Sexual pleasure: An assessment tool

The Global Advisory Board (GAB) for Sexual Health and Wellbeing is proud to present this innovative, practical tool aimed at supporting sexual and reproductive health (SRH) programme designers and managers to incorporate sexual health, sexual rights and sexual pleasure as an integrated approach.

The tool can be used to improve SRH service delivery, sexuality education and sexual health programmes by adequately address sexual pleasure and the links with sexual health and sexual rights.

 

1. BACKGROUND

The GAB’s triangle approach


The Global Advisory Board (GAB) for Sexual Health and Wellbeing was convened by Durex to advocate for a positive and inclusive approach to sexuality. The GAB is committed to promoting the integration of sexual pleasure in sexual and reproductive health (SRH) policies, programmes and activities to enhance their quality. Our goal is “to positively influence attitudes, behaviour, technical, legal and policy interventions towards better sexual health, sexual rights and sexual pleasure.”

Sexuality Triangle

There has been a lack of clarity among policymakers, practitioners and advocates about how to conceptualize and integrate sexual pleasure and sexual rights in the delivery of SRH programmes, services, information and education. As GAB Board members, we therefore designed a conceptual framework – the triangle approach – that combines sexual health, sexual rights and sexual pleasure and clearly shows the links between them.

Based on the triangle approach, we formulated a working definition of sexual pleasure:

‘Sexual pleasure is the physical and psychological satisfaction and enjoyment derived from solitary or shared erotic experiences, including thoughts, dreams and autoeroticism. Self-determination, consent, safety, privacy, confidence and the ability to communicate and negotiate sexual relations are key enabling factors for pleasure to contribute to sexual health and wellbeing. Sexual pleasure should be exercised within the context of sexual rights, particularly the rights to equality and non-discrimination, autonomy and bodily integrity, the right to the highest attainable standard of health and freedom of expression. The experiences of human sexual pleasure are diverse and sexual rights ensure that pleasure is a positive experience for all concerned and not obtained by violating other people’s human rights and wellbeing.’ (GAB, 2018)

Our definition of sexual pleasure recognizes the physical and psychological dimensions of pleasure and the possibility of experiencing it alone or with partners. It identifies six enabling factors for sexual pleasure to contribute to sexual health and wellbeing: self-determination, consent, safety, privacy, confidence and communication/negotiation. These factors are grounded in sexual rights and constitute the conceptual links between sexual health, sexual rights and sexual pleasure. Along with physical and psychological satisfaction/enjoyment, they form the basis of this tool.

  1. INTRODUCTION TO THE ASSESSMENT TOOL

This innovative, practical tool shows you how to integrate the GAB’s triangle approach in your work, assess programmes, and make the approach more tangible and visible. The tool advances our vision by highlighting the importance of sexual pleasure and considering sexual health, sexual rights and sexual pleasure equally. It’s based on two principles:

Inclusivity: We believe that everyone – across all sectors of society – should be respected and their sexuality valued, regardless of their age, sexual orientation, gender identity and expression, race, ethnicity, disability, practices, socio-economic background, HIV status or any other characteristic. Everyone should be able to enjoy the same rights and opportunities, including decision-making in sexual and reproductive health and rights (SRHR).

Sex-positivity: We believe that sex isn’t something to be embarrassed about or ashamed of. We promote a positive attitude to sex and respect others’ sexual preferences. Sex-positivity is defined as an open, accepting stance toward sexuality: this involves perceiving each person’s sexuality as a unique, multifaceted set of values, experiences and preferences. Sex-positivity entails developing self-awareness about sexual values and any assumptions we may have about different sexual practices.[I]

 

[I] Robinson BB, Bockting WO, Rosser BR, Miner M, Coleman E (2002). The Sexual Health Model: application of a sexological approach to HIV prevention. Health Education Resource. 17 (1) 43-57; Williams DJ, Thomas JN, Prior EE, Walters W (2015). Introducing a multidisciplinary framework of positive sexuality. Journal of positive sexuality. Vol 1 Issue 1.

2.1 Why use the tool?

The tool can benefit your work in many ways.

It creates the opportunity to explore programmatic links between sexual rights, sexual health and sexual pleasure.[II],[III] When healthcare providers and educators don’t talk about sex or sexual pleasure, perhaps due to taboos and discomfort, this restricts explanations of SRH issues. Evidence shows that a failure to address sexual pleasure not only detracts from an exploration of sexuality but also limits conversations about the real concerns related to libido and eroticism.[IV] Contraceptive programmes often deny women’s sexuality and sexual pleasure or emphasize – especially in adolescent pregnancy prevention policies – that “sex isn’t for fun”. 

Establishing sexual pleasure as a starting point, however, can provide a more comprehensive and positive focus on sexuality and sexual health and help people make informed decisions about sexual relationships and avoid risks.[V] It can counteract any incorrect assumptions health professionals might have about clients’ sex lives and sexual relationships that could lead to inappropriate information and care.[VI]

The triangle approach, which underpins the tool, promotes understanding of inequities in sexuality, sexual health, sexual orientation, gender identity and expression. The tool will improve individual health and wellbeing by developing people’s critical thinking skills to challenge social norms. It enables you to show solidarity with people whose (sexual) rights are denied and lend them support, particularly young people, sex workers, people with disabilities, LGBTIQ people and people living with HIV. Using the tool can raise awareness, promote fulfilment of everyone's sexual rights, and foster advocacy for marginalized populations.

We know that the repression of female pleasure is linked to female disempowerment.[VII] In many countries, unmarried young people, particularly young women and girls, are unable to exercise their fundamental sexual rights: this is a root cause of many reproductive health issues.  And yet, SRH services, information, education and communication programmes often focus on ‘safe’, uncontroversial issues, such as maternal mortality, and solely emphasize the risks of sex and sexuality.[VIII] In contrast, this new tool provides a balanced, nuanced way to address sexual rights and sexual pleasure in your work and adopt a gender-transformative approach.

Finally, the tool can create synergy between international definitions and agreements on SRHR and increase the effectiveness and quality of SRH programmes.

 

[II] Anderson RM (2013). Positive sexuality and its impact on overall well-being. Bundesgesundheitsblatt - Gesundheitsforschung - Gesundheitsschutz 2. 

[III] Ford JV, Corona Vargas E, Finotelli Jr I., Fortenberry JD, Kismödi E, Philpott A, Rubio-Aurioles E and Coleman E (2019). Why pleasure matters: its global relevance for sexual health, sexual rights and wellbeing. International Journal of Sexual Health, 31:3, 217-230, DOI: 10.1080/19317611.2019.1654587.

[IV] Higgins JA, Smith NK. The sexual acceptability of contraception: reviewing the literature and building a new concept. J Sex Res. 2016;53(4-5):417–456. doi:10.1080/00224499.2015.1134425.

[V] McGeeney E (2015). Young people, sexual pleasure and sexual health services: what happens when “good sex” is bad for your health? In: Wright, Katie and McLeod, Julie (eds.) Rethinking youth wellbeing: critical perspectives. Springer, pp. 91-108. ISBN 9789812871879.

[VI] Higgins JA, Hirsch JS (2007). The pleasure deficit: revisiting the “sexuality connection” in reproductive health. International Family Planning Perspectives.

[VII] Jolly S, Cornwall A, Hawkins K (2013). Women, sexuality, and the political power of pleasure, Zed Books.

[VIII] Hirst J (2013). ‘It's got to be about enjoying yourself’: young people, sexual pleasure, and sex and relationships education, Sex Education, 13:4, 423-436. J.Hirst (2018). Developing sexual competence? Exploring strategies for the provision of effective sexualities and relationships education, Sex Education, 8:4, 399-413.

2.2 What is the tool for?

The aim of the tool is to support SRH programme designers and managers to check whether sexual pleasure and sexual rights have been incorporated in their work, and to showcase this integrated approach. The tool can be used to assess existing programmes and activities or develop new ones.

Specifically, it enables you to:

  • Assess the comprehensiveness of SRH programmes by focusing on specific enabling factors of sexual pleasure (See 3.0), linked to sexual health and sexual rights, and identifying strengths and weaknesses.
  • Set benchmarks and track progress in incorporating sexual pleasure and sexual rights in SRH programmes.
  • Inform the debate and strengthen advocacy by making available information on the importance of sexual pleasure in a way that is clear, accessible and easy to analyse, tailored to different audiences.

This tool does not provide an overall assessment of the content, quality, delivery, pedagogy or implementation of programmes. Instead, it focuses on specific factors of sexual health, sexual rights and sexual pleasure and the conceptual links between them.

2.3 Who is the tool aimed at?

The target audience is broad. The tool can be used by staff of both governmental and non-governmental organizations, by management as well as staff on the ground. It’s aimed at anyone involved in improving service delivery and sexuality education/sexual health programmes, for example, it can help standardize programmes and activities.

We anticipate that users will include people involved in:

  • Designing, implementing or monitoring SRH services, whether stand-alone or integrated. (Refer to the essential package of SRH interventions developed by the Guttmacher-Lancet Commission on Sexual and Reproductive Health and Rights).
  • Developing and implementing curricula and educational materials, including sexuality education curricula, inside and outside the school setting.
  • Training and building the capacity of health professionals, medical students, teachers, educators, social workers, human rights defenders and advocates.
  • Developing information, education and communication materials on SRHR, including for websites, social media platforms and campaigns.
  • Promoting sexual health, sexual rights and sexual pleasure for all.

2.4 How was the tool developed?

The tool is informed by and based on a growing body of research, experiential evidence and promising practices.

This document is a work in progress. We understand that the tool will need to be adapted for use in different contexts, settings and programmes. New lessons learnt will be incorporated at a later stage.

This version will be trialled in several countries. Ongoing feedback will ensure that the tool is relevant, easy to understand and simple to use.

  1. USING THE ASSESSMENT TOOL

To carry out the assessment, in Section 4 you will find a number of statements that are presented as “gold standards”: benchmarks or aspirational goals to aim for in your work. These represent an ideal vision. Most programme activities won’t attain this standard, but this tool will help you identify which elements of your work should be strengthened.

You can use the statements as a checklist for your programme and activities. The statements are based on our lessons learned, some promising practices and international literature on sexual health, sexual rights and sexual rights. They focus on programmatic issues but also address conditions that need to be in place to create an enabling environment for the activities.

There are three sub-sections (4.1–4.3) that list:

  • Statements outlining overarching principles on inclusivity and sex-positivity (See 4.1).
  • Statements to assess the degree to which sexual pleasure and sexual rights have been incorporated in three SRH categories:
    1. Sexuality education (See 4.2 A)
    2. Sexual and reproductive health services (See 4.2 B)
    3. Social media campaigns and information (See 4.2 C).
  • Statement to assess the creation of a supportive enabling environment for the concepts of sexual pleasure and sexual rights (See 4.3). They can be applied to sexuality education, SRH services and social media campaigns and information. Both strategic and management statements are included.

These statements are based on the enabling factors in the GAB’s definition of sexual pleasure, namely: physical and psychological satisfaction/enjoyment, self-determination, consent, safety, privacy, confidence and communication/negotiation. See below for an explanation of terms.

ENABLING FACTORS IN THE GAB’S DEFINITION OF SEXUAL PLEASURE

  • Physical and psychological satisfaction/enjoyment: everyone – regardless of age, sexual orientation, gender identity and expression, race, ethnicity, disability, practices, socio-economic background, HIV status or any other characteristic – can enjoy their sexuality in the way they choose.
  • Self-determination: people’s capacity to make free choices regarding their sexuality.
  • Consent: actively agreeing to have sex or engage in sexual activity.
  • Safety: encompasses physical and emotional safety in sexual relationships. It also refers to safer sex, including condom use; contraception; safe abortion; HIV/STI testing, prevention, treatment and care; pre-exposure prophylaxis (PrEP) and post-exposure prophylaxis (PEP).
  • Privacy: enjoying sexual activity (alone or with others) in private.
  • Confidence: feeling comfortable in one’s own sexuality and feeling good about the decisions taken in one’s sex life.
  • Communication/negotiation: communicating openly about sex and sexuality and discussing expectations with partners: what they want and don’t want to do.

 

In each category, we provide links to further resources on the issue and how it can be applied to programmes. For example, for comprehensive sexuality education (CSE) we provide a link to examples of programmes and curricula that are in line with our overall principles.

How to use the tool

The assessment tool can be used by individuals to check whether the programme adequately addresses sexual pleasure and the links with sexual health and sexual rights. But it works best when you bring together a group of people – including staff, volunteers and beneficiaries – who are involved in the programme activities. For example, when assessing clinical services, we advise you to bring together medical and non-medical staff, educators, managers, volunteers, representatives from the community, clients and external experts. A facilitator is required.

Instructions on how to use the tool:

  • By discussing the statements in a group, you will be able to identify which areas need more attention or have room for improvement.
  • It’s worth filling in all the sections even if you are unable to address or change the issues described in the statements. This will give you an idea of what needs to be in place to strengthen the focus on sexual pleasure, linked with sexual health and sexual rights.
  • You need to decide which sub-section is most useful to your programme. We are aware that not all questions may be relevant to your work. We may not have included everything.
  • For each statement, fill in the columns that relate to whether your work addresses the issue, doesn't address the issue, or inadequately addresses it. There is room for comments and actions to improve the situation. Do fill in the comments: this will help with future planning.
  • You or your team need to analyse the answers and discuss why certain areas are not in place or only inadequately. As with any analysis or assessment, the results need to be shared with relevant stakeholders for approval and validation.
  • The assessment is a first step in strengthening programmes. It highlights major gaps: it’s up to you to decide which gaps need to be prioritized. You may not be able to change everything, especially when it involves changes in policies or institutional approaches. You may, however, decide to advocate for change at all levels of your organization.
  • Draw up an action plan to address the most urgent issues. See Annex 2 for an example.
  • Decide how to monitor progress and ensure adequate follow-up. See FOLLOW-UP.

Cultural context and the triangle approach

The GAB believes in a culturally sensitive approach. But we also believe that our work should be firmly based on evidence. It is only through dialogue that we can begin to address complex, sensitive issues regarding sexuality. Finding common ground between faith and sex-positive values of dignity, equality, respect and compassion is vital.

You must be aware of existing evidence – this should be the baseline for the assessment.  To be able to respond to the statements, you also need to have in-depth knowledge of existing laws and policies in your country.

To adapt the assessment to your own context, you must know your demographic: identify and work with them to understand their context, realities, communities, safe spaces and identities. You must be aware of existing norms while defining a minimum of what you would consider an effective triangle approach. It’s helpful to address primary concerns first, such as violence, abuse and freedom of expression.

4. THE ASSESSMENT TOOL

4.1 Assessment statements on overarching principles for all programmes

4.2 Assessment statements for three areas (sexuality education, services, and social media campaigns and information)

A. Assessment statements for sexuality education

These assessment statements can be used to develop curricula and educational materials as well as assess existing ones. The statements are limited to the content of sexuality/comprehensive sexuality education (CSE) programmes in formal and non-formal settings. The delivery and implementation of sexuality/CSE programmes are not included. When reflecting on the statements, consider learners’ age, background, context and evolving capacity.

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Self-determination

Sexuality education programmes that promote social inclusion help ensure that the programme is not heteronormative. Sexual diversity is still a controversial topic, which is rarely addressed in sexuality education curricula. Some curricula show some form of acceptance, but hardly any celebrate (sexual) diversity beyond heterosexual relationships.

B. Assessment statements for sexual and reproductive health services

In order to fully embrace sexuality and sexual pleasure, health professionals need to become more open and accepting of a diverse range of relationships and sexual preferences, beyond heteronormative monogamy. Many providers may find this difficult, but training and becoming familiar with alternative relationships can help. It should also be remembered that effective communication and acting ethically (such as honesty, openness and negotiating boundaries) are key ingredients for all healthy relationships, regardless of their styles or structures.

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Gender-based violence

Sexual and reproductive healthcare providers must be able to provide empathetic care to those clients who may be experiencing abuse to enable them to seek further help and support. Nurses and other health professionals need appropriate knowledge and skills to do this and support clients to begin the gradual process of integrating sexual pleasure in their lives again in a positive way.

C. Assessment statements for social media campaigns and information

Social media provides a vast amount of resources on a variety of topics relating to sexual health, sexual rights and sexual pleasure. It is often the main source of information for young people, engaging those who are not particular interested in sexual health. But sexual pleasure remains a controversial issue, and discussion focuses on the impact of pornography on young people.

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Safety

Forms of sexual violence online:

  • Cyberbullying is harassment via the internet or mobile phone. Cyberbullying can have extremely negative effects, with victims reporting sadness, hopelessness, powerlessness and even suicidal thoughts.
  • Sexting is the private exchange of sexual images and texts that people (usually young people) have created themselves on phones or the internet. Although it can be exciting and informative, sexting can also have negative consequences. Once online, the texts and images can never be entirely deleted and can be used to hurt the person who has shared them.
  • Grooming is when someone builds an emotional connection with a child to gain their trust for the purposes of sexual abuse, sexual exploitation or trafficking. Children and young people can be groomed online or face-to-face, by a stranger or someone they know, for example a family member, friend or professional. Groomers may be male or female, and any age.

Sextortion takes different forms, but at its core it is the threat to expose sexual images in order to make a person do something. These threats come from both strangers met online and once intimate partners attempting to harass, embarrass and control victims.

4.3 Assessment statements for your organization/programme: creating an enabling environment

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Policies

Organizations should have policies in place that enable people to claim their sexual rights. Sexual rights embrace the right to a safe and full sex life, as well as the right to make free, informed, voluntary and responsible decisions about one’s sexuality, sexual orientation and gender identity, without coercion, discrimination or violence. Policies should uphold the right to information and the means necessary for people to enjoy good sexual health and reproductive health. Organizations need to understand and enforce a positive, open and accepting approach to sexuality.

  1. ACTION PLANNING

What happens after the assessment?

Review the results.As a group, identify the most critical areas that need attention. It’s a good idea to start with ‘low hanging fruit', but don't forget the more challenging areas. Often the reality is complex, and people carrying out the assessment wish they had more options. For example, in Section 4.2b, the answer may only apply to services for young people, not for adults. In this scenario, describe different realities in the comments column.

When you want to address a gap or challenge faced in the assessment, it may be helpful to explore the reason for the gap. The ‘why-why-why’ approach can be useful. This is an iterative interrogative technique – derived from an anecdotal observation of the number of iterations needed to resolve the problem – used to explore the cause-and-effect relationships underlying a particular issue. The primary goal of the technique is to determine the root cause of a problem by repeating the question ‘Why?’ three times. Each answer forms the basis of the next question. However, not all problems have a single root cause. To uncover multiple root causes, the method must be repeated, asking a different sequence of questions each time. The method provides no hard and fast rules about the line of questions to explore, or how long to continue searching for additional root causes. Therefore, even when the method is strictly followed, the outcome still depends on the knowledge and persistence of the people included in the review.

Make an action plan. Based on your analysis, you can draw up an action plan outlining the first steps needed. Consider these questions:

  • How strong is the institutional commitment to change?
  • Is there financial commitment and potential for sustainability?
  • Where can we find active support for the creation of an enabling social environment to bring about change?

See Annex 2 for an example of an action plan.

  1. FOLLOW-UP

This is a new tool: a first step in introducing sexual pleasure and sexual rights in SRH programming and assessing their inclusion. It’s important to monitor and reflect on progress on an ongoing basis.

Depending on the stage you have reached in developing a new programme or assessing an existing programme, indicators or markers of progress should be identified, aligned to the approach and the expected change you want to see. If indicators are developed, they should be specific, measurable and tailored to the context: reflecting the local vision of what it means to implement the triangle approach.

It can also be helpful to ask: ‘What does change look like?’ and to identify milestones to be reached after a certain period, for example six months.

  1. CONCLUSION

Organizations, institutions and individuals who want to use the assessment tool to strengthen the focus on sexual pleasure in a CSE programme, SRH services or social media must commit to a journey that takes time.

Adopting the GAB’s triangle approach can be challenging as sexual pleasure and sexual rights are a neglected area. Even when they are promoted or addressed in international guidelines or standards, they are often overlooked in programmes. Societal norms and personal values can also be at odds with an innovative approach that focuses on sexual pleasure and sexual rights.

However, the benefits are numerous. Enabling people to enjoy and express their sexuality – regardless of age, disability, sexual orientation, gender identity or expression – will enhance their health and wellbeing. Beneficiaries, providers and programme managers will all gain from this approach. And by showing solidarity with marginalized groups whose sexuality has been repressed, and challenging harmful social norms, you will empower vulnerable individuals to claim their fundamental rights.

8. ANNEXES

Annex 1: Working definitions

Sexuality

‘Sexuality is a central aspect of being human throughout life and encompasses sex, gender identities and roles, sexual orientation, eroticism, pleasure, intimacy and reproductions. Sexuality is experienced in thoughts, fantasies, beliefs, attitudes, values, behaviours, practices and relationships. While sexuality can include all these dimensions, not all of them are always experienced and expressed. Sexuality is influenced by the interaction of biological, social economic, political, cultural, legal, historical, religious and spiritual factors.’ (WHO, 2006)

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, 2006)

Sexual rights

‘The fulfillment of sexual health is tied to the extent to which human rights are respected, protected and fulfilled. Sexual rights embrace certain human rights that are already recognized in international and regional human rights documents and other consensus documents and in national laws. Rights critical to the realization of sexual health include:

  • the rights to equality and non-discrimination
  • the right to be free from torture or to cruel, inhumane or degrading treatment or punishment
  • the right to privacy
  • the rights to the highest attainable standard of health (including sexual health) and social security
  • the right to marry and to found a family and enter into marriage with the free and full consent of the intending spouses, and to equality in and at the dissolution of marriage
  • the right to decide the number and spacing of one's children
  • the rights to information, as well as education
  • the rights to freedom of opinion and expression, and
  • the right to an effective remedy for violations of fundamental rights.

The responsible exercise of human rights requires that all persons respect the rights of others. The application of existing human rights to sexuality and sexual health constitute sexual rights. Sexual rights protect all people's rights to fulfil and express their sexuality and enjoy sexual health, with due regard for the rights of others and within a framework of protection against discrimination.’ (WHO, 2006, updated 2010)

Sexual and reproductive health

‘Sexual and reproductive health is a state of physical, emotional, mental and social well-being in relation to all aspects of sexuality and reproduction, not merely the absence of disease, dysfunction or infirmity. Therefore, a positive approach to sexuality and reproduction should recognize the part played by pleasurable sexual relationships, trust and communication in promoting self-esteem and overall well-being. All individuals have a right to make decisions governing their bodies and to access services that support that right.’ (Guttmacher-Lancet Commission on Sexual and Reproductive Health and Rights, 2018)

Sexual pleasure

‘Sexual pleasure is the physical and/or psychological satisfaction and enjoyment derived from solitary or shared erotic experiences, including thoughts, dreams and autoeroticism. Self-determination, consent, safety, privacy, confidence and the ability to communicate and negotiate sexual relations are key enabling factors for pleasure to contribute to sexual health and wellbeing. Sexual pleasure should be exercised within the context of sexual rights, particularly the rights to equality and non-discrimination, autonomy and bodily integrity, the right to the highest attainable standard of health and freedom of expression. The experiences of human sexual pleasure are diverse and sexual rights ensure that pleasure is a positive experience for all concerned and not obtained by violating other people’s human rights and wellbeing.’ (GAB, 2016)

Annex 2: Action plan

Annex 3: Relevant resources

General

The Global Advisory Board (GAB) for Sexual Health and Wellbeing

World Association for Sexual Health (WAS) (2014) WAS Declaration of Sexual Rights

IPPF (2008) Sexual Rights, an IPPF Declaration

Gruskin, S., Yadav, V., Castellanos-Usigli, A., Khizanishvili G. and Kismödi  E. (2019) Sexual health, sexual rights and sexual pleasure: meaningfully engaging the perfect triangle, Sexual and Reproductive Health Matters, Volume 27 - Issue 1: Open Issue

WAS/IPPF/RNW (2017) Fulfil! Guidance document for the implementation of young people’s sexual rights

Higgins, J. A. and Hirsch J.S. (2008) Pleasure, power, and inequality: incorporating sexuality into research on contraceptive use, American Journal of Public Health 98.10: 1803-1813.

Philpott, A., Knerr, W. and Boydell, V. (2006) Pleasure and prevention: when good sex is safer sex, Reproductive Health Matters, 14(28), 23-31.

Philpott, A., Knerr, W. and Maher, D. (2006) Promoting protection and pleasure: amplifying the effectiveness of barriers against sexually transmitted infections and pregnancy, The Lancet, 368(9551), 2028-31.

The Pleasure Project aims to promote safer sex by focusing on pleasure and desire: providing sex education with the emphasis on ‘sex’, not ‘education’.

RFSU (the Swedish Association for Sexuality Education) has a wealth of sex-positive resources – comprehensive information, useful diagrams and images – in English and Swedish. RFSU has also produced an engaging sexuality education film for teenagers called Sex on the map (with English or Spanish subtitles). Although not suitable for clients in every context, the resources can develop knowledge and understanding of sexuality, sexual pleasure and sexual response.

HuffPost Cliteracy increases awareness of the clitoris and women’s pleasure, challenging myths about sex and the female body.

 

Inclusive CSE

Rutgers (2016) Sexual diversity: building bridges towards mainstreaming of sexual and gender diversity in SRHR organisations – lessons learned in Africa and Asia

TKI Inclusive Education Supporting LGBTIQA+ students: supporting the inclusion and wellbeing of students who identify as sex, gender, or sexuality diverse  

TKI Inclusive Education Plan sexuality and gender education years 1-8: suggestion for implementing the strategy ‘Developing an inclusive classroom and curriculum’

UNESCO Bangkok Office (2014) Lesson plans for teaching about sexual and gender diversity in Thailand  

 

Curriculum for young people with disabilities

Clackmannanshire Council and NHS Forth Valley (2017) Relationships, sexual health and parenthood education for children and young people with additional support needs

IPPF (2019) Watch: Let’s talk about.... Sex & Disability

 

Gender equality

Save the Children International (2009) Choices: empowering boys and girls to change gender norms: a curriculum for 10 to 14 year olds in Nepal

Population Council (2013) Health and life skills curriculum for the Adolescent Girls Empowerment Program (AGEP)

Zambia Community HIV Prevention Project (Z-CHPP) (2017) Stepping Stones: a training manual for sexual and reproductive health and relationship communication skills and empowerment

 

For very young people

Persona Doll Training – equality in practice The persona dolls and their stories develop children’s communication and listening skills and encourage empathy, critical thinking and problem solving.

 

Sexual- and gender-based violence

Men for Change Healthy relationships – violence prevention curriculum

The Education State and Victoria State Government Safe Schools: guide to making your school safe and inclusive for LGBTI students

Global Alliance for LGBT Education (Gale) (2011) Toolkit Working with Schools 1.0

GLSEN Including LGBT-content in sex education: four wrong ways (and one right one)

UNESCO (2012) Education sector responses to homophobic bullying

UNESCO Bangkok Office and Regional Bureau for Education in Asia and the Pacific (2015) From insult to inclusion: Asia-Pacific report on school bullying, violence and discrimination on the basis of sexual orientation and gender identity

 

B. Sexual and reproductive health services

Social inclusion

UNFPA/UN Economic Commission for Europe (2013) Inequalities, social inclusion and rights

 

Gender equality

WHO/UNAIDS (2016) A tool for strengthening gender-sensitive national HIV and sexual and reproductive health (SRH) monitoring and evaluation systems  

Pan American Health Organization (PAHO) (2010) Linking sexual and reproductive health and gender programs and services with prevention of HIV/STI

IPPF (2015) Sexual and reproductive health and rights – the key to gender equality and women’s empowerment

IPPF (2011) Keys to youth-friendly services: celebrating diversity

 

Transgender

Planned Parenthood What do I need to know about trans health care?

UNFPA (2018) Your rights: information for women and young people with disabilities

UNFPA (2018) Young persons with disabilities: global study on ending gender-based violence and realizing sexual and reproductive health and rights – easy read report

 

Gender-based violence

UNFPA (2010) Addressing violence against women and girls in sexual and reproductive health services

IPPF Western Hemisphere Region (2010) Improving the health sector response to gender based violence: a resource manual for health care professionals in developing countries

Tanya Jarvik, M.A., and David Tovey, M.D. (2016) Sex-positive healthcare: respecting diversity in sexual identity, orientation, and practices among patients

Johns Hopkins School of Nursing (2017) Taking a sex-positive health history

IPPF (2011) Keys to youth-friendly services: adopting a sex positive approach

IPPF (2012) Keys to youth-friendly services: obtaining informed consent

IPPF (2011) Keys to youth-friendly services: ensuring confidentiality

GAB (2018) Sexual pleasure: the forgotten link in sexual and reproductive health and rights – training toolkit

C. Social media campaigns and information

Please see the resources outlined in section A. sexuality education, which are also relevant.

Guidance and support

Erika Owen and L. Kris Gowen, PhD, EdM (2015) A guide to teaching about sexually explicit content online: the basics

UNESCO (2015) Keystones to foster inclusive knowledge societies: access to information and knowledge, freedom of expression, privacy, and ethics on a global internet

Institute of Development Studies (IDS) Bulletin (2017) Sex education in the digital era. This useful source of information shares experiences of internet-based sex education in 14 countries. The authors explore how familiar forms of exclusion and inequality, as well as empathy and solidarity, manifest themselves in these new digital spaces in highly diverse national settings.

 

Sexual pleasure

Love Matters Open, honest and sex-positive, Love Matters is a global leader in delivering information and media on love, sex and relationships to 18-30-year-olds in areas where it is censored or taboo.

Love Matters Africa provides easy-to-access information and news on sexuality and sexual health for young people.

F*ck Yes  is a modern sex ed series focused on improving communication (and sex) between consenting adults.

Scarleteen is an independent, feminist, grassroots sexuality and relationships education media and support organization and website.

Queer Sex Ed is a queer-positive, sex-positive platform for open, honest and direct communication about sex and relationships.

OMGyes aims to lift the veil and take an honest, research-based look at the specific ways in which women find pleasure.

 

Older people

Senior Planet (2016) A senior’s guide to sex without intercourse

 

Feminist sex-positive porn

Center for Sexual Pleasure & Health Sex-positive and feminist-friendly porn

Goldstein A. (2020) Beyond porn literacy: drawing on young people’s pornography narratives to expand sex education pedagogies, Sex Education, 20:1, 59-74, DOI: 10.1080/14681811.2019.1621826

 

Consent

Custers B., van der Hof S., Schermer B., Appleby-Arnold S. and Brockdorf N. (2013) Informed consent in social media use – the gap between user expectations and EU personal data protection law, Scripted, Volume 10, Issue 4

 

Safety

Thorn (2018) Sextortion

Trend Micro Forward-Looking Threat Research Team (2018) Digital extortion: a forward-looking view

Bullying UK How to stay safe online

Austrian Institute for Applied Telecommunications (2012) Ch@dvice handbook for educators: sex and violence in digital media – prevention, help and counselling

 

Privacy

GDPR.EU Complete guide to GDPR compliance

 

Annex 4: Glossary of terms and concepts

  • Adolescent: A person aged 10–19 years, as defined by the United Nations.
  • Anal sex: Sexual activity involving penetration of the anus.
  • Bisexual: A person who is attracted to both men and women.
  • Child: A person under 18 years, as defined by the United Nations.
  • Coercion: The action or practice of persuading someone to do something by using force or threats.
  • Discrimination: Any unfair treatment or arbitrary distinction based on a person’s race, sex, religion, nationality, ethnic origin, sexual orientation, gender identity or expression, disability, age, language, socio-economic background or other status.
  • Gay: A person who is primarily attracted to and/or has relationships with someone of the same sex. Although commonly used for men, some women also use this term.
  • Gender: The social attributes, opportunities, roles and relationships associated with being male, female or transgender. These are socially determined and learned through socialization processes. Gender differences vary between cultures and countries: this means they are not fixed.
  • Gender-based violence: Violence that results in – or is likely to result in – physical, sexual or psychological harm to someone based on gender discrimination, gender roles and expectations, or the differential power status assigned to gender.
  • Gender expression: How a person expresses their own gender to the world, such as through names, clothes, how they move, speak, communicate, societal roles and their general behaviour.
  • Gender identity: A person’s deeply felt internal and individual experience of gender, which may or may not correspond with the sex assigned to them at birth. This includes a personal sense of the body (which may involve, if freely chosen, modification of bodily appearance or function by medical, surgical or other means) and other expressions of gender, including dress, speech and mannerisms.
  • Heteronormative: Reflecting the belief that heterosexuality is the only acceptable expression of sexuality.
  • Homosexual/homosexuality: A person who is emotionally and sexually attracted to people of the same sex.
  • Inclusive education: Process of strengthening the capacity of the education system to reach out to all learners.
  • Informed consent: Process for obtaining voluntary agreement to participate in research or an intervention.
  • Intercourse: Sexual activity involving penetration of the vagina or anus by the penis.
  • Intersex: People who are born with sex characteristics (including genitals, gonads and chromosome patterns) that do not fit typical binary notions of male or female bodies. Intersex is an umbrella term used to describe a wide range of natural bodily variations, some of which may not be physically apparent. Being intersex is distinct from a person’s sexual orientation or gender identity: an intersex person may be straight, gay, lesbian or bisexual, and may identify as female, male, both or neither.
  • Lesbian: A woman who experiences sexual attraction to, and the capacity for an intimate relationship primarily with, other women.
  • LGBTIQ: Refers to lesbian, gay, bisexual, transgender, intersex and queer/questioning people.
  • Masturbation: Stimulation of the genitals and other parts of the body for sexual pleasure.
  • Oral sex: Sexual activity using the mouth and tongue to stimulate a partner’s genital or anal area, providing sexual pleasure.
  • Orgasm: The climax of sexual excitement, characterized by intensely pleasurable feelings centred mainly in the genitals and (in men) usually accompanied by ejaculation.
  • Queer: A term used by some people, particularly young people, to reject specific labels of sexual orientation and/or gender identity. Once considered pejorative, queer has been reclaimed by some LGBTIQ people to describe themselves, however, it is not a universally accepted term even within the LGBTIQ community.
  • Questioning: A person who is exploring their sexual orientation or gender identity.
  • Sex: Classification of people as male, female or intersex, assigned at birth, based on anatomy and biology.
  • Sexual orientation: A person’s capacity for profound emotional and sexual attraction to, and intimate and sexual relations with, individuals of a different gender, the same gender or more than one gender.
  • Stigma: Negative opinions or judgements held by individuals or society that reflect on a person or group. Discrimination occurs when stigma is acted on.
  • Transgender: A person whose gender identity differs from their sex at birth. Transgender people may be male-to-female (female identity and appearance) or female-to-male (male identity and appearance). Transgender people may be heterosexual, homosexual or bisexual.
  • Violence: Any action, explicit or symbolic, that results in – or is likely to result in – physical, sexual or psychological harm.
  • Young person: A person between 10 and 24 years old, as defined by the United Nations.

9. ACKNOWLEDGMENTS

Written by Doortje Braeken

Reviewed and edited by Sarah Hyde

Technical input provided by Vithika Yadav and Antón Castellanos-Usigli

Supported by the Global Advisory Board for Sexual Health and Wellbeing www.gab-shw.org

Project coordinated and reviewed by Caryn Gooi

Supported via an unrestricted grant from logo Durex

Published in July 2020