Towards a psychology of sexual health

Increased attention has been made in recent years to issues of sexual and reproductive health in relation to broader social and political environments and human rights issues. The World Health Organization (WHO, 2015) has indicated that we cannot consider sexual and reproductive health concerns such as HIV and other sexually transmitted diseases, sexual violence, sexual problems, unwanted pregnancies and unsafe abortions, without considering discrimination and inequality. Many individuals around the world may be actively discriminated against and even abused on the basis of their sexual and gender identity, who they choose to have sex with and their sexual practices. Within this framework, sexual health is not to be understood only in terms of the absence of sexual disease or dysfunction, but rather more holistically in terms of physical as well as psychological and social well-being. Sexual health is not just about disease, but also identity and relationships. As the WHO (2015) states, ‘For sexual health to be attained and maintained, the sexual rights of all persons must be respected, protected and fulfilled’ (p. 5). This inclusive definition of sexual health demands an imaginative sexual health psychology that theorises the individual as embedded within their psychosocial, sociocultural and geopolitical contexts. This inclusive definition also demarcates the rather impoverished attempt to develop a sexual health psychology to date. Much of the existing work on sexual health psychology has for the most part aligned with funding opportunities which address the proximal determinants of sexual ill-health. Such approaches align themselves with the medical profession and focus on behavioural determinants of unsafe sex and the transmission of sexual infections, the determinants and psychological consequences of sexual violence, and understanding the causes and psychological treatments of what are termed ‘sexual dysfunctions’ (e.g. Miller and Green, 2002). These are all important areas of work, but their overall focus on the proximal determinants of sexual ill-health elides other, and potentially more important determinants of sexual health. Moreover, a biomedical focus on sexual health alone and a tendency to only use the individual as a unit of analysis and theory amplifies and interpellates notions of individual responsibility and culpability. It can diminish and obscure social and other structural determinants of sex (e.g. Campbell, 2003 and Tomlinson et al., 2010 in relation to HIV) and lead to the medicalisation of sexual difficulties (Moynihan, 2003; Tiefer, 2006). Such partial understandings of sexual health can severely delimit the ways we can imagine and develop sexual health interventions (Marks et al., 2018)