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Case: A couple is in a mutually monogamous relationship. After 5 years one of the partners expresses a desire to have sex with other people. They agree that the partner can have other partners but has to follow a set up agreed upon rules.

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Honesty with partner is key

Set clear expectations/boundaries

Decide what to share with each other

Prioritize health

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Every relationship, whether open or monogamous, is as unique as the people involved.

That's why, if you ask me what makes an open relationship work, I can't give you a pat answer.

There's no simple formula for the ideal open relationship. Like any relationship, it takes honesty, communication, and attention.

Here's an easier question: How common are open relationships?

In my experience, our society still maintains pretty puritanical ideas about commitment and sex.

So it might seem surprising that a 2019 study published in the Journal of Sex Research found that 1 in 5 people surveyed had been in an open relationship at some point. Surveys about sexual habits tend to underreport people's real-life behavior, so the real number might be even higher.

The 2019 study didn't consider how participants would describe their specific open relationships. That matters because there's no singular way to participate in openness.

As I see it, it's not about a title or label. Instead, it's about the boundaries, or lack thereof, that the individuals in the relationship have chosen.

On this front, I have some experience.

Sometimes I've had consistent secondary relationships with one party of a committed, open couple; it's what I like to refer to as a "series regular."

Sometimes my role as a third was as a partner in sexual encounters with one or both parties... a "guest starring" role, if you will.

Here's what I've learned along the way:

When it comes to open relationships, one of the most common communication quandaries I've noticed is how to have conversations about opening an already established relationship.

First and foremost, honesty is necessary.

It might not be the kind of honesty you're used to, like telling someone they have pepper in their teeth or admitting that it was you who dealt what you smelt.

It's my experience that the decision to open a relationship can take a lot of vulnerability and work.

Part of that work is separating yourself from the relationship norms many of us have grown up with since childhood. These conversations can be easier if honesty has been a cornerstone of the partnership all along.

Boundaries are important in any relationship, monogamous or nonmonogamous. One common assumption I've noticed about open relationships is that there are "no rules."

For some, that might be the case. But, in my view, the absence of rules is a rule. It should absolutely be discussed.

A word of caution: I don't usually like to use the word "rules" at all. I find that terms such as "boundaries" or "agreements" feel a bit less restrictive.

Remember, for some people, "rules" are meant to be broken. Our little, lizard brains can't help it.

By restricting a fairly basic part of the sexual experience, these couples set themselves up to cheat at their own game.

As a third, I've always appreciated when boundaries are shared with me beforehand so I'm on the same page.

Some couples have agreements where they aren't allowed to stay overnight, some have agreements where they can only have sex together with a third, and some have agreements about when external encounters can occur based on work schedules and travel schedules.

There's no limit as long as all parties are comfortable with the plan.

It's also important to discuss how much you will share with one another.

In my first experience with being open, our agreement was to share everything in order to evaluate what we were comfortable discussing. In other words, how much information is too much, and how much is too little?

Neither of us truly knew our limits. Rather than begin by withholding anything, we chose complete transparency.

This will be different for every open relationship but should be discussed. Some people don't communicate about their outside experiences at all. Some divulge every detail. Some like to be sent pictures or videos or even be looped in on a video chat to share in the experience.

If an open relationship involves either partner participating in penetrative sex with a third, or any activity where bodily fluids can be exchanged, it's vital to discuss what steps every member of the relationship will take to reduce the risk for STIs.

The most common agreement I've encountered is a shared decision to always use condoms during sex with strangers.

The Centers for Disease Control and Prevention (CDC) notes that wearing a condom is the most effective, realistic way for sexually active adults to reduce STI transmission.

On that note, I'm a big supporter of getting tested regularly, in general. I've read advice that it's a good idea to get tested before and after every new partner, but I know that's not realistic for everyone.

Depending on the number of partners you have and other factors, the CDC suggests that every 3 to 6 months is a reasonable frequency.

An open relationship often brings new partners into our sex lives, individually or communally. That means taking necessary precautions for your health and sexual well-being.

Do you need to start taking some form of birth control? Should you start PrEP (Pre-Exposure Prophylaxis) to reduce your risk of contracting HIV? It's a good idea to discuss these questions with your partner and your physician.

Open relationships have no set algorithm. Continued conversations with all partners involved is imperative.

Sometimes non-monogamy can last for an entire relationship. Sometimes periods of openness come and go throughout a relationship's journey.

At all points, everyone needs to be on the same page. Non-monogamy requires consent. Non-monogamy without consent isn't non-monogamy at all. It's infidelity.

In my opinion, being part of an open partnership is a step, not a fix.

If a partnership is shaky for some reason - whether it be a lack of emotional connection, trust, or other frustrations - having sex with others won't fix the relationship. It will just serve as a distraction.

Does sex solve any problems? Personally, I've noticed that sex with people other than your primary partner can help alleviate sexual needs that your primary partner can't or doesn't want to fulfill.

There are many reasons why a partner may not want or be able to participate in a sexual activity or kink. It might come down to distance, ability, genitalia, libido level, or lack of interest, among other possibilities. It doesn't mean there's anything wrong with your relationship.

Openness is one way that both partners can have their desires fulfilled, even when those desires don't completely align. It can also help prevent resentment when libido and interests don't match up.

Love and sex are not synonymous. It's thrilling when the two are combined, but I've enjoyed both independently of one another with great success.

With honesty, consent, and good communication, open relationships can prosper happily and healthily, just like the old nursery rhyme... you and me and the hookup makes three.

Kenny Francoeur is a freelance writer focusing on queer culture and sexual health. His work has also been published by The Advocate, WOLFY Magazine, HIV Advocates Magazine, Twin Cities Pride Magazine, among others. Kenny is also the creator and host of Normalize This, a podcast that investigates sexuality, kink, identity, and sexual culture on a mission to create an honest, unsanitized educational resource. Connect with Kenny on Instagram @kenny.francoeur or Twitter @kenny_francoeur, and check out his work at www.kenny-francoeur.com.

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Happy, Healthy Open Relationships: My Personal Tips

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Every relationship, whether open or monogamous, is as unique as the people involved. That's why, if you ask me what makes an open relationship work, I can't give you a pat answer. There's no simple formula for the ideal open relationship. Like any relationship, it takes honesty, communication, and attention.

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Five key steps that can help individuals achieve good sexual health:

Value who you are and decide what’s right for you

Treat your partners well and expect them to treat you well

Build positive relationships

Get smart about your body and protect it

Make sexual health part of your healthcare routine

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Being sexually healthy means being able to enjoy a healthier body, a satisfying sexual life, positive relationships, and peace of mind.

Sexual health is having a healthier body. A satisfying sex life. Valuing and feeling good about yourself. Having peace of mind. Positive relationships, whether short term or long term. Experiencing pleasure, intimacy, and joy. Avoiding sexually transmitted infections (STIs) and unplanned pregnancies. These are just a few of the important benefits of good sexual health.

Action Steps to Good Sexual Health

The NCSH has identified five key steps that can help individuals achieve good sexual health:

Value who you are and decide what’s right for you

Treat your partners well and expect them to treat you well

Build positive relationships

Get smart about your body and protect it

Make sexual health part of your healthcare routine

Click here to learn more about our sexual health messages for the public.

Audience Profiles

Research Products

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Being sexually healthy means being able to enjoy a healthier body, a satisfying sexual life, positive relationships, and peace of mind.

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Sexual health is having a healthier body overall. It includes knowing one's right to having a satisfying sex life, valuing and feeling good about yourself and your body, having peace of mind when engaging in sexual activity. As well as, having positive relationships and experiencing pleasure, intimacy, and joy in those relationships. It encompasses being mindful of contraceptions and taking measures to avoid STIs and unplanned pregnancies. Sexual health also includes addressing sexual issues beyond male-female or heteronormative ideals, but acknowledging that sexual health involves a wide variety of sexual orientations and gender identities.

It is also important to note that sex is more than just a physical act, it has holistic affects and implications including but not limited to one's emotional and mental health, spiritual health, relational health, physiological health and other factors that can impact one's desire, ability and capacity to practice healthy sex.

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Inclusivity of age, disability, sexual orientation, gender identity, culture, spirituality etc.
Not conforming to heteronormative sexual health worldviews

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Our case fits our definition of sexual health because the partners have agreed for the partner who desires to have sex with other people to explore that desire, as long as agreed upon rules are followed.

With rules being in place, it sounds like there are boundaries to help keep the sexual health of their relationship intact.

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Processing the couples current sex life and what that looks like

Ensuring that practices outside the relationship are safe

Psychoeducation on STI and ensuring that they understand the risks involved but are still remaining safe and getting tested often

Encourage partners to consistently check in with one another on how they are feeling about the open relationship (appears that only one partner is exploring an open relationship). Making sure they are on the same page to avoid any stress and resentment on the relationship

Rules of engagement: mutual agreement between both parties. discussing what is acceptable within the dynamic from both parties in a clear and concise way (talking about boundaries)

Talking about how they might priorities their primary relationship

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Sexual health is something that an individual defines for themselves, in association with their partner(s). Therefore, it is important not to limit or restrict what may be considered "healthy" or "normal."

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Understand different types of open relationships (poly, kink, open relationships)

Find health provided you trust

Open and honest communication with health provider

Appropriate testing (varies upon person depending on several factors)

Mental health support

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Updated February 13, 2019.
Open relationships are nothing new, but with the rise of relationship descriptors like " monogamish," and more mainstream media representations of non-monogamous unions, more people than ever are becoming curious about alternative sexual lifestyles.

Although there is little data on the subject, San Francisco-based organization TASHRA, the Alternative Sexualities Health Research Alliance, estimates that about 10 percent of the US population engages in non-traditional sexual practices. Many of these people face unique health issues and barriers to care that may not exist for monogamous individuals.

If you're in a non-monogamous relationship-or are just interested in exploring your options-know the particular health precautions you should take to protect yourself and your partners.

What are the different kinds of open relationships?

While the concept of an "open" relationship may seem self-explanatory, there are many different forms of non-monogamy that can include a variety of sexual practices and philosophies. A few terms and distinctions to know:

Polyamory or poly: Maintaining multiple sexual and/or romantic relationships simultaneously; all people involved have full knowledge of the situation and are completely consenting.

Kink: Otherwise known as BDSM (bondage and discipline/domination and submission/sadism and masochism), fetish, and/or S&M, "kink" refers to a lifestyle or practice based on consent and mutually defined activities that, according to TASHRA, involves "eroticization of power via dominance and submission, role playing/fantasy, and/or intense sensory stimulation and/or physical restriction."

Open relationship: Can include polyamory, but also other non-monogamous relationships like swinging (i.e., the practice of singles or partners in committed romantic relationships engaging in sexual activities with others), and other forms of sexually or romantically open arrangements.

What does my relationship have to do with my health?

As with any sexual relationship, there are health risks to consider, and safety should be a top concern for all partners. The nature of your relationship influences the kinds of health considerations you may want to take into account. While people who engage in BDSM may face unique health hazards such as physical injuries, anyone involved in a poly or open relationship should be aware of the increased risk for sexually transmitted diseases (STDs) and take precaution.

The keys to staying safe in any type of sexual relationship, however, are consent, honesty, and trust. Communication between all partners is crucial, and forming a trusting relationship with an experienced, sex-positive health provider can greatly reduce the risks of disease and injury for everyone involved.

Here are a few guidelines for staying safe and protecting your health in a non-monogamous relationship:

Communicate openly and honestly with all partners.

According to a study published in the Journal of Sexual Health, "sexually unfaithful" individuals (i.e., cheaters) demonstrated significantly lower rates of protective sexual health behaviors than "negotiated non-monogamous" individuals (i.e., people in open relationships), both with primary partners and in other sexual encounters. Negotiated non-monogamists were more likely to use condoms correctly than the sexually unfaithful individuals who secretly cheated on their partners. Those in consensual non-monogamous relationships were also more apt to openly discuss STDs, share their sexual history, and sterilize sex toys.

Another study found that couples who have more positive communication styles tend to heal faster when it comes to certain ailments. Researchers speculate this effect may be due to the release of oxytocin, known as "the love hormone," which is thought to impact emotional responses connected to relaxation, trust, and psychological stability.

Communicate openly and honestly with your provider.

According to TASHRA lead investigator and UCSF associate professor Jess Waldura, MD, the fear and anxiety many individuals feel about coming clean to their health care providers may be unwarranted.

"Many of the individuals in our study who self-identified as kinky, poly, or some version of that, expressed discomfort about coming out to their providers, but very few of them got a bad response [when they did]," Waldura says. "The anticipated stigma did not translate into the actual experience of stigma. They largely had good experiences, even when the providers were inexperienced."

The only way to ensure you're getting comprehensive, adequate care is to find a provider you trust, and to be completely candid with him or her about all aspects of your sexual health. "You are not going to get good care if you're not honest about your risk factors," Waldura says. "And if your provider gives you a bad response, then get another provider who knows how to handle [your situation]."

Get tested appropriately.

If you are in non-monogamous sexual relationship, you should be tested for STDs but the appropriate frequency of testing varies from person to person depending on several factors. Gay men who are sexually active with multiple partners, for example, are encouraged to complete STD testing every three to six months. However, it may not be necessary for all individuals involved in poly or kink relationships to be tested this frequently, and many providers may be hesitant to order such frequent tests because of prohibitive costs and the possibility of false positive results.

"In the poly community especially, there's a very big, open discussion around testing status and STD status, and it's quite routine to bring recent lab results to new partners," Waldura says. "However, many poly individuals-like women who have sex with men but those men don't have sex with men-actually have a low risk. This can cause tension because patients have been encouraged to get frequent tests, but providers don't feel they qualify, and over-testing low-risk individuals can increase the risk of getting a false positive."

If you're unsure about your own STD testing needs, the Centers for Disease Control and Prevention (CDC) offers population-based recommendations. However, if you feel your individual risk is higher or lower for whatever reason, it's important to negotiate a testing schedule with your provider that's appropriate for your situation. "Tests are not intended to alleviate fears, but to uncover disease," Waldura says.

Find a therapist who understands your needs.

Establishing a relationship with a mental health provider who is sensitive to your needs can help you feel comfortable discussing and disclosing issues that may impact your health. Some mental health professionals specialize in issues related to polyamory and kink, and can provide guidance around a variety of specific topics. Research therapists in your area, or ask your health care provider for a recommendation. If you live in the San Francisco Bay Area, you can find a poly/kink-friendly therapist here: http://bayareaopenminds.org/about/members/.

Compassionate and sincere, Amy uses evidence-based medicine and preventive care to empower her patients to live healthfully. She listens to patients' unique needs and advocates for them to help them achieve their health goals. She is well-versed in treating hypertension, diabetes, lipid disorders, and atrial fibrillation. Amy earned her master's of science in nursing from the University of Pennsylvania and is a certified Adult Health and Gerontological Nurse Practitioner by the ANCC. Amy is a One Medical Group provider and sees patients in our Washington DC offices.

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The One Medical blog is published by One Medical, a national, modern primary care practice pairing 24/7 virtual care services with inviting and convenient in-person care at over 100 locations across the U.S. One Medical is on a mission to transform health care for all through a human-centered, technology-powered approach to caring for people at every stage of life.

Any general advice posted on our blog, website, or app is for informational purposes only and is not intended to replace or substitute for any medical or other advice. 1Life Healthcare, Inc. and the One Medical entities make no representations or warranties and expressly disclaim any and all liability concerning any treatment, action by, or effect on any person following the general information offered or provided within or through the blog, website, or app. If you have specific concerns or a situation arises in which you require medical advice, you should consult with an appropriately trained and qualified medical services provider.

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How to Stay Healthy in an Open Relationship

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Updated February 13, 2019.Open relationships are nothing new, but with the rise of relationship descriptors like "monogamish," and more mainstream media representations of non-monogamous unions, more people than ever are becoming curious about alternative sexual lifestyles.Although there is little data on the subject, San Francisco-based organization TASHRA, the Alternative Sexualities Health Research Alliance, estimates that about 10 percent of the US population engages in non-traditional sexual practices.

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Enter your ZIP code to find a testing site near you.

If you are sexually active, getting tested for STDs is one of the most important things you can do to protect your health. Make sure you have an open and honest conversation about your sexual history and STD testing with your doctor and ask whether you should be tested for STDs. If you are not comfortable talking with your regular health care provider about STDs, there are many clinics that provide confidential and free or low-cost testing. Below is a brief overview of STD testing recommendations.

All adults and adolescents from ages 13 to 64 should be tested at least once for HIV.

All sexually active women younger than 25 years should be tested for gonorrhea and chlamydia every year. Women 25 years and older with risk factors such as new or multiple sex partners or a sex partner who has an STD should also be tested for gonorrhea and chlamydia every year.

Everyone who is pregnant should be tested for syphilis, HIV, hepatitis B, and hepatitis C starting early in pregnancy. Those at risk for infection should also be tested for chlamydia and gonorrhea starting early in pregnancy. Repeat testing may be needed in some cases.

All sexually active gay, bisexual, and other men who have sex with men should be tested:

At least once a year for syphilis, chlamydia, and gonorrhea. Those who have multiple or anonymous partners should be tested more frequently (e.g., every 3 to 6 months).

At least once a year for HIV and may benefit from more frequent HIV testing (e.g., every 3 to 6 months).

At least once a year for hepatitis C, if living with HIV.

Anyone who engages in sexual behaviors that could place them at risk for infection or shares injection drug equipment should get tested for HIV at least once a year.

People who have had oral or anal sex should talk with their healthcare provider about throat and rectal testing options.

STD screening information for healthcare providers can be found in the STI Treatment Guidelines.

Want to add an STD testing site finder (like the one above) to your own site? See STD Widgets.

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std prevention (sexually transmitted disease)

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STD & HIV Screening Recommendations from CDC