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.

Why do heterosexual women climax less often than their lesbian and bi peers?

According to a 2024 study published in the Journal of Social Psychological and Personality Science, 65% of heterosexual women, compared to 95% of men, report experiencing orgasm when having sex, which reveals a significant contrast in orgasm rates between heterosexual women and men. However, this gap diminishes substantially when considering lesbian women, among whom 86% usually or always experience orgasm during sex. Additionally, the orgasm gap almost completely disappears when women engage in masturbation or self-pleasuring involving clitoral stimulation. Therapists working with clients need to feel more comfortable in speaking wtih their clients about their sexual behaviors and fantasies in order to support diverse definitions of pleasurable sexual experiences and to encourage more agency around speaking about each of their sexual and erotic needs. As we celebrate Pride, it’s time therapists and clients become more curious about the underlying factors contributing to the orgasm gap between queer and heterosexual women. This curiosity to ask more directly about clients’ sexual challenges and interests allows for increased erotic intelligence both in the professional and layperson population. It can also hopefully facilitate female-identifying clients to feel more sexual confidence to explore their needs when it comes to reaching orgasm.

The Orgasm Gap

The concept of the ‘orgasm gap’ stems from previous research highlighting the statistic that heterosexual and gay men experience orgasms more frequently than women during partnered sexual encounters. Additionally, this term can also speak to the difference in reported orgasm rates between lesbian and heterosexual women.

According to Grace Wetzel, one of the study’s authors, “there is nothing inherently biological” about why an ‘orgasm gap’ exists. In other words, the majority of women have the physical ability to climax during sex, yet, heterosexual women don’t report having orgasms in partnered encounters nearly as frequently as men.

According to the 2024 study by Kate Dickman et al., orgasm frequencies vary not based on gender but based on sexual orientation. The study shows a notable 21% disparity in orgasm rates between straight and lesbian women, whereas the gap between straight and gay men is only 6%. Continuously, bisexual women also report low rates of orgasm that more closely resemble the rates of straight women. However, one of the study’s most intriguing findings, was that 64% of bisexual women experience orgasm when their partner is a woman compared to 7% when their partner is a man. Therefore this study suggests that the difference in orgasm rates may be due to the gender or the partner during sex and/or what kinds of sexual activities in which they participate.

Social Scripts and How They Affect Orgasms 

Given that the traditional scripts about sex involve “foreplay,” vaginal intercourse, and the man’s orgasm, clitorial stimulation is often overlooked in media, conversation, and education about sex. Research indicates that breaking away from these predefined scripts can result in increased sexual satisfaction and orgasm rates. Additionally, when women experience fewer orgasms, they may begin to devalue them during sexual encounters. This study underscores the inadequate focus on clitoral pleasure when cis women engage in sexual activity with men, especially considering that many women do not achieve orgasm through penetration alone. How can women effectively communicate their needs, and how can men and partners ensure their female counterparts experience equal pleasure? What changes occur when traditional sexual scripts are discarded?

What We Can Learn from Queer Couples

In 2003, The Gottman Institute conducted a groundbreaking 12-year longitudinal study on gay and lesbian couples, one of the first of its kind. The study revealed that during conflicts, gay and lesbian couples exhibit more positivity, are better at comforting each other, and demonstrate greater kindness compared to heterosexual couples.

Additionally, queer couples were found to use fewer emotionally manipulative and hostile tactics, which researchers interpreted as indicative of greater fairness and power-sharing dynamics within these relationships. The research also showed that the Gottman Method Couples Therapy was twice as effective and required half as many sessions for gay and lesbian couples compared to heterosexual couples. Based on both research studies, queer couples serve as exemplary models for effective communication, innovation, exploration, and mutual satisfaction in sexual encounters.

While queer couples enjoy advantages like increased orgasm rates and more equitable power dynamics, they also encounter distinctive challenges. Queer individuals may face higher rates of prejudice, contend with greater internalized shame, and may find self-acceptance more difficult. However, there are many lessons we can extract from queer relationships to benefit our own intimate relationships in general.

Lessons to increase pleasure:

1. Center female pleasure during sexual encounters, which involves expanding beyond penetrative sex alone.
2. Take some time by yourself to learn what you like and don’t like.
3. Explore the use of toys and engage in sexual activities that focus on clitoral stimulation, ensuring comfort and consent throughout the experimentation process.
4. Gently massage the surrounding area of the clitoris as an alternative to direct stimulation, recognizing that direct contact may feel overwhelming or painful for some individuals.
5. Be mindful of erogenous zones such as thighs, neck, nipples, and breasts during sexual activity, paying attention to their stimulation both leading up to climax and throughout the experience.
6. Incorporate lubrication to enhance smoothness and comfort during stimulation, facilitating a more pleasurable experience.
7. Communicate your needs to your partner and listen to what your partner needs in and out of the bedroom

Key terms for cis-gender females to learn as part of a Sex Esteem® tool-kit when it comes to penetrative sexual pain.

According to a nationally representative study of American adults, about 30% of cis-females have experienced pain during vaginal penetrative sex. When sex therapy cis-female clients come to treatment for individual or couples treatment, one of the issues they’re asked about is whether and how often they have had pain during vaginal penetrative sex. Painful sex not only impacts the cis-woman experiencing it but her partner(s) as well, especially if the pain has occurred over months or years. This is why painful sex should also be treated in couples sex therapy when a client is involved in a committed partnership or marriage.

There are several diagnostic terms that are used by medical professionals, therefore as part of developing one’s Sex Esteem® confidence it’s important to learn some key terms when discussing sexual pleasure with partners and treatment needs with medical professionals. 

Here is a primer on best principles in seeking help,  the most common terms, assessment techniques, and explanations for women to learn if they are experiencing sexual pain.  

Sex Esteem® Principles around Seeking Medical Care for Sexual Pain

Many cis-women have suffered with GPPD for years without getting a proper diagnosis from their medical professsionals. One reason may be due to the fact that of the 43% of American women aged 18 to 85 who report experiencing some form of sexual complaint, only 12% self-report to a provider.  In fact,  a woman might use understated terms like ‘discomfort’ or ‘uncomfortable’ when describing the sensations they’re experiencing during vaginal penetrative sex to their gynecologist instead of the word ‘pain’. 

Part of the Sex Esteem® Principles is to empower clients to become their own best advocates when it comes to reporting pain to medical providers. A sex therapist will coach clients to use a numbered scale system out of 10, when describing the level of pain, to discourage them from minimizing the level of pain by using mild adjectives. A sex therapist should also teach women to use the proper terminology to identify and tell their ob/gyns the location of the pain and by coaching them with these key questions that should be asked by their doctors:

• If their vestibule (vaginal opening) is a clock that their provider is facing when examining them, what o’clock is the pain usually felt upon penetration? 3 o’clock,6 o’clock, etc? 
• Is the sensation they feel more like burning, cutting or tearing and is it on the inner labia or both inner and outer labia? What level of pain is it on a scale of 10? 
• During penetration, does the sensation feel like searing pain or an aching thudding pressure against their vaginal walls? 
• Do they feel a sharp pinch when a dildo or penis bumps up against their cervix during penetration?
• Before making an appointment with a new gynecologist, we will practice asking a medical provider if they utilize a Q-tip assessment of the vestibule as part of their exams. 

The second challenge for cis-females seeking medical care for vaginal pain is that the majority of ob/gyns unfortunately have not had any or much training and clinical experience in female sexual disorders during their medical school education or their residencies. A recent survey reported that out  of 236 American medical school students, 58.5% reported receiving instruction in female sexual disorders (FSD) compared with 78.4%  who received training in male sexual disorders (MSD) in their preclinical curriculum. It’s clear that medical schools have to do more to increase the amount and depth of training around FSD. 

Pelvic Floor Muscle Dysfunction (PFMD) & Physical Therapists

The pelvic floor often refers to the muscles, tissues, nerves, and ligaments that are a bowl-like structure that supports one’s pelvic organs used for digestion, urination, and sexual activity. Research has shown that 25% of women experience one or more pelvic floor disorders in their lifetime. Pelvic floor muscle dysfunction (PFMD) is often classified into two main types:

Hypertonic: the muscles in the pelvic floor have tightened at rest and/or shortened, which causes spasms or pain.   

Hypotonic: the muscles are lengthened at rest, which weakens them. It is hard to contract your muscles with this condition.

Most cis-women who seek out sex therapy after years experiencing pain during sex require a multi-disciplinary biopsychosocial approach that includes a pelvic floor physical therapist to teach them how to strengthen hypotonic muscles and to provide pressure point massage to release hypertonic muscles.  

Most Common Sexual Pain Disorders and Proper Diagnostic Terms

1. Sexual Pain Disorder: Genito-Pelvic Pain/Penetration Disorder (GPPPD)

The Diagnostic and Statistical Manual of Mental Disorders (DSM5) categorizes Genito-Pelvic Pain/Penetration Disorder (GPPPD) is a sexual pain disorder, occurring in the vagina, the vulva, the opening and/ or inside the belly either during vaginal penetration, or spontaneously. 

1. Vulvodynia: chronic pain in the entire vulva, or in multiple areas in the vulvar region.
2. Vestibulodynia: pain in one’s vestibule, which is the tissue, at the opening of the vagina, within one’s vulva. 
3. Neuroproliferative Vestibulodynia (NPV): Women often have too many nerve endings in their vestibular tissue.
4. Vaginismus This term was removed from the DSM 5 since most women who have fear, anxiety and accompanying involuntary vaginal muscle spasms usually also have a co-occurring pain disorder so this term was incorporated into the updated GPPPD diagnosis described above.  However there are many women who have fear and spasms who have NOT experienced pain and the spasms are due to a phobic or trauma related response.  These may be women with a sexual trauma history and/or have grown up in a strict religious upbringing.  

Sex therapists conduct a thorough sexual history when working with clients to find out how long a woman has experienced Vulvodynia and Vestibulodynia or NPV, where exactly it is felt, under what conditions and how they have dealt with it when it comes to their sexual relationships. They also work with the woman with her partner or husband in order to teach them alternative techniques to increase both partners’ sexual pleasure and avoid continued painful experiences. As we know from both clinical care and research, partners exploring other types of sexual play and oral or anal penetration may experience high rates of pleasure and orgasm while a woman is getting treatment for her GPPPD. 

They’ll ask if the condition is Primary (meaning they have had pain their whole life) or

Secondary or acquired (pain developed later in life). They’ll also ask under which conditions the pain occurs; is it when the area is touched or during insertion of a tampon, finger or penis/dildo (provoked) or quite spontaneously while walking around or sitting (unprovoked)?

Sex Esteem® Steps to Advocate For Yourself if You are Experiencing Pain or Spasms:

1. Read up on how a sexual health professional conducts an exam on a recently created ISSWSH self-help handout or at Prosayla. 
2. Find an ob/gyn who is educated in diagnosing and treating sexual pain using a biopsychosocial framework through ISSWSH. 
3. Write down a highly detailed description of the pain and conditions you’re experiencing along with how long each symptom has been experienced before your scheduled ob/gyn appointment. 
4. Request a very specific exam of the pelvis, vulva, and vagina including the Q-tip test for mapping and diagnosing pain in the vulva.  (NOTE: if your provider does not offer this type of diagnostic test it may be a sign that they are not trained in sexual pain disorders). 
5. Work with an experienced sex therapist individually and/or with your partner (if in a longstanding relationship) to re-learn how to engage in pleasurable sex while re-establishing new neural pathways in your brain in approaching sex. 
6. If needed, get referrals for a pelvic floor physical therapist from your trusted ob/gyn or sex therapist or through the International Pelvic Pain Society. 
7. And remember, one shouldn’t continue to have penetrative sex if it hurts. 

Goodbye to cuffing season and hello to horny season

As folks transition out of winter and have re-set their clocks forward, it is critical to better understand how single people can approach consensual flirting this spring fever season. Given the turnover from what singles describe as cuffing season to horny season, appreciating the nuanced shades of what exactly do these terms; flirting, wanted vs. unwanted attention, signaling actually mean? Defining and disentangling misinformed beliefs about giving and receiving attention is essential to understanding flirty and/or mating cues whether on date #1, and any subsequent date and/or sexual encounter. 

Unwanted Sexual Attention vs Flirting

A 2015 study of 52 opposite-sex pairs of college students found that only 36% of men and 18% of women accurately identified when the opposite gender was actually flirting. This study suggests that males “over-estimate female interest so as not to miss an opportunity to mate, thereby rendering their judgment more accurate when females are actually flirting, but impairing judgment when they are not flirting.” This study then found that third-party observers of these interactions did not predict flirting any better. The third-party observers detected flirting when it happened only 38% of the time. Given the coupled context of flirting, which typically requires that one individual be more active while the other partner take on a more following or receiving role, the predominance of gender role beliefs in predicting behaviors may reflect the perception that a certain role must be taken on for the flirtation dance to move ahead.

Gendered Interpretation of Flirting Signals 

Since many dating clients report that they have trouble picking up on flirting cues, how can help clients differentiate between unwanted advances and actual flirting? Even more so, how can a person agree to flirting without agreeing to anything when people can not even identify when or if they are flirting? A 2023 study examined gender differences in the aftermath of unwanted advances. They found that 71% of women in the study reported experiencing unwanted advances earlier in life compared to men, and additionally have more negative experiences and worries about rejecting unwanted advances. Given this, how do women’s flirtation cues get misinterpreted by men? 

A 2024 study on how men perceive women’s sexual interest found that when women’s global cues(i.e. clothing or appearance) and specific cues (i.e. facial expression) were conflicting (not aligned with one another) about sexual interest towards men, men often misinterpreted the women’s intentions to mean she was interested. Furthermore, according to this study,  researchers found that if a man was sexually aroused or if he usually looked upon women as sexual objects, he would be more likely to misinterpret a woman’s cues thinking she was interested when she wasn’t. 

How to Manage Expectations in the Dating Sphere

When single therapy clients discuss their anxiety around getting back to dating apps after taking a pause or starting to date after a breakup or divorce, they are feeling unsure of how to show interest so that they can go at their own pace.  Many of them find their date is more sexually assertive and at times aggressive when they’re not ready for that level. They ask for help through coaching on how to set their date’s expectations non-verbally and/or verbally. At other times, dating clients express frustration in session when they believe they are explicitly expressing themselves in a flirty manner on a date and interpret their date’s responsiveness as mutual interest only to find that they have been ghosted a few days later.  

The Influence of Gender Re-Flirting Behaviors

A 2021 study exploring what influenced non-verbal flirting which included heterosexual, bisexual, lesbian and gay participants from a college community in western Canada found gender, rather than sexual orientation, to be the primary predictor of flirting techniques. What researchers found was that “men who globally identify as masculine will be particularly likely to select masculine-typed flirting behaviors which fulfill this traditional role. Gender-role beliefs, however-which have to do with relations between men and women-did not predict flirting behaviors. Thus, for men, the individual’s identification with the traditional norms of their gender, rather than their beliefs about gendered relations, are more important to flirting behavior.”  

Interestingly, “for participants who identified as women, sexual orientation did not emerge as a predictor of flirting behaviors.” Their results support the findings of previous research, “in that they indicated no difference in flirting styles between heterosexual and sexual minority women.” However, what researchers found in this study is that what did impact women more critically in flirting behavior were their beliefs about men’s and women’s roles rather than their self-concepts of femininity or the adherence to a traditional feminine identity.

However, it is also important to note that the sample of people who identified as non-binary participants was minimal. Therefore the analysis of flirting in individuals who identify as non-binary is limited. Similarly, the measures used to determine flirting were also based on studies and measures designed for heterosexual samples, and thus, it is hard to truly say whether these scales accurately portray flirting patterns of gender-expansive and queer populations. As gender becomes more fluid it is hard to say how applicable any of these measuring scales truly are as ideas around gender expand. Nonetheless, these results do shine a light on the presence of traditional gender role behavior when it comes to flirting. 

It is important to note that most of the other studies were also done with entirely, or mostly, cis-gender white heterosexual participants, which may make the results less generalizable to queer-identifying, gender-expansive, and people of color . However, these results call for more clear communication skills and boundary-setting techniques in dating and new relationships. 

Signal Sending, Receiving, and Consensual Communication

It is essential to note that if you’re sending signals that aren’t being mirrored back or reciprocated, that should be taken as a sign that the flirtation is not mutual and to back off. If you interpret that someone is mirroring back your flirtation, check in on your interpretation by asking them if they’d like a hug. You can tell them you’re really attracted to them, and wait to see if they respond in kind. If you think they are leaning in and sharing personal space with you and smiling and connecting with your eyes a lot, and you’re into them, ask them if you can kiss them. It’s a first step that many people skip over but is essential to beginning consensual communication early on in a romantic or sexual relationship. 

You can also flirt by telling a date you are thinking about what it would be like to kiss them and see if the person responds that they too are curious about what your lips would feel like. Talking about doing a sensual or sexual thing can be a sexy type of flirtation and is a way of feeling out verbally whether your interpretation of non-verbal signals is accurate.  The 2nd partner might not want to kiss at that very moment, so an option they have is to say in a flirty inviting way: I’m not ready at this time but definitely ask me next time we’re out, or at the end of the night. It can be fun, and light, and yet express the notion that sexual interest might not be mutual at one point but could be revisited at a later point. This is a more nuanced way of keeping an erotic seduction vibe while maintaining consensual language embedded in the dating experience.

Techniques to Embrace a Fun Flirty Spring

1. Practice eye gazing with short pauses looking away as a form of showing interest in a person you’re interested in at a social gathering or on a date. 
2. If you’re finding yourself attracted to a person, let them know by moving towards them and perhaps asking to touch their shoulder or forearm as you’re telling a story. If you find you’re less interested in them, move back in your seat, do not touch them, and cross your arms to show less openness in your body language. 
3. If you feel someone is showing you more attention than you’re comfortable with, break eye gaze more frequently, take more distance from them, and maybe end the date a little earlier. 
4. When someone touches you and you’re uncomfortable, you can either move further away or verbally let them know you’re sensitive to touch and would prefer not to be touched at this time. If you are interested in the person, you can let them know that you take a while to warm up to someone and that you are interested in them.  
5. If you are feeling unsafe or pressured by a date partner, you can end the date by either saying you have been feeling under the weather and need to get home earlier than you expected or that you have an early start at work the next day.  

How to reduce stigma and become educated on the kink community.

BDSM, is an acronym to represent a few different power exchange play practices including: 

• Bondage and Discipline
• Dominance and Submission
• Sadism and Masochism  

BDSM has long been misunderstood both by the general public and mental health professionals. This blog will dispel the top 5 of the more common myths about BDSM and Kink. 

Myth 1: BDSM and Kink Activities are the same

The terms kink and BDSM are frequently used interchangeably meaning that if one is seen as being kinky or into kink, they are assumed to be into the practice of BDSM. 

 However, for some people who identify as kinky, their particular erotic/sexual interest might not have anything to do with power exchange, humiliation, or strong sensation/pain. While if someone identifies as being into BDSM, there clearly is power exchange included in their sexual practices. 

For some kinky folx, their erotic trigger has more to do with fantasies and behaviors like:  

• getting aroused by shoes or another non-human object like leather or latex . 
• urinating without humiliation (sometimes referred to as golden showers or water sports)
• Enjoyment of semi-public sex 
• The desire for a third or more (group sex) 
• Restricted mobility (wearing a mask to increase focus on sensations)
• Rough sex or gentle sex (Tantra) 
• eroticizing intense sensations or strong stimuli practices like spanking, or being spanked
• consensual voyeurism in which one person watches a partner self-pleasuring
• Cuckolding; in which a partner gets turned on hearing about or watching their primary partner have sex with someone else.

So one can think of kink as a larger umbrella category and BDSM is just one of the experiences within it. 

How many people actually participate in BDSM experiences? 

In 2015, Indiana University published a representative survey using a sample of 2,021 American adults . Many said they had tried elements of BDSM including: 

• spanking (30 percent) 
• dominant/submissive role-playing (22 percent) 
• restraint (20 percent)
• flogging (13 percent) 

Kink, BDSM, and fetishes are sexual interests and/or behaviors that are atypical, meaning the people who are into it are a smaller proportion of the general public. Sex therapists tend to explain these terms using similar language to researchers and discuss sexual behaviors as they are listed on a bell curve with their clients. By discussing the range of less common behaviors plotted out on the legs of the bell curve while the largest groups of  behaviors which are positioned across the top of the curve, these behaviors are viewed in more of a scientific, neutral and non-shaming way.  Because there is a negative stigma, taboo and explicit shame expressed in the mainstream culture associated with less common sexual practices, it is incumbent upon sex therapists to offer clients a safe place to share what their authentic desires and practices are.   

The difference between a fetish and a kink is that a person with a fetish requires to have their interest integrated into the erotic experience in order to be turned on and to get aroused while for a kinky person, they don’t absolutely need it included to be turned on.  

It’s important to note that some people with fetishes seek relationship counseling or individual therapy for reasons that have nothing to do with the fetish which gives them the utmost pleasure and enjoyment. 

Myth 2: Submissives or Bottoms have little to no power

Often, views on sexual positions are constructed within a heteronormative and racialized framework. People often assume someone’s position (i.e. top, bottom, power bottom, etc.) based on their gender, race, appearance, etc. It’s significant to understand that the position one takes in a sexual experience is not associated with who is leading or has power in that moment and may or may not include aggression. People can even lead from the bottom colloquially called ‘power bottoms’, which hold elements of both tops and bottoms. Lastly, some folks identifying as LGBTQ+ also identify as kinky or belonging to a BDSM community. 

Contrary to popular belief, the submissive partner in any BDSM scene is actually the person who holds the majority of the power because they have the power to stop any scene through the use of their safe word. The bottom, or sub, submits and gives their initial power to the top, or person in charge after consensually agreeing to what the ‘scene’ will include, and then they also have power throughout by ending the BDSM scene at any moment they want.

Myth 3: People who enjoy BDSM are victims of childhood sexual abuse or sexual violence

A 2008 survey (that didn’t include folks who have non-binary gender identities) found that neither men’s nor women’s engagement in BDSM practices was associated with having been coerced in the past.  A 2016 survey on National Kink Health found that 9.6% of participants had high ACE scores (Adverse Childhood Events). However, in a 2018 study, 15.8% of Americans were found to have high ACE scores, a much highter percentage. Therefore, there is very little evidence that supports the belief held by many in the general public and in the mental health field that kink/BDSM interests are related to or in response to past trauma or sexual violence. 

Myth 4: BDSM is Non-Consensual and Abusive

The main mantras of the BDSM/Kink community are: Safe, Sane, and Consensual, and in fact folx discuss the scene they’re going to play in before, during, and after the scene is over (this is referred to as debriefing). Many practices have been adopted in order to keep BDSM interactions safe and consensual. Some of these practices include: 

• safewords 
• negotiation and discussion of limits
• and aftercare by any means necessary. 

In BDSM consent is an ongoing and evolving process. Similarly, there is sometimes an identification of soft and hard limits, which outlines what someone is and is not willing to do as well as what they might be open to under certain circumstances. In fact, most people report that any violence they experienced occurred outside of the kink community, not within it.

Myth 5: BDSM is about dominating women

A 2008 survey on BDSM found that 2.2% of men and 1.3% of women had been involved in BDSM in the past year. BDSM engagement has also been found to be higher among people who identify as gay, lesbian, and bisexual in this same survey. A 2015 survey found that 38% of the female sample reported that they were generally a sub, which as already stated gives them the most power in any engagement. Dr. Francesca Tripodi, in her 2017 research, reported that women are empowered and encouraged to embrace their desires in this community. Furthermore Tripodi also found that submissives and bottoms felt that “the act of submission increases sexual agency and empowerment through intimacy.” 

Many kink and BDSM players experience high rates of intimacy, trust and sexual and erotic pleasure in their sex lives.  They are wary of sharing their experiences with mental health professionals who are not kink-aware for fear that their sexual practices will be misunderstood, pathologized and potentially reported as a crime.  It is therefore, critically important that more mental health and medical professionals become kink aware or to refer their clients to sex therapists who are.

How one can learn to become a more authentic, present-focused dating partner.

According to a recent Pew Research survey, 3 in 10 U.S. adults use online dating sites or apps or have at some point in their life.  Among people who have used dating apps recently, 44% of them are using the app to meet a long-term partner. Given that online dating has become more of an acceptable or expected method for singles to meet new partners, it is critical for those using this technology who are using it to meet a future committed partner to learn a more nuanced approach once one is matched with a potential new partner. How one shows up as a date can impact participants’ mental health issues including their: self-esteem, attachment concerns, trust in others, sexual health, body self-image, and intimacy needs.  

How Are Single People Using Dating Apps to Meet New Partners?

According to a recent survey by Pew Research about 7% of all Americans met their current partner on a dating site or app. Dating apps are even more popular among young people with 20% of people aged 18-29 having met their current partner online. 

Given that there are fewer offline places to meet a partner if you identify as LGBTQIA +, it seems that queer people are turning to dating apps more often than their heterosexual counterparts. The 2023 Pew Research Study finds that 24% of LGB adults compared to 9% of straight adults met their partner online. But what are the common challenges that all singles and daters have to deal with? 

What is the Emotional Experience of Those Singles Using Dating Apps? 

In the early aughts, sociologist Zygmunt Bauman described the digital dating mode of mating as a type of “liquid love” since it made the traditional bonds between people and institutions (like marriage) to which previous generations felt more bound. Bauman wrote: “Dating is being transformed into a recreational activity, where people are seen as largely disposable as one can always ‘press delete’.” More recently MIT researcher Sherry Turkle added that “these days insecure in our relationship and anxious about intimacy, we look to technology for ways to be in relationships and to protect us from them at the same time.” 

Many singles approach online dating in general through the year and certainly as Valentine’s Day approaches with larger amounts of dread and less hope if they’ve been dating for a while.

Many clients in therapeutic settings complain of dating fatigue, a sense of futility in the swiping and texting that never seems to result in an in-person date. Singles frequently describe the image in their mind’s eye of the perfect partner while expressing disappointment with the process and lack of progress in finding the ‘one’. Dating apps have negatively influenced the process of dating itself because daters can make quick snap judgments around things that don’t jive with the perfect requirement list they have crafted and tweaked over many months and maybe years of dating. 

One pattern that is observed in clinical practice is that when a client is on a date with someone new, and they find their date says something they disagree with, or has a part of their body that is not exactly keeping with their ideal in that moment that person gets ‘cut’ from the dater’s mind as a possible potential partner for missing an item on their requirement list. A clinician might call this perfection-seeking, but Bauman described digital dating as consumerist behavior replacing romance and seduction into a type of entertainment where users can date “secure in the knowledge they can always return to the marketplace for another bout of shopping”.  

There is another possible approach to dating that offers a less transactional networked intimacy where perfection recedes and mindful inquiry is utilized. Proposing a new framework for using dating apps, could in fact offer single folx renewed vitality and deeper authenticity in their experiences and their search for a committed monogamous relationship.

How to Become a More Present-Focused, Compassionate Date. What is Mindful Dating? 

As many people’s relationships are being formed online the latest popular approach, and recommended by a dating coach, is to focus more on how to be a present-focused dater instead of the checklist interviewer seeking the ‘perfect’ partner. According to the popular dating app’s annual survey, 2023 Tinder Year in Swipe, N.A.T.O.(Not Being Attached to an Outcome) is the 2nd most popular approach to dating online. Meditation teachers like Sharon Salzberg have been inviting people to practice mindful meditation for many years. Given that there is so much emotional energy expended by people on dating apps, especially if one is seeking a longtime mate, it can be healthier and more sustainable to approach each date as an experience to learn something new about someone else while being present-focused.  

Instead of saying, “What am I getting out of it” we need to learn to think: How can I be fully embodied in the present moment and really be curious about this other person? I encourage clients to notice nuanced movements, the way they use their hands, how they laugh, and the way their eyes move. Just as a noticing inquiry practice, not as a data collection technique.  Finally, notice how one’s own body is feeling without judgment and with what Salzberg encourages; lovingkindness. This will enable a transition to become a more compassionate dater and will increase one’s energy and sense of fuller embodiment. 

Tips to Mindfully Date

1. Get off the phone after matching and attempt to meet the person after a week of texting.
2. Present yourself authentically while keeping certain intimate details private. 
3. Try to enter the space with the mindset of just learning something about this person. 
4. Ditch your mental checklist and use the gifts of mindful breathing and grounding to stay present and embodied in your own body, not chasing ideas in your mind. 
5. Communicate your interests, and passions along with any boundaries that seem important for early-stage dating.   

As Valentine’s Day approaches, therapists and single people can invite their clients, or themselves to put aside mental checklists and learn the techniques to become mindful and compassionate daters.

Learn How to Cultivate your Own Erotic Wellness From Thanksgiving Through to New Years Day. 

Sometimes, sexuality studies don’t provide us with a full, nuanced picture of what folks are actually experiencing in their erotic lives over the holiday season. Does quantity really increase sexual desire or erotic wellness? As a gift to yourself this holiday season learn how to tell the difference and cultivate your own erotic wellness, pleasure and increased desire.

Most Popular Times Folks Report Sexual Activity

According to some studies the peak season for folks to have sex are the summer months, quickly followed by a lull in the fall. This pattern is seen in condom sales, Google searches for sexual content, online dating activity, conception rates, as well as STI rates. This might seem unsurprising given people take vacations during the summer, they spend time outdoors more, and perhaps they feel less encumbered by work and their kids’ school responsibilities (if they are parents). Even though people seem to have less sex in the winter than in the summer, there is a second peak in sexual activity appearing to be during the holiday season with the largest surge specifically in the week between Christmas and New Year’s Day.

In a study by Luis Rocha at Indiana University in collaboration with the Instituto Gulbenkian de Ciência in Portugal, researchers used birth rates, Google searches, and social media posts to dive deeper into the social and cultural trends that occur during the holiday season across nearly 130 different countries. Rocha et al were able to pinpoint an increase in sexual activity during the holiday months in both Christian and Muslim observing countries, regardless of their geography.  Interestingly, other holidays did not elicit the same interest in sex. 

A Study Addressing Women’s Lower Desire During the Holiday Season

However, it is important to note that these studies are narrowly focused solely on birth rates and Google searches and are not gaining insight into the quality of sexual pleasure of these partners into account and unfortunately focus solely on heterosexual couples, leaving the experience of LGBTQ+ couples, cohabitating couples, and non-monogamous pods out of the research outcomes entirely. These studies therefore don’t illustrate  the full picture of how partners experience levels of sexual desire during the holiday season. In an as yet unpublished study, researchers at Stanford University looked at data from 500,000 women and found less sex is reported in the three days leading up to Christmas than average, and that desire dip lingers for days until midnight on December 31, into New Year’s Day, when there is a spike in sexual activity worldwide. This finding furthers the curiosity around erotic desire and holiday seasons. 

What do Clients and Couples in Sex Therapy Actually Discuss as they Approach Thanksgiving, Christmas and the Holiday Season?

Interestingly in clinical practice, sex therapists and couples counselors tend to hear a similar narrative to the third study and different story from the first two studies when speaking to partners regarding their lower sexual desire during this heightened time. Many clients frequently report struggling with stress and anticipatory anxiety leading up to and during the holiday season stemming from:

• Balancing work responsibilities and planning for travel
• Planning, shopping for and preparing holiday meals
• Anticipating arguments and/or tension from unresolved family of origin dynamics 
• Increased fatigue stemming from less sleep due to late-night online shopping for Christmas, Chanukah, Kwanzaa and/or Diwali gifts
• Additional attention  on caring for children, older family members and/or one’s partner’s enjoyment during the holiday.  
• Less time for self-care like exercise, catching up with friends, or quiet time alone. 

These issues make it difficult for clients to cultivate pleasure and what I call erotic wellness, often leaving them with low sexual desire.  We must also focus on people’s authentic erotic desire and sexual pleasure as well. Prioritizing your sensual self and lust can help you implement techniques to cultivate erotic wellness for yourself individually and if you are in a relationship, to co-create erotic wellness with a partner in addition to your solo practice this holiday season. 

Cultivating Erotic Wellness During The Holiday Season 

What is Erotic Wellness? 

I define erotic wellness as the state in which one feels in touch with one’s erotic fantasies, practices rituals and fun activities that stimulate what I’ve called one’s erotic triggers.This is part of what I term one’s Sex Esteem and can be practiced individually or with a partner. If your primary erotic trigger is touch, activities can include tactile experiences like swimming, taking a jacuzzi, or getting a massage. If your primary erotic trigger is sight, one might take some time to watch an explicit sexual media like feminist pornography, or a scene in your favorite film, or dressing in an outfit that awakens your own sexual empowerment. 

Many times folks consent to having a sexual encounter with a partner but aren’t as erotically turned on as they would be if their erotic triggers had been primed by themselves or a partner before they engage in partnered sex. This shift would allow the intimacy to be imbued with more pleasure and erotic playfulness. By cultivating an individual erotic wellness practice in your own body and mind before approaching a partner (if you’re currently involved with a partner) you have warmed up your erotic triggers and thereby increased your desire. Like other types of self care, this involves intentionally carving out time and space to focus on one’s sensual self and erotic triggers. 

Erotic Wellness Tips 

Here are some antidotes to help keep your erotic wellness alive during the holiday season:

• Reconsider a quickie with yourself. Quickies are sometimes assumed to be a turn off or for the sole purpose of one partner to reach orgasm. However, you can incorporate a sex toy in a shower, or bath, as a way to get your juices flowing, perhaps bringing yourself to orgasm or use it as a teasing experience to leave you wanting more. Quickies can be reclaimed for individual sexual activity and be used between family meals over the holiday visit to a family member’s home. 
• Explore the erotic potential of staying in your childhood room when you return home for the holidays. For some it may be a turn on to explore and enact your teenage sexual fantasies or activities by making out with clothes on above the covers on your bed, having a bit of top off sexual play in the bathroom or looking at the erotica you might have watched as a kid. Being able to relive a time when you were young and sneakily got away with a naughty behavior  can be a huge psychological turn-on for some people. 

Holidays Can Also Be Vacation Time

• Create the vacation mentality. It is a holiday after all, find ways to incorporate the aspects you love about being on vacation. If you’re with your partner , fur-baby and/or kids, ask your family members ahead of time to take care of your kids or pets for a few hours so you can sleep in late, get some exercise in, or take a nap. You could even use this time to have slow sex with your partner and focus on each other’s pleasure. For a fuller vacation experience, book a hotel for a few nights nearby while your kids/pets are with the grandparents, so that you have evenings and mornings to catch up on sleep and erotic wellness. 
• Give yourself a break. You don’t have to be involved in every planned activity with your relatives. Consider the time you request for  your erotic wellness  as a well-deserved gift you’re giving yourself during this bustling holiday  season. 

Given the recent viral arguments taking place on social media recently debating therapeutic terms like: boundaries, coercive control, ultimatums and consent regarding the past couple made up of surfer Sarah Brady and actor Jonah Hill, I thought defining and discussing these terms could be a helpful tool to many current dating, and/or established partners out there.  

What seems to be happening out there on social media platforms like Instagram and Twitter is a war of words about power during relationships and after a break up.  As these two people are public figures and not known to me, I won’t claim to know what went on in their relationship but I think there are many lessons here for humans out there entering into or already in emotionally committed relationships that I’d like to help define and clarify these therapy terminologies. 

Boundaries

According to The American Psychological Association the definition of a boundary is: “a psychological demarcation that protects the integrity of an individual or group or that helps the person or group set realistic limits on participation in a relationship or activity.” 

In psychotherapy sessions, therapists help their clients set boundaries when they: 

• are more concerned with pleasing someone else than listening to their own needs 
• need to create space to reflect quietly to consider their own needs first 
• have not had past experiences or childhoods of having their needs validated by others 
• require counseling to develop the skills needed to express their needs to another person.  

Many times these folks have been taught either explicitly or implicitly in their family of origin and/or community that their individual desires or needs are not as important as others around them. This kind of psychological modelling could have come from parents, siblings, grandparents,a religious leader,  a romantic partner and/or the community as a whole. For example, a client who was routinely told she was selfish each time she sought out help with her anxiety over schoolwork as a kid or when a classmate bullied her became an adult who felt like an imposter at work and submitted to every demand her boss demanded of her, even when it was above and beyond what was expected of her colleagues.  

Therefore in a romantic relationship, a boundary is a request by one partner that enhances the relationship. For example, a partner requests that his girlfriend make more of an effort to arrive on time for the dates they’ve agreed to because it shows that she has respect for their agreements and for the time they’ve carved out to be with one another.  

Another example regarding a sexual encounter which I’ve heard frequently in a sex therapy session occurs when a woman requests that her husband refrain from abruptly touching her breasts right after she’s consented to be intimate with him as it is a sexual turn-off rather than a turn-on.  When a person hasn’t had these kinds of requests modelled in a healthy manner growing up, they really lack the confidence, skill and when it comes to sexuality the Sex Esteem to listen to their needs and make these requests smoothly. Alternatively, if they’ve seen a parent make demands, threats or demeaning comments when asking the other parent to change a behavior, the child has witnessed coercion. 

Boundaries Can Prevent Future Heartache

In the recent Netflix show Jewish Matchmaker, one of the more religious single women Fay goes out with a man named Shaya and they seem to really enjoy one another’s company, sense of humor and they both practice Orthodox Judaism and are looking for a spouse, to get married and have children. However, when Fay says that it’s important to her that her husband pray with a group of other men three times a day and devote themselves to studying the Torah, Shaya lets her know that he prays on his own in the morning and that he’s not a studious kind of Jew.  She gives it some thought after the date and in a respectful manner lets him know that this wouldn’t fit with what she’s looking for in a family. They part on good terms and this is part of what each of them understand as religious boundaries that are to be respected.  What they both understand after deep reflection (we even see a scene of Shaya talking to his rabbi about his ambivalence), they agree that they are not eachother’s people. 

Implicit Vs. Explicit Boundaries

Back to the Jonah Hill/ Sarah Brady drama, why are so many people defending Hill and attacking Sarah Brady? Because she has released texts she received from her ex-boyfriend in public without his permission.  While sharing texts between two people (and not related to a crime) is not considered a crime legally, Sarah may have broken a relational boundary. This boundary is that partners assume that what is shared between them is to be kept from public scrutiny via social media.  This is what we would call an implicit agreement. However, as a couples and sex therapist with many years of practice, I can tell you that this is one of the all-time misunderstandings in most relationships.  Don’t rely on implicit agreements. Why? 

Because what one partner may consider private information, another partner feels freer to share either with close friends or with the world. That is why having meaningful conversations about what boundaries you want to keep in your joint relationship around your intimate sharing of information is so important. 

Secondly, expecting certain boundaries to be adhered to by a partner can also be misused by partners who are either trying to control the actions of their partner, or are beginning to groom their partner for future emotional abuse and/or physical abuse.  I believe that the many folks online who are angrily reacting to Jonah Hill’s alleged use of the term “boundaries” are actually viewing this usage as a covert step towards manipulative control and coercion (which I’ll talk about in a future blog).

The fact that Sarah claims to have taken down some of the photos from Instagram that Jonah allegedly found disagreeable or objectionable has been interpreted by many of her online followers as evidence that she was being coerced. But was it?

Differentiation

One concept I teach partners in relationships is “differentiation” which means that you are able to remain confident in understanding how to nourish and expand your own self-esteem while respecting your partner to have different ways of doing so for themselves without damaging the relationship. For example, one partner might really depend on their yoga practice and community for helping them keep their mental health stable and their body equally strong.  If their partner isn’t as physically agile, but has a good sense of differentiation they can lift up and support their partner’s commitment to their work/health balance without viewing it as a negative reflection on them.  Another way to express differentiation?  You do you, I’ll do me.  

What if the texter (allegedly Jonah Hill) revealed by Sarah Brady on her Instagram instead wrote: When I see you in the photos, I feel insecure of losing you to another man. It triggers my own jealousy and anxiety when you post photos of yourself in a bathing suit and I’m not sure how I will handle this going forward. But you shouldn’t change what makes you special and vital.  You do you, I’ll do me. And I don’t think I can show up as a supportive partner for you in the way you deserve.  I’m so sorry, there’s nothing critical I am saying about your actions, this is about work I need to do or the type of partner I would be better suited to.  This is not on you, this is on me to figure out. 

What are the Lessons Learned Here?

DON’T become deeply involved with someone who carries a fantasy that you will change your daily behaviors, dress, career, praying habits, or social groups in order to be your significant other.  

DON’T try to diminish someone’s strengths and vitality because you’re feeling more insecure or anxious by it. If you can’t stand the heat baby, get out of the kitchen! Even if that heat initially really turns you on. 

PLEASE DO create written agreements about how texts between you will be kept confidential and private during the relationship and perchance if it doesn’t work out, after a relationship ends. 

DO make agreements about what information between you is to be kept private and what information can be shared with close friends and/or family.