Let's Talk About Sex: Q&A With Prof. Jessie Ford

With Valentine’s Day around the corner, thoughts turn to candlelit dinners, bouquets of flowers, and the inevitable rendezvous between the sheets. Sex is the subject of voluminous public health research, but too often the way public health thinks about sex is limited to reproduction and risk, says Jessie Ford, assistant professor of sociomedical sciences who studies sexuality. It’s important to recognize one of the main reasons people have sex: because it’s pleasurable.

In her research, Ford, who joined the Columbia Mailman faculty in September, observes that the HIV epidemic forced public health researchers to consider sexual behaviors and sexuality. It is important to realize that sexuality is social behavior, shaped by societal forces and inequities. Her research through the Columbia Mailman-led SHIFT (Sexual Health Initiative to Foster Transformation) research project has shed light on societal prejudices and expectations that contribute to unwanted sex among undergraduates. Her writings about sexual pleasure include a recent paper that makes a case that clinicians should talk to their patients about sexuality and sexual pleasure as part of their annual check-ups.

How did you get into public health and sexual health?

When I was an undergraduate, I took a feminist sexuality workshop taught by future SMS [sociomedical sciences] PhD student Anne Montgomery. It was inspiring. After college, I also worked on a study of sex during the final trimester of pregnancy to see if it resulted in better birth outcomes, but our IRB approval was blocked by the [George W.] Bush Administration. A few years later, I enrolled at the London School of Hygiene & Tropical Medicine, where I did a meta-analysis of research on sexual pleasure. At NYU, where I got my PhD in sociology, I wrote my dissertation on unwanted sex.

Tell me more about your research.

My research looks at how expectations and inequalities around gender and sexuality shape sexual health, violence, and pleasure. In one study, we found that young women were more likely to use alcohol and cannabis prior to sex. The behavior may be a coping mechanism related to how women are judged around having sex. Women tell us they feel equal to men until they are having sex. We have also found high rates of sexual assault among LGBTQ populations related to social isolation and inexperience with sexual scripts. Sex ed and society, in general, emphasize heterosexual norms, which can make sex treacherous for LGBTQ people.

How common is unwanted sex and why are people doing it?

Probably everyone will have unwanted sex as some point in their lives. People have unwanted sex because it’s a way of avoiding conflict and conforming to social pressures. But unwanted sex becomes sexual assault anytime someone feels like they don’t have control or the volition to say no. But this is tricky because volition is shaded by gender norms. Men might physically have the power to leave, but they are compelled to stay. Women may have the idea of rape in their heads, which can make them wonder whether all men have the potential to “snap.”

What has the pandemic meant for sex?

Even before the pandemic, we were seeing what has been called a sexual recession. The age of virginity loss has been going up. And the number of people who had no sex in the last year is also up. COVID has been hard on mental health and wellbeing. And we know people who are depressed are less likely to have sex. Some people have gotten creative by trying phone sex, for example. There was a big uptick in pornography search terms around “masks” and sex. And the use of pornography generally continues to grow. From a standpoint of preventing STIs and unwanted pregnancies, less sex is a good thing. But prevention isn’t everything. Sex is important to people. It’s correlated with mental health, well-being, family, community. Not everyone has to have sex—there is nothing wrong with being asexual—but for many people, sexual health and pleasure are important parts of life.

How should public health think about sexual pleasure?

We need to recognize that pleasure is key to healthy sex. And understanding what makes sex good is important to preventing unwanted or unsafe sex. In clinical settings too, sexual pleasure is often ignored. Or it’s framed as sexual dysfunction—usually when a man needs a prescription for Viagra or a postpartum woman is encouraged to use more lubricant. Doctors aren’t trained to talk to their patients about sexuality and sexual pleasure. There are now frameworks like the “Pleasuremeter,” which help clinicians assess the physical and psychological dimensions of pleasure—and to address any needs the patient may have.

What is next on your research agenda?

I’m interested in studying shifting patterns around sexual identity and behavior—especially among people who are bisexual. I’d like to look at bisexual people who are impacted by structural stigma and how this impacts their sexual behaviors. I’m very interested in gender inequality and health. Finally, there is a huge need for more research on sexual pleasure.