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Introduction to healthy sexual relationships
What is a healthy sexual relationship?
What makes a sexual relationship unhealthy?
Physical health risks in sexual relationships
Psychological health risks in sexual relationships
Common sexual difficulties
How lifestyle affects your sexual relationships
Tips for building a healthy sexual relationship

Having a healthy sex life and relationship are important parts of your overall health and wellbeing. The majority of adults experience sexual difficulties or health problems at some point. Sexually transmitted infections (including human immunodeficiency virus or HIV) and unwanted pregnancy are the most common sexual threats to physical health. There are also a range of emotional factors which can affect your sexual health and the health of your sexual relationship.
Most societies hold expectations about when, how often and with whom individuals should have sex (e.g. heterosexual vs homosexual, and casual vs steady relationships). These expectations generally vary considerably from individuals' sexual practices, desires and experiences, leading many to believe that what they want or do in a sexual relationship is abnormal or unhealthy.

What is a healthy sexual relationship?

According to the World Health Organisation, "sexual health is a state of physical, emotional, mental and social wellbeing in relation to sexuality; it is not merely the absence of disease, dysfunction or infirmity."
A healthy sexual relationship, therefore, is one in which the individuals involved are physically and psychologically content with the frequency and nature of sexual encounters. A healthy sexual relationship should involve protection against STIs and unwanted pregnancy (e.g. through condom use), be free of coercion, sexual assault, rape, discrimination, violence and pain. All individuals involved should be aware of their rights to stop sexual encounters at any time and feel confident to discuss and initiate sexual activities as they desire. Healthy sexual relationships may involve periods of abstinence, when sex is not desired or when the desired sexual partner is not available.
In terms of the types and frequency of sexual engagement, however, there is no recipe for a healthy sexual relationship. Peoples' sexual desires, perspectives and histories vary considerably. What is positive and healthy in one relationship may have negative health impacts in another.
Australians engage in a wide variety of sexual behaviours in addition to penetrative. A study of the sexual practices of over 20,000 adult Australian men and women found that:
65% of men and 35% of women had masturbated in the four weeks prior to being interviewed, and 12% and 14% respectively had used a sex toy
37% of men and 16% ofwomen watched X-rated movies
17%of men and 2% ofwomen visited internet sex sites (on purpose!)
17% of men and 14% of women engaged in anal stimulation
Nearly 10% of women and over 5% of men reported a homosexual experience
Around 4% of men and women reported engaging in roleplay, 2% in bondage and 4.5% in anal-oral stimulation.

Clearly there is no normal set of sexual behaviours in Australia and all of the sexual practices listed above are healthy, as long as the individuals involved feel comfortable with them.

What makes a sexual relationship unhealthy?

Physical health risks in sexual relationships
All sexual relationships involve the risk of unwanted pregnancy and STI.While condoms and other contraceptives mean both these threats can be avoided, they are still common in Australian society. Around 20% of Australian men and 17% of Australia women who participated in the Australian Study of Health and Relationships (ASHR) reported having had an STI at some point in their life. More than 2% of men and women reported anSTI in the year prior to the survey. Many Australians do not have a good knowledge of how STIs are transmitted, or the health consequences of them.
While the use of hormonal contraceptives in Australia is high (around 95% of sexually active, fertile women use them), over 20% of women surveyed reported terminating one or more pregnancies in their life.The proportion of Australians using condoms in steady relationships (7.1% and 22.5% respectively for cohabiting and noncohabiting relationships) and casual encounters (41.4%) remains low. Amongst heterosexuals, condoms are usually used to prevent pregnancy rather than STI.
Sexual relationships that involved physical violence, sexual coercion and/or rape are also unhealthy. Unfortunately violence, sexual coercion and rape are common in Australia. Because many people do not report to the police when someone they love abuses them sexually or physically, it is impossible to say exactly how many people have experienced this type of treatment. In the ASHR, one in five women and one in twenty men reported that they had been coerced to have sex. If you are in a relationship where your partner hurts you physically, makes threats or forces you to have sex, talk to a health professional so that you can find support to leave or improve the relationship. Your doctor will be able to refer you to an appropriate specialist.
Psychological health risks in sexual relationships
Psychological factors influence the way an individual feels about their sexual relationships. In every society, particular sexual behaviours are considered more and less acceptable, and those who engage in socially less acceptable (but nonetheless common) sexual practices may experience guilt or discrimination as a result. Sexual relationships generally involve strong positive emotions (e.g. love), but many relationships also involve negative emotional aspects. Physical violence, coercion to engage in sex, and rape have longterm psychological impacts. People who have been sexually abused on average report more sexual difficulties than those that have not been.You should be aware of your right to say no to unwanted sexual encounters (whether or not they involve penetrative sex, touching, kissing or other behaviours), as well as your right to engage in sexual practices you desire (as long as these don't violate the sexual rights of others).
Sexual difficulties are extremely common amongst Australian men and women and are often associated with psychological factors (e.g. women who report dissatisfaction with relationships can also be more likely to report difficulty achieving adequate vaginal lubrication). The ASHR noted thatthe majority of women (70%) and around a quarter of men reported a lack of sexual desire, and significant proportions of both sexes experienced sexual difficulties at some point in the year before the survey took place.
Considerable proportions of women reported experiencing lack of interest in sex (54.8%), lack of sexual enjoyment (27.3%), feeling selfconscious of their body while having sex (35.9%), performance anxiety (17%), being unable to reach orgasm (28.6%), pain during sex (20.3%) and problems with vaginal lubrication (23.9%). Physical pain, selfconsciousness of body and performance anxiety were more common amongst younger women, while the lack of interest and desire to have sex and inability to orgasm and lubricate were reported by more older women.
A significant proportion of men also reported lack of interest in sex (24.9%). Other common sexual difficulties for men included erectile disorder (9.5%), being unable to orgasm (6.3%), premature ejaculation (23.8%), performance anxiety (16%), not finding sex pleasurable (5.6%) and selfconsciousness about their bodies (14.2%). Men under 20 were more likely to report performance anxiety or selfconsciousness than their older counterpart; the likelihood of other sexual difficulties in men increased with age.
Importantly, sexual difficulties experienced by your partner can have a negative impact on your sexual function.While studies are limited, it has been shown that male sexual dysfunction can negatively impact the sexual function of female partners. A study comparing the sexual function of women with partners with erectile dysfunction to those without showed that sexual arousal, lubrication, orgasm, satisfaction, pain and total score were significantly lower in those who had partners with erectile dysfunction. Later in that study, a large proportion of the men with erectile dysfunction underwent treatment. Following treatment, sexual arousal, lubrication, orgasm, satisfaction and pain were all significantly increased. It was concluded that female sexual function is impacted by male erection status, which may improve following treatment of male sexual dysfunction.

How lifestyle affects your sexual relationships

Many things that you do every day will affect your sexual relationship (e.g. going to work, being pregnant, looking after children and drinking alcohol).Stress and anxiety reduce sexual desire and pleasure for men and women. Many people suffer from stress related to their work, their children or other aspects of their life (e.g. one-off events like a death in the family).
Having children has also been shown to influence sexuality. In the period immediately after childbirth, this is mainly related to hormonal changes in women. As children grow up, stress, fatigue and the responsibility of looking after kids all tend to reduce libido.
Drinking excessive amounts of alcohol also affects your sex life. After drinking alcohol, men are less likely to maintain an erection than when they have not consumed alcohol.
If you feel that your sexual relationship is unhealthy, perhaps you need to think, and talk to your partner about, how these lifestyle issues might affect you.

Tips for building a healthy sexual relationship

In order to be healthy, your sexual relationship must fulfill your sexual desires and those of your partner/s. While there is no recipe for a healthy relationship, these tips may help you improve or maintain the health of your relationship:

• Use contraceptives to protect against unwanted pregnancy.

• Use condoms to protect against STIs, especially if you have more than one sexual partner or have casual sexual partners.

• If you or your partner has trouble maintaining an erection, talk to a health professional about whether or not medication will help.

• If you or your partner has trouble with vaginal lubrication, try using a water-based lubricant, available over the counter at a pharmacy or supermarket.(e.g. if you have trouble lubricating or maintaining an erection, it may be due to dissatisfaction with your relationship or anxiety about sex, not a biological condition).

• Remember that a wide variety of sexual practices are normal, including homosexual behaviours, masturbation and use of visual sexual stimuli.Consider trying these in addition to, or instead of, what you currently do if you are not satisfied with your sexual relationship.

• Sex can also include intimate behaviour without genital contact (e.g. kissing and cuddling). This should be an important part of sexual relationships.

• Talk to your partner. Be open and honest about your desires and level of satisfaction and try not to be judgmental when your partner is discussing their desires.

• Talk to a health professional (e.g. a sex therapist, marriage counselor or psychologist) about aspects of your sexual relationship you would like to improve. Never use violence or other forms of intimidation to coerce a partner to engage in a particular sexual practice and be aware of your right to say no to sexual practices you are not comfortable with (even if you have done them before).

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If you have found controlling your weight harder as you have gotten older you are not alone. Data from the most recent Australian surveys show that we do indeed get fatter as we get older. Obesity figures peak at around the 50-59 year old age group, affecting some 24% of men and 30% of women. Making matters worse is that this weight gain tends to accumulate around the middle - hence the term "middle-age spread" - and this pattern of fat distribution carries an increased risk of diabetes, heart disease and high blood pressure.

Women tend to notice the most dramatic changes to their waistline around the menopausal years. Hormones can be blamed at least in part. They can't be blamed for the excess fat laid down, but hormones are involved in changing where you store any excess fat. Oestrogen levels drop by some 90% during menopause and this change in the balance of hormones means that women tend to take on a more male pattern of fat distribution - less on the hips, thighs and limbs and more around the waist. This is one reason why the risk of heart disease in women increases after menopause and becomes similar to that for men. In men the changes may have been more subtle with waistlines slowly expanding over the years. You may suddenly notice how overweight you have become, but don't really know how or when it happened. So why does this happen and is there any way to prevent middle age spread?

The first thing to realise and accept is that middle-age spread is not inevitable, nor is the cause any different to weight gain at any other time of life. Aside from the change in fat distribution for women, the basic laws of biology apply: if you have gained weight over the last few years you have been consuming more kilojoules than you have been expending. It just feels like middle-age spread because that is when your expended waistline becomes noticeable - in fact it has been creeping up on you for many years. The average weight gain is around 0.5kg (1lb) a year - it doesn't seem like a lot, but 10 years later you weigh 5kg more. If this continues by the time you reach middle age you may well find you weigh in excess of 10 kilograms more than you did in your 20s. There are several reasons why we experience this slow weight gain:

1. As we age we slowly lose muscle, primarily because we don't use it. This is turn slows our metabolic rate and so we burn less energy every minute of every day.
2. Secondly we continue to eat the same amount of food, sometimes more, with business lunches, socialising around food and perhaps greater affluence allowing for more meals eaten out.
3. We tend to move less - both in terms of more formal exercise and in day to day activity. This can be a time factor and/or it can be linked to more health problems or aches and pains making you feel less like being active as you get older.

Interestingly for women in particular there is also a psychological side to middle-age weight gain. The Women's Health Australia Study followed 900 women over a three year period as they experienced menopause. The researchers found differences in behaviour and lifestyle between those women who gained weight and those who didn't. Of little surprise is that the women who avoided weight gain were more likely to have cut back on high fat foods, but they were also less likely to eat in response to emotions such as anger, anxiety and depression. It seems that particularly during the menopause, a time of psychological change that affects some women more than others, finding non-food ways of dealing with negative emotions is important if weight gain is to be avoided.

What can we do about it?
There is no magic to weight loss at any age; the answer lies in five words - eat less and move more. While the philosophy is simple, as anyone who has tried to lose weight and keep it off knows full well that putting it into practice is much more difficult. But understanding how we burn and store fat can help to form the most effective approach to both preventing weight gain and losing weight in middle age

The myth of the "fat-burning zone"

The body burns two major fuels at rest and during exercise - fat and glucose (carbohydrate). But there is no switch from one to the other, rather there is always a mixture of the two. What does change is the ratio of fat to glucose being used. At low compared to high intensities of exercise the percentage of energy drawn from fat will be higher. This knowledge led to the widespread use in exercise circles of the "fat-burning zone". Many fitness instructors still use this and calculate from your age, the best heart rate for you to work at to burn fat. It might sound a solid scientific way to increase fat burning but there is a serious flaw to the theory. While at lower intensities you might burn a higher proportion of fat, the total amount of energy you expend is less and therefore the total fat you use up is also likely to be less. Furthermore in the post-exercise period we continue to burn fat and in fact after working out at higher intensities this post-exercise fat burning is greater than following a lower intensity workout. To illustrate this let's consider two workouts; you plan a 30 minute exercise session - will you burn more fat by walking, keeping your heart rate in the "fat-burning zone", or by increasing the intensity and jogging?

Walking does indeed use a higher proportion of fat; in this example 60% of the total energy comes from fat. This decreases to 40% of the total energy when we increase the intensity to a jog. However because jogging uses more energy in total, the amount of fat used up remains almost the same. Furthermore because the total energy expenditure is greater when jogging you use up more of your glucose stores. In the first few hours after the exercise session your body then works on restocking these stores from incoming food. Meanwhile the body continues to burn fat to support the ongoing energy requirements. After the lower intensity workout this happens to a far less extent since less total energy was expended. In other words it's not just how much fat and energy in used up during the exercise session, but how much fat is used up in total during and after exercise

So forget about a fat-burning zone. Rather work as hard as you can for the time that you have. Of course don't work so hard that you only keep it up for a short length of time - you need to keep the time the same. Alternatively you can work at the lower intensity but do it for longer….but for those that already struggle to find the time to exercise, working out at a higher intensity is the effective route to results.

The best fat burning exercises

1. Lifting weights
One of the reasons for middle age spread is that we lose muscle as we age resulting in a declining metabolic rate. It's not therefore surprising that lifting weights to maintain, or ideally to increase, your muscle mass can dramatically reduce the gain in body fat over time. A study of 164 American overweight women found that those who weight trained twice a week over a two-year period decreased their body fat percentage by 3.7%, while the control group who did no weight training experienced no change. Furthermore the weight-training group significantly reduced the typical gain in fat around the middle - they experienced a gain of 7% in intra-abdominal fat compared to 21% in the control group. Convincing evidence that lifting weights really can help to reduce middle-age spread.
How to do it:
Join a health club and have a weight training program designed for you using gym equipment
Find a personal trainer who will design and supervise your strength training workout. They may use a gym or bring their own equipment to work with you in your own home or outdoors.
Use a home workout DVD incorporating resistance exercises using your body weight (can be just as effective as using weights) e.g. push-ups, or using a resistance training band.

2. Cardio exercise
Any exercise that raises your heart rate and gets you puffing and panting works the cardiovascular system - hence the term cardio exercise. This form of exercise is where you can push the intensity of your workout and expend the most amount of energy in a session. The more intense the workout, the more kilojoules are burned, so aim to work hard with the time you have. This doesn't mean you have go running - if you a newcomer to exercise a brisk walk may feel hard, but as you get fitter you will find you can increase the pace and keep the exercise challenging. Whatever the mode of exercise use a scale of 0-10 to help you work at the right level - 0 is at complete rest and 10 is extremely hard. Aim to work at around 7-8 ie hard enough to have you puffing but not so hard you couldn't keep it up for very long.
How to do it:

Walking, jogging and running are hard to beat for cardio exercise. What's more they are free (after the cost of a decent pair of shoes) and can be done at any time. This is ideal for busy people who struggle to find the time to work out. While running may not be an option for many reasons including bad backs, knees or being very overweight, almost everyone will benefit from walking. Set yourself a time or distance and aim to complete it at least every other day.
Cycling is another good option although you obviously need to invest in a bike and helmet to get started. Alternatively look for an indoor cycling class, or use the stationary bikes at your local health club or leisure centre. Cycling is non-weight bearing and therefore can be ideal for those with joint pain who struggle with walking or jogging. However make sure to get some advice from a professional to ensure you are set up correctly on the bike to avoid back or knee pain.
Cardio machines - either on the gym floor or for home use provide a convenient means of getting a cardio workout indoors. These include bikes, treadmills, cross-trainers, stair-climbers and rowing machines. Each has its own advantages and so a combination of equipment is best. Be wary of splurging on an expensive piece of equipment for home. More often than not these end up gathering dust and taking up space in the corner of the room when the novelty wears off. You are far better off joining a health club with a variety of equipment to enable you to vary your routine and prevent boredom setting in.

Yoga
Yoga is usually thought of in relation to flexibility or stress-relief rather than fat-burning, but a US study of 15,500 middle-aged men and women found that yoga may help to prevent middle-age spread in normal-weight people and may promote weight loss in those who are overweight. The normal-weight men and women who regularly practised yoga (at least 30 minutes one or more times a week) gained less weight over the study period of 10 years, than those who didn't practice yoga. The results were more impressive for those who were overweight - those who practised yoga lost weight over the 10 years while those who didn't gained over 6kg. What is interesting about this study is that the results cannot simply be due to how much fat or total energy is burned by the exercise since most forms of yoga are not sufficiently aerobic to burn a serious amount of kilojoules. The authors speculate that it is the psychological side of yoga that may elicit the effect. Yoga involves building an inner strength, sometimes through a form of meditation, and develops body awareness. The theory is that together these factors help you to find the inner strength and resourcefulness to stick with a healthy eating plan and to respect your body enough to feed it well. Whatever the reasons there seems little to lose with so many other benefits to this form of exercise.

How to do it:
Look for a good yoga school in your area and experiment with different styles until you find one you like - some are more physically demanding where others may be of a more meditative nature.
Most health clubs and leisure centres now run yoga classes, although often these are taught by fitness instructors who have learned yoga rather than experienced yoga masters who have practised for many years. As a result they may not remain as true to the original practice. Ask about the qualifications of the instructor if you are not sure.
Practise in the comfort of your own home. You can either buy an instructional DVD or practise the moves you have learned in class

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How can women improve their sex drive? According to recent results published in the Journal of Sexual Medicine  – take a placebo.
 data from a previous clinical trial that followed 200 women with sexual dysfunction over a 12-week period. Of the 200 women, 50 were randomly chosen to receive a placebo instead of a drug treatment for low sexual arousal.
 
Over 12 weeks the women rated their symptoms of sexual dysfunction (including low sexual desire, low sexual arousal, and problems with orgasm), talked to a health provider about their difficulties, and monitored their sexual behaviors and feelings regularly. The results showed that on average, one in three of the women who took a placebo showed an overall improvement, with most of the improvement happening in the first four weeks.
This study shows that simply opening a new line of communication about sex can have a positive effect in many women with low libidos. "The findings from our study show how a woman's expectations to improve sexually can have a substantial positive effect on her sexual wellbeing without any actual drug treatment," . "Expecting to get better and trying to find a solution to a sexual problem by participating in a study seems to make couples feel closer, communicate more, and even act differently towards each other during sexual encounters."
 in the "Theme Program: What's Love Got to Do With It?"  an overview of findings from a 6 year, intensive investigation of human sexual motivation that involved over 3,000 individuals. This work revealed that women have sex for 237 distinct reasons ranging from the mundane to the spiritual and from the altruistic to the vengeful. And only one of the reasons is love.