34 Maintaining Healthy Relationships

Questions to consider:

  • How does self-care benefit relationships?
  • Why is community so important to healthy relationships?
  • What is sexual health?

Relationships are key to happy and healthy lives. According to Dr. Robert Waldinger, director of the Harvard Study of Adult Development, people with the best health outcomes were people who “leaned into relationships, with family, with friends, with community.”

A photo shows two young women sitting on the edge of a busy sidewalk eating a meal. One reaches to the other’s face as if to remove a piece of food.
Figure 11.11 Healthy relationships involve trust, respect, and support. (Credit: Garry Knight / Flickr / Attribution 2.0 Generic (CC-BY 2.0))

The quality of our relationships is important, however. What makes a relationship healthy? Relationships come in many forms: lovers, family, friends, coworkers, team members, and neighbors. Think of a relationship where you have mutual respect and trust, supporting each other in tough times, celebrating the good times, and communicating with ease and honesty. This is a healthy relationship. Do you have someone in mind? On the other hand, if communication is often tense or strained, confidences are broken, or you don’t feel listened to, appreciated, or valued, these are signs of an unhealthy relationship. Unhealthy relationships can have both immediate and longer-term health impacts. If you are unhappy in a relationship, try to improve the relationship, or end it. Do not stay in a relationship for the wrong reasons, such as fear of being alone or guilt.

If a partner tries to force you to do something sexually, harms you physically, or is verbally abusive, you are in an unhealthy relationship. Even if you believe the person loves you, it does not make up for the harm they are doing to you. End the relationship.

Take a moment to assess the health of your relationships. Who are the people who make you smile, who boost your confidence, who truly listen when you need to talk, and who want only the best for you? Investing in these relationships is likely to make you happier and healthier. Relationships are two-way streets. How committed are you to your relationships? How much effort do you put into nurturing your relationships?


Healthy relationships start with healthy individuals. Self-care is learning to take good care of yourself and to prioritize your own needs. Self-care involves any activity that nurtures and refuels you, such as taking a walk in the woods, going to a yoga class, attending a sporting event, reading a good book, or spending time with friends. When you are feeling calm and nourished, you are going to look forward to your day, and despite how busy it is, you will prioritize time with friends and family. If you don’t take care of and learn to love yourself, you will never be able to bring your best self to any relationship.

An important dynamic you bring to any relationship is how you feel about yourself. Self-esteem is about loving yourself and being happy for who you are. Building healthy self-esteem impacts how you see yourself, which can drastically improve your relationships. While low self-esteem won’t keep us from romantic love, it can act as a barrier to a healthy relationship. If you do not believe you are good enough, how can you expect your partner to think so?

When you feel secure in yourself, this allows you and your partner to feel more secure about the relationship. If you have insecurities, it may show in your relationship as jealousy, defensiveness, or tension that leads to unnecessary arguments. Healthy self-esteem goes hand in hand with self-confidence, and feeling confident about yourself will translate into a stronger and more satisfying relationship. If you are experiencing low self-esteem, you may give your partner too much credit or stay in a relationship that is not healthy for you. If you find yourself changing your personality for someone else, that is never a sign of a healthy relationship.

You can reverse negative self-talk and build your self-esteem. If you catch yourself thinking you are unlovable, unattractive, or not good enough, it’s important to start talking to yourself in a positive way and to celebrate all that is uniquely you.

Self-care includes self-forgiveness. We all make mistakes. A misstep isn’t the end of the world. Pick yourself up, put things in perspective, acknowledge any lessons to be learned, focus on all that makes you special, and move forward. Be kind to yourself.

The Importance of Community

The Nicoya Peninsula in Costa Rica is home to some of the highest number of centenarians (people who are 100 years old or older) in the world. Costa Ricans in general report a high level of life satisfaction. Dan Buettner, author of the Blue Zones study of the longest living populations in the world, explains that Costa Rica “is a place where religion, family, and social interaction are the main values, unlike trying to get ahead, or financial security, or status. Their cities are set up so they’re bumping into each other all day long. They walk to the markets, where they have conversations with people.”26

In Costa Rica, multiple generations live together under the same roof or nearby where they can be involved in each other’s lives. Neighbors are like extended family, and people often stop in for a visit and go out of their way to help one another.

While this isn’t the way many of us live in the United States, the lessons from the Blue Zone study underscore the importance of community and the health benefits of connecting to and staying close to a community. What communities do you belong to? The people you live with? A sports team? A club or people you volunteer with? When you start seeing the social circles you connect to as communities and prioritize your time to develop more closeness with those communities, you will experience many physical, mental, and emotional health benefits.

A photo shows people sitting at tables during a college club showcase fair, while prospective members speak to them and look at materials. The tables are decorated with signs for clubs including the Student Veteran’s Club.
Figure 11.12 Joining clubs in college can be an outstanding way to join and build communities. (Credit: SupportPDX, Cerritos College / Flickr / Attribution 2.0 Generic (CC-BY 2.0))

According to an analysis of research on college students (Joe Cuseo, The Most Potent, Research-Based Principles of College Success), college students who have a higher sense of belonging and are more involved in their college community are more successful. Additionally, college students who are involved in extracurricular, volunteer, and part-time work experiences outside the classroom (less than 20 hours per week) earn higher grades than students who do not get involved in any out-of-class activities at all.


Make a list of the communities you belong to. Your list should include formal communities—for example, sports teams, fraternities or sororities, and membership in clubs and other organizations. Your list should also include informal communities—for example, your neighbors or the people you always see at your favorite exercise class.

Next to each community, write how being a member of this community benefits you and how your involvement benefits the community. Now, make a new list of your personal interests and passions. How well do these align with the communities you already belong to? Are there new communities that would be a good fit for you?

If you are struggling to identify communities you already belong to, think about your passions, causes you care about, and ways you love to spend your time. Find a group or club that aligns with your interests. If you can’t find one that already exists, start a new club!

Research has shown that friends provide a sense of meaning or purpose in our lives, and that having a healthy social life is important to staying physically healthy. In a meta-analysis of the research results from 148 studies of over 300,000 participants, researchers found that social relationships are important in improving our lifespan. Social support has been linked to lower blood pressure and better immune system functioning. The meta-analysis also showed that social support operates on a continuum: the greater the extent of the relationships, the lower the health risks.27

According to a 2018 report from the American College Health Association, in a 12-month period, 63 percent of college students have felt very lonely. If you are feeling lonely or having a hard time making friends, know that the majority of people around you have also felt this way. Joining a group or a club of people who share your interests and passions is one of the best ways to make great friends and stay connected.

Sexual Health

Affection, love, and sexual intimacy all play an important role in healthy relationships, and a responsible approach to intimacy is essential for sexual health. Whether you are already sexually active or become sexually active in the future, your choices can affect your safety as well as the health and safety of your sexual partners. It’s important to understand what you can do to protect yourself from sexually transmitted infections (STIs).

Common Sexually Transmitted Infections
Infection Symptoms Diagnosis and Treatment
Human papillomavirus (HPV)
  • HPV can be passed even when an infected person has no signs or symptoms.
  • Most people with HPV do not know they are infected.
  • Symptoms can include genital warts, abnormal Pap test results, and cancer.
  • There is no test for HPV.
  • There is a vaccine to prevent it.
  • There is no treatment for HPV, although there are treatments for the health problems it can cause.
  • Routine Pap tests can identify problems.
  • Symptoms include a burning sensation when urinating and/or discharge from the penis or vagina; however, most people who have chlamydia have no symptoms.
  • In women, it can cause damage to the reproductive system.
  • Testing usually involves a urine sample or vaginal swab.
  • It can be cured with the right treatment.
Genital herpes
  • Genital herpes is caused by two types of viruses, herpes simplex type 1 and herpes simplex type 2.
  • The virus can be released through sores or through the skin even when sores are not visible.
  • Get examined by your doctor if you notice an unusual sore, a smelly discharge, or burning when urinating.
  • It can be diagnosed through the symptoms, testing a sample from the sore(s), or a blood test.
  • There is no cure for herpes; however, there are medicines that can prevent or shorten outbreaks.
  • Symptoms can include a burning sensation when urinating, abnormal discharge from the penis or vagina, and bleeding between periods.
  • Rectal infection symptoms include itching, burning, and bleeding.
  • Get examined by your doctor if you or your sexual partner notice any of these symptoms.
  • Testing is usually a urine sample and possibly a throat or rectum swab.
  • It can be cured with the right treatment.
  • Medication will stop the infection, but it will not undo any permanent damage caused by the disease.
Human immunodeficiency virus (HIV)
  • HIV damages the body’s immune system cells.
  • The most advanced stage of HIV infection is commonly referred to as AIDS (acquired immunodeficiency syndrome).
  • It most often spreads through fluid exchange via unprotected sex or by sharing drug needles with an infected person.
  • Women can pass HIV to their babies during pregnancy or childbirth.
  • Medications such as pre-exposure prophylaxis (PrEP) can reduce risk when taken consistently and with other prevention measures.
  • People can live with the disease for many years, especially if they are diagnosed and treated early.
  • Early diagnosis is also important to reduce the risk of transmitting HIV to others.
Table 11.1 STI data, symptoms, diagnosis, and treatment information courtesy of Centers for Disease Control and Prevention, https://www.cdc.gov/std

How You Can Protect Yourself against STIs

For the most certain protection against STIs, abstinence—avoiding any form of vaginal, anal, or oral sex—is your most definitive safeguard. That said, if you are contemplating sexual activity, thoughtful preparation is crucial. Ensure both you and your partner undergo testing and adhere consistently to condom usage. Condoms remain necessary until both parties have clear test results, are engaged in mutual monogamy, and employ alternative methods for birth control. Mutual monogamy refers to a shared agreement to exclusively engage in sexual activity with one another, providing a layer of protection against STIs, given that both parties are verified to be STI-free. Resourceful tools for locating confidential STI testing locations are readily available online.

Engage in an open dialogue with your partner about strategies for STI and pregnancy prevention before commencing sexual activity. Being ready for sexual encounters signifies readiness to guard your well-being and long-term health. Clearly establish boundaries and activities that you are comfortable with; your partner should unequivocally respect your ability to decline any actions that make you uneasy. In all scenarios, consent and mutual respect are non-negotiable prerequisites.

Prompt consultation with a healthcare provider is vital should you discover you have an STI. Openness about your STI status with your partner, although potentially awkward, is essential. Such candor enables your partner to make well-informed decisions that protect their health as well.


  • 26https://www.bluezones.com/2017/10/costa-rica-singapore-two-happiest-places-earth/
  • 27Holt-Lunstad, PLoS Medicine, https://journals.plos.org/plosmedicine/article?id=10.1371/journal.pmed.1000316


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