Why We Need Better Measures For Pleasure And Sexual Health

This piece highlights how STI rates surged during the pandemic not only because people delayed routine care, but also because the U.S. lacks a strong, proactive system for measuring and addressing sexual health. Despite high—and costly—rates of STIs, unintended pregnancies, HIV, sexual violence, reproductive cancers, and sexual dysfunction, national sexual health indicators remain fragmented and stigmatized, shaped by a long history of fear-based messaging that treats sexuality as dangerous rather than integral to well-being. The author argues for a comprehensive sexual health scorecard, similar to systems used in England and by the WHO, that would monitor key domains such as education, behaviors, service access, pleasure, and outcomes. Encouragingly, federal agencies like HHS, the National Academies, and the CDC are beginning to endorse more holistic approaches to sexual health. Still, the U.S. needs a dedicated, recurring national survey to track trends and guide effective policy. Measuring sexual health—including pleasure—is essential not only for responding to STI spikes but also for addressing intersecting epidemics like HIV, substance use, and mental health.