Let's Talk about the “P” Word: Expanding our Definition of Sexual Health

During my junior year in undergrad, my friend and I sat on the beach attempting to navigate the dreaded “intern" summer. It felt like the world around us stumbled into the perfect internships, and left me behind. 

“What about the one through IIGH, about sex? It feels like something you'd like."

Immediately, she shared the link. Fighting the sand flying around my fingers, I opened the internship website, ready to apply. Six weeks later, I received my offer letter, magically becoming a member of the internship club. Unknown to me at the time, that email also marked the beginning of my career in sexual health.

Long before I was formally paid to discuss sex, I was already doing it for free. In high school, I sat in my car with a friend, who had just broken up with her first boyfriend, to listen to a podcast about different sexual preferences and fetishes. After each segment, I'd go first—naming, out loud, whatever on the list I was curious about or already knew I liked—before turning to her and asking the same. I would wait a beat, sitting in the uncomfortable silence, as my friend responded with her own opinions. Five years later, I sat in my apartment while she made direct eye contact with me to disclose she had contracted an STI.

The contrast was striking: a diagnosis, a fact about her body felt so much easier, requiring none of the vulnerability that naming a fantasy out loud once had. 

The contrast is hardly unique to her. Some conversations about sex simply seem easier to discuss. The mechanics of sexual health—routine testing, condom usage, and consent—have a comfortable place in our vocabulary. The second you introduce desire or pleasure into the mix, people squirm in their seats, avoid eye contact, and pray the conversation will be swift. That discomfort isn't just personal, but structural.

Our sexual lives sit in a unique space between private and public decisions. The choices we make about our bodies, relationships, and pleasure are deeply personal, yet our ability to make those choices is shaped by public policy, education, healthcare, and culture. Sex, then, exists within a strange contradiction: we regulate it publicly while going to great lengths to keep conversations about it private. The silence creates the perfect conditions for shame and stigma to take root. The widely accepted solution then becomes to shroud sex in secrecy and strip conversations about it to their barest, most clinical bones. But avoiding pleasure does not make sexual health education neutral. It reinforces the idea that pleasure is somehow less legitimate, less appropriate, or more shameful than the other realities of our sexual lives. 

The ability to ask for what we want matters. Understanding pleasure is not simply about making sex more enjoyable; it gives us the language for our desires, boundaries and expectations. That language must be learned somewhere. 

Sex-education is largely the first point of knowledge for adolescents about sexual health, and with only about half of the US's students having received some sort of sex-ed before graduating high school—much of it lacking information on key topics like consent and contraception—risk-averse frameworks and education are falling short. Despite global health organizations like the UN, WHO, and CDC all agreeing that pleasure belongs in our sexual health discussions, the majority of sex-ed curriculums largely omit the "p" word. 

Pleasure is as effective a tool as risk and prevention education. Lack of pleasure-based sex-ed undermines curriculum goals. When you attempt to build a compass used in navigating the complexities of relationships, without addressing the central theme of those relationships, you create a foundation unable to withstand conflict. 

The goal of sex-education must move beyond hoping students “will gain knowledge to avoid or reduce sexual behaviors that increase risk for sexually transmitted infections (STIs), HIV, and pregnancy.” It must provide a space for “young people to gain the information and skills they need to make the best decisions for themselves about sex and relationships throughout their lives.” When shame already fills the silence around sex and consistently shapes our access and utilization of sexual healthcare, it is not enough for sex education to simply be neutral. It is imperative that our ideas of sexual health actively hold space for pleasure. 

A pleasure-based framework does not ask to abandon conversations about risk, but instead requires us to actively expand them. Absence of a negative health outcome does not by itself equate to the presence of sexual well-being. Prevention belongs in bed with pleasure. 

Disconnecting our pleasure from our health disconnects us from our rights. We have a right to pleasurable experiences. It's time our definition of sexual health encompasses it.