National Women’s Health Week, celebrated this year from May 14-20, is an annual observance to empower women to make their health a priority. This year, NACCHO highlights the importance of sexual and relationship health for women at every age. Note that while some of this information pertains specifically to cisgender women, most of it applies to anyone who identifies as a woman.

When most people hear the term “sexual health,” they think of preventing infections like HIV and STIs, or visiting the gynecologist. While these behaviors are part of what make up sexual health, it’s also so much more; sexual health, as defined by the American Sexual Health Association, “is the ability to embrace and enjoy our sexuality throughout our lives. It is an important part of our physical and emotional health. Being sexually healthy means:

• Understanding that sexuality is a natural part of life and involves more than sexual behavior.
• Recognizing and respecting the sexual rights we all share.
• Having access to sexual health information, education, and care.
• Making an effort to prevent unintended pregnancies and STDs and seek care and treatment when needed.
• Being able to experience sexual pleasure, satisfaction, and intimacy when desired.
• Being able to communicate about sexual health with others including sexual partners and healthcare providers.”

In recognition of Women’s Health Week, celebrated last month, NACCHO presents tips to help women stay healthy at every age.

Adolescence (10-19 years old): Adolescence is a period of intense physical, emotional, and social change. Puberty transforms young girls into young women, and they enter early adulthood with new bodies and new feelings. Many young women start initiating romantic and sexual activity during this time. While not all young women will have sex before they’re 20, it’s important that they can access information and services related to sexual health, as well as a trusted adult who can answer their questions in a non-judgmental, medically accurate way. Ideally, young women will know about preventing pregnancy and sexually transmitted infections, accessing contraceptives and condoms, and recognizing dating violence before they have sex. Additionally, all girls can and should get the HPV vaccine as early as 11 years old.

While many resources and programs exist to provide services and education, there are fewer opportunities for young women to learn about navigating relationships and intimacy. Patterns that emerge in early relationships can be harder to break later on, and the social pressures that might make it difficult for women to assert themselves in relationships can influence women at a young age. Local health departments (LHDs) can support adolescents by assessing LHD clinics to ensure that they are youth-friendly; developing referral guides for adolescent-friendly health centers in their communities; and educating medical providers about adolescent sexual and reproductive health services including screening and testing recommendations, confidentiality and minor consent laws, and how to take a sexual history with adolescents. Many schools also provide sexual health education, and some provide sexual health services. Local health departments can support this work in a number of ways, including directly educating students or training teachers to educate students and providing sexual health services.

Twenties: Young women in their twenties (20-24) have the highest rates of sexually transmitted infections, compared to women of other age groups. Women aged 20-24 also have the highest unintended pregnancy rates. The Centers for Disease Control and Prevention (CDC) recommends that all women under the age of 25 be tested for chlamydia and gonorrhea annually, and should continue to be tested over the age of 25 if they have new sex partners or if their partners might be having sex with other people. It can be hard for women of this age to access sexual health services for a number of reasons including the inability to pay, lack of transportation, long waiting times, conflict between clinic hours and work and school schedules, and concerns about confidentiality (especially if they are covered under their parents’ insurance).

LHDs can help facilitate the access of sexual and reproductive health services among this population by developing referral guides to clinics with sliding fee scales, alternative hours of operation (e.g., late nights), and those close to public transportation. Additionally, they can engage in community outreach programs to educate community members, particularly young women of color who bear a disproportionate burden of sexually transmitted infections, about testing and treatment. But again, sexual health isn’t just about reducing risk. A lot of women in this age group are still unsure of themselves and how to communicate their sexual needs, wants, and fears, and unfortunately, there’s not a lot out there that helps them be more confident. This lack of confidence also contributes to unintended pregnancy and sexually transmitted infections, as it can be difficult to negotiate using condoms and other contraceptives with partners.

Thirties to Forties: In popular culture, women in their thirties and forties are considered to be in their sexual peak. Contrary to popular belief, this has nothing to do with anatomy, but increased confidence and comfort talking about sex with partners. Despite confidence in the bedroom, women might not have confidence to address their sexual health needs with their medical providers. As people get married later, or not at all, many women continue having multiple sexual partners during this age. Your medical provider might not recommend that you get screened for HIV/STIs, but you should always ask to get tested if you want to know your status. Providers also typically stop testing if women indicate they are in a monogamous relationship, but it’s always okay to ask, and it doesn’t mean that you don’t trust your partner.

Fifties to Sixties: Women at this age will likely experience changes in desire and physiology as they enter menopause. Because pregnancy is usually not a concern at this age, a lot of people don’t use condoms with new partners, but STIs are skyrocketing among older adults, and as of 2013, a quarter of individuals living with HIV were over 50 years old. Thinning vaginal walls can put women of this age at more risk for HIV, but medical providers are less likely to ask about sexual practices among older adults. Talk to your partners about getting tested together and advocating for safer sex if you’re not going to be monogamous, or if your partner is already living with an STI or HIV.

Seventies and Older: People assume that older adults stop being sexual somewhere in their sixties, but research and anecdotal evidence tell us that’s not the case. Like younger women, anyone with multiple or new sexual partners should continue getting tested for HIV and STIs.

At any age: Sex and relationships should always bring pleasure. If a partner says or does anything that makes you feel uncomfortable or unsafe, contact the National Domestic Violence Hotline to speak with someone or find resources in your area. HIV testing is recommended at least once in a lifetime between the ages of 13-64, but ask to be tested more frequently if you have multiple sexual partners or think one of your sexual partners might be having sex with someone else.

Local health departments can continue to support women’s sexual health across the lifespan by increasing the capacity of their staff to provide sensitive, responsive, and medically accurate services and education, and prioritizing women’s sexual health in strategic planning. From providing sexual health education in schools to training clinical providers to conduct sexual histories with older women, local health department staff can ensure that sexual health is maintained throughout the decades.