Sexual Health and Wellbeing

Worried about a sore, a strange discharge, a test result, or that sex just does not feel the way it used to? Sexual health is part of your overall health, and questions about it are common. Nurses and doctors hear them every day.

What is happening

Sexual health covers much more than infections. It includes safer sex, contraception, desire, pleasure, pain, erection problems, fertility and feeling safe and respected. Mind and body are closely linked here: stress, depression, anxiety, grief, tiredness, some medicines, alcohol, diabetes and heart disease can all lower desire or affect performance.

In South Africa, many sexually transmitted infections (STIs) are common and some cause no symptoms, especially in women. HIV is manageable with treatment, and people on treatment with an undetectable viral load do not pass HIV on through sex. Public clinics offer free HIV testing, STI treatment, condoms, contraception and PrEP (a daily pill that prevents HIV). PEP is emergency medicine after a possible HIV exposure, such as a condom breaking or sexual assault, and must be started as soon as possible, within 72 hours.

Consent matters every time. Sex should never be pressured, forced, or traded for safety, money or a place to stay.

Signs to notice

• Discharge, burning when passing urine, sores, lumps or itching in the genital area
• Pain during or after sex
• Ongoing low desire that bothers you or your partner
• Erection problems that keep happening
• Worry about a possible exposure
• Feeling pressured into sex or unable to say no

30-second self-check

Answer yes or no to each question.

• Have you not had an HIV test in the last year?
• Have you had sex without a condom with a partner whose status you do not know?
• Do you have any unusual discharge, sores or pain?
• Has low desire or erection difficulty lasted more than a few months?
• Do alcohol or drugs often play a part when you have sex?
• Do you feel you cannot talk to your partner about sex or protection?
• Have you ever felt pressured into sex?

0-1 yes: You are looking after your sexual health. Keep testing regularly.
2-3 yes: It is worth a visit to a clinic or doctor for a check and a confidential chat.
4 or more yes: Please get support soon. A nurse can test and treat, and a counsellor can help with relationship or pressure concerns.

What you can do next

• Today: If a condom broke or you were forced, go to a clinic or hospital today and ask for PEP. Do not wait.
• This week: Get an HIV and STI check at a clinic, pharmacy clinic or GP, or use an HIV self-test kit.
• This month: Talk to your partner about testing together, protection and what feels good. Ask your clinic about PrEP and contraception that suit you.
• If desire or erections have changed, ask for a blood pressure and sugar test. These problems can be early signs of heart disease or diabetes.
• Take your partner along if an STI is found, so you are both treated and do not reinfect each other.

Your tool

Lifestyle Health Check - a two-minute private check of your sleep, stress, alcohol, smoking and activity habits, all of which affect desire and sexual health.

When to get professional help

Get checked if you have any symptoms, a possible exposure, or ongoing problems with desire, pain or erections. If you have been sexually assaulted, go to a hospital or Thuthuzela Care Centre as soon as you can for PEP, emergency contraception and care; you can decide about opening a case later. If you are in danger right now, call SAPS on 10111 or the GBV Command Centre on 0800 428 428.
Who can help: nurse, doctor, psychologist, counsellor, social worker, emergency services

Getting help in South Africa

Public clinics offer free, confidential HIV testing, STI treatment, condoms, contraception, PrEP and PEP. Thuthuzela Care Centres, based in public hospitals, support survivors of sexual violence. For relationship, desire or emotional concerns, the Cleared Mind 24-hour Careline on 0800 212 146 can link you to a counsellor.