The Brazilian Committee Specialized in Sexology of the Brazilian Federation of Gynecology
and Obstetrics Associations (FEBRASGO) and the Brazilian Association of Studies on
Human Sexuality (SBRASH) have been asked to talk about the controversy involving sexuality
education (SE) in elementary and high schools. The broad discussion of the members
of the FEBRASGO committee and the board of SBRASH, that is, physicians (gynecologists,
obstetricians, psychiatrists and urologists), psychologists, and educators, resulted
in the present editorial.
According to the World Health Organization (WHO), SE should be a comprehensive educational
process on sexuality, comprising knowledge, skills, and values that enable young people
to make informed and responsible choices related to their sexual experiences. Sexuality
education offers opportunities to explore and build one's own values, behaviors, and
attitudes to acquire decision-making skills, improve communication skills, and reduce
behaviors that represent sexual and general risks.[1]
Sexuality is a central dimension of life that is fully experienced in adolescence,
a period marked by impulsivity, experimentation, restlessness, and by reduced concern
toward prevention aspects.[1] Therefore, it is imperative to incorporate sexuality into the pedagogical process
of the school system to complement the role of the family in the construction of one's
sexuality. Our position is also based on the Declaration of Sexual Rights of the World
Association for Sexual Health,[2] which considers that everyone shall have:
9. The right to information – [...] access to scientifically accurate and understandable
information related to sexuality, sexual health, and sexual rights through diverse
sources. Such information should not be arbitrarily censored, withheld, or intentionally
misrepresented.
10. The right to education and the right to comprehensive sexuality education – [...]
Comprehensive sexuality education must be age appropriate, scientifically accurate,
culturally competent, and grounded in human rights, gender equality, and a positive
approach to sexuality and pleasure.
The development of SE programs in schools face barriers that prevent their effectiveness.[3]
[4] Following this perspective, UNESCO has evaluated the impact of SE programs by reviewing
87 studies on their effectiveness and concluded that sexuality education:
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does NOT increase sexual activity in adolescence,
-
does NOT encourage sexual risk-taking behavior, and
-
does NOT increase the risk for sexually transmitted infections (STIs).
Many of these studies show SE helps postpone sexual initiation and reduce the number
of sexual partners, and that it is effective in increasing the use of condoms and
contraceptive methods.[5] A cost-effectiveness evaluation of these programs showed government savings of US$
67,825.00 in a European country per individual who did not have HIV due to these SE
programs.
In 2010, UNESCO revised and issued its International Technical Guidance on Sexuality
Education to all countries of the world, recommending nations to address topics related
to sexuality in school education, with guidelines to conduct this task with children
of at least 5 years old, adolescents and adults of all ages ([Table 1]).[5]
Table 1
Principles of sexuality education according to UNESCO[5]
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Sexuality education conducted in formal and non-formal contexts should observe the
following principles:
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✓ Be based on scientific evidence
|
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✓ Be comprehensive (increment information about the theme)
|
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✓ Be appropriate to the child's age and cognitive development
|
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✓ Be specific to each gender
|
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✓ Be culturally relevant and transformative
|
Source: UNESCO. EVALUATION OF SEXUALITY EDUCATION; Goal of Sexuality Education. Berlin: United
Nations Education, Scientific and Cultural Organization; 2017.
In order to achieve the standard set by UNESCO, combined education and health actions
are required, involving training to parents and elementary and high school teachers,
who may feel uncomfortable teaching sexuality topics when the content is in conflict
with their cultural values and beliefs. Health professionals should have scientific
knowledge about sexuality and define strategies based on scientific evidence. This
implies that the didactic material for sexuality education in schools needs to be
analyzed and validated by health and education professionals together. And these professionals
should get acquainted with the results of scientific studies on the subject and the
principles set by UNESCO to enhance the quality of SE programs ([Table 1]).[5]
The American College of Obstetricians and Gynecologists (ACOG) advocates the participation
of gynecologists in sexuality education programs because of the broad access these
professionals have to important aspects of adolescent sexuality and the sexual health
of couples.[6] In Brazil, sexology is one of the areas in which gynecologists and obstetricians
(GO) operate, so the Brazilian Committee Specialized in Sexology of FEBRASGO is responsible
for providing didactic material based on scientific evidence and for participating
in sexuality education programs and in those that provide support to people with sexual
dysfunctions. FEBRASGO grants sexologist degrees through an annual test, which evaluates
the knowledge on sexuality of gynecologists and obstetricians during the medical residency
program in Gynecology and Obstetrics or in an equivalent program. To apply for a sexologist
degree, the physician needs a prior GO specialist degree (TEGO).
The Brazilian Association of Studies on Human Sexuality (SBRASH) grants human sexuality
specialist degrees (TESH) in the fields of Sexual Therapy, Sexual Education, and Social
Sexology through a test held during SBRASH biennial congresses.
The Brazilian Federation of Gynecology and Obstetrics Associations (FEBRASGO) and
SBRASH both recognize sexuality education should be incorporated into the syllabuses
of elementary and high schools to lower the rates of sexual violence (sexual abuse
and rape) and reduce risk-taking behaviors in adolescence.[1] The road toward a sexually healthy society requires a serious approach to the subject,
scientific evidence, and ethical responsibility. Hence, professionals responsible
for SE in schools in Brazil, with the legal support from the National Curricular Parameters
(BRAZIL, 1998) should seek training provided by entities specialized in human sexuality,
such as FEBRASGO and SBRASH, and be committed to employing evidence-based methodologies.
