Each year statistics of sexually-transmitted infections and casual unprotected sex hit the headlines but health promotion officer Elaine Dutton says that the research is still very limited. She speaks to Christian Peregin about some of the myths on sexual health and calls for a more holistic approach to sex education.
With no accurate research about sexual health locally, "we do not know if we are being effective", says Ms Dutton, from the Health Promotion and Disease Prevention Department.
The sensational statistics that hit the headlines every year are not representative of the population as a whole because they are based just on what is reported to doctors and laboratories.
"We need to have proper research to see if we are failing or making progress but the indications are definitely that we are not doing enough," she admits.
Her concern is that the concept of sexual health is often misunderstood as meaning focusing simply on safe sex and disease prevention: "I believe that sexual health includes the physical, mental, emotional and spiritual well-being of a person."
Ms Dutton, who is responsible for the promotion of sexual health in Malta, describes herself as a bit of a Joan of Arc character because her field is still rather taboo in Malta.
Her vision is to have a diverse group of professionals to promote this area, rather than only one person employed in the department.
"What we need is a working group made up of educators, psychologists, health professionals, people specialised in sexually-transmitted infections and in health promotion and marketing, representatives of minority groups and so on. We need to target young people, older people, those who are separated, migrants, gays and lesbians, prisoners... We need to find out how all these groups are experiencing sexual health."
"Incidentally, only a few weeks ago the department organised a focus group in which people representing several NGOs, youth workers and also students were present. To see so many people around one table all pouring ideas and hopes in this area was really encouraging," she says.
Ms Dutton battles with misconceptions every day.
"Imagine someone in authority saying that condoms can get easily removed from the penis and lodged inside the fallopian tubes, causing infertility," she says in exasperation.
But the biggest misconception is that sexual health education can encourage promiscuity or early experimentation, she adds.
With regard to the media, Ms Dutton thinks statistics are often used sensationally, without giving the full picture.
"I want parents to understand what their children are going through and why. There is no point in scaring people. Let's give the whole picture. What about the news that most young people say they want to have sex in a loving relationship? Why doesn't this hit the headlines," she asks.
Regarding sex education in schools, Ms Dutton says there are still teachers or headmasters who are resistant or uncomfortable when it comes to sex education.
She believes sex education is everyone's responsibility and we should not keep passing on the buck. She emphasises the important role of parents in education and says that although parents might not know everything, they can be health promotion officers by starting a discussion and guiding their children to find the right information.
"Sexual health education can start from the age of four or five when parents teach their children about the different parts of their body and how to take care of personal hygiene. Simple things like these are already part of sexual health. Other important elements are self-esteem, self-appreciation, assertiveness and empowerment."
Ms Dutton stresses, however, that education must be tailored to a person's age. She says that the difficulty many sexual health educators face is that they must cater for a whole class of young people at different stages of development.
In her opinion the most worrying trends in sexual behaviour include casual sex, unprotected sex, being pressured into sex by partners or through social pressure, and infidelity.
She adds a trend that is rarely spoken of: Serial monogamy, often characterised by unprotected sex, in a series of long- or short-term, exclusive sexual relationships.
"You might trust your boyfriend or girlfriend, but do you trust their ex?" This is Ms Dutton's response to those people who choose not to use protection when in a monogamous relationship with a new partner.
"Then again, I always say that a condom is as useful as a helmet on a motorcycle. If you've decided to drive around with your motorcycle then it makes sense to put a helmet on but there are always accidents where people wear helmets and things go wrong anyway. It is a protective measure that reduces your risk but it is not infallible," she insists.
"Condoms are not cycling pants; they only cover the obvious part so there might be infections like genital warts or crabs that are on the skin around the genital area which condoms do not protect you from."
Ms Dutton has heard it all when it comes to condoms. "Two condoms are not better than one and they do not come out of the factory with holes in them. And you don't check them by pouring water into them!" she says.
She admits that sexual health is often seen and promoted in very negative terms.
"A young boy once told me: 'Isn't sex also something nice?' and I thanked him for reminding me," she said.
"We keep marketing sexual health as being something to be scared of and this makes people switch off immediately when we talk to them about it."
She thinks there are also those who are too paranoid about STIs and recalls a man who told her he was afraid of getting an infection from a hug.
"Putting a poster here and there is not going to solve our problems. A campaign needs to be targeted properly and needs to be ongoing - people don't just have sex on World Aids Day. Our message must be continuous."
For issues related to sexual health one can contact the helpline 2326 6121 or e-mail sexualhealth@gov.mt - all calls or e-mails are treated in strict confidence.