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What is Sexual Health?

In today’s society with a barrage of pornography, sexually explicit language both on the television and in music; multiply that with the social media over consuming our culture, it’s no wonder people cannot define what a healthy sexual relationship is. The following is a brief outline of some ideas to start conversations with your partner. At the end of this there is a short questionnaire that will stimulate more reflection around your sexuality.

What is healthy sexuality?

  • Healthy sexuality involves recognizing that we are all sexual beings, and celebrating the ways that our sexuality benefits us physically, emotionally, and spiritually.

  • Healthy sexuality is positive and enriches our lives. Healthy sexuality allows us to enjoy and control our sexual and reproductive behavior without guilt, fear or shame.

  • Sexual expression is a form of communication through which we give and receive pleasure and emotion. It has a wide range of possibilities - from sharing fun activities, feelings and thoughts, warm touch or hugs, to physical intimacy. It is expressed both individually and in relationships throughout life.

The healthy sex “CERTS” model

This model requires that the following conditions be met for a person to enjoy healthy & satisfying sex: Consent, Equality, Respect, Trust, and Safety.

CONSENT means you can freely and comfortably choose whether or not to engage in sexual activity. You are able to stop the activity at any time during the sexual contact. It also means that you respect when someone else does not want to engage in a particular activity, for any reason.

EQUALITY means your sense of personal power is on an equal level with your partner. Neither of you dominates the other.

RESPECT means you have positive regard for yourself and for your partner. You feel respected by your partner and you respect them.

TRUST means you trust your partner on both a physical and emotional level. You have mutual acceptance of vulnerability and an ability to respond to it with sensitivity.

SAFETY means you feel secure and safe within the sexual setting. You are comfortable with and assertive about where, when and how the sexual activity takes place. You feel safe from the possibility of harm, such as unwanted pregnancy, sexually transmitted infection, and physical injury.

It takes spending time together and engaging in lots of honest, open communication to make sure that the CERTS conditions are operating in your relationship. That's why it is helpful to allow all aspects of a relationship to grow and develop at a consistent pace with physical intimacy.

Meeting the CERTS conditions does not ensure that you'll have amazing sex, but it can help you feel more secure in your relationship and increase your level of self-esteem.

Practice good communication

  • Good communication is crucial to healthy sex. You can greatly increase feelings of mutual respect, emotional closeness, and sexual pleasure when you and your partner know how to communicate well with each other. Knowing how to talk openly and comfortably can help you solve sexual problems that come up from time to time in the normal course of an on-going intimate relationship.

  • Be patient with yourself and your partner as you work to develop new communication skills. It takes time and a lot of practice to open up emotionally and discuss personal topics in safe and sensitive ways.

Strengthen trust

  • Trust is an important quality in healthy sex. It helps us feel emotionally safe and secure about choosing to remain in an intimate relationship with our partner. Without trust, we’re likely to feel increased amounts of anxiety, fear, disappointment and betrayal.

  • Trust grows when both people in the relationship act responsibly and follow-through with commitments. While no one can guarantee that any relationship will last and remain satisfying for both people, you can strengthen mutual trust by having clear understandings about what you expect from each other in the relationship.

  • Spend time with your partner discussing what you need and expect in the relationship for you to feel emotionally safe. Based on your discussion, create a list of understandings you will both agree to honor. You may want to formalize your list into an actual “contract” you will follow.

What is a Healthy Sex Life?

It’s normal to have questions about your sex life. Your doctor, nurse or midwife can help.

Every woman is sexual in her own way. What makes you feel good – how much desire you feel, and how often, or what type of activities you enjoy – will be different for everyone.

It’s common to have questions about whether your sex life is normal, but it can be hard to talk about. Surveys show that up to half of all women have concerns about their sexual health; however, many are too embarrassed or uneasy to bring the subject up with their doctors, nurses or midwives.

This brochure can help you understand some of the things that may affect your sex life and where you can find help.

Many factors can affect your sexual health

It’s normal for sexual activity and habits to change throughout your life. There are many factors which influence how you feel, both mentally and physically:

Your personality

  • Your religious beliefs

  • Your social and cultural background

  • Your physical health, including changes such as puberty, pregnancy and menopause

  • Your mental health and stress

  • Your relationship with your partner

  • The health of your partner

  • Your living situation

Change isn’t necessarily bad

What used to be normal for you may change as you age or start a new phase of life. For example, many women notice that their desire for sex changes, or that they have sex less frequently, as they get older. This isn’t necessarily a bad thing: decreased desire or frequency doesn’t always mean decreased satisfaction. If you are still enjoying your sexual activity, it’s okay that it’s different.

What if I’m not happy?

If a decrease in desire or frequency – or whatever type of change you are experiencing – is distressing, you might be experiencing sexual dysfunction. Your health-care provider can help.

Sexual dysfunction is a term that refers to a wide array of conditions or issues that might be negatively affecting your sexual health and activity.

What can cause sexual dysfunction?

Causes of sexual problems vary from person to person — What is a problem for one person might be okay for another. It’s only a concern if it is causing distress for you. Magazine articles and TV shows can sometimes lead us to believe otherwise, but sexual health is a very individual thing and you must be guided by your own feelings. If you are bothered by an issue related to your sex life, it is important to consider the following types of factors:

Biological causes

Healthy sexuality depends on your body: nerves, hormones and blood flow must all function properly. Problems with any of these can lead to dysfunction. For example, side­effects from medication may be associated with up to 25 per cent of sexual concerns. Pelvic surgery may have a direct or indirect effect on sexual health. There are also certain conditions which can cause pain during sex (such as dyspareunia and vaginismus). Some medical illnesses can affect sexual function, such as cardiovascular disease, diabetes and thyroid disorders. The menopause transition often has an impact on your sexuality.

Psychological causes

There are many lifestyle and health issues that may affect a people's level of interest in sex. Past sexual trauma, a mood disorder, stress, fatigue and medication can have an impact on your desire. Treatment of depression often contributes to decreased desire, especially if certain kinds of medication are prescribed.

Relationship factors

The level of intimacy, your partner’s sexual interest and function, as well as your partner’s physical and mental health, can have an impact on your sexual interest and function.

Social and cultural causes

Cultural and religious attitudes may affect a person's sense of their sexual self and the meaning they attaches to being sexual.

Is it normal not to want to have sex?

When a person loses sexual desire entirely, it is sometimes diagnosed as hypoactivesexual desire disorder. Generally, low sexual desire, low arousal, and orgasmic difficulties are more likely to happen amongst postmenopausal women. If low desire is causing stress for you or your partner, the next step is to talk to your doctor, nurse or midwife about what might be causing the problem.

Here are some questions to think about if you are concerned about your sexual health:

  • In the past, was your level of sexual desire or function good and satisfying to you?

  • Has there been a decrease in your level of sexual desire or function?

  • Are you bothered by your decreased level of sexual desire or function?

  • Would you like your level of sexual desire or function to increase?

  • Do you feel like any of these factors might be contributing to your current decrease in sexual desire or function:

  • An operation, depression, injuries, or other medical condition

  • Drugs, alcohol or medication you are currently taking

  • Pregnancy, recent childbirth, menopausal symptoms

  • Other sexual issues you may be having (pain, decreased arousal or orgasm)

  • Your partner’s sexual desire or function

  • Dissatisfaction with your relationship or partner

  • Stress or fatigue

How to talk to your doctor about your sex life

Bringing up sexual health issues with your doctor, nurse or midwife can feel awkward. Sometimes the first step occurs when a person is having an annual check-up or other medical appointment. Your care provider may ask you a general question about your sexual health to open the door for you to ask questions or raise concerns.

You can take this brochure to your appointment to help you discuss concerns with your health-care provider.

What sexual situation or behavior do I need to stop and think about?

Put a check mark next to this specific sexual situation that you need to evaluate.

_____ Increase ability to sexual function.

_____ Change level of sexual interest, desire, or arousal.

_____ Experience a specific sexual turn-on, perform a specific sex act or an unusual or kinky sex act.

_____ Express feelings of love, affection, and commitment express love to a partner or to receive expressions of love from a partner.

Stop and think how often these sexual situations or behaviors was linked with using drugs or alcohol before recovery. Circle a number that matches your thoughts.

0 - 1 - 2 - 3 - 4 - 5 - 6 - 7 - 8 - 9 - 10

Never Always

Dr. Ryan Westrum is a Sex Therapist in Minneapolis Minnesota. He specializes in Sexual Addiction, Pornography Addiction and the spectrum of sexual health. You can contact him at 952-261-5269 or

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