Sexual Health and Wellbeing through the Life Course: Ensuring Sexual Health, Rights and Pleasure for All.

This commentary summarizes the context and positioning of sexual health, sexual rights and sexual pleasure, as three interlinked and indivisible aspects of sexual health and wellbeing (SH&W). In turn, sexual health is a major domain within broader sexual and reproductive health and rights (SRHR), both in its own right as a human right, and owing to the importance of good sexual health for ensuring good reproductive outcomes. Furthermore, SRHR is a necessary, core part of overall health, thus sexual health and wellbeing is a fundamental aspect of general health that is often overlooked or even denied for some. In this commentary, we utilize a life course approach to illustrate how the tripartite of sexual health, rights and pleasure manifest themselves with different interlocking linkages, and actively contribute to overall health throughout life. As other papers in this series attest, the linkages of pleasure with the right to and attainment of health has received inadequate attention to date, both within the scientific literature and in policy narratives.

Invest in adolescents and young people: it pays.

This year's Women Deliver conference made a strong call for investing in the health and development of adolescents and young people. It highlighted the unique problems faced by adolescent girls and young women-some of the most vulnerable and neglected individuals in the world-and stressed the importance of addressing their needs and rights, not only for their individual benefit, but also to achieve global goals such as reducing maternal mortality and HIV infection.In response to an invitation from the editors of Reproductive Health, we-the sixteen coauthors of this commentary-put together key themes that reverberated throughout the conference, on the health and development needs of adolescents and young people, and promising solutions to meet them.1. Investing in adolescents and young people is crucial for ensuring health, creating prosperity and fulfilling human rights.2. Gender inequality contributes to many health and social problems. Adolescent girls and boys, and their families and communities, should be challenged and supported to change inequitable gender norms.- Child marriage utterly disempowers girls. It is one of the most devastating manifestations of gender discrimination.- Negative social and cultural attitudes towards menstruation constrain the lives of millions of girls. This may well establish the foundation for lifelong discomfort felt by girls about their bodies and reticence in seeking help when problems arise.3. Adolescents need comprehensive, accurate and developmentally appropriate sexuality education. This will provide the bedrock for attitude formation and decision making.4. Adolescent-centered health services can prevent sexual and reproductive health problems and detect and treat them if and when they occur.5. National governments have the authority and the responsibility to address social and cultural barriers to the provision of sexual and reproductive health education and services for adolescents and young people.6. Adolescents should be involved more meaningfully in national and local actions intended to meet their needs and respond to their problems.7. The time to act is now. We know more now than ever before about the health and development needs of adolescents and young people, as well as the solutions to meeting those needs.

Sexual and reproductive health needs of young people: matching needs with systems.

Access to services is a central concern surrounding the promotion of sexual and reproductive health and rights (SRHR) of young people. A more holistic (so-called "positive") approach toward SRHR is needed, as is provision of services that tackle sexual and gender-based violence, sexual diversity, discrimination, relationship issues, and fears and concerns about sex and sexuality. Despite efforts to provide youth-friendly services, the uptake of services by young people is very low. What must be taken into account are young people's pathways to seeking services; and the specific barriers they face before getting to the services, while receiving services, and after leaving the service delivery sites. Attention to the perceptions and needs of young people is essential, along with development of policies, services, and programs that address those needs, particularly the youth-friendly approach to service delivery.