It’s wedding season and with it come a slew of decisions that engaged couples have to make before their wedding day. According to The Knot’s 2022 Real Wedding Study, 28% of weddings take place in the summer months while 43% took place between September and November. As a couples and sex therapist and the Director of a group practice specializing in couples counseling, the months leading up to the summer and fall draw a large number of couples seeking premarital counseling. Whether they identify as straight, queer or on any other identity on the LGBTQIA+ spectrum, folx who are planning weddings seek couples therapy to clarify many issues, including their finances and whether to create a prenuptial agreement. As unromantic as financial conversations and prenups may sound compared to tear-jerking vows and lavish cakes, the benefits these tough discussions have to a relationship’s foundation can be akin to building a solid scaffolding when building a new home.

The Avoidance of Financial Discussions Before a Wedding is Common

Engaged partners may be aware that 50% of marriages in America end in divorce, however they might not know that financial issues have been linked as a main reason for 37% of these divorces according to Forbes. Premarital counseling is a wonderful way to help partners have challenging conversations about their intimacy but also about how they expect to approach finances while married and in case of a divorce, how to divide up assets afterwards through the creation of a prenuptial agreement. As exciting and stressful as weddings are to plan, it is critical for partners to also consider their marriage as a legal partnership, and that like any business decision, worthy of the detailed financial planning a prenup conversation provides. This is true whether or not the couple decide they create a prenup.

Who Creates Prenups?

Prenups, or prenuptial agreements, are written contracts created by partners before they are married. Contrary to popular belief, it is not only the wealthy who draw up prenups. According to a recent Harris Poll, 15% of Americans reported they signed a prenup. Increasingly, couples with more modest means are turning to prenups to discuss how their assets would be divided in case their marriage isn’t sustainable. While it may be challenging to partners in the throes of love, lust and pre-wedding excitement to address what seems like a depressing thought that their marriage might end up in divorce, as a counselor I find it useful to facilitate discussions around what money means for each partner and how their career goals, spending and saving habits are cornerstones to the way they’re approaching the commitment of marriage. For many partners, even those that are cohabitating, these deeper conversations frequently are avoided but can become silent fodders of resentment especially if partners have grown up in starkly different economic and cultural family backgrounds.

Downsides to Bringing Up the Possibility of a Prenup

What can commonly occur is that when one partner introduces the idea that they should create a prenup, that initiation is perceived by the other partner as what attorney Heather Mahar termed a “negative signaling” that the initiator somehow has less trust in their partner, is less committed to the marriage, is expressing a level of power or selfishness or has been pressured by others in their family to create a prenup. When the 2nd partner becomes emotionally triggered and arguments ensue by the prenup conversation, the couple might seek counseling as the conflict raises the emotional stakes in the relationship and if the fights escalate, it can cause one partner or both partners to call off the wedding. For example, a partner who comes from a financially resourced family who doesn’t have student loans because their family paid for college, has saved a lot while working for several years in a lucrative career will have a different outlook on saving than a partner who is the first of their family to graduate college, may have had to work while putting themselves through college, has tens of thousands of dollars in loans, and while working long hours, may earn just enough to cover their monthly nut and the minimum monthly amount of their school loan. Premarital counseling around how they might approach a prenup will address the meanings they each associate with their privilege, their parents’ financial habits and decisions, their sense of entitlement, as well as possible intersectional microaggressions that come up in arguments which come from lack of education and understanding.

Increasingly, the needs individuals expect of their marriages and spouses to serve have become more complex, more abstract, and more focused on self-actualization than in previous marital eras, according to an article written by then law student Rachel Collier in the Houston Law Review in 2019. And as the nature of marriage in the United States has undergone fundamental changes in the last century, so, too, have metrics for determining happiness. After all, the future has a foothold in the now, and a couples’ commitment to a relationship is today deemed only partially based on their current satisfaction with that relationship.

Can One Predict a Couples’ Future Happiness?

A study by Baker et al demonstrates that current satisfaction is not the key predictor of commitment many assume it to be. Instead, the level of commitment between a couple is determined more strongly by perceived levels of future satisfaction. “Future satisfaction” does not just refer to a carnal metric of pleasure, but includes financial stability and emotional stability as well, both of which can be accounted for with realistic discussions and collaborative decisions. So, this research suggests that if you think you and your partner could have a good future, that strongly predicts what your mentality will be throughout the relationship. Thus having these challenging talks early on around how to align on sharing expenses, how to come to compromises now on goals around buying or renting a home, how each partner hopes to financially and emotionally support children (if kids are in their future plans) and how these resources would be divided to sustain these goals are all part of financial premarital counseling. It also may help in deciding whether or not a couple even wants to draw up a prenup.

What Values and Goals do You Create When You Get Married?

The utility in initiating and pursuing a discussion around a prenup is not solely to shield one party’s property or as a weapon wielded only in the face of divorce as many people initially assume. These unique agreements can, and ought to be, collaborative efforts designed to state the couple’s mission statement for their union. Thus when planning a wedding, don’t get solely caught up in the small decisions of what color the tablecloths should be and ignore your goals towards what your marriage will need as far as achieving both your economic and financial goals. Because marriage is an evolving practice based on shared values, commitment and emotional and economic goals for the future. Prenups are an option in providing the path for achieving this shared future while acknowledging what will occur if the marriage dissolves. By opening up communication before the wedding on the topic of money which most couples find difficult to discuss, the prenup process can at times provide a road map to a more satisfying financial future and celebratory wedding nuptials.

Four Relational Contributors to Heterosexual Women’s Low Sexual Desire

April 8, 2023

Sari Cooper

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

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

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

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

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

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

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

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

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

Stress, Future Research and Treatment:

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

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

How the Psychology of Gifting Can Help a Sexual Relationship

February 8, 2023

Sari Cooper

Couples Therapy Sex Therapy No Comments

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

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

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

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

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

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

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

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

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

Cultivating 6 Practices of R.E.N.E.W.A.L. to Usher in The New Year

January 25, 2023

Sari Cooper

blog Sex Therapy No Comments

Each New Year and the month of January inspires people to renew their commitments to meaningful intentions. This is why people take on resolutions, whether to lose weight, get in better shape by joining a gym (More than 12 percent of gym members join in January, compared to an average of 8.3 percent per month for the full year, according to the International Health, Racquet, and Sportsclub Association (IHRSA)), partake in a “Dry January”, or to decrease stress and improve their relationships by starting therapy. The commitments that are made globally the minute we cross into the new year express a collective consciousness of shortcomings and individual strides towards living more fully and healthily. Instead of resolutions which often get put on by the wayside by mid-February, I propose a practice of RENEWAL to integrate throughout the year. This RENEWAL includes actions, internal inquiry, to go beyond the goals set by folks when they make New Year’s resolutions. This RENEWAL practice strongly reflects the way that I invite clients to subtly say or begin new behaviors to align with their sex therapy or sex coaching goal. At times I will encourage partners to create new rituals for themselves and with one another when they are creating time for intimacy to shift their oft-repeated sexual script or routine. Through R.E.N.E.W.A.L., I have created an acronym representing practices you can cultivate throughout this year not just for the first 30-90 days.

RENEWAL:

French Sociologist Emilie Durkheim wrote about his studies of rites and rituals in his book Elementary Forms of Religious Life and regarded religion as the incarnate of society’s conscience collective–or its “collective consciousness” or “collective conscience.” While a 2020 Gallup poll stated that only 47% of American adults say they belong to a house of worship, many clients who come to sex therapy self-identify as spiritual. And like many spiritual practices worldwide, rituals express the consciousness or larger mission with which people align their larger life’s purpose.

R: Rituals were, for Durkheim, sites of “collective effervescence”, moments when the very fact of congregating to perform set religious actions imparted special energy to the participants–which lends meaning to a certain point in time, a specific event or a particular life cycle moment. For this new year, I invite clients to create a ritual from scratch, adopt a ritual from another culture to address a specific experience or emotion one wants to process, or collaborate with a partner to while paying tribute to either or both your cultural or religious heritages. Sometimes people create rituals for a joyful occasion like moving in with a partner, deciding to open up a relationship to welcome another partner, or deciding to adopt a child as a single parent. These are moments in one’s life that contain many emotions and psychological meaning but are not necessarily represented in traditional religions. People may invite people they feel closest to to cocreate the collective effervescence of the ritual or decide to do it on their own.

E: Engage with people you care deeply for. In this societal era where digital communication–where we convey our emotions using emojis and profess our feelings through text–is considered touching base, strive to engage in person or through video calls with those you hold dearest or those with whom you’d like to become closer. Opt to engage with more intention: intention through physical proximity and intimacy, as well as intention with whom you choose to spend your time.

N: Nesting is a practice we associate with parents who are expecting a baby, where to-be parents adjust their behaviors to ones that demonstrate a protection for the child coming into the world. However, I say we extend this practice of creating a warm, clean, loving home space to part of a yearly cleaning out and bringing in peaceful energy. A Feng Shui for the soul, to sweep out the past and create a peaceful place for new opportunities and connections to grow.

E: Erotic Embodiment is for anyone in the relationship they have with themselves, and it is important in developing great Sex Esteem. It is accomplished through engaging one’s body in a mindful way that focuses on the development of a deeper body/mind/spirit connection. This mindfulness and bodily connectivity, be it through yoga, T’ai Chi, or a dance class, is helpful in renewing your sex life, whether or not you have a partner. Learning how to identify and cultivate your own erotic energy is a key element of juicy sexuality.

W: Wonder Cultivation is accomplished in adults through acknowledging what captivates your wonder–a feat admired in youth, but often shut down in adults–both now and from your experience as a child. By allowing space for noticing what captures your current curiosity you allow room for wonder to grow. Wonder allows for inquiry and the opportunity to learn new things about the world around us, the people with whom we share the Earth, and ourselves. One doesn’t have to accept that wonder is lost after working hard to achieve once-distant goals; one can utilize adult wonder in a complex manner. Psychologist and researcher Jeffrey Davis describes how, compared to his children, he has a larger awareness of mortality, which “heightens my experience of wonder and actually helps me be even more present to the moment with them or with you or with other human beings that, understandably, they don’t. They have a wide eyed wonder, and we have a more grown up wonder.”

A: Allow yourself to create a real period of time to relax. True relaxation means a quieting of the internalized “shoulds” list of things to be done in the future and “should-haves” of regret of things that weren’t done in the past. Without truly being at rest, the blood in our veins and capillaries can’t flow freely. Without relaxed blood flow, we can’t fully feel pleasure in intimacy.

L: Lovingkindness as defined by renowned meditation teacher Sharon Salzberg, “about opening ourselves up to others with compassion and equanimity, which is a challenging exercise, requiring us to push back against assumptions, prejudices, and labels that most of us have internalized.” Lovingkindness, which is different from what is presented as romantic and/or sexualized love, is a feeling and an action of compassion that need not be suppressed but, through its expression, can enhance deep moments. Lovingkindness is not a soft virtue, but a powerful force whose power can spread exponentially just through expression. I invite clients to either use the traditional blessings of lovingkindness or create original blessings for oneself, one’s loved ones and then all the world’s beings.

Erectile Disorder and 8 Masculinity Myths Part 2

November 17, 2022

Sari Cooper

Couples Therapy Sex Therapy No Comments

Myth #5 Erectile Disorder is All in Your Mind

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

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

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

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

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

Myth #7 Erectile Dysfunction Only Affects Older Men

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

Myth # 8 Online Remedies for ED are Effective

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

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

Erectile Disorder and 8 Masculinity Myths Part 1

November 8, 2022

Sari Cooper

Erectile Disorder Men's sexuality Sex Therapy No Comments

Many men approach a sex therapist having self-diagnosed themselves with Erectile Disorder. Frequently a man may have intermittent trouble obtaining or maintaining an erection but these situations aren’t consistent enough or continue over a period of 6 months or longer to qualify for the DSM 5 diagnosis of Erectile Disorder. Here are the symptoms of Erectile Disorder:

Inability to get an erection during sexual activity
Inability to maintain an erection long enough to finish a sexual act
Inability to get an erection that is as rigid as previously experienced
the problem causes stress or loss of self-confidence, affects a relationship, or is found to be a sign of an underlying health condition that requires immediate treatment

Myth #1: Men are Always Ready, Willing and Able to Have Sex

From a young age, boys and teens are often told, or it’s depicted that “real men” have to demonstrate power over their sexual partners and take charge while having sex, whether engaging with female partners or as a top in sex with men. Through generations of conditioning to this end, there has been established a societal belief that males are always DTF (ready to be erotically turned on every time it’s on offer) , and should be ready to go at a moment’s notice due to a perceived heightened sexual prowess. This is simply not true. Many factors, such as diet, sleep, stress, illnesses and relational satisfaction affect one’s desire and ability to become aroused enough to get an erection. The pressure “to perform” is ingrained in men’s psyche in most societies such that men will avoid any flirtation, dating or relationship encounter in order to avoid feeling deep shame if their penis isn’t responding to a partner.

Myth #2 A Bigger Penis Makes You a Real Man and Sex More Satisfying.

Boys also learn through watching sexual explicit media, stand up comedians or colloquial sayings which they overhear that a penis has to be large if they’re going to pleasure a partner. People have all sorts of erotic and sexual desires and the size of a partner’s penis may be low on the erotic prioity list of many women, men and non-binary partners. For example, 75% of women require direct clitoral stimulation to bring them to orgasm so that vaginal or anal penetration is not as high on their desire list as oral, manual or sex toy stroking and licking. Some men who have sex with men prefer non-penetrative sexuality and would prefer being a side where both partners can self-stimulate or stimulate one another through oral or manual stimulation. Some partners’ primary turn on may be the sound of emotionally intimate talk, dirty whispers or dominant commands rather than the size of a partner’s penis. A 2020 review of research on penis size found that the average length of an erect penis is between 5.1 inches and 5.5 inches. However, the girth of a penis and the potential for intravaginal stimulation has been shown to be more alluring to a small sample of colleage-aged heterosexual women. while a study by Nicole Prause Et Al using 3D models of erect penises contrasted the penis size heterosexual women found desirable in a one-time sexual experience from what they found attractive in a long-term partner.

Myth #3 Porn is a Realistic Depiction of Real Sexuality

Porn or sexually explicit material is a form of entertainment to trigger an erotic response. Much of the porn/SEM industry is owned and produced by men for men who watch it in larger numbers than women. However, as in PG films, the actors are just performers who are chosen for their physical looks including what their genitalia look like in a close up. These performers are also acting, so that when a woman squeals with excitement without any kissing, caressing or receiving any stimulation from her male partner, the film is misrepresenting what many women state they need in order to get turned on psychologically and emotionally as well as physically aroused.

Myth #4 Sex Needs to Include Ejaculation

While most men expect to have an orgasm/ejaculation if they are engaging in a sexual act, it doesn’t mean that it should be a given or a demand. Studies of white heterosexual couples in relationship have shown us that there is an orgasm gap between the amount of times women come to orgasm with partner sex, and a gap between how often men think their female partners have reached orgasm and the actual number of times they do orgasm. Sex is a sexual umbrella under which many sexual behaviors are included. It is more important to focus on what each person desires and defines as a pleasurable and satisfying experience each and every time since each person’s body is in a different state each day and each moment. And while male partners may feel discomfort or pain when they don’t climax after sexual arousal, suffering what is colloquially called “blue balls” isn’t dangerous and the feeling subsides.

How ADHD Influences Your Sex Life and Intimate Relationships

October 4, 2022

Sari Cooper

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

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

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

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

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

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

Seeking Orgasms and Female Sexual Satisfaction

August 26, 2022

Sari Cooper

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If a woman has never experienced an orgasm, does this mean she would be diagnosed with Anorgasmia or, as it is now called in the DSM 5, Female Orgasmic Disorder (FOD)? In the recent film Good Luck to You, Leo Grande, 55 year old British widow Nancy Stokes, played by Emma Thompson, has never had an orgasm. At the start of the film, Nancy (a retired religious school teacher) has only ever had penetrative sex with one man (her recently deceased husband) in one position. She describes her body as a carcass she’s been dragging around with her for decades.

The inability to orgasm is a common presenting issue brought to a sex therapy practice. It is estimated that up to 41 percent of women worldwide do not experience orgasm and 50 percent of those who do, are dissatisfied with how often they orgasm. A number of factors that contribute to a women’s inability to orgasm including internalized shame about sex, religious conflict, body image issues, previous sexual trauma, fatigue, stress, depression, and shyness about asking for adequate touch. After conducting a sexual history, a therapist would diagnose FOD if the client has not been able to orgasm after a normal sexual excitement phase in all (or almost all) sexual encounters.

A sexual history of Nancy would have revealed that she has never attempted to self-pleasure and that her husband never offered to stimulate her manually, orally, or with a sex toy. Given this history, a sex therapist would not have diagnosed Nancy with FOD, but rather honed in on the behavioral issues contributing to her unexplored orgasmic potential. A sex therapist might begin by debunking the societal myth that women should be able to orgasm solely through vaginal penetration with a partner. In a study exploring middle aged women and touch researchers discovered that women who rarely or never engaged in sexual touching, were almost 3 times less likely to climax than those who always engage in sexual touching.

In the film, Good Luck to You, Leo Grande, Nancy does not employ the help of a sex therapist, but rather a young sex worker who goes by the name Leo Grande. After the death of her husband, Nancy’s embarrassment about her limited sexual knowledge and experience is outweighed by her desperation to find out what she has missed out on–including the elusive orgasm.

Nancy and Leo’s banter throughout the film ranges from witty and playful to thoughtful and moving–exploring the themes of aging and sex, women’s critical self-image, and feelings of guilt related to pleasure. Nancy, like many women, begins the film believing that the desire for sexual pleasure is irrational, gluttonous, and shameful. She is unable to prioritize her erotic feelings and sexual desires after years of catering to a husband’s needs and shunning her own.

In their first meeting, Nancy reads Leo a list of sexual activities she wants to experience. When Leo begins to initiate touch and tries to remove Nancy’s clothing, she withdraws and repeats negative descriptions of her older body, assuming that it disgusts him. Like Nancy, so many women experience body shame or dysphoria. Body image issues have been shown to cause low sexual desire, difficulty with lubrication and orgasm, and painful or unpleasurable sex. While women of all ages carry body shame due societal beauty standards and what the media centers as “beautiful”, post menopausal women carry unique issues resulting from the natural weight gain that ensures after one stops having a period.

Part of the work of sex therapy is encouraging clients to become embodied, and to view their physical bodies with compassion and curiosity so they are open to experimenting with erotic and sensual touch. An important element of this is an invitation to put aside a goal of having an orgasm–which Leo communicates to Nancy. For a woman like Nancy, learning to be present and in the moment is the most important first step.

The theme of being cut off from one’s body is also explored as it is related to the societal role of women, and mothers in particular, who spend more time in their heads making lists, planning ahead, and chastising themselves than they don’t meet all their goals including being sexually responsive. When Leo tells Nancy that in order to enjoy their time together she’ll have to let go of the part of her that watches and judges her from the outside–a phenomenon that sex therapists refer to as “spectatoring”–, she tells him that that voice is the only thing that keeps her life on track.

For many women, another intrusive voice is the one that pressures women to constantly put the needs of their families above their own. When Nancy’s daughter calls her numerous times, Nancy tells Leo that she always–no matter what–answers her phone. Many mothers who seek out sex therapy report feeling guilty if they are not fully available for their loved ones, but then resent their loved ones when they are unable to be in the moment.

No matter how long a woman reports she hasn’t been able to climax, there is hope. Between 80 and 92 percent of women who have never had an orgasm are able to orgasm after sex therapy treatment. Included in this statistic are women like Nancy, who desire sexual fulfillment and are no longer willing to participate in the charade that they are enjoying themselves. Sixty-seven percent of women who have faked an orgasm are no longer willing to do so as they age.

Good Luck to You, Leo Grande is a movie about the mental prerequisites for experiencing sexual fulfillment–feeling entitled to happiness and pleasure, contentment with oneself, and peace with one’s body. In the film, two people learn about themselves and one another through intimacy, being fully present, and honoring and communicating boundaries. The movie ends (spoiler alert!) with Nancy experiencing her first orgasm through self-pleasure. When Nancy stands gazing at her naked body in the mirror at the end of the film, it is clear she has learned to treat herself with compassion rather than judgment, experience mindful embodiment, and how empowering sexual arousal can be–all lessons that are important at any age.

“Dating Sucks”: Identifying dating burnout and how to fix it

July 19, 2022

Sari Cooper

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5 signs you have dating burnout

1. You are losing hope

Whether it is because you’ve had your heart broken one too many times or because you’ve been on one too many dates where conversation dwindles before the appetizer arrives–it’s easy to start believing that dating sucks. So many people do! “Dating sucks” is a common adage represented in books, movies, and heard in therapists’ offices. If you are one of the many people who has expressed feeling hopeless in the search for a romantic partner, you may have dating burnout.

2. It’s affecting your mental health

All our relationships impact our well-being and mental health. However, romantic relationships are particularly impactful. Intimate, passionate, and committed relationships bring about heightened emotions, romantic and erotic fantasies, and meaningful hope. As a result, the state of a person’s romantic relationships is closely related to their experiences of anxiety, depression, substance abuse, self-worth, self-esteem and overall mental health.

3. You aren’t prioritizing self-care

Dating can be time consuming! Especially in our culture in which we believe that the more “work” you put in (or in this case the more dates you go on) the better the result. More dates in a week does not necessarily mean you are more likely to find the right person or relationship–particularly if you are not showing up to those dates as your best self. Dating burnout may mean you are sitting across from romantic partners feeling tired, unable to focus, and without the ability to show your date your authentic self.

4. You are struggling with rejection

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Modern day dating, particularly on dating apps, means that people are rejected or are rejecting others a number of times a day as they casually swipe on Hinge or Tinder. The 70 million adults in America that use dating apps have developed a rejection mindset that makes dating feel particularly unpromising and exhausting. Rejection–whether you or your potential partner is saying no to pursuing a relationship, situationship, or another type of non-monogamous partnership–is an unavoidable part of dating. If you’re already in an unhealthy headspace, getting turned down or ghosted can feel like a reflection of your lack of worth, attractiveness, or ability to make a romantic relationship work. When you’re in a healthy headspace, a rejection is just par for the course in the search for a romantic partner (“thank u next”).

5. You feel like you’re going through the motions

Going on autopilot on a date prevents you from truly learning about the person sitting across from you, and ultimately deciding if you are interested in them romantically or not. Autopilot prevents you from bringing the playful, curious, and engaging parts of your personality to the table and conversation. It may feel like a way to conserve your energy and get through dates, but the return on investment for that kind of dating is slim to none.

7 ways to bounce back from dating burnout

1. Take a break

When dating feels like a chore or a drain on your social battery it is important to carve out time for yourself. Whether that means spending time with people you love or engaging in some sort of physical activity–taking a break can re-nourish the soul and increase energy levels allowing you to show up to dates refreshed and optimistic.

2. Be more intentional

Before committing a huge portion of your time to dating, it is important that you consider a few important questions like “What do I want from dating?” and “What are my non-negotiables in a relationship (do I want a family, to live in a certain area, practice a religion jointly, etc.)?” Pay attention to how you are feeling internally–what kind of dating has been fun in the past and, even if the romantic connection isn’t there, how can you make dating an intellectually expansive and pleasurable experience for yourself?

3. Date people you want to date, not just those who want to date you

Agency prevents burnout. It is important that you are choosing to continue dating people who you find attractive, intriguing, and sexy. The ego boost from someone expressing their interest in you is short lived and continuing to date someone you’re not that into is ultimately unlikely to lead to a meaningful connection.

4. Be disciplined–track the time you spend on the apps

It is important that you track the amount of time you spend on dating apps. Studies have shown that every additional hour a person spends scrolling on their phone decreases their psychological well-being–increasing anxiety and emotional instability and decreasing self-esteem. While it may seem productive to spend time swiping left or right, doing so is negatively impacting your mental health and ultimately making it more difficult to find a romantic partner.

5. Let go of your timeline to meet “the one”

Many people consciously or unconsciously subscribe to a dating timeline–meet someone by 25, get engaged by 28, get married by 30, etc. But that kind of timeline is arbitrary and, in fact, detrimental to your dating success. Dating because you really want to be dating is different from dating because of the stress of a self-imposed time crunch. Releasing yourself from this pressure to perform in a given timeframe will be reflected in the decreased anxiety you bring to your dating experiences.

6. Change up your usual dating activities

Instead of going to a bar or coffee shop on a first date, do something different. Suggest a short hike, a bike ride, a visit to a sculpture park, or volunteer together. Trying something new with someone new can increase your dopamine levels, excite your body and mind, and break the cycle of same old, same old dating. Novelty can be a powerful trigger for erotic fantasy so incorporating adventure into your dating might just be the catalyst you need to feel inspired by the person you’re with and energized internally.

7. Generate insightful conversation

There are a number of ways you might improve conversation on dates with potential partners. I suggest going on dates with the intention of identifying what makes the person sitting across from you unique as opposed to their “stats” or information about where they grew up, went to college, or what they do for work. Other inspiring ways to generate meaningful conversation include these 36 questions by researcher Arthur Aron, or this card game created by Ester Perel.

7 Critical Talks To Have Before Your Wedding Day

June 13, 2022

Sari Cooper

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June marks the beginning of wedding season. According to the wedding website The Knot, 80 percent of weddings take place between May and October each year. In 2021 there were a total of 1,934,982 weddings in the U.S. After postponing and re-postponing their nuptials because of COVID, 2.5 million people are expected to be married this year–a 15 percent increase from 2021.

COVID-19 has shaken up the so-called traditional wedding “rules” and partners are now celebrating their nuptials in increasingly non-traditional ways. After waiting for two years to get married, couples feel less pressure to participate in religious or conventional wedding traditions that aren’t meaningful to them and are less likely to have a wedding party, walk down the aisle with their parents, throw their bouquets, or have the ceremony conducted by a religious figure.

The millions of people getting married this wedding season are planning these celebrations–whatever they might look like–in the context of inflation, continuing supply chain issues, rumors of a recession, and the uncertainty that comes with new COVID-19 variants. It is vital that, despite these stressors, couples keep the desire to make a deeper commitment to their relationship at the center of the celebration. Here is a list of essential conversations couples who are getting ready to walk down the aisle should have:

Create boundaries with each of your families of origin

Leading up to the wedding, couples may feel a lot of pressure from their family of origin to center certain beliefs, rituals, and values in their wedding ceremony. However, a wedding marks the creation of a new family. You and your partner need to decide on what is important to the family you are building–whether that family will involve children or not–and set up boundaries with family members to protect those values.

Discuss having children

Many of my clients were ambivalent about having children at the time of their wedding. They were enjoying their time as a couple and thought that they would make decisions about children down the road. However, I’ve found it vital to the longevity of a relationship for couples to enter into marriage having discussed their long-term desires to be a parent. Critical questions include, “Do you want to be a parent in your lifetime?”, “How do you imagine us parenting together?”, and “Why would we decide to bring children into the world at this time?”.

It takes a village

Just like it takes a village to raise a child, it takes a village to support a couple. Modern marriages tend to come with an expectation that a person’s partner will provide them with everything they need. But one person cannot realistically meet all of the emotional, psychological, practical, sexual, and social needs of another person. Building community outside of your marriage–particularly of people who support that marriage–is so important to the long-term success of the relationship.

Tell your partner you appreciate them

When a couple first starts to date they often tell each other what they find special, beautiful, and enthralling about their partner. After some time, couples tend to stop verbalizing what they appreciate about their partner. People have a deep need to be seen, witnessed, and celebrated. Verbalizing what you appreciate about your partner, whether they are the same reasons you fell in love with them or ways they have grown or adapted over time, is vital to the success of a relationship.

Define what monogamy means to each partner

When getting married, couples often express their commitment to monogamy and fidelity. But what those concepts specifically mean to each person is often only discussed after one person feels the agreement has been broken. One partner may think that a drunken kiss or online video chat with someone outside of the relationship does not break their commitment while the other person feels betrayed. Once one person feels the agreement has been broken, the couple is in crisis mode and discussing how monogamy and fidelity are defined is extremely difficult to do. It is vital they happen at the start of a marriage.

Be your partner’s emissary to your family of origin

Wedding planning is notoriously stressful and can be a source of conflict for partners and their families. If your partner is in conflict with someone in your family, it is important that you step in, represent your partner’s interests, and work to resolve the conflict on their behalf. You have a history of resolving differences and conflicts with your family members that your partner does not. They may need help representing their views and good intentions. Showing support for your partner and representing their wishes is critical to family integration and will benefit your marriage in the long run.

Discuss religious and spiritual beliefs and practices

Engaging in deep conversations about your current and historical religious and spiritual beliefs is vital to any new marriage. While your partner may not be following any religious practices or rituals now, they may have an emotional relationship to those traditions that may crop up later on in their lifetime–particularly in the context of raising children. For example, the idea of having a Christmas tree or going to temple for high holidays may not have deep religious meaning for one partner, and strike the other as counter to the spiritual upbringing they want for their children. Understanding how both you and your partner would want to raise children in relation to religion and spirituality is key.

While these conversations are critical before a couple walks down the aisle, they are also conversations that would benefit any couple at any stage in their relationship. Particularly because people change! How a person feels about having children, monogamy, or spirituality might shift several times over the course of a marriage. Having these conversations ahead of the wedding will lay the groundwork for an open line of communication over a lifetime about your individual needs and desires and your marriage as a whole.