Sexual health is 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.
Sexuality is a big part of being human. Love, affection and sexual intimacy all play a role in healthy relationships. They also contribute to your sense of well-being. A number of disorders can affect the ability to have or enjoy sex in both men and women. Concerns about infertility or fear of unplanned pregnancy can also come into play. In addition, a number of diseases and disorders affect sexual health. These include sexually transmitted diseases and cancer. In men, treatment of prostate cancer can cause erectile dysfunction. In women, cervical, uterine, vaginal, vulvar, or ovarian cancer may have sexual effects.
Public Health Approach to Sexual Health
Sexuality affects individuals and society across a broad spectrum of activities: through health, but also through factors at multiple levels, such as gender relations, reproduction, and economics. Physiologic, behavioral, and affective measurement of sexuality and sexual behavior is complicated by cultural values and norms, but is essential to individual health (including happiness) as well as public health.
Cultural or structural norms that stigmatize aspects of sexuality, such as sexual orientation, have adverse effects on individuals across their lifespan, with homophobia being a prominent example of such. In addition, survey data reveal several individual and relationship factors that are important to sexual health at all levels, with overall health noted as the greatest predictor of sexual satisfaction.
Sexuality is important to society not only because of health implications; it also affects gender and property relations, reproduction potential, and economics. Physical, mental, social, and cultural factors affect health, especially sexual health. For instance, infidelity between couples often leads to hurt and divorce, and in Western countries, between 25% and 50% of divorcees cite a spouse’s infidelity as the primary cause of divorce.
Sexual dysfunction can pose public health problems, as it is related to public health issues and affects people’s happiness and general well-being.
According to the National Health and Social Life Survey,
- The prevalence of sexual dysfunction was found to be higher among women than men.
- Lack of sexual desire is the most common problem among women
- For men, the most common sexual problem is premature ejaculation, not erectile dysfunction.
- Sexual problems increase with age, but sex-related personal distress decreases.
Sexual frequency is important for sexual relationship satisfaction. Sexual intercourse frequency is noted as being the most important factor when predicting sexual satisfaction. Satisfaction declines with age but not as steeply as sexual frequency declines. However, although satisfaction is lower in women, satisfaction levels do not change over time among women, compared with men.
Sex and Health
Duration and age matter, but health matters most of all. Health proves to be a critical predictor of sexual satisfaction. Among those indicating their health is at least “very good,” more than half say they are satisfied with their sex lives. The majority of older Americans do not practice safe sex, even if they have multiple partners. It was reported that only 1 in 5 sexually active, dating singles use condoms regularly. Many older Americans report dating more than one person at a time and being sexually active with more than one sex partner (6% of men and 1% of women).
There are cultural differences that affect sexual and romantic happiness. Despite having a lower overall reported health rating, Hispanics report being happier with their sex lives compared with the general population. Sexuality was found to be a higher priority for older Hispanics, who report higher levels of sexual activity and satisfaction. Having a partner matters.
The most important indicator of the sexual happiness of older Americans is having a steady sex partner. That indicator is less important than the frequency of sexual intercourse, good health, low levels of stress, and the absence of financial worries. There are still behavioral differences between older men and women, and older men and women continue to rank the importance of sex and the enjoyment of sex differently—even as they age. Older men continue to have more sex and think about sex more than older women; they see it as more important to their quality of life. Older men report having more frequent orgasms than women (2 out of 3 men, compared with 1 in 3 women), but their frequency of orgasm drops with age. Older men are twice as likely (21% compared with 11%) to admit sexual activity outside their relationship than women.
Sex trafficking is a modern-day form of slavery in which a commercial sex act is induced by force, fraud, or coercion, or in which the person induced to perform such an act is under the age of 18 years. Enactment of the Trafficking Victims Protection Act of 2000 (TVPA) made sex trafficking a serious violation of Federal law. The TVPA also recognizes labor trafficking, which is discussed in a separate fact sheet.
As defined by the TVPA, the term ‘commercial sex act’ means any sex act on account of which anything of value is given to or received by any person.
The TVPA recognizes that traffickers use psychological and well as physical coercion and bondage, and it defines coercion to include: threats of serious harm to or physical restraint against any person; any scheme, plan, or pattern intended to cause a person to believe that failure to perform an act would result in serious harm to or physical restraint against any person; or the abuse or threatened abuse of the legal process.
Victims of Sex Trafficking and What They Face
Victims of sex trafficking can be women or men, girls or boys, but the majority are women and girls. There are a number of common patterns for luring victims into situations of sex trafficking, including:
- A promise of a good job in another country
- A false marriage proposal turned into a bondage situation
- Being sold into the sex trade by parents, husbands, boyfriends
- Being kidnapped by traffickers
Sex traffickers frequently subject their victims to debt-bondage, an illegal practice in which the traffickers tell their victims that they owe money (often relating to the victims’ living expenses and transport into the country) and that they must pledge their personal services to repay the debt.
Sex traffickers use a variety of methods to “condition” their victims including starvation, confinement, beatings, physical abuse, rape, gang rape, threats of violence to the victims and the victims’ families, forced drug use and the threat of shaming their victims by revealing their activities to their family and their families’ friends.
Victims face numerous health risks. Physical risks include drug and alcohol addiction; physical injuries (broken bones, concussions, burns, vaginal/anal tearings); traumatic brain injury (TBI) resulting in memory loss, dizziness, headaches, numbness; sexually transmitted diseases (e.g., HIV/AIDS, gonorrhea, syphilis, UTIs, pubic lice); sterility, miscarriages, menstrual problems; other diseases (e.g., TB, hepatitis, malaria, pneumonia); and forced or coerced abortions.
Psychological harms include mind/body separation/disassociated ego states, shame, grief, fear, distrust, hatred of men, self-hatred, suicide, and suicidal thoughts. Victims are at risk for Posttraumatic Stress Disorder (PTSD)—acute anxiety, depression, insomnia, physical hyper-alertness, self-loathing that is long-lasting and resistant to change (complex-PTSD).
Victims may also suffer from traumatic bonding—a form of coercive control in which the perpetrator instills in the victim fear as well as gratitude for being allowed to live.
Types of Sex Trafficking
Victims of trafficking are forced into various forms of commercial sexual exploitation including prostitution, pornography, stripping, live-sex shows, mail-order brides, military prostitution and sex tourism.Victims trafficked into prostitution and pornography are usually involved in the most exploitive forms of commercial sex operations. Sex trafficking operations can be found in highly-visible venues such as street prostitution, as well as more underground systems such as closed-brothels that operate out of residential homes. Sex trafficking also takes place in a variety of public and private locations such as massage parlors, spas, strip clubs and other fronts for prostitution. Victims may start off dancing or stripping in clubs and then be coerced into situations of prostitution and pornography.
Learning Activity: Identifying and Interacting With Victims of Human Trafficking
Find out about how to identify and interact with victims of human trafficking.
- What would you do if you think you identified someone who might be a victim of human trafficking?
Sexuality: Sexuality, NLM, NIH, http://www.nlm.nih.gov/medlineplus/sexualhealth.html
Public Health Approach to Sexual Health: Public Health Approaches to Sexual Health, Centers for Disease Control and Prevention. A Public Health Approach for Advancing Sexual Health in the United States: Rationale and Options for Implementation, Meeting Report of an External Consultation. Atlanta, Georgia: Centers for Disease Control and Prevention; December, 2010. http://www.cdc.gov/sexualhealth/docs/SexualHealthReport-2011-508.pdf
Sex Trafficking: Sex Trafficking Fact Sheet, Administration for Children and Families, USDHHS, http://www.acf.hhs.gov/trafficking/about/fact_sex.html