Sexual health: Towards an integrated framework Dr Charlene Rapsey Department of Psychological Medicine University of Otago

Overview 1.Sexual health frameworks and background 2.From safe sex to good sex: Sexual health and lifestyles project 1.Prevalence of sexual difficulties 2.Predictors of sexual difficulties 3.Implications for intervention 4.Questions

World Health Organisation Definition of Sexual Health Sexual health is a state of physical, emotional, mental and social well-being in relation to sexuality; it is not merely the absence of disease, dysfunction or infirmity. Sexual health requires a positive and respectful approach to sexuality and sexual relationships, as well as the possibility of having pleasurable and safe sexual experiences, free of coercion, discrimination and violence. For sexual health to be attained and maintained, the sexual rights of all persons must be respected, protected and fulfilled. (WHO, 2002)

(Adapted from Mason Durie's Whaiora: Māori Health Development. Auckland: Oxford University Press, 1994, page 70).

“Human sexuality researchers, relationships researchers, and HIV prevention researchers have not often fused their research programs” (Noar, Zimmerman, and Atwood, 2004).

…fragmented across many social science disciplines with little integrative or collaborative efforts evident… sexuality is negatively viewed as the source of problems and disease rather than an integral part of human development and health… (Di Mauro, 1997)

“…adolescent sexual dysfunction is an oxymoron.” (Tolman, 2002b, p. 197)

RISK alcohol Condoms STIs Pregnancy Chlamydia Media sex Climate change Risk HIV/AIDS Teen parent Safe sex Condoms RISK Condoms Pelvic inflammatory disease Infection Disease contraception STIs contraception disease pregnant infection pregnant drugs HPV party Britney Spears HIV Reproductive management Birth control protection infection SAFE Adolescent Sexual Health No hubba hubba Genital herpes

From safe sex to good sex.

Method Late Adolescent Sample N = 209 First-year tertiary students (University, Polytechnic, Teachers’ College) Living in halls of residence Participants aged (mean = 18 years) Questionnaire: opt-in, 30-50% representation

Descriptives - Females

Descriptives - Males

Sexual satisfaction/difficulties and sexual risk behaviour Late adolescent sample

Sexual Risk-Taking and Sexual Difficulties: Males Sexual Risk Behaviours rp Sexual Satisfaction-.28**.006 Erectile Difficulties.24*.016 Early Ejaculation.25*.010

Sexual Risk-Taking and Sexual Difficulties: Females Sexual Risk Behaviours rp Sexual Satisfaction-.25**.005 Sexual pain Orgasm difficulties.22*.011

Sexual satisfaction/difficulties and relationship satisfaction Late adolescent sample

Relationship satisfaction and Sexual Difficulties: Males Relationship Satisfaction rp Sexual Satisfaction.48**.000 Erectile Difficulties-.22*.048 Early Ejaculation-.23*.033

Relationship satisfaction and Sexual Difficulties: Females Relationship Satisfaction rp Sexual Satisfaction.43**.000 Sexual pain Orgasm difficulties-.31**.001

Time together and Sexual Difficulties Time together rp Males Sexual Satisfaction.53**.000 Erectile Difficulties-.27*.015 Early Ejaculation-.23*.040 Females Sexual Satisfaction.48**.000 Sexual pain Orgasm difficulties-.50**.000

“We have overlooked the very reason for coupling, namely to be intimate with another person” (Wright, 1998)

‘When you come to it, you feel like a dork asking a guy to put a condom on’ (Abel and Fitzgerald, 2006)

Conclusions Sexual health is comprised of physical, mental, emotional, and social elements A wellbeing perspective benefits for multiple sexual health outcomes.  An integrated approach may allow for more effectively targeted interventions.

Acknowledgements Associate Professor Oliver Davidson Department of Psychological Medicine Libby Schaughency and Tamar Murachver Andrew Gray Amy Smith and Katie Ryan University of Otago School of Medicine “Finishing your PhD” scholarship Participants and Halls of Residence staff