Issued June 28, the special report from U.S Surgeon General David Satcher, MD, PhD, boldly places a number of key sexuality issues on the nation's public health agenda.

Citing alarmingly high rates of sexually transmitted infection, unintended pregnancy, abortion, and sexual violence, The Surgeon General's Call to Action to Promote Sexual Health and Responsible Sexual Behavior presses for action from the nation's citizens, leaders, and medical community. "We face a serious public health challenge regarding the sexual health of our nation," says Satcher. "Doing nothing is unacceptable. If we are to meet this challenge, we must find common ground and reach consensus on the nature of these problems and their solutions, consistent with the best available science."

The Nature of the Problem

Regular visitors to SexHealth.com may already be familiar with many of the public health crises underlined in the Surgeon General's report, but readers new to the subject may be surprised by some, if not all, of the following facts:

-- More than 12 million people in the U.S. are newly infected with a sexually transmitted disease each year. (The American Social Health Association estimates the number may be as high as 15.3 million new infections annually!)

-- Between 800,000 and 900,000 people in the U.S. are infected with HIV, and an estimated 33% of them are unaware they are infected.

-- Each year, more than 100,000 children in this country are the victims of sexual abuse.

-- Averaged over 24 separate studies, 80% of gay men and lesbians experienced verbal or physical harassment on the basis of their sexual orientation; 45% had been threatened with violence; and 17% had experienced a physical attack.

-- Almost one half of all pregnancies in the U.S. are unintended. (And nearly half of those end in abortion.)

A Public Health Challenge

As "the nation's leading spokesman on matters of public health," Dr. Satcher proposes that these sexual-health problems be approached scientifically, using the methodology of public health administration: 1. identify the problem; 2. identify factors and entities that can improve or worsen the problem (human biology, parents and family, schools, the community, the media, religion, the medical community, the law, reproductive health services); 3. develop and test various interventions (programs administered by the community, the schools, the church, and medical clinics); and 4. implement and further evaluate those programs that prove effective.

Although no specific remedies are proposed in the report, three general strategies are outlined. They include increasing the public's awareness of issues relating to sexual health and responsible sexual behavior, providing the health and social interventions necessary to promote and enhance sexual health and responsible sexual behavior, and investing in research related to sexual health and widely disseminating the findings of that research.

SELECTED EXCERPTS FROM THE SURGEON GENERAL'S REPORT FOLLOW.

On the scope and importance of sexual health...

"Sexual health is inextricably bound to both physical and mental health. Just as physical and mental health problems can contribute to sexual dysfunction and diseases, those dysfunctions and diseases can contribute to physical and mental health problems. Sexual health is not limited to the absence of disease or dysfunction, nor is its importance confined to just the reproductive years. It includes the ability to understand and weigh the risks, responsibilities, outcomes and impacts of sexual actions and to practice abstinence when appropriate. It includes freedom from sexual abuse and discrimination and the ability of individuals to integrate their sexuality into their lives, derive pleasure from it, and to reproduce if they so choose."

On the role of the individual and the community in the promotion of sexual health...

"Sexual responsibility should be understood in its broadest sense. While personal responsibility is crucial to any individual's health status, communities also have important responsibilities. Individual responsibility includes: understanding and awareness of one's sexuality and sexual development; respect for oneself and one's partner; avoidance of physical or emotional harm to either oneself or one's partner; ensuring that pregnancy occurs only when welcomed; and recognition and tolerance of the diversity of sexual values within any community. Community responsibility includes assurance that its members have: access to developmentally and culturally appropriate sexuality education, as well as sexual and reproductive health care and counseling; the latitude to make appropriate sexual and reproductive choices; respect for diversity; and freedom from stigmatization and violence on the basis of gender, race, ethnicity, religion, or sexual orientation."

On problems of sexual violence and abuse...

"Sexual abuse contributes to sexual dysfunction and other public health problems such as substance abuse and mental health problems. There are an estimated 104,000 child victims of sexual abuse per year, and the proportion of women in current relationships who are subject to sexual violence is estimated at eight percent. While it is estimated that only a relatively small proportion of rapes are reported, a major national study found that 22 percent of women and approximately two percent of men had been victims of such an incident."

On the problems of nonheterosexual individuals...

"Sexual orientation is usually determined by adolescence, if not earlier, and there is no valid scientific evidence that sexual orientation can be changed. Nonetheless, our culture often stigmatizes homosexual behavior, identity and relationships. These anti-homosexual attitudes are associated with psychological distress for homosexual persons and may have a negative impact on mental health, including a greater incidence of depression and suicide, lower self-acceptance and a greater likelihood of hiding sexual orientation. Although the research is limited, transgendered persons are reported to experience similar problems. In their extreme form, these negative attitudes lead to antigay violence."

On the life-long need for sexual-health resources...

"Human beings are sexual beings throughout their lives and human sexual development involves many other aspects of development--physical, behavioral, intellectual, emotional, and interpersonal. Human sexual development follows a progression that, within certain ranges, applies to most persons. The challenge of achieving sexual health begins early in life and continues throughout the lifespan. The actions communities and health care professionals must take to support healthy sexual development vary from one stage of development to the next. Children need stable environments, parenting that promotes healthy social and emotional development, and protection from abuse. Adolescents need education, skills training, self-esteem promoting experiences, and appropriate services related to sexuality, along with positive expectations and sound preparation for their future roles as partners in committed relationships and as parents. Adults need continuing education as they achieve sexual maturity--to learn to communicate effectively with their children and partners and to accept continued responsibility for their sexuality, as well as necessary sexual and reproductive health care services."

On the importance of school-based comprehensive sexuality education...

"Despite the available evidence regarding the effectiveness of school-based sexuality education, it remains a controversial issue for many--in terms of whether schools are the most appropriate venue for such education, as well as curriculum content. Few would disagree that parents should be the primary sexuality educators of their children or that sexual abstinence until engaged in a committed and mutually monogamous relationship is an important component in any sexuality education program. It does seem clear, however, that providing sexuality education in the schools is a useful mechanism to ensure that this Nation's youth have a basic understanding of sexuality. Traditionally, schools have had a role in ensuring equity of access to information that is perhaps greater than most other institutions. In addition, given that one-half of adolescents in the United States are already sexually active--and at risk of unintended pregnancy and STD/HIV infection--it also seems clear that adolescents need accurate information about contraceptive methods so that they can reduce those risks."

On the magnitude of the problem and the purpose of the Surgeon General's report...

"Based on the scientific evidence, we face a serious public health challenge regarding the sexual health of our nation. Doing nothing is unacceptable. More than anyone, it is our children who will suffer the consequences of our failure to meet these responsibilities. Solutions are complex but we do have evidence that we can promote sexual health and responsible sexual behavior. Given the diversity of attitudes, beliefs, values and opinions, finding common ground might not be easy but it is attainable. We are more likely to find this common ground through a national dialogue with honest and respectful communication. We need to appreciate and respect the diversity of our culture and be informed by the science that is available to us."

Want to know more?

For more information visit the Surgeon General's "Virtual Office" on the Web at http://www.surgeongeneral.gov/sgoffice.htm. The full text of the Surgeon General's report on sexual health is available at http://www.surgeongeneral.gov/library/sexualhealth/.