The WHO defines sexual health as “a state of physical, mental and social well-being in relation to sexuality (…)”, underlining the importance of the psychological aspect of sexuality. While sexual health is often seen through the prism of sexually transmitted infections (STIs) and somatic dysfunctions, it is important to remember that sexuality is above all mental. It involves desire, libido, arousal, attraction and so on. So let’s use this World Sexual Health Day to take a look at the mental and social aspects of sexual health.
1. Sexual disorders and dysfunctions
The first mental impact on sexual health can also be seen on the physical level, namely sexual disorders and dysfunctions. These disorders can have a purely physiological origin, but the psyche is often at the heart of these problems.
The best known of these dysfunctions are erectile function disorders, i.e. difficulty in getting or maintaining an erection when desired, ejaculation disorders, most often when ejaculation occurs earlier than desired, orgasm disorders, i.e. the inability to reach orgasm, and vaginismus, a disorder causing intense contraction of the vagina leading to intense pain during penetration.
These disorders may have a physical origin, but when this is ruled out by a doctor, the psychological origin remains the most likely. Therapy will then be necessary to work on these difficulties, the origin of which is often multifactorial. The aim is to understand how the body functions, the thoughts and behaviours that maintain these difficulties, and to modify them in order to regain satisfactory functioning.
Another category of disorders influenced by the psychic dimension of the person concerns desire and libido, which can be defined simply as the desire to engage in sexual activity (alone or with others). This desire naturally fluctuates throughout life, sometimes high, sometimes very low, or even non-existent. This intensity does not determine the disorder. It is the impact on the person’s life and the suffering that this intensity causes that will determine whether the person needs help.
However, according to the WHO, sexual health “is not merely the absence of disease, dysfunction or infirmity”. Well-being therefore goes beyond bodily and psychological functioning. The factors that contribute to it extend around the individual, in the environment, the surroundings, the partners, and many others.
The WHO defines it as “the opportunity for safe and pleasurable sexual experiences, free from coercion, discrimination and violence“. This phrase highlights a central and fundamental aspect of healthy sexuality: consent.
2. Sexual consent
Sexual consent is defined as the agreement to participate in one or more intimate and/or sexual acts.
To be valid, consent must meet three conditions: it must be given freely, it must be informed and it must be given by a person capable of giving consent.
Free consent means that the acceptance must not be given under violence, coercion, pressure or threat.
Informed consent means that the person giving consent must not be in a state that impairs their judgement and capacity to consent. A person who is heavily intoxicated or under the influence of substances, for example, is not in a state to give informed consent.
That the person is capable of consenting, finally, presumes that the person is of sufficient age to understand what he or she is consenting to, that his or her mental, psychic and intellectual state allows him or her to understand what he or she is consenting to and that he or she is conscious. A person who loses consciousness during an activity to which he or she has consented is no longer in a condition to consent. A person who is asleep is not in a state to give consent, regardless of the body’s automatic physiological response.
Consent is not based on the presence or absence of sexual arousal, or on any other sign. Consent is a state of mind that must be communicated and can be revoked at any time.
Consent and how it is understood in the general population today highlights two pillars of sexual health that need to be strengthened in the future: education and communication.
Knowledge of how sexuality works, its variations, and the good practices that surround it are not innate, and appropriate education allows everyone to live a fulfilling sexuality, understanding their body and desire and respecting those of others.