ABSTRACT
Sexual health is both a state of wellbeing as well as an approach to working on issues of sexuality. While one cannot quarrel with the notion of sexual health as a health goal to be attained, as an approach to working on sexuality more generally it has perhaps got some limitations. What, then, is lacking in a sexual health framework? Put in a nutshell, while claiming that sexual health is not just the absence of disease, sexual health work still limits sexuality to bodies and essentialises sexuality as a biological construct. Because of its focus on health, it does not give sufficient weight to non-biological or non-physical expressions and aspects of sexuality such as desires, fantasies and cravings, as well as the gender and power relations that govern gender and sexual expressions. In the few cases when sexual health extends its ambit to the provision of education, such as in the form of sexuality education and sex and relationships programmes, the perspective is once again often one of prevention – of HIV, STIs, unplanned pregnancy, sexual abuse, all very worthy causes, deserving of attention. But insufficient attention is often given to more positive goals such as the pursuit of happiness, pleasure or of achieving one’s full (sexual) potential. Because of their normative focus, notions of sexual health also run the risk of setting up standards of what is to be considered ‘sexually healthy’, which can become a trap in itself. For instance, monogamy may be promoted as a standard HIV prevention message. But what if Partying Penis and Vagrant Vulva, users of lubricants and condoms, want to have a good time with as many people as they possibly can? Or, what if someone wants to do something that may not be considered ‘good’ for them, such as participation in sadomasochism or watersports? These problems and others call for a more expansive framework that recognises that people have different sexual desires, that sex manifests itself and is understood differently in different places and across time (Weeks 1986) and that sexual categories that exist today, such as ‘homosexuality’ were invented in relatively recent times (Katz 1990). As contributions elsewhere in this volume highlight, there is a growing awareness that gender is also not quite as fixed a category as it was thought to be, and the possibility of authentic expression for gender non-conforming people traverses a range of landscapes, from the beautifully vibrant to the agonisingly bleak. Crucially, sexual health is not about making lifestyle choices. The woman who lives in poverty and does not use contraception is doing so not because she has made a choice. She may do so in order to protect herself from violence from a husband who beats her up if she suggests the use of condoms. She could use a
government-supported injectable contraceptive, you might say, to take care of her contraception-related sexual health. Yes, she could, provided it were proved to be safe, which it is not yet, and she was aware of all the risks. The woman who lives in a mansion and is forced to have yet another abortion because the foetus is female, is doing so not because she has made a choice. It is because her husband and her inlaws with whom she lives are forcing her to do so in a society that values sons over daughters. These are real-life examples from our work on the TARSHI sexuality helpline in New Delhi, India.1
