TruAlign

Chapter 36: Sexual Health - Caring for the Body, Protecting the Bond

A practical guide to sexual health as relationship care, with tools for consent, communication, and support.

16 min read•Hope

Note: This chapter is educational and not a substitute for medical care. If symptoms are persistent, painful, sudden, or distressing, consider a clinician visit.

Why sexual health belongs in every relationship profile

Sexual health is not just "no STIs" or "everything works." It is whole-person well-being that includes physical, emotional, mental, and relational safety. The World Health Organization frames sexual health as well-being, not merely the absence of disease, and emphasizes freedom from coercion and violence.1

When couples treat sexual health as a normal part of how they care for each other, it becomes easier to:

  • Catch medical issues early
  • Reduce shame and blame
  • Protect trust
  • Keep intimacy tender even when things are hard

Sexual health is a relationship skill: consent, honesty, communication, and care. That is why it belongs alongside emotional safety, boundaries, and repair.

Dignity Rules (Non-Negotiable)

  • Consent is required every time, and either partner can pause or stop at any moment.
  • No mocking, diagnosing, comparing to exes, or using sex as punishment.
  • We talk about sexual concerns as a team problem, not a character flaw.
  • Privacy is protected: we do not disclose details to others without consent.

The Sexual Health Profile (overview)

This is a two-part tool:

  1. Each partner fills it out privately.
  2. You share what you are comfortable sharing and create a plan together.

Use the printable worksheet here: Sexual Health Profile.

This is not a test. It is a map. If you have never talked about sexual health directly, start with the safety and respect baseline first. Then you can add specifics over time.

What goes in the profile:

  • Consent and respect baseline
  • Boundaries (hard and soft)
  • Health snapshot (sleep, stress, meds, conditions)
  • Prevention and protection (testing dates, contraception if relevant, vaccines)
  • What helps you feel safe and desired
  • What you are not ready for

How to use it without pressure:

  • Fill it out privately.
  • Share the parts you are ready to share.
  • Agree on one small next step, not a full overhaul.

Ongoing health checks (individual + couple cadence)

Think "maintenance," not "something is wrong with you."

Couple check-in (monthly or quarterly, 10 to 20 minutes):

  • "How connected do we feel?" (0-10 each)
  • "Any pressure, avoidance, or resentment building?"
  • "Any changes in desire, erections/arousal, comfort, or pain?"
  • "One thing I appreciated about you lately..."
  • "One request for next month..." (small and kind)

Individual preventive care (at least annually, or as advised):

  • Include sexual concerns as part of routine care.
  • HIV screening is recommended broadly across ages with risk-based guidance.2
  • Cervical cancer screening timing depends on age and method; follow clinician guidance and current recommendations.3
  • STI testing and screening intervals depend on age and risk; follow CDC guidance.4
  • Vaccines such as HPV and hepatitis B support long-term prevention; check your status and eligibility.56

Medication review trigger:

  • If desire or function changes after starting, stopping, or adjusting medications, review with a clinician. Some blood pressure medicines and antidepressants can affect sexual function.7

Checklist: Ongoing Sexual Health Check-In.

Why ED and libido changes are common (and not a personal verdict)

When sexual health changes, it is easy to assume it is about attraction or effort. That is rarely the full story.

Erectile dysfunction (ED)

Occasional erection difficulty happens to most men and is often related to stress, fatigue, alcohol, or medication effects. Frequent or persistent ED can be linked to blood pressure, cholesterol, diabetes, depression/anxiety, and hormonal changes.8

Two dignity-protecting truths:

  • ED is not the same thing as lack of attraction.9
  • ED can sometimes be an early warning sign of cardiovascular issues, which is why it deserves medical attention when persistent.8

Low libido (any gender)

Low desire is often multi-causal: relationship stress, anxiety/depression, pregnancy/postpartum changes, menopause, medications, sleep, alcohol, and chronic illness can all contribute.1011

This is not a personal verdict on someone's love or character. It is a signal that deserves care and conversation.

Painful sex and discomfort

Pain or persistent discomfort should be evaluated. It can be related to pelvic floor issues, hormonal changes, infections, or other medical causes. If it is painful, it is not "just push through." That is a safety and dignity issue first.12

Common concerns and what helps (non-graphic, practical)

Anxiety and shame: Anxiety narrows attention and makes it harder to stay present. Shame makes people withdraw and hide. What helps is slow pacing, reassurance, and a clear statement that connection matters more than performance.

Medication effects: If desire or function changes after starting or changing a medication, review with a clinician. There are often alternatives or adjustments.

Postpartum and menopause changes: Hormonal shifts, sleep deprivation, and body changes can strongly affect desire and comfort. Normalize the transition and emphasize safety, patience, and gradual reconnection.

Stress and sleep: High stress and poor sleep reduce desire and sensitivity. A small improvement in rest often helps more than "trying harder."

Chronic illness: Pain, fatigue, and medication side effects can affect sexual function. Couples do best when they treat this as a shared care problem and keep affection alive in non-sexual ways.

Libido mismatch: If one partner wants more and the other wants less, move from pressure to clear requests, and keep closeness alive without forcing frequency.

Warning signs (medical + relationship)

Medical warning signs (check in with a clinician):

  • New or persistent ED, especially if sudden or paired with other health changes
  • Pain with sex, bleeding, or ongoing discomfort
  • Genital sores, unusual discharge, burning, lumps, or symptoms suggesting infection
  • Sudden major libido change plus fatigue, mood changes, or other systemic symptoms

Relationship warning signs (protect dignity and trust):

  • Sex becomes a scoreboard ("You never..." "You always...")
  • A partner uses ED/low desire as a weapon (jokes, threats, humiliation)
  • Avoidance and secrecy replace teamwork
  • Pressure, coercion, or entitlement enters the relationship

Red Flags (Safety First)

If coercion, intimidation, threats, isolation, or violence are present, sexual health becomes a safety issue first. Seek support. You are not responsible for managing someone else's coercion.

How to talk to your partner (without taking their dignity)

A useful principle: same team, same problem.

A 6-step conversation structure

  1. Ask permission: "Can we talk about our sexual health for 15 minutes? Not to blame, just to understand and support each other."
  2. Lead with care: "I love you. I am not keeping a tally. I want us to feel close and safe."
  3. Describe, do not diagnose: "I have noticed we have been avoiding intimacy / I feel distance."
  4. Name your emotion: "I miss you" or "I feel worried and I do not want to assume the worst."
  5. Invite their truth gently: "What has this been like for you? What do you wish I understood?"
  6. Pick one next step together: schedule a visit, try therapy, or choose low-pressure closeness.

Scripts you can use

  • Gentle opener: "I want to check in about our sexual health. I am on your team and I want us to feel safe and close."
  • Direct request: "I would like us to plan one low-pressure connection night this week. No expectations, just closeness."
  • Repair after a fight: "I am sorry I pushed. That was not fair. I want to rebuild trust and move at a pace that feels safe."
  • Talking about testing/STI status: "I want us to be honest about testing and protection so we both feel safe."
  • Talking about ED/low libido without implying lack of attraction: "I do not see this as a lack of desire for me. I want to understand what you are going through and support you."

What not to say (dignity killers)

  • "What is wrong with you?"
  • "Are you not attracted to me?"
  • "Just take a pill and fix it."
  • "If you loved me, you would..."

Talking about testing and protection (a short script)

"I want us to be clear about testing and protection so neither of us has to guess. I am willing to share my last testing date and talk about what makes us both feel safe."

If there is uncertainty or a new partner history, say it plainly and kindly. Honesty is protective.

If You're the Partner Supporting Someone With ED/Low Libido

  • Protect their dignity first. Shame makes symptoms worse.
  • Do not equate function with attraction. Say it out loud.
  • Offer teamwork: "We can figure this out together."
  • Keep affection and connection alive without pressure.

Libido mismatch (without pressure or scorekeeping)

Libido mismatch is common. The goal is not to force alignment; it is to negotiate with care.

Try this:

  • Agree on a shared language for "yes," "no," and "not now."
  • Focus on connection, not frequency. Create a menu of non-sex intimacy.
  • If one partner wants more, turn pressure into a clear request rather than a demand.
  • Protect the lower-desire partner from guilt and the higher-desire partner from rejection spirals by naming the emotional stakes.

Example language:

  • "I am feeling a lot of desire and I also want you to feel safe."
  • "I am not in the mood for sex, but I would love closeness."

Honesty, secrecy, and trust (why truth matters when intimacy is strained)

When sex is strained, partners often fill silence with stories: "They do not want me," "They are cheating," "I am broken."

Honesty interrupts that spiral. Not brutal honesty, but protective honesty:

  • Truthful
  • Kind
  • Specific
  • Paired with a plan

Even a simple truth can restore oxygen:

"I have been anxious and ashamed. I did not want you to think it was you."

That kind of disclosure builds trust because it says: "You are safe with the real me."

Common secrecy traps to avoid:

  • Hiding symptoms out of embarrassment
  • Avoiding testing conversations to prevent discomfort
  • Pretending everything is fine to keep peace
  • Using distance or withdrawal instead of naming fear

If you have withheld important health information, repair requires clarity and accountability. Name the truth, name the impact, and invite your partner to choose what they need next.

Repair plan: restoring trust, reducing pressure, building closeness again

Use this mini-plan when sexual health is strained:

  1. Name the issue without blame: "We are both feeling pressure and distance."
  2. Agree on dignity rules: no jokes, no pressure, no scorekeeping.
  3. Choose one low-pressure connection practice: affection, touch, date night, or a check-in.
  4. Address health contributors: sleep, stress, medication review, and clinician support if needed.
  5. Set a short timeline and review: "Let's try this for 4 weeks and check in."
  6. Protect privacy: agree on what stays between you and what can be shared with a clinician or trusted support.

Myths vs Facts

  • Myth: ED means a lack of attraction. Fact: ED is often multi-causal and commonly unrelated to attraction.[^mayo-ed-myths]
  • Myth: Low libido means something is wrong with the relationship. Fact: Desire is affected by health, stress, hormones, and life transitions.
  • Myth: If it is hard to talk about, it is better not to bring it up. Fact: Silence breeds shame; respectful honesty builds trust.

When to seek professional support

Seek support sooner than later if symptoms are persistent or distressing. Early support prevents shame spirals and protects dignity.

  • Primary care: first-line for general evaluation and referral
  • Urology / Gynecology: for sexual function, pain, or hormone-related concerns
  • Pelvic floor physical therapy: for pain, tension, or recovery after childbirth
  • Therapy / Sex therapy: for anxiety, shame, mismatch, or communication loops

Many sexual health issues have treatable medical contributors. Therapy can also help rewire fear, pressure, and avoidance patterns.1112

Key takeaways

  • Sexual health is part of relationship health, not a side issue.
  • Dignity and consent are non-negotiable.
  • ED and libido changes are common and multi-causal; do not shame or personalize.
  • Honest, respectful conversation protects trust.
  • Early support protects the bond.

Try this this week

Pick one:

  • Fill out the Sexual Health Profile privately and share one thing you want your partner to know.
  • Schedule a 15-minute Ongoing Check-In.
  • Write a short "team statement": "We treat sexual health as a shared care issue, not a performance issue."

Worksheets and resources

Sources

Footnotes

  1. World Health Organization. Sexual health and its link to health and human rights. https://www.who.int/teams/gender-equity-and-human-rights/sexual-health-and-its-link-to-health-and-human-rights ↩

  2. U.S. Preventive Services Task Force. HIV Screening recommendation. https://www.uspreventiveservicestaskforce.org/uspstf/recommendation/hiv-screening ↩

  3. U.S. Preventive Services Task Force. Cervical cancer screening recommendation. https://www.uspreventiveservicestaskforce.org/uspstf/recommendation/cervical-cancer-screening ↩

  4. Centers for Disease Control and Prevention. Getting tested for STIs. https://www.cdc.gov/sti/testing/ ↩

  5. Centers for Disease Control and Prevention. HPV vaccination recommendations. https://www.cdc.gov/vaccines/vpd/hpv/hcp/recommendations.html ↩

  6. Centers for Disease Control and Prevention. Hepatitis B vaccination guidance. https://www.cdc.gov/hepatitis/hbv/vaccadults.htm ↩

  7. MedlinePlus. Erectile dysfunction. https://medlineplus.gov/erectiledysfunction.html ↩

  8. Mayo Clinic. Erectile dysfunction: Symptoms and causes. https://www.mayoclinic.org/diseases-conditions/erectile-dysfunction/symptoms-causes/syc-20355776 ↩ ↩2

  9. Mayo Clinic Health System. Myths about erectile dysfunction. https://www.mayoclinichealthsystem.org/hometown-health/speaking-of-health/ed-myths ↩

  10. NHS. Loss of libido. https://www.nhs.uk/conditions/loss-of-libido/ ↩

  11. Mayo Clinic. Low sex drive in women. https://www.mayoclinic.org/diseases-conditions/low-libido-in-women/symptoms-causes/syc-20374554 ↩ ↩2

  12. American College of Obstetricians and Gynecologists. Your sexual health. https://www.acog.org/womens-health/faqs/your-sexual-health ↩ ↩2