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A Measure of Sex-cess Wide-Ranging Assessment of Well-Being Puts Twin States at Top

Sunday, January 06, 2013
Lebanon — Whether it’s obesity, diabetes, smoking or other indicators of health, residents of the Twin States tend to fare pretty well compared with the rest of the nation.

Turns out, we do pretty well on how we approach sex, too.

A recent report that ranked the sexual health of all 50 states and the District of Columbia put Vermont at the top of the list and ranked New Hampshire No. 3.

The report’s author, Meriden resident Martin Downs, is a public health consultant and journalist who writes a regular sex advice column, “Carnal Knowledge,” for Penthouse magazine. But his report isn’t just about how active people are in the bedroom.

Rather, it goes beyond traditional notions of sexual health — how often partners have sex, rates of sexually transmitted disease, access to contraceptives, etc. — to incorporate human rights, sexual identity and other factors that may not be strictly health-related, but that nevertheless affect a person’s sexual well-being.

When accounting for political and societal factors, Downs said, it’s not so surprising that Vermont and New Hampshire do well compared with other states.

“It’s partly a function of the demographic makeup of Vermont and it’s also a function of … proactive and positive policies,” Downs said at his Lebanon office last week. “It’s a combination of all those things.”

Downs is working with The Center for Sexual Pleasure and Health, a nonprofit education and advocacy organization in Rhode Island, to spread awareness of his research.

People tend to perceive sexual health as something physical, Downs said. But, according to the World Health Organization, the term also refers to “emotional, mental and social well-being in relation to sexuality.” Sexual health not just about disease or dysfunction. It is about developing positive sexual relationships and necessarily involves all of the social factors — including discrimination and violence — that influence them, according to the WHO.

Downs, who has a master’s degree in public health from the Dartmouth Institute for Health Policy and Clinical Practice, used the WHO definition as a guide in developing 26 separate measures of sexual health to determine how the states compared.

Rates of sexually transmitted diseases, such as AIDS, gonorrhea and syphilis, are among the measures. But so are incidence of rape, the status of state laws addressing bias or hate crimes based on sexual orientation, marriage equality and sexual education in schools. This region didn’t rank highly on all measures — New Hampshire had slightly higher rates of rape than the national average — but was in the top 10 on a majority of them.

The Northeast did well overall, with Connecticut, New Jersey and Massachusetts rounding out the top five. The bottom included mostly Southeastern states, with Mississippi as the worst.

Vermont’s good showing did not much surprise Breena Holmes, director of maternal and child health for the Vermont Department of Health. The state has done a lot to promote sex education, access to women’s health services and prevent sexually transmitted disease, she said. Sex education is mandated in public schools and contraceptives are widely available at clinics throughout the state.

But Vermont has broadened its approach to sexual health beyond contraception and disease prevention.

Sexual violence has received greater attention since the death of 12-year-old Brooke Bennett, whose body was found in Randolph in 2008. Bennett’s uncle, Michael Jacques, is awaiting trial on charges that he raped and killed her.

Brooke’s death, and the related allegations of sexual assault, moved Vermont lawmakers to require schools to educate students and staff about sexual abuse, as well as offer information to parents.

As for Downs’ report, Holmes said, she found a lot to like, particularly in its balance of disease prevention, state policy and health access measures. Downs’ analysis could be a bit long for the average reader, she said, but otherwise he did a good job at broadening the conversation around sexual health.

“I like it,” she said. “I think it has to be this broad if we’re going to have a real 2013 conversation about sex.”

Downs’ findings parallel similar lists, such as America’s Health Rankings, which looks at state obesity rates, smoking, diabetes and active lifestyle. Last year, Vermont claimed the top spot for overall health and New Hampshire was third. Downs found this encouraging, as such similarities between the rankings seem to validate his argument that sexual health and a person’s general well-being are related.

Sexual health “is a part of health and an important one,” Downs said. “It is not about special circumstances.”

Measuring sexual health of populations can be difficult, said Gilbert Herdt, professor of human sexuality studies and anthropology at San Francisco State University. However, it is still important to study.

“These kinds of cross country comparisons are hard to make due to the markers used (which vary by country) and incomparability of epidemiological data,” Herdt said in an email. “However, they are crucial to make, and in the 21st century can help people strive toward better sexual health.”

The report is not intended to be the official yardstick on sexual health, Downs said. Instead, he wants it to further the discussion of how the issue is perceived, to shift the focus from a definition that emphasizes disease to one that promotes a positive viewpoint.

To that end, the report is a success, said Sharon McDonnell, an epidemiologist at the University of New Hampshire and a former instructor of Downs’ at Dartmouth.

“We tend to think of sexuality as very physical, but that’s just our association,” she said. “There is a whole gamut of things that contribute to that.”

The report raises questions about whether community and culture create people who will have sexually healthy lives. Determining which factors matter most in measuring sexual health is a difficult question, she said.

McDonnell said she agreed with the measures Downs chose, but is not sure they are the only ones that should be considered. There is no end to the number of factors that could influence a person’s sexual health. This is an important part of the discussion researchers must have as societal notions of sexual health evolve, she said.

“If Martin is lucky, this work will generate enough interest to be controversial and people will argue about these things,” McDonnell said in a follow up email. “Scientists will opine and offer their research and begin to discuss different compound measures for health and how/if they influence all that is the expression of sexuality.”

Megan Andelloux, director of The Center for Sexual Pleasure, will be discussing the report in presentations at more than two dozen universities and conferences in the coming months. She will be visiting Yale University, Smith College and other schools in New England, although nowhere in Vermont or New Hampshire, she said.

Andelloux wants to open up the conversation around sexual health to include pleasure as well as disease prevention. Downs’ report was a step in that direction, and she hoped it would spur further research.

“It’s not just about HIV prevention,” she said. “It’s about how do we help people be happy about their sexual lives.”

Downs views the state rankings, which he believes is the first of its kind for sexual health, as a work in progress. He expects there will not only be adjustments in which measures to include, but also in how they are weighted.

There also is a more general need to help people open up about their sexuality, he said. There’s a stigma attached to discussing human sexuality, as though it were something shocking that cannot be talked about publicly.

“Part of what this project does, is it really re-frames how a person might think about sexual health,” he said. “If nothing else, I think this is going to get people to start thinking about sexual health in a different way.”

Editor’s note: The Sexual Health Rankings data may be viewed at Chris Fleisher can be reached at 603-727-3229 or

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