What does it mean to be sexually healthy, and why is it important?
To learn more, HealthySteps to Wellness sat down with Brianna Booth, PhD, Director of Positive Sexuality, Design & Development in Stanford’s Office of Sexual Assault & Relationship Abuse Education & Response (SARA); and Donnovan Somera Yisrael, MA, Health Educator (specializing in emotional and sexual health education) at Stanford’s Vaden Health Center.
How would you define sexual health?
Booth: I used to think of sexual health from a public health perspective — relating to our physical bodies and reproductive systems, but I have learned that the lived experience of sexuality is much bigger and more complex than that.
A public health view is concerned with community ills, such as sexually transmitted infections, unwanted pregnancies, and sexual violence. These problems tend to be the rationale for sex education in schools, which is what motivated me in my early work. But I quickly realized that there was a lot more going on, and more that needed to be addressed. I started to look at sexuality as an integral part of the whole human being.
In our society, we tend to view sexuality as something outside of us, something that acts upon us, something that we need to wrestle with and manage. But what if sexuality is a dimension of who we are, akin to our personality? (These themes were articulated in “Reconceptualizing sexuality education”, a 2008 project brief from Real Reason.) I became focused on the question of how we can navigate the terrain of sexuality in a way that contributes to our well-being.
In my work, I refer to sexual health as just one facet of sexuality. What’s more important is our overall sexual well-being. I use a model of sexuality (adapted from Dennis Dailey, 1984) that is comprised of seven interacting categories:
- Sexual health – the physical and reproductive health aspects of our bodies
- Sexual identity – the way we make sense of who we are as sexual beings in a social world, including our gender identity and sexual orientation and how we express them
- Intimacy – our desire, and our capacity, to be close to others
- Sensuality – how we enjoy our bodies and others’ bodies through our senses and in our minds
- Meaning – the values, beliefs, attitudes, feelings, and ethics we assign to our experiences, which include our stories and how we tell them
- Context – our cultures, family, religion, laws, norms, belief systems, and media that surround us and shape all of our experiences
- Agency – our ability to make choices with our sexuality, whether toward care (love, respect, pleasure) or harm (disrespect, shaming, violation)
The most important thing I learned in my research is that we have an intense desire to connect — whether through our bodies and feelings or through our stories. We want to feel seen and affirmed in our identities and in our experiences — in spaces where we feel safe and with people with whom we feel safe. This includes our partners, as well as in our families, with our friends, and in our communities. Connection is profoundly important to us and oftentimes makes us profoundly vulnerable when it comes to sexuality. This vulnerability is what makes it so scary, but also so rich. Connection is at the heart of sexual well-being.
Yisrael: A very basic definition of sexual health is being free of medical issues/problems. However, I agree with the first line of the Constitution of the World Health Organization (WHO), which says: “Health is a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity.”
One crucial facet of sexual health is “authenticity” — the extent to which a person is able to feel at home in their body and express themselves as they choose or as is consistent with their internal experience of themselves when it comes to gender identity, sexual orientation, romantic orientation, relationship style. When we are “closeted” in some way, it is very stressful. (This statement is not meant as a judgement regarding someone who hides an identity consciously or unconsciously as an act of physical or psychological self-protection.)
Authenticity is related to Dr. Daniel J. Siegel’s definition of health, which is “integration,” or the linking of differentiated parts. We all have essential components of our humanity: intellect, emotion, physical bodies, spirituality … and sexuality. When all of those parts are working together like a championship athletic team or a symphony, there is integration, which is healthy. In other words, our sexual health is determined by the extent to which one’s various sexuality-related identities are integrated.
Similar to emotions, sexuality yearns to be expressed. The concepts of integration and authenticity are about a person’s freedom to embody and express their desire in ways that benefit the individual without harming others. Thus, another aspect of healthy sexuality encompasses our ability to use power/influence in sexual relationships in healthy ways. (Power/influence used in unhealthy sexual behavior is the issue finally coming to light in the media, which has led to the ‘me too.’ movement.) A slogan from the Men Against Violence Against Women movement reads: “My Strength is Not for Hurting.” More specifically, a crucial part of being a sexually healthy citizen of the world is having the ability to ask others for consent and to hear and respect “No.”
When we analyze why some men have chosen to act out their sexuality in harassing and abusive ways, we find that these men have not found a way to integrate their sexuality and power into their lives in appropriate and healthy ways. I firmly believe that individual people should be held accountable for their actions. We must also acknowledge that our shame-based, sex-negative history/culture and objectification and exploitation of women’s bodies in the media must bear some responsibility. Brené Brown teaches that there are three ways we act out our shame: cry and hide, appease and please and lash out in violence. I believe we are seeing all three of these types of sexual behavior in our world born of sexual shame. We need to teach our children from a very young age to love, honor and celebrate their sexuality and help them to find ways to express their sexuality in ways that benefit/do not hurt others.
Has the definition of sexual health changed over time?
Booth: Absolutely. Our ideas of sexual health evolve as values and culture evolve. I often reference an early sex educator, Mary Ware Dennett, who wrote a pamphlet for young people in 1919 about “the sex side of life.” This pamphlet was popular at the time, distributed by physicians, clergymen, YMCAs, and social workers. Dennett introduces the topic:
“When boys and girls get into their ‘teens,’ a side of them begins to wake up which has been asleep or only partly developed ever since they were born, that is, the sex side of them. It is the most wonderful and interesting part of growing up. This waking is partly of the mind, partly of the body and partly of the feelings or emotions.”
This is such gentle, welcoming language. It acknowledges sexuality as a part of us that connects to our bodies, feelings, and emotions. Further, “sex emotion,” as she calls it, is something to be curious toward. On the other side of the 24-page pamphlet, she writes to parents:
“Yes, give them the facts, give them the nature study, too, but also give them some conception of sex life as a vivifying joy, as a vital art, as a thing to be studied and developed with reverence for its big meaning, with understanding of its far-reaching reactions, psychologically and spiritually, with temperant [sic] restraint, good taste and the highest idealism.”
While her language has hints of the Victorian era, it is also decidedly affirming of sexuality and the importance of developing it — central to our well-being. Dennett’s views could be considered “sex-positive” for her time, even if some of the facts and norms she espouses are outdated by today’s standards. Today, though, I see less of this warm, poetic approach in sex education and in discourse about sex generally. Assuming education isn’t fear-based, there tends to be a focus on objectivity and medical accuracy, often devoid of emotion or meaning. In doing so, I think we lose some of the art — that felt sense of our humanness — when we discuss or engage with sexuality, especially as it relates to young people’s development. This is why I center student storytelling — replete with meaning and emotion — and define sexuality beyond the problems or the bare mechanics. I want to help people connect to these vibrant parts of our humanity. I think this is an approach that inspires behaviors and attitudes that will go toward health and well-being.
Yisrael: No doubt it has. In the last few decades, the appearance of HIV/AIDS and the development of the many LGBTQ+ movements have made a major impact on how we view sexual health, as have more recent developments such as our increased awareness and understanding of people who identify as transgender, asexual and aromantic.
What is positive sexuality?
Booth: I think of “positive sexuality” as having a thoughtful, connected, and compassionate relationship to sexuality — toward oneself and others. “Positive sexuality” regards sexuality as an integral part of the whole human, in all its developmental stages from birth to death, and in all its diversity of expression.
Yisrael: Because positive sexuality connotes the acknowledging, embracing and integrating of the sexual parts of who we are, without the fear of disconnection/rejection by others, educators must be careful not to extend this definition to the implication that “everyone should be having sex all the time.” What’s more prudent is to nudge the discussion towards “sexual self-acceptance” and to focus the discussion on sexual identity and expression vs. sexual behavior. This approach is also more inclusive of folks who identify as asexual, have limited sexual experience or are just at a point in their life (due to values, religious or otherwise) where they are not having sex.
How can we develop a more “sex-positive” perspective?
Yisrael: Lots of therapy! [Laughter] Seriously, to the extent that shame is the main obstacle to positive sexuality, then the recommended path is working the tools that lead to shame resilience. The main idea is to “mine” our psychology and history for feelings, thoughts and experiences where we have stored sexual shame and allow them to arise. Carl Jung might call this something like our “sexual shadow.” We have to allow “light” to shine on this shadow (awareness, alternative positive perspectives, acceptance) so that we can begin to heal any wounds and take what was previously in the shadows and integrate it into the life that we openly show ourselves and others. One simple thing a person can do is to begin honest, vulnerable sharing/dialogue about their sexual lives with a trusted friend, therapist, or friendly neighborhood health educator.
Is there a way to measure our sexual well-being?
Booth: As I mentioned earlier, our ability to connect is at the heart of sexual well-being. From a theoretical perspective, a good measurement for sexual well-being would be an assessment of the quality and satisfaction of our connections, as well as our skill of tuning in to our own and others’ bodies, feelings, thoughts, expressions, responses, needs, desires, and boundaries. Recognize that “tuning in” can be both verbal and felt.
What is one thing each of us can do to improve or maintain our sexual health?
Yisrael: In the courses I teach, one of the assignments is to have the students watch their favorite “rom com” or other media that portrays sexual behaviors and attitudes and to keep a pen and paper close by to write down implicit and explicit messages. The idea with this media literacy exercise is to become consciously aware of when we “consume” these messages from media and to begin to acknowledge the unhealthy messages we have already internalized. The path to sexual health must include healing any sexual self-loathing with self-acceptance and self-love. With self-acceptance, one gains the strength to avoid dangerous sexual behaviors committed out of shame.
Booth: Familiarize yourself with yourself. Make sexuality less of a stranger and more of a friend. Because sexuality is often fraught with shame, fear, secrecy, and pain, I suggest breathing warmth into these areas. One way to do this is to listen to other people’s stories. Hearing a story does two major things: it gives us a window into someone else’s lived experience, and it simultaneously offers us the opportunity to get in touch with our own feelings, reactions, and stories. Discomfort is normal! Sexuality is evocative; it’s vibrant and vulnerable, and it means a lot to us. In my work, I create spaces for students to explore the breadth and depth of their experiences and share stories with one another. When we listen to others’ stories and tell our own, we can become better attuned to ourselves and others, as well as the cultures that shape our experiences. That is powerful. Attunement is an art and a skill that is so worth practicing — and one that requires practice throughout our whole lives.