Non-demand touch, such as hand massage and other “sensate focus” exercises, are still recommended by many sex therapists who want to help couples struggling with sexual difficulties. Non-demand touch exercises help take the pressure off partners who are too focused or anxious about penis-vagina penetration to stay present with their own or their partner’s responses. These exercises are designed to build or restore emotional safety and sexual trust; cultivate awareness of sensual stimulation and preferences; and facilitate intimate communication through exploratory questions and answers as both partners experience giving and receiving touch.

The giver may ask questions like:
“Is this a good place to touch you?”
“Do you like this touch to be fast or slow, firm or light?”

The receiver may say things like:
“No, I don’t like my nipples touched until I am more aroused.”
“Yes, that feels good. But press just a little more firmly there.”

You may have experienced these “homeplay” exercises if you have consulted a sex therapist or clinical sexologist. If you are a sexologist or therapist yourself, you may be used to routinely including a program of sensate focus exercises in your clinical practice. However, some people experience anxiety during these exercises, or find them to be a turn-off, or otherwise counter-productive. Some people may resist doing these exercises, but are not sure why, and this resistance can add to the difficulties already experienced by the couple.

It’s time we were all more aware of sensory integration dysfunctions and their potential effects on sexual intimacy. We have to ask ourselves, “what is the impact of sensory dysfunction on sexual behavior?” A couple of years ago I coined an unofficial term for this problem, “adult sexual-sensory dysfunction” or ASSD. And though many of us are fed up with acronyms and the “alphabet soup” diagnoses, I’d like to use this term to advance a new meme and awareness. I see sensory integration dysfunction as one of the missing links in addressing and managing sexual concerns, particularly for people who also have a diagnosis of ADHD or ADD; or Asperger’s Syndrome or another autism spectrum condition; or any other pervasive developmental condition where sensory dysfunction often occurs. However, some people simply experience sensory integration problems which are not co-morbid. Children who are diagnosed with sensory disorders often receive help through “sensory diet” planned by occupational therapists. But for many adults, sensory dysfunction is seldom considered or diagnosed.

What is sensory dysfunction? Someone who has a low threshold for noise, touch, smell, taste, or sound is hypersensitive, and will avoid those things. A person who has a high threshold for various types of sensory input is hyposensitive, and will seek out these sensations. Many people combine low and high thresholds for various kinds of stimuli. For example, a person may crave super-spicy food (hyposensitive to taste) but be unable to tolerate the sound of a humming refrigerator (hypersensitive to sound). If you are hyposensitive, you will seek more of that kind of sensation. You will be a “sensory seeker.” Mosh pits and loud rock concerts are filled with hyposensitive sensation seekers. A hypersensitive person will be sensory avoidant. The person who flinches from touch is tactile avoidant. A person who cannot bear to kiss or give oral sex may have oral sensitivities. The senses of balance and body awareness are also included in sensory integration.

I have had a few clients who cannot bear to give oral sex. As children, these people hated having their face washed or their teeth brushed – any sensation around their face or mouth is unbearable. I have had a few clients who were aversive to certain types of touch. They may go through the roof with gentle stroking but enjoy a firm, non-moving grip. Even certain types of fabric – a change to flannel sheets, for example – can interrupt an otherwise promising sexual encounter.

There is growing anecdotal awareness in the BDSM and kink communities that for many people, consensual bondage, sensation play, and certain fetishes may be providing an eroticized – and much needed – adult sensory diet for people who experience some form of sensory dysfunction. As a “kink aware professional,” I feel we need much more research and understanding of the creative ways in which some adults cope with sensory dysfunction and its impact on sexual behavior and feelings.

Some sensory dysfunction websites provide checklists for sensory issues. While I do not suggest that these checklists will provide grounds for a diagnosis, they may indicate the wisdom of referring certain clients to occupational therapists for assessment. In the meantime, you can also use the results of these checklists to modify sensate focus and other homeplay strategies as needed. In the absence of abundant research on this topic, you may feel that you are “playing detective,” but please persist – this is an area which deserves diligent and careful inquiry.

How often do you want sex? And is that enough? But the majority of these women are heterosexual with male partners who are – you guessed it – complaining. So I guess I should say “relatively low levels of sexual desire!”

Over and over again I’ve found that moving in together does create a drop in the frequency of sexual activity for all couples regardless of gender. Long distance romance remains exciting because it provides space and distance interspersed with sexy weekend liaisons. But which is “normal” – the level of desire we experience early in a relationship or what unfolds later on?

Research consistently shows that low sexual desire affects 10-20% of women generally, with some studies finding that 40% of midlife women report low sexual desire. However, approximately 1 in 3 women experience low sexual desire at some point, making this one of the most common sexual concerns.

This is why couples therapist Esther Perel points out that “good intimacy doesn’t always guarantee good sex.” Her book Mating in Captivity explores the paradoxical union of domesticity and sexual desire, examining what it takes to sustain passion in long-term relationships. In it she points out that “the very elements that nurture love – reciprocity, mutuality, protection, closeness, emotional security, predictability – are sometimes the very things that stifle desire.”

So these guys start to feel like a brother or worse yet a child, and sex with family members is a definite no-no in our culture. Children and pets need caregiving, which we provide as an act of love.

Recent research on heteronormativity theory supports this observation, showing that unequal distribution of household labor places considerable burden on women, leading to feelings of inequity and exhaustion that ultimately diminish desire. The blurring of maternal and partnership roles, where women often find themselves mothering their partners, can lead to feelings of overwhelm and decreased desire.

Research conducted with married women who experienced desire decline found three core themes: institutionalization of the relationship, over-familiarity, and the de-sexualization of roles. For some women, formalizing their relationship through marriage made sex so available and sanctioned that it lost the forbidden and erotic quality that had formerly ignited passion. For others, overfamiliarity with their partner led to a decline in romance and sexual experimentation, as well as loss of motivation for self-care once they had “secured” their relationship.

A third group of women reported that holding down a job, being mom, and being a wife was overwhelming and “highly desexualizing,” making it extremely difficult to shift into romantic mode after changing diapers and fulfilling their professional roles. Many of the participants in all three groups specifically noted that while they were committed to their marriage, they thought desire would return if someone new came along who desired them.

As researchers now understand, women’s desire may be driven to the same extent as it is in men by novelty and excitement. The idea that female desire is simply about loving somebody has proven to be an oversimplification.

Over and above anyone else, we are our own point of reference for how sexy we are. Feeling good about ourselves emotionally and physically appears to be a bigger mediator of female desire than relationship factors alone. Research shows that sexual self-esteem, sexual desire, and sexual assertiveness all correlate positively with sexual function in women. This certainly bears out in my conversations with female clients.

Recently, for example, a woman told me that she no longer wanted to have sex “on top” of or astride her mate, “because my stomach sticks out and it would look terrible to him from that angle!” He shook his head, “Honey, I probably don’t even have my eyes open … that used to be your favorite position because it felt best to you … what else could possibly matter?”

*If you’re experiencing concerns about sexual desire, consider reaching out to one of our qualified therapists who specialize in sexual health and relationships.*

Gewirtz-Meydan, A., Sowan, W., Estlein, R., & Winstok, Z. (2024). Rights or obligations: The extent to which sexual desire and gender roles determine sexual intimacy in romantic relationships. Journal of Sex & Marital Therapy, 50(5), 482-497.

Johansen, E., Harkin, A., Keating, F., Sanchez, A., & Buzwell, S. (2023). Fairer sex: The role of relationship equity in female sexual desire. Journal of Sex Research, 60(4), 498-507.

O’Kane, K. M. K., Goldberg, S. Y., Bouchard, K. N., & Dawson, S. J. (2023). Debunking desire: Sexual science, social media, and strategy in the pursuit of knowledge dissemination. Archives of Sexual Behavior, 52(3), 1087-1099.

Peixoto, M. M., Amarelo-Pires, I., Pereira, H., & Nobre, P. (2023). Solitary and dyadic sexual desire and sexual satisfaction in women with and without sexual concerns. Journal of Sex & Marital Therapy, 49(1), 77-87.

Perel, E. (2006). Mating in captivity: Unlocking erotic intelligence. Harper.

Rowen, T. S., & Goldstein, A. T. (2024). Sexual desire and pharmacologic management. Obstetrics and Gynecology Clinics, 51(2), 259-271.

Sims, K. E., & Meana, M. (2010). Why did passion wane? A qualitative study of married women’s attributions for declines in sexual desire. Journal of Sex & Marital Therapy, 36(4), 360-380.

Thomas, H. N., Brotto, L. A., de Abril Cameron, F., Yabes, J., & Thurston, R. C. (2023). A virtual, group-based mindfulness intervention for midlife and older women with low libido lowers sexual distress in a randomized controlled pilot study. Journal of Sexual Medicine, 20(8), 1060-1068.

Wainberg, M. L., Muench, F., Morgenstern, J., O’Leary, A., Foote, J., Krupitsky, E., & Silverman, E. (2018). Prevalence and predictors of sexual problems among midlife Canadian adults: Results from a national survey. Journal of Sexual Medicine, 15(6), 873-879.

References:

1. Gewirtz-Meydan, A., Sowan, W., Estlein, R., & Winstok, Z. (2024). Rights or obligations: The extent to which sexual desire and gender roles determine sexual intimacy in romantic relationships. Journal of Sex & Marital Therapy, 50(5), 482-497.
2. Johansen, E., Harkin, A., Keating, F., Sanchez, A., & Buzwell, S. (2023). Fairer sex: The role of relationship equity in female sexual desire. Journal of Sex Research, 60(4), 498-507.
3. O’Kane, K. M. K., Goldberg, S. Y., Bouchard, K. N., & Dawson, S. J. (2023). Debunking desire: Sexual science, social media, and strategy in the pursuit of knowledge dissemination. Archives of Sexual Behavior, 52(3), 1087-1099.
4. Peixoto, M. M., Amarelo-Pires, I., Pereira, H., & Nobre, P. (2023). Solitary and dyadic sexual desire and sexual satisfaction in women with and without sexual concerns. Journal of Sex & Marital Therapy, 49(1), 77-87.
5. Perel, E. (2006). Mating in captivity: Unlocking erotic intelligence. Harper.
6. Rowen, T. S., & Goldstein, A. T. (2024). Sexual desire and pharmacologic management. Obstetrics and Gynecology Clinics, 51(2), 259-271.
7. Sims, K. E., & Meana, M. (2010). Why did passion wane? A qualitative study of married women’s attributions for declines in sexual desire. Journal of Sex & Marital Therapy, 36(4), 360-380.
8. Thomas, H. N., Brotto, L. A., de Abril Cameron, F., Yabes, J., & Thurston, R. C. (2023). A virtual, group-based mindfulness intervention for midlife and older women with low libido lowers sexual distress in a randomized controlled pilot study. Journal of Sexual Medicine, 20(8), 1060-1068.
9. Wainberg, M. L., Muench, F., Morgenstern, J., O’Leary, A., Foote, J., Krupitsky, E., & Silverman, E. (2018). Prevalence and predictors of sexual problems among midlife Canadian adults: Results from a national survey. Journal of Sexual Medicine, 15(6), 873-879.

As a unique form of short-term, complementary and alternative modality (CAM), clinical sexologists are largely under-recognized and under-used. Though it’s said we specialize in studying “what people do and how they feel about it,” sexology touches on everything from erotology to anthropology, law, medicine, psychology, anatomy and physiology (naturally!), gender studies, public policy, history, and so on. That’s because human sexual behavior is pervasive, it affects everything we collectively do and create. As a sexologist, my interests have included Asperger’s Syndrome and sexuality, Native Hawaiian sexual traditions, objectum sexuality, parenting transgender children, the effect of sensory dysfunction on sexual behavior, and the use of hypnosis to address sexual concerns. Almost anything can provide delightful grist for a perpetual, intellectual mill and this has been my joy. Sometimes useful clinical insights emerge from regarding artifacts or incidents through a sexological lens. However, even when there is no immediate clinical application, the overall effect is a deepened respect for the unstoppable and endlessly creative human engagement with eros.

For some, this process accelerates during a “unique baptism by fire” known as the Sexual Attitude Restructuring (SAR) process. At the Institute for Advanced Study of Human Sexuality in San Francisco (which pioneered SARs during an earlier incarnation as the National Sex Forum), this is no mere weekend of “Sexuality 101 and 201”. At IASHS, you are immersed for eight days in everything you always wanted to know about sex and possibly a whole lot of things you may wish you’d never seen. Explicit media and small group processing are integral aspects. The experience is intense. Even seasoned sexologists have been known to melt down. But a good SAR results in a near-unconditional acceptance of one’s own erotic quirks, and those of fellow human beings. One goal of SAR process is to discover exactly what aspects of human sexuality are personal turn-ons or turn-offs, so that clients are not harmed by the reactions of untrained clinicians. I can say, after having experienced two eight-day SARs, that my ability to hear just about anything is pretty good – and I know when and how to gracefully suggest a referral when out of my depth. For this reason, the American Association of Sex Educators, Counselors and Therapists (AASECT) requires a (briefer) SAR experience of everyone seeking certification through the organization.

AASECT certifies the separate categories of sex educator and sex counselor, but not the hybrid practice of clinical sexology, which does both. Though I have recently completed requirements for sex counselor certification, I am sorry my own professional category is invisible within an organization that has so many of us as members. However, I recognize the reasons for this. For one thing, standards for clinical training in sexology are not as defined or generally agreed upon as they should be. For another, right now in the public mind a “sexologist” may be anything from Masters & Jonson to a woman in lingerie groped in a darkened room during an episode of The Pick Up Artist.

However, clinical sexologists practice with Annon’s PLISSIT model: permission (P), limited information (LI), and specific suggestions (SS). We make referrals for intensive therapy (IT) if necessary. Our understanding of human sexual behavior is fostered by our training, which exceeds the sexuality education requirements of other professions. This depth enables us to attend to clients seeking techniques for sexual enrichment and/or short-term management of non-medical sexual problems. As complementary specialists, we work well in consultation with a range of licensed professionals. Within the ethical scope of our practice, we support sexual health, function, self-esteem, and the intimate capacities of our clients.

There is a place where most couples want to get and feel good about getting to, a place where most people would agree is what a wonderful long term relationship is all about. That lovely secure place is the feeling of comfort. Most couples would agree that it’s the small things that make the long- term relationship special. Shopping for groceries, fixing up the house, running errands together, doing laundry, waking up together, making breakfast, etc. You get the idea, it’s the day to day, simple little things we do that we get to do together in a long term relationship that makes it special, and yes, comfortable.

But, at some point comfort often lends its way to laziness, procrastination, taking our partners for granted, and recognizing that long term is a long time, and too often couples find themselves resting on their laurels. You know what I am talking about, “I am too tired,”  “I am not in the mood,” and “Tomorrow. Let’s do it tomorrow.” We begin to put off, what really should done today, until tomorrow. And, a lot of times, we know we are doing it, and we recognize that it might not be good for our relationship, but we can’t seem to break the pattern. Instead, we start worrying or wondering if our partner might be stepping out, and sometimes jealousy and insecurity kick in, creating an even more vicious cycle. We fall back on the comfort, but somewhere in the back of our minds is a sense of discomfort. So, the comfort is a safety zone, but something is missing. We know we must break the cycle of comfort, but it’s too easy of a pattern to fall into and after a while breaking the cycle is weird, awkward and even somewhat embarrassing. We get to know our partner really well emotionally and intimately and we forget to integrate our, re-integrate our sexuality. We intuitively know how but with so many other bridges build it feels like learning to walk all over again. And in many ways it is. It’s learning to walk down the sexual, sensual path with your intimate partner and confidante in a romantic way.

The good news is that it can be done, and it can actually be done fairly easily. And, guess what? You have the power to do it. It just takes a tiny little effort to say, “Yes,” instead of “Not tonight.” Yes, even if you are still angry, even if it feels weird, even if you are really not in the mood and don’t have the energy, learn to say, “Yes” to your relationship. It’s worth it, isn’t it?

I know what you are thinking. Easier said than done, right? Well, there is a way to get your needs met too, in the process. Communication has a lot to do with it. Yes, does not necessarily mean that the man must achieve a full erection, or the woman achieve a full arousal. “Yes,” does it even mean that intercourse has to occur, or orgasm has to be achieved. Yes, may mean kissing each other for 5 minutes, or taking off your clothes and lying together naked and just talking about your day. Yes, could mean taking a bath together, or just lighting some candles and breathing together. Yes, could mean reading erotic novels together or watching an erotic film, going to an adult store, or doing a sensual massage together. Yes, could mean talking about a fantasy or creating one together. Yes, can mean a non-sexual role-play that is still arousing. “Yes,” could mean mutual masturbation.

My point is that “Yes,” does not have to be sexual but that it should be sensual and arousing, exciting and fun, romantic and titillating, and it should be comfortable. Sometimes the thought of having to perform sexually with someone who has become our best friend, can seem down right daunting. You have permission to take it slow, and to take it where you want and need it to go. Your partner has permission to join along on the ride, with no expectations. No one has to have sex, no one needs to orgasm, just enjoy each other’s company in a sensual setting. I do however strongly recommend getting naked, and women this can mean slipping into something sexy first. I also recommend tuning off the TV, computers and cell-phones. Get creative, break the cycle not just of the comfort, but of your ideas of sex, sexuality and sensuality which contribute to the comfort default, the perceived comfort. Learn to connect in other intimate ways. It takes five minutes a day.

If you still feel like you are having troubles, there may be other roadblocks. Talking to a psychotherapist or sex therapist can always help.

For people who are dating or dealing with the starting and ending of intimate relationships, a certain question tends to arise… can ex-partners maintain healthy roles in each others’ lives? And if so, when, where, how, and (most obviously) why? Sometimes an ex’s role is clear; for example, a couple who has children together will most likely continue as co-parents in the event of a separation. Other post-breakup scenarios have less obvious answers. Exes can, often unintentionally, fall into dysfunctional roles in each other’s lives, such as a baggage-laden “friend”, convenient sexual outlet, or receptacle of lingering animosity. Deciding how to continue forward, together or separately, after a relationship dissolves can be tricky for anyone. However, for several reasons, this quandary appears to be particularly challenging for lesbians.

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First of all, gay women’s friends and lovers are typically the same gender, making boundaries around friendships and romantic relationships more flexible. This is a challenge unique to lesbian relationships, simply because women—of any sexuality—tend to forge their closest bonds with other women. The potential for any gay-leaning friend or acquaintance to become a lover adds a level of challenge and confusion to many lesbian social circles. It is very common for lesbian friendships to morph into a more intimate configuration for a period of time, changing the interpersonal patterns within their friendship group. If the romantic relationship ends, it is often natural for the former couple to try to return to being “just friends”. It may sound simple in theory, but the physical and emotional intimacy shared and corresponding bonds established are not easily severed. And it’s not always the most comfortable of arrangements for the exes or for the new partners involved, to say the least.

This leads to another issue contributing to lesbian post-breakup complications… both partners in the couple are guided by the emotional physiology of the human female. In heterosexual relationships, a hormonal balance is generally struck so that reactions may be tempered through differing intensities of experience and response to emotional stimulation. Meaning men are often less emotionally reactive whereas women tend to be more highly sensitive. When both partners in a couple are sensitive women, the resulting emotional intensity can create significant difficulty for the ex-couple.

An anecdotal social review suggests it is uncommon for lesbians to neatly pronounce the death of a relationship and simply move forward separately without looking back. This may be related to the neurochemistry involved; women experience much stronger effects than men of oxytocin, the “bonding hormone”, which promotes nesting, monogamy, pair bonding, and emotional extremes. This hormone is activated very easily; a single touch starts it flowing and further intimacy-creating activities (including sex) break the dam. So, two neurochemically typical women will naturally create very tight bonds which only break with great difficulty and emotional pain. Many women avoid completely detaching from an ex in an attempt to minimize the pain involved with a breakup.

An additional piece of scientific information helps explain the difficulty of intimate breakups between women. Brain researchers have discovered that emotional and sexual intimacy between individuals creates a physical connection in the brain which cements that relationship neurologically as a meaningful attachment. The evolutionary purpose of sexual contact and its related hormonal processes is to bond people together— and these hormonal and neurological operations are especially effective in women. So when a breakup occurs, the critical healing task is to break that physical bond of intimacy in the brain in order to move forward with emotional freedom and strength. While the bond remains in tact, so do the feelings associated with the loss of the bonded object: sadness, fear, anger, shame, and love. Again, women experience and process this connection more intensely than men do, so an intimacy bond between two women can be even more difficult to break. This phenomenon is evidenced by the number of lesbians who choose to keep their exes in their lives as friends or some permutation of such. Full severing of the intimacy bond requires physical and emotional distance, negative associations with the ex-partner, and forgiveness.These goals cannot be achieved with continued contact immediately after the breakup. Any true friendship or healthy continuation of contact is possible between exes only after the bond of intimacy is completely broken.

The conclusion to be drawn from this information is that after a period of separation and deep emotional healing, ex-partners may be able to occupy space in each others’ lives. Offered below are some healthy scenarios for continuing contact with an ex, with cautions to consider.

Exes as friends. Intimate relationships are typically based on a combination of shared interests and sexual chemistry. After the chemistry dies and the emotional intimacy vanishes, the shared interests will likely remain. Rather than avoiding the places, groups, and activities they both enjoy, exes may find it more convenient to develop a civil and friendly relationship with one another in order to be at peace when their paths cross. When an intimate relationship is lost, it can be additionally painful if a cherished social circle or activity is also affected. It may, in fact, be possible for exes to resume a functional friendship after each has thoroughly healed from the loss and resolved any lingering feelings related to the relationship or breakup.

Caution: Sharing interests with an ex may be possible, but emotional sharing or activities which may rekindle the bond of intimacy (read: substance use and/or amorous exchanges) are strictly to be avoided to keep things healthily platonic.

Exes as support. If a relationship ends constructively and sufficient time has passed for the emotional fallout to settle, continued contact with an ex may serve a purpose of support in times of need. This scenario can be tricky because, again, the support being offered cannot be emotional in nature. Sharing feelings is something to be done with intimates only, if healthy boundaries are desired. If, after recovering from a breakup, an ex-partner maintains residual concern for someone with whom she spent a significant time of her life, she may be psychologically prepared to help out during a time of need. It can be nice to have a connection with a caring individual in life, as the coming and going of hard times is a fact of human existence.

Caution: It is important for exes to monitor their feelings around their supportive interactions and regain personal space as needed to resolve any lingering emotions that might threaten their peace of mind or current relationship.

Exes as history. Intimates who have experienced important eras of their lives together are irreplaceable emblems in one another’s lives. Although they move forward on their life paths, retaining a connection with the past is something that can offer comfort and a sense of continuity along life’s long and winding road. Googling someone from long ago or occasionally checking in via email can be a perfectly reasonable way to enjoy a bit of nostalgia, reflect on the past, and gain perspective on the present.

Caution: When relationships begin to sour, human nature instinctively nudges people to reflect on the past with rose-colored glasses. It is helpful to be honest with oneself about the reasons for seeking re-connection with an ex to ensure one is not escaping from a problem in their current relationship or resurrecting emotions formerly associated with their ex.

Many people believe that negotiating intimate relationships is the crux of life’s purpose. The bonds of love and intimacy formed with others bear witness to the value of human interconnectedness. The memory of loved ones cannot easily be forgotten and, as mentioned above, new roles can sometimes be assumed once the intimate nature of a relationship has changed. These are tricky waters which require emotional strength and stamina to navigate successfully. Observing a new partner’s decisions around her relationships with exes can provide valuable information regarding her emotional needs, boundaries, and strengths. And noticing one’s own tendencies in this area can highlight areas of mental and emotional health and areas in need of attention. If personal growth and deep healing are desired, discarding exes as emotional crutches and severing outdated intimacy bonds will strongly support the goal of moving forward in a healthy, happy way.

It’s a pretty well known fact that ‘happily ever after’ is a concept that is often easier said than done. People still cling to and admire the ideals of a long-term commitment and marriage and with a little effort and cooperation many find that it is actually doable when they have both feet in the relationship, whilst others are finding that finding a new partner is sometimes just easier, and divorcing themselves from their partner and situation makes more sense. But with so much exposure to new and alternative ways of embracing marriage, more and more couples are ‘coming out’ so to speak, to embrace their sexuality by exploring alternative lifestyles within the marriage. Alternative lifestyles, also known as open relationships, are giving couples a third option, so to speak, when relationships need a little extra push to get up that hill.

So, what exactly are these alternative lifestyles and how do you know they are for you?

When I speak about alternative lifestyles I am talking about anything that deviates from the expected and usual monogamous, heterosexual marriage. Some lifestyles include the swinger lifestyle which is when a couple may choose to swap partners with another couple, threesomes/foursomes which may be in the form of polygamy or polyandry (marriage with more than one wife or husband, respectively) or just introducing a new member/s occasionally or on short term basis. LGBTQ lifestyles are another style where although married, one partner, or perhaps both parties have another partner of the same sex, or may be involved in a lifestyle as another gender, with another gender, etc..outside the marriage. The variations, labels and titles are endless.

These lifestyles differ from the norm because in general they introduce more people into an intimate space, either physical or emotional, and beyond what is generally viewed as the space of the dyad or couple, and hence referred to as ‘alternative.’ Sometimes these happen naturally. Sometimes the couple makes a decision to do this together based on other circumstances. They are not always the easiest of lifestyles and couples need to communicate openly and honestly to both get their needs met. Communication and cooperation are key here. Note: To me, cheating and infidelity do not qualify as an alternative lifestyle, although technically other people are involved. A healthy alternative lifestyle with your partner includes consent, honesty, and communication.

I’d like to refresh your memory a little on a little old study Dr. Helen Fisher, PhD did. She found that there were 3 stages of love. Basically they were Lust, Romance and Commitment. In the lust and romance phase things are exciting, passionate and the sex is great. In the commitment phase all the excitement and unrest leads to stability, security, things which are perfect for family raising, and often times also lack luster sex, especially when couples are comparing it to before. I call it the 2-year lull. Couples often start freaking out at this point and wonder what is wrong with them. Couples in the know recognize this is normal and find a way to flow through this time with continued efforts and this is also a time when many couples decide they may want to do something different or alternative to spice up the relationship.

How do you know if this lifestyle is for you? You have to be honest with yourself and your partner. If something doesn’t feel right or comfortable discuss it openly. If there is something that does interest you, discuss it with your partner and try to set as many ground rules as you can before proceeding as it can get a little complex out there. Getting more people involved means more emotions, personalities, time spent, so on and so on. Jealousy and insecurity happen too. So be realistic and don’t be afraid to speak up to your partner.

Setting ground rules is key. Things will come up while you are out there ‘mixing it up’ so having as many key words, and advance communication to help ease the situation will make it all the better.

One last thing to remember is that this lifestyle isn’t for everyone, and it’s okay if you’re not feeling it. A must read on the subject matter is “Ethical Slut,” by Dossie Easton, Catherine A. Liszt, if you are truly thinking about embarking on something new and adventurous with your partner.

Are you a person who takes care of everyone else before yourself? Do you believe you should put yourself last? If you routinely take care of others’ needs before your own, then you may have codependent tendencies. In a relationship, codependent behaviors can potentially sabotage your relationship success. If you neglect your personal needs and wishes and care for others instead, then you may begin to feel resentful and empty. Taking care of yourself enables you to then be available to take care of others.

Codependent Behaviors

Let’s explore some codependent behaviors. Ask yourself the following questions:

• When you are criticized, do you become defensive and angry because your behavior was questioned?
• Do you feel better about yourself when you are helping (and only when you are helping) others?
• Do you settle for being needed when you really want to be truly loved?
• If you are a caretaker, do you anticipate others’ needs?
• Do you feel responsible for others’ feelings, thoughts, actions, choices, wants, needs, well-being or their lack of the aforementioned topics?
• Do you find it easy to change your plans for another person’s needs?
• Do you often feel angry and used even though you choose to ignore yourself?
• Do you always say “yes” even when you want to say “no?”
• Do you say “yes” even when it is not in your best interest?
• Do you feel you do more than your fair share?

If you tell yourself that your circumstance will improve later, get depressed or sick without understanding the reason why, over-eat, feel overextended, or if you stay busy to keep from addressing the issues you need to address, you may be in a state of denial.

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Do you find it difficult to feel joy, to have fun, or to do something at the spur of the moment? Do you find it hard to enjoy sex? Do you have sex when you really don’t want to have sex? Do you make up reasons to avoid having sex? Do you have sex when you really just want to be held and loved? Do you look for happiness in others and not within yourself? Do you choose partners who are not available (physically or emotionally) to love you? Do you stay in a relationship long after it is clear it is not working? Do you think you are not loveable? Is your communication poor? Do you blame, threaten, or beg for your needs to be met? Do you ask for your needs and wants indirectly, thinking people will just know what your needs are because they love you enough? Do you think what you have to say is unimportant? Do you avoid talking about yourself, thoughts, or dreams? Do you ignore your thoughts without voicing them? Do you fail to voice your opinions for fear of being rejected or put down?

From an early age, women are usually taught about the importance of nurturing and taking care of others. Mothers generally focus on meeting the needs of the children, husband, and household before addressing their own needs. Simultaneously, society and the media send women the message that they must be perfect. They are given the message they need to be thin, beautiful, young, perfectly dressed, and in all ways flawless. Men are taught to be outwardly strong. They are taught it is acceptable to be angry, but not sad, vulnerable, or outwardly emotional. These incorrect, constant messages will destroy us if we allow them to.

Do you often feel overwhelmed, depressed, or anxious? Are there times where you feel like an empty shell wanting to isolate yourself from the world? Do you also find it difficult to connect with others? If so, it may indicate that certain needs aren’t being addressed. Addressing neglected aspects of your inner and outer world is related to self-care.

What is “Self-Care?”

Self-care can have a different meaning for each of us. Essentially, self-care is associated with taking care of your needs, asserting yourself to increase the possibility of those needs being met, and monitoring your time and energy given to others. To feel balanced in today’s world, we must address both our inner and outer needs. Taking care of yourself will allow you to be there for your relationship. It will allow you to feel the Goddess or God you truly are inside. Your partner will respond to you in a more positive manner, and emotional intimacy will be more easily deepened when your needs are satisfied.

As parents, we get caught up in the family fast track. We are consumed by school, homework, little league, karate, dance class, and on and on. There is little time left to focus on self-care. Parents get caught in this cycle, leaving little to no energy left to meet their own physical, emotional, mental, or spiritual needs. There is no time left for themselves, much less their intimate relationships.

When we neglect self-care by focusing on trying to meet the needs of others before taking care of ourselves, we can lose our identity and power. We also harvest a great amount of resentment and self-hatred when we neglect ourselves. Ultimately, it is when we connect and address our needs that we can find balance and happiness. When this happens, we can give to others from a full heart. In other words, we can enhance our relationships by taking care of ourselves.

The list of things you can do to develop a self-care practice is endless! Learning to respond to your needs with acceptance, compassion, and a willingness to make healthy changes can begin to bring balance into your life and allow you to connect with joy. Self-care does not mean spending money. A spa day or week is great, but self-care can mean much more than having services performed.

Make a list of your needs: spiritual, emotional, physical, intellectual, and relationship intimacy needs. Under each heading, record activities that will support self-care in that area. Keep space for additions as you think of them.

Here are some suggestions:

• Journaling, meditating, yoga class, moving to your favorite music, taking time to enjoy your favorite music, lunch with the girls/guys, overnight romantic time with your honey, walk in the rain, bubble bath with candles and music, taking a lunch to the river, reading a book, or anything you enjoy. Search your soul for those things that really nurture you.
• Make a list of things that nourish your spirit and make you come alive. Is it music, art, writing, cooking, or dancing? If you’re not sure what would be on this list, then explore new activities or hobbies.
• Connecting with nature can be extremely nurturing. Take a walk on the beach or in a park and really listen to the surrounding sounds and sights. Allow your senses to open and let yourself be nourished by nature. “Taking time to smell the roses” is good advice after all.
• Laughter can be the best medicine. Play. Play with your partner. Find ways to put humor and playfulness into your everyday living. Let that “inner child” out often. Allow yourself to be silly. Allow yourself to enjoy. Allow yourself JOY.When you are filled with joy, even part of the time, all of your relationships will benefit, not just your romantic relationship.

Accept the fact that the road of life will have bumps. Instead of resisting or personalizing these bumps, accept that there are things you cannot change. Realize that the only thing you truly have control over is yourself. Be present in what is happening in your life. Reflect on whether you’re responding to your emotional, mental, spiritual, or physical needs. Are you taking good care of both outer and inner needs? Are you listening to your inner voice when it tells you to slow down, set boundaries, take care of your body, rest, or exercise?

Take care of yourself. Have fun. Life is short, so enjoy every moment. May your day be interspersed with joy.

I want to start off by saying that pornography in and of itself is not a ‘bad’ thing. We have preconceived notions about porn being something bad. Men feel guilty about it. Women feel threatened by it. I want to talk a little bit about why porn is good, and why porn is bad. At the core, I believe that everything in moderation is the best format to follow. And a little bit of porn should be fine, as long as it’s not interfering with your sex life, social life, finances, job, relationship, family, responsibilities and so on. (Read: Most mental health professionals will in fact determine whether or not something is considered an addiction, or if someone is addicted based on the aforementioned variables of responsibilities. If something is being affected, such as any or all of job, relationship, family, money, chances are the individual has a problem or addiction, and will likely be treated as such by the mental health professional.)

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So, with that said, we are long overdue to begin to wonder how the internet’s biggest industry Porn, which continues to infiltrate our relationships, our sex lives, our bedrooms, not to mention the lives of teenagers who have the highest porn viewing statistics, and so much more continues to thrive, when it seems to have so many negative connotations? How can 63 million viewers be so wrong*? As a sex educator, I feel that a lot of it has to do with our attitudes about sex. Naturally, when we don’t feel comfortable talking about something, that we already feel we know so little about, and ill-equipped to talk about, read: yes, I am talking about Sex, its presence, in a highly graphic manner is going to intrigue us. Hence we are enticed to watch such movies and videos. But on the flipside, the messages we were sent growing up about masturbation, sex and nudity, and the silence we were fed when it came to anal sex, girl-on-girl or man-on-man sex, group sex or orgies, and sodomy may also lead to anxiety about what we see, which can lead to the on the better end, aforementioned feelings of guilt, and full blown addictions on the worst-case-scenario end. (more…)

Since my last blog, Depression Medications: How Can You Get Your Libido Back? a number of you have asked for more information about possible sexual side effects caused by antidepressants. Before I say more—a cautionary word—I’m a psychotherapist/counselor, not a medical doctor/psychiatrist. So what I write in this blog is drawn from my (extensive) experience working with people who have challenges and/or difficulties with sex—I’m a sexologist, not a psychopharmacologist!

Some of the worst culprits, or libido smashers, are the selective serotonin reuptake inhibitors (SSRIs) such as Effexor, Paxil, Prozac, and Zoloft. Unfortunately, these are all heavily prescribed. I mentioned last month that many folks can benefit from a so-called “drug holiday,” when they forgo their medication for a few days. Be aware that this intervention does not work for Prozac. This is due to the much longer period of time that Prozac remains in the bloodstream, compared to the other shorter-acting SSRIs, like Zoloft.

Several types of antidepressants have virtually no side effects. The most common ones that I hear about are Wellbutrin, Xanax, and Klonopin. I’ll often suggest, to the new people I see, substituting (with the agreement of their medical doctor, of course) Xanax or Klonopin for Wellbutrin because the latter can exacerbate anxiety or “agitated depression,” as it’s called by psychiatrists.

Wellbutrin is also infamous for causing insomnia and headaches, which tend to make most of us anxious, and it certainly doesn’t contribute to an enjoyable sexual connection! Wellbutrin is pharmacologically distinct from the SSRIs, as it enhances the neurotransmitter dopamine, which has the opposite effect on libido and orgasm of serotonin. Xanax and Klonopin are usually prescribed to combat anxiety, not serotonin, so they tend to have very few sexual side effects.

I will often recommend that people who are leery about psychotropics try St. John’s Wort, which is most effective, I’ve found, for Type A blood types (remember, I’m not prescribing, just using anecdotal experience to make these suggestions!). Because it’s not regulated as a pharmaceutical substance, I’m told that efficacy can vary widely.

[fat_widget_left] The individuals I see in my office have reported that Viagra is effective for SSRI-induced absence of orgasm, and I’ve known people of both genders who swear by the botanical preparation ginkgo biloba to reverse libido, arousal, and/or orgasm problems. One sex therapist colleague tells me that Viagra can be helpful for women as well, but no one I work with has directly reported this to me.

If switching to an alternative psychotropic is not clinically appropriate or effective, some doctors might recommend adding another medication on a daily or as-needed basis. Many people are hesitant about taking one drug, let alone two! But for those who are comfortable with it, a second medication can often offer an antidote to the side effects of an otherwise helpful medication.

Most commonly, a sexual-savvy psychiatrist will prescribe a single low dose of Wellbutrin for people complaining of sexual side effects from other antidepressants—employing lower does of Wellbutrin than would be necessary to treat depression alone. These small doses can restore the serotonin-dopamine balance that I mentioned earlier, alleviating sexual side effects.

People starting out with me often ask if I suspect that their sexual problems are relationship issues or caused by medication. I always ask them how long the sexual challenges have been occurring. SSRI-induced sexual dysfunction follows a fairly typical pattern: it begins within days or weeks of starting the new psychotropic medication. For example, a woman may report that she can no longer reach orgasm with her husband within weeks of beginning Prozac for obsessive compulsive disorder.

Women rarely volunteer this immediately, but I ask LOTS of questions, which makes it easier to discuss sexual concerns. Men usually have less hesitation talking about such problems, and as one man said to me recently, “that’s why we came to a sex therapist and not the marriage therapist down the street!” The fact that I coach by phone also seems to help, especially for men, who might have difficulty opening up “when the plumbing doesn’t work!”

Don’t forget—if you have questions about your medications, make sure to discuss them with your medical doctor or psychiatrist.

As the New Year begins, we think about resolutions. Though couples may have resolved to have a better relationship, resolve their differences, have less conflict, it occurred to us that we don’t really “resolve” issues in relationships.

“Resolving” connotes the process of solving a problem or difficulty, finding an answer, making a decision, bringing a disagreement to an end. Though we certainly do solve problems, make decisions and conclude conflicts with our partners, we never fully finish. Most couples have chronic issues that they continue to dialogue about during the lifetime of their marriages. Actually, our relationships are in a continual process of “evolution,” growing healthier and stronger or becoming weaker and more fragile. As 2011 gets off to a start we want to share our thoughts with you about “Relationship Evolution.”

“Relationship Evolution” is the never-ending, continual process of consciously creating the head, heart, hormone connection through the ongoing actions and words exchanged between two people. (more…)

When we think of sex therapy, we generally assume this takes place with (and is for) adults or couples. This neglects the importance of helping our children understand sexuality and their bodies.

If you are a parent, an aunt or uncle, or a much older sibling, you know that when it comes to the subject of sex and children, we walk around on eggshells. Children are sexual beings from the day they are born, though, and in depriving them of sexual knowledge and their own natural expressions we do them an injustice, often stunting their sexual development and growth.

We worry about overstimulation: that we are somehow being voyeuristic when we encourage kids to talk about sex. We worry that we might encourage or victimize them by educating and informing them. As educators, we worry about not having the parental permission. We assume, also, that many children live in a world where they are protected from sexually explicit material. I think we know that even the most protected child is exposed to sexual material in one form or another. Parents cannot monitor everything, but we can provide kids with tools to make informed choices and to process what they see, hear, and read.

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It’s important to recognize that children are sexual beings. Children explore their bodies alone and with each other. This is normal behavior and should not be shamed or shunned. I am referring here to masturbation and mutual exploration (i.e. playing “doctor” or “house.”) Please note: I am not referring to sexual play between two or more youths of disparate age, or an adult with a child. Age is key here. A child is naturally inquisitive and curious about his or her body; an older individual should not exploit this. It is important to know, however, that same-age or close-in-age peer exploration is a part of natural and normal sexual development.

It’s important to recognize that children are sexual beings. Children explore their bodies alone and with each other. 

An example I make is of two girls, age 8, who are found being sexual in bed. The parents decide to punish the girls, separating them from future play dates. The parents are confused and shocked, perceiving this behavior to be wrong.

It is important to know, also, that exploration is often done with a peer of the same sex.

Punishment and shunning of normal and natural behaviors, including masturbation, may lead to shame and guilt about sexuality in adulthood, and confusion and embarrassment throughout development.

A great book to read on this matter is Sex, Therapy, and Kids: Addressing Their Concerns Through Talk and Play, by Sharon Lamb. If you are feeling ill-equipped, under-informed, or worrisome about talking about sex, it is important to know that when we’re silent, kids aren’t getting the adult guidance and help they need.

When we are silent in response to sexual material brought up by children, we mimic and reproduce the world the child is exposed to every day, one that excites and confuses him or her and provides little space for processing. As adults, it is important for us to take the lead and teach.

Seeking a trained psychotherapist in the area of sexuality can also be a great place to start.

Has my entire marriage been a lie? Am I to blame? Is there any hope for my marriage? Is divorce my best option? These are just a few of the questions that will run through your mind after discovering a partner’s sexual betrayal and sex addiction. You will experience a roller coaster of emotions.

You want to, first, encourage the betraying-spouse to take care of himself or herself while you seek support. Next, don’t make any permanent or rash decisions while the feelings are raw and fresh. Finally, realize that divorce does not have to be the answer, if both individuals in are willing to follow an intentional path toward healing the relationship.

Let’s take a look at these intentional, choices that can make healing a reality, in a relationship overwhelmed by sexual addiction.

• Both partners are willing to do their own work: Though there may come a time down the road for each individual to go to counseling together, it is very important for each person to be committed to a plan that will help them individually. The betraying partner may not be in a place to consider working on the marriage. Rather than forcing that the issue, work your own plan to deal with the grieving, the pain, the anger, and the actual betrayal. Focus on who you are, first, before concerning yourself with your role in the relationship, and how it has/will change. At the same time, the partner that has done the betraying needs to have a very clear and specific plan for himself or herself, individually.  If this step does not take place, it will prove to be very challenging. Each partner needs to be committed to their individual healing. [fat_widget_right]

• Steps to stop the sexual addictive behaviors: Once a betrayed-spouse knows about the sexually addictive choices and behaviors his/her partner has engaged in, it becomes increasingly difficult to stay engaged in the relationship. Major steps to end the behavior(s) need to be taken. This does not make him/her the dictator, but it is fair for the betrayed-spouse to set boundaries which state that, in order to stay together, the addictive behavior(s) must stop. This can look different for each couple, from having check-in meetings, to creating an actual written agreement. Again, this goes back to the betraying-partner’s willingness to face their sexual addiction, take accountability, get counseling, and engage in an openness of sharing that will foster and rebuild trust. This will have a dual benefit to the relationship. The hurt partner will see an effort in their spouse to take care of him or herself and also begin to honor the relationship. The partner facing the battle with sexual addiction will finally get some freedom from the shame they have been living with, and begin to find a new approach to life.

• Be willing to give each other space and respect each other’s healing process and timeline: Too often, when the betraying-spouse unloads on their partner, they feel a sense of relief; A weight has been lifted from living in lies. At the same time, their partner is realizing a terrible truth about the marriage in a way he/she never dreamed would happen. Now is NOT the time to press an agenda, other than agreeing to each take steps toward healing, and respecting that each person will progress at their own pace. By working on an individual path, each partner will be focusing their energy on him/herself, while, at the same time, honoring the work the other is doing. Each partner will have time to adjust to the changes that are now taking place in his/her own life.

Where divorce does not have to be discussed at this point, it will, more than likely, cross each partners’ mind. Before this decision is made, or things are said that will be difficult to overcome, take some time to work through each of these steps. Again, if there is going to be hope, and eventually healing, each partner will have to be committed to first focusing on themselves and then, when each is at a safe place and most likely with the guidance of a therapist, they can begin to take steps to restore their relationship.