Parecer da Comissão Nacional Especializada de Sexologia da FEBRASGO e da Associação Brasileira de Estudos em Sexualidade Humana – SBRASH
A Comissão Nacional Especializada de Sexologia da Federação Brasileira das Associações de Ginecologia e Obstetrícia – FEBRASGO e a Associação Brasileira de Estudos em Sexualidade Humana – SBRASH tem sido solicitadas a opinar a respeito da Educação em Sexualidade nas escolas do ensino fundamental e médio. A ampla discussão dos membros da comissão da FEBRASGO e da diretoria da SBRASH compostas por médicos (ginecologistas e obstetras, psiquiatras e urologistas), psicóloga(o)s e educadores resultou neste parecer.
De acordo com a Organização Mundial de Saúde (OMS), a Educação em Sexualidade (ES) deve ser um processo educativo abrangente compreendendo conhecimentos, habilidades e valores que capacite os jovens a fazer escolhas conscientes e responsáveis sobre suas vivências sexuais. A ES oferece oportunidades para explorar e construir os próprios valores, comportamentos e atitudes, para adquirir habilidades de tomada de decisão, para ampliar a capacidade de comunicação e para reduzir os comportamentos de risco sexual e geral [1].
Portanto, a ES envolve, entre outros, oferecer aos adolescentes o conhecimento sobre o funcionamento do sistema reprodutor masculino e feminino, sobre o desenvolvimento do corpo e o aparecimento dos caracteres sexuais secundários, sobre os riscos para a saúde mental e geral da iniciação sexual precoce, sobre os riscos da gravidez na adolescência e prevenção da violência sexual (abuso sexual infantil e estupro). Além disso, a ES na escola visa oferecer treinamento aos pais sobre como informar seus filhos sobre sexualidade, e sobre as medidas mais efetivas para evitar a iniciação sexual precoce em meninas e meninos.
Também visa oferecer o treinamento dos professores para responder adequadamente ao questionamento dos alunos sobre sexualidade.
A sexualidade não é somente sexo, é uma dimensão central da vida que é vivenciada plenamente na adolescência, um período marcado pela impulsividade, experimentação e inquietude, e pela reduzida preocupação com os aspectos de prevenção [1]. Isso torna imperativa a integração da sexualidade no processo pedagógico do sistema escolar, a fim de complementar a atuação da família na construção da sexualidade do indivíduo. Nosso posicionamento encontra respaldo também, na Declaração Mundial dos Direitos Sexuais da World Association for Sexual Health [2] que considera que toda pessoa tem:
9. O direito à informação – […] acesso à informação cientificamente precisa e esclarecedora sobre sexualidade, saúde sexual, e direitos sexuais através de diversas fontes. Tal informação não deve ser arbitrariamente censurada, retida ou intencionalmente deturpada.10. O direito à educação e o direito à educação sexual esclarecedora – […]. A educação sexual esclarecedora deve ser adequada à idade, cientificamente acurada, culturalmente idônea, baseada nos direitos humanos, na equidade de gêneros e ter uma abordagem positiva quanto à sexualidade e o prazer.
Existem desafios na elaboração de programas de ES nas escolas para que sejam, de fato, efetivos [3, 4]. Nesta perspectiva, a UNESCO avaliou o impacto de programas de ES através da compilação de 87 estudos sobre a sua efetividade e concluiu que, a Educação em Sexualidade:
i) NÃO aumenta a atividade sexual na adolescência,ii) NÃO estimula o comportamento sexual de risco e,iii) NÃO aumenta risco para infecções sexualmente transmissíveis (IST).
Boa parte dos estudos evidencia que a ES contribui para postergar a iniciação sexual e reduzir o número de parceiros sexuais, sendo também efetiva para aumentar o uso de preservativos e de métodos contraceptivos [5]. Uma avaliação de custo-efetividade destes programas revelou uma economia de US$ 67.825 para os cofres públicos de um país europeu por individuo que deixou de contrair o HIV, devido aos programas de ES.
Em 2010, a UNESCO editou e divulgou para todos os países do mundo uma Orientação Técnica Internacional sobre Educação em Sexualidade, recomendando uma abordagem de temas relacionados à sexualidade na educação escolar, indicando diretrizes para a realização dessa tarefa com crianças a partir dos cinco anos de idade, adolescentes e adultos de todas as idades (Quadro 1) [5].
Quadro 1: Princípios da Educação em Sexualidade segundo a UNESCO 1
Para atingir o padrão estabelecido pela UNESCO, são necessárias ações conjuntas das áreas de Educação e Saúde, e envolve o treinamento dos pais e dos professores das escolas do ensino fundamental e médio, que podem sentir desconfortáveis ao ensinar temas da sexualidade. Os profissionais de saúde precisam deter o conhecimento científico sobre Sexualidade, e definir estratégias de ações pró educação sexual baseadas em evidência científica. Isso implica, que o material didático sobre Sexualidade, para as escolas, precisa ser analisado e validado por profissionais da Saúde e Educação em conjunto. E que estes profissionais sejam conhecedores dos resultados de pesquisas cientificas sobre o tema, e estejam alinhados com os princípios estabelecidos pela UNESCO, para a qualidade dos programas de Educação em Sexualidade (Quadro 1) [5].
O American College of Obstetricians and Gynecologists (ACOG) defende a participação dos Ginecologistas em programas de Educação em Sexualidade, pelo amplo acesso que este profissional tem a importantes aspectos da sexualidade da adolescente, e da saúde sexual dos casais [6]. No Brasil, a Sexologia é uma das áreas de atuação dos Ginecologistas e Obstetras (GO) e a Comissão Nacional Especializada em Sexologia da FEBRASGO é responsável por fornecer material didático baseado em evidência científica, e participar de programas que visem a Educação em Sexualidade e a assistência às pessoas com disfunções sexuais.
A FEBRASGO possibilita essa titulação mediante a realização de uma prova anual, que avalia o conhecimento em sexualidade adquirido pelo GO, durante a residência médica em Ginecologia e Obstetrícia, ou em programas equivalentes. Para se candidatar ao título de especialista em Sexologia, o médico precisa, antecipadamente, ter obtido o título de especialista em GO (TEGO).
A FEBRASGO, juntamente com a SBRASH, reconhece a necessidade da implantação da Educação em Sexualidade nas Escolas do Ensino Fundamental e Médio, com a finalidade de reduzir as taxas de violência sexual (abuso sexual e estupro), e para reduzir os comportamentos sexuais de risco na adolescência [1]. Os caminhos para uma sociedade sexualmente sadia requerem um trato do tema com seriedade, evidencia científica, e responsabilidade ética. Desta forma, os profissionais responsáveis pela Educação em Sexualidade nas escolas no Brasil, além do suporte legal dos Parâmetros Curriculares Nacionais (BRASIL, 1998) – precisam buscar capacitação junto às entidades especializadas em trabalhar com a Sexualidade Humana como a FEBRASGO e a SBRASH, e precisam ter o compromisso de empregar metodologia baseada em evidencia.
Referências
1. Lara LAS, Abdo CHN. Age at Time of Initial Sexual Intercourse and Health of Adolescent Girls. Journal of pediatric and adolescent gynecology 2016; 29: 417-23.
2. Health. WWAfS. Declaração dos Direitos Sexuais. . 2017 [cited 2018 12/10/2018]; Available from: http://www.worldsexology.org/wp-content/uploads/2013/08/DSR-Portugese.pdf
3. Keogh SC, Stillman M, Awusabo-Asare K et al. Challenges to implementing national comprehensive sexuality education curricula in low- and middle-income countries: Case studies of Ghana, Kenya, Peru and Guatemala. PloS one 2018; 13: e0200513.
4. de Haas B, Hutter I. Teachers’ conflicting cultural schemas of teaching comprehensive school-based sexuality education in Kampala, Uganda. Culture, health & sexuality 2018: 1-15.
5. UNESCO. EVALUATION OF SEXUALITY EDUCATION; Goal of Sexuality Education. Berlin: United Nations Education, Scientific and Cultural Organization; 2017.
6. Committee Opinion No. 678 Summary: Comprehensive Sexuality Education. Obstetrics and gynecology 2016; 128: 1196-7.
Comissão Nacional Especializada em Sexologia e Associação Brasileira de Estudos em Sexualidade Humana – SBRASH.
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