On July 9, 2001, the Surgeon General of the United States, David Satcher, wrote A Call to Action to Promote Sexual Health and Responsible Sexual Behavior. This Call to Action came because of “the alarmingly high levels of sexually transmitted disease and HIV/AIDS infection, unintended pregnancies, abortions, sexual dysfunction, and sexual violence in the United States.” The Surgeon General noted that if we were going to change these negative public health outcomes that it was necessary to appreciate what “sexual health” is. He began a collaborative process based on a series of scientific review papers contributed by experts in relevant fields; on recommendations developed at two national conferences; and on extensive review from a wide range of experts with representation from the academic, medical, and religious communities, policy makers, advocates, teachers, parents, and youth. The Surgeon General’s collaborative process concluded that many aspects of sexuality are a fundamental part of human life and include not only the physical, but the mental and spiritual as well. Sexuality is a core component of personality, important throughout the entire lifespan, not just the reproductive years.
- A working definition of “healthy sexuality” includes not only individual responsibilities but community responsibilities as well:
- Healthy sexuality includes the ability to understand and weigh risks, responsibilities, outcomes and impacts of sexual actions
- Healthy sexuality includes the ability to practice abstinence when appropriate or reproduce when one chooses
- Healthy sexuality includes freedom from sexual abuse and discrimination
- Healthy sexuality includes the ability of individuals to integrate their sexuality into their lives and derive pleasure from it
Individual Responsibility
- Healthy sexuality requires an understanding and awareness of one’s sexuality and sexual development
- Healthy sexuality is respectful of oneself and one’s partner
- Healthy sexuality avoids physical or emotional harm to oneself and one’s partner
- Healthy sexuality ensures that pregnancy occurs only when welcomed
- Healthy sexuality recognizes and tolerates the diversity of sexual values within any community
Community Responsibility
- A community assures that its members have access to developmentally and culturally appropriate sexuality education
- A community provides access to sexual and reproductive health care and counseling
- A community provides latitude to make appropriate sexual and reproductive choices
- A community respects diversity
- A community provides freedom from stigmatization and violence on the basis of gender, race, ethnicity, religion, or sexual orientation
Given this visionary list of healthy sexuality, how did we as a nation progress to the alarmingly high rates of negative public health outcomes regarding the sexual health of our citizens? In an effort to raise public awareness, advocates have begun to expose the insidious manifestations of our cultural beliefs which involve the corruption and distortion of our sexuality – a primary one being that sexuality is only associated with genitalia.
Brad Perry, MA, of the Virginia Sexual & Domestic Violence Action Alliance states: “Feminist scholars and activists have shown that many of the norms governing important aspects of our life, such as sexuality, exist on a foundation of relatively rigid and well-enforced ideas about gender”: (Brad Perry’s article attached)
Masculine Stereotypes that negatively impact male sexuality
- Males should be dominant, active and aggressive, self-reliant, invulnerable, independent, and exercise power and control
- Males are heterosexual
- Males place importance on penile erections-length, width, hardness, and the ability to stay hard long
- Males do not get sexually assaulted (only gays do)
- Sexual interaction for males is a game to be won and includes the normalization of disrespect and violence
Female stereotypes that negatively impact female sexuality
- Girls are taught to be passive, pleasing, and submissive
- Girls must be “good” girls, but at the same time, girls must be sexually desirable but not grant sexual access too easily or frequently
- Girls are responsible for any negative outcomes of sexual interaction (i.e. rape, pregnancy, devalued desirability)
Brad Perry continues: “Sexuality then becomes an adversarial pursuit where males prove their worth by doing that which will lessen females. The risk of sexual violence is present at numerous levels in this dynamic. It can be used as a tactic for ‘winning,’ and/or it can result from disdain for the defeated opponent. Norms that shame and/or constrain our experience of sexuality also hinder sexual violence prevention efforts (i.e. if you honestly address sexual violence you are often shut down in the name of modesty and decency). Therefore, it is clear that a healthy sexuality perspective is a must for the efforts of primary sexual violence prevention. Safe or consensual sex becomes the bare minimum of our objectives. We need to promote the fundamental principles of healthy sexuality.”
The ultimate goal is for people to view healthy sexuality as an important piece of their own and others’ humanity. Thus individuals in healthy sexual interactions would likely:
- Share with one another instead of doing to one another.
- Have a genuine respect for each other’s wishes—staying wholly connected to heightened intimacy
- Value honest, proactive communication about likes, dislikes, expectations
- Value positive sexual expression in whatever form in takes—connecting more deeply with the emotional, intellectual, spiritual, and social elements of one’s own and one’s partner’s sexuality
- Promote physical sexual health by proactively taking the necessary precautions
To further promote these healthy objectives, the Vermont Network against Domestic & Sexual Violence has begun Joyful Sexuality as Sexual Violence Prevention. The mission of this group is to shift the cultural norms toward joyful and healthy sexuality by creating opportunities for individuals and communities to explore, reclaim, and discover a deeper and more expansive understanding of how sexuality informs our humanity. They began to regain a broad organic definition of sexuality by listening to music and poetry, writing, cooking, eating, finger painting, and talking. A question was posed to discover this deep sense of connectedness: “What are you doing when your body feels the happiest? The workgroup found that the answers were clearly indicative of how very young children are naturally tuned in to their sense of joyful sexuality: petting my dog, singing, running, dancing, jumping on the bed, sharing a toy. If we as humans can move more freely in the connection and sensual delight within us, like very young children do, we will become a culture of whole, sexually healthy adults. Here is where we find the joy of sexual violence prevention.”
We must understand, then, what is natural and healthy sexuality for young children. As a rule of thumb, Toni Cavanagh Johnson, PhD, shares, “remember that we are sexual beings from birth”:
- Sexuality is an information gathering process. Children explore their own bodies and other’s bodies by looking and touching
- Exploration is done with children similar in age, size, and developmental status with participation on a voluntary basis and is mutually enjoyable, lighthearted, and spontaneous
- Interest in physiological sex is balanced with other things
- Exploration includes pleasurable sensations with sexual arousal being a normal physiological response
- Orgasms can happen at any age
It is important to note that unhealthy sexuality would involve coercion or force by older children or adults that produce feelings of shame, guilt, fear, anxiety, anger, or harming self or others.
To understand further: Helen H. Johnson has developed a curriculum called Bodyworks. In her book, The Growing Edge, she shares: “Many adults and children have been taught, explicitly or implicitly, that our bodies are ‘dirty’. We have sanitized and deodorized and compartmentalized essential realities. It is no surprise that we have grown up feeling split from our selves as well as from the web of life which binds all species together. To assist a child to expand the sense of her own body’s power (the power to transform food into energy, then into waste, to pump blood through a web of tiny tubes, to fill and empty her lungs, to send and receive messages, to throw away dead skin and grow new, to keep a place for a baby perhaps to grow, to open and close passageways, to mend broken bones and torn muscles) is to deepen her sense of connectedness between her infant self, her child self, and her adult self. As a child’s sense of her own inner physical self enlarges, so does her sense of belonging among others who share the same wondrous powers. Her awareness is strengthened by her glimpse of the common ‘insides’ beneath unique ‘outsides’. Surface differences—size, age, ability, race, gender—dwindle in significance. Your confidence—that everyone, everything belongs–will help children develop healthy attitudes toward blood and mucus, farts and feces. For our deepest wish as people is to be found, to be known, and to be cherished.”
Various prevention programs are switching from the negative concepts of sexual health to the positive as a way to elevate the discussion from just “consent” to embrace larger concepts of respect and responsibility. A sample “Personal Bill of Rights” from the San Diego High School Student Handbook lists fifteen core rights, including
- Your body is yours to respect and protect.
- You have the right to say “no” to anything that does not feel comfortable to you. You don’t have to give explanations, saying “no” or “I don’t want to” is enough
- You have the right to set sexual limits and you have the responsibility to respect other people’s right to say no to you.
You can begin to imagine how the incidence of sexual assault would be decreased if teenagers were equipped with these core messages.
In conclusion, examining the process by which our sexuality is corrupted and distorted can expose both the range of negative health outcomes in which sexual violence exists and how harmful notions are normalized and reinforced. The next step is to help adults become comfortable with their sexuality and at ease with open discussion of sexual issues which will create a family environment that supports healthy sexual behavior and responsible sexual choices. The premise is if you focus on what is healthy, then you can more easily recognize what isn’t.
Success on protecting our children depends upon the support and open communication by important adults in a child’s life. Nurses can help adults to overcome anxiety about discussing sexual topics. Home parties held in an informal and relaxed atmosphere is a strategy to reach as many people as possible. Another non-threatening strategy is to get the community library involved in providing educational books and videos on self-esteem, healthy sexuality, parenting, and healing of sexual abuse. Book reviews written by clergy, teachers, community leaders, parents, grandparents, and children can be run in the local newspapers, church newsletters, or library newsletters. Nurses can help lead this discussion and focus.
Ending sexual violence requires professionals and community members to blend efforts. Nurses must be committed to creating a socially healthy culture. This extends beyond educational programs to initiatives that enhance the capacity of families to care for their children to include family support programs, such as drop-in centers, self-help support groups, youth leadership training and parenting education. These activities help empower individuals and families and encourage healthy family functioning.
Finally, we must work diligently to challenge the institutions and practices that uphold male domination, the powerlessness of children, the turning of sexuality into a commodity and the glorification of violence and exploration of fellow human beings.
The following critical thinking exercises are meant to stimulate holistic thought. The first exercise has some suggested responses – for the other two, take a minute to think of some possible responses.
Critical Thinking Exercise #1
A mother has brought her 14 year old daughter in for a SANE exam because the mother has caught the daughter having sex with a 16 year old boyfriend. The 14 year old is not using contraceptives.
What might be the physical issues?
Pregnancy, pregnancy risk, sexual activity of a 14 year old, birth control, risk for STD
What might be the psychological issues?
The teen’s understanding of sexuality, the dialogue between mother/daughter, did the youth choose to be “caught” by the mom
What might be the social issues related to this case scenario?
Sex education in the schools, information about safe sex, implications about unprotected sex, how is the teen getting information about sex
What might be the nursing/SANE issues?
What makes this “sexual assault”? Strategies for separating the mom and daughter during the exam, referrals for the daughter, support for the mother in talking about sex
Critical Thinking Exercise #2
An 18 year old Hispanic female who has a 20 year old boyfriend comes in for a SANE exam. During the history, your patient tells you that a 20 year old male acquaintance has sexually assaulted her. She immediately called her boyfriend who tells her it is her fault. She cuts her wrists and neck superficially and goes to the boyfriend’s house to lie in the middle of the road hoping to get run over by a vehicle. The Police were called by onlookers and took the 18 year old to the ER. SANE is dispatched by the ER after medically releasing her.
What might be the physical issues?
What might be the psychological issues?
What might be the social issues related to this case scenario?
What might be the nursing/SANE issues?
Critical Thinking Exercise #3
The police have dispatched SANE. A 21 year old active duty military male has reported that he has been sexually assaulted while passed out from alcohol by a fellow military male that has rank over him. He has pain in the anal area so he thinks he has been anally penetrated.
What might be the physical issues to this case scenario?
What might be the psychological issues?
What might be the social issue related to this case?
What might be the nursing/SANE issues?
References
Brunner, L.S., Sudderth, (1984). Textbook of Medical-Surgical Nursing. Lippincott Williams & Wilkins. Philadelphia.
Johnson, H.H., Eccleston, H.W., Palmer. P.J. (1994). The Growing Edge: Teaching & Learning Through the Bodyworks. Bemini Press
Johnson, Toni Cavanagh. (1999). Understanding Your Child’s Sexual Behavior. What’s natural and Healthy. New Harbinger Publications, Inc.
Perry, B. (2004). Beyond Consent: Healthy Sexuality & Sexual Violence Prevention. Moving Upstream, VSDVAA newsletter.
Satcher, D. (2001, June). A Call to Action to Promote Sexual Health and Responsible Sexual Behavior. Office of the Surgeon General.