u13214160THERE are different interpretations when the term sexual health is used. Be that as it may, one should remember the definition by a technical committee of the World Health Organisation (WHO): “Sexual health is a state of physical, emotional, mental and social wellbeing in relation to sexuality; it is not merely the absence of disease, dysfunction or infirmity. Sexual health requires a positive and respectful approach to sexuality and sexual relationships, as well as the possibility of having pleasurable and safe sexual experiences, free of coercion, discrimination and violence.”

crbs06616332This has to be distinguished from sexuality which has been defined by the WHO group as “a central aspect of being human throughout life and encompasses sex, gender identities and roles, sexual orientation, eroticism, pleasure, intimacy and reproduction.

Sexuality is experienced and expressed in thoughts, fantasies, desires, beliefs, attitudes, values, behaviour, practices, roles and relationships.

While sexuality can include all of these dimensions, not all of them are always experienced or expressed. Sexuality is influenced by the interaction of biological, psychological, social, economic, political, cultural, ethical, legal, historical, religious and spiritual factors.”

Sexual health has always been intertwined with reproductive health, especially after the International Conference on Population and Development in Cairo, in 1994, when it was defined as a component of reproductive health, which usually covers the period from 15 to 45 years of a woman’s age.

u11359049However, it is now recognised that sexual health is more encompassing than reproductive health. It is a pre-requisite for reproductive health and is relevant throughout a woman’s life span and not just confined to the reproductive years.

Sexual health issues

There are several components of and issues in sexual health and they include, among others, the following:

·sexually transmitted infections (STIs), including HIV/AIDS, and reproductive tract infections (RTIs), with its social stigma and discrimination;

ispi051009·unintended pregnancy and unsafe abortion, which can have devastating effects on health and socio-economic opportunities and are often associated with sexual coercion and lack of access to information and services;

·infertility, which is often a consequence of untreated or inadequately treated STIs, unintended pregnancy and unsafe abortion;

·sexual well-being (including sexual satisfaction, pleasure and dysfunction);

·violence related to gender and sexuality;

·certain aspects of mental health;

·the impact of physical disabilities and chronic illnesses on sexual health;

·female genital mutilation.

133201rkeSome of the sexual health issues such as unintended pregnancy and unsafe abortion, sexual well-being, sexual violence, the impact of physical disabilities and chronic illnesses on sexual health and female genital mutilation, are often ignored and come to public cognisance only when untoward events occur, usually to the detriment of females.

Complex causes

Many of the fundamental causes of sexual health issues are beyond the scope of the health sector. One of the most momentous developments recently has been the recognition that complex social, economic and political factors impact significantly on sexual health. The addressing of poverty, gender power imbalances and unequal access to health, and education are essential in the efforts to improve the population’s sexual health.

Poverty directly impacts on sexual health especially on the access to health care services and education opportunities. It also has indirect impacts – some women are put into situations that affect their sexual health like commercial sex.

u14089676A report Measuring and Monitoring Gender Equality published in 2007 by the Ministry of Women, Family and Community Development in partnership with the United Nations Development Programme noted that notwithstanding “the significant progress in reducing gender inequalities, this level of gender inequality is still high compared to some of the high human development countries.”

There is still much room to improve gender power balances. Because of these imbalances, girls and women are still disadvantaged in access to resources, decision-making, choices and opportunities, all of which impact directly on sexual health. There may be pressure of early marriage, choice of spouse, immediate childbearing and engagement in sexual activity as a marital obligation.

ispc028065Submission to male authority increases the vulnerability to poor sexual health. In particular, the refusal of many men to use condoms has resulted in numerous STIs, including HIV/AIDS, and unintended pregnancies. Reports of the increasing heterosexual transmission of HIV/AIDS certainly warrant greater sexual health promotion.

Sexist statements by members of parliament and the intrusion into the private privacy of public figures provide an idea of the chauvinistic attitudes and gender power imbalances prevalent among some influential members of the community.

Violence has negative impacts on the sexual and reproductive health of women, which may be long lasting. The violence against women can be physical, sexual and emotional in nature, and is inflicted at any time, including during pregnancy.

ispi045545The majority of those who inflict the violence are the spouse or sexual partner. There were more than 3,000 reported cases of rape annually in the past few years. This, together with that of sexual assaul,t are but the tip of the iceberg, because it is well known that for every reported case, there are many unreported cases, as the stigma is unacceptable to many victims. Violence against women result in sexually transmitted infections, including HIV/AIDS, unwanted pregnancy, unsafe abortion, infertility, chronic pelvic pain and mental conditions.

Education provides girls with literacy and decision making skills. It leads to better employment opportunities and with it, economic autonomy.

Sexuality education, if implemented well, have been reported to be effective in delaying onset of sexual activity, increasing usage of contraception, delaying early marriage and child bearing and decreasing the incidence of sexually transmitted infections, all of which enhance sexual health.

bms018054WHO advocates that a comprehensive approach be taken in the promotion of sexual health involving the health, education, political, economic and legal sectors.

Education has a critical role to play as it is a major pillar for the promotion of sexual health.

Whilst sexuality education has been introduced in our schools, there is no published data on assessments of its quality and outcomes.

Everyone has a right to sexual health. There are many components of sexual health, with complex multiple causes for the various issues.

The promotion of sexual health is multi-sectoral and is underpinned by comprehensive sexuality education which, if implemented well, is effective in enhancing everyone’s sexual health.

Source: Dr Milton Lum