Does sexual health issue affect mental wellness?

Sexual health has provided a guiding framework for addressing sexuality in public health for several decades. Although the WHO definition of sexual health is revolutionary in acknowledging positive sexuality, public health approaches remain focused on risk and adverse outcomes. The long-standing conflation of sexual health and sexual well-being has affected our ability to address everyday sexual issues. This Viewpoint provides a way forward to resolve this impasse.

The widely-adopted definition of sexual health developed by WHO is expansive. It includes concepts such as the absence of disease and coercion, and draws attention to sexual rights and to the possibility of sexual pleasure. Yet, wellbeing is mentioned as an adjunctive element of sexual health; the unique elements of wellbeing distinct from sexual health are not identified.

Sexual health

Our model follows key issues identified in the WHO definition of sexual health: fertility regulation, prevention and management of sexually transmitted infections (STIs; including HIV), sexual violence prevention, and sexual functions (including sexual desire and arousal). The relevance of these issues to global public health were underlined by the 2018 Guttmacher–Lancet Commission on sexual and reproductive health and rights focusing on the role of the Sustainable Development Goals.

Sexual pleasure

Sexual pleasure is related to both sexual health and sexual wellbeing but its distinct relevance to public health is increasingly recognized. A recent definition of sexual pleasure addresses the diverse physical and psychological satisfactions of sexual experience, and key enabling factors, such as self-determination, consent, safety, privacy, confidence, and the ability to communicate and negotiate sexual relations. Furthermore, this definition specifies that pleasure requires fundamental social and cultural conditions of sexual rights in terms of equality, non-discrimination, autonomy, bodily integrity, and freedom of expression.

We anticipate some resistance to considering wellbeing as a valid goal of public health. Critics refer to the subjective and variable qualities of wellbeing, necessarily influenced by social and cultural contexts, and played out in individual attitudes and actions. Introduction of surveillance infrastructures and goals in diverse national and cultural settings will require persistence and careful data gathering.

Conclusion

We believe that the adoption and integration of sexual wellbeing as an essential concept in efforts to address sexual inequities is imperative for the field of public health. A broad and consistent body of research supports the relevance of sexual wellbeing as a distinct correlate of sexual health whose importance has been obscured.