Improving your sexual health

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

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In this chapter:

 

In this chapter:

Having better sexual health means:

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STIs
HIV and AIDS

• 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 people must have access to information about family planning methods and ways to prevent STIs, including HIV. Anyone who can become pregnant also needs control over when to use these methods. For information about family planning and choosing a method that works best for you, see Chapter 13, “Family Planning.” See information about making sex safer.
• changing harmful gender roles, including harmful beliefs about women’s sexuality. This kind of change takes time, because it means people must develop different ways of relating to each other.

Opening up gender roles begins at home.

All people are capable of feeling— and controlling—their desires.

Feeling more pleasure from sex

Many people want to share sexual pleasure with their partners. When people know the kinds of sexual talk and touch that their partners like, everyone can enjoy sex more. This requires communication.

There are many reasons a woman may not feel pleasure during sex. She may have been taught women should enjoy sex less than men or that she should not tell her partner what she likes. Her partner may not realize her body responds to sexual touch differently than his. Understanding that a woman can enjoy sex just as much as a man, that it is okay to do so, and that it is okay to talk with a partner about what you like sexually may help both people enjoy sex more.

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sexual desire

How bodies respond to sexual pleasure

Sex often begins with kissing, touching, or talking in a way that makes a person feel excited. They may begin to breathe harder, and their heart may begin to beat faster. Their nipples and skin may become very sensitive.

For people with a vulva, the clitoris gets hard and swells, 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 the person reaches a peak of pleasure and has an orgasm (climax). For many people, this happens by touching the clitoris.

For people with a penis, it gets hard and swells. When they have an orgasm, their penis usually releases semen, a mixture of sperm and other fluid.

It is possible for almost everyone to have orgasms. But because women are taught to focus on men’s pleasure, not their own, many women do not have orgasms or have them only once in a while. Sex can also be pleasurable without orgasms. By touching herself (see the next page), a woman can learn what feels good for her during sex and better understand her body. This can help a woman tell her partner what she likes and make sex more pleasurable.

A woman can have sex with a partner of any gender or with herself.

Touching yourself for pleasure (masturbation)

You can learn to touch yourself in a way that gives sexual pleasure. This will not use up sexual desire and is a good way to learn about your body and what kinds of sexual touch you like. Many communities have beliefs that touching yourself is wrong, so sometimes people feel shame about this. But it does not cause harm as long as it is something you want to do. And it can help you enjoy sex with a partner.

Touching yourself is a good way to learn what kinds of sexual touch feel best.

Choose a time and place when you will have privacy and not be interrupted. It may help to think about a person or a situation that made you feel sexual. Try touching your nipples or genitals in different ways and see what feels pleasurable. There is no right or wrong way—do what makes you feel good. Be sure any object you use to touch or put inside yourself is as clean as possible.

Lack of desire

Someone who has been raped or sexually assaulted may need time, and sometimes mental health support, before they will want to have sex again. see Health Problems of Rape.

Many things can affect how much sexual desire a person feels. For example, when life seems exciting—such as when starting a new relationship or a new job—someone may feel more sexual desire. People may feel less desire when they:

• feel tired or stressed from work, do not have enough food, are ill, or have new baby.
• are very worried or upset.
• are having trouble in their relationship or dislike their partner.
• worry that others will see or hear them having sex.
• are afraid of an unwanted pregnancy or an STI.

The amount of desire people feel changes throughout their lives, and for people who can become pregnant, it may change throughout the menstrual cycle.

Changes in desire affect how your body responds during sex. If your body makes less wetness in the vagina, using lubricant will make sex less painful and also safer. Sometimes a person’s penis does not get hard. This may cause feelings of shame and sometimes more difficulty getting hard the next time.

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

Pain during sex
Sex should not be painful. Pain during sex is usually a sign that something is wrong. Pain may be caused by:

• not enough lubrication—because the person is not naturally wet enough (in the vagina) or needs to use lubricant (in the vagina or anus).
• feelings of guilt, shame, or lack of desire to have sex.
• menopause.
• an infection or growth in the vagina or lower belly.
• genital cutting.

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

Safer sex

What is safer sex?

With most kinds of sex, there is a possibility you can get a sexually transmitted infection (STI). By having sex in ways that are “safer,” you can reduce your chance of getting an STI, but this is not the same as having no chance.

Like all infections, STIs are caused by germs. The germs that cause STIs are passed during sex. Some STIs cause sores or discharge on the genitals, but you often cannot tell if a person has an STI just by looking. Many people have STIs without knowing it themselves.

The germs for some STIs (such as gonorrhea, chlamydia, hepatitis, syphilis, and HIV) live in the body fluids of a person with that infection. They are passed when the blood, semen, or vaginal wetness from an infected person comes in contact with the inside of the vagina, anus, opening of the penis, or mouth of another person. The germs of other STIs (such as genital warts and herpes) live on the skin of the genitals and are passed during skinto-skin contact. All of these infections can cause serious health problems. HIV, without ongoing treatment, can cause death.

Practicing safer sex means having as little unprotected contact as possible with your partner’s body fluids and the skin of their genitals, unless you are absolutely certain they are not infected with any STI.

There is little to no chance of getting an STI from kissing.

There is little to no chance of getting an STI from touching.

There is some chance of getting an STI from oral sex, but less chance with a condom.

There more chance of getting an STI from penis-in-vagina sex, but less chance with a condom.

There is the most chance of getting an STI from penis-in-anus sex, but less chance with a condom.

How to make sex safer

Each person has to decide how much risk they are comfortable with and what they will do to lessen their risk of getting an STI. Here are some ways to have safer sex:

• Have no sex. If you do not have any kind of sex (abstinence), you will not be exposed to STIs. This is the best option for some people, especially when they are young. For most people, this is not possible or desirable long term.

• Have sex with only one partner who you know has sex only with you. Get tested to be sure neither of you has an STI from a previous partner.

• Have sex so a penis does not enter a vagina or anus. There are many ways to give and get pleasure, like kissing, massaging or rubbing different parts of the body, and touching each other’s genitals with your hands (mutual masturbation) or using your mouth on them (oral sex).

• Use a condom every time you have sex. Put the condom on yourself or your partner before your genitals touch. Internal (female) condoms protect best against STIs because they cover more. Use condoms or plastic wrap during oral sex.

• Use lubricant and avoid “dry sex.” When the vagina or anus is dry, sex can cause small tears that increase the chance of an STI getting into the body. Use saliva (spit) or lubricant to make the vagina or anus slippery. Do not use oil, lotion, or petroleum gel if you are using condoms—these can weaken a condom so it breaks.

• If your partner has signs of a STI , help them get tested and treated before you have sex with them.

• Get treated for STIs you may have. Having one STI makes it easier to become infected with other STIs

What happens in this story could happen anywhere in the world.

Fátima’s story:

Fátima lives in a rural town in Brazil—and she has HIV. 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 left her baby with Wilson’s parents and went 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 the government began building a highway to Belem, near her home town, Fátima got a job cooking for the road construction workers so that she could be with her daughter. That is where 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.

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 together, but he was small and sickly and died after a year. Then Fátima became sick. A healer she trusted gave her different herbal medicines, but nothing helped. Finally she went to a clinic in a nearby town. After doing some tests, they told her she had HIV. When she asked how she could have HIV, the doctor replied, “You should not 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!

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

Maybe she thought that only sex workers and homosexuals could get HIV.

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 HIV, 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

Talking to your partner about having safer sex is not always easy. Most women are taught that it is not “proper” to talk about sex, so they lack practice with these conversations. And talking about this with a partner when you are worried how it will affect your relationship can also be difficult. Here are some suggestions:

Educate your community about condoms and how to use them. This will help make condoms more acceptable.

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.

Learn as much as you can about STIs and how to have safer sex. If your partner does not know much about STIs, how they spread, and their long-term harms, safer sex may not seem important to them. Information can help them see the need to practice safer sex and how to do it.

Practice talking with a friend. Ask a friend to pretend to be your partner and practice what you want to say. Try to think of the different things your partner might say and practice how you will respond. Remember that your partner will probably also feel nervous about talking, so try to put them at ease.

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, and when neither of you has been using alcohol or drugs. 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 one of you travels often, talk ahead of time about how to protect your sexual health.

Focus on safety. When you talk about safer sex, your partner may think you do not trust them to be faithful. But the issue is safety. Since someone may have an STI without knowing it, or may get HIV from something other than sex, it can be difficult for a person to know for sure they are not infected. Safer sex is a good idea for everyone, even couples that have sex only with each other.

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

Listen to your partner’s concerns. Using condoms is the best way to protect each other from STIs and also can prevent unwanted pregnancy. But many people do not want to use them at first.

Here are some ways to respond:

This page was updated:22 Jan 2024