Delivered at Sex, Drugs & Scotland's Health Virtual Conference, this presentation was delivered by Prof. Kirstin Mitchell. More information about the virtual event is available here: http://ow.ly/YntW50GWhJ0

1. MRC/CSO Social and Public Health Sciences Unit,University of Glasgow
What is sexual wellbeing and why does it matter for Public Health?
Prof. Kirstin Mitchell
MRC/CSO Social and Public Health Sciences Unit, University of Glasgow
On behalf of: Dennis Fortenberry, Ruth Lewis, Karen Maxwell, Raquel Boso Perez,
Lucia O’Sullivan, Chris Bonell, Wendy MacDowall, Cath Mercer, Pam Sonnenberg
20th October 2021

2. Personal wellbeing
Our relationships Health
What we do
Where we live
Personal finance
Economy
Education and skills
Governance
Environment
ONS tracked Indicators of Wellbeing ‘How we’re
doing – as
individuals,
communities
and nations
The
OECD
measures
wellbeing
across
countries

3. MRC/CSO Social and Public Health Sciences Unit,University of Glasgow
Absence of sexual dimensions in Measurement of wellbeing
Commonly used
measures of wellbeing
that include a sexual
dimension
BUT Hooghe et al
2012 showed it’s
possible. They
asked about 5
things:
Health
Leisure
Family
Social
Sexual
Maslow’s hierarchy of needs

4. The WHO definition is revolutionary in acknowledging positive sexuality…..
….yet public health approaches remain focused on risk and adverse
outcomes.
“…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)

5. => Limited our ability to
address everyday sexual
issues.
Long standing conflation of
Sexual wellbeing and sexual
health.
Sexual wellbeing also used
interchangeably with
function, pleasure or sexual
satisfaction….
Conceptual muddle

7. Why measurement of sexual wellbeing is important for public health:
• Goals related to pleasure shape both risk taking and risk reduction
• Marker of health equity
• Meaningful population indicator of wellbeing
• Captures population trends distinct from sexual health measures
• Helps refocus the ethics, form and practice of public health

8. Sexual wellbeing
“How we are doing sexually”

9. Key criteria for measuring sexual wellbeing
1. Applicable to people regardless
of whether they are sexually
active
2. Applicable regardless of
relationship status
3. Aspects of sexual wellbeing
should be amenable to change
4. Brief

10. DESIRED VERSUS REALITY
Subjectivity in priorities and preferences
Capturing structural-influences in an
individual self-report measure
Catering for widely varying experiences
and sexual histories

11. MRC/CSO Social and Public Health Sciences Unit,University of Glasgow
Measure development work
• Conceptual/theoretical work to establish key domains
• 40 semi-structured interviews with adults aged 18 plus
across UK
• Maximum variation sampling: sex, age group, ethnicity,
area level deprivation, sexual identity, marital status.
• Recruited via professional recruitment agency
• 20 majored on sexual wellbeing (minor on digital media);
20 majored on digital media (minor on wellbeing)

12. MRC/CSO Social and Public Health Sciences Unit,University of Glasgow
Sexual security and safety
Definition:
Experience of
limited threat
coupled with
actions taken
to assuage
vulnerability
• “when you’re doing things and
you’re meeting people and you’re
having hook-ups as they call it, you
know, it is quite scary because
you don’t know if you’re going to
somebody’s home or they’re coming
to yours and they know your
address and then you have to sort
of use your like your common sense
[…] but erm, really you don’t know,
you don’t know, and you have to
take sort of safety into account”
[G1 Male]
Relevance to Public
Health (example):
Addressing risks to
sex workers

13. MRC/CSO Social and Public Health Sciences Unit,University of Glasgow
Sexual comfort
Definition:
Experience of
ease in
contemplation,
communication,
and enactments
of sexuality and
sex
“Obviously you need to be
comfortable, […] it’s not
really just comfortable on the
outside, [it’s] like on the
inside as well. […] because
obviously if you don’t feel
comfortablethen […]
you’re going to be in panic
mode when it’s happening
and so you won’t really be
concentrating on being
relaxed and enjoying it.
You would be more on
edge.” [G12 Male]
Relevance: Communication
of sexual matters to improve
efficacy of contraceptive use

14. MRC/CSO Social and Public Health Sciences Unit,University of Glasgow
Sexual self-determination
Definition: Free
choice or
rejection of
sexual
partner(s),
behaviors,
context and
timing without
pressure, force,
or felt obligation
• “the first time when I was younger, I
had a lot of pressure from friends
and stuff. [...] there was a lot of
pressure. If I didn’t want to, then I
really could’ve said, no, but it was kind
of more like, it was an awkward
situation it was like, oh, well I’ve kind of
got to do it, do you know what I mean.
[…]” [L16 Female]
• “the sense of control and ability to
choose who I have sex with, that
was a very important thing for me
‘cause I don’t want to have sex with
anyone, I have to know who they are,
what they are, and kind of, erm, have a
common ground with them, and not
just… [Uh-huh, okay]. …have sex with
them.” [L5 Male]
Relevance:
Interventions to
improve Reproductive
self-determination for
women

15. MRC/CSO Social and Public Health Sciences Unit,University of Glasgow
Sexual respect
Definition:
Perception of
positive regard by
others for one’s
sexual
personhood
• “…so I guess [sexual respect] means
that my husband and I are on the
same page […] I know he’s just gone to
Magaluf and he paid for a private dance
and it really upset me.” [Female L19]
• “[My family aren’t really accepting of
it [my bisexuality], to be honest with
you. […] Which is difficult. So yeah, I
personally think it’s very important
because of my own experience of it.”
[L12 Male]
Relevance:
Policies to protect
sexual minority
groups living with
HIV

16. MRC/CSO Social and Public Health Sciences Unit,University of Glasgow
Sexual self-esteem
• “I was in a relationship where I wasn’t being
pleased and I didn’t do what I wanted to do
and I lost touch with what I actually wanted
to do. But now I’ve slept with someone else […]
and I’ve tried new things and I want to do
different things and when I have sex with
someone, it’s nice to have because I kind of
forgot what it was like.” [Female G4]
• “feeling sexually attractive to others, I think
that’s really important, it’s really important
to me, and it’s something that’s kind of
impacted since I’ve had the illness, because
I’ve had physical changes to my body, to my
face, and it makes me, […]I used to be quite
a confident person about my looks, and I’m
not so much anymore [...] [G5]
Definition:
Affective
appraisals of
oneself as a
sexual being
Relevance:
Interventions to
improve overall
sexual
functioning

17. MRC/CSO Social and Public Health Sciences Unit,University of Glasgow
Relevance: Lessens
sexual minority
stressors
Support for recovery
from emotional
trauma
Sexual resilience
Definition:
Maintain
equilibrium in
response to
sexual stress,
dysfunctions,
adversity, or
trauma
• “we’re massively having to adapt, and
we’re trying our best, and we’re
working through it I suppose, it’s
something that we’ve never really had
to experience before [...], and then,
you know, if things do improve we’ll
have to adapt again. And I find you
keep having to adapt.” [G5]
• “I think [being assaulted by an older
man] put me off for a while, but I
knew that all other people are not
like this person […] obviously I
knew that that as wrong [...] But I
knew other people weren’tlike that”
[G9 Female]

18. MRC/CSO Social and Public Health Sciences Unit,University of Glasgow
Sexual forgiveness (letting go/closure)
Definition:
Interrupts
patterns of self-
blame, self-
stigmatization,
shame,
avoidance,
aggression, and
revenge
“I would say that’s very
important because if you
can't… put your past behind
you, because every
relationship or every
experience is different. […]
you've got to be able to […]
let go of negative thoughts,
[…] because if you can't,
how can you fully engage in
the relationship that you're
in or the moment you're in?
” [Male aged 38]
Relevance:
Interventions for
survivors of trauma

19. Summary
• Measures of general wellbeing rarely include sexual dimension
• Conceptual muddle including conflation of Sexual wellbeing and sexual
health
• Proposed pillars for Public Health Enquiry: Sexual health, Sexual wellbeing,
Sexual Justice and Sexual pleasure.
• Sexual wellbeing means ‘how we are doing sexually’.
• Seven domains: sexual forgiveness, sexual resilience, sexual self-esteem,
sexual respect, sexual determination and sexual comfort.
• Sexual wellbeing is key to public health as a marker of health equity; as a
meaningful population indicator of wellbeing; in capturing trends distinct
from sexual health; in helping refocus the ethics, form and practice of
public health

20. Thank you for listening!
Kirstin.mitchell@glasgow.ac.uk @KMitchinGlasgow www.natsal.ac.uk
Many thanks to our participants, funders and the Natsal-4 team