02cf

      中文翻译：彭晓辉(中国武汉华中师范大学生命科学学院 430079)完成时间：2006年3月
      Translator：Xiaohui Peng (Life Science College of CCNU, Wuhan, 430079, China)
      校   对：吴敏伦(中国香港香港大学医学院)完成时间：2006年8月

概念框架

基本概念

在人类性学(human sexuality)和性健康( Sexual Health)领域，对所使用的术语的普遍一致性和精确性是必要的。显然，为了针对性健康促进而达到有效的沟通、传播信息和制定专门的行动方案和计划的目的，对某些关键的概念做出这样的定义是有必要的。可是，已经证明要达成如此一致的认可程度有一定的困难。

对人类性学从概念上要下一个定义是困难的。困难主要在于诸如此类的定义是一个抽象概括的过程12，同样地，人类性学的定义会受到特定的社会文化、历史背景和历史进程的影响，这些因素制约着定义的建构。

在设法定义人类性学的时候，还常常碰到另一个难题，那就是在“性”(sex)和性(sexuality)之间不能做出区别*。因此，术语“性”(sex)和性(sexuality)究竟是什么含义*，常常发生混淆。术语“性“(sex)在其通常的用法和许多背景条件下是指不同的概念*。下面的引用语举证了这种情形：“我们很早就从各种途径获悉'自然的’性行为(sex)就是发生在异性(opposite sex)成员之间的性行为？”(“We learn very early on from many sources that “natural” sex is what takes place with members of the opposite sex?”) 这个术语(指sex——译者注)既指一种行为也指一个人的类别，既指一种实践也指一个性别13*。

为了构建适合于描述性健康的概念框架，对“性" (sex)和性(sexuality)*的基本概念需要加以定义和对其定义取得一致的意见(怎样翻译”sex”和”sexuality”成中文术语？译者与华裔美国性学家阮芳赋和中国人民大学性社会学家潘绥铭通过电子邮件进行了学术探讨。具体翻译如下，而探讨的详情请见本译文后面的注释。该注视作为一篇论文已经发表：彭晓辉.对“sex”和“sexuality”的讨论及其定义的中文翻译.见：潘绥铭主编.中国“性”研究的起点与使命[阮芳赋主编性学万有文库(012)，高雄：万有出版社，2005。——译者注)。为着将来研究便利起见，出席本次区域磋商会议的专家工作小组首先建议使用如下的定义：

“性”* (sex)

性* (sexuality)

性是指包括“性”、性别、性别认同与性身份、性取向、性爱倾向、情感依恋/情欲和生殖的人的核心方面。它以思想、幻想、欲望、信仰、态度、价值、行为、习惯、角色和关系予以体验或表达。性是生物的、心理的、社会经济的、文化上的、伦理上的和宗教上/精神上的诸因素相互影响的结果。虽然性包括了所有的这些方面，并不是所有这些方面必须都得要去体验或去表达。可是，总而言之，人类的性是人类之所在、之所知、之所思和之所做而获得的或所表达的有关性的所有方面的总和。

性健康是指与性有关的生理、心理和社会文化方面正处于良好状态的一种体验。性健康由性潜能的自由和负责的表达所证实，性潜能促进个人和社会的和谐与健康，丰富个人和社会的生活。性健康不仅仅是指没有功能障碍、没有疾病和/或身体无虚弱。为了获得和维持性健康，必须认可和支持所有人的性权利。

性别是指基于“性”*的文化价值、态度、角色、实践和特性的总和。正像在历史上、跨文化方面和当代社会所存在的那样，性别折射出和永恒地延续着男女之间的特殊权利关系。

性身份定义每一个人认可自己是男人还是女人或者这两者都认可的程度。性身份是一个人的内在素养，它随着时间的过去而构建，它使个人能够建构起自我概念和在社会中履行和尊从他/她所感知到的“性”*和性别。性身份决定个体体验其性别的方式，它也体现了个人在群体中的趋同感、独立感和归属感的方式。

性取向是指关于性活动中所涉及性伴的“性”*和性别的个人性爱倾向和/或情感依恋的组成状态。个人的性行为、性思想、性幻想和性欲任何之一或及其复合体都可以清楚地表露他/她的性取向。

性别认同是指包括个人如何认同作为男性、女性、男性气概、女性气质或及其复合体以及个人性取向在内的全部的自我性身份。性别认同是一个人的内在素养，它随着时间的过去而构建，并使个人基于他/她的性、性别和性取向而构建起的自我概念和在社会中履行和尊从他/她所感知到的性能力。

性爱倾向是指个人感知与体验作为性欲、性唤起、性高潮和通常视同于性快乐的生理现象的主观反应的能力。性爱倾向在与他人的各个方面相联系中，以象征的和具体的含义既在个人层面也在社会层面所构建。

情感依恋是指个人通过情感与他人建立和维持亲密的人际关系的能力。情感依恋在与他人的各个方面相联系中，以象征的和具体的含义既在个人层面也在社会层面所构建。爱情就是情感依恋的一种特别而愉悦身心的代表形式。

性活动是指个人的性*在行为方面的表达，通过这种行为表达，其性欲成分(erotic component of sexuality，指性*的生理欲望、心理取向和社会文化特征等要素——译者注)最为明显。性活动的行为特点在于以行为方式寻求性兴奋。性活动与性行为(sexual behavior)的含义相同。

性习惯是指个人或群体在行为上所展露的被认为具有高度一致性的一种性活动形态。

安全性行为是惯常于特指为降低性传播疾病、尤其降低HIV感染和传播风险的性实践和性行为的术语。

负责任的性行为是在个体、人际之间和社会的层面来体现的，它在于对性快乐和性健康方面体现出自主、相互关联、诚实、尊重、允诺、保护和寻求快乐的特点。个人所展示的负责任的性行为并不是在性的方面意欲引起伤害，而是摒弃自私的利用、骚扰、操纵和歧视。社会通过提供知识、资源和公正来促进负责任的性行为，而个人则必须要参与促进负责任的性行为的实践活动。

表2：涉及性别、性身份、性取向、性别认同、性爱倾向、情感依恋、性活动、性习惯、安全性行为和负责任的性行为的概念与定义。

“性”是指决定人类男女两性性象谱的生物特征的总和。在通俗语言里，术语“性”的通常含义包括它作为行为(例如，having sex-发生性行为)和作为一系列举止方式(例如，性角色)的用法。可是，为了概念上的精确性，从学术讨论和评注的方面来看，术语“性”的用法被限定在生物属性的层面。

性是指包括“性”、性别、性别认同与性身份、性取向、性爱倾向、情感依恋/情欲和生殖的人的核心方面。它以思想、幻想、欲望、信仰、态度、价值、行为、习惯、角色和关系予以体验或表达。性是生物的、心理的、社会经济的、文化上的、伦理上的和宗教上/精神上的诸因素相互影响的结果。虽然性包括了所有的这些方面，并不是所有这些方面必须都得要去体验或去表达。可是，大体上，人类的性是人类之所在、之所知、之所思和之所做而获得的或所表达的有关性的所有方面的总和。

早先，世界卫生组织的磋商会议既没有提供人类的性的定义14，也没有提供其精确概念15。正像此处所定义的一样，性是指人类的性的生物属性(人类的生物性别特征)的附加组成部分(即后天获得的部分——译者注)。人类既从象征性也从具体上、即从实践上也从概念上对性的内涵的理解和归因的能力则是性的凝结力。从性方面的文献中的普遍观点来看，性除了有生物属性方面的因素 (即上述的“性”所定义的内容——译者注) 以外，它还指个人和社会层面的性的内涵16。

虽然性可能包括性爱倾向、情感依恋、爱情、"性"(sex)、性别和生殖17，但并不是所有这些方面都需要表达出来。尽管影响性的各种各样的情感表达和结果可能具有跨时代的差异，但是它演绎于人的一生18。所以，性受到特殊的历史和文化环境制约，也受到被构建和正在构建的习俗、传统和价值的制约。性的全面发展依赖于诸如接触的欲望、亲近的欲望、情感表达的欲望、快乐的欲望、表示爱的欲望和爱情的欲望等人的这些基本需要的满足。

性学界除了普遍认同上述观点以外，也有人对性的社会文化组成部分(其中的部分含义)提出了商榷，认为人的性过于概念化；在理论研究方法里有一个明确的倾向，那就是性不仅是指人类的生殖能力，而且(在许多例子里，主要)也指人的性快乐能力19。

一些理论家已经涉足过对诸如情感依恋/情欲等的性的另一组成成分的研究20。心理分析文献通常在术语方面包括爱情、爱情病理学和性的研究，认为爱情不能与诸如性爱吸引(erotic attraction)等某些性的情感表达相区别21。可是，近年来有人根据神经生物学的研究发现，认为在动物22中有可能存在着调节情感依恋和雌雄配对的特有的神经中枢系统，并且这个系统在人类也发挥着相同的功能23。

性健康 (Sexual Health )

性健康是指与性有关的生理、心理和社会文化方面正处在康乐状态的一种体验过程。

性健康是以自由的和负责任的性品质的表达来实现的，这种性品质促进个人和社会的和谐与健康，丰富个人和社会的生活。性健康不仅仅是指没有功能障碍、没有疾病或无身体虚弱。为了获得和维持性健康，必须认可和支持所有人的性权利。

从历史上看，不同的群体使用了“性健康”这个术语，却表达着不同的含义。对于一些人来说，性健康用来委婉地传达性传播疾病状态的信息；对于其他人来说，它用于促进生殖健康教育方面这一狭义概念上。应该从本会议纪要上述的定义清楚地领会到，我们已经提出的性健康是一个全面的或广义的概念。世界卫生组织规定“健康是指整个的生理、精神和社会适应的康乐状态，而并不仅仅是指没有疾病或无身体虚弱”24。显而易见，当把这个定义用于行为层面时，原本清晰的定义就变得模糊不清了。当把健康的定义与行为相关联的时候，一直就有人对健康定义的含义存在着争议。有观点认为，不应该把行为和生活方式掺入健康的概念里去25。这些观点质询这种牵涉到价值决定体制的有关健康定义的正确性26，并且提议只有对那些可量化的指标进行度量时，才可以定义健康的概念。

这种论争的焦点其实就是健康与价值观的辩论。一些理论取一种价值中立的方式来给健康下定义；其他的理论则为健康的价值决定观辩护27；还有一些理论却质询价值中立的自然科学有关健康主张的真正可行性28。因此，本会议的专家工作小组建议采用更为模糊的立场也许是一个好的选择，这种立场认为科学活动、以自然科学为基础的卫生保健和健康促进不可能完全由价值中立取向来推动，因而有关健康的价值决定的建议、定义和概念是不可避免的。应该从本会议纪要上述的定义清楚地领会到，我们已经提出的性健康是一个全面的或广义的概念。世界卫生组织规定“健康是指整个的生理、精神和社会适应的康乐状态，而并不仅仅是指没有疾病或无身体虚弱”。世界卫生组织的这个有关健康的定义也许是一个最好的例证，其中的健康是以康乐状态为依据所下的定义。康乐被人理解为一种价值决定的状态。

鉴于此，专家工作小组经过协商后认为设定性健康的定义既是可能的也是值得的，这个定义源自于并且体现在性权利的概念之上。(“性”、性和性健康的基本定义在表1做出了摘要。涉及性的相关概念在表2给出了定义。)

性权利 (Sexual rights )

人权乃人类与生俱来的；可是，重视与生俱来的权利本身不会产生权利。人权高于文化价值。如果特定的文化具有违反人权的社会习俗，那么这种文化价值就应该被改变；象女性生殖器官损毁的文化习俗就是应该加以改变的事例29。人权是促进健康的途径，它已经在促进生殖健康的定义中明确地予以陈述过30。

性权利越来越得到了人们的重视。人权是普遍达成共识的作为保护人的尊严的普世法则，它促进正义、平等、自由和生存。既然健康保护是基本人权，由此得出结论：性健康包括性权利。

本专家工作小组向诸如世界卫生组织和其他联合国的代理机构强烈建议，敦请这些机构促进和倡导世界性学会的有关人类普世的性权利宣言(表3)，以达成普遍共识。

表3：摘自世界性学会发行的《性权利宣言》；其全文刊于本纪要附录I。

性健康既能从个体的层面也能从社会的层面来验证。从个体层面来看，有研究者已经认识到性健康个体具有特定的行为特征31，并且以性健康个体的生活举止来呈现。专家小组成员建议采纳下述已经在数个国家得到确认的性健康行为方式(见表4)。

表4：美国性知识和性教育委员会(SIECUS)关于性健康成人生活行为方式列表

肯定人的发展包括性的发展，而性的发展也许包括或也许不包括生殖或生殖器官的性体验。

区分什么是提高生活质量的性行为，什么是对己或对他人有害的性行为。

习惯于健康促进行为，如有规律的乳房双侧自检和早期辨察潜在病症。

以自己的思考、感情、价值观和涉性的行为来判断家庭、文化、宗教、媒体和社会信息的影响力。

表4.本性健康成人生活方式列表由美国性知识和性教育委员会(SIECUS)表决通过。

性健康也能够在社会的层面进行鉴别。专家工作小组成员审定出性健康社会的数个特征，见表5。

政治上的承诺。国家承认性健康是一项基本人权并担当起促进性健康的责任。

明晰的国家政策。包括政府机构在内的社会公共机构规划、制定和执行涉及明晰而准确的维护和促进性健康的政策，把其作为一项基本人权。

性权利立法。为了促进性健康，必需制定保障性权利的法律。尤其必须制定防止弱势群体受到性剥削(例如，儿童卖淫)的法律；承认全体国人身体不受损害(例如：保护生殖器不受损毁)权利的法律；保护性少数权利的法律，把其作为教育、健康和就业的一项基本人权(例如：反歧视立法)；以及促进两性平等(例如：平等就业机会立法)的法律。

良好的国民性教育。性健康社会的必需要素是国民普遍有权终生得到与其年龄相符的、全面的性教育

足够的基础设施。为了确保人人有权得到性卫生保健服务，专门从事性健康忧虑和性健康问题服务的专业人员和辅助专业人员服务网络是必不可少的。这还包括为专业人员提供专门的性卫生保健服务培训项目。

性学研究。一个尽责于其社会成员的性健康社会，将会适当而有效地支持针对涉及临床、教育和公共卫生保健的性学研究。这将既包括对正浮现的健康问题(例如：新出现的传染病)的研究，也包括卫生防疫的行为监测(例如：对高危亚人群中的安全性行为发生率、性暴力发生率、性功能障碍的流行程度，等等)。

完备的预警机制。为了监测性健康忧虑和性健康问题的生物指标与行为特征，有必要建立性健康预警机制。

开放的文化环境。开放的和优先考虑的性健康文化环境是必需的。媒体对性健康忧虑的报道质量，以及对有关严重威胁公共卫生安全的信息公开披露程度可以成为衡量文化开放程度的风向标。

Conceptual Framework

Basic Concepts

It is essential to have commonly agreed-upon, precise definitions of the terminology used in the fields of human sexuality and Sexual Health. Obviously, such definitions of key concepts are necessary in order to effectively communicate, disseminate information and develop specific actions and programs aimed at the promotion of Sexual Health. However, arriving at a consensus about the efficacy of such has proven difficult.

Human sexuality as a concept defies easy definition. The difficulty arises mainly from the fact that the definition is a process of abstraction ¹², and as such, is influenced by the particular socio-cultural and historical context and process in which the definition is constructed.

Another problem in trying to define human sexuality is that the distinction between sex and sexuality are not often made. Consequently, there is often confusion about what the terms sex and sexuality actually mean. The term “sex,” in its common usage and in many settings, refers to different notions. The following quotation illustrates this situation: “We learn very early on from many sources that “natural” sex is what takes place with members of the opposite sex?” The term refers both to an act and to a category of a person, to a practice and to a gender ¹³.”

In order to construct an appropriate framework for the consideration of Sexual Health, basic concepts referring to sex and sexuality need to be defined and their definitions agreed upon. As a step forward, the expert working group attending the regional consultation suggest the following definitions:

SEX

Sex refers to the sum of biological characteristics that define the spectrum of humans as females and males.

Sexuality refers to a core dimension of being human which includes sex, gender, sexual and gender identity, sexual orientation, eroticism, emotional attachment/love, and reproduction. It is experienced or expressed in thoughts, fantasies, desires, beliefs, attitudes, values, activities, practices, roles, relationships. Sexuality is a result of the interplay of biological, psychological, socio-economic, cultural, ethical and religious/spiritual factors. While sexuality can include all of these aspects, not all of these dimensions need to be experienced or expressed. However, in sum, our sexuality is experienced and expressed in all that we are, what we feel, think and do.

SEXUAL HEALTH

Sexual health is the experience of the ongoing process of physical, psychological, and socio-cultural well being related to sexuality. Sexual health is evidenced in the free and responsible expressions of sexual capabilities that foster harmonious personal and social wellness, enriching individual and social life. It is not merely the absence of dysfunction, disease and/or infirmity. For Sexual Health to be attained and maintained it is necessary that the sexual rights of all people be recognized and upheld.

Gender is the sum of cultural values, attitudes, roles, practices, and characteristics based on sex. Gender, as it has existed historically, cross-culturally, and in contemporary societies, reflects and perpetuates particular power relations between men and women.

Gender identity defines the degree to which each person identifies as male, female, or some combination. It is the internal framework, constructed over time, which enables an individual to organize a self-concept and to perform socially in regards to his/her perceived sex and gender. Gender identity determines the way individuals experience their gender and contributes to an individual sense of sameness, uniqueness and belonging.

Sexual orientation is the organization of an individual eroticism and/or emotional attachment with reference to the sex and gender of the partner involved in sexual activity. Sexual orientation may be manifested in any one or a combination of sexual behavior, thoughts, fantasies or desire.

Sexual identity is the overall sexual self identity which includes how the individual identifies as male, female, masculine, feminine, or some combination and the individual sexual orientation. It is the internal framework, constructed over time, that allows an individual to organize a self-concept based upon his/her sex, gender, and sexual orientation and to perform socially in regards to his/her perceived sexual capabilities.

Eroticism is the human capacity to experience subjective responses that elicit physical phenomena perceived as sexual desire, sexual arousal and orgasm, and usually identified with sexual pleasure. Eroticism is constructed both at individual and societal levels with symbolic and concrete meanings that link it to other human dimensions.

Emotional attachment is the human capacity to establish bonds with other human beings that are built and maintained through emotions. Emotional attachment is constructed both at individual and societal levels with symbolic and concrete meanings that link it to other human dimensions. Love represents an especially desirable kind of emotional attachment.

Sexual activity is a behavioral expression of one sexuality where the erotic component of sexuality is most evident. Sexual activity is characterized by behaviors that seek eroticism and is synonymous to sexual behavior

Sexual practice is a pattern of sexual activity that is exhibited by an individual or a community with enough consistency to be expected as a behavior.

Safer sex is a term used to specify sexual practices and sexual behaviors that reduce the risk of contracting and transmitting sexually transmitted infections, especially HIV.

Responsible sexual behavior is expressed at individual, interpersonal and community levels. It is characterized by autonomy, mutuality, honesty, respectfulness, consent, protection, pursuit of pleasure, and wellness. The person exhibiting responsible sexual behavior does not intend to cause harm, and refrains from exploitation, harassment, manipulation and discrimination. A community promotes responsible sexual behaviors by providing the knowledge, resources and rights individuals need to engage in these practices.

Table 2. Related concepts and definitions of gender, gender identity, sexual orientation, sexual identity, eroticism, emotional attachment, sexual activity, sexual practice, safer sex, and responsible sexual behavior.

Sex refers to the sum of biological characteristics that define the spectrum of humans as females and males. The usual meaning of the term “sex” in colloquial language includes its usage as an activity (e.g., having sex) and as a set of behaviors (e.g., sex roles). However, for conceptual precision, it was agreed that for technical discussions and documents the usage of the term “sex” be restricted to the biological dimensions.

Previous WHO consultations either did not provide a definition of human sexuality¹⁴ or offered imprecise concepts¹⁵. As defined here, sexuality refers to the additional components of our sexual nature (the human characteristic of being sexed). The human capacity of understanding and ascribing meanings both symbolic and concrete, to experiences and concepts are the bonding forces of sexuality. There is general agreement in the literature that sexuality refers to the individual and social meanings of sex, in addition to the biological aspects of sex ¹⁶.

While sexuality can include eroticism, emotional attachment, love, sex, gender, and reproduction ¹⁷, not all these dimensions need to be expressed. Sexuality is present throughout the life span, although the various expressions and influences affecting sexuality may differ across time ¹⁸. It is circumscribed by a particular historic and cultural context, therefore, being organized and organizing mores, traditions and values. Its full development depends upon the satisfaction of basic human needs such as the desire for contact, intimacy, emotional expression, pleasure, tenderness and love.

Besides the agreement that the socio-cultural components (shared meanings) of sexuality are critical for the conceptualization of human sexuality, there is a clear trend in theoretical approaches that sexuality refers not only to the reproductive capabilities of the human being, but also (and in many instances, mainly) to pleasure ¹⁹.

Another component of sexuality, emotional attachment/love has been considered in the work of some theoreticians²⁰. Psychoanalytical literature includes considerations of love, love pathology and sexuality usually in a language in which love is indistinguishable from other sexual expressions such as erotic attraction ²¹. However, some recent findings discuss the possibility of a distinct neurobiological system that regulates attachment and pair bonding in animals ²² and performs the same function in humans ²³.

Sexual Health

Sexual health is the experience of the ongoing process of physical, psychological, and socio-cultural well being related to sexuality.

Sexual health is evidenced in the free and responsible expressions of sexual capabilities that foster harmonious personal and social wellness, enriching individual and social life. It is not merely the absence of dysfunction, disease and/or infirmity. For Sexual Health to be attained and maintained, it is necessary that the sexual rights of all people be recognized and upheld.

Historically, different groups have used the term “sexual health” to mean different things. For some, the term has been used as a euphemism for information on sexually transmitted infections; for others, it has been used to promote a narrow approach to education on reproduction. It should be clear from the above definition that in this document, a comprehensive meaning of the concept is proposed. The World Health Organization states that “Health is a state of complete physical, mental, and social well-being and not merely the absence of disease or infirmity²⁴.” The clarity apparent in this definition becomes less obvious when it is applied to behavior. There is an ongoing debate on the implications of defining health as that definition relates to behavior. There are points of view that do not conceptualize health as a matter that should be concerned with behaviors and lifestyles²⁵. They question the validity of health definitions that relate to a value-defined framework²⁶ and propose that health be defined only in terms of measurable indicators of clearly defined conditions.

Central to this controversy is the debate of values and health. Some theorists define health in a value-free fashion; others defend the value-defined concept of health ²⁷. Still others question the very feasibility of value-free scientific propositions 28. The expert working group recommended that a more plausible position is one that recognizes that scientific activity, and therefore, science-based health care and promotion cannot be performed from a totally value-free stance, and thus, value-defined propositions, definitions and concepts are unavoidable. It should be clear from the above definition that in this document, a comprehensive meaning of the concept is proposed. The World Health Organization states that “Health is a state of complete physical, mental, and social well-being and not merely the absence of disease or infirmity.” The WHO health definition is perhaps the best example of this, where health is basically defined in terms of well being. Well being is understood to be a value-defined state.

Thus, the expert working group agreed that establishing a definition of Sexual Health is both possible and desirable provided that the definition is derived from, and embodies the concept of sexual rights. (The basic definitions of sex, sexuality and Sexual Health are summarized in Table 1. Related concepts of sexuality are defined in Table 2.)

Sexual rights

Human rights are inherent to human beings; however, recognition of inherent rights does not create rights per se. Human rights are above cultural values. If a particular culture has a practice that contravenes a human right, the cultural value should be changed, as in the case of the cultural practice of female genital mutilation ²⁹. The human rights approach to health promotion has been explicitly stated in the case of the promotion of reproductive health ³⁰.

The recognition of sexual rights is evolving. Human rights are those principles that are universally perceived as protecting human dignity while promoting justice, equality, liberty, and life. Since protection of health is a basic human right, it follows that Sexual Health involves sexual rights.

The expert working group strongly recommends that international organizations such as the WHO and other United Nations agencies promote and serve as advocates to achieve a consensus on the World Association for Sexology statement of universal human sexual rights (See Table 3).

2.The right to sexual autonomy, sexual integrity, and safety of the sexual body.

Table 3. This list is taken from the Declaration of Sexual Rights issued by the World Association for Sexology; the full text of this declaration is presented in Appendix I

Sexual health can be recognized both at the individual and societal level. At the individual level, there are specific behaviors that have been identified that characterize the sexually healthy individual 31 and these are presented as Life Behaviors of the Sexually Healthy Individual. The groups of experts suggest adopting this list that has been validated in several countries (See Table 4).

Affirm that human development includes sexual development that may or may not include reproduction or genital sexual experience.

Affirm one's own sexual orientation and respect the sexual orientation of others.

Discriminate between life-enhancing sexual behaviors and those that are harmful to self and/or others.

Avoid contracting or transmitting a sexually transmitted disease, including HIV.

Practice health-promoting behaviors, such as regular check-ups, breast and testicular self-exam, and early identification of potential problems.

Exercise democratic responsibility to influence legislation dealing with sexual issues.

Assess the impact of family, cultural, religious, media, and societal messages on one's thoughts, feelings, values, and behaviors related to sexuality.

Table 4.List of Life Behaviors of a Sexually Health Adult adopted by The Sexuality Information and Education Council of the United States (SIECUS).

Sexual health can also be identified at a societal level. The expert working group identified several characteristics of a sexually healthy society and these are presented in the following Table 5.

Societies that prioritize and protect the Sexual Health of their members have the following characteristics: Political commitment. The State recognizes that Sexual Health is a fundamental human right and takes the responsibility of promoting Sexual Health.

Explicit Policies. Social institutions, including governmental agencies, formulate, develop and implement public policies involving clear and precise directions for protecting and promoting Sexual Health as a fundamental human right.

Legislation. Laws to protect the sexual rights are necessary to promote Sexual Health. Specifically, legislation is necessary that protects the vulnerable from exploitation (e.g., child prostitution), recognizes the rights of all persons to integrity of the body (e.g., protection from genital mutilation), protects the rights of sexual minorities to such fundamental human rights as education, health, and employment (e.g., anti-discrimination legislation), and promotes equity across sexual dimensions (e.g., equal opportunity legislation).

Good Education. A necessary component of a sexually healthy society is universal access to age-appropriate, comprehensive sexuality education across the lifespan.

Sufficient Infrastructure. To ensure persons have access to services, an infrastructure of professionals and paraprofessionals specializing in sexual concerns and problems is necessary. This includes the provision of training programs for professionals to specialize in Sexual Health.

Research. A society committed to the Sexual Health of its members will support adequate and sound research to address the Sexual Health related clinical, educational and public health concerns. This includes both research on emerging concerns (e.g., new infections), and behavioral surveillance to monitor preventive health concerns (e.g., rates of unsafe sex in high-risk subpopulations, rates of sexual violence, prevalence of sexual dysfunctions, etc.).

Adequate Surveillance. Surveillance is necessary to monitor biomedical and behavioral markers of Sexual Health concerns and problems.

Culture. A culture of openness to, and prioritization of, Sexual Health is necessary. Such indicators as the quality of media reporting on Sexual Health concerns, and the degree to which public health messages regarding serious threats to Sexual Health can be openly promoted can measure the culture.

*“Sex”和“Sexuality”的学术探讨及中文翻译

彭晓辉(华中师范大学生命科学学院，武汉，43079)

自2004年10月在北京人民大会堂召开中国性学会成立十周年暨学术会议期间，德国性学家黑格乐教授把他的性学互联网站所有的资料光盘送给我后，我就有了翻译成中文的念头。今年年初，在香港大学玛丽医学院健康系的吴敏伦教授的提议和鼓励下，我于年初开始了翻译，并得到了华裔性学家阮芳赋教授的全力支持。

可是，对于性学中“sex”和“sexuality”的中文翻译，一直是困扰国内外性学家的一个问题。自己也冥思苦想，想找出一个合适的翻译答案，于是就有了下面的学术通信和坦诚的交流。现将交流的情况和自己翻译过程中的学术思路整理成文^[1]：

1.按照阮芳赋教授的考证，“Sex”一词的演变轨迹是：Sex←自拉丁文Sexus，相当于Secare(即“分开”、“切开”之意)。

2. 以被评为美国最好的大学性育教材之一的《Becoming a sexual person》(Robert T.Francoeur著，纽约MacMillan出版公司，1991年第二版)中，对Sex和Sexuality的界说：^[2]Sex：一个人基于其外生殖器解剖学上的雌雄而决定的生物学状态；性交。 (第72页，第627页)。

Sexuality：最起码要包括四个主要方面：

基于外生殖器解剖学上的雌与雄；

作为男与女的性别自认；

所采取的与解剖学上的雌雄差异如男女的性别差异相适合的角色和行为；

被吸引的和所爱和性别。

人的Sexuality是一个生物心理社会文化现象。(第4页，第637页)。

3. Sexuality究竟如何翻译成中文？较早时，梁实秋在《远东英语大辞典》里把它翻译成”性之具有”、”性之性质”(i.e.”性性”)、”性兴趣”、”性本能”和”性感”。

近年来，性学家刘达临参考了华裔性学家阮芳赋的想法(1984)将其翻译为 “性性”^[3]，他说“性性在构词上属偏正结构，前偏后正。前面的词素“性’是指性科学中的性(sex)，后面的词素“性’是指特性、秉性”。

阮芳赋认为：Sexuality的“这个(性性)译法，既“信’且“达’，但毕竟不“雅’。重复连用两个同形同音异义字，实在有点别扭，也不便于进一步造词”。所以，阮芳赋教授从未在著述中采用这一译法^[4]。尽管“性性”这个翻译符合英文的原意，但不符合汉语的使用习惯。所以，他又建议将其译为“性”。他认为“最好的解决办法是：逐渐地公认“性’是Sexuality的中文标准译名，而将Sex则按上下文分别译为“性行为’、“性交’，等等。当然有时Sex所指的正是Sexuality所指的一切，也就译为“性’字了……。”^[5]阮芳赋在通信中对Sexuality的中文翻译进一步解释道：“除了译为“性’字，其它的译法都是不可行的。这不是任何个人的英文和/或中文的高下问题，而是内在因素所决定的：当代英文中Sex词义的缩小和Sex原来无所不包的词义向Sexuality的转化与进一步扩大，是通过构词法来实现的。汉语中根本没有这种构词法手段。不管你往“性’字的前面或后面加一个或一个以上的其它字，都会把Sexuality的词义缩小,而不能包括Sexuality的所有层面所有词义。”

性社会学家潘绥铭则将“sexuality”译为”性存在”^[6]。本人的观点认为，综合考虑来看，潘绥铭的翻译也可以进一步商榷。正要完稿之际，潘绥铭教授通过电子邮件发送的答复及时到达，他在给本人的回信中说对于Sexuality：

“我当初的想法，“性存在’是为了强调“性’的非生物的方面，暗喻着：性是社会中的、生活中的、是一种实现了的状态，而不仅仅是一种(潜在的)生理功能。可是这些年来，我也感到这种翻译可能并不好：

首先，“存在’已经被当作一个哲学概念，因此“性存在’容易使人觉得是一个哲学名词，而且似乎与萨特的“存在主义’有什么关系(实际上没什么关系)。

其次，“性存在’似乎太强调现实了，容易使得人们忽视性的心理、想法与欲望。

第三，“性存在’很难组词，“性存在教育’就说不通。所以，我觉得还是翻译为一个加引号的“性’为好。至于“性’与原来意义上的性，恐怕只能等到人们对这问题了解得更多之后，才能认真地加以区别。

也有的研究者提出，干脆什么新词也不要，只改变性的内涵。时间长了，约定俗成即可。我觉得这也是一个办法。”

4.毋庸质疑，阮芳赋教授通过20多年的潜心研究，对“Sex”和“Sexuality”的演变、学术内涵及中文翻译的论点是合适的。除此之外，本人冒昧作一个补充：既然“Sex”的学术含义逐渐扩展给“Sexuality”，仅缩至主要涉及性的生物的层面，既然按照阮芳赋教授的学术建议用“性”来翻译“Sexuality”，那么“Sex”的原有的学术翻译“性”在此处就不可再用，拟暂改译“性行为、性交，性生物特性,性生物基础,性本原,……”。沿着这么一个思路，本网站的所有涉及“Sex”的定义时，统一使用“性本原”的翻译。试对泛美卫生组织和世界卫生组织于2000年的“性健康促进行动方案建议”中有关“Sex”和“Sexuality”的定义翻译如下：

【SEX】：Sex refers to the sum of biological characteristics that define the spectrum of humans as females and males.

——性本原(sex)是指决定人类男女两性性象谱的生物特征的总和。

【SEXUALITY】：Sexuality refers to a core dimension of being human which includes sex, gender, sexual and gender identity, sexual orientation, eroticism, emotional attachment/love, and reproduction. It is experienced or expressed in thoughts, fantasies, desires, beliefs, attitudes, values, activities, practices, roles, relationships. Sexuality is a result of the interplay of biological, psychological, socio-economic, cultural, ethical and religious/spiritual factors. While sexuality can include all of these aspects, not all of these dimensions need to be experienced or expressed. However, in sum, our sexuality is experienced and expressed in all that we are, what we feel, think and do.

——性(sexuality)是指包括性本原、性别、性别认同与性身份、性取向、性爱倾向、情感依恋/情欲和生殖的人的核心方面。它以思想、幻想、欲望、信仰、态度、价值、行为、实践、角色和关系予以体验或表达。性是生物的、心理的、社会经济的、文化上的、伦理上的和宗教上/精神上的诸因素相互影响的结果。虽然性包括了所有的这些方面，并不是所有这些方面必须都得要去体验或去表达。可是，大体上，人类的性是人类之所在、之所知、之所思和之所做而获得的或所表达的有关性的所有方面的总和。

5.在本人决定定稿的第二天(7月14日上午)，欣然接到阮芳赋教授的电子邮件回复(本人回复潘绥铭教授电子邮件的同时，为慎重起见，也将该信抄送一份给了阮教授)，他在信中极力主张采纳潘绥铭教授的新的学术观点(见上述)。阮教授的信件有关内容的原文如下：

“I strongly support Suiming's new and current opinions on the translation of sexuality.…I suggest the translations that: sex- “性’ (means to have had be translated as 性 in the past, so add quotation marks); sexuality -性 (means that now 性 is a new and standard translation of sexuality, so no need to have quotation marks. What said of sex in the past we use sexuality to replace it now)”。

“我强烈支持绥铭的新的和现时的sexuality的翻译。……我建议翻译如下：sex—“性’——(代表过去不得不翻译成的性，所以加上引号)；sexuality—性——(意思是：性现在是sexuality的新的和标准的翻译，所以不需要加上引号。过去我们所说的sex，现在用sexuality替换下来。)]”

对于本人的“sex——性本原”的翻译，阮芳赋教授建议放弃，他说：

“I think that please Xiaohui do not make another word 性本原 to make people in more confusing. Actually 性本原 itself is too philosophical, is not suitable to translate “sex”, it really just means coitus, intercourse, fuck, etc, nothing philosophically, now.”

“我认为请晓辉不要制造另外一个词“性本原’，这会使人们更迷惑。实际上，“性本原’本身太哲学化了，用它翻译‘sex’不合适，‘sex’恰恰表示交媾、性交、操……等等，它现在没有任何哲学含义。)”

两位教授对于学术的严谨和负责的态度令人钦佩：潘绥铭教授有魄力修正自己从1994年起所提出的“Sexuality——性存在”的学术内涵和中文翻译；阮芳赋教授也有胆识接受潘绥铭教授的最新主张，并且在潘绥铭的观点启发下，对“sex”的原翻译，做了新的翻译。另外，阮芳赋教授对本人的提醒，我不得不承认：真理更多地偏向他那一边。

所以，本人在此申明：前述的对世界卫生组织关于sex和sexuality定义的翻译“sex——性本原”改为“sex——‘性’”。

参考文献

[1]根据本人与阮芳赋教授和潘绥铭教授的私人通信及本人的学术理解，通信日期：2005年7月12日，13-14日通过与阮芳赋教授互联网即时文字对话、通信和潘绥铭教授的通信定稿。

[2] 阮芳赋.中美性科学的现状与未来.见：杨振宁.霍金等.学术报告厅.西安：陕西师范大学出版社，2002.第271-272页

[3] 刘达临.中华性学辞典.哈尔滨：黑龙江人民出版社，1993.第104页

[4] 阮芳赋.中美性科学的现状与未来.见：杨振宁.霍金等.学术报告厅.西安：陕西师范大学出版社，2002.第273页

[5] 阮芳赋.中美性科学的现状与未来.见：杨振宁.霍金等.学术报告厅.西安：陕西师范大学出版社，2002.第273页

[6] 潘绥铭.社会学概论新修(第九章：家庭、婚姻、性与社会性别).北京：中国人民大学出版社，1994年

**性象谱：按照华裔美国性学家阮芳赋的翻译，见：阮芳赋.性的报告.北京：中医古籍出版社，2002.第145页。

***另参见周福春译.徐震雷校.Eli Coleman著.在新千年里性健康和性权利发展和展望.中国性科学，2003年第12卷.第2期：43-44。或者参见网络：

http://www.med8th.com/humed/2/20031211sjxxhgyxqldxy.htm ；请参见英文原文以资比较( The English version. In：Pan American Health Organization, World Health Organization, World Association for Sexology, Promotion of Sexual Health—Recommendations for Actions, in Antigua Guatemala, Guatemala, May 19-22, 2000,p37-38;see also:

http://www.sexarchive.info/GESUND/ARCHIV/ANTIGUA.PDF )。

12 Cfr. Rubio, E. Introducción al Estudio de la Sexualidad Humana. In CONAPO (Editor). Antología de la Sexualidad Humana Vol. 1. CONAPO, México 1994.

13 Weeks, J. Sexuality. Ellis Horwood Limited. Tavistock Publications. London 1986.

14 World Health Organization. Education and Treatment in Human Sexuality: The Training of Health Professionals, Technical Report Series Nr. 572, in 1975.

15 The definition of human sexuality in the report of the meeting of 1983 is: “Sexuality is an integral part of the personality of everyone: man, woman and child. It is a basic need and an aspect of being human that cannot be separated from other aspects of life. Sexuality is not synonymous with sexual intercourse, it is not whether we have orgasm or not, and it is not the sum total of our erotic lives. These may be part of our sexuality but equally they may not. Sexuality is so much more: it is the energy that motivates us to find love, contact, warmth and intimacy; it is expressed in the way we feel, move, touch and are touched; it is about being sensual as well as being sexual. Sexuality influences thoughts, feelings, actions, interactions, and thereby our mental and physical health. Since health is a fundamental human right, so must Sexual Health also be a basic human right”. (p 5). Langfeldt, T. & Porter, M.. Sexuality and family planning: Report of a consultation and research findings. World Health Organization. Regional Office for Europe. Copenhagen, 1986.

16 See for instance the definitions put forward by Ruth Dixon-Muller in: The sexuality connection in reproductive health. In S. Zeidenstein & K. More (Eds.) Learning about Human Sexuality: A practical beginning. The Population Council and International Women's Health Coalition. New York. 1996. “Sexual behavior consists of actions that are empirically observable (in principle, at least)……on contrast, sexuality is a more comprehensive concept that encompasses the physical capability for sexual arousal and pleasure (libido), as well as the personalized and shared social meanings attached to both sexual behavior and to the formation of sexual and gender identities”(p. 139). Or, Ira Reiss in Journey into Sexuality: an exploratory voyage. Prentice Hall, Englewood Cliffs New Jersey. 1986: “Human sexuality in all societies consist of those scripts shared by a group that are supposed to lead to erotic arousal and in turn to produce genital response” (p. 20).

17 Cfr. Rubio, E.. Introducción al Estudio de la Sexualidad Humana. In CONAPO (Ed). Antologío de la Sexualidad Humana Vol. 1. CONAPO, México 1994. Rubio presents a model of human sexuality from a general system theory perspective and defines human sexuality as the result of the (mental) integration of four human potentialities that originate four holons (or subsystems): reproductiveness, gender, eroticism and interpersonal affective bonding. (p.29).

18 See the definition provided by The Sexuality Information Council of the United States: Human sexuality encompasses the sexual knowledge, beliefs, attitudes, values, and behaviors of individuals. Its dimensions include the anatomy, physiology, and biochemistry of the sexual response system; identity, orientation, roles and personality; and thoughts, feelings, and relationships. The expression of sexuality is influenced by ethical, spiritual, cultural, and moral concerns. Making the Connection: Sexuality and Reproductive Health Definitions of Sexually Related Health Terminology. http://www.siecus.com/pubs/cnct/cnct0001.html

19 Some good examples of this are: Alazate, H.. Sexualidad Humana. Editorial Temis. Santa Fe de Bogot? Colombia (1997). Alzate explains: “Human sexuality...can be defined as the collection of structural, physiologic, behavioral and socio-cultural, that allow the exercise of sexual function. In its time, sexual function is defined as the conscious and culturally conditioned function, that has derivate itself philogenetically from the reproductive function, but which is exercised in the first place in a pleasant or ludic way (erotic function), and secondarily in a reproductive way, through the use of body zones or organs of special sensitivity” (p.5). In this line there is also the work of Paul R. Abramsom and Steven D. Pinkerton. With Pleasure: Thoughts on the Nature of Human Sexuality. New York, Oxford University Press, 1995, where we read: “Sex isn't just for reproduction anymore - it's also for pleasure. The intense pleasure that accompanies sex may serve to motivate copulation and thereby facilitate reproduction, but this is no longer its sole function. Instead human sexuality has bifurcated: reproduction taking one route; unadulterated pleasure another” (p.5).

20 Notably John Money in his Love & Lovesickness the science of Sex, Gender Difference and Pair-bonding. The John Hopkins University Press, Baltimore 1981. Other writers (Abramsom, P. & Pinkerton, S.D. With Pleasure: Thoughts on the Nature of Human Sexuality. New York, Oxford University Press, 1995. Reiss, I. Journey into Sexuality: an exploratory voyage. Prentice Hall, Englewood Cliffs New Jersey. 1986) tend to see love ties as a by-product of erotic pleasure.

21 To give an idea: a search on the following 8 Psychoanalytic Journals: Journal of the American Psychoanalytic Association, Bulletin of the American Psychoanalytic Association, International Journal of Psycho-Analysis, International Review of Psycho-Analysis, Bulletin of the International Psycho-Analytical Association, Psychoanalytic Quarterly, Contemporary Psychoanalysis, Psychoanalytic Study of the Child resulted in 864 articles published from 1980 to 1997 where love and sex were considered.

22 The recent evidence of the possible regulation of pair-bonding has been reviewed by Thomas R. Insel: A Neurobiological Basis of Social Attachment Am J Psychiatry 1997; 154:726 -735, where the participation of the neurotransmitters oxitocin and vasopressin is demonstrated in lower species, more recently the same group investigators reported the relevance of Dopamine D2 receptors in the prairie vole (Microtus ochrogaster), a monogamous rodent that forms long-lasting pair bonds (Gingrich, B., Liu Y., Cascio. C., Wang, Z. & Insel, T.R. Dopamine D2 receptors in the nucleus accumbens are important for social attachment in female prairie voles. Behav Neurosci 2000 Feb;114(1):173-183).

23 Marazziti, D., Akiskal, H. S. Rossi, A. & Cassano, G. B.. Alteration of the platelet serotonin transporter in romantic love. Psychological Medicine (1999), 29:741-745.

24 The WHO definition of health is: “Health is a state of complete physical, mental, and social well-being and not merely the absence of disease or infirmity.”

http://www.who.int/aboutwho/en/definition.html

25 The most outspoken writer on this issue is Thomas Szasz who together with other anti-psychiatrists writers has put forward the idea that mental illness is a myth. He recently wrote: “ Mental illness is a metaphor (metaphorical disease). The word “disease” denotes a demonstrable biological process that affects the bodies of living organisms (plants, animals, and humans). The term “mental illness” refers to the undesirable thoughts, feelings, and behaviors of persons. Classifying thoughts, feelings, and behaviors as diseases is a logical and semantic error, like classifying the whale as a fish. As the whale is not a fish, mental illness is not a disease. Individuals with brain diseases (bad brains) or kidney diseases (bad kidneys) are literally sick. Individuals with mental diseases (bad behaviors) like societies with economic diseases (bad fiscal policies) are metaphorically sick. The classification of (mis)behavior as illness provides an ideological justification for state-sponsored social control as medical treatment” Thomas Szasz. Thomas Szasz's Summary Statement and Manifesto March 1998.

http://www.enabling.org/ia/szasz/manifesto.html

26 See Saracci, R. The World Health Organisation needs to reconsider its definition of health BMJ 1997;314:1409 (10 May).

27 For a more complete discussion see Ruse, M. Homosexuality a Philosophical Inquiry. Basil Blackwell, New York. 1988. In brief, Ruse proposes that health and disease can be defined with either a naturalistic approach (Cfr. Broose, 1977: Health as a theoretical concept. Philosophy of Science, 44, 452-73) where views of diseases are seen as value-neutral, or a normativist approach, where normativist theorists argue that disease is a value concept, being defined in terms of functioning as a human person, which involves reference to a value notion of a good life.

28 Of relevance for this discussion with special reference to sexuality research and sexology is the essay of Ira Reiss: La filosofía de la ciencia aplicada al estudio de la sexualidad humana.. In CONAPO (Editor). Antología de la Sexualidad Humana Vol. 1. CONAPO, México 1994, which is a revised version of Reiss, I. The Future of Sex Research and the Meaning of Science. Journal of Sex Research. 30: 3-11, 1993.

29 Female genital mutilation (FGM) is a violation of the basic human right to bodily integrity and it involves serious health risks. The body of the girl is mutilated in an irreversible manner at an age where the girl herself is not able to make an independent decision as to whether she wants to go through this procedure. These are the main reasons why FGM should be actively abolished. Besides the serious health risks connected to the procedure itself, FGM increases vulnerability to STDs and HIV. Transmission can occur during the mutilation if the same instrument is used on several girls. Afterwards, the wounds and the increased likelihood of tearing of the skin during sexual intercourse constitute major risks for STDs and HIV transmission. FGM is practiced in as many as 28 African countries and known or suspected to be practiced in a number of developed countries by immigrants from Africa. WHO has estimated that between 85 and 115 million women living in the world today have been subjected to FGM and that 2 million girls under go the procedure each year. UNFPA documents: UNFPA and Adolescence.At:http://www.unfpa.org/ICPD/round%26meetings/ny_adolescent/reports/adoles.htm

30 “Since 1994, there has been a noticeable momentum in policy and program development in reproductive rights and health, with significant progress in the understanding of a human rights-based approach to reproductive health, including family planning and Sexual Health; in moving away from vertical service provision, demographic targets and quotas; and in promoting adolescent reproductive health”. Report of the International Forum for the Operational Review and Appraisal of the Implementation of the Programme of Action of the International Conference on Population and Development (ICPD). The Hague Forum. The United Nations General Assembly. Special Session on the International Conference on Population and Development (ICPD) 30 June - 2 July 1999.

31 SIECUS list of behaviors of sexually healthy adults, which was constructed with the consensus of experts not only from the USA but also from such diverse countries as Brazil, Nigeria, and Russia, was created. Sexuality Information and Education Council of the United States. Making the Connection: Sexuality and Reproductive Health: Life Behaviors of a Sexually Healthy Adult: http://www.siecus.com/pubs/cnct/cnct0002.html