization they difend sexuality as: “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.
- Sexualty is influenced by the interaction of biological, psychological, social,
economic, political, cultural, legal, historical, religious and spiritual factors.” (WHO,
2006a).
The awareness for sexual health is important.
Genieten van seks (onderzoek Rutgers 2017):
● 92% van de mannen genieten van seks.
● 75% van de vrouwen genieten van seks.
→ Place pressuremarks around sexualtity and pleasure / erotica that they are aligned.
All good sex?
● Sex associated with pleasure → positive effect quality of life … but also associated
with problems/ challenges.
○ Positive impact sexuality threatened:
■ Problems sexual functioning
● E.g. erectile dysfunction, pain.
■ Risk sexual behaviour
● E.g. STI’s, unplanned pregnancy, sexual violence.
○ Negative health outcomes individual and population level:
■ Large share of disease burden, costs.
And also there are gender differences. Interesting phenomenon. Men and women and others
do not equally benefit from sexuality.
, 2
What is sexual health? The WHO tried to do so: “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.”
(WHO, 2006a)
- Especially pleasure.
- Talk about safety.
- People have their right to have pleasure.
- Criticism of this definition: physical, emotional, mental and social well being.
Sexual rights:
● The application of international human rights law to sexuality and sexual health.
● “Sexual rights protect all people’s rights to fulfil and express their sexuality and enjoy
sexual health, with due regard for the rights of others and within a framework of
protection against discrimination.” (WHO 2006a, updated 2010)
Sexual Rights Initiative (UN initiative):
● Control and decide freely on matters related to their sexuality;
● Be free from violence, coercion or intimidation in their sexual lives;
● Have access to sexual and reproductive health care information, education and
services.
● To be protected from discrimination based on exercise of their sexuality.
Sexual health care Netherlands:
1. Municipal Health Services (GGD) ; for STI tests.
2. Primary care physician/general practitioner (‘GP’) ; individual care.
3. Sexologist ; more complicated sex issues. A secondary practitioner.
In this course we focus on 1 and 2.
Public Health
● Aim Public Health: Improve health of populations, reduce health inequalities.
● National, regional, local primary care.
● Public Health research:
○ Identify determinants of sexually ill health.
○ Monitor sexual health of groups.
○ Identify vulnerable groups (risk groups).
○ Prevention, e.g. reduce risk through health promotion (harm reduction).
○ Evaluate effect of sexual health interventions.
Context is important:
Political, medical and social environment impact:
● Access to health care (e.g. clinics, medicine, stigma).
● Sexual behaviour.
● Agency and vulnerability (e.g. gender relations and condom use).
, 3
Aim of the course:
Current sexual health issues in their larger societal, medical and scientific context
● Primarily at a population level (book).
● Trends, patterns, vulnerabilities, interventions.
Sexual health research theory and methods
● Think critically about ways in which different sources of knowledge (academic,
popular) can be used to improve sexual health of populations/ individuals.
Explore ways in which aspects of identity and social position play a role in vulnerability for ill
sexual health.
Theoretical frames:
HC 2: Theoretical approach
What is ‘theory’?
● A system of ideas intended to explain something.
● A set of principles on which the practice of an activity is based.
● An idea used to account for a situation or justify a course of action.
● A pair of glasses to understand the world.
Sexual Health
People, everywhere, all the time:
- Whe have sex because..
- We desire what we desire because..
Paradigms:
● Shared, explanatory models of our perceived world.
● Sources of morality and practices.
● Informed by religion, science, culture.
Societal norms or morals we made of think there are:
- No sex before marriage.
- Heterosexual relationsships are the norm.
- Anti-abortus.
, 4
- What a man should do, what a female should do.
- What a man is and what a woman is.
- There are a lot of implications.
Taboos & regulation of sexuality
- Homosexuality (male sexuality the most).
- Masturbation (was a sin).
- Pleasure and enjoying sex was a taboo (especially for woman).
- Why especially women? Combination of religious and cultural factors.
Because it is not necessary condition for women to enjoy sex to procreate,
whereas for men it is quite necessary to reach a point of enjoyment. Might
also be that the gender roles were for women to be docile and submissive, so
enjoying sex might fall outside this gender role. In addition I also think that for
a long time, the female sexuality was thought to be nonexistent. And ‘voor het
zingen de kerk uit’.
- Sexuality and children.
Our ideas about sexuality shape:
● What we believe is right, ‘natural’, normal, worthy of protection.
● How we behave and identify.
● How we organise our societies (e.g. marriage, family structure).
● What we hold to be true about our bodies, relationships, desires, identities.
● Where and how we look for answers to (intellectual) questions.
● We look to the world through a set of frames.
Scientific sexuality paradigms:
1. Essentialism
a. Study of sex as natural science.
b. Aim: discover single, fundamental ‘truth’ about sexuality (“natural law”).
c. Locates this truth in the individual:
i. Physical body and biology (e.g. hormones, DNA, brain, etc.).
ii. Psychology/psychobiology (experiences/trauma, psychological
mechanisms, evolution, etc.).
d. Inescapable: we are what we are, sexuality innate, instinct.
e. Famous essentialist: Charles Darwin and Freud.
f. Impact essentialism on society: the values of norms of the scientist are not
taken with the theories. Essentialisme can take a society in two different
directions, they exist in dynamic society. Conservative direction (regulation of
sexuality was forced with criminalization of homosexuality) and the other is a
direction where ‘Nudity is given by God’. Essentialists have no directions, they
have an impact in society that is already directed.
g. Critique: ...
2. Social constructionism
a. Sexuality product of social and historical forces (‘socially constructed’).
i. Interactions between people.
ii. Specific to time, context.
b. Not one ‘natural law’ or essential truth about sexuality (and gender).
