Attempts to give a universal definition of sexual health were undertaken by many researchers. However, most of them were not successful. This is due to the fact that in each culture there are specific features in attitudes, perceptions and assessments of sexuality. Cultural identity should be taken into account when developing programs for health education, primary prevention of sexual disharmony, psychotherapy counseling and treatment.
One of the attempts made to determine sexual health was experts of the World Health Organization. It sounds like this:
Sexual health is a complex of somatic, emotional, intellectual and social aspects of a person’s sexual existence, positively enriching a person, increasing the communicability of a person and his ability to love.
The concept of sexual health includes three main elements:
- The ability to enjoy and control sexual and childbearing behavior in accordance with the norms of social and personal ethics.
- Freedom from fear, feelings of shame and guilt, false ideas and other psychological factors that suppress sexual reaction and violate sexual relationships.
- Absence of organic disorders, diseases and “inadequacies” that interfere with the exercise of sexual and reproductive functions.
A more acceptable way of determining the norm in sexual relations is now seen in the output of sexology outside the clinic, i.e., sexopathology. In order to break the vicious circle, when the norm is explained through pathology, and the pathology is determined in relation to the implied norm, which is reliably unknown, it is necessary to turn to studying the behavior, physiology and motivation of normal, healthy, ordinary people in the natural conditions of their life.
As IS Kon writes, who and what is normal? The concept of the norm in biology and medicine is multivalued. First, the norm is understood as a normative, i.e., something due, a standard for which it is necessary to be equal, evaluating individual behavior on it; such as, for example, sports standards or dietary norms.
Such norm-norms are always conditional and have value only in a certain frame of reference. Secondly, the norm is understood as a statistically average, the most common, mass phenomenon. In modern science, the normal in the statistical sense includes not only the average statistical value, but also a series of deviations from it in a certain range. Thirdly, the norm is understood as a functional optimum, implying the flow of all processes in the system with the most possible coherence, reliability, economy and efficiency. The functional norm is always individual, and its violation is determined not by the magnitude of the deviation from the statistical average, but by functional consequences.
As you know, the variable range of extreme manifestations of sexuality is determined by the figure 1: 4500. This is the extreme variability of the individual deviations in sexual life, found by Kinsey in his polls. The reasons for this variance are:
- biological (type of sexual constitution);
- level of general and sexual culture (upbringing);
- personal experience (subjectivity in the evaluation of sexual practice).
As can be seen, in addition to formal and methodological measurements, the concept of the norm has a number of meaningful parameters. Conversation about the norm always implies the question: “The norm of what?” Norms of morality, physiology and psychology may or may not coincide, but they are different norms having different systems counting. The intensity of sexual life is measured differently from the degree of satisfaction obtained from it, etc. Unfortunately, it is precisely in the discussion of “normal” or “abnormal” sexuality that these concepts are often not specified; moral norms are mixed with mental or physiological standards, the average with functional, quantitative with qualitative, and so on. In general, since sexology is an interdisciplinary science, the sexological norm must also be a combination of the norms of all sciences.
For a specialist working in the field of health psychology, one of the variational guidelines in understanding the sexual norm can be the three categories of norm proposed by K. Imelinsky: optimal, accepted and tolerant.
The optimal norm should include sexual actions and behaviors, which, due to their characteristics, are most desirable from the individual and social points of view. It is for this reason that they can be promoted in the form of a model for sex education.
Accepted (accepted, acceptable) norms include such sexual acts and behaviors that, although not optimal, do not limit the individual developed person and do not prevent him from establishing close inter-human contacts, that is, actions and behaviors that do not cause fundamental objections.
Tolerant (tolerant) norms include such sexual actions and behavior, the evaluation of which may be different in terms of norm or pathology and depends on the personal, situational and partner context. This includes such forms of behavior that limit the possibilities of harmonious selection of a sexual partner and the establishment of close inter-human relations with him. However, these restrictions are not absolutely pathological, because the appropriate sexual choice can ensure a harmonious sexual life of partners.
All the above categories of norms are equally attributed to the sexual norm in the clinical sense, i.e., not requiring any therapeutic intervention. The situation is different from the point of view of pedagogy, in which only the optimal variant is considered the norm, at the most acceptable, while sexual actions and behaviors within the framework of a tolerable norm can be considered undesirable and even beyond.
Among the criteria that determine sexual health, coincides with the “ranges of acceptability” of partners. This concept, introduced in 1966 by the sexopathologist NV Ivanov, includes all three categories of the sexual norm. The range of acceptability has an individual framework and applies to all aspects of sexual activity (from caresses to sexual intercourse methods). If the range of acceptability suits both partners, then, as a rule, sexual relations are harmonious, but if one of the partners is narrowed to the limit, and the other, on the contrary, is expanded, then the disharmony of sexual relations arises. The reason for narrowing the range of acceptability can be puritanical upbringing, distorted information about sexual relations, coarse partner, etc. With age and the accumulation of sexual experience, the acceptability range tends to expand, provided that this process is not roughly forced by one of the partners.
Like a certain behavioral program, in the course of ontogenetic development a person has his own “sexual scenario”. The normative components of the sexual scenario – who, what, with whom, where, when, how and why should, can or should not and can not do in a sexual way – are outlined in general by the appropriate culture. However, this does not exclude large individual differences and variations in the quantitative and qualitative order.
The concept of individual differences in relation to forms of sexual behavior has long been rejected, despite the fact that in medicine it was universally accepted. In this connection, narrow and rigid frameworks were established on the range of acceptability in which the sexual life of a person should take place, so that it could be regarded as “normal”.
In accordance with the criteria developed by the Sexological Institute in Hamburg, all forms of sexual activity, sexual behavior and sexual activities that occur between two mature persons of different sex can be normalized, taken by both of them and aimed at achieving pleasure that do not harm their health and do not violate the norms of the hostel. The nature of sexual forms of behavior and actions does not have any significance for qualifying them as normal or pathological phenomena. This follows from the sexological concept of individual differences, which recognizes the right of a person to search for his own, individual ways to achieve pleasure.
Thus, based on this definition, it can be said that adults have the opportunity to choose such sexual actions and behaviors that give them maximum enjoyment, are approved by them and do not damage their health and society. Approximation of sexual relations to the specified criteria of the partner norm is always connected with an increasing degree of strengthening of the partners’ ties, which is reflected, for example, in the well-being of relations in marriage. Sexuality in itself is an important stabilizing factor of matrimony. Satisfaction of spouses with sexual life necessarily affects the deepening and harmony of feelings.