In sexual healthcare, pleasure is often secondary

In healthcare, sexuality is usually approached in terms of problems, not pleasure. Disorders, fertility, and risks take priority; enjoyment often comes up only later, if at all. Yet for most people, that is exactly what lies at the heart of their sexual lives, emphasize Marieke Dewitte and Charmaine Borg in a recent article.

The researchers show that this focus developed historically. For a long time, sexuality was primarily viewed through the lens of medical goals, such as disease prevention. Pleasure played a role, but it mostly remained in the background and received little attention in research and treatment.

Dewitte and Borg point out that medical goals are of course important, but this narrow focus often overlooks what people truly value in their sex lives: pleasure, intimacy, and connection. According to them, pleasure is not a side issue but arises from a combination of biological, psychological, relational, and socio-cultural factors.

Gender norms and heteronormative sexual scripts have also long shaped what is considered ‘normal,’ leaving the pleasure of women and LGBTQ+ individuals largely underrecognized.

When pleasure consistently takes a back seat, it can affect the quality of care. Research shows that attention to enjoyment can reduce anxiety and pain, strengthen intimacy, and make treatments for sexual problems more effective.

The authors’ recommendation is clear: do not treat pleasure as secondary. Ask patients not only what isn’t working, but also what feels good. In this way, sexual healthcare shifts from problem-focused to person-centered — coming closer to what sexuality truly means for people.

• Dewitte, M., & Borg, C. (2026). Rethinking sexual pleasure in research, health care and society. Nature Reviews Urology. https://doi.org/10.1038/s41585-025-01113-8