Sex, intimacy, and mental health
Reviewed by Susan Radzilowski, MSW, LMSW, ACSW
Written bytherapist.com team
Last updated: 07/31/2023
Sex is a normal part of life that affects and interacts with other parts of your life, including your sexual identity, physical health, relationships, family planning, and mental health. Consensual, healthy sex can have both physical and mental benefits.
Sex and consent
When we talk about sex, we’re also talking about consent—freely and willingly agreeing to engage in sexual activity. Consent is the key to a healthy sexual experience. Your choice to have or abstain from sex should be entirely yours.
What is consent?
Consent is often defined as an “enthusiastic yes” to any type of sexual activity. This means verbally agreeing to sexual activity as well as using nonverbal cues (like body language) that match this agreement. Nonverbal cues alone aren’t enough to show consent; explicit verbal communication is also important.
Someone who seems to show interest with their body language hasn’t given consent until they also say they want to engage in a sexual activity. Similarly, someone who feels pressured or coerced into having sex—and who doesn’t explicitly say no, but clearly communicates through their body language that they don’t want to have sex—has not given consent.
Consent isn’t a one-time event. Consenting to sex once with someone doesn’t mean you agree to have sex with them forever. Similarly, consenting to one kind of sexual activity doesn’t mean you’re saying yes to all sexual activities. Consent can also be taken back at any time before or during sex.
Shame, pressure, expectation, or threats should play no part in influencing your decision to engage in a sexual activity. Similarly, you should never use these tactics to try and convince someone to engage in sexual activity with you.
Who can consent to sex?
Only adults can consent to sex. Minors categorically can’t. People of any age who are incapacitated or overly intoxicated by alcohol or drugs also can’t give consent, and neither can people who are cognitively impaired due to injury, illness, or certain disabilities.
Masturbation, abstinence, and asexuality
The rule of consent also applies to sex by yourself. Private self-exploration through masturbation is normal and healthy, but no one should ever feel pressured into any sexual activity, including masturbation. People can live full, healthy lives without sex, whether they identify as asexual or freely choose to be abstinent or celibate.
What is sex positivity?
Sex positivity is the attitude that healthy, safe, consensual sex between adults is generally a good thing. It rejects the idea that sex (particularly “too much” sex or certain kinds of sex acts) is unhealthy, morally bad, or “dirty.” It also avoids the idea that some types of sex—such as heterosexual intercourse, sex for reproductive purposes, or sex that always ends with orgasm—are superior to others.
Many mental health experts take a sex-positive approach in their work. Using a sex-positive framework, mental health professionals can help people of all sexualities and identities learn to have a healthy relationship with sex, their sexual identity, and their potential or committed sexual partners. They can also help people protect and prioritize their physical and mental health around engaging in sexual activity.
Is sex healthy?
Healthy, consensual sex protects and prioritizes the physical and mental health of all participants. Sex can have many physical benefits, including:
- Better heart health: Having sex is considered a light form of cardiovascular exercise. It lowers blood pressure and reduces risk for heart disease.1, 2
- Pain relief: Sex can relieve headaches, migraines, and other types of physical pain.3, 4
- Better sleep: If you have an orgasm during sex, your body releases a hormone called prolactin that’s linked to better sleep.5
The mental health benefits of having sex can include:
- Stress relief: Having sex can lower stress hormones like cortisol.6
- Happiness: Sex can release hormones that make us feel good, including dopamine, endorphins, and oxytocin. This may temporarily boost your mood, reducing symptoms of anxiety or depression.7
- Increased self-esteem: Sex and masturbation can allow us to explore our bodies in ways that increase self-confidence.
- Better communication: Communication is important during sex to ensure everyone feels safe and enjoys the experience. Sex can help you learn how to communicate better with your partner(s), inside and outside the bedroom.
- Increased intimacy: Sex can be an intimate experience, especially if you have it regularly with the same partner(s). It can make people feel physically and emotionally closer to each other.
Healthy sexual activity is motivated by pleasure, curiosity, and/or experimentation. It’s unhealthy, though, to engage in sexual behavior as a way to avoid difficult emotions or to intentionally harm yourself or others.
Is it unhealthy to have multiple sexual partners?
It’s not inherently unhealthy, bad, or wrong to have multiple sexual partners. No matter how many you partners you have, you’ll need to take intentional steps to protect your sexual health and your mental health. (See our tips below.)
How sexual health affects mental health
Protecting and promoting your sexual health, as well as your mental health, requires safety. If your sexual life lacks physical, mental, or emotional safety, you may face negative mental health outcomes, such as:
- Increased anxiety: Engaging in unsafe or obsessive sexual behavior increases your risk for sexually transmitted infections or diseases. This risk to your physical health can increase your anxiety.
- Emotional distress: Excessive preoccupation with sex can affect both your physical and mental health. If you’re diagnosed with hypersexual disorder (sometimes called “sex addiction”), a seemingly uncontrollable desire for sex may cause you distress, threaten your health, and inhibit your daily functioning. If you think your sexual behavior may be compulsive or you feel out of control, seek help from a sex therapist.
- Guilt, shame, or depression: If you’re LGBTQIA+ or exploring or questioning your sexuality, you may struggle with guilt, shame, or depression due to societal discrimination, lack of family or community support, or your own internalized homophobia or transphobia. Your identity isn’t the cause of these feelings, but society’s bigotry may put you at risk.
How mental health affects sex
Just as sex can affect your mental health, your mental health can affect your relationship to sex. Certain conditions (and their treatments, including some medications) can affect your sexual desire and performance. These include anxiety, depression, insomnia, stress, grief, and some antidepressants.
Unresolved or untreated trauma—particularly trauma rooted in sexual abuse or assault—can have a huge impact on your experiences with sex. Posttraumatic stress disorder (PTSD) symptoms can be triggered by sexual activity, especially if you’ve experienced sexual trauma. Traumatic birthing experiences can also affect your sexual desire.
If you have mental health challenges related to sex, a sex therapist, trauma-informed therapist, and/or a couples counselor can help you start your journey toward healing. Browse our directory to find a licensed mental health professional near you.
Intimacy and mental health
“Intimacy” refers to closeness, and it’s another part of life that intersects with sex and mental health. Intimacy often characterizes committed sexual relationships; however, not all sex is intimate, and not all intimacy is sexual. Examples of intimacy include:
- Physical intimacy: Holding hands, hugging, sharing physical space, sitting close
- Emotional intimacy: Confiding in someone, asking for advice, offering encouragement, expressing feelings verbally
- Sexual intimacy: Being naked with a sexual partner, holding each other, massaging one another, engaging in sexual activity
Both sexual and nonsexual intimacy are associated with various mental health benefits, including decreased stress, a stronger sense of belonging, and the joy of connecting with another person. Making time for nonsexual intimacy can also increase your enjoyment of sexual intimacy.
Tips for navigating sex, intimacy, and mental health
Sex, intimacy, and mental health are intersecting aspects of the human experience. Your relationship with one can affect or change your experience of another. Here are some tips for navigating these complex parts of your life in ways that prioritize and protect your health and safety.
Explore your own body
Self-exploration is one of the best ways to learn about sex, your own sexual preferences, and your sexual identity. Masturbation is a safe, healthy part of sexual development. Age-appropriate sex education and self-exploration destigmatize sex and protect both minors and adults from sexual abuse or exploitation.
Having sex can be a vulnerable experience. You may feel a strong desire to do it “correctly,” and movies, TV shows, statistics, porn, and friends’ anecdotes can all promote certain sexual ideals that may feel impossible to achieve.
Real healthy sex, however, is all about learning, making mistakes, and trying new things. Sex is rarely “perfect.” More often than not, it’s silly, funny, vulnerable, confusing, intimate, creative, and enjoyable. Instead of comparing yourself to others, trying to impress your partner, or striving to meet to certain ideas about sex, try to simply be present instead. You and your partner will likely have a more enjoyable experience if you can focus on what’s actually happening, rather than what you imagine should be happening.
Reject simple definitions of sex
Some people believe that sex only “counts” if it ends in orgasm or involves penile-vaginal intercourse. Such strict definitions can limit your sexual experiences and make you feel pressured to perform in a particular way. Instead of defining sex so narrowly, embrace a broader definition that includes different types of intimacy.
Ask yourself what you want
Some people choose to pursue sex and intimacy together, often in the form of a committed relationship to a single sexual partner. Others choose to pursue sex and intimacy separately. It’s important to ask yourself whether you want to pursue them together or in different ways.
There’s no right answer, and your answer may change over time. What’s important is knowing what you’re looking for in a sexual partner or an intimate relationship, so you have the best chance of finding it.
Practice safe sex
The best way to protect your sexual health is to practice safe (or “safer”) sex. Safe sex means:
- Waiting to have sex until you’re of legal age
- Having the freedom to say no or stop at any time
- Having sex only with other consenting adults
- Using contraceptives to prevent unwanted pregnancy and/or sexually transmitted infections
- Knowing and understanding your options if contraceptives fail
- Having regular sexual health checkups with a medical professional
- Communicating openly with your partner(s) about sexual health
Prioritize your mental health
Your relationship with sex and intimacy is informed and affected by your mental health. Therapy can help you learn how to set boundaries, communicate more effectively, trust those closest to you, challenge unhelpful thoughts and emotions, and be fully present.
Prioritizing your mental health benefits you physically, mentally, emotionally, spiritually—and yes, even sexually. Browse our directory to find a therapist near you.
About the author
The editorial team at therapist.com works with the world’s leading clinical experts to bring you accessible, insightful information about mental health topics and trends.
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