WHO has been working in the area of sexual health since at least 1974, when the deliberations of an expert committee resulted in the publication of a technical report entitled “Education and treatment in human sexuality” (WHO, 1975).

In 2000, the Pan American Health Organization (PAHO) and WHO convened a number of expert consultations to review terminology and identify programme options. In the course of these meetings, the working definitions of key terms used here were developed. In a subsequent meeting, organized by PAHO and the World Association for Sexual Health (WAS), a number of sexual health concerns were addressed with respect to body integrity, sexual safety, eroticism, gender, sexual orientation, emotional attachment and reproduction.

Working definitions

Sex

Sex refers to the biological characteristics that define humans as female or male. While these sets of biological characteristics are not mutually exclusive, as there are individuals who possess both, they tend to differentiate humans as males and females. In general use in many languages, the term sex is often used to mean “sexual activity”, but for technical purposes in the context of sexuality and sexual health discussions, the above definition is preferred.

Sexual health

According to the current working definition, 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, 2006a)

Sexuality

Sexual health cannot be defined, understood or made operational without a broad consideration of sexuality, which underlies important behaviours and outcomes related to sexual health. The working definition of sexuality is:

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

Sexual rights

There is a growing consensus that sexual health cannot be achieved and maintained without respect for, and protection of, certain human rights. The working definition of sexual rights given below is a contribution to the continuing dialogue on human rights related to sexual health (1).

“The fulfilment 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:

• 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, 2006a, updated 2010)

(1) It should be noted that this definition does not represent an official WHO position and should not be used or quoted as such. It is offered instead as a contribution to ongoing discussion about sexual health.

“Human rights provide an international legal framework within which the sexual and reproductive health needs and aspirations of all people can be considered.”

(Gruskin, 2005)

In recent years, international human rights instruments have been increasingly used to support and advance legal claims by individuals and whole communities so that national governments will guarantee the respect, protection and fulfilment of their sexual and reproductive health rights (Cook et al., 2003). The working definitions and framework for programming presented here are grounded in internationally recognized human rights and offer a rights-based approach to programming in sexual health. The key conceptual elements of sexual health are listed below.

Key conceptual elements of sexual health

When viewed holistically and positively:

• Sexual health is about well-being, not merely the absence of disease.
• Sexual health involves respect, safety and freedom from discrimination and violence.
• Sexual health depends on the fulfilment of certain human rights.
• Sexual health is relevant throughout the individual’s lifespan, not only to those in the reproductive years, but also to both the young and the elderly.
• Sexual health is expressed through diverse sexualities and forms of sexual expression.
• Sexual health is critically influenced by gender norms, roles, expectations and power dynamics.

Sexual health needs to be understood within specific social, economic and political contexts.