As therapists, we sit with people during some of their most vulnerable moments. And when it comes to talking about sex, many clients come in carrying layers of shame, confusion, or silence. Others are still figuring out what they even believe about their sexual selves. That’s why I find the Six Principles of Sexual Health to be such a grounding and empowering framework—both for our clients and for us as clinicians.

These principles, developed by the National Coalition for Sexual Health, give us language to support conversations around sexual wellbeing in a way that’s clear, nonjudgmental, and client-centered. They help us teach, guide, and hold space for exploration—whether we’re working with individuals, couples, or folks in non-monogamous relationships.

Here’s how I like to bring them into clinical work:

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Consent

Consent isn’t just about saying “yes” or “no”—it’s about presence, clarity, and ongoing communication. And yet, so many clients haven’t been taught how to recognize or give true consent. In session, we can help clients explore what it feels like in their body when something is a “yes,” a “no,” or a “maybe.” We can talk about how trauma, people-pleasing, or socialization might be making it hard to hold their boundaries.

Try this: Invite clients to practice everyday boundary-setting. It might start with something as simple as deciding what they want to eat or whether they feel like hugging someone. The more we practice consent outside of sex, the more natural it becomes within it.

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Non-Exploitation

Non-exploitation means safety—not just physical, but emotional and relational. It’s helping clients notice where pressure, coercion, or imbalance has shown up, and how that’s impacted their experience of sex or intimacy. This principle can open up deep work around past harms and future healing.

Try this: Ask questions like, “Did you feel like you had a choice?” or “What would it have been like to speak up in that moment?” These open the door to understanding without blame or shame.

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Protection from STIs and Unintended Pregnancy

So many clients come in with gaps in their sexual health education. Our job isn’t to lecture—it’s to create a space where they can ask questions and make informed choices. Protection is personal, and it needs to be contextualized to the client’s relationships, values, and access to care.

Try this: Normalize STI testing and safer sex conversations by weaving them into your assessments, even when clients aren’t bringing it up directly. You might ask, “How do you and your partner talk about testing?” or “What forms of protection feel right for you?”

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Honesty

Sexual honesty can feel risky—especially if someone is worried about rejection, judgment, or loss. But it’s also a key piece of authentic intimacy. Our work here is about helping clients uncover their truths and decide when, how, and with whom to share them.

Try this: Validate the courage it takes to say something out loud for the first time. Whether it’s naming a desire, a disconnection, or a part of themselves they’re just starting to understand, that honesty deserves to be met with compassion.

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Shared Values

So much of sexual compatibility comes down to shared values—not just technique or frequency. What does each person want sex to mean in their life? What are they hoping to feel, to give, to receive? This principle is especially important when working with couples navigating change, misalignment, or opening their relationship.

Try this: Ask, “What does a good sexual relationship look like to you?” Then invite partners to share where they overlap and where they differ—with curiosity, not judgment.

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Mutual Pleasure

Pleasure is not optional—it’s essential. And yet, many clients, especially those socialized as women or living with chronic illness, trauma, or pain, have been taught to disconnect from pleasure or deprioritize it. Our job is to help them reconnect to their body and define what pleasure means to them.

Try this: Explore pleasure through a broad lens—touch, movement, breath, stillness, imagination. For some clients, just naming what feels good (with or without sex) is a big first step.

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Final Thoughts

The Six Principles of Sexual Health aren’t a checklist—they’re a framework. They give us language to help clients build safety, agency, and connection in their sexual lives. And they help us, as clinicians, stay grounded in a sex-positive, inclusive, trauma-informed approach.

Whether you’re working with long-term couples, newly out individuals, or someone rediscovering themselves after years of silence, these principles can guide the way.

Much Respect,

Melinda Porter

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