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Sexual health has provided a guiding framework for addressing sexuality in public health for several decades. Although the WHO definition of sexual health is revolutionary in acknowledging positive sexuality, public health approaches remain focused on risk and adverse outcomes. The long-standing conflation of sexual health and sexual wellbeing has affected our ability to address everyday sexual issues. This Viewpoint provides a way forward to resolve this impasse. We propose sexual wellbeing as a distinct and revolutionary concept that can be operationalised as a seven-domain model. We situate sexual wellbeing alongside sexual health, sexual justice, and sexual pleasure as one of four pillars of public health enquiry. We argue that sexual wellbeing is imperative to public health as a marker of health equity, a meaningful population indicator of wellbeing, a means to capture population trends distinct from sexual health, and an opportunity to refocus the ethics, form, and practices of public health.
Definition | Contribution to sexual wellbeing | Relevance to public health (examples) | Potential operationalised measures | |
---|---|---|---|---|
Sexual safety and security, | Experience of reduced threat coupled with experience of actions taken to assuage vulnerability | Free expression of sexuality;, rituals of safety; relationship trust; coercion-free environments | Gender-based violence; technologies for partner identification; sexual coercion;, legal protections for sexual rights;, teaching sexual consent; addressing risks to sex workers | Little worry about future sex life; absence of unwanted vulnerability during sexual activities; feeling safe with a sexual partner |
Sexual respect | Perception of positive regard by others for one's sexual personhood | Mitigates influence of experiences of violence; tolerance of differences; validation by others | Elements of interventions to reduce sexual harassment (eg, in higher education); sexual rights of people with minority identities and or marginalised experiences (eg, sexual minority groups living with HIV) | Sexual identity and preferences accepted by those around you; sexual identity and preferences accepted by broader culture |
Sexual self-esteem, | Affective appraisals of oneself as a sexual being | Associated with sexual satisfaction; mindful attention to sexual interactions | Interventions to improve overall sexual functioning; building capacities to sexually relate to a partner | Feeling good about your body sexually; feeling in control of sexual thoughts and desires |
Resilience in relation to sexual experiences | Maintenance of equilibrium in response to sexual stress, dysfunctions, adversity, or trauma | Influences long-term trajectories of wellbeing; interplay of person's resources, needs, and assets | Lessens the effects of sexual minority stressors; support for recovery from emotional trauma | Having someone to talk to openly about your sex life; taking a long time to recover if something bad happens in your sex life |
Forgiveness of past sexual experiences | Halted patterns of self-blame, self-stigmatisation, shame, avoidance, aggression, regret, and revenge, | Reduces harm and improves wellbeing; improves relationship quality; mitigates trauma of laws, policies, and practices that harm or do not prevent harm | Interventions to support recovery from sexual trauma and improve subsequent health outcomes, | Forgiveness of yourself about mistakes made in past sex life; forgiveness of others about things they have done to you in past sex life |
Self-determination in one's sex life | Free choice or rejection of sexual partner(s), behaviours, context and timing without pressure, force, or felt obligation | Directly influences sexual wellbeing; autonomous choice about sexuality supports ability to orient choices toward others | Global public health significance of unwanted sexual interactions; reproductive self-determination for women | Only doing sexual activities that you really want to do; not feeling pressure from others to do specific sexual activities |
Comfort with sexuality | Experience of ease in contemplation, communication, and enactments of sexuality and sex | Exploration of sexual identities and experiences; associated with partner communication, trust, and forgiveness; mindfulness in attending to sexual contexts, | Comfort in sexual communication associated with improved sexual health behaviours such as contraceptive use; ease in discussing sexual anatomy with a health professional; alleviating sexual guilt | Feeling focused and experiencing a sense of flow during sexual activities; absence of unwanted thoughts during sexual activities; absence of shame about sexual thoughts and desires; feeling comfortable with your sexual identity and preferences; a pleasurable sex life |