4 September : World Sexual Health Day

The first mental impact on sexual health is also perceived physically, encompassing sexual disorders and dysfunctions. These disorders can have a purely physiological origin, but the psyche is often at the heart of these issues.

The most well-known of these dysfunctions include erectile dysfunction, which is the difficulty in achieving or maintaining an erection when desired, ejaculation disorders, most commonly premature ejaculation, orgasmic disorders, which are the inability to reach orgasm, and vaginismus, a condition causing intense vaginal contraction leading to severe pain during penetration.

While these disorders can have a physical origin, when this is ruled out by a physician, a psychological origin remains most likely. Therapy will then be necessary to address these difficulties, which often have multifactorial origins. The goal will be to understand how the body functions, identify the thoughts and behaviors that maintain these difficulties, and modify them to restore satisfactory functioning.

Another category of disorders influenced by the psychological dimension concerns desire and libido, which can be simply defined as the desire to engage in sexual activity (alone or with others). This desire naturally fluctuates throughout life, sometimes high, sometimes very low, or even non-existent. The intensity does not determine the disorder. It is the impact on the person's life and the suffering that this intensity causes that will determine if the person needs help.

However, according to the WHO, sexual health "is not merely the absence of disease, dysfunction, or infirmity." Well-being thus goes beyond bodily and psychological functioning. The contributing factors extend around the individual, including the environment, relationships, partners, and more.

The WHO clarifies its definition by stating "the possibility of having pleasurable and safe sexual experiences, free of coercion, discrimination, and violence." This phrase highlights a central and fundamental aspect of healthy sexuality: consent.

Sexual consent is defined as the agreement to participate in one or more intimate and/or sexual acts.

For consent to be valid, it must meet three conditions: it must be given freely, with full knowledge, and by a person capable of consenting.

Free consent means that acceptance must not be given under violence, coercion, pressure, or threat.

Informed consent means that the person giving consent must not be in a state that impairs their judgment and capacity to consent. A person who is highly intoxicated or under the influence of substances, for example, is not in a state to give informed consent.

Capacity to consent presumes that the person is of sufficient age to understand what they are consenting to, and that their mental, psychological, and intellectual state allows them to understand what they are consenting to, and that they are conscious. A person losing consciousness during an activity to which they consented is no longer in a state to consent. A sleeping person is not in a state to give consent, regardless of any automatic physiological reaction of their body.

Consent is not based on the presence or absence of sexual arousal or any other sign. Consent is a state of mind that must be communicated and can be revoked at any time.

The way consent is understood today in the general population highlights two pillars of sexual health that need to be strengthened in the future: education and communication.

Understanding how sexuality functions, its variations, and the best practices surrounding it is not innate, and appropriate education allows everyone to experience a fulfilling sexuality, understanding their body and desire, and respecting those of others.