Documento sin título

Revista Sexología y Sociedad. 2013; Vol. 19, No. 1
ISSN 1682-0045
Versión electrónica


ARTCULO ORIGINAL

On what theoretical and methodological precepts should the study and comprehensive
education on sexuality for adolescents and youth be based?

Dra. Natividad Guerrero Borrego,* Lic. Maylín Pérez Enríquez**
Centro de Estudios sobre la Juventud (CESJ)

nguerrero@cenesex.sld.cu; sexualidad@opjm.ujc.cu

*Doctor in Psychological Sciences, Researcher and Full Professor, Master Degree in Sexology.    **Master in Psychology

ABSTRACT

In Cuba, experts1 who study sexuality come from different fields because health-related problems are included in the study together with pedagogic, psychological, social, historic, cultural, philosophical, and anthropological aspects, among other branches of knowledge. This article collects information on theoretical approaches and contents useful for understanding sexuality while serving as a tool for research on the subject. It also recommends contents that due to their topical relevance should be the object of research in this field. The intention is to offer a cognitive platform to facilitate analysis in future research efforts. Approaches identified as essential relate to humanist implications and they include the historic-cultural approach, the critical personality approach, the social determinants approach, the risk approach, and the holistic approach. Likewise, the gender approach and the rights approach are characterized as cross-cutting approaches. The main thematic contents identified are the following: sexual education, couple relations, erotic sexual relations, sexual and reproductive health, sexual diversity, gender and sex violence, prostitution, and social and demographic variables.

Key words: theoretical approaches, thematic contents, education on sexuality, adolescence, youth

Introducción

Cuba has more than 30 years of experience in the study and comprehensive education of sexuality.  Several academic and scientific institutions began to explore on a regular basis the topic related to sexual behavior and the knowledge and attitudes of the adolescent and young population.

The Centro de Estudios sobre la Juventud (CESJ, its acronym in Spanish) (Youth Study Center) was one of the institutions involved in this effort, together with what is known today as the University of Pedagogical Sciences and the School of Psychology of the University of Havana.

The outcomes of that research were immediately put into practice and the actions derived from those nation-wide studies undertaken by CESJ were also immediately implemented.  Intervention programs to educate adolescents and youth on sexuality, radio programs, and articles published in a Sunday section in the press, were the first forms of socializing the information obtained in accordance with the context and reality of those times.2 Today, the situation has changed and the work of this Center related to the study and comprehensive education of sexuality requires addressing the new demands from a social science perspective.

In times of globalization, new forms of social relations flourish and the hierarchy of prevailing values mobilizing human beings is modified. The expressions of sexuality are visualized in many ways.  It is a controversial issue that in our country, given the fact that it is an inherently human condition, is promoted as part of the human rights question.  It is dealt with as part of the defense of social justice, non-discrimination of any kind, not only on the basis of skin color, age, social class, sex, religion or ethnic origin but also on the basis of gender identity and sexual orientation.

This paper systematizes information on the theoretical approaches that not only help to understand sexuality but can also serve as tools for research on the topic, facilitating the design of intervention projects for education in this field, taking into considerations the findings of such research.   It also proposes those contents that due to their topical relevance should be the object of research and identifies the institutions and experts with experience in these matters. In brief, the purpose of this paper is to provide a cognitive platform to facilitate the analysis on future research by experts on this topic in the CESJ.  The purpose will be to guide and consolidate knowledge in order to change risk behavior patterns in the young population.3 This paper required the identification of Cuban experts who were selected on the basis of their outstanding scientific works on this topic and related in anyway to adolescents and youth.

General objective

Identify the theoretical reference and thematic contents that the CESJ should take into consideration in order to contribute to sex studies and sexuality education for Cuban adolescents and youth.

Methodology Used

The study was conducted using the Delphi Methodology in accordance with F. Ortega (1), who describes three main characteristics for its implementation:

  • Blind method. During the process, no expert knows the identity of the other members of the debate group and this has several positive aspects.  First, it prevents a member of the group being influenced by the reputation of another member or by the burden that opposing the majority entails.  The only possible influence is that of congruence of arguments.  It also allows a member to change his/her views without loosing face.  Finally, the expert can defend his/her arguments under the peace of mind that in the event he/she is wrong, no other member of the group will find out.
  • Controlled feedback.  Through this mechanism, research is conducted on the basis of “rounds” in which every expert submits his/her view.  This allows the experts to learn about the different views and change his/her view if they consider that arguments submitted are more appropriate than their own.
  • Statistical group response. Experts are not only provided with the opinion of the majority but with all the views, trying to seek consensus.

The CESJ applied this method to a group made up of eight experts who accepted the request for participation in the study.  The request was sent to fifteen experts studying the subject of sexuality in Cuba from the perspective of different disciplines and working in different specialized institutions in the country.  The selection was based on expert’s experience regarding the specific problems studied.

With more than twenty years of experience in sexuality studies and sex education in different populations, most of the members of the group had a master degree in Sexology and have been members of the Cuban Multidisciplinary Society for Sexuality    Studies (SOCUMES) for over twenty years.  These were the selection criteria that were taken into consideration, besides the fact that they all had scientific degrees on the matter.

To attain the objective, a form with key questions was sent to them.  Three rounds of Q & A were carried out on the need for the investigation, after which the expected consensus was reached.

The application of this method allowed identifying a set of theoretical approaches and topics which are part of the scientific and popular debate regarding sexuality in adolescents and youth. After reviewing the bibliography and as a result of its analysis and interpretation, the authors of this paper reached the conclusions that are summarized in the findings set out below.

Findings

In the case of studies on sexuality, the references we have lead to understanding the importance of the sexuality dimension as a manifestation or psychological configuration of the personality as part of the psycho-social development of the individual throughout the different stages of his/her life.  In this regard, the historical-cultural approach suggested by Vigotski, who places the human being at the center of the educational process, provides a valid perspective to understand this area of the subjects throughout their lives taking into consideration their individual characteristics and their specific social and cultural environment.

In this regard and in the particular case of sex education, children are usually raised in a family environment where they observe and participate in the bond of affection between parents, grandparents, elder siblings with their couples, neighbors, in sum, the adults that surround them and will help them in growing up.  Later, in school, they begin to interact with their coevals, sharing common spaces and they tend to establish closer communication among them, particularly during adolescence.  In this regard, each individual begins to place more value on the criteria of his/her peers.  Thus, whatever sexual education each of them has will influence the others.

Both adolescents and youth are continuously receiving messages on sexuality from the persons in the environment in which they are growing up, influencing their sexual behavior and attitude.   Thus, they can have an active character depending on the values that have been assimilated by them throughout their lives and, in this regard, their realities can be construed, lived and transmitted differently from their surrounding environment. This first approach allows us to understand human behavior in general and provides arguments that can explain sexual behavior.

The comprehensive and sexual-reproductive health social determinants approach was proposed by doctor Ada Alfonso, who believes allows the analysis of the differences, similarities, and affinities that can be configured in the sexualities of each individual and of each human group according to the stratifying and intermediary determinants.   Though the theoretical-conceptual approach and its main arguments seek to explain the health issue, its foundations are a significant starting point for any analysis focused on the social aspect as the genesis of and relation with other process or constructions.

When analyzing sexual behavior related problems such as teenage pregnancy, the young girls involved in most cases have a low cultural level and low financial incomes. This does not necessarily mean that there is a direct proportional relation but it does reveal certain influence of the social and physical environment.

There is a wide spectrum of nuances in social determinants associated with sex education ranging from the information sources most frequently used, selection of couple, the decision whether or not to have protected sex and the type of contraceptive to be used all the way up to family planning.  Likewise, in terms of ethics and sexuality, understanding sexual diversity in its many different and complex expressions and awareness of the foundations for couple stability are an expression of the different sexual life styles.

The risk approach (2) was also identified in the bibliographic review made by the authors.  In relation to health, D. Krauskopf refers to the need of analyzing young age population from a morbidity-mortality perspective.  Factors affecting morbidity-mortality are essentially of a external and behavioral nature: accidents, drugs, suicides, school dropout, pregnancy, STIs, and violence, among others. In this regard, a risk approach would promote a comprehensive care of the population in these ages, given the fact that although adolescents and youth are considered a healthy population, such external factors may change its reality thus implying the need for providing a differentiated care.

In terms of sex education, this approach is obviously required in, for example, the prevention of STI/HIV-AIDS, as this is associated with the overall health of the individual.  Therefore, adolescents and youth are considered a vulnerable population as they are undergoing a stage of discovery and active sexual exchange in their lives.  If they have not been educated to assume a responsible sexual life, they may fall into sexual behaviors that can adversely affect their health.

The risk approach is based on identifying high-risk individuals and allowing them access to proper treatment. Within this approach it is believed that broader knowledge of risk factors will allow defining preventive actions and reducing the frequency of health damages.

This health-related analysis focused on the research target population reveals the potential gaps, which should be and studied in order to mitigate and modify the current comprehensive health status thus guaranteeing the future well-being of the population.

Another approach identified through the Delphi Method is the holistic approach. Analyzing sex education from this perspective helps to understand and construe individual behavior, as it studies the individual as a whole permeated by external influences, which is interconnected with and legitimized by the abovementioned approaches.

Sex education takes place under a system of internal and external influences (biological, psychological and socio-cultural) affecting the personality and therefore requires a holistic approach. This approach provides the tools to explore myths, prejudices, and sexist stereotypes that for centuries have distorted this domain and permeated the social imaginary, as well as the cultural values influencing the education of youth and other population groups. This approach allows us to deal with sexual sub-systems such as reproduction, gender, and affects.

The holistic vision consists in not viewing the world from a dualist perspective but rather to accept that the whole and its energetic convergence of events are closely linked to constant and paradoxical interactions for which we have no explanation. Man perceives things or events as significant totalities and not as isolated entities (3).

The personality critical humanist approach and its sexual domain was identified by Doctor Alicia González who states that it is underpinned by the principle of conceiving the formation influences on every human being --irrespective of sex, age, race, cultural background or any other condition— respecting the inherent differences of each person, group and their environment. According to this approach, educational and socializing processes should be designed through methodologies that  first and foremost acknowledge, respect, and promote each person’s freedom to choose or self-determine his/her decisions and actions with a critical sense of one owns freedom and the freedom of others, enabling to act with responsibility and justice in terms of one’s own sexual life and of the elections, decisions, and behaviors of others under conditions of equality, peace, and social justice.

On the basis of this humanist approach, some suggestions for the purpose of sex education are made: a) stress the need to prepare the individual as protagonist in the construction of his/her sexuality; b) develop attitudes that will allow him/her to cope with the contradictions of his/her own subjectivity and of others; c) promote confidence in the capabilities of human beings for their personal realization; d) encourage the legitimacy of their right to determine the limits and spaces as well as sexual expression roles; e) encourage an active, divergent attitude in subjects as well as those that will enable them to transform themselves and their reality; f) promote relations of cooperation, tolerance, equality, and reciprocity between genders; g) cultivate the right to pleasure and physical and spiritual enjoyment without harming those persons with whom they relate; h) ensure the right to a free, full and healthy sexuality while respecting freedom of sexual expression of the others (4).

This perspective is associated with a profoundly human, customized, democratic and contextualized sex education process that articulates both personal and social needs.

The approaches analyzed so far, provide arguments that contribute to human sexuality studies and education.  In this regard and as we are referring to human beings, gender and rights related approaches should be identified as interacting with the abovementioned approaches. The male-female condition determines the way in which each sex participates in society according to the diverse life social patterns. Likewise, the rights perspective approach ensures wellbeing and dignity in human development.

In the words of Dr. Ada Alfonso, a gender approach allows us to know, broaden, face, and overcome the social roles assigned to each sex, and to understand how power relations that foment links among children, youth, and adults of either sex within the family, the couple, and the different spaces for social interaction are shaped.

Gender relations are power links that vary from one society to another, existing at the same time within a society with multiple gender systems.  They are characterized by such social variables as age, skin color, sexual orientation, and religion.  We cannot speak about woman or man as a universal being.

Why should we use this approach for the sake of sex education? Sex education in Cuba is still based on the pillars of patriarchy as a paradigm.  This reality shows inequalities in terms of being a man or a woman in such fields as education, employment, and public activities in general.   However it is significant to see how they are magnified within the sexual, family, and couple relations domains.  From a gender perspective, women today are more vulnerable than men, as they have been assigned certain roles that place them at a disadvantage.

The gender approach allows us to know, face, and overcome the social roles assigned to each sex.  At the same time, it helps to understand how power relations that foment links among children, youth, and adults of either sex within the family, the couple, and the different social interaction spaces are shaped.

According to Dr. Alicia González and Dr. Ada Alfonso, a human rights approach allows us to identify and deconstruct the obstacles in the sexual and reproductive life of man and woman that not only violates their human rights but also impede or limit their exercise and the perception, state, and enjoyment of wellbeing (or not) to which adolescents and youth of both sexes have a right to in terms of sexuality.

To talk about rights implies talking about who has responsibilities regarding such rights.  Sexual and reproductive rights are also human rights as they cover all the needs of a person regarding the free exercise of his/her sexuality and reproduction.  They seek to allow each person to freely and autonomously decide about their body irrespective of their age, sex, race, social condition, religion…, without generating discrimination or violence.

The Cuban education system has yet to succeed in the education of rights as an inherent condition of the human being.  This is particularly relevant in the case of sex education because it has a bearing on the identity that requires to be socially legitimized, as many a time violations in this regard become invisible.

Reflections herein are an invaluable contribution to sex education.  The theoretical precepts analyzed facilitate the education of the human being on this sphere of life.  They not only provide arguments that should be taken into consideration in the different analysis but should also help to understand the diversity of answers and interpretations of the behaviors studied. An in-depth analysis of these precepts in future studies will bring about other approaches that will help to answer questions that may arise in the research. Following this analysis, we share the view of Dr. Ada Alfonso, who believes that any approach is good, provided that it addresses the interests of researchers and the purpose of the study.

Besides the theoretical references, thematic contents that should be considered in terms of sexuality studies and education were also identified.  The contents identified were the result of a review carried out in a given context and time frame, so it does not mean that they are the only ones to be taken up in future studies bearing in mind the ever changing social reality.

After a comprehensive bibliographic review and sorting out of the information, the themes and contents that would require an in-depth study, according to the consensus reached by the experts and the view of the authors of this paper, would be the following:

Sex Education: In this regard, it was important to investigate the information sources to which adolescents and youth resort to for information on sexuality, taking into consideration the need for such sources to provide them with truthful information.   Sexual myths, beliefs, prejudices, taboos, and stereotypes permeating social and group imaginary of adolescents, which are transmitted within the group of peers, the family, the school, the couple, the community in which they live in,… should also be studied...

Other contents to be studied are related to social and psychological processes that have a positive or harmful bearing on the shaping and expression of the sexuality of adolescents and youth of both sexes. In particular, reference should be made to family environment, the way in which they relate with their peers, the couple, their knowledge of and attitude towards risk situations in their sexual life such as premature sexual relations, teenage pregnancy, early motherhood, and STIs/HIV-AIDS, among others.

The role played by the mass media, the family, the school and other socializing agents is also important, not only in shaping the sexuality of adolescents and youth taking affections into consideration, but also in developing sexual education topics and active individuals pursuing their life projects in today´s society.

Couple relations: Regarding this variable we need to explore everything related to the approximate number of couple relations, duration, life projects and immediate plans. It would also be important to know  about the type of relationship in adolescent and youth couples (parity, equality, control and/or subordination). We also need to study forms of seeking and giving pleasure without risks, the establishment of bonds of affection without meaning love, and deep and stable affection or love, … Another aspect to be studied is the characteristics of some of the stages of this love relationship: flirting, infatuation, love.

Given the fact that adolescents are characterized by the frequency with which they change couples, we could study their notion of fidelity and infidelity, their meaning and hierarchy in terms of couple stability.  It is also important to study their knowledge and appraisal of their body and that of the other sex, the impact of pubertal changes in girls and boys, the sexual female and male response and their place in love relations, in coital and non-coital sexual and erotic games, as well as self-eroticism or masturbation both in boys and girls.

Other aspects that require the attention on part of the experts are those related to the main concerns and needs of this population regarding couple relations, the type of attachment within couple relations and how intimacy influences sexual satisfaction. It would be likewise relevant to explore the education they have received and how they have been prepared for living in couple regarding communication, parenthood, and erotic exchanges, relations and behaviors. This would allow knowing if their concept of couple includes sexual diversity.

Erotic sexual relations: As part of this variable it would be worth studying the age at which they begin to have sexual relations, their motives for doing so, their frequency, what consequences adolescents think it may have, and their experiences in first and subsequent erotic relations.  It would also be relevant to determine if the decision  to have sex for the first time was influenced by the group of peers or the educational influence of adults and, in this regard, to explore the level of communication with the family regarding their first sexual behaviors, sexual orientation,…

Other important issues to be studied are the risk perception and the knowledge they have about how diseases are transmitted, the most effective prevention measures, the risk and severity conduct of HIV and other STIs.  Likewise, behaviors expressing a responsible sexual conduct and the ability of girls to negotiate the use of condoms are very interesting topical issues, bearing in mind that the number of persons infected with a STI is higher than in previous years, despite the efforts of the country in reducing the incidence of such infections.

It is also important to determine the personal criteria, opinions and assessments regarding sexual interchange from a diversity approach (“sexual binge”, simultaneous erotic relations with more than one person irrespective of sexual orientation,…)

Sexual and Reproductive Health: As part of this topic, it would be valid to explore the knowledge and values adolescents and youth have regarding full, healthy, and responsible sexual conducts and about the behaviors expressing such conducts.  Moreover, the existing contraceptive methods and their effectiveness, particularly the use of condoms, should also be studied. In the case of the use of condoms, it is essential to study the factors that have a bearing on the use, rejection and acceptance of the condom nowadays, and whether or not they consider family planning as an important aspect for having children. Regarding the latter, it would be good to find out, particularly in the case of young people, what is their criteria regarding the conditions to be met before having a child as well as the factors and reasons for postponing parenthood nowadays.

There should also be an in-depth study of body representations, its reproductive function and its meanings.  Their views about teenage pregnancy and its consequences for the girl, the boy, the family, and society are also topics to be considered given their repercussion.  Likewise, the consequence of postponing maternity in risk ages and the implications of abortion and menstrual regulations for the health of the adolescent should also be studied.

Sexual Diversity:  As part of diversity, it is important to study the different constructions and expressions of sexual identities and the interpretation of the social models of masculinity and femininity through the roles or sexual behaviors in children, adolescents, youth, and adults.  Sexual orientation and its relation with affectation are topics that require an in-depth study. The assessment of persons with a homo or bisexual orientation, according to the degree of acceptance or rejection, as well as the criteria on the different ways of experiencing and expressing masculinity and femininity in persons with such sexual orientations are topics that must be studied.

Very closely linked to the foregoing is the study of the role played by support networks (friends, family, and adults at large) in the processes of acceptance, self-acceptance and degree of responsibility in assuming the different ways of experiencing and expressing sexual orientation and gender roles imposed by patriarchal, androcentric and heterosexist societies.

Another topic to be studied is related to the personal knowledge and assessments about the legal and educational actions in the countries regarding the rights of the LGBT group (lesbians, gays, bisexuals, and transsexuals.)

Violence: As part of this topic, we should analyze violence associated with the construction, expression, and exercise of male and female sexuality in personal, couple, family, and social life based on the relations of power and discrimination.

Another aspect that requires an in-depth and systematic study is violence between persons of different sexes, persons of the same sex, as well as between educator-student, students-students, father/mother-daughter/son and other members of the family, friends-friends and couples.

Studying the knowledge, assessments and practice of violence regarding the sexual rights of children, adolescents, women, homosexuals and other alienated groups who are subject to discrimination, as well as the possible ways to educate on the basis of a culture of peace, equity and social justice, are also considered valuable topics.

Prostitution. The manifestation of this phenomenon in men and women, its causes, prevention, control, and eradication at the personal, group, family, social, and legal levels, are aspects that contribute to the efforts on sex education in the Cuban society.

Research on bisexual and homosexual behaviors in persons of both sexes who practice prostitution and its relation with STIs and the HIV-AIDS epidemic, as well as on the knowledge and assessments about procurers, transactional sex and complementary sex is also necessary.

In conclusion

It could be said that the resulting analysis from the exchange with the experts and the bibliographic review articulates theoretical arguments and the topics and contents related to human sexual behavior and give a picture of the current status, after the first decade of the 21st century has elapsed.

This article shows the key topics in terms of sexuality that should be studied in-depth in the young population.  From this perspective, the interpretation of the information obtained from such results can have as underpinning arguments the theoretical approaches and thematic contents herein identified, thus improving sex education in Cuba.

Notes

1 Gender language will be implicit in the document. Following the guidance of the Cuban Linguistic Institute, los/as (articles used in Spanish for male and female) will not be used.  In fact, most sexuality scholars in Cuba are women.

2 Program «Descubriendo caminos, valores y sexualidad»; permanent section «Pensando juntos» in Habana Radio; permanent section «Juventud y sexualidad»  in the Juventud Rebelde journal.

3 Young population will be understood as adolescents between 12 and 19 years old, taking into consideration that puberty starts between the ages of 10 and 12 and at these ages exploration of sensations and experiences in sexual inter-personal relations are accentuated, generating questions, fears and curiosity that most of the time requires specialized orientation.  It shall also be understood as youth between 20 and 29 years old.

References

1. Ortega F. El método Delphi, prospectiva en Ciencias Sociales[quoted January 31, 2012]. 2008. Available at: http://redalyc.uaemex.mx/src/inicio/ArtPdfRed.jsp?iCve =20612981004.

2. Krauskopf D. Enfoque de riesgo. [Printed material, s/f].

3. Lugo B. Psicología holística [quoted January 31, 2012]. s/f. Available at: http:// www.yogaintegral.biz/psicologiaholistica.html.

4. González A, Castellanos B. Sexualidad y géneros. Alternativas para su educación ante los retos del siglo xxi. Havana: Editorial Científico-Técnica; 2003.

FECHA DE RECEPCIÓN DE ORIGINAL: 23 de abril 2013
FECHA DE APROBACIÓN PARA SU PUBLICACIÓN: 6 de junio 2013

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