Beyond contraception, HIV prevention and maternal healthcare, sexual and reproductive health must also recognise pleasure, intimacy, bodily autonomy and the right to fulfilling relationships.
For decades, conversations about women’s sexual and reproductive health have largely focused on preventing, reducing and protecting (preventing unwanted pregnancies, preventing HIV and other sexually transmitted infections (STIs), reducing maternal deaths and protecting women from sexual violence). These priorities are essential, and the investments made in these areas have saved lives.
But there is another conversation we urgently need to have: who is talking about women’s sexual pleasure, and why are so many women still afraid to talk about it themselves?
The recent debate on decolonising global sexual health challenges us to reconsider whose knowledge matters, who sets research and funding priorities, and whose experiences are left out of the picture. For those of us working on gender equality and sexual and reproductive health and rights (SRHR) in Cameroon and across Africa, this conversation must also confront the cultural norms that silence women’s sexual needs.
We cannot continue to talk about women’s sexual health as though it were only about reproduction, disease prevention and protection from harm. Women are not simply bodies to be protected from pregnancy, infection or violence. They are human beings with feelings, desires, preferences, questions and the right to make informed decisions about their own bodies.
If sexual health is about wellbeing, why does women’s pleasure remain such an uncomfortable subject in so many of our communities?
When a woman cannot say, “I am not sexually satisfied”
In many communities, talking openly about women’s sexual pleasure remains taboo. A woman who expresses dissatisfaction in her sexual relationship may be accused of being promiscuous, unfaithful or morally deficient. Some are labelled prostitutes simply because they dare to communicate that their sexual needs are not being met.
Consider the woman who has been married for years but has never felt comfortable telling her husband that their sexual relationship is unsatisfying. She may fear that he will interpret her concerns as an insult to his masculinity, an accusation of inadequacy or evidence that she has been sexually involved with someone else.
What happens when she cannot speak without risking humiliation, conflict, abandonment or divorce?
Too often, she remains silent.
This silence is reinforced by gender expectations that normalise male sexual desire while requiring women to be modest, submissive and unquestioning. Women may be expected to satisfy their partners without being encouraged to understand, express or negotiate their own needs.
Yet sexual relationships involve two people. Both deserve respect, care, consent and the opportunity to communicate honestly.
Sexual dissatisfaction can arise for many reasons, including difficulties with arousal or orgasm, painful intercourse, mismatched levels of desire, stress, health conditions, medication, emotional disconnection or a lack of communication. These experiences are not unusual, and they do not automatically mean that a relationship has failed.
What makes the situation worse is when couples have nowhere to turn, do not know what help is available, or believe that discussing their difficulties is shameful.
A woman should not have to choose between her dignity and her marriage simply because she wants to talk about her sexual wellbeing.
The uncomfortable conversation about infidelity
We must also be willing to discuss infidelity honestly, without moralising women’s experiences or suggesting that sexual dissatisfaction inevitably leads to betrayal.
Unmet sexual needs may be one of several factors contributing to some extramarital relationships. Emotional disconnection, relationship conflict, a desire for validation, opportunity, individual circumstances and many other factors may also play a role. Women are not a homogeneous group, and there is no single explanation for infidelity.
Nevertheless, we should listen when women describe seeking intimacy or sexual fulfilment elsewhere because they feel unable to communicate their needs within their relationships.
When a woman has been taught that asking for pleasure is shameful, proposing professional counselling is an insult, and discussing sexual difficulties could threaten her marriage, she may seek answers in secrecy rather than through open communication or healthcare.
For some, these encounters can expose them to risks they were not adequately prepared to negotiate. Women who lack access to reliable information, contraception, STI prevention services or the power to insist on safer sex may face sexually transmitted infections, unintended pregnancies and emotional distress. Some also experience guilt, fear, anxiety and psychological trauma.
These consequences should concern us as a public health and gender equality issue.
This is not about excusing infidelity, encouraging extramarital relationships or blaming men for women’s choices. Nor should sexual dissatisfaction ever be used to justify coercion, violence or deception. It is about acknowledging that silencing conversations about sexuality does not make sexual needs disappear.
We cannot prevent harm effectively if we refuse to discuss the realities that shape people’s sexual decisions.
Rather than condemning women for having needs, we should create conditions in which couples can communicate, seek appropriate support and make informed choices before dissatisfaction develops into a source of secrecy, conflict or harm.
Sexology: the missing conversation in sexual healthcare
One of the gaps in public understanding of sexual health is the limited awareness of the professionals who can help people address sexual difficulties.
Many people know they can consult a doctor for physical pain, a cardiologist for heart problems or a psychologist for emotional distress. Far fewer understand that sexual difficulties can also be discussed with appropriately qualified professionals.
Sexology is the study of human sexuality. Depending on the country and the professional’s qualifications, support may be available through sexual medicine specialists, qualified sex therapists, gynaecologists, urologists, psychologists and other trained healthcare providers.
These professionals may help individuals and couples address concerns such as painful intercourse, difficulties with arousal or orgasm, erectile dysfunction, changes in sexual desire, anxiety about sexual performance, and the effects of illness, medication, ageing or trauma on intimacy.
The appropriate professional depends on the concern. Some difficulties require medical assessment, while others may benefit from psychological support, relationship counselling or a combination of approaches.
Yet how many couples in our communities know that they can seek such support?
How many women understand that persistent pain during intercourse is a legitimate health concern rather than something they must endure? How many men know that changes in erectile function can warrant medical assessment rather than ridicule or silence? How many couples realise that asking for professional help does not mean their relationship has failed?
I am particularly concerned about the experiences of women who have suggested consulting a sexologist or another qualified professional, only to face threats of divorce or abandonment from their partners.
Think about what this means. A woman proposes seeking help to improve intimacy, understand a health concern or strengthen her relationship, yet her suggestion is interpreted as an attack.
When the mere idea of seeking professional assistance becomes a threat to a woman’s security, the problem extends beyond sexual health. It becomes a question of gender inequality, power and the freedom to seek healthcare without intimidation.
We need public education that makes sexual healthcare more visible, accessible and acceptable. Couples should know where to seek confidential support and understand that sexual difficulties are not moral failures.
Seeking help should be treated as a responsible step towards wellbeing, not as an admission of shame.
What happens when sexual functioning changes with age?
Another conversation we rarely have openly concerns sexual pleasure as people grow older or experience changes in their health.
Sexual functioning can change with age, illness, medication, hormonal changes, disability and other circumstances. Men may experience changes in erectile function or sexual desire. Women may experience menopause-related symptoms, vaginal dryness, discomfort during intercourse or changes in desire and arousal.
These changes do not necessarily end the possibility of intimacy or pleasure.
Yet, in some communities, there is little room to discuss how couples can adapt when conventional sexual intercourse becomes difficult or when one partner’s sexual functioning changes.
Sexual aids, including vibrators and other devices, may be one option for some consenting adults. Appropriate use can help some people explore pleasure or adapt to particular health circumstances. They are not necessary or suitable for everyone, and their use should be informed by individual preferences, consent and relevant health considerations.
Nevertheless, mentioning sexual aids can provoke discomfort or condemnation. Some people view them as immoral or assume that their use means a partner is inadequate.
Why should adults be denied access to reliable information about consensual options for sexual wellbeing simply because the subject makes others uncomfortable?
The purpose is not to prescribe how people should experience pleasure. It is to ensure that they can make informed choices without shame or misinformation.
A person’s worth is not defined by sexual performance. A couple’s intimacy needs not end when their bodies change. And seeking alternatives to address sexual difficulties should not automatically be treated as a threat to a relationship.
We need to create room for these conversations in health education, counselling and community engagement.
Decolonising sexual health must also challenge patriarchal silence
The call to decolonise global sexual health is important because it challenges unequal research relationships, funding structures and the assumption that knowledge and expertise flow primarily from wealthy countries to the rest of the world.
But decolonisation must mean more than changing who delivers programmes while leaving the same narrow assumptions about sexuality untouched.
The sexual and reproductive health agenda has often concentrated on measurable outcomes such as contraceptive uptake, HIV prevention and maternal mortality. These remain vital. However, programmes that fail to consider intimacy, sexual communication, bodily autonomy and pleasure risk presenting an incomplete picture of sexual wellbeing.
At the same time, we must recognise that harmful silences are not the product of one influence alone. Colonial histories, imported moral frameworks, patriarchal traditions, religious interpretations, economic inequalities and contemporary social expectations interact in complex ways. African communities are diverse, and our cultures should neither be romanticised as uniformly liberating nor dismissed as uniformly oppressive.
Decolonising sexual health means asking difficult questions about both external power and internal inequalities.
It means questioning why communities affected by sexual health challenges are often treated primarily as recipients of interventions rather than as producers of knowledge and designers of solutions.
It also means asking why women may be expected to protect their reproductive health while being discouraged from discussing their sexual experiences.
The World Health Organization’s working definition of sexual health offers an important foundation for this conversation. It describes sexual health as physical, emotional, mental and social wellbeing in relation to sexuality, going beyond the absence of disease or dysfunction. It also recognises the possibility of pleasurable and safe sexual experiences free from coercion, discrimination and violence.
This understanding reinforces a point we must not overlook: sexual health is about wellbeing, dignity, respect and rights, not simply the prevention of negative outcomes.
African-led research, community knowledge, women’s lived experiences and rigorous scientific evidence must all contribute to how we understand and address sexual health.
We must be able to challenge harmful cultural practices without rejecting our identities, and embrace scientific advances without assuming that solutions must always originate elsewhere.
What needs to change?
If we are serious about advancing sexual and reproductive health and rights, we must move beyond acknowledging that pleasure matters and begin translating that recognition into practical action.
1. Expand comprehensive sexuality education.
Sexuality education should address more than reproduction, abstinence and disease prevention. Age-appropriate, evidence-based education should cover consent, healthy relationships, communication, bodily autonomy, sexual functioning, pleasure, contraception and STI prevention. It must promote respect and safety without shaming people for asking questions.
2. Make sexual healthcare visible and accessible.
Health ministries, healthcare providers, universities, Civil Society Organizations and professional associations should help the public understand where to seek support for sexual difficulties. Healthcare workers need training to discuss these issues sensitively and to refer patients to appropriately qualified professionals. Confidentiality, affordability and non-discrimination are essential.
3. Encourage honest conversations between partners.
Community dialogues, relationship education and counselling can help challenge the belief that talking about sexual dissatisfaction is an attack on masculinity or evidence of relationship failure. Partners should be encouraged to communicate with mutual respect, listen without humiliation and seek help when needed.
However, communication must never be used to pressure women to remain in unsafe relationships. No one should be forced to engage in sexual activity or remain in a relationship to protect another person’s reputation.
4. Invest in African-led research on sexual wellbeing.
We need research that asks women themselves what sexual wellbeing means to them, what prevents them from seeking help and what kinds of services they trust. This research should include diverse age groups, rural and urban communities, people with disabilities and different socioeconomic circumstances.
Community organisations and researchers should work together to develop ethical, confidential and culturally responsive approaches. Women must have a meaningful role in defining research priorities, interpreting findings and shaping interventions.
5. Address unequal power and barriers to pleasurable sex.
Sexual pleasure cannot be separated from consent, bodily autonomy and the ability to negotiate protection. Women who depend economically on their partners or fear abandonment may find it difficult to insist on condoms, contraception or other protective measures.
Programmes must therefore address gender inequality and economic vulnerability alongside sexual health education. Women need access to information, services and support that strengthen their ability to make decisions without coercion.
6. Shift funding and decision-making towards local expertise.
Funders and international organisations should support African institutions, researchers and community-led organisations to define sexual health priorities and develop solutions grounded in local realities. Funding should allow communities to investigate questions that matter to them, including questions about pleasure, intimacy, ageing and relationship wellbeing.
Decolonisation must change not only the language of global health but also who controls resources, whose evidence is valued and whose priorities receive attention.
What this means for PaWED-IATC and the wider SRHR movement
For PaWED-IATC and other African organisations working at the intersection of gender equality, sexual and reproductive health and rights, and gender-based violence prevention, this conversation presents an opportunity to broaden our advocacy.
We must continue fighting for access to contraception, safe maternal healthcare, HIV prevention and treatment, comprehensive sexuality education, and protection from sexual and gender-based violence. But we should also create space to discuss the questions that are often left unspoken.
Can a woman tell her partner that she is not sexually satisfied without fearing humiliation or abandonment? Can a couple seek professional help for sexual difficulties without being treated as immoral? Can women access reliable information about their bodies and sexual health at different stages of life? Can researchers and policymakers listen to women’s experiences without imposing assumptions about what they should want or how they should live?
These are legitimate questions for sexual and reproductive health advocacy.
PaWED-IATC can contribute by supporting community dialogues, promoting accessible information about sexual healthcare, engaging healthcare professionals, strengthening partnerships with African researchers and advocating for women’s participation in shaping sexual health policies and programmes.
Our approach must remain evidence-based, survivor-centred and respectful of individual choices. Not every woman prioritises sexual pleasure, and no single model of sexuality should be imposed on everyone. Some women choose abstinence; others are asexual; others define intimacy in ways that do not centre sexual activity. Their choices deserve equal respect.
The goal is not to tell women what their sexuality should look like. It is to ensure that women can understand their options, make informed decisions and seek support without fear, coercion or discrimination.
From surviving sexuality to experiencing wellbeing
For generations, too many women have been taught to endure rather than communicate, submit rather than negotiate, and remain silent rather than seek help.
We must challenge the idea that a woman’s sexual needs are shameful, that a man’s sexual difficulties cannot be discussed, or that seeking professional support threatens the integrity of a relationship.
Sexual pleasure is not a substitute for preventing HIV, reducing maternal mortality, expanding contraceptive access or ending sexual violence. It is one dimension of a broader understanding of sexual health that includes physical, emotional, mental and social wellbeing.
Nor should women’s worth be measured by whether they experience pleasure in a particular way. The point is that they should have the freedom, information and support to define their own wellbeing.
Decolonising sexual health requires us to question who sets the agenda, whose knowledge informs policy and whose experiences remain invisible. It also requires us to confront the cultural silences and unequal power relations that prevent women from speaking about their bodies, their relationships and their health.
African women deserve more than protection from sexual harm. They deserve dignity, bodily autonomy, access to trustworthy information, compassionate healthcare and the freedom to make informed choices about their own lives.
If sexual health is truly about wellbeing, then women’s pleasure cannot remain an embarrassing footnote. It must be part of the conversation.
Because sexual health without women’s voices is incomplete, and sexual rights without meaningful autonomy remain only partially realised.
Disclaimer: This article is an advocacy and thought-leadership contribution to public discussion on sexual and reproductive health and rights. It reflects the author’s analysis and does not necessarily represent an officially adopted position of every PaWED–IATC partner or stakeholder.
