Sexual Health: A Practical Guide for Adults

Sexual health is part of overall health. It includes protection from sexually transmitted infections (STIs) and unintended pregnancy, but it also includes consent, communication, comfort, sexual function, and access to reliable care.

There is no single routine that fits every person. Your needs can change with your relationships, health conditions, medications, pregnancy plans, and age. The sections below cover the practical basics and correct several recommendations that appeared in an older version of this page.

Safer sex and STI prevention

STIs can spread through vaginal, anal, or oral sex. Some cause symptoms such as sores, discharge, burning, or pelvic pain, while others may cause no symptoms at all.

External condoms, internal condoms, and dental dams reduce exposure when used correctly for every sex act. They lower the risk of many infections and pregnancy, but they do not provide complete protection. Infections such as herpes and human papillomavirus (HPV) can spread from skin that a condom does not cover.

Use a new barrier each time and follow the package directions. Oil can weaken latex condoms, so check that any lubricant you use is compatible with the barrier material.

Vaccination can prevent HPV and hepatitis B. HIV prevention may also include pre-exposure prophylaxis (PrEP) for people with an ongoing risk and post-exposure prophylaxis (PEP) after a possible recent exposure. PEP is time-sensitive and should be started as soon as possible.

Testing is part of safer sex because many STIs are silent. Which tests you need depends on your age, anatomy, partners, sexual practices, pregnancy status, and prior results. The CDC explains current STI testing options, including when throat or rectal testing may be relevant.

Safer sex also requires clear, voluntary consent. Anyone can change their mind at any time. Pressure, fear, intoxication, or an inability to understand what is happening means consent is not present.

Vulvovaginal health

The vulva is the external genital area; the vagina is the internal canal. Normal vaginal discharge helps keep the vagina healthy, and its amount can change during the menstrual cycle.

Wash the vulva gently with lukewarm water. If you use soap, choose a mild, fragrance-free product and keep it on the external skin. Do not put soap, deodorant, or cleansing products inside the vagina, and do not douche. These products can irritate tissue and disturb the normal balance of microorganisms. The American College of Obstetricians and Gynecologists (ACOG) gives more detailed vulvovaginal care advice.

A new strong odor, unusual discharge, itching, burning, sores, bleeding after sex, or ongoing pain deserves medical attention. These symptoms have several possible causes, so repeated self-treatment for a presumed yeast infection can delay the right diagnosis.

Cervical screening and HPV vaccination

Cervical screening looks for high-risk HPV or abnormal cervical cells before they become cancer. It is different from an STI test and from a pelvic exam.

Most people at average risk do not need cervical screening every year. In the United States, the recommended starting age and test interval vary slightly among medical organizations. Depending on age and the guideline followed, screening may use a Pap test every three years, an HPV test every five years, or an HPV/Pap cotest every five years. The National Cancer Institute summarizes the current options.

People with a history of abnormal results, cervical precancer or cancer, immune suppression, HIV, or prenatal exposure to diethylstilbestrol may need a different schedule. HPV vaccination greatly lowers the risk of several HPV-related cancers, but vaccinated people with a cervix should still follow screening guidance.

Contraception and emergency contraception

Contraceptive choices include condoms, pills, patches, rings, injections, implants, intrauterine devices (IUDs), diaphragms, fertility-awareness methods, and permanent procedures. Effectiveness, side effects, convenience, cost, and future pregnancy plans all affect the choice.

Condoms are the only common contraceptive method that also lowers the risk of many STIs. Some people use condoms together with another birth-control method for both infection and pregnancy protection.

If sex occurred without contraception or a method failed, emergency contraception may still prevent pregnancy. Options include emergency contraceptive pills and certain IUDs. Timing and access vary by method; some options can be used up to five days afterward, and earlier use is generally better. Emergency contraception does not end an established pregnancy. ACOG provides current guidance on the available choices.

After sexual assault, urgent medical care can address injuries, pregnancy prevention, STI testing or preventive treatment, and emotional support. Care is available even if you are unsure whether you want to report the assault.

Fertility and pregnancy planning

Pregnancy is most likely during the fertile window around ovulation, but predicting the exact day is difficult. Cycle apps and calendar estimates can be useful clues; they do not confirm ovulation and should not be treated as dependable contraception on their own.

A missed period can be an early sign of pregnancy, but stress, illness, weight changes, intense exercise, perimenopause, and other conditions can also delay bleeding. A home pregnancy test is a practical first step when pregnancy is possible. Testing again after several days or speaking with a clinician may be useful if the result is negative and the period still does not arrive.

Fertility involves both partners. ACOG recommends an infertility evaluation after 12 months of regular sex without contraception when the person trying to become pregnant is younger than 35, after six months at age 35 or older, and sooner after age 40. Known fertility risks or very irregular cycles can also justify earlier care. See ACOG's infertility evaluation guidance for what an assessment may involve.

Menopause and sexual health

Perimenopause is the transition leading up to menopause. Periods may become irregular, and symptoms can include hot flashes, sleep changes, mood changes, vaginal dryness, and pain during sex. Menopause is confirmed after 12 months without a period or spotting when another cause is not responsible. The average age in the United States is 52, although the timing varies.

Pregnancy remains possible during the transition. The National Institute on Aging advises continuing birth control for a full 12 months after the last period when pregnancy is not desired.

Vaginal moisturizers can help ongoing dryness, while lubricant reduces friction during sex. Prescription options, including local vaginal estrogen and other therapies, may help when symptoms continue. A clinician can help weigh benefits and risks based on medical history. Menopause care may also include attention to bone and heart health; supplements are not automatically necessary for everyone.

Penis and testicular health

Wash the penis gently with warm water and avoid aggressive scrubbing or heavily fragranced products. If you have a foreskin and it retracts comfortably, pull it back gently, rinse underneath, dry the area, and return it to its usual position. Do not force a foreskin that does not retract.

See a clinician for a persistent rash, sore, lump, unusual discharge, painful urination, swelling, or a change in the shape of the penis. A new testicular lump or swelling also needs prompt assessment. Sudden, severe pain in a testicle is an emergency because a twisted testicle can lose its blood supply.

Erections, ejaculation, desire, and pain

Sexual function changes from time to time. Stress, relationship strain, sleep, alcohol, health conditions, hormonal changes, and medications can all affect desire, arousal, orgasm, erections, and ejaculation.

Erectile dysfunction

Erectile dysfunction (ED) means repeatedly having trouble getting or keeping an erection firm enough for sex. Occasional difficulty is common. Persistent ED can be related to diabetes, blood-vessel disease, nerve problems, hormone changes, medications, or mental health. The National Institute of Diabetes and Digestive and Kidney Diseases explains how clinicians evaluate the possible causes.

Effective treatments are available, but online or borrowed ED drugs are risky. A clinician needs to review interactions and determine whether an underlying condition also needs care.

Ejaculation concerns

Premature, delayed, or absent ejaculation can become a health concern when it is persistent and causes distress. There is no single amount of time that defines a satisfying sexual experience for everyone. Treatment depends on the pattern and may involve education, counseling, behavioral strategies, topical products, or prescription medicine.

Pain and low desire

Pain during sex is not something you have to accept. Dryness, infection, pelvic-floor problems, skin conditions, endometriosis, hormonal changes, and other causes may contribute. Low desire can also have physical, emotional, medication-related, or relationship causes. A clinician can help identify the cause instead of treating every case the same way.

Masturbation facts

Masturbation is a common sexual activity. It does not cause blindness, acne, mental illness, weakness, or infertility. Frequency varies widely, and there is no medically required amount.

Very vigorous or repeated friction can cause temporary soreness or skin irritation. Lubrication and a break usually help minor irritation. Speak with a clinician if there is an injury, ongoing pain, bleeding, or swelling. It may also be useful to seek support if sexual behavior feels difficult to control or interferes with sleep, work, relationships, or daily responsibilities.

When to seek care

Arrange a medical visit for possible STI exposure, new sores or discharge, persistent itching, pain during sex, bleeding after sex, an unexplained genital change, ongoing erection or ejaculation problems, or fertility concerns. Many sexual-health conditions are treatable, and confidential services may be available through primary-care, sexual-health, gynecology, or urology clinics.

Seek urgent care for sudden severe pelvic or testicular pain, heavy bleeding, a serious injury, or a possible recent HIV exposure. If a partner is controlling, threatening, or hurting you, confidential domestic-violence and sexual-assault services can help you plan for safety.

This article provides general information and does not replace individual medical advice.