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Healthy Sexuality

Lorraine Benuto, Ph.D., edited by C. E. Zupanick, Psy.D.

Experts in the study of sexuality have identified several characteristics of healthy sexuality. Healthy sexuality may include an ability to integrate sexuality into one's daily life, rather than it being some external event that happens on its own. It may include affection, tenderness, and companionship between two people (Firestone & Cartlett, 1999). In an ongoing sexual relationship, both partners should be aware of the important role that sex plays in their lives. While it is important not to make sex an exaggerated area of focus, it is certainly important to recognize sexuality as a natural part of being human. Humans are naturally, sexual creatures. Healthy and natural sexuality should also include an acceptance of our animal nature and a positive attitude toward our bodies, our nudity, and our sexual urges (Firestone, Firestone, & Catlett, 2006). Some researchers have described healthy sexuality as including being able to attach emotions and meaning to sexual experiences (Schnarch, 1991).

open book with eyeglasses There are also several formal definitions of what makes up healthy sexuality. Firestone, Firestone, and Catlett (2006) reviewed several definitions and outlined the following: One definition reviewed included:

  • having an appreciation for one's own body
  • learning about reproduction
  • understanding that human development includes sexual development, such as reproduction and genital sexual experiences)
  • interacting with both genders respectfully and appropriately
  • understanding and respecting sexual orientation
  • appropriately expressing love and intimacy
  • developing and maintaining meaningful relationships while avoiding exploitative or manipulative ones.

Healthy sexuality has also been suggested to include:

  • communicating and accepting love
  • expressing emotion
  • giving and receiving pleasure
  • having the ability to enjoy and control sexual and reproductive behavior without feelings of guilt, fear, or shame (Firestone, Firestone, & Catlett, 2006).

In addition to the great difference among people's sexual behaviors, determining what is normal or healthy is further complicated by several types of categories that also impact sexuality. This includes gender, age, and health. Because of these, from person-to-person what makes up healthy sexuality may be very different.

Sexuality, specifically sexual function, is impacted by many things. When we consider health from a comprehensive view, we begin to recognize that both mental and physical health factors significantly impact healthy, sexual functioning. Anxiety, depression, and other mental health conditions can greatly affect one's sexual health. For example, reduced interest in sex is commonly reported by people who are depressed. Also, physical conditions can heavily impact sexual function. What might be considered abnormal for one physically healthy person, might be considered normal (or average) for a person who has a condition that affects the circulatory system. This might include diabetes, heart-related conditions, high blood pressure, obesity, etc. Lifestyle choices, such as smoking and alcohol consumption, can also impact sexual function. It is important to know that this is not a complete list of the things that can impact sexuality. There are also many variables that influence how we define what is normal and healthy. A discussion of these differences follows.

Clear-Cut Differences in Healthy Sexuality

When it comes to sexuality, it is important to consider there are many well established differences between men and women, and also differences across the lifespan. Starting with sexual desire, it is a well-proven fact that men have a stronger sex drive than women. In 2001, Baumeister and colleagues conducted an extensive review of the research and found that men generally want sex more than women. In fact, men think and fantasize about sex more than women. Women are willing to wait longer to begin sexual activity in new relationships and are less likely to masturbate than men. In terms of sexual arousal, on average it takes women longer to get turned on than men. Finally, gender differences in orgasm exist as well. Not only do men and women reach orgasm at different rates, but men can reach orgasm through penetration alone, while a large number of women cannot. A more detailed description of gender differences in sexuality follows.

Gender Differences in Sexuality

Often, very simple things can have a great deal of impact on sexual health. One example is thinking. During sexual activity, thoughts may not always be on sex. This lack of attention to the present moment of sexual activity is defined as a general cognitive (thinking) distraction. It is quite common for someone to experience distraction as the mind wanders to the grind of everyday life. This might include thoughts about balancing checkbooks, paying bills, or taking children to extracurricular activities. While distraction can certainly impact sexuality, there are other specific types of cognitive distraction that can also impact sexuality.

Because thoughts and concerns about performance are common during the act of sex, the term performance anxiety has been used to describe this situation. Performance anxiety can cause big problems for sexual function, as well as make the sexual experience quite unpleasant. When we are anxious, we receive a surge of adrenaline and a large quantity of adrenaline is bad for sexual arousal.

Another type of thinking distraction that can impact the sexual experience is appearance-based. This means having thoughts or concerns about one's body during sexual activity. For example, you may be thinking "Does my body look ok to the other person?"

When it comes to the way cognitive distractions can affect sexual functioning, there are well-established gender differences. It seems that both men and women are preoccupied with thoughts about their sexual performance during sex. However, women are more concerned than men about how their bodies appear while they are engaging in sexual activity.

How does this greater concern about body image impact women's sexuality? Recalling our discussion of healthy sexuality, the appreciation of one's own body was a part of the definition. Despite recent concerns about the increase of body image problems among men, women continue to be more impacted than men by body image disturbances. Yamamiya, Cash, and Thompson (2006) identified that body dissatisfaction is related to sexual dissatisfaction, avoidance of sexual activities, sexual distress, and feeling sexually unskilled.

In addition to gender differences in thinking distractions, the research also identifies the ability to be flexible in sexual attitudes and behaviors (known as erotic plasticity) as being different between the genders. Scientific research has identified that women are more sexually fluid than men when it comes to engaging in same-sex behaviors.

The theory of Female Erotic Plasticity was first proposed by Baumeister in 2000. His review of the literature on gender differences in sexuality revealed that women are more flexible when it comes to sexuality than men. It seems that female sexual responses and behaviors are largely shaped by cultural, social, and situational factors. In contrast, male sexuality seems to be formed early in childhood (or before) and is less likely to change throughout the lifespan. Baumeister identified research studies that demonstrated that women tend to change their sexual attitudes and behaviors more throughout their life than men. For example, men tend to engage in a consistent amount of sexual activity (with a partner or alone) over the course of their lifetime. Women may go through periods of time when they are extremely sexual and then go through periods of time where they are not sexual at all. Baumeister also found research that suggested that female sexuality tends to be more affected by religion, parental attitudes, peer attitudes, and cultural than male sexuality. Finally, he found research that suggested that women are more likely than men to say one thing (attitude) and then do another (behavior). For example, a woman is more likely to say she is against premarital sex, but then have sex outside of marriage. Researchers have found that it seems that even female sexual orientation is more flexible than male sexual orientation. Clearly, there are many other gender differences in sexuality than those explained here, but the above is intended to simply show that male and female sexuality are quite variable. Because of this, what is considered "normal" or "healthy" for a man might not be the same for a woman.