Why Public Health Must Talk About Sexual Pleasure
More Than Risk: Sexual Health Includes Pleasure
Most of the time, sex is a positive and pleasurable part of life, even contributing to health, yet public health discussions often frame sex only in terms of risk and danger (Herbenick et al., 2018; World Health Organization [WHO], 2022). Topics like disease prevention, unintended pregnancy, and “safer sex” dominate the conversation, while the word pleasure is seldom mentioned. This silence around pleasure isn’t just an awkward omission; it’s a gap that undermines the effectiveness and equity of our sexual health programs. It’s time to talk openly about why pleasure matters, and why leaving it out of public health does a disservice to everyone.
Public health experts define sexual health broadly. According to the WHO (2006), sexual health is “a state of physical, emotional, mental and social well-being… not merely the absence of disease,” and it “requires… the possibility of having pleasurable and safe sexual experiences, free of coercion, discrimination and violence” (p. 5). In other words, enjoyment and well-being are central to sexual health, right alongside safety and consent. However, many health campaigns and educational programs haven’t caught up to this idea. They still focus almost exclusively on avoiding bad outcomes, such as pregnancy, infections, and abuse, without acknowledging the normal human desire for intimacy and joy.
In the United States, for example, traditional sex education has been guided by a narrow risk-reduction framework. It emphasizes how to avoid negative outcomes (like STIs or teen pregnancy) but often ignores how to pursue positive ones. As one analysis noted, U.S. sex ed “focuses almost exclusively on avoiding unintended pregnancy and sexually transmitted diseases, overlooking other critical topics… related to sexual pleasure” (Guttmacher Institute, 2023, para. 1). Discussions about healthy relationships, sexual satisfaction, and communication are glossed over. Not surprisingly, young people notice what’s missing. Many express frustration that their classes never address things like how to navigate intimacy or what consent looks like in a pleasurable context. Sexual and gender minority youths, in particular, often feel completely overlooked by current approaches (Kaiser Family Foundation [KFF], 2023).
Who Pays the Price for Leaving Pleasure Out?
Omitting pleasure from sexual health education and policy doesn’t affect everyone equally, and it tends to hurt those who are already marginalized. When curricula assume a one-size-fits-all, heterosexual model focused on dangers, women and LGBTQ+ individuals often get left behind. For instance, research on the “orgasm gap” finds that women in heterosexual relationships frequently receive less information and affirmation about their pleasure, leading them to expect and even accept less satisfaction over time (Herbenick et al., 2018). Similarly, lesbian, gay, bisexual, transgender, and queer youth rarely see their experiences reflected in standard sex ed. A curriculum that never mentions same-sex relationships or diverse gender identities – let alone the idea that sex should feel good for everyone, and can leave these young people isolated and uneducated about healthy sexuality.
The public health consequences are serious. LGBTQ+ youth already face higher risks of sexual ill-health, and those risks are compounded in regions where inclusive, honest education is lacking (KFF, 2023). On the flip side, inclusive programs make a difference: a recent CDC report found that students who receive LGBTQ-inclusive sex education feel more connected to school and have lower rates of depression and bullying (Centers for Disease Control and Prevention [CDC], 2023a). These benefits are, as the report noted, “especially critical” for LGBTQ+ youth (CDC, 2023a, para. 12), indicating how an inclusive, pleasure-aware approach can improve mental health and safety. Even beyond LGBTQ communities, any group that historically hasn’t had a voice in sexual health discussions, whether due to race, disability, or cultural taboo, stands to benefit when we broaden the conversation. It’s often the communities with the most restricted sex education that suffer the worst health outcomes. Additionally, several U.S. states with the most restrictive, abstinence-focused sex ed policies also have among the highest teen birth and STI rates (Guttmacher Institute, 2023). Lack of comprehensive, realistic information deepens health disparities.
In short, ignoring pleasure and real-life sexuality doesn’t protect people; it leaves them more vulnerable.
A Public Health Paradigm Shift: Pleasure and Well-Being
The good news is that a paradigm shift is underway. Major health organizations and leaders are beginning to push for a more expansive, sex-positive approach. It is one that treats sexual pleasure, consent, and well-being as integral to public health rather than afterthoughts. For example, in 2022, the theme of World Sexual Health Day was “Let’s Talk Pleasure,” reflecting a growing global movement to normalize this conversation (World Association for Sexual Health, 2019). That same year, a WHO-led research analysis made waves by showing that considering sexual pleasure in interventions isn’t frivolous at all; it actually improves outcomes. The systematic review found that when sexual health programs address the reasons people have sex (including the pursuit of pleasure), participants have better knowledge and higher uptake of safer sex practices like condom use (WHO, 2022). In other words, acknowledging pleasure can make sex safer.
“Sexual health education and services have traditionally focused on risk reduction and preventing disease, without acknowledging how safer sex can also promote intimacy, pleasure, consent, and well-being,” notes Dr. Lianne Gonsalves of WHO’s research program on human reproduction (WHO, 2022, para. 5). Her message is simple but powerful: programs that meet people where they are, recognizing that humans seek sexual pleasure, achieve better health outcomes. When individuals see that public health isn’t just saying “no” or warning about dangers, but also affirming that sex can be safe and enjoyable, they are more likely to engage in healthy behaviors.
Policy leaders are starting to listen. In recent years, the U.S. Department of Health and Human Services, the National Academies of Sciences, and the WHO’s regional offices have all called for promoting sexual well-being (including pleasure) as part of public health strategies (World Association for Sexual Health, 2019). International professional bodies are on board, too. The World Association for Sexual Health, a global coalition of experts, declared in 2019 that “the possibility of having pleasurable and safe sexual experiences… is a fundamental part of sexual health and well-being for all,” and urged that sexual pleasure be integrated into education, health promotion, and policy worldwide (World Association for Sexual Health, 2019, p. 2). From global declarations to national strategic plans, the consensus is growing: pleasure is not a luxury or a moral extra in sexual health, it’s a core component. Embracing that fact can lead to more honest education, more effective health services, and more empowered communities.
A Call to Action: Putting Pleasure on the Agenda
It’s time for public health organizations, educators, and policy-makers to put this knowledge into practice. A values-driven, pleasure-inclusive approach to sexual health is both possible and necessary. Here are some practical steps for leaders and institutions ready to take action:
Update Policies and Curricula: Revise sexual health policies, school curricula, and program guidelines to explicitly include sexual pleasure as a topic, alongside consent, safety, and health. Organizations like WHO and the CDC already emphasize that sexual health is about well-being; our educational standards should reflect that by teaching that safe, consensual sex can and should be pleasurable for all participants (WHO, 2006; WHO, 2022).
Train and Empower Educators: Provide professional development for health educators, clinicians, and community health workers on how to discuss pleasure in an age-appropriate, culturally sensitive way. Many educators have never been trained to talk about positive sexuality. Giving them the tools and confidence to handle these discussions, including how pleasure relates to consent and communication, will improve the quality of programs.
Center Equity and Inclusion: Ensure that pleasure-based approaches are inclusive of all genders, sexual orientations, and cultural backgrounds. This means consulting with historically marginalized groups when designing curricula or campaigns. Representation matters: every community should see that their experiences and enjoyment of sexuality are acknowledged as valid. Inclusive, affirming content leads to better engagement and health outcomes, especially for those who have been left out in the past (KFF, 2023).
Measure What Matters: Expand research and evaluation metrics beyond just negative outcomes (like STI rates), also to track positive outcomes such as sexual satisfaction, agency, and relationship quality. Doing so sends a message that these aspects are valued. It also provides data to inform improvements. As WHO researchers have shown, “acknowledging that people balance desire, pleasure, intimacy and yes, risk, is key to reflecting real experiences” (WHO, 2022, para. 6).
Honestly, talking about sexual pleasure in public health is about respect and realism. It means respecting that all individuals, including teens, elders, LGBTQIA+ folks, people with disabilities, and those from conservative cultures, deserve accurate, complete information about their bodies and relationships. It means being realistic that people seek sexual fulfillment, and that this can go hand-in-hand with safety, consent, and responsibility. Breaking the taboo on pleasure allows us to affirm that sexual health is true health: not just the avoidance of disease, but the presence of wellness and joy.
Let’s lead with clarity and compassion on this issue. Public health organizations and educators have a responsibility to paint the full picture of sexual health, one that includes pleasure, alongside protection and consent, as a natural and important part of human experience. Embracing a pleasure-positive approach will not only improve our programs; it will help build a world where everyone, no matter their background, has the knowledge and support to pursue safe, consensual, and fulfilling sexual lives. The conversation starts now, and we all have a role in keeping it going.
