Medically reviewed by Dr. C.H. Weaver M.D. 2/2021
Sexual health includes a range of issues concerning human intimacy—issues that affect us physically, mentally, and emotionally. From sexual functioning and awareness of sexually transmitted diseases (STDs) to family planning and the role of physical intimacy in healthy relationships, understanding the various aspects of sexual health can enhance your intimate relationships and your individual well-being and protect your health.
In a healthy relationship, sexual intimacy—along with love, affection, and mutual respect—can help draw two people closer together. There are, however, risks and complications associated with human sexuality; to minimize these and emphasize the positive aspects of physical intimacy, it’s important to understand how to reduce certain risks (STDs, for example) and to work through complications (such as erectile dysfunction or decrease in sex drive). Education and open communication between you and your partner are a good place to start.
Sexually Transmitted Diseases
Sexually transmitted diseases, or STDs, are diseases that are transmitted through intimate sexual contact with another person who has the disease. It is estimated that more than 13 million people are affected by STDs every year.
STDs are divided into two main groups:
- STDs caused by bacteria: These can be treated and often cured with antibiotics. They include chlamydia, gonorrhea, trichomoniasis, and syphilis.
- STDs caused by a virus: These can be controlled but not cured; in other words, if you have a viral STD, you will have it for life. They include HIV/AIDS, genital herpes, genital warts, human papillomavirus, and hepatitis B.
Symptoms of STDs vary depending on the type of infection. There are, however, some common warning signs that may indicate an STD. The following symptoms should be discussed with a healthcare provider:
- Unusual discharge from the penis or vagina
- Sores or warts on the genital area
- Burning sensation when urinating
- Itching and redness in the genital area
- Itching, soreness, or bleeding around the anus
There is a risk of getting an STD with any type of intimate sexual contact. You can, however, reduce your risk by practicing what’s known as safe sex. Safe sex practices include using a condom anytime you have vaginal, oral, or anal intercourse; knowing your partner’s STD and overall health status; and having regular medical check-ups (this is particularly important for people who have more than one sexual partner).
Sex drive or desire, also known as libido, can rise and fall for a number of reasons. Causes may be psychological, emotional, medical, or physical. For women, sex drive may vary according to their menstrual cycle, with a sometimes elevated drive occurring during the days before ovulation. Others factors affecting sex drive include:
- Fatigue or stress
- A history of trauma or sexual abuse
- Anxiety about performance or body image
- Body weight (being very underweight or severely obese—both can cause disruptions in normal hormone levels)
- Medical conditions (for example, hypothyroidism)
- Certain medications (such as birth control pills, antidepressants, antipsychotics, opioids, and beta blockers)
- Relationship issues (tension or not feeling connected to each other)
If you’re experiencing a loss of or reduction in sex drive, it may have placed strain on your relationship. By identifying and understanding the cause(s) of your diminished drive, you can address the issue as appropriate (make lifestyle changes where necessary or seek medical help, for example) and improve your sex drive.
When Your Partner Has Erectile Dysfunction
Erectile dysfunction (ED) refers to a man’s inability to get or maintain an erection. Causes of ED may include disease, injury, or side effects of drugs, and involve injury to the nerves or impaired blood flow to the penis. Incidence of ED increases with age.
The first steps in the treatment of ED often involve healthy lifestyle changes. Measures like quitting smoking, reducing alcohol consumption, losing excess weight, and increasing physical activity may help. If it’s suspected that ED is a side effect of certain medications, changing these drugs or the dosage may help restore sexual function. Additional approaches to treat ED include psychotherapy and behavioral modification, oral and injected drugs, vacuum devices, and surgically implanted devices. Surgery involving veins or arteries is considered in rare cases.
Menopause and Sex
Menopause (the natural transition in a woman’s life when menstruation ends) can be associated with physical changes that may affect her feelings about sexuality as well as her sexual functioning. If you’ve gone through or are going through menopause now, be aware of the following potential changes in your sex life:
Pain during intercourse. Sex may become painful for many reasons for women of any age. After menopause, sexual discomfort may be caused by lower estrogen levels and subsequent effects on the vagina. Because estrogen affects the vagina’s ability to secrete lubricant, expand and contract, and grow new cells, once levels are diminished—which is accompanied by diminishing blood flow over time—the vagina and vulva can atrophy. As a result, intercourse may become painful and can be followed by a burning sensation or bleeding. There are, however, ways to manage atrophy to the vagina and vulva; estrogen treatments (pills, patches, and creams) as well as over-the-counter lubricants may help.
Difficulty reaching orgasm. The drop in estrogen levels after menopause can also affect a woman’s ability to orgasm; this is due to changes to the nerves and blood supply to the clitoris. A healthcare professional may be able to recommend methods to improve lubrication, blood flow, and sensation.
Pain During Intercourse
Women of any age may experience sexual discomfort. No matter your age, if you find sex painful, you should talk to you doctor. There may be a medical condition causing your discomfort that can be addressed and treated. Some causes of pain during intercourse include:
Vestibulodynia. This condition can affect women of any age but is the most common cause of sexual pain in women under 50. Vestibulodynia is associated with severe pain when any pressure is applied at the entrance of the vagina. It can be treated with topical anesthetics, estrogen cream, antidepressants, drugs used for nerve-related pain, and physical therapy.
Vulvodynia. This condition, which may be related to abnormal nerve firing, can cause irritation to the vulva even without sexual contact or any contact. It involves pain, stinging, burning, irritation, and rawness. Vulvodynia is treated similarly to vestibulodynia (described above).
Vaginismus or Pelvic Floor Muscle Dysfunction. This condition involves the voluntary spasm of the vaginal and perineal muscles when sexual contact is attempted, making intercourse difficult or impossible. It can be caused by trauma or underlying physical conditions. Vaginismus may be treated with dilator therapy (relaxation techniques are used while the vagina is dilated using progressive-sized dilators) or physical therapy.
For women who have gone through menopause, pain during intercourse can be the result of changes to the body during this transition. This is discussed in the previous section, “Menopause and Sex.”
It’s not entirely understood why women have orgasms. Regardless of the reason, however, orgasms may have health benefits. In addition to pleasure, orgasms also trigger a release of the “feel-good” hormones oxytocin and endorphins. These natural chemicals can aid relaxation, help couples bond more closely, and help reduce, stress, pain, and depression.
Not all women reach orgasm with every sexual encounter, and when a women does reach orgasm, it’s not always through intercourse. This is important to keep in mind because when orgasm becomes too much of a priority during intimacy, it can overshadow the other positive and pleasurable aspects of sexual contact—especially when orgasm isn’t reached. Several factors that may affect your ability to have an orgasm include:
- Medical illness
- Gynecologic surgeries (hysterectomy or cancer surgeries)
- Medications (including blood pressure medicines, antihistamines, and antidepressants)
- Drug use and excess alcohol consumption
- The aging process (see “Menopause and Sex” for more information)
- Psychological causes (including mental health problems, performance anxiety, and stress)
- Relationship issues (conflicts or problems with trust and communication)
Some women who have trouble reaching an orgasm are able to learn techniques to help them reach climax. These methods aim to help women relax most of their body but tense the muscles in the lower pelvis, which can help induce an orgasm. A healthcare professional can suggest resources for learning more about ways to help you reach orgasm. Medical conditions as well as side effects of medications can interfere with your ability to orgasm—your healthcare provider can help you with this as well.
- Sexual Health. The National Institutes of Health Web site. Available at: http://health.nih.gov/topic/SexualHealthGeneral. Accessed June 2020.
- Sex and Relationships. HealthyWomen. Available at: http://www.healthywomen.org/ages-and-stages/healthy-living/sex-and-relationships. Accessed June 2020.