Saturday, August 16, 2008

Sexual Health and Sexual Behavior/Expression

Throughout history, there have been attempts to define the range of sexually appropriate behavior. Within the Judeo-Christian Tradition, for example, the Holiness code of the early Israelite community was an attempt to define healthy sexual behavior which reflected their values, knowledge and community goals. As a small nomadic people, sexually healthy behavior reflected and emphasized procreation. As a patriarchal society, women were seen as property so most of the holiness code focused on male sexuality. As a society with limited information on current biology, the code attempted to identify sexually healthy behaviors as a function of blood and energy: loss of blood equals loss of energy and reflects a threat for survival. During the time of her period, women were to be avoided. Fast forward two thousand years and we have a Europe dominated by the Romans with a new religion slowly distinguishing itself from the pagan sexualities. Hence anything that reflected the pagan traditions was ultimately rejected. Fast forward another 2000 years, and we have a society that is unlike any previous society with its corresponding attempts toward defining sexual behavior. Our understanding of biology, genetics, and multi-cultural reality results in a variety of definitions of sexual health.

Perhaps the most frustrating aspect of the current debate in the field of sexual compulsivity is the same struggle that has occurred across time and is bound to fail. Many of the past attempts to define sexual health behaviors have emphasized actual sexual acts and condemned the behavior within the context of a religious statement. “This act is unhealthy, it is a sin.” As a result these definitions are culturally and time bound. Too often clients are stuck in the trap of asking the “expert” to define what he or she can do moving forward. Too often clinicians are readily open to defining what is and isn’t healthy based on their world view. These clinicians, in my opinion, fall into the same pitfalls of the historical attempts of defining healthy sexual behavior

In the last twenty-five to thirty years, experts in the field of human sexuality have also attempted to define sexual health. The definition of sexual health used in this book highlights the debate and development. While not reviewed here, the process of defining sexual health has experienced multiple revisions, discussions and bumps along the way. At one point, it was argued that a universal definition was not possible given the diversity of people, sexualities, cultures, and circumstances. The more recent attempts have attempted to facilitate an interaction between the individual and culture by incorporating a dynamic feedback process in clarifying sexually healthy behaviors.

What you won’t find in this book is a list of healthy/unhealthy behaviors. (In my opinion, there probably are very behaviors that are unhealthy. What few unhealthy behaviors are included below.) Rather than a list, my goal is to help you start thinking about the values that shape your life. In identifying these values, your responsibility is to assess the consistency between your values and your behaviors. The discussion below highlights a few critical values that I think are important. I recognize that these reflect my values. They are designed to help you start your conversation for yourself.

Unhealthy Sexual Behaviors

Generally speaking, the consensus among experts in a variety of fields (medicine, mental health, child welfare, and clergy) is that unhealthy sexual behaviors are defined as any behaviors that are exploitive or done without consent. For example, exploitation of children is one of the few universal consistent behaviors that have been condemned across time.

Problems with Identifying Unhealthy Sexual Behavior.

Yet, even this example has some problems. There are grey areas. In modern America, the definition of a child who can give legal consent for sexual contact ranges from ages 14 (Idaho) to 18. Centuries ago, it wasn’t uncommon for a 12-year old girl who just completed puberty (i.e., had a period) to be considered an adult. Today, our collective culture would define this as abuse. Another grey area is questions of exploitation. Many individuals against the pornography industry argue that the material exploits women. These grey areas highlight the ongoing danger and difficulty of universal declarations.

An example sure to raise hackles is the emphasis by a significant group of people in the world which suggests that only sexual behavior focused on procreation within a marriage relationship is the only form of healthy sex. Any sex act that isn’t open to procreation, even within a marriage, is a sin. This approach includes any masturbation and use of pornography as a sin. Some people have modified this approach to emphasize that sex within a marriage relationship is healthy. Others continue to modify this approach that consensual sex within a marriage is healthy recognizing that some traditions emphasize the wife’s religious duty to submit to her husband. Recently, there has been a push within the GLBT community to emphasis monogamy as the only form of healthy sex and the need for marriage rights as a validation of these healthy behaviors. Sadly, where the line of healthy/unhealthy sexual behavior is drawn seems to depend on what side of the line that you fall on. If you’re “outside” the line, you redraw the line to include your sexual behaviors.

Healthy Behaviors

The approach taken in this workbook and highlighted in the recent development of definition of sexual health is to emphasis a dynamic process between the community and the individual. Your values shape what behaviors are healthy for you. However, this is not a free-for all. Part of the process includes disclosure and community conversations via your support network and your prevention plan. This will be discussed below. The rest of this conversation is a process of presenting certain values that may be helpful in defining healthy sexual behaviors. As part of Stage three, you will be asked to identify both values and sexual behaviors that are congruent and reflect your personal definition of sexual health. This topic is designed to help you start that reflection process.

1) Generativity. Generativity is the experience that any sexual behaviors makes you alive and energized as part of the experience. In this value, your personal identity is affirmed, created and even expanded. You can walk away from the experience with your head held high. There is a sense of fulfillment and even pride in the experience. While life giving, generativity doesn’t necessarily mean the experience is “great sex” but rather the identity and personhood of those involved is enhanced. Sexual behavior is sometimes referred to as “adult play” suggesting a sense of fun, playfulness, and sense of timelessness. Review the topic “Reasons for having Sex.” The behaviors reflect healthy reasons for having sex.

2) Open and Honest. Healthy sexual behavior is above board, open, and honest. Full consent and awareness are present in the encounters. While you may not talk about the incident because of discretion, you could disclose the activity to your support network. And in the disclosure the support network would be able to conclude that the behavior is consistent with your declared values and prevention plan.

3) Consensual and Mutual. Consent implies that all partners are actively giving permission to engage in the behavior. For consent to be present, this requires appropriate disclosures and considerations. This measure assumes that full disclosure has occurred with your partner, including risks for STIs, pregnancy, relationship status/availability or any number of measures. There is a decidedly lack of manipulation in the experience (i.e., if you love me, you’d have sex with me).

It is important to highlight that in some circumstances, consent is not possible. Children, for example are not able to give consent. Relationships with power differences (for example, student/teacher, boss/employee, therapist/client) are by definition non-consensual. Other circumstances exist where the ability for parties to give consent is questionable including impairment due to mental health issues, chemical use, and/or financial status (prostitution also known as survival sex). Another notion within consent is that all parties need to be aware of the experience, which is why exhibitionism and voyeurism are defined as unhealthy (as well as illegal).

Finally, within the concept of mutuality is the concept of respect for the partner’s boundaries and limits. If consent is removed (i.e, stop, no, I don’t want to), the behavior must stop. Consent can be removed by any person in the experience at any time. The removal of consent does not require a reason; it simply is.

4) Responsibility. As a value, this requires you to fully assert your sexual needs, likes and dislikes. How are you protecting your values? It isn’t up to the other person, rather it is up to you to affirm and do the necessary reflection for the protection and communication of the values.


Review the topic Sex History.” As you look at all the behaviors you may have done, how many of these behaviors are consistent with the values above? If they aren’t, I’d encourage you to remove them from the list of sexually healthy behaviors. Anything that remains would be a candidate for a “healthy behavior.” The last task is to finish the Topic Defining your personal Definition of Sexual Health and Creating your Future. Again review the candidate list of healthy behaviors. Which behaviors remain? Review this list with the support network. What behaviors remain? This is the list of healthy behaviors to be included in your Personal Definition of Sexual Health.

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