Sexual Health

2. Individual freedom, legal security and self-determination

2.1. Sexual Health

Photo: G.H.Lunde

Sexology was a topic in Mrs. Willard's book Sexology as the Philosophy of Life (1) published as early as in 1867. Today, sexology is a large and extensive field of study that covers many themes. Sexuality does not only mean needs based on biological factors. Sexology as a field investigates subjects such as the meaning of sexuality, its role in individuals’ lives, the relationship between sexuality and human rights, including the state’s responsibility with respect to, protecting and fulfilment of sexual rights.

One way to understand what sexual health means is to look at the model of sexual health (2), which consists following components:

A basic component, 

A physiological component

A cognitive component

A relative component

A personal component 

Each component is important when you talk with your child/sibling/client about sexual health. Every component affects our sexuality, and can be therapeutically affected (2). 

Fig 1: Sexual Health model (2). 

Basic component (fig. 1) includes biological gender (XX or XY). Physiological component includes the senses, such as sight, hearing, smell and taste, as well as physiological and medical conditions in the body. Cognitive component includes thoughts, knowledge, ignorance and the imagination in men and women's sexuality. The personal component includes gender identity; in what way we feel we are a gender, male and female. Sexual desire, fantasies and wishes are also part of the personal component. The relational component includes presence; how we act and communicate in a sexual situation, how we touch others, seduce, talk to each other, etc.(2).

The World Health Organization (WHO) defines the concept of sexuality through the lenses of sexual health and sexual rights. The definition of sexual health entails a comprehensive and integrated approach to sexuality, relationships and sexual experiences. The necessity of respecting, protecting and fulfilling sexual rights as a means of achieving well-being, are emphasised (3). Today there is a World Association for Sexual Health (WAS) that, among other things, have developed a Declaration of sexual rights (4)

Society's view on sexuality influences how people perceive themselves and others. E.g. in the media, sexuality is often closely related to youth, beauty and success. Such ‘media-captured stereotypes’ make acceptance of sexuality difficult for those who do not fit into this ‘frame’. For instance, it has been questioned whether PWID have sexuality, and whether they should have the possibility to be sexually active. An understanding of sexual orientation opens the possibility to diverse ways of expressing sexual activities. Based on this understanding, PWID are sexual individuals who experience sexuality just like other people. People do not have sex only for reproduction, but also because it contributes to a good quality of life. Humans are born as sexual beings, and everybody undergoes a personal sexual development (5). 

‘Cohabitation and sexuality’ is a familiar topic for most of us. Friends, lovers, caring, emotions, knowledge of your own body, contraception, flirting, masturbation, intercourse and so on, are topics we meet in our lives. In addition, we have to handle topics such as norms, rules, laws, ethics, sexual deviations and technical aids. E.g. people with ID are vulnerable due to cognitive difficulties (6) and legal security is important to protect them  against abuse, or arbitrariness by the authorities.   

Parents usually have close contact with their children and adolescents. Nevertheless, talking about autonomy and sexuality can be difficult. There are several reasons for this. This lack of confidence and openness may be due to lack of words the child understands or is familiar with. Gender, age, up-bringing, ethnic origin, religion and social harmony may also influence the conversation. The level of disabilities may also have an influence, as well as how visible a disability is. People with disabilities have a natural right to participate in everyday life and in society. Self-determination is a human right that enables us to manage our lives and sexuality. You may read more about this topic in the Human Rights module.

Experiences shows that parents and caretakers often neglect sexuality in PWID (6). For some PWID there can be a connection between lack of attention on gender and sexuality and the development of challenging behaviour. Some claim that a person’s sexual needs are also triggers for challenging behaviour (7). Furthermore, the lack of knowledge of the relationship between challenging behaviours and sexuality can cause misunderstandings in interactions between parents and children, as well as between service providers and service recipients (7: 434).

ACTIVITY:

• When you consider public discourse in your country, do you think sexuality of PWID is valued as a human right? 
• In what way do you think your own acceptance of sexuality influence your child/sibling/client’s sexuality?
• If you do not accept your child/sibling/client as a sexual person, what is the reason for this?

Photo: G.H.Lunde