The power of pleasure

Pleasure and human bonding are some of the primary reasons people have sex. And researchers from the World Health Organization (WHO) and advocacy group The Pleasure Project have found that including desire and pleasure into sexual health programmes and education – not just scare stories about disease – improves attitudes to sex and increases condom use, which can reduce sexually transmitted infections (STIs) (Zaneva et al, 2022).

Analysis of global evidence over 15 years found 33 sexual health programmes that focused on reducing risks of HIV and STIs, and incorporated messages about pleasure (Zaneva et al, 2022). Eight of these that reported condom use outcomes found that condom use was greater than for those that did not discuss sexual pleasure. Behavioural skills that heightened pleasure, such as using lubrication or making condom use fun or sexy, resulted in people practising safer sex (Zaneva et al, 2022).

The researchers recommend that agencies responsible for sexual and reproductive health and education incorporate sexual pleasure into their programmes (Zaneva et al, 2022). ‘We can’t know what we want if we are only told what to stop doing,’ says Anne Philpott, study co-author and founder of The Pleasure Project, an education and advocacy organisation for pleasure-based sexual health. ‘Sexual health and sex education narratives have been stuck in messages of prevention and fear, and have not allowed people to explore what they enjoy and want.’

For example, condom use could be seen as part of sex rather than interrupting it, Anne says. ‘We need to focus on the positives and benefits of using them,’ she adds. ‘Also, learning to explain and know what we want, and aiming for joy and wellbeing, enables us to think about consent more positively and safely – in terms of how we feel happy when we are safe – and all the myriad ways we need to have our sexual rights honoured and how that enables desire and joy.

‘We also know that a pleasure-based approach is successful for those who have suffered sexual trauma, as it keeps the possibility of a sexuality that can be positive.’

Motivating behaviour change

Sex education and sexual health programmes are usually framed around avoiding danger, death and disease rather than striving for pleasurable, satisfying and safe sexual experiences (Singh et al, 2020). This is despite growing evidence that people with more positive views of sexuality are more likely to practise safer sex, use contraception consistently, have higher sexual self-esteem and be more assertive (Singh et al, 2020).

One study has found that sex education delivered to children and teenagers using lecture-based teaching results in them being more likely to practise unsafe sexual behaviours than when they are taught about sex education using either a student-centred, problem-based learning approach or a combination of the two approaches (Millanzi et al, 2021). This research suggests involving discussion between teachers, health workers and children in sex education programmes can enhance safe sexual behaviours.

Sophie Collins, education and wellbeing specialist at sexual health charity Brook, says that while risk-heavy messaging about safe sex might increase awareness, it is unlikely to motivate behaviour change. ‘I don’t think people are motivated by risk avoidance, especially young people,’ she says. ‘Instead, I think we motivate behaviour change through encouraging people to think about their sexual wants and needs with their partners.’

It’s also incredibly important to talk about pleasure for safeguarding reasons. ‘By asking clients if the sex they have is enjoyable, or if they ever have sex they don’t enjoy, we can open up discussions about the safety of the relationships and the client’s wellbeing,’ Sophie says. ‘If young people know that they are an equal partner in a sexual exchange with as much right as the other person to enjoy themselves, they are more likely to be assertive with what they want and less likely to engage in sexual acts that they don’t want to partake in.’

Start the messaging early

Rebecca Jennings, an author, teacher and trainer of sex and relationships education (SRE) based in Sutton Coldfield, says teenagers need learning that incorporates messages about safe sex and sexual pleasure. ‘I always say to young people that your sexual health is just as important as any other element of your health and your body,’ Rebecca adds. ‘We want young people to understand that [sex] should be something enjoyable and not forced.’

According to the curriculum in England, Scotland and Wales, secondary schools in particular should provide a full SRE programme that includes what makes a healthy relationship, builds on pupils’ understanding of people’s different identities – whether gender or sexuality – and outlines nuances around consent, Rebecca explains.

‘The curriculum has to be built upon from year to year. So for example, Year 7s may learn about their bodies, puberty and changes and permission-seeking. Year 8s will perhaps build on consent and healthy relationships,’ she says. ‘We also need to consider the impact of pornography and how that can play a part in [teenagers’] expectations of what a body should look like and what sex should look like.’

Suzanne Millar, relationships, health and sex education lead at Central and North West London NHS Foundation Trust, works with schools and school nurses on teaching safe sex, consent and happy relationships. She says the concept of pleasure cannot be separated from any teaching about sex and relationships.

‘It’s part of what we do. Not so much that we say “Now we’re going to talk about pleasure”, but we emphasise that sex should be a pleasurable experience,’ Suzanne says. ‘We talk about the anatomy of pleasure and the parts of genitalia specifically designed for pleasure – that these are the parts of your body that can experience sensations. It all goes back to relationships and what a healthy relationship is. If it doesn’t feel right, then we shouldn’t be doing it.’

But the service provided by the Central and North West London NHS Foundation Trust is not typical of the SRE offering in schools across the UK. ‘We are quite lucky to have Suzanne,’ says Suzanne’s manager, Marta Thlon, clinical service lead for Kensington Chelsea and Westminster School Health. ‘And she has got support workers. Most teams don’t have the luxury of a special, dedicated team who are fully trained.’

Getting it right

Marta highlights the importance of getting the messages right about pleasure and sex for young people. ‘It’s about how you say it. If [a school nurse] visits a faith school [for example] and says “I’m going to talk to children about how to pleasure themselves”, families are not going to accept that,’ she says. ‘But if they talk about safe relationships and the importance of understanding how the human body works, [families] will be more receptive.

Discussing sensitive topics with teenagers about how the body works, relationships and consent, while respecting some families’ beliefs that sex should only happen within marriage, is crucial, Marta explains: ‘We also need to explain that abstinence models don’t work. When teenagers know the joys and dangers of sexual relationships, they are more likely to make responsible decisions than those who are completely kept in the dark or learn from the internet.’

If CPs talk about safe relationships and the importance of understanding how the human body works, families will be more receptive

The diversity of the communities Suzanne and Marta work in also means being sensitive to the needs of particular groups of pupils. For example, in schools for children with SEND, they may need to talk to pupils about when it’s appropriate and when it’s not appropriate to touch or expose themselves. ‘It is important to spend time with children and get to know them before discussing sensitive topics like this,’ Marta says. ‘Also, some children struggle with social cues and need to learn that just because something feels good does not always mean it is okay to do with other people around. All children need to learn the importance of privacy.’

In addition, working with girls who have suffered female genital mutilation requires care to not bring up abuse memories. ‘Just showing a picture of a normal vulva could trigger trauma in someone, and that is why we as a team of school nurses are trained in trauma-informed practice,’ Marta adds.

How can you help?

Ceri Evans, senior sexual health adviser and president of Unite’s Society of Sexual Health Advisers, says school nurses have a lot of ground to cover and may not necessarily be comfortable talking about sexual pleasure, so they should learn from sexual health staff where possible and understand the process for referring young people to clinics.

‘Community practitioners [CPs] don’t necessarily need to know all the answers or do all the teaching on safer sex, but [they] should know how, why, when and where to refer to other services,’ Ceri adds.

But school nurses should try to be open to talking about sex as much as possible, she says, and remember that ‘wagging a finger or scolding never works’.

‘We know that telling young people it is illegal to have sex under the age of 16 is not a deterrent… and it is also important to ensure that young people feel able to open up and talk to parents, carers or teachers and school nurses,’ Ceri says.

‘It is important for them to not feel they are being judged and that the conversations are confidential, within safeguarding guidelines of course.’

She adds there is a ‘fine line to tread’ between encouraging people to have fun, enjoyable and exciting sex, but also encouraging them to have safer sex. ‘Condom fatigue sets in – people have heard about condom use so much that they switch off and stop listening, or think they know everything necessary,’ Ceri says.

Ceri points out that people who get an STI frequently say they are never going to have sex again, or that they are always going to use a condom in future. ‘They mean it at the time, but it is an unrealistic goal. It’s much better to work with people about negotiating condom use with partners and/or having regular sexual health check-ups,’ she adds.

It’s also important to avoid messaging that can leave young people feeling fearful of sex, Sophie says. ‘Most – although by no means all – teenagers and young people are interested in sex and plan to have sex at some point in the future,’ she says. ‘If all our messaging stresses possible risks or harms, then their interest in sex can feel confusing or even shameful. By talking about sexual pleasure, we validate young people’s interest and reduce shame and stigma.’

She advises that professionals reiterate to young people that one of the primary reasons people have sex is for pleasure. ‘Pleasure might not feel like the most comfortable word, so connection, fun or enjoyment might do instead,’ Sophie adds. ‘When someone knows how sex should make them feel, they’ll find it easier to spot if they’re in situations that make them uncomfortable.’

It is important to ensure that young people feel able to open up and talk to parents, carers or teachers and school nurses

Sexual health education across the UK

Northern Ireland

SRE is mandatory and each school must develop its own policy based on its ‘school ethos’ – it’s up to each school to decide what to include in sex education Council for the Curriculum, Examinations and Assessment, 2015

Scotland

Within the curriculum, children learn about the importance of and need for commitment, trust and respect in loving and sexual relationships Scottish Government, 2014

Wales

Children over the age of 11 need to develop an understanding that they are entitled to safe and pleasurable relationships Welsh Government, 2022

England

Among the aims of the curriculum are to teach pupils the benefits to their mental wellbeing and self-esteem of healthy relationships and empower them to identify when relationships are unhealthy Department for Education, 2021b

Sexual health throughout life

These messages are not only for teenagers and young adults – sexual health and its benefits should be redefined throughout life, says the WHO (2022). Sexual health is ‘not a fixed state of being, and every person’s needs will change across the life course’, it writes. Nor is it ‘just the absence of dysfunction or infirmity’, but a ‘state of physical, emotional, mental and social wellbeing related to sexuality’.

Sexual health programmes and education should include a range of activities that are relevant for people of all ages, including support of sexual wellbeing, prevention and management of disease, the WHO states (2022). A useful approach to educational and health programmes is interlinking sexual health, sexual rights and sexual pleasure throughout life stages (Sladden et al, 2021).

For example, during the later years of life, menopause, sustaining sexual function and preventing cancers of reproductive organs are among the issues to address in enabling older people to pursue a satisfying, safe and pleasurable sex life (Sladden et al, 2021). ‘Sex is a big part of a lot of people’s lives,’ Sophie says.

‘As CPs, it’s crucial to offer a space for people to discuss this central part of their lives so that issues can be solved where possible and support found where necessary,’ she adds.

Anne agrees: ‘CPs are often the first to hear and talk about safer sex and have good relationships with their clients. They should know that flipping the narrative and being positive also leads to safer sex, more empowered people and a better conversation about what people want to flourish.’

Resources

Health for Teens, a website delivered with NHS agencies to provide information and signposting for teenagers healthforteens.co.uk/sexual-health

Brook sexual health charity for young people brook.org.uk

Explanation on what’s meant by a pleasure-based approach to sex and relationships education bit.ly/pleasure_approach

The Global Advisory Board for Sexual Health and Wellbeing’s assessment tool helps those delivering sex education and sexual health to incorporate pleasure within their programmes bit.ly/GABSHW_assessment

The Pleasure Principles: a guide to pleasure-based sexual health thepleasureproject.org/the-pleasure-principles

References

CCEA. (2015) Relationships and sexuality education guidance: an update for post-primary schools. See: https://ccea.org.uk/downloads/docs/ccea-asset/Curriculum/Relationships%20and%20Sexuality%20Education%20Guidance%20An%20Update%20for%20Post-Primary%20Schools.pdf  (accessed 21 June 2022). 

Department for Education. (2021a) Experiences of relationships and sex education and sexual risk taking. See: https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/1035862/SRE_and_sexual_risk-taking_research_brief_Nov21.pdf (accessed 21 June 2022). 

Department for Education. (2021b) Relationships and sex education (RSE) (Secondary). See: www.gov.uk/government/publications/relationships-education-relationships-and-sex-education-rse-and-health-education/relationships-and-sex-education-rse-secondary#:~:text=The%20aim%20of%20RSE%20is,kinds%2C%20not%20just%20intimate%20relationships/  (accessed 21 June 2022). 

Millanzi WC, Osaki KM, Kibusi SM. (2021) The effect of educational intervention on shaping safe sexual behavior based on problem-based pedagogy in the field of sex education and reproductive health: clinical trial among adolescents in Tanzania. Health Psychology and Behavioral Medicine 10(1): 262-90. 

Public Health Agency. (2020) STI surveillance in Northern Ireland 2020: an analysis of data for the calendar year 2019. See: www.publichealth.hscni.net/sites/default/files/2020-11/STI%20Surveillance%20Report%202020%20%282019%20data%29.pdf (accessed 21 June 2022). 

Public Health England. (2021) Sexually transmitted infections and screening for chlamydia in England 2020. See: https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/1015176/STI_NCSP_report_2020.pdf (accessed 21 June 2022).  

Public Health Information for Scotland. (2021) High risk groups. See: scotpho.org.uk/behaviour/sexual-health/data/high-risk-groups (accessed 21 June 2022).  

Public Health Wales. (2019) Sexual health in Wales surveillance scheme. See: phw.nhs.wales/topics/sexual-health/sexual-health-reports/sexual-health-in-wales-surveillance-scheme-quarterly-report-july-2019 (accessed 21 June 2022). 

Scott RH, Wellings K, Lindberg L. (2020) Adolescent Sexual Activity, Contraceptive Use, and Pregnancy in Britain and the US: A multidecade comparison. Journal of Adolescent Health 66(5): 582–88.

Scottish Government. (2014) Conduct of relationships, sexual health and parenthood education in schools. See: gov.scot/binaries/content/documents/govscot/publications/advice-and-guidance/2014/12/conduct-relationships-sexual-health-parenthood-education-schools/documents/00465948-pdf/00465948-pdf/govscot%3Adocument/00465948.pdf (accessed 21 June 2022). 

Sladden T, Philpott A, Braeken D et al. (2021) Sexual Health and Wellbeing through the Life Course: Ensuring Sexual Health, Rights and Pleasure for All. International Journal of Sexual Health 33(4): 565-71.

Singh A, Both R, Philpott A. (2020) ‘I tell them that sex is sweet at the right time’ – A qualitative review of ‘pleasure gaps and opportunities’ in sexuality and education programmes in Ghana and Kenya. Global Public Health 16(5): 788-800.

Welsh Government. (2022) The curriculum for Wales – relationships and sexuality education code. See: https://gov.wales/sites/default/files/publications/2022-01/curriculum-for-wales-relationships-sexuality-education-code.pdf (accessed 21 June 2022).

WHO. (2022) Redefining sexual health for benefits throughout life. See: who.int/news/item/11-02-2022-redefining-sexual-health-for-benefits-throughout-life (accessed 21 June 2022).

Zaneva M, Philpott A, Singh A et al. (2022) What is the added value of incorporating pleasure in sexual health interventions? A systematic review and meta-analysis. PLOS One 17(2): e0261034.

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