SECOND OPINION:Sexuality is seen in terms of ill health rather than wellbeing, writes JACKY JONES
WHY IS SEXUALITY so often portrayed from a problem perspective? In the same way that mental health is seen in terms of suicide, depression and mental illnesses, sexual health is seen in terms of sexually transmitted infections (STIs), crisis pregnancies, menopausal “symptoms” and impotency. Sexual development in young people is typified as something problematic, to be contained and controlled, particularly for girls. Adult sexual health is portrayed as a source of distress rather than how it enriches relationships and intimacy.
Sexual health is primarily about enjoyment, desire, fantasies and a satisfying sexual life. A World Health Organisation (WHO) report in 2010 defines sexual health as encompassing “the right of all persons to . . . pursue a safe and pleasurable sexual life”. The report notes that we need a conceptual shift from the current focus on sexual ill health to wellbeing, pleasure and satisfaction. This means a rights-based approach which includes supportive legislation and skill-based sexual education for all ages so that people can vindicate their rights.
The WHO report emphasises the role of comprehensive education programmes for young people before they become sexually active and that this should include the role of pleasure, satisfaction and negotiation skills. In Ireland, it has taken many years to get sexual education into schools and even now these programmes are very limited. The Relationships and Sexuality (RSE) resources available to post-primary schools are heavily laden with religious values, inappropriate messages about being male and female, and are definitely not comprehensive. Resources for both junior and senior cycle stress that “making decisions about sexual behaviour is not simply a private matter” and that “marriage is a positive context for sexual intercourse”. Lesson Six on human reproduction in the senior cycle contains two poems with the lines: “I am woman . . . created by god, perfection is me” and “I am man . . . gifted I am”. This is sexist and inaccurate. Teenagers have natural angst about sex at that age, and why is the girl “perfect” and the boy “gifted”?
Lesson Six notes that male ejaculation is “the climax of sexual excitement”. There is no mention of female orgasm, pleasure or negotiation skills. Lesson Eight about family planning is inappropriate because at that age they need to be learning about safe, enjoyable sexual activity, not planning their future families. Abstinence and the Billings method, both approved by the Catholic Church, are top of the “family planning list” and there is no lesson on using condoms safely.
The overall message in the Irish school programme is abstinence is the best policy. This grossly inadequate sexual education denies young people the right to make their own decisions. It is also irresponsible, as there is no evidence for the effectiveness of abstinence education programmes, according to the Health Development Agency (UK). On the contrary, an emphasis on abstinence can be harmful. Young people are less likely to protect themselves when they do initiate sex because they are not operating with a “safe sex” mindset. There is strong evidence that comprehensive programmes, when linked to contraceptive services, delay the onset of sexual activity. This is an objective of the HSE Crisis Pregnancy Programme which won’t be achieved unless the Irish school programmes are drastically changed.
For Irish adults, sexual health services are virtually non-existent unless you are pregnant, contract an STI or have some sexual dysfunction. The menopause, a completely natural stage in women’s lives, is treated as a medical problem, as is male impotence, another natural event. In addition, the media gives the impression of muscular, sleek males and thin, young, beautiful women enjoying sensational sex lives. The reality, as Alain de Botton puts it, is “Our bodies smell, ache, sag, pulse, throb and age. They force us to fart and burp and to . . . wind up in bed with people, sweating . . . and letting out intense sounds reminiscent of hyenas calling out to one another across the barren wastes of the American deserts.”
Sexual health is portrayed negatively because we don’t talk about it unless there is a problem and then with difficulty. Sexual pleasure is hardly ever discussed in the media. Instead, we are inundated with unachievable and boring portrayals of sexuality that distort the reality of life’s greatest pleasure. We urgently need a national sexual health strategy to redress the balance and, finally, bring Ireland into 21st-century sexual health thinking.
Dr Jacky Jones is a former regional manager of health promotion with the HSE