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La santé sexuelle, genèse et usages d’un concept. Étude d’épistémologie historique, XIXe – XXIe siècles

Abstract : The concept of sexual health was institutionalized by the World Health Organization (WHO) in the 1970s, when controversies between psychoanalysis and cognitive-behaviourism were growing. The new working definition proposed by the WHO in the early 2000s endorsed the cognitive-behavioural approach articulated to utilitarianism, by firmly embedding it in the continuation of its concept of health as a state of well-being. This concept thus combines an epistemological dimension with a moral and social dimension.This research work aims to shed light on the contemporary uses of the concept of sexual health by tracing its genesis, which far precedes its institutionalization by the WHO. We thus go back to its first occurrences in the first half of the 19th century, when health refers mainly to the absence of disease.We adopt a method of historical epistemology, with work on the texts of the time in the Anglo-American medical field and in the field of medicine on the European continent. While it is common to question the concepts of the medical and health fields, particularly those related to sexuality, from a social perspective that highlights their normative and biopower dimensions, this work aims to study the concept of sexual health by conducting an internal analysis of the fields in which the concept has been forged and deployed. Without contesting the relevance of the socio-political approach, the methodological choice that acknowledges its internal rationality makes it possible to better emphasize what can be irreducibly normative in the concept of sexual health.The latter is therefore analysed according to the scientific model in which it emerges, namely vitalist hygienist physiology. This genesis will shape its history until today, while a sexology that makes it its object, and a mechanistic sexual medicine that also refers to it, are in opposition. The history of biological epistemologies sheds light not only on the genesis and uses of the concept of sexual health, but also on its relationship to the field of sexual pathology. The opposition of epistemological models results in different, if not adverse, therapeutic approaches to the conception and treatment of sexual problems. According to the WHO, sexual health is not reduced to the absence of sexual diseases, but is holistic and aims to cover the mental and social aspects as well, in a preventive and educational approach in the area of public health. This last point also underlines the ethical burden, from a eudemonic perspective, conferred on it by its hygienic uses since the 19th century.This work thus allows at the same time: 1) to place the concept of sexual health in a longer history than that which usually begins after the Second World War; 2) to enrich the historiography of sexology, for which the concept of sexual health has become major in the 21st century; 3) to question the history of sexuality as developed by Michel Foucault; 4) to shed light on the relationships between the normal and the pathological that are at stake in the concept of sexual health and in the controversies between psychodynamics and cognitive-behaviourism; 5) to examine the idea that contemporary uses of this concept would contribute to the medicalization of sexuality.
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David Simard. La santé sexuelle, genèse et usages d’un concept. Étude d’épistémologie historique, XIXe – XXIe siècles. Philosophie. Université Paris-Est, 2019. Français. ⟨NNT : 2019PESC0102⟩. ⟨tel-02471065⟩

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