In this Women’s Live’s, Women’s Voice’ feature Eilish Mc Art, Coordinator of the Sexual Health Education Programme at the Donegal Women’s Centre in Letterkenny, talks about the education and training programme she delivers, highlighting the topic of sexual health and the importance of including and discussing sexuality + health to support our health and wellbeing.
Donegal Women’s Centre Providing Sexual Health Services
Donegal Women’s Centre has long been associated with health care provision and began in 1989, providing a ‘Health and Family Planning’ clinic, one of the first in Ireland, in a community setting. In more recent years a Sexual Health Project for young people began, initiated by an insightful colleague and I became the Sexual Heath Project Coordinator, this was followed up with a Young Women’s Sexual Health Clinic in Donegal Women’s Centre, which is one of only two in Ireland in the community settings, funded by HSE Sexual Health & Crisis Pregnancy Programme.
Sexuality Health not just Sexual Health and why it matters
I have always felt challenged that Sexuality Health is not given more recognition by society as a primary element of Health & Wellbeing, particularly the ‘BEING.’ Other areas of health are discussed in open forums, but the mere mention of sexuality, and social response is a nod to it (and possibly a wink!). This is rooted in our attitudes and values, garnered by our generational, historical and religious systemic culture.
But, yet is sexuality not at the very core of who we are, from birth until death, how we identify to ourselves and to others, how we connect spiritually and physically. We cannot merely reduce sexuality to a discussion on contraception, Sexually Transmitted Infection (STI’s), and gender identity, although essential to holistic sexuality health provision.
The World Health Organisation Statement on 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, 2006)
I would also include the capacity for sensuality. It is within this statement I consider my testimony to sexuality to be true, it is in sync with my beliefs, but also from years of working with the subject, agencies and people.
The Power Of Sexuality
I would not underestimate the power of sexuality. Sexuality transcends differences and divides of culture and politics, it is a bio/physiological condition familiar to all humans. Sexuality is not defined or confined by issues of, or consequences of being gay, gender identity, race, marginalisation by any factors such as economic class, education level, religious practice, ethnic group, migrant, traveller or settled, prisoner or free, ability or disability, or age, no, it is a behaviour common to all, it is mutual and unifying. Nor is it the domain and responsibility of the female of the population groups. The power of sexuality has had a place in history and many fabled and real political liaisons and strategy.
I recently carried out a scoping exercise for HSE Sexual Health & Crisis Pregnancy Programme titled ‘The Sexual Health Needs of Marginalised and Migrant Communities’. Women refugees who had been displaced due to war, through direct provision and in resettlement programmes in this county and women from Irish ethnic minority communities.
This was a gift that enabled me to have privileged access to work with women. I have also worked with women and men from disability sectors in programmes and training in sexuality, and throughout my career in wellbeing and sexual health, which includes people from LGBT, gender identity, those from socially, emotionally and economically marginalised, and privileged areas, they have been my tutors, and I have learned that sexuality and the issues from sexual health are common to all.
It is the glue that binds us as Humans. It is our inherent need for connection, bonding, and sensuality, the need to give love and receive love, feel and be desired, ecstasy, fulfilled, and attraction, and the gift of humanness. The soul of human sexuality is Powerful, and full of affirmative Power.
I do have to mention, negative use of sexual power, for the greater part in the setting of domestic violence. This is an area that needs to be addressed. The issue of domestic violence rightly has been given a respectful setting within the political, community, and funding sectors, but, discussion of the relevance of sexual control is a developing awareness, and programmes are being created to address this. I tried to research this issue for work, and it is limited in terms of information in this country, with one cross border community group and local support group, including this issue, and doing excellent work in their training in domestic violence.
In war, sexual violence is one of the conquering, degrading demeaning and divisive tactics used by marauding nations. This is one of the underlying experiences that the women who participated in the scoping exercise experienced. This awareness and visioning was provided by the most eminent of project workers who provided me with a deeper awareness of the impact of the ravages of war, refugee camps, displacement and direct provision have on men and women. The ugliness of emasculation for the men and that impact for women, the war that is unspoken, struggles of need – the silent war shaped by despair. Where can that anger and rage go? There are consequences and this impacts on sexuality and sexual behaviour for men and women.
Irish women from ethnic minorities experience hardships and vulnerability that are further exacerbated by levels of education, issues of residence, alcohol, homelessness and mental health.
One common experience for marginalised women highlighted to me in the focus sessions was the inability to relate to ‘white middle class services and leaflets on sexual health’ and the non-familiar language, women cannot identify with it. The research highlighted that a patriarchal system was evident, and was mentioned, and had an impact on women’s’ experiencing of safe sexual encounters, and attending for health care.
When we experience assault, any assault, we separate ourselves from our sexuality self, but it is an innate part of who we are and that means being separated from our soulful self. It leaves a gap, an emptiness.
I don’t wish to dwell on the negative elements of sexuality health, for to do so is sad, but I don’t apologise for including the issue, not to do so would be remiss and insulting to all the women and men I have worked with.
The Relationship of Sexuality with Mental Health
To discuss sexuality, we cannot neglect the fundamental component of self-esteem. Self Esteem underpins our sexual health choices, and our sexual health behaviours, and this links sexual health to mental health. Without the inclusion of self-esteem then any discussion on sexual identity, contraceptives, STIs, abortion or signposting to sexual health services is less effective.
Consent is a major issue in sexual behaviour and it is relative to self-esteem, and this is largely dependent on having experienced the 3A’s, Affirmation, Approval, and Acceptance from an early age and throughout life. I call it the AAA battery for a positive life experience. Having or acquiring healthy self-esteem, enables us to make healthy decision, and choices with partner behaviour, recognise difficulties, and act for a better way, recognise or wonderful connections, and grow with that.
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 recognised in international and regional human rights documents and other consensus documents and in national laws.
Rights critical to the realisation of sexual health include:
Rights critical to the realisation 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.
The physical act of sex, is often talked about under healthy and unhealthy headings. Literature on safe sex is available, and it is important to recognise the value of promoting safe sex, the correct use of contraception, information on STI’s, crisis pregnancy supports and services. There is also safer sex, and that is about responsibility in safe sex practice, respect for self and others. It means seeking consent, using contraception as directed. It may also include using visual aids, stimulating aids, where consent is agreed and partners are the legal age to use.
Reduce the risk of coronavirus during sex
It is not always obvious if someone has coronavirus. Being sexually active with another person involves some risk of getting the virus. There is a need to reduce this risk by following the advice below.
Only be sexually active with someone you live with who does not have the virus or symptoms of the virus.
Avoid being sexually active with anyone outside your household.
Avoid kissing anyone outside of your household and anyone with symptoms. Kissing can easily pass on coronavirus.
Taking a break from physical and face-to face interactions is worth considering.
Consider using video dates. Make sure to disinfect keyboards and touch screens that you share with others
While the current advice is not to have sex with or kiss anyone outside of your household, if you do, it is important to limit it to as few partners as possible. Remember close sexual contact with anyone you are not living with can put you and others at risk of coronavirus. Use condoms and dental dams to reduce contact with saliva or faeces, especially during oral .
Wash before and after sex. This is more important than ever. Wash hands thoroughly and often with soap and water.
The Donegal Women’s Centres, Sexual Health Information Project has compiled some useful advice about keeping on top of your sexual well-being now that it’s easier to get out and about and meet people. To find out more please visit here.
Training in enabling the normalising of sexual/ity health discussion for professionals.
I have the honour of working in partnership with a wonderful talented young woman from health promotion and improvement delivering training in Sexual Health Promotion, a national training programme funded by HSE Sexual Health & Crisis Pregnancy Programme. At the outset of the training the professionals often state that they seek confidence in discussing the subject, and indeed that is part of the design of the programme. It is often noticed that by the end of the 10 days the participants have achieved that confidence through discussion, heightened awareness of the relevance to human wellbeing, but also that taboo around the normalising of sexuality discussion has diminished and is joyful to witness. The days are challenging and full of new consciousness of the positive value in sexuality health provision. It is emphasised to participants, nationally, to be inclusive of the affirmative element of pleasure, ecstasy and joy in sexual participation, and the benefits of self-satisfaction and connection, to the individual’s health and therefore societal health. When humans are happy, they are mostly in a healthy state of Being.
This does not direct that people have to be sexually active to achieve wellbeing, that is a choice. Rather, is it about the relationship with self to begin, an interpersonal connection, and that which achieves an ability to sense the higher self, fulfilment, it is sensuality, and knowing the components of and experiencing joy for self. Sensuality is the pleasure that we derive in being with someone, by choice, and that changes with age, ability, health, life events but the joy and pleasure remains in being a tuned with that core component of sensual pleasure.
Donegal Women’s Network invited me to contribute an article to the women’s lives, Women’s Voices series, an opportunity to address the taboo on the subject of sexuality, knowing that I am passionate about the subject, and also about putting across the relevance of Sexuality Health within general health provision, my view is, it has to be included to achieve Well-being.
I wondered how do I address ‘taboo’ part of the challenge. For me it is about making the subject acceptable, normalising the issue. How do I do that? – it concerns YOU, EVERY YOU. It matters to YOU, it is WHO YOU ARE in your world, how you choose to project yourself, and, your wellbeing.
So, in my processing world Sexuality and Sexual Health Care, cannot be separated from general health care, to do so, leaves out a core element. Sexuality Health is, will always be relevant, a priority, and core contributory factor to humans being and societal well-being.
I am grateful to all the women of the Donegal Women’s Centre who support me in doing the work of the Sexual Health Project, in schools in the community and delivering the national training, and also to HSE Sexual Health & Crisis Pregnancy Programme who fund the Project.