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Sexual Expression

Having healthy relationships is an important part of sexual health. Sexual health is holistic. Physical health and pleasure are important, but so are emotional and social well being. Unhealthy sexual relationships can affect a woman's mental and emotional health and, in the case of violent relationships, put her in physical danger. A current or past experience with violence can have a significant effect on a woman's sexual health.

Each woman values different things in her sexual and intimate relationships and enjoys different sexual activities. Being aware of your values and desires can help you make decisions that are right for you. We all experience the physical and emotional elements of sex differently. Take some time to learn about your sexual self.

One important aspect of our sexual selves is sexual orientation. Women may be sexually attracted to men, women or both. They may think of themselves as heterosexual, lesbian or bisexual, or they may not like any of these labels.

Women face different issues at different stages of their lives. A woman who has been married for many years may have different concerns than a woman choosing sex for the first time. For both women though, healthy relationships can depend on honest communication and mutual respect.

Relationships can begin and end; a woman may want a relationship or she may enjoy independence. Long-term relationships can grow and change sexually, just as they do in other aspects. A woman and her partner often discover cycles in a sexual relationship when sex becomes more or less intense or important to the health of the relationship.

Different stages of a woman's life can also influence her sexuality. Being sexual when pregnant, after giving birth or during or after menopause can all bring changes and challenges.

The impact of violence | Sexual orientation | Learning about your sexual self| Healthy sexual relationships | Your first sexual relationship | Sex and menopause

The impact of violence

Violence and sexual assault can have a deep impact on a woman's life including her sexual responses and relationships. Sexual assault is any unwanted sexual contact or attention. It can also include name-calling or anything that makes you feel bad about your sexual self or physical appearance.

If the assault has just occurred or if you are with a violent partner, here is how to get help.

Even if the abuse happened a long time ago, it can still influence your relationships with others, although your current partner may be loving and supportive. If a woman has been assaulted or abused she may:

  • not want to be touched
  • feel like she will never enjoy sex again
  • not be able to relax during sex
  • have disturbing memories of the assault(s) that may be triggered in some sexual situations
  • feel emotionally detached from her sexual activities
  • feel shame or self-conscious about her body

These feelings can be very painful for a woman and for her partner(s). It is not unusual for a woman having these feelings to also feel angry with herself or her partner. If you have these feelings, you should not try to deal with them alone. Therapy can help a survivor of abuse deal with her feelings and may ultimately help her find a healthy way of participating in sexual relationships.

Women's College Hospital offers programs for survivors of physical and sexual abuse, through our Sexual Assault/Domestic Violence Care Centre at (416)-323-6040.

Sexual orientation

Everyone has a sexual orientation. A woman who is attracted only to other women is called a lesbian: while women who are attracted to men are called heterosexuals. A woman who is attracted to men and women is called bisexual.

Some women who are attracted to other women don't like these words or feel that they don't describe their experiences. Women may be attracted to different people at different stages of their lives. So a woman may live for many years as a lesbian and then become involved with a man, or a heterosexual woman may discover lesbian desires.

You may be sexually attracted to men, women or both. None of these attractions is right or wrong, although most Canadian women have been taught at least some negative things about being attracted to someone of the same sex. These negative attitudes are called homophobia. If you are attracted to women you will have to deal with your own homophobic feelings and beliefs. You will also have to deal with the negative beliefs and judgments of others including your family and friends. Many organizations provide information and support for lesbian and bisexual women confronting homophobia.

 Women who are attracted to other women have a broad range of sexual and emotional relationships just as heterosexual (straight) women do. Some women live with a single partner for many years; others live independently relying on a social network of friends and lovers. Some lesbians choose to become mothers. Being a lesbian does not mean that you can't have the emotional or social relationships you want, although these relationships may sometimes be limited by homophobia. Same-sex marriage was formally legalized across Canada by the Civil Marriage Act in July 2005. Court decisions, starting in 2003, had already legalized the issue of marriage licenses to same-sex couples in eight out of 10 provinces and one of three territories, whose residents comprised about 90 percent of Canada's population. Most legal benefits commonly associated with marriage had been extended to cohabiting same-sex couples in Canada since 1999.

Living in a homophobic society may also have a negative effect on the physical and emotional health of lesbian and bisexual women. Lesbians and bisexual women may:

  • have higher levels of stress and depression
  • be at risk for alcoholism
  • not receive regular gynecological and medical care because they fear homophobic responses from health care providers

If a woman only has sex with other women, she does not need birth control, but she is still at risk of some sexually transmitted diseases. The following infections may result from sex between women:

  • herpes
  • genital warts
  • crabs
  • trichomonas
  • bacterial vaginosis
  • yeast infections
  • very rarely, HIV may also be transmitted from one woman to another

Different sexual activities have different risks for infection. Read our safer sex section to learn more about the risks of specific activities and check out the discussion of each infection to learn about how it is transmitted. Other non-sexual activities, such as sharing needles to inject drugs, also increases a woman's risk of infection, regardless of her sexual orientation.

Learning about your sexual self

Self-respect is the foundation of sexual health and of healthy sexual relationships. All people are sexual and it is normal and healthy for women to have sexual desires. It is also normal and healthy to not want to do some things even if the world around you suggests that 'everybody' is doing it. Respect your body's desires and your own ability to make good decisions.

Sexual choices have consequences. Some of the most difficult choices you ever make will be about sex. Your choices may shape your:

  • social relationships
  • relationship with your family
  • future lifestyle
  • experience of emotions like love and trust

There is a lot riding on your decisions, so you have to make sure that you chose what you really want. If you're not sure about a relationship or if you don't want to do something sexually - wait. Human sexuality has many physical, emotional and mental elements. Ideally, all three are leading you to the same decisions, but in the real world, things may not be that neat. Give yourself time to work through conflicting desires; this is an important part of self-respect. Don't let other people make your decisions, if they respect you, they'll wait too.

Because it can be difficult to make decisions in the 'heat of the moment,' think about what you want in advance.

What does it mean to you to have sex?

Our culture gives women and men very mixed messages about sex. We are often taught that we must be in love to have sex. We may also be taught that having sex is an important part of being an adult, or that sex proves we are desirable. Sex can be about all of these things, or it may not involve any of them. What do you think the purpose of sex should be?

  • Does a sexual relationship also involve other social and emotional commitments?
  • Can it be casual, just a way to learn about yourself or release physical tension?
  • What do you need to know or feel about your partner before you have sex?

There is no 'right' way to answer these questions, but it is important to be honest with your partner about what having sex means to you. Honest communication is one of the essential parts of a healthy sexual relationship. It is often very painful when two people have not thought about and discussed what they expect sex to mean. What you want out of a sexual relationship may change at different stages of your life.

What are your sexual interests and limits?

You are entitled to sexual pleasure but you need to decide what is pleasurable and appealing to you. If you respect yourself, you will not 'put up' with activities that hurt or embarrass you. Think about your fantasies. If you are already sexually active, remember what activities you have enjoyed in the past. What you enjoy may change over time. Be ready to talk to your partner about what you enjoy and what you don't. Finding sexual activities that are enjoyable for both partners is an important part of a healthy sexual relationship.

Explore your own sexual responses

Each woman enjoys different things sexually. Some women like having their clitoris rubbed; others find it is too sensitive to be touched directly. You can explore your sexual responses with a partner but you can also learn about your responses by masturbating.

Some women don't enjoy masturbating or don't believe they should do it because of their religious beliefs. Other women use masturbation to explore how they like being touched. This is particularly useful for women who are not reaching orgasm with their partner. Learning how your body responds can help you relax and enjoy sex. It also gives you information to teach your partner about what you like.

Healthy relationships

Healthy relationships are built on honest communication and mutual respect. This is true of all relationships, not just romantic or sexual ones. To be healthy, all people need to feel that there are people in their life, who they can trust to listen to them and care about them.

The Brief Psychotherapy Centre for Women at Sunnybrook and Women's has created a list of questions to help you decide whether a relationship provides a healthy connection to another person. These questions and a short discussion about the value of connecting with others are offered in the A-Z Health Topics sections of our site.

Having sex with some else is a very personal and intimate thing, even when the relationship is casual or short-lived. Responsible people respect their partners' feelings and desires; they want to protect them from infection and unwanted pregnancy.

Sex partners should always:

  • have one another's consent
  • be able to talk honestly to each other
  • treat each other with respect
  • care about their partner's pleasure
  • protect each other against physical and emotional harm, unwanted pregnancy and sexually transmitted infection
  • accept responsibility for their actions

All relationships have their ups and downs, but even in difficult times you and your partner should be able to trust each other to behave in this way. Being able to deal with the tough times and treat each other equally and with respect even when you are angry is an important sign of a healthy relationship.

There can also be signs that a relationship is not healthy. Use this quiz to help determine if you are experiencing the warning signs of an unhealthy relationship. If you are having these experiences or feelings, your relationship may need to end or you and your partner may need supportive counseling to work through your relationship problems.

Relationships should make you feel good! No one can be happy all the time, but you should look forward to the time you spend with your partner and enjoy his or her company.

Your First Sexual Relationship

There is no age at which you 'should' begin having sex; the important part of this decision is that you have thought about it, and that it feels right to you. The law in Canada does outline ages of consent, which specify how old a person has to be to consent to sex in several specific situations. Learn more about the age of consent in our frequently asked questions section. You should never feel pressured to have sex because someone else wants you to. Thinking about what you want and what feels good to you is discussed in learning about your sexual self.

Deciding to Have Sex

Here are some things that should be true BEFORE you have sex. These are important whether or not you've had sex before.

  • I've thought about it outside of the 'heat of the moment' and decided I'm ready
  • I've talked to my partner about my feelings and his/hers; we both feel ready
  • my partner and I have decided on a way to protect ourselves from infection (and pregnancy if that is an unwanted risk for you); we know how to use it
  • my partner and I have talked about the risks of sexually transmitted infections (and pregnancy if that is an unwanted risk for you); we could cope with it if it happened
  • I've thought about my relationship with my partner; our relationship has the level of trust and commitment I need to feel good about sex
  • I feel I could say no to my partner if I wanted to
  • I feel comfortable with this decision; I don't have nagging doubts that I can't explain

If you've talked to your partner and all of these statements seem true to both of you, you may be ready to have sex. Or you may think about all these things and decide it is not the right time. Either way is OK.

Having intercourse for the first time

Some heterosexual couples practice 'outercourse' for a while, to get comfortable with each other and with the idea of being intimate. Outercourse means sexual play that does not involve putting the man's penis in the woman's vagina. It includes hugging and kissing, as well as massaging and stimulating one another's body and genitals with your hands or mouth. Outercourse has a lower risk for pregnancy and infection than intercourse.

The first time you have intercourse is not likely to be the best time. Don't expect too much. Many women find it painful or at least uncomfortable the first time they have intercourse. This is normal. If it is uncomfortable, have your partner back off for a while and try again later or even on another day when you've both had a chance to relax. Wait until you are well lubricated before you try again. You may want to buy a water-based lubricant to make it easier, especially if you are using condoms for protection.

Sometimes a man may ejaculate before penetration is complete (or satisfying!) This is very common especially for teenagers. Don't worry. You can try again. If the ground doesn't move for you on the first night, there will be other opportunities. Talk to your partner about what makes you feel good.

For some couples, it just doesn't work in the beginning. Your vagina may seem too tight and your partner may ejaculate or lose his erection before he can get inside. Don't put too much pressure on yourselves. Getting upset is likely to make you tenser and exaggerate the problem.

One solution is to not try to have intercourse the next few times you are intimate with your partner. Instead, encourage him to put his fingers in your vagina. This may help stretch the vagina and will let you get comfortable with having something inside you. When you are ready to try again, use lots of lubricant to help ease the penis into the vagina.

If you continue to have problems, talk to your doctor or to the people at the clinic where you get your birth control. They may be able to help or at least reassure you that nothing is wrong.

Talk to your partner. He needs to know what you are feeling. He may also be feeling insecure if your sex life isn't everything you both hoped for. Satisfying sex may take patience and encouragement, but couples that are attentive to each other's pleasure can usually work it out with time.

Sex during pregnancy

Most of the time it is perfectly safe to have sex during pregnancy. If you have a high-risk pregnancy, ask your doctor or another caregiver if it's safe.

Will you want to? Different women have different feelings and your interest in sex may decline (or grow). You and your partner will need to talk about what feels right to you.

As your pregnancy advances, intercourse may become uncomfortable. You may want to try other sexual activities or explore new positions. Be creative and find what is right for you.

Sex after giving birth

The months after giving birth are a challenging and tiring time. The demands of your new life may be a more important limit on your sex life than any physical changes. Some couples feel that sex is an important way to make time for each other; others would rather take the time to talk and cuddle. Women may feel 'touched out' because they spend so much of their time touching and holding their baby. Both parents may feel overwhelmed by their new responsibilities. Take the time to talk about your feelings and consider trying to find time for sex during the day when you are less exhausted and sleepy.

Physically it is safe to have sex after the lochia stops. Lochia is the vaginal bleeding that occurs after delivery. This bleeding stops when the cervix has returned to its natural size. Having sex before the lochia stops could put you at risk of a serious infection.

Sex may be uncomfortable, especially in the first weeks. You may have pain around an episiotomy or Caesarean incision. While scars are forming in these areas, try to use positions that don't put pressure on the new tissue.

Vaginal dryness is also common especially if you are breast-feeding. The same hormones that prompt your body to produce milk also reduce your ability to lubricate. A water-based lubricant may help. Go slow and give your body more time to lubricate. The hormones stimulated by orgasm also cause your breast milk to flow, so don't be surprised if you need a towel.

If you don't want to get pregnant again, birth control is important. Cervical barriers may have to be re-sized before you can use them again. Talk to your doctor or caregiver about what forms of birth control are best for you. Hormonal methods that do not contain estrogen-like Depo Provera (injections) and Micronor (pills) are safe for use once breastfeeding has been well established. Breast-feeding alone may help to prevent pregnancy in the first six months as long as your period has not started again and this is the only way your baby is eating. However breast-feeding as a mode of birth control is not completely reliable. To be more certain of avoiding pregnancy, you may wish to begin using birth control again shortly after giving birth.

The hormonal changes after pregnancy may affect some women's sexual desire. This is temporary. Talk to your doctor if it feels like it has gone on for too long. This can be one sign of post-partum depression.

Some women may also be self-conscious about their bodies after giving birth. It is important for your partner to be loving and supportive of body image issues.

Sex and menopause

As a woman ages, her sexual desires change and her interest in being sexually active may decrease or increase. Changes may be prompted by her past sexual experiences or by the availability of a sexual partner.

Menopause occurs when a woman's body stops releasing eggs and her menstrual cycles cease. The hormonal changes associated with menopause may affect a woman's physical responses and interest in sex (libido). Hormonal fluctuations in the time before menopause (called perimenopause) may also affect a woman's libido and sexual experience.

Sexual changes associated with menopause

Some of the sexual changes commonly associated with menopause are:

  • slower sexual arousal
  • less lubrication produced during sex
  • the vaginal wall gets thinner and intercourse may be uncomfortable
  • intensity of orgasm may be reduced
  • skin sensitivity is often increased

Although many women have a reduced interest in sex, others have an increase in sexual desire.

What needs to be done about these changes depends on how you feel about them and how readily you can incorporate them into your current sexual life. Even women who find that their sexual interest is greatly reduced may accept these changes, particularly if they have lost their sexual partner to illness or death. If the changes are less dramatic, a woman may welcome a slower, more sensual, sexual experience that emphasizes non-sexual touching and allows more time for lubrication. Since men also become aroused more slowly as they age, heterosexual couples may adapt their sexual lives in a way that 'works' for both partners. If both lesbian partners are experiencing menopause, the changes in their desires may also fit well together.

For some women and their partners, these changes are a problem. Women may be frustrated that their orgasms don't feel right. Partners may conclude that a woman is less interested because she lubricates less. It is important to talk to your partner(s) about the changes that are happening to your body and what both of you are feeling about these changes.

Treating menopausal symptoms

Some of the changes associated with menopause can be treated simply. A lack of vaginal lubrication can be overcome by purchasing a lubricant at the drug store. You can also buy vaginal moisturizers that help protect vaginal tissues from dryness and thinning. Simply going slower during sexual activity may help to increase lubrication and build a more intense orgasm.

For some women, these tactics are not enough. They may choose supplements of hormones to deal with sexual changes and/or other signs of menopause such as:

  • hot flashes
  • sleep disturbances
  • urinary tract infections
  • night sweats
  • bone thinning
  • mood changes

Hormone replacement therapy

Hormone Replacement Therapy (HRT) usually refers to supplements of estrogen and progestin. Although estrogen effectively treats these disturbances, progestin is necessary to protect the uterus unless a woman has had a hysterectomy.

Temporary side effects of HRT may include:

  • breast swelling and tenderness
  • bloating
  • headaches
  • mood changes

These side effects usually occur in the first three months of therapy, then decrease over time. HRT may cause "breakthrough" spotting in the first year. The spotting stops with continued use. Changing the dose, schedule or product may reduce the side effects.

To learn more about HRT, visit our Guide to Hormone Replacement Therapy. You should talk to your doctor about the risks and benefits of HRT for you.

Other treatment options

Studies have also suggested that supplements of the male hormone testosterone may help increase libido and the intensity of orgasm. Side effects of testosterone are very rare, especially with the low doses used today. Rare side effects may include hoarseness or development of facial hair or acne.

Some women are trying natural products, which contain estrogen-like substances. Soy products such as tofu or soymilk added to the diet may lessen some of these symptoms. Some women report success with herbal 'hormonal stabilizers' like black cohosh, chasteberry or evening primrose oil.


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