February 28, 2013 — "A Multidimensional Model of Sexual Health and Sexual and Prevention Behavior Among Adolescent Women," Hensel/Fortenberry, Journal of Adolescent Health, August 20, 2012.
A sexual health perspective among young people "differs from traditionally risk-focused perspectives by emphasizing the positive developmental contributions that sexuality provides to adolescent well-being within the context of romantic, family, and social relationships," according to Devon Hensel and Dennis Fortenberry of the Indiana University School of Medicine. "Sexual health refers to a state of optimal well-being related to sexuality through the lifespan," they noted.
Research to date has not empirically assessed sexual health as a multidimensional construct or its association to sexual behaviors. The researchers developed a study to evaluate the relationship between underlying dimensions of sexual health to overall sexual health, assess the stability and structural quality of overall sexual health; and understand the influence of sexual health on various behaviors.
The researchers used a subset of data from a larger longitudinal cohort study of girls ages 14 to 17 that examined sexual relationships, sexual behaviors and STIs. They selected 242 participants who had complete sexual history available, had only one partner at the time of their enrollment interview and were not pregnant at enrollment.
The researchers identified four key sexual health domains to study: emotional, physical, mental/attitudinal and social. They further divided the domains into dimensions. The emotional domain included the quality of the adolescent's relationship, while the physical domain assessed sexual satisfaction by asking about the individual's sexual relationship with her partner and genital pain. The mental/attitudinal domain examined attitudes toward pregnancy prevention, condom use efficacy, sexual esteem and sexual anxiety. Finally, the social domain explored the individual's sexual autonomy and sexual communication with her partner.
The researchers assessed the empirical relationship between the underlying dimensions of sexual health and overall sexual health, as well as the soundness of the model. They then evaluated the association between sexual health and certain behavior outcomes, such as sexual abstinence and contraceptive use.
All dimensions were significantly associated with overall sexual health, "suggesting that sexual health has significant underlying components." Specifically, greater sexual health was associated with higher relationship and sexual satisfaction, less genital pain, greater commitment to pregnancy prevention, greater condom use efficacy, higher sexual esteem, lower sexual anxiety and higher sexual autonomy.
When evaluating sexual health as a predictor of adolescents' behaviors, the researchers found that higher sexual health was associated with a greater likelihood of sexual abstinence; more frequent noncoital sex, as well as vaginal sex; greater condom use; use of various pregnancy prevention methods; and absence of STIs.
The "data demonstrate that sexual health is an empirically coherent structure, in which the totality of sexual-development dimensions is significantly linked to a wide range of behaviors," the researchers wrote. Further, the "results confirm that separate attitudes, beliefs, and evaluations all contribute to a core of sexual well-being during" adolescence, they added.
The data "also support a greater emphasis on research strategies that systematically track developmentally relevant indicators of sexual health and associated behaviors," the researchers continued, noting that "[e]fforts to realign public health prevention and control efforts away from risk-based perspectives to a sexual health perspective have been hampered by a general lack of data." For example, adolescent STI prevention strategies that focus on "elements of sexual health, such as sexual pleasure, sexual satisfaction, and relationships, would possibly open a new era in public health approaches to prevention."
The researchers called for future research "to better consider the influence of sexual health across a spectrum of sexual outcomes." They also noted that major changes to national surveys are necessary "to fully operationalize measures of sexual health." Nonetheless, their "analyses provide a strong hint that such data would profitably contribute to a new public health perspective on adolescents and STI," they wrote, concluding that the lack of "social and political will to adopt such a perspective seems ... problematic."
Debra Ness, publisher & president, National Partnership
Andrea Friedman, associate editor & director of reproductive health programs, National Partnership
Marya Torrez, associate editor & senior reproductive health policy counsel, National Partnership
Melissa Safford, associate editor & policy advocate for reproductive health, National Partnership
Perry Sacks, assistant editor & health program associate, National Partnership
Cindy Romero, assistant editor & communications assistant, National Partnership
Justyn Ware, editor
Amanda Wolfe, editor-in-chief
Heather Drost, Hanna Jaquith, Marcelle Maginnis, Ashley Marchand and Michelle Stuckey, staff writers
Tucker Ball, director of new media, National Partnership