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What Is Healthy?

To raise the bar on the intimate relationship in our marriages, couples need to know what healthy sexual relationships are if they want to be able to create a “sextraordinary marriage.”[i] In part 1 and part 2 of this article you will find 20 characteristics that help determine what defines healthy and unhealthy sexuality.

Many husbands and wives struggle to understand what healthy sexuality really is. One wife said to me, “I don’t even know if I know what healthy sexuality looks like other than that I need to have a voice in the bedroom and not have it be all about him.” Husbands also admit that they really don’t have an idea of what healthy is either given how much their sexual learning is from questionable sources like pornography.

One of the reasons I created this list is to help couples understand what a healthy or ideal sexual relationship looks like and what unhealthy looks like. I also wanted to help couples figure out how they might need to relearn healthy sexuality as they unlearn some ways of thinking, being and behaving in their intimate relationships.

Broader Context to Sexual Characteristics

Most lists of this kind have a focus on the unhealthy characteristics related primarily to pornography or addiction. Author and sex therapist, Wendy Maltz created a simple list of differences between healthy sex and porn-related or “unhealthy” sex[ii]—concepts that have been integrated into this chart. Additional insights have been gleaned from the book Every Man’s Battle by Christian author Stephen Arterburn and Men’s Sexual Health by renowned sex therapists Barry W. McCarthy and Michael E. Metz.

I didn’t want this list to be solely about addictive or compulsive issues since that is just one of many dimensions of unhealthy sexuality. So, I have added my clinical experience as a marriage counselor and sex therapist helping couples develop healthy sexual relationships. This added context creates a broader perspective on healthy and unhealthy sexual relationships. Additional insights come from my Male Sexuality Survey of nearly 900 respondents.

This list is a rare resource not only due to its comprehensive look at healthy sexuality and the uniqueness of both male and female sexual wiring, but also because it seeks to include God’s designs for sex. With such a broad perspective, this list can help both husbands and wives move toward a healthier, richer intimate relationship—a “sextraordinary marriage!”

The table is meant to be a simplified listing of the 20 characteristics of healthy and unhealthy sexuality with additional commentary below the chart to clarify and expand on each item for greater understanding. Part 1 of this article contains characteristics 1-10.

Commentary on Characteristics of Healthy and Unhealthy Sexuality

1.Accepting of body vs. Uncomfortable with body – This characteristic may tend to be more of an issue for women than for men but both husbands and wives need to learn to love and accept themselves and make peace with their bodies as imperfect as they may be. Women especially struggle with body image issues, so not working through and overcoming body image struggles will contribute to a reticence to engage sexually. On the other hand, when women are able to accept their body as is even embracing and confidently sharing themselves sexually, they are able to more fully and completely let go and enjoy the intimate experience with their spouse—thus creating a stronger connection.

The self-talk of this healthy acceptance would sound like, “I like who I am. I accept my body and I’m happy to share it with you.”[iv] Men can develop this healthy self-acceptance as well, but it is less likely for negative thoughts about their appearance to dominate their minds. Unhealthy sexuality includes dissatisfaction with your spouse’s body because it can’t compete with surgically and digitally enhanced bodies often seen in media. Some will subtly or overtly pressure their partners to have their bodies surgically altered or enhanced. Both spouses need to accept the other’s body even if not in tip-top shape or it increases feelings of rejection and adds more resistance to opening up sexually.

2. Affection for its own sake vs. Affection only leading to sex – Affection or loving touch is needed in a marriage for its own sake—not just as something that leads to sex. Many women over the years have told me how they remember when they decided to simply stop touching their husbands because it always led to sex. That may not be the best way for either spouse to address issues of unmet needs but is a typical response. It’s a common characteristic of unhealthy sexuality where one asks for respectful behavior from the other but doesn’t receive it, so they just withdraw altogether.

Men might similarly decide to stop doing something loving because it doesn’t lead to their desired outcome. It’s an issue for both spouses to consider.  Healthy sexuality means that both husbands and wives are able to enjoy non-sexual touch or affection for its own sake, not solely as a precursor to sex. The spontaneous-desire spouse may think why just cuddle or hold hands when you can have the bigger bang of sex? In reality, both are necessary in a healthy marriage because there’s a need for non-sexual affection separate from, and in addition to frequent lovemaking.

3. Agency vs. Entitlement – Healthy sexuality requires that both spouses feel like they have a voice in the bedroom and an ability to freely discuss their desires and choose which desires to act upon. The different wiring and general disparity in sexual desire common to any marriage, can often create a dilemma when it comes to agency and choice. For sexuality to truly bless a marriage, both spouses must engage with authenticity. The cultivated-desire (lower-desire) or less-verbally expressive spouse needs to have an equal voice regarding bedroom activities and needs to feel able to genuinely choose to engage sexually or not. Sometimes that means the less-expressive spouse needs to be able to speak first, so that both have the ability to be heard. It’s also a matter of balancing desire as in the case of the woman who said to her husband, “If I say no to sex, and you are a grouch for three days then I can’t really choose.” It’s human nature to resist any form of pressure or persuasion especially if we’re trying to avoid “duty sex” and shoot for “I want you” sex. And “I want you” sex doesn’t sound like this, “I know it’s been awhile honey, so we can have sex if you want to.”

If the cultivated-desire spouse is consistently uninterested in being intimate, or barely willing, then it can leave the spontaneous-desire spouse feeling stuck. Agency is such an important principle in a healthy sexual relationship. It’s like in the story of Beauty and the Beast. It’s not until the Beast lets Belle go that she can freely choose to love the Beast of her own accord. It’s why the cultivated-desire spouse (with their lower desire) needs to feel like they can genuinely choose, in order for them to freely and enthusiastically engage. That means the spontaneous-desire spouse needs to learn how to be okay even when that need isn’t being met exactly how, when and how often they want.

The catch-22 with agency is that until you can genuinely let go of something you won’t be able to have it. And when you do let go of it, that is when you can have it. The cultivated-desire spouse also needs to be working on developing their sexuality so that it’s something they do and enjoy as part of their own wholeness and not just something they do for their spouse. The ultimate goal is for husband and wife to both move toward becoming more balanced in their desire. While sexuality is definitely a vital aspect of marriage, if one person has a demanding entitlement to sex, then the other will naturally feel pressure and expectation—even manipulation or coercion—which inevitably inhibits them from freely choosing to engage in “I want you” sex. The result is duty sex at best. Sexual self-mastery and bridling of desires are needed for the spontaneous-desire spouse with sexual development being needed for the cultivated-desire spouse as an important part of a healthy, balanced sexual relationship.

4. Bridled vs. Unrestrained – Even within marriage and the passion of a sexual relationship there is still a need for bridling one’s desires or cultivating one’s desires. Marriage isn’t a constant sexual nirvana. Differing needs, desires and priorities will need to be negotiated. A truly successful sexual relationship requires self-mastery and bridling of desires by both spouses. The spontaneous-desire spouse will need to exercise self-control, as well as manage their own expectations, desires and emotions. They will need to learn to find joy in cantering or trotting along to more closely match pace with their spouse—even though their inclination is to gallop.

The cultivated-desire spouse will similarly need to exercise self-control to rise above fears or frustrations, to prioritize sexual growth, and to manage their expectations, desires, and emotions. They will need to learn to find joy in trotting and even cantering to more closely match pace with their spouse—even though their natural inclination is to walk. However counterintuitive it may seem and frustrating it may feel, the spontaneous-desire spouse needs to create a safe, pressure-free environment to allow the cultivated-desire spouse to shift their focus and energy away from self-protection and towards sexual growth. If neither the spontaneous-desire spouse works on bridling and balancing his desires with his spouse nor the cultivated-desire spouse works on embracing and developing her desires, then that alone will create an unhealthy imbalance in the sexual relationship.

Sex is a team sport, and both will need to work on it in order to create a “sextraordinary marriage.”[v] For men with their God-given testosterone-driven libido most still need to consistently work at sexual self-mastery. Since female fuel for desire tends to be emotional and relational; mutual respect, emotional connection and safety will be needed. In addition, since women tend to come into marriage with a general lack of affirming sexual conditioning, they will often need to work at embracing, nurturing, developing and enjoying their sexuality though the younger generations of women seem to be moving toward better sexual readiness including more affirming sexual attitudes in marriage. When the heightened sexual fuel of pornography is or has been involved with one or both spouses then special attention to relearning healthy sexuality, respecting personal boundaries, mastering any compulsive or obsessive sexual desires for specific activities or impractical frequency is vital for a mutually fulfilling and healthy sexual relationship.

5.Connection-based vs. Performance based – Healthy sexuality is centered on more than just orgasm and the desirable physical pleasures of sex. It aspires to also deepen the interpersonal connection between husband and wife. Ideally, sexuality incorporates the inevitable idiosyncrasies or ups and downs of human sexuality making space for imperfect “good-enough sex”[vi] to be good enough. An over focus on performance, perfection or outcome induces greater performance anxiety. Potential spectatoring (watching yourself versus letting go) decreases the ability to fully abandon ourselves to the exquisite involuntary response of sexual climax.

6.Fully present and engaged vs. Detached and passive – Unhealthy sexual interactions often consist of a mechanical or passive experience of “going through the motions” sexually. I often call this “dead-fish sex.” Individuals are often detached or not fully present mentally, emotionally or physically. Whether it’s a wife who struggles with keeping her mind focused on the sensual experience, or a husband whose mind wanders to fantasizing about other images or activities, both avenues keep couples from enjoying the fully connected experience of healthy connected sex. Being fully present means you are focusing on each other and the pleasure you are giving and receiving. Being fully engaged means you are actively participating in the intimate experience versus being a passive bystander.

7. Informed and educated vs. Uninformed and uneducated – Unfortunately too few individuals come into marriage sufficiently informed in positive ways about important details regarding each other’s differences in male/female sexual wiring and the specific intricacies and inhibitors of male and female sexuality. This lack of knowledge—affirming the goodness of healthy sexuality within marriage—contributes to unhealthy sexuality, lack of fulfillment, hurt feelings and disconnection in the sexual dimension. Both spouses becoming educated on these important topics will allow them to see each other, and their differing sexual wiring, with patience, understanding and compassion, rather than seeing each other as defective or depraved.

One couple found that as they got educated on these important details, she was able to see him not as an overly sex-obsessed man, but as a healthy, normal guy. He was more patient and helpful as he came to understand how and why she still needed to be warmed up each time even after she began to experience the ecstasy of orgasm. He realized that she wasn’t broken, but that he hadn’t known how to light her fire. Many young people have received most of their information about sex (if any at all) from negative, inaccurate or pornographic media sources. Such inaccurate, stereotypical and distorted information leads to unhealthy, unrealistic expectations and negative intimate interactions.

Sometimes being uninformed or misinformed by questionable sources leads a spouse to believe they already know everything there is to know, when in reality they simply don’t know what they don’t know. Having an affirmingly informed and educated understanding of healthy male and female sexuality will also result in having healthy, affirming thoughts and beliefs about sex. In the course of gaining a healthy and wholesome sex education, the ability to openly and comfortably discuss sex and sexuality becomes a vital skill for both husband and wife.

8.Multi-dimensional intimacy vs. One-dimensional focus – Ideal sexuality has a multi-dimensional, holistic quality where there is mental, emotional and even spiritual intimacy and connection—in addition to the sexual. Unhealthy sexuality tends to be one-dimensional with all the attention going solely to the physical act or outcome. Without the added elements of mental, emotional, spiritual and relational the intimate experience feels detached—like it’s a separate, unrelated experience meant solely for physical release. It can leave both feeling unfulfilled in multiple ways.

One wife explained, “When my husband is so focused on us doing a specific sexual act than he is on connecting with me that’s when I feel like it’s his addiction talking.” Being interested in exploring new or enhanced ways of being intimate can be healthy and fun, but a focus on a technique or position to the point of ignoring or disregarding connection with one’s spouse is not healthy. It’s the repeated focus or over-focus on the physical or a new sexual novelty that causes the problem. Even with a quickie, healthy sexuality still includes connection that is more than just physical.

9. Mutual initiation vs. Imbalanced initiation and effort – Since men generally have the higher, spontaneous desire given their biology and the extra testosterone in their system, they tend to do most of the initiating. There is also about 20% of men that function as the lower-desire spouse[vii] who may have to work on initiating just like the wives who have more of a cultivated/responsive desire. Striving for healthy sexuality ultimately means it becomes possible for both spouses to genuinely initiate. Given the spontaneous-desire spouse’s (often the man’s) desire to be wanted and desired, healthy sexual relationships need to have a more balanced effort in initiating sex. Healthy sexuality has the benefit of a bridled male (or spontaneous) sexual desire and an embraced and developed female (or cultivated) sexuality resulting in a more balanced effort and investment in the sexual dimension of marriage.

10.Mutuality vs. Self-centered – In general, healthy sexuality has an other-oriented focus. There is a mutuality to the sexual relationship, with an ongoing interest in and respect for each other’s differing sexual process. Flowing from mutuality is a deep respect for the sensitivities and desires of the other. With this particular characteristic there can especially be a gender issue at play. Since women are generally socialized to attend to others even at the expense of themselves, women focusing too much on their spouse can negatively affect the sexual experience. Given a woman’s wiring to warm up more slowly and be more easily distracted, wives actually need to focus on their own sensual experience in order to attain sufficient arousal and enjoyment.

Her enjoyment is wired in as part of his enjoyment in healthy sexual relationships. On the other hand, with a man’s higher physiological drive and ease of access to arousal, men generally need to focus on bridling their desires in order to stay alongside the wife’s arousal. When unhealthy sexuality is further compounded by the harmful effects of pornography and sexual compulsivity, it leads to ignoring the spouse’s feelings, desires and boundaries—sometimes pushing them to engage in behaviors they may consider to be disrespectful at best or degrading and victimizing. These activities harm both self and spouse. The less-expressive spouse will often submit to self-centered requests in an effort to please or to avoid conflict and confrontation. This simply begins a process of accumulating anger, resentment and/or fear. This is not a healthy response but common for the dynamic of the imbalance of power prevalent in many marriage relationships.

Knowledge is power, so I hope these insights on the characteristics of healthy and unhealthy sexuality will help you raise the bar on the intimate relationship in your marriage—allowing you to create your own “sextraordinary marriage.”

(CLICK HERE to read Part 2 — characteristics #11-20!)


BIO — Laura M. Brotherson, LMFT, CST, CFLE

Licensed Marriage and Family Therapist and Certified Sex Therapist, Laura M. Brotherson is the founder of The Marital Intimacy Institute with a mission to help couples create “sextraordinary marriages.” She counsels with couples, individuals and families in private practice (and online). Laura is the author of the best-selling book, And They Were Not Ashamed: Strengthening Marriage through Sexual Fulfillment, and her latest book, Knowing HER Intimately: 12 Keys for Creating a Sextraordinary Marriage.

Laura is actively engaged in providing marriage education through Couples Cruises, articles, newsletters, radio and television broadcasts, and presenting at conferences and workshops. Laura is passionate about helping couples navigate the intricacies of intimacy to help build strong marriages and families. Laura and her husband are the founders of StrengtheningMarriage.comyour trusted resource for education, products and services to strengthen marriages … intimately!

Connect with Laura:

Instagram: @StrengtheningMarriage

[i] Laura M. Brotherson, Knowing HER Intimately: 12 Keys for Creating a Sextraordinary Marriage (Boise, Idaho: Inspire Book, 2016).

[ii] Wendy and Larry Maltz, The Porn Trap: The Essential Guide to Overcoming Problems Caused by Pornography (Collins Living, 2008), 182.

[iii] Barry W. McCarthy and Michael E. Metz, Men’s Sexual Health (Routledge, 2007).

[iv] Brotherson, Knowing HER Intimately, 25.

[v] Brotherson, Knowing HER Intimately.

[vi] McCarthy and Metz, Men’s Sexual Health.

[vii] Daniel J. DeNoon, “When a Man’s Sex Drive Is Too Low,” WebMD, May 21, 2009,