Human Sexuality and Sexual Health: A Western Perspective

Sexuality refers to a human’s ability to experience pleasure from sexual activity and practices in its broadest sense. Sexual norms and practices are inextricably linked to prevailing cultural norms and individual identity (e.g., sexual and gender identification) and personality (e.g., gender roles). They also encompass multiple dimensions of psychology and behavior, including relationship structure (e.g., partner choice and object attraction); reproduction (e.g., biological roles); and recreation (e.g., pleasure and eroticism). Sexual customs and traditions are critical to public health because they are associated with multiple health outcomes, including physical, emotional, mental, and social well-being. Sexual health is a fundamental human right, including pleasure and desire, reproductive and relationship choices, and freedom from violence and coercion. As humans initiate sexual activity in adolescence and over the life course, sexuality carries the possibility of disease. In that sense, safer sexual practices, such as using a condom during intercourse or using pre-exposure prophylaxis to prevent HIV acquisition, are those that prevent sexually active people from acquiring sexually transmitted infections. Comprehensive rights-based sexuality education is a cornerstone of sexual health, as discussed in the Oxford Bibliographies in Public Health article Sex Education in HIV/AIDS Prevention by Jessica M. Sales and Ralph J. DiClemente. Freedom to choose a partner is a human right, which has faced multiple challenges to its exercise. Women and girls in many contexts have faced forced and child marriage, and sexual minorities have often faced stigma and discrimination, with the beginning of same-sex marriage legislation being passed relatively recently in modern history and not worldwide. The rights of gender nonconforming individuals to affirm their gender identity have only even more recently begun to be recognized. Sex is inextricably linked with reproduction; evolutionary theories have posed that partner choice and sexual attractiveness are based on the biological desire to reproduce, with marked sex differences in reproductive roles. However, women and girls have faced challenges in making reproductive choices and accessing modern family planning to prevent unwanted pregnancies and protect their health. Gender norms regarding sexuality have been more permissive to male sexuality in specific historical periods while limiting women’s sexual choices. Furthermore, power inequalities between the sexes have placed women, girls, and sexual minorities at increased risk for unwanted or coerced sex, gender-based violence, injury, and death. From a Western perspective, this article summarizes the leading public health issues related to sexuality and sexual norms and customs within sexual and reproductive health and rights. We have limited our focus to sexuality and sexual health in the West as we believe that fully representing the diversity of global perspectives would necessitate a separate entry.