Medicine and Sex Positivity
What does it mean to be sex-positive?
Sex positivity, in simple words, means keeping a positive attitude towards sex, being comfortable with one’s sexual identity as well as others’. Sex-positive culture emphasises on sex being a positive aspect of life, an activity that a person can enjoy without feeling shameful or guilty. This might seem to be a very obvious idea, but with the constellation of taboos and restrictions built around the normal and very natural act of sex, it becomes extremely important to talk about it in a constructive manner.
It goes without saying that our entire society reeks of sex-negativity. Whether it's a neighbourhood aunty gossiping about your visible bra-strap, parents being told not to breastfeed their children in public, or a gynaecologist asking if you’re married instead of whether you are sexually active; it’s quite a long list.
Impacts of sex-negativity
Sex negativity approaches sex and sexuality from a place of fear, oppression, and stigma. It propagates the belief that sex is dirty, vile, and unnatural. Having a highly negative outlook on sex can lead to violence against sex-workers, rape culture, slut-shaming and victim-blaming.
On an individual level, it can adversely affect one’s mental health, inhibit sexual pleasure and interfere with the way you perceive and react to other people’s sexual behaviour. Most people have this internalised prejudice that can be overcome only by conscious efforts to embrace and explore sexuality and sexual behaviour. This becomes even more difficult owing to cultural and religious bars, and a complete lack of sex education, (or abstinence-only sex education.) In our country especially, parents do not have ‘the talk’ with their children, leaving the responsibility to the internet and equally ignorant peers.
Sex positivity in Healthcare
Sex-positive healthcare practitioners understand that: 1) sexuality is a vital component of overall health and well-being; 2) the sexual spectrum is vast, and includes preferences and practices very different from one’s own preferences and practices; and 3) everyone is entitled to comprehensive health education and professional, compassionate, judgment-free care.
It becomes extremely important for healthcare providers to be sensitised to mete out services in a method that is comfortable and smooth, both for the doctor and the patient. Sexual history taking has been established essential for diagnosing sexually transmitted infections (STIs), but sexual health encompasses a wider sphere. Although STI prevention is a public health priority, it should not be our only goal in treating individuals. There should be a parallel focus on addressing sexual pleasure, intimacy and healthy relationships. Some sexual minority groups exhibit troubling health disparities. Many of these disparities can be traced to discrimination which is rampant in our society.
When patients feel scared or uncomfortable in healthcare settings, they may avoid seeking treatment. Candid, respectful conversations about sexual wellness should be a routine part of comprehensive healthcare. Sexual minorities experience health care disparities that will be eliminated only if doctors elicit information about sexual orientation and gender identity from their patients through thoughtful, non-judgemental discussion and history-taking.
Where do we stand?
India has recorded a large number of sexual abuse cases over the last few years, and sex-positivity may be the answer to reducing it. A recent report by UNESCO on comprehensive sexuality education (CSE) points out the urgent need for imparting this education to young people to help them lead healthy and sexually satisfying lives. With one-fourth of our population between 10-19 years, India is the youngest country in the world. We are likely to have 358 million young people in the next three decades. We need to empower people to make informed decisions about their contraceptive choices, which should be accessible and available openly, and not just under the banner of “family planning”.
Data collected from the 13 states surveyed in Phase 1 from the latest National Family Health Survey show that 82% of women and 70% of men lacked comprehensive information about HIV/AIDS and safe sex practices. In India, the subject of sex education has been a controversial one. In 2007 when the Centre, along with the NACO, NCERT and UN agencies announced the launch of the Adolescence Education Programme in schools, 13 states announced an immediate ban who felt comprehensive sex education is “against Indian culture”. There is a glaringly obvious disparity in the healthcare system. For example, transgender people do not have a separate ward in any hospital or any beds reserved for them. Many people want to undergo hormonal therapy and sex reassignment surgery (SRS). Unfortunately, they are denied these services in the majority of hospitals. Many of the surgeries are done without prior assessment, psychiatrist consult, hormonal therapy and real-life understanding or even proper aseptic precautions. Healthcare providers should be made to undergo an extensive gender sensitisation and training program before they can start treating patients. There is an urgent need to standardize SRS guidelines for the Indian transgender community and make these services affordable and accessible in all the hospitals.
The path ahead
Becoming a sex-positive person requires an ongoing dedication to becoming increasingly inclusive and aware. It requires a commitment to practising anti-oppressive philosophies and practices. It is a continuous process and requires patience and courage to accept things that we might not agree upon and to not impose our personal beliefs on others. We have to challenge what we thought was correct, unlearn redundant concepts, and consciously indulge in areas out of our comfort zones.
References:
https://www.issm.info/sexual-health-qa/what-does-sex-positive-mean/
https://cdn.ymaws.com/www.nursepractitionersoforegon.org/resource/collection/CD93CD1B-53DC-44DB-8EF4-F3B02E0E1AB2/312-Handout-NPO2016Con.pdf
https://www.business-standard.com/article/punditry/why-india-needs-a-sex-positive-approach-116020200529_1.html
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3657897/