What Are “Sexuality” and “Sexual Health”?

Sexuality is reflected in the total expression of who we are as human beings. It is shaped by our values, attitudes, behaviors, physical appearance, beliefs, emotions, personality, likes and dislikes, and spiritual selves, as well as all the ways in which we have been socialized.

Sexuality begins before birth and lasts a lifetime, and it is influenced by ethical, spiritual, cultural, and moral factors. It involves giving and receiving sexual pleasure, as well as enabling reproduction. Sexuality is a total sensory experience, involving the whole mind and body—not just the genitals.

Sexual health is the ability to express one’s sexuality free from the risk of sexually transmitted infections (STIs), unwanted pregnancy, coercion, violence, and discrimination. It means being able to have an informed, enjoyable, and safe sex life, based on a positive approach to sexual expression and mutual respect in sexual relations. It is positively enriching, includes pleasure, and enhances self-determination, communication, and relationships.

Sexual health is defined by the World Health Organization (WHO) as follows:
 

The integration of the physical, emotional, intellectual and social aspects of sexual being in ways that are positively enriching and that enhance personality, communication, and love. Every person has a right to receive sexual information and to consider sexual relationships for pleasure as well as for procreation.
(WHO Technical Report Series #572)

Addressing sexuality in health services is an integral part of relating to the client as a whole person. Clients’ sexual and reproductive health decisions (such as whether or when to have children, use of contraception, and whether to engage in risk-taking activities) are influenced by a variety of social and contextual factors, including the effect of these decisions on a client’s sexual life. Health services that take these factors into consideration will be better able to help clients realize their health and life goals and find the health services they need to achieve reproduction and healthy and enjoyable sexuality.

For example, some contraceptive methods greatly reduce libido in some women, and a woman who is not prepared for this possibility and is unaware of alternative methods may discontinue contraception—and may have an unintended pregnancy as a result. Additionally, a client’s concerns about the way that condom use interrupts the sexual act might inhibit the client’s use of this method, possibly putting the client at risk of contracting an STI.

Addressing gender inequalities
Gender inequalities may also influence decisions, and gender-based power imbalances may greatly affect a woman’s control and ability to make these decisions. For example, a woman may decide that she wants to protect herself from HIV and other STIs because of concerns about her partner’s behaviors, yet she may not have the power to confront her partner, negotiate condom use, or even discuss the matter without fear of reprisal. A woman may want to avoid having additional children, yet must choose a method that can be used secretly without her partner’s knowledge, even if it is not the ideal method for her in other respects.

Improving service quality
Clients do not often seek services directly related to sexual matters. Their concerns related to sex and sexuality tend to emerge when you explore beyond the client’s presenting need or physical complaint—during history taking, physical examination, or counseling sessions. A focus on sexuality and sexual health is essential to providing high-quality, client-centered services. Decision making, implementation of choices, and prevention of STIs and unwanted pregnancies cannot be successfully addressed without a focus on sexuality.

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