Sexualities, social justice and sexual justice

Full text

Sexual Justice and Sexualities
Josephine Cornell, Jeff Hearn, Kopano Ratele, and Shose Kessi
Contents
Introduction .... . . . .. .............................................................................. 2
A Brief History of Sexualities Research ......................................................... 3
Sexualities and Public Health ... . . .. .. .. .. .. ..................................................... 8
Critical Approaches to Sexualities and Sexual Justice .......................................... 9
Contextual, Locational, and Global Approaches to Sexualities . .. . . . ........................... 10
Reflexivity and Sexualities Scholarship .......................................................... 12
Challenging Dominant Assumptions with Sexualities Research ................................ 13
Sexualities of Invisible and Othered Bodies . .. .. .. .. .. ..... . . . .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. 14
Sexualities, Sexual Justice, and Action .......................................................... 15
Conclusion and Future Directions ................................................................ 16
References ........................................................................................ 17
J. Cornell (*)
Department of Psychology, School of Social Sciences, Birmingham City University,
Birmingham, UK
e-mail: Josephine.cornell@bcu.ac.uk
J. Hearn
FLO, Hanken School of Economics, Helsinki, Finland
University of Huddersfield, Huddersfield, UK
Örebro University, Örebro, Sweden
e-mail: hearn@hanken.fi
K. Ratele
Psychology Department, Stellenbosch University, Stellenbosch, South Africa
e-mail: kratele@sun.ac.za
S. Kessi
Faculty of Humanities, University of Cape Town, Cape Town, South Africa
e-mail: shose.kessi@uct.ac.za
© Springer Nature Switzerland AG 2023
P. Liamputtong (ed.), Handbook of Social Sciences and Global Public Health,
https://doi.org/10.1007/978-3-030-96778-9_120-1
1

Abstract
Sexualities research is a diverse and wide-ranging field, comprising a variety of
theoretical and methodological approaches. Mainstream public health scholars
have tended to approach the study of sexualities from an essentialist and biomedical
framework, at times drawing on deficit-focused interpretations of sexuality and
neglecting questions of power, context, and sexual diversity. Public health
researchers have an important role to play in promoting and working toward sexual
justice, and critical perspectives and understandings of sexuality are crucial in this
regard. Approaching sexualities with a critical lens requires always paying attention
to the power relations that shape sexual experiences, identities, and practices. This
is of particular urgency in light of the many forms of repression, exclusion, and
regressive backlash occurring across the globe, despite the many successes of the
struggle for sexual rights and justice. This chapter provides a historicaloverview of
sexualities research in the social sciences and public health and delineates some of
the key theoretical trends within sexualities scholarship. It then presents some key
priorities for critical research into sexualities within public health that may mean-
ingfully contribute to advancing sexual justice globally.
Keywords
Sexualities · Sexual justice · Biomedical perspectives · Critical approaches ·
Action · Reflexivity
Introduction
Although sexualities research began as a relatively narrow field rooted in sexology,
since the 1970s, it has grown substantially to encompass scholarship from across the
social sciences (Parker 2009). Contemporary research into sexuality is wide ranging,
drawing on a multitude of methodological approaches and varied theoretical per-
spectives (Fahs and McClelland 2016; Fletcher et al. 2013; Parker 2009). Within this
diverse field, mainstream global public health research into sexualities is rooted
within the biomedical paradigm, focusing on risk factors and negative health out-
comes associated with sexuality (Mitchell et al. 2021). In some ways, this body of
research has played a vital role in addressing health inequalities and promoting
sexual health. However, the tendencies toward essentialist and deficit-focused bias in
much mainstream public health research have produced binary and often patholo-
gizing understandings of sexuality that ignore questions of power, context, and
sexual diversity (Corrêa et al. 2008; Mitchell et al. 2021).
Forglobalpublichealthresearchtoexplicitlyworktowardsexualjustice,itis
crucial that scholars embrace critical approaches to sexuality studies that are more
common within other social science disciplines. A strand of research and frameworks
informed by the “social determinants approach”to sexual health already exist in public
health (Leifheit and Jennings 2019; Rao et al. 2012;WHO2010). While not
2 J. Cornell et al.

necessarily informed by critical theory, this research is somewhat closer to critical
perspectives on sexualities. Critical perspectives are particularly important as the many
successes of the struggle for sexual rights and justice globally “exist side-by-side with
ongoing forms of oppression and exclusion”(Parker 2009, p. 261). Indeed, the legal
victories, visibility, and acceptance of more diverse and varied understandings of
sexuality have been met with conservative backlash and regressive policy revisions
in many countries across the world (Ferfolja and Ullman 2017; Windsor et al. 2019).
This is both a very long-term historical and a very topical and immediate process and
politics. It is clear and evident, for example, in the recent overturning of Roe v. Wade
by the US Supreme Court which ended the constitutional right to abortion in the USA
(Tolentino 2022); the passing of Florida’s“Don’t Say Gay”bill in the USAwhich bans
teaching about sexual orientation and gender identity in schools (Popat and Honderich
2022); the refusal of the Conservative British Government to include transgender
people in the ban on conversion therapy in the UK (Bychawski 2022); and multiple
examples of legal and political action against LGBT*IQA+ people and movement in
Eastern Europe and the Russian Federation, directed by strong populist politicians,
segments of the Catholic church, or even the very center of the state (Kuhar and
Paternotte 2017). Moreover, there are still about 70 countries (c.70) where same-sex
practices are criminalized/illegal and punishable by the state (https://www.
humandignitytrust.org/lgbt-the-law/map-of-criminalisation/).
Sexuality as a subjective and social experience, and sexuality research are matters
of politics, policy, and professional and other practices. As Windsor et al. (2019,
p. 705) caution, sexuality is policed and constructed through policymaking and
legislative decisions, and these “rapid shifts in policy illustrate how quickly issues
can be redefined.”However, regressive, harmful, and marginalizing understandings
of sexuality have always been met with resistance and activism (Windsor et al.
2019). Global public health research into sexualities has a vital role to play in this
regard. This chapter provides an overview of the history of and key theoretical trends
within sexualities research in the social sciences more broadly and public health
specifically. It then outlines some key priorities for critical research into sexualities
that may meaningfully contribute to advancing sexual justice globally.
A Brief History of Sexualities Research
The study of sexuality has always been shaped by the prevailing moral cultures and
anxieties around sexuality that dominate public discourse at the time (Todd 2021;
Weeks 2014). As Tiefer (2018, p.188) reminds us:
Because sexuality is a contested political terrain where various ideological forces struggle
for legitimacy and cultural authority, all discourse about sexuality, including scientific and
clinical discourses, represents some worldview and political agenda.
Until the early twentieth century, the dominant understanding of sexuality in many
Western societies was framed by religion (Parker 2009). Religious institutions
Sexual Justice and Sexualities 3

controlled the moral boundaries around sex, and sexuality was largely understood
through a framework of sin (Tiefer 2018). Western Christian –in contrast to, for
example, independent African Christian –understandings of sexuality were also
central to justifying the colonial and imperialist project, with sexual behaviors and
identities in contexts like Africa and Asia framed as primitive, dysfunctional, and
immoral and, thus, in need of “civilization”through missionary and political inter-
vention (Bhana et al. 2022; Tamale 2015). Non-Christian religions have their own
complex relations to sexuality, often also highly controlling, but also sometimes
acknowledging, even incorporating, sexual and gender diversity within their corpus.
For example, same-sex sexualities figure in some early Hindutexts and depictions, and
with its embedded polythesism numerous Hindu deities could be said to be gender-
fluid (Chakraborty and Thakurata 2013), even while there are dangers of placing such
forms into Western categorizations. Despite most formal interpretations of the Quran,
there is also a long history of same-sex, nonheteronormative, and homoerotic acts and
desires within some Muslim societies, however often without individual sexual self-
identification in these terms (Schmidtke 1999). There are also innumerable examples
of diverse gender and sexual forms in non-Western and indigenous societies, such as
hijras, muxes, and various “third sexes”and “third genders”(Herdt 1994).
Scholarly and scientific interest in sexuality and sexual behavior first emerged in
the late nineteenth and early twentieth century in the work of Sigmund Freud and
Charles Darwin and sexologists such as Richard von Krafft-Ebing and Havelock Ellis
(Bland and Doan 1998; Corrêa et al. 2008;Irvine2005;Plummer2020). Freud and
Darwin, in particular, laid the groundwork for the scientific study of sex, which
disrupted prevailing religious conceptualizations and myths about sexuality. A key
goal of the early sexologists was to categorize and classify all human sexual behavior
(Corrêa et al. 2008;Parker2009; Todd 2021). The central assumption underpinning
much of this early work was the idea that sexuality was “natural,”and that reproduc-
tion was the principal driver of normative human sexuality (Todd 2021). The “natu-
ralness”of sexuality refers to the idea that “sex is a simple and universal biological
function”that all humans “perform in roughly the same way.”This construction of sex
is one that is still drawn on by many in the medical profession to this day (Tiefer 2018,
p. XIV). Natural sexuality was generally understood as heterosexuality.
Freud employed clinical case studies to examine a broad array of sexual practices
and preferences (Corrêa et al. 2008; Freud 2001; Weeks 1985). However, despite
documenting diverse sexual proclivities, Freud’s model of sexuality and sexual desire
was still unitary, normative, and “fundamentally heterosexual, procreative, and essen-
tially male”(Corrêa et al. 2008, p. 88). Freud (2001) argued, on the one hand, that the
development of sexual desire followed a natural universal pattern, while at the same
time proposing supposed differences in sexual behavior between Western societies and
so-called “uncivilized”non-Western contexts (Jolly 2021). Similarly interested in
categorizing human sexuality, Havelock Ellis (1936,1932), who worked around the
same time as Freud, theorized the Psychology of Sex, in which he described and
documented what he believed to be the full diversity of human sexuality (Corrêa et al.
2008). Through a compilation and analysis of sexual histories, Ellis concluded that
humanity as a species naturally contained immense variation in expressions of
4 J. Cornell et al.

sexuality (Bullough 1998; Corrêa et al. 2008). Both Freud and Ellis conceptualized
sexuality as an underlying natural drive. Freud, however, believed it to be a “negative
force”requiring repression and social control; Ellis considered it to be a “positive force
warped by a negative civilization”(Corrêa et al. 2008,p.107).
This body of early theorizing was hugely influential in terms of how sexuality
would come to be investigated and conceptualized (Corrêa et al. 2008, Todd 2021;
Week s 1985). Although acknowledging the immense variation in human sexuality,
these early thinkers –and Freud in particular –divided sexual behaviors into binary
categories of “perverse”or “normal,”with sexual practices or desires that did not result
in reproductive sex categorized as perverse (Tiefer 2018; Todd 2021; Weeks 2015). An
example of this is the binary divide between heterosexuality and homosexuality, with
heterosexuality as the unmarked but dominant norm (Weeks 2015). Paradoxically,
these early scholars who attempted to promote sexual reform in the face of religious
control also became “powerful agents in the organisation, and potential control, of the
sexual behaviours they sought to describe”(Weeks 2014, p. 188). At the same time,
this work also led in due course to various forms of critical and progressive engage-
ments with sexualities, not least various streams of feminist and kindred psychoana-
lytic insights and practices (see, e.g., Suttie 1935/1988;Zakin2011).
From the mid-1900s, in the USA the sexologist Alfred Kinsey and collaborators
extended attempts at categorizing sexuality and sought to catalog all human sexual
behavior (Kinsey et al. 1975,1978). Kinsey’s work was greatly influential in terms of
challenging dominant assumptions around what constituted “abnormal”sexual activ-
ity. He demonstrated that many sexual practices that had been labeled perverse by
earlier scholars were, in fact, widespread and commonplace (Bullough 1998;Tiefer
2018; Todd 2021). Kinsey’s work upended the widely held view that the private sexual
behavior of the general US public adhered to “official cultural sex norms,”(i.e., no
masturbation, adultery, or premarital sex) (Tiefer 2018,p.13;seealsoKinseyetal.
1975,1978). Kinsey proposed the “Kinsey Scale”which introduced the concept that
human sexuality should be best understood along a continuum rather than comprising
binary categories (Todd 2021; Weeks 2015). However, Kinsey, much like the earlier
authors, tended to emphasize the conceptualization of sexuality as natural and biolog-
ical (Todd 2021). Tiefer (2018) contends that the weight placed within sexology on the
naturalness of sexuality was rooted in the desire by these scholars to justify and
legitimize the study of sex and, in turn, their own respectability as scholars.
In the broadest terms, the “sexology paradigm”that emerged through much of the
work of these early scholars centered on the pursuit of: a “scientific”explanation of
sexual behavior; the medicalization and psychologization of sexuality (i.e., the
disciplines of medicine and psychology/psychiatry exercising authority and control
over sexual behavior); and the promotion of essentialist understandings of sexuality
(Corrêa et al. 2008; Tiefer 2018). Regardless of the diversity and variability in the
range of sexual preferences and behaviors these early sex researchers documented,
they still assumed sexual categories were universal (Tiefer 2018). The essentialism
underlying this founding body of sexological work has come to provide the pre-
vailing framework for wider societal understandings of human sexuality (Parker
2009).
Sexual Justice and Sexualities 5

However, from the mid-1970s onwards, scholars interested in sexuality began to
challenge the positivist and exclusively biomedical framing (Parker 2009; Plummer
2020; Weeks 2010). This move toward social constructionist perspectives was
underpinned by a desire to challenge understandings of the “naturalness”of
human sexuality, ideas of repressed biological drives, and fixed categories of sexual
identity (Corrêa et al. 2008; Parker 2009; Tiefer 2018). The work of Michel Foucault
(1978,1985,1986), and his concern with discourse and power, was especially
influential in this regard (King et al. 2017; Plummer 2020; Teunis and Herdt
2007). In his collection of books, The History of Sexuality, Foucault challenged
the idea that sexuality constituted a universal and ahistorical concept, emphasizing
the discursive nature of sexuality (King et al. 2017). Foucault’s work served,
somewhat paradoxically, as the canonical text and standard tool for much subsequent
critical scholarship on sexuality within the social sciences (King et al. 2017;
Plummer 2020), although not, as will be discussed below, within public health–
oriented work on sexualities. The biomedical model for understanding sexuality has
continued to dominate much theory and research (Tiefer 2018). Indeed, Leonore
Tiefer (2018, p. 24) suggests that efforts to destabilize the medicalization of sexuality
and to promote social constructionist understandings of sexuality within mainstream
scholarship have been “an uphill battle.”In this light, journals such as Journal of
Homosexuality, founded in 1976, Agenda (1987), Journal of the History of Sexuality
(1990), Journal of Gay and Lesbian Social Services (1994), and Sexualities (1998)
have been important locations of activism and critical scholarship.
The study of sexualities from the 1970s was also influenced by feminist and
lesbian, gay, bisexual, transgender, intersex, queer, and asexual+ (LGBT*IQA+)
activism and scholarship, which challenged the heterosexist and patriarchal ideas of
sexuality dominant at the time and produced new analyses and understandings of
sexuality and gender (Corrêa et al. 2008;Kingetal.2017;Plummer2020; Teunis and
Herdt 2007). Central to much of this scholarship was the idea that earlier sexological
approaches repressed and ignored the knowledge of many of the people whose sexual
behaviors and identities they sought to classify (Weeks 2015). As Jeffrey Weeks
(2015, p. 1095) suggests, “the subjects of scientific investigation and definition have
their own voices, and are not prepared to simply accept what they are told.”
Building on the feminist and women’s health movements of the 1960s and 1970s,
feminist researchers and scholars challenged established and traditional views on
women’s sexuality and highlighted the interplay of sexuality and power (Corrêa et al.
2008; King et al. 2017; Rubin 1985; Teunis and Herdt 2007). Feminist researchers
challenged the patriarchal character and biological determinism of mainstream
scholarship on sexuality (Tiefer 2018). Furthermore, from the 1990s, the concept
of intersectionality emerging from the Black feminist critique of mainstream femi-
nism (see Crenshaw 1991, Hill Collins 2000) has been influential in highlighting
how sexuality must be examined in relation to other crosscutting categories of
identity, such as race, class, gender, nationality, and ability (King et al. 2017).
Feminist research also emphasized the need to pay attention to the methods used
in researching sexuality, and in particular the power differentials between the
researcher and the researched (Todd 2021).
6 J. Cornell et al.

LGBT*IQA+ social movements and scholarship have been similarly impactful
on the contemporary study of sexuality (Hearn et al. 2018). Such work has been
pivotal in highlighting sexual diversity and emphasizing the need to challenge rigid
and binary classifications of sexuality (Corrêa et al. 2008) and building sexuality into
human rights and associated policy and practice (Yogyakarta Principles 2007, 2016).
For example, “sexual orientations, and gender identities and expressions”(SOGIE)
intersect with freedom of religion and belief (Sonneveld 2016). These critical
approaches have also underscored the need for novel methodologies and alternative
strategies for studying sexuality (Corrêa et al. 2008).
In summary, the influence of social constructionist thought as well as feminist and
LGBT*IQA+ social movements and scholarship of the 1970s and early 1980s
destabilized understandings of sexuality as exclusively biological and rooted in
nature, and, instead, research within the social sciences has increasingly framed
sexual behavior as the outcome of interlocking and complex social, historical, and
cultural processes (Parker 2009). This has refocused “research attention on the
symbolic dimensions of sexual experience and on the inter-subjective cultural
forms that shape and structure the experience of sexual life in different social
settings”(Parker 2009, p. 253).
From the 1980s onward, another major influence on the field of sexualities
research was the HIV/AIDs epidemic (Boyce et al. 2007; Corrêa et al. 2008;
Plummer 2020; Teunis and Herdt 2007; Tamale 2015; Todd 2021). Research into
HIV/AIDs became a “global industry”and an international program of sexuality
research emerged (Plummer 2020). In many ways, this surge of interest in sexuality
through the HIV/AIDs research agenda increased the availability of funding for and
the sense of “legitimacy”associated with scholarship into sex and sexuality
(Plummer 2020). However, as Ken Plummer (2020, p. 160) remarks, much of this
work was “moribund, opportunistic, and limited to a very dull and expensive
program of behavioral studies in classic positivist mold, which revealed little”.
Initial dominant cultural and political responses to HIV/AIDs were in many ways
“a throwback to medieval notions of sin and disease”(Patton 1990, p. 5).
This is seen in much of the scholarship produced about the epidemic on the
African continent (see Patton 1990, and Tamale 2015 for a detailed overview).
African countries were the focus of a great deal of this research as many Western
researchers and international development organizations descended upon the conti-
nent (Patton 1990; Tamale 2015). Sylvia Tamale (2015) suggested that HIV/AIDs
became, in turn, a multibillion dollar industry, which led to the commodification of
sexual health. The majority of this body of research was epidemiological and
neglected the sociopolitical dynamics of the epidemic, engendering a “profound
re-medicalization of African sexualities”(Tamale 2015, p. 25). Western science
consolidated around the construction of “African AIDS”(Patton 1990), which was
homogenizing, pathologizing, and rooted in colonial understandings of African
sexualities (Patton 1990; Tamale 2015). Within this body of research, sexuality in
Africa was often viewed as “insatiable, alien and deviant”(Tamale 2015, p. 25) and
the bodies of African people were constructed as diseased and “other”(Patton 1990).
Indeed, Patton (1990, p. 77) argued that these dominant medical inventions around
Sexual Justice and Sexualities 7

African sexuality “set medical science on a genocidal course which masquerades as
Western altruism toward the client-state ‘Other’.”
Arguably, the biomedical emphasis and focus on the links between sexuality and
disease that characterized much of this body of research reversed and undermined
some of the earlier critical and social constructionist currents that had emerged within
sexualities research from the 1970s onward (Boyce et al. 2007). However, there was at
the same time, particularly by gay activists and places like South Africa (Mbali 2013;
Singer 1994), a surge of pioneering activism and research around HIV/AIDs which
advocated for more effective and nuanced interventions and scholarship around
sexuality and health and drew attention to the need to consider local knowledge and
local practices for understanding sexuality (Boyce et al. 2007;Corrêaetal.2008;
Plummer 2020). Crucially, this scholarship and activism highlighted the contestation,
fluidity, and variability of sexual practices and behavior, and illustrated how construc-
tions of sexuality and epidemiologies are context dependent (Boyce et al. 2007;
Plummer 2020). As Weeks (2015, p. 1095) suggests, an essentialist/constructionist
split “still cuts across the global response to HIV/AIDS, posed as a separation between
medicalized interventions and social, cultural, and political responses.”Ultimately,
HIV/AIDs research across both sides of the biomedical/social divide has been pivotal
in shaping public health interventions in different ways and set the agenda for much
contemporary sexuality scholarship (Corrêa et al. 2008; Weeks 2015).
This is by no means an exhaustive account of the history of the study of
sexualities. However, it is meant to offer an overview of some of the broad themes
and theoretical trends that have shaped contemporary understandings of sexuality
(for more comprehensive overviews, see, for example, Corrêa et al. 2008; Plummer
2020; Tamale 2015; Tiefer 2018; Todd 2021; Weeks 2014). In the section that
follows, the chapter will look more specifically at public health research and the
understanding of sexuality that has been prevalent within the field.
Sexualities and Public Health
Mainstream public health scholarship and policy has by and large fallen more on the
essentialist side of the essentialist-constructionist debate within sexualities research
(Plummer 2020). Much public health research globally has drawn on biomedical
approaches that understand sexuality as purely biological, natural, and fixed (Corrêa
et al. 2008;Mitchelletal.2021). The influence of early sexological theory is clear.
Indeed, many contemporary medical, psychiatric, and psychological texts in the main
continue to classify sexual behaviors and predilections that fall outside of a “procreative
model for sex”as abnormal, including, for example, the desire for pain during sex and
the preference for masturbation or oral sex over penetrative sex (Tiefer 2018,p.11).
An emphasis on risk factors and adverse sexual health outcomes has dominated
research in this area, overshadowing other aspects of sexuality within public health
(Mitchell et al. 2021; Epstein and Mamo 2017). Sexual health, for example, has often
been framed purely in terms of disease prevention and surveillance rather than the
quality of sexual experience, with concepts such as agency or pleasure all too frequently
8 J. Cornell et al.

ignored (Epstein and Mamo 2017; Wellings and Johnson 2013;Shefer2019). This
narrow and deficit-focused perspective limits the possibility of adequately
comprehending and addressing everyday sexual issues and experiences (Mitchell
et al. 2021). Indeed, many of the categories that have been utilized within public health
epidemiology to classify and explain sexuality are lacking universality or applicability
across global contexts (Parker 2009). In South Africa, for example, public health
scholarship has frequently reproduced colonial, pathologizing, deterministic, and
raced representations of sexuality (Ratele 2022; Shefer 2019) that position Black
women as victims and Black men as violent in relation to sexuality (Boonzaier and
Kessi 2018; Ratele 2018;Shefer2019). This is especially so in relation to young people
(Shefer and Hearn 2022). Indeed, some public health research has been an influential
factor in reproducing the stigmatizing discourses around HIV/AIDs, blackness, and
sexuality, as discussed above. Indeed, well beyond the South African context, sexuality
research has consistently been “shaped by the invisibility of a historically nonreflexive,
nonembodied Whiteness”that “anchor investigations into sexuality to hetero-
patriarchal, hegemonic and colonizing ideologies”(Madrone and Clements 2021,
p. 74). Progressive public health scholars and researchers have an important role to
play in promoting and working toward sexual justice (Mitchell et al. 2021), and critical
perspectives and understandings of sexuality are crucial in this regard.
Critical Approaches to Sexualities and Sexual Justice
Broadly speaking, although critical voices are evident in public health (e.g., Borde
2020;Rateleetal.2010;Riemann2019), and the journal Critical Public Health
provides an important site against biomedicalizing discourses, public health researchers
have largely drawn on biomedical approaches. The overreliance on biomedical meth-
odologies, theories, epistemology, and ontology applies to sexuality, with HIV/AIDs a
paradigmatic case (Mitchell et al. 2021). In contrast, within the social sciences, critical
approaches to understanding sexuality are more common. Several theorists have
outlined what they consider to be key theoretical coordinates and priorities for critical
sexuality studies (see Corrêa et al. 2008; Fahs and McClelland 2016; Marzullo 2021;
Plummer 2020). As Fahs and McClelland (2016) propose, critical approaches to
studying sexuality should attend to: what we research (the concept and people); how
we research (our methodological decisions and designs); and those we work with
(collaborators, publications, and communities). In the section below, the chapter pro-
vides an overview of some of the core themes and aims of critical scholarship around
sexualities and sexual justice, and how they might offer a nuanced, contexualized,
agentic, and socially just approach to sexualities within global public health.
It is perhaps useful first to provide a definition of sexuality from a critical social
sciences perspective. Rather than reducing sexuality to a fixed biological property,
critical approaches view sexuality as constantly shifting and embedded within
political, social, and cultural systems, as both materials produced through dominant
discourses and norms (Corrêa et al. 2008; Plummer 2020). As Plummer (2020,
p. 157) suggests, sexuality should be understood as:
Sexual Justice and Sexualities 9

Meaningful, symbolic, and cultural; as material and embodied; as structural and shaped by
intersectional inequalities; as historical and generational; as processual and emergent; as
multiple; as conflictual and political; as mediated and as globally interconnected.
Indeed, critical approaches to sexuality do not discard biological perspectives, but rather
view biology as one of many interconnected ways of comprehending sexuality
(Marzullo 2021). Furthermore, sexuality is always shaped by a range of other
intersecting identities, such as class, race/racialization, gender, ability, religion, nation-
ality, and age and cannot be understood in isolation from these other subjectivities
(Crenshaw 1991;Plummer2020). There are multiple instantiations of sexuality, namely
“sexual practice, sexual desire and sexual identification, including narcissistic, lesbian,
gay, bisexual, transgender, transsexual, transitioning, intersectional, queer, queer+,
asexual, and heterosexual practices and preferences”(Hearn et al. 2018, p. 229). In
light of the multiplicity and variability of sexuality, many critical scholars conceptualize
sexualities in the plural (Hearn et al. 2018). Indeed, thinking in terms of multiple
sexualities is vital for disrupting the legacy of essentialism within much sexuality
scholarship (Tamale 2015). The fluidity and multiplicity of human sexualities mean
that “there will always be disagreements over what sexualities should mean and be”
(Plummer 2020, p. 158), and certain sexualities are dominant or dissident (Hearn et al.
2018). The study of sexualities may examine a diversity of topics, themes, and phe-
nomena such as “sexual knowledge, beliefs, values, attitudes and behaviors, as well as
procreation, sexual orientation, and personal and interpersonal sexual relations”(Tamale
2015, p. 17).
Approaching sexualities with a critical lens requires always paying attention to
the power relations that shape sexual experiences, identities, and practices (Asencio
2019; Fahs and McClelland 2016; Fletcher et al. 2013; Marzullo 2021; Tamale 2015;
Weeks 2010). As Fahs and McClelland (2016, p. 408) suggest, it is vital to consider
“the ways that sex and power collide and, ultimately, who is asked to pay for this
collision.”As the body of critical feminist, queer, and decolonial scholarship has
demonstrated, questions of sexuality cannot be separated from reflections on struc-
tures of power (Tamale 2015; Weeks 2010). Indeed, a central consideration of
interlocking systems of power and how they relate to sexualities could perhaps be
seen as an overarching aim for critical approaches to studying sexuality within
global public health (Fahs and McClelland 2016). The chapter will now consider
some of the key theoretical coordinates of critical sexualities scholarship through
which power is implicated in various ways.
Contextual, Locational, and Global Approaches to Sexualities
A crucial assumption of critical approaches to sexuality studies is an acknowledg-
ment that sexualities cannot be divorced from location, from geography, and indeed
from history (Corrêa et al. 2008; Fletcher et al. 2013; King et al. 2017; Marzullo
2021; Plummer 2020). Sexualities must always be considered within the context of
the broader social, political, economic, religious, and cultural systems within which
10 J. Cornell et al.

they are situated, as well as the dominant discourses and ideologies that underpin
these systems (Corrêa et al. 2008; Huysamen, 2022; King et al. 2017). How sexual
health and sexual rights are experienced, for example, is inconsistent across histor-
ical periods, nations, and between people of different intersecting identities within
the same contexts (Corrêa et al. 2008; Tamale 2015). Although there are a number of
common trends that have shaped the understanding of sexualities over time, the
dynamics of contemporary sexualities manifest differently in different countries
(Plummer 2020: 168). History with its myriad political and religious conflicts has
of course unfolded differently across the globe. Critical sexualities studies are, thus,
necessarily global and local in its focus, recognizing how understandings of sexu-
alities are underpinned by a distinctive set of cultural and political issues in different
contexts across the world (Plummer 2020).
Localitionality and geopolitical location, in particular, are vital contextualizing
perspectives in critical work on sexualities. Inspired by feminist and queer geogra-
phies (Bell and Valentine 1995; Nelson and Seager 2005), the geography of sexu-
alities has become an important and growing (trans)disciplinary development in
recent decades (see Bonner-Thompson et al. 2020). This has been especially signif-
icant within urban geography, including recognizing the geographies of pleasure.
David Bell and Jon Binnie (2000, p. 4) consider “the city as a stage”and underscore
that urban contexts are asymmetrically organized geographies produced by inclu-
sions and exclusions depending on gender, sexual identity, race, and further social
relations (p. 84), with clear implications for health and public health. Accordingly,
critical studies of sexuality “must be attendant to situational contexts as simulta-
neous to glocal power ‘locations’” (Marzullo 2021, p. 82). This often involves the
recognition of multiple contradictions, both spatial and social, as well between the
spatial and the social, for example:
On one hand, capitalism develops through the perpetuation of gendered hierarchy of
heterosexuality, in the family, in capitalist organizations, in the consumer marketplace, and
in civil society. On the other, capitalism and urbanization together have been major forces for
the undermining of heterosexual hegemony (D’Emilio 1983;D’Emilio and Freedman 1988).
This has occurred in the creation of the social conditions for greater sexual specialization
possible within cities and under capitalism; in the creation of the ‘pink economy’in cities;
and the possibility (perhaps more theoretically than empirically) that capital and capitalists
do not care about the sexuality of workers as long as they produce surplus value. (Hearn and
Parkin 2001, pp. 33–34)
Such social, economic, and political conditions and contradictions in turn affect and
construct the health of different populations, both individually and more collectively,
including as a public health issue, as in the provision of and access to health services
and health education, as well as in mutual support systems. One way of framing
these concerns is in terms of variable sexual citizenships (Evans 1993) subject to the
production and transformation of geographies (Brown 1997).
More specifically, Plummer (2020) proposes two useful concepts for critical
studies of sexualities in these regards: generational sexualities and cosmopolitan
sexualities. Generational and, indeed, aged sexualities suggest that “while human
Sexual Justice and Sexualities 11

sexualities live in a present in which they are studied, they are grounded in a history
of age cohorts of the past that live on as ghosts in the present”(Plummer 2020,
p. 169). In this regard, a neglect of old(er) sexualities and the associated agism still
persist despite major and growing recognition in recent decades, as will be discussed
later. Cosmopolitan sexualities, on the other hand, “suggest the complexities of
different, changing world sexual cultures with the ultimate challenge of finding
ways to live with these differences in the future”(Plummer 2020, p. 169). Critical
studies of sexuality that are oriented toward sexual justice should “help us find ways
of both appreciating and living with differences even as we struggle to find common
values and shared assumptions that will enable us to build better future sexual worlds
for all”(Plummer 2020, p. 169).
Thus, this is not only a question of relating sexualities to the broad political
economies of globalization (see Altman 2001), but also more specifically to various
movements (in several senses) across national borders (see Povinelli and Chauncey
1999). Such transnational movements include the impacts of: migration; social
movement organizing; sex tourism, sex trade, sex work, and sex trafficking; infor-
mation and communication technologies (ICTs) and biotechnologies; as well as
transnational sexual cultures more broadly (Hearn 2006). One example here is in
lesbian, gay, transgender, and further gender-sexual migrations, seeking greater
gender and sexual freedom in moving from, say, South America to New York or
San Francisco, or from the Middle East to Berlin or London (D’Emilio 1998;
Vasquez del Aquila 2014). Such migrations may involve considerable personal
risk at several points in the process, both in moving from the home country, and
sometimes again in the host country too. Sexualities are both immediate, fleshly,
local, and distanced, mediated, transnational (Hearn 2015; Zhou et al. 2021), even
less easily defined, more uncertain, in relation to or distinct from other forms of
sociality.
The Internet and digitalization are also important here, with multiple sexual
categories listed on Tumblr or Nonbinary Wiki, for example. ICTs have clear
potential for both enhancing and damaging sexual health and well-being.
Reflexivity and Sexualities Scholarship
The problem of coloniality and how it shapes researchers’questions and interpreta-
tions has received almost no attention from Whitestream Western public health. So
have racism and capitalism been relatively disregarded. In addition, at the level of
epistemology and method, the essentialist, empiricist, and behavioralist bias in much
mainstream public health research has meant that traditionally sexualities research
has tended to ignore the researchers’positionality and influence. Scientific“objec-
tivity”has been the principal argument for this inattention and bias. Teunis and Herdt
(2007, p. 22) suggest that this drive for objectivity can be seen as an attempt by some
to keep control within the academy over the disruptions from queer, feminist, and
decolonial scholarship on sexuality. Indeed, in keeping with traditions of feminist
theory and research, critical work on sexualities must “go beyond apologizing for a
12 J. Cornell et al.

lack of objectivity”and directly acknowledge that researchers’subjectivities are
“precisely what make sexuality research possible and insightful”(Teunis and Herdt
2007, p.17). A critical reflexive approach is thus a crucial aspect of meaningful
scholarship on sex (Huysamen 2022).
Reflexivity involves acknowledgment and consideration of the influence of
researchers’intersecting identities, roles within the research project, and their theo-
retical and ideological assumptions (Shefer et al. 2006). This emphasis on self-
reflection and critique (both of individual researchers and the discipline more
broadly) is particularly crucial for public health–orientated work in light of the
way that much mainstream public health research has been responsible for perpet-
uating harmful and stigmatizing representations of sexuality (Boonzaier and Kessi
2018; Ratele 2018; Shefer, 2019). This is also especially important for research
projects, in which scholars from the Global North may be studying sexualities within
the context of the Global South or in collaboration with researchers from the Global
South. Researchers should be cognizant of the stigmatizing colonial discourses that
have shaped, and continue to shape, dominant understandings of sexualities (Tamale
2015). Indeed, critical scholars of sexualities are required to “turn a reflexive gaze
back”on both the discipline and their own research practice (Fahs and McClelland
2016, p. 394), so that blind spots and assumptions may be elucidated and challenged
(Fahs and McClelland 2016; Fletcher et al. 2013; Marzullo 2021). This includes, for
example, questioning the implications of the definitions and concepts that they
employ within their work (Fahs and McClelland 2016). A critical reflexive approach
should be practiced throughout the research process (for an excellent recent guide to
taking a critical reflexive approach to researching sex, see Huysamen 2022). The
study of sexualities can be far from linear, and researchers should approach their
research designs with flexibility and open-mindedness and reexamine their method-
ological decisions as research projects proceed (Tamale 2015). Acknowledging the
researchers’subjectivity and ideological standpoints and abandoning “objectivity”is
a crucial step in producing work that not only advances theory but also advocates for
sexual justice (Teunis and Herdt 2007).
Challenging Dominant Assumptions with Sexualities Research
A vital component of critical reflection within sexualities research is the need to
disrupt taken-for-granted assumptions around sexuality (Marzullo 2021; Fahs and
McClelland 2016; Fletcher et al. 2013). In particular, critical sexualities scholars
must challenge the dominance of Western-centricity, middle-class values, whiteness,
and heteronormativity within much public health work on sexuality (Fahs and
McClelland 2016; Madrone and Clements 2021; Shefer 2019). Assumptions around
heteronormativity, for example, are evident in the narrow emphasis on “sex as
intercourse, sex within the context of heterosexual marriage, sex as necessarily
penetrative (and risky), and sex as producing orgasm”within much mainstream
research on sexualities which ignores a wide range of sexual practices, identities, and
experiences (Fahs and McClelland 2016, p. 394). Indeed, addressing sexual injustice
Sexual Justice and Sexualities 13

requires disrupting heteronormativity (Hearn et al. 2018). It is vital too to examine
how heteronormativity intersects with whiteness within these research spaces
(Shefer 2019). As Madrone and Clements (2021, p. 74) argue:
Colonization can function within sexuality research as a method of stabilizing and solidify-
ing Whiteness as the origin of producing legitimate bodies, including bodies of knowledge,
segregating sexuality according to a White understanding of difference and sameness.
Sexualities research must explicitly interrogate the role of whiteness in shaping
research into sexualities (Madrone and Clements 2021). Decolonial feminist theory
is particularly useful in this regard and has much to offer critical sexualities studies
(Shefer 2019). Decoloniality recognizes “the continuities in the decimation, destruc-
tion and dispossession wrought by colonialism”and seeks to address lingering
colonial relations of power (Boonzaier and van Niekerk 2019, p. 2). At times,
however, work drawing on a decolonial lens has prioritized racialized subjectivities
over other intersecting categories of identity such as gender and sexuality (Boonzaier
& van Niekerk 2019). Maria Lugones’(2008) work on the coloniality of gender
seeks to bridge that gap by linking the biological, patriarchal, and heterosexual
arrangement of the modern/colonial gender system to racialized systems of oppres-
sion. This is evident in Alexander’s(2005) observations on gendered violence in the
Bahamas where Black women’s sexual agency was seen by the neocolonial state as a
threat to the heterosexual family and the nation and provides a critical lens through
which to understand gendered and sexual violence as intrinsically tied to institution-
alized racial violence. Furthermore, gendered violence also includes the greater
exposure of some genders and sexualities to various forms of microaggressions,
greater worry about such exposure to (micro)aggressions, and internalized harms
(Nadal et al. 2012). A decolonial feminist approach to understanding sexualities
must account for the historical connection between race, gender, and sexuality in the
colonial construction of the largely taken-for-granted modern nation-state.
Sexualities of Invisible and Othered Bodies
Related to the need to challenge the dominant and taken-for-granted discourses
within sexualities research is the importance of producing nuanced work on the
kinds of subjectivities that have so often been othered within mainstream sexuality
scholarship in public health. The sexualities of certain kinds of bodies have fre-
quently been ignored and silenced on the one hand or marked as “abject,”fetishized,
and pathologized on the other (Fahs and McClelland 2016). Scholars working within
critical approaches to sexualities in public health should bring marginalized bodies
to the center in ways that emphasize agency, pleasure, and sexual justice. Critical
scholars must consider the sexualities of old bodies, sick bodies, young bodies, fat
bodies, bodies with disabilities, menstruating bodies, and other bodies that are
“otherwise out of sight, out of bounds, overly one-dimensional, or stereotyped/
caricatured”(Fahs and McClelland 2016, p. 405). Marshall (2011), for example,
describes the “graying of sexual health”as a critical research agenda. Increasingly,
14 J. Cornell et al.

discourses around the asexuality or postsexuality of older people are being chal-
lenged, and critical sexualities scholars are examining the “sites and processes by
which mid- and late-life sexualities are being shaped”as well as “the forms of sexual
agency on offer to older people”(Marshall 2011, p. 392).
The intersection of disability and sexualities is similarly an important focus for
critical scholars of sexualities (see Hunt et al. 2021;McRuer2006; Shuttleworth
2007; Shuttleworth and Mona 2021). The dominance of the medical model of disability
has meant that “the diverse sexual and reproductive health needs of disabled people”
have often been ignored within mainstream public health research and practice. Sexu-
ality is frequently neglected as a legitimate area in disability services (Hunt et al. 2021;
Shuttleworth and Mona 2021). People with disabilities are often stereotyped as lacking
sexual desire, having “perverted”sexual desires, or unable to have sex. These infantil-
izing myths around the sexuality of people with disabilities “represent social barriers
excluding people with disabilities from full participation and enjoying fully sexual lives”
(Hunt et al. 2021, pp. 3–4). Critical approaches to disability and sexualities seek to
promote the sexual rights and well-being of people with disabilities and their access to
sexual pleasure (Shuttleworth and Mona 2021, p. 28). Shuttleworth and Mona (2021)
assert that activism and scholarship focused on sexual justice and disability is crucial in
the face of the resistance to the development of prosexuality disability services. As Fahs
and McClelland (2016, p. 405) assert, a key concern of critical sexuality studies is the
prioritization of the body as a site of potential resistance, particularly for bodies that
rarely appear in narratives about how people imagine their own and others’sexuality.
Sexualities, Sexual Justice, and Action
It is inadequate for critical scholarship to merely explain sexuality and advance
theory. Work within critical sexualities must also be explicitly focused on sexual
justice and researchers should seek to be agents of change (Fahs and McClelland
2016; Plummer 2020; Teunis and Herdt 2007). As Tiefer (2018, p. 124) urges:
We live in a time of intensely competing sexual discourses, and sexuality is one of the arenas
for struggle against oppression and injustice. There is really no way to be apolitical as a
sexologist –every action supports some interests and opposes others.
Indeed, scholarship and interventions into sexuality within global public health
should be approached as “extensions of broader struggles for human rights and
social justice”(Corrêa et al. 2008, p. 3). Participatory action research (PAR) methods
are useful in this regard (see Cornell et al. 2016,2019; Hunt et al. 2021; Shefer
2019). In PAR projects, participants are coresearchers, directly participating in all
elements of the research process. PAR methods are explicitly focused on advocating
for change within the participants’communities and contexts (Kemmis et al. 2014).
As such, PAR methods subvert the researchers’authority and the boundaries
between activism and scholarship (Shefer 2019, p. 421).
Another important element of critical sexualities work aimed at social justice is to
be in dialogue and collaboration with activists and sexual justice projects (Shefer
Sexual Justice and Sexualities 15

2019). As has been discussed earlier in this chapter, social movements and activism
has been a pivotal influence on critical research in sexualities (Corrêa et al. 2008;
King et al. 2017; Plummer 2020). However, although many sexualities scholars
within the social sciences have embraced activism and been influenced by activist
traditions, in mainstream public health, the academy has been slow to address the
gap between activism and theory and policy (Teunis and Herdt 2007). Shefer (2019,
p. 427) advocates, for example, for “opening up more space for the entangled
projects of transgressive and queer art as scholarly and pedagogical production
together with other forms of research and theoretical work.”
In some of the authors’own work, they have seen the value of both PAR
approaches and collaboration with activists for producing work aimed at promoting
sexual justice. They have drawn on photovoice, a visual PAR methodology, to explore
South African university students’acts of resistance and agency in the face of
discrimination and marginalization in relation to sexuality as it intersects with other
aspects of identity such as race, gender, and class (Cornell et al. 2016,2022).
Photovoice –an increasingly popular method within public health research –involves
providing participants with cameras to document aspects of their lives and key
concerns in their communities with the aim of reaching key policymakers and
advocating for change through public exhibitions (Evans-Agnew and Strack 2022;
Wang and Burris 1997). In the authors’study, they collaborated with students –many
of whom were part of activist groups on campus –to explore how students might
challenge the patriarchal, colonial, and cisgender status quo in South African higher
education. Transgender and gender nonbinary students in their study, for example,
used the photographic exhibitions to problematize –among other exclusionary prac-
tices –the lack of gender-neutral bathrooms on campus and their placement within
student residences based on the gender they were assigned at birth. Through these
exhibitions, students were able to express their concerns and document their experi-
ences of marginalization directly to university leadership, and many students contin-
ued to use the photographs they produced in the project as part of their own activism
(see Cornell et al. 2016,2022, for a detailed discussion of some of this research).
The authors have sought in this section, to provide an overview of some of the
theoretical trends and central priorities for critical research into sexualities. There are
many other methods and approaches that scholars of sexualities may and do draw on,
however, the authors hope that some of the theoretical concerns discussed here may be
of use to scholars who wish to conduct public health research that is oriented toward
sexual justice.
Conclusion and Future Directions
In this chapter, the authors have traced the history of scholarship on sexualities
within the social sciences and examined the varied influences of early sexological
theory, postructuralist thought, feminist and LGBT*IQA+ activism, and the HIV/
AIDs epidemic on how contemporary sexualities are understood. While mainstream
public health research has predominantly drawn on biomedical and essentialists
16 J. Cornell et al.

constructions of sexualities that risk pathologizing or neglecting certain sexual
practices, experiences, and identities, there is also an abundance of critical scholar-
ship on sexualities which demonstrates how sexualities are constantly shifting and
embedded within political, social, and cultural systems. Critical approaches to
sexualities should seek to promote “an inclusive sexuality for all while aiming to
reduce the harm of what can be called dehumanizing sexualities”(Plummer 2020,
p. 196).
To this end, critical scholarship on sexualities and sexual justice should be always
attentive to the broader power dynamics underlying how sexualities are constructed
and understood. Indeed, as Asencio (2019, p. 2) asserts “sexuality is not just about
identity and behaviors; it is a portal to understand society and issues of power.”A
critical approach to sexualities in contemporary scholarship acknowledges that
sexualities are embedded within and influenced by particular historical, social,
political, and economic contexts; must be continually reflexive and self-critical of
both the research process and the discipline of sexuality studies more broadly; must
challenge the coloniality and heteronormative bias within dominant assumptions
around sexualities; disrupt both the neglect of and the pathologizing overemphasis
on the sexualities of certain kinds of bodies over others within global public health;
and, crucially, should be explicitly focused on sexual justice and action.
Public health scholars and social scientists are increasingly drawn on and trusted
to offer expert advice on sexual policy globally. Such public health expertise needs
to include critical, inclusive, and informed expertise and knowledge on sexuality.
However, the academy has often, perhaps even in general, lagged behind activists
with regard to promoting radical and progressive sexual policy (Tiefer 2018).
Indeed, Parker (2009) cautions that as critical sexualities research has gained legit-
imacy and acceptance within the mainstream of the academy, it has risked losing
some of its transgressive power. Particularly in light of the regressive backlash to
gains in sexual justice in many contexts across the globe (Windsor et al. 2019), it is
vital that public health scholars working around sexualities are both familiar with
critical approaches to sexualities and are explicitly focused on producing work that
promotes sexual justice in a myriad of forms (Tiefer 2018), both as a broad policy
frame and in everyday practice.
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