Let’s talk about sexual health.
Did you know that erectile dysfunction can be an early sign of heart disease or that sex burns an average of 3.1 calories per minute? Traditionally when we talk about sexual health, we talk about STIs, but there’s so much more to it than that.
Humans are social creatures by nature. Whether you’re monogamous or have multiple partners, sex plays a pivotal role in our interactions.
Understanding your sexual health is a life skill, and one that’s seldom openly talked about. As of September 2020, only 22 states require sex education in school to be “medically accurate.”
It’s time to upgrade our sexual health education – and we’re starting with our guide to sexual health. In this guide, we will be covering:
- Sexual Health, Mental Health, and Sexual Wellness
- Men’s Sexual Health
- Women’s Sexual Health
- Sexual Health and the LGBTQ+ Community
- Talking to Your Doctor About Sexual Health
Feel free to skip to the portions of this guide that are most relevant to you. There’s a lot to cover – so let’s get started…
Sexual Health, Mental Health, and Sexual Wellness
Do you wonder why you’re always horny or can go days without even thinking about sex? Does sex stress you out, or are some of your sexual desires confusing or unconventional? Understanding sexual health could be the key to solving most – or all – of your questions about love, lust, and intimacy.
Sexual health is your emotional and physical well-being with regard to your sexuality. It’s also about your interactions with people that you’re attracted to and intimate with.
Having a strong comprehension of your sexual health lets you better understand your body, how it should function, and when it’s not functioning properly. Understanding your sexual health also strengthens your ability to take charge of your emotional well-being. When it comes to your intimate relationships, this is vital.
Sexual health is directly connected to mental health, sexual wellness, sexual functionality, sexual enjoyment, and much more.
The Benefits of Sex
Sex makes for great cardiovascular exercise. During intercourse, women tend to burn 60-75 calories while men can burn up to twice that amount. It’s less intense than jogging, but it’s more efficient than walking – and usually much more enjoyable.
When we have sex, we release the hormone oxytocin which, like its companion's dopamine and serotonin, are referred to as our “happy hormones.”
Oxytocin promotes feelings of love, social bonding, and well-being. It’s also been tested as an anti-anxiety drug. In the brain, oxytocin acts as a chemical messenger and has been shown to be important in human behaviors including sexual arousal, recognition, trust, anxiety, and mother-infant bonding. It’s suggested to play an important role in social behavior.
Sex is a great stress reliever. However, for some people sex can have the opposite effect. We’ll get to that shortly.
Sexual Health and Sexual Wellness
Sexual health, mental health, and sexual wellness are all interrelated.
Sexual wellness refers to your physical, emotional, mental, and social well-being related to sexuality. It’s also the knowledge and practice of ethical and respectful conduct and consent.
Changes in your health or function can indicate there’s something going on sexually. For example, when guys have erectile dysfunction, it could be a sign of early heart disease. In order for the penis to get and stay erect, you need adequate blood flow. If there’s atherosclerosis, or hardening of the arteries, that can impair the quality of an erection. This is usually detectable years before there’s an issue of the heart.
Other indicators of poor sexual wellness can include:
- Mental or physical stress
- Poor libido
- Abnormal testosterone levels
Severe anxiety, stress, or depression can impair your sexual performance. If you’ve had adverse sexual experiences in the past, sex can be triggering.
Mental health is a powerful predictor of sexual health. If you’re depressed or have been diagnosed with a mental illness, you’ll usually want to be isolated and have decreased sexual desire. Mental illness can also point to an increased sexual desire, usually to feel wanted or connected. Some people also endure psychotic symptoms, such as a voice in your head telling you that you’re ugly or unworthy of another’s affection.
An imbalance in your mental health can lead to sexual dysfunction.
Sexual dysfunction is anything that physically or mentally causes sexual impairment – either for the parts that are needed for sex or the enjoyment of sex. This includes erectile dysfunction or other problems with sexual arousal, difficulty achieving orgasms, and premature ejaculation.
Sexual dysfunction can be physically uncomfortable. If your vagina isn’t adequately lubricated, or if you have skin lesions, or a fractured penis, sex could be downright painful.
Talking to a doctor about your sexual and mental health can be illuminating. Your doctor can determine the underlying cause of a dysfunction and make sure your heart and hormones are working well. They can also determine if there’s a larger underlying disease process going on and suggest ways to fix it.
Your libido is your desire for sex – and this desire is different for everyone. Some people have little interest sex, while teenagers and college kids can think about the men’s gymnastics team or Natalie Portman and Mila Kunis’ sex scene in Black Swan every two minutes. Some people have no desire for sex whatsoever and identify as asexual. All of these libido levels are perfectly normal.
Loss of libido is common, and it affects many men and women at some point in their lifetime.
It can be a sign of relationship health. Once people get into routines, sexual activity could be something that decreases rather quickly.
Low libido can also be linked to relationship issues, stress, and exhaustion. Hormonal deficiencies in testosterone and DHEA (a hormone produced by your body’s adrenal glands) can also decrease your sex drive.
This isn’t necessarily a bad thing. Depending on your lifestyle, a decreased libido could be fitting.
Conversely, high libido levels could be linked to an imbalance in your neurotransmitters – your body’s chemical messengers. High levels of your “happy hormones” (dopamine and serotonin) can cause a high libido.
Does running or working out get you in the mood? That’s because endorphins can increase your libido, too.
If you’d like to increase your libido, schedule a check-up with your doctor so that they can check for hormonal abnormalities. There’s usually a root cause for low libido, and it’s a problem with many solutions.
Testosterone is another hormone found in both men and women. It’s an androgen, meaning that it stimulates the development of male characteristics.
In puberty, it causes the enlargement of the penis, body hair growth, and muscular development. It also plays a role in:
- Heart health
- Bone health
- Fat distribution
- Muscular strength and mass
- Erection function
Testosterone is produced by the Leydig cells in testes in men and ovaries in women. Your adrenal glands also produce it in small quantities. We’ll touch on testosterone more when we talk about men’s sexual health.
Speaking of touching…
Is It Okay to Masturbate? Absolutely.
Masturbation is a helpful tool (pun intended) when determining healthy sexual function. For instance, if you have no issues achieving orgasm while masturbating but do with a partner, you’ll at least know that your plumbing is working as it should. Sexual issues with a partner could stem from something else entirely, not your ability to perform.
Masturbation feels good and it’s great for stress relief. Also, ejaculating at least 21 times a month significantly reduces a man’s risk of prostate cancer (reduce, but not prevent).
For both men and women, masturbation is a healthy way to help you become more comfortable and aware of your body parts. It’ll help you understand what you like and what you don’t like, which you can communicate to your partner(s) for enhanced enjoyment. Masturbation is also a great way to determine if there are any abnormalities that you should discuss with your doctor, like difficulty ejaculating or if your vagina isn’t lubricating properly.
Now, there are some occasions when you should take a hands-off approach to masturbation. If you’re canceling plans, too distracted at work, or if masturbation is causing a tug-of-war with your day-to-day life, it can be problematic.
Watching too much porn can also affect your sexual appetite. When regularly watching your true proclivities and desire played out online, it can become difficult to achieve an erection and have an orgasm with a sexual partner. Orgasms activate parts of your CNS (central nervous system), meaning that this act is mental as well as physical. If you’ve grown accustomed to the fantasy of porn, you risk training your brain to make it difficult to achieve an orgasm during intercourse.
Diet and Exercise
Eating and moving play huge roles in sexual health. Healthy eating can dramatically improve your sex life, and reduces your risk of heart disease and diabetes – both of which can be damaging to sexual function. As a rule of thumb, try to avoid processed food. You should also practice:
- Cholesterol management
- Exercising regularly
- Cardiovascular health management
- Weight training
In addition to these practices, you should also get regular check-ups, just in case.
Now that we’ve covered many of the general topics surrounding sexual health, we’re breaking the rest of this reeducation down by category.
Men’s Sexual Health
You should get routine screenings for coronary heart disease after age 35 even if you don’t have any known risk factors If your heart’s not working well, it could lead to (or be the root cause of) erectile dysfunction, which we’re about to cover.
In addition to erectile dysfunction, we’ll also explore low testosterone levels, premature ejaculation, and prostate exams.
Erectile dysfunction (ED) is – to the surprise of no one – by far the most search term in sexual health. ED occurs when your penis is unable to get engorged with enough blood to have penetrative sex.
Erectile dysfunction comes (or rather, doesn’t) in a couple of forms. Sometimes it’s a complete inability to achieve tumescence, or get hard. Other times, you get partially hard, or get an erection only to quickly lose it.
There are both physical and mental barriers that result in erectile dysfunction. To achieve an erection, you need adequate blood flow – which again is related to cardiovascular health. You also need adequate levels of both testosterone and estradiol (estrogen) to do the deed. If all of these levels are balanced, then your autonomic nervous system may be the culprit.
Arousal and the Autonomic Nervous System
The autonomic nervous system is responsible for control of the bodily functions not consciously directed, including sexual arousal. Regarding arousal, there are two key divisions in the autonomic nervous system: sympathetic and parasympathetic. These divisions cannot function at the same time.
The parasympathetic system is one of your excitatory pathways that originate in your brain and tell you that you’re aroused. This system is also responsible for your rested, relaxed, and calm states – all of which help keep your body in balance so that you can be sexually aroused.
The sympathetic system is associated with your fight-or-flight response. If you’re stressed or on edge, your sympathetic system activates and overrides your excitatory pathways, killing your sexual arousal faster than walking in on your grandparents having sex (for most of us anyway). This sympathetic system also causes many guys to lose their erections after orgasm.
Erectile dysfunction can be a self-fulfilling prophecy. If you’re nervous or concerned about getting an erection, you could trigger your sympathetic system. This can create a self-hating loop, and those don’t do anyone any good.
The next time you’re nervous about a sexual encounter just remember – ED could just be your head.
Low Testosterone Levels and What You Can Do About Them
As you get older – typically sometime in your 30s – your testosterone level begins gradually declining by roughly 1% a year. This can cause changes in your sexual function, such as reduced sexual desire, fewer spontaneous erections, and even infertility.
Decreasing testosterone levels can lead to physical and emotional changes as well. You may experience increased body fat, reduced muscle mass and strength, and decreased bone density. You may also have less energy, motivation, self-confidence and memory fog.
Low testosterone affects almost 40% of men aged 45 and older (hence the term “manopause”). Besides age, there are many potential causes of low testosterone. Some of which include:
- Metabolic disorders
- Alcohol abuse
- Chronic renal (kidney) failure
- Cirrhosis of the liver
- Testicular injuries or trauma
- Obstructive sleep apnea
- Obesity of extreme weight loss
- Excess of estrogen
Low testosterone is treatable with testosterone replacement therapy, which helps you feel more alert, mentally sharp, energetic, and sexually functional. However, testosterone replacement therapy isn’t always a recommended solution, and is more dependent on your general health. In some cases, it can actually worsen some of your symptoms, so consult your doctor first.
Premature ejaculation can be touch and go. It’s caused by a number of factors – both psychological and biological.
Some psychological factors can include:
- Worrying about finishing quickly
- Feelings of guilt
- Poor body image
- Sexual abuse
- Relationship problems
Biologically, it can relate to unbalanced hormone levels, inflammation, and infection of your prostate or urethra, or penis sensitivity.
Sometimes premature ejaculation occurs because you’re too in your own head, so don’t be the victim of another self-fulfilling prophecy. Topicals, such as lidocaine, can help decrease sensitivity. Antidepressants and anxiety medication can also help if taken at low doses. Still, talk to your doctor before trying anything.
While you’re at your doctor’s, get a check-up.
These exams screen for prostate cancer. However, we first recommend getting a blood test to analyze your prostate specific antigen (PSA) levels. PSA is a protein made by cells in the prostate gland. As guys get older, their PSA increases. Cancer will increase your PSA levels faster.
Recent ejaculation, anal sex, and infections can also elevate in your PSA, so inform your doctor of these factors. It’ll be helpful before they’re interpreting the results.
If you have an elevated PSA, the next step would be a prostate exam. During this exam, your doctor’s finger goes up the bum past the anal sphincter and palpates the prostate, checking for any lumps or abnormalities. The procedure can be uncomfortable, but it doesn’t do any damage to your prostate – and it’s over pretty quickly.
During a prostate exam, only a portion of the prostate is palpated. There’s a chance that potential pathologies can be missed. Another option is to get a trans-rectal ultrasound, which allows your doctor to investigate your prostate more thoroughly.
We recommend getting a prostate exam annually after you turn 50, or 40 if you have a family history of prostate cancer. Prostate cancer is asymptomatic, so men usually don’t show signs or symptoms of the disease until it’s progressed. You should take getting checked regularly very seriously.
Women’s Sexual Health
From pap smears to menopause, women’s bodies tell them plenty about their sexual health. By understanding how your body functions, you’ll be better at identifying when there’s unusual activity.
Pap Smears and Pelvic Exams
Pap smears are procedures that test for cervical cancer. During a pap smear, your doctor uses a speculum, a plastic or metal tool, to separate your vaginal walls and inspect your cervix. There, they collect cell samples to check for abnormalities, such as HPV. The speculum may feel uncomfortable or weird, but it shouldn’t hurt. If it does, your doctor may be able to fix the speculum’s size or position. We recommend that women start getting routine pap smears after age 21.
Pelvic exams are no longer recommended as a routine procedure. During a pelvic exam, your doctor inserts two gloved fingers inside your vagina while simultaneously pressing down on your abdomen. Doing this helps them evaluate your ovaries, uterus, and other pelvic organs.
Recently, an expert panel appointed by the American College of Physicians has recommended against annual pelvic exams for women who are healthy and low-risk. They found no benefit from a routine exam. It often causes discomfort and stress, and sometimes it even leads to unnecessary surgery.
Ask your doctor about pelvic exams if you have symptoms of pelvic pain or abnormal bloody discharge. Otherwise, a pap smear will usually suffice.
What Your Period is Telling You
Your menstrual cycle plays a pivotal role in your sexual health. Cycle lengths, the number of days there’s bleeding, lighter or heavier flows, bloating, cramping, and breast swelling and tenderness are all indications of how your body is functioning.
For example, women who have heavy periods and clots are at higher risk of having anemia or an iron deficiency. Examining your blood cell counts helps us determine if any dietary changes or iron supplements could be beneficial.
If your period is disrupting your usual activities because of excess blood loss or cramping, you might have menorrhagia, or “severe” blood loss. In some cases, the cause for menorrhagia is unknown, but common causes include:
- Hormone imbalance
- Uterine fibroids
- Pregnancy cancer
- Dysfunction of the ovaries
- Inherited bleeding disorders
- Other medical conditions
Infrequent periods are another common issue for women. If you only have a couple periods a year, you could have polycystic ovary syndrome (PCOS). PCOS is a health problem that affects 1 in 10 women during your childbearing years. Women with PCOS commonly have hormonal imbalances and issues with their metabolism – both of which can impact your overall health and appearance. PCOS can also increase your risk of diabetes, high blood pressure, depression, anxiety, poor cholesterol levels, and endometrial cancer. While there’s no cure for PCOS, its symptoms are treatable.
Changes in your period are also often the first sign of menopause. Your periods may become irregular – longer or shorter, and with more or less bleeding than usual. These changes are all normal, but you should see your doctor if your periods come closer together, you have spotting, heavy bleeding, or if they last longer than a week.
Estrogen and Vaginal Dryness
Vaginal dryness occurs when your estrogen levels decrease. Estrogen is a hormone found in both women and men, but is much more prevalent in women. It’s what keeps the lining of the vagina thick, elastic, and lubricated. If you’re experiencing pain, soreness, or a burning sensation either inside your vagina or the lower vagina, vaginal dryness may be the culprit.
While vaginal dryness is more common in older women, you can experience it at any age. When your vagina is dry, the tissue becomes more pliable and micro tears may occur. These can cause you pain, discomfort, and even bleeding during sex or masturbation. It can also lead to bacterial or yeast infections.
Depending on your condition, there are multiple treatments recommended for vaginal dryness. Lubricants and creams can help moisten the vaginal area, and water-soluble vaginal lubricants can help during sex. Topical estrogen is also available as a tablet, suppository, cream, or ring. There are also alternative therapies for vaginal dryness, but you should consult your doctor before trying anything new.
Abnormal periods and vaginal dryness are both possible signs of menopause. Menopause is the time that marks the end of your menstrual cycles. Typically, women enter menopause between the ages 45-55, and it’s diagnosed after you’ve gone a year without a menstrual period.
Other signs include:
- Hot flashes
- Mood swings
- Ovarian hormone imbalances
- Night sweats
- Decreased libido
- Breast soreness
There are about 34 symptoms in all. Symptoms of menopause last for 4-5 years, but decrease in frequency and intensity.
Once you enter menopause, your risk of a heart attack, stroke, or a cardiovascular disease goes up dramatically. Menopause also affects bone health and may result in fractures or osteoporosis.
However, menopause doesn’t equate to the death of your sex life. Many women still enjoy active, healthy sex lives post-menopause – and we encourage it! Adding sex lube can help make intercourse more enjoyable. Foreplay also works great for vaginal lubrication. We also recommend looking into bioidentical hormone replacement therapy. It can do wonders for your body and, in turn, your sex life.
How Women Can Improve Their Sexual Health
Getting to know and becoming comfortable with your body will help you determine when everything is functioning properly and also when you may need to see a doctor. Keep an eye on your periods, and be wary of any pain or if it takes longer for your vagina to moisten. We also strongly recommend working with a physician with whom you’re comfortable talking about sex. It’s often a taboo subject, but also a necessary conversation to have if you want to achieve optimal sexual health.
Sexual Health and the LGBTQ+ Community
You are a member of the LGBTQ+ community, we strongly recommend coming out to your doctor. It’s not always an easy conversation to have, but developing that level of trust is paramount in the patient-physician relationship. Your doctor cannot provide the best care unless they get to know you. If you’re not comfortable coming out to your current doctor, they may not be the best physician for you at this time.
There’s no right or wrong way to come out to your doctor. If you don’t feel comfortable vocalizing it, you can write out your sexual orientation and preferences on a medical questionnaire. You’ll also have the opportunity to talk about it during your intake appointment. If you’ve been seeing a doctor regularly and haven’t come out yet, there’s no better time like the present. In the patient-physician relationship, there’s only room for one person to feel awkward or uncomfortable, and your doctor isn’t it.
Once you’ve come out, you and your doctor can start talking about your sexual health and the top sexual health issues you may face.
Top Sexual Health Issues for the LGBTQ+ Community
Everyone’s journey is different, but when it comes to sexual health, it’s important that you understand the common issues you may face.
Gay men have a higher risk of transmitting HIV. There are also several STIs that are more prevalent among gay men including hepatitis A, syphilis, and giardia.
Hepatitis A can be transmitted through both oral and anal sex. Not only is it very contagious, but you can spread it before ever feeling sick. People usually recover from hepatitis A without complications, but in rare cases it may lead to liver failure.
Syphilis is also transmitted sexually and, if left untreated, can cause serious health problems. The symptoms of syphilis occur in three stages. The first stage starts with highly contagious sores. In the second stage, your symptoms progress to rashes, flu-like symptoms, a slight fever, headache, and swollen glands. In the third stage, syphilis can cause tumors, blindness, paralysis. It can also damage your nervous system, your brain and other organs, and may even kill you. Thankfully, syphilis is easily curable in its early stages.
Giardia is an intestinal infection marked by abdominal cramps, bloating, nausea, and bouts of watery diarrhea. Giardia can be spread through anal sex or analingus can cause weight loss, dehydration, malnutrition, and even lactose intolerance. This infection is curable, and can be prevented by washing your hands regularly and practicing safer sex.
Gay men are also more active in the “party-and-play” scene (PnP). If you PnP, talk to your doctor about the risks involved using poppers and party drugs.
If you identity as lesbian, you need to have a provider who is knowledgeable and comfortable talking about women’s health. For instance, your physician should be aware that you’re still at risk of cervical cancer and HPV even if you’re not having penial intercourse.
In fact, lesbians may be at elevated risk for cervical cancer due to a lack of adherence to screening guidelines. Be sure to get routine pap smears and other tests, even if you’re not having sex with men.
Your provider should not be assuming the type of sex that you’re having. They should emphasize that you’re entitled to have sex that’s safe and enjoyable no matter where you are during your transition. You should also never be forced to do anything that you’re uncomfortable doing.
As a transgendered individual, you and your doctor should be comfortable talking about what body part you’re using for where and for what. This knowledge helps determine your sexual function, safety, and what screenings may be necessary.
For transgendered woman, one prevalent sexual health issue you may face is the link between testosterone blockers and erectile function. This can lead to dysphoria, feelings of unhappiness, uneasiness, or dissatisfaction. However, this can be fixed by adjusting the dosage of your testosterone blocker.
If you’re a post-operative transgendered woman, make sure that you’re vaginal introitus, or opening, remains adequately dilated. You can do this through dilation or penetrative sex. Also, make sure to use adequate lubrication if you’re having penetrative sex. Lubrication can turn a painful sexual experience into a pleasurable one.
As a transgendered man, you should learn of the potential side of effects of testosterone therapy. It’s most likely going to increase your libido, which also increases your sexual relationships with your partner(s). However, it can also cause weight gain, acne, male-pattern baldness, sleep apnea, high red blood cell counts, and high blood pressure. Know all of the pros and cons before starting testosterone therapy.
Understanding Gender, Sex, and Biological Sex
To be clear, gender, sex, and biological sex are all different.
Gender is how you see yourself in regard to expression, whether you’re feeling more masculine or expressing as a male, feeling more feminine or expressing as a female, or fluid, where you switch from one day to the next. No matter how you identify, your gender expression is perfectly normal. You should feel comfortable in your own skin.
Sex is who you are attracted to and/or who you go to bed with.
Biological sex refers to the biological differences between males (XY), females (XX), individuals who identify as intersex, or by another biological identity.
Anal Sex – It is Safe?
Yes – and it’s quite enjoyable. However, unlike a vagina, there isn’t a natural lube for the anus, so going at it without lubricant can be painful. Also, practice caution when performing analingus. Doing so puts at risk of gastrointestinal diseases and parasites like giardia.
Common Misconceptions about LGBTQ+ Sexual Health
Everyone is different – and we should be celebrating our differences because they make us our unique, awesome selves. These differences often stir up many assumptions about various aspects of the LGBTQ+ community that need to be debunked. Here a few of them.
Misconception 1: Gay guys are nonmonogamous.
They can be – and that’s their choice. However, this blanket statement is far from the truth. A recent study found that younger gay men are seeking and having more monogamous relationships than older gay men. Of the gay men in relationships that partook in the study, 47% reported that they were in open relationships, 45% identified as monogamous, and 8% were unsure of what type of relationship they were in.
Misconception 2: Marriage = monogamy.
Assuming you and your partner are in agreement, you don’t have to be monogamous if you’re married. However, you do have to have ground rules. By articulating your wants, needs, and fears with your relationship, you can write your own rules. Be honest, keep the lines of communication open, and tell your partner if there’s something that makes you uncomfortable.
Misconception 3: Lesbians can’t get cervical cancer
We touched on this already, but it’s worth repeating. Even if you’re not having penetrative sex, you can still get cervical cancer, so get screened regularly.
Misconception 4: Transgendered individuals always struggle with dysphoria
While this is common in the transgendered community, it’s not absolute. Many people actually experience gender euphoria – the joy of feeling one’s gender identity, expression, or behavior affirmation. You could find yourself feeling this way whenever you’re a biological woman wearing boys clothes, or a biological man in a dress. This joy also comes from using different gendered pronouns, or by not taking offense if someone accidentally calls you “he” or “she.”
Talking to Your Doctor About Sexual Health
Sex in our society is taboo. This can often make conversations about your sexual health uncomfortable. Everything you talk about with your doctor is confidential. Once you find a doctor you feel comfortable with, you should be able to address any and every question you may have about your sexual health.
Sometimes it’s easy to lead with the most uncomfortable conversations first. Other times, you may feel more comfortable addressing more routine issues, like back pain or rashes first, and build up to the more awkward conversations. Whatever works for you should also work for your physician.
Your Action Plan for a Health Sex Life
Everyone’s sex life is different, and so your action plan will also be different. However, here are a few steps you should implement, if you aren’t already:
- Exercise regularly. Cardiovascular health and sexual health are deeply intertwined
- Make sure that everything is functional and working as it should
- If you have multiple partners, get screened regularly STIs can be asymptomatic, so even if you’re not showing any symptoms, get screened regularly anyway
- Practice talking about sex with your partners – what you like, don’t like, and are interested in exploring
- Talk to your doctor if you’re experiencing any changes
By following these steps and reverting back to this guide whenever you have questions, you’re well your way to achieving optimal sexual health.