Women who experience painful penetrative sex due to Provoked Vestibulodynia (PVD), Vulvodynia and other forms of Pelvic Pain may have suffered in silence for years. They may have thought that the pain was due to being new to intercourse and that it would subside. Or perhaps they may have mentioned it to a gynecologist, only to be told that there was no evidence of any diagnosis, or that they had a bacterial infection and prescribed a medication that didn’t help. For some women who had painful sex that was intolerable, they may have avoided going to a gynecologist for their entire adult life.
Women we see at Center for Love and Sex who are in heterosexual relationships where penetrative sex is an expected part of the sexual repertoire over time develop tremendous shame, anxiety and fear of any sexual encounter if they feel it will lead to intercourse. Their partners may gradually avoid initiating sex due to the obvious reason of not wanting to cause their partner/spouse pain but in addition, of wanting to avoid being turned down which they experience as outright rejection, lack of desirability and at times shame.
As a consequence to the painful sex, some male partners/husbands may develop their own sexual disorder like erectile dysfunction or premature/uncontrolled ejaculation due to the anxiety that develops around their penetration hurting their partner. Couples like this tend to self refer to a CLS therapists when sexual avoidance has gone on for some time and couple is in crisis or fear of losing their sex life altogether. The physical ailment causes intra-personal and interpersonal challenges that have to be addressed in therapy. Many times these women can treat and heal their pain when working with a pelvic pain physical therapist.
When I mention pelvic floor physical therapists to friends and even other therapists, they have never heard that this specialty even exists. As a systemic sex therapist, I frequently see women and couples who present with painful sex and collaborate with pelvic floor PTs to coordinate treatment in a holistic manner. I have had general therapists refer some of these cases to me after seeing clients for many months or years assuming the pain was a somatic outcome of early trauma.
It is critical for all therapists to understand the structure of the pelvis and causes of pain so that they know how to support, advocate and refer their client to the right doctors and pelvic floor PTs so that they can move ahead quickly with a treatment protocol that addresses their particular issue. It is also important for pelvic floor PTs to understand the consequences the pain has had on the client’s primary relationships, her Sex Esteem®, and shame level around discussing the specifics of her condition so that they can collaborate with the therapist. I will often assign homework assignments that will echo or support the exercises being assigned by the pelvic floor physical therapist.
In my upcoming webinar for therapists, sex therapists and physical therapists titled The Collaborative Clinical Care Model Between Therapists and Pelvic Floor Physical Therapists Involving Sexual Pain, I’ll be collaborating with Amy Stein, DPT Founder and Director of Beyond Basics, a specialty PT practice in NYC and the author of Heal Pelvic Pain, a self-help book for people dealing with painful sex, urination and other physical activities involving the pelvis. I invite you to spread the word about the webinar which will be live and take place on Monday February 6th from 12:30-2:30 PM EST and is geared for professionals.
For those of you reading this who suffer from any sort of pain during sexual activity, I invite you to contact my practice, Center for Love and Sex via email email@example.com or firstname.lastname@example.org to discuss your situation and set up an appointment for an in person session or a coaching session if you’re outside of the NYC region.
It’s wedding season, and I felt fortunate to attend a wedding of a man and woman who had met on Tinder. Each person that got up to make a speech at the rehearsal dinner and at the wedding mentioned this detail in their toast to the bride and groom. It made me feel surprised and yet rejoiced that this particular couple felt no embarrassment nor any discomfort that they had met up (a few years back now) on what was then known as more of a hook-up app. They did not feel repentant, naughty or shady about their initial desire to meet someone for some playful fun.
However as a sex therapist, I treat single people who are dating, newish couples and long-term committed couples, and several clients have discussed their feeling awkward when their friends or family ask how they met their new significant other. Does it seem better at that very minute to conjure up a romantic or at the very least a quirky, serendipitous story rather than admitting that you matched with a click or a swipe?
Not only have over 15% of US adults used online dating sites or dating apps, but the numbers of users and success stories increases each year for all ages.
The media in our culture still encourages fairy tale romances, seen in so many romcoms or series in which a young man sweeps a young woman off her feet, or a woman just has to look at another woman at a party and they fall in love (or lust as the case may be) instantly. In a show like Transparent, or Girlfriends’ Guide to Divorce , two characters make eye contact from across the room and know they have to have each other . But we know that this isn’t the only way people meet. Perhaps swiping right or clicking ‘like’ is’ the new fairytale romance that we are just waiting to see in movies and television. When over one third of singles have used a website or app to meet others, it is time to rethink our idea of romantic introductions
Despite online dating’s popularity, there is some stigma around it. A recent study found that 23% of adults agree that “people who use online dating sites are desperate” . Although this percentage has decreased since 2005, ideas like this are discouraging for those who already fear the judgement from others as they reveal their true story of how they met. As a therapist who often sees single clients who are dating, I often hear people express embarrassment when they start seeing someone and their parents or friends start asking more questions about where they met. The exception to this pattern are gay couples who are more comfortable with meeting men on apps like Grindr for a hookup which may or may not lead to a relationship.
When I inquire further, I discover they think people will think the relationship is not a “real” one and that it doesn’t have much hope for a long-term union because it started online. There is also the belief that others will judge them for shopping for hookups and trying to dress it up as a “date” when they’re speaking of it. People often believe that they should be embarrassed about having some relationships which are more about a sexual connection than an emotional/romantic union. These thoughts and feelings reflect more on American society, and religious/cultural beliefs than it does about human sexuality and the interest people have to have casual sex without a monogamous contract. If the understanding is clear and transparent, and both parties are sober and consensual and hopefully have discussed safer sex precautions, it is their prerogative on how they meet and connect with a partner.
However, when a couple meet on an app and then have the relationship develop into a long-term committed relationship, I encourage them to accept the relationship’s origin with pride and encourage them to explore more deeply the reasons behind their reluctance to share including internalized shame, anxiety of being shunned or criticized and the worry their relationship will not be respected.
A recent heterosexual couple who came in to address their flagging sex life told me: “Her parents would die if they knew she found me on Tinder” and “ My parents won’t take our engagement seriously if they knew how we met and they’re helping to pay for the wedding”. If you are nervous to answer when someone asks you how you met, I am empathic since you are part of a generation of innovators who still have to explain Instagram and Snapchat to your parents. My advice to you is to use your Sex Esteem®, which is the combination of Curiosity+Confidence+Clarity+Communication+Creativity. I explored the idea of their shame in sharing their story is partly the same shame that was contributing to the less frequent sex in their relationship.
In addition to therapy, my practice provides Sex Esteem® classes and coaching which empowers people to tell others about the origins of their relationship without fear or shame. (There are some cultures in which the knowledge pre-marital and/or gay sex could have grave consequences so I help clients make well-thought out decisions when it comes to sharing this information). They also empower people to articulate the sex they desire from their partner in clear, calm way that allows for a partner to hear without defensiveness or hurt.
If you tell a listener in a confident and authentic manner what allowed the two of you to become more serious after initially being attracted to their physical appearance it is not different than your relative seeing a person they were attracted to at a disco or at a friend’s party. Relating it to situations of their generation that may have seemed illicit or less “serious” by their parents allows them to identify with the erotic and emotional feelings that are centuries old. Rather than focusing on the fact that you met online, tell a story about the moment you knew this connection had legs to become a committed relationship.
The focus does not have to be about your online profile or how many people you swiped through to find her (unless you want it to be!). Instead, talk about the first time you laughed together, the reason why you were embarrassingly late to dinner, or how you hit it off when you both ordered the salad without the olives.
I invite you to become empowered. You met online because you took the initiative to find someone right for you who has similar interests, passions, and hobbies. You knew what you wanted in someone, and you went out and found the right person. Who says you have to wait for destiny? You found them. Own and celebrate your Sex Esteem®!
There could be a lot of lessons to be gleaned by this very unusual primary season thus far but nothing has baffled politicians, pundits and journalists as the immense popularity of Donald J.Trump. I thought I would use Trump as a good example of a person who exhibits many of the behaviors consistent with a person who a therapist would diagnosis with Narcissistic Personality Disorder. I write this blog to assist those people who feel like they might be involved with a person who may have similar tendencies with hopes they can begin to see the pattern of negative dynamics, the low self esteem that their behavior engenders in others and look to ways a person might change their relationship or leave to preserve their sense of self. In my years as a therapist, I have worked with many people who complain that their partner or spouse is berating them for a small behavior, or degrading them for not being attractive enough to have sex with, or throwing a tantrum when their partner finds fault with some of the narcissist’s behavior.
The symptomatic behavior of Narcissistic Personality Disorder are expressed when a person to is compelled to rely heavily on others’ adulation to maintain their own self esteem at a high level. Underneath all that self-aggrandizement is actually a very fragile ego. One can see Trump’s lack of empathy and bullying manner as efforts to be viewed consistently as a take-no-prisoners winner in the nominee race. He keeps talking to drown out any doubt about his abilities. People with this disorder can be at one time charming in order to get what they want from others and the next antagonistic, displaying feelings of entitlement, selfishness, and attention seeking. His frequent displays of lack of empathy and disdain are illustrated in his immigration policies and rhetoric on minorities and women, and his heightened sense of self-importance. Past tweets including one that reads “…my I.Q. is one of the highest -and you all know it! Please don’t feel so stupid or insecure,it’s not your fault” exemplify just this.
Clients of mine who tell me that their partner either yells when they try to address a conflict or retreats into a depressive state express the feeling that they often feel stifled to ask for what they authentically desire in the relationship for fear of their partner’s reaction. The “walking on eggshell” comment is a frequent description of how they feel. Although only about 0.5-1% of the general population is diagnosed with the disorder, about 50-75% of those diagnosed are men. There are also those who do not qualify for all criteria of a Personality Disorder by still display a few narcissistic trait. For example a man may feel his boyfriend is with him merely because he has great looks and is well built but when they begin to have sex the experience feels empty, as if he’s there only to make the narcissistic partner feel special enough to have won such a good looking partner. His boyfriend may begin that he is not fully seen as a 3 dimensional person nor that his needs are really met with authentic concern.
You may have already noticed these patterns in your relationship but I use this blog to outline more specifically five patterns of narcissists which we have seen in Trump’s behavior to enable you to figure out if your partner fits into these types of patterns.
1. Narcissists are only connected to those who mirror back greatness in looks, success, and greatness.
As their values are rooted in their thoughts of their own superiority and greatness, narcissists surround themselves with only those who they see as superior as well. This is used as a mirror of their own excellence. Their relationships are based on the reward they see in each person, judged by how well the person matches their description of power, control, dominance, and superiority.
Trump has claimed that “all of the women on The Apprentice flirted with [him]” illustrating that he thinks he is a kind of irresistible hunk that no woman could resist. Trump seeks out women who have superstar looks(according to this society’s beauty ideals) as a reflection of his own looks and to illustrate his power. While this behavior is not that unusual in our patriarchal society, Trump takes it a step further when he boasts of his sexual porwess: “And, he referred to my hands — ‘if they’re small, something else must be small.’ I guarantee you there’s no problem. I guarantee”, inferring that because his penis is large he is deserving and sexually appealing to Melania his current wife, who is several years younger than Donald, and a much photographed professional model. While there may be a lot more to his wife than we know, she is only brought out as arm candy to adorn his designer suits and upscale photo ops.
The realization that a narcissist may have been demeaned or abandoned by someone they loved or looked to for praise in their past cuts deep and in response, they often add to their bullying pattern externally, a set of extremely challenging goals as revenge for their experience of victimhood. For example was Donald driven to building a larger real estate empire to show his critical mother that he is more powerful than his father, or beat a brother who was favored for his warmer personality? We may never know what that chip on his shoulder is.
If your partner feels like he has to be a the best in every category and his pursuit of money, prestige and attention override his engagement with you, his partner, it may be that he considers you just another possession that he has won along his path to success. Research has shown a possible link between narcissists’ low self esteem and structural differences in their brains, with weaker links of the brain regions involved in self- esteem.with weaker links of the brain regions involved in self- esteem.(Citation). Narcissists have underlying beliefs that they are actually frauds and they are in constant panic of being exposed of perceived failure, leading them to overcompensate in many ways. You may see your partner being extremely self-blaming about their own mistakes and project this anger on you their partner as well as others, who are around them on a daily basis, like children, employees and parents.
3. They also lash out with narcissistic rage when someone criticizes them so that they never have to be vulnerable or responsible, this can leave their partner emotionally abused.
Given that their superiority is simply a facade to accommodate past questioning and failure, narcissists will attack those who question their dominance or criticize their ego. This is quick, easy way to maintain the illusion of entitlement and selfishness, as those who show any sign of weakening them are quickly devalued and diminished
Trump exemplifies this pattern, seen when he attacked Fox News Anchor Megyn Kelly multiple times. In August 2015, Kelly asked Trump a question regarding his language use toward women, calling them ‘fat pigs’, ‘dogs, slobs and disgusting animals’. Trump responded by claiming that she had “blood coming out of her wherever” (some took this as Trump referring to her menstrual cycle, although he denies this) and then went to Twitter to post public tweets, in form of a rant, about Kelly, her personal life, her professional success, and more. This illustrates the pattern of rage, lack of empathy, and aggression in response to questioning of authority.
In an intimate relationship, this rage and blame can leaving the partner emotionally and/or physically hurt, while the abuser shows little to no remorse, never taking responsibility for their contribution to an argument or fight. Instead, the attack leaves the narcissist feeling even more in control, in the right and remarkably calm.
4. They will cut you off if you don’t continually feed them positive feedback.
Months after his attack on Megyn Kelly, Trump announced that he would not attend the Republican Party debate that Kelly hosted in Iowa . Although he later denied that it was because of Kelly, I argue that this was his way of cutting her off and avoiding the chance of future criticism and lack of positive regard. By doing so, Trump asserted his presumed power and continued his cycle of dominance.
He also broke up his first two marriages and while we don’t know all the details, given his vicious attacks in public during this primary, one could guess that perhaps his wives challenged him and he wasn’t going to accept that kind of behavior from a woman or anyone for that matter. His current wife stated recently that she and Donald don’t try to change each other. Perhaps, this is another way of her saying she doesn’t challenge him too much.
You may experience your partner will cut off communication, positive regard or even financial support if you do not constantly focus, support, and reassure them of their power and greatness in order bolster their superiority facade. They may ignore your phone calls, block you from social media, and remain silent. This makes the person feel in control and proud of their imposed emotional distance while leaving you their partner feeling rejected, at fault and abandoned. It is their last resort in establishing dominance while distancing themselves from potential harm.
5. As a partner you’ll feel superficially connected during sex. You may feel like you have to perform in bed, and feel anxious if you’re not thoroughly turned on causing you to ‘fake’ your arousal and/or orgasm. You may feel like you have to appear perfect and/or spend a lot of time and/or money on your appearance. If you feel like a reflection of your partner who expects everyone and everything in his life to be of the highest quality, there may come a time when you start questioning your appearance and develop some body image disorders or disordered eating.
Your partner may make comments about the size of your breasts, your weight or your nose or compare you negatively to other women. This pattern of verbal abuse can lead a partner to seek out plastic surgery, go on extreme diets and lower their sense of self to an extremely low level leaving a partner feeling depressed and demoralized.
Do any of these descriptions sound like your partner? Have you remained quiet and cautious of complaining of their treatment of you or asking for your needs to be met? Lastly, If you have this feeling of never being enough to satisfy your partner’s visual and performative expectations, feel like you’re constantly walking on eggshells and can’t express yourself honestly, I encourage you to seek help from a licensed experienced AASECT-Certified sex therapist or a coach who can help you gain back your self esteem and your Sex Esteem®.
These days millennials are getting involved in serious relationships later and less often. With the rise of social media, dating apps, and increased gender equality, millennials are less likely to follow the romantic scripts that we see in other generations and popular media. Many often stray away from labels and are less eager for exclusivity; they are more accepting of nontraditional relationships with a free flow structure. Relationships vary amongst the 18 to 34 year olds, falling anywhere along a continuum of relational descriptions: casual hookups, friends-with-benefits, monogamous dating, non-monogamous couple, couple living together (either with a monogamy agreement or a non-monogamy agreement), or legal monogamous/non-monogamous marriage. So, how do millennials celebrate Valentine’s Day? The answer may surprise you.
According to the latest statistics, millennials are expected to spend an average of $290 each this Valentine’s Day. That is almost $100 more than the average expected cost of the holiday amongst other generations. Despite 58% of millennials believing that the holiday is overrated, 56% of them have plans to celebrate. They’re not just spending money, they also have other plans. According to a recent study, 73% percent of young Americans plan on having sex this February 14th. What I have found in my work as a sex therapist and sex coach is that one partner may have it in his/her mind that certain sexual activities will be part of the Valentine’s Day date while the other may not. And they’ve never alluded to the difference in their expectations. Not smart. It’s better for one’s relationship and V-Day date to give a heads up to your date (or if you’re in a triad, dates) about what kind of sexual scenario you’re hoping to have to see if you’re on the same page. Don’t expect alcohol to do your seduction for you because you may regret it, or not remember it in the morning. Too much alcohol may also cause a boundary crossing that is actually illegal (while several of my clients have been in this situation in the past, they do not label it as rape, although it technically is since they let their partner know they did not want to have intercourse and the partner drunkenly penetrated them or did another behavior that was not agreed to). I will discuss this in an upcoming blog.
Back to millennials and their generous outlay of cash on V-Day, what is that about? Could it be that younger adults are trying to impress their partners with fancier, more extravagant dinners and flowers?
Another explanation might be that this generation generally finds the holiday less romantic than others and chooses to spread the love amongst friends, family and coworkers as well. It is seen as a day of love for all of the important people in their lives, not just a romantic partner. They may not buy into the love in the holiday, but they do love buying gifts for everyone. In fact, the average 25-36 year old spends over $40 on their pet for the holiday.
Millennials have been brought up with the internet as part of their everyday life and with it the ease with which to purchase all sorts of things. In fact, the research reveals that a millennial “not only highly values experiences, but they are increasingly spending time and money on them”, rather than the traditional gift or object. So perhaps a Valentine’s Day trip to the beach over a pair of pearl earrings feels a lot more inviting and ultimately erotic. I think it’s important to note that while V-Day has a lot of hype and commercialism built into it, it’s also a time where lovers spend energy planning, anticipating and savoring the day. These are all important keys to attaining and retaining Sex Esteem® throughout a long-term relationship. Many long term couples do not spend the time and effort when planning dates or fun adventures to keep their erotic energy stoked.
In addition to V-Day, the newish Singles Awareness Day offers those millennials without a partner to spread the love and feel joyous as well. Similar to China’s uber commercial Singles Day, the holiday gives single men and women a day to practice self love, enjoy the day with friends, rather than wallowing in the media driven “single life pity”. Some spend the day treating themselves with a mani-pedi, and others grab a group of friends and go out. Either way, millennials have made the holiday into something enjoyable for all involved.
My advice to those of you who are heading out for the night on either Valentine’s Day or Singles Awareness Day, is to think about the love you’re hoping to express and receive and plan accordingly. Let the other(s) know what you want to do, what you want to spend, and how much you want to drink. Think about your sexual menu and decide the limits you’d like to set (and yes, even for those that have a very long sexual menu, there are always some things they do NOT want to do) or establish a safe word. Have a fun, safe Valentine’s Day with those you have chosen to share some love! And think about how you want to bring these sexual ideas into the rest of the 364 days of your year. >
The holiday season is meant to be joyful and merry, but it often comes with a whole lot of stress and anxiety for Americans. I am lucky in that Thanksgiving is chosen holiday for me given that I was born in Canada and never celebrated any type of Thanksgiving until I moved to the U.S. So that history that others have with their childhood Thanksgivings and both the positive and the negative associations people have with them is not something I have. However, I am keenly aware how this holiday and the holiday season that follows next month stir up many people’s anxiety pot. Over the years I’ve helped clients in my private practice and coaching clients online to prepare before and process after the holiday. Holiday stress ends up affecting people in many ways, including their eating habits, how the food intake then affects their body image, and very frequently impacting their sex lives. Their Sex Esteem® can become impacted by the way they feel inside their body and how they focus on how they are perceived by others.
When it is time to reunite with family members, people often find themselves sinking back into the family patterns from childhood which may include misunderstanding, resentments and dysfunction they hoped would be left behind years ago. With family members reuniting, quizzing each other on their jobs, significant others, and recent accomplishments, it is far too easy to forget that this time of year is meant to be a time to rejoice and relax.
Eating disorders are more than twice as prevalent as they were 40 years ago, affecting up to 30 million Americans today (20 million women and 10 million men). When people are under stress from the marathon of holiday events they attend, they tend to miss out on much-needed sleep, which may lead to emotional eating. With appetizers, dinners, desserts and wine as center pieces, it is easy to get sucked into a holiday “diet”, leaving you even more stressed and self conscious than before. It is far too common to then feel heavier and weighed down, especially as the temperatures sink outside.
Messages and pictures from the media often influence and perpetuate body dissatisfaction and self-criticism. Americans watch, on average, three hours of television each day with commercials and shows containing subconscious as well as conscious messages that to convey an ideal of beauty and virility Female characters on TV, commercials and in films are unrealistically thin, busty, and curved in the right places, failing to represent what women truly look like. Photographs of models’ and actresses’ bodies are edited to make their breasts look bigger, waists smaller, and skin more flawless. Research has found a link between exposure to the thin ideal and unrealistic body types in the media to body dissatisfaction and disordered eating among women. In other words, the more women are exposed to the unrealistic body and beauty expectations of women through TV, ads, and other media, the worse they feel about themselves and the more likely they are to have unhealthy eating habits. In the end, women are left feeling self conscious and unhappy with their bodies.
In my practice, I have found that women who are self-conscious about their bodies are also unable to thoroughly enjoy sex with their partner, at times avoiding sexual encounters. The focus is taken away from feeling pleasure in their bodies as they ruminate over what they perceive as faults, or insufficiencies while in the act of sex. Research has shown that low body image and weight concern affect women’s sex drive. When women feel worse about their bodies, they are less sexually active and less able to become sexually aroused.
Increased drinking, combined with an inadequate amount of sleep, can all add up to feeling down, or a euphoric feeling that leads to eating more than one needs to be physically satiated. When one feels over-stuffed one has much less energy for sexual intimacy (which under good circumstances can feel pleasurable). I’m providing a warning to all you holiday revelers to resist the urge to alienate yourself from true holiday pleasure in your body, mind and heart which can result in feeling less sexual and most likely more isolated.
What can you do to feel healthier, sexier, and more active? Want to retain and build on the Sex Esteem® you have been growing through reading my blog? I urge you to be mindful of your relationship with stress and food at this time of year. It is important to be aware of your emotions and how you may be attempting to numb them by throwing a huge pile of stuffing and pumpkin pie on your plate. I invite you to think about your erotic self and how your inner mind wants to keep you feeling vital, passionate and connected. What are my holiday tips this year?
Begin the day by doing some sort of movement to get you in touch with your body, whether it’s some simple stretches, a walk or run outside, or a trip to the gym or a yoga class if that’s your thing. Perhaps organizing a family tag football game will give you some running, some playing and some fun time with the extended family or friends before sitting down to the meal.
If you are feeling stressed with particular people at the gather, like your Uncle Tim and Aunt Lisa, focus on others with whom you connect more; like 8 year old cousin Brittany who wants to play house with you. If the tension becomes high for you, excuse yourself to take a little break outside to get some fresh air and breath deeply for 5 minutes. If you are working on goals to eat more healthily fill a smaller plate and resist the urges (your own and others’) to take seconds or thirds to satisfy an emotional need. Instead enjoy the flavors of the food by eating more slowly and mindfully.
In my new webshow Sex Esteem® on Youtube I discuss the power our senses have in our ability to turn ourselves on. For some the smells of pumpkin pie become a trigger for sex while others seek out the texture and flavors of homemade creamed spinach, mashed sweet potatoes, and turkey with a bit of gravy on the side. Think about what aspects of the holiday contain erotic triggers for you. If you aren’t cooking and are trying to keep to a healthier regimen, volunteer to bring along some healthy side like sauteed green beans or roasted asparagus.
If you are in a relationship It is important to prepare for the holidays by telling your partner about what concerns you have about the relatives you’ll be visiting, the menu and your personal food and alcohol goals and ask him/her to support you during the celebration. Check in with him/her before the meal and throughout to be in connection with each other. Discuss how much alcohol you plan to drink and how comfortable you feel at the table. If you’re both on the same page, having a buddy sticking to a plan is a great way to enjoy eachother and the holiday even more.
Initiate hugs and touching with your beloved sporadically throughout the day so that you are giving and receiving support, love, and connection. By creating an intimate plan with your partner, you are making sure that you will look after each other and know what to expect throughout the day.
Communicate ahead of time to find pockets of time you might have time (and privacy) for some sensual fun. It will keep one another grounded and connected in what may feel like a maelstrom of activity outside the bedroom. If you are single, try to sit next to the person with whom you feel closest. Be of service to those you love by helping out with the preparation of the food and or table. Giving hugs provides closeness to both those you hug and yourself.
Do not rush, and take time to savor every positive moment. The holidays are a time to reflect on your company, health, and positive relationships. Remind yourself what you are grateful for and what you love about yourself. Take a deep breathe and appreciate all that you have around you. Avoid overstressing and try to check back into what makes you happy. Remember that your emotional and sensual peace is much more significant than the size of your waist.
This past August, the Food and Drug Administration (FDA) approved the first prescription drug designed to increase women’s sexual drive. Addyi (rhymes with Daddy, don’t ask me how they come up with these names), developed by Sprout Pharmaceuticals, has been dubbed the “Female Viagra.” However, unlike Viagra used primarily by men to help them with their erections and other PDE5 inhibitors which allow more blood flow to a penis, this medication works on the brain. Another important difference is that Viagra (and the medications for a man’s Erectile Dysfunction) is taken as needed and works pretty rapidly whereas Addyi is taken every day, much like an anti-depressant and one may not see improvement until 4 weeks have passed.
Addyi is being hailed as the first of its kind to treat the root of the issue formerly known as Hypo Sexual Desire Disorder (or HSDD), now called Female Sexual Interest/Arousal Disorder (FSIAD) in the new DSM 5 (Diagnostic and Statistical Manual)
in pre-menopausal women. The new DSM 5 merged the experience of not feeling frisky or interested with the experience of not being able to get physically aroused.
HSDD is characterized by low sexual desire that causes marked distress or interpersonal difficulty and is not due to a co-existing medical or psychiatric condition, problems within the relationship, or the effects of a medication or other drug substance. HSDD is acquired when it develops in a patient who previously had no problems with sexual desire. HSDD is generalized when it occurs regardless of the type of sexual activity, the situation or the sexual partner. (www.fda.gov)
Originally developed as an antidepressant, Addyi works on the neurotransmitters in the brain to increase desire. While it is without question that the FDA and pharmaceutical companies often discriminate towards women in drug development and manufacturing, before women across the United States can truly claim victory, there remain strong concerns that this miracle pill (dubbed the little pink pill as a marketing ploy to resonate with the little blue pill that is Viagra) might actually bring more harm than good. One of the biggest concerns surrounding Addyi is whether the drug actually does what it claims. Approval for Addyi (when it was called Flibanserin) was actually previously rejected by the FDA twice – in 2010 and 2013 – for many reasons, including lack of effectiveness.
Even in the most recent studies, women taking Addyi only saw just one more sexually satisfying event (SSE) per month than those participants just taking the placebo. What my clients come in discussing is the loss of their intrinsic desire (or what some would call horniness, a physical tingling that alert them to their desire, an erotic fantasy or awareness that one is turned on) versus receptive desire (prompted by flirting, a fun date, or an intimate connection for example). Some in my field are not clear whether the Addyi study really were able to tell the difference in these types of issues by looking mainly at SSEs.
Moreover, many women do not realize the power their erotic mind has in boosting their drive and they do not understand that intrinsic physiologic triggers wear off naturally over time – which is why many in my field are asking whether we know enough about women’s desire to a) called it a medical pathology in the first place and b) offer them a medication versus educating women on other ways to increase their desire through other means? Considering that there was a high placebo effect in the study confirms my belief that some women need more education on how to enhance their erotic triggers besides intrinsic biological triggers.
In addition to the minimal evidence that the medication provides any substantial benefit to a woman’s sexual desire, I also share others concerns surrounding the side effects of this medication. As I mentioned above, the FDA previously rejected Addyi and another reason for those rejections were due to the high risk of side effects. First, there are the common side effects which including fainting, drowsiness, nausea, dizziness, and low blood pressure. While these are common for many other medications, women taking Addyi are also heavily counselled to abstain entirely from alcohol while on this medication because of the increased risk of severe hypotension and syncope due to the interaction between Addyi and alcohol.
The FDA felt so strongly about these side effects that each Addyi box will contain strong labeling highlighting these risks. Moreover, any doctor wishing to prescribe Addyi and any pharmacist that sells this medication must complete an online training course. It seems unrealistic to ask women – who may use alcohol as a means to relax prior to a sexual encounter – to abstain from alcohol and experience strong side effects from a pill that might only minimally increase their sexual arousal.
Finally, it also remains unclear that insurance companies will even cover Addyi. Some argue it would be equivalent to a monthly dose of traditional Viagra which is approximately $400, not an affordable medication for most folks. This means that even for a patient who does experience increased libido with no side effects, cost might continue to be a barrier. But pharmaceuticals are big business and when Sprout Pharmaceuticals was acquired by Valeant for $1 billion dollars, it was clear they were investing for a huge long-term gain on investment. You have probably heard about Valeant as recently as this past week, since it has reportedly raised the price on its brand name medications an average of 66% this past year.
While I am hopeful now that the FDA are taking women’s medical issues more seriously, and that they are interested in helping women who indeed have HSDD, I think we have to help women strengthen their Sex Esteem® by
a) figuring out if their low desire fits the criteria for the diagnosis of FSIAD
b) continuing to educate women on the many-layered causes for lower desire over long-term relationships
c) help them make an educated decision whether they need a medication.
d) ensure that they aren’t going to use alcohol when on the medication.
It’s Spring again and a new crop of couples are preparing all the details for their upcoming nuptials. Unfortunately, many people get caught up in the romance, erotic excitement, and wedding and dress plans of that first year to two years of their relationship that they neglect to talk about some critical elements that will help them safeguard their marriage and fidelity for the long haul. Since June is one of the most popular months to marry and Americans are spending an average of $30,000 on a wedding according to theknot.com , I thought I would use this month’s blog to offer some sage advice to those out there that are getting ready to invest their hearts and money to wed.
Frequently in the media we have heard engagements and weddings called off by celebrities like Bristol Palin and Miley Cyrus . The actual statistic of cancelled weddings have been estimated at 20%, and the issues can be about lies discovered, financial concerns or frequent arguments that never seem to get resolved. I have done a lot of pre-marital counseling and have helped some couples who decide to delay their wedding until they are able to nail down some pretty challenging issues before they can say “I do” with the skills and confidence needed to fulfill their vows.
Some of the issues couples come in to discuss before their weddings include: sexual incompatibility, concerns about cheating, alcohol or substance abuse, disagreements over financial habits, whether and/or when to have children, and differing religious beliefs. After 20+ years of counseling couples who have been traumatized by infidelity, financial secrets, or constant arguing, I can state that EXPLICIT agreements are needed at the beginning of a marriage and need to be updated continually as situations change and people grow.
Relationship agreement? I know, some of you are scratching your heads and thinking: “ What agreement? We get married and we vow to honor, love and be faithful to one another, isn’t that all we need?” The definitive answer is no, one needs to discuss these issues as seriously as where they want to hold the ceremony, reception and go for their honeymoon. (As a note, I think the following tips could also be helpful to those committed couples that haven’t sat down in a while to discuss critical aspects of the marriage/relationship agreement).
Make sure you share the same bottom line goals in life.
I am always surprised when couples have gotten engaged without discussing things like whether they both want or don’t want to have children, the religion in which they would raise their children, what city in which they would live. Make sure you and your fiancé(e) have a thorough discussion about these questions and make sure you’re agreed on the decisions. Leaving what I call deal-breaker decisions until after the honeymoon can frequently derail a marriage later on.
2. What do you consider cheating?
I know this sounds obvious but I have to reinforce the idea that couples frequently have different ideas about what they regard as broken commitments to their oath of fidelity. Most people don’t have what I have termed Sex Esteem™, the confidence, education and skills to discuss sexual issues with one’s partner and yet sexual fidelity is a critical part of the agreement you’re creating with your partner.
If this topic is too challenging to discuss on your own, or you have already run into questionable situations of trusting your partner, seek out an experienced sex therapist to have some sessions on this topic before the wedding. It could save you a lot of heartache later on. An example of what partners might disagree on would be: a one-time kiss at a company party after having drunk too much, watching certain types of sexually explicit material, dancing all night with another man/woman, and a hook-up during a bachelor/bachelorette trip to Vegas.
3. How much time do you each want to spend on your own, with your friends/family and with one another?
It’s hard to judge what your baseline needs are when you are in the throes of a new relationship because all those hormones are making you want to spend every minute with one another. But once that stage settles down you each have your own sense of lifestyle that makes one feel balanced. Your partner may have a very different expectation about how much time you’ll spend as a couple going forward. Make sure you’re clear about how many times a week and the amount of time you want to work out, how many times you like to speak to your parents/sister/brother, how many nights you want to have dinner together, and how frequently you want to have a date and/or sex etc. Take some inspiration from Priscilla Chan, wife of Mark Zuckerberg who asked her fiance to agree to 100 minutes of time each week, 1 dinner date a week and a 2-week trip abroad at the very minimum.
4. Commit to being your partner’s emissary to your parents
Some of the most stressful times couples experience as they plan a wedding is with their soon-to-be in-laws. Remember you are creating a new family with your own beliefs and traditions from your family of origin. You each need to explain to your own parents why you and your fiancé(e) have made your decisions and that they need to support you both and not blame or criticize her/him because they’re disappointed. ( I think this role needs to last for the first 2-3 years of a relationship until the son/daughter-in-law can forge their own relationship with their in-laws)
5. Plan business meetings to discuss finances
Marriages are about mutual love and support, fun and erotic connection in addition to being a financial partnership. I find that many couples discuss their financial goals and budgetary concerns as frequently as they discuss their sex life. Meaning, not as often as they should. I find those in long term partnerships or marriages need to carve out time (that is not designated for fun or sex) to discuss each of their goals, the steps they each are going to take to get them there and who is responsible for what aspect of their financial plan. Whether it’s how much to save for retirement, what each of you consider a reasonable rent, or how to plan for a vacation, preparing for a meeting and the considerations you each want to address can help keep underlying tension and anxiety from building. You can then move ahead to your fun time together more unified and eager to bond romantically.
Can Dakota Johnson and Jamie Dornan Fulfill Their Roles as Ana and Christian?
I got a sneak preview of the much anticipated movie Fifty Shades of Grey last night and I was surprised to see that Dakota Johnson does a great job creating the nuances needed to express the innocence, wonder, and inner strength of Anastasia Steele. Johnson was able to express a dry humor that shows her intelligence and assertiveness in a tension filled scene as they negotiate hard and soft limits. And her handling of a drunk dial call to Christian is quite cute and funny.
Unfortunately, I felt Jamie Dornan seemed pretty blocked off emotionally as Christian Grey until close to the end of the movie when the audience glimpses his little boy fear as the reality of Ana’s potential rejection becomes more apparent. Some of the lines showed the arrogance and entitlement Christian Grey’s character has regarding his type of sexuality. When Ana asks: “Why would you want to do this” Christian responds: “To please me”. Unfortunately he leaves out the pleasures and excitement the arrangement might bring to Ana based on the limits they set. In another scene Ana asks: “What would I get out of it?”, alluding to the contract. His answer is simply: “Me”. But this shows the limits and inexperience of Christian Grey integrating love and lust due to his history of early trauma that affects his attachment abilities.
I actually expected the movie makers to keep it more PG and leave the audience wondering if they’d get to see the explicit scenes in the book visually expressed on the screen. Well, Hollywood delivers with many visual depictions of both the vanilla and kinky scenes between Ana and Christian. I was concerned in the first sexual encounter Ana has with Christian in that the audience never sees Christian stimulating Ana externally before he penetrates her. What a shame I thought, since this is her first sexual experience. However, there are plenty of variations of his arousing her to heights of passion after this scene to illustrate his mastery of touch and tongue.
The faults of Christian’s character in the book are expressed in the movie in that he loses control when it comes to making the right decision of not introducing extreme BDSM experiences to a woman who is a beginner. He also doesn’t know the rules when it comes to the pacing of a dating relationship and respect for Ana’s personal space. However, his Christian expresses his vulnerability through his mournful tunes he plays on the piano in the middle of the night to signal Ana that there is more to his rigidity as a person. What she does respond positively to is his striving for excellence, his extreme wealth and generosity, his love of adventure and surprise and his singular pursuit of her as a playmate.
The audience will get to see quite clearly how floggers, ropes, and cuffs are used in a BDSM room. This may be a turn off for some viewers while others might be drawn in to the technical and erotic aspects to this type of sexuality. They will also see how the characters take on roles of dominant and submissive when playing in the Red Room.
This movie illustrates Ana’s initial steps of growth in confidence and knowledge (the prime ingredients of Sex Esteem™), as she falls in love for the larger than life, complex character of Christian Grey. Enjoy the film, would love to hear your comments.Can Dakota Johnson and Jamie Dornan Fulfill Their Roles as Ana and Christian?
Why are women having sex without orgasms in their relationships?
I saw an older rom-com last weekend titled: “Because I Said So” (link is external) with Diane Keaton playing a neurotic mother trying to find a partner for her youngest still single daughter. While the movie is not one of Keaton’s best (hands down Annie Hall (link is external)), the moment that touched me the most (no big spoiler alert here) was when she let her daughter know that she had never experienced an orgasm.
Because I Said So
The female orgasm is under the microscope again in the media but for different reasons. n the recent HuffPost article (link is external) by Catherine Pearson, women discussed their acceptance of not orgasming with their partners while still being able to bring themselves to orgasm through masturbation. A few women expressed the wish to stop faking having them during intercourse, and one woman said she wished her partner would try harder. It occurred to me that what wasn’t fleshed out fully in the article was the anxiety and fear these women had in their partner’s reactions when they brought up the fact that they weren’t orgasming. One man became enraged that his wife was faking and keeping it from him for so long and yet didn’t attempt to bring her to orgasm in their subsequent sexual sessions. The other man sobbed for all the years his wife had missed out on the pleasure she could have received and at his failing to give to her.
The other point was the fact that many of these women hadn’t developed enough Sex Esteem™ to show their partners how they bring themselves to orgasm when they self pleasure. Sex Esteem™ is my term for the confidence and ability to bring yourself the erotic pleasure and intimacy you want. While most of my clients say they feel too shy to masturbate in front of their partner or spouse after years of doing it in private and not considering it part of partner sex, it can be so helpful for women to pump up their confidence to do this if need be. Perhaps due to their upbringing and their love for their partner, the women in this article were protecting their partner’s feelings and ego when they kept the information to themselves and didn’t let on that they weren’t orgasming and that they wanted to put effort into figuring out how.
If these women had more Sex Esteem™ they would desire to further their discovery of sexual practices on their own, show their partner with their hands, or by watching a video together to grow as a couple. An exception in this story was Lisa, who did coach her husband as he tried oral and manual touch. When they tried a vibrator, though, he became excited very quickly, which caused him to climax quickly, so he nixed the idea of the vibrator completely. Instead of pursuing the vibrator which would have challenged him to work on his ejaculatory control while she could build her arousal, she backed down. She says in a surrendering way: “It still really bums me out, whenever I think about the fact that I can’t have that with him”.
While an orgasm is not the be-all end-all of any sexual encounter by any means (in fact, putting too much emphasis on ‘finishing’ may create performance anxiety and inhibit couples’ ability to linger upon and savor other sensual acts), it nevertheless upset me that so many women are in relationships with a sexual disparity without a healthy way to address it if they want to. I am not judging women who seem happy without a partnered orgasm, I just wonder if they had more Sex Esteem™ which=education+communication skills+ confidence, they might feel even closer to their partners. While there are certain medications and medical issues or past trauma which may inhibit a women’s physical ability to orgasm with or without a partner, the majority of these women had relationship or power dynamics, and/or lack of their partner’s technique in resolving their dilemma.
We have come (pun intended) a long way since the 1970s when my colleague Betty Dodson (link is external) began running her Bodysex (link is external) groups where women learned about their bodies and how to self pleasure. Betty was and still is a disruptor of accepted myths. At that time, the accepted theory was still Freud’s (link is external) that a clitoral orgasm wasn’t a mature one and that a “real” orgasm was a vaginal orgasm.
Betty Dodson in the 1970s
Most women need direct clitoral stimulation to reach climax, and about 25-30 percent of women may climax with vaginal penetration. While there are a variety of types of orgasm which I’ve previously discussed (link is external) in articles, the majority of women need a longer warm up and more clitoral stimulation before climaxing.
However, I still see women of all ages in my private practice who have challenges achieving orgasm for a variety of different reasons. Some women are capable of achieving orgasms alone, but not with a partner; others have never had an orgasm, and others still who are generally dissatisfied with the quality of their sex lives (solo or partnered). Some of them still feel shame and embarrassment that they aren’t climaxing with their partner and/or with intercourse. Others may feel that they’re rejecting their partner or being antisocial as was suggested in a recent NY Magazine articl (link is external)e if they pleasure themselves alone.
In my view, masturbation can be approached as a practice (much like yoga or meditation) allowing a person to explore and find new ways of attaining pleasure and relaxation. Orgasmic ability does not decrease with age, and just as one’s taste for food might change throughout their life, so too might the type of stimulation they find pleasurable and erotic. Women who have had their first orgasm after years of trying are often moved by the extreme pleasure their bodies are capable of and the sense of mastery and Sex Esteem it brings to their relationships. We are seeing more references to self-pleasuring in the pop music world (link is external) thanks to St. Vincent, Rihanna, and Miley Cyrus. Women need more films that show a partner stimulating a woman either manually or orally so that women understand what physical arousal is needed. It’s Valentine’s Day coming up, and the Fifty Shades of Grey movie is about to premiere. Give yourself or your partner a V-Day gift; time alone to explore your inner Goddess.
After discovering that her mother had never had an orgasm, I wish the daughter character in the film “Because I Said So” had said: “Mom, I’m ordering a vibrator online for you right now, you are going to love it!”
Taste, Aroma & Touch can enhance both your dining and sensual intimacy
Eroticism and food have long been paired together in the annals of history—with references to culinary pleasures found in literature, film, and pop culture. Pleasure taken from eating and drinking often falls into a category of sensual experiences. Indeed, the definition of sensual is “of or arousing gratification of the senses and physical, especially sexual, pleasure”. Certainly, while food itself may not bring about sexual excitement or orgasm per se, the act of eating and drinking bring to many a profound and visceral pleasure. The intersection of food and sensuality is often portrayed in popular culture when one partner feeds their blindfolded lover—who, deprived of one of the five senses, is overwhelmed by their heightened sense of taste. Popular culture has also used this pairing for comedic effect—notably, I recall a Seinfeld episode in which George, pairs his love of food and sex (link is external)unconsciously and ends up sneaking pastrami sandwiches into bed. While Katz’s may be delicious, perhaps it’s best to choose an item a little less messy.
There have been many cultural and artistic depictions of the link between food, sensuality, and sexuality. Take for example an infamous scene (link is external) from the 1963 film Tom Jones, based on Henry Fielding’s 1749 novel. Two couples gaze longingly at one another has they feast on delicacies such as crab, wild game, oysters, and fruit. They flirt with one another through the seductive manner in which they eat—practically acting out their sexual desires upon the food in front of them. In this instance, the food has become both a symbol of and a part of their passion. The shared meal is a slow seduction—culminating in the couple’s passionate kiss.
Readers might be familiar with a Sex and the City episode (link is external) in which Samantha Jones covers her nude body in sushi upon request from her boyfriend, as an erotic treat for when he returns from work. Samantha hopes that the sight of her body as a literal serving dish, coupled with the smell and taste of delicate sushi, will encourage her partner to experience her body in a similar way to the tiny morsels. Sushi is pristine, beautiful, and delicate—a work of art in and of itself. By presenting her body in such a manner, she is inviting her partner to take the same approach to savor her appearance, smell, and taste.
Social media has ushered in not only the age of the “selfie”, but that of “food porn”. Food porn is a term referring to images of food that are so succulent and enticing they provoke deep reactions in viewers akin to viewing pornography. As with viewing erotic art, there is an anticipation which builds when one sees an image of a particularly inviting meal. The viewer salivates, eyes widen, and pulse may quicken, just like a sexual response. Additionally, terming images as “food porn (link is external)” connotes a form of teasing between the artist and viewer.
Social media sites such as Facebook and Instagram are full of photos of friends’ meals. Going out for a meal and photographing your food prior to digging in has become so common that some restaurants have had to ban (link is external) the practice. Like sharing images of attractive partners or talking about sex with your close friends, there is an element of braggadocio here.
Pop culture references aside, Thanksgiving and winter holiday celebrations often center around food. Certain foods are eaten due to tradition or their status as a delicacy and rare treat. Think of sugary butter cookies or chocolate truffles thst melt in your mouth, the exquisite velvet texture of foie grois, or champagne bubbles giddily poppingin your mouth. Holidays like Thanksgiving, Hanukkah, Christmas, and Kwanza, prominently feature special foods. Turkey, stuffing and potatoes are classic Thanksgiving (link is external) fare; Potato latkes (link is external) are a traditional and symbolic Hanukkah dish; Christmas culinary traditions (link is external) vary around the world, but some notable examples include fruit cake, eggnog, mulled wine or cider, and a vast array of sweet and savory pies. Kwanza cuisine encompasses classic Southern dishes with an African flair, such as sweet potato pie and collard greens. While all of these holidays feature special and culturally significant foods that are a cause for celebration themselves, these holiday gatherings are typically intended as times to be with large groups of family and close friends.
Unfortunately it is not until New Year’s Eve that it is deemed culturally appropriate to share a glass of champagne (and perhaps sex) after the kids have gone to bed or the party with friends have ended. This long stretch of holiday festivities can be extremely stressful for the individual and couple at hand. Often, clients tell me they feel guilty for taking time to themselves during purportedly family holidays. However, there is no need to feel guilty—it’s okay to be a little selfish and take some time for yourself and your partner to honor your relationship in the holiday spirit. Taking some alone time to enjoy some culinary delights might bring you closer, aid your communication in and out of the bedroom, and give you some much needed alone time amidst the holiday rush.
Many of the words we use to describe sexuality and food are similar—both areas of experience deal with different textures, tastes, and smells. If couples can connect over what tastes good and pleasurable to them, they can have the same types of discussions about what feels good to them.
The holidays are often a stressful time—planning parties, travel arrangements, gift buying and giving—it’s no wonder that by the time New Year’s Eve rolls around, many people feel completely depleted.. I encourage you to carve out time between now and when the ball drops to ring in 2015 for sensuality.
Perhaps it can be the night before the big office party or a sleepy Sunday morning before the next holiday open house, when you create a sexy tasting menu for two (or more depending on your “tastes” (link is external))
You don’t have to blindfold one another to enjoy it, either. Pick a few things that you and your partner(s) enjoy—perhaps a decadent truffle, juicy pineapple, or a nutty cheese—the food itself doesn’t matter, but it should be something that tastes good to you.
Take turns feeding each other a bite and describing all the sensations: How does it smell? How does it feel? How does it taste? The best part about this kind of activity is that it’s a great way to relax and be flirty in the midst of holiday gatherings. If you’re short on time, you could do something like this for only five to ten minutes. Thinking about the sensual nature of food can bring out sensual communication and intimacy in other areas of your relationship as well, and help you de-stress over the holidays!