Therapy is often seen as a space where you can talk about anything: your feelings, fears, worries, past experiences, identities, relationships, etc. Everything is on the table. But some topics still feel really uncomfortable to share. One thing that some people can feel really unsure about talking about in therapy is sex.

In Western societies, sex is still one of the common topics that many are taught to not talk about along with religion and politics. We are taught that sex is an intimate and private experience. But feeling the need to keep this part of our lives hidden for some can also lead to feelings of uncertainty, shame, fear, and viewing sex as “dirty” or “wrong.” The silence around sex can hold a loud message all on its own.

But why is talking about sex important? And what does it have to do with therapy? When many people hear the phrase sexual health, their minds automatically turn to things like risk, disease, and dysfunction. Sexual health often emphasizes barrier products, such as condoms and dental dams, contraception, risky sexual behaviors, sexually transmitted infections, sexual dysfunctions, and reproductive care. These are all hugely important aspects of sexual health, and the University of Oregon Health Services in collaboration with Protection Connection offer a wide variety of services to help you meet these sexual health needs. Check out their website for additional information, such as on free sexual health supply delivery and pick-up options and STI screening services.

However, sexual health goes beyond just the physical. The World Health Organization defines sexual health more broadly as a “state of physical, emotional, mental and social well-being in relation to sexuality.” They emphasize that sexual health is more than just the absence of disease or dysfunction, but is a state of well-being. Sexual health also includes:

  • A positive and respectful approach to sexuality and sexual relationships
  • The possibility of having pleasurable sex
  • Experiencing safe sexual encounters free of coercion, discrimination, and violence
  • The protection and fulfillment of all people’s sexual rights, such as right to comprehensive sexual education, sexual and reproductive healthcare, body autonomy, consensual relations, and personal choice to decide when, how, and if a person wants to be sexually active

With this broader definition, we can begin to see how sexual health and mental health are linked and influence one another.

Mental illnesses such as depression, anxiety, ADHD, and post-traumatic stress disorder can all impact sexual experiences. Lowered sex drive, arousal, satisfaction, and pleasure can all be common symptoms of mental illness and stress. Additionally, difficulty reaching orgasm or becoming aroused can be common side effects when taking medications to help with mental health. But again, sexual health is more than just physical experiences. The beliefs and attitudes that we hold also influence our sexual health. Feelings of guilt, shame, and fear about sex can keep people from reaching the mental and emotional well-being aspects of sexual health. Additionally, past harmful experiences with others and sex can also influence our approach to sex.

The messages we learn in our society about sex can sometimes contribute to people having negative views of themselves, others, and sex. And the messages we learn about sex are often tied to our identities. In our Western media, sex for White, heterosexual, cisgender, thin, able-bodied, individuals in monogamous relationships is often centralized and depicted. The sexual expressions of people with marginalized identities is often stigmatized and stereotyped. You’ve likely received messages, either directly or indirectly, about your identities in relation to sex and sexuality. The way that you’ve held onto these messages may either enhance your sexual and intimate relationships or may get in the way of the type of sex and relationships you are hoping to have. Either way, therapy can be a space to better understand and unpack these messages as they relate to your own experiences.

I believe that one of the ways we can help to destigmatize diverse expressions of sexuality is to talk about sex (hence the reason for me writing this blog post). So, I want to share some of my own experience. My experience of sexual education was an emphasis on abstinence and the clear message that sex outside of a heterosexual marriage led to scary outcomes, like pregnancy and sexually transmitted infections. I don’t remember my parents, family, or other adults in my life, ever talking about sex while I was growing up. This silence about sex, mixed with fear and abstinence based sexual education greatly contradicted the sexualized images and scenes I was seeing commonly, such as on TV, in movies, and commercials and frankly left me often confused as to what I “should” be doing. As a fat, queer woman myself, society tells me in many ways that my expressions of sexuality are wrong or “gross.”

In an effort to increase discussions of sex on campus, Protection Connection has started their “Sex Talk Chronicles” campaign and is asking, “What do you wish you knew about sex when you were younger?” My answer is that I wish I had known that it was okay to focus on what I did or did not want out of sex. I wish I had known that my pleasure, joy, happiness, and sexual freedom mattered. I wish I had known that people who shared my identities could have great sex in the way that they wanted!

What do you wish you had known about sex when you were younger? Submit your own anonymous story to Protection Connection here: Submit your own anonymous reflection to Protection Connection here.

If you want to read other people’s submissions, check out the Protection Connection newsletter. The newsletter also provides a range of information about sex, intimacy, relationships, and pleasure, including libido, lube, sensuality, love-languages, and so much more! Check out past editions on the website or sign up for the newsletter here.

As I close this post, I want to come back to my earlier question of what does talking about sex have to do with therapy? If you would like to improve your sexual health through increasing your physical, emotional, mental, and social well-being as related to sex, consider coming to University Counseling Services and speaking with one of our counselors. For many reasons highlighted above, it can sometimes feel uncomfortable to bring up sex in therapy. If it feels uncomfortable for you, I encourage you to share this with your therapist. Try saying, “I feel a little uncomfortable bringing this up, but I kind of want to talk about sex.” Or “I’m not really sure how to talk about this, but I’m having some things going on with my sex life that I want to talk about.” Your therapist will help you explore these feelings and help create space to talk more. You have the right to decide how, when, and if you would like to have sex. And if you would like to explore your sexual health further, we at University Counseling Services are here for you.

Carolyn Meiller, M.S.
Doctoral Intern