Human Sexuality and Sexual Health: A Western Perspective
- LAST REVIEWED: 23 March 2022
- LAST MODIFIED: 23 March 2022
- DOI: 10.1093/obo/9780199756797-0212
- LAST REVIEWED: 23 March 2022
- LAST MODIFIED: 23 March 2022
- DOI: 10.1093/obo/9780199756797-0212
Introduction
Sexuality refers to a human’s ability to experience pleasure from sexual activity and practices in its broadest sense. Sexual norms and practices are inextricably linked to prevailing cultural norms and individual identity (e.g., sexual and gender identification) and personality (e.g., gender roles). They also encompass multiple dimensions of psychology and behavior, including relationship structure (e.g., partner choice and object attraction); reproduction (e.g., biological roles); and recreation (e.g., pleasure and eroticism). Sexual customs and traditions are critical to public health because they are associated with multiple health outcomes, including physical, emotional, mental, and social well-being. Sexual health is a fundamental human right, including pleasure and desire, reproductive and relationship choices, and freedom from violence and coercion. As humans initiate sexual activity in adolescence and over the life course, sexuality carries the possibility of disease. In that sense, safer sexual practices, such as using a condom during intercourse or using pre-exposure prophylaxis to prevent HIV acquisition, are those that prevent sexually active people from acquiring sexually transmitted infections. Comprehensive rights-based sexuality education is a cornerstone of sexual health, as discussed in the Oxford Bibliographies in Public Health article Sex Education in HIV/AIDS Prevention by Jessica M. Sales and Ralph J. DiClemente. Freedom to choose a partner is a human right, which has faced multiple challenges to its exercise. Women and girls in many contexts have faced forced and child marriage, and sexual minorities have often faced stigma and discrimination, with the beginning of same-sex marriage legislation being passed relatively recently in modern history and not worldwide. The rights of gender nonconforming individuals to affirm their gender identity have only even more recently begun to be recognized. Sex is inextricably linked with reproduction; evolutionary theories have posed that partner choice and sexual attractiveness are based on the biological desire to reproduce, with marked sex differences in reproductive roles. However, women and girls have faced challenges in making reproductive choices and accessing modern family planning to prevent unwanted pregnancies and protect their health. Gender norms regarding sexuality have been more permissive to male sexuality in specific historical periods while limiting women’s sexual choices. Furthermore, power inequalities between the sexes have placed women, girls, and sexual minorities at increased risk for unwanted or coerced sex, gender-based violence, injury, and death. From a Western perspective, this article summarizes the leading public health issues related to sexuality and sexual norms and customs within sexual and reproductive health and rights. We have limited our focus to sexuality and sexual health in the West as we believe that fully representing the diversity of global perspectives would necessitate a separate entry.
Definitions
When discussing and researching sexual practices and customs, definitions of key terms are essential to ensure homogeneity and clarity, particularly given that specific terms, such as ““sex” and “gender,” which have different meanings are often interchanged. Various professional fields approach sex and sexual customs and practices from a different perspective; even within a given field, multiple definitions exist for the same concept, or concepts are used interchangeably even though they have different nuances. In this section, we cite a few go-to sources to provide a better picture of the other existing terminologies in the fields of public health, psychology, and sociology. The World Health Organization 2006 has defined vital concepts and terms related to sex and sexual practices to harmonize terminology in the context of public health. The APA Dictionary of Psychology 2020, regularly updated to reflect changing discourse in the field, can be consulted for definitions related to the psychology of sex. In addition, APA Style 2020 presents guidelines on terminology recommended to ensure unbiased language, complemented by APA n.d consolidating terms related to sexual orientation and gender identity and providing source documents. Finally, Fischer 2016 summarizes the main issues and concepts related to diverse sexualities from a sociological standpoint.
American Psychological Association. 2020. APA dictionary of psychology.
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The APA Dictionary of Psychology provides definitions for essential terms and concepts related to aspects of the psychology of sex and sexual practices and customs. Terms defined by the APA to ensure uniform language in the field of psychology which are relevant to this review are “sexuality,” “sexual identification,” “gender,” “gender identity,” and “sexual orientation.”
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American Psychological Association. 2020. Publication Manual of the American Psychological Association. Washington, DC: American Psychological Association.
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The American Psychological Association style guidelines provide clear definitions of terminology related to sexuality, sexual orientation, gender identification, and guidance to facilitate the use of inclusive and bias-free language. The guidance highlights both unbiased and problematic uses. The APA has consolidated different terminology and sources related to sexual orientation and gender identity language. These definitions are available online.
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American Psychological Association. Definitions related to sexual orientation and gender diversity in APA documents.
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This APA document presents consolidated terminology to refer to sexual orientation and gender identity issues and provides the sources for each of the defined terms, with a view to building understanding about how language can perpetuate stigma and discrimination or instead promote inclusiveness.
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Fischer, N. L. 2016. Sexualities. Oxford Bibliographies in Sociology. Oxford: Oxford University Press.
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Provides details on the sociological aspects of diverse sexualities, including issues of gender identification—such as identifying as cisgender, transgender, and intersex, among others—that emerge from the interaction of individuals and their biology with the cultural and social environment.
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World Health Organization. 2006. Chapter 1: Introduction. Defining sexual health. Report of a technical consultation on sexual health 28–31 January 2002, Geneva. Geneva, Switzerland: World Health Organization.
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In this introduction to sexual health the World Health Organization defines key terms related to sexual and reproductive health, including “sex,” “sexuality,” “sexual health,” and “sexual rights.” The working definitions were developed based on a consultation with technical global public health experts. The definitions are presented as part of an ongoing conversation in the ever-evolving sexual and reproductive health and rights field.
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Human Sexuality and Sexual Health: An Overview
Patterns of human sexuality are inextricably linked to the historical and cultural context and vary drastically from one culture to another and over the years. This introduction tries to present diverse perspectives related to an understanding of sex and sexuality from different fields of practice and specific subpopulations. Barker 2018 is an introductory text that provides an overview of human sexuality for lay readers and explores intercultural differences in sexual norms and customs. From an evolutionary perspective, sex evolved from a need for reproduction. Two textbooks are included that discuss the evolutionary origins of human sexuality. Gray and Garcia 2016, in a book intended for a lay audience, provides an overview of human sexual behavior. In contrast, in his book on the origins of human mating systems, Dixon 2009 provides a cross-cultural overview of mating arrangements, including the preponderance of monogamy and limited extra-pair paternity, and issues related to differential male and female attractiveness and sexual selection primarily via female choice. Sex, as associated with pleasure, has also been the subject of study. Behavioral scientists have long been puzzled over the unexplained role of the female orgasm in evolution; Pavličev and Wagner 2016 propose a biological explanation that female orgasm, ancestrally, induced ovulation. In the collection of essays tailored to mental health professionals, Akhtar and Gulati 2019 provides an overview of current concepts related to eroticism. Schmitt and Buss 2000 draws on personality psychology to explain the dimensions of personality associated with different intimate relationships and attraction. A seminal work on human sexuality, Foucault 1976–1984 uses discourse to analyze why sex and sexual orientation are taboo in the West, focusing on homosexuality. Kang, et al. 2017 provides an introductory text to sexuality from feminist sociology, analyzing female sexuality in the context of socially constructed structures of power. Aggleton, et al. 2018, a collection of essays, discusses the experiences of gender- and sexually-diverse youth and their actions to expand normative conceptions of sex and gender. Finally, Meyerowitz 2004 presents the history of transsexuality in the United States.
Aggleton, P., R. Cover, D. Leahy, D. Marshall, and M. L. Rasmussen, eds. 2018. Youth, sexuality, and sexual citizenship. London: Routledge.
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This book is tailored for students and scholars of gender and sexuality and health and sex education. It focuses on how gender and sexually diverse youth act to excerpt sexual citizenship to defy and change norms. The book explores young people’s experiences as influencers and change agents in multiple settings, schools, work, social media, and healthcare settings.
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Akhtar, S., and R. Gulati, eds. 2019. Eroticism: Developmental, cultural, and clinical realms. New York: Routledge.
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Meant for mental health professionals, this essay collection provides an overview of current concepts related to eroticism. It includes new theoretical and clinical advances to decenter male- and Western-dominated practice and incorporates the lens of feminist theory, sexual minorities, gender nonconformism, and non-Western erotic paradigms. The book is divided into three parts: the evolution of human eroticism, eroticism across cultures, and recommendations for clinicians given recent theoretical advances.
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Barker, M.- J. 2018. The psychology of sex. London: Routledge.
DOI: 10.4324/9781315560038Save Citation »Export Citation » Share Citation »
This is an introductory text on the subject of sex through the lens of psychology. It is short and easy to read and written for a lay audience. The book proposes that cultural norms shape how we understand sex, including how psychologists treat nonconforming sexual practices as “problems.” Understanding the social construction of sex can reduce stigmatization of individuals who do not fit the “norm.”
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Dixon, A. F. 2009. Sexual selection and the origins of human mating systems. New York: Oxford Univ. Press.
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This is a collection of essays on the evolutionary origins of human sexuality, which draws from evolutionary biology, anthropology, and psychology to compare human mating patterns, sexual selection, partner choice, and differential features of male and female attractiveness across cultures. It also compares and contrasts human sexuality to that of other primates.
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Foucault, M. 1976–1984. The history of sexuality. Translated by Robert Hurley. 4 vols. New York: Pantheon Books.
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This classic work presents the evolution of attitudes toward sex in Western culture through language and sexual discourse analysis. Foucault questions the “repressive hypothesis” that proposed that sex became taboo in the 17th century and even after the “sexual revolution” of the ‘60s. Certain parts of the book have given rise to controversy because of its acceptance of pedophilia as a natural phenomenon.
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Gray, P. B., and J. R. Garcia. 2016. Evolution and human sexual behavior. Cambridge, MA: Harvard Univ. Press.
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This book, intended for a lay audience, provides an overview of human sexual behavior from an evolutionary perspective. The authors draw on anthropology, neuroscience, and gender studies to describe the patterns and variations in human sexual behavior and sexualities. Chapters cover various topics, including the evolution of human sexuality, sexuality in adolescence and sexual development, monogamy and other sexual pairings, and sex and pleasure among older adults.
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Kang, M., D. Lessard, L. Heston, and S. Nordmarken. 2017. Introduction to women, gender, and sexuality studies. Amherst, MA: The Univ. of Massachusetts.
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Drawing from feminist sociology, this introductory textbook presents an overview of key feminist concepts and analytical frameworks in women’s sexuality and associated power structures. After presenting theoretical frameworks for analyzing women, gender, and sexuality, the book covers gender binary and nonbinary identification, institutional and economic gender-based power inequalities, and the history of contemporary feminist movements. The textbook is available online for free as an open online source.
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Meyerowitz, J. 2004. How sex changed: A history of transsexuality in the United States. Cambridge, MA: Harvard Univ. Press.
DOI: 10.2307/j.ctv1c7zfrvSave Citation »Export Citation » Share Citation »
This book provides a historical account of the history of transsexuality in the United States. The book traces the history of the transgender movement from its early questioning of a binary conception of gender in the early 20th century to the demand for rights and equity and subsequent growing recognition of these rights. Meyerowitz explains how definitions of sex and gender changed over time from a purely biological standpoint to a more fluid and nonbinary understanding of sexual identity.
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Pavličev, M., and G. Wagner. 2016. The evolutionary origin of female orgasm. Journal of Experimental Zoology Part B: Molecular and Developmental Evolution 326.6: 326–337.
DOI: 10.1002/jez.b.22690Save Citation »Export Citation » Share Citation »
In a study describing patterns of female orgasm and proposing a biological theory for its origins. Pavlicev and Wagner address the paradox of female orgasm from an evolutionary perspective. The authors suggest that female orgasm, which is more common during masturbation and homosexual intercourse and less common during heterosexual intercourse, is an ancestral reflex that induced ovulation before females of our species developed spontaneous ovulation.
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Schmitt, D. P., and D. M. Buss. 2000. Sexual dimensions of person description: Beyond or subsumed by the Big Five? Journal of Research in Personality 34.2: 141–177.
DOI: 10.1006/jrpe.1999.2267Save Citation »Export Citation » Share Citation »
In personality psychology, individual-level differences in the sexual sphere are essential determinants of social integration, relationship building, and, ultimately, evolutionary success. In this paper, the authors identify the underlying dimensions of human sexuality and evaluate their psychometric properties. The authors identify seven dimensions of human sexuality— sexual attractiveness, relationship exclusivity, gender orientation, sexual restraint, erotophilic disposition, emotional investment, and sexual orientation—which are useful to identify sexual functioning and dysfunction.
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Sexual and Reproductive Rights and Justice
In recent decades, significant progress has been made toward achieving sexual and reproductive health and rights (SRHR) for all. The International Conference on Population and Development Programme of Action (ICPD) and the Beijing Declaration Platform for Action are landmark resolutions passed in the mid-1990s, articulating a groundbreaking vision for SRHR, and were recently reaffirmed by the global community marking twenty-five years since their passage. The import of the ICPD is summarized in the report the United Nations Population Fund 2019, while the final adopted text for the Beijing Declaration can be found in United Nations 1995. Preceding the passage of these two resolutions, the reproductive justice movement had emerged as a formidable force in the United States in the 1980s and 1990s, securing gains for women and girls’ reproductive rights; the emergence of this movement is described further in The History of Reproductive Justice Movement. World Health Organization 2010 recounts progress made globally on SRHR since the ICPD and Beijing resolutions. Despite notable progress, this report acknowledges gaps and challenges that remain, turning its focus toward the future and posing solutions to close critical gaps in health outcomes and access to SRHR services and resources.
United Nations. 1995. Report of the Fourth World Conference on Women. Beijing, 4–15 September 1995. U.N. Doc. A/CONF.177/20/Rev.1. New York: U.N.
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In 1995, at the Fourth World Conference on Women, governments signed the Beijing Declaration and Platform for Action, a landmark agreement and program of action recognizing the human rights of women and girls; underscoring their sexual and reproductive health and rights; and recognizing their right to freedom from violence, education, and equal pay. The Beijing Declaration is still relevant today and, in March 2020, governments reaffirmed their commitment to the program.
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United Nations Population Fund. 2019. Explainer: What is the ICPD, and why does it matter? UNFPA. March 29.
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In 1994, world governments and advocates met at Cairo’s International Conference on Population and Development, known as ICPD. They adopted the landmark ICPD Programme of Action, recognizing women’s reproductive health and rights as a necessary centerpiece of the development agenda. The Program of Action continues to be relevant and to guide the Sustainable Development Goals. In 2019, governments met in Nairobi to celebrate the ICPD’s 25th anniversary.
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World Health Organization. 2010. Social determinants of sexual and reproductive health: Informing future research and programme implementation. Geneva, Switzerland: World Health Organization.
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This compilation of essays by WHO researchers presents an overview of progress made toward achieving universal access to sexual and reproductive health and highlights priority areas to address gaps and reduce inequities in access to sexual and reproductive health services worldwide. Following an introduction to sexual and reproductive health seen through a disparities lens, the book is divided into the health system and community-based approaches to reducing health disparities.
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History of Reproductive Justice Movement
To fully appreciate recent progress in advancing the sexual and reproductive health and rights agenda, it is essential to understand the reproductive justice movement in the United States, which emerged in the 1980s and 1990s in response to SRHR and other social justice issues impacting women of color. In their 2001 mission statement, SisterSong, a reproductive justice organization founded in 1997, defines reproductive justice as “the human right to maintain personal bodily autonomy, have children, not have children, and parent the children we have in safe and sustainable communities.” Ross and Solinger 2017 provides a concise yet thorough introduction to the reproductive justice movement in the United States, outlining its history and present-day challenges. The reproductive justice movement cannot be separated from the struggle for racial justice and equality. In respective mission statements, Combahee River Collective 1977 and Black Women’s Health Project 1993/2018, two reproductive justice organizations founded by Black women, acknowledge the unique struggles experienced by Black women in the United States, including sexual oppression and disparities in sexual and reproductive health outcomes. The book Roberts 2017 traces the history of reproductive oppression against Black women in the United States, demonstrating how Black women’s right to reproductive choice has been systematically undermined. Although some of the first reproductive justice organizations were created to advance the rights of Black women, the banner of reproductive justice has also been taken up by the LGBTQ+ community, Indigenous women, Latinx women, and others. The Native American Women’s Health Education Resource Center, founded in 1988, is one such reproductive justice organization created to advance the reproductive rights of Indigenous women.
Combahee River Collective. 1977. The Combahee River Collective Statement
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This landmark statement, written in 1977 by a coalition of Black feminists known as the Combahee River Collective, articulates the major ideas inherent in Black feminist politics, making a case for an intersectional view of feminism now dominant in contemporary scholarship and discourse. In this statement, the group advances its feminist and antiracist agenda and anticapitalist position and introduces identity politics.
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National Black Women’s Health Project. 2018. Black Women’s Health Project case statement 1993. Meridians: Feminism, Race, Transnationalism 16.2: 260–275.
DOI: 10.2979/meridians.16.2.07Save Citation »Export Citation » Share Citation »
In 1993, the National Black Women’s Health Project (NBWHP) released a statement setting forth its agenda for advancing the health and promoting the rights of Black women. The statement outlines health disparities faced by Black women, segueing into describing NBWHP’s role in addressing these disparities through self-help groups, awareness-raising programs, and much more. At the heart of the organization’s work are the principles of self-empowerment and community solidarity.
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Native American Women’s Health Education Resource Center..
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This website features various online resources created by the Native American Women’s Health Education Resource Center (NAWHERC), an Indigenous-led organization founded in 1988 and rooted in the principles of reproductive justice, human rights, and cultural preservation. With strong ties to the communities it serves and a robust national presence, NAWHERC is committed to direct service provision on the local and advocacy and coalition building on a broader scale.
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Roberts, D. 2017. Killing the Black body: Race, reproduction, and the meaning of liberty. 2d ed. New York: Vintage Books.
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This highly influential book by scholar Dorothy Roberts examines how society has undermined Black women’s reproductive rights through regulations, rhetoric, and other means. Roberts begins by looking at the past, demonstrating how reproductive oppression against Black women has taken on different forms throughout history and eventually arrives at the present day, arguing for a reimagining of today’s reproductive justice agenda.
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Ross, L. J., and R. Solinger. 2017. Reproductive justice: An introduction. Oakland: Univ. of California Press.
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Internationally recognized scholars Loretta Ross and Rickie Solinger introduce the field of reproductive justice in a concise, authoritative fashion, tracing its historical roots and delineating contemporary issues and challenges. Throughout the text, the authors apply an intersectional framework, demonstrating how the convergence of multiple forms of oppression undermines reproductive autonomy. The epilogue contains short pieces written by leaders of six different reproductive justice organizations.
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SisterSong. 2018. SisterSong 2001 mission statement and principles of unity. Meridians: Feminism, Race, Transnationalism 16.2: 326–328.
DOI: 10.2979/meridians.16.2.12Save Citation »Export Citation » Share Citation »
This statement captures the ethos of SisterSong, a reproductive justice organization founded in 1997 for Black, Indigenous, and other women of color that has since grown to include trans people, queer women, and members of other marginalized communities among its ranks. This statement puts forth a definition for reproductive justice widely quoted by scholars to this day.
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Sexual Health
This overview of issues related to sexual health is divided into three broad subsections as follows: the first section presents authoritative sources of information on Sexuality and Sexual and Reproductive Health over the Life Course, which deal with topics related to healthy sexuality for the general population and specific age subgroups, such as adolescents and older adults; the second section, Safe Sex and Sexually Transmitted Infections, presents sources of information on issues related to safer sex promotion and prevalence of sexually transmitted infections in the United States overall and by specific population subgroups, including young and transgender people; and the third section focuses on Sex and Substance Use presenting evidence on the linkages between the use of substances, such as alcohol, and sexual health.
Sexuality and Sexual and Reproductive Health over the Life Course
Promoting and maintaining sexual health requires strategies and approaches that change over the life course, spanning from sexual maturation and initiation around puberty to reproduction and supporting healthy sexuality in later years. The issues related to sexual health vary by age and sex, gender, and sexual orientation, thus requiring a tailored approach to care. This section presents a collection of sources that take a life course approach to sexual health to guide students, researchers, and practitioners. The U.S. Centers for Disease Control and Prevention (CDC) landing page on sexual health presents an overview of topics related to sexual health, which are developed in-depth in separate subpages. A resource for decision makers, the U.S. Department of Health and Human Services Healthy People 2030 presents the US government’s health priorities in sexual health to guide policy and program priorities. Next, we present several articles addressing adolescent sexual health and the specific considerations when examining sexuality in this age group: Fortenberry 2013 provides a framework for analyzing sexual development from a lifecourse approach, and Liang, et al. 2019 presents the global sexual and reproductive health priorities in adolescent health, focusing on the progress made in the last twenty-five years and the current gaps. The U.S. Department of Health and Human Services informational page on sexuality and the commentary Lusti-Narasimhan and Beard 2013 and Srinivasan, et al. 2019 present an overview of issues related to ensuring healthy sexuality among older adults who are past their reproductive years. Discuss approaches relevant to mental health professionals in treating older adults with sexual health concerns, and focus on the needs of sexual minorities.
Fortenberry, J. D. 2013. Puberty and adolescent sexuality. Hormones and Behavior 64.2: 280–287.
DOI: 10.1016/j.yhbeh.2013.03.007Save Citation »Export Citation » Share Citation »
Using a lifecourse approach, this review article, which is part of a special issue on “Puberty and Adolescence,” describes the development of healthy sexuality in adolescence and its continuum into adulthood. The review proposes a framework for understanding the emergence of sexuality based on desire, arousal, sexual behavior, and sexual function and how these set the foundations for adult sexuality.
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Liang, M., S. Simelane, G. F. Fillo, et al. 2019. The state of adolescent sexual and reproductive health. Journal of Adolescent Health 65.6: S3–S15.
DOI: 10.1016/j.jadohealth.2019.09.015Save Citation »Export Citation » Share Citation »
This article by United Nations adolescent health experts describes the global progress in advancing adolescent sexual and reproductive health and rights since the 1994 International Conference on Population and Development Program of Action. Girls today are more likely to delay marriage and childbirth and use contraceptives than twenty-five years ago but significant disparities persist between populations. Importantly, the absolute number of girls getting married and having children is greater than in 1994.
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Lusti-Narasimhan, M., and J. R. Beard. 2013. Sexual health in older women. Bulletin of the World Health Organization 91:707–709.
DOI: 10.2471/BLT.13.119230Save Citation »Export Citation » Share Citation »
This article written by technical experts from the World Health Organization provides a brief overview of the main issues related to sexual health and sexuality. It questions ageist stereotypes that assume that sexual desire diminishes with age. The article highlights the need for more assets-based evidence-based research on interventions to ensure that all women can achieve their full sexual health, regardless of age.
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Srinivasan, S., J. Glover, R. R. Tampi, D. J. Tampi, and D. D. Sewell. 2019. Sexuality and the older adult. Current Psychiatry Reports 21.10: 1–9.
DOI: 10.1007/s11920-019-1090-4Save Citation »Export Citation » Share Citation »
Written by psychiatrists, this article reviews healthy sexuality in older adults and the importance of provider training on healthy sexuality and aging to ensure quality care. The authors highlight the integral importance of sexuality to health and well-being in older adults and the stigma surrounding sexual expression in older adults, highlighting the need to build healthcare providers’ capacity to ensure quality sexual healthcare for older adults, including those with dementia and who are LGBTQ.
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U.S. Centers for Disease Control and Prevention (CDC). Sexual health.
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The CDC page on sexual page presents definitions, the latest US-based data, and evidence-based publications related to sexual health, including safer sex practices. The page’s subsections provide access to data and information on sexually transmitted infections, reproductive health, sexual violence prevention, healthy pregnancy, and LGBT health.
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U.S. Department of Health and Human Services. National Institutes on Aging. Sexuality in later life. In HHS.gov.
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This introductory informational page on sexuality in older adults by the National Institutes on Aging provides basic information related to normal changes in sexuality with age, what causes sexual dysfunction, and some remedies. It also includes a list of resources to learn more about healthy sexuality in later life.
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U.S. Department of Health and Human Services. Sexually Transmitted Infections. In Healthy People 2030.
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Healthy People 2030 captures the priorities for the US government’s health agenda, setting goals, objectives, and indicators for 2030. One of the focus areas is reducing sexually transmitted infections, dealing with prevention in adolescence, congenital transmission, and the LGBT population as specific focus areas. This page provides an overview of this goal and the particular objectives and evidence-based clinical guidelines for screening and treating STIs.
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Safe Sex and Sexually Transmitted Infections
Sexually transmitted infections (STIs), including HIV, affect millions of people in the United States each year and can have grave consequences including, pregnancy complications, infertility, cancer, and death, if not treated in a timely manner. Safer sexual practices, such as using condoms consistently in each sexual encounter, are strategies to prevent STIs that should be tailored to the needs of specific populations. The U.S. Centers for Disease Control and Prevention (CDC) provides information on the incidence and prevalence of STIs in the United States and informational materials for STI prevention. The commentary in Guilamo-Ramos, et al. 2019 is a call for renewed efforts to reach the populations most at risk for STIs, particularly young sexual minority men. Wangu and Burstein 2017 presents updated clinical guidelines for preventing, managing, and treating STIs among adolescents. Based on the Global Burden of Diseases, Injuries, and Risk Factors Study, Frank, et al. 2019 present the latest data on the incidence and prevalence of HIV worldwide and trends over the last thirty years. The meta-analysis in Becasen, et al. 2019 presents estimates of HIV prevalence among transgender people living in the United States, an understudied population. Finally, unprotected anal intercourse is among the riskiest sexual practices, however it has been almost exclusively studied among homosexual populations; the review Stewart, et al. 2020 presents the state of the literature on heterosexual anal intercourse, calling for additional research into this practice to inform STI prevention programs.
Becasen, J. S., C. L. Denard, M. M. Mullins, D. H. Higa, and T. A. Sipe. 2019. Estimating the prevalence of HIV and sexual behaviors among the U.S. transgender population: A systematic review and meta-analysis, 2006–2017. American Journal of Public Health 109.1: e1–e8.
DOI: 10.2105/AJPH.2018.304727Save Citation »Export Citation » Share Citation »
This systematic review and meta-analysis addresses a data gap related to the prevalence of HIV, sexual and injection behaviors, and other factors associated with the risk of contracting HIV among transgender people living in the United States. The study provides valuable data for students and researchers interested in the sexual health of transgender people in the United States, presents specific HIV prevalence and risk behaviors among transgender women and men, and highlights some priority areas for HIV prevention.
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Frank, T. D., A. Carter, D. Jahagirdar, et al. 2019. Global, regional, and national incidence, prevalence, and mortality of HIV, 1980–2017, and forecasts to 2030, for 195 countries and territories: A systematic analysis for the Global Burden of Diseases, Injuries, and Risk Factors Study 2017. The Lancet HIV 6.12: e831–e859.
DOI: 10.1016/S2352-3018(19)30196-1Save Citation »Export Citation » Share Citation »
This systematic review presents the latest estimates on global, regional, and national HIV prevalence, mortality, and treatment coverage, analyzing trends from 1980 to 2017 and providing forecasts for 2030. Useful for students and researchers to understand the state of HIV today and the priorities in the future.
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Guilamo-Ramos, V., M. Thimm-Kaiser, A. Benzekri, and D. Futterman. 2019. Youth at risk of HIV: The overlooked US HIV prevention crisis. The Lancet HIV 6.5: e275–e278.
DOI: 10.1016/S2352-3018(19)30037-2Save Citation »Export Citation » Share Citation »
This commentary presents data on the growing share of new HIV diagnoses among adolescents and young adults, particularly among young minority youth and men who have sex with men. The authors identify how screening, treatment, and prevention programs, such as PrEP distribution, are not meeting the needs of the populations at highest risk for HIV infection and advocate for the adoption of tailored youth-friendly HIV prevention models addressing the social determinants of health.
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Stewart, J., G. Douglas, T. O’Rourke, and C. Gammel. December 30, 2020. Promoting safer sex in the context of heterosexual anal intercourse: A scoping review. Journal of Clinical Nursing.
DOI: 10.1111/jocn.15628Save Citation »Export Citation » Share Citation »
This scoping review summarizes the literature on heterosexual anal intercourse. Despite the risk of sexually transmitted infection associated with this practice, there is limited research in this field. The article highlights the need for more research to understand condom use in the context of heterosexual anal intercourse, the factors that influence this practice, and the health promotion strategies that may be useful in reducing unprotected anal intercourse.
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U.S. Centers for Disease Control and Prevention (CDC) Sexually Transmitted Disease (STD) Surveillance.
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This page is the CDC’s hub for materials and information related to sexually transmitted infections (STI) and STI monitoring and surveillance. Subpages include findings from the STD surveillance report, STD factsheets, data repositories, and tools for program managers. STD-specific data is available for chlamydia, gonorrhea, herpes, and HIV, among others. Topics covered to include prevalence, screening, and treatment of STIs in adolescents and young adults, in the LGBTQ population, and during pregnancy.
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Wangu, Z., and G. R. Burstein. 2017. Adolescent sexuality: Updates to the sexually transmitted infection guidelines. Pediatric Clinics of North America 64.2: 389–411.
DOI: 10.1016/j.pcl.2016.11.008Save Citation »Export Citation » Share Citation »
Developed for and by clinicians, this article summarizes the epidemiology of sexually transmitted infections (STI) among adolescents in the United States. It provides updated guidelines for screening, treatment, and management of STIs in this age group, including age-specific issues related to retention in care and prevention of reinfection.
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Sex and Substance Use
Due to the effect of psychoactive substances on mental functioning, including in areas of the brain related to judgment and decision making, a substantial body of literature has documented the role of substance use as a contributing factor to sexual risk taking; a phenomenon that is particularly pronounced among adolescents and young people who are exploring both sexuality and use of substances as part of normal development. The U.S. Centers for Disease Control and Prevention (CDC) provides general information and links to resources and educational materials on using different psychoactive substances and sexual risk among young people. Alcohol is the most widely used substance consumed worldwide, and a few of the articles presented here focus on the association between alcohol use and sexual health. The World Health Organization (WHO) 2005 presents findings from a multicountry study on the association of sexual risk-taking and alcohol use. In contrast, the discussion paper Capasso and DiClemente 2019 provides an ecological framework for the prevention of STI and problem alcohol use among women. In addition to alcohol, some substances are explicitly used to enhance sexual experiences. Lafortune, et al. 2020 discusses the factors associated with the use of Chemsex by men who have sex with men. Marijuana is another widely used, albeit understudied, substance associated with sexual risk taking. Pahl, et al. 2021 investigate marijuana use as a predictor of having a risky sexual male partner among ethnic and racial minority women and the role of ethnic identity commitment as a preventive factor. Jackson, et al. 2012 presents findings from a systematic review summarizing the evidence on interventions to promote safer sex and reduce substance use among school-aged children. Alcohol myopia theory (AMT) is one of the most popular theories used to explain sexual risk taking following alcohol use, and Griffin, et al. 2010 reviews the evidence on the efficacy of prevention interventions based on AMT.
Capasso, A., and R. J. DiClemente. 2019 Alcohol and HIV: Barriers and opportunities to improving women’s sexual and reproductive health. ARCH Women Health Care Volume 2.2: 1–3.
DOI: 10.31038/AWHC.2019221Save Citation »Export Citation » Share Citation »
Using an ecological framework, this commentary provides an overview of the main issues affecting alcohol use and sexual and reproductive health in women in the United States at different levels. It makes a case for a health promotion program based on coordinated multisectoral efforts.
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Griffin, J. A., M. R. Umstattd, and S. L. Usdan. 2010. Alcohol use and high-risk sexual behavior among collegiate women: A review of research on alcohol myopia theory. Journal of American College Health 58.6: 523–532.
DOI: 10.1080/07448481003621718Save Citation »Export Citation » Share Citation »
The alcohol myopia theory (AMT) is commonly used to explain unsafe sexual risk practices in the context of alcohol use. This article presents a review of studies that have applied AMT among college-aged women as the basis for evaluation and analysis. Review findings support the utility of the AMT as a framework to develop interventions to promote safer sex practices among collegiate women.
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Jackson, C., R. Geddes, S. Haw, and J. Frank. 2012. Interventions to prevent substance use and risky sexual behaviour in young people: A systematic review. Addiction 107.4: 733–747.
DOI: 10.1111/j.1360-0443.2011.03751.xSave Citation »Export Citation » Share Citation »
Substance use in adolescents is associated with unsafe sexual practices and can lead to problem substance use later in life. This systematic review summarizes data from interventions to reduce substance use in school children and promote safer sex practices. Authors found that multipronged interventions addressing several domains—individual, peer, family, community—were the most effective. Findings can inform the development of future interventions to promote safer sex among adolescents, particularly as associated with substance use.
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Lafortune, D., M. Blais, G. Miller, L. Dion, F. Lalonde, and L. Dargis. 2020. Psychological and interpersonal factors associated with sexualized drug use among men who have sex with men: A mixed-methods systematic review. Archives of Sexual Behavior 50.2: 427–460.
DOI: 10.1007/s10508-020-01741-8Save Citation »Export Citation » Share Citation »
This systematic review summarizes the evidence on psychological and interpersonal factors associated with Chemsex, defined as consuming specific drugs to enhance sexual activity, among men who have sex with men (MSM). The authors identified three factors associated with Chemsex-use: sexual control, sexual functioning and mental health; life stressors; and sexual identity identification. Findings serve to inform interventions to promote safer sex practices among MSM, particularly concerning Chemsex-associated behaviors.
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Pahl, K., A. Capasso, H. -M. Lekas, J. Y. Lee, J. Winters, and R. E. Pérez-Figueroa. 2021. Longitudinal predictors of male sexual partner risk among Black and Latina women in their late thirties: Ethnic/racial identity commitment as a protective factor. Journal of Behavioral Medicine 44.2: 202–211.
DOI: 10.1007/s10865-020-00184-9Save Citation »Export Citation » Share Citation »
This study investigated longitudinal predictors of having a risky male sexual partner among Latinas and Black women in their thirties, finding that ethnic and racial identity commitment was protective against male sexual partner risk among Latina and Black women who use marijuana. Findings warrant further research on the protective role of different dimensions of ethnic and racial identity against sexually transmitted infections, including HIV, particularly in the context of substance use.
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U.S. Centers for Disease Control and Prevention (CDC). Substance Use and Sexual Risk Behaviors Among Youth In Centers for Disease Control and Prevention.
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This website from the CDC provides general information on the association of substance use and sexual risk behaviors among young people. The site includes information on what is currently known, evidence-based interventions, and current CDC initiatives. A fact sheet is also available for download in pdf format.
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World Health Organization (WHO). 2005. Alcohol use and sexual risk behaviour: A cross-cultural study in eight countries. Geneva, Switzerland: WHO.
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This publication presents findings of from a WHO study on alcohol use and sexual behaviors in Kenya, South Africa, Zambia, Mexico, Belarus, Romania, the Russian Federation, and India. It identifies settings and patterns in which alcohol presents a heightened risk for unprotected sexual intercourse, including in toxic masculinity, negative coping, alcohol-serving venues, drinking alcohol at sexual initiation, and alcohol use in pornographic material, setting the stage for prevention strategies.
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Disparities in Sexual Health
Although progress has been made in closing critical gaps in sexual health outcomes, significant disparities remain. Black women face a disproportionate risk for poor sexual and reproductive health outcomes, ranging from increased HIV and STI incidence to higher preterm birth rates. Applying the social-ecological model, Prather, et al. 2016 explores the influence of racism on individual, interpersonal, and community-level determinants of sexual and reproductive health. Prather, et al. 2018, meanwhile, uses a historical lens to illuminate how discriminatory practices in the past shape early 21st century disparities in reproductive and sexual health among Black women. As Perritt 2020 demonstrates, the United States’s legacy of racism shapes health outcomes and health behaviors, and decisions surrounding sexual and reproductive health. Perritt recounts one example of this is birth-control mistrust among some women of color stemming from centuries of medical disenfranchisement and mistreatment. As in the case of Black women, systemic racism and transgenerational oppression have been implicated in health disparities observed among Indigenous women and Latinx women. Rosenthal and Lobel 2020 use survey data to establish possible pathways linking racism experienced by Latinx and Black women to poor reproductive and sexual health outcomes, while Gurr 2011 demonstrates how federal policies and practices through history have undermined the reproductive rights of Indigenous women. Fenton 2001, meanwhile, evaluates individual-level and community-level strategies for reducing race-based health disparities and addressing the social determinants of health underlying them. Although many members of the LGBTQ+ community and people with disabilities are subject to the harmful effects of racism, they are also subject to other forms of discrimination with negative consequences for their sexual health. Sexual inequities observed among LGBTQ+ individuals and people with disabilities are explored further in Inequities by Gender Identity and Sexual Orientation and Sexual Health Health Among People with Disabilities, respectively.
Fenton, K. A. 2001. Strategies for improving sexual health in ethnic minorities. Current Opinion in Infectious Diseases 14.1: 63–69.
DOI: 10.1097/00001432-200102000-00011Save Citation »Export Citation » Share Citation »
This article reviews evidence-based strategies to reduce ethnic disparities in sexual health, weighing the merits of different approaches ranging from individualized behavioral interventions to intersectoral partnerships. The authors advocate for strategies that are culturally competent, community-based, and rooted in the social determinants of health.
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Gurr, B. 2011. Mothering in the borderlands: Policing Native American women’s reproductive healthcare. International Journal of Sociology of the Family 37.1: 69–84.
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Drawing on various sources, including public documents and interviews with Native American women, the author illustrates how the US government has historically undermined Native American women’s right to reproductive self-determination through numerous restrictive practices and policies. This attack on Native American motherhood is viewed as the outgrowth of a profoundly racist construction of the archetypal American family.
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Perritt, J. 2020. Reproductive Justice with Dr. Jamila Perritt.
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In this episode told by an OB/GYN sheds light on the larger forces that shape women’s decision making regarding contraception. For women from marginalized communities with histories of medical mistrust and mistreatment, contraceptive effectiveness is often weighed against other considerations, including accessibility and degree of user autonomy. The author invokes the concepts of reproductive justice and intersectionality to capture the influence of structural forces and overlapping social identities on individual choice.
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Prather, C., T. R. Fuller, K. J. Marshall, and W. L. Jeffries IV. 2016. The impact of racism on the sexual and reproductive health of African American women. Journal of Women’s Health, 25.7: 664–671.
DOI: 10.1089/jwh.2015.5637Save Citation »Export Citation » Share Citation »
Applying the social-ecological model, this article examines the numerous pathways through which the United States’ legacy of racism adversely impacts African American women’s reproductive and sexual health. The relationship between this legacy and poor health outcomes is explored on four levels: the individual, interpersonal, community, and societal. Interventions targeting each level are proposed to promote health equity.
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Prather, C., T. R. Fuller, W. L. Jeffries IV, et al. 2018. Racism, African American women, and their sexual and reproductive health: A review of historical and contemporary evidence and implications for health equity. Health Equity 2.1: 249–259.
DOI: 10.1089/heq.2017.0045Save Citation »Export Citation » Share Citation »
This article examines current reproductive and sexual health disparities among African American women from a historical lens, highlighting the lasting effects of race-based mistreatment and medical disenfranchisement throughout US history. To address these disparities and the social determinants underlying them, the authors propose numerous strategies, including adopting community-based research and increased minority representation among health professionals.
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Rosenthal, L., and M. Lobel. 2020. Gendered racism and the sexual and reproductive health of Black and Latina Women. Ethnicity & Health 25.3: 367–392.
DOI: 10.1080/13557858.2018.1439896Save Citation »Export Citation » Share Citation »
Using survey data from women of various races and ethnicities, this study examines factors influencing pregnancy-related stress and sexual relationship power. Gendered racism and birth-control-related mistrust, both reported at higher levels among Black and Latina women, are found to be significant predictors of pregnancy-related stress and sexual relationship power, respectively. The researchers argue that gendered racism and birth-control-related mistrust may account for racial disparities in reproductive and sexual health.
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Inequities by Gender Identity and Sexual Orientation
Research shows that LGBTQ+ individuals experience heightened vulnerability to specific poor sexual health outcomes along with barriers to SRHR services and equitable, culturally competent healthcare. Discrimination against LGBTQ+ individuals, which persists to this day in various overt and covert forms, has been a significant driver of these disparities observed in the United States and worldwide. Even within healthcare settings, LGBTQ+ individuals are often subject to bias among healthcare professionals, damaging patient-provider interactions, and dissuading of patients from seeking further care. Discrimination based on sexual orientation has also been linked to poor mental health outcomes. In their empirical review, Wade and Harper 2020 surveys the current evidence on racialized sexual discrimination, arguing that discrimination experienced by Black gay and bisexual men on online networking platforms can adversely impact their mental health. The report James, et al. 2016 from the National Center for Transgender Equality, meanwhile, provides insight into the types of discrimination transgender people experience, including bias among medical providers and lack of appropriate care. Dubin, et al. 2018 posits that the lack of culturally competent, compassionate healthcare may partially account for health disparities observed among transgender individuals. The authors review the current evidence on educational interventions to educate medical students on transgender health.
Dubin, S. N., I. T. Nolan, C. G. Streed Jr, R. E. Greene, A. E. Radix, and S. D. Morrison. 2018. Transgender health care: Improving medical students’ and residents’ training and awareness. Advances in Medical Education and Practice 9:377–391.
DOI: 10.2147/AMEP.S147183Save Citation »Export Citation » Share Citation »
To understand the current landscape of transgender education in medical training, the authors present findings from a scoping review on the subject. The authors review numerous interventions and best practices in the literature to improve medical students’ and residents’ attitudes towards and knowledge of transgender health. Recommendations for assessing these interventions over time and improving their clinical impact are proposed.
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James, S. E., J. L. Herman, S. Rankin, M. Keisling, L. Mottet, and M. Anafi. 2016. The Report of the 2015 U.S. Transgender Survey. Washington, DC: National Center for Transgender Equality.
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The National Center for Transgender Equality resource provides results from a 2015 survey—the largest of its kind in the United States—conducted among transgender adults in the United States. The authors present findings cutting across many public and private life domains, including health care, the workplace, interpersonal relationships, family life, and much more.
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Wade, R. M., and G. W. Harper. 2020. Racialized sexual discrimination (RSD) in the age of online sexual networking: Are young Black gay/bisexual men (YBGBM) at elevated risk for adverse psychological health? American Journal of Community Psychology 65.3–4: 504–523.
DOI: 10.1002/ajcp.12401Save Citation »Export Citation » Share Citation »
Drawing on empirical research, the authors of this article make the case that racialized sexual discrimination toward Black gay/bisexual men is often manifested on online dating and sexual networking platforms. Given extensive literature pointing toward a negative relationship between racialized sexual discrimination and psychological well-being, the authors posit that discrimination experienced on online dating platforms is likely to adversely impact Black gay and bisexual men’s psychological health.
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Sexual Health Among People with Disabilities
Due to many factors, ranging from social stigma to lack of culturally competent sexual health resources and services, people with disabilities often encounter barriers to realizing their SRHR rights. Alexander and Taylor Gomez 2017 illustrates in its commentary ways society has contributed to the sexual disempowerment of people with intellectual disabilities, making a case for more inclusive sex education. Addlakha, et al. 2017, in their editorial for Reproductive Health Matters issue on sexuality and disability, take stock of progress made on advancing the SRHR rights of people with disabilities while acknowledging barriers and gaps that persist. One barrier often cited in the literature is the lack of developmentally appropriate sexual education for people with intellectual disabilities, an issue explored in Black and Kammes 2019. Another barrier is inadequate training of healthcare providers to care for people with disabilities and provide culturally competent sexual health services. Mona, et al. 2017 proposes a disability and sexuality health care competency model to address this barrier. Similarly, Walters and Gray 2018 outlines ways pediatricians can provide sexual health education to youth with developmental disabilities. Streur, et al. 2019 highlights the need for sexual health discussions initiated by health care providers based on qualitative research conducted among women with spina bifida. A significant contributor to stigma surrounding sexuality and disability is the inaccurate perception of people with disabilities as being asexual, even among some healthcare providers. In their research article, Kattari and Turner 2017 challenge this perception, noting the diversity in sexual satisfaction levels and definitions of sexual activity reported by people with disabilities. For LGBTQ+ people with disabilities, navigating conversations about their sexuality and disability with healthcare providers can be a fraught process, an issue explored in O’Shea, et al. 2020. Evidence shows that people with disabilities are especially vulnerable to sexual abuse and gender-based violence, a direct violation of their sexual and reproductive rights. United Nations Population Fund (UNFPA) 2018 identifies priority areas and provides recommendations to improve the legal and social response to gender-based violence against young persons with disabilities.
Addlakha, R., J. Price, and S. Heidari, eds. 2017. Disability and sexuality: Claiming sexual and reproductive rights. In Special issue: Disability and Sexuality: Claiming Sexual and Reproductive Rights. Reproductive Health Matters 25:4–9.
DOI: 10.1080/09688080.2017.1336375Save Citation »Export Citation » Share Citation »
This editorial serves as an introduction to the 2017 special issue on disability and sexuality, which features original research, commentary, and other works from various contexts, including middle- and lower-income countries. The authors set the stage for critical topics examined throughout the issue, including intersectionality, disability awareness and inclusion, access to reproductive services, and other topics primarily overlooked in the extant literature.
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Alexander, N., and M. Taylor Gomez. 2017. Pleasure, sex, prohibition, intellectual disability, and dangerous ideas. In Special issue: Disability and Sexuality: Claiming Sexual and Reproductive Rights. Reproductive Health Matters 25:114–120.
DOI: 10.1080/09688080.2017.1331690Save Citation »Export Citation » Share Citation »
This article, jointly written by two experts in disability research, explores sexual expression and satisfaction among people with disabilities, describing social, cultural, and legal barriers that have inhibited people with disabilities from fully expressing and embracing their sexuality. Although the authors draw on their personal experiences working as practitioners in the U.K. and Australia, their observations are still relevant to other contexts.
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Black, R. S., and R. R. Kammes. 2019. Restrictions, power, companionship, and intimacy: A meta-synthesis of people with intellectual disability speaking about sex and relationships. Intellectual and Developmental Disabilities 57.3: 212–233.
DOI: 10.1352/1934-9556-57.3.212Save Citation »Export Citation » Share Citation »
This meta-synthesis captures the voices of people with intellectual disabilities (PWID), highlighting their varied perspectives on sex and romantic relationships. Themes from sixteen studies involving one-on-one and focus group interviews with PWID are enumerated and explored in detail. The authors conclude with practice recommendations, suggesting improvements that can be made to sexual education curricula delivered to PWID.
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Kattari, S. K., and G. Turner. 2017. Examining more inclusive approaches to social work, physical disability, and sexuality. Journal of Social Work in Disability & Rehabilitation 16.1: 38–53.
DOI: 10.1080/1536710X.2017.1260517Save Citation »Export Citation » Share Citation »
This study used an anonymous survey to measure levels of sexual satisfaction among people with disabilities (PWD) and examine differences in participants’ definitions of sexual activity across disability types. Results indicated that higher levels of independence were associated with higher levels of sexual satisfaction. People with invisible disabilities tended to have more expansive definitions of sexuality but reported lower levels of sexual satisfaction.
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Mona, L. R., R. P. Cameron, and C. Clemency Cordes. 2017. Disability culturally competent sexual healthcare. American Psychologist 72.9: 1000–1010.
DOI: 10.1037/amp0000283Save Citation »Export Citation » Share Citation »
To address the need for culturally competent care for people with disabilities, the authors propose the disability and sexuality health care competency model, designed to facilitate self-assessment among healthcare providers, including psychologists, and deepen their knowledge about PIDs’ experiences with intimacy and sexuality. This model represents a step towards fully incorporating disability and sexuality into clinical assessment and practice.
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O’Shea, A., J. R. Latham, R. McNair, et al. 2020. Experiences of LGBTIQA+ people with disability in healthcare and community services: Towards embracing multiple identities. International Journal of Environmental Research and Public Health 17.21: 8080.
DOI: 10.3390/ijerph17218080Save Citation »Export Citation » Share Citation »
This article presents findings from focus groups among LGBTQIA+ people with disabilities, shedding light on their healthcare needs and experiences accessing health and community services. The complexities of disclosing disability status and sexual orientation within the healthcare context are explored, while the importance of inclusive community services and networks is discussed. The direct involvement of LGBTQIA+ people with disabilities in the study’s design, execution, and analysis is notable.
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Streur, C. S., C. L. Schafer, V. P. Garcia, E. H. Quint, D. E. Sandberg, and D. A. Wittmann. 2019. “If everyone else is having this talk with their doctor, why am I not having this talk with mine?”: The experiences of sexuality and sexual health education of young women with spina bifida. The Journal of Sexual Medicine 16.6: 853–859.
DOI: 10.1016/j.jsxm.2019.03.012Save Citation »Export Citation » Share Citation »
This qualitative study involving twenty-five women with spina bifida examines their understanding of and experiences with sexuality and intimacy and exposure to sexual health resources and education, including conversations on the topic with their healthcare provider. Primary themes that emerged include misperceptions surrounding participants’ sexuality, lack of sexual health resources and education tailored towards people with spina bifida, disability-specific difficulties during sexual activity, and vulnerability to sexual assault.
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United Nations Population Fund (UNFPA). 2018. Young persons with disabilities: Global study on ending gender-based violence, and realizing sexual and reproductive health and rights. New York: UNFPA.
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Using a case-study approach, this report provides findings from a 2016 global study commissioned by UNFPA to identify gaps, priorities, and best practices relating to sexual and reproductive health and rights among young persons with disabilities. In addition to capturing the perspectives of young persons with disabilities, this report highlights the crucial roles of civil society and governments in preventing violence and ensuring equality.
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Walters, F. P., and S. H. Gray. 2018. Addressing sexual and reproductive health in adolescents and young adults with intellectual and developmental disabilities. Current Opinion in Pediatrics 30.4: 451–458.
DOI: 10.1097/MOP.0000000000000635Save Citation »Export Citation » Share Citation »
Acknowledging the gaps in effective, developmentally appropriate sexuality education for youth with intellectual and developmental disabilities, the authors outline special considerations for pediatricians, support workers, caregivers, and parents in addressing this population’s unique needs and vulnerabilities. The authors highlight the need for pediatricians to talk about sexual health with youth during healthcare visits and equip parents and caregivers to continue these conversations beyond the clinic.
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Non-Volitional Sex
Nonvolitional sex is defined as any unwanted sexual act that violates a person’s right to choose when, how, and with whom to engage in any form of sex. It may take the form of rape, sexual abuse, or sexual coercion. The report Smith, et al. 2017 presents the latest data on the prevalence of sexual violence in the United States based on a national survey, estimating that 36 percent of women and 17 percent of men have experienced sexual violence. Sexual violence has both immediate and long-term mental, physical, and reproductive health consequences, such as the increased risk for depression and posttraumatic stress disorder, and for sexually transmitted infections, unwanted pregnancy, pregnancy loss, and low-birth-weight newborns as described in Ellsberg, et al. 2008 and Jina and Thomas 2013. Sexual violence has significant societal consequences, including taking a toll on a person’s economic well-being, as explained in Loya 2015. Hailes, et al. 2019 summarizes the lifelong adverse effects of childhood sexual assault. The study of sexual violence has focused primarily on violence against women and girls; however, sexual violence against men and boys also has harmful consequences and is not uncommon among adult men, as noted in Peterson, et al. 2011, particularly among specific subpopulations. There is a mounting body of evidence indicating that gender and sexual minorities experience higher rates of sexual violence with long-lasting mental health outcomes, most likely compounded by a context of stigma and discrimination as described in Rothman, et al. 2011, as well as among persons involved in the criminal justice system as presented in Wolff, et al. 2006. Finally, a more recent area of research has focused on reproductive coercion, defined as a male partner using physical or emotional coercive strategies to make his female partner get pregnant, with adverse consequences on reproductive and mental health, including unplanned pregnancy and problem substance use, as described in Miller, et al. 2010 and Capasso, et al. 2019, respectively.
Capasso, A., R. J. DiClemente, and G. M. Wingood. 2019. Pregnancy coercion as a risk factor for HIV and other sexually transmitted infections among young African American women. JAIDS Journal of Acquired Immune Deficiency Syndromes 82 supp 2: S155–S161.
DOI: 10.1097/qai.0000000000002174Save Citation »Export Citation » Share Citation »
This article examines correlates of pregnancy coercion and HIV risk among young African American women. Authors found that women who experienced pregnancy coercion were more likely to test positive for a sexually transmitted infection, have unprotected sex, and have lower condom use intentions. The findings underscore the need to include empowerment components in HIV prevention interventions among African American women.
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Ellsberg, M., H. A. Jansen, L. Heise, C. H. Watts, and C. Garcia-Moreno. 2008. Intimate partner violence and women’s physical and mental health in the WHO multi-country study on women’s health and domestic violence: An observational study. The Lancet 371.9619: 1165–1172.
DOI: 10.1016/S0140-6736(08)60522-XSave Citation »Export Citation » Share Citation »
Based on data from the WHO Multi-Country Study on Women’s Health and Domestic Violence against Women, this study estimates the impact of sexual and physical violence by an intimate partner on women’s physical and mental health. IPV survivors were more likely than nonsurvivors to experience pain, memory loss, emotional distress, and suicidal ideation. Findings build a public health case for ending sexual and physical intimate partner violence.
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Hailes, H. P., R. Yu, A. Danese, and S. Fazel. 2019. Long-term outcomes of childhood sexual abuse: An umbrella review. The Lancet Psychiatry 6.10: 830–839.
DOI: 10.1016/S2215-0366(19)30286-XSave Citation »Export Citation » Share Citation »
This article synthesizes meta-analytic findings on the long-term consequences of sexual abuse in childhood (CSA). CSA was associated with a range of psychiatric diagnoses. The authors calculate the population attributable risk fractions for specific outcomes, ranging from 1.7 percent for unprotected sexual intercourse to 14.4 percent for conversion disorder. However, except for posttraumatic stress disorder and schizophrenia, the findings quality was low, with authors calling for quality evidence.
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Jina, R., and L. S. Thomas. 2013. Health consequences of sexual violence against women. Best Practice & Research Clinical Obstetrics & Gynaecology 27.1: 15–26.
DOI: 10.1016/j.bpobgyn.2012.08.012Save Citation »Export Citation » Share Citation »
This review on the physical, reproductive, and mental health consequences of sexual violence are geared to healthcare providers, particularly obstetrics and gynecology. It makes a case for universal screening by obstetricians and gynecologists to foster early detection and linkage to treatment for sexual violence survivors, particularly posttraumatic stress disorder.
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Loya, R. M. 2015. Rape as an economic crime: The impact of sexual violence on survivors’ employment and economic well-being. Journal of Interpersonal Violence 30.16: 2793–2813.
DOI: 10.1177/0886260514554291Save Citation »Export Citation » Share Citation »
Based on interviews with survivors and rape crisis providers, this article examines how sexual violence and resulting trauma disrupt survivors’ employment, affecting their livelihood and economic well-being over the life course. Findings on the economic impact of sexual violence highlight the importance of providing financial and employment support, in addition to psychological and safety support, to survivors during the recovery process.
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Miller, E., M. R. Decker, H. L. McCauley, et al. 2010. Pregnancy coercion, intimate partner violence, and unintended pregnancy. Contraception 81.4: 316–322.
DOI: 10.1016/j.contraception.2009.12.004Save Citation »Export Citation » Share Citation »
Miller has led seminal research on reproductive coercion, including pregnancy coercion and birth-control sabotage by intimate partners. This clinic-based study reported pregnancy coercion and birth-control sabotage rates among young women and its linkages to unintended pregnancy in the context of intimate partner violence. In addition to screening for intimate partner violence, screening for reproductive coercion is essential to prevent unintended pregnancies.
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Peterson, Z. D., E. K. Voller, M. A. Polusny, and M. Murdoch. 2011. Prevalence and consequences of adult sexual assault of men: Review of empirical findings and state of the literature. Clinical Psychology Review 31.1: 1–24.
DOI: 10.1016/j.cpr.2010.08.006Save Citation »Export Citation » Share Citation »
This is a systematic review of the evidence on the prevalence of sexual assault against adult men. The review identified a higher prevalence of sexual victimization against specific subpopulations, such as veterans, inmates, and sexual minorities. The review also points to the dearth of data on the consequences of sexual assault against adult men, with existing studies showing adverse mental and physical consequences.
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Rothman, E. F., D. Exner, and A. L. Baughman. 2011. The prevalence of sexual assault against people who identify as gay, lesbian, or bisexual in the United States: A systematic review. Trauma, Violence, & Abuse 12.2: 55–66.
DOI: 10.1177/1524838010390707Save Citation »Export Citation » Share Citation »
This systematic review summarizes findings presenting prevalence data on sexual violence against gay or bisexual (G.B.) men and lesbian or bisexual (L.B.) women in the United States. The prevalence of sexual assault ranged from 15.6 percent to 85 percent against women and from 11.8 percent to 54 percent against men. The review compares specific types of assault rates, such as childhood sexual assault and adult sexual assault, between men and women.
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Smith, S. G., J. Chen, K. C. Basile, et al. 2017. The National Intimate Partner and Sexual Violence Survey (NISVS): 2010–2012 State Report. Atlanta, GA: National Center for Injury Prevention and Control and the Centers for Disease Control and Prevention.
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Based on 2010–2012 data from The National Intimate Partner and Sexual Violence Survey this national report is the most comprehensive report on the prevalence of sexual violence and stalking in the United States. The report presents contemporaneous past-twelve-month and lifetime sexual violence prevalence estimates disaggregated by sex, racial and ethnic minority status, US state of residence, and relationship to perpetrator.
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Wolff, N., C. L. Blitz, J. Shi, R. Bachman, and J. A. Siegel. 2006. Sexual violence inside prisons: Rates of victimization. Journal of Urban Health 83.5: 835–848.
DOI: 10.1007/s11524-006-9065-2Save Citation »Export Citation » Share Citation »
Sexual violence rates against prison inmates in the United States are higher than in the general population. Based on an extensive survey of prison inmates, this study presents rates and types of sexual victimization in a state prison system by sex, age, perpetrator, and facility. Women reported higher rates of sexual victimization than men; violence perpetrators included other inmates and facility staff. Prevention interventions are urgently needed.
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Sex in the Digital Age
Few aspects of society have escaped the transformative, far-reaching effects of digital media. People’s intimate relationships and sexual lives are no exception. Nixon and Düsterhöft 2018 is a book that explores the transformation of human sexuality and the intimate relationships of digital media. With the advent of the Internet and the emergence of Internet-based porn, pornography consumption has risen steadily in recent decades. Facilitated in large part by the proliferation of smartphones, dating apps and sexting have also become more widespread. While references on sexting and data apps are featured below, references specific to pornography can be found in the subsection Internet Pornography. The rise of sexting among youth is explored in the systematic review and meta-analysis Madigan, et al. 2018. Barrense-Dias, et al. 2017, meanwhile, examines how sexting is conceptualized by researchers and adolescents, a key demographic linked to sexting. Similarly, Setty 2019 reveals young people’s attitudes toward sexting, finding gender stereotyping and victim-blaming prevalent among youth. Englander 2019, meanwhile, outlines three major phases in the research history of sexting, describing the shift from focusing on sexting’s potentially harmful consequences to normalizing the practice. Through interviews with caregivers of adolescents, Fix, et al. 2021 examines the trend of sexting from caregivers’ perspective, identifying the need for educating caregivers on the topic. Patchin and Hinduja 2020 argues for equipping parents and caregivers to talk about safe sexting practices with youth. A large body of research on sexting has focused on the practice’s adverse effects. For example, nonconsensual sexting has been equated by some researchers to sexual violence. In their systematic review, Krieger 2017 draws attention to the ways nonconsensual sexting is conceptualized in the literature. Like sexting, the use of dating apps has increased in recent years. As discussed in Albury, et al. 2020, the mental health impacts of dating apps have been hotly contested within popular media, with some sources framing dating apps as a threat to users’ mental health. Castro and Barrada 2020 paints a more nuanced picture of dating apps in their systematic review, highlighting the benefits and drawbacks of frequent dating app use.
Albury, K., A. McCosker, T. Pym, and P. Byron. 2020. Dating apps as public health ‘problems’: cautionary tales and vernacular pedagogies in news media. Health Sociology Review 29.3: 232–248.
DOI: 10.1080/14461242.2020.1777885Save Citation »Export Citation » Share Citation »
Employing a mixed-methods approach, the authors of this study analyze news articles and other media content from the U.K., United States, and Australia, addressing the emergence of dating apps and their attendant mental and sexual health impacts. Underpinning the authors’ analyses is the theory of biocommunicability, which describes the interplay between popular media framing of health issues and expert narratives put forth by health professionals.
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Barrense-Dias, Y., A. Berchtold, J.- C. Surís, and C. Akre. 2017. Sexting and the definition issue. Journal of Adolescent Health 61.5: 544–554.
DOI: 10.1016/j.jadohealth.2017.05.009Save Citation »Export Citation » Share Citation »
This article reviews the current knowledge base on sexting, establishing adolescent prevalence rates, and identifying important activity correlations. The authors note a lack of a consensus in defining sexting. Definitions of sexting were found to differ in terms of the type of action (sending or receiving explicit material); transmission mode (online posting or private sharing); and media format (video, audio, image, etc.) considered.
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Castro, Á., and J. R. Barrada. 2020. Dating apps and their sociodemographic and psychosocial correlates: A systematic review. International Journal of Environmental Research and Public Health 17.18: 6500.
DOI: 10.3390/ijerph17186500Save Citation »Export Citation » Share Citation »
In this systematic review, the authors examine seventy articles on dating apps published between 2016 and 2020 to characterize dating app usage in terms of prevalence, user demographics, and implications for users’ health, among other considerations. The authors highlight the ubiquity of dating app usage across different demographic groups, the range of motives underlying use, and the trade-off between usage benefits and potential drawbacks.
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Englander, E. 2019. What do we know about sexting, and when did we know it? Journal of Adolescent Health 65.5: 577–578.
DOI: 10.1016/j.jadohealth.2019.08.004Save Citation »Export Citation » Share Citation »
This editorial explores the fifteen-year research history of sexting, outlining the three research phases since sexting was first identified in 2005. Englander notes that while the first phase of sexting research focused on egregious cases with severe consequences, research revealed that the second phase of sexting was more benign. The third phase of sexting research, normalizes sexting as a practice and emphasizes the need for less fear-based messaging.
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Fix, R. L., L. C. Assini-Meytin, A. J. Harris, and E. J. Letourneau. 2021. Caregivers’ perceptions and responses to a new norm: The missing link in addressing adolescent sexting behaviors in the U.S. Archives of Sexual Behavior 50.2: 575–588.
DOI: 10.1007/s10508-020-01704-zSave Citation »Export Citation » Share Citation »
Researchers interviewed parents and caregivers to identify their attitudes and concerns surrounding adolescent sexting. Although few caregivers reported having conversations with adolescents on sexting, the importance of instilling boundaries in adolescents and encouraging safe sexting behaviors was widely acknowledged. Based on their findings, the researchers highlight the need to educate caregivers on sexting in order to more adeptly navigate conversations on the topic with their teens.
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Krieger, M. A. 2017. Unpacking “sexting”: A systematic review of nonconsensual sexting in legal, educational, and psychological literatures. Trauma, Violence, & Abuse 18.5: 593–601.
DOI: 10.1177/1524838016659486Save Citation »Export Citation » Share Citation »
This paper presents a review and synthesis of the psychological, educational, and legal literature on nonconsensual sexting acts, paying particular attention to how the literature distinguishes these acts from consensual sexting and how nonconsensual sexting is understood in terms of risk, responsibilization, and victim blaming. The author highlights concerns with the current literature on this topic, citing the potentially harmful ramifications of conflating consensual and nonconsensual acts and the need for more research.
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Madigan, S., A. Ly, C. L. Rash, J. Van Ouytsel, and J. R. Temple. 2018. Prevalence of multiple forms of sexting behavior among youth: A systematic review and meta-analysis. JAMA Pediatrics 172.4: 327–335.
DOI: 10.1001/jamapediatrics.2017.5314Save Citation »Export Citation » Share Citation »
Acknowledging the variability in prevalence estimates of sexting in the existing literature, the authors perform a meta-analysis of seventy-nine studies describing sexting prevalence among youth. Among other findings, the authors report an increase in sexting prevalence over time and note that receiving sexts tends to be more common than forwarding or sending explicit material. However, all three behaviors show a similar trend of increasing with age.
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Nixon, P., and I. Düsterhöft, eds. 2018. Sex in the digital age. London: Routledge.
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Featuring contributions from experts in the field, this seminal volume provides an introduction to the subject of digital media and sexuality, exploring the role of the Internet and other modern technologies in shaping human sexuality and behavior. This volume covers various substantive issues, including pornography, sexting, mass media, sexual health education, sexuality-related online communities, and other topics.
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Patchin, J. W., and S. Hinduja. 2020. It is time to teach safe sexting. Journal of Adolescent Health 66.2: 140–143.
DOI: 10.1016/j.jadohealth.2019.10.010Save Citation »Export Citation » Share Citation »
In this commentary on sexting among youth, Patchin and Hinduja caution against using fear-based messaging and education to dissuade teens from engaging in the activity, highlighting the potential unintended effects of such seemingly well-intended efforts. Instead of a fear-based approach, the authors make a case for proactively educating youth on safer sexting as a harm reduction strategy.
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Setty, E. 2019. A rights-based approach to youth sexting: Challenging risk, shame, and the denial of rights to bodily and sexual expression within youth digital sexual culture. International Journal of Bullying Prevention 1.4: 298–311.
DOI: 10.1007/s42380-019-00050-6Save Citation »Export Citation » Share Citation »
This qualitative study involving a sample of teenagers between the ages of 14 and 18 examines youth’s perceptions and constructions of sexting. Finding victim blaming, moral distancing, social shaming, and gender stereotyping prevalent among participants, the author situates these tendencies within the broader context of gender norms and societal expectations relating to sexuality and sexual expression.
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Internet Pornography
With the rapid advance of media technology in recent decades, the consumption of Internet pornography has risen steadily. Recent research on Internet pornography consumption has refined understanding of the practice’s harms, benefits, and public perceptions. In their qualitative study, McCormack and Wignall 2017 explore the benefits of pornography, including Internet-based content, as a means for exploring sexuality and embracing nonheteronormative sexual identities. Using survey data collected among college students, Morgan 2011 parses out the effects of pornography on young people’s relationships and sex lives and characteristics associated with frequent exposure to sexually explicit material. Consistent with previous research, Morgan finds Internet-based porn a dominant form of pornography consumed among females and males alike. Pornography has been widely debated in society, with some even calling it a public health crisis. In their book, Sullivan and McKee 2015 critically analyzes the significant currents of thought in the pornography debate and challenge mainstream constructions of pornography and its role within the digital revolution. In light of recent legislation in various states declaring pornography to be a health crisis, Nelson and Rothman 2020 evaluates the rise of pornography against standards of what constitutes a public health crisis. Even after considering the recent emergence of Internet-based porn, the authors conclude that pornography consumption as a social phenomenon doesn’t define a public health crisis.
McCormack, M., and L. Wignall. 2017. Enjoyment, exploration and education: Understanding the consumption of pornography among young men with non-exclusive sexual orientations. Sociology 51.5: 975–991.
DOI: 10.1177/0038038516629909Save Citation »Export Citation » Share Citation »
Diverging from the “negative effects paradigm,” coined by the authors to describe a hyperfocus in the literature on the harms of pornography, this qualitative study highlights some of the benefits of Internet pornography consumption. Based on in-depth interviews conducted among young men with nonexclusive sexual orientations, the authors conclude that Internet pornography can help foster users’ discovery and exploration of their sexual identities and desires, thus conferring educational benefits.
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Morgan, E. M. 2011. Associations between young adults’ use of sexually explicit materials and their sexual preferences, behaviors, and satisfaction. Journal of Sex Research 48.6: 520–530.
DOI: 10.1080/00224499.2010.543960Save Citation »Export Citation » Share Citation »
To examine the impact of exposure to sexually explicit material (SEM) on youth’s sexual development, researchers surveyed college students on their use of SEM, including online and offline content. Data on important correlates and outcomes of SEM usage, including users’ sexual preferences and sexual satisfaction, were also collected. Study researchers found several significant associations between SEM use and other variables of interest, as reported in this paper.
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Nelson, K. M., and E. F. Rothman. 2020. Should public health professionals consider pornography a public health crisis? American Journal of Public Health 110.2: 151–153.
DOI: 10.2105/AJPH.2019.305498Save Citation »Export Citation » Share Citation »
Two prominent authors examine the popular narrative framing pornography as a public health crisis. The authors compare this narrative against the scientific community’s standards of what constitutes a public health crisis, finding that the narrative doesn’t hold up to these standards. Although the authors do not explicitly distinguish between online versus offline pornography consumption, they acknowledge the growth of Internet porn in recent years.
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Sullivan, R., and A. McKee. 2015. Pornography: Structures, agency and performance. Cambridge, MA: Polity Press.
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This book, written by two experts in media and cultural studies, examines pornography within the broader societal context, exploring how pornography is understood, constructed, and debated within contemporary society. Throughout the book, the authors critically analyze conceptual frameworks concerning pornography that pervade popular discourse and scholarship. Individual chapters cover topics such as pornography as a creative industry, pornography’s role in technological innovation, and online porn communities.
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