What is “healthy” Sex?
Trying to define what makes healthy sex can be a challenge, in part because how we think about sex is so deeply influenced by our cultural and social beliefs and positions. Your particular religious beliefs, for example, could suggest certain kinds of sex are good for you or bad for you. There is even some disagreement about what exactly counts as sex.
To try and get folks on the same page, the principles of sexual health have been articulated in a couple different ways.
Braun-Harvey & Vigorito, both experts in the field of sex therapy and education, list out the six principles they consider to be necessary in order for sex to be considered healthy:
1. Consent
This principle is about all members of the sexual encounter being able to provide their voluntary cooperation to what is happening in the encounter. Consent can also carry a legal dimension based on age of consent laws in different states and countries. The ability to give and retract consent throughout a sexual encounter, without fear of harm or retaliation, is necessary in order to safety to be established. Sometimes consent is negotiated verbally, other times there are non-verbal ways of establishing consent. However, when in doubt, it is recommended to ask your partner(s) to verify their enthusiastic consent whenever possible.
2. Non-exploitative
Exploitation refers to the use of power to influence someone in a way that is unfair or unkind in order to receive some kind of personal benefit. Manipulation, emotional blackmail, threats of harm, and gaslighting are all examples of exploitative behavior. Generally speaking, we exploit others when we create a situation that makes it harder (or impossible) for them to hold to their physical, emotional, or sexual boundaries. One way of helping to minimize the presence of exploitation is to communicate clearly with all partners and attempt to give as much information as possible so that everyone is able to make an informed decision.
3. Honest
Honest here refers to open and direct communication with oneself and with one’s partners about sex, gender, sexual experiences, sexual education, and relationship diversity. Honest does not mean that someone has to share all of the information about themselves whenever asked. It does mean that each partner is responsible for sharing enough information about themselves, their likes and dislikes, their physiological and psychological health, etc so that the goals of the sexual encounter can be met in ways that uphold the other principles of sexual health. For example, not being honest about one’s HIV status can limit potential partner’s ability to consent (because they are not able to consent with all of the relevant information). This can also look like one partner thinking a sexual encounter means that there is now a long-term commitment created between the partners while a different partner thinks the a sexual encounter means that they had a very meaningful connection but there is no long-term commitment.
4. Shared Values
Values in sexual spaces often refer to what sex means (only for people who are married? something fun that adults do sometimes?), what particular elements of engaging sexual could signify (is oral sex only for birthdays? does having sex with the lights on increase or decrease the vulnerability?), and what things feel pleasurable or fulfilling (more frequent sense means the relationship is going well or is the preference long marathons of weekend long sex that happen every other month?). Having open and honest conversations about these things can make sure all partners are on the same page and have the opportunity to maximize the parts of sex they enjoy and minimize the parts that are less fun.
5. Protection from Sexually Transmitted Infections (STIs) and Unwanted Pregnancy
Sexual education about science-based approaches to management of sexually transmitted infections and control over pregnancy are imperative to sexual health. Birth control methods, such as latex condoms and medical contraception, can help to minimize the risk of unwanted pregnancy and STIs. Specific medications like PrEP (pre-exposure prophylaxis) for HIV and vaccines for HPV and hepatitis B can help to minimize the chances of contracting certain infections and diseases. Regular testing for STIs can help you stay informed about your own sexual health as well as the sexual health of your partners. Being clear with the expectations around sexual practice with any potential partners can also help you to make informed choices about the risk level you are comfortable with (e.g. are you and the person you are having sex with mutually monogamous? Is there an agreement to get tested for STIs before engaging with one another if there have been additional sexual experiences with others since the last encounter? Are you and your partners limited sexual encounters outside of the agreed upon relationship structure?)
6. Pleasure
Sexual practice- whether individual or partnered- should be enjoyable. While many people experience some amount of conflict between their identity in social spaces and what they find pleasurable in sexual encounters, there is the possibility of allowing sex to be a safe and exciting arena for self-expression and self-exploration.
References
Braun-Harvey, D., & Vigorito, M. A. (2016). Treating Out of Control Sexual Behavior: Rethinking Sex Addiction. Springer Publishing Company.
Buehler, S. P. C. (2016). What Every Mental Health Professional Needs to Know About Sex. Springer Publishing Company.
Goldfarb, E. S., & Lieberman, L. D. (2021). Three decades of research: The case for comprehensive sex education. Journal of Adolescent Health, 68 (1), 13-27. https://doi.org/10.1016/j.jadohealth.2020.07.036
McKee, A, Liston, K, Byron, P, & Ingham, R (2021). The relationship between consumption of pornography and consensual sexual practice: Results of a mixed method systematic review. The Canadian Journal of Human Sexuality, 30(3), 387-396. https://doi.org/10.3138/cjhs.2021-0010
Mitchell, K. R., Lewis, R., O’Sullivan, L. F., & Fortenberry, J. D. (2021) What is sexual wellbeing and why does it matter for public health? Lancet Public Health, 6(8), 608-613. https://doi.org/10.1016/S2468-2667(21)00099-2