02cf

      中文翻譯：彭曉輝(中國武漢華中師範大學生命科學學院 430079)完成時間：2006年3月
      Translator：Xiaohui Peng (Life Science College of CCNU, Wuhan, 430079, China)
      校   對：吳敏倫(中國香港香港大學醫學院)完成時間：2006年8月

概念框架

基本概念

在人類性學(human sexuality)和性健康( Sexual Health)領域，對所使用的術語的普遍一致性和精確性是必要的。顯然，為了針對性健康促進而達到有效的溝通、傳播資訊和制定專門的行動方案和計畫的目的，對某些關鍵的概念做出這樣的定義是有必要的。可是，已經證明要達成如此一致的認可程度有一定的困難。

對人類性學從概念上要下一個定義是困難的。困難主要在於諸如此類的定義是一個抽象概括的過程12，同樣地，人類性學的定義會受到特定的社會文化、歷史背景和歷史進程的影響，這些因素制約著定義的建構。

在設法定義人類性學的時候，還常常碰到另一個難題，那就是在“性”(sex)和性(sexuality)之間不能做出區別*。因此，術語“性”(sex)和性(sexuality)究竟是什麼含義*，常常發生混淆。術語“性“(sex)在其通常的用法和許多背景條件下是指不同的概念*。下面的引用語舉證了這種情形：“我們很早就從各種途徑獲悉'自然的’性行為(sex)就是發生在異性(opposite sex)成員之間的性行為？”(“We learn very early on from many sources that “natural” sex is what takes place with members of the opposite sex?”) 這個術語(指sex——譯者注)既指一種行為也指一個人的類別，既指一種實踐也指一個性別13*。

為了構建適合於描述性健康的概念框架，對“性" (sex)和性(sexuality)*的基本概念需要加以定義和對其定義取得一致的意見(怎樣翻譯”sex”和”sexuality”成中文術語？譯者與華裔美國性學家阮芳賦和中國人民大學性社會學家潘綏銘通過電子郵件進行了學術探討。具體翻譯如下，而探討的詳情請見本譯文後面的注釋。該注視作為一篇論文已經發表：彭曉輝.對“sex”和“sexuality”的討論及其定義的中文翻譯.見：潘綏銘主編.中國“性”研究的起點與使命[阮芳賦主編性學萬有文庫(012)，高雄：萬有出版社，2005。——譯者注)。為著將來研究便利起見，出席本次區域磋商會議的專家工作小組首先建議使用如下的定義：

“性”* (sex)

性* (sexuality)

性是指包括“性”、性別、性別認同與性身份、性取向、性愛傾向、情感依戀/情欲和生殖的人的核心方面。它以思想、幻想、欲望、信仰、態度、價值、行為、習慣、角色和關係予以體驗或表達。性是生物的、心理的、社會經濟的、文化上的、倫理上的和宗教上/精神上的諸因素相互影響的結果。雖然性包括了所有的這些方面，並不是所有這些方面必須都得要去體驗或去表達。可是，總而言之，人類的性是人類之所在、之所知、之所思和之所做而獲得的或所表達的有關性的所有方面的總和。

性健康是指與性有關的生理、心理和社會文化方面正處於良好狀態的一種體驗。性健康由性潛能的自由和負責的表達所證實，性潛能促進個人和社會的和諧與健康，豐富個人和社會的生活。性健康不僅僅是指沒有功能障礙、沒有疾病和/或身體無虛弱。為了獲得和維持性健康，必須認可和支持所有人的性權利。

性別是指基於“性”*的文化價值、態度、角色、實踐和特性的總和。正像在歷史上、跨文化方面和當代社會所存在的那樣，性別折射出和永恆地延續著男女之間的特殊權利關係。

性身份定義每一個人認可自己是男人還是女人或者這兩者都認可的程度。性身份是一個人的內在素養，它隨著時間的過去而構建，它使個人能夠建構起自我概念和在社會中履行和尊從他/她所感知到的“性”*和性別。性身份決定個體體驗其性別的方式，它也體現了個人在群體中的趨同感、獨立感和歸屬感的方式。

性取向是指關於性活動中所涉及性伴的“性”*和性別的個人性愛傾向和/或情感依戀的組成狀態。個人的性行為、性思想、性幻想和性欲任何之一或及其複合體都可以清楚地表露他/她的性取向。

性別認同是指包括個人如何認同作為男性、女性、男性氣概、女性氣質或及其複合體以及個人性取向在內的全部的自我性身份。性別認同是一個人的內在素養，它隨著時間的過去而構建，並使個人基於他/她的性、性別和性取向而構建起的自我概念和在社會中履行和尊從他/她所感知到的性能力。

性愛傾向是指個人感知與體驗作為性欲、性喚起、性高潮和通常視同於性快樂的生理現象的主觀反應的能力。性愛傾向在與他人的各個方面相聯繫中，以象徵的和具體的含義既在個人層面也在社會層面所構建。

情感依戀是指個人通過情感與他人建立和維持親密的人際關係的能力。情感依戀在與他人的各個方面相聯繫中，以象徵的和具體的含義既在個人層面也在社會層面所構建。愛情就是情感依戀的一種特別而愉悅身心的代表形式。

性活動是指個人的性*在行為方面的表達，通過這種行為表達，其性欲成分(erotic component of sexuality，指性*的生理欲望、心理取向和社會文化特徵等要素——譯者注)最為明顯。性活動的行為特點在於以行為方式尋求性興奮。性活動與性行為(sexual behavior)的含義相同。

性習慣是指個人或群體在行為上所展露的被認為具有高度一致性的一種性活動形態。

安全性行為是慣常於特指為降低性傳播疾病、尤其降低HIV感染和傳播風險的性實踐和性行為的術語。

負責任的性行為是在個體、人際之間和社會的層面來體現的，它在於對性快樂和性健康方面體現出自主、相互關聯、誠實、尊重、允諾、保護和尋求快樂的特點。個人所展示的負責任的性行為並不是在性的方面意欲引起傷害，而是摒棄自私的利用、騷擾、操縱和歧視。社會通過提供知識、資源和公正來促進負責任的性行為，而個人則必須要參與促進負責任的性行為的實踐活動。

表2：涉及性別、性身份、性取向、性別認同、性愛傾向、情感依戀、性活動、性習慣、安全性行為和負責任的性行為的概念與定義。

“性”是指決定人類男女兩性性象譜的生物特徵的總和。在通俗語言裏，術語“性”的通常含義包括它作為行為(例如，having sex-發生性行為)和作為一系列舉止方式(例如，性角色)的用法。可是，為了概念上的精確性，從學術討論和評注的方面來看，術語“性”的用法被限定在生物屬性的層面。

性是指包括“性”、性別、性別認同與性身份、性取向、性愛傾向、情感依戀/情欲和生殖的人的核心方面。它以思想、幻想、欲望、信仰、態度、價值、行為、習慣、角色和關係予以體驗或表達。性是生物的、心理的、社會經濟的、文化上的、倫理上的和宗教上/精神上的諸因素相互影響的結果。雖然性包括了所有的這些方面，並不是所有這些方面必須都得要去體驗或去表達。可是，大體上，人類的性是人類之所在、之所知、之所思和之所做而獲得的或所表達的有關性的所有方面的總和。

早先，世界衛生組織的磋商會議既沒有提供人類的性的定義14，也沒有提供其精確概念15。正像此處所定義的一樣，性是指人類的性的生物屬性(人類的生物性別特徵)的附加組成部分(即後天獲得的部分——譯者注)。人類既從象徵性也從具體上、即從實踐上也從概念上對性的內涵的理解和歸因的能力則是性的凝結力。從性方面的文獻中的普遍觀點來看，性除了有生物屬性方面的因素 (即上述的“性”所定義的內容——譯者注) 以外，它還指個人和社會層面的性的內涵16。

雖然性可能包括性愛傾向、情感依戀、愛情、"性"(sex)、性別和生殖17，但並不是所有這些方面都需要表達出來。儘管影響性的各種各樣的情感表達和結果可能具有跨時代的差異，但是它演繹於人的一生18。所以，性受到特殊的歷史和文化環境制約，也受到被構建和正在構建的習俗、傳統和價值的制約。性的全面發展依賴于諸如接觸的欲望、親近的欲望、情感表達的欲望、快樂的欲望、表示愛的欲望和愛情的欲望等人的這些基本需要的滿足。

性學界除了普遍認同上述觀點以外，也有人對性的社會文化組成部分(其中的部分含義)提出了商榷，認為人的性過於概念化；在理論研究方法裏有一個明確的傾向，那就是性不僅是指人類的生殖能力，而且(在許多例子裏，主要)也指人的性快樂能力19。

一些理論家已經涉足過對諸如情感依戀/情欲等的性的另一組成成分的研究20。心理分析文獻通常在術語方面包括愛情、愛情病理學和性的研究，認為愛情不能與諸如性愛吸引(erotic attraction)等某些性的情感表達相區別21。可是，近年來有人根據神經生物學的研究發現，認為在動物22中有可能存在著調節情感依戀和雌雄配對的特有的神經中樞系統，並且這個系統在人類也發揮著相同的功能23。

性健康 (Sexual Health )

性健康是指與性有關的生理、心理和社會文化方面正處在康樂狀態的一種體驗過程。

性健康是以自由的和負責任的性品質的表達來實現的，這種性品質促進個人和社會的和諧與健康，豐富個人和社會的生活。性健康不僅僅是指沒有功能障礙、沒有疾病或無身體虛弱。為了獲得和維持性健康，必須認可和支持所有人的性權利。

從歷史上看，不同的群體使用了“性健康”這個術語，卻表達著不同的含義。對於一些人來說，性健康用來委婉地傳達性傳播疾病狀態的資訊；對於其他人來說，它用於促進生殖健康教育方面這一狹義概念上。應該從本會議紀要上述的定義清楚地領會到，我們已經提出的性健康是一個全面的或廣義的概念。世界衛生組織規定“健康是指整個的生理、精神和社會適應的康樂狀態，而並不僅僅是指沒有疾病或無身體虛弱”24。顯而易見，當把這個定義用於行為層面時，原本清晰的定義就變得模糊不清了。當把健康的定義與行為相關聯的時候，一直就有人對健康定義的含義存在著爭議。有觀點認為，不應該把行為和生活方式摻入健康的概念裏去25。這些觀點質詢這種牽涉到價值決定體制的有關健康定義的正確性26，並且提議只有對那些可量化的指標進行度量時，才可以定義健康的概念。

這種論爭的焦點其實就是健康與價值觀的辯論。一些理論取一種價值中立的方式來給健康下定義；其他的理論則為健康的價值決定觀辯護27；還有一些理論卻質詢價值中立的自然科學有關健康主張的真正可行性28。因此，本會議的專家工作小組建議採用更為模糊的立場也許是一個好的選擇，這種立場認為科學活動、以自然科學為基礎的衛生保健和健康促進不可能完全由價值中立取向來推動，因而有關健康的價值決定的建議、定義和概念是不可避免的。應該從本會議紀要上述的定義清楚地領會到，我們已經提出的性健康是一個全面的或廣義的概念。世界衛生組織規定“健康是指整個的生理、精神和社會適應的康樂狀態，而並不僅僅是指沒有疾病或無身體虛弱”。世界衛生組織的這個有關健康的定義也許是一個最好的例證，其中的健康是以康樂狀態為依據所下的定義。康樂被人理解為一種價值決定的狀態。

鑒於此，專家工作小組經過協商後認為設定性健康的定義既是可能的也是值得的，這個定義源自於並且體現在性權利的概念之上。(“性”、性和性健康的基本定義在表1做出了摘要。涉及性的相關概念在表2給出了定義。)

性權利 (Sexual rights )

人權乃人類與生俱來的；可是，重視與生俱來的權利本身不會產生權利。人權高於文化價值。如果特定的文化具有違反人權的社會習俗，那麼這種文化價值就應該被改變；象女性生殖器官損毀的文化習俗就是應該加以改變的事例29。人權是促進健康的途徑，它已經在促進生殖健康的定義中明確地予以陳述過30。

性權利越來越得到了人們的重視。人權是普遍達成共識的作為保護人的尊嚴的普世法則，它促進正義、平等、自由和生存。既然健康保護是基本人權，由此得出結論：性健康包括性權利。

本專家工作小組向諸如世界衛生組織和其他聯合國的代理機構強烈建議，敦請這些機構促進和宣導世界性學會的有關人類普世的性權利宣言(表3)，以達成普遍共識。

表3：摘自世界性學會發行的《性權利宣言》；其全文刊於本紀要附錄I。

性健康既能從個體的層面也能從社會的層面來驗證。從個體層面來看，有研究者已經認識到性健康個體具有特定的行為特徵31，並且以性健康個體的生活舉止來呈現。專家小組成員建議採納下述已經在數個國家得到確認的性健康行為方式(見表4)。

表4：美國性知識和性教育委員會(SIECUS)關於性健康成人生活行為方式列表

肯定人的發展包括性的發展，而性的發展也許包括或也許不包括生殖或生殖器官的性體驗。

區分什麼是提高生活品質的性行為，什麼是對己或對他人有害的性行為。

習慣于健康促進行為，如有規律的乳房雙側自檢和早期辨察潛在病症。

以自己的思考、感情、價值觀和涉性的行為來判斷家庭、文化、宗教、媒體和社會資訊的影響力。

表4.本性健康成人生活方式列表由美國性知識和性教育委員會(SIECUS)表決通過。

性健康也能夠在社會的層面進行鑒別。專家工作小組成員審定出性健康社會的數個特徵，見表5。

政治上的承諾。國家承認性健康是一項基本人權並擔當起促進性健康的責任。

明晰的國家政策。包括政府機構在內的社會公共機構規劃、制定和執行涉及明晰而準確的維護和促進性健康的政策，把其作為一項基本人權。

性權利立法。為了促進性健康，必需制定保障性權利的法律。尤其必須制定防止弱勢群體受到性剝削(例如，兒童賣淫)的法律；承認全體國人身體不受損害(例如：保護生殖器不受損毀)權利的法律；保護性少數權利的法律，把其作為教育、健康和就業的一項基本人權(例如：反歧視立法)；以及促進兩性平等(例如：平等就業機會立法)的法律。

良好的國民性教育。性健康社會的必需要素是國民普遍有權終生得到與其年齡相符的、全面的性教育

足夠的基礎設施。為了確保人人有權得到性衛生保健服務，專門從事性健康憂慮和性健康問題服務的專業人員和輔助專業人員服務網路是必不可少的。這還包括為專業人員提供專門的性衛生保健服務培訓專案。

性學研究。一個盡責于其社會成員的性健康社會，將會適當而有效地支持針對涉及臨床、教育和公共衛生保健的性學研究。這將既包括對正浮現的健康問題(例如：新出現的傳染病)的研究，也包括衛生防疫的行為監測(例如：對高危亞人群中的安全性行為發生率、性暴力發生率、性功能障礙的流行程度，等等)。

完備的預警機制。為了監測性健康憂慮和性健康問題的生物指標與行為特徵，有必要建立性健康預警機制。

開放的文化環境。開放的和優先考慮的性健康文化環境是必需的。媒體對性健康憂慮的報導品質，以及對有關嚴重威脅公共衛生安全的資訊公開披露程度可以成為衡量文化開放程度的風向標。

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”的學術探討及中文翻譯

彭曉輝(華中師範大學生命科學學院，武漢，43079)

自2004年10月在北京人民大會堂召開中國性學會成立十周年暨學術會議期間，德國性學家黑格樂教授把他的性學互聯網站所有的資料光碟送給我後，我就有了翻譯成中文的念頭。今年年初，在香港大學瑪麗醫學院健康系的吳敏倫教授的提議和鼓勵下，我於年初開始了翻譯，並得到了華裔性學家阮芳賦教授的全力支持。

可是，對於性學中“sex”和“sexuality”的中文翻譯，一直是困擾國內外性學家的一個問題。自己也冥思苦想，想找出一個合適的翻譯答案，於是就有了下面的學術通信和坦誠的交流。現將交流的情況和自己翻譯過程中的學術思路整理成文^[1]：

1.按照阮芳賦教授的考證，“Sex”一詞的演變軌跡是：Sex←自拉丁文Sexus，相當於Secare(即“分開”、“切開”之意)。

2. 以被評為美國最好的大學性育教材之一的《Becoming a sexual person》(Robert T.Francoeur著，紐約MacMillan出版公司，1991年第二版)中，對Sex和Sexuality的界說：^[2]Sex：一個人基於其外生殖器解剖學上的雌雄而決定的生物學狀態；性交。 (第72頁，第627頁)。

Sexuality：最起碼要包括四個主要方面：

基於外生殖器解剖學上的雌與雄；

作為男與女的性別自認；

所採取的與解剖學上的雌雄差異如男女的性別差異相適合的角色和行為；

被吸引的和所愛和性別。

人的Sexuality是一個生物心理社會文化現象。(第4頁，第637頁)。

3. Sexuality究竟如何翻譯成中文？較早時，梁實秋在《遠東英語大辭典》裏把它翻譯成”性之具有”、”性之性質”(i.e.”性性”)、”性興趣”、”性本能”和”性感”。

近年來，性學家劉達臨參考了華裔性學家阮芳賦的想法(1984)將其翻譯為 “性性”^[3]，他說“性性在構詞上屬偏正結構，前偏後正。前面的詞素“性’是指性科學中的性(sex)，後面的詞素“性’是指特性、秉性”。

阮芳賦認為：Sexuality的“這個(性性)譯法，既“信’且“達’，但畢竟不“雅’。重複連用兩個同形同音異義字，實在有點彆扭，也不便於進一步造詞”。所以，阮芳賦教授從未在著述中採用這一譯法^[4]。儘管“性性”這個翻譯符合英文的原意，但不符合漢語的使用習慣。所以，他又建議將其譯為“性”。他認為“最好的解決辦法是：逐漸地公認“性’是Sexuality的中文標準譯名，而將Sex則按上下文分別譯為“性行為’、“性交’，等等。當然有時Sex所指的正是Sexuality所指的一切，也就譯為“性’字了……。”^[5]阮芳賦在通信中對Sexuality的中文翻譯進一步解釋道：“除了譯為“性’字，其他的譯法都是不可行的。這不是任何個人的英文和/或中文的高下問題，而是內在因素所決定的：當代英文中Sex詞義的縮小和Sex原來無所不包的詞義向Sexuality的轉化與進一步擴大，是通過構詞法來實現的。漢語中根本沒有這種構詞法手段。不管你往“性’字的前面或後面加一個或一個以上的其他字，都會把Sexuality的詞義縮小,而不能包括Sexuality的所有層面所有詞義。”

性社會學家潘綏銘則將“sexuality”譯為”性存在”^[6]。本人的觀點認為，綜合考慮來看，潘綏銘的翻譯也可以進一步商榷。正要完稿之際，潘綏銘教授通過電子郵件發送的答復及時到達，他在給本人的回信中說對於Sexuality：

“我當初的想法，“性存在’是為了強調“性’的非生物的方面，暗喻著：性是社會中的、生活中的、是一種實現了的狀態，而不僅僅是一種(潛在的)生理功能。可是這些年來，我也感到這種翻譯可能並不好：

首先，“存在’已經被當作一個哲學概念，因此“性存在’容易使人覺得是一個哲學名詞，而且似乎與薩特的“存在主義’有什麼關係(實際上沒什麼關係)。

其次，“性存在’似乎太強調現實了，容易使得人們忽視性的心理、想法與欲望。

第三，“性存在’很難組詞，“性存在教育’就說不通。所以，我覺得還是翻譯為一個加引號的“性’為好。至於“性’與原來意義上的性，恐怕只能等到人們對這問題瞭解得更多之後，才能認真地加以區別。

也有的研究者提出，乾脆什麼新詞也不要，只改變性的內涵。時間長了，約定俗成即可。我覺得這也是一個辦法。”

4.毋庸質疑，阮芳賦教授通過20多年的潛心研究，對“Sex”和“Sexuality”的演變、學術內涵及中文翻譯的論點是合適的。除此之外，本人冒昧作一個補充：既然“Sex”的學術含義逐漸擴展給“Sexuality”，僅縮至主要涉及性的生物的層面，既然按照阮芳賦教授的學術建議用“性”來翻譯“Sexuality”，那麼“Sex”的原有的學術翻譯“性”在此處就不可再用，擬暫改譯“性行為、性交，性生物特性,性生物基礎,性本原,……”。沿著這麼一個思路，本網站的所有涉及“Sex”的定義時，統一使用“性本原”的翻譯。試對泛美衛生組織和世界衛生組織於2000年的“性健康促進行動方案建議”中有關“Sex”和“Sexuality”的定義翻譯如下：

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

——性本原(sex)是指決定人類男女兩性性象譜的生物特徵的總和。

【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、性別、性別認同與性身份、性取向、性愛傾向、情感依戀/情欲和生殖的人的核心方面。它以思想、幻想、欲望、信仰、態度、價值、行為、實踐、角色和關係予以體驗或表達。性是生物的、心理的、社會經濟的、文化上的、倫理上的和宗教上/精神上的諸因素相互影響的結果。雖然性包括了所有的這些方面，並不是所有這些方面必須都得要去體驗或去表達。可是，大體上，人類的性是人類之所在、之所知、之所思和之所做而獲得的或所表達的有關性的所有方面的總和。

5.在本人決定定稿的第二天(7月14日上午)，欣然接到阮芳賦教授的電子郵件回復(本人回復潘綏銘教授電子郵件的同時，為慎重起見，也將該信抄送一份給了阮教授)，他在信中極力主張採納潘綏銘教授的新的學術觀點(見上述)。阮教授的信件有關內容的原文如下：

“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)”。

“我強烈支持綏銘的新的和現時的sexuality的翻譯。……我建議翻譯如下：sex—“性’——(代表過去不得不翻譯成的性，所以加上引號)；sexuality—性——(意思是：性現在是sexuality的新的和標準的翻譯，所以不需要加上引號。過去我們所說的sex，現在用sexuality替換下來。)]”

對於本人的“sex——性本原”的翻譯，阮芳賦教授建議放棄，他說：

“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.”

“我認為請曉輝不要製造另外一個詞“性本原’，這會使人們更迷惑。實際上，“性本原’本身太哲學化了，用它翻譯‘sex’不合適，‘sex’恰恰表示交媾、性交、操……等等，它現在沒有任何哲學含義。)”

兩位教授對於學術的嚴謹和負責的態度令人欽佩：潘綏銘教授有魄力修正自己從1994年起所提出的“Sexuality——性存在”的學術內涵和中文翻譯；阮芳賦教授也有膽識接受潘綏銘教授的最新主張，並且在潘綏銘的觀點啟發下，對“sex”的原翻譯，做了新的翻譯。另外，阮芳賦教授對本人的提醒，我不得不承認：真理更多地偏向他那一邊。

所以，本人在此申明：前述的對世界衛生組織關於sex和sexuality定義的翻譯“sex——性本原”改為“sex——‘性’”。

參考文獻

[1]根據本人與阮芳賦教授和潘綏銘教授的私人通信及本人的學術理解，通信日期：2005年7月12日，13-14日通過與阮芳賦教授互聯網即時文字對話、通信和潘綏銘教授的通信定稿。

[2] 阮芳賦.中美性科學的現狀與未來.見：楊振寧.霍金等.學術報告廳.西安：陝西師範大學出版社，2002.第271-272頁

[3] 劉達臨.中華性學辭典.哈爾濱：黑龍江人民出版社，1993.第104頁

[4] 阮芳賦.中美性科學的現狀與未來.見：楊振寧.霍金等.學術報告廳.西安：陝西師範大學出版社，2002.第273頁

[5] 阮芳賦.中美性科學的現狀與未來.見：楊振寧.霍金等.學術報告廳.西安：陝西師範大學出版社，2002.第273頁

[6] 潘綏銘.社會學概論新修(第九章：家庭、婚姻、性與社會性別).北京：中國人民大學出版社，1994年

**性象譜：按照華裔美國性學家阮芳賦的翻譯，見：阮芳賦.性的報告.北京：中醫古籍出版社，2002.第145頁。

***另參見周福春譯.徐震雷校.Eli Coleman著.在新千年裏性健康和性權利發展和展望.中國性科學，2003年第12卷.第2期：43-44。或者參見網路：

http://www.med8th.com/humed/2/20031211sjxxhgyxqldxy.htm ；請參見英文原文以資比較( 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