Public Health Must Pay More Attention to Sexual Pleasure

Most of the time, sex is pleasurable and promotes good health. Yet public health research largely frames sex in terms of harm reduction—especially, preventing HIV and other sexually transmitted infections.

In a new commentary in the American Journal of Epidemiology, Jessie V. Ford at Columbia University Mailman School of Public Health and Julia C. Bond at Boston University School of Public Health advocate for a sex-positive epidemiology that considers and incorporates pleasure, satisfaction, and well-being alongside familiar outcomes such as sexually transmitted infections. They also identify several potential obstacles to its implementation.

“Epidemiology has provided critical insights into sexual health, particularly in the form of understanding and preventing the transmission of STIs. Despite some high-profile efforts to push the field in a new direction, epidemiologic research into sexual pleasure and other positive sexual outcomes has so far been scant,” says Ford, an assistant professor of Sociomedical Sciences. (Read a Q&A with Ford.)

Recent efforts to advocate for the promotion of sexual well-being were initiated by the U.S. Department of Health and Human Services Sexually Transmitted Infections National Strategic Plan, the National Academies of Sciences, Engineering, and Medicine, and the World Health Organization Action Plan for Sexual and Reproductive Health. In Europe, research teams have launched nationally representative surveys focused on sexual health and well-being.

While research on the health benefits of sex has been limited, epidemiologists have contributed several compelling findings, including:

• Lower orgasm frequency was associated with 1.9 times the odds of all-cause mortality over 10 years of follow up compared to high frequency orgasm.
• Increased frequency of ejaculation in men has been associated with a lower hazard of prostate cancer over 18 years of follow up.
• Women who were sexually active weekly had a 28-percent reduction in early menopause compared to those who were sexually active less than monthly.

(In a 2023 paper, Ford proposed a scorecard for measuring progress on a broad spectrum of sexual health indicators ranging from traditional outcomes like rates of STIs to attitudes and relationships related to sexual health.)

In the new paper, Ford and Bond point to several technical challenges that may make epidemiologists reluctant to pursue sex-positive research. Among these are the subjective nature of sexual pleasure and satisfaction and uncertainty about whether sexual pleasure promotes overall positive health or vice versa or if both are true. For these two questions and others, the authors explain that these challenges can be overcome or already have been overcome.

Another barrier is stigma. Sex and sexual pleasure are often considered to be not only taboo, but frivolous, indulgent, and/or trivial, the authors argue. Further, public health researchers can be uncomfortable with asking about things like masturbation, penetration, foreplay, lubrication, and positioning, as well as how partners actually negotiate sex.

“Acknowledging the fact that people balance desire, pleasure, intimacy, interpersonal relationships, and, yes, risk, when making decisions about sexual activity is key to formulating research questions that reflect people’s lived experiences,” says Ford.  

The authors report no conflict of interest.