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Sexual Health

Sexual health is a state of physical, emotional, mental and social well-being in relation to sexuality; it is not merely the absence of disease. Sexual health requires a positive and respectful approach to sexuality and sexual relationships, as well as the possibility of having pleasurable and safe sexual experiences free of coercion, discrimination, and violence.

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 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.

Sexual health is an important component of a person's overall health, and a normal part of the human experience. 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.

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.

Sexual risk behaviors place individuals at an increased likelihood of HIV infection, other sexually transmitted infections (STIs), and unintended pregnancy.

What is "sex"?

Sex can mean a lot of different things to different people. There is a large spectrum of sexual activity. Some common sexual practices that have an increased likelihood of acquiring or transmitting an STI include:
  • Oral sex: Oral sex involves using the mouth, lips, or tongue to stimulate the penis (fellatio), vagina (cunnilingus), or anus (anilingus) of a sex partner.
  • Vaginal/penile sex: Vaginal/penile sex involves insertion of the penis into the vagina.
  • Anal sex: Anal sex involves the insertion of the penis into the anus.

STI/HIV Transmission

STIs and HIV can be transmitted to an uninfected partner from an infected partner. There are many diseases that can be transmitted sexually. Reportable infections include chlamydia, gonorrhea, syphilis, and HIV.

Hawai'i has seen a 20% increase in chlamydia cases over the past ten years. During that same time, gonorrhea rates doubled, and syphilis infections increased 150%. In 2017, there were nearly 8,400 people in Hawai'i who were diagnosed with an STI.

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 Hawai'i some of these subgroups include youth aged 15-24, individuals with a previous STI diagnosis, people who use injection drugs (PWID), and men who have sex with men (MSM) and transgender women.

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. See Condom Use Guidelines.
  • Birth control - There are many options for pregnancy prevention including condom use, hormonal methods (pill, patch, ring, shot), intrauterine devices (IUD), implants, and other barrier methods.
  • Pre-exposure prophylaxis (PrEP) - PrEP is a biomedical prevention medication for those who have a higher likelihood of acquiring HIV. When taken consistently, PrEP has been shown to reduce the risk of HIV infection in people who are at high risk by up to 92%.
  • 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.
  • 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.
  • 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.
  • Vaccinations - There are vaccines for both the human papilloma virus (HPV), and Hepatitis B infection.

Accurate and timely reporting of hepatitis, STIs, and HIV/AIDS cases are necessary for successful disease prevention and control. Reporting allows programs to visualize trends, identify potential outbreaks, initiate early interventions, and assist healthcare providers in the medical management of partners who may be infected. In Hawai'i both health care providers and laboratories are mandated to report the following diseases within three working days (72 hours) of confirmation: Hepatitis A, Hepatitis B, Hepatitis C, HIV, AIDS, Chlamydia trachomatis, Neiserria gonorrheae, Treponema pallidum (syphilis), Haemophilus ducreyi (chancroid), and Pelvic inflammatory disease (PID).

The Behavioral Risk Factor Surveillance System (BRFSS) collects information on HPV immunization, and HIV testing among adults and participation in high risk activities for HIV transmission. The Youth Risk Behavior Survey (YRBS) includes questions about sexual activity and condom use. The Pregnancy Risk Assessment and Monitoring Survey (PRAMS) collects information on HIV testing during pregnancy and birth control use pre and post pregnancy.

Hawai'i Health Matters Indicator Dashboards

Behavioral Risk Factor Surveillance System (BRFSS)

Pregnancy Risk Assessment Monitoring System (PRAMS)

Youth Risk Behavior Survey (YRBS)