Healthy Sexual Relationships

• Introduction to healthy sexual relationships
• What is a healthy sexual relationship?
• What makes a sexual relationship unhealthy?
  • Physical health risks in sexual relationships
  • Psychological health risks in sexual relationships
• Common sexual difficulties
• How lifestyle affects your sexual relationships
• Tips for building a healthy sexual relationship

Introduction

Having a healthy sex life and relationship are important parts of your overall health and wellbeing. The majority of adults experience sexual difficulties or health problems at some point. Sexually transmitted infections (including human immunodeficiency virus or HIV) and unwanted pregnancy are the most common sexual threats to physical health. There are also a range of emotional factors which can affect your sexual health and the health of your sexual relationship.

Most societies hold expectations about when, how often and with whom individuals should have sex (e.g. heterosexual vs homosexual, and casual vs steady relationships). These expectations generally vary considerably from individuals’ sexual practices, desires and experiences, leading many to believe that what they want or do in a sexual relationship is abnormal or unhealthy.

What is a healthy sexual relationship?

According to the World Health Organisation, "sexual health is a state of physical, emotional, mental and social wellbeing in relation to sexuality; it is not merely the absence of disease, dysfunction or infirmity."

A healthy sexual relationship, therefore, is one in which the individuals involved are physically and psychologically content with the frequency and nature of sexual encounters. A healthy sexual relationship should involve protection against STIs and unwanted pregnancy (e.g. through condom use), be free of coercion, sexual assault, rape, discrimination, violence and pain. All individuals involved should be aware of their rights to stop sexual encounters at any time and feel confident to discuss and initiate sexual activities as they desire. Healthy sexual relationships may involve periods of abstinence, when sex is not desired or when the desired sexual partner is not available.

In terms of the types and frequency of sexual engagement, however, there is no recipe for a healthy sexual relationship. Peoples’ sexual desires, perspectives and histories vary considerably. What is positive and healthy in one relationship may have negative health impacts in another.

Australians engage in a wide variety of sexual behaviours in addition to penetrative. A study of the sexual practices of over 20,000 adult Australian men and women found that:

• 65% of men and 35% of women had masturbated in the four weeks prior to being interviewed, and 12% and 14% respectively had used a sex toy
• 37% of men and 16% ofwomen watched X-rated movies
• 17%of men and 2% ofwomen visited internet sex sites (on purpose!)
• 17% of men and 14% of women engaged in anal stimulation
• Nearly 10% of women and over 5% of men reported a homosexual experience
• Around 4% of men and women reported engaging in roleplay, 2% in bondage and 4.5% in anal-oral stimulation.

Clearly there is no normal set of sexual behaviours in Australia and all of the sexual practices listed above are healthy, as long as the individuals involved feel comfortable with them.

What makes a sexual relationship unhealthy?

Physical health risks in sexual relationships

All sexual relationships involve the risk of unwanted pregnancy and STI.While condoms and other contraceptives mean both these threats can be avoided, they are still common in Australian society. Around 20% of Australian men and 17% of Australia women who participated in the Australian Study of Health and Relationships (ASHR) reported having had an STI at some point in their life. More than 2% of men and women reported anSTI in the year prior to the survey. Many Australians do not have a good knowledge of how STIs are transmitted, or the health consequences of them.

While the use of hormonal contraceptives in Australia is high (around 95% of sexually active, fertile women use them), over 20% of women surveyed reported terminating one or more pregnancies in their life.The proportion of Australians using condoms in steady relationships (7.1% and 22.5% respectively for cohabiting and noncohabiting relationships) and casual encounters (41.4%) remains low. Amongst heterosexuals, condoms are usually used to prevent pregnancy rather than STI.

Sexual relationships that involved physical violence, sexual coercion and/or rape are also unhealthy. Unfortunately violence, sexual coercion and rape are common in Australia. Because many people do not report to the police when someone they love abuses them sexually or physically, it is impossible to say exactly how many people have experienced this type of treatment. In the ASHR, one in five women and one in twenty men reported that they had been coerced to have sex. If you are in a relationship where your partner hurts you physically, makes threats or forces you to have sex, talk to a health professional so that you can find support to leave or improve the relationship. Your doctor will be able to refer you to an appropriate specialist.

Psychological health risks in sexual relationships

Psychological factors influence the way an individual feels about their sexual relationships. In every society, particular sexual behaviours are considered more and less acceptable, and those who engage in socially less acceptable (but nonetheless common) sexual practices may experience guilt or discrimination as a result. Sexual relationships generally involve strong positive emotions (e.g. love), but many relationships also involve negative emotional aspects. Physical violence, coercion to engage in sex, and rape have longterm psychological impacts. People who have been sexually abused on average report more sexual difficulties than those that have not been.You should be aware of your right to say no to unwanted sexual encounters (whether or not they involve penetrative sex, touching, kissing or other behaviours), as well as your right to engage in sexual practices you desire (as long as these don’t violate the sexual rights of others).

Common sexual difficulties

Sexual difficulties are extremely common amongst Australian men and women and are often associated with psychological factors (e.g. women who report dissatisfaction with relationships can also be more likely to report difficulty achieving adequate vaginal lubrication). The ASHR noted thatthe majority of women (70%) and around a quarter of men reported a lack of sexual desire, and significant proportions of both sexes experienced sexual difficulties at some point in the year before the survey took place.

Considerable proportions of women reported experiencing lack of interest in sex (54.8%), lack of sexual enjoyment (27.3%), feeling selfconscious of their body while having sex (35.9%), performance anxiety (17%), being unable to reach orgasm (28.6%), pain during sex (20.3%) and problems with vaginal lubrication (23.9%). Physical pain, selfconsciousness of body and performance anxiety were more common amongst younger women, while the lack of interest and desire to have sex and inability to orgasm and lubricate were reported by more older women.

A significant proportion of men also reported lack of interest in sex (24.9%). Other common sexual difficulties for men included erectile disorder (9.5%), being unable to orgasm (6.3%), premature ejaculation (23.8%), performance anxiety (16%), not finding sex pleasurable (5.6%) and selfconsciousness about their bodies (14.2%). Men under 20 were more likely to report performance anxiety or selfconsciousness than their older counterpart; the likelihood of other sexual difficulties in men increased with age.

Importantly, sexual difficulties experienced by your partner can have a negative impact on your sexual function.While studies are limited, it has been shown that male sexual dysfunction can negatively impact the sexual function of female partners. A study comparing the sexual function of women with partners with erectile dysfunction to those without showed that sexual arousal, lubrication, orgasm, satisfaction, pain and total score were significantly lower in those who had partners with erectile dysfunction. Later in that study, a large proportion of the men with erectile dysfunction underwent treatment. Following treatment, sexual arousal, lubrication, orgasm, satisfaction and pain were all significantly increased. It was concluded that female sexual function is impacted by male erection status, which may improve following treatment of male sexual dysfunction.

How lifestyle affects your sexual relationships

Many things that you do every day will affect your sexual relationship (e.g. going to work, being pregnant, looking after children and drinking alcohol).Stress and anxiety reduce sexual desire and pleasure for men and women. Many people suffer from stress related to their work, their children or other aspects of their life (e.g. one-off events like a death in the family).

Having children has also been shown to influence sexuality. In the period immediately after childbirth, this is mainly related to hormonal changes in women. As children grow up, stress, fatigue and the responsibility of looking after kids all tend to reduce libido.

Drinking excessive amounts of alcohol also affects your sex life. After drinking alcohol, men are less likely to maintain an erection than when they have not consumed alcohol.

If you feel that your sexual relationship is unhealthy, perhaps you need to think, and talk to your partner about, how these lifestyle issues might affect you.

Tips for building a healthy sexual relationship

In order to be healthy, your sexual relationship must fulfill your sexual desires and those of your partner/s. While there is no recipe for a healthy relationship, these tips may help you improve or maintain the health of your relationship:

• Use contraceptives to protect against unwanted pregnancy.
• Use condoms to protect against STIs, especially if you have more than one sexual partner or have casual sexual partners.
• If you or your partner has trouble maintaining an erection, talk to a health professional about whether or not medication will help.
• If you or your partner has trouble with vaginal lubrication, try using a water-based lubricant, available over the counter at a pharmacy or supermarket.
• Remember that many physical sexual difficulties may be caused by psychological factors (e.g. if you have trouble lubricating or maintaining an erection, it may be due to dissatisfaction with your relationship or anxiety about sex, not a biological condition). See Sex Therapy for more information.
• Remember that a wide variety of sexual practices are normal, including homosexual behaviours, masturbation and use of visual sexual stimuli.Consider trying these in addition to, or instead of, what you currently do if you are not satisfied with your sexual relationship.
• Sex can also include intimate behaviour without genital contact (e.g. kissing and cuddling). This should be an important part of sexual relationships.
• Talk to your partner. Be open and honest about your desires and level of satisfaction and try not to be judgmental when your partner is discussing their desires.
• Talk to a health professional (e.g. a sex therapist, marriage counselor or psychologist) about aspects of your sexual relationship you would like to improve.
• Never use violence or other forms of intimidation to coerce a partner to engage in a particular sexual practice and be aware of your right to say no to sexual practices you are not comfortable with (even if you have done them before).

More information

For more information on erectile dysfunction and related treatments, see Erectile Dysfunction.

 

For more information on testosterone deficiency disorders and replacement therapy treatment, see Testosterone Deficiency.

 

References

1. Richters J, Grulich AE, de Visser RO, et al. Sex in Australia: Sexual difficulties in a representative sample of adults. Aust NZ J Public Health. 2003;27(2):164-70. [Abstract]
2. Defining sexual health: Report of a technical consultation on sexual health 28-31 January, 2002, Geneva [online]. Geneva: World Health Organization; December 2006 [cited 30 July 2008]. Available from: URL link
3. Richters J, Grulich AE, de Visser RO, et al. Sex in Australia: Autoerotic, esoteric and other sexual practices engaged in by a representative sample of adults. Aust NZ J Public Health. 2003;27(2):180-90. [Abstract]
4. de Visser RO, Smith AMA, Rissel CE, et al. Sex in Australia: Safer sex and condom use among a representative sample of adults. Aust NZ J Public Health. 2003;27(2):223-9. [Abstract]
5. de Visser RO, Smith AMA, Rissel CE, et al. Sex in Australia: Experiences of sexual coercion among a representative sample of adults. Aust N Z J Public Health. 2003;27(2):198-203. [Abstract]
6. Grulich AE, de Visser RO, Smith AMA, et al. Sex in Australia: Sexually transmissible infection and blood-borne virus history in a representative sample of adults. Aust NZ J Public Health. 2003;27(2):234-41. [Abstract]
7. Smith MA, Rissel CE, Richters J, et al. Sex in Australia: Reproductive experiences and reproductive health among a representative sample of women. Aust NZ J Public Health. 2003;27(2):204-9. [Abstract]
8. Grulich AE, de Visser RO, Smith AMA, et al. Sex in Australia: Knowledge about sexually transmissible infections and blood-borne viruses in a representative sample of adults. Aust NZ J Public Health. 2003;27(2):230-3. [Abstract]
9. Richters J, Grulich AE, de Visser RO, et al. Sex in Australia: Contraceptive practices among a representative sample of women. Aust NZ J Public Health. 2003;27(2):210-6. [Abstract]
10. DeJudicibus MA, McCabe MP. Psychological factors and the sexuality of pregnant and postpartum women. J Sex Res. 2002 May;39(2):94-103. [Abstract]
11. Slowinski J. Sexual problems and dysfunctions in men. In: Owens AF, Tepper M (eds). Sexual Health: State-of-the-art treatments and research (Volume 4). Westport, CT: Praeger Publishing; 2007. [Publisher]
12. Cayan S, Bozlu M, Canpolat B, Akbay E. The assessment of sexual functions in women with male partners complaining of erectile dysfunction: Does treatment of male sexual dysfunction improve female partner’s sexual functions? J Sex Marital Ther. 2004;30(5):333-41. [Abstract]