A focus on pleasure in sexual health education can increase condom use and enhance positive attitudes toward safe sex, according to a new international study led by the University of Oxford.
Author
Jennifer Power
Associate Professor and Principal Research Fellow at the Australian Research Centre in Sex, Health and Society, La Trobe University
The study, published today, supports decades of policy and advocacy work seeking to push sexuality education beyond abstinence or risk-based approaches to improve sexual health outcomes.
What did the researchers find?
The study, a systematic review and meta-analysis, involved collating and analysing all existing research on the topic.
The review included 33 interventions that placed pleasure and fun at the centre of safe-sex messaging. Interventions ranged from sex education workshops to online resources, videos and pamphlets.
The interventions targeted people from multiple countries and backgrounds, including gay men, heterosexual young people and adults, women attending primary care clinics, and men recently diagnosed with a sexually transmissible infection (STI).
Despite this wide diversity in settings and population groups, the studies showed consistent findings. Interventions which affirmed people's right to pursue pleasurable sex were associated with more consistent use of sexual health services and improved awareness of contraception and preventing STIs.
The meta-analysis combined data from eight interventions aimed at increasing condom use among their target population.
Findings showed emphasising eroticism and fun in condom messaging was more effective at increasing people's uptake of condoms than other approaches, such as those that focus on messages about negative health outcomes.
This study makes an important contribution to existing evidence that risk-focused approaches to sexual health education, or health promotion, are less effective than comprehensive approaches, which encourage open communication about multiple aspects of sex and relationships, including sexual pleasure.
Pleasure is part of life
Sexual health interventions - which may include school-based education or broader health promotion campaigns targeting people of all ages - are usually designed to achieve particular health goals. These might be increasing STI screening, promoting human papillomavirus (HPV) vaccination, or reducing incidence of STIs.
Concern for sexual pleasure is often not considered relevant and messages about health risk dominate.
However, sexual relationships and pleasure are important aspects of human life and sexual health promotion is more effective if it accounts for this.
Compelling examples of this come from the HIV prevention campaigns created by activists and community organisations in the 1980s and 90s. Many of these campaigns were controversial due to their use of highly sexualised imagery and celebration of gay and bisexual men's sexuality, which had been criticised as hedonistic and irresponsible in the face of the HIV/AIDS crisis.
However, sex-positive messages were key to the success of these campaigns, which worked to normalise safe-sex through presenting it as fun and erotic.
Pleasure and consent
Affirmation of sexual pleasure is an important part of sexual consent education.
More than 30 years ago, in an important early paper, American scholar Michelle Fine famously articulated how a "missing discourse of desire" in school-based sexuality education undermines young women's sexual health and safety.
Writing about the US education system, Fine argued school-based sexuality education invalidates female sexual desire. This leaves young women more vulnerable to sexual violence or unwanted pregnancy.
The capacity to assert what one does not want in their sexual relationships, requires awareness of what one does want. It also requires the confidence to voice these desires without fear of being shamed.
Sexuality education should therefore be about building people's sexual agency and confidence to talk openly about the pleasures and risks of sex. Achieving this requires recognition of, and respect for, young people's sexuality and relationships.
Does sexual pleasure belong in classrooms?
The idea that school-based sexuality education should focus on pleasure can be controversial. How do we teach sexual pleasure in a classroom?
However, pleasure-based sexuality education is not about the mechanics of sex. Rather it's an approach to sexuality education that affirms people's right to sexual pleasure and fulfilment.
This may include emphasising fun and enjoyment in condom use, rather than focusing on cautionary tales.
Or it may be about giving people permission to talk openly about sexual identity or the complexities of relationships.
Educators caution this approach should not impose particular definitions of pleasure - pleasure can be many different things to different people.
Rather, pleasure-based sex education is about opening educational space for young people to safely explore, and developing critical thinking around, sex and relationships.
Sexual pleasure supports sexual rights and health
The basis of sexual rights is the opportunity for all people to pursue satisfying sexual relationships, free from harm or discrimination.
Respect for sexual rights underpins inclusive sexuality education, universal access to sexual and reproductive health care, and protection from sexual violence and discrimination.
Intrinsic to sexual rights is the acknowledgement that sexual pleasure is a valued part of human relationships that supports health and well-being.
Jennifer Power receives funding from the Australian Research Council, the Australian Department of Health and Fairer Victoria. She has previously received funding from ViiV Healthcare.
