Sexuality 101

Sexuality is an intrinsic part of being human that can bring pleasure, intimacy, and stress relief. Culture, religious beliefs, and family traditions all affect who we are sexually. No matter how you define your personal sexuality, it affects your overall health and wellbeing throughout your life, including during and after pregnancy. It’s always important to pay attention to your sexual health!

What is Sexual Health?

Being sexually healthy means being able to enjoy a satisfying sexual life, positive relationships, and peace of mind – however is most comfortable for you. Your sex life is important, no matter your age or the relationships you choose. Sexual health means taking care of yourself and your partner(s), and talking openly with health care providers about your needs and concerns.

The National Coalition for Sexual Health outlines 5 action steps to take charge of your sexual health:

• Make sexual health part of your health care routine
• Get smart about your body and protect it
• Build positive relationships
• Treat your partners well and expect them to treat you well
• Value who you are and decide what’s right for you

Doing these actions can result in a wealth of benefits, from communicating honestly in relationships that are respectful, pleasurable, comfortable, and safe to feeling positive about practicing safer sex and using condoms and contraceptives. You can choose to be sexually active or not. You can protect your health and your partners’ health. You can achieve a safe, satisfying, and pleasurable sex life. You are in control of your sexual choices.

What is Sexual Dysfunction?

Some people encounter sexual problems or sexual dysfunction. It can happen to anyone at any time throughout life. There are 4 main types of female sexual dysfunction:

• Not feeling sexual desire or interest
• Not feeling aroused, or trouble feeling like you want to have sex
• Painful sex, or dyspareunia
• Difficulty or inability to have orgasm

These issues can be caused by any number or combination of physical stressors, such as diabetes, menopause, certain diseases, cancer and chemotherapy, or alcohol or drug abuse. They can also be caused by mental and emotional stressors, like psychological issues, depression, or a history of sexual abuse. If you are having relationship problems with your partner(s), they may lead to difficulties with your sex life. Even some medications can contribute to sexual dysfunction.

Overall physical health is important to optimal sexual functioning. Staying fit and active will often improve your sexual health too. So will open and honest communication with your partners. For more information and specific ideas for improving your sexual health, click here.

Unfortunately, there are no specific FDA-approved medications to treat female sexual arousal problems right now. If you experience any of the sexual problems listed above, talk to your midwife or other health care provider. They may be able to give you some suggestions or support. Be honest – let it all out! It’s okay to talk about the issues you’re experiencing. They can help you come up with a solution. There may be therapy or medications available for some of the conditions that contribute to sexual dysfunction.

Sex During & After Pregnancy

There are a lot of myths about sex during pregnancy, but it is perfectly safe for women with healthy pregnancies. It will not harm the baby, and the baby does not know what’s going on! Unless your midwife or other health care provider tells you otherwise, sex during pregnancy is safe for you and your baby. You may actually find that you want to have sex more often when you are pregnant, and that may be due to the influence of all the hormones. Here’s how it might break down by trimester:

• First trimester: because of common symptoms like fatigue or morning sickness, you might feel like having sex less.
• Second trimester: your other symptoms have probably gone away, your blood vessels dilate, and more blood is circulating in your body, mostly below the waist. You might want to have sex more often, and you might find that it’s easier to have orgasms. When you have an orgasm, your uterus contracts. In pregnancy, you might experience a contraction during orgasm. This is normal.
• Third trimester: because of your growing belly and the anticipation of childbirth, you may have less interest in sex, though many women enjoy the comfort of an intimate relationship at this time. The most important thing is to keep the lines of communication open with your partner regarding your sexual interest during pregnancy. While you might not want to have intercourse, having intimacy with your partner is important. You may feel the need for more snuggling and kissing.

After you give birth, your body will start to change again. Some changes will happen quickly, though getting back to feeling like yourself may take longer. Remember: it took you 9 months to get here. Be patient and understanding with yourself as you start to “return to normal.” You can start having sex again about 4-6 weeks after you have your baby, or when your bleeding stops and you feel ready. Check with your midwife or other health care provider if you have questions, and consider using a lubricant. After giving birth, breastmilk may leak during orgasm. This is also normal. It’s okay to take it slow. You can and will achieve a healthy sex life again after giving birth, and you can do it at your own pace.

Sexually Transmitted Infections

A sexually transmitted infection (STI) is an infection that you get from someone else by having sex, including vaginal, anal, or oral sex. STIs are very common – the second most common infections in the United States and Canada (the most common is a cold). The most common STIs are:

• Chlamydia. Most women do not have any symptoms of chlamydia, but it is the most common STI in the United States. You can cure chlamydia by taking medicine – your partner will need to take it, too.
• Trichomoniasis (“trich”). You might experience itching or burning, and a bad-smelling discharge from your vagina. Trichomoniasis can be cured if you and your partner both take medicine.
• Herpes. About 1 in 6 adults has genital herpes (usually herpes II), which causes painful sores on your vagina or anus during outbreaks. There is no cure, but treatments can prevent outbreaks and keep you more comfortable when you do have outbreaks.
• Genital warts (HPV). Genital warts are caused by human papillomavirus, also known as HPV. Most people who have sex will get HPV at some point in their lives. The biggest concern is that some kinds of HPV cause cervical cancer – having regular Pap tests can help prevent cervical problems, and so can getting the HPV vaccine.

You can reduce your risk of getting an STI by talking to your partner(s) about their sexual history before having sex, and by using condoms or dental dams with all new sex partners all the time. You should have an exam for STIs as often as your midwife or other health care provider recommends.

If you contract an STI, or think you may have contracted one, visit your midwife or other health care provider immediately. They can provide medication for you to either cure the infection or treat it, and give you advice on how to have safer sex in the future. Untreated STIs have the potential to turn into bigger health problems later on, so it’s important to know your status and to follow instructions to clear up any infections that you get.

Sexual & Gender Identity

Your sexual orientation and gender identity can have a big influence on your health. Research suggests that lesbian, gay, bisexual, and transgender (LGBT+) people face health disparities, or gaps in quality of health or health care because of social stigma, discrimination, and denial of civil rights. Social stigma and discrimination can impact whether or not you seek out care not just for sexual health issues, but for overall wellness.

Lesbian, gay, bisexual, and queer-identified people have specific health needs and encounter barriers to good health at a higher rate than other groups of people. For example, lesbian, gay, bisexual, and queer-identified people may be more likely to experience:

• Psychiatric disorders and suicide. Lesbian, gay, bisexual, and queer-identified people are at a higher risk for mental illness because of discrimination and the long-term effects of bullying and violence, which are common.
• Tobacco smoking, binge drinking, and substance abuse, probably also related to more psychological distress because of marginalization.
• Certain cancers, because of less preventive care. Lesbians or women who have sex with women may be less likely to get regular Pap smears. You can still get HPV, and you can develop cervical cancer, even if you do not have sex with men.
• Sexually transmitted infections (STIs). Men who have sex with men are still the most prevalent transmission category for HIV and AIDS, and you can contract STIs no matter who you have sex with.

Transgender and gender-variant people also have specific health needs and encounter barriers to good health at an even higher rate than other groups of people, including many lesbian, gay, and queer-identified people. For example, transgender and gender-variant people may be more likely to experience:

• Mental illness and suicide. Transgender and gender-variant people are at an even higher risk for mental illness because of discrimination and the long-term effects of bullying.
• Violence and homelessness. As many as one in 5 transgender people are homeless, which makes accessing health care nearly impossible.
• Issues with transitional care. If you are transitioning, you may have difficulty getting your insurance and health care providers to recognize your needs as medically necessary.
• Sexually transmitted infections. Like anyone else who has sex, transgender people are at risk of getting STIs. Click here for more information about sexual health for transwomen and transmen.
• Pregnancy issues. People of any gender may want to become pregnant and have a baby. If you are transgender or gender-variant and want to have a baby, you should learn more about the hormones you take and the ones required to become pregnant, the reproductive organs you will use, and birth control.

Accessing health care can be a major problem for all LGBT+ people because of discriminatory laws that don’t allow domestic partners to be covered by health insurance the same way spouses are or deny coverage because of sexual orientation. The good news is that there are resources that can help you access this important care.

Under the Affordable Care Act, everyone in the United States should now have health insurance. Thanks to that law, nearly all plans, whether through the health care “marketplaces” or through private insurers, cover a wide range of preventive and screening health care tests at no additional cost to the patient. Many also cover the cost of the office visit for an annual well woman exam or adult physical. This means that most people can get these important health promotion and preventive care checkups for free.

Insurers can no longer turn someone away just because they are lesbian, gay, bisexual, or transgender. The website for the “marketplaces” is also designed to help you locate health insurers that cover domestic partners. If you have private health insurance, check with your plan to see what is covered. You can start researching online if you have health insurance through the marketplaces, Medicaid, or Medicare.

You always have options, even if you have no health insurance. Check online for free clinics and community health centers in your area, or look for a health center run by the US Health Resources and Services Administration, where you pay what you can afford, based on your income. You can even look for clinics that specifically focus on transgender health.

People of all genders and all sexualities deserve sensitive, culturally-competent care. You deserve a safe place to discuss your health needs, sexual and otherwise, with a midwife or other health care provider who is trained to help you and adjust to you. The most important thing you can do to take charge and promote your own health is to tell your provider about your sexuality. A midwife can assist you and provide health support that is tailored just for you. When you decide to visit a midwife, you will receive a special level of care that may not always be present in most health care settings. Midwives often spend extra time with you during your appointment, listening to your concerns, and addressing problems. Listening is the hallmark of midwifery care. Your midwife strives to be your partner in care, not just your provider of care.