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Sexual relationships are some of the most significant in our lives. Sexuality is more than what you do with another person sexually. It is an important aspect of your wellness. Elements of your sexuality include the person you feel you are, your body, how you feel as a man or woman, the way you dress, move, and speak, the way you act, and how you feel about other people.

Everyone has his or her own way of being or feeling sexual. Choosing to wait until you feel ready to be in a sexual relationship is healthy. You may also choose to be sexually abstinent at different times in your life.

Sexual activity is a normal part of human experience. Thoughts, feelings, words and actions are all a part of sexuality. There are a wide variety of behavioral patterns that define appropriate sexual activity. There are as many sexualities as there are individuals.

Making Sexual Decisions

Human sexuality is a universal experience. We experience our sexuality through our relationships with others, through our own personal fantasies, and through the many symbols of sexuality in the media. As we learn to understand these sexual experiences within and around ourselves, we form beliefs about acceptable sexual etiquette and learn about the ways our bodies respond to sexual emotions.

Enjoying your sexuality depends, to a large extent, on communication and education. It is crucial that you talk about sexuality with your partner(s), friends, and family. Ensure that discussions of sexuality include education about sexual activity, the proper use of contraceptives, safer sex practice, deciding whether or not to have sex, and values, beliefs, self-care and commitment.

When making decisions about when to be sexually active you should ask yourself these questions: Do I want to be sexually active, and if so, to what degree? How important is independence to me? How important is my virginity to me? Do I feel lonely, unsafe or uncool without a sexual partner? Why or why not should I have sex? For whom am I making this sexual decision? Do I have a reproductive life plan and am I using/considering birth control accordingly? Am I protecting myself against AIDS and other sexually transmitted diseases with contraceptives? With whom, and in what context will I have sex? Do I reserve intercourse for a permanent partnership or marriage? Do I have questions about my sexual orientation or the kinds of people I feel attracted to?

Sexual Concerns

Our sexuality is one of the most basic aspects of our existence. It is a component of life we share with other living things on this planet. At its core is our biological drive to continue the species …a drive we can never completely escape or suppress, even if we want to. But it is a drive that varies greatly from one person to the next …one stage of life to the next …and, one moment to the next. The wonderful difference of being human is the capacity to be self-aware …to watch ourselves, and analyze our own thoughts, feelings, behaviors and motives. But this difference that can interfere with our capacity to enjoy our sexuality, for experiences and thoughts can also affect this powerful sexual drive negatively.

Causes of Sexual Problems

While some problems of sexual functioning are biological or chemical, psychological concerns and stress cause the majority of sexual problems. As many as half of the sexual problems that damage people’s lives and relationships result from inadequate knowledge. Even very highly educated people may believe sexual myths or incorrect information. Rigid or fearful sex education from parents, teachers, churches or the media can cause very serious problems. In addition, the widespread occurrences of rape, incest, and sexual harassment often have profound negative impacts on self-esteem and sexual function. Add to these the high incidences of physical abuse, emotional abuse, neglect and sexual abuse that occurs in our society to children and adolescents and you begin to understand why studies show that half of all long-term intimate relationships experience at least one sexual dysfunction. Significant relationship problems can diminished or eliminate sexual pleasure. Finally, medical and environmental issues may deteriorate a formerly healthy sexuality. Fortunately, advances in psychology, medicine and sexual science have led to a reasonable potential for healing most or all of the damage these destructive influences cause.

Common Sexual Problems

The most common sexual problem among males, especially young males, is premature ejaculation, or the inability to control the timing of orgasm consistently. Some men learn ejaculatory control more quickly than others. Ejaculatory control is not biologically normal. From an evolutionary perspective, males who ejaculate quickly are most likely to pass along genetic material. For example, the African gazelle is able to copulate and ejaculate in mid-air while running. However, because mutual pleasure is important in sexual relationships, it is vital that men learn to control the timing of their orgasms.

Another male sexual problem is erectile dysfunction (ED), or the inability to achieve or maintain an erection. Although all men experience occasional difficulties achieving or maintaining erections, some may experience ED frequently enough to cause problems in their sexual relationships. It is important to determine whether ED is primarily medical or psychological. If a man is able to achieve and maintain an erection when alone or has nocturnal or waking erections it is less likely that he has a medical problem. ED may also be associated unless the problem appears associated with alcohol or illegal drug use or the use of prescription medication. The primary psychological cause for ED is performance anxiety, or worrying about erection and sexual performance. Many events could trigger enough worry or anxiety to cause ED. Recent advances in medical pharmacology, such as Viagra, have helped some men overcome ED.

Both men and women may experience anorgasmia, or the inability to orgasm.  Anorgasmia is more common among women than it is among men. The inability of a female to orgasm during heterosexual intercourse is perfectly normal. Only 30-40% of women are able to orgasm during heterosexual intercourse without clitoral stimulation. Most women who orgasm consistently during intercourse also report that added direct stimulation to the clitoris during intercourse is necessary. In almost all of the common heterosexual positions, a man’s penis does not come in contact with a woman’s most erotically sensitive area: the clitoris, or the Grafenberg spot (G-spot) deep inside the vagina. Some people report that they have never orgasmed or only very rarely orgasm, either alone or with a partner. If you feel you become adequately aroused, but do not orgasm, you might consider a visit a sex therapist.

Both men and women may also experience inhibited sexual desire (ISD).  People with ISD report they never or almost never think about sex in a positive way. Fear, past sexual trauma, severe psychological depression, and relationship problems are frequent causes of ISD. ISD usually requires psychotherapy specific to its root cause followed by and sex therapy. Much less frequently, a medi­cal problem, such as a hormonal imbalance, may cause ISD.

Physical pain during sex, or dyspareunia, almost always has a medical cause.  A gynecologist or urologist can help you investigate the cause of dyspareunia. An unlikely exception to this rule is a female disorder called vaginismus, or the spastic and painful tensing of muscles surrounding the vagina whenever vaginal penetration begins. Sex therapists can treat vaginismus.

If you experience a problem with sexual function, consult a sensitive physician to rule out medical causes. If the problem relates to relationship difficulties, help from a sex therapist or relationship counselor may greatly enhance sexual pleasure in the relationship. If the problem is not medical, but of long duration, or if function has never been adequate, consult with a certified sex therapist.

The Sexual Response Cycle

The sexual response cycle is a sequence of physical and emotional changes that occur as a person becomes sexually aroused during sexually stimulating activities including intercourse and masturbation. Knowing how your body responds during each phase of the cycle can enhance your relationship and help you pinpoint the cause of sexual dysfunction.

There are four phases of the sexual response cycle: excitement, plateau, orgasm and resolution. Both men and women experience these phases, but the intensity of the response and the time spent in each phase varies from person to person. For example, it is unlikely that both partners will orgasm at the same time. Understanding these phases may help partners better understand one another’s bodies and responses, and enhance the sexual experience.

Phase 1: Excitement

The excitement phase can last from a few minutes to several hours. During this phase

  • Muscle tension builds.
  • Heart rate and breathing accelerate.
  • Skin may flush.
  • Nipples become erect.
  • Blood flow to the genitals increases. A woman’s clitoris and labia minora (inner lips) swell, and a man’s penis becomes erect.
  • Vaginal lubrication begins.
  • A woman’s breasts become fuller and her vaginal walls begin to swell.
  • A man’s testicles swell, his scrotum tightens, and his penis secretes lubricating liquid.

Phase 2: Plateau

The plateau phase extends to the brink of orgasm. During the plateau phase

  • Body changes that began in the excitement phase intensify.
  • A woman’s vagina continues to swell, and the vaginal walls turn a dark purple.
  • A woman’s clitoris becomes highly sensitive and may even be painful to touch. The clitoris retracts under the clitoral hood to avoid direct stimulation from the penis.
  • A man’s testicles withdraw into the scrotum.
  • Breathing, heart rate and blood pressure continue to increase.
  • Muscle spasms may begin in the feet, face and hands.
  • Tension in the muscles increases.

Phase 3: Orgasm

This phase is the climax of the sexual response cycle. It generally lasts only a few seconds. During orgasm

  • Involuntary muscle contractions begin.
  • Blood pressure, heart rate and breathing are at their highest rates, with a rapid intake of oxygen.
  • Muscles in the feet spasm.
  • There is a sudden, forceful release of sexual tension.
  • A woman’s vaginal muscles and uterus contract rhythmically.
  • A man’s muscles at the base of his penis contract rhythmically while he ejaculates semen.
  • A rash, or “sex flush,” may appear over the entire body.

Phase 4: Resolution

During this phase, the body slowly returns to its normal level of functioning, and swollen or erect body parts return to their previous size and color. During this phase, you may feel a general sense of well-being, enhanced intimacy and, often, fatigue. Some women are capable of a rapid return to the orgasm phase with further sexual stimulation and may experience multiple orgasms. Men need recovery time after orgasm, called a refractory period, during which they cannot reach orgasm again. The duration of the refractory period varies among men and changes with age.

Sexually Transmitted Diseases

Being aware of your body is always important, especially if you are sexually active. Noticing rashes, growths, or unusual changes in penile or vaginal discharges can help you detect several sexually transmitted infections early. Some sexually transmitted infections and diseases produce no obvious symptoms—especially among women—which helps explain why it has been difficult to curb the spread of many of the sexual pathogens. If you believe that you or your partner may have a sexually transmitted infection, please see your physician for testing. Everyone who is sexually active should receive periodic STD checks to ensure their own health and the health of their partner.

Several factors may contribute to the rising incidence of STDs. There is an increasing tendency for young adults to have multiple sexual partners and increased sexual activity among adolescents. The increased use of birth control pills rather than condoms or vaginal spermicides increases the risks of transmitting STIs. Even more alarming is that many people remain uneducated or uninterested in the causes and consequences of STDs.

Unfortunately, women and teenagers may be at greatest risk for contracting a STD. The delicate lining and warm, moist environment of the vagina make it twice as easy for a male to transmit a STD to a female than vice-versa. Anal sex also increases the receiver’s risk for similar reasons: The anus’s highly sensitive tissue may tear easily, creating opening large enough for infections to enter. Also, there is a higher incidence of STDs among younger women than older women. Adolescent girls’ and young women’s cervixes are surrounded by an ectropion, a rim of red tissue composed of immature cervical cells that can be invaded easily by sexually transmitted viruses and bacteria. As women age the ectropion recedes into the cervical canal, women become less vulnerable to infection.

Sexually transmitted infections are a risk to the sexually active, but certain behaviors carry the highest risk. These behaviors include: oral-genital sex without a condom or dental dam; semen in mouth; vaginal intercourse without a condom; anal intercourse without a condom; and other oral or manual contact with the anus.

Safer Sex Practices

Practice safer sex by talking openly with your partner in order to find out about his or her health and sexual patterns and to communicate your own. Discuss what will happen between the two of you and choose to protect yourselves during sexual activity. What you do, not who you are, creates risk for sexually transmitted diseases.


  • Dry kissing
  • Masturbation on skin with no open sores/cuts
  • Oral sex on a man wearing a condom
  • External watersports (urinating on skin without open sores)
  • Touching or massaging
  • Sharing fantasies (the brain is the largest, most versatile sex organ)

Less Risky

  • Vaginal intercourse with a condom
  • Wet kissing


  • Oral sex on a man without a condom
  • Masturbation on open or broken skin
  • Oral sex on a woman
  • Anal intercourse with a condom
  • Engaging in sexual contact after alcohol or drug use
  • Oral sex with dental dam
  • Vaginal sex with female condom


  • Vaginal intercourse without a condom
  • Anal intercourse without a condom
  • Internal watersports (urinating into mouth, vagina or rectum)
  • Sharing a needle for intravenous drug use
  • Fisting (putting hand or fist into someone’s rectum or vagina)
  • Rimming (oral to anal contact)