Category Archives: Psychotherapy

Four Relational Contributors to Heterosexual Women’s Low Sexual Desire

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. 



11 Facts You May Not Know About Stonewall: Celebrating Stonewall 50

Much like women’s history, much of LGBTQ+ history has simply not been well-documented. This month we celebrate Stonewall 50, the 50th anniversary of the Stonewall Riots.  I thought it would be a great time to revisit some important facts about Stonewall – and what you may not know.

  1. The Stonewall Riot  wasn’t just one night.

Though documented historical accounts of the riots agree that the violent police raid of the Stonewall Inn broke out in the early morning hours of June 28th, 1969, the riots gained momentum, with the crowd growing into the thousands, drawing out the battle on and off across five more nights.

  1. The crowd wasn’t limited to just gays and lesbians.
Marsha P. Johnson one of the instrumental activists of the Stonewall Riots

While the Stonewall Riots are largely regarded as the start to the gay rights movement, Marsha P. Johnson and Sylvia Rivera, who were instrumental catalysts in the uprising, were actually transgender women of color. Though there are many accounts of how the Stonewall Riots began, Johnson and Rivera were the first protesters to physically resist the police raid – in fact, Johnson is said to have thrown the first brick.

  1. Sex workers’ rights were also born out of Stonewall.

Though the issue of sex workers’ rights is still a relatively modern debate, sex work was actually a survival tactic for many civil rights activists at the time. A vast number of LGBTQ+ youth were living on the streets of Greenwich Village after being kicked out of their homes, and the majority of them, including Johnson and Rivera, turned to sex work in order to survive.

  1. The riots had nothing to do with the death of Judy Garland.

  A long-standing myth that the Stonewall Riots were sparked by the death (and funeral on Madison Avenue and 83rd Street) of Judy Garland has been debunked by many in the community, including Thomas Lanigan-Schmidt, a reliable witness and protester who was in attendance for each of the six nights. While it is somewhat understandable that the death of an unmistakable gay icon like Judy Garland may have provoked enough outcry to bring about the violent riots, Stonewall was more so centered around trying to survive as an LGBTQ+ community in a contentious environment like New York City. 

  1. After 47 years, the Stonewall Inn and the LGBTQ+ community received its first national monument.

On June 24th, 2016, the first national monument in honor of the United States LGBTQ+ community was opened in Greenwich Village. President Barack Obama designated 7.7 acres along Christopher Street as an LGBTQ+ historic site, encompassing the Stonewall Inn, and the block bordering the Christopher Street Park, including the Park itself, where the 1992 Gay Liberation statue stands, consisting of four figures – two men and two women – positioned in natural, easy poses.

  1. At the time of the riots, homosexuality was actually illegal.

Though LGBTQ+ equality remains a human rights issue to this day, it wasn’t long ago that homosexual sex was considered illegal, punishable by law, in a majority of states. It was also classified as a mental disorder by the American Psychiatric Association, found in the Diagnostic and Statistical Manual of Mental Disorders up until 1973. Some states are behind on legislation, even now – 13 states in the U.S., as of 2014, still have anal penetration listed as an illegal act of sodomy: Alabama, Florida, Georgia, Idaho, Louisiana, Maryland, Massachusetts, Michigan, Minnesota, Mississippi, North Carolina, South Carolina, Oklahoma.  On June 26th, 2003, the Supreme Court found the Texas Homosexual Conduct Law unconstitutional and established, for the first time, that LGBTQ+ citizens had just as many rights as heterosexual citizens. While the landmark Supreme Court case of Lawrence v. Texas ruled these laws unconstitutional, therefore rendering them impossible to be enforced, the aforementioned states still have not repealed their anti-sodomy laws.

  1. The Stonewall Inn was originally owned by the Mafia.

Given the hostility surrounding the gay community at the time, many popular gay bars and other establishments had their licenses suspended or revoked for “indecent conduct.” The New York Mafia saw a business opportunity in owning and operating establishments catering to the gay community. The Stonewall Inn was considered a sanctuary to many gays, lesbians, and transgender individuals in the community, and if individuals weren’t recognized or assumed to be gay through the peephole on the door, they would not be let in.

  1. Most community members in the crowds during the Stonewall Riots are no longer alive.

Thomas Lanigan-Schmidt, now 71 years old, is among the very few still alive who participated in the riots. He explains that many of these rioters were gay or transgender youth living brutal lives on the streets, and if they did make it through the brutality of surviving in such marginalized conditions, they faced the AIDS crisis barely a decade later.

9. The Stonewall Inn had only one exit – the front door.

The Stonewall Inn, NYC

Since the Stonewall Inn was owned and operated by the Mafia, care was not taken to ensure health and fire codes. Before backup law enforcement arrived, rioters barricaded the police and other patrons in the bar as shouts turned into physical fights, including the throwing of bricks and other heavy objects at police officers.

10. The first gay pride march was a solemn, politically-driven demonstration in honor of the first anniversary of the Stonewall Riots.

Gay Pride March NYC

While this year’s Pride 50 NYC  Parade will be celebrated as a festive, rainbow-strewn party, it started out as a simple commemoration of the brutality of the Stonewall Riots. Originally called Christopher Street Liberation Day, June 28th, 1970 marked the first celebration of LGBTQ+ pride, which now celebrates equality, dignity, community, visibility, and joyous emancipation.

11. Homosexuality was considered a mental illness by the American Psychoanalytic Association.

The APA considered homosexuality as “phobia,” “sexual deviation,” “sociopathic personalitydisturbance,” and “neurosis.” Transgender folks were simply regarded as another version of patients who needed to be cured of their homosexuality.   This led to the diagnosis of homosexuality to be included as a “sexual deviation” in the 1968 Diagnostic and Statistical Manual.  After Stonewall, activists disrupted the 1970 conference of the American Psychiatric Association demanding they de-pathologize homosexuality by removing it from the DSM. It wasn’t until this week on June 20th, 2019 that the President of American Psychoanalytic Association (APsaA) made a formal apology for the many years of conversion therapy clinicians used to practice. At the annual conference,  Lee Jaffe M.D. stated: “Regrettably, much of our past understanding of homosexuality as an illness can be attributed to the American psychoanalytic establishment. While our efforts in advocating for sexual and gender diversity since are worthy of pride, it is long past time to recognize and apologize for our role in the discrimination and trauma caused by our profession and say ‘we are sorry.’”

 There’s now a new children’s book, for 5 to 8 year olds, titled: Stonewall: A Building. An Uprising. A Revolution by Rob Sanders, illustrated by Jamey Christoph.

For more information on Stonewall, check out these first-person narratives about the Stonewall riots, as well as poetry and creative art that came out of the oppression.

Bourdain and Kate Spade Suicides Highlight Need for Prevention

This week the country has been immersed on the topic of suicides following the tragic suicides of Kate Spade and Anthony Bourdain today June 8th, in Strasbourg, France.

Anthony Bourdain

The past week and a half I have been watching the recent season of the Netflix series 13 Reasons Why, a fictionalized show that follows the grappling of a community following the suicide of a high school sophomore named Hannah Baker.  In my practice Center for Love and Sex, the therapists and I also treat Depression, anxiety and other psychiatric issues that clients present to us. What is clearly disturbing is that according to recent studies by the Center for Disease Control more Americans in every age group, from 10 to 75, are committing suicide. While the precipitating event may be different for a middle-aged person than a teen, the fact that the behavior is on the rise should be a concern for every American.

The Suddeness of Suicide 

Most people are shocked that someone can seem ostensibly fine or stable one day and end their life the next. The sheer switch and deliberateness is terrifying. Although both Kate Spade’s best friend, brother and husband all knew she was struggling with and being treated for Depression, they were all shocked that she’d end her life. Anthony Bourdain can be seen rejoicing on the set of his CNN show Parts Unknown in Hong Kong with his director and girlfriend Asia Argento and director of cinematography Christopher Doyle. Did something happen in the past 5 days? Or was suicide an option that both Spade and Bourdain had secretly contemplated over a period of years?

Inside the Mind of a Depressed Client

As a psychotherapist who has treated clients with Depression and anxiety for over 20 years, I am trained to listen to what’s between the lines and to ask more direct questions about a person’s intentions regarding suicide. 

Unless you’ve suffered from Major Depression, it can be very hard for most people to comprehend the ways a mind can consider death a way out of a pain that seems so interminable.  As Andrew Solomon so eloquently wrote in his New Yorker article: Anatomy of Melancholy

“When you are depressed, the past and the future are absorbed entirely by the present, as in the world of a three-year-old. You can neither remember feeling better nor imagine that you will feel better. Being upset, even profoundly upset, is a temporal experience, whereas depression is atemporal. Depression means that you have no point of view.”

How Can You Help? 

What can folks do to help stave off this latest wave of suicides? On a micro level, one can ask those that are closest to you who have already been diagnosed with a psychiatric illness whether they have thought about suicide or hurting themselves. It’s important not to avoid the word suicide. In saying his word out loud you’re letting them know you are strong enough to listen to them, no matter what. Then listen.

Be mindful not to give them the reasons they shouldn’t be unhappy by saying: “But you’re so successful!” or “You have so much to live for” . Let them know you’re there for them and that you want to help them find the psychiatric help they need so the pain can be alleviated. With these last two celebrities’ suicides, it’s clear that fame, fortune and family do not prevent people from suffering.  Ask your friend or family member if they’d be willing to share these concerns with more people to widen the network of support you can provide.

On a macro level to fighting suicides, one can advocate for more funding for affordable and/or free mental health care for all people. Support the National Alliance on Mental Illness, a non-profit that fights for legislation to expand psychiatric treatment.

Do outreach to your congressperson and senator to pass stricter gun laws since about half of suicides are done by guns. The national map of suicide shows higher levels of suicide in states with the highest gun ownership r

Lastly, if you yourself have had suicidal ideation or the pain,  or have thought about active plans on how you would end your life, I encourage you to seek out help right away. Contact National Support Lifeline https://suicidepreventionlifeline.org/ via text or call. 1-800-273-8255.   Make one call to a trusted person. There is hope and an alternative to the pain.