Sexual health & wellbeing

Consent has to be a free choice. Agreeing because of pressure, guilt-tripping, threats, tricks or fear is not consent. Feeling like you “have to” because you are in a relationship is not consent either.

Pressure can sound like

• “If you loved me, you would.”
• “Everyone else is doing it.”
• Asking again and again after you have said no
• Making you feel you owe them

Consent can be withdrawn at any time, including in the middle of something. When someone says stop, or seems unsure, the respectful thing is to stop and check in.

Saying yes once does not mean yes next time. Being in a relationship, or having been close before, never means automatic consent.

Agreeing to one activity does not cover others. For example, agreeing to kiss someone does not mean agreeing to anything more.

Checking in as things change (“Is this okay?”) is caring and respectful. It is not awkward; it builds trust.

To consent, a person must be able to make and communicate a decision. People who are asleep, unconscious, or affected by alcohol or drugs cannot give consent.

There are also legal ages of consent, which differ between countries and U.S. states. These laws exist to protect young people from being taken advantage of.

Consent should be clear and wanted, not just “not saying no”. If someone is quiet, hesitant, pulls away or freezes, that is a sign to stop and check in.

Freezing is a natural stress response. Many survivors blame themselves for not fighting back or saying no. Freezing is never consent, and never your fault.

Sexual violence can happen in person, online or through technology. Pressuring someone for images, or sharing someone’s private images without permission, is harmful and can be illegal.

The CDC recommends that everyone aged 13 to 64 is tested for HIV at least once. It also recommends yearly testing for some STIs for sexually active women under 25, and at least yearly testing for men who have sex with men.

People with new or several partners may be advised to test more often. Your clinical provider can tell you which tests make sense for you.

Many people feel nervous or embarrassed about testing. Health professionals talk about this every day. It is a normal part of looking after your health, like a dental checkup.

Easing the nerves

• Bring a written list of questions
• Ask what each test is for
• Remember you choose what to share
• Take a trusted friend if it helps

In the U.S., the CDC’s Get Tested website (gettested.cdc.gov) helps you find fast, free or low-cost and confidential testing near you, including self-collection options.

Your own doctor, a community health center or a sexual health clinic are also good places to start. Outside the U.S., a local doctor or sexual health clinic can help.

The World Health Organization says that, used correctly every time, condoms are one of the most effective ways to protect against STIs, though they do not protect against every infection.

Counselling guidance lists “Can I insist on safer sex?” as one of the questions that helps tell a healthy relationship from a harmful one. Pressure to skip protection is a red flag.

Ways to bring it up

• “Before we go further, can we talk about protection?”
• “I feel more relaxed when we both know we’re safe.”
• “When were you last tested? I can share mine too.”

The National Institute on Aging notes that age does not protect you from STIs, and that sexually active older adults can be at risk. It suggests talking with your provider about ways to protect yourself during regular checkups.

For many people, faith gives meaning and guidance about relationships and intimacy. Holding values about sex is not a problem. Difficulties come when guilt or fear stays strong even within the choices your values support, for example after marriage.

Good therapists respect your culture and beliefs. They do not try to change your values; they help you live by them with less fear and pain.

In many families, sex is never discussed. Children may pick up the idea that their body or feelings are dirty or wrong. These early messages can last into adulthood, even when we no longer believe them.

Learning accurate, kind information about bodies and relationships, as an adult or teen, can loosen these old messages. Sex education is one of the things sex therapists help with.

People who have experienced sexual harm often feel shame, as if they did something wrong. The responsibility always lies with the person who caused harm, never with the survivor.

Shame thrives in silence and harsh self-talk. Noticing the voice (“I’m disgusting”, “I’m broken”) and gently answering it (“I’m human, and I’m learning”) can soften it over time.

Small steps

• Notice where a shaming message came from
• Ask: do I still believe this?
• Talk to one safe person
• Consider a therapist trained in sexual health

Filters, editing and unrealistic media images can make real bodies seem “wrong”. Real bodies come in every shape, size, colour and ability, and they change with age, illness, pregnancy and life.

Changes after illness, surgery, injury, pregnancy, menopause or with age can affect confidence and how the body responds. These are very common, and can be talked about with your clinical provider.

Many people find new ways to enjoy closeness after body changes. A sex therapist can help with this.

Try

• Thanking your body for what it does, not just how it looks
• Wearing what feels comfortable
• Focusing on touch, warmth and connection rather than appearance
• Talking to your partner about your worries; they may see you very differently

The Trevor Project describes asexuality as a sexual orientation, just like being bi, gay, lesbian, pan or straight. It is an umbrella term on a spectrum. Some people are demisexual, feeling sexual attraction only after a strong emotional bond. Some are “grey-A”, somewhere between sexual and asexual.

Ace people may want, and can have, many kinds of intimate relationships. No one should ever feel pressured into sex they don’t want.

When partners have different orientations or levels of attraction, the same tools help: honest talk, a yes / no / maybe list (see the Intimacy & closeness guide), and agreeing on kinds of closeness that work for both people.

In the same study, only 38% of men and 22% of women had talked about sex with a doctor since age 50, even though about half of sexually active people had at least one bothersome problem.

Body changes with age, menopause and health conditions are very common and often helped. It is okay to raise it; your clinical provider has heard it all before.

As bodies change, many couples find new ways to be close: cuddling, massage, holding hands, or simply sharing time and conversation. Non-sexual touch builds closeness without pressure.

Grief after losing a partner can include missing touch and closeness. That is a natural part of loss. See the “Grief: understanding loss” guide.

Many people find love again after divorce or loss. Consent, honest conversations and safer sex matter at every age, including later in life.

Having been close before does not mean consent in the future. This is true in dating, long-term relationships and marriage.

Up to 43% of women and 31% of men report some sexual difficulty, and 30% to 40% of people experience them at some point. You are far from alone.

Low desire is often caused by stress, depression, anxiety, tiredness or health changes, not by a lack of love.

In a U.S. study, 53% of adults aged 65 to 74 and 26% of those aged 75 to 85 had been sexually active in the past year.

Consent must be freely given. Silence, freezing or not fighting back are never a yes.

Sex therapy is confidential talk therapy with a trained, licensed professional. There is never any physical contact or sexual activity with the therapist.