How is sexual health attained and maintained?

By Justin Dubé

Though I’d like to think the studies I run facilitate sexual health, translating research into practice can take a loooong time (17 years!) [1]. Also, people generally want to manage their sexual health by speaking with a clinician [2, 3]. Clinicians, however, often feel ill-equipped to navigate these conversations due to gaps in their sexual health training [4]. For example, North American medical schools typically offer less than 10 hours of sexual health curricula [5]; a mere 26% of doctoral programs in psychology offer sexuality courses [6]. These gaps in training are often filled with personal beliefs or experiences, leading to biases in how clinicians evaluate and treat sexual health problems. To counter this, Braun-Harvey and Vigorito encourage clinicians to adopt a principle-centered approach to sexual health [7].

Braun-Harvey and Vigorito propose the following six sexual health principles:

1. Consent is the most fundamental and universal principle of sexual health. A person has sex with another person only when both people have agreed to have sex, full stop.

2. Non-exploitative.

Often conflated with consent, non-exploitative sex means not using your position of power to gain access to sex. For example, maybe someone has consented to have sex with you (yay!), but they’ve only agreed because you’re their boss and they want to keep their job (boo!).

3. Protected against sexual transmitted infection (STI) & unintended pregnancy.

This principle is what typically comes to mind when people think of sexual health. While recent conceptualizations of sexual health are more balanced (i.e., they’re not all doom and gloom), this principle remains relevant because people typically desire a sexual relationship free from STI (and unintended pregnancy).

4. A degree of honesty (WHHAAT? A degree?!).

So, why not complete and full honesty? Braun-Harvey and Vigorito emphasize a degree of honesty, versus full transparency, because
-People are entitled to a degree of privacy within their sexual lives
-People sometimes value a sense of mystery in their sexual relationships. Indeed, over-familiarity among sexual partners is sometimes a factor that inhibits sexual desire [8].

Confused? In practice, if you’re clear about what areas of your sexual life require complete honesty (e.g., maybe it’s essential to know your partner’s STI status) and your relationship agreements are respected (e.g., maybe you’ve agreed to be in a sexually exclusive relationship), then you should be ok.


Mavich Stock Man/

5. Shared values.

Essentially, sex is best enjoyed when it means the same thing to both/all partners. For example, you think having sex with Jenny means you’re now in an exclusive relationship with her (and that you and Jenny are going to get married and have dogs and cats and babies and eventually be buried side-by-side with matching gravestones, etc). If sex means something different to Jenny, then you’re probably going to end up disappointed when Jenny has sex with Quinn (especially if you already bought those non-refundable matching gravestones).

6. Mutual pleasure.

This principle encourages an approach to sexual health where both/all sexual partners are afforded the opportunity to give and receive pleasure. This seems like a given, but the United States Centers for Disease Control & Prevention (CDC) removed “pleasure” from their definition of sexual health in 2011. The good news is that the CDC now endorses the World Health Organization’s (WHO) definition, which pragmatically allows for “the possibility of having pleasurable and safe sexual experiences” [9]. That’s right folks, maybe, juuust maybe, sex will be pleasurable and safe (sigh).

Why does this matter?

Sexual health is attained and maintained when the sexual rights of all people are respected, protected, and fulfilled [9]. Approaching sexual health via a set of principles instead of culturally sanctioned values or behaviours accommodates sexual diversity and mitigates clinician bias. This is a critical contribution of Braun-Harvey and Vigorito, given the gaps in public sex education [10] and clinical sexual health training [4, 6]. So, unless you can wait 17 years for my next groundbreaking study to reach the masses, a principle-centered approach will be useful when promoting sexual health in your relationships, research, and practice.

For further reading, check out Braun-Harvey and Vigorito’s book, Treating out of control sexual behavior: Rethinking sex addiction.  
For further watching, check out Braun-Harvey’s discussion of the six sexual health principles here!



[1] Morris Z.S., Wooding S., & Grant J. (2011). The answer is 17 years, what is the question: Understanding time lags in translational research. Journal of the Royal Society of Medicine, 104, 510-20.

[2] Berman L., Berman J., Felder S., et al. (2003). Seeking help for sexual function complaints: What gynecologists need to know about the female patient’s experience. Fertility and Sterility, 79,  572-76.

[3] Schein M., Zyzanski S., Levine S., Medalie J., Dickman R., & Alemagno S. (1988). The frequency of sexual problems among family practice patients. Family practice research Journal, 7, 122-34.

[4] Wittenberg A., & Gerber J.(2009).  EDUCATION: Recommendations for Improving Sexual Health Curricula in Medical Schools: Results from a Two‐Arm Study Collecting Data from Patients and Medical Students. The Journal of Sexual Medicine, 6, 362-68.

[5] Solursh D., Ernst J., Lewis R.W., et al. (2003). The human sexuality education of physicians in North American medical schools. International Journal of Impotence Research, 15, S41.

[6] Mollen D., Burnes T., Lee S., & Abbott D.M. (2018). Sexuality training in counseling psychology. Counselling Psychology Quarterly,  1-18.

[7] Braun-Harvey D., & Vigorito M.A. (2015). Treating out of control sexual behavior: Rethinking sex addiction. Springer Publishing Company.

[8] Sims K.A., & Meana M. (2010). Why did passion wane? A qualitative study of married women’s attributions for declines in sexual desire. Journal of Sex & Marital Therapy, 36, 360-80.

[9] World Health Organization. (2006). The world health report 2006: Working together for health.

[10] Lindberg L.D., Maddow-Zimet I., &Boonstra H. (2016). Changes in adolescents’ receipt of sex education, 2006–2013. Journal of Adolescent Health, 58,  621-27.