Sexual expression and health are central to the human experience. Our sexuality creates life, pleasure, bonding and identity, and deserves to be honoured and embraced. The World Health Organization partially defines sexual health as “a state of well-being in relation to sexuality across the life span that involves physical, emotional, mental, social, and spiritual dimensions.” Unfortunately, in the United State of America, many conversations around and depictions of sexual health and nudity are labelled as taboo, which has often led to unsupportive, counterproductive or even harmful situations and environments. Perceptions of sexual health and nudity as taboo have often also led to a lack of comprehensive sexual education and community conversation. The start of community discussion must begin with a personal conversation, such as understanding one’s own sexuality and sexual conditioning. By thinking and talking openly about our sexuality, we can start to create a welcoming conversation that supports sexual health and eliminates taboos, fears and stigmas.
To help contribute to this conversation, I am creating an anonymous survey asking people about how their perceptions on sex and sexuality are influenced by their physical, emotional, mental and social well-being. After I compile the answers, I will group them into individual books. In all, there will be 18 books, each labelled by a corresponding question from the survey and containing the answers from the corresponding question. To resemble a constant stream of thought, I will not make a distinction between when one person's answer ends and another begins. Additionally, alongside the bound books, I will showcase my art, which I make to advocate the admiration of the human form and support of sexual health. Together, the bound books and fine art will be a community art project. The purpose of this project is to encourage both viewers and participants to practice introspection and start an open and inclusive conversation about sexual health within the community to help improve sexual health education and positivity.
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The World Association for Sexual Health defines sexuality as” a source of pleasure and well-being that contributes to overall fulfilment and satisfaction.” The broad spectrum of human sexuality, which “encompasses sex, gender identities, sexual orientations, eroticism, pleasure, intimacy, and reproduction” (WAS) is a central part of humanity deserving of honour and freedom. When one’s expression of sexuality is suppressed, their self-worth, quality of life, and understanding of their own sexuality can be hindered. Furthermore, becoming comfortable with talking about our personal sexualities can help us to better relate to and understand others’ experiences, which can diversify the sexual health conversation and improve overall sex education and positivity.
A prime example of how sexual expression suppression damages self-worth and mental health is in the LGBT community. As a result of stigma, discrimination, violence and exclusion, many LGBT members deal with depression, anxiety and suicide attempts. LGBT youth are almost fives times more likely to have attempted suicide than heterosexual youth (CDC) and, each event of LGBT victimisation increases the likelihood of self-harm behaviour by 2.5 times, on average (IMPACT). Furthermore, in a systematic review of 39 studies conducted in 12 countries, Collier et al found strong evidence that peer abuse based on sexual orientation and gender identity/expression is associated with a lower sense of belonging and depressive symptoms.
There is also a significant relationship between sexual satisfaction, physical health and reported welfare. From a self-report questionnaire of 3,515 people, Flynn et al found that sexuality and sexual expression were influential and salient parts of their quality of life. High sexual satisfaction was associated with higher general self-rated perceptions of health. Compared to participants with poorer health, those with excellent health also had higher sexual satisfaction ratings. Furthermore, on a study of the relationship between sexual satisfaction, quality of life, and intimacy in patients with sexual dysfunctions (Daker-White & Donovan), researchers found that participants who had a revival of their sex lives reported increased happiness and life satisfaction. One participant mentioned the resurgence of her sex life “made her feel extremely alive” and like she could enjoy herself and her partner more, sexually. Conversely, participants who were unable to have sex reported feeling very unsatisfied and unhappy in their lives. As one woman described, her illness, which made sex impossible, led to feeling “turned upside down” and like a failure, sexually.
The aforementioned research and research on the LGBT community suggests that part of the solution to improving the overall quality of life and, therefore, the conversation about sexual health, is encouraging a discussion of our sexual satisfaction. Additionally, we need to be more welcoming of the broad spectrum of sexual expression. By ignoring or silencing the conversation of sexual expression and satisfaction in ourselves and communities, we are removing a salient part of our overall health and wellness.
In addition to being affected by physical health, sexual satisfaction can be impacted by our body image perceptions. There are multiple studies showing a strong positive correlation between body image and sexual satisfaction and arousal. In a study done by Quinn-Nilas et al, 88 women were surveyed to “To determine whether, and to what degree, body image concerns (evaluative, affective, and behavioural) influence aspects of women's sexual functioning (desire, arousal, and orgasm).” Compared to women who had positive reflections on their bodies, those with more negative feelings and evaluations had an overall decreased sexual desire and arousal. Furthermore, women with negative evaluations of their bodies also reported difficulties orgasming compared to women with positive body-image evaluations.
Additionally, body image has a positive correlation with sexual confidence levels, frequency of sex, and sexual exploration. To evaluate the relationship between women’s body and self-image and sexual behaviour and determine factors that influence frequency and comfort with sex, Ackard et al surveyed 3,637 women. They found that women who reported higher body and self-image satisfaction were more sexually active, had more frequent orgasms, greater comfort initiating sex and were more sexually adventurous than women who were dissatisfied. This research on body image demonstrates that perception of one’s physical appearance can significantly influence sexual satisfaction, sexual confidence and even perceived sexual worth.
In many societies, physical appearance and a society’s perception of one’s sexual worth are interlinked. Pertaining to women, Objectification theory (Fredrickson and Roberts) provides the framework that sociocultural, sexually objectifying perceptions of girls’ and women’s bodies equate females’ worth to their physical appearance and sexual output. Instead of being viewed as a whole person, or having their social worth be determined by cognitive, social or personal skills, women are viewed as a physical object for male sexual desire. Often, this sexually objectifying attitude leads to sexual ridicule (i.e ‘slut-shaming’) and a lack of autonomy, such as a reduction in sexual health rights. When a person’s worth is solely based on their physical appearance or sexual use for others, are shamed for their sexual independence, and are stripped of their right to their own body, they may feel detached from their sexual expression. Feeling like their body is not their own and is only for the sexual use and pleasure of others can also increase anxiety and dissatisfaction with one’s body and sexuality; thus, decreasing their overall quality of life. Furthermore, by sexually objectifying and depriving people of sexual health rights, we are also discouraging them from reflecting on and understanding their sexuality, which perpetuates exclusive and potentially harmful conversations about sexual health.
Unfortunately, there is less research discussing the effect of body image on sexuality in men. This lack of male representation in body and self-image based research makes sense, though. Often negative body image is only discussed as a feminine problem, as women are more likely to receive sexual scrutiny (i.e sexual harassment, shaming and objectification) than men. However, men also deal with appearance pressures, like the expectation of an ideal man, which is often depicted as lean, tall, muscular and with very little representation of homosexual males. Furthermore, compared to women’s sexualities being objectified, exploited or silenced, heterosexual men’s sexual expression or dominance tends to be encouraged and viewed as superior to women. As a result, there may be more of an assumption that men do not deal with body-image or sexual insecurity problems. Assuming men are and should be wholly confident in their bodies and sexualities perpetuates toxic masculinity, discourages men to reflect on their own sexualities and sexual conditioning and silences them in the conversation of sexual health; thus, halting the progression of a sexual healthy community.
Inclusivity in the discussion of sexual health is also a fundamental part of Sexual Health Rights, which include the right to non-discrimination, autonomy and bodily integrity, freedom from all forms of violence and coercion, information, and comprehensive sexual health education (WAS) Given that they also include “the highest attainable standard of health, including sexual health” and the possibility of sexual satisfaction (WAS), which is linked to overall welfare, inclusive sexual health rhetoric and education needs to be both a community and national health priority. Unfortunately, because conversations and depictions of sex are labelled as taboo in the U.S, there is a serious lack of positive sex education. Historically, sex stigmas in the U.S have been produced by negative, fear-based messages about sexual health, such as STI’s, like HIV, stereotypes towards ethnic and sexual identity minorities, and religious beliefs. There is also a shortfall of sexual health information between health-care professionals, as many are not trained how to properly and effectively take, discuss and understand the sexual histories of patients (Office of the Surgeon General). Malhotra et al surveyed 500 fourth-year medical students to “assess medical school sexual health curricula through student and faculty descriptions of training content, methods and effectiveness.” Of the 92 medical schools surveyed, 44% lacked formal sexual health instruction and, of the students surveyed, the ones who were taught how to properly take and understand patient histories were more comfortable. (Malhotra et al)
Furthermore, legally, there are restrictions on sexual health. Such as, individual school systems can determine what is included in their sex education, state restrictions can make access to abortion very difficult (Planned Parenthood), and the current federal administration has proposed rolling-back protections for sex discrimination in the Affordable Care Act (HHS). By limiting information and education, the U.S is depriving people of their sexual rights, which diminishes encouragement of personal sexual reflection and sexual openness; therefore, depressing the development of a healthy sexual health conversation.
In their video, Creating a Sexually Healthy Nation, The American Sexual Health Association interviewed experts and the general population on what a sexually healthy nation looks like. The most prevalent answer prioritised open and educated communication and conversation of sexual health. An open conversation includes comprehensive and universally mandated sex education, inclusive of all ages, genders and identities, and “embracing our sexuality in whatever forms it comes in”(ASHA) The priority of the sexual health conversation needs to be inclusive of everyone and all sexual expressions. By leaving out groups and identities, we risk perpetuating sex stereotypes, fears and, instead of promoting health, preventing it.
Regarding personal conversation, discussing our personal relationships with our sexuality has therapeutic benefits to our self-esteem and sexual confidence. As many effective conversations around sexual health are often limited by censorship, some people may feel ashamed to discuss their relationship with sex. A person’s connection with sex can be influenced by conversations (or lack thereof) about sex in their lifetime, religious and cultural influences, personal sexual experiences, and societal influences. In some cases, a person’s sexual history can negatively impact their sexual satisfaction and expression, either through feelings of shame, guilt, or anxiety (Shapiro). When the conversation about sexual health is silenced or labelled as shameful, many may be denied the ability to deal with and discuss harmful sexual pasts and feel disconnected from their sexualities. By discussing one’s sexual histories and influencers, one may feel more in control and connected to their sexuality, thus improving sexual satisfaction and quality of life. Additionally, being open to talking about your own sexuality and sexual history may help change the societal and cultural outlook on the conversation of sex to one that engenders positivity for individuals and groups.
Part of understanding our own and other’s sexualities is recognising what value(s) sex has to us, personally. In her book, Bringing Sex Into Focus: The Quest For Sexual integrity, Caroline J. Simon discusses sexual perceptions into six different “lenses”: The Plain view, which emphasises mutual consent, consideration and satisfaction disconnected from biology and emotional connections; The Romantic view, which recognises sex as an expression of deep affection, gift-giving, passion, and defined by long-term commitment; The Expressive view, which determines that “sex is an expression of growth and development including joy, creativity[‚] human connection,”(Press) and reveals the value of people; The Covenantal view, which places marriage as the ideal for relationship and emphasises chastity; The Procreative view, which sees sex as a means of life production and only for generativity; And, lastly, the Power view, which sees sex as an expression of power dynamics.
These six lenses are often intermingled and influence our sexualities in different ways, either if we hold their values, or if other people’s values have affected us. By recognising our own values, we can start to identify their origins, how our sexual expression and influences our actions, and see how our perspectives interact with others’ perspectives. A benefit of practising personal conversation and spending time to understand our sexualities is that it can open up an understanding of other peoples’ experiences, perceptions and desires. We can begin to see how everyone’s sexual values affect and are affected by society. By making the connection between each other’s sexual values and experiences, we can begin to propel and change the conversation of sexual expression to be a more inclusive and positive one.
In his essay, Is Sex Interesting? Wallace Shawn proposes multiple reasons why people find sex so uncomfortable to discuss. One reason, he claims, is that people detach themselves from how natural the act is. Shawn makes a strong and logical point claiming that “sex is ‘the environment’ coming inside, coming inside our homes and taking root inside our minds.” Humans, no matter how much we try to avoid it, abide by the laws of nature. Without sex, we would not exist, same as any other creature. However, we often try to separate ourselves from nature. We place ourselves above it by building cities and technology to bypass evolutionary barriers or even cheat death with advancing medical sciences. The moments we are confronted with the reality that we are part of nature, we often become scared and look for ways to separate farther from it. Regarding sex, we enact arbitrary rules, such as how to have sex, who you can have sex with or who has control over your sexuality, to contain it and paint a black and white picture of right or wrong.
In pursuit of avoiding or controlling the naturalness of sex, we have stigmatised it and made people fear or avoid understanding their own nature. Shawn suggests that “perhaps it would be a good thing if people saw themselves as a part of nature, connected to the environment in which they live.” Perhaps if we let down our guards and fears and accepted the natural multifariousness of human sexuality the same way we do the vast variety of fauna and flora, our conversations about sexual health would become more inclusive, accepted, and positive. Instead of being feared and repressed, sex should be wholly embraced, as an equalising force, to benefit the cognitive, physical, cultural, and social health of all.
Citations
American Sexual Health Association. Creating a Sexually Healthy Nation. Sexual Health TV, American Sexual Health Association, 2014, www.sexualhealthtv.org/channels/.
Ackard, DM, et al. Effect of Body Image and Self-Image on Women's Sexual Behaviors. The International Journal of Eating Disorders, U.S. National Library of Medicine, Dec. 2000, www.ncbi.nlm.nih.gov/pubmed/11054789.
CDC. Sexual Identity, Sex of Sexual Contacts, and Health-Risk Behaviours Among Students in Grades 9-12: Youth Risk Behavior Surveillance. Atlanta, GA: U.S Department of Health and Human Services. 2016
Collier, Kate L et al. Sexual orientation and gender identity/expression related peer victimization in adolescence: a systematic review of associated psychosocial and health outcomes. Journal of sex research vol. 50,3-4 (2013): 299-317. doi:10.1080/00224499.2012.750639
Daker‐White, G. and Donovan, J. Sexual satisfaction, quality of life and the transaction of intimacy in hospital patients’ accounts of their (hetero)sexual relationships. Sociology of Health & Illness. (2002). 24: 89-113. doi:10.1111/1467-9566.00005
Flynn, Kathryn E et al. Sexual Satisfaction and the Importance of Sexual Health to Quality of Life Throughout the Life Course of U.S. Adults. The journal of sexual medicine vol. 13,11 (2016): 1642-1650. doi:10.1016/j.jsxm.2016.08.011
Fredrickson, B. L., & Roberts, T. (1997). Objectification theory: Toward understanding women’s lived experiences and mental health risks. Psychology of Women Quarterly, 21, 173-206
IMPACT. Mental health disorders, psychological distress, and suicidality in a diverse sample of lesbian, gay, bisexual, and transgender youths. American Journal of Public Health. 100(12), 2426-32. 2010
Malhotra S, Khurshid A, Hendricks KA, Mann JR. Medical school sexual health curriculum and training in the United States. Journal of the National Medical Association. 2008 Sep;100(9):1097–1106.
Office of the Surgeon General (US); Office of Population Affairs (US). The Surgeon General's Call to Action to Promote Sexual Health and Responsible Sexual Behavior. Rockville (MD): Office of the Surgeon General (US); 2001 Jul.
Parenthood, Planned. Where Is Abortion Illegal?: Abortion Limits by State. Planned Parenthood Action Fund, Planned Parenthood, 6 Sept. 2019, www.plannedparenthoodaction.org/abortion-access-tool/ND.
Press, Joshua. “Knowing Yourself: The 6 Views of Sex.” Medium, Medium, 31 Aug. 2019, medium.com/@thejoshuapress/knowing-yourself-the-6-views-of-sex-423cfb7941ae.
Quinn-Nilas, Christopher et al. The Relationship Between Body Image and Domains of Sexual Functioning Among Heterosexual, Emerging Adult Women. Sexual medicine vol. 4,3 (2016): e182-9. doi:10.1016/j.esxm.2016.02.004
Shapiro, Gila. Sexual Self-Esteem: A Short Course. HuffPost, HuffPost, 21 July 2017, www.huffpost.com/entry/sexual-selfesteem-a-short_b_11079260.
Shawn, Wallace. Wallace Shawn: Essays. Haymarket Books, 2009.
Simon, Caroline Joyce. Bringing Sex into Focus: The Quest for Sexual Integrity. IVP Academic, 2012.
World Health Association for Sexual Health. Declaration of Sexual Rights. WAS; 2014
World Health Organization. Defining sexual health, report of a technical consultation on sexual health 28-31 January 2002.Geneva: WHO; 2006.
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