Every September 4th, the World Association of Sexual Health celebrates World Sexual Health Day. This year’s theme for WSHD is Healthy Relationships. Healthy relationships provide safe and consensual environments for all partners to feel respected in all aspects of their lives including sexual activity. Unfortunately, in the past 5-10 years, research has shown that there has been a large uptick in choking as a sexual trend among young people. Dr. Debby Herbenick, Director of the Center for Sexual Health Promotion at Indiana University, has conducted much of the research surrounding what up until only a few years ago had been a very rare form of kink behavior called breath play. According to Susan Wright, President of The National Coalition of Sexual Health (NCSH) who presented on this topic at the 2024 International Society for the Study of Women’s Sexual Health (ISSWSH) conference with Herbenick, stated the behavior is not sanctioned by NCSH and is considered controversial and high risk in kink and BDSM communities.
In a follow up study, Herbenick et al. found that a higher percentage of transgender or gender non-binary (TGNB+) students (68.6%) and women (50.0%) reported that being choked was very pleasurable. Cultural norms and expectations often lead women and sexual minorities to remain silent around the specific sexual behaviors they prefer and the boundaries they expect for their sexual health before consenting to sexual encounters. This sex therapist wonders whether those who consent to being choked might do it for reasons related to wanting to be hip or current, since there have been many more depictions of choking in sexually explicit media and in mainstream entertainment.
Choking Depictions in Media Outlets
While porn has unfortunately been a major source of sex ed for teens for years, choking and rough sex has become more popular in mainstream media. “Fifty Shades of Grey”, and popular shows such as “Euphoria” and “The Idol”, depict choking with little discussion, and illustrate no safety concerns. While choking has worked its way into mainstream media and behavior, the way adults are prepared to discuss the sex they want before a sexual encounter has not changed much. According to SIECUS, only 2 states have an “A” rating on their sex education policies, meaning young adults enter their adult sexual lives with unrealistic notions on what they can ask for in partnered encounters.
Health Risks of Choking:
Those being choked are being so with more force and for longer periods of time. Research shows that 1 in 5 students who are choked become “cloudy” — being close to passing out, but not completely unconscious. Those choked reported lightheadedness, neck pain, headaches, temporary loss of coordination and ear ringing. Although these symptoms resolve quickly, according to the American Academy of Neurology, the restriction of blood flow to the brain, even for brief periods of time, can cause permanent injury, including stroke or cognitive impairment.
Dr. Keisuke Kawata, a neuroscientist, has been co-authoring studies with Dr. Herbenick and presented on the same panel at ISSWSH to discuss the association between sexual choking and neurophysiological responses. In their 2023 study, undergraduate women who were choked regularly were compared to a never-choked control group. The choked group showed a reduction in cortical folding in the brain, widespread cortical thickening, and skewed brain hemispheres, which are all associated with higher risk of mental illness and mood disorders. It remains unclear whether women with mental health challenges are seeking out choking during intimacy, or if choking is causing these mental health challenges in the first place. However, the risk of worsening a woman’s cognitive health seems convincing.
Blurred Lines of Consent:
Teaching that “no means no” might be useful in some sexual encounters, but if someone is in a compromised position, verbal consent can be difficult to explicitly give or take away. In order to make rough sex safe for all, therapists must continue to have practical discussions about what clients have experienced, what they are hoping to experience and how to state what they want and what their boundaries are. Even when hetero/bisexual female subjects stated they enjoyed being choked by their male partners, many also said that their partners never or only sometimes asked before choking them, at times creating moments where they could not breathe or speak, limiting the amount of consent they could give. Many acts that involve physical pleasure (i.e. receiving oral sex) tend to favor men, while those that may entail pain or submission are usually enacted upon women or TGNB+. What can therapists do to help unearth what their clients are consenting to, enjoying, desiring and risking in their sexual lives?
Conclusion:
By not discussing the rewards of mutual consent, pleasure and the danger of choking in open conversation with clients, therapists have a large blindspot in the opportunity to provide critical sexuality education. Therapists need to be better educated and prepared to ask their adult clients about all the behaviors they do in sexual situations, including asking if they have been involved with choking. If therapists aren’t the ones bringing the topic of sex up, clients will feel less comfortable initiating the conversation. Psychotherapists can be trained to teach clients skills on how to communicate around pleasure, desires for specific behaviors, and setting boundaries before and during a sexual encounter.
Sex positivity is important to any psychotherapy practice. Talk to your clients and couples about:
What realistic verbal and non-verbal cues are for giving and taking away consent.
How male clients might speak with their female partners to learn more about what could bring them to orgasm
Encourage clients to practice in sessions on what they are comfortable and uncomfortable with before going on dates and/or having sex with a partner.
By discussing all sexual behaviors more openly and neutrally with clients, therapists can help to create a safer, more pleasurable culture around intimacy.
Each New Year and the month of January inspires people to renew their commitments to meaningful intentions. This is why people take on resolutions, whether to lose weight, get in better shape by joining a gym (More than 12 percent of gym members join in January, compared to an average of 8.3 percent per month for the full year, according to the International Health, Racquet, and Sportsclub Association (IHRSA)), partake in a “Dry January”, or to decrease stress and improve their relationships by starting therapy. The commitments that are made globally the minute we cross into the new year express a collective consciousness of shortcomings and individual strides towards living more fully and healthily. Instead of resolutions which often get put on by the wayside by mid-February, I propose a practice of RENEWAL to integrate throughout the year. This RENEWAL includes actions, internal inquiry, to go beyond the goals set by folks when they make New Year’s resolutions. This RENEWAL practice strongly reflects the way that I invite clients to subtly say or begin new behaviors to align with their sex therapy or sex coaching goal. At times I will encourage partners to create new rituals for themselves and with one another when they are creating time for intimacy to shift their oft-repeated sexual script or routine. Through R.E.N.E.W.A.L., I have created an acronym representing practices you can cultivate throughout this year not just for the first 30-90 days.
RENEWAL:
French Sociologist Emilie Durkheim wrote about his studies of rites and rituals in his book Elementary Forms of Religious Life and regarded religion as the incarnate of society’s conscience collective–or its “collective consciousness” or “collective conscience.” While a 2020 Gallup poll stated that only 47% of American adults say they belong to a house of worship, many clients who come to sex therapy self-identify as spiritual. And like many spiritual practices worldwide, rituals express the consciousness or larger mission with which people align their larger life’s purpose.
R: Rituals were, for Durkheim, sites of “collective effervescence”, moments when the very fact of congregating to perform set religious actions imparted special energy to the participants–which lends meaning to a certain point in time, a specific event or a particular life cycle moment. For this new year, I invite clients to create a ritual from scratch, adopt a ritual from another culture to address a specific experience or emotion one wants to process, or collaborate with a partner to while paying tribute to either or both your cultural or religious heritages. Sometimes people create rituals for a joyful occasion like moving in with a partner, deciding to open up a relationship to welcome another partner, or deciding to adopt a child as a single parent. These are moments in one’s life that contain many emotions and psychological meaning but are not necessarily represented in traditional religions. People may invite people they feel closest to to cocreate the collective effervescence of the ritual or decide to do it on their own.
E: Engagewith people you care deeply for. In this societal era where digital communication–where we convey our emotions using emojis and profess our feelings through text–is considered touching base, strive to engage in person or through video calls with those you hold dearest or those with whom you’d like to become closer. Opt to engage with more intention: intention through physical proximity and intimacy, as well as intention with whom you choose to spend your time.
N: Nesting is a practice we associate with parents who are expecting a baby, where to-be parents adjust their behaviors to ones that demonstrate a protection for the child coming into the world. However, I say we extend this practice of creating a warm, clean, loving home space to part of a yearly cleaning out and bringing in peaceful energy. A Feng Shui for the soul, to sweep out the past and create a peaceful place for new opportunities and connections to grow.
E: Erotic Embodiment is for anyone in the relationship they have with themselves, and it is important in developing great Sex Esteem. It is accomplished through engaging one’s body in a mindful way that focuses on the development of a deeper body/mind/spirit connection. This mindfulness and bodily connectivity, be it through yoga, T’ai Chi, or a dance class, is helpful in renewing your sex life, whether or not you have a partner. Learning how to identify and cultivate your own erotic energy is a key element of juicy sexuality.
W: Wonder Cultivation is accomplished in adults through acknowledging what captivates your wonder–a feat admired in youth, but often shut down in adults–both now and from your experience as a child. By allowing space for noticing what captures your current curiosity you allow room for wonder to grow. Wonder allows for inquiry and the opportunity to learn new things about the world around us, the people with whom we share the Earth, and ourselves. One doesn’t have to accept that wonder is lost after working hard to achieve once-distant goals; one can utilize adult wonder in a complex manner. Psychologist and researcher Jeffrey Davis describes how, compared to his children, he has a larger awareness of mortality, which “heightens my experience of wonder and actually helps me be even more present to the moment with them or with you or with other human beings that, understandably, they don’t. They have a wide eyed wonder, and we have a more grown up wonder.”
A: Allowyourself to create a real period of time to relax. True relaxation means a quieting of the internalized “shoulds” list of things to be done in the future and “should-haves” of regret of things that weren’t done in the past. Without truly being at rest, the blood in our veins and capillaries can’t flow freely. Without relaxed blood flow, we can’t fully feel pleasure in intimacy.
L: Lovingkindness as defined by renowned meditation teacher Sharon Salzberg, “about opening ourselves up to others with compassion and equanimity, which is a challenging exercise, requiring us to push back against assumptions, prejudices, and labels that most of us have internalized.” Lovingkindness, which is different from what is presented as romantic and/or sexualized love, is a feeling and an action of compassion that need not be suppressed but, through its expression, can enhance deep moments. Lovingkindness is not a soft virtue, but a powerful force whose power can spread exponentially just through expression. I invite clients to either use the traditional blessings of lovingkindness or create original blessings for oneself, one’s loved ones and then all the world’s beings.
Infidelity, substance abuse, pornography use, and considering leaving one’s partner—these are the types of secrets that frequently arise in sex therapy and couples counseling. Secret-keeping by its very nature requires partners to lie to their spouse or partner—and hence secrets and lying are themselves married or fused.
Partners keep a variety of secrets from their partners for many expected and at times surprising reasons. They may feel something is too taboo to discuss—like marital problems, financial issues, sexual preferences, or their own or their partner’s mental health and addiction issues. They may have broken their sexual exclusivity or monogamy agreement in a long-term committed relationship or marriage. And they may omit information or outright lie about topics like their physical health, their previous sexual partners, or beliefs on death or religion.
How does a secret affect a family?
In the context of a family, secrets can be kept by whole families from outsiders, between only certain members of the family, or by an individual from their family. According to researchers Vangelisti and Caughlin, these types of secrets are extremely common—with 96.7, 99.1, and 95.8 percent of people reporting them, respectively.
Maintaining secrets in the context of a family can be done for practical or functional motives. People keep secrets to protect members of their family, bond with certain family members, and even alter the power within the family’s dynamics. Secrets have the potential to change family dynamics because family members tend to organize their relationships around who knows and does not know their secret.
In my practice, I often see major changes in family dynamics because some family members know only a part of a secret—without knowing it is only part of the secret—which makes those who know the full secret cautious and distant for fear that the rest of the secret may accidentally come tumbling out. For example, I have worked with men whose secret of seeing sex workers get discovered by their female partners. A wife who discovered her husband’s past secret sexual alliances with sex workers disclosed this secret only to one of her siblings while her parents, her other siblings, and her partner’s entire family were kept in the dark. She did this so that she didn’t feel so lonely with the betrayal, which naturally devastated her emotionally.
The brother to whom she shared this secret lived in another country and would only see the whole family once a year at holiday time, making the odds of the secret coming out less likely. However, at a Christmas gathering, the brother felt so uncomfortable holding onto the secret that he avoided spending extended time chatting not only with his sister’s in-laws, but with his own parents and his siblings that didn’t know as well.
How does one’s attachment style affect secret-keeping?
Source: Deposit Photos
The reasons one partner keeps a secret from their spouse or partner and how they feel about doing so differs from person to person. For instance, a person’s attachment style plays a major role in their decision to keep a secret and their feelings about doing so. According to a 2015 study, people who scored higher in anxious attachment styles and avoidant-attachment styles are more likely than securely attached people to keep secrets from their partner. The reasons an anxious person keeps a secret differs from the reasons an avoidant person keeps a secret—anxious people are often avoiding the disapproval of their partner, while avoidant people use secrecy as a way of maintaining a comfortable emotional distance from their partner.
Anxious people ruminate and feel higher levels of anxiety about keeping secrets in addition to feelings of guilt—even though they may have felt justified in their need to keep some information secret—especially if it’s negative information closeted to avoid their partner’s disapproval. Somewhat surprisingly, avoidantly attached subjects were more likely to ruminate (but not to experience feelings of guilt), than those with low avoidance.
In my clinical practice. I have seen avoidantly-attached partners ruminate about being discovered for fears of the secrets causing him to lose his reputation as a family man. That is, the concern of how he would appear, and the potential loss of outsiders’ respect was experienced as more anxiety-provoking than how their partner would feel if their secret sexual behavior were to be discovered.
Differentiating between secrecy and privacy in a couple’s sex life
If the secret keeper is not experiencing anxiety, rumination, or guilt—is it really a secret? There is a difference between keeping secrets and maintaining privacy. Some couples therapists have written that the difference is in how it makes the secret-keeper feel.
According to Evan Imber-Black, privacy is not bad for a person’s physical or emotional health, while secrets can impact a person’s well-being and decision-making. And privacy, rather than secrecy, can be healthy not only for the emotional but also the erotic intimacy of a relationship or marriage. Mystery can add a touch of spark and elusive power in the realm of the erotic.
The development of intimacy may actually be enhanced by keeping some privacy and sharing some secrets between partners in a couple while maintaining secrets from those outside of the relationship. My view is that privacy is some freedom each person is entitled to as long it doesn’t directly impact or hurt another person.
Many partners have sexual fantasies which they decide not to share with their mate. Many of them wonder in individual therapy sessions whether they’re being unfaithful by not sharing all their fantasies.
While some mates feel that a sense of true intimacy means there are absolutely no thoughts, events, or decisions that aren’t completely shared, I align myself with therapists Esther Perel’s and Stephen Levine’s theoretical stance that maintaining one’s own private space within a couple or relationship and sharing some thoughts and ideas with close friends outside the relationship—or keeping them to oneself—is all a healthy part of what family therapy pioneer Murray Bowen called “differentiation” in a couple. It’s also part of my Sex Esteem model.
Can we truly know our partners?
An existential anxiety provoking many people is that they’ll never fully know everything about their partner and alternatively, they won’t ever be fully known by them either. This dilemma of unknowingness and the fact that we change continually throughout our lifetime is the fear that many partners try to conquer through demanding full disclosure in their relationships, and this quest for knowing all can cause suffering and disappointment.
As Michel Foucault wrote:
“Sexuality is a part of our behavior. It’s part of our world freedom. Sexuality is something that we ourselves create. It is our own creation, and much more than the discovery of a secret side of our desire. We have to understand that with our desires go new forms of relationships, new forms of love, new forms of creation. Sex is not a fatality; it’s a possibility for creative life.”
I would add that sexual mystery and curiosity, if left to breathe and expand in a consensually aligned relationship, contributes to a more creatively erotic connection with a partner or spouse, whether they be new or long-term.
Many couples seeking to reinforce their relationships may resolve to have more sex in the new year. However, does more sex really make partners happier? Is this belief held up equally among single, gender-fluid, gay, lesbian, and polyamorous folks?
Whose happiness matters during sex?
The assumption behind the oft-made resolution to have more intimate/erotic times with one’s partner assumes that upping sex will make a relationship stronger and bring about more happiness between two partners. While some studies do show a correlation between partners’ sexual habits and their happiness, the nature of these studies’ participants reveals an intrinsic bias. There is bias about what is a working definition of sex for each partner, who experiences pleasure in couples, and whether by “couple” they mean heterosexual couples. Then, the bias continues: which partner’s opinions on pleasure are more readily available through research studies in general?
A November 2015 study from the Social Psychology and Personality Science titled “Sexual Frequency Predicts Greater Well-Being, But More is Not Always Better” points to the idea that more sex for heterosexual married couples tends to lead to more happiness for both people in the relationship. According to a press release from the Society for Personality and Social Psychology, the subjects “are most representative of married heterosexual couples or those in established relationships.” But does this type of claim take into account the different meanings of happiness for all genders?
In sex therapy, the experience of “happiness” can also have intersectionally different meanings. For a Black woman who may feel less-empowered in her relationship with a Latinx man, happiness may mean that she focuses more on her partner’s pleasure and less on her own, with the thought that this will protect their relationship from a non-consensual hookup or affair. However can she be keyed into her own sexual pleasure within a sexual encounter? For an Indian-American first generation man, penetrative sex in which both he and his wife, who is white & third generation, climax, may have him report feeling “happy” since they both have orgasmed, but may have a meaning that has more to do with his feel masterful and turned on because he’s proven himself “worthy” of her. Whereas his wife senses that he’s not fully present to his own experience and this leaves her feeling like the sex they’re having is more performative. Perhaps she feels like her orgasm is for him and less about what kind of sex she would rather be having.
Sexual Quality over Sexual Quantity
For those in consensually monogamous heterosexual relationships, more sex might be a good resolution; but some studies bring in the variable of affection to see if it changes the happiness quotient. In a March 2017 study published by Personality and Social Psychology Bulletin, researchers asked sixty couples to take notes on their phones about their sexual and non-sexual activities, and when they individually experienced affection.
The study found that sex created feelings of affection not just immediately after the sexual act, but hours later. This suggests that sex can be a means to an affectionate end. A clear takeaway from this study is the idea that sex with affection between sexually-exclusive consensually monogamous couples can be the glue that makes that particular type of relationship stronger.
This may seem like an obvious result. However, what clients report in the therapeutic space is that while some partners want more frequent sexual connection, the quality of the sexual experience helps to make them feel either closer to or more distant from their partner.
In fact, in another study researchers explored the hypothesis that more sex would enhance a couples happiness. They asked one group of heterosexual couples to double the amount of weekly intercourse sessions they normally would have. The findings surprisingly showed that partner did not report feeling happier. I have clinically found through clients’ reports in sex therapy treatment that if partners create more time and relaxation around a sex date they are more likely to feel more intimate. Bringing more intention to their sexual and emotional connection and staying embodied is more likely to be increase pleasure on all body/mind/spirit levels.
Communication and Sex Within the LGBTQ+ Community
There are many assumptions in the aforementioned March 2017 study published by Personality and Social Psychology Bulletin to the finding of sex as a reinforcer for a happy relationship between a committed couple: one needs to examine the meaning of the terms: “committed,” “happiness,” and “couple.” Largely, these terms belong to the world of consensually monogamous, sexually exclusive, heterosexual relationships. One needs to keep in mind that the sixty couples who were subjects were most likely to be married, heterosexual couples, and not representative of some parts of the population who don’t identify with one or all of these variables.
As a sex therapist who works with many types of couples, including LGBTQ+, consensually non-monogamous, kink-identified, in addition to sexually-exclusive heterosexual couples, I have found that the bonding or glue comes when there are two (or more) partners fully present in a sexual experience. When one partner is not fully present or is going through the motions, the experience of bonding may not be mutually enhancing.
When one partner is continually giving pleasure to another partner, they may not experience feeling as bonded. In addition, if one partner feels it is their duty or responsibility to have penetrative sex, it may actually alienate that partner from their own embodied pleasure. This is why I give many mindfulness-based exercises to clients so that they can check in with themselves to see whether they are turning themselves off, avoiding feeling excited or feeling distracted from the sensations and experience. These sexual encounters don’t always result in happier or more bonded couples.
The queer community might have higher rates of orgasm
A 2017 study from Archives of Sexual Behavior published by the NIH found that in heterosexual relationships, heterosexual men were most likely to say they usually-always orgasmed when sexually intimate (95%), while the women they were sleeping with reported the lowest likelihood, at 66%. The queer community had the higher reporting of orgasm, on average: gay men (89%), bisexual men (88%), lesbian women (86%), and bisexual women (66%).
In the clinical setting, LGBTQ+ clients tend to have a wider menu of sexual activities than heterosexually-identified clients. While it is not a requirement that all partners need to orgasm every time they have a sexual encounter, it is important that partners check in with one another on whether they’re satiated. It is part of my Sex Esteem®️ model as a sex therapist and coach to help clients expand their sexual menu to include many erotic and sexual experiences. Orgasms are an important menu item for all genders.
Another step in the Sex Esteem®️ model allows for each partner to communicate the array of options they would be open to explore with a partner, whether they are a longtime sexually exclusive partner, a longtime consensually non-monogamous partner, or a person they are dating or hooking up with.
For those seeking to make a New Year’s resolution for a current romantic relationship, be aware that the resolution to “have more sex” is riddled with preconceptions about happiness, sex, orientation, relationship status and identity. It would do one well to do a deep dive into how you feel about each of these topics’ meanings for yourself personally before diving under the covers with one’s longtime bae or a new partner. This type of inquiry and practice would be what I call a New Year’s Sexolution and would boost your Sex Esteem®️ intelligence.
The Crown‘s latest season shows Princess Diana’s longtime cycle of Bulimia, an eating disorder involving binging on food then vomiting it up soon afterwards. The depiction of Diana’s patterned rituals is quite graphic in its detail. In this period of social distancing, increased loneliness and upcoming meal-based holiday season, here are some psychological concepts audiences can learn from the Netflix show.
After eating emotionally during a hearty holiday meal, it is all too easy for a person suffering from disordered eating and eating disorders to engage in a litany of self-criticism and potentially binging. The intensely negative self-talk often leads to internal negotiations around forms of restriction. Inevitably, the unforgiving rules imposed on oneself in moments of harsh guilt will reach a tipping point. At that moment, the person’s shame and rebellion lead to an overthrow of the restrictive policies leading to new overeating or binging. This is the cycle of eating disorders and disordered eating.
We see extreme cycles of Bulimia in the latest season of Netflix’s The Crown. The introduction of Lady Diana to the royal family was presented as a fairy tale romance in the press. Her public image, however, was somewhat a foil to her private life. In the television drama, we see Princess Diana in a secretive isolating cycle, experiencing years of intermittent bulimia. Starved of physical touch, kindness, sympathy, and sexual intimacy from Prince Charles, Diana sought control, expressing hurt, anger, loneliness and possibly vengeance by binging on royal delicacies and then making herself throw up afterwards.
The Connection between Infidelity, Betrayal and Eating Disorders
Eating disorders (like Bulimia and Anorexia) and disordered eating patterns are interpersonal as well as intra-personal disorders, meaning that they are triggered by feelings of betrayal or abandonment by others then turned inward as hatred or humiliation of oneself. What Diana experienced was an extreme sense of isolation almost immediately after she first became engaged to Prince Charles. Soon after the engagement announcement was made public, she became aware that Prince Charles was still romantically involved with Camilla Parker-Bowles. In Diana, In Her Own Words, a documentary also on Netflix featuring secret recordings of Diana, she states that: “The bulimia started the week after we got engaged.”
After discovering that the whole engagement and courtship was totally fake and that the marriage was solely “a call to duty” and nothing more, Princess Diana experienced infidelity’s pang of betrayal as a deeply interpersonal wound. Turning Charles’ rejection against herself, she tried to be more of what she thought her husband wanted, hoping to win him back. As a sex therapist working with couples after the discovery of infidelity or an affair, the betrayed partner frequently takes out feelings like self-blame and anger at their partner out on their own bodies. At times they begin behaviors of binging, purging or restrictive diets to lose weight in an effort to compete with their partner’s lover or a paid sex worker, who they assume are thinner than they are.
In a BBC1 Panorama Radio Interview Diana gave in 1995, she described how after spending her days fulfilling her royal duties visiting charities which involved comforting others, she was left feeling emotionally depleted and rejected by Charles who was giving his emotional and sexual attention to Parker-Bowles.
“I’d come home feeling pretty empty, because my engagements at that time would be to do with people dying, people very sick, people’s marriage problems, and I’d come home and it would be very difficult to know how to comfort myself having been comforting lots of other people, so it would be a regular pattern to jump into the fridge.”
Eating Disorders in the Media
While in reality, Diana’s eating disorder thrived in secrecy and shame for years, The Crown’s decision to portray bulimia in graphic scenes could be seen as glamorizing the disorder. Mary Anne Cohen LCSW, author of French Toast for Breakfast, says: “[Depictions of eating disorders in the media] can be a tremendous relief and, hopefully, become the first step to make the decision to get help and share one’s burden.”
Generally, eating disorders are treated by therapists who are specialists through individual and group therapy with a focus on healing a client’s attachment style, learning regulation skills, and mindfulness techniques while creating new habits.
Attachment Styles and Eating Disorder Treatment
Secure attachment to caretakers extends to one’s secure attachment to comfort in eating and feeling comfortable in one’s own skin. Insecure attachments, on the other hand, come from early unmet developmental needs. Diana revealed through her secret tapes In Diana in Her Own Words that she had been treated like “the virgin, the sacrificial lamb” by Prince Charles, the royal family and her own family. “Isolation with pastry needs to be replaced by intimacy with people,” writes Cohen.
A crucial element of eating disorder treatment involves helping a client learn how to express their emotional needs directly to people they can rely on and to cognitively shift from a diet mindset to an anti-diet mindset. An anti-diet mindset is precisely what eating disorder specialist Alexis Conason Ph.D. recommends for those struggling with this punishing cycle.
A New Year’s Resolution Worth Trying: The Anti-Diet Mindset
Dr. Conason suggests a sustainable and fundamental shift in mindset. “You haven’t failed your diet,” writes Dr. Conason, “Your diet has failed you.”
An anti-diet mindset is an agreement to eat in a way that honors your body’s needs, connecting to one’s body in a nurturing and peaceful way rather than a belittling, abusive one. Repairing this relationship with your own body is a way to repair the insecure attachment of childhood and the as outcome of infidelity.
People have traditionally created New Year’s resolutions to begin a diet after weeks of emotional holiday (Christmas, Chanukah, Kwanzaa) eating. However, given that 2020 saw an avalanche of COVID-19 weight-gain memes, with people feeling so guilty about their added pounds, we can logically expect the 2021 New Year’s diet self-recriminations to be even more rigid and punishing.
Many times people who are dieting may feel too weak or less desirous of sexual intimacy. Whether they are waiting to show their body to a partner when their body is at the “perfect” size, or too ashamed to have their partner touch them for fear they will feel a part that has too much fat , many people with eating disorders deprive themselves of sexual pleasure.
Part of their healing is to understand that all emotions are human, including the desire for sexual intimacy and comfort. Helping them to turn toward a person instead of food or dieting to alleviate hurt and express anger is a critical step in their recovery.
The Trifecta: Sexuality, Eating Disorders and Body Dysmorphia
Sexual disorders, Bulimia, Anorexia and Body Dysmorphia are interrelated issues. Researchers in an NCBI study “Sexual Functioning in Women with Eating Disorders” found that more women with eating disorders had:
loss of libido
prevalence of sexual anxiety, tension, frequent changes and higher frequency of detached relationships
relationships without intercourse and fewer with intercourse
avoided sexual relationships
In Diana: Her True Story – In Her Own Words, Andrew Morton quotes the Princess of Wales saying: “My husband [Prince Charles] put his hand on my waistline and said: ‘Oh, a bit chubby here, aren’t we?’ and that triggered off something in me.”
Some of our CLS clients verbally express body disgust for their own bodies in session to their therapist in addition to directly telling their partner their aversions. Most often their partner still feels quite attracted to them, continually trying to reassure them of their desire for them, yet feeling helpless to have their compliments authentically received. If a comment about one’s weight is made unwittingly by a partner, the partner with the eating disorder catastrophizes and thinks their entire body is revolting.
Another important fact to consider is that Body Dysmorphia (BDD a persistent and intrusive preoccupation with an imagined or slight defect in one’s appearance) is not exclusively a women’s disease. In one American survey, for example, found that an estimated 2.2% for men and 2.5% of women suffered from Body Dysmorphia. Whether the focus is on weight, the thinness of hair or the longing for more muscles, men can be as secretive about their body shame and disordered eating as women. BDD interferes with male sexual desire and connection in similar ways as other eating disorders.
How to Approach the 2020 COVID Holiday Season as an Anti-Dieter
Understanding the larger context of a meal is the first step to enjoying the holidays as an anti-dieter. With the additional stressors of the COVID-19 pandemic this year, I encourage more self-compassion and present-moment mindfulness. Make sure you have a buddy who you can call on when feeling triggered to binge, purge or withhold food. Give yourself permission to take a walk to ground yourself if feeling overwhelmed.
Coach yourself to receive sexual pleasure. Erotic intimacy should be considered a place to play and feel aroused rather than a space in which one needs to perform or pose. High Sex EsteemⓇ means that one accepts the notion that erotic behavior is a pleasurable, connecting place we go to experience comfort, fun, stress relief and passion, all basic human needs. Given that most Americans won’t be travelling long distances to gather with large groups of relatives this holiday season, use the extra time to have some mindful, sensual touching sessions with a partner who you can rely on, whether that be someone else or yourself.
If you are struggling with an eating disorder, a free resource in the U.S. is The National Eating Disorders Association. They offer extra chat hours over the holidays: https://www.nationaleatingdisorders.org/.
Now that the presidential election has been called, Americans are gradually coming to terms with the results whether that’s letting out a celebratory exclamation of joy or sadly mourning the loss of their candidate. While many citizens are still worried and anxious due to the president’s refusal to concede, the holiday season is beginning with advertisement campaigns. Family members’ anxiety may be further fueled by the increase in COVID cases and deaths. The uptick may result in texting, chatting, and/or Facetiming one another with last-minute plan changes to the traditional Thanksgiving gathering.
In what has already been the most challenging 2020 year–given the COVID-19 pandemic, job losses, quarantine, and deaths of so many–the prospect of holidays spent apart from extended family and chosen family members can feel like a big mountain that feels too big to climb. As we begin to think about the upcoming holidays of Thanksgiving, Diwali, Christmas, Chanukah or Kwanzaa, it is really important to give space for both the sadness of who and what will be missing, AND consider what can be created anew to provide nourishment for the soul.
Pre-COVID Holiday Stress
While pre-COVID Halloween is usually celebrated with the nuclear family or among adult friend groups, the upcoming holidays of Thanksgiving and Christmas are usually gathering times for extended family. Holiday gatherings offer emotional and psychological grounding that is part of the foundation of our identity within our community. Meeting with those we love also reinforces our self-esteem.
The holiday season is difficult enough for many. It is notoriously the season of breakups, folks challenged by Seasonal affective disorder (SAD), facing ostracization due to gender non-conforming status or sexual orientation, and increased alcohol intake. Unsurprisingly, forced joviality often has the opposite effect, making one feel inauthentic and disconnected from oneself and those around us. The numerous additional stressors of 2020 present an even greater threat on Americans’ mental health than previous national crises. According to a recent study by Czeisler et al published by the CDC, “the prevalence of symptoms of anxiety disorder (in 2020) was approximately three times those reported in the second quarter of 2019 (25.5% versus 8.1%), and prevalence of depressive disorder was approximately four times that reported in the second quarter of 2019 (24.3% versus 6.5%)”.
Rituals For Holidays and Lifecycle Events
In her paper “Rituals in the Time of COVID-19,” family therapist Evan Imber-Black writes of the importance of rituals. “Special time demarcates ritual time from regular time, enabling us to look forward to a ritual, whether it is daily, seasonal, or yearly. Special place may be a church or a hotel or restaurant or graveyard—or it may be a backyard, a kitchen table, a living room, all transformed by a ritual to become a special place.”
I have always let my clients know that it is helpful for one’s sense of agency, connection and continuity to consider restrictions as creative opportunities to come up with new rituals. As a former choreographer, dance pieces commissioned on a tiny stages required me to imagine movements I never would have created. Rituals like art provide us with structured time. Art is a way of marking the time as special and out of the ordinary, and imbue meaning that reflects our deepest values. They fortify our identity, and strengthen the connections to the people we love.
When past clients have had to face miscarriages, abortions, separations or coming out, I’ve encouraged them to create a ritual that is meaningful to them. Then, client could perhaps repeat each year to honor the pain, loss, relief and joy of a lifestage milestone that hasn’t been recognized in society or certain religions.
COVID Creativity; Innovative Rituals to Bring People closer During Holidays and Lifecycle Events.
Around the world, families are coming up with creative ways to celebrate the holidays together in various states of distance: physical (due to a global pandemic) and, in some families, political (the drawn-out 2020 U.S. election). People across the world created new rituals for Easter, Ramadan, and for life-cycle events like weddings and funerals.
For instance, Ramadan, a holiday that starts on the evening of 4/23 and culminates on 5/23, sees Muslim fast during the daylight hours. As mosques closed due to COVID-19, those observing the holiday found ways to pray at home. Practicing Muslims focused on individual prayer habits and turning the isolation into inner peace. For Easter, families celebrated from a distance by decorating homes, playing virtual Easter-themed games like bingo, and hosting online family gatherings on Easter Sunday. Weddings and funerals became virtual affairs as well, with slideshows, streaming, and postponements becoming the norm. During the earlier days of COVID-19 I attended two shivas and a funeral via Zoom. They actually felt very intimate. One shiva created breakout rooms where I could speak with the mourner one-on-one. This is a good example of restrictions providing fodder for newer meaningful rituals.
The wedding industry developed a new vocabulary in light of the virus. Many to-be-weds celebrated with “minimonies,” microweddings, or elopements. Graduation ceremonies this May took to the road, with teachers and families driving down neighborhood streets to mark commencement. Former President Barack Obama and Oprah Winfrey. addressed graduates in livestreamed speeches. Students recreated proms and yearbooks over social media. Witty pregnancy announcements went viral, with jokes about parents not social distancing and buying the wrong protection.
Thanksgiving Rituals
Thanksgiving as a holiday is not considered religious by most Americans. However, some experience it as a spiritual ritual that binds families and friends to one another. Due to an increased number of COVID cases in many parts of the country right now, some families may choose to celebrate apart from one another according to updated CDC recommendations. However, there is still a need to create an intentional family ritual and celebration.
There are creative ways to create rituals and a sense of togetherness over Thanksgiving to celebrate this spiritual awareness. For instance, for my family’s Passover Zoom, my brother and I planned songs and improv assignments for each family. This way, every family contributed something fun or meaningful to the holiday.
Here are some ideas to create anticipation, connection and meaning to your 2020 COVID-19 Thanksgiving;
Order craft supplies online and have them delivered to each family member’s home ahead of Thanksgiving. You can create themed DIY projects together via Zoom. For example, you can buy the makings of a fall wreath and each family can work on it together while catching up on Zoom displaying their crafting ability.
Safely prepare dishes and deliver them to family and neighbors in a way that does not involve contact with others. For example, leave them on the porch.
A game of charades is always fun, and can be played virtually.
Karaoke is a good way to bring music into your celebrations–belt out your favorite tunes over Zoom.
Schedule a time to share a meal together virtually.
Have people share recipes ahead of the big day. This way, they can cook their turkey, dressing, or other dishes alongside one another via video calls.
Once seated for dinner with your loved ones online, go around the screen and say what one is thankful for. This would be a wonderful new ritual to emphasize family bonds and heal potential family rifts.
Come up with mindfulness techniques to ground oneself and keep anxiety, worries and fears down.
You may also want to create a space for mindfulness during the holidays. This could be a private mindfulness breathing exercise each morning. Alternatively, one could host a mindfulness session with the family at the outset of the virtual gathering. Carving calm from the chaos is, as Dr. Jamie D. Aten writes, a necessity. “When disaster hits, life can feel chaotic, and our energy is used up fighting fires. But when the flames die down, it’s important to make space to do some of the things we once enjoyed doing.”
On the eve before election day, I led a mindful grounding session for colleagues who were feeling anxious. This was a way I could give service and help others remain centered. Sending food to tireless hospital workers working over the holidays who are now swamped with COVID cases is another nice way to give back to your community. Be sure to reach out to neighbors, especially those who may live alone. A simple text or phone call could be enough to brighten their day. If you don’t feel able to deliver food to those homebound or homeless, find ways to donate time or money so those folks can have a holiday meal. These are ways, with the support and willingness of a community, to still come together.
Get the whole family involved in exercise during the holidays.
A recent study showed that the pandemic has had a clear impact on diet and physical activity and therefore cardiovascular health. Exercising during COVID-19 to weave into creative ways for the whole family to move together during a Zoom family gathering. Some examples might be:
A younger family member can bring a dance move learned on TikTok to teach everyone else.
A young adult or avid music fan can create and share a music playlist for the family to dance to over Zoom.
An older member of the group can bring a family story or poem that they feel exemplifies the spirit of the holiday.
Facing a Post-Election Holiday Season with Compassion.
Because this Thanksgiving holiday takes place in the aftermath of a highly unprecedented election, it is important to create boundaries around political discussions before you all gather together (whether it’s virtual or in IRL). Let family members know in advance that you plan to listen but would appreciate not discussing politics at the gathering.
It may be a opportunity this year, that relatives who have different political beliefs’ are at a greater physical distance. Physical distance might give family members a chance to focus on missing one another rather than attempting to win debates. We can use holiday rituals as an opportunity to heal political fissions by focusing on what we all have in common. This could be a great exercise in compassion. Meditation teacher and published author Sharon Salzberg emphasizes that compassion does not connote agreement; in fact, she says that agreement is not even a part of feeling compassion. “We are all linked, and compassion is the natural response of seeing that linkage. It is caring and concern rather than a feeling of separation into us and them…[Compassion] is the result of the recognition [of the interconnectedness of everything].”
Here are two guided gratitude meditations for the family or individual preparing for the holidays this year: Greater Good in Action and YouTube.
Developing mindfulness skills in advance of that Zoom holiday gathering or phone call might be the most powerful gift you can give yourself and your family/friends.
Please keep several mental health resources handy this upcoming holiday season.
National Suicide Prevention Lifeline: (800) 273-8255
SAMHSA’s (Substance Abuse and Mental Health Services Administration) National Helpline: (800) 662-4357
National Eating Disorders Center Helpline: (800) 931-2237
When it comes to women talking about sexual pain, omission is a form of communication.
Vulvodynia = Women’s sexual pain.
Our society still grapples with the experience of female sexual pain. Specifically, Vulvodynia (vulvar pain) affects some 16 percent of women. “Vulvodynia is chronic vulvar pain without an identifiable cause,” reads a statement from the National Vulvodynia Association (NVA), a non-profit created in 1994 to help improve the health and quality of life of women suffering from sexual pain. “The location, constancy, and severity of the pain vary among sufferers. Some women experience pain in only one area of the vulva, while others experience pain in multiple areas.” While some sexual pain may be located on the vulva or in the vestibule (the vaginal opening), some women may feel pain internally as well. Unfortunately, millions of women experiencing pain during sex are being misdiagnosed. And so, millions suffer in silence.
Dyspareunia is an older term to describe all types of female painful sex. The most recent diagnosis of genito pelvic-penetration pain disorder (GPPPD) is the clinical diagnosis in the Diagnostic and Statistical Manual Version 5. It is the name of the conditions formally known as vaginismus and dyspareunia. Vaginismus results from involuntary contraction of the vaginal musculature. Primary vaginismus occurs in women who have never been able to have penetrative intercourse. Women with secondary vaginismus were previously able to have penetrative intercourse but are no longer able to do so.
How Women’s Sexual Pain Shows up in the Medical Realm
Epidemiological studies indicate that only 60% of women with vulvovaginal pain seek medical help and among those, 40% never receive a diagnosis. The lack of support from the health care system may contribute to feelings of invalidation and stigmatization often experienced by women with Vulvodynia. When it comes to pain specific to female anatomy, like the vulva, diagnoses frequently veer off-course. Doctors suspect menopause, PMS, depression, or anxiety. Yet surprisingly, many of the women sex therapists see are actually younger than 40 and nowhere near peri-menopause or menopause.
This gap in a detailed assessment process leaves a woman with the wrong diagnoses and still in pain, with the additional psychological pain and loneliness of being misunderstood. Women presenting with genital pain frequently experience rejection from their biopsychosocial environment. This contributes to a belief that silence is better than being misunderstood and embarrassed.
“There’s a huge problem,” Dr. Elizabeth G. Stewart, M.D., told attendees at a session on vulvovaginal disorders at Internal Medicine 2011. “There’s virtually no vulvovaginal training for clinicians.” Due to the minimal training doctors receive about women’s sexual health in medical schools, doctors may feel stymied when their female patients report having genital pain. Stewart also added that “clinicians also tend to rely on patients’ self-diagnosis and manage their problems by phone, or don’t do a physical exam before treating, which leads to incorrect therapies.”
What might cause Vulvodynia?
In a recorded webinar presented by Center for Love and Sex (CLS) created for professionals with my colleague gynecologist Dr. Chris Creatura titled “How to Help Women with Sexual Pain and Low Desire,” Creatura let therapists and gynecologists know that while examining a woman with vulvovaginal symptoms, a doctor must consider many differential diagnoses. Although we still don’t know exactly what causes all Vulvodynia symptoms, she explained that some contributing factors include:
An allergy
Atrophy
A drug reaction
Sexually transmitted infections
Infection
Low estrogen
A dermatological source
Disease elsewhere in the body
A drug
Cancer or a precancerous condition
A combination of these factors
How Women’s Sexual Pain Affects Their Partners and Relationships
Many women often keep the reality of the level of sexual pain or discomfort from their partners (whether they are new partners or longtime partners or spouses). Omission in the realms of sexuality and intimacy is a mechanism women resort to in order to feel more accepted by a partner and society out of fear of rejection, shame, and exclusion. Recent research cited in Michael Castlemen’s recent post also illustrates that it is a reaction to a patriarchal society that privileges men’s sexual pleasure over women’s desire and pleasure. Women reported that the reason they don’t tell their partners about their pain is because they felt “they should subordinate their erotic pleasure to their men’s.”
In fact, studies show that male partners of women who experience sexual pain are also deeply affected by their own shame when they are aware of the pain. In a recent study published in the Journal of Pain researching women with Vulvodynia and their partners, women experienced greater pain when they also reported pain-related shame, while their partners experienced distress when they felt shame related to the pain they were causing their partner through sexual activity. Furthermore, on days they had sexual activity both partners reported greater levels of sexual distress. The authors of the study state: “Qualitative studies have reported that many of them feel inadequate, are apprehensive to speak about their pain, and fear this condition spells the end of their romantic relationship.”
How Can Sex Therapists Help Women and Their Male Partners
As a systemic sex therapist, I consider the reach and power of a woman’s genital pain, the impact on her partner, and their relationship. It is critical for a sex therapist to first validate and empathize with the woman’s pain, since most women feel like a complainer or at times even like a hypochondriac. To uncover the source, experience, and history of the pain, the sex therapist should conduct a thorough sexual status and history assessment. (The Center for Love and Sex offers two recorded webinars on these interventions for medical professionals including therapists, sex therapists, pelvic floor physical therapists and doctors.) But then they also need to conduct assessments of her partner.
Frequently, for women in committed sexual relationships (in the cases I provide here, the partner is male), the vulvar pain also has an effect on a man’s sexual functioning. Male partners, feeling guilty for causing pain in their partner during penetrative vaginal sex, may experience erectile dysfunction, uncontrolled ejaculation, or low desire. It is important for women to seek help not only on their own but with their partner as well.
The Plan
The research cited above provides a strong argument for therapists to work with both partners in couples systemic sex therapy. Within this type of couples sex therapy, it’s critical for sex therapists to:
Provide sex education about Vulvodynia to both partners so they understand that this is a medical condition and no one’s fault.
Refer the woman suffering from pain to a well-trained sexual health medical professional able to diagnose and treat Vulvodynia and GPPPD.
Explain how the disorder impacts the entire couples’ system.
Encourage the couple to use the therapy space to address both partners’ feelings of shame, anxiety, and sense of brokenness. Give them hope that these conditions can be treated, and that their reactions are understandable.
While treatment for Vulvodynia is ongoing, outline a treatment plan to work on the pain treatment, their couple communication, and sexual alternatives.
Teach them mindfulness techniques in order for them to become more relaxed and embodied and focused on giving and receiving sexual pleasure. There is a whole body of research and a recent book written by Lori Brotto showing the benefits of MBSR (Mindfulness Based Stress Reduction) for women suffering with sexual pain.
Advocate and support women as they work with allied health care professionals.
Creating a Holistic Systems-Oriented Medical Team to Help a Woman and the Couple
In the second of CLS’s webinars on sexual pain co-presented with Pelvic Floor Physical Therapist Amy Stein titled: (“The Collaborative Clinical Care Model Between Therapists and Pelvic Floor Physical Therapists”), a case example showed a client (all identifying information was removed) experiencing severe genital pain who described feeling like a freak amongst her sexually active college peers. Another woman described a breakup with a boyfriend, suspecting the cause to be her pain during sex and the consequent lack of sex. In another example, a high-achieving professional woman worried she would lose her supportive fiancé once he started business school. In almost all cases, these women felt extremely isolated.
Therefore, silence about pain, shame, and distress creates a vicious cycle of communication and intimacy breakdowns. Excellent communication skills and having a team may ameliorate and amend communications. The system around a woman in pain–her gynecologist, therapist, physical therapist, sex therapist, and her partner(s)–must all work holistically to treat Vulvodynia and sexual pain. Sex therapists can create and coordinate care among all these providers. They can encourage women to speak authentically about the sexual pain to their sex therapist, their medical providers, and their partner.
References
Kearney-Strouse, J. (2011, June 1). Vulvovaginal disorders common but commonly misdiagnosed. ACP Internist.
Millions Of Women With This Condition Are Being Misdiagnosed: Here’s What To Know About Vulvodynia. (2018, March 14). National Coalition for Sexual Health.
Paquet, M., Rosen, N., Steben, M., & Bergeron, S. (2019, April 1). (174) Let’s Talk about it: Daily Associations between Shame and Pain and Sexual Distress in Couples Coping with Vulvodynia. The Journal of Pain. Brotto, L. (2018) Better Sex Through Mindfulness: How Women Can Cultivate Desire, Greystone Books: Vancouver
Vulvodynia Treatments. (2020). The National Vulvodynia Association.
What is Vulvodynia? (2020). The National Vulvodynia Association.
Brotto, L. (2018) Better Sex Through Mindfulness: How Women Can Cultivate Desire, Greystone Books: Vancouver
As a sex therapist I’m privy to a variety of different sexual lifestyles that our sex therapy and sex coaching clients practice. I had been working on this blog about sex parties based on an interview I did with Killing Kittens founder Emma Sayle right before the COVID-19 self-quarantine began. I followed up with Sayle via Skype in order to find out how the stay home order had affected KK’s community. I am including both the Pre-Covid-19 Live Interview and Part 2 Online Covid-19 Skype Interview on the topic of group sex historically and what’s occurred online now that the shelter in place requirement has extended to both sides of the pond.
History around Sex Parties
Interest in sex parties and/or orgies has been around since the times of the Greeks and Romans. However it’s a less-studied topic in modern sexuality research. Recently the anthropologist Kate Frank published a book on the topic titled: Plays Well in Groups: A Journey Through The World of Group Sex in which she explores the history and range of behaviors that people practice in modern day sex parties. Frank defines group sex as “erotic or sexual activity that implicates more than two people and consists of various possible configurations of participants and observers”.
Research on Group Sex, Sex Parties and Threesomes
While the majority of Americans prefer engaging sexually in private, there are a percentage of folks who enjoy engaging sexually in a group setting (either on their own or with a primary partner). Colloquially participants refer to these events as play parties. In a recent cross-sectional, Internet-based, U.S. nationally representative probability survey of 2,021 adults (975 men, 1,046 women), many more men reported having ever engaged in a threesome (17.8% vs. 10.3%) or group sex (11.5% vs. 6.3%) while there was less of a difference between men and women ever having gone to a sex party (6.3% vs. 5.2 %).
Perhaps this is because coupled partners may attend a sex party more frequently as a pair than as individual partners. Some couples report that these types of group sex dates can be a their top erotic interest or another way they “spice up” their sex life. Sex parties are commonly referred to as play parties and partners are called play partners. I would include threesomes under the umbrella category of group sex because sometimes couples may go to a party to find a third partner with whom to “play” rather than looking exclusively to play with another couple. According to Pornhub’s 2019 Year in Review page, the threesome genre was within the top 15 search terms coming in at #13.
There are many more options for Americans these days to intentionally experiment with strangers at public or private play parties in which attendees are vetted beforehand. Some sex parties can be organized by friends at a private home where there are perhaps six or fewer degrees of separation between guests and vetting isn’t required. Whether attendees identify as being: Polyamorous, in the “lifestyle”, “swingers”(a term used more by boomers), consensually non-monogamous or as being “into playing”, there are a variety of fantasies or specific sexual acts and scripts partygoers explore at sex parties. While some sex parties are exclusively organized for gay men or straight couples, others offer folks who are bi-curious, sexually fluid or bisexual to explore the wide spectrum of sexual interests.
In a 2009 non-randomized study researching swinging culture, Professor Edward M. Fernandes found that about 50% of the women engaged in woman-to-woman play only while about 8% of the men reported engaging in man-to-man contact only. According to an analysis done by researchers D’Lane Compton and Tristan Bridges on the results of the 2018General Social Survey data, almost 6% of women responding to the survey identified as bisexual compared with 1.5% in 2008. And the most recent data on the question of sexual fluidity hints at the fact that about 14 percent of women and about 10 percent of men express some degree of same-sex attraction although many of them may identify as mostly straight. According to sexuality researcher Lisa Diamond “ the largest group of individuals walking around with same sex attractions are individuals who you would never know had same-sex attractions. They identify as heterosexual. They think they’re mainly heterosexual, but they’re, like, hetero-flexible.”
The Connection between Sexual Fluidity, Female Sex Esteem®
and Sex Parties
Onebusinesswoman innately understood that women were more sexually fluid in their fantasy life and if given the right opportunity, would enact these desires if given the right context. Emma Sayle had her ear to the ground at the right time just as the television show Sex in The City began inspiring women to talk more openly about sexuality. From discussing these shows with her peers and listening to their more candid conversations, she gleaned the fact that women are more curious to explore sex with other women. While the audience for Sex in the City was predominantly white, resourced urban women, the underlying theme of single women’s being independent and unashamed to casually date and have sex was catnip to Emma Sayle, CEO of Killing Kittens. Emma recognized a wave of female sexual empowerment that the show helped to unleash. This desire for more sexual fluidity and empowerment are key ingredients to what I teach in Sex Esteem® workshops and panels so was eager to find out more about KK’s origins.
Killing Kittens is a UK-based sex party and online dating and discussion community that brought her parties stateside to NYC two years ago. The parties have flourished and she maintains the same model she did originally, creating parties for heterosexual and lesbian couples and single women to explore their sexuality in female-empowered, elegant surroundings.
I got a chance to sit down with Emma for an intimate interview after she had invited me to be an expert on her Valentine’s panel, The Dating Debate in a hip downtown hotel in NYC in pre-Corona February (which seems like a long time ago now). In the interview she explains the feminist origins of her very successful sex party model. Soon after the COVID-19 required all clubs, restaurants and gatherings to close down, I got back in touch with Emma virtually to create an addendum to this blog. This is an edited version of both interviews. Enjoy and as always, I invite your questions and reflections.
S: Can you tell me how you came up with Killing Kittens in the first place?
E: It was founded in 2005 and it was a long time coming, it wasn’t a sudden thing it was I went to an all-girls boarding school for ten years whilst my parents lived in the middle east, I kind of had this unbalanced view of women and what we could do. At school I was taught I could do whatever I wanted to be and do whatever I wanted to do, then you’d go home and see sort of the women were second class citizens and how they were treated out in the middle east. And I had friends and sort of grew up running around with them. And the fire got lit very early and kept being flamed. That fire in this sex life isn’t right and it’s unbalanced, it’s not fair kind of thing.
S: How did this belief affect you once you became more sexually active?
E: I’d be out and about at university in my early twenties and seeing that if girls had a one-night stand they were sluts and all the slut-shaming going on. But if boys had a one-night stand they were legends and high-fived and I’d hear guy friends of mine saying: ‘Oh I’ve met a really nice girl but she’s not girlfriend material.’ and I’d be like: ‘Why isn’t she girlfriend material?’ ‘Because she’s slept with loads of men’….That’s how society was.
S:What was the turning point from witnessing the double standard into creating a response to it?
E: Sex and the City came out and suddenly women were talking about vibrators and having sex lives and it became okay to talk about at the same time I was doing PR for a big erotica exhibition in London. And I again saw loads of wonderful amazing people and businesses but it was all run by men. It was all run by men claiming to be female friendly.
S: Tell me why you felt it wasn’t female friendly.
E: It was all the porn stuff , brightly lit with white lights. And the more I saw it and that world, it was very black and white for men. If they saw sex going on, they’d be turned on. Women were much grey…. We kind of operate across the spectrum and our brain is our biggest sex organ and we need to be turned on. It’s the touch and the feel and the smell and it’s the mood. I was watching this and there was a massive difference.Everything out there was very male and in your face. …it wasn’t turning me on.
S: It wasn’t serving you, you weren’t the customer they were targeting with this type of entertainment.
E: Nooo. There were two dildos in your face, and it was nothing subtle, and I thought that’s what’s missing. Female-friendly in the end is that subtlety.
S: So for people in America who may still know about the term Killing Kittens, can you tell them where the name came from?
E: That was the lightbulb moment, I was at a wedding in Ibiza with a loose hedonistic crowd. And who were all very strong, sexual women who sort of slept with each other. And no one had really been asleep for 3 days and someone phoned up the groom who hadn’t made the wedding and asked: Are you guys just sitting around killing kittens at the moment? So we had this discussion and thought about what killing kittens was.
It’s a very old cyber slang meme, that every time a female masturbates, God kills a kitten. Or anytime anyone masturbates, God kills a kitten.
That’s where the name came from.
I was like, right that’s it. I like it, it’s crazy but it’s kind of about pleasuring yourself, that’s what it stands for. And I liked the two Ks. K is a very strong letter. I want to set up an offline, online community that is all about women exploring their sexuality in a safe space. And it’s all about them, and they make the rules without any fear of judgement.
S: Talk about the rules. Tell us how you created a boundaried setup for people and
what the parties are like.
E: The rules are still the same and they’re the same at all the events. And the same across online.Men can’t approach women they have to wait for the women to make the first move. And not letting in single guys, it takes that testosterone factor out. And they’re the main rules.
S: I like the fact that you flipped the erotic power.. I talk about the term I use, Erotic Triggers which are a combination of the 5 senses and add psychology and emotional intimacy. I discuss power exchange with Sex Esteem workshop attendees and what you declared to women was that you now have the power to make decisions about where you want to go, and how you want to set it up.
E: Exactly.
You discussed that good friends distanced themselves from you when you began this business which helped to spur you on even further. Can you articulate what you think it was that they were distancing from?
E: I think people are scared, the majority of people like a comfort zone, or the norm.
Follow Up Post COVID-19 Shelter at Home Interview
S: Has there been more or less activity on the KK platform since the advent of COVID-19?
E: We have seen a 330% increase in user activity online and 425% more messages being sent.
S: How many new members have joined?
E: There’s been an 18% increase in new member sign ups.
S: How do you explain the increase in folks signing up for KK when there are no longer any in-person events going on?
E: KK from day 1 has always been about community and has always had a strong online community, we now have over 160k members and over 60% of revenue comes from the digital side of the business so the events with approx 1000 attendees a month globally out of 160K online members are actually just the tip of a much bigger iceberg. Our chatrooms have always been busy as well as the direct messaging so now people are in isolation they have turned to the online side of KK to be part of that community.
S: In our pre-Corona interview in NYC you mentioned that there was at least 50% or more business on the dating platform versus the in-person parties, are people using the dating platform not necessarily identifying as folks into sex parties?
E: Yes, most of our members do not ever attend a KK party, they join the online platform for the dating, social community side of KK, to belong to an open minded, sex positive ,non- judgemental environment that has women at its core.
S: Has KK begun to offer virtual sex parites?
E: Yes we are doing weekly zoom house parties, featuring KK performers, DJ playlists and up to 100 members, hosted by some of our community kittens. We are doing uk , Australia and NYC parties now along with girls-only virtual cliteratti events.
S: How have you encouraged continued engagement of your members?
E: We are doing weekly virtual house parties, weekly virtual workshops and weekly insta live chats where I speak to dating, relationship, sex experts from around the world, along with more educational blog posts too so theres a lot of virtual activity within kk going on!
S: Are any people going on first time virtual dates ?
E: Yes, there’s a lot of hanging out, Netflix film watching dates, virtual drinks dates and just a lot of chat going on. Old school dating of actually getting to know people and not having 4 drinks before jumping into bed with them on night 1!
S: What changes can you envision for sex parties in general and for KK in particular
once we all emerge from self-quarantine?
E: I think our parties will not change we will just keep a lot of the virtual offerings as it is a good way to engage our whole community which we haven’t really done before rather than seeing it all by city. The virtual world brings together the global community regardless of location.
When Bad Things Happen to Good People, the world seems more fragile
When Robert Bowers, the gunman who ran into The Tree of Life Synagogue in Pittsburgh this past Saturday he murdered 11 innocent people and wounded 6 more. The event also tore into the fabric of the American community’s sense of safety, respect and collective faith in the country.
Each time there’s been a traumatic event in the US whether it’s a terrorist threat (the bomb packages allegedly sent by Cesar Soyac last week), the Las Vegas shooting one year ago at the Harvest Music Festival and the riot allegedly incited by white supremacists RAM members in Charlottesville, Virginia last year, clients come in to sessions and are palpably frightened. They are seeking a place to express their feelings of rage, fear and vulnerability (many of the bomb packages were mailed to locations all around Manhattan). The rabbi of the Tree of Life Synagogue described receiving letters of condolence and support from people all over the world. The media shows communities spontaneously gathering to hold candlelight vigils in cities around the USA. What does a therapist who specializes in sex therapy advise after a traumatic event that shakes a nation like this? How does this even connect with one’s sex life?
Vulnerability and Sex
One of the main challenges for clients in my group practice Center for Love and Sex, is the longing they have for more meaningful sex. This can come in the form of wanting more frequent sex with their partner or spouse. It can also present as the desire to express a long-held fantasy to a partner in order to feel more whole in their sexual expression. It also can be described as the wish to lower one’s anxiety so as to feel more present and freer in partnered sex. For many of these presenting problems, anxiety is a large contributor to the challenge. According to the Anxiety and Depression Association of American, anxiety disorders affect approximately 40 million US adults aged 18 and older.
One might not be surprised that folks who already suffer from anxiety will feel a spike in their anxiety levels when a mass shooting or terrorist attack occurs. According to a Gallup Poll taken soon after the Las Vegas mass shooting 39% of Americans are either very worried or somewhat worried that they or someone they love will become a victim of a mass shooter. These levels were similar to a poll taken right after the San Bernadino mass shooting. So how do people with anxiety seek out comfort? What is interesting to me is that while most of my female clients (whatever their sexual orientation) feel comfortable in seeking out comfort verbally from their partner or friends, most of my male clients are reluctant to ask their partner/spouse directly. However, they may ask indirectly by initiating some type of physical touch, whether a cuddle, a hug or some sort of more direct sexual signal. Why might that be?
Men and Comfort, an oxymoron?
Most men are acculturated to repress their fear outwardly. They’re taught that to be “real” men they need to be tough and indifferent because that is the way you win and get ahead. Never show your hand when it comes to cards, in business and at times in romantic relationships. Thus there’s a small menu of emotions that are socially sanctioned in American life (although there’s some variance depending on your cultural background). Some of these common emotional expressions include: anger, rage, disdain, belittling others (either in humor or with aggression), frustration, disgust and physical extensions of these emotions.
American men (this includes those that identify as gay, bisexual and queer) are taught that they have to be the ones that their partners can lean on. But in the years I have worked with men from diverse ethnic, cultural, religious and orientations, I have witnessed there’s one place they can experience a wider menu of emotions. This is in the sexual and erotic realm. Through a sexual scenario a more vulnerable side (even if most men aren’t even conscious of it) emerges, and sex isn’t just something he is performing or doing. It becomes the place he goes to be held, rocked, whispered to allowing him to feel accepted, loved and yes comforted.
Meaning of Sex and Death Anxiety
When I work with men I help them become more aware of their own fears and how they might learn how to express their worries and concerns to their partners in other ways beside being withdrawn, belligerent, complaining or in some cases angry when their partners turn them down for sex. I help them uncover what sexual activity with their partner means to them in the larger significance of their lives. For some it is a return to connection that is beyond having to prove themselves, for others it’s a space they can be gentle givers of pleasure, for others it’s where they’re given free reign to lead which quiets their fear of lack of control in the outside world. And for others it’s a haven from death.
Death Anxiety and The Lack of Living Fully
Irving Yalom, the famous existential therapist and writer has written about his theory of death anxiety can keep people from truly living deeply, including shutting off their sexual desires. He wrote: ““…the more unlived your life, the greater your death anxiety. The more you fail to experience your life fully, the more you will fear death.” But when faced with death either through a terminal illness or at the top of the World Trade Center, a man urgently calls their partner and/or family to tell them in an emotionally authentic voice how much they love them, finally freed of society’s chains of decorum.
Ask for Comfort without Shame
When a massively violent event occurs like the Tree of Life Shooting last weekend, it tears into our day to day lives and threatens our own sense of safety. It is the human condition to want to reach out, to hold a partner close and to give and get comfort through touch. It’s our primal urge when we’re born and it’s a haven against our own fears regarding our own eventual deaths. I always let clients know that inside all of us are the children we used to be; playful, eager to learn, and longing to be comforted when we’re frightened. This need is not something to be ashamed of. The increase in mass shootings are fear-inducing for all Americans and for all humans. If you have a partner, let your guard down, tell them of your fears and invite them to comfort you and offer yours to them. If you don’t have a partner, reach out to friends, your community, attend one of the hundreds of interfaith vigils that are still occurring across the country and offer to give and receive a hug. The only way through this is to confront pure hate with pure love and authentic comfort.
While I’m not sure in what order they should be listed, I have spent years helping people say the unsayable, articulate what turns them on, and supporting their journeys in coming to terms with the particular consensual erotic interests they find most compelling. At CLS, we also help those who tell us they have a porn addiction or who find that their porn gazing has become out-of-control. In a recent performance called “Prurience” created and performed by Christopher Green at the Guggenheim’s Works & Process Series, Green created a space in The Wright restaurant that while not a safe therapeutic environment, still encouraged some participants/audience members/performers to communicate what they are erotically drawn to when watching porn or how their porn watching became what they deemed to be an addiction.
Green invited participants into an unusual immersion/theater which was a combination of a 12-step sex addiction meeting, a confessional, a one-way-mirror-interrogation, and a-funhouse-mirror-maze. I was lucky enough to interview Mr. Green during his show’s run in NYC given how it reflects on some of the issues our clients are confronting given their porn use whether as an out-of-control behavior on their own or wanting to incorporate the fantasies they enjoy with a partner or spouse
I wondered if the impetus to create the piece coincided with the changes in UK laws regarding pornography. Green stated: “Funnily enough no, it happened all at the same time. Suddenly when I was writing it, David Cameron became obsessed with it and started legislating and talking about porn all the time.” In 2013 Prime Minister Cameron proposed having all porn blocked by internet providers in the UK, where Green grew up.
The audience is invited by the person we think of as the leader of the Prurience group, an American artsy-man with an effeminate inflection in his speech played by Green, to make a circle with the chairs as usual before the “meeting” begins. He is apologizing for being late and haphazardly setting up the product table in the corner, offering up swag printed with the Prurience logo. Once settled, he begins the group by asking participants to share their first memory of seeing porn for the first time. This question aligns with many of the questions we ask at CLS when conducting a Sexual History as part of a full bio-psychosocial assessment to learn about our clients, their families of origin, their education regarding sex (formal and otherwise) both through self-pleasuring and/or partner sexuality.
In this immersive theater experience, several participants shared the discovery of their father’s Playboy, or a friend’s older brother’s stash of videos, or searching online at sites like Pornhub. In our practice, clients express how they watched their parents hold hands, or kissed a “crush” for the first time in 5th grade at a friend’s house party or happened upon porn online at age 14. The firsts of our lives leave an imprint, and at times it is so strong that it becomes a go-to fantasy that one seeks to recreate again and again whether in one’s imagination, online, or with a partner.
In “Prurience” we are led to believe that the members of this so-called self-help group are struggling with so called porn addiction. While the term sex addiction was not accepted as a formal DSM5 diagnosis, nor has it been accepted by the American Association of Sexual Educators, Counselors and Therapists (AASECT), the terms sex or porn addiction has been popularized enough by people like Patrick Carnes, the unscientific YourBrainonPorn site and the many rehabs that continue to charge thousands of dollars to help people with sexual behavior they may find out of control, sinful, shameful and unfaithful.
At CLS we work with people who struggle with Out of Control Sexual Behavior or hyper-sexual behavior that have put their relationships, family and livelihoods at risk. In a structured, thorough assessment process we discover what other overlapping challenges, potential diagnoses, past trauma and/or relationship dynamics are contributing to the behavior and collaborate with the client on the treatment goals and individualized plans we recommend.
In the Prurience porn addiction meeting one soon hears from people who are revealing ever more detailed descriptions of what they like to watch, what they desire and the level to which these desires haunt their waking and sleeping hours. The comments are sharp, humorous, disturbing, self-flagellating, erotic, disgusted and intriguing.
SC: How important was it for you to create an Uber-reality of a 12-step meeting?
CG: “Yeah, I wanted to unsettle people because one of the effects of porn as we know one of the effects of porn is it’s deeply troubling, or arousing in the fundamental sense of the word. It alerts us and wakes us up…I wanted to try and replicate that in a theatrical setting”.
SC: “Like in a parallel process kind of experience?”
CG: “Yeah, absolutely.”
The term I used in this last question, “parallel process” is a psychotherapeutic term to express the feelings or dynamics that crop up in the relationship between a supervisor and a therapist who is telling the supervisor about a particular client. While relaying the issues, the dynamic may well unconsciously mirror the dynamic that is occurring between the therapist and their client.
In his run on the West End in London, Green told me that some audience members got up at the break and walked out, never to return. They were too disturbed, or embarrassed or uncomfortable to stay through the 2nd part. The topic of porn is still rarely brought up in general therapy but in sex therapy, we try to help clients describe what turns them on so that they can articulate it to their partner(s). If a person is into porn, or erotic novels or other fantasy-type trigger, describing a scene or exchange can help them formulate what it is that fires up their erotic ignition.
Green wondered how I felt at witnessing his role as group leader who didn’t really “hold” the members of the porn addiction recovery group in a safe space by setting clear boundaries on the length of people’s contributions or the intensity of what was shared even when someone seemed to be in a high risk situation. I thought it was an astute question since in fact I was quite aware that the experience was theater and that his playing the role in a passive manner was intentionally done. It certainly unnerved some folks who felt unsure of what was to come. Much like getting on a roller coaster that might make you nauseous, many audience members were rattled by the tea break.
This lack of structure and support that one sees in the group is NOT like a professional therapeutic experience where a therapist lets a client know what comes next in the process, allows the client to ask questions, holds their fears so that they don’t become overwhelmed and may stop someone who becomes hurtful to another. The therapist closely monitors the clients’ experience, and checks in to ensure that the sessions are going at an emotional pace that they can handle.
I asked Green about the fact that the group didn’t seem to have a performer playing a partner who has suddenly discovered their partner/spouse’s compulsive sexual habits and come to the group to express their shocked, hurt and angry reactions. He let me know that in fact in the original version of the piece there had been a female character who had discovered her husband’s porn use and ostensibly came to the meeting as almost one would go to AlAnon to get more education and support but that in the final edits made by the dramaturge, he lost this character which saddens him at times.
In our work with a client wanting help with their compulsive sexual behavior at Center for Love and Sex we at times work with the individual and refer the couple to another therapist for couple/marital counseling. in other cases we’ll work with both the couple and each partner individually if it seems like a better plan. Like any secret kept hidden for years, the ripple effect after the discovery of an out-of-control porn problem has tremendous impact on both the partner with the issue and the relationship. For many of our clients the recovery of Out-Of-Control sexual behavior includes the opportunity to speak about all sorts of issues (including their sex life) which had been swept under the carpet for years.
We help them understand the behavior, treat the underlying or coinciding disorders that might have contributed to the behavior and then help them and their partners begin the long road to rebuilding trust, expressing hurt, articulate anxiety, and describe erotic desires. The split-off part of their self that was continually numbed out through the compulsive behavior can now emerge and be known not only to the individual but to their partner. And the therapist helps them stay grounded through the at times painful, anxiety-ridden process.
I’ll quote Chris Green with his perceptive reflection on therapy and theater to end this blog:
“I think a lot of therapy is sitting with discomfort isn’t it? It’s being able to turn your face towards the thing you normally turn away from. And it’s.. to put that into theater you have to sit with discomfort, you have to encourage people to sit with discomfort. And it’s only through that that we make any breakthroughs in life” .