Sexual health

The widely-adopted definition of sexual health developed by the World Health Organization (WHO) includes concepts such as the absence of disease and coercion, and draws attention to sexual rights and to the possibility of sexual pleasure. Sexual health should also include sexual wellbeing in the context of sexual health, sexual pleasure, and sexual justice.¹

The ability to achieve sexual health and well-being depends on:²

• Access to comprehensive, good-quality information about sex and sexuality.

• Knowledge about the risks they may face and their vulnerability to adverse consequences of unprotected sexual activity.

• Ability to access sexual health care.

• Living in an environment that affirms and promotes sexual health.

Therefore, 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.³

The promotion of sexual health should enhance sexual and emotional well-being and help people to reduce the risk of sexually transmitted infections (STIs) and unwanted pregnancy. Sexual health includes a broad range of important health issues (see below under the section 'Sexual health needs'), many of which are considered priorities for the NHS. Encouraging open and discreet access to all at-risk groups (including teenagers and minority groups) and explicit confidentiality procedures are essential to encourage service uptake.⁴

Sexual health needs

Sexual health needs may be associated with:

• Detecting and managing STIs, including HIV, chlamydial genital infection, genital herpes simplex, gonorrhoea and syphilis.

• Contraception advice and provision.

• Pregnancy testing and support.

• Termination of pregnancy services, including support and counselling.

• Sexual dysfunction, including erectile dysfunction, premature ejaculation, vaginismus and orgasmic problems in women (see also separate article Sex Therapy and Counselling).

• Related problems, eg, infertility - see separate articles Female Infertility, Infertility Treatments.

• Experiences such as sexual assault or coercion.

• Psychological problems, including poor self-esteem and dependent personality.

The data for STI's published by UK Health Security Agency in June 2023 show:⁵

• 392,453 STIs reported in England in 2022 (24% increase on the previous year), with a 50% increase in gonorrhoea, 24% increase in chlamydia and 15% increase in syphilis since 2021.

• 26% increase in STI diagnoses among young people aged 15 to 24 since 2021.

• 21% increase in chlamydia in young people (despite no increase in testing).

Risk factors

Specific action should recognise and meet the needs of particular groups of people, such as:⁴

• Young people who are, or are contemplating becoming, sexually active:
  

  • Teenage conception and abortion rates remain consistently high.

  • Rising numbers of new STIs among those in their teens and early twenties.

• Men who have sex with men:⁶
  

  • The peak in HIV incidence in men who have sex with men in England was estimated to have occurred in 2012 or 2013, at least 1 year before the observed peak in new diagnoses in 2014.

  • Studies have indicated a steep decrease in the annual number of new infections among men who have sex with men, from 2770 in 2013 to 1740 in 2015, followed by a steadier decrease from 2016, down to 854 infections in 2018.

  • Similar trends were estimated in the number of undiagnosed infections, with the greatest decrease after 2013 in the 25–34 years age group.

  • The percentage of all people living with HIV whose infection was diagnosed therefore steadily increased from 86% in 2013 to 94% in 2019.⁷

  • High rates of other STIs are also diagnosed, especially gonorrhoea and syphilis.

• Black and minority ethnic communities:
  

  • A disproportionate number of STIs, including HIV, in some black and minority ethnic communities in England.

• Other individuals, who may have higher levels of sexual health needs or who may have access to services: these might include people with disabilities, those with learning difficulties, refugees and asylum seekers, homeless people, people in custodial settings and young people who are in care or are leaving care provision.

Promoting sexual health⁴

• Vaccinations (eg Hepatitis A, Hepatitis B) and pre-exposure prophylaxis (PrEP) for HIV. Although HIV incidence was falling before its introduction, PrEP has had a major impact in driving down HIV transmission.⁹

• People should have prompt access to a full range of sexual health services and to comprehensive information on local sexual health service provision.

• People should be provided with information and support to assess their personal risk, and to access and use services effectively.

• The promotion of sexual health should enhance sexual and emotional well-being and help people to reduce the risk of STIs and unwanted pregnancy.

• Health promotion interventions should provide the information, support and opportunities to enhance personal and social skills, to enable people to exercise control over, and improve, their sexual health.

• There should be a range of general measures to improve detection of sexual health needs, including providing open access to appropriate health professionals in primary, community and secondary care, and specific measures, including screening for chlamydia.

• Shared decision-making between professionals and service users can result in better health outcomes.

• Services should ensure action to encourage service uptake, target high-need communities and expand opportunities to identify needs in a range of health settings.

• Sexual health networks should facilitate prompt and equitable access, co-ordination between services, development of integrated care pathways, increased user choice and consistent quality of care.