Hawaiʻi Health Data Warehouse

Sexual Health

Sexual health is not just the absence of disease; it encompasses our physical, emotional, mental and social well-being in relation to sexuality. It requires a positive and respectful approach to sexuality and sexual relationships, including the possibility of having pleasurable and safe sexual experiences that are free of coercion, discrimination, and violence.1

Why It’s Important

Being sexually healthy means:

  • Understanding that sexuality is a natural part of life and involves more than sexual behavior.
  • Recognizing and respecting the sexual rights we all share.
  • Having access to sexual health information, education, and care.
  • Making an effort to prevent unintended pregnancies and sexually transmitted infections (STIs) and seek care and treatment when needed.
  • Being able to experience sexual pleasure, satisfaction, and intimacy when desired.
  • Being able to communicate about sexual health with others, including sexual partners and healthcare providers.

A lack of routine care of a person’s sexual health can lead to adverse outcomes, such as infertility or problems conceiving; mental, physical, and emotional anguish; long-term sexual violence (coercion, control, assault); and other long-term side effects.

STIs, HIV (human immunodeficiency virus) and other diseases can be transmitted to an uninfected partner from an infected partner. Risky sexual behaviors place individuals at an increased likelihood of HIV infection, other STIs, and unintended pregnancy. Reportable infections include chlamydia, gonorrhea, syphilis, and HIV. New incidences of STIs cost the United States (US) $16 billion in direct medical costs each year.2

What Is Known

In the US, 1 in 5 people have an STI, which translates to nearly 68 million infected persons in 2018.2 Around half of new STIs were among those 15-24 years old.2 In Hawai‘i,

  • Gonorrhea rates have doubled over the past 10 years.3 In 2018, the gonorrhea incidence rate was 90.0 per 100,000 population (Hawai‘i State Department of Health [DOH]).
  • Syphilis infections have increased 150% over the past 10 years.3 Between 2014-2018, the incidence rate was 6.4 cases per 100,000 population (DOH).
  • Chlamydia cases have increased 20% over the past 10 years.3
  • 32.4% of all adults and 34.5% of young adults have ever been tested for HIV (BRFSS 2020).
  • 43.8% of female and 48.3% of male public school students in grades 9-12 used a condom the last time they had intercourse (YRBS 2019).

Who Is at Risk

Any sexually active person can contract an STI/HIV through condomless vaginal, anal, or oral sex. Some STIs can also be contracted simply through mutual genital contact such as genital herpes and human papillomavirus (HPV). All sexually active people should have an honest and open talk with their healthcare provider and ask whether they should be tested for HIV or other STIs.

Inequalities affect communities differently and have a greater influence on health outcomes than either individual choices or one’s ability to access health care. Certain groups are more impacted by STIs/HIV due to inequities caused by generations-long limited access to healthcare, social, environmental, and economic conditions. Adverse health outcomes have a critical influence on an individual’s health, in addition to personal choice. In Hawaiʻi some of these subgroups include youth aged 15-24, individuals with a previous STI diagnosis, people who use injection drugs (PWID), men who have sex with men (MSM), and transgender women.

Sexual health is often stigmatized – meaning it can be difficult to discuss and can be perceived negatively. Stigma can make it hard for people to have open discussions with their partners, family, and friends, and often increases barriers to accessing care and resources.

How To Reduce Risk

To reduce unintended pregnancies, adolescent births, and HIV/STIs, it is important to encourage responsible sexual behavior and have access to resources and care. This can be accomplished by:

  • Condom use – Condoms are 98% effective if used correctly and consistently during every sexual encounter.4
  • Pre-exposure prophylaxis (PrEP) – PrEP is a biomedical prevention medication for those who have a higher likelihood of acquiring HIV. PrEP reduces the risk of getting HIV through sex by about 99%.5
  • Postponing/abstinence – Delaying sexual initiation until a person is emotionally and physically prepared, and has more knowledge about sexual activity, can help reduce the risk of contracting an STI/HIV.4
  • Limiting partners and increasing testing – Limiting the number of sexual partners and getting screened annually, or with a new partner prior to any sexual contact will reduce the risk of contracting STIs/HIV.4
  • Alternative forms of sexual activity – There are many alternative forms of sexual activity that are lower risk and gratifying that people can engage in such as hugging, holding hands, masturbation, and mutual masturbation.
  • Mutual monogamy – Having sex with only one partner, while that partner is also only having sex with you, will limit any other bacteria from entering your genital region potentially resulting in an STI.4
  • Vaccinations – There are vaccines for both the human papillomavirus (HPV) and Hepatitis B infection.4

Page last updated July 29, 2022

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1 Sexual Health. Centers for Disease Control and Prevention. https://www.cdc.gov/sexualhealth/Default.html Updated June 25, 2019. Accessed July 21, 2022.
2 Sexually Transmitted Infections Prevalence, Incidence, and Cost Estimates in the United States. Centers for Disease Control and Prevention. https://www.cdc.gov/std/statistics/prevalence-incidence-cost-2020.htm Updated February 18, 2021. Accessed July 21, 2022.
3 About Sexually Transmitted Infections (STIs). Hawai’i State Department of Health. https://health.hawaii.gov/harmreduction/learn-about-diseases/sexually-transmitted-infections/about-stis/ Accessed July 21, 2022.
4 How You Can Prevent Sexually Transmitted Diseases. Centers for Disease Control and Prevention. https://www.cdc.gov/std/prevention/default.htm Updated March 23, 2022. Accessed July 21, 2022.
5 Pre-Exposure Prophylaxis (PrEP). Centers for Disease Control and Prevention. https://www.cdc.gov/hiv/risk/prep/index.html Updated July 5, 2022. Accessed July 21, 2022.