Sexual health and blood borne virus action plan: 2023 to 2026

Sexual Wellbeing

Sexual wellbeing is not the same as good sexual health. Whilst there is currently no agreed definition of sexual wellbeing, we mean this to be about sexual emotions and cognitions which includes feeling respected, comfortable, confident, autonomous, secure, and able to enjoy safe, healthy, respectful, consensual and pleasurable relationships and sexual interactions.

A research paper published in 2021 highlights concern around the conflation of sexual health and sexual wellbeing, suggesting that a failure to make the distinction between the two concepts has negatively impacted progress towards addressing key issues and inequities.

Sexual wellbeing is much wider than the provision of clinical services, and includes, education, information and lifelong learning, gender equality, expression of sexuality, mental health, gender-based violence, justice and a myriad of other important aspects. As a consequence, this is inevitably a long-term aim to embed sexual wellbeing in Scottish society and is not something that is within this gift of this particular Action Plan.

However, services do have important role within this. Sexual health and BBV services in Scotland should take a holistic and person-centred approach to sexual health and wellbeing, and place emphasis on the fundamental importance of personal choice, and of healthy, consensual interactions. This also links to the HIS Sexual Health Standard 5 on Sexual Wellbeing⁵, that in Scotland, our ambition is "All individuals are empowered to maintain positive sexual health, wellbeing and function."

There are a number of population groups for whom a focus on sexual wellbeing will be particularly beneficial, for example, young people, people who use drugs or engage in 'chemsex', people who sell or exchange sex, transgender people, LGBTQ+ individuals and those who have experienced sexual trauma or assault. Whilst implementing our plans around sexual wellbeing will have a positive impact on the population as a whole, we will continue to consider the needs of specific populations at all stages of planning and implementation.

Definitions of sexual wellbeing have varied widely often being left to individuals to define. In order to accurately baseline and measure changes to sexual wellbeing we first need to develop an agreed definition of sexual wellbeing that can be used consistently across Scotland.

The Scottish Government has provided funding to a project run by researchers at the University of Glasgow, which will provide the first steps towards embedding sexual wellbeing as an ambition for Scotland. This project will establish consensus amongst stakeholders regarding the definition of sexual wellbeing. The University of Glasgow project team will then develop recommendations on the production and monitoring of baseline indicator data for sexual wellbeing which will be used to track progress.

A sexual wellbeing measure has been included within the 4^th Natsal (National Surveys of Sexual Attitudes and Lifestyles) survey 2022-2024, which will sample the opinions of around 10,000 individuals between the ages of 16-59 to provide updated data on sexual lifestyles within Britain. Around 650 participants from Scotland have been invited to contribute. We anticipate that the Natsal results, when published, will be a valuable resource which will help to inform aspects of sexual wellbeing policy despite the definition of 'sexual wellbeing' in this context being unclear.

Action 12: A definition of sexual wellbeing and will be co-developed by the University of Glasgow and stakeholders with accompanying key indicators.

Action 13: Public Health Scotland (PHS) with support from National Monitoring Assurance and Research Group (NMARG) to use these key indicators to produce baseline data for Scotlandfor sexual wellbeing, ensuring that reporting and benchmarking can be used to effectively track progress.