Sex still carries shame for many people. This is true of professionals, as well. I have had clients who completed inpatient substance abuse programs tell me that while in treatment they never spoke of their sexual practices, most of which were critically linked to their drug use. Why wasn't this discussed? In many cases it was because the counselor was uncomfortable speaking about sexual practices. When I train other therapists we pay close attention to their sexual competence: the ability to be comfortable speaking about sexual concerns and make it safe for their clients to do so as well.

How is your sexual competence? Here are some tips for speaking up about sex:

1. Respect yourself. Gay men and women need to work at self love even harder than society at large simply because we are consistently bombarded with negative messages, both overt and covert. You have a right to your feelings, a right to speak up and be heard, and a right to have your sexual limits honored.

2. Minimize embarrassment or shame when speaking about your sexual needs, concerns, or problems. You're not the first to have such feelings and not speaking up could have fatal consequences. That goes for discussions with your doctor, as well. I know one man who didn't want to speak to his physician about his anal warts which consequently went untreated and developed into rectal cancer.

3. Speak your truth, whether it's your HIV status, the need to use condoms, or your concern that your sex life might be a little out of control. Don't keep it to yourself. Speak up and be willing to listen to the feedback you receive.

4. Make your healthcare provider an ally. Be certain that you can frankly discuss your sexual practices and concerns in a safe, non-judgmental atmosphere. Even if you want to ask what you might think is a naive question, speak up, Believe me, they have heard it before.

Sex should be fun, but anxiety, anger, or other negative feelings resulting from unspoken concerns can quickly destroy the mood. When discussing something as important as sexual needs or sexual health, everything should be on the table. Your life depends on it.