9. Sexual health Flashcards
What is sexual health?
a state of physical, emotional, mental and social well-being 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
Why is the term sexual health better than reproductive health?
not all sex is reproductive
- not all in childbearing age e.g. post-menopausal
- not all heterosexual
Should we refer to STIs or STDs or RTIs?
should we refer to STDs? or STIs? or RTIs?
much medical research focuses on disease (HIV and other STIs) and sexual dysfunction
(+ unplanned pregnancy)
less attention is given to non-disease / dysfunction
but given the definition of sexual health it is important to look at sexual well-being in more broad terms
sexual satisfaction
sexual difficulties
sexual coercion
sexually transmitted infections
Sexual satisfaction
87% of men and 79% of women agree that
“An active sex life is important for your sense of well-being”
overall relationship satisfaction is strongly related to sexual satisfaction
in national surveys (USA and Australia) satisfaction with emotional aspects of relationships is significantly related to greater physical satisfaction and more frequent sex
Frequency of sex
men have higher ideal frequency of sex but large overlap for men and women
actual frequency of sex is similar for men and women, and lower than ideal
only 15% of men and 26% of men report a match between their ideal and actual frequency of sex
- most men and women want sex more often than they do
mean frequency in relationships is 1.5 times per week
Sexual difficulties
men women lacked interest in sex 25% 55% orgasm too quickly 24% 12% unable to orgasm 6% 29% anxious about ability to perform 16% 17% sex not pleasurable 6% 27% pain during intercourse 2% 20% vaginal dryness . 24% unable to keep erection 10% .
low function also related to greater age *
depression
poor physical health
lower relationship satisfaction
inability to talk about sex with partners
poor physical health has -ve effect on sexual frequency and satisfaction
Sexual coercion
around 5% of men and 20% of women have ever been sexually coerced
= forced or frightened into unwanted sexual activity
sexual coercion has potentially long lasting effects on
- psychological well-being
e. g., higher prevalence of depression and anxiety - physical well-being
e. g., lower well-being, greater cigarette/drug/alcohol use - sexual well-being
e. g., more STIs, more negative attitudes attitudes
any sexual coercion has these detrimental effects
Sexual health across lifespan
sexual health concerns vary over time
e. g. youth – avoiding unintended pregnancy
- avoiding STIs
- treating STIs to protect reproductive health
e. g. adulthood - optimising reproductive health
- optimising sexual satisfaction
e. g. older age - optimising sexual function
- limiting impact of physical health on sexual health
? less lifespan variation in sexual health needs of homosexual people
age and/or cohort effects society more sexualised
sexual health more valued
First vaginal intercourse and first oral sex
people are now sexually active at younger ages
potential exposure to STIs / unplanned pregnancy is therefore also happening at earlier ages
people may also be sexually active later in life, so potential exposure to STIs / unplanned pregnancy is longer
Sexual problems variance
prevalence of sexual difficulties varies with age
- not simply more problems with age
note, sexual function not simply physical - also related to relationship satisfaction, and inability to talk about sex with partners
Age related sexual problems along men
some important age differences
among men
16-19 and 50-59 most likely to be anxious about performance
40+ significantly more likely to have erectile problems
40+ significantly more likely to have difficulty having orgasm
Age related sexual problems among women
among women
16-19 least likely to have lacked interest
50-59 significantly more likely to have problems with vaginal dryness
50-59 significantly more likely to have difficulty having orgasm
20-29 most likely to have pain during intercourse
Promoting preventive behaviour
major focus in sexual health is prevention
absence of vaccines, cures or effective treatment increases importance of behaviour
high and increasing rates of STIs, particularly among young people
condom use
90% of men and women have ever used condoms
but only 23% used one last time they had vaginal sex
and 15% said the condom was put on late
much more is needed to promote condom use and correct condom use
What affects condom use?
The IMB Model - the key to effective safe sexual promotion
weighted average correlations with condom use • Knowledge • condom attitudes • Susceptibility • subjective norms • severity • self-efficacy • intentions to use communication re: condom
interventions that include a skills component in addition to knowledge/ attitudes are the most effective
… but very few condom promotion materials focus on the skills that most strongly influence condom use
condom use is influenced more by concerns about pregnancy than STIs
… dual use is uncommon
easier access to contraception and post-coital
contraception (morning after pill) may mean
greater risk of STI transmission
is it responsible to prescribe the pill without
also giving condoms to protect against STIs?
STI diagnoses are increasing
STI diagnoses are increasing
artefact? - more sensitive tests - more people getting tested real increase - more young people sexually active - inconsistent condom use - lack of concern about HIV affects STI concern - belief that STIs are not serious
