What is sexual wellbeing and why does it matter for public health?

Abstract

Sexual health has provided a guiding framework for addressing sexuality in public health for several decades. Although the WHO definition of sexual health is revolutionary in acknowledging positive sexuality, public health approaches remain focused on risk and adverse outcomes. The long-standing conflation of sexual health and sexual wellbeing has affected our ability to address everyday sexual issues. This Viewpoint provides a way forward to resolve this impasse. We propose sexual wellbeing as a distinct and revolutionary concept that can be operationalised as a seven-domain model. We situate sexual wellbeing alongside sexual health, sexual justice, and sexual pleasure as one of four pillars of public health enquiry. We argue that sexual wellbeing is imperative to public health as a marker of health equity, a meaningful population indicator of wellbeing, a means to capture population trends distinct from sexual health, and an opportunity to refocus the ethics, form, and practices of public health.

Healthy sexuality development in adolescence: proposing a competency-based framework to inform programmes and research

“…Here, we differentiate between personal and relational aspects of sexual wellbeing and give examples of potential outcomes. Our conceptualisation is in line with the sexual wellbeing domains proposed recently by Mitchell and colleagues, 25 e.g. comfort with sexuality, sexual self-esteem, and safety and security – albeit with different terminology and adapted specifically for the adolescent population.…”

“…In their recent (2021) framework for sexual wellbeing in mid and later life, Mitchell and colleagues 25 further define sexual wellbeing as distinct from (rather than adjunctive to) sexual health. They do so by placing sexual wellbeing and sexual health alongside sexual pleasure and sexual justice as four intersecting pillars that underlie public health studies and programmes.…”

“…They do so by placing sexual wellbeing and sexual health alongside sexual pleasure and sexual justice as four intersecting pillars that underlie public health studies and programmes. Sexual wellbeing is conceptualised as spanning seven domains: “sexual safety and security, sexual respect, sexual self-esteem, resilience in relation to past sexual experience, forgiveness of past sexual events, self-determination in one’s sex life, and comfort with one’s sexuality” 25 – all of which applies to people regardless of whether they are sexually active or in relationships. The authors points to the need to monitor sexual wellbeing outcomes as important public health indicators in their own right, e.g.…”

“…Based on our review of the above definitions and frameworks, we note that most existing models tend to be academic/theoretical rather than application oriented in their nature, thereby limiting the application to programme development and evaluation. And even for those that are more focused on skills (such as Arbeit’s model) 1 or that more explicitly operationalise sexual wellbeing outcomes (such as Mitchell and colleagues), 25 they seem to be (more) applicable to (older) age groups who are already in relationships and/or sexually active, and less so to the earliest years of adolescence. Comprehensive sexuality education, for example, aims not only to prevent traditional public health outcomes but to improve “soft outcomes” such as gender equal norms, consent communication and perceived self-efficacy in relation to different age groups (from early childhood to late adolescence).…”

International Sex Survey: Study protocol of a large, cross-cultural collaborative study in 45 countries

“…Future studies will be needed to further examine the validity and reliability of the screening tools planned for use in the ISS in other populations (e.g., adolescents; B} othe, Vaillancourt-Morel, Dion, Stulhofer, & Bergeron, 2021) and corroborate the identified sexual profiles and profile correlates, with a special focus on non-WEIRD, nationally representative, and treatment-seeking samples (Grubbs et al, 2020;Klein et al, 2021). Moreover, given limits in the survey battery (e.g., relating to respondent burden), it will not be possible to assess all sexuality-related variables (e.g., use of sexual enhancement products; Corazza et al, 2014) or psychosocial characteristics (e.g., sexual self-esteem; Mitchell, Lewis, O'Sullivan, & Fortenberry, 2021) that may be relevant to CSBD, PPU, sexual well-being, or sexual health. Thus, building off ISS findings, future studies will be needed to examine a wider range of variables in relation to CSBD and PPU, preferably in longitudinal settings, providing information about the natural course and temporal stability of assessed and observed associations (Grubbs & Gola, 2019;Grubbs & Kraus, 2021;Stulhofer, Rousseau, & Shekarchi, 2020).…”