What is sexual health? A conversation with sex educator Emily Nagoski on sexual well-being, pleasure and porn

  • Sexual health includes all aspects of reproductive and sexual well-being.
  • When sexual health is discussed in the culture, race and disability are often overlooked.
  • There is no such thing as "normal" when it comes to sexual well-being.

When someone says "sexual health," what comes to mind? Perhaps you think about the absence of disease or ways to prevent unplanned pregnancy. Maybe you think of sexual dysfunction. But sex educators say sexual health encompasses all aspects of physical and mental well-being related to sexuality, and during September's Sexual Health Awareness Month, sexual health was emphasized as a human right.

USA TODAY spoke with sex educator and "Come As You Are" author Emily Nagoski on the importance of sexual health, and the necessity for every person to have access to sex-related information, medical support and pleasure. 

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Question: What is sexual health?

Answer: Governmental, nonprofit and professional organizations all have extensive, detailed definitions of sexual health. As a sex educator who works primarily with adults, I define sexual health not just as the absence of disease or distress, but as every individual having access to the resources they need to attend to every domain of their sexual and reproductive well-being, including physical, mental, emotional and spiritual.

The theme of this year's Sexual Health Awareness Month is “Let’s Talk Pleasure.” How is our experience of sexual pleasure challenged by our culture? 

Educators like me talk generally about the exclusion of a variety of people from being included in our sense of who “deserves” pleasure, but I want to talk about the impact of that on our brains. Pleasure is processed in the brain by just a handful of “hedonic hotspots,” and stress – including identity stress – can disrupt those hotspots' ability to respond to sensations that, in a different context, it would.

"The World Association for Sexual Health began organizing a Sexual Health Awareness Month each September as part of their efforts to promote sexual rights as human rights," said sex educator Emily Nagoski.

Students of neuroscience have all heard that “neurons that fire together, wire together.” Well, many of us have had our brains trained not to be able to notice pleasure. People of color, people with disabilities, LGBTQ people and others have been raised in a culture that told them their bodies do not belong and they do not deserve pleasure, and their brains reflect that.

But I think it’s not a coincidence that pleasure-based activism now is led by precisely the people who were taught they don’t deserve pleasure: Adrienne Maree Brown and Ericka Hart, to name just two.

What are some areas of sexual health that don't get enough attention, and why are they important?

Two fundamental areas are race and disability. The bleak reality is that sex education in America originated in the eugenics movement. ... Even “comprehensive” formal sex education is still grounded in ableist white supremacy. That shows up in our cultural discourse and even in sex research, which overwhelmingly problematizes Black people’s sexuality, rather than treating it as a normal, healthy part of their lives. That’s beginning to change, though I worry sometimes that racial justice in sex ed will get overlooked as reproductive rights and basic evidence-based sex education are eroded more and more.

And people with different physical, cognitive, and social abilities deserve sex education that supports their diverse needs. Sex ed needs to be accessible, of course, but the larger culture has to change, too. I have had women college students with physical disabilities tell me their doctors had never, not once, talked to them about how their disability might affect their sexuality, and certainly didn’t offer resources for expanding their access to pleasure.

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Which groups face the most challenges in caring for their sexual health and why?

I dream of a world where a Black, kinky, queer, nonbinary transfemme immigrant, who is unhoused and undocumented, has access to all the resources they need to attend to every domain of their sexual and reproductive well-being. Fully. Freely. Across their whole lifespan. And any objections anyone has to that, any judgments anyone has about my imaginary person, those are the obstacles we have to overcome in order for everyone to be able to care for their sexual health.

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Are there universal truisms around sexual health, or is sexual health defined by individuals?

As much as I might wish there were universal truisms – each person’s body belongs to them and they get to choose how and whether they are touched, the gender binary is a trap that stops us from truly understanding ourselves and others, stigma is worse for our health than STIs, no one gets to impose their values on anyone else, people are allowed to be who they are – it really is for the best that each person has their own definition of sexual health. 

Are you concerned about the attacks on comprehensive sex education?

I am deeply worried about the continuing attacks on real sex education all over the country. We need comprehensive, evidence-based sex education ... because it normalizes the reality of human sexuality. I particularly advocate for values-based sex ed that offers an opportunity for young people to think about what matters to them, instead of explaining to them what’s supposed to matter to them.

The worst part to me is that the evidence of the efficacy of sex education in reducing harm has been there for decades. It is not that we do not know what works, it’s that we lack the political will to give young people the education they deserve. But we can change that. Organizations like educateUS: SIECUS In Action are working to change sex education policies across the country.

What is sex positivity?

People have different definitions, but here’s mine: Sex positivity is the radical, all-inclusive belief that each person’s body belongs to that person, and they get to choose what they do with it and how they feel about it.

Sex drive:Have we been thinking about it all wrong?

Internet porn is a much-debated topic. I've heard people call it inherently sexist, say it has led to the exploitation of performers, that it's psychologically damaging to children. I've read defenses about the ways in which porn can be healthy, feminist and autonomous. What is your position on internet porn?

Porn can be all those things. And it can also be a fun addition to individual or partnered sex, or a way to introduce a new idea to your partner, or even a way to learn about yourself. For adults.

Apart from the potential for harm to performers you mentioned, especially women and trans performers in mainstream porn, the worst consequence of the instant availability of endless porn online has made it a replacement for actual sex education.

By the early 2010s, college students were asking me questions about their bodies and how sex worked, based on what they had learned from porn. They thought they were broken because their bodies didn’t do what bodies in porn did. Learning about sex from porn is like learning to drive by watching NASCAR. Those are professionals on a closed course with a pit crew.

My advice about internet porn is that if you decide you’d like to watch it, you should pay for it, just like you’d pay for a magazine. And just as you might buy coffee based on its alignment with your values – the eco-friendly option, the fair trade option, etc. – buy porn that is ethically produced, gives performers true choice about what they do and don’t do,

If you could only emphasize one message about sexual health, what would it be?

The question I’m asked most often is some variation of “Am I normal?” To me, “normal” sex is any sexual contact where everyone involved is glad to be there and free to leave whenever they choose, with no unwanted consequences, and no one experiences unwanted pain. Beyond that, your body and mind are yours to explore or not, based on your curiosity and your values.

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