7 THE INTERSECTIONS BETWEEN TOURISM, SEX, AND HEALTH – Contributions by Liza Berdychevsky
I have been studying the intersections between sex, tourism, leisure, health, and well-being for over fifteen years, and there has never been a dull moment. What an exciting journey that I would not trade for any other! The transdisciplinary nature of my work has offered numerous rewarding opportunities to collaborate with scholars from other fields and disciplines, including tourism and leisure studies, public health, sexuality studies, human development, family studies, gender studies, gerontology, communication, sociology, criminology, and technology/computer sciences. Nevertheless, my tourism and leisure colleagues have often asked me, especially at the beginning of my research journey, “Liza, why sex? Why haven’t you chosen to study another safer/relevant/appropriate/conventional topic?” Some seemed to pose this question with a genuine curiosity regarding the source of my motivation, which is when I dived into an in-depth discussion of the importance, innovation, impacts, and translational capacity of studying sex and its links to tourism, leisure, and health. Others appeared to ask the question in such a sniggering tone that made it evident that they view sex as beneath the dignity of any respectful academic discourse, in which case there was no point in continuing the conversation.
So, indeed, why study sex in tourism? First, sex and tourism have historically dovetailed each other in societal imagination, and various tourist experiences are overtly and covertly marketed as characterized by the supremacy of senses and expectations of sexual intimacy and escapades (Bauer & McKercher, 2003; Carter & Clift, 2000; Berdychevsky, 2016; Oguz Kiper & Ulema, 2021). Second, evidence shows that tourism contributes to the geographical expansion of sexually transmitted infections (Brown, Ellard, Mooney-Somers, Prestage, Crawford & Langdon, 2014; Qvarnström & Oscarsson, 2014; Vivancos, Abubakar, & Hunter, 2010). Third, studies have demonstrated that many kinds of tourist experiences offer a unique social reality that affects people’s sexual behavior by offering perceived anonymity, diminishing sexual inhibitions, and encouraging sexual adventurousness and risk taking (cf. Berdychevsky, 2016; Eiser & Ford, 1995; Milhausen, Graham, Crosby, Ingram, Tetro, Bransfield & Yarber, 2020; Ragsdale, Difranceisco & Pinkerton, 2006; Thomas, 2005). Fourth, tourists’ sexual experimentation often has short- and long-term positive and negative impacts on their health, well-being, and identity (Berdychevsky & Gibson, 2015a, Berdychevsky, Gibson, & Poria, 2013; 2015). Thus, it is essential to develop evidence-based, comprehensive, and context-specific sexual health education programs explicitly targeting tourists (Bauer, 2009; Berdychevsky, 2017a;b, in press|c; Matteelli & Capone, 2016; Tanton, Johnson, Macdowall, Datta, Clifton, Field & Mercer , 2016). Finally, one of the primary foci of the relatively small amount of scholarship on sex in tourism has been on commercial sex tourism, which overshadowed the complexity and importance of sexual expression in tourism devoid of financial transaction and contributed to the narrow “tunnel vision” of the intersections between sex and tourism (Berdychevsky & Carr, in press; Berdychevsky, Poria, & Uriely, 2013a; McKercher & Bauer, 2003).
Despite the above reasons for and benefits of studying sex in tourism, it has been a severely understudied area of research relative to the central roles of sex in various tourist experiences (Berdychevsky & Carr, in press; Carr & Poria, 2010). This might be the case due to the social norms and values mitigating against open and honest discussions of sex in general and in academia in particular (Berdychevsky, 2018; Carr, 2016), which is hypocritical (to say the least) in a Western society saturated by the public displays of sex (Attwood & Smith, 2013; Berdychevsky & Carr, 2020a; Lucas & Fox, 2019). Studying sex also presents numerous methodological challenges revolving around institutional approvals (i.e., increased scrutiny by the institutional review boards/ethics boards), access, safety, privacy, confidentiality, social desirability, reactivity, measurement, validity, generalizability, and reflexivity (Berdychevsky, 2021; Berdychevsky & Gibson, 2015b). Another limitation is the fact that the limited available knowledge on sex, tourism, and travel is scattered across the sibling fields of tourism, leisure, and sexual travel medicine, and the silo mentality prevents effective cross-pollination and advancement of this body of knowledge (Berdychevsky, 2018). Also, sex in tourism falls in the category of risky research that can be more challenging to publish in tourism journals. Consequently, junior scholars are often advised to refrain from or postpone risky research to have a smooth(er) sale through the hoops of promotion and tenure (Berdychevsky, 2021; Hammond & Kingston, 2014; Williams, Prior, & Thomas, 2021). These challenges discourage academics from exploring sex in tourism as a legitimate research topic and interfere with developing this valuable body of knowledge.
Another tendency that I have noticed is that many colleagues in our field find it easier to appreciate the value of research that treats sex as an issue to be fixed. Indeed, as a field, we gravitate towards the socially defined righteous topics (such as eliminating commercial sex tourism or mitigating tourism’s contribution to the spread of sexually transmitted infections across the globe), while sexual expression, pleasure, exploration, and transformation have gained very limited attention (Berdychevsky & Carr, 2020a, in press; Berdychevsky, Poria & Uriely, 2013b; Frohlick, 2010). Hence, my studies on sexual risk taking in tourism and sexual health education for tourists have been received with less resistance than studies investigating sex holistically to understand its roles in various tourist experiences. However, although some sexual behaviors in certain contexts can be risky and even criminal, which begs for effective health and criminal justice interventions, overall, sex is an integral and rewarding part of human nature that should be understood, appreciated, and celebrated (Berdychevsky & Carr, 2020a; Resnick, 2019). Failing to understand the roles of pleasure at the nexus of sex and tourism is shortsighted because “to ignore this reality is to fail to understand the position of sex in tourism” (Carr, 2016, p. 194). With these ideas in mind, my most concerted efforts to address the gaps in knowledge on sex in tourism are reflected in the edited book titled, “Sex in tourism: Exploring the light and the dark” (Carr & Berdychevsky, in press) and the special issue in Leisure Sciences titled, “Innovation and impact of sex as leisure in research and practice” (Berdychevsky & Carr, 2020b). In addition, I believe that my following thematically organized research contributions have shed some much-needed light on the under-researched phenomena at the nexus of sex, tourism, health and wellbeing, and sexual health education.
Women’s sexual behavior, surveillance, resistance, and technologies of the self in tourism
Sexual behavior and health comprise one of the areas where gender-specific research attention is particularly urgent due to the influence of sexual double standards that set divergent expectations and norms of sexual behavior for men and women (Hensman Kettrey, 2016). My research contributed to understanding the perceptions, feelings, meanings, and outcomes of women’s sexual behavior in tourism. It revealed that many women construe their tourist experiences as a liminoid realm, chora time-space, or heterotopia where they can explore, transform, and resist through sexual behavior with steady or casual sexual partner(s) (Berdychevsky, Gibson, & Poria, 2013; 2015). Within the liminoid space characterized by transition and a sense of being between and betwixt social orders (Turner, 1974), women can perform beyond the routine gender-biased norms and rules of appropriateness applied to sexual behavior. Within the chora tourism space allowing for creation, transformation, and exploration of multiple subjectivities (Wearing & Wearing, 1996), women can experiment with their sexual behavior and reconstruct their selves through alternative sexual comportment.
Within the post-structuralist view of tourism as heterotopia—a space functioning as a counter-site where daily social order is transgressed, contested, and inverted (Foucault, 1986), women can resist the gender-biased norms of appropriate sexual behavior, leading to feelings of control, maturity, challenge, growth, adventurousness, and empowerment. This resistance also contributes to the inversions of sexual roles (Foucault, 1984), manifesting themselves through the triplex of mind, language, and body (Berdychevsky et al., 2015). These inversions can be understood as technologies of the self that revolve around subjectification, care of the self, and challenging the injustice in the societal status quo (Foucault, 1988). Following the latter, technologies of the self-aim at self-transformation through resistance to the normalization and surveillance of the technologies of power (Foucault, 1976; 1977). Nevertheless, even anonymous tourism environments are not devoid of surveillance because even when women view social surveillance as reduced or vanished, the internalized social values—i.e., self-surveillance—still control their sexual behavior (Berdychevsky, Gibson, et al., 2013).
To conclude, it is crucial to appreciate the diversity of sexual expression in tourism and its complex meanings. Thus, my research has offered a taxonomy of women travelers’ non-commercial sexual behavior based on the nature of the changes in sexual behavior in tourism compared to everyday life (in terms of quantity, quality, and diversity); the kind of sexual partner involved; the associated motivations, perceptions, and meanings; the types of tourist experiences; and the impacts of sexual behavior on the overall satisfaction with the tourist experience (Berdychevsky et al., 2013b). This complexity was also translated into practical recommendations for various tourism and hospitality accommodations (e.g., hotel, bed and breakfast, hostel, backpacking lodge) regarding the design and management of their private and public spaces to maximize privacy, safety, and appropriate arousing atmosphere (Berdychevsky et al., 2013a).
Gender and sexual risk taking in tourism
Through my research of women’s sexual behavior in tourism, I have discovered that it often involves various forms of risk taking, with a plethora of positive and negative outcomes. I felt compelled to investigate it. Consequently, my research contributed a qualitative phenomenology of women’s sexual risk taking in tourism, revealing it as a complex and multifaceted phenomenon (Berdychevsky, 2016; Berdychevsky & Gibson, 2015a). Its phenomenological textures (i.e., noema—the “what” of the phenomenon) include physical, sexual health, social, emotional, mental/self-perceptional, and cultural and legal aspects (Berdychevsky & Gibson, 2015a). Physical textures revolved around physical and sexual violence and the prospect of abduction, while sexual health textures involved sexually transmitted infections and unwanted pregnancy. Social textures incorporated a damaged reputation and feeling judged or embarrassed, while mental/self-perceptional textures spanned the violations of personal values and resultant feelings of discomfort and self-rejection. Finally, the cultural and legal textures were comprised of the language barriers, fear of offending local cultural norms, and legal issues with obtaining justice in case of violence. The phenomenological structures (i.e., noesis—the “how” and the “why” of women’s sexual risk taking in tourism) were classified into socio-personal and touristic antecedent determinant factors (Berdychevsky, 2016). The socio-personal structures include definitions of sex and the influences of sexual attitudes, sexual double standards, and age/life stage. The touristic structures encompass a sense of perceived anonymity, temporariness/ephemerality, and fun-oriented mentality depending on length, destination, and type of tourist experience. While the socio-personal structures emphasize the cross-pollination between sex-related views in everyday life and tourism, the touristic structures highlight the uniqueness of tourist experiences as contexts for sexual risk taking (Berdychevsky, 2016).
To generalize and conceptualize these phenomenological findings, I have studied them quantitatively (N = 853) and used a combination of the sensation-seeking theory (Zuckerman, 2007) and the tripartite model of context, likelihood, and consequences for understanding risk in tourism (Ryan, 2003) as a theoretical framework. Quantitative results also presented women’s perceptions of sexual risk taking in tourism as a multidimensional construct with physical/sexual health, mental/emotional, and socio-cultural factors, whereas women’s perceptions of the first two factors varied based on their sensation-seeking propensity (Berdychevsky & Gibson, 2015c). Also, framed by the tripartite model of context, likelihood, and consequences, I have (1) identified the characteristics of the ultimate tourism contexts for sexual risk taking (in terms of the types of tourist experiences, average length, traveling companion(s), and destination); (2) examined the increased likelihood and actual frequency of sexual risk taking in tourism; and (3) classified the expected consequences into three motivational/reward factors of anonymous experimentation, safe thrills and empowerment, and fun and less inhibition (Berdychevsky & Gibson, 2015b). Finally, in this research, I have developed and validated a measurement scale for sexual risk taking in tourism to serve as an instrument for scholars and practitioners working at the nexus of sex, health, and tourism (Berdychevsky & Gibson, 2015c).
At this point, I felt it was time to examine the under-researched men’s non-commercial sexual risk taking in tourism and conduct gender comparisons of sex-related attitudes, perceptions, and behaviors. To this end, I have investigated gender differences and similarities in the sex definitions and perceptions of and experiences with sex and sexual risk taking in tourism (N = 1,278; Berdychevsky, in press|a). I have found that while both genders gravitate toward narrow(er) intercourse-focused definition of sex in tourism, men still had somewhat broader definitions than women. Also, women have consistently rated all 25 proposed sexually risky activities in tourism as significantly riskier than men, and significantly higher numbers of men have experienced all the risky activities in tourism compared to women. The most frequently reported sexually risky experiences in tourism included having sex under the influence of alcohol, having sex in unfamiliar surroundings, having casual vaginal sex, having sex in semi-public spaces, having unprotected sex with a steady partner, attending strip clubs, and having casual oral sex (Berdychevsky, in press|a). While this is a start, I will continue interrogating the roles of gender at the intersection of sex and tourism.
Sexual health education for tourists
Through my research, I aspire to contribute to both theory and practice. Having accumulated substantial insights into sexual behavior and risk taking in tourism, I felt it was time to translate and put this knowledge to work by providing direct input into the development of sexual health education for tourists. The time is ripe because while people welcome the idea of sexual health education for tourists (Berdychevsky, 2017a; Qvarnström & Oscarsson, 2014), existing sexual health education options are scarce, unsatisfactory, and severely under-researched and poorly understood (Berdychevsky, in press|b; Matteelli & Capone, 2016; Tanton et al., 2016). To address this gap, I have conducted a sequential mixed-methods qualitative-to-quantitative study exploring the importance of sexual health education for tourists and examining the characteristics of successful sexual health messages (Berdychevsky, 2017a; b).
The findings emphasize the necessity for innovative sexual health education for tourists and offer specific recommendations for its design. First, this education needs to focus on encouraging agency and responsibility while informing decisions about safer sex instead of condemning it. Namely, it should adopt comprehensive harm reduction and health promotion approaches (Bridges & Hauser, 2014; Johnson, 2014) instead of the abstinence-only approach. Second, it is essential to develop tourism-focused, gender-sensitive, age-specific messages. This complexity can be accommodated by adopting targeted health communications methods intended for specific segments of the general population. Third, the results suggest varying messages’ foci on risks vs. benefits, which can be achieved through framing health messages. Framing motivates behavioral change by modelling loss-framed (e.g., highlighting risks of sexual risk taking) and gain-framed messages (e.g., focusing on the benefits of responsible choices; Gallagher & Updegraff, 2012; Gerend & Shepherd, 2016).
Finally, the study recommends individualizing messages based on risk perceptions and motivations. This can be achieved by adopting a tailoring approach where tailored health communications are designed for individuals based on their personal determinants of risk, psychological antecedents of altering risky behavior, and the setting for implementing the intervention (Noar & Harrington, 2016). To provide input into the antecedent determinants driving the tailoring algorithm, I have identified clusters of sexual risk takers based on their risk perceptions and motivations (i.e., (1) diversely motivated broad risk perceivers; (2) fun-seeking broad risk perceivers; (3) diversely motivated physical risk perceivers; (4) anonymity- and empowerment-seeking risk disregarders; and (5) unmotivated broad risk perceivers) and profiled them in terms of women’s intentions to engage in sexual risk taking in tourism, sensation-seeking propensities, perceptions of tourist characteristics, levels of sexual experience, and demographic backgrounds (Berdychevsky, 2017b). This contribution is important because messages tailored to tourists’ perceptions and needs could approximate interpersonal counselling and be delivered using innovative and low-cost computer-tailoring technologies (Berdychevsky, 2017a; in press|c). Further, my contributions in sexual health education for tourists are still unfolding. I am working on implementing the social-ecological ecosystems model to identifying additional characteristics of high-risk groups, honing the content of health messages, developing the tailoring algorithm, finding the optimal timing and delivery modes, assessing tourists’ and organizations’ willingness to adopt innovative computerized delivery methods, and identifying stakeholders (e.g., tourism industry, healthcare systems in tourist-sending and receiving countries, communities, non-profit organizations) who should be in charge of developing, delivering, and assessing the effectiveness of sexual health education for tourists (Berdychevsky, in press|c).
Social-ecological model of sex in tourism
To provide a comprehensive understanding of sex in tourism and to guide research and practice in the area, I have developed a holistic social-ecological model of sex in tourism that draws evidence from my research and relevant literature (see Figure 1, reprinted with permission from Berdychevsky, in press|b; Berdychevsky & Carr, in press). The model encompasses both non-commercial and commercial sexual behavior and a plethora of positive and negative consequences of sexual expression among tourists and locals, analyzed alongside the light-dark continuum. The model is grounded in the ecological systems developmental theory grasping a complex interplay between individual, interpersonal, community, societal, and global factors affecting human behavior, attitudes, and values (Bronfenbrenner, 1979; 1989). This nuanced approach allows to grasp the complex interplay across multiple micro-level and macro-level factors and stakeholders involved in or affected by the sex and the sexual in tourism (Berdychevsky, in press|b).
The individual social-ecological level includes biological factors and personal knowledge, attitudes, values, skills, and sexual histories. On the light side of the individual level of sex in tourism, we can locate liberated expression, pleasure, increased skills, agency, empowerment, and contributions to sexual wellbeing. Conversely, we can find humiliation, fear, powerlessness, self-rejection, and sexual health issues on the dark side. The interpersonal social-ecological level focuses on the relationships between sexual partners and their immediate social networks.
On the light side of the interpersonal social-ecological level of sex in tourism, we can identify fulfilling and safe sexual relationships among consenting adults (both tourists and locals). On the dark side, we can observe sexual encounters characterized by coercion, exploitation, victimization, and severe power imbalances. The community social-ecological level contains the tourist-receiving community characteristics and resources that might influence or be affected by sex in tourism. On the light side of the community level of sex in tourism, sex in tourism can have positive impacts by raising awareness of pressing sexual issues and contributing to the improvement and modernization of local services, educational programs, and policies. However, on the dark side, sex in tourism can exacerbate illegal prostitution, crime, and community degradation and lead to locals’ hostility toward tourists. The societal/country social-ecological level encompasses destination image, sexual rights, and norms in tourist-sending and receiving countries and their impacts on the policies, laws, and available healthcare services. On the light side of the societal/country level of sex in tourism, we can note contributions to equal sexual rights, progressive legal and policy reforms, and cosmopolitan destination images. On the dark side, we can detect the reproduction of power imbalances, corruption, discriminatory laws, and a destination image of the ‘world’s brothel.’ The global social-ecological level incorporates international relationships and organizations, politics, economics, legal issues, and technological advances relevant to sex in tourism. On the light side of the global social-ecological level of sex in tourism, we can recognize improvements in corporate responsibility in the tourism industry and the establishment of international advocacy organizations focusing on sexual rights. On the dark side, sex in tourism contributes to the global spread of sexually transmitted infections, propagates transnational human trafficking, and proliferates the global child sex economy.
It is important to highlight that the impacts of sex in tourism cut across the social-ecological levels. First, at the micro-level, individual and interpersonal sexual dynamics are inextricably intertwined. Second, the aggregated micro-level influences produce ripple effects at the macro-levels of community, country/society, and the globe. In turn, norms, policies, laws, and supply and demand factors from the macro-levels produce conditions that facilitate or inhibit various kinds of sexual behavior at the micro-levels. Thus, the social-ecological sex in tourism model offers a holistic and nuanced analytical prism for future analyses of the complexity and diversity of sexual expression in tourism, thereby contributing to knowledge and practice.
To conclude, sex and tourism will continue being cozy bedfellows whether academia and the tourism industry admit it or not. The arguments and the evidence presented above demonstrate the significance, innovation, and translational capacity of studying sex in tourism as well as the avenues for tourism researchers to connect their scholarship to public health, sexology, criminal justice, and other research areas to overcome the isolation from other disciplines. We cannot trivialize the meaningful and complex links between sex and tourism because they have significant consequences for people, communities, tourist-sending and receiving countries, and the tourism industry. It is crucial to promote cutting-edge, state-of-the-art research at the nexus of sex and tourism to inform the relevant body of knowledge, education, practice, policy, and advocacy to help various stakeholders understand, study, forecast, develop, and manage with respect to sex in tourism.
Written by Liza Berdychevsky, University of Illinois at Urbana-Champaign, United States
Read Liza’s letter to future generations of tourism researchers
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