Healthy Sexuality - a patient education video

Sexuality is the experience and/or expression of a person as a sexual being. Sexuality can be different from person to person and can vary over time in an individual.

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Sex and sexuality are important issues for many people, regardless of their age, sex, or gender.  Although many people are embarrassed or afraid to talk about sex or sexuality, it’s important to bring up any concerns with your healthcare provider or sexual counselor. 

Let’s begin with some definitions and explanations.

Sexuality is the experience and/or expression of a person as a sexual being. It involves the complex interplay of sex (whether a person is biologically male or female), gender identity (how people identify themselves as male, female or other), gender roles (a person’s expression of social and behavioral norms), and sexual orientation (who a person is sexually attracted to).  It’s important to understand that sexuality can be different for each person and may vary over the course of a lifetime.

The World Health Organization has 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. Sexual health requires a positive and respectful approach to sexuality and sexual relationships, as well as the possibility of having pleasurable and safe sexual experiences, free of coercion, discrimination and violence. For sexual health to be attained and maintained, the sexual rights of all persons must be respected, protected and fulfilled.”  

The concept of “sex,” is difficult to define and varies from person to person.  There are many ways to express sexuality in all types of relationships, whether between men and women or partners of the same sex.   Sex often is considered to be penile-vaginal intercourse between a man and a woman. Other sexual activities, such as oral sex, anal sex, mutual masturbation, etc., can be included where intercourse may not be the goal in the sexual experience.  What is most important is that a sexual experience is safe, healthy, and enjoyable.

Sexual health is a vital part of a person’s total well-being.  Of course, sex is essential for reproduction, but it can also build intimacy in relationships and be a source of immense pleasure and satisfaction.  Sex also has many other positive health benefits, such as reducing stress, improving self-esteem, and cardiovascular health. 

A person’s physical sexual response is an important part of his or her sexuality. Let’s talk about how a woman’s body responds to sexual stimulation.  

During sexual arousal, blood flow increases to a woman’s genitals.  Her vagina is lubricated by secretions from the walls of the vagina.  The vaginal muscles relax, causing the vagina to lengthen and widen. The clitoris grows larger and the labia (the lips of the genitals) become engorged and open, revealing the opening to the vagina. The uterus enlarges and rises upward into the abdomen. Also during this phase, many non-genital changes occur;  a woman’s nipples become erect, her blood pressure and heart rate increase, and a “sex flush” from the stomach to breasts and neck develops.  During orgasm, also called the climax, there are strong rhythmic contractions of the pelvic floor, the vagina, and uterus. After orgasm, this process may be repeated or the body may return to its unexcited state, called resolution. 

There are also physical changes during the sexual response in men. During arousal, a man’s penis becomes filled with blood, causing it to rise and stiffen.  The smooth muscles of the scrotum contract, the skin of the scrotum thickens and the testicles are drawn up toward the abdomen.  Meanwhile, seminal fluid collects in the prostatic urethra and the bulbourethral glands secrete a few drops of clear liquid at the tip of the penis.  While all this is happening, many other changes occur: heart rate and blood pressure increase and some men also develop a sex flush and nipple erection.  During orgasm, there are strong, rhythmic contractions of the genital ducts, accessory glands, and penis.  Semen is forced through the urethra, called ejaculation. Orgasm and ejaculation often occur close together, but they are actually two separate events.  After orgasm, the body returns to its unaroused stated, called resolution.  

“Normal” sexual function has been described in many ways by different investigators.  Most people think about sexual function as described by Masters and Johnson in the mid-1960s. They described 4 stages, beginning with the “excitement” phase, with psychologic and physical interest and arousal, followed by the “plateau” phase with the peak of sexual arousal, then “orgasm,” which is the climax of the sexual response, and then “resolution,” when the body returns to its unstimulated state. 

Since Masters and Johnson, other researchers have modified the original concept with different descriptions of the sexual response.  In 1979, desire was added to the sexual reponse model, and then response was changed to only desire, arousal, and orgasm.  The thought was that wanting sex or wanting to be sexual is thought to start arousal.

Because a woman’s sexual response is more complex and circuitous than that of a man, and is also affected by many psychosocial factors, other researchers have shown that a women’s response intertwines both her physical and emotional sexual drive.  This would explain how women can start, or be receptive to, a sexual encounter.  For example, a woman may enter into sexual activity to increase emotional closeness and commitment without having any previous desire or thoughts about sexual activities.  As she focuses on the sexual stimulation and sensations, her body begins to respond both physically and psychologically.  Continued stimulation produces increased intensive sexual excitement and that produces sexual desire that she may not have had at first. 

Sometimes people worry about their sexual health and function.  If you have these concerns, you’re not alone; it’s estimated that 43% of women and 31% of men have experienced some type of sexual concern.  Some common concerns are a decrease or loss of interest in sex, the inability to become aroused, problems getting and/or maintaining an erection, a delay or absence of orgasm and pain with sexual activity. 

Psychologic factors that may play a role include anxiety, depression, stress, abuse, and poor body image.  Memories of a sexual trauma can greatly influence how a person functions sexually. Social and interpersonal factors that can affect sexual function include relationship problems, religious beliefs, cultural beliefs, and one’s upbringing.

Sex is an important part of your life and sexual concerns should be taken seriously. When a sexual problem causes you distress, don’t be afraid to talk with a health care professional. Everyone can achieve the healthy and satisfying sex life that they deserve.
is a patient education website of ASRM.



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