What makes sex healthy?

What makes sex healthy?

What makes sex healthy?

I often work with clients where sex feels out of control and unhealthy. Sex for them can be a numbing and empty behavior rather than something life affirming and energizing. These clients know that things need to change to have a healthier relationship to sex but what exactly does that mean? How do you move your sex life in a healthier direction?

Psychotherapists Douglas Braun-Harvey and Michael Vigorito offer a six-principle definition of sexual health.(1) I think it is a great way to assess your current behavior and experience and identify a path forward to more healthy sex. Below are the principles and some of my thoughts about them.


This one may seem self-explanatory but it is worth a little exploration. Consent means that all partners voluntarily agree to what sex will mean before it starts and once it is happening. It can be a formal conversation ahead of time about what is cool and what is not cool. It might happen in the moment with a quick question and response. It also might mean a change of mind by any partner -- consent can be revoked at any time. 

While your language may not need be so formal as “I consent to this” you should be clear in what you are asking and in what you are consenting to. “I’m cool with X but not with Y.” is fine, as is stating what you are not interested in, what must happen for a sex act to be acceptable, etc.  

Sometimes clients I work with find themselves in patterns of behavior where they regret things that they have done or feel like they have put themselves at some kind of risk. Getting really clear with yourself about what is acceptable and what is not acceptable before you engage in sex can be helpful, especially if you are noticing patterns of behavior where you don't want something but are consenting anyway.


Exploiting a sexual partner is about using your power to get pleasure from another in a way that compromises their ability to consent. In other words, you have the power and get what you want, but at a cost to the other person. While exploitation can be about specific behaviors, I think it is also about the attitude you have to your partner(s). A  mindset of non-exploitation is about viewing partners with respect and consideration and having a willingness to communicate and understand where they are at and what they want.

An attitude of non-exploitativeness can also be present during sex. While you may initiate a sex act without verbalizing a request for it, you can also be aware of your partner’s body language and sensitive to their behavior, holding an attitude of non-exploitation. And, of course, you can always ask in the moment if something is OK, allowing your partner to give or not give consent.

Note that there are frequently power differences during sex, some fluid and changing throughout sex and some agreed upon before sex happens. For example, in dominance/submission relationships, power differences are often discussed and arranged in advance. While one partner has more power, it is used in a way that is non-exploitative, with a mindset of mutual pleasure.

Protection from HIV/STIs and unwanted pregnancy

Healthy sex includes education and communication about HIV, sexually transmitted infections, contraception and pregnancy, as well as self-awareness around these issues. On a personal level, this could include education for yourself, as well as planning and taking preventative measures. You, not your partner, are responsible for your own health, making decisions and taking actions to protect yourself. 

On a relational level, this means an attitude of honesty and openness around discussing how to keep yourself and your partner healthy. It also means being able to tolerate discomfort around difficult (and honest) conversations and being able to speak up about steps you will take to protect yourself.


Honesty gets it’s own mention because it is crucial to any healthy relationship, sexual or otherwise. Honesty in what you want to consent to, what you want from your sexual partner, about your sexual health status - anything less than honesty keeps sex from being as healthy as it can be. Note that there is a difference between honesty and intimacy. Intimacy is an experience that can be immediate or that can take time to build, and you don’t necessarily want to share every internal experience with every sexual partner. However, being honest about what you want and need is part of all healthy sexual relationships. 

Shared values

The idea of shared values doesn’t mean that you have to have the same political or religious views as your sexual partner. Rather, it is about being in agreement about what sex and specific sex acts mean for each of you. This requires some dialog between partners. An example of a shared value is where there is mutual agreement between two partners that sex is “no strings” and that neither is pursuing a relationship. Both partners feel that they are on the same page and operating from similar perspectives. If something changes, partners agree to keep communication open.

Mutual pleasure

Ultimately, healthy sex is about giving and receiving pleasure and holding an attitude that giving and receiving pleasure is a vital and life enhancing activity. This can be a constantly changing and evolving state for partners but ultimately drives all healthy sexual behavior.

Exploring these concepts can be helpful for identifying areas where you might be stuck or engaging in unhealthy behaviors. Creating a plan for how to reduce harmful behaviors and promote healthy communication can be useful, as can talking to a therapist about the deeper issues that motivate you around sex.

1. Braun-Harvey, D. and M. Vigarito (2016) Treating out of control sexual behavior: rethinking sex addiction. New York: Springer

A Holiday Mental Health Cheatsheet

A Holiday Mental Health Cheatsheet

Dealing with the Post-Election Experience

Dealing with the Post-Election Experience