The prevention of sexually transmitted infections, unintended pregnancies, and sexual violence are all public health issues. To address these issues, the “Sexual Health” program led by Santé publique France is based on the National Sexual Health Strategy: Agenda 2017–2030.

What is sexual health?

According to the WHO definition adopted in 2002, sexual health is “a state of physical, emotional, mental, and social well-being related 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, and the ability to have sexual experiences that bring pleasure safely and without coercion, discrimination, or violence. To achieve and maintain sexual health, the sexual rights of all people must be respected, protected, and fulfilled. Sexuality is a central aspect of the human person throughout life and encompasses biological sex, gender identity and gender roles, sexual orientation, eroticism, pleasure, intimacy, and reproduction. Sexuality is experienced through thoughts, fantasies, desires, beliefs, attitudes, values, behaviors, practices, roles, and relationships. While sexuality may include all these dimensions, they are not always experienced or expressed simultaneously. Sexuality is influenced by biological, psychological, social, economic, political, cultural, ethical, legal, historical, religious, and spiritual factors.”

What exactly does the field of sexual health encompass?

Sexual health is a broad concept that encompasses both sexuality and reproductive health. It covers the following areas:

• Sexually Transmitted Infections (STIs), including the human immunodeficiency virus (HIV) – Acquired Immunodeficiency Syndrome (AIDS)

• Unplanned pregnancies / Voluntary Termination of Pregnancy (VTP) / contraception

• Sexual disorders / infertility

• Sexual and gender-based violence

• Youth sexual health and sexuality education

• Sexual orientation and gender identity

• Mental health issues related to or associated with sexual health

• The impact of physical disabilities and chronic illnesses on sexual well-being

• Promoting safe and satisfying sexual experiences

What are the three pillars of sexual health?

• Autonomy

This means that everyone has the ability to exercise control over their own sexuality. Each individual must be able to accept what suits them and refuse what does not. Everyone must be able to freely decide matters related to their sexuality, choosing the partner(s) of their choice and the sexual practices they desire, without discrimination or coercion. Beyond the guarantee of basic means of subsistence (which limits the risks of non-consensual sex work undertaken to secure shelter or vital resources), and beyond rights and public protection, it is access to tools and information that opens up these possibilities, enabling a critical and autonomous perspective on one’s own sexuality.

• Satisfaction

This is not limited to the mere notion of the absence or presence of pleasure and orgasm. In fact, achieving a general sense of sexual satisfaction often requires much more than mere sensory gratification. Thus, social dimensions (the alignment of one’s lived sexuality or potential with one’s own aspirations and values), psychological dimensions (self-esteem and self-image), and emotional dimensions (the presence and quality of emotional relationships) have a major impact on sexual satisfaction.

• Safety

Current prevention policies play an essential role here, as they aim to empower people to engage in safe sexual activity. Safety requires individuals to be able to recognize situations that pose a risk to their health and respond to them, as well as to identify and anticipate their moments of vulnerability.

What is the situation in France?

In France, overall indicators of sexual health—measured in terms of autonomy, safety, and satisfaction—are relatively good compared to those of other countries:

• In 2016, among women concerned with contraception, 82% used a method to prevent pregnancy;

• Since the 2000s, more than 85% of young people have used a condom during their first sexual encounter;

• More than 80% of men and women report being satisfied with their sex lives.

However, other indicators related to sexual health are less than satisfactory:

• Despite progress in recognizing the rights of LGBT people, discriminatory and violent attitudes toward them persist: in 2019, 35% of LGBT people reported having experienced at least one form of discrimination in their lifetime due to their sexual orientation or gender identity.

• Despite high contraceptive use, one-third of pregnancies remain unplanned amid underutilization of emergency contraception.

• While in the vast majority of cases, the first sexual encounter is desired “at that moment,” 11% of women report having yielded to their partner’s expectations, and 2% of women state they were forced to have sex.

• 19% of women and 5% of men aged 18–69 report having experienced attempted or forced sexual intercourse at some point in their lives.

• HIV transmission remains active in France, with more than 6,000 new HIV diagnoses each year. Men who have sex with men (MSM) and people born abroad (80% of whom were born in a sub-Saharan African country) remain the two most affected groups. At the same time, the spread of certain bacterial STIs (gonorrhea and chlamydia) continues among MSM as well as among young heterosexuals.

• 25% of schools do not implement any sex education programs despite the legal requirement.