How to Stay Sexually Healthy From a Physical Perspective

When you think of your sexual health, you probably leap to thoughts of sexually transmitted infections (STIs) and contraception. However, this area of health includes more than that.

In 2019, the World Health Organization (WHO) defined sexual health as "a state of physical, emotional, mental and social well-being in relation to sexuality; it is not merely the absence of disease, dysfunction or infirmity."

Deborah Lee, M.B.Ch.B., a sexual and reproductive health specialist at Dr Fox Pharmacy, an online doctor and pharmacy service in the United Kingdom, explained sexual health affects everybody's physical, emotional and social health.

"It has far-reaching consequences, affecting pregnancy and neonatal outcomes," Lee said. "When we think of sexual health, we're not just talking of STIs. We need to consider a huge range of other issues, including sexual identity, sexual orientation and gender, reproductive health, fertility, sexual assault and unsafe practices, such as female genital mutilation."

This article is the first of four during the month of September in which we'll cover all of the above and more, including the physical, mental, social and communicative aspects of sexual health.

"Start by realizing the importance of your sexual health," Lee said, specifically noting that when it comes to infection and disease, "Most STIs have no symptoms, so you may not realize you are infected."

STIs and sexually transmitted diseases (STDs) are not to be taken lightly. Lee listed potentially serious consequences of STIs and STDs that people may not know:

• Chlamydia and gonorrhea are major causes of chronic pelvic pain and infertility.
• Chlamydial infection is strongly linked to ectopic pregnancy, the most common cause of death in the first trimester of pregnancy.
• The human papillomavirus (HPV) is the primary cause of cervical cancer.
• Cases of syphilis increased by 33 percent in the United States between 2020 and 2021. Syphilis can go undetected for many years and has devastating neurological and cardiac complications. The disease can also be passed to the unborn babies of people afflicted.
• HIV (human immunodeficiency virus) is a serious, chronic viral infection that can be effectively managed with antivirals. However, untreated, it could lead to AIDS (acquired immunodeficiency syndrome).
• Pelvic inflammatory disease (PID) is a largely unrecognized condition that affects more than 1 million American women annually. PID can be caused by chlamydia and gonorrhea.

Monte Swarup, M.D., a board-certified OB-GYN in Arizona and founder of HPD Rx, said the most common STDs and STIs to be concerned about are: chlamydia, gonorrhea, hepatitis, herpes, HIV, HPV, syphilis and trichomoniasis.

"If you are sexually active, it's important to get tested regularly, especially if you have new sexual partners," he explained. "There are several ways that you can be proactive and take control of your sexual health."

Taking control of your sexual health begins with a basic knowledge of when you should get screened and then following through.

Lee recommended getting screened for STIs before having sex with a new partner or every three to six months, and anytime you're presenting symptoms.

"If you're a young person aged 25 and under and you've never been screened, it's now time to make an appointment," Lee said.

But it's not just young people who are affected by STIs, Lee explained. In 2019, the Centers for Disease Control and Prevention (CDC) reported an 86 percent rise in the number of cases of chlamydia in Americans ages 55 and older.

"Around 50 percent of marriages in the U.S. end in divorce," Lee said. "Older people are more likely than ever to start new relationships. STI screening is imperative for those of all ages, especially for anyone with a recent new sexual partner."

Swarup added that this is why you should really get to know your sexual partners.

"The more partners you or your partners have, the higher your risk of getting an STD," he said. "You need to know about not just your partner but if your partner is having sexual relations with anyone else."

Women should also have STI screening during pregnancy, Lee said, as STIs have serious harmful consequences for both mother and baby.

"If you have an STI, being diagnosed and treated as soon as possible greatly improves the pregnancy outcome," she advised.

It's important to be screened for STIs if you have been raped or sexually assaulted. Some clinics and hospitals provide STI screening at no cost.

"You need to be tested as soon as possible after the assault, and then again at three and six months," Lee said. "The sooner any infection is diagnosed and treated, the better the outcome. This could also have major implications if the case goes to trial."

"If you are concerned about your sexual health, you should speak with your healthcare provider," Swarup said. "Try to find a provider you can trust, be honest with and feel able to open up to about your sexual health concerns."

Your healthcare provider isn't just there to offer screenings but can also assist you with other issues, such as pain during sex, low libido, sexual dysfunction, difficulty conceiving, sexual abuse and all other aspects of your sexual health.

We all take risks in life: getting in a car, traveling on a plane, swimming in the ocean. These are all actions that require an amount of risk, even if just a sliver. However, when we weigh the risks versus the benefits and fully understand the measures we can take to make a situation safer, those decisions are easier to make.

Think about having sex in this light. On one hand, it can feel pretty good. On the other hand, there's an element of risk, including pregnancy, contracting an STI or even just experiencing pain, either emotionally or physically.

Every risk you take requires assessing the situation and taking the necessary steps to be as safe as you can.

Firstly, "Use a latex or polyurethane condom every time you have anal, oral or vaginal sex to reduce the risk of infection," Swarup recommended.

You need to be aware of how to use a condom correctly and understand that condoms protect only the covered area. If you have sores or ulcers from an STD in a location a condom doesn't cover, the disease can still be passed on to your partner.

When using a condom, remember to:

• Use a new condom every time you ejaculate. Using a new condom prevents semen from leaking out of the used condom.
• Use a condom for anal and vaginal sex, and a dental dam for oral sex. Dental dams are used to create a barrier between a woman's genital area and her partner's mouth during oral sex.
• Use a water-based or silicone lubricant, as they make condoms more enjoyable and less likely to break. Do not use an oil-based lubricant with a latex condom because it can break down the material. Don't use silicone lube on sex toys made of silicone, jelly or CyberSkin as you could run the risk of rapid deterioration.
• Make sure you're wearing the right size condom—not too loose, not too tight—and that it fits correctly.
• Store your condoms in a cool, dry place and check the expiration date before use. Never use an out-of-date condom.
• Put your condom on before you start sex and make sure it's the right way around.
• If there's any chance that you suspect the condom is ripped or damaged, don't use it.
• After use, dispose of your condom quickly and safely. Wrap the used condom in tissue paper and throw it in the trash. Do not flush it down the toilet or you could run the risk of a latex buildup in your pipes and septic system.

Another aspect of safer sex is establishing boundaries. Think about your personal and spiritual beliefs, cultural standards, dreams and desires, and what you feel comfortable with. Once you can list and understand your sexual boundaries, you'll feel more adept at communicating them to others and sticking up for them if challenged.

Try to communicate with your sexual partner. Be assertive and trust your instincts. If you don't feel comfortable in a situation, try to remove yourself immediately. Let's be clear: Sexual contact without clear consent from both parties is sexual assault.

Sexual assault is never the victim's fault. No one deserves to be raped or assaulted. Call 911 or your local police department to report a crime. If you don't feel comfortable making the call, find a person to help and advocate for you: a friend, family member or colleague you trust.

If you choose not to involve the police, Lee stressed that any woman who is sexually assaulted needs to pay close attention to issues such as immediate emergency contraception and STI screening, and then further screening again in three and six months. Consult regularly with counselors for therapy and support.

It's not just your own body that needs looking after to make sex safer. It's also important you take steps to look after sex toys before and after use. The sex toy experts at Bedbible provided their top tips for staying safe when using sex toys:

1. Always wash your sex toys before and after every use to prevent infections and get rid of any small particles and dust.
2. If your toy is waterproof and made from a nonporous material, such as 100 percent silicone, stainless steel or glass, you can wash it with warm water and fragrance-free soap or a sex toy cleaner. If it has no electrical parts, these materials can be boiled in a pan of water for deep cleaning.
3. If your toy is not waterproof, you can wipe it down with a clean, damp cloth and some soap or a sex toy cleaner, making sure to remove any residue.
4. Nonporous materials, including those made from jelly, rubber, PVC and TPE, have microscopic holes that cannot be fully cleaned, so try to avoid these materials, especially for insertable toys such as butt plugs and dildos. Plus, jelly, rubber and PVC can contain harmful chemicals that can leach into your body.

Always ensure your sex toy is completely dry before storing it. Sex toys should be stored either in a case with separate compartments or in individual bags to keep them clean and safe until you want to use them again.

Besides condoms, there are numerous other types of contraception to protect against unwanted pregnancy. But note that they are the only type of birth control that protects against STDs. You can opt to use another type of contraception to protect against pregnancy, but if you're at risk of getting an STD, you need to use a condom.

There are 18 types of contraception to protect against unwanted pregnancy. Rather than listing them all here, please follow this link to a special guide called Contraception 101.

"There's a contraception method to suit everyone," Lee explained. "There is also emergency contraception, known as the 'morning after pill.' This gives you an opportunity, if you've had unprotected sex and don't want to be pregnant, to prevent the pregnancy. But it's not a good idea to rely on emergency contraception. If you keep needing to take it, it is far preferable to switch to a reliable method of contraception."

You can best look after your sexual health by getting to know your body better. Get to know what is "normal" for you. Lee recommended a few self-checks that you should incorporate into your regimen to stay sexually healthy:

• Make sure you keep a date of your periods so you'll always know if a period is late or missed.
• Keep an eye on your vaginal discharge. If it becomes copious, thick, discolored, smelly or unpleasant, go to a sexual health clinic. Blood-stained discharge is always an emergency.
• Check your genitals. If you notice any bumps or sores in the genital region, see your healthcare provider.
• Check your breasts once a month, just before each period.
• Check your testicles regularly for lumps or tenderness.
• Get regular screening for sexually transmitted infections. Home-test STI kits are also available.

"Get vaccinated," Swarup said. "Vaccines are available to help protect against hepatitis B and human papillomavirus."

As well as being the primary cause of cervical cancer, HPV causes cancers of the mouth, throat, head and neck, and the anal and genital regions.

"The HPV vaccine is highly effective. In the U.K., girls who were given the vaccination aged 12 to 13 were found to have a 90 percent reduction in the risk of cervical cancer in their 20s," Lee said. "CDC figures show that only 59 percent of U.S. teenagers are up to date with HPV vaccinations. In addition, being vaccinated against hepatitis B gives 98 to 99 percent effectiveness at preventing hepatitis B infection."

Hepatitis B is a major cause of hepatitis, cirrhosis and liver cancer.

The CDC recommends hepatitis B vaccination for all U.S. citizens from birth to age 60. Lee noted that although children are vaccinated at birth, many adults may not be vaccinated. If you're not sure if you've had the hepatitis B vaccination, speak to your healthcare provider for advice.

Lee and Swarup collaborated to provide their top 10 tips:

1. Learn about your body and how it works. Get to know your body.
2. Choose your sexual partners carefully. Respect your body.
3. Read books, check websites, speak to friends and family, and learn everything you can about sex and sexual health.
4. Communicate with your partner(s) before you start to have sex and talk with them about what you like and don't like sexually. Set boundaries and keep them.
5. Screen for STIs before you start a new relationship and ensure your partner does the same. Get tested regularly, even if you present no symptoms.
6. Though a monogamous relationship makes it easier for both parties to ensure safety, if you're in a nonmonogamous relationship, you should be aware of the status of all sexual partners.
7. If you need treatment for an STI, take the antibiotics exactly as prescribed, finish the course and do not have sex while being treated, not even with a condom.
8. Research what's available and use reliable contraception that works best for you.
9. Get HPV and hepatitis B vaccinations.
10. Never let anyone coerce you into having sex against your will, and never coerce others.