5 Healthy Relationships and Sexuality

Chapter Objectives

  • Explore attributes of a healthy romantic and/or sexual relationship
  • Discuss potentially unhealthy relationship situations
  • Evaluate possible courses of action to address or leave an unhealthy relationship


“The world is not to be divided into sheep and goats, and not all things are black nor all things white. It is a fundamental of taxonomy that nature rarely deals with discrete categories. Only the human mind invents categories and tries to force facts into separated pigeon-holes. The living world is a continuum in each and every one of its aspects. The sooner we learn this concerning human sexual behavior, the sooner we shall reach a sound understanding of the realities of sex.”  ~ Alfred Kinsey

Gender and Sexuality

Sex and gender have potentially been two of the most socially significant factors in the history of the world. Sex is one’s biological classification as male or female, which is biologically determined at the moment the sperm fertilizes the egg. Sex can be precisely defined at the genetic level with females having two X chromosomes (XX), while males posses an XY pairing. The female’s eggs contain only an X chromosome, while the male’s sperm contains half X and half Y chromosomes. Therefore, the sperm that fertilizes the egg determines whether a person has XX (female) or XY (male) pairing of chromosomes. The main difference between sexes is the reproductive body parts assigned to each (including their functions and corresponding hormones).

Gender is culturally-based and varies in a thousand subtle ways across the many diverse cultures of the world. Gender has been shaped by social norms, politics, religion, philosophy, language, tradition and other cultural forces for many years. Gender identity is our personal internal sense of our own place on the gender continuum. Every society has a slightly different view of what it means to be of a certain gender.

Sexual Scripts

A script is what actors read or study and what guides their behavior in a certain role. A script is a blueprint for what we “should do” in our roles. Sexual scripts are blueprints and guidelines for what we define as our role in sexual expression, sexual orientation, sexual behaviors, sexual desires, and the sexual component of our self-definition. All of us are sexual beings, yet none of us is exactly identical to another in our sexual definitions and script expectations. Having said that, keep in mind that we are not just born with sexual scripts in place; they are learned. Sexual socialization is the process by which we learn how, when, where, with whom, why, and with which motivations we are sexual beings.

We are all born with drives, which are biological needs that demand our attention and behavioral responses to them. The most powerful drives are circulation, breathing, voiding waste, eating, drinking, sleeping, and sexual involvement. Sexual drives are biological urges to participate in sexual activity and in certain sexual roles.  Sexual scripts, once learned, will shape how that drive is answered. Sexuality is learned via culture and socialization. There are as many unique sexual scripts as there are people, yet some of these scripts have common themes and can be viewed as a collective pattern or trend in the larger social level.

Many of us learn our sexual scripts in a passive way. In other words, we don’t learn from experience, but from a synthesis of concepts, images, ideals, and sometimes misconceptions. For example, the commonly held belief that men and women are two different creatures, perhaps even from different planets, was a very successful fad in recent years that led an entire generation to believe that men might be from “Mars” while women might be from “Venus.”

Some traditional sexual scripts that have been studied include a number of problematic assumptions. Some of these assumptions include but are not limited to: the man must be in charge, the woman must not enjoy (or let on that she enjoys) the sexual experience, the man is a performer whose skills are proven effective upon arrival of his partner’s orgasm, and men are sexual while women are not. Numerous studies have shown that most of these traditional scripts are not realistic, healthy, conducive to open communication, nor negotiation of sexual needs and desires for couples. In sum, rather, these traditional notions can be an undermining influence in a couple’s intimacy. Scripts that are more contemporary include these simple ideas:

1) A person needs to ownership of their own sexual experiences.

2) Both partners need to learn to communicate openly and honestly about their feelings.

3) Both partners need to learn to meet one another’s desires, needs, and wishes while making sure that their own needs are being met.

Sex and Gender

When filling out official documents, you are often asked to provide your name, birth date, and sex or gender. But have you ever been asked to provide your sex and your gender? Sociologists and most other social scientists view sex and gender as conceptually distinct. Sex denotes biological characteristics and exists along a spectrum from male to female. Gender, on the other hand, denotes social and cultural characteristics that are assigned to different sexes. Sex and gender are not always synchronous, meaning they do not always line up in an easy-to-categorize way.

“Sex” refers to physiological differences found among male, female, and various intersex bodies. Sex includes both primary sex characteristics (those related to the reproductive system) and secondary sex characteristics (those that are not directly related to the reproductive system, such as breasts and facial hair). In humans, the biological sex of a child is determined at birth based on several factors, including chromosomes, gonads, hormones, internal reproductive anatomy, and genitalia. Biological sex has traditionally been conceptualized as a binary in Western medicine, typically divided into male and female. However, anywhere from 1.0 to 1.7% of children are born intersex, having a variation in sex characteristics (including chromosomes, gonads, or genitals) that do not allow them to be distinctly identified as male or female. Due to the existence of multiple forms of intersex conditions (which are more prevalent than researchers once thought), many view sex as existing along a spectrum, rather than simply two mutually exclusive categories.

Figure 3. Female and Male Sex Symbols


A person’s sex, as determined by his or her biology, does not always correspond with their gender; therefore, the terms “sex” and “gender” are not interchangeable. “Gender” is a term that refers to social or cultural distinctions associated with being male, female, or intersex. Typically, babies born with male sex characteristics (sex) are assigned as boys (gender); babies born with female sex characteristics (sex) are assigned as girls (gender). Because our society operates in a binary system when it comes to gender (in other words, seeing gender as only having two options), many children who are born intersex are forcibly assigned as either a boy or a girl and even surgically “corrected” to fit a particular gender.

Gender identity is a person’s sense of self as a member of a particular gender. Individuals who identify with a role that corresponds to the sex assigned to them at birth (for example, they were born with male sex characteristics, were assigned as a boy, and identify today as a boy or man) are cisgender. Those who identify with a role that is different from their biological sex (for example, they were born with male sex characteristics, were assigned as a boy, but identify today as a girl, woman, or some other gender altogether) are often referred to as transgender. The term “transgender” encompasses a wide range of possible identities, including agender, genderfluid, genderqueer, two-spirit, androgynous, and many others.

Figure 4. The Transgender Sex Symbol

Cultural Variations of Gender

Since the term “sex” refers to biological or physical distinctions, characteristics of sex will not vary significantly between different human societies. For example, persons of the female sex, in general, regardless of culture, will eventually menstruate and develop breasts that can lactate. Characteristics of gender, on the other hand, may vary greatly between different societies. For example, in American culture, it is considered feminine (or a trait of the female gender) to wear a dress or skirt. However, in many Middle Eastern, Asian, and African cultures, dresses or skirts (often referred to as sarongs, robes, or gowns) can be considered masculine. Similarly, the kilt worn by a Scottish male does not make him appear feminine in his culture.

Sexual Identity and Orientation

Human beings are socialized into their adult roles and learn their sexual identities along with their gender roles, work roles, and family roles. Sexual orientation is the sexual preference one has for their partner: male, female, both, or neither. There are a few common sexual orientations that can be seen at the societal and personal level. Heterosexuality is the sexual attraction between a male and a female. Homosexuality is a sexual attraction between a male to another male or a female to another female. Bisexuality is a sexual attraction to both male and female sexual partners. Pansexuality is sexual, romantic, or emotional attraction towards people regardless of their sex or gender identity.

Sexual desire is the attractions we have for sexual partners and experience that exist independent of our behaviors. Sexual behaviors are our actual sexual actions and interactions. It is important to note that orientations, desires, and behaviors are not always the same thing. They do overlap at times. For example, a heterosexual male may have had a homosexual experience in the past, or not. He may at times desire males and females regardless of his actual sexual activities. A lesbian female may have had a short-term heterosexual relationship, yet define herself as a lesbian.

The Janus Report reported their findings on sexual behaviors and sexual orientation. Their sample reported 22% of men and 17% of women said yes to the question, “Have you had a homosexual experience?” Janus also reported that 91% of men and 95% of women claimed to be heterosexual; four percent of men and two percent of women claimed to be homosexual; and five percent of men and three percent of women claimed to be bisexual. Generally speaking Janus and Laumann found that the U.S. is a very sexual nation. They reported that very few men and women reported never having had vaginal sexual intercourse (less than five percent). They reported that men typically have sex sooner than women and that most had sex by age 20. Janus specifically reported that only nine percent of men and 17% of women had NO sexual experience before marriage.

Relationships and Communication

Attachments are crucial to human existence and are essentially the emotional context of those relationships we form in life. As an infant you learned to trust those who cared for you; you learned that they returned once they were out of view and were dependable. Eventually, as your cognitive development matures, your brain allows you to love the person you are attached to and to care for them—whether or not they are caring for you. You learn then that your attachments begin to facilitate your needs and wants being met. How you attached as an infant and young child shape (at least in theory) how you will likely attach as an adult. For example, if you had strong attachments in childhood, then forming adult relationships should be easier for you; if you had weak or interrupted attachments in childhood, then forming adult relationships would be more difficult.

Abraham Maslow, addressed love in terms of how our needs are met by the other person. His basic premise is that we pair-off with those whose love styles fill an unmet childhood need. In other words, Maslow said that if our childhood needs were not met in the basics of survival, safety, food, shelter, love, belonging, and even self-esteem, then we look for an adult companion that can fill those needs for us. It’s like an empty cup from our childhood that our adult partner fills for us. Maslow also said that when all those basic needs are met in childhood, we are attracted to an adult partner who compliments our full development into our psychological potential.

Sternberg’s Triangular Theory of Love

Robert Sternberg was the “Geometry of Love” psychologist who triangulated love using intimacy, passion, and commitment by measuring the intensity of each and how intense the triangulation was for the couple. To Sternberg it was important to consider how each partner’s triangle matched the other partner’s. He said that a couple with all three types of love balanced, and in sufficient magnitude, would have a rare yet rewarding type of love that encompassed much of what couples seek in a loving relationship.3 Sternberg’s consummate love is a love type that had equal measures of passion, intimacy, and commitment that is satisfactory to both lovers.

In modern day applications of love, various components have been found as the ingredients of love: commitment, passion, friendship, trust, loyalty, affections, intimacy, acceptance, caring, concern, care, selflessness, infatuation, and romance. There is a love type identified that many people are aware of called unconditional love. Unconditional love is the sincere love that does not vary regardless of the actions of the person who is loved.

Theories of Mate Selection

The Social Exchange Theory and its rational choice formula clarify the selection process even further. We strive to maximize rewards and minimize costs in our choices of a mate.

Rewards – Costs = Choice

When we interact with potential dates and mates, we run a mental balance sheet in our heads. She might think, “He’s tall, confident, funny, and friends with my friends.” As she talks a bit more she might say, “But, he chews tobacco, only wants to party, and just flirted with another woman while we were talking.” The entire time we interact with potential dates and mates we evaluate them on their appearance, disposition, goals and aspirations, and other traits. This while simultaneously remembering how we rate and evaluate ourselves. Rarely do we seek out the best looking person at the party unless we define ourselves as an even match for him or her. More often we rank and rate ourselves compared to others and as we size up and evaluate potentials we define the overall exchange rationally or in an economic context where we try to maximize our rewards while minimizing our losses.

The overall evaluation of the deal also depends to a great extent on how well we feel matched on racial and ethnic traits, religious background, social economic class, and age similarities. The complexity of the date and mate selection process includes many obvious and some more subtle processes.

How do strangers transition from not even knowing one another to eventually cohabiting or marrying? From the very first encounter, two strangers begin a process that either excludes one another as potential dates or mates or includes them and begins the process of establishing intimacy. Intimacy is the mutual feeling of acceptance, trust, and connection to another person, even with the understanding of personal faults of the individual. In other words, intimacy is the ability to become close to one another, to accept one another as is, and eventually to feel accepted by the other. Intimacy is not sexual intercourse, although sexual intercourse may be one of many expressions of intimacy. When two strangers meet they have a stimulus that alerts one or both to take notice of the other.

Effective Communication

Effective communication is critical to successful relationships. Researchers and therapists have found at least nine skills that can help couples learn to talk effectively about important issues (Gottman 1994; Markman, Stanley, and Blumberg 2010; Schramm and Harris 2011). How we interact about issues such as time spent together/apart, money, health, gender differences, children, family, friends, commitment, trust, and intimacy affects our ability to develop and maintain lasting friendships. If learned well, these nine skills can help put our relationships on a positive trajectory for success.

What Do Couples Talk About?

  • Time Together/Apart. Both the quantity and quality of time spent together influence the wellbeing of relationships. Spending time apart participating in other activities also influences the well-being of a relationships.
  • Money. Thoughts and talk about money, spending habits, and ability to budget, invest, and plan for the future impact couple financial management processes and practices.
  • Health. Couples must talk about many health-related issues, including nutrition, exercise, illness, disease, accidents, health care, mortality, and death.
  • Personality. Because some individuals tend to be more task-oriented in their communication styles and others tend to be more process-oriented, task-oriented people tend to want to solve issues immediately, while process-oriented people tend to want to talk about them more and come to a consensus about what should be done.
  • Children. How children develop physically, socially, emotionally, intellectually, and spiritually are often topics of discussion. Focusing on the best ways to consistently meet children’s needs is considered being child-centered.
  • Family/In-Laws/Friends. Couples often talk about situations and circumstances surrounding the interactions they have with their closest relationships.

What do couples argue about?

Because the items listed above are some of the major topics couples talk about, it follows that they are also the same topics that can spur disagreements. For instance, it is a familiar joke that people can have difficulties in their relationships with in-laws. Take for example, “What is the difference between in-laws and outlaws? Answer: One is ‘Wanted!’” Sayings such as these underscore the importance of knowing how your relationships with others can affect your marriage and could potentially become the topic of a marital conflict.

Learning and Practicing New Habits

Effective communication isn’t easy. Teaching and learning new communication skills take patience as well as practice.  Taking the time to talk is important. Your relationship provides a safe place to share feelings, thoughts, fears, dreams, and hopes. Make a special effort to find time to talk to your partner more frequently. In tough times, people feel overwhelmed with worries and responsibilities. Time together as a couple is often the last thing on our minds as we deal with the hassles of daily life. Although you may be busy, stressed, and worried, take the time to focus on your partners’ needs and spend quality time together without interruption. Even a few minutes a day talking about what has occurred can be a relief from stress. Be thoughtful by considering whether those difficult or problem-solving discussions could be reserved for other times when you and your partner are not tired or distracted.

Finding Time to Talk

  • Spend time talking with limited interruptions.
  • Make a date to talk to your partner.
  • Plan at least one routine family time each week.
  • Talk instead of watching TV.
  • Talk when you take a walk together.
  • Talk while you work together on household chores.
  • Talk in the car while traveling to activities.

Negative Patterns of Interaction

In good times and bad, couples need each other. Good communication does not mean your partner will always like what you have to say. However, chances of solving problems are much higher if you and your partner can express yourselves openly and freely with each other.

For couples today, there is an abundance of information on how to sustain healthy, happy relationships. Most information available to couples falls short on giving examples of “what not to do” in a relationship. Communication is the key, but it is difficult to apply effective strategies to harmful interactions.

Four negative patterns of interaction have been demonstrated as major destroyers of relationships:

  • Criticism
  • Contempt
  • Defensiveness
  • Stonewalling

Criticism is using hurtful or judgmental comments aimed at your partner’s character or personality. With criticism, the blame is placed on the person and not the problematic behavior. Criticism tends to be a repetitive cycle—a single critical moment can end up in a continued exchange. Most critical statements can be recognized by the phrases, “you always” or “you never.” The following are some examples of criticism:

  • You never finish any project that you start. You’re so lazy.
  • When we go out to eat, you always embarrass me with your table manners.

Contempt is a more complex negative interaction. It is an effort to psychologically abuse your partner through disrespectful statements and actions. Contempt has both verbal and non-verbal deliveries. Verbal examples of contempt include sarcasm, hostile humor, and mockery. For example, nonverbal displays of contempt include rolling of the eyes and sucking of the teeth during conflict. Contempt sends your partner a message of scorn—that they are inferior and worthless.


Defensiveness is often a natural response to receiving criticism and contempt. When faced with criticism and contempt, most people find a need to defend themselves. However, couples can be defensive even when criticism is constructive. Defensiveness may be a response to previous, current, and/or future attacks. If one or both persons are acting defensively, it is most likely the case they are not listening. Defensiveness may take many forms including:

  • Making excuses for behavior
  • Repeating a statement for effect
  • Denying responsibility for actions
  • Answering a complaint with another complaint

The final negative pattern of interaction is stonewalling. As the name implies, this occurs when partners “put a wall” around themselves, either physically or psychologically. Stonewalling is often used to decrease conflict, and when delivered in moderation, can be healthy. On the other hand, continual failure to respond and/or engage in conversation escalates rather than reduces conflict. Examples of stonewalling include:

  • Leaving the room
  • Putting a physical barrier between you and your partner (newspaper, book, child)
  • Focusing intently on something other than your partner during a discussion
  • Failure to actively listen
  • Responding with a blank stare
What can be done?

All of the above can become patterns of interaction within a relationship. One negative interaction leads to another, often in a repetitive cycle. The following suggestions can be used to break the cycle and promote a healthy relationship:

  1. Eliminate criticism. Discussing your feelings about the behavior is okay as long as there are no personal attacks. Use the word I instead of you and describe how the behavior makes you feel. Talk about the behavior and not the person.
  • Example: “When we go out to eat, you always embarrass me,” becomes “I feel hurt and ashamed when you make fun of me in public.
  1. Build on your friendship base. Validate your partner and his/her feelings, thoughts, needs, and desires, etc.
  • Example: “I recognize that you need to talk more about our relationship. What is on your mind?”
  1. Take accountability and responsibility for your own actions. Do not make excuses. Apologize and correct the behavior (if possible).
  •  Example: “I’m sorry that I yelled at you earlier. I’ve been under a lot of pressure at work, but it is unfair to take it out on you.”
  1. Use reflective listening. Repeat what your partner has stated and then respond. Show them that you are listening and hearing them.
  •   Example: Partner 1: I would appreciate it if you would talk to me before you discipline the kids. That way we can be a united front.”
  • Partner 2: What I’m hearing is that you would like for us to talk about disciplining the kids before I make any decisions. I think that is a good idea.
  1. Continue dating. Make a point to rekindle the dating aspect of your relationship.
  •  Example: Go for walks, hold hands, act silly, etc. Find ways to show appreciation to your partner throughout the day (i.e., e-mails, notes, phone calls, etc.)
  1. Seek help if needed. If you can identify these negative interactions in your relationship or you think you may need help, see a licensed marriage and family therapist or other professional. Do not try and fix everything on your own.
  •   Example: Talk to a trusted family member, friend, or your local extension agent in order to find resources in your area.

Before a couple can learn and/or practice new routines in their relationship, they must rid themselves of the old ways that aren’t working. It is important to first identify negative patterns and destructive behaviors and target them for change. At that point, the couple can begin rebuilding their relationship.


Violence in Relationships

Violence is a serious public health problem in the United States. From infants to the elderly, it affects people in all stages of life. In the United States, violence accounts for approximately 51,000 deaths annually. In 2007, more than 18,000 people were victims of homicide and more than 34,000 took their own life.
The number of violent deaths tells only part of the story. Many more survive violence and are left with permanent physical and emotional scars. Violence also erodes communities by reducing productivity, decreasing property values, and disrupting social services.

Understanding Violence

Interpersonal violence is defined as the actual or threatened intentional use of force—physical, sexual, or emotional—against another person, group, or community. It may result in physical injury, psychological harm, or even death. Violence also includes suicide and nonfatal acts of self-harm.

Unfortunately, violence is a part of our daily life. It exists in all corners of our nation. It affects us all regardless of our age, gender, race, ethnicity, or socio-economic status.
Violence also erodes the fabric of our communities. It can threaten productivity in the workplace, decrease the value of our homes and businesses, and disrupt essential public and social services. The economic cost of violence is staggering. In 2000, the medical costs and productivity losses associated with nonfatal violence-related injuries and deaths were estimated at more than $70 billion each year. The total burden to society is far greater.

The good news is that violence is a problem with a solution. It can be prevented by using a thoughtful and systematic approach. While the field of violence prevention is still developing, our knowledge of “what works” increases every day.

Types of Violence

  • Child Maltreatment (e.g., child abuse and neglect)
  • Intimate Partner Violence (e.g., violence by a current or former spouse, boy/girlfriend)
  • Sexual Violence (e.g., rape, sexual assault, sexual harassment)
  • Suicide (e.g., fatal and nonfatal suicide behavior)
  • Youth Violence (e.g., bullying, gang violence, peer violence)

Intimate Partner Violence

Figure 1. Couple

Intimate partner violence (IPV) is a serious, preventable public health problem that affects millions of Americans. The term “intimate partner violence” describes physical, sexual, or psychological harm by a current or former partner or spouse. This type of violence can occur among heterosexual or same-sex couples and does not require sexual intimacy.

There are four main types of IPV:

Physical violence is the intentional use of physical force with the potential for causing death, disability, injury, or harm. Physical violence includes, but is not limited to, scratching; pushing; shoving; throwing; grabbing; biting; choking; shaking; aggressive hair pulling; slapping; punching; hitting; burning; use of a weapon; and use of restraints or one’s body, size, or strength against another person.  Physical violence also includes coercing other people to commit any of the above acts.

  • Sexual violence is divided into five categories.  Any of these acts constitute sexual violence, whether attempted or completed.  Additionally all of these acts occur without the victim’s freely given consent, including cases in which the victim is unable to consent due to being too intoxicated or otherwise unable to consent.
    • Rape or penetration of victim – This includes completed or attempted, forced  unwanted vaginal, oral, or anal insertion.  Forced penetration occurs through the perpetrator’s use of physical force against the victim or threats to physically harm the victim. (This includes incidents in which the victim was pressured verbally or through intimidation or misuse of authority to consent or acquiesce to being penetrated.)
    • Victim was made to penetrate someone else – This includes completed or attempted, forced incidents when the victim was made to sexually penetrate a perpetrator or someone else without the victim’s consent.
    • Unwanted sexual contact – This includes intentional touching of the victim or making the victim touch the perpetrator, either directly or through the clothing, on the genitalia, anus, groin, breast, inner thigh, or buttocks without the victim’s consent
    • Non-contact unwanted sexual experiences – This includes unwanted sexual events that are not of a physical nature that occur without the victim’s consent.  Examples include unwanted exposure to sexual situations (e.g., pornography); verbal or behavioral sexual harassment; and /or unwanted filming, taking or disseminating photographs of a sexual nature of another person.
  • Stalking is a pattern of repeated, unwanted, attention and contact that causes fear or concern for one’s own safety or the safety of someone else (e.g., family member or friend).  Some examples include repeated, unwanted phone calls, emails, or texts; leaving cards, letters, flowers, or other items when the victim does not want them; watching or following from a distance; spying; approaching or showing up in places when the victim does not want to see them.

 Psychological Aggression is the use of verbal and non-verbal communication with the intent to harm another person mentally or emotionally, and/or to exert control over another person.  Psychological aggression can include expressive aggression (e.g., name-calling, humiliating); coercive control (e.g., limiting access to transportation, money, friends, and family; excessive monitoring of whereabouts); threats of physical or sexual violence; control of reproductive or sexual health (e.g., refusal to use birth control; coerced pregnancy termination); exploitation of victim’s vulnerability (e.g., immigration status, disability); exploitation of perpetrator’s vulnerability; and presenting false information to the victim with the intent of making them doubt their own memory or perception (e.g., mind games).

Risk Factors for Intimate Partner Violence

Persons with certain risk factors are more likely to become perpetrators or victims of intimate partner violence (IPV). Those risk factors contribute to IPV but might not be direct causes. Not everyone who is identified as “at risk” becomes involved in violence.

A combination of individual, relational, community, and societal factors contribute to the risk of becoming an IPV perpetrator or victim. Understanding these multilevel factors can help identify various opportunities for prevention.

Individual Risk Factors
  • Low self-esteem
  • Low income
  • Low academic achievement
  • Young age
  • Aggressive or delinquent behavior as a youth
  • Heavy alcohol and drug use
  • Depression
  • Anger and hostility
  • Antisocial personality traits
  • Borderline personality traits
  • Prior history of being physically abusive
  • Having few friends and being isolated from other people
  • Unemployment
  • Emotional dependence and insecurity
  • Belief in strict gender roles (e.g., male dominance and aggression in relationships)
  • Desire for power and control in relationships
  • Perpetrating psychological aggression
  • Seeing or being a victim of physical or psychological abuse (consistently one of the strongest predictors of perpetration)
  • History of experiencing poor parenting as a child
  • History of experiencing physical discipline as a child
Relationship Factors
  • Relationship conflict-fights, tension, and other struggles
  • Relationship instability-divorces or separations
  • Dominance and control of the relationship by one partner over the other
  • Economic stress
  • Unhealthy family relationships and interactions
Community Factors
  • Poverty and associated factors (e.g., overcrowding)
  • Low social capital-lack of institutions, relationships, and norms that shape a community’s social interactions
  • Weak community sanctions against IPV (e.g., unwillingness of neighbors to intervene in situations where they witness violence)
Societal Factors
  • Traditional gender norms (e.g., women should stay at home, not enter workforce, and be submissive; men support the family and make the decisions)

Protecting Yourself from Relationship Violence

It can be hard to know if your relationship is headed down the wrong path. While it’s not always possible to prevent relationship violence, there are steps you can take to protect yourself.

If you think your partner might be controlling or abusive, it’s important to:

  • Trust your feelings. If something doesn’t seem right, take it seriously.
  • Learn the warning signs of someone who might become controlling or violent.
  • Get help. Talk to experts in relationship violence.

If your partner is controlling or abusive, it’s better to get help now than to wait. Controlling or violent relationships usually get worse over time.

Remember: if your partner hurts you, it’s not your fault.

How Do I Know if My Relationship Might Become Violent?

Relationship violence can start slowly and be hard to recognize at first. For example, when people first start dating, it’s common to want to spend a lot of time together. But spending less time with other people can also be a sign that your partner is trying to control your time.

Try asking yourself these questions:

  • Does my partner respect me?
  • Does my partner blame me for everything that goes wrong?
  • Does my partner make most of the decisions in our relationship?
  • Am I ever afraid to tell my partner something?
  • Do I ever feel forced to do things that I don’t want to do?
  • Have I ever done anything sexual with my partner when I didn’t want to?
  • Does my partner promise to change and then keep doing the same things?

It’s okay if you aren’t sure – you can still get help. Domestic violence agencies have counselors who are experts at helping people with questions about their relationships. You don’t even have to give your name.

  • Take Action! If you think your partner is controlling or abusive, take steps to protect yourself.
  • Trust your instincts. You are the expert on your life and relationships. If you think your relationship is unhealthy or you are worried about your safety, trust your gut.
  • Plan for your safety. If you are in a relationship with someone who is violent or might become violent, make a plan to keep yourself safe. This is important whether you are planning to leave your partner or not.
  • Start with a phone call. If you need help or have questions about your relationship, call the National Domestic Violence Hotline at 1-800-799-SAFE (1-800-799-7233). You’ll be able to find a domestic violence agency near you or talk to a counselor over the phone. Services are free. If you are in danger right now, call 911.

Healthy vs. Unhealthy Relationships

Sometimes a relationship might not be abusive, but it might have some serious problems that make it unhealthy. If you think you might be in an unhealthy relationship, you should be able to talk to your partner about your concerns. If you feel like you can’t talk to your partner, try talking to a trusted friend, family member, or counselor. Consider calling a confidential hotline to get the support you need and to explore next steps. If you’re afraid to end the relationship, call a hotline for help (1-800-799-SAFE).

Signs of an unhealthy relationship include:

  • Focusing all your energy on your partner
  • Dropping friends and family or activities you enjoy
  • Feeling pressured or controlled a lot
  • Having more bad times in the relationship than good
  • Feeling sad or scared when with your partner

Signs of a healthy relationship include:

  • Having more good times in the relationship than bad
  • Having a life outside the relationship, with your own friends and activities
  • Making decisions together, with each partner compromising at times
  • Dealing with conflicts by talking honestly
  • Feeling comfortable and able to be yourself
  • Feeling able to take care of yourself
  • Feeling like your partner supports you

If you feel confused about your relationship, a mental health professional can help. Remember, you deserve to be treated with respect.

Sexual Health

Sexuality is a major part of being human.  Love, affection and sexual intimacy all play a role in healthy relationships. They also contribute to a sense of well-being. A number of disorders can affect the ability to have or enjoy sex. Concerns about infertility or fear of unplanned pregnancy can also come into play.  In addition, a number of diseases and disorders affect sexual health. These include sexually transmitted diseases and cancer. In men, treatment of prostate cancer can cause erectile dysfunction. In women, cervical, uterine, vaginal, vulvar or ovarian cancer may have sexual effects.

Sexual Dysfunction

Sexual dysfunction can pose public health problems, as it is related to public health issues and affects people’s happiness and general well-being.

According to the National Health and Social Life Survey,

  • The prevalence of sexual dysfunction was found to be higher among women than men.
  • Lack of sexual desire is the most common problem among women
  • For men, the most common sexual problem is premature ejaculation, not erectile dysfunction.
  • Sexual problems increase with age, but sex-related personal distress decreases.

Reproductive Health

Both the male and female reproductive systems play a role in pregnancy. Problems with these systems can affect fertility and the ability to have children. There are many such problems in men and women. Reproductive health problems can also be harmful to overall health and impair a person’s ability to enjoy a sexual relationship.

Your reproductive health is influenced by many factors. These include your age, lifestyle, habits, genetics, use of medicines and exposure to chemicals in the environment. Many problems of the reproductive system can be corrected.

Reproductive health includes a variety of topics, such as:

  • Menstruation and menopause
  • Pregnancy and preconception care
  • Fertility/Infertility
  • Contraception


An unintended pregnancy is a pregnancy that is either mistimed or unwanted at the time of conception. It is a core concept in understanding the fertility of populations and the unmet need for contraception. Unintended pregnancy is associated with an increased risk of morbidity for women, and with health behaviors during pregnancy that are associated with adverse effects. For example, women with an unintended pregnancy may delay prenatal care, which may affect the health of the infant. Women of all ages may have unintended pregnancies, but some groups, such as teens, are at a higher risk.

Efforts to decrease unintended pregnancy include finding better forms of contraception, and increasing contraceptive use and adherence.

Contraception, (also known as “birth control”, is designed to prevent pregnancy. Some types of birth control include (but are not limited to):

  • Barrier methods, such as condoms, the diaphragm, and the cervical cap, are designed to prevent the sperm from reaching the egg for fertilization. Intrauterine device, or IUD, is a small device that is inserted into the uterus by a health care provider. The IUD prevents a fertilized egg from implanting in the uterus. An IUD can stay in the uterus for up to 10 years until a health care provider removes it.
  • Hormonal birth control, such as birth control pills, injections, skin patches, and vaginal rings, release hormones into a woman’s body that interfere with fertility by preventing ovulation, fertilization, or implantation.
  • Sterilization is a method that permanently prevents a woman from getting pregnant or a man from being able to get a woman pregnant. Sterilization involves surgical procedures that must be done by a health care provider and usually cannot be reversed.

The choice of birth control depends on factors such as a person’s overall health, age, frequency of sexual activity, number of sexual partners, desire to have children in the future, and family history of certain diseases. A woman should talk to her health care provider about her choice of birth control method.

It is important to remember that even though birth control methods can prevent pregnancy, they do not all protect against sexually transmitted diseases or HIV.

Barrier Methods

Barrier method contraception work by placing a block or barrier to prevent sperm from reaching the egg.

Contraceptive Sponge

Before having sex, wet the sponge and place it, loop side down, inside the vagina to cover the cervix. The sponge is effective for more than one act of intercourse for up to 24 hours. It needs to be left in for at least 6 hours after having sex to prevent pregnancy. It must then be taken out within 30 hours after it is inserted.

Women who are sensitive to the spermicide nonoxynol-9 should not use the sponge. The sponge does not protect against sexually transmitted infections (STIs)

Diaphragm, cervical cap, and cervical shield

These barrier methods block the sperm from entering the cervix and reaching the egg.

  • The diaphragm is a shallow latex cup.
  • The cervical cap is a thimble-shaped latex cup. It often is called by its brand name, FemCap.
  • The cervical shield is a silicone cup that has a one-way valve that creates suction and helps it fit against the cervix. It often is called by its brand name, Lea’s Shield.

The diaphragm and cervical cap come in different sizes, and you need a doctor to “fit” you for one. The cervical shield comes in one size, and you will not need a fitting.  Before having sex, add spermicide (to block or kill sperm) to the devices. Then place them inside your vagina to cover your cervix. You can buy spermicide gel or foam at a drug store.

All three of these barrier methods must be left in place for 6 to 8 hours after having sex to prevent pregnancy. The diaphragm should be taken out within 24 hours. The cap and shield should be taken out within 48 hours.

Female condom

This condom is worn by the woman inside the vagina as a barrier to sperm. It is made of thin, flexible, rubber and is packaged with a lubricant. It can be inserted up to 8 hours before having sex. A new condom should be used each time and should not be used at the same time as a male condom.

Male condom

Male condoms are a thin sheath placed over an erect penis to contain sperm. Condoms can be made of latex, polyurethane, or “natural/lambskin”. Natural condoms do not protect against STIs. A new condom needs to be used with each sex act.

Condoms are either:

  • Lubricated, which can make sexual intercourse more comfortable
  • Non-lubricated, which can also be used for oral sex. It is best to add lubrication to nonlubricated condoms if you use them for vaginal or anal sex. Use of a water-based lubricant, such as K-Y jelly is recommended. (Oil-based lubricants like massage oils, baby oil, lotions, or petroleum jelly will weaken the condom, causing it to tear or break.)

Keep condoms in a cool, dry place. Condoms kept in a warm place (like a wallet or glove compartment) may break down increasing risk of condom failure.

Hormonal methods

Hormonal methods prevent pregnancy by interfering with ovulation, fertilization and/or implantation.

Oral contraceptives  – (“The pill”)

The pill contains the hormones estrogen and progestin. It is taken daily to keep the ovaries from releasing an egg. The pill also causes changes in the lining of the uterus and the cervical mucus to keep the sperm from joining the egg.

Some women prefer the “extended cycle” pills. These have 12 weeks of pills that contain hormones (active) and 1 week of pills that don’t contain hormones (inactive). While taking extended cycle pills, women only have their period three to four times a year.

Your doctor may advise a person against taking the pill if:

  • Older than 35 and smoke
  • Have a history of blood clots
  • Have a history of breast, liver, or endometrial cancer

The patch

Also called by its brand name, Ortho Evra, this skin patch is worn on the lower abdomen, buttocks, outer arm, or upper body. It releases the hormones progestin and estrogen into the bloodstream to stop the ovaries from releasing eggs. It also thickens the cervical mucus, which keeps the sperm from joining with the egg. A new patch is applied once a week for 3 weeks. You don’t use a patch the fourth week in order to have a period.


The birth control shot is often called by its brand name Depo-Provera. With this method you get injections, or shots, of the hormone progestin in the buttocks or arm every 3 months. A new version of the shot can now be injected under the skin as well. The birth control shot stops the ovaries from releasing an egg in most women. It also causes changes in the cervix that keep the sperm from joining with the egg.

Vaginal ring

This is a thin, flexible ring that releases the hormones progestin and estrogen. It works by stopping the ovaries from releasing eggs. It also thickens the cervical mucus, which keeps the sperm from joining the egg.  It is commonly called NuvaRing, its brand name. You squeeze the ring between your thumb and index finger and insert it into your vagina. You wear the ring for 3 weeks, take it out for the week that you have your period, and then put in a new ring.

Implantable devices

Implantable devices provide a slow release of hormones that impact ovulation or implantation.

Implantable rod

This is a matchstick-size, flexible rod that is put under the skin of the upper arm. It is often called by its brand name, Implanon. The rod releases a progestin, which causes changes in the lining of the uterus and the cervical mucus to keep the sperm from joining an egg. Less often, it stops the ovaries from releasing eggs. It is effective for up to 3 years.

Intrauterine devices or IUDs

An IUD is a small device shaped like a “T” that goes in the uterus. There are two types:

  • Copper IUD – The copper IUD goes by the brand name ParaGard. It releases a small amount of copper into the uterus, which prevents the sperm from reaching and fertilizing the egg. If fertilization does occur, the IUD keeps the fertilized egg from implanting in the lining of the uterus. A doctor needs to insert the copper IUD and can stay in your uterus for 5 to 10 years.
  • Hormonal IUD – The hormonal IUD goes by the brand name Mirena. It is sometimes called an intrauterine system, or IUS. It releases progestin into the uterus, which keeps the ovaries from releasing an egg and causes the cervical mucus to thicken so sperm can’t reach the egg. It also affects the ability of a fertilized egg to successfully implant in the uterus. A doctor needs to insert the hormonal IUD and it can stay in your uterus for up to 5 years.

Sterilization implant

Essure is the first non-surgical method of sterilizing women. A thin tube is used to thread a tiny spring-like device through the vagina and uterus into each fallopian tube. The device works by causing scar tissue to form around the coil. This blocks the fallopian tubes and stops the egg and sperm from joining.

It can take about 3 months for the scar tissue to grow, so it’s important to use another form of birth control during this time. Then you will have to return to your doctor for a test to see if scar tissue has fully blocked your tubes.

Surgical sterilization

For women, surgical sterilization closes the fallopian tubes by cutting and tying this pathway. This stops the eggs from going down to the uterus where they can be fertilized. The surgery can be done a number of ways. Sometimes, a woman having cesarean birth has the procedure done at the same time, so as to avoid having additional surgery later.

For men, having a vasectomy keeps sperm from leaving the penis (ejaculate lacks sperm). Sperm stays in the system after surgery for about 3 months. During that time, use a backup form of birth control to prevent pregnancy. A simple test (called semen analysis) can be done to check if all the sperm is absent from ejaculate.

Emergency contraception

Emergency contraception may go by the names Plan B, One-Step or Next Step. It is also called the “morning after pill.”  Emergency contraception prevents pregnancy after unprotected sex or after contraceptive failure (such as a condom breaking).


Abortion is the ending of pregnancy by removing a fetus or embryo before it can survive outside the uterus.  An abortion that occurs spontaneously is also known as a miscarriage. The word abortion is often used to mean only induced abortions though can include removal of fetal tissue that is no longer living if the woman’s body does not expel naturally.

When allowed by law, abortion in the developed world is one of the safest procedures in medicine. Modern methods use medication or surgery for abortions. The drug mifepristone in combination with prostaglandin appears to be as safe and effective as surgery during the first and second trimester of pregnancy.  Birth control, such as the pill or intrauterine devices, can be used immediately following abortion. When performed legally and safely, induced abortions do not increase the risk of long-term mental or physical problems. In contrast, unsafe abortions (those performed by unskilled individuals, with hazardous equipment, or in unsanitary facilities) cause 47,000 deaths and 5 million hospital admissions each year. The World Health Organization recommends safe and legal abortions be available to all women.

Around 56 million abortions are performed each year in the world, with about 45% done unsafely. Abortion rates have shown steady decrease as access to family planning and birth control increases. As of 2008, 40% of the world’s women had access to legal abortions without limits as to reason.

Historically, abortions have been attempted using herbal medicines, sharp tools, with force, or through other traditional methods. Abortion laws and cultural or religious views of abortions are different around the world. In some areas abortion is legal only in specific cases such as rape, problems with the fetus, poverty, risk to a woman’s health, or incest. In many places there is much debate over the moral, ethical, and legal issues of abortion. Those who oppose abortion often maintain that an embryo or fetus is a human with a right to life and may compare abortion to murder. Those who favor the legality of abortion often hold that a woman has a right to make decisions about her own body.

Contraception Use

All birth control methods work the best if used correctly and every time there is sexual contact. The misuse of contraceptives is known as human error and is the main reason why effectiveness is determined by typical use and perfect use. Common errors with condom use include putting it on “inside-out” or not leaving enough room at the tip for ejaculate.

Infectious Diseases and Sexually Transmitted Infections (STI’s)

STDs are a substantial health challenge facing the United States. CDC estimates that nearly 20 million new sexually transmitted infections occur every year in this country, half among young people aged 15–24, and account for almost $16 billion in health care costs. Each of these infections is a potential threat to an individual’s immediate and long-term health and well-being. In addition to increasing a person’s risk for acquiring and transmitting HIV infection, STDs can lead to chronic pain and severe reproductive health complications, such as infertility and ectopic pregnancy. Approximately 20 different infections are known to be transmitted through sexual contact. Here are descriptions of some of the most common and well known:

  • Chlamydia
  • Gonorrhea
  • Genital Herpes
  • Human Papillomavirus (HPV)
  • Syphilis
  • Bacterial Vaginosis
  • Trichomoniasis
  • Viral Hepatitis

Bacterial STIs

Bacterial STIs are caused by transmission of bacteria and usually affect one are of the body (but can be spread to others). Bacterial infections can be treated with antibiotics.


Chlamydia is a common STD/STI caused by the bacterium Chlamydia trachomatis. Chlamydia can be transmitted during vaginal, oral, or anal sexual contact with an infected partner. While many individuals will not experience symptoms, chlamydia can cause fever, abdominal pain, and unusual discharge of the penis or vagina.

In women, whether or not they are having symptoms and know about their infection, chlamydia can cause pelvic inflammatory disease (PID). PID can lead to permanent damage to the woman’s reproductive organs resulting ectopic pregnancy (in which the fetus develops in abnormal places outside of the womb, a condition that can be life-threatening) and infertility.

Additionally, if the woman is pregnant, she can pass chlamydia can be passed to her fetus during pregnancy and delivery. If chlamydia is detected early, it can be treated easily with an oral antibiotic.


Gonorrhea is caused by the bacterium Neisseria gonorrhoeae, which can grow rapidly and multiply easily in the warm, moist areas of the reproductive tract. The most common symptoms of gonorrheal infection are a discharge from the vagina or penis and painful or difficult urination.

As with chlamydial infection, the most common and serious complications of gonorrhea occur in women and include pelvic inflammatory disease (PID), ectopic pregnancy, infertility, and the potential spread to the developing fetus if acquired during pregnancy. Gonorrhea can also infect the mouth, throat, eyes, rectum and can spread to the blood, where it can become a life-threatening illness.

In addition, people with gonorrhea can more easily contract HIV, the virus that causes AIDS. People infected with HIV and gonorrhea are also more likely to transmit the HIV virus to someone else.

Gonorrhea is a bacterial STIs that can be treated with antibiotics given either orally or by injection. Current sexual partners should be treated at the same time.


Syphilis infections, caused by the bacterium Treponema pallidum, are passed from person to person during vaginal, anal, or oral sex through direct contact with sores, called chancres. The first sign of syphilis is a chancre, a painless genital sore that most often appears on the penis or in and around the vagina. Beyond being the first sign of a syphilis infection, chancres make a person two to five times more likely to contract an HIV infection. If the person is already infected with HIV, chancres also increase the likelihood that the virus will be passed on to a sexual partner. These sores typically resolve on their own, even without treatment. However, the body does not clear the infection on its own, and, over time, syphilis may involve other organs, including the skin, heart, blood vessels, liver, bones, and joints in secondary syphilis. If the illness is still not treated, tertiary syphilis can develop over a period of years and involve the nerves, eyes, and brain and can potentially cause death.

Expectant mothers harboring the bacterium are at an increased risk of miscarriage and stillbirth, and they can pass the infection on to their fetuses during pregnancy and delivery. Infants that acquire congenital syphilis during pregnancy may suffer from skeletal deformity, difficulty with speech and motor development, seizure, anemia, liver disease, and neurologic problems.

If recognized during the early stages, usually within the first year of infection, syphilis can be treated with a single intramuscular injection of antibiotic. A person being treated for syphilis must avoid sexual contact until the chancre sores caused by the bacteria are completely healed to avoid infecting other people.

If a person does not recognize the infection early, or does not seek treatment immediately, longer treatment with antibiotics may be required. If left untreated, the infection can progress even further and potentially cause death. Although antibiotics can prevent the infection from getting worse, they cannot reverse damage that has already occurred.

Bacterial Vaginosis

Bacterial vaginosis is a common, possibly sexually transmitted, vaginal infection in women of reproductive age. While it is healthy and normal for a vagina to have bacteria, just like the skin, mouth, or gastrointestinal (GI) tract, sometimes changes in the balance of different types of bacteria can cause problems.

Bacterial vaginosis occurs when problematic bacteria that are normally present only in small amounts increase in number, replace normal vaginal lactobacilli bacteria, and upset the usual balance. This situation becomes more likely if a woman douches frequently or has new or multiple sexual partners. The most common sign of a bacterial vaginosis infection is a thin, milky discharge that is often described as having a “fishy” odor. However, some women will have no symptoms at all.

Regardless of symptoms, having bacterial vaginosis increases the risk of getting other STDs/STIs and is also associated with pelvic inflammatory disease (PID), an infection of the female reproductive organs, including the uterus and the fallopian tubes (which carry eggs to the uterus), and postoperative infections. Preterm labor and birth are also possibly more common in women with bacterial vaginosis.

Bacterial vaginosis can be treated with antibiotics, typically metronidazole or clindamycin. Generally, male sexual partners of women with bacterial vaginosis do not need to be treated because treatment of partners has not been shown to reduce the risk of recurrence. Treatment during pregnancy is recommended primarily for women at risk for preterm labor or having a low birthweight infant.

Viral STIs

Viral STIs are cause by transmission of a virus. Viruses infect cells throughout the body and cannot be treated or “cured” with antibiotics. Vaccines have been developed to prevent transmission of some viruses.

Genital Herpes

Genital herpes is a contagious infection caused by the herpes simplex virus (HSV). There are two different strains, or types, of HSV: herpes simplex virus type 1 (HSV-1) and type 2 (HSV-2). Both can cause genital herpes, although most cases of genital herpes are caused by HSV-2. When symptomatic, HSV-1 usually appears as fever blisters or cold sores on the lips, but it can also infect the genital region through oral-genital or genital-genital contact. Symptomatic HSV-2 typically causes painful, watery skin blisters on or around the genitals or anus. However, substantial numbers of people who carry these viruses have no or only minimal signs or symptoms.

Neither HSV-1 nor HSV-2 can be cured, and even during times when an infected person has no symptoms, the virus can be found in the body’s nerve cells. Periodically, (usually in response to stress) a person will experience outbreaks in which new blisters form on the skin in the genital area; at those times, the virus is more likely to be passed on to other people.

Pregnant women, especially those who acquire genital herpes for the first time during pregnancy, may pass the infection to their newborns, causing life-threatening neonatal HSV, an infection affecting the infant’s skin, brain, and other organs.

Genital herpes outbreaks can be treated with antiviral drugs. Although this medication can limit the length and severity of outbreaks, it does not cure the infection. In addition, daily suppressive therapy (daily use of antiviral medication) for herpes can reduce the likelihood of transmission to partners. A pregnant woman known to have the infection must take additional care because she can pass the infection to her infant during delivery. Women who first acquire genital HSV during pregnancy are at highest risk of transmission to their infants. If a pregnant woman has an outbreak when she goes into labor, she may need to have a cesarean section (C-section) to prevent the infant from getting the virus during birth.


HIV, or the human immunodeficiency virus, is the virus that causes AIDS (acquired immunodeficiency syndrome). HIV destroys the body’s immune system by killing the blood cells that fight infection. Once HIV destroys a substantial proportion of these cells (CD4 cells), the body’s ability to fight off and recover from infections is compromised. This advanced stage of HIV infection is known as AIDS.

The CD4 count is like a snapshot of how well your immune system is functioning. CD4 cells (also known as CD4+ T cells) are white blood cells that fight infection. The more you have, the better. These are the cells that the HIV virus kills. As HIV infection progresses, the number of these cells declines. When the CD4 count drops below 200 due to advanced HIV disease, a person is diagnosed with AIDS. A normal range for CD4 cells is about 500-1,500. Usually, when a person with low CD4 cells starts HIV medicines, the CD4 cell count increases as the HIV virus is controlled. Most, but not all, people will experience an increase in CD4 cells with effective HIV treatment.

People whose HIV has progressed to AIDS are very susceptible to opportunistic infections and certain forms of cancer.

AIDS can be prevented by early initiation of antiretroviral therapy in those with HIV infection. Transmission of the virus primarily occurs during unprotected sexual activity and by sharing needles used to inject intravenous drugs, although the virus also can spread from mother to infant during pregnancy, delivery, and breastfeeding.

In 2013, NIH-supported researchers reported that a 2-year-old child who was born with HIV and was treated starting in the first few days of life has had her HIV infection go into remission. This appears to be the first case of functional cure of HIV.

There is no cure for HIV/AIDS. However, research into new treatments has improved outcomes for people living with the disease. A combination of antiretroviral drugs can be given in highly active antiretroviral therapy to control the virus, promote a healthy immune system, help people with the virus live longer lives, and reduce the risk of transmission.

Human Papillomavirus (HPV)

HPV is the most common STD/STI. More than 40 HPV types strains, and all of them can infect both men and women. The types of HPVs vary in their ability to cause genital warts; infect other regions of the body, including the mouth and throat; and cause cancers of the cervix, vulva, penis, and mouth.

Although no cure exists for HPV infection once it occurs, regular screening with a Pap smear test can detect at an early stage most cases cervical cancer that may have been caused by HPV. (A Pap smear test involves a health care provider taking samples of cells from the cervix during a standard gynecologic exam; these cells are examined under a microscope for signs of developing cancer).

A person who has an HPV infection cannot be cured. However, a health care provider can treat genital warts caused by the virus as well as monitor and control a woman’s risk of cervical cancer through frequent screening with Pap smear tests.

An available vaccine protects against most (but not all) HPV types that cause cervical cancer. The American Academy of Pediatrics recommends this vaccine for school-aged boys and girls.

Viral Hepatitis

Viral hepatitis is a serious liver disease that can be caused by several different viruses, which can be transmitted through sexual contact.

  • Hepatitis A virus (HAV) causes a short-term or self-limited liver infection that can be quite serious, although it does not result in chronic infection. While there are other ways the virus can be transmitted, HAV can be spread from person to person during sexual activity through oral-rectal contact. Vaccination can prevent HAV infection.
    • Usually the infection gets better on its own without requiring treatment. In some cases, however, individuals may have lasting damage to their livers or may have such severe nausea and vomiting that they must be admitted to the hospital.
  • Hepatitis B virus (HBV) causes a serious liver disease that can result in both immediate illness and lifelong infection leading to permanent liver scarring (cirrhosis), cancer, liver failure, and death. HBV spreads through both heterosexual and homosexual contact as well as through contact with other bodily fluids, such as blood, through shared contaminated needles used for injecting intravenous (IV) drugs, tattooing, and piercing. Pregnant women with HBV can transmit the virus to their infants during delivery. HBV infection is preventable through vaccination.
    • People with HBV infection will need to see a liver specialist with experience treating individuals with chronic liver disease. These individuals need to take special care not to pass on the virus to their sexual partners, and sexual partners should receive hepatitis B vaccine if not already immune.
  • Hepatitis C virus (HCV) can cause an immediate illness affecting the liver, but it more commonly becomes a silent, chronic infection that leads to liver scarring (cirrhosis), cancer, liver failure, and death. HCV is most commonly transmitted through sharing needles or exposure to infected blood. However, it can spread through sexual contact or from mother to fetus during pregnancy and delivery. There is no vaccine for HCV, and treatments are not always effective.
    • As with hepatitis B, individuals with HCV may have a lifelong infection and will always be at risk of passing the virus on to their sexual partners. New treatments are available that can clear the infection in some individuals.

Parasitic STIs

Parasitic infestation result from parasitic transfer from one body to another, and the parasite using the body as a host. Parasitic infestations are treatable but some types require cleaning/sterilization of clothing, bedding and other linens to prevent reinfestation.


Trichomoniasis infection is caused by the single-celled protozoan parasite Trichomonas vaginalis and is common in young, sexually active women. The parasite also infects men, though less frequently. The parasite can be transmitted between men and women as well as between women whenever physical contact occurs between the genital areas. Although Trichomonas infections do not always cause symptoms, they can cause frequent, painful, or burning urination in men and women as well as vaginal discharge, genital soreness, redness, or itching in women. Because the infection can occur without symptoms, a person may be unaware that he or she is infected and continue to re-infect a sexual partner who is having recurrent signs of infection. As with bacterial STDs/STIs, all sexual partners should be treated at the same time to avoid re-infection.

Trichomoniasis can be treated with a single dose of an antibiotic, usually either metronidazole or tinidazole, taken by mouth.

Pubic Lice (“crabs”)

Pubic lice — also known as crabs — are small parasites that live on the skin and coarse hairs that are around genitals, and they feed blood. (Pubic lice are different than head lice and infest different areas of the body.)

Pubic lice are spread through personal contact. Sexual intercourse is not necessary for the transmission of pubic lice because lice stay outside the body and infest areas with course hair such as eyelashes, eyebrows, chest hair, armpits, beards, and mustaches. Sometimes pubic lice are spread by using an infected person’s clothes, towels, or bed.

You can treat pubic lice with topical lice treatments.

STD/STI Prevention:

Every year, there are an estimated 20 million new sexually transmitted infections in the United States. Anyone who is sexually active can get an STI.

The Good News: STI’s ARE preventable. Steps can be taken to keep yourself and your partner(s) healthy. Here’s How You Can Avoid (or reduce the risk of) giving or getting an STI:

Practice Abstinence

The surest way to avoid STI’s is to not have sex.  This means not having vaginal, oral, or anal sex as well as other activities that involve close personal contact or coming in contact with another person’s body fluids.

Use Condoms

Using a condom correctly every time a person participates is sexual activity can reduce risk of STI transmission. Certain STI’s, like herpes or HPV, can still be transmitted by contact with a partner’s skin (even when using a condom).

Have Fewer Partners

Agree to only have sex with one person who agrees to only have sex with you. Make sure you both get tested to know for sure that neither of you has an STI. This is one of the most reliable ways to avoid STI’s.

Get Vaccinated

Some common STI can be prevented by a vaccine. The HPV vaccine is safe, effective, and can help you avoid HPV-related health problems like genital warts and some cancers.

Talk With Your Partner

Talk with your sex partner(s) about STI’s and staying safe before having sex. It might be uncomfortable to start the conversation, but protecting your health is your responsibility.

Get Tested

Many STI’s don’t have symptoms, but they can still cause health problems.

  1. Talk with your health care provider
  2. Search for CDC recommended tests
  3. Find a location to get tested for STDs

The only way to know for sure if you have an STI is to get tested.

Check for Understanding

  1. What is the difference between sex and gender? How are these influence by social constructs?
  2. What factors are important for forming healthy relationships? What are some signs of an unhealthy relationship?
  3. What methods of contraception can be use to reduce risk of unwanted pregnancy?
  4. What methods of protection can be use to reduce risk of STI transmission?
  5. What are the three main categories of STIs and how do these differ in transmission and treatment?


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Women's Health by Dawn Markell is licensed under a Creative Commons Attribution 4.0 International License, except where otherwise noted.

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