As we become adults, we might start to think about or hear more about our sexual and/or reproductive health. Adulthood is a time in life when many of us will either begin to wonder about family planning or are told we should be thinking about it. While the topic of “baby-making” and the beginning of some routine sexual health tests (like routine pap tests recommended from age 21 on) may mean we are getting more information about sexual and reproductive health, it doesn’t mean that we always get a full picture of what sexual health and well-being during this time of our lives can look like.

Some of us are thinking about starting a family (in the near or distant future). This may not be as straightforward as people often make it and it can involve challenges we’ll have to manage, such as anxiety around conceiving, involuntary childlessness, infertility, miscarriage and/or infant loss, or difficult pregnancies.

Some of us choose to remain child-free or to delay having children until later in life. This can be an exciting time for us to continue forging our own paths and build the relationships, chosen families, networks, and lives we want. But it can also involve navigating the pressures from those around us about having children and taking care of our sexual health by choosing the right contraception method, getting routinely tested for STIs, having access to abortion care, and so much more.

Our sexual and reproductive health is also much more than just our decisions about having children or not. In adulthood, we may have different health concerns about sexual health – genital pain or endometriosis, sexual trauma or violence, sexual disfunction (including erective disfunction, mental health issues related to sexual health, the onset of perimenopause, etc.).

When it comes to sexual health, there are no neat and distinct lines between youth, young adult, and older adult experiences. This section covers important topics that are relevant at various times in our lives, including during adulthood, to help us think through what impacts and what sustains our sexual health and well-being.

Rights and Entitlements

We can’t about health without talking about rights.

All adults have human rights that relate to sexual and reproductive health. These rights are universal and apply to everyone, regardless of who they are and where they live. Every human being is fundamentally equal, deserves being treated with respect and dignity, and is entitled to live free from discrimination. Human rights are a set of entitlements and responsibilities. While we are entitled to them, we are also responsible for upholding the rights of others through our actions and interactions.

Unfortunately, when it comes to sexual and reproductive health, not all people’s rights are equally respected.

How do Human Rights Relate to Sexual Health?

Sexual rights are the human rights of all people to have full control over their sexuality, reproduction, and gender, including sexual and reproductive health. Sexual rights are fundamental to living with equality and dignity and living free from discrimination, coercion, violence, and harm.

Our rights being respected is necessary for us to be healthy. This is certainly true for our sexual and reproductive health because it is linked to our ability to access the care we need, the information necessary to make and act on health decisions, and protection or redress against discrimination.

Our Sexual Health and Well-Being: Important things to remember

Sexual health is not just the absence of disease, it’s an essential and positive dimension of being human. For some of us, talking about sex and sexual health is difficult or uncomfortable but our overall wellness includes dimensions of physical, emotional, mental, and social well-being in relation to our gender and sexuality.

Many important topics come under the broad umbrella of sexual health—from questions and concerns about how to have comfortable and enjoyable sex to concerns over reproductive health, STIs, or erectile disfunction. We have a right to sexual health, evidence-based sexual health information, public policy that supports sexual health, and pleasure.

There are important ways in which we can nurture our sexual health and well-being, even when we face challenges. The first step is to get informed and have conversations about our sexual health with our loved ones and with our healthcare providers. This helps us make sure that we don’t neglect this important part of ourselves.

Sex

There is no single definition of sex, sex means different things to different people. For some, sex means vaginal or anal penetration. For others, any kind of genital stimulation counts as sex. For many, it can include touch and closeness, sex toys, or erotic scenarios. There is no single definition.

Sexuality is not just about sexual activity. It encompasses many different aspects of our lives, including sexual orientation. What makes up our sexual orientation is our emotional, romantic, physical, and/or sexual attraction to others— or the lack of any. Some of us do not experience sexual attraction or an intrinsic desire to have sexual or romantic relationships, which means we may identify as asexual and/or aromantic.

Click here to read more about asexuality »

People with different bodies, sexualities, and genders will all have sex in different ways. Finding what feels pleasurable and enjoyable is a lifelong process that we encourage people to engage in. Our sexualities will evolve throughout our lives: what we find enjoyable can change as we age, when our bodies change (naturally or because of illness or trauma), due to side effects of medication or medical treatments we may need, because of who we are attracted to or partner with, because our own understanding of our gender changes, and so much more.

Pleasure

There are many reasons to have sex and one of them is to feel pleasure.
When we talk about our sexual health and wellness, we too often focus on preventing negative outcomes like infections or unplanned pregnancies. While talking about those things is important, taking care of our sexual health also means paying attention to our sexual satisfaction and overall sexual well-being. It means getting the information and support we need to feel healthy, happy, and satisfied when it comes to our sexuality and sex.
When we face challenges, anxieties, issues, or have questions about how to have enjoyable and comfortable sex, we should feel good about seeking support from our partner(s), trusted people, and our healthcare team. Talking about pleasure is important to nurture this part of our lives.

Click here to read about sex-positivity and sex-negativity »

What’s “Normal’’?

A very common question people have when it comes to their sexuality, their level of desire, what they are into, and what they fantasize about is: “am I normal?’’

It’s perfectly normal to wonder about sex and sexuality and how we might fit in. How we feel about our sex lives and the sex we want to have will most likely change throughout our lives. Societal attitudes also change over time. Let’s try not to get caught up in the concept of normal. The only relevant concerns when it comes to a sexual act, practice, or experience are the consent, pleasure, and well-being of the people engaged in it or affected by it (including ourselves).

A lot of us are curious about sexual norms because talking about sex openly can still feel taboo or uncomfortable. This means we are often left in the dark when we face challenges; we don’t know who to turn to and many of our questions go unanswered. The stigma and discomfort around talking about sex are reasons why many people don’t bring up sexual health and sex issues with their healthcare providers, even if they are quite concerned or unhappy. We encourage you to find a sex-positive healthcare provider and ask your sexual health questions during your visit. Make sure to include questions and concerns about your sex life.

Some of us might see our sexual desire go up and down. This can be situational, temporary, something we feel at peace with, etc. That said, some of us may feel worried about our level of desire and we are entitled to support. Hypoactive sexual desire disorder (HSDD) and sexual aversion disorder (SAD) affect people of all genders and are quite common. However, healthcare providers or patients often don’t address a lack of desire for sexual activity or aversion towards sexual activity because of how awkward it can feel to talk about.

Want to learn more about desire? Click here to read more about responsive desire and spontaneous desire »

Do Cisgender Men Orgasm more than Cisgender Women?

There’s been plenty of research done about orgasm frequency and the “orgasm gap,” which is how people describe the difference between how often cisgender women and men experience or achieve orgasm. A team of researchers from Chapman University and the Kinsey Institute investigated this topic and looked at different sex acts tied to the frequency of orgasm.

They found that there was indeed an orgasm gap between cisgender men and women. However, looking at different types of relationships (for instance, same gender relationships), they found that individuals reported much more frequent orgasms than those in heterosexual relationships. This challenged the stereotype and assumption that cisgender men naturally orgasm more than cisgender women.

A major goal of this study was to find out what attitudes and behaviors seem to lead to more frequent orgasms. The researchers identified behaviours that strongly differentiated women who orgasmed frequently from women who did not. The best predictor of how often a woman orgasms is how often she receives oral sex. Women who orgasmed more frequently reported receiving more oral sex during sexual activity, having sex for longer durations, and being more satisfied with their relationships overall.

Instead of feeling down by the orgasm gap in heterosexual relationships, let’s think about how we can close this gap. The orgasm gap can be closed if we start looking at issues of gender norms and power in our relationships. Men’s pleasure and fantasies are prioritized (most often unconsciously because of our education, pop culture, and lack of representations of authentic female sexuality and pleasure in the media) and less attention is given to the pleasure of women.

This information can also help us think through desire and satisfaction in our relationships. We can look at ways to nurture healthy mutually satisfying sexual relationships where desire can be fueled by giving attention to every partner’s needs. For some of us, it means examining the way we relate to sex with partners, what we feel entitled to, how we can make ourselves vulnerable or not, and more. When needed, seeking support to have those conversations and make changes in how we relate to one another is a great way to nurture this important part of our relationships.

Does Sexual Stimulation = Sexual Response?

When we feel desire, we can sometimes feel sexually aroused. We can feel aroused by a specific person, by observing something (for instance, while watching porn or other depictions of sex), or by dreaming or thinking about sex. When this happens, we can feel very intense bodily sensations of sexual stimulation (a rush of blood to our genitals, a heightened sensitivity to touch, an erection, or a feeling of wetness or lubrication on our vulva or penis). When we feel this way, sex (including masturbation) is often on our minds but stimulation and sexual arousal aren’t always lined up – this is referred to as arousal non-concordance.

Arousal non-concordance can mean different things. Sometimes, something that isn’t sexual leads to an arousal response in our bodies, even if we’re not aroused and not interested in having sex at that moment. Other times, it can mean we want to have sex but our bodies aren’t having it. This can be particularly confusing when we’re flooded with messages about when we’re supposed to feel turned on and by what. It’s essential to remember that someone having an arousal response doesn’t necessarily mean they are interested in having sex. Likewise, not having an arousal response when you’re trying to get it on with someone doesn’t mean you don’t find them attractive or “good at sex.” The good news is, if you are interested in having sex but your body isn’t aroused, there are lots of fun ways to get in the mood, such as lubrication, playing with sex toys, and masturbating.

Healthy Sexuality and Healthy Relationships

Except for those of us who identify as asexual (which is a sexual orientation), humans are generally sexual beings. The way we experience our sexuality is shaped by our values, attitudes, behaviors, body image, beliefs, emotions, personality, experiences, likes and dislikes, spirituality, and all the ways in which we have been socialized.

Even if most of us are sexual beings, it’s normal to have a lot of questions about sex and sexuality. We’re all involved in a lifelong learning process about our sexuality. The more we know about sex and sexuality, the better we’re able to take charge of our sex lives and our sexual health. Click here to read more on healthy sexuality »

When we talk about sexual health and sexual experiences, we have to talk about relationships. Not all relationships are sexual and healthy, good quality relationships and social support networks have a direct impact on our well-being and even on our life expectancy. Strong, healthy relationships help us manage stress effectively, problem-solve, and overcome life’s challenges. The state of our relationships also impacts our sexual satisfaction, even in more casual contexts. Knowing how to nurture healthy relationships is a key part of our overall well-being.

Click here to read more about healthy relationships, including key ingredients for them »

Safety in Relationships

Sometimes relationships work well and bring people joy and other times relationships make people feel down, trapped, or mentally and emotionally exhausted. Some relationships can put your well-being or your safety at risk. Intimate partner violence and sexual violence are important issues that have severe impacts on people who experience them, including children who witness it.

Living free of violence and free of threats of violence (including sexual violence, sexual coercion, degradation, and harassment) is key to sexual health and wellness. Not only does violence put us at higher risk of STIs and reproductive coercion, it impacts our lives, our mental health, and our ability to access resources and support. Healthcare providers can be part of a support system when we face or have faced violence.

Click here to read more about intimate partner violence and sexual violence »

For Healthcare Providers:
Click here to read more about trauma-informed practice »
Click here to read more about when a patient has experienced sexual violence »

Reproductive Health Issues

For many of us, sexual health is closely linked to reproduction. The following list of topics are possible ways in which this can show up in our lives. The list is only a snapshot of some reproductive health concerns/issues but provides information on the intimate ways in which reproductive health can impact our overall wellness.

Menstrual Cycles and the Connection to Mental and Overall Health

By the time we reach adulthood, those of us who have periods probably know quite a lot about our menstrual cycle. We know how often we get our periods, how heavy they are, and so on. However, things change — some of us may be coming off hormonal contraception or starting hormone replacement therapy and experiencing changes to our cycle or we may be considering trying to conceive and interested in tracking it more closely.
Understanding and paying attention to our menstrual cycle is important. It can be a good indicator of the state of our health and fluctuations in energy levels. Knowing how to track your menstrual cycle to understand what is normal for you and how your cycle impacts you is an important part of our sexual health. Hormonal fluctuations related to menstruation can have important impacts on people of reproductive age. It’s good to be paying more attention to how our bodies feel and how mood fluctuates at different points of our cycle so we can better take care of ourselves with that information in mind.
Our menstrual cycle can also have a major impact on our mental health. Click here to read more about how our menstrual cycle can impact our mental health »

Choosing a Birth Control Method

People choose to use contraception for a variety of reasons. There is no “right” reason to use it. Even though the purpose of birth control is to prevent pregnancy, many people choose to use contraception because of certain health advantages or impacts. For example, some hormonal birth control methods may help regulate periods, address mood disorders associated with the menstrual cycle, reduce acne, and/or lower endometriosis-related pain. Other methods can suppress menstruation, which can help with gender dysphoria (a term that describes a wide range of feelings that may occur if we feel different than the sex we’re assigned at birth or the gender we’re assumed to identify with as a result of the sex we were assigned at birth). Some people experience dysphoria related to their periods depending on their gender identity.

Click here for more information on birth/fertility control methods to help you choose what is the best one for you »

Unplanned Pregnancy? Here are your options

People become pregnant at many different ages and stages of life. When making decisions around an unplanned pregnancy, it’s important to remember that everyone is different and we all face different circumstances that inform the choices we make at different times in our lives. Every person needs to make the decision that is right for them. In any given year in Canada, about 60% of all pregnancies are unplanned and of those, close to half end with an abortion and the rest lead to a birth. If you are facing an unplanned pregnancy, know that you are not alone.

It can be hard to sift through our feelings when trying to make a decision about an unplanned pregnancy. It can be especially complicated at a certain point in our adulthood when we are expected to be pregnant, might want to be pregnant later, are facing circumstances that make the idea of continuing a pregnancy scary or unsustainable despite our desire to be pregnant, are nearing the end of our reproductive years, or have children already. Pregnancy options counseling is an excellent way to receive non-judgmental and competent support when considering the many factors that will inform your decision moving forward. If needed, call the Access line to get a referral to reputable pregnancy counseling options.

Click here to learn more about the different options available to us when we face an unplanned pregnancy »

Family Planning, Family Making and Choosing our Family

Planning a family is not just about having children or not. There isn’t only one definition of a family. Families come in different forms and they all deserve respect and recognition; this includes chosen families, which is when a group of people choose one another to play significant roles in each other’s lives even if they are not biologically or legally related.

Families come in endless forms: biological families, nuclear families, adoptive families, families with same-sex parents, queer families, polyamorous pods, step-families, blended families, families that share co-parenting relationships with multiple people, foster families, extended families, immediate families, single-parent families, childless families, multi-generational cohabitating families, divorced families, and so much more. We can create our families in countless ways – through adoption, foster care, choosing family friends to become family (chosen family), assistive reproductive technologies, sperm and/or egg donors, surrogate parents, cohabitating, taking care of one another, etc.

Often, the only type of family we see in the media and in books (including kids’ books) are heterosexual two-parent families. But we can’t tell what someone’s family is like by looking at them and there are lots of ways to make a family. It’s important to be inclusive in the way we talk about families because many of us have or will make our families in ways that defy that particular model. Click here for more information on family diversity in Canada »

Reproductive Coercion: A form of intimate partner violence

Reproductive coercion is a form of intimate partner violence where one partner uses aspects of the other person’s reproductive health (like contraceptive use and pregnancy) to maintain power, control, and domination. The most common forms of reproductive coercion include sabotage of contraceptive methods, pregnancy coercion, and pregnancy pressure.

Sabotage of contraceptive methods means actively interfering with a partner’s contraception to make them pregnant. Examples include hiding, withholding, or destroying a partner’s oral contraceptives; breaking or poking holes in a condom on purpose or removing a condom during sex without consent (often referred to as “stealthing”); not withdrawing when that was the agreed upon method of contraception; and removing vaginal rings, contraceptive patches, or intrauterine devices (IUDs). A large study undertaken in the United States showed that 1 in 7 women between the age of 16 and 29 had experienced birth control sabotage in their lives, 1 in 5 had been pressured by their partner to become pregnant, and 1 in 3 women who reported intimate partner violence also reported reproductive coercion. Reproductive coercion was also reported by 1 in 8 individuals who had not experienced other forms of relationship violence, meaning it happens in relationships that don’t otherwise seem abusive.

Pregnancy pressure means pressuring a partner to become pregnant when they do not wish to become pregnant. Pregnancy coercion involves coercive behaviour like forced sex (sexual assault), threats or violent actions toward a partner who does not comply with the perpetrator’s wishes regarding the decision to terminate or continue a pregnancy. Examples of pregnancy pressure and coercion include: threatening to hurt a partner who does not agree to become pregnant, forcing a partner to carry a pregnancy to term against their wishes through threats or acts of violence, forcing a partner to terminate a pregnancy when they do not want to, or injuring a partner in a way that may cause a miscarriage.

Click here for more information and resources on reproductive coercion »

Trying to Conceive, Infertility and Involuntary Childlessness

Trying to conceive, navigating infertility, and/or being involuntarily childless are all important reproductive health issues that can have significant impacts on our mental health and well-being. We deserve the support of our loved ones, community, and healthcare team when we face challenges in those areas.

If you are trying to get pregnant, there is a lot of information available to figure out what is the best time for sex to conceive, what medical technologies can help to get a person pregnant, what supports LGBTQ2S+ families can seek out, when age starts to impact fertility, when to seek medical help when you’ve been trying for a while, etc. Talking with your trusted friends and family as well as your healthcare team is important to get the support you need to make sense of a lot of medical information, navigate potential medical systems like fertility clinics, and deal with the anticipation and stress this big life event can bring.

Some of us will have a really hard time conceiving. Infertility is more common than we may think, even though many of us have received fear-based messages throughout our younger years about how easy it is to “accidentally” get pregnant (which, while true for some is untrue for others). In Canada, 1 in 6 people wanting to be pregnant experience infertility when trying to conceive their first child or after a successful pregnancy (referred to as secondary infertility). Secondary infertility refers to parents who have failed to conceive after 12 months of trying to get pregnant or who have experienced recurrent miscarriages. If you are having fertility problems, there are options and medical help available. It is important to seek support for the medical side of infertility but also for the emotional impacts it can have. Going through fertility treatments can bring a lot of stress on our bodies, our minds, and on our relationships. Talking about it often means we can connect with others who have been through this experience and this can be helpful to many of us.

While many of us will be successful in using treatment for fertility challenges, some of us will remain involuntarily childless. There isn’t much information available on involuntary childlessness and this can mean that those of us who face this situation get little social support. It is harder to deal with physical and mental health problems such as anxiety and depression that can arise when dealing with grief if you don’t have proper support. If you are finding yourself involuntarily childless, know that you are not alone, it is a serious issue, and you deserve support and care. Your healthcare team can play a role in making sure you are receiving the attention you deserve.

Pregnancy Loss (miscarriage)

Miscarriages are common; they happen in about 15 to 20% of pregnancies. Most of the time, they happen during the first eight weeks. We usually don’t know the cause of miscarriages. While it can be tempting to blame ourselves, miscarriages are not because of something someone did or didn’t do, eat or didn’t eat, etc. If you’ve had a miscarriage, it is not your fault.

When pregnant, it is important we take any vaginal bleeding seriously and seek medical help if it happens. About 20% of people who are pregnant will have some bleeding before the 20th week and about half of those pregnancies will continue without any other issues. But sometimes it can be a symptom of a miscarriage. Medical help will be needed to monitor and, if necessary, manage the miscarriage.

Despite how common this experience is, we don’t talk about it enough. Many people feel quite alone in their experience and are taken aback by how the experience makes them feel. Some of us experience deep grief when losing a wanted pregnancy and it can take time to recover and move through this difficult experience. Your loved ones, community, and healthcare team can all be sources of support when you are facing such an experience.

Stillbirth and Infant Loss

While it is rare, people can lose their babies later in their pregnancy and some babies are born too soon, with a serious illness, or with problems the healthcare team did not expect. In those rare cases, some babies die either late in the pregnancy, shortly before birth, during birth, or shortly after.

Experiencing a stillbirth or infant loss is devastating and compassionate care is crucial.

The Pregnancy and Infant Loss Network has helpful resources for those of us who experience infant loss and bereavement. It includes a section for healthcare providers to support them in providing skilled and compassionate care for those who experience infant loss.

Pregnancy and Prenatal Care

During our adulthood, many of us will become pregnant. If we choose to continue the pregnancy, planned or not, pregnancy care is an important part of the experience.
Pregnancy care consists of prenatal (before birth) and postpartum (after birth) healthcare for people who are pregnant. It involves getting important information, tests, treatments, and care to help decrease risks during pregnancy and increase the chance of a safe and healthy delivery. Regular prenatal visits can help healthcare providers monitor pregnancies and identify any problems or complications before they become serious.

Click here for some important prenatal care tips, including how to choose your prenatal healthcare provider »

While a lot of the information available on pregnancy focuses on prenatal care, postpartum care is also very important. The postpartum period lasts six to eight weeks, beginning right after the baby is born. During this period, someone who has just given birth will go through many physical and emotional changes while learning how to care for a newborn and sleep deprivation. Postpartum care involves getting proper rest, nutrition, lactation support if necessary, vaginal care, and mental health support when needed.

Obstetric Violence

Obstetric violence refers to poor treatment and abuse experienced by individuals in reproductive healthcare settings, typically during the childbirth process. This can range from non-consensual medical treatments or interventions (for example the use of episiotomy or instruments like forceps without consent) to coercive sterilizations or C-sections, denial of care (including denial of pain management), shaming and stigma from healthcare providers, being threatened with the involvement of the Children’s Aid System (particularly for Indigenous and racialized women who disproportionately have their children seized at higher rates), and overt violence during labour (physical violence, verbal humiliation and harassment, sexual assault, or coercive vaginal exams).
The impact of experiencing obstetric violence can be devastating and include health complications, severe phycological distress, trauma, and in some cases death due to neglect.

While most people will have positive and affirming reproductive healthcare experiences, many people experience mistreatment during birth and their postpartum care, a reality that is more and more openly acknowledged and discussed. This is particularly true for those impacted by racism, colonialism, and poverty, as well as those who are substance users. Inaccurate stereotypes around who constitutes a “proper parent” and who is seen as knowledgeable and competent are often to blame.

Birth support workers, including doulas and midwives, can be an excellent support to help mitigate potential violent experiences in reproductive care settings. Unfortunately, doulas and midwives are not always available due to restrictive policies around midwifery and doula care as well as prohibitive costs. Others may not choose to have a doula or midwife as part of their birthing team.

For more information on obstetric violence, please visit The Reproductive Justice Story, a patient advocacy initiative aimed at exposing mistreatment and abuse in reproductive healthcare across Canada.

Discomfort and Pain

Pain and discomfort are important to address when it comes to sexual health and wellness and sexual function issues. Genital and pelvic discomfort and pain, including chronic pain, can seriously affect our quality of life and have a big impact on our overall health, mental health, and the state of our relationships. There can be many causes for pelvic and/or genital pain. When genital or pelvic discomfort and pain interfere with our lives and well-being, it is important that you get the proper care, support, diagnosis, and treatment.

When should I talk to my doctor?
If you feel pain in your pelvic or genital area and it’s disrupting your quality of life, if you know or think you have a medical condition that causes pain, or if you feel pain during non-sexual activities (e.g. urinating, exercising, biking, sitting) you should talk to your healthcare provider as soon as possible. If your pain or discomfort continues to interfere with your enjoyment of sex, you should talk with a healthcare provider.

Urinary tract infection

A urinary tract infection (UTI) is an infection in any part of our urinary system — kidneys, ureters, bladder, and urethra. Most infections involve the lower urinary tract, which includes the bladder and the urethra.

Anyone can have a UTI, including babies and children. People who have vulvas are at greater risk of developing a UTI. Infection limited to the bladder can be painful and annoying; however, serious consequences can occur if a UTI spreads to the kidneys. Typically, UTIs are treated with antibiotics.

While there are not always symptoms, there are common tell-tale signs such as pain and discomfort. We can feel a burning sensation when we pee, our urine can have a strong smell, we may feel a strong, persistent need to urinate (or keep peeing even if we are done emptying our bladder), and our urine can appear cloudy and/or bloody (red, pink or cola colored). Some of us may experience pelvic pain.

If you suspect you have a UTI, it is important to seek medical care.

Vulvas, vaginas, and uterus

There are several causes of pain and discomfort that can impact the vulva, vagina, and uterus.

Painful Sex (Dyspareunia)

Painful sex or dyspareunia is a common but neglected sexual health problem. Dyspareunia is a common and troubling complaint of people with vulvodynia as well as provoked vestibulodynia. Dyspareunia often means we are also experiencing sexual difficulties such as lack of desire and arousal and strain within our sexual relationships. The impact of experiencing this kind of pain can lead to mental health issues like negative body image, hypervigilance to pain, depression and anxiety, and low self‐esteem.

Possible Causes of Genital Pain and Discomfort

Vulvodynia is a chronic syndrome that causes burning, stinging, irritation, or sharp vulvar pain and it affects about 16% of people with vulvas. Pain can be spontaneous (without an obvious cause), provoked by stimulation (e.g. intercourse or tampon use), or both. People with vulvodynia report a poorer quality of life and can suffer from anxiety and depression.

Vulvodynia can be more common among people who have depression or Post Traumatic Stress Disorder (PTSD), indicating a complex link between genital pain and our mental health and wellness.

Another form of chronic genital sexual pain is vaginismus, a painful vaginal spasm occurring during penetration. Genital sexual pain can have significant impacts on mental health and well-being.

Painful sex can also result from a range of conditions, including vulval skin conditions such as lichen sclerosus, a condition that creates patchy, white skin on the genital and anal areas that appears thinner than normal, causes great discomfort, swelling and pain, can tear and bleed, and can be very itchy. It is thought to be caused by an overactive immune system and/or a hormonal imbalance.

Endometriosis

Endometriosis is a painful reproductive disorder that affects millions of people worldwide. This medical condition occurs when the lining of the uterus, called the endometrium, grows in other places, such as the fallopian tubes, ovaries, or along the pelvis. When that lining breaks down, like the regular lining in the uterus that produces the menstruation, it has nowhere to go. This causes cysts, heavy periods, severe cramps, severe pelvic pain, and even infertility. The pain, which can be debilitating, is due to internal bleeding from the lining being shed inside the body and can also lead to scar tissue formation, blocked fallopian tubes, and bowel problems. A 2015 study found that endometriosis can affect quality of life and mental health.

Despite significant symptoms, many people experience long delays in receiving an endometriosis diagnosis. This is in part due to the unconscious biases that healthcare providers may have around how pain is experienced across different genders and ethnicities.

Vaginal Dryness

This condition is more common in older people but it can happen at any age. Vaginal dryness happens when the tissues of the vagina are not well lubricated and healthy, which can cause pain and discomfort during sex. It can also mean we become more susceptible to bacterial or yeast infections.

Symptoms include soreness, itching and burning, painful sex, light bleeding after sex, and mild discharge.
Here’s what can contribute to vaginal dryness:
• Low levels of estrogen. Estrogen is a hormone that helps keep the tissues of the vagina lubricated and healthy.
• Using douches and other irritants like perfumes, certain soaps, lotions, and some laundry detergents can disrupt the natural balance of bacteria and chemicals in the vagina and cause dryness.
• Antihistamines (commonly found in allergy, cold, and asthma medicines) can have a drying effect. Certain antidepressants can also cause vaginal dryness. Other medicines like allergy, cold, and asthma medicines that contain antihistamines can have a drying effect on the body and contribute to reduced vaginal lubrication.
• A low libido or other sexual issues may lead to dryness; dryness and pain may decrease your libido.
• Other causes include menopause and perimenopause, childbirth, breastfeeding, smoking, ovaries being removed, certain immune disorders, cancer treatments, and anti-estrogen medicine, including hormone replacement therapy.

Make sure to visit your healthcare provider if you have symptoms of vaginal dryness that are severe or persistent so you can get the care and support you need.

Pain after giving birth

Most healthcare practitioners advise you to wait 6 weeks postpartum (after delivery) to have vaginal sex. The 6-week delay gives you some time to heal. This healing time can be useful, especially if you experienced a tear on the perineum (the skin in between the vaginal opening and the anus), an episiotomy (a cut made on the perineum), or surgical instruments like forceps were used. For some, it may take longer than 6 weeks before they feel ready to have penetrative sex again (and may want to focus on other sexual activities for a while, if any).
Are you still experiencing pain after been months since you’ve given birth? Click here to read about some of the possible causes of lingering postpartum genital pain »

Penis, testicles and scrotum

There are several causes of pain and discomfort that can impact the penis, testicles, and scrotum. These range from pain sustained through an injury to different genital conditions.

Many other conditions and injuries can cause pain and discomfort in the penis, testicles, and scrotum. It’s important to see a healthcare provider if you have concerns, discomfort, or notice anything different about your penis or scrotum. Often, it can feel embarrassing or scary to see a doctor about your genitals but they are there to help you.

Testicular Conditions

Testicular conditions include testicular torsion, which occurs when a testicle twists or rotates. This twists the spermatic cord and restricts blood-flow to the scrotum and testicles. This can cause sudden severe pain and requires medical intervention. Other testicular conditions include cryptorchidism (undescended testicles), where one or both testicles have not moved down into the scrotum. Other things that can impact the testicles include testicular cancer, which can be identified through growths or lumps in the testicles or scrotum – having lumps does not however always mean you have cancer (as benign lumps also occur).

Hypospadias

Hypospadias is a condition where the urethra does not extend to the tip of the penis, which impacts how one urinates. With this condition, urine will flow from the bottom or from a different spot on the penis instead of from the tip.

Erectile Challenges

Erectile challenges occur due to a restriction of blood-flow to the penis and can be caused by many reasons, including performance anxiety around sex and other medical causes. Erectile challenges can happen at different moments in life, despite misconceptions that only older people experience erectile difficulties.

Click here for more on erectile challenges »

Foreskin Conditions

Foreskin conditions include phimosis (a condition that makes it hard to pull the foreskin back from the head of the penis) and paraphimosis (a retracted or tightened foreskin that cannot be pulled back over the head of the penis).

Sexually Transmitted Infections (STIs) and Getting Tested

STI stands for “sexually transmitted infection.” You might also see the acronym STBBI, which refers to “sexually transmitted and blood-borne infections.” People often assume that STIs are predominantly an issue among youth and younger adults; however, rates of chlamydia, gonorrhea, and infectious syphilis have steadily increased among middle-aged adults over the past decade. This means that it’s important to talk to your healthcare provider about testing and make it a part of your routine healthcare. Some adults might feel they are not at risk of contracting an STI, particularly if they are not changing partners frequently because they do not perceive their behaviour as risky or they lack general information around sexual health. But it is important to make testing a regular part of your healthcare routines if you are sexually active. STIs are quite contagious and many of us don’t have symptoms of an infection even if we have one—and having an STI is a common experience.

Many people find STIs difficult or embarrassing to talk about but they are more common than most people think: 75% of adults will have had at least 1 type of human papillomavirus (HPV) in their lifetime, more than 100,000 cases of chlamydia are reported each year in Canada, and as many as 1 in 7 Canadians aged 14 to 59 may be infected with HSV2, the virus that causes genital herpes. If you have an STI, know that you are not alone and that it is not something to be embarrassed or ashamed of.
The stigma, shame, and fear associated with STIs are real and affect many people. This makes talking about STIs—and prevention and testing—challenging.

Considering how common they are, we should get to know about STIs! Our new STI information hub is currently under construction. It will feature useful information on symptoms, treatment, and testing and a directory of clinics and providers where you can get tested. In the meantime, please visit Heart Your Parts to read more about STIs.

Physical Challenges

Sex and Physical Disability

The term “physical disability” covers a wide range of conditions. Some of these conditions may not affect our day-to-day life, while others require full-time care and assistance. Some of us are born with a physical disability and some of us will acquire one later in life.

People with physical disabilities have sexual health concerns, have or want to have sex (unless they identify as asexual), and are entitled to support and care to attain the highest standard of health. If you have a physical disability that poses certain challenges when it comes to your sexual and reproductive health, you are entitled to support and care and to comfortable and enjoyable sex.

If you are a healthcare provider, click here to learn more about caring for patients with disabilities »

Incontinence

Urinary incontinence or losing control of our bladder and leaking pee is a common issue. Urinary incontinence can range from occasionally leaking urine when we cough, sneeze, or do physical activities like running or playing sports, to having urges to pee that are so sudden and strong, we can’t make it to a bathroom.

Though it is a condition that becomes more common as we age, incontinence can happen at any age and be a persistent condition caused by underlying physical reasons or changes, including pregnancy, childbirth, hysterectomy, enlarged prostate, or some neurological disorders.

If urinary incontinence affects your daily activities (and studies do show it can also impact our sexual functioning and lower our desire for sex among), don’t hesitate to see a healthcare provider. In cases like incontinence caused by pregnancy and childbirth, working with a pelvic floor therapist can help resolve the issue. For most people, simple lifestyle changes or medical treatment can ease discomfort or stop urinary incontinence. While some people may be uncomfortable bringing this topic up with a healthcare provider, it is important not to brush it off.

Sex and Heart Disease

Heart disease is incredibly common and we need to talk about sex in the context of heart disease or after a heart attack. Sex after a heart attack can be impacted by many things such as medications that may affect the ability to maintain an erection or the inability to use certain drugs like Viagra or Cialis depending on what medications you are on (for example, nitrates). Keep an eye out for chest pain, dizziness, or shortness of breath while having sex with heart disease. If you’ve had a heart attack, speak with your doctor about when you can resume having sex or how you might modify the sex you are having (if required), depending on how you’re feeling. This is a completely normal question to ask and your physician is there to support you. For more information, read The Advanced Cardiovascular Life Support Training Centre’s “Is There Sex After a Heart Attack?” (The short answer is YES). If you’re feeling anxious about resuming sex after a cardiac event, open communication with your partner or modifying the ways you are intimate can help.

Erectile Challenges

Being unable to get and keep an erection firm enough for sex can be stressful for those of us who experience this challenge. Having trouble getting an erection from time to time isn’t necessarily a cause for concern – this can be completely normal. But if it does become an ongoing challenge, it can cause stress, affect self-confidence, and contribute to relationship problems. Problems getting or keeping an erection can also be a sign of an underlying health condition that needs treatment and is a risk factor for heart disease.

While we may feel awkward about bringing this up in the doctor’s office, it is important to talk about it. Sometimes treating an underlying condition is enough to reverse erectile dysfunction. In other cases, medications or other direct treatments might be needed and can be provided.

Click here to read more about erectile challenges, including possible symptoms »

Getting Help and Support

Whether it’s knowledge about our bodies or information about treating a specific condition, taking steps to get educated and informed about our sexual health is important to stay healthy. Beyond getting informed, getting the care and support we need is key. Because many of us feel uncomfortable talking about our sexual health or don’t see it as a priority, we sometimes wait a long time before seeking a solution to our sexual health concerns. Sometimes, we only seek help when a problem has become pressing and by then, it may be difficult to seek support.

Sometimes, we just don’t know where to start or who to see. Depending on the issues we want to address, your sexual health team could include a variety of health professionals, such as:
• Your primary care provider (e.g. local nurse practitioner or family doctor)
• An obstetrician-gynecologist
• A midwifery team
• A birth doula and/or full-spectrum doula
• A pelvic floor therapist
• A urologist
• A physiotherapist
• A mental health professional
• A naturopath
• A therapist
• An abortion provider
• A fertility doctor
• A plastic surgeon
• An endocrinologist
• etc.

Taking care of our sexual health means understanding that our overall well-being impacts our sexual health and vice-versa. Many different types of professionals and experts can help us get where we want and deserve to be. Everyone has a right to affirming care, including sexual healthcare.

Click here for information on how to talk to your healthcare providers about sexual health concerns »

Click here if you are a healthcare provider and want to provide affirming sexual and reproductive healthcare »

 

Resources

Andrew Gurza’s Disability After Dark Podcast: http://www.andrewgurza.com/disability-after-dark/

Andrew Gurza’s Picture This Documentary: http://www.andrewgurza.com/picturethisdoc/

Symphonie Privett, ‘’Dangerous Deliveries: Why Are Black Women Dying During Childbirth?” http://www.wlox.com/2018/11/05/dangerous-deliveries-why-are-black-women-dying-during-childbirth/

The Asexual Visibility & Education Network (AVEN), FAQ https://www.asexuality.org/?q=general.html#def

Differences in Orgasm Frequency Among Gay, Lesbian, Bisexual and Heterosexual Men and Women in a U.S National Sample https://link.springer.com/article/10.1007/s10508-017-0939-z

Pregnancy and Infant Loss Network: Resources of Healthcare and Service Professionals https://pailnetwork.sunnybrook.ca/healthcare-professionals/resources/

Society of Obstetricians and Gynecologists of Canada https://sogc.org/

Society of Obstetricians and Gynecologists of Canada, Sex and U: Your Trusted Resource for Sexual and Reproductive Health: https://www.sexandu.ca/

The Gottman Institute: A Research-Based Approach to Relationships: https://www.gottman.com/

Rainbow Health Ontario: A Guidebook for Lesbian, Gay, Bisexual, Trans and Queer

People on Assisted Human Reproduction in Canada: https://www.rainbowhealthontario.ca/wp-content/uploads/woocommerce_uploads/2014/08/AHRC_BOOKLET_ENGLISH.pdf

What Exactly is a Full Spectrum Doula? http://offbeatdoula.com/fullspectrumdoulas/