Abstract
Sexual health can mean a lot of things. Independently, the words “sexual” and “health” carry their own meanings, yet “sexual health” somehow seems entirely different. Steven Epstein’s The Quest for Sexual Health: How an Elusive Ideal Has Transformed Science, Politics, and Everyday Life reveals the nebulousness of sexual health from its origins as a concept to its disparate definitions and expansive applications.
The book brings attention to the “sexual health matters” through which people make sense of and organize their lives (pp. 7–8). To this end, Epstein pursues multiple goals by delving into why sexual health has become the battleground for “morality, normality, expertise, universalism, globalization, collective action, risk, responsibility, rights, passion, and pleasure” (p. 10). Epstein proposes that the vastness of sexual health could lead to either endorsement or resistance depending on context. And Epstein reminds readers of the importance of social location by using intersectionality to argue that the weight of sexual health differs across communities.
Part I guides readers through the genealogy or “historical ontology” of how sexual health came to be (p. 38). Despite the impact of the first definition of sexual health from the World Health Organization (WHO) in 1974, Epstein explains how this early definition continues to fall short of answering the question, “What is sexual health?” In fact, the WHO has never claimed it officially and instead deemed it merely a working definition.
Epstein does not start his timeline in 1974, however. He maps more than a century of events that led to the WHO’s working definition. He then describes attempts to "stitch together” (Epstein's oft-used phrase) the diverse voices associated with sexual health such as the World Association for Sexual Health (WAS) that has made great efforts to join definitions, activities, and experts. Yet, the WHO, WAS, and other key players’ ventures to find consensus do little to solve the problem of the “fuzziness” and “buzzwordiness” of sexual health.
Part II works to “pin down” sexual health by elaborating how it has been observed, measured, or used. Epstein sheds light on medical professionals’ unpreparedness and discomfort discussing sexual health with their patients and the limits of patient sexual health histories. Indeed, providers’ approaches to addressing sexual health reduce patients to risk factors and performance scores.
Once a provider has reached a diagnosis, the International Classification of Diseases (ICD) comes into play. Like all things sexual health, though, the ICD has historically lacked clarity concerning sexual health until the recent introduction of a chapter organized around the subject. As the name suggests, the ICD is a coding mechanism to collect and report health data. However, attempts to classify such data on a global scale are thwarted by international politics, especially concerning gender and sexuality. Researchers also face political divides as they pursue research on sex and sexual health, evidenced by how scholars have historically (re)framed their research to fit institutional comforts. Regarding measurement, quantitative approaches to sexual health research reveal the limitations of categorizing individuals who do not conform to standard assumptions or those with fluid/mixed identities and invite comparisons to what is “normal.” Though Epstein notes the problem of enumeration, he falls short of suggesting how qualitative research could respond to this critique.
Who’s the expert here? This question arises when grassroots organizers, communities, and health practitioners continually disagree about sexual health practices and education. To this end, it has become difficult to determine where to turn for sexual health care and advice when easy-access resources include porn stars and self-help books. When it comes down to who to trust, specialization, professionalization, and credentialing are defining factors.
Part III of The Quest for Sexual Health addresses the optimization of sexual health, including the pursuit of wellness. The idea of “sexual wellness” casts a wide net, including everything from erectile dysfunction pharmaceuticals to vaginal rejuvenation in the name of self-improvement. To be fair, Epstein concedes that sexual wellness is part of the WHO’s multifaceted definition of sexual health, yet the idea of wellness runs the risk of increasing inequalities at the nexus of consumerism, self-improvement, and risk management (p. 231).
Despite best efforts, Epstein describes how the Trump administration failed to ban the phrase “sexual and reproductive health” and, because of established “sexual health governance,” was unsuccessful in deeming transgender, nonbinary, or intersex people “fictional” (p. 234). Sexual health governance helps determine the political significance of more than just sexuality or health, extending to behaviors, social order, rights, and citizenship at all socio-political levels from local to national. Epstein describes the role of sexual health governance in past U.S. presidential administrations and beyond as evidence of how sexuality and health came to be a part of contemporary politics. Digging further, Epstein draws on the concept of “bridging work” and “frame bridging” as strategies both the Christian Right and political Left use to link sexual health to their respective—yet otherwise unconnected—goals. Thus, Epstein concludes, sexual health is here to stay in all its fuzzy facets, tensions, and varieties of unanswered questions.
The Quest for Sexual Health delves into how sexual health has been (re)conceptualized over time by governing bodies, its implementation in health care settings, and its growth beyond science and medicine. The book is organized into ten chapters between introduction and conclusion chapters. While readers may be intimidated by the book’s size, the book’s 449 pages are evidence of extensive research (there are 100+ pages of chapter notes). Otherwise, readers may be constrained by the elevated language which may limit some readers’ comprehension (I, admittedly, had to look up the word “polysemy”).
The Quest for Sexual Health is a thoroughly researched book that contributes to modern foundations of sexual health education across disciplines in higher education, medical education, and community-based health settings. Indeed, the book serves both as a primer and deep dive into the “elusive ideal” of sexual health, as the subtitle suggests. In an age when men who have sex with men are still limited in ways to donate blood, drag queens are supposedly grooming children, transgender folks’ access to care is under threat, and a cure for HIV/AIDS remains on the horizon, it is clear sexual health remains a cultural battleground as The Quest for Sexual Health continues.