“Eighty percent of women masturbate. Ninety-five percent of men masturbate. And the rest lie.” 

This humorous but true quote comes from Jocelyn Elders, the former Surgeon General who was the first African American and only the second woman to be appointed to this position. She was also forced to resign by non-other than President Bill Clinton (yes, the president who was impeached who chose NOT to masturbate but instead have sexual activity with an intern) when she spoke honestly about the importance of including masturbation in sex education guidelines at the 1994 UN World AIDS Day Conference. As Mark Twain observed: “Truth is stranger than fiction” and given that May is International Masturbation Month, it’s wiser for therapists to approach the topic of masturbation in as direct and honest manner as the former and illustrious Surgeon General Dr. Elders. It is still surprising that the topic of masturbation is hidden by clients in therapy as a subject that is too private, guilt-ridden, and/or shameful. Masturbation is for most people a common and healthy sexual behavior that at times remains a taboo topic for them to even discuss, let alone to share with a sexual partner. Self pleasuring can be a great way to learn about what one likes and being able to vocalize that to a partner. If folks can’t be honest with themselves about what feels good, how can they effectively communicate their needs and desires to a partner?

Historical Contributors to Negative Views on Masturbation 

Self pleasure has been seen, throughout Western history, as something that is actively wrong and immoral. Religious dictums, social stigma, and medical distortions created the narrative that masturbation is an act that should be condemned. Author Michael Patton wrote about how society arrived towards such negative views of masturbation in his journal article “Twentieth Century Attitudes Toward Masturbation”. In early Judeo-Christian history, early church members “regarded masturbation as a threat to the survival of the human race” and created doctrine to discourage those from self-pleasuring. As the world became more secular, the language used by the new authorities, namely the medical professionals  (all male and mostly white) shifted.  

According to an article by psychologist Kenneth Zucker, doctors declared that masturbation was the “primary etiology of insanity” while “Freud viewed masturbation as an actual neurosis, but also believed that it was important for psychosexual development from infancy to puberty.” 

In keeping with the sexist notions around women’s sexuality of his day, Freud and generations of analysts who followed him aligned with his view that while it was normal for girls to experience sexual pleasure from their clitoris, adult women had to shift their focus exclusively to vaginal intercourse or risk suffering from psychological disorder like hysteria. The early 20th century community and political leaders (also mostly white men) followed suit, pointing to the solitary sexual activity as an antisocial sexual deviation

It wasn’t until the women’s movement in the 1970s that laypeople forced leaders and medical providers began the fight to stop the double standard around masturbation to alleviate women’s shame. Through consciousness-raising groups in the mostly white feminist spaces in the 1960s and 70s, women began sharing their experiences regarding lack of sexual pleasure through intercourse and learning about their own bodies. The late sexuality educator and pioneer Betty Dodson began offering her Bodysex workshops for women to learn how to appreciate and love their anatomy, learn the proper names of each part by using a mirror to examine their own vulvas and how to develop a self pleasure or what she called a solo sex practice. And while these workshops and her book Sex For One that followed in the 80’s opened doors to women’s internal sense of confidence and agency, women are still lacking in full sexual expression and pleasure in their sex lives due to what my colleague Laurie Mintz has called the “orgasm gap”. Why?  Because there are people of all genders worldwide denied thorough, accurate, normalizing sexuality education and humans still live in a patriarchal heteronormative society that offers better education to people who belong to majority communities. 

What Does Science Tell Us about Masturbation? 

Even with these systemic stigmas, self pleasuring still remains important to a healthy sex life. Research shows that even in long-term, heterosexual relationships, women who are more open about self-pleasure can increase and help maximize both their and their partner’s sexual satisfaction. Specifically, women’s masturbation practices have been seen to have a positive correlation to a healthier partnered sex life. Solo sex practices are part of the principles of Sex Esteem®, is a sexual self-agency model utilized in clinical practice and the Erotic Intimacy Academy SEE IT  Certification training. 

There are many reasons why solo sex creates more enjoyable sexual experiences with a partner. Firstly, masturbating on one’s own promotes self-awareness. By exploring one’s body in a safe and private space, they can gain knowledge about their erogenous zones, the types of touch they enjoy, and their individual arousal patterns. This heightened body literacy can translate into more fulfilling partnered sexual experiences, as they become better equipped to guide and communicate with partners.

Secondly, acknowledging masturbation as a normal part of the human experience helps to reduce shame and stigma that has persevered for centuries. By bringing the topic into the light, without shame, one can challenge these negative narratives and foster a more positive and accepting view of one’s own sexuality. This destigmatization is so important for mental and sexual well-being. It allows individuals to feel comfortable and confident in their bodies.

Due to the prevalence of stigmas and shaming body-image messages that are spread and learned at viral speed through social media at ever younger ages, it is even more critical for parents, educators, and yes, psychotherapists to provide accurate, open, and non-judgmental spaces to initiate normalizing conversations about self-pleasure. Providing normalizing education around masturbation or solo sex (either on one’s own or in partnered sex) are imperative to stop the shaming and increase Sex Esteem® in intimacy.

This blog is a continuation of my last post, which you can find here! 

Once a client begins to intellectually comprehend that the trigger responses they have been experiencing are part of the parasympathetic nervous system’s response to danger, the therapist can begin to invite them to try some somatic inquiry.  Somatic inquiry is the first step used in techniques like Mindfulness Based Stress Reduction (MBSR), created by Jon Kabat Zinn* who codified a Buddhist tradition into a secular, step-by-step technique.  

After they begin to intellectually understand the way the body reacts automatically when triggered, the therapist can gradually begin to ask permission to ask them if they are experiencing somatic responses like this during sexual encounters or at other times. Indeed, the therapist can ask them if they have had any of these reactions in the session itself as the therapist was discussing this information or asking them questions.  This second step is introducing somatic inquiry, an invitation to begin noticing what is occurring physically and emotionally in the here and now.

These slow-paced therapeutic interventions of Somatic Trauma-Informed Sex Therapy can lead to a new language the client creates or chooses to describe the bodily states and symptoms that are triggered by sexual and erotic intimacy.  The sex therapist can gradually invite the client to introduce mindfulness meditation, slow yoga, tai chi or any other slow present-focused movement practice to help the client calm their nervous system and create more skills and thus agency to regulate themselves when triggered. The sex therapist, if working with the survivor and their partner, can then introduce the concept of a choreographed ‘safe space’, a position that they go to immediately if the survivor becomes triggered during a sexual experience. This intervention was introduced by Wendy Maltz in her book The Sexual Healing Journey.  This is a position the survivor states is the position they feel most safe with their partner and will help calm them.  An example might look like this: a survivor sits up in bed, she and her partner both put robes on and she sits up cross-legged, faces her partner, they both close their eyes, take deep breaths while the survivor’s hands are placed face down on top of their partner’s open palms.  This very choreographed position comes solely from the survivor who asks her partner whether they are willing to do this for them to help downregulate the trauma reaction in her body.  

Using Developmentally Age-Appropriate Sex Education To Begin the Building Blocks of Sex Esteem®

For some sexual abuse/assault survivors whose trauma occurred in childhood or early adolescence, the opportunity to learn the norms around sex education, anatomy, and sexuality functioning at age appropriate levels was usually completely absent.  One way to provide this information is to ask a client if they could pinpoint the age they emotionally feel internally rather than the present age, what age would they say they are? Many clients can pinpoint the point at which their psychological and emotional development froze. Offering a client who feels grossed and/or disgusted by adult terms for sexual acts is counter therapeutic.  Instead it’s helpful to offer a sex ed book that is written for children (if their abuse started in early years) or teens with diagrams rather than more graphic photos or imagery.  A book like You Know, Sex: Bodies, Gender, Puberty, and Other Things by Cory Silverberg and Fiona Smyth is an animated book for middle school-aged children that cover topics like anatomy, body autonomy, disclosure, stigma, harassment, pornography, trauma, masturbation, consent, boundaries and safety.

It’s crucial to let the client know that sexual consent is necessary and needs to be crystal clear for every type of sexual interaction.  Survivors need to be taught that sexual consent can be withdrawn at any time, even in the middle of an encounter including what behaviors they want to engage in, what protective barriers they expect each of them to use and what areas of their body are off limits. Sexual trauma survivors also need to learn that consent cannot be inferred in silence unless there is an agreed upon non-verbal signal discussed ahead of time and agreed to by a partner. A sexuality-educated erotically-informed trauma therapist must have enough training and comfort in themselves in order to discuss terms like devising a safe word or non-verbal signal and  ahead of a sexual encounter that will be honored by your partner. 

Helping sexual assault trauma survivors re-engage with their own bodies and with their partners using somatic trauma informed sex therapy and bibliotherapy is multi-disciplinary approach for survivors and their partners as they work their way into consensual sexual pleasure. 

Defining the Terms of Sexual Assault

The first step in helping patients who are survivors of sexual trauma is allowing them to choose the words they may want to use to describe their experience.  Many survivors come to sex therapy for sexual disorders like Genito-Pelvic Penetrative-Pain Disorder, Anorgasmia, or lack of desire. They may come individually or with their romantic partner because their sex life has been lacking, or at times a movement will trigger a violent reaction in the survivor. According to RAINN, sexual assault is defined as sexual contact or behavior that occurs without explicit consent of the victim. Some forms of sexual assault include:

• Attempted rape
• Fondling or unwanted sexual touching
• Forcing a victim to perform sexual acts, such as oral sex or penetrating the perpetrator’s body
• Penetration of the victim’s body, also known as rape

These acts include situations where the victim is incapable of giving consent due to incapacitation, age, or disability.

When a Survivor Refuses to Use the Terms: Trauma or Assault

It can be a delicate clinical situation when a client states they have experienced something that is non-consensual, but doesn’t identify it as an assault or trauma. The decision and specific request by the client NOT to use these terms during therapy sessions can stem from a variety of reasons: 

• Deep shame and guilt over what they consider their fault over the experience
• Disassociation of the experience(s) that have been repressed and compartmentalized
• The normalization of certain behaviors in some communities 
• Confusion about the depth and meaning of words and non-verbal communication needed to give consent
• Internalized societal expectations based on sexist, racist, and homophobic tropes

Even if a sexual assault survivor doesn’t identify their experience as sexual trauma, researchers and clinicians understand that they cause or worsen mental health problems. A 2020 systemic review and analysis on women who have experienced sexual assault indicates that they are more likely to experience psychological disorders such as post-traumatic stress, Depression, Anxiety, and social adjustment issues. When general therapists begin treating a survivor, it’s critical they are not only sexual trauma-educated, but sexuality-educated and erotically-informed. Why? In order to help survivors not only heal from their trauma but also engage in consensual romantic and/or sexual experiences in the future, a therapist will need to be informed and experienced in how to ask the right questions, offer appropriate interventions and understand how to educate the client around sexuality at the developmental stage and pace they are ready for. 

Initial Psychoeducation Therapists Can Utilize with Clients in Trauma-Informed Sex Therapy

While some general therapists feel like it’s their duty to tell a client what occurred to them is rape, abuse or assault, the more trauma-informed sexuality-educated therapist will initially let the client set the pace of therapy and ask them what words they would like to use. Agreeing to use the terms they choose is one of the first steps to create a trusting alliance. 

One of the next interventions is offering a client to learn more about the body/mind connection in the aftermath of non-consensual/unwanted/invasive/coercive sexual behavior. If they accept, it’s critical for the therapist to remind them they can stop the information giving at any point if they feel overwhelmed or physiologically triggered.  The trauma research is then offered as psycho-education. Introduce the 4Fs of traumatic responses as it relates to everyday interactions and sexual experiences: 

• Fight- pushing a partner away, tight jaw, feeling a pit in one’s stomach, urge to punch, suddenly without warning screaming at a partner during sex.  
• Flight- getting up and leaving, over exercising, tingling in arms and feet, avoiding situations of physical touch or initiation of any affection that could progress into a sexual or erotic encounter.
• Freeze- pounding heart, body feeling leaden, pale skin, decreased heart rate, maintaining one’s body in a limp, passive mode during the sexual experience.
• Fawn- complimenting a partner, over inflating how much one enjoys the sexual stimulation the partner is giving them, faking orgasms, ensuring the other person is satisfied with the whole sexual scenario. 

Any of these reactions often includes the experience of Disassociation, which is the experience a person has when their psyche emotionally “leaves” their body. While the client may be aware that they have done this, their partner(s) past or current might not pick up on it. The next psycho-ed then involves explaining how the different parts of the brain react during and after an experience in which they felt fear for their safety. Explain how brain scan research has shown us that the frontal lobe, responsible for logic, planning, decision-making etc. shuts down when a person is triggered. The Amygdala located in the middle of the brain sounds an alarm that immediately activates the brainstem in the back of the brain into one of the 4F reactions.

Another intervention is to ask the client if they would like to read, listen to, or watch some more educational information about common physical reactions clients have to negative/traumatic/non-consensual/assault sexual experiences. This is a way of both normalizing the symptom clusters experienced by many sexual trauma survivors while also providing a wide span of unique reactions that a person might have. Gradually, a client will begin to come to their own conceptualizing and begin to center the words that resonate best with what was done to them.

Part of the psychoeducation includes defining terms like small ‘t’ and Big ‘T’ trauma.  The way we differentiate between small ‘t’ and Big ‘T’ traumas are as follows: 

• Big ‘T’ include war, natural disasters, severe accidents, physical or sexual assault, and other catastrophic events that pose a serious threat to one’s physical or emotional health. 
• Small ‘t’ trauma includes: emotional and psychological abuse, bullying, financial abuse, sexual guilt, constant criticism, sexual coercion, taunting or humiliation, gaslighting and infidelity.   

Depending on the client’s experiences including outside of their sexual trauma, they could have had many types of boundary crossings, and identify with both types of trauma. Once this point has been reached, you can introduce the somatic inquiry interventions, which I will cover in my next blog.

April is Sexual Assault Awareness Month. According to RAINN, sexual violence and assault impacts 1 in 6 women and 1 in 33 men in the US every year. The aftermath of sexual assault results in what therapists refer to as “Big T” trauma which frequently seriously impacts sexual and emotional intimacy in romantic relationships. Many survivors find themselves struggling to regulate and communicate contradictory emotions as well as somatic shutdowns internally, which prevent them from experiencing authentic pleasure in their sexual lives. These struggles are common among survivors of sexual trauma. It is important to know that healing and reclaiming sexual pleasure is possible. 

Understanding Sexual Trauma:

When a sexual trauma survivor experiences Post-Traumatic Stress Disorder, seemingly normal stimuli can cause them to feel as though their life is in imminent danger. Research shows that trauma may change the way the brain functions. Bessel Van de Kolk, a ground breaking trauma specialist, writes in his book The Body Keeps the Score that the frontal lobes in PTSD patients often don’t work properly. The frontal lobe (responsible for planning, reasoning, and decision-making) often shuts down in survivors’ brains so that the medulla (responsible for regulating many bodily survival functions) can react quickly to escape the threat of violence. This is essential to survival when a person is indeed being threatened. 

With sexual trauma, any erotic stimuli can cause survivors to push their partner away in anger, go numb and disassociate (feeling as though the body and mind are separated), avoid the situation entirely, or grin and bear it through intimacy. These survival instincts automatically become triggered and are expressed by one or more of what trauma therapists call the 4 F’s: 

• Fight
• Flight
• Freeze
• Fawn

What sex therapists treating both the survivor and their partner in couples therapy must provide psychoeducation on these neurological processes, and tell them it’s not the partner’s fault if the sexual trauma occurred in a previous encounter or relationship. Sex therapists will need to support both the survivor AND their partner who may not know or realize the full extent of the sexual trauma.

Reactions to Sexual Trauma:

Many survivors will dissociate during intimacy after their assault. Dissociation is often linked as a precursor to other PTSD symptoms that can continue to grow in severity. Sex Therapists assess and name what they call “spectatoring”, where survivors feel their psyche is floating above their body and watching the motions of sex but not feeling integrated pleasure or connection. While the body may respond physically to the stimuli by getting aroused and may even orgasm, the psyche and soul are not registering this as a body/mind/spirit integrated enjoyable experience.  

Most survivors report that something is inherently broken inside them due to these experiences with partnered sex. Wendy Maltz, renowned sex therapist, discusses that the first step for trauma and sexual therapists to do is to help clients make the connection between their past sexual trauma and their present-day somatic reactions to intimacy. This can be challenging, as some clients may have suppressed memories or might not even identify their experience as abuse, assault or trauma. Any instance where sex is used to harm or control, rather than for mutual pleasure, can be considered non-consensual and/or assault. Sexual trauma and boundary crossings do not solely include sexual assault and rape in its definition. Voyeurism, obscene phone calls, stalking, financial abuse and sexual harassment are included in the definition of sexual trauma.

In order to move forward, one must understand the long-term impact that sexual trauma has on sexuality. Maltz’s book, The Sexual Healing Journey, has included many of the most common symptoms that survivors, no matter their gender, can experience: penetrative pain, Erectile Dysfunctions, Anorgasmia, and Delayed Ejaculation. Trauma symptoms can emerge at any time, immediately after the assault or many years later. It’s critical that sexuality-educated and erotically-informed trauma therapists educate their clients on these symptoms as potential consequences of past abuse while offering hope that survivors (and their partners) can learn skills to heal and thrive in their sexual lives. 

How to Help Clients Heal from Sexual Trauma:

Sexual healing is a process of first identifying one’s somatic symptoms, learning how to calm the body’s alarm system after it has been triggered and letting a partner know that one needs some time to get grounded again.  Beginning somatic regulation exercises can include mindfulness and meditation exercises like: body scanning, deep belly breathing, visualization and grounding through tightening and releasing parts of the body, all proven exercises in treating trauma.  The wheel of consent, created by chiropractor, author and teacher Dr. Betty Martin (as seen here) is often one of the more intermediate and advanced techniques I utilize after survivors have learned the regulating exercises named above. In working with the wheel, therapists can teach survivors and their partners to break down any action into answering two questions: 

1. Who is doing the action? 
2. Whose pleasure is it for? 

The “giving” quadrant represents touching someone else for THEIR pleasure. The “receiving” quadrant means you are allowing someone to touch you for your OWN enjoyment. The “taking” quadrant represents touching a partner for one’s OWN pleasure. The “allowing” quadrant is letting someone touch you for THEIR pleasure . Couples are invited to go back to foundational basics to fully understand each boundary, who an action is for, and the permission to pause to check in before requesting action and responding to a partner’s request. 

By clearly naming and teaching survivors and their partners what the meaning and depth of each quadrant is, survivors can gain back power and agency around where their particular boundaries lie, what actually feels enjoyable, and the wide array of choices open to them. Recovery is indeed possible. Working with a somatically-trained, sexual-trauma-informed therapist is usually a recommended first step to addressing symptoms of dissociation, numbness, avoidance, and sexless relationships. This model can lead survivors to communicate more clearly, improve their somatic awareness, and create those mind-body connections that are crucial to healing and sexual pleasure. 

Endometriosis (Endo) is a condition where tissue similar to the lining of the uterus grows in areas like the abdomen, intestines, and bladder. In these other locations, the tissue develops into “growths” or “implants”, causing chronic pain and a range of other symptoms. While the symptoms of Endometriosis on cis-female’s physical well-being is widely discussed in medical journals and forums, it still takes 5 to 12 (at times very painful) years for a symptomatic patient to FINALLY receive a clinical diagnosis. Additionally, its effect on intimacy and sexual health is often overlooked by medical providers, leaving individuals and their partners feeling isolated and frustrated. This Endometriosis Awareness month, I want to shed light on this important aspect of living with Endo, drawing on recent research and clinical insights.

Describing and Defining Pain: Dyspareunia and Endometriosis

When I began specializing in sex therapy, I noticed more and more women in their twenties and thirties coming into my practice with issues of pain during and at times outside of vaginal penetration. This frequently leads to lower desire, arousal, lubrication and increased ‘hypertonic’ tone or tightening of their pelvic floor muscles. People with vulvas and vaginas with Endometriosis-caused sexual pain frequently experience feelings of sadness, anxiety, and frustration in not being able to have a “normal” life, including their sex life. Endometriosis pain can manifest as deep Dyspareunia, felt during deep vaginal penetration, often due to contact with endometriosis lesions on pelvic structures. Research illustrates that up to 50% of women with Endo experience Dyspareunia. Some may also experience superficial dyspareunia: pain at the vaginal opening with or without penetration. 

When women are brave enough to talk about their symptoms’ impact on their sex life before receiving an accurate diagnosis, their primary care or Ob/Gyn doctors usually recommend using lube or prescribing medication for bacterial vaginosis or yeast infection. Why? Because the majority of medical schools are not providing adequate training in Endometriosis or in pleasure positive sexual health. Due to Endometriosis causing Dyspareunia cis-women develop anticipatory anxiety of pain when the slightest sexual encounter is initiated by a partner. I most commonly see this presenting problem in my practice when a partnered woman reaches out on their own for individual sex therapy. During the admission call, they usually state that they need individual treatment “because I’m the issue”.  Female clients experience an enormous amount of shame around not being able to ‘perform’ in sexual encounters without anxiety or pain.

How Couples Sex Therapy offers a Systemic Holistic Approach  

Endometriosis-related pain during intimacy doesn’t solely affect the woman experiencing it. Partners also embark on their own journey. Studies on male partners of women with dyspareunia show increases in distress and their own sexual difficulties, including lack of desire, anxiety, erection problems, and orgasm difficulties. While it’s often assumed that similarity in partners’ sexual desire is beneficial, research suggests that both partners simply feeling supported through intimacy helps with engagement for everyone. Having open dialogues with a partner around pleasure and intimacy is crucial to creating a meaningful, positive sex life for everyone. This may mean offering couples therapy so they both can learn to reframe the way intimacy can be shared and expand the definition of what partnered sex actually can mean. 

Challenging What is “Normal” by Expanding the Definition of ‘Sex’

Often, the idea of “normal sex” in the heterosexual world is defined as penis in vagina (P in V) penetrative intercourse. However, for individuals with endometriosis-related pain, this definition can be limiting and distressing. You don’t need penetration to have sexual pleasure and intimacy for each partner. Rosemary Basson’s Sexual Response model introduced the idea of responsive desire, which is critical to understand when one is suffering with sexual penetrative pain, fatigue, and the many symptoms that are associated with Endometriosis. Responsive desire is a feeling of motivation based on erotic context or a partner’s approach. What Basson’s model offers us is a willingness to enter an erotic or sexually pleasurable experience that isn’t exclusively based on desire. What I invite readers and clients to take away from this Sex Esteem® lesson is that partners don’t exclusively need penetration to enjoy a wide range of sexual pleasure!

Sex researchers have identified a wide range of motivations for sex, categorized as approach motivations (positive aspects like pleasure) and avoidance motivations (fear of disappointment or rejection). Pushing through painful sex often stems from these avoidance motivations, which can lead to more pain and negative associations with intimacy. Part of healing is to rewire the connection between your body and mind that sex will lead to pain. Helping clients to forge a new neural pathway between the body and mind will help a client and couple experience relaxed sexual pleasure. To do this, many women and their partners need to take a break from vaginal penetration and begin a new practice of pleasure-focused sexuality either through solo pleasuring or what sex therapists call: partnered ‘outercourse’.

Initial Steps for Outercourse

• Begin by using mindful breathing to invite your psyche to become aware of your body’s senses without judgement.
• Give yourself sessions where you explore your pleasure zones first by yourself then with your partner (if you are partnered).
• Find a vibrator that has just the right pressure to arouse you externally.
• Show your partner the wide menu of erogenous zones on your body’s skinscape to caress, tease or stimulate.
• Explore erotic fantasies through your imagination, listening to erotic stories, or watching ethical feminist sexual media. Notice the sensations that get activated as a result of erotic thoughts. 
• Invite your partner to touch you in exactly the place and manner you enjoyed on your own
• Ask your partner what kind of touch they would like. Consider if you’re able to provide all or any of this request and then let them know.  

Positive intimate experiences are possible for those with Endometriosis and/or suffering from Dyspareunia. By openly communicating with one another, looking outside the rigid beliefs about what ‘sex’ is, and reducing shame surrounding pain and intimacy, women and their partners can pursue pleasurable and more fulfilling intimate lives.

Swiping with Agency: Beating Dating App Fatigue 

According to Shakespeare: “Love is a smoke and is made with the fume of sighs.” But when that love is sought via online dating, single daters may have to wade through a lot more than just smoke to smell the loving fume of sighs. According to a Pew Research Center study, 30% of American adults have used dating apps to find a partner. Out of that population, 12% of folks have found a long term partner or married their spouse through apps. While dating apps might alleviate social anxiety that some daters experience when attempting to meet a person IRL, there are unique concerns that contribute to what has been described as “burnout” and fatigue by clients who are relying on online dating apps or sites.

While many users find it easy to connect with potential matches based on shared interests or physical attraction, concerns about dishonesty, unwanted messages, and harassment are prevalent. Younger women are particularly vulnerable to these negative experiences. The Pew Study found that over 50% of women ages 18-34 feel as though dating apps are not a safe way to meet people, since they are more likely to receive messages with previously matched swipe rights after communicating that they were not interested. This unwanted non-consensual communication can be in the form of receiving explicit messages or being threatened.

Dishonesty & Dangers on Dating Apps

Single folks in therapy or coaching sessions express shock and fear at having their boundaries crossed and at times repeatedly violated by people they meet via dating apps.. Daters bemoan the common lying their matches enact by failing to communicate significant facts like: unlike what they wrote in their profile, they actually aren’t looking for a long term relationship after all, or they have not actually “moved out” of a home shared with a “previous” partner or spouse. According to a Forbes survey, one in five adults admitted to lying on their profiles in some capacity, which can contribute to a deepening pattern of anxious attachment by those daters who are lied to. The survey found that:

• 20% lie about age
• 14% about hobbies and interests
• 13% about employment or relationship status, and
• 12% about height.

Some therapy clients mourn the loss of their own basic trust in people, and report feeling burnt out after suddenly getting “ghosted” by a regular dating partner of a few months without any warning or explanation.

Dating App Burnout

Out of the portion of Gen Z responders who are on dating platforms, the Forbes survey found   that 79% of single daters were feeling signs of burnout. In addition, survey respondents reported spending on average over 50 minutes a day on these apps and cited a variety of reasons for engaging for long periods of time.  While some are actively screening candidates in search of a potential person looking for a long term relationship, others are simply seeking a social-emotional outlet and/or an ego-boost by continually swiping on their phone screens.

When coaching clients who are actively dating, I conduct a deeper dive of somatic inquiry and ask them whether they’re aware of what their body is experiencing and what emotions are bubbling up as they scroll for longer periods of time.

• Are they feeling tightness in their chest, a pit in their stomach or a clenching in their jaw?
• Has the app-scrolling habit become a mood regulation activity in and of itself in an attempt to tame feelings of loneliness, boredom, depression and/or anxiety?
• Are they disassociating or going into a fugue state while scrolling?

Some daters spend their precious time, energy and planning skills in swiping, responding, trying to be clever or humorous in their communications only to discover that the person on the other side is not only lying about things like their height, but are in fact not even the person they are representing themselves to be (also known as catfishing). Catfishing can lead single daters to become so burnt out with the entire dating app process that they cancel all their registrations and take a long break.

Along with catfishing, ghosting also heavily impacts people in the online dating world, as it has become such a commonplace practice for dating app daters. Getting ghosted whether it’s after weeks of messaging, going on a few dates, dating for several months and/or engaging in an ongoing sexual relationship causes many clients to lose faith they’ll ever find an honest partner . Additionally, breadcrumbing, or leading someone on with little effort and no intention of a real relationship, also has very negative mental health effects. A 2020 study by the NIH found that those who experienced breadcrumbing, or a combo of breadcrumbing and ghosting, reported higher levels of loneliness, helplessness, and lower life satisfaction. Dating platforms have become easy places to treat real people transactionally, leading to many single folks to feel hopeless.

How to Combat Dating Burnout & Date with Sex Esteem®

I encourage clients to consider carving out more of their free time in engaging in activities that provide self-care and nourishment like:

• a physical activity like going to the gym, social dancing or taking an art class
• Spending time with good friends
• attending a community or spiritual event
• volunteering to help others.

I also advise clients to limit swiping and messaging to 30 minutes a day, enough time to engage and move forward with potential dates.

Refrain from scrolling, swiping or texting on a dating app while in bed right before going to sleep, or immediately upon waking so it doesn’t lead to an obsessive activity associated with their bed. I recommend reserving the bed for activities such as sleep and/or sexual-erotic activity, both of which require deep relaxation and trust.  If one is continually scrolling in bed, your mind’s neural pathways begin to associate the bed with anxiety, distrust, and potentially even a feeling of being turned off.  This is obviously not helpful in sustaining or enlivening one’s embodied erotic energy.
Set your boundaries early and often with potential dates by telling them what kinds of messages you DON’T want to receive and what you WON’T be sending.

If you ARE interested in someone, meet them in public fairly soon after matching so you can see if indeed you are a match emotionally and with some chemistry.

Don’t solely rely on dating apps. Organize IRL gatherings with friends and ask each of them to bring someone from their network who you don’t know who might be a potential romantic interest to you.  ‘Meet cutes’ are not just a thing you see in movies, you can actually create fun social outings and expand your dating pool at the same time!

This is part 2 of my interview with Lisa A Phillips, author of the new book First Love: Guiding Teens through Relationships and Heartbreak. You can go to this blog post to see more of our conversation.

Talk about what you learned in your research for this book. We know that with younger generations that social media impacts teens. How does it impact the reluctance they may have around expressing emotional vulnerability in new relationships?

When I was a teen, my crush did not come home with me. He was in math class and I didn’t see him until the next math class. Now, kids have the crush in their pocket all the time to look, gaze upon in pictures, see what he’s doing, and who he’s dating. How do these kids do it? I always teach about Helen Fisher’s research on heartbreak. She conducted brain scans on people who just broke up, but were still in love with the person who rejected them. When Fisher flashed pictures of the ex, people would cry and scream and weep. They were thrust right back into the vividness of this breakup through images. Now, this is the daily reality after a breakup. On social media, you see image after image of your ex living their best life, which is exactly what thrust those people in the brain study into their feelings of distress. The “social media breakup” is an act of self saving, but young people feel like they’re not tough enough. The biggest piece of breakup advice? Unplug from this person as much as humanly possible.

The research shows that Gen Z and Alpha hold off on having sex during high school compared to the Boomer generation. In 1991 54% of high schoolers had stated that they had had sex, whereas by 2021 it had gone down to 30%. You’ve offered some theories about why you think younger people are more tentative towards emotional intimacy. Can we talk about why young people at times are avoiding “catching feelings”?

I think this trend is really fascinating and disturbing. Sure, we don’t have to worry as much about pregnancy, STIs, or dating abuse. However, there’s a lot of dangers around the things that we do to become adults: having sex, driving cars, trying alcohol, being in the workforce. All of these things make you less safe than when you’re at home alone in your room. Young people are entering their adult lives expecting this control, choosing exactly what to interact with. That leads to less openness toward our fellow human beings and deeper, more satisfying relationships. 

Additionally, the relationships that are happening are less defined than they were and when you and I were teens. There’s this whole spectrum of relationship experiences, from talking, to hooking up, to there’s something but we haven’t defined it yet. There’s an ethos of ambivalence that goes along with that. This can be positive; you don’t always have to go right into a relationship. But at the same time, situationships can be really tormenting for young people. They are worried about asking, “What are we?”, which can create a lot of “I’ll take what I can get” situations. 

What I preach in my book is: Choose what kind of relationship you want, but don’t tell yourself that it is not a relationship. Any human connection is a relationship. Being carefree about it is very different from being careless. Ambiguously defined relationships should not be an excuse to disrespect people. Walk through the world as a caring and ethical human being, especially with your sexual and romantic self. 

Today, there is a lot of important conversation around consent. How do you educate young people to discern the difference between flirting versus coercion?

Young people often talk about repeated pressure for someone’s attention as a very negative thing. I don’t know if I can give an easy answer to the line between persuasion and pressure, between erotic tension and manipulative seduction. When flirting is done well, it is very attuned. It’s about what you try and what the other person responds to. We forget that there’s another person on the side. Sometimes you need to not connect with them and you’ve made it very clear. That’s ok! But we also want to allow for a space of discovery and journey, of the fact that sometimes in sexuality and desire, yes and no are not clear. Creating spaces to find clarity and to figure out how to pursue is a very different thing than pressuring and ignoring the agency of the person on the other side. 

We are in a phase of correction, which is so important. By talking about consent, we are raising our young people to be really in touch with their desires and needs. But then we should also work on getting back some mystery in a way that is not violating, but enlivening.

You talk in the book about issues with mental health, which so many young people are going through and are more aware of. How are mental health and relationships tied together?

Every relationship story seems to entail one partner or both having some kind of breakdown or dealing with depression or being in crisis. At first, I started looking for stories that didn’t involve these things, but I realized that every teen love story is also a mental health story. This generation is distinctly troubled. The rates of depression and anxiety are not good, but their mental health literacy is also very high. When you feel someone in your life is not as loving to you as you are to them, you’re going to get the feels. You’re going to feel sad, unwell, and in pain. It is all part of human design. It does not mean you are broken; it often means you are whole.

First Love: Guiding Teens through Relationships and Heartbreak, is available to the public on February 4th, just in time for Valentine’s Day!

Earlier this month, I had the honor of interviewing Lisa Phillips, the author of Unrequited: The Thinking Woman’s Guide to Romantic Obsession and Public Radio: Behind The Voices. She’s written about relationships, mental health and teens for the New York Times, Washington Post, Psych today, Cosmopolitan, and many other outlets. She currently teaches journalism and the popular love and heartbreak seminar at the State University of New York at New Paltz. In her new book, First Love: Guiding Teens through Relationships and Heartbreak, chronicles the challenges today’s adolescents face as they navigate crushes, dating and breakups, and also the challenges that adults face as they strive to provide guidance and support. It’s told from the perspective of a professor, a mother, and an award winning journalist. This is a condensed version of our interview, which will soon be on our youtube page. The second half of this interview will be posted in another blog in the coming weeks.

In one of the earlier chapters, you talk about your own experience as a mother. When your daughter first kind of crushed on somebody, she used the language, “I’m so gone”. You described your feelings as a parent, as a mother, as also feeling like your daughter was so gone from you as an attachment figure. What should be concerning when teens are so “gone” from their own core sense of self in relationships? 

It’s developmentally appropriate, they’re supposed to be having these feelings. They’re developing sexually and emotionally and they essentially are supposed to be on a journey of finding new attachment figures to replace us with. Not as their new mother or father, obviously, but as their peer, main attachment figure. This is what we do as human beings. It is how the species perpetuates itself. It is how we all have the promise of living healthy relationship lives. This is part of what keeps us healthy. Parents may think: This can’t be healthy, because everything is about the other person and the enmeshment of the relationship, and that, of course, can be cause for concern. If you can, engage your child about this. Sometimes even they feel like less of themselves and that can be a very hard thing to interfere with. But, it is absolutely something that, if you have some language for it, can be a real awakening for a young person. Ask: Do you feel like more of yourself? Do you feel like less of yourself? They might not necessarily say, Hey, Mom, you just made me see the truth of this situation. This dude is gone. It may not happen that way, but you know how young people are. They hear you, even if they don’t always let on that they hear you. So this is one of the ways that parents can offer ideas and language to help them assess how gone they are and if it’s healthy. If it’s not ask your child what might they want to be thinking about to change that?

What would you say to parents about how to prepare themselves? Not talking about having conversations around sex, but how to prepare kids for understanding what will happen to them when they initially fall in love?

Young people will be exposed to representations of romance, desire, and love from a very early age. I mean, this is in Disney movies, right? So you can actually start those discussions really early. And I definitely did with my daughter. We had an ongoing joke about Snow White and the foolish things she did. Why is she opening the door for strangers? Just overall, whenever we saw a representation of love on screen, we would engage about it. What I talk to my students about a lot is that this is a force that can be very disorienting and very intense, and it can lead to wonderful things. As Helen Fisher says, it’s a great addiction when it’s going well and a horrible addiction when it’s going badly, but it ties us to something that is so fundamental to being human. If we didn’t have these feelings, we would not open the door to lasting, loving, romantic relationships. It can be very redeeming for young people to hear that it’s not just because I can’t control myself that I feel this way. It is a part of the life force of being a human being.

What did you find when interviewing parents about what emotions got raised as they witnessed their kids emerging romantic lives?

A friend of mine read an early version of this book and her comment was, “we’re all still recovering from being teens”.  Parents get very stirred up by watching their kids enter the teen years, because it brings up a lot. It’s like they get to have all the firsts again. They hopefully get to do it better than we did, right? It stirs up regret, longing for different lives, nostalgia, all kinds of things I think we all go through. Fathers tend to get depressed watching their sons date, but they also have a rise in self esteem. That was like a wacky finding from that study, and it’s almost like what their sons are doing out in the word world sexually, is some reflection on the fathers, where the mothers tend to have these feelings of, you know, regret and longing, should I change my life and things like that. 

I think that what I have heard from parents is a lot of “I don’t want my child to turn out like I did, or to go through what I did”. If they had experienced sexual assault, dating abuse, domestic abuse, or anything traumatic, they felt very concerned about what could happen to their child. Sometimes that really opens them up in a really beautiful and inspiring way, then sometimes it shuts them down where there are things they literally couldn’t see because they were still in their own stuff. One of the big messages in my book is for parents to take that time to really tune into what they’re going through and not impose it on their child. Their child, at this juncture, really needs to be seen and heard for what they are going through at the moment. 

Children are often very curious about their parents’ past romantic lives. It’s not like you can never bring that up. They’re really powerful, lasting cautionary tales that teens will quote to me. The timing of this disclosure is really important. If your child is in strife about a breakup, for example, this is not the time to go into your worst breakup when you were 15. Timing is everything. So it’s just really about when you bring these things into the conversation that’s really important. Also, to just know you’re going to need care for yourself if it really stirs up a lot. You want to try to find that balance between acknowledging some of the reasons for the ways you react and the policies you set and giving your children their own reality in this journey. It opens up a space for parents to start to connect on a deeper level about what they were going through intergenerationally, and not just like one person’s past and one person’s present.

How do we prepare kids to think about what they are interested in having in a sexual encounter?

One of the things that parents get really concerned about is relationship policy, like, what do I do? I think there are some interesting conundrums that come up because we have to figure out what kind of space is okay in our homes for our children to explore their sexuality? At what age is the closed bedroom door okay? At what age is the sleepover okay, if it’s ever going to be okay? I think when I got to those questions in my own life, I was really fascinated by things that I felt okay about and things I didn’t. A young woman I interviewed for the book told me that she would ask her parents to go out to dinner when she’s just having a date. She’d basically say, like, Mom and Dad, could you please go out to dinner? I’m going to have this person over. She said they knew that this was basically: will you give me privacy to have sex? And I thought to myself, “Oh my God, this is so great, but I can’t do that”. I just can’t do it! I can’t be that open. I felt really confused about that, and I struggled to express it in our family policy. And then I finally kind of figured out a language, which is that I really wanted my daughter to be aware of pleasure and equality. We have talked about it in a limited way, and she often was like, “No, Mom, no, I know about that, conversation over”, but at least we got it out there, right? So we both know it matters to us. 

But then we need to be open about giving kids space to truly explore, which, especially for girls in heterosexual relationships, means talking about the fact that the boy orgasm is automatic while the girl orgasm is an art form. And our art takes time. It takes privacy, it takes being relaxed. I sort of struggled with feeling a little bit like a hypocrite for this, until I finally said, You know what, I want you to know that I really value the privacy around this. I think I figured out a kind of unspoken way to talk about it that wasn’t quite as explicit. My husband and I just started to leave more open spaces and made sure she knew they were open spaces.

First Love: Guiding Teens through Relationships and Heartbreak, is available to the public on February 4th, just in time for Valentine’s Day! 

The Silent Crisis: Men’s Health

Men’s medical self-care has long been a topic avoided by men. However, it’s a critical issue that deserves to be amplified. On average, men live 5 years shorter than women, and often experience poorer health outcomes and die earlier from preventable causes. A study published in Psychology of Men & Masculinity names 11 distinct masculine norms in society that men view as “ideal” — winning, emotional control, risk-taking, violence, playboy, self-reliance, dominance, primacy of work, heterosexual self-presentation, power over women and pursuit of status. Partly due to these pressures on men to adhere to these “masculine” ideals, men’s health actually suffers. As therapists, it is crucial to open up conversations about medical symptoms and conditions with men who are in psychotherapy.  

The Toxic Mask of Masculinity and Its Impact on Mental and Sexual Health

Since societal pressure on men to present as strong, independent, and emotionally stoic it discourages men from seeking the proper medical help, even when they’re struggling with physical or mental health issues. As a result, many men delay seeking medical attention, leading to more severe health problems. Men die earlier than women, despite having more socioeconomic resources. According to a study by the American Sociological Association, men with strong masculinity beliefs are half as likely as men with more moderate masculinity beliefs to receive preventative care. 

Even when men with high masculinity beliefs are educated on the importance of preventative care, the likelihood of them seeking out care actually decreases as their occupational status, wealth, and income increases. In another study done at Indiana University among Black men in Chicago, researchers found that masculinity, but not socioeconomic status, was positively associated with excellent self-reported health, leading them to choose NOT to seek out preventative medical care. 

How does this stoicism get seen in a sex therapist’s practice?  Men tend to suffer in silence and avoid intimacy with their partners (if married or partnered) for months in order to prevent being viewed by their partners as broken or lacking in so-called masculinity.  They also feel deep shame if they can’t “perform” sexually, which is indicative of how they understand what sex is supposed to be; that is a performance.   Their erectile and/or ejaculatory challenges or disorders also impact their mental health, decreasing the ability they may have had before to express emotional intimacy and may have the domino effect of their partners feeling like they are no longer attractive to their male partners.  It is usually when a man is given an ultimatum by their partner who threatens to break up or divorce them unless they go to sex therapy or if the man is unpartnered, he finally accepts that he needs help that he agrees to seek out sex therapy. 

The Role of Therapists in Men’s Mental and Sexual Health

In 2021, nearly 80% of deaths by suicide are men. Additionally, the NIH reported that 60% of men who died by suicide had accessed mental health care in the past year. Although many men do not seek out preventative mental health services, when they do, many clinicians may not accurately assess their mental health and sexual health diagnoses. It is shown that depression in men often presents differently than in women, leading many clinicians to misdiagnose when men are actually struggling. And, since the majority of general clinicians and couples counselors aren’t trained and/or comfortable asking about their clients’ sexual health and function, erectile or ejaculatory disorders are missed as well.  In a 2019 study(1) of 79 mental health professionals, only a third of the participating psychiatrists and psychotherapists stated they addressed sexual health in patients as part of their daily routine. 25% of the physicians suspected sexual health problems in 60–100% of their patients but did not ask their patients about whether they had sexuality concerns.

Based on the 11 masculine norms for men stated earlier in this blog, research by the NIH has shown that the masculine norms of Self-Reliance, Playboy (i.e., desire to have multiple sexual partners), and Violence, had heightened risk of Depression symptoms.  These traits may differ greatly for women, leading certain therapists to not be able to note key warning signs for men. Aggressiveness, substance abuse, and risky sexual behavior can be telltale signs of Depression in men but may not be directly screened for by therapists.

More research is needed to understand the ties between negative health outcomes and masculinity. Organizations like Movember, the Canadian Men’s Mental Health Foundation, and HeadsUp Guys all have great toolkits for therapists to battle the biases we all carry to help men with their mental health. Non-profits like The Sexual Medicine Society of Sexual Medicine Foundation and the Urology Care Foundation are good sites to get accurate sexual medicine information. 

While the month of November has ended and with it, men’s mental health awareness month, all medical and mental health professionals need to become more confident and better informed around mental health and sexuality related disorders to better serve their male clients all year round.

November is Men’s Health Month, an important time for men to think about their physical, mental, and sexual well being. The Movember organization works to bring awareness and create programs to battle against the stigma of men’s physical and mental health. On average, cis-gender men in the United States die 5 years earlier than their cis-gender female counterparts. According to Harvard Health, there are multiple reasons for this:

• Men generally work more dangerous jobs
• die by suicide at higher rates than women,
• are less socially connected and
• generally avoiding doctors more often.

Hannah Farrimond, a sociology researcher based in the UK, describes this avoidance of medical help as a way for men to feel more masculine and in control. In her study, she describes that her subjects felt as though not seeking out help from anyone else was their way of acting responsibly and maintaining their masculinity. By taking matters into their own hands instead of relying on a medical professional, they feel stronger and more capable.

It is often very difficult for men to put down the facade of feeling strong and masculine when thinking about their physical health, but things really compound when we talk about men’s mental and sexual health. In an extensive 2018 literature review of 49 published studies in The Journal of Sexual Medicine the nexus between erectile dysfunction (ED) and Depression in men was discussed. The findings suggested that men with ED are significantly more likely to experience depressive symptoms than those without ED. While the review found this link, it remains unclear which is the cause and which is the effect. From a behavioral model perspective the authors state that “patients with depression tend to engage in negative thought and are less confident, which results in performance anxiety that further reduces erectile function”. On the other hand, the “biological model postulates that depression affects the hypothalamic pituitary adrenocortical (HPA) axis, leading to excess catecholamine production, which in turn, leads to poor cavernosal muscle relaxation and ED”. In clinical practice, therapists find that when men’s sexual prowess and mental strength are being questioned, many report feeling emasculated due to societal pressures instilled in them from early ages. They commonly begin to avoid all intimate touch or even verbal expression that might be interpreted as a sexual initiation by a partner. 

Societal expectations for men to be tough, competitive, emotionally stoic, and the primary breadwinners can result in men neglecting preventative health measures, especially when it comes to mental and sexual health. While the tie between depression and ED is apparent, our society still makes working through these issues even more difficult. Therapists should understand how to have clear, honest, and compassionate discussions with their male clients surrounding sexual wellness. Since studies and sexual therapy clinical observations support the biopsychosocial-sexual connection between ED and Depression, therapists need to get more training and sense of comfort in asking their male clients about their sexual health and functioning in addition to screening for their mental health.  General therapists might need to learn more about how each client’s or couple’s challenges are frequently complex and varies from case to case  It’s important that clinicians treat ED as a multifactorial condition frequently requiring a multidisciplinary team approach which might include:

• urologists
• sex therapists
• pelvic floor physical therapists
• oncologists.

While there are PDE5 inhibitors (like Cialis and Viagra) and other medical interventions that treat symptoms of ED, medical providers often forget the importance of the psychosocial-sexual-spiritual component of sexual wellness. Researchers at the European Society of Sexual Medicine published a 2021 report stating that there is “increasing evidence that psychological treatments of ED can improve medical treatments, the patient’s adherence to treatment, and the quality of the sexual relationship”. Since many general therapists aren’t trained in sexual health issues and specifically male sexual disorders, it might be more intimidating to ask detailed questions regarding ED symptoms including; timing, frequency, how full an erection is, and the history of the disorder.  If general therapists gain more sexual health information while also becoming more comfort in asking these questions, they can support their male clients through the stigmatized barriers that society has put up around sexual expression, while inviting them to seek out medical care and treatment for the biological aspects of their symptoms leading to an emotionally healthier and a more fulfilling sex life.  They may also provide the support they need in going to a urologist or a cardiologist since many research studies has shown that early signs of ED can be red flag warnings to future cardiovascular disease. 

In order for therapists’ male clients to feel empowered emotionally, physically, and sexually, clinicians must be ready to get more educated on how to assess for sexuality related issues and disorders that may feel taboo to bring up or had previously not been part of their own training and education. Encouraging male clients in psychotherapy to express more of their sexual health and psychological challenges is key to men gaining the medical and emotional treatment needed. By expanding their training and becoming biopsychosocial-sexual and spiritually clinicians, psychotherapists can model for their male clients to overcome the stigmas society has engrained in them.  Therapists can offer them guidance and support to seek out appropriate medical professionals which will not only help them to improve their mental health but will get targeted treatment for sexuality and sexual-health related disorders which can also prevent potentially serious medical problems down the line.