Healthy Sexuality
Part One: Understanding
What is Healthy Sex?
Sexual energy is a powerful, very natural force in our lives. But like any natural force we encounter -- be it wind, sun, rain, or our own laughter -- our sexual energy has the potential to be channeled and experienced in either destructive or life-affirming ways.
Healthy sex involves the conscious, positive expression of our sexual energy in ways that enhance self-esteem, physical health, and emotional relationship. It is mutually beneficial and harms no one.
Negative influences and problems
Unfortunately, we live in a society that constantly bombards us with images of sex that have very little to do with healthy sexuality. In movies, on television, in books, over the Internet, and in magazines, we are exposed to countless examples of impulsive, irresponsible, uncaring sex. People are treated as sex objects and sex is often portrayed as a form of power and control over another person. It’s no wonder that many of us have experienced some tragic consequences of poorly channeled sexual energy, such as sexual abuse, sexual addiction, porn problems, sexual exploitation, sexually transmitted disease, unwanted pregnancy, and/or chronic sexual unhappiness.
The number of people harmed by sexual experiences is staggering. Studies in the United States reveal that:
1 in 3 females are sexually abused in childhood.
1 in 5-7 males are sexually abused in childhood.
1 in 4 women are raped sometime in their lifetime.
1 in 2 sexually active people will contract a sexually transmitted disease by twenty-five years of age.
1 in 4 people suffer from a sexually transmitted disease sometime in their lives.
1 in 3 women have at least one abortion by the time they are forty-five years of age.
1 in 7-10 people develop a sexual addiction.
1 in 5 women and 1 in 10 men report that sex gives them no pleasure.
What’s been missing
Most of the sex education available in the world today, focuses on reproduction, birth control and disease prevention. While this is important information, it stops short of helping us learn what we need to know to prevent sexual abuse, addiction, and dissatisfaction. In addition, many of us need new information to overcome problems caused by past sexual hurts so that we can go on to experience healthy and deeply satisfying sexual intimacy with a partner.
As sex and relationship therapists, we speak with many people who have trouble conceptualizing healthy sexuality. They want to know: “How does healthy sex differ from sexual abuse?”, “How does healthy sex differ from sexual addiction?”, and “What are the conditions necessary to ensure that the sex I’m experiencing is good for me and for my sexual partner?”
The CERTS Model for Healthy Sex
We believe that healthy sexuality requires that these five basic conditions be met:
Consent, Equality, Respect, Trust, and Safety
Let’s look at each of these conditions more closely:
CONSENT means you can freely and comfortably choose whether or not to engage in sexual activity. This means you are conscious, informed, and able to stop the activity at any time during the sexual contact.
EQUALITY means your sense of personal power is on an equal level with your partner. Neither of you dominates or intimidates the other.
RESPECT means you have positive regard for yourself and for your partner. You also feel respected by your partner based on how your partner is treating you.
TRUST means you trust your partner on physical and emotional levels. You accept each other’s needs and vulnerabilities and are able to respond to concerns with sensitivity.
SAFETY means you feel secure and safe within the sexual setting. You are comfortable with and assertive about where, when and how the sexual activity takes place. You feel safe from the possibility of negative consequences, such as unwanted pregnancy, sexually transmitted infection, and physical injury.
Spending time together and engaging in lots of honest, open communication are good ways to make sure that the CERTS conditions are operating in your relationship. That’s why we often recommend you build a strong friendship with a partner first, before becoming lovers.
Meeting the CERTS conditions does not ensure that you’ll experience terrific sex, but it can help you feel secure knowing you’ve minimized the possibility of something bad resulting from your sexual experiences.
Comparisons Chart
Learning to distinguish healthy sexuality from other forms of sexual experience empowers you to bring healthy sex more into your own life and relationships. Below you will find a “comparisons” chart that contrasts “healthy sexuality” with a “sexual abuse and sexual addiction” perspective on sex. Pay attention to any items that concern or confuse you. You may want to discuss these with a friend, counselor, or health educator, to tease out the differences more. How you think about sex significantly effects how you and your partner will experience and feel about it.
|
Sexual Abuse and Addiction |
Healthy Sex |
|
Sex is uncontrollable energy |
Sex is controllable energy |
Sex is an obligation |
Sex is a choice |
Sex is addictive |
Sex is a natural drive |
Sex is hurtful |
Sex is nurturing, healing |
Sex is a condition for love or devoid of love |
Sex is an expression of love |
Sex is "doing to" someone |
Sex
is sharing with someone; |
Sex is void of communication |
Sex requires communication |
Sex is secretive |
Sex is private |
Sex is exploitative |
Sex is respectful |
Sex is deceitful |
Sex is honest |
Sex benefits one person |
Sex is mutual |
Sex is emotionally distant |
Sex is intimate |
Sex is irresponsible |
Sex is responsible |
Sex is unsafe |
Sex is safe |
Sex has no limits |
Sex has boundaries |
Sex is power over someone |
Sex is empowering |
Sex requires a double life |
Sex enhances who you really are |
Sex compromises your values |
Sex reflects your values |
Sex feels shameful |
Sex enhances self esteem |
If you are concerned about pornography, you may want to look at the comparison chart we developed for recovering porn users. Entitled, “Do You Know The Difference?” it compares “porn-related sex” to “healthy sexuality.” This porn-oriented comparison chart is published in our book, “The Porn Trap: The Essential Guide to Understanding Problems Caused by Pornography” and is also available as a free poster that you can download on this site.
Qualities of Healthy Sex Exercise
In 1991 Wendy Maltz LCSW developed the HealthySex™ nightshirt to help survivors of sexual abuse and others understand healthy sexuality. The nightshirt evolved from a workshop exercise in which participants brainstormed positive qualities of sex.
As you read the qualities below, identify which ones are present and true in your sexual relating. If you identify qualities that are often lacking, you may want to concentrate on learning more about them and integrating these qualities into your lovemaking in the future.
Healthy sex is. . .
____ having choice
____ nurturing
____ built on trust
____ playful
____ loving myself
____ respectful
____ being honest
____ physically safe
____ feeling ready 
____ caring
____ warmth
____ laughter
____ socially responsible
____ fun
____ shared intimacy
____ something I deserve
____ being friends
____ comfortable
____ expressing love
____ being equal partners
____ mutually desired
____ celebration
____ feeling good
____ honoring my pace
____ sensual touches
____ private
____ arousing
____ being patient
____ relaxing
____ open communication
____ enjoyable
____ satisfying
____ good memories
. . . for me!
(The HealthySex™ Nightshirt is currently out of stock.)
The Maltz Hierarchy Model
“The Maltz Hierarchy of Sexual Interaction” article presents a detailed, academic model for understanding healthy sexuality and how it differs from destructive expressions of sexual energy. Wendy Maltz wrote the article for mental health professionals and other people working on sexual healing. The article was first published in the Journal on Sexual Addiction & Compulsivity, 1995 (Volume 2, Number 1). Relationship therapists, sex educators, abuse and addictions treatment specialists still use the hierarchy model to help individuals better understand the necessary conditions for healthy sexual relating. The ultimate positive expression of sexual energy is identified and explained as “authentic sexual intimacy”.
ABSTRACT of The Maltz Hierarchy of Sexual Interaction article
Due to changes in sexual mores and behaviors during the 1900’s, our society has been left without clear guidelines to help channel sexual energy. The Maltz Hierarchy of Sexual Interaction is a progressive model for understanding sexual relating. It provides a way of evaluating sexual behavior within the context of relationships. Sexual energy is presented as a benign, natural force, which can be channeled in either destructive or life-affirming ways. The model presents six levels of sexual interaction; three negative levels (impersonal, abusive and violent) and three positive levels (role fulfillment, making love, and authentic sexual intimacy). As a tool in sexual abuse and addiction treatment, couples therapy and sex education, the hierarchy helps individuals understand the need for communication, safety and trust, and points to authentic sexual intimacy as a peak experience in human sexual relating.
Read the entire article The Maltz Hierarchy of Sexual Interaction
Part Two: Guidelines
Sexual Health Risks Checklist
Healthy sex involves being safe from negative physical consequences. You need to know how to protect yourself and your partner from serious health problems, such as sexually transmitted diseases and infections (STDs), injury, and unwanted pregnancy. It is important to stay informed and up-to-date on the latest information about disease prevention and birth control.
• Read books, pamphlets and brochures from your local health department or library.
• Check out the information on reputable health education web sites.
• Regularly visit and talk with your health care provider.
• Learn about risks, options, and self-care exams
And then, make wise decisions so that you can do all that is possible to minimize the risk of something negative resulting from your lovemaking.
To test your knowledge of health risks involved in sexual activity, read through the following HealthySex™ Risks Checklist. This list does not cover all the risks involved in sex.
Everyone should know these facts, DO YOU?
___ 1. There is no method of contraception that is 100% effective.
___ 2. A woman who does not use any form of birth control has an 85% chance of getting pregnant within one year.
___ 3. For birth control methods to be effective, they must be used correctly and consistently.
___ 4. Taking medications, such as antibiotics, can reduce the effectiveness of birth control pills.
___ 5. When used correctly, condoms (rubbers) can greatly reduce the risk of pregnancy and STDs, such as Herpes, Gonorrhea, Syphilis, Chlamydia, Hepatitis B, and AIDS.
___ 6. At least one in two sexually active Americans will contract a sexually transmitted infection/disease (STD) by age twenty-five.
___ 7. Every year, there are at least 19 million new cases of STDs/STIs, some of which are curable.
___ 8. STDs can be passed from one person to another through vaginal, anal or oral intercourse.
___ 9. Some STDs, such as syphilis and herpes, can be passed through kissing.
___ 10. Birth control pills and diaphragms do not protect against STDs.
___ 11. Though the likelihood of getting genital warts can be decreased by condom use, contagious warts may exist elsewhere (such as on buttocks, inner thighs, outer lips).
___ 12. Dental dams or plastic wrap need to be used in oral sex to prevent the transmission of STDs.
___ 13. For additional protection against pregnancy, latex condoms can be used in conjunction with a spermicide. (However, if a person is allergic to spermicide, the resulting irritation can increase the potential for sexually transmitted infection).
___ 14. When using a latex condom it is very important that you DO NOT use an oil-based lubricant (such as massage oil, baby oil or Vaseline). Oil can damage the latex very quickly destroying the condom. (Use water-based lubricants, such as Astroglide or K-Y jellie or liquid instead).
___ 15. Many people with STDs, such as Gonorrhea, HIV+, Chlamydia, and Herpes, show absolutely NO visible symptoms.
___ 16. Medical tests can determine if you or your partner have an STD.
___ 17. Some STDs can be easily treated and cured.
___ 18. Some STDs may stay in the system causing health problems or requiring medications forever.
___ 19. Some STDs, such as Chlamydia and Gonorrhea, can cause sterility in a man or a woman, rendering them unable to ever conceive a child.
___ 20. The more sexual partners you have the greater your risk of acquiring an STD.
The HealthySex™ Trust Contract
Trust is an important quality in healthy sex. It helps us feel emotionally safe and secure about choosing to remain in an intimate relationship with a partner. Without trust, we’re likely to feel growing amounts of anxiety, fear, disappointment and betrayal.
Trust grows when both people in the relationship act responsibly and follow-through with commitments. While no one can guarantee that any relationship will last and remain satisfying for both people, you can strengthen mutual trust by having clear understandings about what you expect from each other in the relationship.
Spend time with your partner discussing what you need and expect in the relationship for you to feel emotionally safe. From you discussion, create a list of understandings you will both agree to honor. You may want to formalize your list into an actual “contract” you will follow.
A Sample HealthySex™ Trust Contract
© 2007 Wendy Maltz, all rights reserved
These mutual understandings are often important to building trust in a healthy sexual relationship. Feel free to use this sample list to help you and your partner generate your own set of relationship ground rules.
We agree that:
- It’s okay to say no to sex at ANY TIME.
- It’s okay to ask for what we want sexually, without being teased or shamed for it.
- We don’t ever have to do anything we don’t want to do sexually.
- We will take a break or stop sexual activity whenever either of us requests it.
- It’s okay to say how we are feeling or what we are needing at ANY TIME.
- We agree to be responsive to each other’s needs for improving physical comfort.
- What we do sexually is private and not to be discussed with others outside our relationship unless we give permission to discuss it.
- We are each ultimately responsible for our own sexual fulfillment and orgasm.
- Our sexual thoughts and fantasies are our own and we don’t have to share them with each other unless we want to reveal them.
- We don’t have to disclose the details of a previous sexual relationship unless that information is important to our present partner’s physical health or safety.
- We can initiate or decline sex without incurring a negative reaction from our partner.
- We each agree to be sexually monogamous unless we have a clear, prior understanding that it’s okay to have sex outside the relationship (this includes virtual sex, such as phone or Internet sex, or using pornography as a sexual outlet).
- We will support each other in minimizing risk and using protection to decrease the possibility of disease and/or unwanted pregnancy.
- We will each agree to be medically tested for sexually transmitted disease at any time.
- We will notify each other immediately if we have or suspect we have a sexually transmitted infection.
- We will notify each other if we suspect or know that a pregnancy has occurred from our lovemaking.
- We will support each other in handling any negative consequences that may result from our lovemaking.
Communication Guidelines for Healthy Sex
Good communication is crucial to healthy sexual relating. You can greatly increase feelings of mutual respect, emotional closeness, and sexual pleasure when you and your partner communicate well with each other. Knowing how to talk openly and comfortably helps you solve sexual problems that come up from time to time in the normal course of an on-going intimate relationship.
Be patient with yourself and your partner as you work to develop new communication skills. It takes time and a lot of practice to open up emotionally and discuss personal topics in safe and sensitive ways.
The HealthySex™ Communications Guidelines
© 2007 Wendy Maltz and Larry Maltz, Maltz Counseling Associates, all rights reserved.
1. Both partners need to make a commitment to engage in a discussion about intimate concerns.
2. Choose a quiet time for discussion when you are not likely to be interrupted. Give your undivided attention to being with your partner.
3. Sit reasonably close to each other and maintain eye contact. Be aware of the tone and volume of your voice.
4. Avoid blaming, name-calling, accusations and sarcasm.
5. Deal with only one issue at a time.
6. State specifically and clearly what you feel and need. Use "I statements", rather than "you statements." (Example: Say "I felt rejected when you didn't want to hug last night" rather than "You're so cold; the way you treat me is cruel.")
7. Maintain an optimistic perspective that change is possible. Avoid bringing up resentments from the distant past. Refrain from using the words "always" or "never".
8. Listen to your partner. Strive to understand each other's feelings and needs. Communicate that understanding to your partner. (You can communicate understanding and still have a different opinion or perspective than your partner).
9. When discussing sexual intimacy concerns, keep in mind that partners are apt to feel scared, embarrassed, or hurt. Emphasize what you like and what works well before making a new request or discussing something that bothers you.
10. Avoid getting sidetracked on irrelevant issues; "It happened in 2005." "No, it was 2004." Refrain from "I'm right, you're wrong" arguments.
11. Explore and discuss various options for change. Work together to brainstorm how individual needs can be met and feelings addressed more effectively. Make the issue the "problem", not each other.
12. See intimate problems as a normal, natural part of a relationship. Turn them into opportunities to learn and grow as a couple.
13. If you and your partner agree to a solution to the problem, try it out, then plan to discuss in the near future how the solution is working for both of you.
14. Give yourselves permission to table discussion of an issue if you feel no progress is being made. You each may get new insights and understandings thinking about it independently. Make sure you resume discussion within several days.
15. Seek professional help when needed. Don’t allow unresolved sexual issues to fester and erode your positive feelings for each other.
Part Three: Inspirations
Positive sexual images and ideas can be hard to find. Here are some poems from Wendy Maltz’s bestselling poetry anthologies and some of her favorite quotes on healthy sexuality.
Sexual Love Poetry
In the early 1990’s sex and relationship therapist Wendy Maltz began a search to find examples of healthy sexual intimacy to share with couples who wanted to learn more. She scoured films, video selections, popular books, and magazines for images that portrayed sex as mutually enjoyable, socially responsible, and physically safe.
Wendy was shocked at how few examples of healthy sex she could find. It wasn’t until she began sifting through and collecting poetry that she discovered “heartcore” poems; poems in which heart connection is at the core of the sexual experience.
Wendy’s quest for healthy sex descriptions eventually lead her to compile and edit two award-winning poetry anthologies: Passionate Hearts: The Poetry of Sexual Love and Intimate Kisses: The Poetry of Sexual Pleasure. These collections inspire and celebrate healthy sexual intimacy.
from Passionate Hearts:
WOMAN BATHING
by Raymond Carver
Natches River. Just below the falls.
Twenty miles from any town. A day
of dense sunlight
heavy with odors of love.
How long have we?
Already your body, sharpness of Picasso,
is drying in this highland air.
I towel down your back, your hips,
with my undershirt.
Time is a mountain lion.
We laugh at nothing,
and as I touch your breasts
even the ground-
squirrels
are dazzeled.
DESIRE
by Connemara Wadsworth
Taking off
my clothes
piece by piece,
I turn to you,
unwrap my body,
feel you trace
its contours
with your fingers.
I am accustomed 
to covering,
what I now bare,
watch you waken
and wash me
with your eyes.
I feel the cloth
of your skin,
uncovered,
inviting me in,
feel your breath
warm in my ear.
I lean closer
into you, feel
your blood surge
as you hold me
and I echo
the beat pulling
on us as I wrap
my legs around you
and open as morning
glories do
when the sun
warms them.
TWIN FLAMES
by James Broughton
Embers of night flare up afresh
when you ignite the morning in my arms
and kindle the familiar hearth of love
Year after year we have warmed our lives
around the mystery of mutual fire
that heats our domain of risk and rapture
Whenever scorched however scarred
we hearten heal reconflagrate
Twin flames ever in blissful blaze
from Intimate Kisses:
THE ENJOYMENT
by Anon
Ye gods! the raptures of that night!
What fierce convulsions of delight!
How in each other’s arms involved
We lay confounded and dissolved!
Bodies mingling, sexes blending,
Which should be most lost contending,
Darting fierce and flaming kisses,
Plunging into boundless blisses,
Our bodies and our souls on fire,
Tossed by a tempest of desire
Till with utmost fury driven
Down, at once, we sunk to heaven.
AFTER NEW HAMPSHIRE
by Rosemary Klein
Folded into each other,
origami hearts, love
knots. Each time
I never believe
we will get any closer.
Afternoon lowers
her eyes as dusk
steals across the vision
of us, still touching.
Silk light.
Silk laughter.
My body floods
its boundaries.
You hold me through
each shudder, each
moan, my head tucked
into your chest, my legs
wrapped around your body,
my body filled with light,
my body light. Past
freedom and individuality
and the delight of my own
opinions, beyond serenity
and rock n’ roll, there is
happiness and I have found
its natural habitat beneath
your kiss and only
in your arms.
LOVE POEM
by Sarah Brown Weitzman
From here those slaps of color unravel
form you said and stepped back
from the Monet to see the separate strokes
fall into water and lilies again.
Shards of light take the eye to blossoms
pale as breasts. Sky, leaf, water, flower
merge and waver, blur then clear
as each takes something from the other
to reflect or repeat so that not a single
moment is preserved but several.
Later in the splay of late afternoon
we repeat that painting.
The spread blooms of our bodies
blend and shift and merge again until
we know as Monet knew in the crystal rush
of water over the sun-glazed lilies
the radiance of an instant.
Favorite Quotes
You can learn more about healthy sexuality through discovering what other therapists, writers, and sexual health advocates have said about it.
Here are some of Wendy’s favorite quotations:
Healthy Sex Quotations:
Only the united beat of sex and heart together can create ecstacy. --Anais Nin
Nothing is sexier than the naked mind--nothing more seductive than the inventive imagination. -- Michael Grosso
The flower, the sky, your beloved, can only be found in the present moment. --Thich Nhat Hanh
An embrace should fill the heart as well as the arms. --Hugh & Gail Prather
“Sexual love is the most stupendous fact of the universe, and the most magical mystery our poor blind senses know.” --Amy Lowell
Good sex begins when your clothes are still on. --William Masters & Virginia Johnson
To climb to the heights, sex education is not enough. We need to learn how to love. --Joseph & Lois Bird
Our organic drives and urges are never separable from the search for meaning and the quest for communion. --James Nelson
Sexual love is socially responsible; nurturing the fabric of the larger community to which the lovers belong. --James Nelson
Sexual love is joyous; it is exuberant in its appreciation of love’s mystery and life’s gift. --James Nelson
Sex is more than sensation and is within life rather than outside or apart from other experiences. --C. Leon Hopper
The sacred meaning of sexuality is not located in sexuality itself, but rather in human mutuality. . .Sexuality is a mode in which mutuality is expressed. --John Buehrens
The reason people sweat is that they won’t catch fire making love.--Don Rose
Never be ashamed of passion. If you are strongly sexed, you are richly endowed. --Margaret Sanger