Health Promotion International, Vol. 20 No. 4 Ó The Author 2005. Published by Oxford University Press. All rights reserved.

doi:10.1093/heapro/dai021 For Permissions, please email:
Advance access publication 13 September 2005

Masculinities and young men’s sex education needs
in Ireland: problematizing client-centred health
promotion approaches

Downloaded from at Universitas Diponegoro on January 8, 2015
School of Nursing, Midwifery and Health Systems, University College Dublin, Dublin 4, Ireland and
Department of Sociology, University College Dublin, Dublin 4, Ireland

In recent decades, dominant discourses in health promotion young men tended to prioritize practical guidance that
have emphasized empowerment, client participation and would provide them with the skills and confidence to
the notion of people identifying and being facilitated to take the lead in sexual encounters, and display competence
meet their own health needs. However, there has been little in the act of penetrative sex. We argue that these self-defined
analysis of the concept of ‘need’ and the possibility, at least, sex education needs emanate from a culture of traditional
that the fulfilment of some such self-defined needs are not in masculinity where, for a male, one’s place in the pecking
the interest of social justice and equality. In this article, we order is derived from one’s capacity to conquer, lead and
present an account of the sex education needs of secondary display mastery with regard to sex. In the discussion, we
school pupils from their own perspectives, and problemat- attempt to unpack the notion of clients identifying their
ize the concept of self-identified needs in health education. own needs and the concept of empowerment as it relates
Twenty-nine focus group interviews were conducted with to our data, in the context of gender-based structural
226 secondary school pupils in Ireland, and data were sub- inequalities.
jected to a qualitative analysis. Findings suggested that

Key words: sex education; masculinities; client-centred approach


Those who have followed health promotion (MacDonald, 1998) has generally been con-
developments even fleetingly over the past few sidered to be a positive development, expanding
decades will be familiar with dominant thinking Enlightenment principles of freedom, equality
within the field since the Alma Declaration in and democracy. This style of health promotion
1978. In its simplest form, this new wave health is often considered under the banner of the
promotion embraces a bottom-up rather than a ‘community development approach’, but of
top-down approach (Catford, 2004), where health course it does not need to be confined to the
workers focus on enabling and empowering peo- notion of geographical communities.
ple to identify and meet their own needs, rather In this article, we present data from a wider
than prescribing what is good for them in a pater- study of secondary school pupils’ perceptions of
nalistic manner. This is, of course, merely sex and sexuality, and focus specifically on the
one aspect of contemporary health promotion issue of young men’s self-identified needs in rela-
ideals, but one on which we will focus here. tion to sex education. In the discussion section, we
This anti-authoritarian philosophy mediating consider this data in relation to central issues in
contemporary health promotion discourses contemporary health promotion theory.


pupils were in their examination may actually be a trustworthy representation of year. The sample elucidate the dilemma that researchers face in dis- profile is shown in Tables 1 and 2. as these may be influenced by cul- sample size of extensive empirical scope—most tural expectations (Holmberg.oxfordjournals. and half in rural Number of transition year groups 3 areas. with one exception where there were insuffi. and the very phenomena that participants were retro- Senior Cycle (18 or 19 years). and finished in January 2004. people may hold views about ted. questions have been voiced had been achieved after 29 focus group interviews about the validity of responses or accounts on had been conducted at 10 schools. which was deemed to best serve its aims and Total number of participants 226 objectives. a research strategy resembling to determine the nature and extent of sex educa. 1994). Number of male participants 124 Number of focus groups 29 primary schools by location. and from at least one of their parents and revisions as new issues. noted for its value in analysing groupwork audio-recorded focus group interview. The sample was comprised of pupils from views.. The constant comparative method is sensitive issues (Robinson. which was later subjected to scrutiny themselves. all were single sex. written ers familiarized themselves with an ‘interview consent was obtained from both participants guide’. we also 2003. emerged. Glaser. 1994). three focus groups were conduc. 1998. but In both quantitative and qualitative research it transpired that enough diversity and saturation on young people. with similar items grouped together in a particu- tural norms of the adolescents. Number of junior certificate groups 11 half in the city of Dublin. In addition. tion at the schools in advance of their selection. p. The Department of Education and Number of female participants 102 Science’s website facilitated the search of post. We noted that at times during the inter- study. 2015 lacking’ (Inglis. At each of experiences. Although Relationships and Sexuality Number of mixed groups 3 Education (RSE) had just become mandatory (senior and junior cycle mixed) in Irish schools. particularly since group interaction group. 1999). In all. 12 schools would be involved in the study. in press) we examination and the Senior Cycle in the Leaving argue that what appear to be exaggerated or con- Certificate (LC) examination. interview- had agreed to facilitate the focus groups. with adolescents creates further challenges for prised of five to 12 pupils and apart from one researchers. At the outset of this study. Using focus groups one of the focus groups. Masculinities and young men’s sex education needs in Ireland 335 METHODOLOGY Table 1: Profile of the sample Overview This study invoked a qualitative methodology. [The Junior spectively recounting as a feature of their culture. previously unanticip- or guardians. Cycle culminates in the Junior Certificate (JC) In a separate article (Hyde et al. A list of schools was drawn up. However. tinguishing which parts of the interview mimic . and it was impossible In this study. 22 schools were cerns that males may exaggerate their sexual approached of which 12 declined. type of school and Number of leaving certificate groups 12 size of school. and 124 males) participated in the duced. This is a the topic of sex. sex. 1998. 2001). 1992) was used to analyse data. at Universitas Diponegoro on January 8. Once schools lar category. grounded theory (Glaser and Strauss. episodes of acting out lent support to the both the Junior Cycle (15 or 16 years). Gendered expectations raise con- (Kitzinger. It was initially anticipated that ated. 3). is concerned with developing had been used previously in researching sexual theoretical insights using the constant comparat- matters and was found to be useful in exploring ive method. a strategy whereupon incoming data are com- the interaction among participants had the pared and coded into conceptual categories potential to generate richer data about the cul. Grounded The method chosen to collect data was the theory. In all. In all apart from at trived aspects of data generated in focus groups one school. Moreover. 226 young people can influence the status of the knowledge pro- (102 females.] The data collection commenced in October sub-cultural group processes. Each focus group com. an Expert Advisory Group con- cluded that sex education provision was ‘gener- ally uneven. Conner and focus groups consist of four to five interviews Flesch. uncoordinated and sometimes Downloaded from http://heapro. but may actually behave in ways that are cient numbers of pupils willing to participate for contrary to these views. 1967. while females might play theirs the 10 schools. as this (Kitzinger.

defined sex education needs of young men. people like that could be individual voices. 2015 5 6 6 10 8 8 8 7 8 9 8 8 8 8 8 The school number refers to the order in which the interviews were undertaken. there was more success in identifying the nurses. School 10/Focus Group 1. males tended to want more so that their contribution could be followed information on the ‘practical’ issues around the throughout the interview. with a priority on acquiring material on the topics of contraception. Rural. Leaving Certificate. Where interviewers also transcribed a Int: Do you think that there is anything that tape.) summary of the needs of the young women is use- ful in contextualizing data. normative group cultural dynamics. P6: Like in England they have instructions to show you FINDINGS how to put on a condom like and here they just show you a video and that’s all they do. ‘P’ denotes that a participant is speak. female focus groups are identified as ‘(f)’ and male as ‘(m)’. additional interest in covering the topics of emo- ings. P7: Like instructions. . and ‘Int’ that the interviewer is speaking. In the case of one group (at School 6). In the case of co-educational schools. general knowledge (General laughter. a group was a mixed sex group ‘(m/f)’. Table 2: Rural and urban schools Rural (five schools) Co-ed Male Male Female Female School number 1 School number 2 School number 10 School number 5 School number 8 LC (m) LC (f) JC (f) LC JC JC JC LC LC Mxd Mxd Mxd JC LC 8 7 8 9 7 5 8 8 6 8 7 7 11 12 — Urban (five schools) Co-ed Co-ed Male Male Female School number 6 School number 7 School number 4 School number 9 School number 3 LC (m/f) JC (f) JC (m) JC (m) LC (f) LC (m) JC JC LC T T T LC JC LC Downloaded from http://heapro. Int: Did you get sex education in school? ing. needs from those of the young men was their Before moving on to present the study’s find.336 A. making it difficult for the assistant inter. when it mechanics of sex. sexually practical knowledge on how to conduct them- transmitted infections (STIs) and how pregnancy selves in sexual encounters.] extremely difficult to distinguish each one. female counterparts. clarification is required about how extracts tions and relationships in sex education classes. ‘T’ denotes that students were in their transition year. In the quotations While young men and women did identify some that follow. The last row indicates the number of participants in each group. Young people in focus groups tend to ter. However. ‘Mxd’ denotes that the focus group was drawn from a mix of junior and leaving certificate pupils. they sometimes talked over each Among the practical issues raised was the need other. and which arises. shared issues in terms of their sex education needs ing. . what distinguished the young women’s parts can be taken at face value. School 1 (Co-ed)/ voices and with the same accents. Hyde et al. Rural. a brief (Male. and this is so where ‘P’ appears without a P4: Just. In addition.) speak with the same level of maturity in their [ at Universitas Diponegoro on January 8. making it Focus Group 1. Although a strong Young men’s sex education needs tended to be theme emerging from young women’s accounts presented in an objective and emotionally was the need for greater exposure to learning detached way. . (such as more information on STIs). from the data are presented. school counsellors. doing? Several: Yeah. unlike their Participants were each identified by a number. for instructions on using condoms correctly: viewer to keep track of the order in which people spoke. came to transcribing the tapes.oxfordjournals. it was not always possible to identify which participant was speak.) P3: There was no practical side to it! (General laugh- number. While the main focus in this paper is on the self.

a lot of people don’t P: Hope you’re not making a fool of yourself. Like in first year they just tell them about it and in performance anxiety was an overbearing feature third year they make them put condoms on—dildos in how they viewed sex. if you didn’t know (Male. (Male. P2: But it was in a girl’s magazine! What’s the point in P3: Yeah. mastery and conveying Int: Are there any magazines for your age group? a strong interest in matters of sex and sexual pur- P1: No. School 2/Focus you are doing. Rural. Urban.) . in openly seeking out Boys’ needs for a specific form of sexual health information about enhancing one’s sexual education appeared to be rooted in a culture of technique. participants in our study were influenced by (Male. School 9/Focus Group 2. like. and ‘what sex) and you couldn’t perform. the young The cultural expectation of male control in sex- men nonetheless expressed their need for ual encounters is borne out clearly in the follow- information on the psychomotor and physical ing quotation in which one young man describes a dimensions of sex. . this sense of masculinity. Junior Certificate. You are just sticking it in. School 9/Focus Group 2. right thing—they know how to do it proper (laughs). they P1: Probably porn stars like they’re going to do the want people to go and try different positions. one’s identity man revealed how the male peer group as male is strongly associated with one’s achieve. You’d be murdered if suit are also dimensions of this version of mascu. and one’s sexual performance P1: Well. . P2: Penetration. not for our age group. like. . Transition. of masculinity is judged by the number of sexual Int: Would you yeah? conquests. Junior Certificate. there’d be some riding [sexual activity having it in there? Do they want people to go out and (vernacular)] going on in there (laughs)! try it? (Male. doing. Urban. like.oxfordjournals. Urban. At the same time. so that it’s porno at the end of it.? conveys the cultural expectation that this P: Just a service that gives you advice on like (interrup. you still don’t actually know what (Male. . Junior Certificate. Transition. . School 2/Focus Group 3. while the need for more know. . Urban. what to do. 2015 right. 2000). His group-mate’s response clearly service. at Universitas Diponegoro on January 8.) ledge about how to act in sexual encounters was cross-cut by expressions of immaturity. direct and know core for each year. Downloaded from http://heapro. Junior Certificate. . you’d be absolutely slagged [teased] if you (Measor et al. School 4/Focus In some groups. what would the girl think. to do’.) Group 2. and all. . One’s sense of self-esteem in the hierarchy [sex] positions. . P3: You’re just looking for tips. you were caught reading a magazine for different linity. Urban. 1992). . . P3: You need more things like. a guy sitting on a chair. School 9/Focus Group 2. Transition. . P3: At this age. . Masculinities and young men’s sex education needs in Ireland 337 P2: They should bring in sex education. how to act in sexual encounters.) ing for the best. P3: . it had a diagram of. School 9/Focus Group 3. . P3: What to do in your situation like what you are P1: . One young this construction of masculinity. information is irrelevant for females.) P1: You would feel nervous hoping you are doing it P2: There was nothing about how to please a woman. what would you like. For young men.) Taking the lead in getting into positions during The priority of male sexual performance in a sexual encounters was clearly seen as a male culture of traditional masculinity role. believing that males P1: In England they have it every year and it gets hard. . (Male. . .) what to do? (Male. ted). School 4/Focus (Male. Urban. Group 2. According to cast upon their sexual prowess. young men risked aspersions being dominant traditional masculinity. Dis. . and hop- Group 3. masculinity: playing sexual prowess. Anyway. .. rather than females should lead. male were looking for tips out of a magazine. Rural. know about ‘em. . To varying degrees. sex position that he saw in a magazine directed at Int: Do you think that if there was a (sex information) young women.) Others were looking for more practical advice P2: It would be worse if she wanted to (have penetrative as to how to sexually please a partner. he was lying down and [interrupted]. . monitored and invigilated cultural norms of ments in sexual conquest (Giddens. .

’ sexual pleasure ( at Universitas Diponegoro on January 8. but people and endurance. the impression that they were sexually experi- enced risked being labelled as ‘slags’ (data per. Int: So what do you think your biggest influence is on taining to this issue will be reported on the way you think about sex. p. tially damage male self-esteem rooted in tradi- Downloaded from http://heapro. expressing masculinity. dominance in sexual actions. at home when they watch TV say.) representation of masculinity and femininity has been associated with enhancing the male Talking about sex for the young men centred sense of phallic control and mastery (Ussher. . played into P3: If you’re saying. School 10/Focus Group 1. . Collectively. Rural. many were open in the interviews about A number of young men accessed porno- their need to enhance their knowledge about to graphy. young women was transferred to constructing women more gen- who took the lead in sexual encounters or gave erally as being available and disposable.) would just slag you or something and you’d just get down. strength. this study identified for themselves. What prob- be influenced by the media. more on their sexual psychomotor skills rather 1997). activity P6: I don’t know what way to phrase it like. and of judging success in terms of dis- talk—what would you talk about first like? playing sexual prowess and mastery. indeed for responsible sexual behaviour. School 4/Focus sex education needs were largely centred on Group 2. than the wider issues associated with sexual rela- tions or the emotional experience mediating the DISCUSSION physical actions. the focus on ‘hardness. Urban. There is a suggestion in the issue of perfecting performance around the the following quotation that television may influ. Yet the erotic heights young men wanted their masculine identity to reached in televised versions of sex are probably be further affirmed in sex education classes. there is of course and may give young people unrealistic expecta.’ centralized on the erect penis. Urban. notion that their own sexual behaviour might this practical knowledge is essential.338 A. they’re the next!’ (Male. Junior Certificate. rarely achieved by most sexually active people. School 4/Focus Group 2. pornographies—sit there and just jerk off. Junior Certificate. 2015 P5: When you go out and you see a girl and you say ‘Ah tional yardsticks of masculinity. . male (Male. would it be friends or TV separately). there was some evid. In the following extract. Although both male and female wanting to learn how to put on a condom prop- participants generally tended to dismiss any erly. the culture of exalting penetrative Int: Do you think it would be easy to talk—I mean sex over and above other means of expressing before you decided to have sex with a girl would you masculinity. a powerful culturally derived (Male. yeah. ‘Well. Pornography. Junior Certificate. lematizes it is that it seems to be bound up with ence to suggest otherwise. School 7 (Co-ed)/ But doing it with someone who has experience they Focus Group 1. From our data. nothing inherently sexist about a young man tions about sex. indirectly reinforcing a dominant Many young men in the sample revealed that masculine identity that mediated young men’s their greatest source of knowledge about sex cultural milieu. 2002.) inherently expected to know what to do. ironic- ally. ‘Was that ing sexual health needs that male participants in alright?’ or ‘Was I doing something wrong?’ or ‘Should I put it in a different place?’. In this phallocentric cul- ture.) accomplishing or enhancing sexual performance and in doing so. While young men believed that they were (Male. With regard to condom use. Sexually assertive women threatened or other things: the male cultural expectation of leadership and P3: Probably TV. act of penetrative sex as a central feature of ence sexual behaviour. In short. we want to do leaves little space or value or non-penetrative that as well. and could poten- P: Pornographies. ‘Do you want to talk?’ to a girl after the construction of the most immediate and press- her first time it would be easier like to say. Hyde et al.oxfordjournals. which women are objectified in pornography According to the boys’ accounts. P8: Telly. it emerged that emanated from television. 137). the way in achieve good penetrative sex. Urban.

the rights claims of various groups need to be by cutting off or invalidating other possibilities considered in relation to those of others of manifesting masculinity that might allow for (Tones. 2000. However. ive expectations of this cultural form keep men problematic because of its relativist perspective on top in terms of dominance. with knowledge about the psychomotor skills of . and disempowered. it also places a that does not privilege one interpretation great deal of pressure and stress on them. 101) related this to ‘. theorized power An assumption of the community development as something that is performed or exercised at approach is that the client group at which different points in the social network rather health promotion is directed is disadvantage than something possessed (Foucault. 1996). This creates theoretical tensions ring to the insecurity and anxiety about sexuality with the political aims of feminism and with underpinning the attitudes and behaviour of the much health promotion discourse that makes young men in their study. Measor et al. the expression of vulnerability.oxfordjournals. this is often the case. and by impeding Feeding into existing dominant phallocentric the development of a positive identity that does models of sexuality would reproduce inequalities not depend on sexual capacity or prowess. . namely: empowerment as the means through which the (i) the issue of client groups identifying their underdogs take or share some level of this own needs. while it simultaneously the needs of lay groups (in this case young constrains and regulates them (and of course men) are not always noble. and enabling works against women).. The see that on the one hand. and for the young men themselves buttresses culturally. of ways: by encapsulating the parameters of Other theorists have of course recognized that their identity within normatively defined limits. While on the one hand the normat. Client groups identifying their own needs Michel Foucault. 2003. focusing on gender as sexuality affords them mastery and control and a site of oppression. this construction of upshot is that our data. disadvantage. Yet post-structuralist notions of power conceive of power in a very different way. within Foucauldian thinking. yet at the same time leave young men be an appropriate course of action for health exposed and vulnerable brings us to the issue promoters is to set aside as a priority the agenda of empowerment. for example. and these cross-cut each other in relate to the dominant model of sexuality we various ways and to varying degrees. if we draw upon the data gender. such as and repressive. a dominant cultural form that expects them to Using a post-structuralist framework for take control. masculinity and these vary both historically and ive). 94). power has the potential to be both productive Downloaded from http://heapro. (Measor value judgments about ethics. The complexity of the concept of empowerment A recognition that the traditional version of Implications for health educators masculine sexuality can both sustain male domin. Space limitations prohibit the development they pay for the power and dominance they of this theoretical discussion—we are merely claim’. individual capacity’ (Tones and Tilford. by sustaining a secondary sex role for women in There are many forms possible for expressing the realm of sexuality (to be passive yet respons. p. over another. understanding gender dynamics is. . the price forth. suggest quite simply that works in their favour. however. Much health promotion theory of the young men and their quest for more has invoked structuralist theories of power. what might ance. and in the sense of economic Most significantly. and health promotion theory and practice. Thus. and (ii) the complexity of the concept power through an ‘upsteam’ focus of ‘building of ‘empowerment’.org/ at Universitas Diponegoro on January 8. p. justice and so et al. Dominant discourses of these needs to be met is not always in the masculinity can work against men in a number interest of others in the society as a whole. power being conceptualized as something related wider issues that have implications for centrally held by one group over another. that impact upon people’s health and in this paper concerning how male participants well-being. Refer. 2015 there are other sites of oppression. Masculinities and young men’s sex education needs in Ireland 339 Our data throw up for discussion two key inter. In the case under consideration here. flagging it here as an issue that may be taken up in further theoretical debates within health promotion. 1994).

p. ative ways of thinking that may well result in Hyde. we defend the notion of health pro. In short. T. thinking is not overly ambitious. (1998) Lessons in Irish Sexuality. (2000) Young People’s Pregnancy Agency for funding this research. B. Foucault. E-mail: abbey. However. their own needs and facilitating people to meet Glaser. Yet REFERENCES arguably those with knowledge of alternative ways of viewing the world that allow injustices Catford. and Strauss. London. In addition. London. Inglis. The focus some groups of clients not having their initial group method: insights from focus group interviews self-identified needs met. Grounded Theory. G. 16. Sage. Social Science and that some of the issues raised in this paper may Medicine.. London. (2001) Reflection as a transforming develop programmes that succeed in superseding process: student advanced nurse practitioners’ discourses that have been handed down through experiences of developing reflective skills as part of an MSc programme. 34: generations. University be developed in future theoretical and empirical College Dublin Press. (ed. Giddens. and are a pervasive aspect of patri. Kitzinger J. It is a huge challenge for sex educators to Glaze. Sexuality. and Bunton. ACKNOWLEDGEMENTS MacDonald. ies and groups. Routledge. E. A. of course. 31: 89–112 indignation and concern over social issues and Foucault. (1992) The Transformation of Intimacy: practice of health promotors going to communit. (1994) The methodology of Focus Groups: the importance of interaction between research participants. . These efforts at consciousness. but must be accompanied by critical on the determinants of intentions.hyde@ucd. 2015 that transmitting health knowledge is not suffi. H. Penguin of empowering people through facilitating Books. Journal of Social consciousness-raising designed to ‘create Psychology. Conner. The opinions expressed in this publication are Potts. in press. Address for correspondence: challenging them to consider ways of thinking Abbey Hyde School of Nursing. In the process Works of Foucault: 1954–1984: Volume III). identities developed may be a more appropriate Belfield Campus. R. (1994) In Faubion. Tiffin. Hyde et al. Mill Valley. Journal of Advanced Nursing. 1–4. D. Chicago. Sociology of Health and Illness. 103–121. London. in the interests of social justice. and Miller. J. encouraging them to identify Cambridge. 113–133. emancipat. D. (1967) The Discovery of new set of discourses. A.340 A. Views on Sex Education: Education Attitudes and Behaviour. A. and Drennan. an aspiration of some shift in Holmberg. B. Dublin. Teenage Sexuality in Ireland. Dublin. (1998) Rethinking Health Promotion: A Global Approach. E. ory models are not so much based on the pp. Dublin 4 ing to ‘a constructive exercise of power that Ireland improves the medical gaze’ (Gastaldo. Belfield. E. In Petersen. G. Downloaded from http://heapro. K. A. Polity. M.. (2004) Health promotion’s record card: how to become transparent have a moral obligation principled are we 20 years on? Health Promotion Interna- to enlighten others. A. M. (2001) Having casual sex: additive and interactive effects of alcohol and condom availability cient. (1992) Basics of Grounded Theory Analysis: these. London. 1997. T. (1997) ‘Is health education good for you? them to meet their own needs. Crisis Pregnancy Agency. Hyde. Aldine. Love and Eroticism in Modern Societies. L. C. A. 16). J. sex. raising may. we hope on sexual health with adolescents. Gastaldo. C. The authors would like to thank the Crisis 118). (eds) ment of critical consciousness. J. Instead. way to proceed. They would certainly amount to efforts to redefine ‘normality’ for the young men.oxfordjournals. (2004) Understanding moters acting to enlighten their clients on altern. Health and Medicine. California. Routledge. Brady. 1996. but rather on enlightening people and Emergence vs. and Howlett. p. D. 639–647 archy. their ‘own Re-thinking health education through the concept of needs’ become redefined through the develop.. Routledge. 19. Midwifery and Health Systems about masculinities and how their own sexual University College Dublin. (2002) The Science/Fiction of Sex: Feminist those of the authors and not necessarily those Deconstruction and the Vocabularies of Heterosex. Indeed. face the charge of amount. at Universitas Diponegoro on January 8. Routledge. J. D.) Power (Essential injustices’ (Tones. bio-power’. Howlett. and Flesch. London. Glaser. (1998) Sexualities and Popular Culture. Thus. Tones argues tional. Sociology revising their worldviews by exposing them to a Press. of the sponsor. work within health promotion.

Penguin. pp. K. N. Macmillan Press Ltd. (1996) The anatomy and ideology of health pro.oxfordjournals. motion: empowerment in context. Ussher. 2015 . 905–913. Boundaries of Sex. Masculinities and young men’s sex education needs in Ireland 341 Robinson. (1997) Fantasies of Femininity: Reframing the Tones. Journal of Advanced Nursing. 9–21. In Health Promotion: Downloaded from http://heapro. Angela Scriven & Judy Orme. at Universitas Diponegoro on January 8.M. J. (1999) The use of focus group methodology— Professional Perspectives. with selected examples from sexual health research. 29.