Hesperian Health Guides

Hesperian Health Guides

Improving your sexual health

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HealthWiki > Where Women Have No Doctor > Chapter 12: Sexual Health > Improving Your Sexual Health


Improving sexual health means:

  • learning about our bodies and what gives us pleasure. See below for more information about sexual pleasure.
  • reducing the risk of unwanted pregnancy and infections passed through sex. This means women must have access to information about family planning methods and ways to prevent infections, including HIV. Women also need control over when to use these methods. For information about family planning and choosing a method that works best for you, see the chapter on “Family Planning.” Also see 'Making sex safer'.
  • changing harmful gender roles, including harmful beliefs about women’s sexuality. This kind of change takes time, because it means women and men must develop different ways of relating to each other.
Mutual respect is shown in many areas of life.
a man, a woman, and three children doing kitchen cleanup together

Both men and women are capable of feeling — and controlling — their desires.

More Information
lack of desire

What brings pleasure to one person should not be harmful to another.

Feeling more pleasure from sex

It is natural for women and men to want to share sexual pleasure with their partners. When each partner knows the kind of sexual talk and touch that the other likes, they can both enjoy sex more.

If a woman does not feel pleasure with sex, there may be many reasons. Her partner may not realize that her body responds differently to sexual touch from the way a man’s body does. Or she may have been taught that women should enjoy sex less than men, or that she should not tell her partner what she likes. Understanding that women are capable of enjoying sex just as much as men, and that it is okay to do so, may help her like sex more.

How a woman’s body responds to sexual pleasure

Sex often begins with kissing, touching, talking, or looking in a way that makes a person feel excited. Different women respond differently to sexual thoughts and touch. A woman may begin to breathe harder, and her heart may begin to beat faster. Her nipples and skin can become very sensitive.

The clitoris gets hard and may swell, and the lips and walls of the vagina become wet and sensitive to touch. If sexual touch and thought continue, sexual tension can build up until she reaches a peak of pleasure and has an orgasm (comes).

When a man reaches his peak of sexual excitement, his penis releases a mixture of sperm and other fluid called semen. If this happens inside or near a woman’s vagina, his sperm can swim into her womb or tubes, and fertilize an egg, making her pregnant.

It often takes longer for a woman to reach orgasm than a man. But when orgasm happens, the energy and tension in her body releases, and she feels relaxed and full of pleasure.

It is possible for almost all women to have orgasms, but many women never have them or have them only once in a while. If she wants, a woman may be able to learn how to have an orgasm, either by touching herself (see the next page), or by letting her partner know what feels good.

a man and woman lying together on a mat

A woman can have sex with a partner of the opposite sex, the same sex, or with herself.

Touching oneself for pleasure

a woman lying down with her hand between her bare thighs

A woman can learn to touch herself in a way that gives sexual pleasure. Touching oneself does not use up sexual desire, and can be a good way for a woman to learn about her body and what kinds of sexual touch feel best. Many communities have beliefs that touching oneself is wrong, so sometimes it makes people feel ashamed. But it does not cause harm as long as a woman feels comfortable with it. Any object that is put in the vagina should be as clean as possible.

Touching oneself can be a good way for a woman to learn what kinds of sexual touch feel best.

Choose a time and place when you will not be interrupted. It may help to think about a lover or a situation that made you feel very sexual. Try touching your breasts or genitals in different ways and see what makes you feel excited. There is no right or wrong way — whatever makes you feel good.

Lack of desire

If a woman has been raped or forced to have sex, she may need time — or to talk with someone she trusts or a trained mental health worker — before she wants to have sex again.

Many things can affect how much sexual desire a woman or man feels. For example, when life seems exciting — such as when starting a new relationship or a new job — a woman or man may feel more sexual desire. The amount of desire a women feels may change throughout her monthly cycle, or at certain times during her life. It is common for a woman to feel less desire when she:

  • feels tired from hard work, not enough food, illness, or a new baby.
  • is very worried about something.
  • has a partner she does not like.
  • fears that others will see or hear her having sex.
  • is afraid of becoming pregnant or getting an infection.


When a woman lacks desire, her body makes less of its natural wetness, and she may need to use lubrication, like saliva, so that sex is not painful. When a man lacks desire, it is more difficult for his penis to get hard. He may feel ashamed, and this may make it more difficult for him to get hard the next time.

If you or your partner do not feel like having sex, try to forgive each other and to talk about it. Allow time for sex when you both want it, and try to do things that you both will find exciting.

a man lying on top of a woman in bed, both looking unhappy

If sex is painful
Sex should not be painful. Pain during sex is usually a sign that something is wrong. A woman may feel pain with sex when:

IMPORTANT! Pain during sex can be a sign of serious infection, especially if it comes soon after childbirth, miscarriage, or abortion, or if the woman also has a discharge from her vagina. See a health worker right away.

Making sex safer
Why practice ‘safer sex’?

There are often risks involved with sex, but there are ways to make it safer. We say “safer” sex as a way of reminding people that less risk is not the same as no risk. But, safer sex can save your life.

Like all infections that people get, sexually transmitted infections (STIs) are caused by germs. Some infections are caused by germs passed through the air, food, or water. STIs are passed through sexual contact. Some STIs cause sores or discharge on the genitals, but you usually cannot tell if a person has an STI just by looking. Many men and women can have STIs without knowing it themselves. The germs that cause some STIs (like genital warts or herpes) are on the skin of the genitals and are passed by skin-to-skin contact.

The germs that cause other STIs, (like gonorrhea, chlamydia, hepatitis, syphilis, and HIV) live in the body fluids of an infected person. These are passed when blood, semen, or the wetness of the vagina of an infected person comes in contact with the skin of the vagina, anus, tip of the penis, or mouth of another person. All of these infections can cause serious health problems. HIV, without ongoing treatment, is fatal.

So, to practice safer sex means having as little contact as possible with the skin of your partner’s genitals, and with his or her body fluids unless you are absolutely certain that he or she is not infected with any STI.

Some kinds of sex are safer than others
Kissing is safe
Touching is safe
Oral sex is less safe — but safer with a condom
Vaginal sex is risky — but safer with a condom
Anal sex is very risky — but safer with a condom

Safer sex methods

Every woman needs to decide how much risk she is willing to accept, and what steps she can take to make sex safer. The following are different ways that women can reduce their risk:

Very safe:
  • Avoid having sex at all. If you do not have sex, you will not be exposed to STIs. Some women may find this the best option, especially when they are young. However for most women, this choice is not possible or desirable.
  • Have sex with only one partner, who you know for sure has sex with only you, and when you know for sure that neither of you was infected by a previous partner. This can only be known by testing for STIs.
  • Have sex by touching genitals with your hands (mutual masturbation).
  • Use condoms during oral sex. A barrier of latex or plastic helps prevent infection with herpes and gonorrhea in the throat. It also protects against the very small risk of infection with HIV through tiny cuts in the mouth.
Safe:
  • Always use latex condoms — for either men or women — when having vaginal or anal sex.
  • Have sex in ways that avoid getting your partner’s body fluids in your vagina or anus. Sex using your mouth is much less likely to spread HIV. If you get semen in your mouth, spit it out (or at least swallow it) right away.
Other ways to lower risk:
  • Have the man withdraw his penis before he comes (ejaculates). You can still get HIV if he has it, and you can still get pregnant, but it is not so likely since less semen gets inside your body.
  • Using a diaphragm may lower your risk. For more information, see 'The Diaphragm'.
  • Avoid dry sex. When the vagina (or anus) is dry, it tears more easily, and increases the chances of infection. Use saliva (spit), spermicide, or lubricant to make the vagina slippery. Do not use oil, lotion, or petroleum gel if you are using condoms — these can make the condom break.
  • Get treated for any STIs you may have. Having one STI makes it easier to become infected with HIV or other STIs.

Every woman should protect herself from AIDS

The following story could happen in any community.

Fátima’s story: Every woman should protect herself

Fátima lives in a rural town in Brazil — and she is dying of AIDS. When she was 17, she married a man named Wilson. He was killed a few years later in an accident at the cooperative where he worked. Fátima had to leave her baby with Wilson’s parents and go to the city to find work. When she had extra money, she sent it back home. The work was hard, and she was very lonely.

When she learned that the government was building a highway near Belem, Fátima got a job cooking for the road construction workers so that she could stay at home. It was there that she met Emanuel. He was handsome, had cash in his pockets, and charmed her little girl when he came around after work. When the work crew had to move on, he promised to return.


"Fátima thinking about the two men she has had sex with"

Emanuel did come back, but he never stayed long. He got a new job driving trucks that kept him on the road most of the time. Fátima thought he probably had other women, but he always told her she was his only one. They had a baby boy, but he was small and sickly and died after a year. Soon Fátima began to feel sick, too. The nurse at the health post gave her different medicines, but nothing helped. Finally she went to the hospital in the city. They did some tests, and told her she had AIDS. When she asked how she could have AIDS, the doctor replied, “You shouldn’t have slept with so many men.” Fátima did not think she was at risk for HIV — she had only had sex with 2 men in her life! She thought that only prostitutes and homosexuals in the cities got HIV or AIDS.


Why did Fátima think she was not at risk for AIDS?


a group of women and men sitting and talking together
She thought that only prostitutes and homosexuals could get HIV or AIDS.
She thought that as long as SHE was faithful she would not be at risk.
Emanuel said he was faithful, but he probably wasn't.
She shared Emanuel's risk for getting HIV, even though she didn't know it.

Fátima was at risk for getting AIDS, not because of her own sexual behavior, but because of her partner’s.

We share the risks our partners take — both the risks they take now and any risks they have taken in the past.

Talking about safer sex

If you think your partner might support your wish to have safer sex, try to talk together about the health risks of STIs. This is not always easy! Most women are taught that it is not ‘proper’ to talk about sex — especially with their partners or other men — so they lack practice. A man may talk with other men about sex, but is often uncomfortable talking with his partner. Here are some suggestions:

Work with your community to educate women and men about condoms and how to use them. This will help make condoms more acceptable.

a man with his arm around a woman while both are thinking
I don't want to put her at risk, but I'm not sure how to tell her what happened...
I think we should be using condoms, but I'm afraid of what he will think if I ask.

Focus on safety. When you talk about safer sex, your partner may say that you do not trust him. But the issue is safety, not trust. Since a person may have an STI without knowing it, or may get HIV from something other than sex, it is difficult for a person to be sure he or she is not infected. Safer sex is a good idea for every couple, even if both partners have sex only with each other.

Practice talking with a friend first. Ask a friend to pretend to be your partner and then practice what you want to say. Try to think of the different things he might say and practice for each possibility. Remember that he will probably feel nervous about talking too, so try to put him at ease.

a woman hugging a man and talking to him with another couple nearby
My brother told me he always uses condoms now.

Do not wait until you are about to have sex to talk about it. Choose a time when you are feeling good about each other. If you have stopped having sex because you have a new baby, or were being treated for an STI, try to talk before you have sex again. If you and your partner live far apart or must travel often, talk ahead of time about how to protect your sexual health.

Learn as much as you can about the risks of unsafe sex, and about how to have safer sex. If your partner does not know much about STIs, how they are spread, and the long-term health effects from them, he may not understand the real risks involved in unsafe sex. Information can help convince him of the need to practice safer sex.

Use other people as examples. Sometimes learning that others are practicing safer sex can help influence your partner to do so, too.

Try to respond to your partner’s concerns.
Using condoms is one of the easiest ways to prevent infections and unwanted pregnancy. But many people do not want to use them at first. Here are responses to some common complaints about condoms:


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