Category Archives: Couples Therapy

Four Relational Contributors to Heterosexual Women’s Low Sexual Desire

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In a recent study, titled “The Heteronormativity Theory of Low Sexual Desire in Women Partnered with Men”,  researchers Sari M. van Anders, et al. found that lower female libido can be a result of many societal norms, especially related to heterosexual couples. This article is extremely important since low sexual desire is a common, though not-often-talked-about, sexual struggle for women and a frequent treatment goal of sex therapy clients and couples in a therapy practice. 

Sex is often seen and related only to reproduction (Anders, S. et al), placing women in a box of being a “mother” and a “caretaker”. Studies have found that men do not equally share parenting and housekeeping responsibilities, which creates resentment from their female partners and contributes to a decrease in desire for partnered sex. Although more recent studies show an increase in men’s domestic contributions in heterosexual marriages, women still do most of the chores and/or family organization leading to lower satisfaction with their marriage, as stated in the article “Perceived Housework Equity, Marital Happiness, and Divorce in Dual-Earner Households” by Michelle Frisco and Kristi Williams, which isn’t exactly an aphrodisiac in the desire department for women. 

Anders, S. et al found four predictions of how heterosexual relationships lead to low sexual desire: 

Prediction 1: Inequitable gendered divisions of labor leads to inequitable gendered divisions of desire: Women are often responsible for relationship maintenance and family management. Women also often do the recurring chores like cooking, washing dishes, cleaning and laundry. These are all considered “low-schedule control” tasks. Men often take care of “high-schedule control” chores like house and car maintenance and paying bills, which are performed less frequently and with more flexibility. These differences in chores and responsibility can cause stress on the women in the relationship, leading to low sexual desire. Women can often feel more like a mother than a partner, and society regularly desexualizes mothers and parenting. Men may have more time to spend on being a “partner”. Women are expected to achieve more in the house, women have to ask men to share responsibility or “nag” them to be equals in the house. Marginalized women often have a harder time asking and receiving help and women who rely on men financially often have a harder time standing up for themself or feeling like they have a right to ask for more help with the house and kids. These inequities between partners often have negative effects on the sexual aspects of a relationship. Tasks at home can add up to a lot of stress, with chores constantly being added to the to-do list, women feel like sex gets relegated to a lower priority. One woman stated that they “would rather make sure the bills are paid, clean the house, do things that need to get done than participate in sexual activity.”

Prediction 2: Having to be a partner’s mother dampens women’s sexual desire: Heterosexual couples have traditionally thrust women into a role of  nurturer and caregiver. Once children enter the picture, relationships can go from partner-partner to mother-child, with one partner becoming caregiver dependent. Women will do the same tasks for their husband/partner that they do for their children including; 

  • reminding/planning/organizing of chores and social events 
  • buying clothes
  • planning/shopping/preparingdinner every night. 

Heterosexual male partners/husbands sometimes still expect their partner/wives to care for them like their mom did, as it is what was modeled for them in their parents’ marriages. This is not usually a role women are choosing to have between them and their partner, which can frequently lessen their sexual desire.

Prediction 3:Objectification of women downregulates women’s desire: Heteronormativity focuses on women’s sexual appearance over their pleasure. Women are taught early on that they should appear sexy rather than feel their sexuality for themselves. Women are for men to get enjoyment from, making women’s wants and needs a low priority. Men believe women’s bodies are offered to them as part of a marriage contract, they can have sex whenever they feel like it and the women are expected  to consent . Women’s desire is often based on whether men find them  desirable, causing women to feel like they need to spend a lot of time on their appearance for the other. The study found that women who have lower self-esteem tended to have lower sexual desire and lower sexual pleasure. In many cultures and families, children are taught that women’s genitals are “dirty” or nonsexual, this belief can distract women as adults during sex and lead to low self-esteem. Sex education focuses on vaginas as a reproductive organ , rather than focusing on the clitoris, vulva and labia, which are the pleasure centers of the female genitalia . The study observed that men view sex as a way to show off their technical skills, often viewing access to women’s sexuality as a trophy to be won, rather than focusing on women’s enjoyment during sex. 

Prediction 4:Gender norms surrounding sexual initiation contribute to women’s low sexual desire: Sex is often started when men initiate it, some women feel uncomfortable making the first move. Women are taught to want to have sex when men are ready, they are shamed for having their own desire, having been called a “slut” if they initiate too directly. Yet when women turn down  a sexual initiation they have traditionally been labeled a “prude”, “stuck up” or a “tease”. The study shows that women reported  feeling  like masturbating might be seen as cheating by their partners, so they avoid solo sex even if they want to. Heterosexual sex is painted as real sex, which has traditionally still been shown as offering a low rate of orgasming without direct clitoral stimulation. When sex does not lead to sexual pleasure it brings down one’s sex drive. Women continuously say that they view sex as a “job requirement”. The study states that “Women may be unable to refuse sex because of justified fears of violence or resource withdrawal…”, that is why “marital rape” needs to be discussed much more widely.

Stress, Future Research and Treatment: 

Stress is a major contributing factor in low sexual desire. Women may feel stress from pregnancy, whether wanted or not, babies/children, physical pain from breastfeeding, carrying, rocking and lifting, as well as sexual abuse. 

Unfortunately most research on women’s sexuality is still done with white, middle class, able-bodied, heterosexual, cisgender and monogamous women, so any women outside of these categories should and do feel like they cannot get evidence-based answers or care for their low desire or other sexual questions and needs. As a sex therapist and general psychotherapist we witness the ways in which individual CBT and psychodynamic therapy and couples counseling  can improve concerns related to low female desire, decreased sex in relationships and marriages as well as lower intimacy and attachment in relationships. As a systemically oriented couples and Certified Sex Therapist, I am also aware that sexual desire is an intersectional experience and has to be addressed by using thorough biopsychocultural-spiritual assessments and collaborative treatment goals. 



How the Psychology of Gifting Can Help a Sexual Relationship

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According to the National Retail Foundation, 54% of the money spent on Valentine’s Day in 2021 was spent on a significant other. The act of gift-giving–an activity inextricably linked to Valentine’s Day can be, nonetheless, one of the more stress-inducing activities of this holiday, but it can also offer us lessons in how we relate to partners with intimate and erotic behaviors. In a recent research review by Galak, J et al of studies researching gift-giving, the authors hypothesize that many giver-recipient discrepancies are partly due to the notion that when givers choose a gift, they are focused more on the anticipated moment of when their gift will be unwrapped and viewed for the first time, whereas receivers usually focus on how valuable a gift will be once they own it.  Gifts are valued expressions of warmth, love and friendship to and from others. However at times, gifts may also be used in a more transactional manner or even as expressions of competition or power as in: “Which one of us bought the more expensive gift?”  Most folks, though, give gifts on Valentine’s Day because they desire to make a partner or best friend happy, and choose to provide them something, even if it is a modest present or a thoughtful act, to provide joy, and to show the receiver that they are held with warmth or love in the giver’s heart.

So during the Valentine’s Day season, I invite you to consider lessons partners can glean from this gift-giving-receiving process and how it might relate to couple’s offerings and accepting sexual and erotic behaviors to one another? How does the process of gift-giving relate to challenges partners confront when it comes to sexual initiations? 

The first thing to consider is that some partners don’t want to give or receive a gift from their partner similar to the way a partner identified as Asexual has decided they want to be emotionally close to a partner without engaging in a sexual act.  Another example occurs when a partner feels so anxious or frightened of getting the wrong gift for their partner, much in the way a person who is suffering from sexual pain, Erectile Disorder or traumatic history  avoids any initiation of intimacy for fear of physical pain, embarrassment, disappointment and disassociation. While these couples might agree to pause on any or some sexual activity with one another, other couples need help in finding better ways to initiate intimacy into their sexual practice.  

So how does a partner consider their sensual offerings without falling victim to the most common mistakes social psychologists have discovered when it comes to gifting?  During Valentine’s Day, when one is deciding on what gift to get a partner, it’s critical to put themselves in their partner’s shoes beyond the moment of when they will be unwrapping their gift. Similarly partners need to understand what their partners’ primary erotic language is and initiate an erotic or sexual experience in the  language that aligns with the partner’s sensibilities and what will feel pleasurable to the receiver.   

Another common error that people make whether they’re purchasing Valentine’s Day gifts or initiating a sexual encounter is that they offer their partner what they, the giver, would want to get, not necessarily thinking about what the receiver might desire. Whether it’s a habit of just responding to advertisements or an unconscious way to send a partner a not-too-subtle hint that they feel underappreciated, giving-to-get-back can be experienced as transactional by the receiver.  For example, if one partner likes to be seduced by having their genitals touched directly they might approach the second partner in the same way and turn them off with this approach because it’s not their preferred way of being invited into intimacy.  When thinking about initiating much as in deciding on what to get as a V-Day gift, a partner would be much better off by asking their partner what sexual or erotic signals they find meaningful or exciting. This process doesn’t always have to be drawn-out, either. Ask your partner directly and listen carefully. 

Oftentimes, a receiver might feel pressured by the invitation and respond immediately to an initiation by saying no. Giving and receiving are two sides of an experience, so a receiver can also gain skills on how to express gratitude for an initiation whether or not it’s a good time for them and offer in return further insight into what they’d love to experience. Just as a receiver would say thank you for a VDay gift even if it’s not what they most want, first expressing appreciation in positive tones goes a long way to the gift and initiation scenarios. 

 Both sexual encounters and gift exchanges require skill and nuanced responses for givers and receivers. The giver may do the bare minimum in choosing a gift or signaling they want to have sex, but that latent desire to please is rendered meaningless if the receiver begrudgingly takes what is put in front of them to satiate a partner who is putting pressure on the other. Frequently a receiver responds to what the giver wants for themselves with the hope of receiving pleasure later on in the event in a transactional way (as in I “do” you then you “do” me), or because it is expected (“we should be having sex”).  What can also become a negative exchange occurs when the receiver communicates abruptly that they don’t want to accept it because it’s not exactly what they want, or it was given at the wrong time of day which will most likely cause the giver to feel misunderstood, criticized and/or rejected.  If the giver got it wrong, the receiver should find something positive in the gift/sexual initiation and then gently explain how the receiver’s needs were misunderstood and how they might pivot by rescheduling, finding an alternative activity in the moment or deciding to try something the receiver suggests.  The receiver should still take into consideration the giver’s thoughtfulness in making the initial gesture with expression of gratitude for their efforts. To give and to receive are not mutually exclusive. 

Fully appreciating both the giving/receiving relational dynamic can be challenging for many partners whether on Valentine’s Day or below the sheets. While some people may struggle to conceptualize what their partner would truly desire, others may know erotically what it is their partner desires, but not how to enact it. For the former group, discussing erotic turn ons is critical so that these fantasies or desires can be spelled out and each partner can give examples of each turn on.  For the second group they may still need guidance verbally or nonverbally on what techniques would satisfy their partner’s erotic and sexual turn ons.  If, for example, one’s partner is particularly into tactile expressions, the giver might think about getting them a new vibrator, dildo, or clothing that has the feel they find sexy. Or a giver may begin by asking the receiver to guide their hand onto their skin to demonstrate how they want to be touched.  

Sexual intimacy can be nourishing when both halves of the pair are ready, willing and able to work as a team to give and receive pleasure with humility and erotic inquiry.  Gifting can be reconceptualized as an opportunity for learning more about your partner, yourself and improving sexual attachment. Everybody has a different language of love, just as everybody has varied erotic desires. These are steps in creating a more authentic emotional and erotic relationship on Valentine’s Day and going forward.. 

Erectile Disorder and 8 Masculinity Myths Part 2

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Myth #5 Erectile Disorder is All in Your Mind

Erectile Disorder has comorbid origins in medical diagnoses and at times is the early harbingers of underlying illnesses like MS or Cardiovascular Disease. While sex therapists do a thorough assessment that includes psychiatric diagnoses like Major Depression, Anxiety Disorders, Bipolar Disorder, ADHD, and  PTSD that can impact erections, they also do a thorough history-taking of medical issues and medications that can frequently impact a man’s erectile functioning including: Diabetes, PTSD, Parkinsons, and past genital injuries.  There are also many medications that have sexual side effects like SSRIs and statins.

Additionally, there is a  recent study by Kevin Chu, Et Al  showing an increased chance of new onset Erectile Dysfunction post-COVID-19 infection.  

In this study conducted by the University of Miami Urology Department, it was observed that the likelihood of having an erectile dysfunction diagnosis was 20% higher if the male patient had a prior COVID-19 diagnosis. This may be due to virus-induced cell dysfunction. Nonetheless, many people with penises may have recently been wondering why they have been having newfound issues with performance. If a COVID-19 diagnosis is in their past, this data may provide men a resolve to the confusion and frustration, and encourage them to seek treatment from a urologist.  

Myth #6 Erectile Dysfunction Is a Man’s Problem to Deal with on His Own

Men are taught that in order to be ‘a man’, they need to “pick themselves up by their own bootstraps” (which by the way is a phrase originally intended as a sarcastic Physics-derived comment on the impossibility of such a task).  Frequently partnered and married men come in to sex therapy on their own with the misguided notion that since they are having a problem with their penis, the responsibility lies solely with them to resolve it.  What many of these men miss is that they are part of a relationship system and that there is an impact and a relationship feedback loop that can help and at times hinder progress in healing the erectile issue.  In other words, they are better off not going at it alone. Sexual chemistry and well-informed, clear and compassionate communication (all cornerstones of higher levels of Sex Esteem) are essential for increased pleasure in partnered sex and what couples can address in couples therapy with an experienced sex therapist. Further, the increasing emphasis on surgical and pharmacological solutions to erectile dysfunction has led to a neglect of the importance that couples dynamics including attachment must hold in the conversation–in terms of the genesis and response to erectile challenges. This is true for heterosexual and LGBTQ+ couples.  According to a study by Kristen. Mark “Attachment style appears to be a more important contributing factor to satisfaction than desire amongst diverse sexual orientations”. 

Myth #7 Erectile Dysfunction Only Affects Older Men

There has been a notable rise in complaints of erectile dysfunction in younger people, chiefly between the ages of 16-35 years-old. This demographic includes people with traits such as psychiatric diagnoses (anxiety, depression, bipolar). Erectile dysfunction is associated with major depressive disorder (MDD), and treatment is associated with decreased rates of MDD. A recent study by Sirpi Nackeeran Et Al showed that men who received ED therapies had lower rates of depression compared after ED treatment to those who did not. Further, relationship concerns, performance anxiety, technological savviness and many other issues can be resolved by ED treatment. 

Myth # 8 Online Remedies for ED are Effective 

Due to the heightened rate of erectile dysfunction, be it as a result of psychiatric stressors, medical illness and/or medications, relationship issues or following a case of COVID-19, many men are seeking remedies outside of a medical practice. With an increased demand, erectile dysfunction supplements (ED-S) have been featured on online marketplaces like Amazon.com, with dedicated pages and claims that they naturally treat ED. However, their efficacy and safety are largely debated, which limits the ability to counsel patients regarding their use. Human studies that evaluated the efficacy of ED-S ingredients are limited and have yielded no definitive findings of the effects on ED. This is to say, patients who are considering ED-Ss should receive appropriate counseling by an experienced medical provider and potentially include sex therapy as part of their treatment plan. 

Men often learn about their bodies and sex through societal standards displayed on TV or in porn. In short, men are told they must conform with traditional masculinity in the bedroom–be strong and dominant–and that they must always be down for sex–get turned on fast, be aroused easily and finish just as quickly. These notions are not standards, far from it, and many more men are being diagnosed with some form of erectile disorder. This can manifest in many forms from difficulty getting and/or maintaining an erection to getting less hard, and these symptoms appear for myriad reasons that do not make one less of a man. Stress, relationship struggles, ADHD, even diet, and now COVID-19 can be underlying conditions that lead to erectile dysfunction. There is no uniform way in which sexual activities should be performed, no base rate for hardness and no timer going for erection duration. The ways in which a man has sex is not able to be generalized, and to perform in a way that does not align with commonly held notions does not necessitate a lack of masculinity. Very often, and increasing daily, men are discovering that they have erectile disorders that can be caused by external stressors. There is no shame in this, and to talk with a sex therapist and seek a diagnosis is very beneficial to one’s sexual confidence, and in turn, one’s mental health.



How ADHD Influences Your Sex Life and Intimate Relationships

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It is not uncommon for a couple to seek out sex therapy and for the sex therapist to discover that one of the partners has been struggling for years with undiagnosed Attention Deficit Hyperactivity Disorder (ADHD/ADD). A recent research literature review by Soldati et al in the Journal of Sexual Medicine found “that subjects with ADHD report more sexual desire, more masturbation frequency, less sexual satisfaction, and more sexual dysfunctions than the general population.”  

For partners in which relational intimacy is their primary erotic impulse, a partner with ADHD  may struggle to foster and sustain sexually intimate relationships —be it brief or enduring due to the symptoms of the disorder including: impulsivity, novelty seeking, forgetfulness, rapid mood changes and challenges in consistency. Part of this break in intimacy may also be due to the dynamic of the partner who doesn’t have ADHD taking on more responsibilities in the relationship, household and/or with their children.  Over time the non-ADHD partner feels more and more resentment and may begin to feel more like a parent while the partner with ADHD may feel a combination of emotions including feeling:  nagged, disrespected, embarrassed and angry. These feelings all contribute to a less than desired relational pattern that can spark sexual passion. Part of the work a couples therapist can focus on is to have each partner write blocks of time or deadlines when tasks can realistically get completed in a joint family calendar and have the partner with ADHD utilize reminders or sounds to help them transition into chore time. 

Another point in this study was the pattern of partners going to bed at different times when the ADHD partner has extra work to catch up on or who may have poor sleep hygiene. One of the interventions a therapist can help couples with is intentional times that partners can go to bed together and help them create intimacy dates.  In terms of the actual sexual experiences, partners who have ADHD/ADD report having trouble attending to some types of physical stimulation when the sexual script becomes repetitive, predictable and less novel over time leading to a lowering of sexual desire, a lost erection, or an inability to orgasm.  When involved in a sexual script that is un-varied,  the mind of an ADHD person wanders to places that do not include the bedroom like work related tasks that they’re behind on which is a turn-off or alternatively the mind searches for more novel types of erotic fantasies that they’ve watched on sexual explicit media, have had in the past or wish they’d like to have in the future.   In fact some of the studies reviewed in this literature review found that the person with ADHD/ADD themselves may has less sexual satisfaction in partnered sexual experiences which may be due to their mind continually wandering. The potential problem when their focus goes to erotic imagination is that it might look like an emotional detachment to their partner, in fact some clients in sex therapy have described this occurence as their partner “ just going away”. These clinical observations are supported by a 2008 survey by Gina Pera of partners of people with ADHD who reported that “30% felt no connection when having sex with their ADHD partner, as if their partner was not there.” In order for emotional intimacy and sexual intimacy to form and grow, it is imperative there be an environment that is built on—and promotes—relaxation and playfulness and a sense of embodiment (a body/mind connection). One can cultivate this through present-focused techniques like yoga or meditation or introducing sex games that both partners would find fun and novel.

There are extensive other sexual difficulties that those with ADHD deal with aside from a lack of focus during partnered sexual activity: Medical News Today found that another desire issue was found in folks with ADHD; hyposexuality—that is, a level of interest or involvement in sexual activity lower than the norm, which is sometimes symptomatic of ADHD and sometimes an effect of medications used to treat ADHD symptoms; a healthy sex drive yet a struggle to reach orgasm despite prolonged stimulation, which is often due to boredom, trouble with focus, or an influx of other feelings; hypersensitivity—that is, a sense of discomfort in response to tactile stimulus, such as painful sensations in response to genital stimulation. It’s important to find out what kinds of touch a partner with ADHD finds pleasurable when working with a couple who have avoided sexual connection due to this issue.

ADHD can cause a person to thrive on excitement and to be fulfilled by an ever-changing landscape. This restlessness, only satiated by new phenomena, grows exponentially and often involves sexual fantasies as well for men. According to a 2019 study by Bothe et al, ADHD symptoms might be a critical driver in the severity of hypersexuality or out of control sexual behavior for folks of both sexes, whereas ADHD symptoms might only be significant with problematic porn use solely among men. The literature review by Soldati et al noted that people with ADHD have demonstrated an extensive use of online pornography, which, in such excess, leads to a difficulty in the formation of secure attachments. However, the studies reviewed bySoldati et al were not fully conclusive that people with ADHD were more likely to struggle with out of control sexual behavior or CSBD (Compulsive Sexual Behavior Disorder).  In a study by Bejlenga et al,  the  most common sexual disorders among men who had ADHD vs. men who didn’t have ADHD were orgasmic problems (10-14% vs 3%), premature ejaculation (PE) (13-18% vs 10%), sexual aversion (12-13% vs 1%), and negative emotions during/after sex (10%, no data in the control group), whereas women reported sexual excitement problems (8-26% vs 3%), orgasmic problems (22-23% vs 10%), and sexual aversion (15% vs 4%). There were no significant differences in the results between patients treated with ADHD medication and patients without psychostimulant treatment. 

It is critical for those folks seeking help for these sexual problems to be sure their therapist has the experience to conduct a thorough biopsychosocial assessment to explore the possibility of an ADHD/ADD diagnosis. A therapist needs to address the ADHD/ADD diagnosis, the consequences of this disorder on the couple’s relationship over time and the sexual disorders to which it has contributed. I will add some Sex Esteem tips for couples in a future blog.

This is What Black Women’s Sexual Pleasure Looks Like in America

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What if the gender, racial identity with which you identify and the positive sexual pleasure you had was repeatedly ignored by sexuality scientists? What if the most common sexuality topics researched about your community with whom you identify were exclusively focused on (unplanned) pregnancy and sexually transmitted infections (STIs)?  Would you feel the racist stereotypes associated with your racial and gender identity hopelessly stuck in American society? In celebration of National Women’s History Month (and International Women’s Day), I wanted to center this month’s blog on a much-needed discussion regarding what American Black women’s sexual pleasure in relationships really look like.

While we sex therapists see Black women in treatment discussing their dating, relationship and sexual issues, queer identity, and/or their issues that might come up in their interracial partnerships, there have been a dearth of studies exploring Black women’s erotic and sexual pleasure. 

Thankfully, there is a brand new study by Ashley Townes, et al. titled Partnered Sexual Behaviors, Pleasure, and Orgasms at Last Sexual Encounter: Findings from a U.S. Probability Sample of Black Women Ages 18 to 92 Years in The Journal of Sex and Marital Therapy . The study exclusively focuses on American Black women’s partnered sexual pleasure and orgasms in the Journal of Sex and Marital Therapy bringing us factual information about a group long excluded from academic research.  Dr. Townes is a Sexuality Researcher and Educator based in Atlanta.  I was fortunate enough to get some of my own questions answered by Dr. Townes which I’ve edited for the blog below.

In the study, Townes and her colleagues found that over 74% of Black women respondents indicated that their most recent sexual experience was with a male friend, significant other or spouse. In other words, these partners were known to the women and many were intimate partners. According to several researchers and authors including Patricia Hill Collins, Black American women continue to be racially profiled as promiscuous, hyper-sexual, sexually free, and as having “animalistic” sexuality. The study emphasizes the ways in which Black women have been oppressed and abused through the frame of their sexuality. These racist stereotypes are part of a longstanding litany of names attributed to Black women including: 

“Mammy, Aunt Jemima, Auntee, Jezebel, Sapphire, Sister Savior, Diva, and Freak” implying a wanton sexual desire to be assaulted have continued to be projected on women since the original period of slavery in America. 

SC: Beyond the sexualized racist stereotypes listed in the study, what are further stereotypes that Black women have to contend with in modern day media, dating apps, and relationship studies? 

AT: The “strong Black woman” stereotype creates an unrealistic expectation of strength for Black girls and women in all areas of their lives. This idea that Black women are not allowed to be vulnerable, weak, in pain, or deal with physical or mental illness actually can lead to greater physical and mental illness; it’s as if Black women are not allowed to express their imperfections.

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Many of our BIPOC clients describe this same feeling when they talk about letting their partners down when they’re going through a hard time or experiencing loss of desire due to stress and fatigue.  They at times even express concern for their therapist when they have to miss a session due to extra work they’re doing in hopes of getting a promotion at work. They  worry more about what the loss of the session income will mean for their therapist rather than reflecting on what the impact of wanting or needing to over-deliver at work is on their own mental and physical health. 

I also noted that over 92% of the women in Townes’ study identified as heterosexual.  While the study mentioned that most Black heterosexual women choose Black men as partners, the heterosexual Black women we see clinically in the practice are frequently in relationships with men that identify as white and brown. I wonder if perhaps this is due to the fact that more than 50% of Townes’ respondents were from the south and the practice is located in the Northeast.  The interracial couples who come in to see me or my associates for help frequently bring divergent lenses when it comes to beliefs, values and rituals related to their sexuality desires and practices.  Frequently, these gaps in core values can lead to a misalignment and conflict in the bedroom. What a specific desire or sexual behavior one partner enjoys may be loaded with negative meaning for their partner due to the way they were raised.  They may also feel shame about letting their partner down if they’re experiencing penetrative pelvic or vaginal pain.  

What was also notable about these latest findings is the fact that most of the women had their most recent sexual experiences with a man they knew, were dating or who was a longstanding partner or spouse. 

SC: What do you make of that finding that most of the partnered sexual relationships were with a male partner that the woman knew vs. someone they had just met?

 AT:  For this finding, I think it is important to highlight the idea of “hookup culture.” There has been a thought or belief for decades that Black women are promiscuous and that young people, especially, are engaged in hooking up or sexual exploration with many sexual partners. Less than 2% of the Black women in this study had partnered experiences with men they had just met. I think this finding dispels the idea that Black women engage in “riskier” sexual behaviors (i.e., one-nighters).

Sex therapists see a skewed population in terms of the fact that folks coming in for treatment are looking to get therapy for presenting issues like:  past trauma, neglect, painful penetration, lack of desire, anorgasmia, recent breakup or discovery of a partner’s breaking of a monogamous agreement. Although our therapists will always ask about sexual experiences that have included boundary crossings, abuse and assault, sometimes our clients will wait until they are several sessions into treatment before revealing past sexual trauma.  

As a white cis-gender female therapist I am conscious of the fact that a Black female-identified client may open up more cautiously in a cross-racial therapeutic relationship than they would with a BIPOC female therapist in the CLS practice.  What was surprising to me in this study was the fact that very few Black women reported “unwanted” sex and those that did were in a specific age group.  Differently than in a therapy practice where clients at times request to see a particular therapist, study participants are not aware of the researchers’ racial identities. I was curious to learn more.  

 

SC: What reflections do you have on the responses from respondents that the most recent sexual encounters they had were wanted in all but the 25-29 year old cohort of Black women studied? 

AT: Overall, less than 1% of Black women reported an unwanted sexual experience and this happened to be reported by women in the 25-29 year old age cohort. We report that a limitation of this study is that women who were invited to participate in the survey and were less comfortable with discussing sexual health may not have consented to participate or may have not answered certain questions, and therefore, contributes to limited information or nonresponse bias. As researchers, we do our best to ensure privacy and explain the nature of the study, yet some individuals may remain uncomfortable completing a sexuality questionnaire.

Unwanted sex may include sexual harassment, coerced sex, sexual assault and sexual abuse. These traumatic experiences are usually kept as secrets especially if they occurred at a younger age. I often encourage all the therapists I supervise to engage their clients in discussions around boundary crossings from time to time in treatment to ensure that the client is assured that the therapist can hear these stories if they aren’t readily shared in the initial sexual history taking. 

A big taboo subject for many Black women to discuss openly is their participation in Bondage & Discipline/Dominance & Submission/Sadism & Masochism sexual experiences.  Having been cast in the aforementioned stereotypes in America, sex that from the outside looks like a recreation of historical chattel slavery scenes might make a Black female kinkster feel extremely anxious about revealing to a therapist anything about their being erotically turned on by these experiences.   As a white ally and kink-aware Certified Sex Therapist, I collaborate with clients who identify as kinky on ways to navigate their desires and address the challenges they feel when they are dating or in relationships. I’m highly aware that BDSM can be judged harshly by those who are not part of the scene. I was curious about the fact that the Black women’s sexual behaviors studied here were by and large on a vanilla menu.  There are paltry few studies researching sexual practices of Black women in kink and BDSM play. 

SC: Are there reasons you chose not to include more kinky sexual behaviors into this study? 

AT: The 2018 National Study of Sexual Health and Behavior (NSSHB) was carefully planned and included a range of aspects about sexual/response functions, particularly, pleasure, desire, orgasm, and painful intercourse. There are other results from this nationally representative study exploring kink and BDSM activities experienced by Black women. Here are the results from that other wave of research: 

  • Public sex 37% 
  • role-playing 20% 
  • spanking/being spanking 36% 
  • Using anal sex toys >17% 
  • playful whipping 17% 
  • tying up/being tied up 9% 
  • having engaged in threesomes 8% 
  • Lifetime group sex, attending sex parties, sucking/licking a partner’s toes, and going to BDSM parties were uncommon each <8% 

While a minority of Black women in this last study are involved in various types of kink-type sex play, it is an area only recently explored more publicly by artists like: Jeremy O Harris’ whose play Slave Play took a deep dive into Antebellum power exchange and interracial relationships and the NY Times profile of Sexuality Educator and writer Mollena Williams-Haas who is a Black 24/7 slave and muse to her white husband composer Georg Friedrich Haas.  True erotic pleasure is a deeply personal, creative, transformative and at times revolutionary and healing act.  It’s an honor to see Black women’s authentic sexual pleasure given the time, respect and nuanced exploration by academics in the world of sex research. 

 

Citations: 

Townes A, Thorpe, S, Parmer T, Wright,B, & Herbenick, D. (2021): Partnered Sexual Behaviors, Pleasure, and Orgasms at Last Sexual Encounter: Findings from a U.S. Probability Sample of Black Women Ages 18 to 92 Years, Journal of Sex & Marital Therapy, DOI: 10.1080/0092623X.2021.1878315 

Townes A, Fu TC, Herbenick D, and Dodge B. (2018, June 14-17). Sexual diversity among black and Hispanic women: Results from a nationally representative study. [Conference presentation]. American Association of Sexuality Educators, Counselors, and Therapists 2018 Annual Conference, Denver, CO. 

Rosenthal, L., & Lobel, M. (2016). Stereotypes of Black American Women Related to Sexuality and Motherhood. Psychology of women quarterly, 40(3), 414–427. https://doi.org/10.1177/0361684315627459

Woodard JB, Mastin T.( 2005)  Black Womanhood: Essence and its Treatment of Stereotypical Images of Black Women. Journal of Black Studies.;36(2):264-281. doi:10.1177/0021934704273152

https://lareviewofbooks.org/article/consentsowhite-on-the-erotics-of-slave-play-in-slave-play/ 

 

Watching The Crown’s Portrayal of Bulimia as a Sex Therapist

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Princess Diana’s Bulimia Disorder

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

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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.

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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

 

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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

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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

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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

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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/.

Why Are Women Still Staying Silent About Their Sexual Pain?

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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

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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

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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:

  1. Provide sex education about Vulvodynia to both partners so they understand that this is a medical condition and no one’s fault.
  2. Refer the woman suffering from pain to a well-trained sexual health medical professional able to diagnose and treat Vulvodynia and GPPPD.
  3. Explain how the disorder impacts the entire couples’ system.
  4. 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.
  5. While treatment for Vulvodynia is ongoing, outline a treatment plan to work on the pain treatment, their couple communication, and sexual alternatives.
  6. 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.
  7. 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

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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

 

 

What’s in a Name? Is Out of Control Sexual Behavior Treatment Really Different from Sex Addiction Recovery Programs?

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What IS so important about the name of a pattern of sexual behavior? A new term called Out of Control Sexual Behavior is closer to the clinical frame I have used to help clients coming in to CLS for help to stop their compulsive sexual encounters.  People diagnosed–casually, jokingly, or professionally–as suffering from “sex addiction” might want to think twice about what this term implies and how it in fact will impact their therapeutic treatment,  how they feel about themselves and the relationship with partners (if they are in a relationship).  

Although most people in the field of sexual addiction cite Patrick Carnes as a the father of the term sex addiction, it was actually a Cornell psychiatrist Dr. Lawrence Hatterer, who defined homosexuality as a pathology, conflating homosexuality/queerness with “addictive hypersexualized living” and “addictive sexual pattern.” The term he wrote about argued that a sexual orientation was an illness. He unfortunately stood by this opnion both before and long after homosexuality was removed as a diagnosis from the Diagnostic and Statistical Manual (DSM).

But Carnes popularized the term sex addiction, putting it on the map in America by creating a list of thoughts, feelings and behaviors that he cited were proof of of a pathological diagnosable disorder.  He created the Sex Addiction Screening Test (SAST) that attempts to create a differential assessment of addictive vs. non-addictive behaviors.  However, this assessment is still prone to pathologizing certain sexual behaviors deemed alternative, or kinky.  

Many of the treatment recommendations in his curriculum and at many of the sex addiction programs or 12-step groups around the country are based on heteronormative expectations in sobriety including only having sex with one’s spouse, no casual sex at all and/or no masturbation with or without porn.  There has been a long debate between Certified Sex Addiction Therapist (CSAT) and AASECT Certified Sex Therapists and Counselors. As part of their training, CSAT therapists have historically not received training in established Sexual Disorders in the Diagnostic and Statistical Manual, sexual anatomy, ethics nor education on the diverse practices of sexual health.

These are requirements in the AASECT Certification Training.  

I would argue that Carnes regards the sexual behavior itself as the illness.  Sex therapists view the sexual behavior as a symptom. 

Sex therapists utilize a Sexual health model that understand that even though some people may feel tremendous shame about the erotic interests and sexual behaviors they enact,  frequently there is nothing inherently pathological about them.  The behavior may feel out of control because it’s against one’s values or it may be tied with an underlying untreated diagnosis.  The term and treatment of sex addiction may not thoroughly assess and treat underlying established diagnoses like: Depressive Disorder, Biploar Disorder, Attentional Deficit Hyperactivity Disorder (ADHD), Panic Disorder or PTSD. Many clients who report years of Out of Control Sexual Behavior may have in fact experienced attachment trauma by a loved one who abandoned them,  severe neglect or physical or sexual abuse early on. 

The organization solely responsible for certifying Sex Therapists in the U.S., American Association of Sexuality Educators, Counselors and Therapists (AASECT), released a statement calling for the retirement of the term “sex addict” referring to it as a treatable illness including this section: 

“AASECT:

 1) does not find sufficient empirical evidence to support the classification of sex addiction or porn addiction as a mental health disorder, and 

2) does not find the sexual addiction training and treatment methods and educational pedagogies to be adequately informed by accurate human sexuality knowledge.

 Therefore, it is the position of AASECT that linking problems related to sexual urges, thoughts or behaviors to a porn/sexual addiction process cannot be advanced by AASECT as a standard of practice for sexuality education delivery, counseling or therapy.”

There have now been several suggestions put forth by sex therapists and/or researchers for behaviors that contributes to negative outcomes socially, professionally and relationally.  These include: 

  • Compulsive Sexual Behavior (Eli Coleman): “…the experience of sexual urges, sexually arousing fantasies, and sexual behaviors that are recurrent, intense, and a distressful interference in one’s daily functioning”
  • Hyper-Sexual Behavior (Martin Kafka): “a sexual behavior disorder with an impulsivity component.”
  • Out-of-Control Sexual Behavior (Doug Braun-Harvey): “a sexual health problem in which an individual’s consensual sexual urges, thoughts, and behaviors feel out of control [to them]” (p. 10, Treating Out of Control Sexual Behavior).

These are all different names that do NOT include the term addiction  but instead utilize a model that points to underlying disorders, internalization of shame in the face of not living up to one’s values and the ambivalence around changing. They also point to behavior that is more linked to underlying psychiatric disorders than a process oriented addiction.  

I believe two of the greatest strengths of the Out of Control Sexual Behavior model are that it not only addresses potential underlying causes of compulsive sexual behavior, but also that it is focused on organizing around and encouraging the individual’s unique expression of sexual health through wanted sexual behavior–which the Sex Addiction model fails to do. 

When a client comes in to our office self-identified as a “sex addict” we look at the whole person, their family of origin, their religious beliefs, how and when the pattern of sexual behavior began, whether they have a history of abuse, whether their symptoms line up with a proven psychiatric disorder and how the secretive nature of their sexual practices play into the beliefs they have about sex, fantasy, consent, monogamy and desire.  We ask them to create a sexual health plan that allows for all the disparate parts they’ve been splitting off into secretive sexual behaviors to come together into one person who is supported in their search for personal integrity and potential treatment for underlying issues. 

What CLS therapists offer is individual therapy and couples work to help clients who are struggling with sexual behaviors that are negatively impacting their mental health, their job, and or their relationships.  We work frequently with clients who are having affairs, hook-ups or encounters with sex workers that feel split off from their own sense of what it right, and hurts their partners or spouses when it’s discovered. On Oct. 20th, I’ll be co-leading a small group-oriented men’s therapy group that creates a safe space for all those in distress to come together and reassess how their sexual habits have gotten out of control and learn new skill to help their behavior align with their own values. Sexual shame thrives in secrecy, and addressing it head-on with others sharing the same difficulties helps to chip away at the shame while allowing a space to consider and create new choices that are supported in a sexual health plan that belongs to you. 

I am co-leading the 6-week Men’s Out of Control Sexual Health group with my colleague Shimmy Feintuch LCSW. It is designed for those identifying as male who feel that their sexual behaviors are out of control and that they want to get more information on why they’ve continued these behaviors despite its negative impact.  If you feel this group could help you or someone you know please email my intake coordinator for more information: coordinator@centerforloveansex.com 

The goals for this group include:

  • Having each member define what their sexual health goals are
  • Identifying the internal conflicts they have regarding these goals and their current behaviors
  • Learning about potential underlying disorders which may have never been diagnosed and treated before that contribute to their behavior like: Depression, Panic Disorder, Obsessive Compulsive Disorder, ADHD, PTSD, Bipolar Disorder and finding sources for treatment
  • Learning new stress and coping mechanisms including: mindfulness, CBT, Embodied recovery for trauma-induced dissociation
  • Developing integrated and positive coping in their sexual lives
  • Relational skills to communicate sexual desires to existing and future partners
  • Increasing one’s core Sex EsteemⓇ 

While the last task force of the DSM (#5) considered the term Hypersexual Disorder, they felt there wasn’t enough solid evidence to prove that this best describes a clinical pattern of behavior.  The most recent International Classification of Disorders-#11 did include Compulsive Sexual Behavior Disorder, defining the pattern as repetitive sexual activities that may become an essential focus of a person’s life to the point that they neglect their health and personal care or other interests, activities and responsibilities. Other symptoms may include continued repetitive sexual behavior despite negative consequences or receiving little or no satisfaction from the behavior.”

So while there are many diagnostic names and criteria still being studied by American researchers and clinicians for a pattern of compulsive sexual behaviors, NONE of these terms include the wording or clinical treatment framework of addiction.

The Attraction to Sex Parties: My Interview with Emma Sayle, CEO of Killing Kittens

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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 2018 General 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 

One businesswoman 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.

Killing Kittens Panel: The Date Debate

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.

References for blog:

https://inequalitybyinteriordesign.wordpress.com/2019/04/12/2018-gss-update-on-the-u-s-lgb-population/ 

https://qz.com/1601527/the-rise-of-bisexuals-in-america-is-driven-by-women/

https://www.ttbook.org/interview/new-science-sexual-fluidity

 

 

 

How to Visit Family & Have Vacation Sex this Holiday Season

Couples Therapy Sex Therapy No Comments

Now that we are approaching the holiday season a lot of folks have planned to visit extended family to celebrate Thanksgiving, Mawlid-al-Nabi, Chanukah, Christmas, and New Year’s. As a couples and sex therapist, my associate therapists and I continually hear common themes and concerns among our CLS clients regarding upcoming plans and their sexual lives.

In a recent report by the US Bureau of Labor Statistics, in 48.3 percent of families with heterosexual couples, both husband and wife were employed.  While the remaining American families may have a parent that is child rearing or unemployed, most couples in our Center (including those couples without children, those that identify as LGBTQ, and those that have consensual non-monogamous relationships) report feeling exhausted by long hours, demanding bosses, and a lot less time for self-care than in that past few years.  Most workers have limits on the number of vacation days they’re allowed to take in a calendar year so saving these days for going home for the holidays with the fam can take a good bite out of that bank of person time off .

The essential questions my associate therapists and I often hear from couples in our offices at CLS is:

“How can we have a real vacation during a visit to our families for the holidays?” 

They are asking essentially: are the two terms literally an oxymoron when combined?
Here are a few common questions partners have posed in recent sessions leading up to anticipated Thanksgiving and Christmas visits to family on their valuable vacation days off work and my responses:

Why do we have to do what everyone else in your family does for every minute of the day? 

Set up a dinner with each other before your travel date to specifically discuss what kind of rhythm each day could have, what parents or relatives may expect of each of you, and what each partner is hoping to get out of the vacation/visit. Then brainstorm compromises around taking time away from the whole group at less peak events (going for a drive after post-Thanksgiving breakfast, scheduling a couples massage Christmas Day afternoon in lieu of watching a movie with everyone else).  Lastly once you come up with a plan, make sure the partner whose family is being visited tells their family what to expect a week or more before the holiday with specific details so that they have time to get used to it.

Credit: Deposit Photos

I don’t want to stay up late drinking since I want to use my vacation to exercise every morning but how can I do that without getting flack?

Many families have a tradition of heavy drinking during these holidays.  For relatives who are either less into partying or actually in sober recovery, family holidays can be really challenging.  Some people are trying to eat healthier by staying away from high caloric food and having lots of alcohol and high sugar foods around can be a high pressure situation.  For those whose ideal vacation is to maintain or catch up on an exercise regimen, the ongoing lounging on the couch and watching football or movies can prove to feel like pressure to join in.  Will you get a guilt trip from a parent or continual ribbing by siblings for going to bed earlier than the rest of the family or joining the breakfast crowd an hour later due to your morning run/yoga/cycling session?  Once you tell your family you’ll be following a particular rhythm over your break, let them know you’re looking forward to spending time with them and perhaps invite them to a class or run with you so that you have an ally in that domain and start a new tradition.

How do we prepare and protect our partner when it comes to touchy topics? 

Many partners feel like they either have full permission to express what they want with their in-laws while some feel like they have to walk around on eggshells for fear of stepping on a sensitive topic and blowing a landmine that explodes.  For example, a boyfriend expressed his openness about a friend’s decision not to have children during a family meal at his girlfriend’s parents’ home last Thanksgiving.  His girlfriend’s mother blanched and immediately excused herself from the table while his girlfriend shot him an accusatory look.

The mood turned into a frigid stone silence and the boyfriend was wondering what he had done wrong.  When they returned to their room, the girlfriend began blaming him for being so emotionally clueless regarding bringing up the topic of children since her mother had always expressed her desire for grandchildren and the idea of not having grandchildren depressed her.  He became defensive and argued that he was clueless because she hadn’t given him any clues!

I invite the partner whose relatives are being visited to act as an emissary and to prepare their partner by setting boundaries on subjects that might be hot topics and to be an ally to their partner when discussing issues and/or plans each day. This is the way partners can care for their mates and relationship while also keeping the peace with their family of origin culture.

How do we help our partners or spouses feel like this time is also made special for them? 

Credit: Deposit Photos

Plan to take some time as a couple away from the larger family unit to have some fun. This could include a visit to a local site, a hike at a nearby park or a grabbing a pint at a favorite pub.  One couple decided to go out dancing at a club they used to frequent as a teenager after their parents headed off to bed one night, another partner booked a couples massage Friday afternoon while the rest of the family went Black Friday shopping assuring their relatives they’d be back to help prepare a family dinner.

 

How can we have sex when we’re sleeping in a guest room near the family room? 

Use this vacation/visit to add creativity to your sexual repertoire:

  • Create playful rules about noise and use blindfolds and tape to limit sight and sound to enhance sex play.
  • Plan to give one another sensual massages with oil from a warm wax candle as a fun way to create outercourse or foreplay while the rest of the family go to sleep, then you have options for what comes next.
  • Stay home while the rest of the family go out for a pickup football game and have a quickie in the shower.

Wishing you a restful, emotionally and sexually satisfying holiday season with your lover and your families.  Happy Holidays!