Pleasure: Mutual Pleasure Matters

Pleasure goes beyond simply having orgasms. It’s about curiosity, connection and caring about your partner’s experience. Pleasure will look different for different people’s or a couples’ experiences and it can change across the lifespan. People in Ethical Non-Monogamous or Polyamorous relationships will also need to consciously explore how their stimulation and experiences with one partner may differ greatly from their sex life with another partner.  Caregivers or parents will often ignore the topic of pleasure when providing sex education for their children at each stage of their developmental growth.  Many adults are uncomfortable and lack their own education to provide thoughtful and loving guidance to their children or young ones about the importance that they are experiencing pleasure by themselves or with a partner, and equally committed to offering to give pleasure to their partners. Most parents were not taught this and because of their own embarrassment or shame are quick to defend this decision by stating that they’re kids are too young for sex and/or masturbation. This same blind spot or denial around discussing sexual pleasure can also occur when adult children are caring for their elder parents who are involved in sexual relationships.  Adult children while fully grown adults, are still their parents’ children and have the ‘ick’ factor to get over in thinking about and frankly discussing sexuality with their parents and in some cases with the retirement or nursing home staff where they live. Pleasure is about balancing all the other sexual health principles with each partner’s authentic sexual curiosity. When a partner ‘fakes an orgasm’ or pretends they are enjoying stimulation a partner is providing they are contributing to their partner’s beliefs that what they are doing is actually what the receiver is enjoying. The sexual encounter is then not mutual nor authentic at all  

Non-Exploitation: Sex Should Never Involve Manipulation or Coercion

Sexual exploitation happens when someone uses their power or dishonesty in a sexual relationship. This power imbalance may arise from differences in partners’ cognitive ability, intoxication level, or other circumstances that limit one person’s capacity to give full consent. Exploitation can also come in the form of verbal or non-verbal manipulation, psychological pressure, and/or guilt-inducing communication by one partner to another. Explicit force doesn’t need to be involved for exploitative sex to occur. For example, when one partner repeatedly threatens to end a relationship unless the other partner agrees to sexual activity, they are psychologically pressuring their partner and undermining joint sexual decision-making. Another example of exploitation occurs when one partner has sex outside the agreement they’ve made with their partner, (whether they have promised sexual exclusivity or are in an ethical non-monogamous relationship). When the betraying partner doesn’t use any STI protection with the secondary or outside partners without telling their primary partner and proceed to continue having unprotected sex with their primary partner, this is exploitative sex.  What the betraying partner has exploited is their primary partner’s trust and lack of knowledge so that they aren’t able to fully consent to having unprotected sex. They have thus put their partner’s sexual health at risk while also breaking their promise of their sexual monogamy agreement. This is also true for partners in an ENM, or Poly agreement, for example when the primary couples agreed they would always have protected penetrative sex in consensual non-monogamous experiences with other partners. 

Prevention: Precautions for Physical Health

This is perhaps what people think of when the topic of sexual health comes up. It’s clearly imperative to discuss safer sex practices like condoms and other forms of birth control to prevent STIs as well as unwanted pregnancy. For example, before becoming sexually active with a new partner, each partner may decide to get tested for STIs and openly show and discuss the results so they can make informed decisions together.  In addition, the sexual health principle of prevention also includes issues like: partners agreeing to not to continue penetration (anal or vaginal) if the receiving partner is having pain.  As Certified Sex Therapists, taking painful penetration off the table for a little while until the condition can be treated medically is one of the first interventions proposed to partners when one partner reports pain during intercourse or anal sex. Psycho-education is provided in sex therapy on the long term physical and emotional damage that follows when people continually grind through a painful sexual experience.  Consequences to pushing oneself or one’s partner through a painful penetration can include trauma symptoms to future initiations of intimacy. Post-trauma symptoms like: freeze, flight, fight, and fawning are common blocks to people having painful sex, The principle of prevention is all about making informed decisions as an individual for one’s sex and one’s partner and/or as a couple when it comes to partnered sex. 

The Six Sexual Health Principles Mindset

Contrary to many people’s beliefs, sexual health isn’t only measured by frequency, fantasy or comparisons to what the rest of the country is doing. It’s built on mutual consent, pleasure, honesty, shared values, respect and protection of oneself and with whoever one has a sexual experience. These six sexual health principles help all types of partners and/or couples build a healthy and meaningful sexual relationship. Instead of asking, “Are we having enough sex?” try asking yourself and your partner(s):

• Do we feel safe communicating about sex?
• Do we adhere to each other’s boundaries?
• Are we honest about our needs?
• Do we both feel respected?
• Are we in full agreement as to how we will protect one another’s health?

Furthermore, these sexual health principles are never static. A healthy sexual relationship requires ongoing conversations with partners because all people’s bodies, desires, health, and circumstances will change over time including from day to day, and hour by hour. 

Oftentimes when people come in for sex therapy, they’ll ask their sex therapist questions like: “How often should I (or we in the case of a couple) be having sex?” or 

“Is it normal for me (or for my partner) to desire to do ‘xyz type’ of sex?” or 

“Does it mean I’m an awful person if I fantasize about an-ex partner when I’m with my current spouse?” 

Doug Braun Harvey and Michael Vigorito, authors of Treating Out of Control Sexual Behavior: Rethinking Sex Addiction created a template for therapists to use when helping clients assess through self-inquiry whether their sex life is in fact sexually healthy. They called this assessment the Six Principles of Sexual Health. They created this model after years of treating mostly male identified clients who were coming to therapy due to sexual behavior which was described as compulsive, hypersexual or out-of-control.  However, this framework could be adapted for any person who wants to optimize their sexual and relational wellness to better reflect their authentic values and priorities. A healthy sex life isn’t solely based on things like frequency or STI and pregnancy protection. Instead, it’s built on these key principles which support an honest inquiry regarding the physical, emotional, psychological, ethical and relationship behaviors and considerations one makes to live an authentic and integrated life as it relates to sexuality. 

Consent: Each Partners Feel Free to Say No

This is perhaps the most important and most basic principle of sexual health. Consent must be ongoing, not a one-off question that one asks at the initiation of a sexual encounter whether with a new partner or a longstanding partner. Each person must feel emotionally safe and confident enough to pause or stop a behavior whenever they choose, even if they are in the middle of the experience to which they had initially agreed. A couple where one partner agrees to go along with sex in order to avoid a conflict or because their partner will act in a resentful fashion if they say no isn’t healthy sexuality, and it is not considered fully consensual. So while verbally agreeing to a specific sexual encounter is legal consent, if either partner feels pressure to keep going,because they’re afraid, anxious or disassociated the sex is no longer fully emotionally consensual. Depending on the relationship power dynamic, it could also be construed as coercive. This kind of ‘going along’ is reported frequently by female clients who present in sex therapy within their heterosexual experiences because they feel like they should, or ought to do it. However, many men also push through doubts or ambivalence in heterosexual or same gender sex because they are avoiding appearing less ‘like a real man’.  These are ingrained beliefs that are part of the heteronormative, patriarchal system and oftentimes leading men to develop erectile disorder or premature ejaculation. These ‘going along’ sexual encounters is not what is considered enthusiastic ongoing consent and if repeated for months or even years, leads to people losing connection or going underground with their own authentic desire and needs. Sex therapy with a Certified Sex Therapist can re-educate and support clients to lead a more authentic sex life in which either partner feels free to say ‘no, not tonight’ without feeling any guilt, remorse or shame.

Honesty: Being Able to Talk About Sex 

A healthy sex life depends on both partners feeling comfortable communicating openly about their sexual relationship, including their desires, boundaries, concerns, and changing needs. A couple with a healthy sex life would be able to speak about topics such as fantasies, desire, boundaries, frequency and any sexual discomfort. Honest conversation means addressing concerns before they turn into longstanding issues. Avoiding  these conversations often negatively impacts the erotic foundations of a romantic relationship. A healthy couple is able to have a clear conversation that avoids blaming or shaming of or by either partner. For example, one partner might say, “I’ve noticed my desire has been lower lately. I don’t think it’s about you, but I’d like us to figure it out together.” Open conversations like this strengthen intimacy.

Shared Values: Being on the Same Team

Though you don’t necessarily need to have the same beliefs to have successful relationships, it’s important that you have shared values when it comes to erotic and sexual agreements.. Compatibility goes beyond libido and can extend into beliefs on topics such as monogamy, pornagraphy, flirting, kinks and so on. Partners need to be able to discuss what sex means to each of them in the relationship. A couple should be able to delve into differing views on topics and come to a reasonable agreement that leaves both partners feeling safe and excited. For example, if one person in the couple enjoys watching porn and the other doesn’t, a healthy couple should be able to discuss the reasons for one’s interest and use of pornagraphy and why the other feels discomfort around the behavior.  Partners need to come to a joint agreement with one another on all sexual and erotic practices whether they are done in private or with one another.

With the rise of shows like Bridgerton, Heated Rivalry, and Off Campus, conversations about “smutty TV” have moved into the mainstream. But these shows may be doing more than entertaining us. Research has long suggested that media plays an important role in the process through which people develop beliefs and expectations about sex and relationships. In a 2003 empirical research review by social psychologist L. Monique Ward, one concluding argument  was that media serves as powerful sources of information about sexuality, particularly when they repeatedly portray certain ideas about attraction, romance, and intimacy. 

What makes today’s smutty media especially interesting, however, is that the fantasy often extends far beyond the sexual acts themselves. In a recent 2025 analysis study published in the journal Sex Roles, researcher Johanna Kluger found that romantic heroes depicted in contemporary romance novels have changed with modern cultural expectations. Rather than the emotionally distant, dominant heroes that were once prevalent in romance stories, today’s most popular love interests are often emotionally intelligent, communicative, and attentive. Building on this thought, in a 2018 analysis of female-authored erotica Mayeesha argues that modern work portrays stories where, “emotionally responsible masculinities are imagined for men who perform emotional labor equally to their female partner” (Mayeesha, 2018). In other words, smutty media doesn’t just portray sexual scenes solely featuring power exchange, it often showcases an idealized emotionally attuned version of partnerships. 

Are Modern Smutty TV Shows Changing Americans’ Expectations About Sex?

In recent years there have been numerous popular so-called “smutty” shows on television and streaming outlets. While no longer considered ‘trashy’ the term ‘smutty’ has become claimed by fans as something that is no longer stigmatized. What’s particularly interesting about many of today’s most popular “smutty” shows is that the fantasy they offer often extends beyond the physical sexuality itself. Shows like Heated Rivalry, Bridgerton, and Off Campus center not solely on the bodies and physical expression of the main actors, but also their characters’ emotional vulnerability, increased communication, and a growing attachment between partners over the storyline’s arc. 

The genre of the modern ‘romantasy’ has cropped up in discussions on social media platforms. Many clients who reach out for relationship or sex therapy articulate the kind of relationships they are longing for. These are clients who may be  frustrated with dating apps because of the many people who match with them are less emotionally attuned than the main characters in their favorite series.  These so called ‘smutty’, ‘romantasy’ series are offering viewers a depiction of emotionally integrated sexual relationships. They are also perhaps a reflection of Americans’ updated practical expectations around intimacy.  The expanded notions of modern erotic storytelling currently produced may be specifically marketed for the “female gaze” . Many female identified therapy clients report taking “breaks” from dating, expressing hopes to have an in real life ‘meet cute’ illustrating the longing for a return to romantic, interpersonal flirtation. . 

The Context around “Smutty” Sex Scenes Has Changed in Modern Shows 

In a 2018 study in Archives of Sexual Behavior, researchers Timmermans and Van den Bulck (2018) found that television was more likely to show explicit sex solely in casual relationships rather than in committed ones. Many of the current popular romance shows are pairing what sex therapists call sexual scripts which combine explicit sex scenes with intense emotional sharing, deep intimacy, and sweeping romantic dates . When clients of any gender come into sex therapy for help in their dating journey, they are questions like: 

• When should I begin having sex with a new partner?
• How do I tell someone I like that I need to be more connected before having sex with someone who says they have sex as a way to to become emotionally attached?
• What do I do if I lose my erection and my date thinks I’m not that into them? 
• Is it a bad thing when I fantasize about the scene I love in Off Campus while having sex with this new person I’m having sex with?
• When should I tell a guy I have vaginal penetrative pain? Should I tell him before we have sex so he doesn’t think it’s his penis size? 
• I’m so tired of a guy expecting sex on the third date, how do tell him I am looking for something intimate and I need more time before I feel connected?
• How do I tell a new partner it takes a while for me to orgasm with a new partner? 

Kluger’s research explains that historically, male leads in erotica books and films were emotionally unavailable, controlling and hyper masculine. What clinical material and these new series are illustrating is the expression and expectation of emotional intelligence, vulnerability, authentic communication and mutual empathy. In addition to these attributes, we’re seeing prolonged stories that involve yearning that lead to explicit sex scenes. In Heated Rivalry, the lead characters Ilya and Shane have years of in-the-closet casual sex over a period of three or four years while Shane encourages Ilya to share more of an emotionally connected relationship. The characters Anthony and Kate spend most of the second season of Bridgerton resisting their sexual attraction for one another while getting to know each other before finally succumbing to their yearning emotions. The fantasy in these stories expands on the slow burn–to include a slow yearn. 

In the series Normal People, the character Connell openly expresses his emotions and seeks therapy when he is struggling. This type of male character and relationship is markedly different from what audiences would have commonly seen twenty years ago. In all of these stories, sex scenes often represent more than physical intimacy; they reveal the emotional dynamics, conflicts, and tremendous personal growth within the relationship. As a result, smutty media is offering audiences more than just sexual fantasies to emulate, it is also presenting ideals about what authentic intimacy and partnership might look like.

Romantasy Smutty Shows’ Potential Impact on Relationships

While characters on series and in books are evolving, are real men’s actions evolving as well? These depictions of emotionally deep and vulnerable relationships could raise expectations among the mostly female audience they are targeting. Though media is just one influence for relationships, it is possible that these standards are unattainable or at least not what men are currently able to provide in relationships. Recently,the recorded message left by ‘voice memo guy’ has lit up social media due to the direct, emotionally deaf and self-involved question regarding his request to have sex on the second date saying his boundary is that he would only come over to her apartment for a home-cooked meal if she consented in advance to ‘hook up, cuddle and be intimate’ with him. Beyond being a clearly self-interested request for sex, what comes across is his belief that consent is a one-time question and answer exchange versus checking in throughout a sexual scenario to see what each person might want to do, or not, he uses the terms “hooking up” alongside “intimacy”.  So while this memo does not have to do with the ‘romantasy’ novels and shows being streamed, he is using the language of intimacy to illustrate perhaps what he thinks she is looking for or maybe just what he experiences as intimacy.   

Final Thoughts

Smutty shows and books may indeed be influencing expectations about partnered sex, but the deeper question is whether they are also changing the way dating people think about relationships and whether partners can live up to these fantasies. Contemporary romance media increasingly presents not only exciting sex and intense chemistry, but also idealized versions of emotional intimacy. Characters are often deeply attentive to their partners, willing to express their feelings, and committed to personal growth in ways that audiences may find both attractive and aspirational.

As Ward’s research suggests, media can play an important role in shaping our beliefs about sexuality and relationships.Modern smut or romantasies may not simply be selling a fantasy of great sex; it may also be selling a fantasy of the perfect partner. Whether these portrayals inspire healthier relationship expectations or create standards that are difficult to meet remains an open question, but they are undoubtedly expanding the conversation beyond sex itself and toward what people want from intimacy, dating, erotic connection, and emotional attachment.

In the 70s, there were a portion of twenty-somethings who were freer with their sexuality and more willing to try out new forms of partnering. Now the media is focusing on the advent of young adults avoiding sex. Research studies report that young adults today are having less sex than previous generations. In a nationally representative 2020 U.S. study published in JAMA Network Open, researchers found that sexual inactivity increased among young adults between 2000 and 2018, with nearly one in three men ages 18 to 24 reporting no sexual activity in the previous year.

At first glance, the research appears to be clear: young people are reporting fewer sexual partners than preceding generations but how exactly are the researchers defining sex?

Many studies define sex narrowly, often focusing on penile-vaginal intercourse among heterosexual participants. But sex therapists and sexuality researchers have long argued that sexuality encompasses far more than intercourse alone. If we broaden the definition to include oral sex, mutual masturbation, sexting, erotic touch, virtual sexual experiences, and other forms of sexual expression, the picture becomes more complicated.

There are many hypotheses as to why people are reporting less sex overall. Dating apps might lead you to believe that people have more opportunity for sexual encounters, but while there is greater access to partners, there is less casual sex happening. People just are not meeting in adventurous or spontaneous ways anymore that would ultimately lead to fun casual hookups. 

One of the main hypotheses researchers have explored is that twenty-somethings are taking longer to grow up than their parents did. In a 2021 article published in Socius: Sociological Research for a Dynamic World, sociologist Jennifer M. Silva argued that the transition to adulthood has become prolonged and individualized, with many twentysomethings spending more time pursuing higher education, establishing financial security, and reaching traditional adult milestones later than previous generations. As a result, long-term committed relationships and marriage are often postponed until the later twenties or beyond.

When heterosexual sex therapy clients in their twenties show up for treatment, they report having had sexual hookups, casual situationships, or short romantic relationships starting in high school or college.  However, what they often also describe is a lack of experiences in which: they felt fully confident in expressing their sexual desires, penetrative sex felt transactional, pressured and at times coercive or assaultive. When taking a sexual history, a sex therapist will also ask about whether someone experienced sex while sober or if most of their encounters occurred under the influence. These narratives expand on the findings of quantitative studies. Thus, “less sex” does not necessarily mean less sexuality, desire, or erotic exploration. 

Less Sex Doesn’t Always Equal Less Sexuality

Sexuality researcher Debby Herbenick and colleagues (2017) have noted that while some traditional sexual behaviors appear to be declining, people may be engaging in a wider range of sexual experiences. This idea is reflected in their study, “Sexual Diversity in the United States: Results from a Nationally Representative Probability Sample of Adult Women and Men,” published in PLOS ONE, which examined a broad range of sexual behaviors beyond intercourse and concluded that U.S. adults engage in more diverse sexual behaviors than previous national surveys had captured.

This distinction matters because desire and behavior are not the same thing. A person may experience attraction, sexual fantasies, or desire while having little or no partnered sex. Sex therapy clients often report engaging in erotic experiences that fall outside conventional definitions of intercourse like interacting with sexually explicit media, online chat rooms, or erotica while self pleasuring. They may also be engaging in hookups that don’t include penetration and therefore don’t define that encounter as ‘real sex’. Some clients may describe encounters with sex workers like masseuses that provide ‘happy endings’ or sex workers that offer oral sex. These distinctions that aren’t necessarily reported in surveys and studies raise an important question: 

Are young people having less sex, or are they just expressing sexuality differently?

The answer may depend on how we define sex in the first place.

Are LGBTQIA+ Folks’ Experiences Different?

Another limitation of many studies is that they have historically focused on heterosexual populations and heteronormative definitions of sex. For example, Ueda and colleagues’ (2020) study in JAMA Network Open measured sexual activity primarily through the frequency of sexual intercourse and number of sexual partners, illustrating how much of the literature has relied on traditional, heterosexual-centered definitions of sexual behavior.

For LGBTQIA+ individuals, sexuality often includes a broader range of behaviors and experiences that may not fit neatly into traditional research categories. As a result, statistics about declining sexual activity may not fully capture the experiences of sexual and gender minority populations. For example, many gay men identify as a “side” rather than a “top” or “bottom,” meaning they do not engage in penetrative sex. Queer women may prefer external stimulation, or what sex therapists call “outercourse,” without viewing their sexual experiences as any less meaningful. According to a 2025 International Journal of Sexual Health study by Lindley et al., some transmasculine and nonbinary individuals avoid genital contact or penetration altogether as a way to reduce gender dysphoria.

These experiences highlight the importance of examining not only how often people are having sex, but also how they define intimacy, pleasure, and connection.

What Does Less Sex Mean for Intimacy?

Intimacy may increasingly be sought through digital connection. Long-distance relationships can now be maintained through phone calls, FaceTime, and texting in ways that might not have been possible years ago. At the same time, sex therapy clients often describe more erotic engagement online, which may contribute to less physical intimacy in person and is worth examining because it may not be as emotionally nourishing.

It would be interesting to explore whether Gen Z and Millennials feel a loss of intimacy or are simply finding it in new ways. While technology provides new outlets for connection, certain aspects of in-person intimacy remain difficult to replace. Physical touch, eye contact, and shared experiences all contribute to feelings of closeness in ways that digital communication cannot fully replicate.

What Should be Researched More Fully?

A more interesting conversation could ultimately revolve around how ARE the general public and our sex therapy clients defining sex and sexuality? If young people are delaying relationships, exploring intimacy online, or engaging in forms of sexuality that fall outside traditional definitions of sex, then simply counting sexual encounters may not tell the whole story. Desire, intimacy, and sexual well-being cannot be fully measured by the number of partners someone has or how often they have penetration.

New Research highlights Notable Results on Mental Health, Sexual Relationships, and Loneliness in the Age of AI.

The Loneliness Paradox

May is National Mental Health Awareness Month in the US. This year’s theme, “More Good Days, Together,” focuses on the importance of connection, support, and community in emotional well-being. The campaign’s message feels especially relevant to these times, when many clients report to their therapists that they feel increasingly lonely despite being digitally connected to just about everyone in their lives. The American Psychological Association’s 2025 Stress in America survey found that over 6 in 10 U.S. adults have felt isolated over the past year.  As a relationship and Certified Sex Therapist, the expression of loneliness may be expressed through specific symptoms like: 

• A client’s reporting of low desire and less frequency of sexual intimacy with their partner. 
• A dating client talking about how much they miss being hugged or even touched. 
• A couple escalating with anger when the topic of their lackluster, boring sex life comes up in a couples therapy session.  
• A male partner stating he is having erectile issues and is afraid of initiating sex with his partner. 

Can AI Companions Help Reduce Isolation?

As loneliness continues to rise, newer studies are also exploring how artificially responsive AI tools are becoming sources of comfort and companionship for increasing numbers of people. In 2024, Chou and colleagues studied how an AI chatbot helped older adults during the COVID-19 lockdown cope with the loneliness and stress of isolation. They observed 35 adults, with an average age of 65, who had anxiety or depression. After 4 weeks of interacting with the AI chatbot, the subjects completed multiple self-report questionnaires. The researchers observed that the loneliness scores in adults over 65 years old improved. 

Similarly, in another 2024 study posted in the Journal of Psychology & Marketing, Marriott and Pitardi analyzed hundreds of Reddit posts made by users of an AI companion app in the United States, and they surveyed over 500 of those app users (ranging in age between 20-45 years old). They found that many participants described using these AI apps because they felt lonely, emotionally unsupported, or afraid of judgment from other people. For example, one user stated: “[The AI friendship app] listened to me when nobody wouldn’t. She has spoken to me when I was too vulnerable to let another human in.” The participants felt that AI was always available, trustworthy, non-judgmental, and actually helped improve their mood and mental health. 

However, these results prompt the questions many sex therapists encounter: Can AI bots or companions actually provide the sustained erotic, sexual, and emotional intimacy that is inherent in an IRL relationship? 

Can it be used as a tool to help folks with social anxiety learn the skills needed to approach a person in real life?  

When overusing AI, some users reported actually feeling as if they were escaping real life, real friends, and real forms of support like therapy. Marriott et al. found that becoming addicted and developing an unhealthy reliance on AI can hurt social and mental well-being rather than help. Many sex therapy clients who begin sex therapy report that they are addicted to porn, overly reliant on a chatbot, and that it is causing harm to their relationships, their work life, and their sense of self-respect. When discussed in therapy, they often describe their online world as easier to engage with than the confusing or overwhelming world of IRL dating or relationships. My colleague Esther Perel describes the online world of AI chatbot experiences with adjectives like “frictionless, polished, one-way”.  Having relationships without a real, differentiated person on the other side who has a different need or opinion is not actually a relationship; it is a self-curated experience. Over time, a person with social anxiety or trauma may feel less capable of engaging with the world over time because they are not building the muscle of relationality.  

While digital communication and AI tools may help reduce feelings of loneliness in the near term, they do not fully replace the nourishment that people can access through in-person emotional connection, physical touch, mutual vulnerability, and sexual intimacy.

What Does the Research Say About Mental Health Benefits of Sexuality

In a 2025 systematic review published in Behavioral Sciences, Pollard et al. examined the relationship between sexual health and mental health in over 3,000 records. The researchers found that sexuality should NOT be considered separate from overall well-being. Rather than defining sexual health as the absence of sexual dysfunction, the paper highlights the importance of other factors like sexual satisfaction, desire, pleasure, and intimacy. These aspects of sexual health were linked to higher psychological well-being and better physical health. For example, they discussed that due to the fact that orgasms are followed by a release of hormones like prolactin and oxytocin, orgasms are a solution to release stress in all humans. Therefore, one of the evidence-based lessons a therapist can pass on to their clients is that Better Sex=Better Overall Health. And always add the caveat that sex can mean all types of touch and connection and does not always involve penetration.  

5 Ways to Create More Emotional & Sexual Intimacy

This Mental Health Month, “More Good Days, Together” is an invitation to get honest about what technology should be used for and what it cannot replace. Here are a few places to start:

• Notice the patterns. Is AI support being used for situations when a friend could be  texted? Try choosing two-way connections over frictionless one-way experiences.
• Prioritize physical touch. Whether with a partner or through therapeutic touch like massage, physical contact releases oxytocin and lowers cortisol levels.
• Initiate one vulnerable conversation this week. Ask a partner or close friend what experiences they are longing for. Then take a turn sharing one’s own desires if one feels safe to do so. These moments build the neural feedback loops, which grow a person’s capacity for mutual emotional connection that AI simply cannot provide, since it is, in fact, not sentient. It was built to serve, not to create a true give-and-take experience. I would recommend researcher Arthur Aron’s 36 Questions study, which showed increased interpersonal closeness, first published in the 1990s. You can practice these with a friend or a romantic partner. 

  

• Use AI as a bridge, not a destination. If a chatbot helps process a difficult feeling or situation, and lets one practice speaking about one’s feelings, then ensure that you take the next step of trying out these conversations with an IRL friend, a partner, or a therapist. 
• Schedule pleasure and block time for intimacy, solo or partnered. With sexual satisfaction being tied to lower anxiety, it really deserves to be part of a person’s wellness practice.

How Sexuality Responses Change After Sexual Assault

When discussing sexual trauma in professional therapy articles, conferences, or in media catering to the general public, it is presented solely on what has been lost by survivors, i.e., sexual desire, erotic excitement, or a sense of embodiment and pleasure in one’s body. While these sexual symptoms are described frequently in sex therapy by sexual trauma survivors, they are only part of the broad array of sexual and erotic experiences that survivors can heal from and gain agency over time in sexual trauma-focused somatic sex therapy treatment.

In both clinical work and in new studies, there are more hopeful outcomes reported by sexual trauma survivors around their partnered and solo sexuality. Many survivors learn that the responses they express with partnered sex fall into one of the four Fs of trauma responses, namely: fight, flight, fear, and fawn. While many survivors do struggle with avoidance of any partnered sex, pushing partners away when triggered, or a pattern of disassociation during sex, others continue to experience desire and curiosity for partnered intimacy. Consequently, not all survivors of sexual trauma respond the same way to erotic and sexual experiences, and their sexual experiences are not always devoid of pleasure. 

This brings up an important question: What actually happens to sexual pleasure, and fantasy life after sexual trauma, and what does sexual healing actually entail?

What Kinds of Sexual Fantasies Do Trauma Survivors Actually Have?

In a recent 2024 study in the Journal of Child Sexual Abuse, Canivet and his colleagues examined sexual fantasies among 48 adult survivors of childhood sexual abuse (CSA) and 44 non-victims, all living in North America. The researchers identified ten categories of fantasies, including romantic connection, group sex, and emotional needs like sexual validation. Interestingly, the most common fantasies amongst the two groups were strikingly similar. In both groups, genital stimulation and oral interactions were the most popular fantasies. These were followed by two fantasy categories equally chosen by both survivors and non-victims: 

• Submission/masochism and 
• desires and imagery about being cared for. 

Contrary to what the public may think, when looking at the overall patterns, most of the fantasy categories were reported equally by survivors and non-victims, with nine out of the ten categories reported in both groups. 

Even themes often mistakenly associated solely with trauma by the general public and many general therapists, like submission/masochism and violence, were also reported by individuals without a history of sexual abuse. This finding challenges the idea that survivors’ fantasies are inherently different or defined primarily by power dynamics or past experiences. The one category that Canivet and their team found unique to survivors might be surprising: versatility. This is a fantasy that focuses on the “openness to fully explore and embrace the diverse roles within sexual power dynamics”. When clients in sex therapy are asked about their fantasies they’d like to experience, they frequently describe their desires to enact roles in both the submission and dominance realms of power exchange. Some describe sexual behaviors associated with BDSM (Bondage, Discipline, Sadism/Masochism) while also expressing to the clinician that they feel terrible shame after watching these kinds of scenes in porn or experiencing them consensually with a partner.

For some survivors, kink fantasies may serve as a way of gaining mastery over the past traumatic experiences by shifting the dynamics of what once felt out of control into full control within their agency. The wide range of fantasies in this study stressed that most survivors did not report fantasies that included violence or sadism. 

This study supports the critical finding that sexual fantasy exploration by trauma survivors is more diverse, individual, and not defined by any single pattern.

Sexual Behaviors Experienced by Survivors Vary Widely

The variability in fantasy life is illustrated in survivors’ lived sexual experiences as well. In a qualitative study published in 2018 in the Journal of Sexual Research, O’Callaghan et al. conducted in-depth interviews with 45 adult female sexual assault survivors and 45 of their informal support providers (partners, family members, etc.) who were not survivors, with interviews taking place on average about 12 years after the assault. 

Rather than finding one consistent pattern in their sexual responses, the study found a wide range of behaviors in survivors’ sex lives. Some trauma survivors became more sexually active by taking more than one sexual partner, while others leaned towards sexual abstinence. 

Notably, none of the survivors described having an explicit fear of sex. 

Instead, many describe a loss of interest, often due to past repeated victimization in sexual encounters or relationships. These are the clients who self-refer to sex therapy with the presenting problem of having a low libido. This is a problem that is causing rifts with their partner or making them feel like they’re missing out on what could be more pleasure in their sex life. 

In O’Callaghan’s study, many participants described having positive sexual experiences in romantic relationships, especially when their partners were communicative, respectful, and attentive to their boundaries. Some partners adjusted their approach to intimacy by moving more slowly and asking for consent more explicitly. For example, one participant verbalized to their partner: “If oral sex bothers you, we don’t have to do it. We’ll just go at your own pace”. 

Sex therapy helps survivors and their partners in couples treatment to learn new verbal scripts like those stated in the study to engage more confidently and safely with partners. It also teaches survivors to recognize when they are being triggered and/or disassociating and asking their partners to stop and pause the sexual activity. This break allows them the space to do grounding and breathing techniques to reconnect with their body and lower the impact of the trauma symptoms. These skills allow a survivor to slow the pace of a sexual encounter so they can engage with a partner who can support their growing sense of safety and agency. 

While challenges such as triggers or mismatched desire are common symptoms among survivors in sex therapy, this study shows that sexual experiences after sexual trauma are not defined solely by avoidance or disconnection. They can also include connection, safety, and sexual pleasure.

What Sexual Trauma Sex Therapy Provides

According to a 2013 Journal of Sexual Medicine study and clinical experience, sexual trauma survivors benefit from actively engaging in healing through a variety of healing modalities, including: 

• Individual sex and trauma psychotherapy 
• couples sex therapy
• support groups, and 
• creative outlets like art therapy or dance classes.

Both the research and clinical techniques described in this blog focus on a sexual assault survivor of any gender or orientation, developing a more intentional, self-defined relationship with their own sexual pleasure. Through sex therapy, survivors learn communication skills, techniques to decrease levels of shame, grounding exercises, and gain accurate education about the wide spectrum of authentic fantasy and sexuality. These interventions open up the wide possibilities of pleasurable sexual behaviors that are consensual, more aligned with their fantasies, and less constrained by trauma triggers and self-limiting beliefs.

New research provides key insights into what partners need when it comes to more pleasurable sex.

In most general couples/relationship therapy, there are common relational and systemic dynamics that affect most romantic relationships, such as:

• communication patterns
• attachment styles of each partner
• past traumas (including sexual trauma, childhood trauma, domestic violence)

However, there is another critical factor that shows up frequently in individual and partner therapy with a Certified Sex Therapist, which can be frequently overlooked by a general couples therapist and/or a romantic partner: Negative self body image.

Many people who struggle with sexual connection, low desire, or relationship satisfaction may not be struggling with the love they feel for a partner or the level of commitment they have to their romantic relationship(s). What they may secretly be challenged by is the lack of comfort and safety they have in their own skin.

A negative body image can come along with a host of symptoms, including avoidance of:

• initiating sex
• expressing desire to a partner, and/or
• communicating boundaries.

In a recent 2025 study in Behavioral Sciences, Rizzo et al. examined these less commonly researched connections on body appreciation, sexual esteem, and sexual assertiveness influenced relationship satisfaction. They found that the way people feel about their bodies and whether this impacts their communication really contributed to how they showed up in their sex life, which in turn can affect their romantic relationship(s) as a whole. These research findings align with the goals the Sex Esteem® framework was created to improve in somatic sex therapy sessions.

The Study: Who Was Included and What Was Measured?

Rizzo and colleagues (2025) recruited 473 Italian adults (50.1% men, 49.7% women; ages 18–49) who were currently in heterosexual romantic relationships.

The participants completed four self-report assessments on:

• Body appreciation (Body Appreciation Scale-2)
• Sexual esteem (Sexual Esteem subscale of the Multidimensional Sexuality Scale)
• Sexual assertiveness (Sexual Assertiveness Questionnaire, focusing on initiating sex and refusing unwanted sex)
• Relationship satisfaction (Dyadic-Familiar Relationship Satisfaction Scale)

The researchers then used structural equation modeling (SEM) to test how these key pieces were connected in those relationships.

The Power Of Both/And: Intrapsychic Sexual Self-Esteem With Interpersonal Communication Skills

Rizzo et al. discovered that when individuals felt more accepting and positive toward their bodies, they also were more confident sexual partners. However, the correlation the authors reported was: “Sexual assertiveness, but not sexual esteem, was positively associated with relationship satisfaction”. In other words, a person having body positivity on its own isn’t enough to improve one’s sex life. It was only when the subjects felt more confident enough to take actions like:

• initiating sexual activity
• communicating their desires and
• clearly accepting the sex they wanted and declining unwanted sex

that the subjects reported improvement in their sexual and romantic relationships.

The difference between sexual esteem on its own versus when it is combined with sexual assertiveness is shown to be critical in this study and in clinical sex therapy.

Internal confidence is great, but alone doesn’t equal relational happiness.

In a somatic sex therapy clinical framework, two key cornerstones are confidence and communication skills. As confirmed in this study, what matters most to adults in a sexual relationship is how their sexual esteem is enacted through clear, confident communication skills followed by actions. Without clarity on what is wanted in a sexual scenario and the limits of what will be a consensual shared sexual encounter, partners frequently find themselves falling into patterns of:

• avoidance (experienced as personal rejection by a partner)
• compliance (resulting in duty sex)
• unspoken (or passive-aggressive or aggressive) resentment over time.
• potential non-consensual and/or coercive sexual encounters.

Further Research Results on Body Image and Sexual Function

The previous study results are consistent with prior research on low body image self-esteem. A 2023 study in the Annals of the Academy of Medicine, Singapore, found that poorer body appreciation was significantly associated with female sexual dysfunction in a questionnaire given to 514 sexually active young women (21-35) (Husain et al.).

In past studies, researchers focused on how being overweight or underweight as a physical factor can impact people’s sex lives. However, similar to the previously cited study by Rizzo et al, Husain et al. found that a negative body image had a strong impact and relation to sexual dysfunction, unlike BMI (body mass index).

Specifically, lower body image and lower self-esteem were linked with poorer scores on the Female Sexual Function Index, whereas BMI categories (e.g., overweight) did not show a strong association with sexual dysfunction outcomes. This suggests that how a person perceives their body matters more than people may think.

How Negative Self-Body Image Intersects with Sex Therapy Skill-Building

Both these studies, along with sex therapy clinical experience, illustrate that when a partner feels disconnected and/or negative about their own body image, it is usually combined with less than optimal communication skills. Sexual avoidance, difficulty initiating, or the lack of communicating preferences can slowly destroy intimacy over time.

Rizzo et al. (2025) remind us that relationship satisfaction is not built on sexual self-esteem alone, although it is helpful. It is the combination of the ability to use that internal security for authentic relational clarity in communication with a sexual partner. Having the courage to say “I want you,” “I don’t like that type of touch,” or “This stimulation feels good” requires a Sex Esteem® confidence, communication skill, and trust in one’s partner to listen without defensiveness, minimizing, or gaslighting. Therefore, improving intimacy may not only include improving or maintaining one’s positive body image but also gaining verbal and non-verbal techniques to express the nuances of what one truly desires and listening to a partner’s needs and wants without feeling pressure to immediately consent, people-please, or enact a sexual scenario.

Positive sexual self-esteem is one cornerstone of gaining authentic Sex Esteem®. It is the development of one’s sexual voice along with improved communication techniques, as the research above suggests, that helps to build improved relational and sexual satisfaction in relationships.

New research busts myths about the best advice for post-breakup recovery.

After a breakup, most young adults are often encouraged to take time to heal without rushing into dating again. After a relationship ends, broken-hearted partners may hear advice like “rebounds are an unhealthy coping mechanism.” However, in a recent 2025 peer-reviewed study in the Archives of Sexual Behavior, researchers reveal surprising results. The article suggests that getting involved with someone new after a breakup may actually be a positive thing.

The study, Breaking Up and Bouncing Back: Distress and Post‑Breakup Adjustment of Young Adults, examined over 800 young adults aged 18-25 who had just experienced a breakup from their romantic relationships. The authors, O’Sullivan, Belu, and Wasson, tracked how levels of self-esteem, distress, and intrusive thoughts changed if they stayed single or entered a new relationship. The findings were eye-opening, especially when psychotherapists usually caution clients from entering rebound relationships soon after a relationship breakup. 

What the Research Found

The researchers conducted their studies using anonymous online surveys with young adults who identified as heterosexual, gay, lesbian, and bisexual. The authors discovered that the breakups were distressing for both partners, regardless of who initiated the breakup. The pain of heartbreak impacts both partners as the daily routines, emotional comfort and sexual connection have now abruptly ended. It is in the recurring and at times obsessive thoughts about the rituals and emotional experiences that cause partners to feel increased feelings of anxiety and a sense of being frozen. 

The study found that people who stayed single after the breakup struggled more frequently with these ruminating thoughts and painful memories. However, the researchers in this study discovered that those partners who rebounded with a new relationship or situationship after a breakup were able to function more easily. While the subjects still experienced grief, the new romantic connection helped them with moving forward with their day-to-day functioning. 

Additionally, the study reported that the rebounding partners’ overall well-being and confidence were greater because they felt desirable again. The study did not explore whether the rebounding relationship lasted a specific amount of time. However, they did discover a curious finding for therapists to hold in their clinical toolkit. The key to better functioning was not that the rebound relationship was going to lead to a new, longer-term relationship or marriage, but that it functioned more as a lifting out of the ruminating habit. The main cause of the post-breakup distress wasn’t the grief itself, but the intrusive and persistent thoughts partners continued to have about their ex-partner. The rumination and obsessions were what kept people stuck.

The Second Arrow: Why Rumination Hurts So Much

This finding aligns closely with the clinical teaching, the Buddhist concept of the Second Arrow, which I introduce to clients in my practice. In this parable, the first arrow that strikes a person is equivalent to a painful event, whether it’s a physical injury or a relationship breakup. The second arrow is what happens when one shoots themselves by adding in self-blame and the negative mental load. 

To break free from it, one must not allow the cycle of negative thoughts to win. Naturally, when people go through a breakup, their mind often fills the silence with rumination. So, in therapy with post-breakup partners, teaching them to mindfully reduce their obsessive thoughts about their ex-partner, while still mourning the loss of the relationship, can be a critical therapeutic technique for their recovery.

A Both/And Approach to Healing from Heartbreak

Many therapists may still hesitate to encourage their clients to initiate a rebound relationship. However, the takeaway here isn’t recommending that heartbroken partners should jump into relationships in order to avoid processing their feelings. Therapists should be open to their clients starting to date while also using therapy to both mourn the past and not isolate themselves in obsessive thought loops.

Mel Robbins echoes this in her Let Them framework, articulated in her podcast and her book. She highlights the importance of no-contact periods after breakups. She even points out that things like “a revenge diet” because of an ex may cause a partner to remain too emotionally enmeshed with their ex. According to Robbins, in order to get over a breakup, a person has to untangle all the aspects of the previous relationship from the new reality. To rewire the brain away from shared routines and constant reminders. In her book, she says: “You have to unlearn your life with them so you can start living your life without them.” 

How to Rewire The Post Breakup Mind

Clinically, this study reminds us that many clients struggle less with grief and mourning itself and more with psychological rumination. Interventions that reduce rumination, like cognitive reframing, emotional expression, and social connection, may be more impactful than focusing solely on “closure.”

Here are tips that will help clients mourn a breakup while rebuilding their lives. 

• Don’t ignore and suppress your feelings
• Return to daily routines you did before the relationship to give a sense of stability
• Talk openly with supportive friends or family instead of isolating
• Join a support group for breakup partners
• Allow the feelings without feeding into obsessive thought loops
• Begin a daily mindful meditation practice to help battle rumination
• Avoid emotional discussion with your ex-partner if it’s a final break. Revisiting the decision isn’t helpful to either partners unless you and they are open to couples counseling.
• Don’t wait too long to start dating again; go out for casual dates to regain confidence and to have some fun. 

Self-pleasure, dating, creative engagement, and new experiences with people can all help to disengage the mind’s rumination and get unstuck. Breakup recovery isn’t about waiting a prescribed amount of time before dating again. It’s about helping and supporting partners to move forward with a clear mind, rather than an obsessive one.

How to create more meaning of your gift-giving experience with your partner. 

The holiday season of Christmas, Chanukah, and Kwanza can be filled with a lot of tasks: planning family gatherings, attending social obligations, confirming travel reservations, and of course, the expectation of purchasing and receiving gifts. While it is true that a gift can serve as an expression of love, many times it is bought in haste, along with so many other items on the checklist. This can then be felt as less meaningful to the partner who is the receiver, and does very little to provide emotional, romantic, and erotic growth to the relationship. Research shows that gifts aren’t solely a tradition, but rather, are great tools to help couples reconnect, show love, and strengthen closeness. Here are three frameworks to help spouses and partners buy a more emotionally attuned gift for their partner this holiday season. 

Tip #1: Gift Giving May Be More Effective Than Speech

In a 2024 study in the Journal of Consumer Psychology by Howe, Wiener, and Chartrand, they found that receiving a small, thoughtful gift was sometimes more effective than a supportive conversation. The participants who received a gift from a loved one reported stronger feelings of being cared for, valued, and emotionally satisfied than those who were simply told kind words. This also aligns with research connected to the Five Love Languages framework. A 2024 study by Impett et al showed that when people rated each love language separately, more than 50% showed that gifts were one of the most meaningful ways they feel loved. 

Additionally discussed by Howe, Wiener, and Chartrand was how crucial it was for the gift to be given intentionally and with the receiver in mind for it to hold such significance. The study specifies that this gift does not have to be something large or expensive; it can be as simple as a scented candle. A carefully chosen gift can reinforce one’s partner’s emotional presence and commitment. 

Tip #2 Experiences or Objects — Both Can Work, If They Include Personal Meaning

When it comes to gift-giving, experiences are rising in popularity, and there is a reason for it. In a Journal of Consumer Research paper by Chan & Mogilner (2016), experiential gifts such as date nights, games, and trips are reported by participants as more effective than receiving objects due to the shared memories the experiences created for the participants. These shared meaningful experiences deepened the relationship in a stronger way than did material gifts. A client described how she created a scavenger hunt around the apartment she shared with her boyfriend, as she knew he loved this game. It ended with a gift card for a private session at a local karaoke bar he loved to go to with their friends. However, this same study also emphasized that emotionally evocative material gifts can also be powerful. These material gifts would include objects with meaning that carried an emotional resonance. When a client had a unique cake from a specific region of Italy delivered to his boyfriend as a holiday gift, his partner was so moved, as they had initially tasted it together on their romantic vacation the summer before. 

Newer research reinforces the benefits of experiential gifts. Across three different recent experiments led by Puente-Díaz & Cavazos-Arroyo with college-aged students, the researchers found that experiential gifts (like events, activities, or shared experiences) make people feel more autonomy-support than material gifts. Autonomy support is defined as the feeling by the recipient that their gift feels like it aligns their particular preferences, individuality, and in essence “fits who they are”. Thoughtfully chosen experiential gifts evoke stronger feelings of being understood, respected, and valued.  

This can readily be seen when the experience is actually not something the giver is that into, so in essence, the gift is very clearly a scenario that is solely for the pleasure of the receiver. A clinical example occurred when a wife relayed how she booked a reservation for an all-day spa day for her husband and her, despite the fact that she had never really been a huge fan of saunas and jacuzzis. She purchased it and took a day off work because she knew how much pleasure he’d get from not only the spa but the fact that she took the time and was there, sharing the experience with him.

In short, the intention, the alignment, and the sharing of the experiential gift to the receiver resonated as deeply than solely the gift itself. So whether an object-gift is a book the giver knows their partner will love, a bottle of sensual massage oil with an invitation to an intimacy date written on a heart shaped homemade card, or an experiential gift of an intimate relationship card game, intentional objects and experiential gifts like these have both been shown to be felt as more meaningful by the receiver than a costly but impersonal gift. 

Tip #3 Gifts Are Relationship Wellness Experiences, NOT a Holiday Duty

What also makes gifts so powerful is their ability to express nonverbal loving communication and a way to tend to the wellness of one’s relationship. They can express care, support, validation, and playful passion, feelings that become even more valuable when so much of the verbal communication during the season gets drowned out by the noise of holiday logistics and planning. Gift giving is a way to enliven the erotic, romantic, and sexual energy of a relationship through the surprise and novelty of the gift, which are keys to the emotional and sexual wellness of every relationship.  Rather than viewing gift-giving as a duty, expanding the concept of experiential and meaningful gifts is a critical strengthening practice for any relationship. Over time, these small gestures of attention and bonding can grow a couple’s foundation beyond trust, emotional safety, and openness to inspire spontaneity, flirtation, and sexual excitement.