The GIFT webinar: Women up to Know Good episode 4

Watch the recorded webinar video below

If sex is so bad, why do we have it?

Infusing joy into sexual health and wellness communication

If sexual health messaging is anything to go by, no one should be having sex. For years, discussions about sex and sexual wellness received the silent treatment, replaced shortly thereafter with the Big Book of Doom and Gloom.

When we discuss how we learned about sex, we’re invariably met with squirms as the pivotal day is recounted. For the lucky few who heard about sex from their parents or family, summoning all their collective muster, an illustrated sex book about the “birds and the bees” was presented to us. Next came the speech about “when a man and a woman really love each other…” and that was when the blackout curtains descended. Or, perhaps it was that Wednesday during second period, when the Life Orientation teacher overdid her “I’m a self-confident woman” bit and blasted “penis” and “vagina” into the ether of teenagers. What followed were perfunctory diagrams of infections and cautionary tales. The message to most young people is clear, “I’m on my own here”. 

In 1991, the all-women hip-hop group Salt-N-Pepa, released “Let’s Talk About Sex”, challenging us to address the elephant in the room. Their advice was to talk about “all the good things and the bad things” about sex. Unfortunately, we only took half of their advice. However, through growing research and determination, Pleasure and Joy are back in the mix. To mark the importance of the 4th of September as World Sexual Health Day, the GIFT team at the University of Cape Town hosted their fourth episode of the Women up to Know Good webinar series, titled Pleasure Down South: Infusing joy into sexual health and research practices. 

Phumla Radebe, from the GIFT team, facilitated the webinar with panellists, Dr Kirsten Mitchell, Dr Jessie Ford, and Dr  . They dived into why we need to put joy back into sexual health and reframe sexual health messaging to highlight wellbeing. Dr Mitchell is a Medical Research Council Investigator based in the School of Health and Wellbeing at the University of Glasgow. She has supported the Scottish Government on strategies to improve sexual health and wellbeing. Dr Ford, a sociologist from Columbia University, explores how norms, power differences, and institutional realities perpetuate social and sexual inequality. Dr Gumbi is a lecturer in Biochemistry at UKZN who strives to find ways to develop sensitive narratives to prevent HIV and other sexually transmitted infections in young women. And, in case there are any eyebrow raises, it’s not just “liberal-minded” academics who advocate for sex-positivity. The World Health Organisation states the need for the promotion of “physical, emotional, mental, and social wellbeing related to sexuality” explaining that sexual health constitutes more than the “absence of disease, dysfunction, or infirmity.”

Sexual health includes physical, emotional, and mental wellbeing including the overall wellness of relationships. Ford argues that from a public health perspective and how we engage with sexual wellbeing, “the reason to emphasise pleasure is because it helps protect people at least as well, if not better than our current approaches.”

According to Mitchell, sexual wellbeing is about “feeling respected, safe, at ease, supported, while also having a sense of self-worth and agency in relation to sex and sexuality” and it’s “integral to consensual, healthy and pleasurable sexual experiences and relationships.” Mitchell summarised six vital components of sexual wellbeing including respect, self-esteem, comfort with sexuality, sexual safety, sexual agency and support in one’s sexual life.

Mitchell and Ford explain that sexual wellbeing is a recent and revolutionary concept in the public health sphere and that historically pleasure has been viewed as frivolous, decadent, and unimportant. For both researchers, wellbeing and mental health are inextricably linked. Ford explains that increasing evidence shows that sexual pleasure and expression have health benefits including lowering mortality rates, improving cardiovascular health, lowering rates of prostate cancer in men, delaying menopause in women, and increasing relationship satisfaction.

Mitchell argues that when it comes to sexual wellbeing, taboos cloud how we discuss it and we should put more focus on the main driver of sex, which is pleasure. She further explains that the move away from a risk-centric approach helps us understand sexual expression that has everyday relevance to real people. In instances where spaces and professionals are geared towards sex-positivity, individuals accessing reproductive health care are more likely to take on beneficial advice.

However, while a pleasure-centric approach is important, Ford asserts that sexual rights are a key component of equality. Pleasure is “part of sexual rights, as human rights, as including diverse sexual experiences and as something that needs to be integrated into policy programme clinics…” Globally, pleasure is unequal and many people don’t have the freedom to expect their pleasure to matter. The key is that in discussions of pleasure, we have to balance sexual rights. This is particularly pertinent in South Africa where gender inequity and gender-based violence are alarming.

Gumbi’s research shines a lens on sexual pleasure and practices among women in rural South Africa and reveals that in the right environment, young women are willing to openly discuss how they enhance sexual pleasure and satisfaction, particularly for their male partners. Gumbi’s research has shown that adolescent girls in her community commonly use over-the-counter products such as Halls lozenges, Stoney Ginger Beer, copper sulphate powder, and nicotine tobacco to enhance their sexual practices to pleasure their partner. Gumbi’s research shows that women prioritise satisfying their partners, reflecting prevailing gender inequality, placing this before their own sexual pleasure. The overarching message is clear– health messaging needs to do more in terms of promoting self-agency and sexual pleasure while also striking a balance between harmful practices.

One cannot discount gender and power dynamics where economically dependent women prioritise their partner’s pleasure. What is positive is that the women who participated in Dr Gumbi’s study did express that their sexual preferences and choices were important regardless of the pressure from male partners. However, structural influences such as inequalities around access to services and education need to be addressed. The anxiety surrounding seeking treatment for sexual health and communicating with partners about sex and sexual pleasure is an issue, and this can be improved through effective sex-positive health messaging.

This is where government agencies, policymakers and educators have a huge role to play in how we frame sexual health. According to Mitchell, government policy should incorporate sex-positive or wellbeing approaches. Globally, only a handful of countries make specific policy commitments that actively promote sexual wellbeing. Despite the gaps in sex-positive and wellbeing approaches, on September 11th 2021, at the World Association for Sexual Health Congress in South Africa, the World Association for Sexual Health Declaration on Sexual Pleasure was signed. This marked a huge step towards pleasure promotion for South Africa.

For too long, society has favoured sexual myths over facts because they’re “easier”. But the question is, easier for whom? The bestselling author Peggy Orenstein had interviews with randomly chosen young women from economically and socially similar Dutch and American universities. When describing their early sexual experiences, the Dutch women reported fewer negative experiences (sexually transmitted infections, pregnancy, or shame) than the American cohort, and more positive outcomes (pleasure, experiencing responsibility, enjoyment). Orenstein concluded that the biggest difference in the groups appeared to be communication. Dutch women explained that they’d received open communication about sex from an early age, which included concepts such as pleasure and mutual trust. On the other hand, the American group received sex and sexual health messaging that was almost entirely framed around risk and danger. This example illustrates how open communication about sex from a young age allows young people to make more informed and confident choices.

Alongside open communication, Mitchell also suggests that we should focus on encouraging conversations about agency and pleasure, rather than focusing on sexual practices. If agency and pleasure are prioritised, then people will start opening up about how they can engage in safer and more equitable sexual practices. Once we shift this conversation, everyone stands to benefit, with Mitchell asserting that “men stand to benefit from women who are finding sex pleasurable and not just being there to fulfil men’s pleasure.”

It’s time we threw out The Big Book of Doom and Gloom and replaced it with The Joy of Sexual Health. The Women up to Know Good, Pleasure Down South: Infusing joy into sexual health and research practices webinar shows that everyone should be talking about sex a lot more openly. As Salt-N-Peppa tried to explain, we also need to talk about the good things, because with great pleasure, comes great responsibility, and in Ford’s words, “Let’s continue to navigate the pleasure wave together”.

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