Promoting sexual well-being

Abstract

INTRODUCTION The fundamental drive behind most feelings, thoughts, and behavior is sexuality. Sexuality influences the way an individual projects himself psychologically and socially, and it is determined by genetic, anatomical, physiological, and other biological characteristics, as well as sociocultural factors. Interpersonal relationships and developmental experiences also shape individual sexuality in a significant way. Sexuality includes the gender identity of a person, internal sexual representations including private thoughts and fantasies as well as manifest behavior with self and others. Our sense of humor, way of dressing, and way of talking are all influenced by sexuality. Neuropsychologist Karl Pribram described four drives that motivate us to accomplish our goals. These drives included feeding, fighting, fleeing, and sex. Physical and psychological health essentially needs these drives. Hence, sex is a crucial aspect of life and sexual health is an important component of overall health. This has been realized by scholars in every field and texts and traditions of ancient origin in almost all cultures attempted to understand, explain, and value sexual knowledge in health and disease. However, sex and sexuality are still relatively less understood and less studied drives.[1] The history of human sexuality is as ancient as human history. Artifacts from some of the ancient cultures are thought to be fertility totems. A Hindu epic Kama Sutra (400 BC–200 BC) describes love, pleasure, and desire. Torah, Quran, and Bible also have rules, advice, and stories about sex. Scientific studies on sexuality started only 150 years ago. Henry Havelock Ellis, a British physician, used case study methods to study sexuality scientifically.[2] He emphasized sexuality of homosexuals is different from transgenders. He also advocated equal sexual rights for women. Sigmund Freud, the father of Psychiatry, linked sex to healthy development and recognized sexuality throughout life. Alfred Kinsey who is recognized as the father of modern sexuality research believed that most sexual knowledge is guesswork and unbiased scientific literature about sexuality is scarce.[3,4] Although a lot of research studies have been conducted and attention has been given to sexuality in recent years, scientific information is still insufficient in several domains. SEXUAL HEALTH The term sex is used in several different ways in different contexts. Sex describes the means of biological reproduction. Sex also describes sexual organs both internal and external defining an individual as male or female. World Health Organisation[5] has defined sexual health as “a state of physical, emotional, mental, and social well-being related to sexuality; it is not merely the absence of disease, dysfunction or infirmity. Human sexuality emerges in the body, but, like other human phenomena, it simultaneously unfolds in mental landscapes, social relations, and cultural spheres. Sexuality is closely linked to personal integrity, identity, body image, bonding, and social curiosity. Physiological and psychosocial determinants contribute significantly to sexual health.” The mere absence of sexual dysfunction is not considered sexual health. The sexual health is often reflected as normal sexual behavior. The normal sexual behavior is defined as having experiences that are pleasurable for oneself and one's partner and may or may not involve sexual intercourse. The behavior is also free from guilt, compulsion, or distress. The concept of normal sexual behavior is also significantly influenced by social and cultural factors. Sexual health like any other health is multifactorial and contextual.[6] The core concepts related to sexual health are defined in Table 1, and Figure 1 elucidates the component of sexual well-being.Figure 1: Components of sexual well-beingTable 1: Core concepts related to sexual wellnessGENDER AND SEXUAL ORIENTATION Gender represents the sociological and psychological representation of biological sex, which includes gender roles and gender identity. Although sex and gender are important aspects of a person's identity, it does not convey anything about orientation. Orientation refers to a person's sexual attraction to others. A person's capacity to have a sexual interest in others refers to sexual attraction. An individual must be comfortable with their sex role and chosen gender and accept themselves without guilt, shame, or fear and should be able to maintain good relationships with both sexes, regardless of whether they are intimate or platonic.[7] Gender equality includes concepts related to equal access to resources including material resources, such as money, clothes, books, etc., and non-material resources, such as love, care, and attention, as well as opportunities in education, occupation, economic pursuits, social acceptance, and decision making for their life. Gender sensitization is about providing information and strategy teaching in behavior modification regarding the adoption of gender equality in speech, behavior, and conduct. Provisions of appropriate information, sensitization, training of relevant stakeholders, and creating an enabling environment that is supportive of freedom of expression about one's orientation and gender identity are important aspects in improving sexual health promotion efforts. ATTITUDE TOWARD SEX Sexuality and general health are associated in diverse and intricate ways, and they can interact both in positive and negative ways. Culture plays a significant role in determining individuals' attitudes toward sexuality. Beliefs about normal and deviant sexual behavior are majorly influenced by culture. Concepts related to sexuality and gender are changing rapidly across the globe owing to rapid globalization and information technology advances, resulting in enhanced dissemination of information and ideas. Traditionally, cultures has been broadly classified as sex-negative and sex-positive cultures. India and the Asian subcontinent were considered sex-negative culture where sex was considered majorly for procreation. Western countries which were considered sex-positive culture considered sex beyond procreation.[8] The contemporary world is much more globalized and homogeneous, and previous concepts are only partially correct. However, consideration of sex as a taboo subject and the unavailability of sex education are still having much influence on the attitudes of people related to sexuality, especially in India. MYTHS ABOUT SEXUALITY A lot of myths and misconceptions prevail about sexuality. In women, myths, like sex is dirty, sex is sweat only during the second decade, having sex during menstruation is harmful, better sex with bigger breasts, women “no” always convey “yes,” orgasm is a must in all encounters, only vaginal and clitoral sex leads to orgasm, women never masturbate, and sexual desire decreases dramatically after menopause, are common and prevalent. Some of the common myths about male sexuality include erectile dysfunction is incurable, if a man does not get an erection by the mere sight of his partner implies that he is unable to perform, masturbation and nocturnal emission leads to impotence, and semen is a special type of cargo.[9] These myths and misconceptions do play an important role in influencing the sexual well-being of a large section of the population. This leads to sexual dissatisfaction, insecurities, and poor sexual interpersonal relationships in couples as well as impacts the presentation, symptomatology, course, and outcome of subjects with sexual dysfunctions. Hence, the provision of age-appropriate sex education addressing common myths and misconceptions can play an important role in handling sexual well-being at public health levels. Inappropriate depiction of optimal sexuality in popular media and movies, like sex is instant, easy, and leading to amazing gratification, can create unrealistic expectations. Advertisement strategies for several products and services related to sexuality often disseminate wrong and exaggerated expectations of sexuality. Such advertisements are often promoted by individuals or corporations that benefit from the promotion of a sense of sexual inadequacy in public. The unregulated advertisement and inadequate modern medicine health service sector in sexual medicine are responsible for the continuation of several sexual myths and misconceptions in society. PROMOTION OF SEXUAL WELL-BEING ACROSS AGES Children and adolescents Children and adolescents have unique needs for sexual health owing to their physical maturity, cognitive capabilities, and sociocultural factors. To become healthy adults with appropriate sexual functioning, children and adolescents would ideally need comprehensive education related to sexual and reproductive matters, freedom from any sexual coercion, and avoidance of inappropriate and premature exposure to sexual content. Aims of sexual well-being in children and adolescents include enabling them to make developmentally appropriate sexual choices, responsible sexual behavior at individual and community levels, and morally and socioculturally appropriate attitudes and outlook toward sexuality. Hence, policymakers and health professionals have always considered comprehensive sex education (CSE) as an important tool not only to promote sexual health and well-being but also the social, emotional health, and academic output of young individuals. Studies have reported that implementation of CSE in school settings helps to improve understanding of gender and gender norms, more considerate attitude toward sexual diversity including LGBTQA (lesbian, gay, bisexual, transgender, queer, and asexual) population, improves knowledge and skills to handle healthy relationships, including reduction in interpersonal violence and dating, as well as having awareness and strategies to prevent child sexual abuse.[10] Older people Although it is widely believed that sex and sexuality are no longer important for older adults, several research studies reported contrary findings. Sexuality continues to be an important aspect of quality of life even in older adults. However, there is a wide variety of inter-individual diversity in the amount of importance given to sexuality in later life. Clinicians need to be aware of and acknowledge this variability along with offering advice, help, and treatment to those who are seeking help with sexual difficulties. The expression of sexuality in older adults is influenced by age-related limitations imposed by bodily functioning, medical factors, and sociocultural concepts of sexuality norms about older adults. Active sexual life has also been useful in helping with better mental and physical health, improving life span, strengthening relationships, and reducing stress and tension. Several strategies to promote healthy aging are also helpful in the promotion of sexuality in this population. Following are the important approaches that can be helpful in having better sexual health in older adults. Accepting and acknowledging age-related changes: Changes in sexual abilities in later life are inevitable. However, it does not necessarily lead to a reduction of enjoyment and pleasure in this activity. older adults can to sex in later life at a or even that with aging is is of the most important of sexual in both However, acknowledging and age-related helps in skills to it and do An enhanced on and physical is the of sexual from to or sex can be if not better physical health, having better and a healthy are other helpful is useful to older adults to medical help for related to sexuality influenced by medical and SEXUAL WELL-BEING Gender rights Sexual health also includes aspects of reproductive health, such as fertility of and of sexual and having pleasurable sexual experiences free from The of sexual well-being is closely associated with human rights like the to the to and to be free from violence and coercion, and the to education and information regarding sexual health have been to gender which include the human rights the on the to the of health, others. the related to sexuality with human rights helps in sexual health. 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