ARCHIVED - Canadian Guidelines for Sexual Health Education

Exploring Sexual Health and Sexual Health Education

The Canadian Guidelines for Sexual Health Education have adopted a working definition of sexual health presented by the World Health Organization (WHO) because it recognizes the complexities of sexual health as well as an individual’s sexual health rights. Access to timely, broadly based sexual health education plays a significant role in ensuring an individual’s sexual health rights. Further, recognizing the complexities of sexual health will help ensure that individuals using the Guidelines will create curricula, programs and learning opportunities that are inclusive. Despite the appeal that is associated with this definition, users should remain aware that there is no single, universal definition for sexual health. ^{Reference Number 88,}

The Social Construction of Sexual Health

Values and norms about sexuality and health come from a variety of sources including social and religious viewpoints, science, medicine and individual experience. No single definition of sexual health will fully represent this diversity. Indeed, a review of the emergence of the concept of sexual health concluded that “there is no international consensus on the concept of sexual health and its implementation in public health policies.” ^{Reference Number 99,}

Individuals or groups that suggest a particular definition of sexual health are likely to appear to have good reasons for their selection. However, these reasons are often informed by cultural practices that, as a result, produce a definition that uncritically fits the existing society. In this context it has been argued that “we cannot step outside of these cultural processes to develop a universally applicable concept of sexuality” ^{Reference Number 1010,} and this document acknowledges that the same is true for the concept of sexual health.

The words “health” and “healthy” can be linked historically to the field of medicine, and as such they often carry a prescribed medical connotation and authority. As a result, the term “sexual health” may be misunderstood to express approval or disapproval of specific behaviours or individuals under the guise of “medical truth”. Thus, some professionals/ educators may be hesitant of promoting a concept of sexual health (directly, by defining it, or indirectly, by developing guidelines) through education.

There are three different approaches that can be considered when defining sexual health:

1. Avoid defining the term “sexual health” because our understanding of sexuality is socially constructed and as a result, a non-ideological or normative definition is impossible. ^{Reference Number 1111, Reference Number 1212,}

   According to this approach, developing a definition of sexual health for use in education programs may result in the transmission of powerful messages indicating what is to be considered “proper” or “normal” sexuality or sexual behaviour. These messages may be presented as if they are “scientific” facts, when in reality they are indicative of well-established normative positions that refl ect an educator’s or mainstream society’s perceptions about sexuality. From this perspective, education programs addressing sexuality should avoid making direct references to definitions of sexual health.

2. Define and use the term with caution. Keep in mind that definitions of sexual health can change and should not be taken as rigid rules of conduct. ^{Reference Number 1313,}

   This approach recognizes that beliefs about sexual health vary from one individual to another and can change over time and in different cultural or faith-based contexts. Although terms like “sexual health” can be problematic, the achievement of overall “health” is generally accepted as a desirable outcome. Therefore, when professionals use terms such as “sexual health”, they should do so with caution. In keeping with this view, definitions of sexual health should be confined to issues such as individual rights, needs, desires and obligations rather than prescriptive codes of conduct or rigid systems of belief.

3. View the term as an optimistic vision. ^{Reference Number 1414,}

   With this approach, the term sexual health is used to provide a range of “sexual health indicators” that suggest a preferred or ideal set of nonjudgmental sexual attitudes and behaviours. For example, such an approach may specify that with respect to their sexuality, individuals should try to achieve and maintain a certain level of sexual functioning free of anxiety and guilt, and work towards pleasurable, intimate relationships in order to achieve optimal sexual health.

   Before applying any of the above approaches, professionals working in this area should be aware of and challenge their own values and standards as well as the values and standards of the organization they work for. They should also be conscious of the needs of the target audience. Finally, they must remain cognizant of the different meanings and understandings associated with the term “sexual health”.

Goals of Sexual Health Education

Sexual health is a major, positive part of personal health and healthy living. Sexual health education should be available to all Canadians as an important element of health promotion programs and services. The goals of sexual health education as outlined in the Guidelines are as follows:

1. to help people achieve positive outcomes (e.g., self-esteem, respect for self and others, non-exploitive sexual relations, rewarding human relationships, informed reproductive choices); and
2. to avoid negative outcomes (e.g., STI/HIV, sexual coercion, unintended pregnancy).

Recognizing and Meeting Diverse Needs in Sexual Health Education

All Canadians have a right to sexual health education that is relevant to their needs. Diverse populations such as sexual minorities, seniors, individuals with disabilities (physical/ developmental) and socio-economically disadvantaged individuals such as street-involved youth often lack access to information and education that meets their specific needs. Correspondingly, it is important that sexual health educators and service providers give particular attention to the kinds of programs and resources that support the sexual health and personal well being of these individuals across their lifespan. The Guidelines propose that the diverse needs of various populations should be included in all facets of broadly based sexual health education. The selected examples that follow are representative of this larger principle.

Sexual Minorities

With respect to sexual diversity, contemporary research indicates that approximately 2 to 10% of individuals within Canadian society self-identify as non-heterosexual. Reference Number 1515, Due to a complex combination of circumstances (e.g., cultural and religious background; geographic location; peer pressure, etc.) even more individuals may engage in same-sex behaviour, yet not label themselves as a lesbian, gay, bisexual, trans-identified, two-spirited or queer (LGBTTQ) person. For example, a survey of 1358 Canadian youth (ages 13-29) found that while 3.5% selfidentified as a sexual minority, 7.5% of the heterosexual youth surveyed acknowledged experimenting sexually with members of the same sex. Reference Number 1616 Given these statistics, it is important to remember that in relation to education sexual behaviour is not always synonymous with sexual identity. This realization has important implications for educators and health care professionals when engaging in sexual health education and promotion for diverse populations.

In relation to the health needs of sexual minorities, it has been suggested that, “appropriate care for [LGBTTQ youth and adults] does not require special skills or extensive training. Rather, awareness that all youth [and adults] are not heterosexual, sensitivity in conducting routine interviews, and understanding the stressors that affect [LGBTTQ youth and adults] will enable providers to assess and address their needs.” ^{Reference Number 1717}

Key protective factors that are important for sexual minority youth include: a supportive family; positive peer and social networks; access to nonjudgmental sexual health information; and inclusive community supports and health services. Reference Number 1818 Inclusive and affirming supports are critical and should be provided for all youth and adults, regardless of their sexual orientation and gender identity. Providing sexual health education applicable to individual needs is one essential step in ensuring quality care and inclusive service to an often invisible and under-served minority in Canadian society.

See Appendix B, for Sexual Orientation and Gender Identity Terms and Definitions.

Seniors

The need for sexual health education is important regardless of age, however, addressing the sexual health needs of seniors may sometimes be overlooked or avoided. Aging brings about natural changes, both physically and mentally, which can affect sexual intimacy and response. ^{Reference Number 1919,} Open communication with a health care professional and access to information that is relevant to their needs can help seniors adjust to the changes that affect their personal and sexual relationships. Having safe sexual relationships is also important, as STIs do not respect age. ^{Reference Number 1919,} The sexual health needs of seniors can be more complex when intimate relationships occur or develop in institutional settings such as long term care facilities, where a lack of privacy and the roles and responsibilities of the staff may be a concern. Sexual health education and awareness of individual needs is important for both seniors and health care professionals in this context.

Individuals with Disabilities

Individuals with physical disabilities, chronic illness, or developmental disabilities require access to sexual health education that meets their specific needs. Although the sexual health education and service needs of people with disabilities are receiving more attention than in the past, for many, the kind of education that supports expression of their sexuality is often insufficient. People with developmental disabilities may therefore be less informed and have fewer opportunities to learn about sexual health than the general population. ^{Reference Number 2020,} The specific needs of individuals with disabilities vary greatly from one individual to another and this should be taken into account when developing programs or curricula. As research indicates, “Not only does the disabled population require the same basic sexual health information and skills development opportunities as the non-disabled population, but people with physical or developmental disabilities also require information and skills related to sexuality that are specific to their disability.” ^{Reference Number 2121,}

Street-involved Youth

The majority of youth receive sexual health education in school and in their homes. However, for youth who are living on the streets and who have dropped out or been expelled from school, there is often no access to broadly based sexual health education. Findings from Canadian studies of street-involved youth have shown that they are more likely to have had sexual intercourse at a younger age ^{Reference Number 2222,} and are at an increased risk for many sexually transmitted infections ^{Reference Number 2323,} when compared with those in the general youth population. Street-involved youth often do not have the benefit of supportive family or school settings and, as such, they are among the most vulnerable populations in Canada. It is important that outreach initiatives and safe environments such as drop-in centres are able to provide sexual health information and services to these youth who may not have access to it otherwise.

Accessibility and comprehensiveness of sexual health education are two important principles of effective sexual health education articulated in the Guidelines. Educators, health professionals and their respective organizations have a responsibility to address the specific sexual health education needs of individuals who may experience isolation or disapproval because of their diversity. Awareness of these distinct needs can foster the inclusive, nonjudgmental, broadly based sexual health education to which all people, including youth, should have access.