The 6 Principles of Sexual Health

This post is Part 1 of a series.

When people come in for sex therapy, they’ll often ask their sex therapist questions like, “How often should I (or we in the case of a couple) be having sex?” or “Is it normal for me (or for my partner) to desire to do ‘xyz type’ of sex?” or “Does it mean I’m an awful person if I fantasize about an ex-partner when I’m with my current spouse?”

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Douglas Braun-Harvey and Michael Vigorito, authors of Treating Out of Control Sexual Behavior: Rethinking Sex Addiction, created a template for therapists to use when helping clients assess through self-inquiry whether their sex life is in fact sexually healthy. They called this assessment the Six Principles of Sexual Health. They created this model after years of treating mostly male-identified clients who were coming to therapy due to sexual behavior that was described as compulsive, hypersexual, or out-of-control. However, this framework could be adapted for any person who wants to optimize their sexual and relational wellness to better reflect their authentic values and priorities. A healthy sex life isn’t solely based on things like frequency or STI and pregnancy protection. Instead, it’s built on key principles that support an honest inquiry into the physical, emotional, psychological, ethical, and relationship behaviors and considerations one makes to live an authentic and integrated life as it relates to sexuality.

Consent: Each Partner Feels Free to Say No

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This is perhaps the most important and basic principle of sexual health. Consent must be ongoing, not a one-off question that one asks at the initiation of a sexual encounter, whether with a new partner or a longstanding partner. Each person must feel emotionally safe and confident enough to pause or stop a behavior whenever they choose, even if they are in the middle of the experience to which they had initially agreed. If one partner agrees to go along with sex in order to avoid a conflict or because their partner will act in a resentful fashion if they say no, this isn't healthy sexuality, and it is not considered fully consensual. So while verbally agreeing to a specific sexual encounter is legal consent, if either partner feels pressure to keep going despite feeling afraid, anxious, or disassociated, the sex is no longer fully emotionally consensual. Depending on the relationship power dynamic, it could also be construed as coercive.

This kind of "going along" is reported frequently by female clients who present in sex therapy within their heterosexual experiences because they feel like they should, or ought to do it. However, many men also push through doubts or ambivalence in heterosexual or same gender sex because they are avoiding appearing less "like a real man." These are ingrained beliefs that are part of the heteronormative, patriarchal system, and oftentimes lead men to develop erectile disorder or premature ejaculation. These "going along" sexual encounters are not what is considered enthusiastic ongoing consent, and if repeated for months or even years, can lead to people losing connection or going underground with their own authentic desire and needs. Sex therapy with a certified sex therapist can re-educate and support clients to lead a more authentic sex life in which either partner feels free to say "no, not tonight" without feeling guilt, remorse, or shame.

Honesty: Being Able to Talk About Sex

A healthy sex life depends on both partners feeling comfortable communicating openly about their sexual relationship, including their desires, boundaries, concerns, and changing needs. A couple with a healthy sex life would be able to speak about topics such as fantasies, desire, boundaries, frequency, and any sexual discomfort. Honest conversation means addressing concerns before they turn into longstanding issues. Avoiding these conversations often negatively impacts the erotic foundations of a romantic relationship. A healthy couple is able to have a clear conversation that avoids blaming or shaming of or by either partner. For example, one partner might say, "I've noticed my desire has been lower lately. I don't think it's about you, but I'd like us to figure it out together." Open conversations like this strengthen intimacy.

Shared Values: Being on the Same Team

Though you don’t necessarily need to have the same beliefs to have successful relationships, it’s important that you have shared values when it comes to erotic and sexual agreements. Compatibility goes beyond libido and can extend into beliefs on topics such as monogamy, pornography, flirting, kinks, and so on. Partners need to be able to discuss what sex means to each of them in the relationship. A couple should be able to explore differing views on topics and come to a reasonable agreement that leaves both partners feeling safe and excited. For example, if one person in the couple enjoys watching porn and the other doesn’t, a healthy couple should be able to discuss the reasons for one’s interest and use of pornography and why the other feels discomfort around the behavior. Partners need to come to a joint agreement with one another on all sexual and erotic practices, whether they are done in private or with one another.