Human Sexuality and Sexual Health: A Western Perspective

by

Ariadna Capasso, Natalie Tikhonovsky, Khadijah M. Davis, Ralph J. DiClemente

• 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.

  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.”

• American Psychological Association. 2020. Publication Manual of the American Psychological Association. Washington, DC: American Psychological Association.

  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.

• American Psychological Association. Definitions related to sexual orientation and gender diversity in APA documents.

  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.

• Fischer, N. L. 2016. Sexualities. Oxford Bibliographies in Sociology. Oxford: Oxford University Press.

  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.

• 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.

  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.