The Importance of Pleasure

It was with great pleasure that I read “The Pleasure Deficit: Revisiting the ‘Sexuality Connection’ in Reproductive Health,” by Jenny A. Higgins and Jennifer S. Hirsch [2007, 39(4):240–247]. It has been some time since I have seen anything in print about sexual pleasure as an issue in birth control programs. The authors’ observations on the impact of different contraceptive methods on women’s sexual pleasure—and the need to recognize those impacts—was especially welcome.

Despite the long list of useful citations, the authors missed an important one. In 1977, J. Mayone Stycos wrote an excellent piece called “Desexing Birth Control.”1 Stycos reminded us that the purpose of contraception is to permit people to enjoy the pleasures of sex without the consequence of pregnancy, and he regretted to note that while “modern advertising has spent the last half century infusing the subject of sex into areas where it has no business, family planners have been busily eradicating sex from the one place where it uniquely belongs.”1(p. 292)

While there has been some progress in the intervening 30 years, Higgins and Hirsch’s excellent commentary reminds us that we have a very long way to go in recognizing the importance of sexual pleasure in birth control.

Philip D. Harvey DKT International Washington, DC

1. Stycos JM, Desexing birth control, Family Planning Perspectives, 1977, 9(6):286–292.

As the author of the 1993 article that Jenny Higgins and Jennifer Hirsch “revisited” in their comment, I was thrilled to see that the issues are still being addressed. I was, however, less thrilled to realize that we in the population/family planning field still have a long way to go in addressing the salience of sexual pleasure (or the lack of it) in our work on sexual and reproductive health and rights.

Higgins and Hirsch discuss the pleasure deficit as it relates to research and programming on contraceptive methods and on condom use for preventing STDs, including HIV. But there is a broader application as well: the pleasure deficit as experienced by women themselves. Sexologists have investigated not only the many forms of human sexual expression as they differ across cultures, but also differences between and among women and men in what they find erotic, enjoyable, degrading or even painful in their sexual lives. Among the more consistent findings from surveys conducted in several countries are that on average, women are significantly less likely than men to experience orgasm during heterosexual vaginal intercourse and less likely to engage in masturbation, even when self-pleasuring is their preferred (or, at least, most reliable) source of orgasm.1–5

As we move toward clearer and more comprehensive definitions and applications of sexual and reproductive health and rights, the issue of the pleasure deficit becomes more compelling. So, too, does the need to explore the concept in its many meanings—for example, What is sexual pleasure? What does it depend on? Who experiences it, and who doesn’t? How, and why? How is it related to other dimensions of physical and emotional well-being, and to effective fertility and STD control? Research on these questions, conducted in a variety of populations, would help our field develop a more holistic understanding of people’s sexual and reproductive attitudes, feelings and behavior.

Ruth Dixon-Mueller Consultant in population and reproductive health Grecia, Costa Rica