SEX AND GENDER

Sex is a term that refers to both bodily sensations and the genital apparatus, to feelings of affection or love, to kinship rules, etc.(3). Throughout history, medicine has produced concepts about sex and sexuality. The distinction between sex and gender is necessary to deconstruct the convergence between the naturalization (religious) and biologization (scientific) of genders and sexuality.

The term sex in gender studies designates aspects of biology and refers to the description of the basic anatomical differences between men and women. Sex is not gender , female is not synonymous with woman, and male does not mean man. The term gender refers to the social differentiation between men and women. It was introduced in the 1970s in an attempt to curb the overwhelming biological determinism and distinguish cultural forms of masculine and feminine. The word gender is inappropriately used today as a synonym for sex, woman or feminist . In its most appropriate sense, gender refers to a system of signs and symbols that denote power relations and hierarchy between the sexes. Gender depends on how society transforms a male into a man and a female into a woman. The cultural construction of gender is evident when one sees that feminine and masculine change in different societies and times(13). The concept of gender makes possible a renewing and transformative understanding of differences and inequalities between men and women(9).

CULTURAL CONSTRUCTION OF SEX DIFFERENCES

The difference between the female and male sexes is the result of a cultural construction. In the past, women were sexually defined as inverted men, with the same organs as men, but inward. This scientific conception, called the one-sex model , was dominant until the 18th century, a period in which women were considered inferior. The distinction between men and women was based not on anatomy, but on political and economic roles(3). At the end of the 18th century, society and the medical-scientific perception of the female anatomical reality changed. Since in the real world the male dominated the female, a new cultural order was created to justify women’s incapacity in public life and their vocation for homemaking. The female sexual body became the cause and justification for the supposedly natural inequalities between men and women. Medical science finally endorsed what ideology had already established. At the end of the 19th century, the belief in women’s physical inferiority in carrying out socioeconomic and political tasks was established. The distinction between the natural and the cultural aims to define and even justify the maintenance of hierarchical relations between genders and races(8).

FEMINIST MOVEMENT AND GENDER STUDIES

The basic pillar of the feminist movement is the fight for equality, and gender studies were a means of institutionalizing the reflection driven by the dialogue between feminism and Brazilian academia. They came to fill the gaps in knowledge about the situation of women in the most varied spheres and to denounce the position of subordination/oppression to which they were subjected in Brazil. Feminism, constantly associated with gender studies, originated from several political events since the 18th century. After the discovery of new contraceptive techniques that gave women more freedom to dedicate themselves to activities other than home and family, feminists began to demand rights (voting, education, work).

The feminist movement caused major changes in gender relations, with discussions about inequality in power relations. Gender studies contributed greatly to the discussion on sexuality by criticizing the biological determinism of male domination(2).

GENDER, HEALTH AND ADOLESCENCE

The hegemonic gender models in current Western culture pose problems and risks to the health and well-being of both men and women. Several clinical conditions are directly related to a gender system based on male dominance, which is quite evident when it comes to individuals in the adolescent age group. We can give the example of mortality rates, whose external causes are the first and predominant among men. Boys are the biggest victims and, at the same time, the main perpetrators. This high mortality rate is directly related to the male gender role. Boys are pressured to be aggressive and competitive. There is a constellation of risky behaviors among boys: drinking alcohol, fighting, violence and unprotected sexual activity. One should always take risks, even if it means being aggressive. Their socialization is generally based on the path of self-sufficiency and independence, hiding emotions, not worrying about health and not seeking help in times of suffering. Masculinity is measured by power, wealth and success: the richer, more powerful and successful, the more masculine.

In the field of sexuality, there is clear evidence of greater exposure to health risks for both boys and girls. Men are intensely intimate with sexual pleasure and the freedom to exercise it. Their sexuality is perceived as something uncontrollable. They seek out the health system when they are concerned about their sexual performance, and not because of the need for family planning(1). Taking sexual risks and gaining a greater number of partners is part of the discourse of masculinity(4). Boys often pretend to be well informed about sex, feel that they cannot express their doubts, and when they have a sexually transmitted disease (STD), they generally resort to self-medication.

Female sexuality is experienced as an object of male conquest and control, submissive to their domination, silent, conformist. Women tend to demonstrate sexual inexperience to characterize their decency. In relation to adolescents, who are more frequently victims of violence and sexual abuse, intimacy and respect are not valued. Gender-based violence is so culturally naturalized that many men ignore the fact that they are committing violence and many women do not realize that they are being violated(7). Girls are educated to passively accept male violence. According to Giffin(5), in a capitalist society, femininity is identified with the sphere of reproduction, caring for others, affection, and family life.

Women are at a disadvantage when negotiating the use of condoms, due to the scenario of gender relations. Women’s entry into sexual life differs greatly from men’s. While for women, the first sexual intercourse becomes a decisive moment in the construction of a true relationship, men view it in the context of personal initiation in which the relationship with their partner counts for little(6).

The inequality in relationships between men and women makes it difficult to exercise sexuality safely. The use of male condoms can be seen as a sign of weakness or distrust for the partner. True macho men have an impulsive, uncontrollable sexuality(12).

Although AIDS is transmitted mainly through sexual contact and the largest number of reported cases are among heterosexual men, they tend to have sexual relations with numerous partners. They do not feel threatened by the epidemic or that they belong to a risk group, since this is the expected behavior of their women, according to the social logic of gender. In some situations, they forbid their wives from using contraceptives, fearing that they will be unfaithful to them; in others, they force sex and do not use condoms, thus facilitating the occurrence of an STD(10).

Research conducted by Taquette et al. (2004) with adolescents of both sexes revealed that boys have more partners and start sexual activity earlier. Girls, on the other hand, use condoms less and are the main victims of sexual abuse. These data confirm a model based on traditional gender values ​​that demarcate the male and female spheres, assuming the supremacy of the former.

CONCLUSIONS

Gender conditioning factors in culture make it difficult for men and women to take actions that benefit their health. It is necessary to think of differentiated information strategies, since these are distinct sexual and reproductive bodies. The debate around the promotion of sexual and reproductive health must include men as protagonists, just as women are already considered. This inclusion should not be done only as a support point for promoting women’s well-being.

Both the development of public policies and the work of guidance on sexuality and health must take gender issues into account. There is no point in telling a teenager to use a condom during all sexual relations to protect herself from an unwanted pregnancy or an STD if we do not question the naturalness with which she submits to her partner’s desires. Preventive health practices must consider that sexuality results from a dynamic of social, historical and economic factors.

Although adolescent men are the main perpetrators and victims of aggression, little reflection has been made on the association between violence and gender. Regarding STDs, it is necessary to broaden the discussion around culturally constructed models of masculinity and femininity for more effective control of them.