Oftentimes when people come in for sex therapy, they’ll ask their sex therapist questions like: “How often should I (or we in the case of a couple) be having sex?” or 

“Is it normal for me (or for my partner) to desire to do ‘xyz type’ of sex?” or 

“Does it mean I’m an awful person if I fantasize about an-ex partner when I’m with my current spouse?” 

Doug Braun Harvey and Michael Vigorito, authors of Treating Out of Control Sexual Behavior: Rethinking Sex Addiction created a template for therapists to use when helping clients assess through self-inquiry whether their sex life is in fact sexually healthy. They called this assessment the Six Principles of Sexual Health. They created this model after years of treating mostly male identified clients who were coming to therapy due to sexual behavior which was described as compulsive, hypersexual or out-of-control.  However, this framework could be adapted for any person who wants to optimize their sexual and relational wellness to better reflect their authentic values and priorities. A healthy sex life isn’t solely based on things like frequency or STI and pregnancy protection. Instead, it’s built on these key principles which support an honest inquiry regarding the physical, emotional, psychological, ethical and relationship behaviors and considerations one makes to live an authentic and integrated life as it relates to sexuality. 

Consent: Each Partners Feel Free to Say No

This is perhaps the most important and most basic principle of sexual health. Consent must be ongoing, not a one-off question that one asks at the initiation of a sexual encounter whether with a new partner or a longstanding partner. Each person must feel emotionally safe and confident enough to pause or stop a behavior whenever they choose, even if they are in the middle of the experience to which they had initially agreed. A couple where one partner agrees to go along with sex in order to avoid a conflict or because their partner will act in a resentful fashion if they say no isn’t healthy sexuality, and it is not considered fully consensual. So while verbally agreeing to a specific sexual encounter is legal consent, if either partner feels pressure to keep going,because they’re afraid, anxious or disassociated the sex is no longer fully emotionally consensual. Depending on the relationship power dynamic, it could also be construed as coercive. This kind of ‘going along’ is reported frequently by female clients who present in sex therapy within their heterosexual experiences because they feel like they should, or ought to do it. However, many men also push through doubts or ambivalence in heterosexual or same gender sex because they are avoiding appearing less ‘like a real man’.  These are ingrained beliefs that are part of the heteronormative, patriarchal system and oftentimes leading men to develop erectile disorder or premature ejaculation. These ‘going along’ sexual encounters is not what is considered enthusiastic ongoing consent and if repeated for months or even years, leads to people losing connection or going underground with their own authentic desire and needs. Sex therapy with a Certified Sex Therapist can re-educate and support clients to lead a more authentic sex life in which either partner feels free to say ‘no, not tonight’ without feeling any guilt, remorse or shame.

Honesty: Being Able to Talk About Sex 

A healthy sex life depends on both partners feeling comfortable communicating openly about their sexual relationship, including their desires, boundaries, concerns, and changing needs. A couple with a healthy sex life would be able to speak about topics such as fantasies, desire, boundaries, frequency and any sexual discomfort. Honest conversation means addressing concerns before they turn into longstanding issues. Avoiding  these conversations often negatively impacts the erotic foundations of a romantic relationship. A healthy couple is able to have a clear conversation that avoids blaming or shaming of or by either partner. For example, one partner might say, “I’ve noticed my desire has been lower lately. I don’t think it’s about you, but I’d like us to figure it out together.” Open conversations like this strengthen intimacy.

Shared Values: Being on the Same Team

Though you don’t necessarily need to have the same beliefs to have successful relationships, it’s important that you have shared values when it comes to erotic and sexual agreements.. Compatibility goes beyond libido and can extend into beliefs on topics such as monogamy, pornagraphy, flirting, kinks and so on. Partners need to be able to discuss what sex means to each of them in the relationship. A couple should be able to delve into differing views on topics and come to a reasonable agreement that leaves both partners feeling safe and excited. For example, if one person in the couple enjoys watching porn and the other doesn’t, a healthy couple should be able to discuss the reasons for one’s interest and use of pornagraphy and why the other feels discomfort around the behavior.  Partners need to come to a joint agreement with one another on all sexual and erotic practices whether they are done in private or with one another.

Pleasure: Mutual Pleasure Matters

Pleasure goes beyond simply having orgasms. It’s about curiosity, connection and caring about your partner’s experience. Pleasure will look different for different couples and it can change across the lifespan. Caregivers will often overlook pleasure for teenagers or express that they are too young for sex or even masturbation. This same blind spot around sexual pleasure can include when adult children are caring for their elder parents who are involved in sexual relationships.  Pleasure is about balancing all the other sexual health principles with each partner’s sexual curiosity and continued growth. When a partner ‘fakes an orgasm’ or pretends they are enjoying stimulation a partner is providing they are contributing to the partner’s beliefs about what the receiver actually enjoys. The sexual encounter is then not mutual nor authentic at all  

Non-Exploitation: Sex Should Never Involve Manipulation or Coercion

Sexual exploitation happens when someone uses their power or dishonesty in a sexual relationship. This power imbalance may arise from differences in partners’ cognitive ability, intoxication level, or other circumstances that limit one person’s capacity to give full consent. Exploitation can also come in the form of verbal or non-verbal manipulation, pressure guilt-inducing communication by one partner to another. Explicit force doesn’t need to be involved for it to be exploitation. For example, repeatedly threatening to end a relationship unless a partner agrees to a sexual activity creates pressure that undermines healthy sexual decision-making, even if no physical force is involved. Another example of exploitation is when one partner has sex outside the agreement they’ve made with their partner, doesn’t use any STI protection and continues to have unprotected sex with their primary partner.  They have exploited their primary partner’s lack of knowledge and put their health at risk while also crossing their oath of monogamy or agreement to having protected sex in agreed upon consensual non-monogamous experiences. 

Prevention: Precautions for Physical Health

This is perhaps what people think of when the topic of sexual health comes up. It’s clearly imperative to discuss safer sex practices like condoms and other forms of birth control to prevent STIs as well as unwanted pregnancy. Prevention is all about making informed decisions as a couple or partnered relationship. For example, before becoming sexually active with a new partner, each partner may decide to get tested for STIs and openly show and discuss the results so they can make informed decisions together.

Conclusion

Sexual Health isn’t only measured by frequency, adventure or comparison to the majority of the population. It’s built on mutual consent, pleasure, honesty, shared values, respect and protection. These principles help all types of partners and/or couples build a healthy and meaningful sexual relationship. Instead of asking, “Are we having enough sex?” try asking:

• Do we feel safe communicating about sex?
• Do we adhere to each other’s boundaries?
• Are we honest about our needs?
• Do we both feel respected?

Furthermore, these sexual health principles are never static. A healthy sexual relationship requires ongoing conversations because people’s bodies, desires, health, and circumstances will change over time including from day to day, moment by moment.