Author Archives: Sari Cooper

Wedding Season Worries for Grooms with Erectile Dysfunction

Given that it’s June and peak wedding season begins this month, I invited my associate Lauren to contribute a blog about the erectile issues that might cause havoc as a straight or gay couple ready themselves to walk down the aisle. 

With the peak of wedding season approaching for the spring and summer, heterosexual and homosexual couples that are getting ready to tie the knot may begin reflecting more on their relationship and their issues within it. Some feel like it’s crunch time and instead of avoiding these concerns, couples might want to finally tackle them before taking on married life. Sexual issues such as erectile dysfunction (ED), which is the difficulty to attain or maintain an erection or remain firm enough for penetration can frequently be put off by a couple and/or a groom because it is a vulnerable and sensitive subject for most partners to address. This procrastination can also lead to avoidance of intimacy in general, which is not a beneficial way to begin a marriage.

What I have found in my clinical work providing sex therapy at Center for Love and Sex is that ED is a common presenting problem for younger men as well as older men. Research has shown that 26 percent of men 40 years of age and younger are effected by ED, with half of them having severe ED.  Given that men are getting married at older ages, the fact that a quarter of these men (and their partners) may be secretly suffering from ED is a concern and one that we see frequently as couples are in the throes of planning their weddings.  Men are also well known avoiders of getting an annual physical.  As part of the CLS model we ask our patients to get a physical, as medical conditions can be a factor in the persistence of ED. The following medical conditions have been associated with ED: high blood pressure, kidney disease, diabetes, obesity, Parkinson’s disease, multiple sclerosis, side effects from medication, and treatment of prostate cancer. 

The young men I see coming in struggling with ED usually discuss performance anxiety, low self-esteem, relationship problems, anxiety, depression, stress, guilt, fear of intimacy, difficulty transitioning between porn and masturbation to partnered sexual experiences, as well as excessive alcohol intake. Other contributing factors may include questioning their sexuality,  having had a negative sexual experience, childhood trauma or worry over the lack of control they feel with their climax. It has been shown that ED and PE (premature or rapid ejaculation) often are presented together and that “ED is increasingly being recognized as the single greatest risk factor for PE”

Many young men who come in for help at Center for Love and Sex report that when they first begin talking about the problem, they feel vulnerable and at times worried about what their partner thinks of them, they feel a lower self-esteem.  However once I let them know these are common feelings that most men have when confronted with ED and that I will guide them slowly on how to address the issue, they begin to open up about the consequences this issue has had on their relationship.  Having sessions with both partners is critical to allow for the partner w/o ED to express their own concern, ask for guidance from the therapist and offer support to their fiance.  

Helping a client track their thought patterns during the sexual scenario with their partner can be extremely helpful.  Here are some thoughts that frequently occur before or during a sexual experience: “I’m not a man if I cannot get an erection,” “I am disappointing my partner because I cannot give them pleasure,” “this is all my fault that our sex life isn’t good,” or “my partner must want someone else because I cannot get an erection.” It is also common in gay relationships for the partner who identifies as the top to have more pressure to obtain and maintain an erection more than the partner who identifies as the bottom.  The anticipatory anxiety (the anxiety leading up to an event) can be just as stressful as the anxiety a man experiences during a sexual experience because it is setting oneself up for failure before anything even happens.

American society in general contributes to many of these negative thinking habits. For most straight teenagers and more recently gay young adults the dream of your wedding night, honeymoon, and marriage is presented like a Hollywood movie, complete with endless love making, excitement and passion. There is a lot of pressure on getting every detail down for the ceremony, ensuring your relatives get along, making sure the first dance goes off without a hitch that thinking about the penis responding properly can be overwhelming.  Given that many young men are now growing up with porn available at any time, comparing oneself to the exaggerated bodies and pharmaceutically assisted behavior of porn actors can only offer more heartache since one can never live up to one’s own and one’s partner’s expectations.   In films and porn men are presented as totally in control, exuding confidence and pleasuring their partner, at times for extended periods of time.

When you come into Center for Love and Sex, ED will be initially be addressed with both members of the couple if this is possible. This is important because sometimes there is unresolved anger or conflict, and difficulty in communication that could also being playing a role in sustaining the problem. It is also important to realize what effect each person has on what is going on in the couple’s system. ED can be the symptom that hides or exacerbates other behaviors, such as the non-symptomatic partner rushing to orgasm very quickly before their partner’s erection is lost.  Therefore, not only does this put pressure on the man with ED, it also puts pressure on the partner to rush through their pleasure.

Lastly, ED could also be masking a lack of sexual desire that one of the partner’s may have, so the man expressing the erectile issues may be in fact reacting to insecurities he feels around his partner’s lack of sexual desire towards him. In order to address these issues, we would discuss and evaluate the feelings each person has around ED, how they feel about their sex life as a whole,  and help each partner understand the relationship between their anxiety and the symptom of ED. It is easy to forget that the partner usually also exhibits anxiety during sexual experiences wondering if things will work out this time or thinking about how the partner with ED is feeling. So the couple must become more mindful of the pleasure of the sexual feelings, instead of putting themselves in a negative thinking pattern which diverts their focus away from the sexual arousal. In addition to that, it is important that when given home exercises to practice between sessions, they do it together in a non-judgmental, relaxed atmosphere where the couple learn to be better intimate partners and use the home exercises to increase pleasure and decrease anxiety as a team. So CLS and I invite you to a place of better understanding, more intimacy, and better communication that can help you not only on your honeymoon but for years to come.

 

American Hookup: Interview with Author Lisa Wade About Millennials’ Sexuality

As Director of Center for Love and Sex, I am frequently helping Millennial’s with their dating and romantic relationships. I was excited  to interview Lisa Wade,  author of the most recent book titled: American Hookup: The New Culture of Sex on Campus to discuss hookups and how this college culture affects millennials’ in their post-graduation romantic and sexual relationships.

Author of American Hookup

I wanted to hear more about her research regarding the state of hookups on campus and she was curious to hear about the issues that millennials are grappling with once they get out into the working world and begin to date.  What does dating look like, is it similar to generations before them, how are they approaching emotional relationships? Do they continue the pattern of hooking up? How do apps and dating sites affect their dating habits and are they able to integrate emotional, psychological desires with their sexual and/or erotic needs?

The interview begins with my questions for Lisa and her responses and then concludes with her questions and my answers.

 

Sari Cooper interviews Lisa Wade 

Given that hookups have been criticized in the larger American culture and media for some time now, I thought I would begin our conversation on a constructive thread.  What have you found are positive emotional. psychological and physical outcomes/by products reported by young adults engaging in hookups during their college years? 

Most students arrive on campus eager to experiment with casual sexual contact, even if just a little. They see sexual activity as a natural part of being human, are increasingly tolerant of a wide range of sexual orientations, and largely reject the idea that it’s okay to judge sexually active women more harshly than men. Thanks to the women’s movement, the sexual revolution, and gay liberation, the stigma of sexual activity has largely lifted.

In that environment, many young people enjoy “first times” — first kisses, first blow jobs, first one night stands — and honing new sexual skills. Many find it exciting to be participating in a part of life that is new to them (puberty was just a few years ago and 50% are virgins when they arrive on campus). It’s pleasurable to indulge one’s desires, to do new things, and to improve, no less with sex than with anything else in life.

Hookups offer these things to young people and, for a nontrivial minority of students, hookups are everything they want. For up to a quarter of students, hookups are incredibly gratifying. Research shows that students who claim to thrive in hookup culture really do: the more they hookup, the higher their self-esteem and sense of well-being.

What intersectionalities did you find in your research regarding status in terms of desirability with racial, gender and LGBTQ culture?  When research is done is it mostly skewed towards white, cisgender heterosexual sexual behaviors?

Students of color, women, and non-heterosexual students report more dissatisfaction with hookup culture and hooking up less than their counterparts, as do students who grew up poor or working-class. Non-heterosexual students often find that hookup culture is indifferent or hostile to their sexualities, so some avoid the hyper-heterosexualized spaces of hookup culture. LGBTQ students, especially if they are men, are much more likely to seek hookups off-campus.

Students of color simultaneously face a white supremacist standard of attractiveness and the possibility of being eroticized as “exotic.” This tends to play out differently for different kinds of students. Black men and Asian women are often fetishized, while black women and Asian men are often actively avoided. On average, then, white students hookup more than nonwhite students.

The other thing that I have found interesting in my work with clients is the vague aspect of the term hookup.  How did your research subjects define hookups?  And what behaviors were more frequently engaged in during hookups on campus?

 Students generally agree that any sexually charged activity can count as a hookup, so long as there is no expectation of future sexual or romantic interaction. In practice, 40% of hookups include intercourse, 12% include only what we might call foreplay (nudity and some touching of genitals), 13% proceed to oral sex but don’t include intercourse, and 35% don’t go any farther than kissing and groping.

What were the most common emotions young people stated they experienced during and after a hookup?

Two psychologists -– Elizabeth Paul and Kristen Hayes -– asked students what emotions they thought their peers felt when they were in the midst of a typical hookup. Their respondents listed emotions as wide-ranging as excitement, embarrassment, regret, fear, anxiety, confusion, and pride, but the most common answer—mentioned by two-thirds of their sample—was lust. The next most common answer, though, wasn’t any of the other emotions listed, it was “nothing,” the absence of emotion. So, students tend to believe that their peers are feeling turned on, but not much else.

Of course, in practice students are experiencing all kinds of emotions — positive and negative, strong and weak, wanted and unwanted — but when they do they often feel bad about it. Believing that their peers are much better at having “emotionless sex,” they feel like they are failing at hookup culture.

What percentage of your study opted out of hookups entirely?  Did you have numbers on whether these young people remained celibate, and/or chose to be in longer-term relationships that involved emotions?

A third of students opt out, reporting zero hookups at graduation, but many of these students don’t end up in relationships instead. On college campuses today, most relationships form out of a series of hookups. Students hook up together once, then twice and then three times, and eventually they start breaking the rules of hookup culture (they begin to like each other and say so). At that point, students will often go on dates and consider beginning an emotionally committed relationship. For students who aren’t willing to hook up, this can’t happen, so relationships can be elusive.

Lastly, what percentage of those that participated in hook-ups reported being in the following states:

  • had had some alcohol,
  • felt drunk
  • had had no/minimal alcohol
  • completely sober

 Most students are at least a little bit drunk when they hook up because inebriation is a primary way that they signal to one another that what they are doing is meaningless. Being drunk is a sign that they are being careless, both about what they’re doing and who they’re doing it with. Sober sex, in contrast, is heavily weighted with meaning. As one of my students explained: “[If you are sober] it means you both are particularly attracted to each other and it’s not really a one-time thing. When drunk, you can kind of just do it because it’s fun and then be able to laugh about it and have it not be awkward or not mean anything. Many of my sexually active students, then, had actually never had sex sober.

Lisa Wade interviews Sari Cooper 

Many parents are worried that their children no longer value emotional closeness, committed relationships, or building a family life. Should they be worried that they’ll children will choose never to marry or have children?

 This is a many-layered question. I actually think once young adults are out in the working world for a few years, some of these millennials are yearning for a close intimate relationship because they see how much they need the comfort and consistency of an ongoing partner. In my practice Center for Love and Sex, we see people in their mid to late twenties and early thirties who are either seeking a meaningful, emotionally close relationship or those that are already in a committed relationship but need help. But the meaning of commitment to this age group may look similar or different to their parents. In other words, some couples are committed to one another as primary bond partners but choose to have a non-monogamous agreement, or decide not to marry or decide to marry but live in different cities while building their careers.

I think parents need to ask themselves what value they place on their children having children, is it a desire to be a grandparent and have that experience, or is it that they think it’s the religiously, or traditionally correct thing to do? I have found couples who have discussed their desire to have children before getting married while also working with couples who are figuring out what neighborhood to live in together without discussing

a) what moving in together means in terms of their commitment to the relationship, or one another or

b) seriously whether each person is aligned with the other around having children in their future.

Lastly, I think many of the college-educated millennials I see in my practice are so focused on their careers that having children may be put on the back burner. These are the couples I see later on in their life when they have trouble with fertility and going through infertility treatments, or have children one right after the other and are struck by the huge toll raising small children while keeping up with both of their demanding jobs has on their romantic and sexual connection.

 What kind of sexual culture are young people out of college encountering? Is the hookup script still powerful? Is the dating script? Is monogamy still the assumed frame for emotional commitment? Or have polyamory and open relationships gone mainstream?

 For those millennials who have gone to college, the first few years on their own may still include hook-ups or casual dating as they are spending more time on establishing themselves professionally and/or living on a modest salary with their parents or roommates. However, the dating is pretty commitment-free and at times frustrating for those looking for a relationship since much of the app-driven “dating” is texting with someone for weeks on end before actually meeting. Some reasons might be that the texting over weeks provides a person with the banter or insight as to whether they actually want to devote time to an actual date (the equivalent of talking to someone at a bar or party for a while before asking or getting asked for a phone number). However, either while this chat-texting is going on the person may “ghost” you, that is, they may just stop texting back. While this no-show experience would happen in the pre-cell phone days, the “ghosting” may also occur after people have dated a few times, perhaps hooked up or even had intercourse together. The person being ghosted becomes more and more skeptical of what real attachment can really be gained from their next “match”.

I find that people don’t begin dating seriously till their later twenties. Monogamy is still the assumed frame of emotional commitment once the couple has had “the exclusion talk”. However the millennial cohort seems more open to talk about having alternative arrangements monogamy-wise. Navigating this agreement is a presenting issue with which couples come in to CLS to get help negotiating since they recognize it can bring up jealousy and are not sure how to establish boundaries that will work for both partners. While I don’t think it has gone mainstream, I do think that traditional agreements are being questioned.

Students say that the skills and strategies for negotiating hookup culture are essentially the opposite of the skills and strategies they need for negotiating committed relationships. After graduation, when students seek out more meaningful relationships, do you find that they struggle with emotional openness, closeness, and risk-taking?

I find the skills needed to develop relationships in the early stages are a bit different than the ones later on so I’ll answer these questions separately. I think because so much time in college is spent either opting out of the hook-up culture or participating in it usually under the influence of alcohol, emotional vulnerability with someone to whom you are also erotically attracted hardly ever occurs. However college students usually develop close platonic friendships.

 Some of these friendships can even develop into love relationships later on. However, they may never have been erotically attached to these partners. So some of these young adults may know how to be good partners, considerate roommates, and love one another but there is very little sexual fizz in that occurs. These couples come in as they’re about to become engaged, get married or decide to have a baby. They are what I call companionate couples and they are open about most everything except their sexual desires and so they are not having much if any sexual contact at all.

Since they haven’t had a lot of practice negotiating compromise over long periods of time, if someone does meet someone with whom they have sexual chemistry, they don’t know how to manage day-to-day conflicts like:

Can you shower before you come on to me?

Do you expect me to walk the dog every day you’re off on this bachelorette trip?

Why are you not saving more money?

If they haven’t developed constructive communication skills, these conflicts can head south quickly and then they may look at their partner and wonder where did my erotic attraction for them go? They may get scared and end the relationship before understanding that to get back into their erotic groove requires patience, openness to listen and practice empathy to come to a connection again. Hookups don’t help in the sustaining enough patience to feel like you’re going to come through it to the other side and find your partner attractive again.

 If they do, is this something to be overly concerned about? Do they learn these skills effectively despite their experience (or lack of experience) in hookup culture? Or are they inhibited from doing so in a way that they wouldn’t have been had they not adapted to this new college context?

 I would say that they’re just starting later and need more practice at the integration of emotional intimacy and sexual connection since they have begun later. For a portion of these millennials, their life online has become more primary to their face-to-face relationships or dates. Whether it’s swiping right or left as a self-esteem sport to see how many matches one gets, or masturbating to porn which doesn’t require expertise, courage to make mistakes or consideration of a partner’s needs/feelings, some young adults prefer to remain on their own as a protective expression against vulnerability, performance anxiety or rejection.

Do students in committed relationships struggle specifically with sexual intimacy? Some of my students worried that the imperative to make sex “meaningless” would later interfere with their ability to experience it as “meaningful.” Acts of tenderness — like cuddling, prolonged eye contact, and gentle kisses — are off script in hookup culture; many of my students had never experienced those things, despite being sexually active. Is it challenging for them to learn how to incorporate tenderness into their sexualities?

This is a good question. I should preface the answer that sexual intimacy is like beauty, it’s in the eye and body of each individual. I think that acts of tenderness can be challenging for some, especially if you’ve spent years compartmentalizing your emotions from your sexual practices. After the novelty of a relationship dies down, a couple really does need to dig deeper to find out what kinds of sexual activity they like and how they become able to enter the erotic zone. One can’t rely only on intrinsic horniness because for many reasons (stress at work, lack of sleep, hormone changes) this may not be as regularly available. So learning to practice intimacy (which is unique to each person) and relaxation as an entryway into erotic connection are skills that people can learn. It may feel awkward and uncomfortable at first (remember the first time you French-kissed?), but with practice incorporating emotional intimacy (which may or may not include some of the acts you described) into sexual connection can gradually feel more syntonic.

 What is some of the most important advice that young people need to hear? If you could get a message to each and every young person transitioning out of college, what would it be?

I would say to the millennials to educate yourself about your erotic triggers to increase your Sex Esteem®. This education can be gleaned from this blog and the following sites: my webshow Sex Esteem® with Sari Cooper,  Columbia University’s site Go Ask Alice and the vast list of sites on Dartmouth University’s site, Gay Men’s Good Sex Guide, and the following books: Guide to Getting it On, Sex For One, She Comes First, The New Male Sexuality, Come as You Are, and SexSmart.

 

Painful Sex: Best Therapy Practices for Women and Couples

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.

Amy Stein Co Presenter

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 sari@saricooper.com or coordinator@saricooper.com 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.

Feel Too Awkward to Tell Your Tinder Dating Story? You Could Use some Sex Esteem®

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.

Girl texting on the phone in a restaurantSince 2013, the number of 18 to 24 year olds on these sites has almost tripled, while it has doubled for Americans between 55 and 64 . So, if meeting online is so common these days, why can it sometimes be uncomfortable for some people to admit how they met?

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.Male and female legs during a date 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.

Online dating app conceptHowever, 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.

I let them know that over 54 million people are utilizing sites like Match.com, EHarmony, and apps like Hinge and Bumble, and that many other like them are sharing their modern day love stories. In so doing they are changing the way the public may see the ‘hookup’ apps such as Tinder and like my friends who married earlier this summer,  beginning to embrace the potential beauty and power of online dating.

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 Couple in love kissing laughing having funCuriosity+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.

BLD022897 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.

Man on smart phone - young business man in airportThe 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®!

 

Trump Redux: 5 Lessons this Presidential Nominee Illustrates about Narcissism in Relationships

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.

Donald Trump at a rally
Donald Trump at a rally

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.Ill man sitting on his bed

Trump says whatever he wants with little remorse or concern for the feelings he may have engendered in others. He constantly works to be the loudest, most powerful, and authoritative figure in every room that he enters. From statements of “I will be the greatest jobs president that God ever created” to “(John McCain is) not a war hero…He’s a war hero because he was captured. I like people that weren’t captured” ,Trump has made it clear that he is a bulldozer, will to squash anyone in his path to his final destination: presidential nominee for the Republican party.

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.
at the "NBC All-Star Party" in the Hollywood & Highland Complex, Hollywood, CA 01-14-04
2. They seemingly have thick skins but in fact are either covering up deep wounds from childhood or a feeling that they aren’t as smart or as capable as their parents may have expected them to be. They cover the narcissistic wound by putting down others to elevate their status.
Trump speaks with horrific insults of groups of people who he perceives as lesser in extremely hateful and derogatory ways. When he announced his run for the nomination he described undocumented Mexican immigrants as “… people that have lots of problems and they’re bringing those problems with us. They’re bringing drugs. They’re bringing crime. They’re rapists”
He constantly searches to put others down in order to establish his own dominance and to cover up his deeper sense of inadequacy. His motto could be hit him hard, non-stop and fast so they don’t know how to hit back. man in boxing gloves
One wonders what woman in his history would cause him to degrade and demean women in his many years in public life.

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. Man yelling at girlfriend not looking at him black and white

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.
Young woman arguing with her boyfriend

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.

Sad couple having an argument sitting on bed

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®.

Millennials and Valentine’s Day

couple in hotel room

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.woman with red hearts over her eyes

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.

Champagne glasses and rose petals for celebrating Valentines Day, on dark background
Champagne glasses and rose petals for celebrating Valentines Day, on dark background
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? couple celebrating Valentine's Day with fancy dinner
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. romantic couple on the beach 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.
Group of Friends Singles Awareness Day

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. Smiling couple>

Sex Esteem® Holiday Tips for Feeling Sexy

Multi Generation Family Celebrating ThanksgivingThe 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.

woman tired of diet restrictions deciding to eat healthy food or sweet cookies 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. Depositphotos_1022974_s-2015With 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.

Woman looking at self in mirrorIn 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.

Cheering upIncreased 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?

Depositphotos_56552229_s-2015Begin 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.
Cheerful multi generation family playing football in the park 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.

christmas dinner table
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. BLD055516

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.
Intimate lovers embrace

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.

Addyi Passed by FDA; Will it Help Low Libido?

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.
sad_woman_420jpg-420x0
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.
pinkpill 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.

Latest Blog: Engagements & Weddings: 5 Topics to Cover

Dissatisfied wedding couple

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.

Wedding couple conflict, bad relationships. Woman bride and man groom looking at each other with angry expression. Isolated on white

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).

Young couple finding out results of pregnancy test at home

  1. 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.

Cheating his wife, young men chatting with his mistress while his wife sleeps

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. Mark-Zuckerberg-and-his-wife-Priscilla-ChanTake 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

Depositphotos_11881176_l

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

coin couple

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.

Fifty Shades of Grey Movie Review

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?