Sexually transmitted infections (STIs)

STIs are conditions that are mainly spread from person-to-person sexual contact which can include oral, vaginal or anal intercourse, and other types of sexual contact. Prevention of STIs includes using barrier methods (condoms and dental dams), getting certain vaccines, and other behaviors. These infections are relatively common, half of all sexually active adults will get an STI by the age of 25 (according to CDC.gov) – https://www.cdc.gov/nchs/fastats/stds.htm.

There are many different STIs. Some are caused by bacteria and can be treated with antibiotics. These include chlamydia, gonorrhea, and syphilis.

Others are caused by viruses and do not have a cure, though treatments may still be available. These STIs include herpes simplex I and II, human papillomavirus (HPV), and human immunodeficiency virus (HIV). Some strains of HPV can be prevented through vaccination. HIV infection can lead to acquired immunodeficiency syndrome or AIDS if left untreated. However, people at risk for HIV infection can take a medication called Pre-exposure prophylaxis (PrEP).

There are also fungal and parasitic infections like trichomoniasis and pubic lice. These infections are treatable with special medications.

Many STIs are asymptomatic or have symptoms that are not very specific like a fever. Thus, it is important to get regular STI tests if you are sexually active. Untreated STIs can lead to pelvic inflammatory disease. Some STIs may be extra dangerous during pregnancy. Men who have sex with men have a higher risk of getting an STI.

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Contraception and birth control

When people try to prevent or space out pregnancy, they are practicing contraception or birth control. There are several broad categories of birth control. Failure of birth control is measured by what number of people who use this method nevertheless become pregnant. The more a person uses a method of birth control, the more likely failure becomes (since there are several ways to fail to use contraceptive methods correctly). See graphs in this New York Times article showing typical and perfect-use effectiveness for several methods.

Barrier methods of contraception include the condom, the internal condom, the diaphragm, the cervical cap, and the contraceptive sponge. Many of these methods may be used together with spermicide.

Hormonal methods of contraception include the birth control pills, the vaginal ring, the patch, the shot, and the implant. Some intrauterine devices also contain hormones, while one IUD has no hormones and is copper-based.

Behavioral methods include abstinence, withdrawal, and fertility awareness methods.

Surgical methods of contraception are tubal ligation and vasectomy and are usually permanent.

If a person fails to use a contraceptive method or their chosen method fails (e.g. a condom tears), there is emergency contraception, which can be used up to 5 days after. The “morning-after” pill is most effective within 24 hours of unprotected sex.

However, pregnancy can still occur even when using these contraception methods. In that case, people should consider whether they want to continue being pregnant and giving birth. They may also consider abortion. There are two main methods of getting an abortion – the abortion pill, and the in-clinic abortion. There are many limits placed on both of these medical interventions by law, including the length of the pregnancy and the reasons for abortion. This year, the Supreme Court case that kept abortion legal in all states called Roe v. Wade was overturned, and many states have already placed severe limits on this medical procedure, in some cases making it impossible for people to obtain it. This will likely lead to many unwanted pregnancies and births and may result in more difficulties for the pregnant person, including traveling out of state to obtain abortion or trying methods to perform an abortion that may not be medically safe. However, there is wide access to abortion pills and many providers can prescribe these medications early in the pregnancy using telehealth. To read more about ways to access abortion, go here https://www.wired.com/story/guide-abortion-resources-post-roe-america/.

Fertility, conception, pregnancy and birth

Fertility refers to the ability of someone to become pregnant or cause someone else to become pregnant. Some people may have trouble with becoming pregnant – this is called infertility and treatments are often available.

When sperm is present in the Fallopian tubes at the same time as an ovum (or egg), fertilization can occur. Read more about this process here – https://www.plannedparenthood.org/learn/pregnancy/how-pregnancy-happens. Home pregnancy tests are quite accurate and easily available and can often be used once a menstrual period is overdue.

Pregnancy lasts about 40 weeks from implantation and is the process of two cells which have combined (sperm and egg) becoming a full grown fetus. Read about the changes each month of pregnancy here – https://www.plannedparenthood.org/learn/pregnancy/pregnancy-month-by-month.

There are several ways to help a pregnancy be as healthy as possible. Getting appropriate prenatal care, ensuring the right nutrients, avoiding drugs, and other behaviors are important. Some pregnancies are considered high risk and there are certain conditions that can develop during pregnancy, including pre-eclampsia, gestational diabetes, and others. Finding the right healthcare provider is also important. People may go to OB/Gyn doctors or family doctors for care. Another option is a Certified Nurse Midwife. Research shows that having a person present during the birth who can support the person in labor leads to better health outcomes for parents and babies – this can include a friend, family member, or partner, or a trained doula. Read more about healthcare professionals here – https://www.parents.com/pregnancy/giving-birth/labor-support/which-birth-professional-is-right-for-you/.

Labor is the process of the fetus being born and has several stages. Labor can last a long time. There are many options for pain management which include medication, breathing techniques, moving, meditation, birthing tubs and others. Labor can result in vaginal delivery or a Cesarean section. Hear about the stages of labor here https://www.youtube.com/watch?v=samWyTjFmS8 .

Post-partum care includes healing of any incisions or tears, pain management, assistance with breastfeeding and lactation, screening for post-partum depression and/or anxiety, and making sure people don’t develop post-partum complications like blood clots, hemorrhage and others. Typically, people go for a post-partum visit with their healthcare provider within six weeks of giving birth.

Sexual identity

There are many aspects of sexual identity that are complicated and interrelated, including our biological sex, our gender identity and expression, our attractions and our behaviors.

Genderbread person - image showing different parts of sexual identity. Gender identity, gender expression, anatomical sex, sexual attraction, romantic attraction.
https://www.genderbread.org/

Read more about each concept on the above picture here – https://www.genderbread.org/wp-content/uploads/2017/02/Breaking-through-the-Binary-by-Sam-Killermann.pdf.

Even something as “simple” as biological sex, or the formation of one’s genitals and gonads, is not as simple as first thought. Scientists have identified many different possibilities that don’t exist on a simple binary of male and female – https://www.scientificamerican.com/article/sex-redefined-the-idea-of-2-sexes-is-overly-simplistic1/.

Sex is different from gender and gender identity. People may express their genders in different ways and gender can be outside of the binary of masculine and feminine. However, society endorses certain gender roles and stereotypes that people may adhere to or reject. Sometimes people may feel that their gender identity does not match the biological sex they were assigned at birth – these people often identify as transgender.

Sexual orientation is how we often think about our sexual and romantic attractions. Common terms include lesbian, gay, bisexual, straight and others. Some people may not experience any sexual or romantic attractions and thus may identify as asexual or aromantic.

People who are sexual minorities may face stigma, social isolation, and lack of acceptance by family and friends. This may make them prone to more depression and anxiety, sexual assault, interpersonal violence, and suicide. There may also be legal issues of discrimination or unequal protection under the law.

Interpersonal violence

Content warning: abuse and violence

On one side of the relationship spectrum are healthy relationships and on the other are abusive relationships or intimate partner violence (IPV). This type of violence happens in various relationships – family, friend or romantic and is quite common – https://www.cdc.gov/violenceprevention/intimatepartnerviolence/fastfact.html.

Image with statistics about IPV. About 1 in 5 women and 1 in 7 men report severe physical violence. About 1 in 5 women and 1 in 12 men experience sexual violence. About 10% of women and 2% of men report having been stalked.
From CDC.gov

IPV can take many forms like physical, verbal or emotional, and sexual violence, and stalking. Other recognized forms include financial control, isolation from family and friends, and monitoring people’s movements and activities. Read about signs of IPV here – https://www.womenshealth.gov/relationships-and-safety/domestic-violence/signs-domestic-violence. It is possible to experience IPV in same-sex relationships. Mainly people experience similar signs of IPV, with a few other possibilities like threats to “out you” to your family or telling you that police won’t help people who are LGBTQIA+.

Another common form of interpersonal violence is sexual assault and rape. People of all sexes can experience sexual assault and help is available to all. People often experience feelings of guilt and shame and thus don’t seek help.

Both of these types of violence can have a profound effect on people’s health and it is important to prevent them whenever possible through laws, policies, and cultural norms.

Healthy relationships

Humans are social animals – we need some level of social support and social networks in order to be fully healthy. We form relationships from birth and require things like love and nurturing in order to stay socially healthy.

Our first relationship is usually with family – they raise us, they teach us, and they model love. We learn our communication patterns and coping skills from family, whether it is a mother and father, a single parent, a grandparent or aunt/uncle, an adoptive family, or a foster family.

There are several different conceptions of love. One is Dr. Robert Sternberg’s triangular theory of love, which identifies three main components: intimacy, passion and commitment. Different types of relationships may exhibit different types of love.

Dr. Helen Fisher has studying what happens in the brain during love – see the video below.

There is a spectrum of positive and negative traits in relationships. Healthy relationships are based on equality, independence, and respect. https://www.loveisrespect.org/wp-content/uploads/2017/07/Relationship-Spectrum-final.pdf It’s also important to set expectations for your relationships and keep healthy boundaries – https://www.loveisrespect.org/pdf/Healthy_Relationships.pdf

Communication is important for healthy relationships. Here are some things important for good communication – https://www.loveisrespect.org/healthy-relationships/communicate-better/. Additionally, partners must understand each others’ ways of communicating so that they have more realistic expectations – https://www.psychologytoday.com/us/blog/contemplating-divorce/201502/how-do-you-define-love.

Healthy sexual activity

Being sexually healthy begins before sexual activity takes place and may include learning about your sexual and reproductive organs, going through the changes of puberty, learning to deal with the menstrual cycle, and so on. Young children learn about their sexual organs through exploration and may begin stimulating them because it brings them pleasure. This type of exploration is quite normal.

After puberty and sexual maturation begins, there may be some changes like ejaculation for people with penises and testes. People will need to learn how to start taking good care of their sexual and reproductive organs (see the Female and Male reproductive system posts). And people will want to develop a healthy sex life . This can include a variety of sexual activity, with other people or not.

Scientists started to study sexual response in the 1950s and 1960s and developed several ways to understand how human bodies react during desire, arousal and orgasm. Read more here – https://www.ourbodiesourselves.org/book-excerpts/health-article/models-sexual-response/. Often, sexual response starts with desire, which is something that happens in our brains when we think about something arousing, or we feel close to our partner, or we experience sensations (which includes images or sounds) that we find exciting.

Image showing typical male and female sexual response cycles with excitement, plateau, and orgasm phases.
Human sexual response as described by Masters & Johnson

When we decide to have sex with other people, it is important to communicate about sex and set expectations with each other. People may want to discuss what they like and don’t like, consent, and safer sex. Read more here – https://www.plannedparenthood.org/learn/sex-and-relationships/sex/how-do-i-talk-my-partner-about-sex.

Male reproductive anatomy and function

The male reproductive and sexual anatomy includes the penis and scrotum (the external parts), and internal reproductive organs. Read more about the names and function of these organs here – https://www.plannedparenthood.org/learn/health-and-wellness/sexual-and-reproductive-anatomy/what-are-parts-male-sexual-anatomy

Image showing the organs of the male sexual and reproductive system.
From Bioscope, HUG (Hôpitaux universitaires de Genève), DIP (Département de l’Instruction Publique), Odile Fillod

Some penises are circumcised and some are not. If parents choose to do this for their infants, they will usually do it very close to birth. There are cultural and religious reasons for circumcision, and there may be health benefits, but routine circumcision is no longer recommended in the United States.

People with testes should do a testicular self-exam monthly. Other care for reproductive health includes HPV vaccination, regular STI exams if they are sexually active with another person, and contraception if they engage in sexual activity with people who may get pregnant.

The main hormone produced by testes is testosterone (though all people produce both estrogen and testosterone). This hormone is responsible for many things like sex drive, sexual development and maturity, and so on.

While people with typical male anatomy do not have an equivalent to menopause and thus may remain fertile until the end of life, some may experience a drop in their testosterone levels as they get older. Read more here – https://www.mayoclinic.org/healthy-lifestyle/mens-health/in-depth/male-menopause/art-20048056?p=1.

Female reproductive anatomy and function

The female reproductive and sexual anatomy includes the vulva (the external parts) and various internal organs like the uterus and ovaries. Read more about the various organs and parts that make up the typical female anatomy here – https://www.plannedparenthood.org/learn/health-and-wellness/sexual-and-reproductive-anatomy/what-are-parts-female-sexual-anatomy

Image showing organs of the female reproductive system including external and internal anatomy.
From https://commons.wikimedia.org/wiki/File:Anatomical_charts_of_the_genital_system-UNIGE_SSI-3Den.pdf

Breasts are also part of the reproductive and sexual anatomy – read more about the form and function of breasts here https://www.scarleteen.com/article/advice/abreast_the_basics_of_boobies.

During puberty, people with a uterus and ovaries typically begin the menstrual cycle. There are three phases of the cycle and it repeats on average every month (but there is a lot of individual variety). It includes ovulation (the release of an ovum or egg) and correspond to a period of fertility (the ability to become pregnant). Some people will have irregular periods, while others have very regular cycles (it can range in the number of days). Read more here https://www.scarleteen.com/article/bodies/on_the_rag_a_guide_to_menstruation. The main hormones that ovaries produce are estrogen and progesterone.

Reproductive and sexual care for this type of anatomy includes regular check-ups with a gynecologist (between every 1 and 3 years) for a procedure called the Pap smear which tests for cervical cancer as well as other tests and screening, HPV vaccination, regular STI tests if the person is sexually active with another person, and understanding contraception choices. Some fairly common health issues include: PCOS, endometriosis, uterine fibroids, and dysmenorrhea.

At the end of fertility for people who menstruate, they will typically go through a process called menopause, which is a change in the production of hormones and the end of ovulation.

What is sexuality?

We each have a unique understanding of our sexuality and it includes a number of different aspects of our lives, including relationships and intimacy, sexual health and reproduction, sexual identity and others. Sexuality is something we have and develop throughout our lifetime.

One holistic model of sexuality was created by Dr. Dennis Dailey and it’s called the 5 circles of sexuality.

Five overlapping circles: sensuality, intimacy, sexual identity, sexual health and reproduction, and sexualization. Sensuality - acceptance of one's own body, enjoyment of one's own body and the bodies of others. Intimacy - ability and need to experience emotional closeness to another human being. Sexual identity - development of who you are, including sex, gender, sexual orientation. Sexual health - attitudes and behaviors related to producing children, care and maintenance of sex and reproductive organs, health consequences of sexual behavior. Sexualization - use of sexuality to influence, control and manipulate others.
From Dennis Dailey, PHD (1981) Sexual expression and aging.

Read more about each circle of sexuality here – http://2www.futureofsexed.org/for-professionals/lesson-plans-professionals/200?task=view.

Some definitions from the World Health Organization are here – https://www.who.int/reproductivehealth/topics/sexual_health/sh_definitions/en/.