Understanding Sexual Health
Understanding Sexual Health
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People often equate college with a time for experimentation. The phrase “campus hookup culture” has ebbed its way into common vocabulary to describe casual sexual relationships between college students. Some students want to partake. Others prefer to hold out for relationships or abstain from romance and sex completely. Regardless of when, how, or with whom you prefer to express your sexuality, your sex life is personal. Your body is yours, and it needs to be taken care of through regular check ups and doctors visits. Just because you’re in college doesn’t make your sexual health any less your responsibility.

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What does sexual health entail?

Some may believe that sexual health merely involves the act of sex, birth control, and avoiding unplanned pregnancy or sexually transmitted infections, but in fact, sexual health embodies both your physical and mental health in relation to your sexuality and your body, as well as the sexuality and bodies of others. Sexual health doesn’t just indicate that you’re physically healthy, but that you approach and maintain sexual relationships in a healthy manner, whether the relationship is with another person or with yourself. Respecting your own body and sexuality, and the bodies and sexuality of others is one step toward being sexually healthy.

Consider the working definition of “sexual health” written by the World Health Organization: “… a state of physical, emotional, mental, and social well-being in relation to sexuality; it is not the mere absence of disease, dysfunction, or infirmity. Sexual health requires a positive and respectful approach to sexuality and sexual relationships, as well as the possibility of having pleasurable and safe sexual experiences, free from coercion, discrimination, and violence. For sexual health to be attained and maintained, the sexual rights of all persons must be respected, protected, and fulfilled.”

Physically, you are sexually healthy when your body, and in particular your reproductive system, is not showing signs of illness or injury. Whether or not you are participating in sexual acts, you still need to take care of your sexual health. This should involve a regular check up with a doctor; females and individuals with female genitalia may consider visiting a gynecologist, while males and individuals with male genitalia may consider a urologist. Your primary care physician may be able to take care of simple procedures, but can also give you a referral to a sexual health specialist if you need further evaluation or treatment.

Mentally, you need to understand your rights as a sexual person and make decisions that you are happy with. Your body is yours alone and you do not have to do anything with your body that you aren’t comfortable with. You shouldn’t be forced into anything sexual by anybody. (Learn more about consent here.) Furthermore, you are guaranteed protection from discrimination on the basis of sex by the Civil Rights Act of 1964. However, discrimination still exists, systematically and individually. Being part of a community of open-minded and nonjudgmental thinkers will go far in maintaining your sexual health, especially if you don’t conform to gender stereotypes. Being sexually healthy means that you should not be victimized on the basis of your sex, your gender identity, who you love, who you choose to engage in intercourse with, or any other aspect of your sexuality.

What is sexuality?

Sexuality is a collective that includes your:

  • Gender identity: your personal concept of your gender, whether or not it corresponds to your sex at birth
  • Gender role: stereotypes about how you should act based on the outward expression of your gender identity
  • Sexual orientation: your patterns of attraction to others, specifically to whom you are attracted (males, females, both, neither, etc.)
  • Body image: your mental representation of your own body; body image can be positive or negative
  • Previous sexual and intimate experiences: these shape your sexuality by helping you determine what you want and don’t want in a partner, relationship, or experience

Sexuality is not the same for any two people because it depends on so many different factors. Partially, sexuality is determined by your DNA, but it is also influenced by the media, your personal history, your parents, your schooling, your religion, and your future goals. It is the sum of many parts and the way that different people express their sexuality is rarely the same. It’s important to note that sexuality is not the same thing as a sexual act. The physical aspect of sex affects one’s sexuality, but more accurately, sexuality is how people express themselves as sexual beings (what they wear, who they love, who they date, how they talk, what they want).

Why is sexual health important for college students?

Sexual health is important for college students in three ways.

First, for a student to be sexually healthy, they must feel free to express their sexuality on campus. College brings students of all gender identities and sexual orientations together. To foster a healthy environment, students need to be open toward and nonjudgmental about their peers, regardless of their internal beliefs about sexuality.

Second, students must respect one another. Sexual assault statistics paint a horrifying picture in which one in five women and one in 16 men will be raped during their four years on campus. By fostering a healthy sexual environment free of bullying and assault and full of consent, students are automatically setting themselves up for positive and healthy sexual interactions.

Third, students need to learn how to maintain their physical health and how to have healthy sexual interactions with others. According to the Spring 2015 National College Health Assessment survey, over 67% of college students reported having ever had vaginal intercourse, 70% reported having ever had oral intercourse, and nearly 25% reported having ever had anal intercourse. Over half of these students reported that they did not use a barrier method of contraception during the encounters. As condoms are the only contraception that can prevent the transfer of sexually transmitted infections, these statistics are concerning. Nearly half of the sexually transmitted infections diagnosed every year are diagnosed in 15–24 year olds. Maintaining physical sexual health is of utmost importance for continued well-being, so learning how to care for your body, protect against pregnancy, and protect against STIs is particularly relevant to college students.

Do I have to date in college?

When and whom you choose to date is entirely up to you. You certainly don’t have to date in college if you don’t want to or haven’t found the right partner. However, you should take the time to maintain your physical and mental sexual health regardless of whether you’re abstinent or engaging in sexual activity. Creating the habit of scheduling physicals and sexual health checkups and evaluating yourself and your desires will serve you well in the future.

How do I maintain my physical sexual health?

Physically, maintaining your sexual health is similar to maintaining your physical health, and it should be part of your physical health maintenance routine. Regular checkups with your primary care physician supplemented with appointments to see a gynecologist or a urologist as necessary should be enough to keep you healthy or catch potentially dangerous illnesses before they become serious.

Preventative screenings for various cancers (breast, cervical, prostate) begin at different ages; your primary care physician may be able to perform these screenings and tests themself or refer you to a specialist when you reach the appropriate age.

Note: Even if you aren’t currently or have never been sexually active, you can still claim your sexual health now. Preventative screenings and vaccines can help ensure a better, healthier future. Please note that the following are recommendations from the Centers for Disease Control and Prevention (CDC). Always talk to your doctor about what’s right for you and your body.

For women and anyone born with female genitalia, including cisgender women; transgender men; and intersex and/or nonbinary individuals who were born with a uterus, vagina, cervix, or other female genitalia:

  • Get the HPV shot. The human papillomavirus (HPV) is an infection that is spread by skin-to-skin contact. Most sexually active people will contract HPV in their lifetimes, usually in their late teens or early 20s. HPV often shows no symptoms, but it can manifest as genital warts, which can lead to cancer if untreated. There is a relatively new vaccine to prevent HPV. It is usually given to children (especially girls) when they are 11 or 12 years old, but if you missed it, you can still get the series of shots until you turn 26. If you haven’t already, talk to your doctor about the HPV vaccine and its potential side effects. You can get the vaccine regardless of your anatomy, even if you don’t identify as female.
  • Get breast and pelvic exams. Breast and pelvic exams often begin earlier than age 21. You may have had your first ones in middle or high school. These exams are brief. During a breast exam, a doctor feels your breasts for lumps or unusual growths. During a pelvic exam, which is similar to a pap smear (below), your doctor may insert their fingers or a speculum into your vagina to make sure that everything looks healthy. Some doctors and gynecologists recommend that you see them annually for a breast and/or pelvic exam. Others will perform these tests alongside every pap smear.
    • You can and should perform breast self-exams at home. The National Breast Cancer Foundation recommends that all women perform self-exams once a month and provides instructions on how to perform them. Feel and look for any changes in the breast tissue (lumps, puckers, dimples, hardness, etc.). If anything changes from one month to the next, make an appointment to visit your doctor.
  • Get a pap smear. Pap smears are tests that take a sample of cells from the cervix. The sample is then examined in a lab to look for abnormal or cancerous cells. It is recommended that you have your first pap smear at age 21 regardless of your level of sexual activity (or within three years of first having intercourse). The exam is slightly uncomfortable, but it is quick and it can be a lifesaver. After your first exam, provided all results are normal, follow up with another exam every three years. After you turn 30, you can follow up every five years.
  • Get tested for STIs. The CDC recommends that everyone between the ages of 13 and 64 years old be tested for HIV. Individuals who do not use protection during sexual intercourse should be tested for HIV more frequently. Furthermore, the CDC has specific recommendations for women: annual testing for chlamydia and gonorrhea for all sexually active women who are less than 25 years old, have multiple sexual partners, or have a partner with a known STI.
    • Not all sexually transmitted infections show outward symptoms, but if you are sexually active and notice that anything changes in the days or weeks following intercourse (pain in the pelvis or lower abdomen, pain during sex, discharge, painful urination, nausea, fever, blisters or sores, etc.), visit a doctor and ask to be tested for STIs. Leaving an STI untreated can lead to lifelong complications, like Pelvic Inflammatory Disease, cervical cancer, and infertility.
  • Visit your doctor if you have any of the following issues:
    • Irregular menstrual cycles
    • Severely painful periods
    • Abnormal bleeding
    • Pain during intercourse
    • Recurring urinary tract infections or yeast infections
    • Suspected pregnancy

For men and anyone born with male genitalia, including cisgender men, transgender women, and intersex and/or nonbinary individuals who were not born with female anatomy:

  • Get the HPV shot. HPV is spread by skin-to-skin contact. The majority of all sexually active people will contract HPV in their lifetimes, usually in their late teens or early 20s. HPV usually shows no symptoms (especially in men), but in some people, it manifests as genital warts, which can lead to cancer if untreated. There is a vaccine to prevent HPV. While it began as a vaccine for young girls, it is now being recommended for 11- and 12-year-old boys as well. Vaccinating boys can reduce their risk of cancers and help control the spread of HPV to girls. If you missed it when you were a child, you can still get the series of shots during adolescence (until age 21). If you haven’t already, talk to your doctor about the HPV vaccine and its potential side effects.
  • Perform testicular self-exams. Testicular cancer is the second most common cancer in teenage males. If you notice a lump, bump, or something else that is unusual while performing a self-examination, make an appointment with your doctor. He or she will perform a more thorough testicular exam and determine if further action needs to be taken. Doctors may also perform testicular exams as part of your annual physical.
  • Get tested for STIs. The CDC recommends that everyone between the ages of 13 and 64 be tested for HIV at least one time. Furthermore, men who have sex with men and men who have sex with both men and women should undergo STI testing at least once a year (and the test should screen for chlamydia, gonorrhea, and syphilis). If you have multiple or anonymous partners, screenings should be more frequent.
    • Many STIs don’t show symptoms, so it may take a significant amount of time before you realize that you have been infected. If you start noticing changes (sores, bumps, painful urination, rash, itching, discharge, nausea, jaundice, fever, hair loss, etc.) make an appointment for an STI screening right away. This may involve a blood test, a urine test, or a genital or oral swab.
  • Visit the doctor if you have any of the following issues:
    • Consistent premature ejaculation
    • Erectile dysfunction
    • Decreasing interest in sexual activity
    • Pain during urination

How do I maintain my mental sexual health?

First, understand that there is nothing inherently wrong with sex or sexuality. As published in the Canadian journal Visions“Sex positivity is the assertion that sexuality is fundamentally a good thing in life and not something naughty, shameful, or only healthy in certain types of relationships. Sex positivity asserts that expression of our desire, our gender identity, and sexual orientation is a basic part of a healthy lifestyle.”

So, the first step to maintaining your mental sexual health, then, is to analyze your behaviors and your desires and your emotional response to them. Your emotions and how you react to particular events shape your sexuality. It’s likely obvious when you step beyond the boundaries of what behaviors you’re comfortable with; you may feel ashamed, sad, confused, or scared. Take these gut reactions seriously and make changes to your behavior accordingly.

If you do something that you are innately uncomfortable with (e.g., hooking up with someone just because everyone else is doing it, talking openly about your sexual orientation before you’re ready, dressing in ways that are expected for your gender but don’t fit your personality, etc.), your sexual health will suffer and instead of being sex positive, you’ll become sex negative. An intimate understanding of yourself is the key to maintaining your sexual health.

You can also help others maintain their sexual health and develop sex positive attitudes; this is just as important as maintaining your own sexual health. Being open and understanding about the sexuality of others and not shaming, judging, or bullying them for their beliefs or behaviors will go far to foster a healthy community.

Page last updated: 03/2019